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September 2014

A rubric for assessment

7th Sept: Reflective case report for analysis

9th Sept: Give your opinion - 2

1.An 86 year old man has atrial fibrillation and congestive cardiac failure. He is being treated with the beta blocker Bisoprolol. Why do you think bisoprolol is being given? Is there an alternative to bisoprolol?
2. A 57 year old man has hypothyroidism but no goitre. He never had any thyroid surgery in the past. What could be the cause of his hypothyroid state?
3. A middle aged woman has rheumatoid arthritis and hypertension and is being treated with methotrexate (weekly) and amlodipine (daily). Her serum calcium is low (2.01mmol/L) even though she is taking calcium supplements. Give reasons for this.
Send your responses

13th Sept: Give your opinion - 3

A 27 year old man complained of severe pain in the right thigh. He was seen by a doctor and, after evaluation, was diagnosed to have ankylosing spondylitis. What do you expect to find in this patient that will justify the diagnosis of ankylosing spondylitis? Send your responses

14th Sept: Recommended reading (Please send your comments on one or both of these articles after reading it).

Send your responses

15th Sept: Give your opinion - 4

This 85 year old man with hypertension for the past 25 years presented with giddiness, body weakness and bilateral pedal edema in March 2014. He did not have an elevated JVP and his lungs were clear on auscultation. There was no neurological deficit. At that time he was noted to have hyponatremia (serum sodium 117mmol/L) and this was attributed to the Tab Frusemide 40mg/day which had been prescribed earlier when he had swelling of both feet. The other investigations done at this time showed:
1. Fasting plasma glucose 4mmol/L
2. Blood urea 8mmol/L (elevated); Serum creatinine 118umol/L (within normal range);
3. Serum albumin 25gm/L (low); Serum bilirubin, ALT and Alk Phosphatase normal.
4. Urine protein 5gm/L; Urine protein: creatinine ratio 498mg/mmol (high)
5. Total cholesterol 8mmol/L; LDL cholesterol 5.5mmol/L
His hyponatremia was corrected with saline infusion and he was advised to stop Frusemide. When this patient was reviewed in June 2014, his pulse rate was 76/min, his BP was 148/90mm Hg and examination of his heart and lungs were normal. He still had bilateral pitting pedal edema. His serum sodium was now 142mmol/L (within normal range). What does the clinical data tell us about the likely cause of his pedal edema?

Dr Vela Menon, MD
Clinical Associate Professor of Medicine
International Medical University, Malaysia

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