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Post by Admin on Jan 11, 2016 15:47:17 GMT
Here are some examples of a focused clinical question for each of these patient encounters that will help you organize a search of the clinical literature for an answer and choose the best article from among those you find.
You have just seen Lydia who recently delivered a healthy baby. She plans to breastfeed, but also wants to start oral contraception. You generally prefer to prescribe combination oral contraceptives (estrogen + progesterone) but you have been told that these might more negatively affect her breastmilk production than progesterone only pills.
John is an 11 year old boy who presents with primary enuresis. He has grown frustrated with the inconvenience and
embarrassment of his problem. You have excluded the possibility of urinary tract anomalies and infection as possible causes. Youconsider recommending a bedwetting alarm, but a colleague tells you he thinks they’re "worthless" and suggests that you treat with imiprimine or desmopressin.
1. Pick your topic
2. Write your focused clinical case
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febi
New Member
Posts: 4 
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Post by febi on Jan 13, 2016 16:55:42 GMT
Jessica's chief complaints included hemoptysis, weight loss, fever, fatigue and night sweats- all indicative of an infection with Mycobacterium tuberculosis. However, upon past medical history, it was found that Jessica also has asthma, for which she has been taking Theophylline. Jessica remembers reading on webmd that Rifampin is a potent anti-tuberculosis drug and she requests to be placed on that specific medication.
As a knowledgeable physician, I was able to advice Jessica that Rifampin would worsen her asthma symptoms as well as cause other unfavourable effects like reddish-orange sputum. An acceptable course of treatment for an asthmatic patient with T.B. would be amoxicillin + clavulanate.
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Post by goodness on Jan 13, 2016 18:25:48 GMT
Grace my patient with a blood clotting defect and is on coumadin (a blood thinner) just came to see me about the pain she has been having, asking about her choice to use Aspirin as a pain reliever.
I explained to her how acetaminophen ( Ibuprofen) will be a better choice for her because aspirin combined with a blood thinner is potently dangerous as it increases her chances of internal bleeding because Aspirin inhibits clot formation by inhibiting thromboxane A2 a platelet aggregator.
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Post by roxanne on Jan 16, 2016 14:56:37 GMT
53y female who is moderately obese, postmenopausal w type 2 diabetes comes in for annual examination. Upon examination, pt is significant for abdominal obesity and has dark pigmented skin around her neck. Blood work reveals elevated LDL, TG, low HDL and glucose level of 145mg/dl (100-125mg/dl). Pt decides to modify her lifestyle focusing on low-fat, low-cholesterol diet and light exercise for 45 minutes 4d/wk. After 3months, her follow-up visit reveals unchanged weight and lipid profile. Based on the result, simvastatin is prescribed. Since, pt also has elevated blood triglycerides and low HDL cholesterol levels, fenofibrate is prescribed w caution. However, a trusted colleague suggests that its best to prescribe a different medication with statin due to high risk of myositis and hepatotoxicity.
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Post by Waliul Chowdhury on Jan 17, 2016 16:47:25 GMT
A 10 year old boy goes to the hospital with complaints of shortness of breath. He has a history of Asthma. The patient is also wheezing upon inspiration. The doctor administers Theophylline to treat his broncho-constriction. Further lab tests and blood cultures show that the patient is infected with Streptococcus pneumoniae bacteria. Erythromycin is also administered to the patient to treat his infection. A 2nd year resident tell his attending that giving Azithromycin instead of Erytrhomycin would be a better alternative because it would avoid the drug contraindicative interactions between Erythromycin and Theophylline; causing a high risk of Theophylline toxicity in the body.
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Post by waliul on Jan 17, 2016 16:50:07 GMT
A 10 year old boy goes to the hospital with complaints of shortness of breath. He has a history of Asthma. The patient is also wheezing upon inspiration. The doctor administers Theophylline to treat his broncho-constriction. Further lab tests and blood cultures show that the patient is infected with Streptococcus pneumoniae bacteria. Erythromycin is also administered to the patient to treat his infection. A 2nd year resident tell his attending that giving Azithromycin instead of Erytrhomycin would be a better alternative because it would avoid the drug contraindicative interactions between Erythromycin and Theophylline; causing a high risk of Theophylline toxicity in the body.
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Post by Admin on Jan 17, 2016 19:05:52 GMT
If I give you an Admin like, it means you have done a great job on the assignment and will receive homework points for completing the assignment on time. Remember all homework should be done by Monday before 8am to receive points for the assignment. All homework assignments have to posted on the forum to receive points in the future. I will not accept paper. - Admin
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Post by rehman on Jan 17, 2016 19:33:06 GMT
A patient is seen in the hospital is taking aspirin as a blood thinner. The patient has had previous clots before and aspirin is very important for the patient in maintaining that they do not go through the same situation again. While in the hospital, it is found that they patient has a strep infection, the physician is unsure of what to do in this situation because penicillin which is very good treatment for strep will increase the toxicity of the aspirin. The physician goes to a colleague who suggests another antibiotic similar to penicillin that wont have an effect on the aspirin and at a reasonable dose that will treat the strep and not have an adverse effect on the aspirin either.
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Post by kjb786 on Jan 17, 2016 23:02:00 GMT
Max, your first patient today, is a 40yr old obese male who leads a sedentary lifestyle, working a 9am to 5pm job, with little regard for diet and nutrition.
He has been recently diagnosed with type II diabetes mellitus, and has been prescribed metformin, but is seeking advice on how to manage his diabetes.
You suggest diet and exercise, and begin to explore other options on how to adjust Max's lifestyle to manage his condition.
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Post by gauravprabhu1994 on Jan 18, 2016 3:07:21 GMT
Lee, a 2 years old boy comes to the clinic with very non specific symptoms signs such as fever, conjunctivitis, erythematous rash of plans and soles and enlarged lymph nodes. The doctor has suspected it to be a case of Kawasaki disease. The complication of which is Coronary artery thrombosis and aneurysm with rupture. The treatment for the above mentioned condition is Aspirin. But the symptoms being very non specific can also indicate of a viral infection. the treatment with Aspirin for some viral infection will cause reye's syndrome. So the doctor suggests to have a coronary Angiography administered to be very sure before taking any steps
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Post by bdjessie on Jan 18, 2016 5:41:27 GMT
Beginning the day (7a.m.) working in an urgent care a family member brings Clint to be seen, Clint is now unconscious. Clint is a 66 year old male with a history of heart attack, hypertension, high cholesterol. Clint's wife stated that he woke up with chest pain, 6/10 on pain scale, he also complained of a slight headache. In order to relieve his pain Clint took a sub-lingual dose of nitroglycerin that his physician gave him for angina. Clint's family was instructed that this self-medication could be potentially dangerous. Treating chest pain with aspirin or nitroglycerin can be dangerous when also experiencing a headache. You are now suggesting that Clint is taken for a CT scan of his head to evaluated the possibility of a stroke.
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Post by ishtpkhera on Jan 18, 2016 11:39:59 GMT
A 62 year old male patient presents with difficulty breathing. He has a history of smoking 1-2 packs per week over the course of 25 years. He has had a productive cough four days prior to being seen by a physician. The sputum is thick and yellow with streaks of blood. He developed a fever, shaking, chills and malaise along with the cough. He has developed pain in his right chest that intensifies with inspiration. While sitting he leans to his right side, holding his right chest with his left arm. Both lungs are resonant by percussion, but the right mid-anterior and right mid-lateral lung fields are dull. An X-ray is conducted as well as a sputum and blood test. The patient presents with pneumococcal pneumonia. The treatment is broad spectrum antibiotics.
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Post by moaviah on Jan 18, 2016 12:01:51 GMT
An 60-year-old woman is referred for cardiovascular evaluation because of a diastolic murmur. She denies symptoms of angina, syncope, or heart failure. The physical examination and echocardiogram are consistent with mitral stenosis (AS). He notifies the patient that she need valve replacement surgery. The doctor considers the using bioprosthetic valve vs mechanical valve even though mechanical valve is more commonly use.
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Post by azaidi9213 on Jan 18, 2016 12:05:49 GMT
A 21-year-old woman known to have a protein C deficiency develops recurrent pulmonary thromboembolism. She has a sudden change in mental status and
experiences difficulty speaking and swallowing. A cerebral angiogram shows a distal left middle cerebral artery occlusion caused by administration of anticoagulant therapy,heparin. There are prolonged PT and PTT times. The physician considers using thrombolytic therapy, although it is still controversial for patients with a pulmonary thromboembolism.
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Post by Ubaid Mirza on Jan 18, 2016 12:18:44 GMT
67 year old patient comes into the clinic, present with no unusual signs or symptoms. Complains that he has trouble falling asleep at night, and bouts of waking up and having trouble falling back to sleep if he is awoken. He says he has had a handful of times waking up to pass urine, but you manage to rule out any urinary tract infections. To fall asleep he takes "Nyquil", even though he doesn't use the drug for any of its necessary purposes. Your choice of treatment is a variety of sleep-aid drugs, how would you treat this case of insomnia?
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