MEDICINE ASSIGNMENT By Prashanth Reddy Anugu( Roll no 107)

 1) Pulmonology 

1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?

Primary etiology could be repeated exposure to Actinomyces (MICROPOLYSPORA FAENI)

leading to fibrosis

blood vessels get compressed in the alveoli

Increased Pulmonary vasculature resistance

With due course of time right heart failure

and the symptoms of right heart failure like pedal edema might have developed

SOB has developed because of decreased compliance of lungs as a result of fibrosis 

      


      5.What could be the causes for her electrolyte imbalance?  

Heart failure can be a cause of electrolyte imbalance

heart failure can cause decreased cardiac output 

though a right heart failure : it can decrease venous return to the left ventricle impairing the cardiac output

patient can also develop metabolic acidosis as is evident in this patient 

electrolyte imbalances like that of potassium are very important as they can make the patient susceptible to life threatening arrhythmias ( ventricular tachycardias)  


      2) Neurology (10 Marks) 


A) Link to patient details:


1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem? 

Primary problem is in the mamillary body and the anterior and the dorsomedial thalamic nuclei


triad of wernicke encephalopathy - 

Ataxia (due to involvement of vestibular nuclei)  

Ophthalmoplegia(occulomotor dysfunction)

confusion    

                    

treatment -first it is important to give thiamine infusion in these patients if it is primarily bcz of alcoholism

  3) Why have neurological symptoms appeared this time, that were absent during withdrawal earlier? What could be a possible cause for this?

neurological symptoms at this time are due to invlovement of mamillary body and thalamic nuclei (foci of hemorrhage and  necrosis) as a result of chronic thiamine deficiency 

7) Could chronic alcoholism have aggravated the foot ulcer formation? If yes, how and why?  

Yes ,alcohol impairs would healing and it also makes the person immunocompromised


B) Link to patient details:


Questions-

1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?

   Patient could have had hypertension which was not diagnosed 

Long standing hypertension (not under any treatment ) would have presented as hypertensive emergency with hemorrhagic stroke with end organ damage [and we know that hypertension is one very important cause of intracranial bleed]

Pathogenesis could be like long standing hypertension could have resulted in formation of charcod bouchard aneurysm in the brain parenchyma which as result of hypertensive emergency might have ruptured and resulting in the patient's present compliants


3) Did the patients history of denovo HTN contribute to his current condition?

Yes ,It could be possibility , it has to considered as it is the most common cause of intracranial bleed

may be patient blood pressure at the time of the episode could give a better picture and also at the time of presentation could also have a clue to the diagnosis

4)Does the patients history of alcoholism make him more susceptible to ischaemic or haemorrhagic type of stroke?
 Yes , since he a chronic alcoholic , this would add to the course of the problem as alcohol is a risk factor for all such category of modern epidemics

C) Link to patient details:


Questions:
1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?

HEART FAILURE

3) What are the changes seen in ECG in case of hypokalemia and associated symptoms?



D) Link to patient details:



QUESTIONS:


1. Is there any relationship between occurrence of seizure to brain stroke. If yes what is the mechanism behind it?
Yes , ischemia irritates the cells and leads generates the seizure foci

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