osce

-
Thota Vaishnavi
Roll no 133
 
OSCE 

Question: How to prevent complications of Diabetes mellitus? 

A healthy lifestyle is the key to prevent complications.
- Follow a healthy eating plan 
- physical activity for atleast 150min a week.
- Get a regular HbA1C and aim to stay in your targets.
- Aim to keep blood pressure 140/90mm Hg
- stop smoking or don't start
- lose weight if you are obese.
- take medicines as indicated.
- make regular appointments with health care team. 



Question: Diagnosis of COPD and OSA. 
OSA 
From history - snore - silence - sleep cycle

The Epworth sleepiness scale
Normal <9
Excessive daytime somnolence >9

The STOP BANG tool. 
Snoring
Tiredness
Observed apnoeas
Pressure
Bodymass index
Age> 50
Neck size > 41cm in women, > 43cm in male
Gender - male

Low risk - yes to 0 - 2 questions
Intermediate risk - yes to 3 - 4 questions
High risk - yes to 5 - 8 questions

Inference 
In my patient, snoring, observed apnoeas, high blood pressure, BMI > 35, Age > 50 are present. 

Home sleep apnea testing
Desaturations in a cyclical manner, which will give a typical saw tooth appearance. 

Severity is defined by apnoea - hypoapnea index ( AHI ) 
AHI <5 : normal 
AHI 5-15: mild OSA 
AHI 15-30 : moderate OSA 
AHI >30 : severe OSA 

Gold standard is Polysomnography which measure body posture and movements, breathing rate and electroencephalography alongside pulse oximetry. 


COPD

Lung function tests: 
FEV1 : FVC ratio reduced.
obstructive pattern, decreased DLCO (<60% predicted)
Chest X ray - over inflation of the lungs with low flattened diaphragm, increased intercoastal space.
Lateral view- barrel shaped chest 




Question: Features of LV failure and COPD.

COPD
Symptoms
Productive cough
Wheeze
Breathlessness 

Signs
Tachypnoea
Intercoastal indrawing
Pursing of lips on expiration
Reduced chest expansion
Lungs are hyperinflated
Loss of the normal cardiac and liver dullness.
Barrel shaped chest


LV failure 
Shortness of breath
Orthopnea
S3 Gallop indicative of elevated left ventricular pressure
Cardiomegaly

Reference: Kumar and Clark's Clinical Medicine. 

What are different types of nerve fibres and their susceptibility to damage? 

Reference : Ganong's review of medical physiology. 


Learning points: 

1) Importance of lifestyle modification in preventing complications of Diabetes. 
2) Early clinical signs of diabetic neuropathy.
3) Importance of history taking and evaluating in reaching diagnosis.
4) Causes of Shortness of breath. 


Popular posts from this blog

35 year old male with sob

-
Image
Name : Thota Vaishnavi Roll no : 133 CHIEF COMPLAINTS A 35 year old who is painter by occupation came with chief complaints of shortness of  breath and fever since 1 week.  HISTORY OF PRESENT ILLNESS  Patient was apparently asymptomatic 1 week back, then he developed  • shortness of breath on exertion, since 1 week. • high-grade fever since 1 week, more during night, relieved on medication and relapses back. • decreased urine output since 1 week • dragging type of pain in both legs and hands, associated with generalised weakness. • orthopnea and PND present since 4 days HISTORY OF PAST ILLNESS No history of DM, HTN, TB, Epilepsy, leprosy, CAD, CVN, Asthma or any other chronic illness. No history of previous transfusion.  PERSONAL HISTORY Built : Weakly nourished Appetite : Decreased since 1 week Diet : mixed Sleep : Decreased since 1 week  Bladder movements:  Anuria since 1 day associated with burning micturition. Bowel movements: regular Addictions : toddy consumer in summer season. R
Read more

A 65 year old with fever, SOB

-
Image
This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.                                                                                      With reference  https://mvineelarollno90.blogspot.com/2023/11/65-y-female-with-co-fever-since-4-days.html I have been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. Chief complaints: 6
Read more

70 YAER OLD MALE WITH QUADRIPARESIS.

-
70 YAER OLD MALE WITH QUADRIPARESIS.                                  This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio. CASE:  Chief complaints 70 year old male, who was an farmer by occupation but has stopped working since 4 years ,came to the hospital with chief complaints of weakness in the both upper and lower limbs since 1 week and unable to carryout routine activities of daily living.  HISTORY OF PRESENT ILLNESS :  Patient was apparently normal 1 week ago and he developed weakness in both upper and lower limbs which was insidious in onset and gradually progressive.  C
Read more