Case senarios

1. JosephNguru
06.12.2017 P /min BP / Wt kg
rEf by Diani BeachHospital. Since 2015 has hadannual check upand has no medical issues.Has
nocturiaof arund 2 – 3 timesbutfree flow urine.Nodysuriaandnohesitancy.Wasfoundto have a
prostate of around 28.8 gm. PSA was saidto be normal Continuedannual checkandnow prostate
size is30.6 and PSA is 10 Urinalysisisessentiallynormal.IsonNorvasc10 mg od, JASA I od,Is on
ventolinpumpPRN andusuallyneedsabout2– 3 timesperweek.Andalsoduringphysical exertion.
Plan:Advisedtostart Avodart 500 mcg od, contiflo 400 mcg od. Change JASA to clopidogrel 75
mg od. Norvasc 10 mg od, Ventolin pump
IftikharAhmed
06.12.2017 P 85/min BP 125/60 Wt 83.3 kg
Is keepinggoodhealth.Isalone withnowife orchildren.Forpast2 mnthshas LUTS and has been
advisedtotake contifloIod whichhelps.Prostate sizeis34.6
Has arthritis buttakesno meds.Betterwithwalking.Mildlychesttightness.Smokingabout2 – 5 cig
perday. Clinical featuresof bronchitisMayneedascoril atone time.
Plan:contifloItab od,Avodart0.5 mg od,Clopidogrel 75mg od,Meloxicam15 mg o.d
BensonKiarie
06.12.2016 P 75/min BP 140/67 Wt 124 kg
Has come backfor review.Hasnoissuesatpresent.Home sugars6.5 - 9.5 mmol
Is on Mixtard30 insulin50/45 iu,lantus30 iu odand galvus50 mg bd @ lunchand dinner,ASA
cardio100mg od,Rovista20 mg noct,
HTN and ison cilvas10 mg od, nebilong10 mg od, and well controlled. He stoppeddiurideandhas
gainedwt,fluidretentionandhasmildankle oedema.UrgedtoCT diuride.Repeatlabs.
CKD recentlydiscovered andRFTs are holdingsteady.U= 12.3, 7.7, 9.0, 8.7, mmol andCr = 172,
166, 184, 152.8, umol UA 590 umol, HbAIC9.5% still notsatisfactory.UACR0.4 mg/mmol
Plan:Lantus Insulin30iu od,Mixtard 30 iu 55/45, galvus50 mg bd@ lunchand dinner,ASA cardio
100mg od, Rovista20 mg noct,nebilong10mg od, cilvas10 mg odand diuride 20 mg od.Allopurinol
100 mg od,Stoptelmi inviewof the CKD.
06.12.2016 P 79/min BP 176/68 Wt 89 kg T 36.2C
Came thismorningfeelingwell.Dialysedwellfor4 hrs thenat the endof the dialysishe vomiteda
lot.BP shotup to 210/77. Was reviewedbyRMOand givenemitino4mg nad efferalganIgmstat.
Didnot iprove.Wasweakand wasdetainedbythe renal unit.He vomitedagain.Tempremained
normal throughout Has intense PUDwith burningepigastrium.HadsimilarepisodeinMay.
PlancT all hismedsandadd esomeprazole80 mg bd,motilium20mg bd, emitino4mg tds,
Fatma Ali Khamis
06.12.2017 P 77/min BP 83/54 Wt 71.4 kg T 36.8°C
Got periods fortwodays aftertwomonths, Had mildabdcramps whichcleared.breastsdidnot
engorge.Quite cheerful andengagespleasantlyinconversation. Feelsheavyandgainingwt.Wants
to go swimmingx 3 eachweekbuthusbandisreluctant - No more numbness inlegsorin arms any
more,Sleepisstill an issue andshe takesalzolamwhenshe sensesshe will notsleep. Cancope with
house holdchores. Hasfinishedherstudiesandisgraduatingthisweek. Hasacidityissuesandalso
getsmildheadachesfromtime totime. TakesbetapynIPRN Libidohasgone downagain andshe
feelsnothing. Noorgasm. Wantsto have a babyand istrying.Wants medsreduced.
Plan:Risperidon2mg noct.robidom20 mg noct,od, Azolam0.5 mg noct. BetapynIPRN