5) Nephrology (and Urology) M.SRI SAI PAVAN ROLL NO :79 8TH SEM

A.LINK TO PATIENT DETAILS:

https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html
1) What could be the reason for SOB??
As the patient was administered diuretics may be it has lead to increased excretion of Bicarbonate ions.So there will be Metabolic Acidosis.To compensate that there will be increase in the respiratory rate to eliminate the CO2 so that equilibrium is maintained.Hence there will be Shortness of Breath due to increased respiratory rate.

2) Why does he have intermittent episodes of drowsiness??
Use of Diuretics has lead to Hyponatremia which resulted in Drowsiness.

3)Why did he complain of fleshy mass like passage in urine ??
There are large no. Of puss cells in his urine.May be the patient confused these with a fleshy Mass.

4)What are the complications of TURP that he may have had ??
TURP -Transurethral resection of   Prostate


- May be Glycerol used for bladder wash during the procedure has caused some damage to the kidney.There was a rise in his creatinine levels following the procedure.
There is also chance of infection.
Patient's WBC count is also Raised.                                                        B) Link to patient details:




                                                                                                                                                                                                                    1.Why is the child excessively hyperactive without much of social etiquettes ?


1ans* The exact pathophysiology of Attention Deficit Hyperactivity Disorder (ADHD) is not clear. With this said, several mechanisms have been proposed as factors associated with the condition. These include abnormalities in the functioning of neurotransmitters, brain structure and cognitive function.

* Due to the efficacy of medications such as psychostimulants and noradrenergic tricyclics in the treatment of ADHD, neurotransmitters such as dopamine and noradrenaline have been suggested as key players in the pathophysiology of ADHD.


 * Depressed dopamine activity has been associated with the condition,





2. Why doesn't the child have the excessive urge of urination at night time ?


2ans:the child doesn’t have the excessive urge of urination at night time because ADHD is a physcosomatic disorder 



3. How would you want to manage the patient to relieve him of his symptoms


 TREATMENT

Amphetamine which is a CNS stimulant will be useful in this Patient.
I would also try to change the Parenting Behaviour and teach the parents Positive Reinforcement Methods so that the child would get A Good Family Support.
Cognitive Training should also be Given to the child.








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