129 CHANDANA first internal answersheet

 

  
      

  

 


















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A 60 year old female came with uncontrolled abnormal movements lasting more than 30 minutes

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This is an elog prepared with the de-identified health data collected after taking the informed consent of the patient and her attender reflecting an attempt at patient-centered approach to learning clinical medicine.  The patient was brought is a 60 year old woman hailing from Nalgonda. She lives with her elder daughter's family and spends most of her time at home, managing the housework. She was brought to the OPD by her daughter 3 days ago in an unconscious state , with uncontrolled abnormal movement of limbs lasting for more than 30 minutes . HOPI The patient was apparently asymptomatic 23 years ago when, due to a head injury she sustained during a fall a few years before, she began experiencing these episodes of "fits" or (uncontrolled abnormal movements of the limbs and loss of consciousness) with a frequency of 0-2 times/year . Patient has been on anticonvulsive medication since the past 23 years. A typical episode begins with headache and dizziness, up-rolli
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OSCE and key learning points (prefinal examination)

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  Following the case discussion of a 60 year old female who presented with active uncontrolled abnormal movements of the limbs, some questions which were discussed as part of the Objective Structured Clinical Examination are: 1. What triggers Status epilepticus in a patient with pre-existing epilepsy?   There are many etiologies for status epilepticus including both obvious causes like non-compliance with the prescribed anti-epileptic medication (To be noted: the medication prescribed in the past for this patient was chronically underdosed) and other causes like: Cerebrovascular accidents Central nervous system infections Drug withdrawal syndromes (alcohol, benzodiazepines) Metabolic derangements (hypoglycemia) Hypoxia Head trauma Hypertensive emergencies Autoimmune disorders In this patient it was noted that at the time of admission, patient had hyperglycemia (GRBS: 222mg/dL) which later normalized without the need for medical intervention.   The next question then becomes: Can hyper
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 A 55 year old male came to the OPD due to weakness and inability to walk History of Present Illness Patient was asymptomatic a few days ago. He was brought to the OP due to extreme weakness and inability to walk. He was facing shortness of breath. On X-Ray examination, fibrotic lesions were more prominent in the left lung. Serum creatinine levels were high.  Past History He is a known case of diabetes (detected 2 years ago) and HTN (since 10 years). He is taking regular medication for these conditions.  X Ray findings indicate the possibility of Tuberculosis. H/O arthritis, gout and nephritis. High uric acid levels associated with pains were recorded during his previous hospital visits.  A month ago, he indulged in heavy alcohol consumption and reduced food intake which may have led to the current complaints. The first time he was hospitalized, it was about 10 years ago due to seizures that were not associated with any brain disease.  The second time, the patient was admitted to a hos
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