1.- A 36-YEAR-OLD MAN GOES TO HIS FIRST ROUTINE EXAMINATION AT HIS HEALTH UNIT. HE REPORTS A 6-YEAR HISTORY OF DIABETES MELLITUSAND HYPERTENSION, THAT ARE MANAGED WITH METFORMIN AND LOSARTAN. THE FOLLOWING IS THE MAIN ADVERSE EFFECT OF THE ANTIHYPERTENSIVE THE PATIENT IS TAKING: COUGH BRADYCHARDIA HYPOPOTASSEMIA VERTIGO.
1.1- THE ANTIHYPERTENSIVE BELONGS TO THE FOLLOWING CLASS OF DRUGS: BETA BLOCKERS ANGIOTENSIN II RECEPTOR ANTAGONISTS THIAZIDES ANGIOTENSIN-CONVERTING-ENZYME INHIBITOR.
2.- A 56-YEAR-OLD MAN WITH A 20-YEAR HISTORY OF DIABETES WITH A MAXIMUM DOSE OF ORAL HYPOGLYCEMIC MEDICATIONS, WAS OFFERED INSULIN THERAPY A YEAR AGO BUT HE REFUSED IT. HE ALSO HAS A HISTORY OF ESOPHAGEAL VARICES BANDING SECONDARY TO ALCOHOLIC HEPATIC CIRRHOSIS (THE PATIENT STILL DRINKS). HE HAS HAD ARTICULAR PAIN FOR THE PAST 7 DAYS. HE SELF MEDICATED 2 TABLETS OF ACETYLSALICYLIC ACID WHICH TAKES 5 OR 6 TIMES A DAY. HE ALSO REPORTS SIGNIFICANT DYSURIA, WITH CLOUDY AND FETID URINE. THE PATIENT GOES TO THE EMERGENCY ROOM BECAUSE OF INTENSE ABDOMINAL PAIN WHICH RADIATES TO THE EPIGASTRIUM AND INCAPACITATES THE PATIENT. HE HAS VOMITED 5 TIMES IN THE PAST 24 HOURS AND PRESENTS ASTHENIA. PHYSICAL EXAMINATION SHOWS: WEIGHT 80 KG, HEIGHT 173 CM, BP 80/60 MM/HG, RAPID, DEEP, DYSPNEIC BREATHING, GLASGOW COMA SCALE OF 10, PALE AND DRY SKIN, MUCOSA AND TEGUMENTS. LABORATORY EXAMS REVEAL: LIPASE 135, AMYLASE 113, TOTAL BILIRUBIN 0.9. URINALYSIS SHOWS: +++ GLYCOSURIA, UNCOUNTABLE LEUKOCYTES, + ERYTHROCYTES, ++ NITRITES. + PROTEINURIA. THE MOST PROBABLE CLINICAL DIAGNOSIS IS: ALCOHOLIC KETOACIDOSIS SALICYLATE INTOXICATION ACUTE PANCREATITIS DIABETIC KETOACIDOSIS .
2.1- THE PATIENT MUST RECEIVE:
ACTIVATED CHARCOAL INTRAVENOUS REHYDRATION AND THIAMINE ADMINISTRATION FASTING AND NASOGASTRIC INTUBATION INTRAVENOUS FLUID REPLACEMENT.
2.2- IT CORRESPONDS TO THE PHYSIOLOGIC EFFECTS OF THE PATIENT’S BREATHING PATTERN: VENTILATORY DEPRESSION WITH COMPENSATING HYPERVENTILATION DECREASE IN CARBON DIOXIDE PARTIAL PRESSURE NEGATIVE INTRALUMINAL PRESSURE DUE TO DIAPHRAGM’S CONTRACTION LOSS OF AUTONOMIC CONTROL OF BREATHING.
3.- A 33-YEAR OLD WOMAN WITH A HISTORY OF FIVE PREGNANCIES COMES TO THE OFFICE WHEN SHE NOTES THAT HER THREE -YEAR OLD UMBILICAL HERNIA DOES NOT DECREASE WITH REST. UPON CLINICAL EXAMINATION A 5 CM UMBILICAL PROTRUDED HERNIA SAC IS OBSERVED, WHICH DOES NOT REDUCE WITH MANUAL MANEUVERS. HIGH PITCHED BOWEL SOUNDS WITHIN THE HERNIAL SAC ARE LISTENED. NEITHER PERITONEAL IRRITATION NOR PAIN ARE DETECTED. - THE MOST PROBABLE CLINICAL DIAGNOSIS OF THIS PATIENT IS: REDUCIBLE HERNIA RICHTER HERNIA STRANGULATED HERNIA INCARCERATED HERNIA.
4.- A NINE-YEAR OLD ACCIDENTALLY POKES HIS LEFT EYE WITH A SHARP PENCIL WHEN PLAYING. RED
EYE, MILD PAIN AND EPIPHORA ARE OBSERVED. - THE MOST LIKELY CLINICAL DIAGNOSIS IS: CONJUNCTIVAL LACERATION RETINA DETACHMENT CORNEAL ABRASION PALPEBRAL LACERATION.
4.1.- A 12 MM SOLUTION OF CONTINUITY ON THE DAMAGED TISSUE IS OBSERVED. THE NEXT BEST STEP IS: EYE PATCH LASER PHOTOCOAGULATION CARBOXIMETHILCELLULOSE SURGICAL SUTURING.
5.- YOU HAVE BEEN SUMMONED TO PARTICIPATE IN A RETROSPECTIVE RESEARCH PROJECT ABOUT THE MOST FREQUENT CARDIAC DISEASES IN OUR COUNTRY. DURING THE ANALYSIS, IT IS FOUND THAT THERE IS AN IMPORTANT DECREASE IN THE INCIDENCE OF VALVULAR DISEASE, ESPECIALLY MITRAL VALVE DISEASE. - THE MOST EFFICIENT STRATEGY AND PROBABLY RESPONSIBLE OF THIS REDUCTION IS: FOLIC ACID ADMINISTRATION TO PREGNANT WOMEN PENICILLIN PRESCRIPTION FOR PHARYNGEAL INFECTIONS VACCINES ADMINISTRATION MILK AND MILK PRODUCTS PASTEURIZATION .
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