Thursday, February 05, 2015

Short Case with Dr. Che Rosle

Patient 1

Middle-aged man lying supine on bed, branula attached with intravenous hydration. He looked lethargic and in pain. There was an anterior neck swelling noted.

On abdomen examination, macular rash was seen over his body, including both arms. Umbilicus was centrally located. Abdomen soft and non-tender. Hepatomegaly noted. Spleen was not palpable. Kidneys not ballotable. Bowel sound was heard.

1. Provisional diagnosis?
Lymphoma

2. Other differentials?
Think of what causes hepatomegaly : leukemia, hepatitis, dengue, portal hypertension etc.

3. How do you confirm lymphoma?
Do lymph node biopsy

4. Investigations?
LDH, FBC, LFT, CXR, CT TAP

5. How do you classify lymphoma?
Hodgkin and non-Hodgkin

Non-Hodgkin’s vs. Hodgkin’s Lymphomas
Taken from this website

6. Ann Arbor staging for lymphoma?
Taken from this website


Patient 2

52-year-old female, lying in supine position. On neurological examination of lower limbs, the findings were confined on the right side. Hypotonia was noted. Hip flexion and extension 1/5, knee flexion and extension 3/5, dorsi and plantarflex 1/5. Hyporeflexia noted. Babinski and clonus negative. Proprioception and sensation intact.

1. Provisional diagnosis?
Right sided hemiparesis with left cerebrovascular accident

2. This patient can talk and no history of abnormal behaviour prior admission, so do you think its cortical or subcortical infarct?
Subcortical infarct. It doesnt involve middle cerebral artery etc. Sensation intact means the infarct involves internal capsule.

Taken from this website

3. Investigations?
CT brain, ECG, FBC, PT/APTT, BUSE, FBS, FLP etc.

4. Who are involved in stroke rehabilitation unit? 
Physiotherapists, speech therapists, occupational therapists, specialists, physicians, nurses and family members

5. Why do we have this unit?
  • To improve patient's quality of life
  • To prevent recurrence of stroke
  • To prevent complications


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