Disease diagnosis questions: Could you med students help me out?

[phunkeyfantom]

These questions are actually from an undergrad bio class that I'm taking right now, but I just wanted to get people's ideas on what the possible diagnoses may be.

Case #1: You are the specialist in blood disorders. Recently, a 40 year old female patient was presented to you with blood in the urine accompanied by kidney failure and acute abdominal pain. When your nursee was doing her physical she noticed small tiny red dots in her lower leg. She also complained of blood in her stool and heavy menstrual bleeding. The lady said, "it started with minute bleeding in her gums." Usually when she bleeds from an injury it is difficult for it to stop. You order an immediate CBC (complete blood count) and ask for more history. You find out she is a heavy alcoholic and she has been using sulfa containing antibiotics six months before for approximately one month. What is her diagnosis? How do you plan to treat her?

~> For me, I thought that the abdominal pain was due in part to the alcoholism and that it caused some type of infection in the GI tract that raised the level of acid and thus causing a peptic ulcer. I then thought that the ulcer could have been brought about the use of the sulfa containing antibiotics.

Case #2: Your patient during a regular physical presented with slightly elevated blood pressure. You advise the patient to go on a low sodium diet and drink at least 10-12 cups of water everyday. You also prescribe a mild diuretic. Based on your knowledge of the excretory system explain to the patient why these measures will help reduce the pressure.

~> I thought that the increase in the amount of water had something to do with helping the body increase its blood volume.

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[Cowboy DO]

not to do your homework for you, but i have this OCD like disorder where i cant let questions go unanswered anymore.

#1 survy - bleeding gums is pretty much a dead give away, coupled by the fact that shes an alcoholic (probably doesnt have a good diet full of vitamins) and she is taking a sulfa drug which increases the elimination of vitamin C it seems pretty obvious which direction this question is leading you.

#2 The low sodium diet and the diuretic, which im assuming is a loop diuretic, both will help keep the total amount of salt in the body down. With less salt the body will retain less water and this is what will lower the blood pressure. The 10-12 cups of water are probably to help prevent side effects like dehydration, headache, muscle cramps etc., as long as its pure water(not soda) it should leave the body pretty much as soon as it enters and wont disrupt the new homeostasis you have created with the low sodium diet and the diuretic.

 

[HiddenTruth]

#1 survy - bleeding gums is pretty much a dead give away, coupled by the fact that shes an alcoholic (probably doesnt have a good diet full of vitamins) and she is taking a sulfa drug which increases the elimination of vitamin C it seems pretty obvious which direction this question is leading you. .

I don't particularly agree with the above response. Although, what you said is true, I wouldn't diagnose this patient with scurvy. She is a freaking ETOHic--cirrhosis!! come on!--deficiency of caogulation factors (except 8), come on! Given the fact that "when she bleeds from an injury it is difficult for it to stop"--that is a clear flashing RED light to think of coagulation problem--additionally, the bleeding udner the gums, although, classic for scurvy, is really calssic for any bleeding disoreder secondary to deficiency or abnormal synthesis of caogulation factors, as it is one of the common sites where bleeding first is noticed (brushing teeth). The hx of sulfa drugs (as with any antiobiotic use) for extended periods of time can kill off your intestinal vit K (necessary for synthesis of caog factors 2, 7, 9 , 10, prot c and S) producing flora; thus, further exacerbating the situation.

Based on the patient's INR, and actually, the fact that she is bleeding, you want to give her Vit K BY MOUTH (not IM or SC or IV, because that can cause her to bleed even more), and if theINR doesn't climb up, and she continues to bleed, you want to consider giving her fresh frozen plasma.

The patient clearly has alcoholic cirrhosis with concomittant renal failure (per your history). But, the symptoms are all primarily secondary to ETOHic cirrhosis, leading to liver failure essentially, and predisposing the person to hepatocellular carcinoma. Hope this helps.

I do agree with the above poster's explanation for the 2nd question.

 

[phunkeyfantom]

Sorry I came off as a bit of a slacker...I think I could have better phrased the question. I was trying to see if I was headed in the right direction with the what I thought the patients problem may be. Well anyway, thanks a bunch for the help. I'm going to do some more research to see if I will be able to find a more concrete answer for what the possible diagnosis is; but your answers have at least given some type of direction to head in.

 

[carrigallen]

#1 survy - bleeding gums is pretty much a dead give away

hmmm bleeding gums is a "dead give away" for almost any coagulation disorder, (acquired or congenital), some vessel wall abnormalities, certain hereditary connective tissue disorders, a host of medication toxicities, select leukemias, or even some of the platelet disorders.

 

[Cowboy DO]

you guys are right. next time ill take a a little more time formulating a diagnosis. I still think scurvy is a possibility ...especially if she's a sailor.


...or better yet a pirate

 

[carrigallen]

Hmm, i don't think Case #1 can really be solved...she could have any one of a bunch of ailments - uti, liver failure, uremia, urological problems, you name it. The sulfa drugs are useless without more information...what type of infection did she have?

And if it is liver failure, explain why it would present in a 40 y/o woman simply from etoh, with no concomitant liver failure symptoms? It looks like an your prof made these questions without giving enough information, imo.