Wednesday, February 17, 2010

Four Sheep, Inc.

I have a friend who was contemplating using the title of this case as a name for a company.

Challenge: Tell me about this patient's past medical history.

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Suheil said...

umm.. i'm not too sure abt this one.. tho i'll give it a shot.. Diabetic retinopathy (proliferative) .. probably and elderly patient with history of Uncontrolled/ poorly controlled diabetes mellitus for atleast 10-15 years probably with HbA1c levels of over 10-12%. Patient probably complains of decreased vision and is likely to have symptoms related to other micro and macrovascular complications of DM like nephropathy (symptoms may only present at late stages- edema etc) Peripheral neuropathy (initially detectable as loss of vibration sense, proprioceptive sensations eventually leading to full blown glove and stocking type of paraesthesia and numbness) Peripheral vascular disease (presenting as painful arterial ulcers over the lower extremeties, claudication pain in the legs, may even be rest pain which is relieved by hanging the legs off the bed- all due to accelerated atherosclerotic occlusion of the medium sized arteries in diabetics) coronary artery disease (accelerated atherosclerosis) recurrent infections (possible reactivation of latent TB, vaginal candidiasis in women, balanoposthitis in men, also) poor wound healing etc.. Patient is likely to be overweight with a BMI of atleast over 25 but probably above 30.. unless the patient has TYPE I DM..

Again this may be a classic diaplay of my foot in mouth condition.. sorry if it is..

Suheil said...

Oh.. Fundus picture shows- Neovascularisation at the optic disc, hemorrhages, IRMAs.. are those the four sheep?

Craig Chen said...

the sheep reference is to the cotton wool spots. DM can be a cause of the cotton wool spots, but HTN is the most common reason
Four Sheep, Inc.

The fundoscopic exam shows cotton wool spots, seen in hypertensive retinopathy. Mild hypertension can lead to vasospasm, arteriolar wall thickening or opacification, or A/V nicking. Moderate hypertension causes flame or dot hemorrhages, cotton-wool spots, hard exudates, and microaneurysms. Severe hypertension causes optic disc edema (papilledema). Note, cotton wool spots can be seen in other disease states like vasculitis, diabetes, and infections.

Sources: UpToDate;