Patient centered questions for assessment of "Clinical problem solving and Medical decision making skills (29M)

A 29-year-old-male with a strong family history of stroke and renal failure develops a fever of unknown origin for last three months. He has a history of hypertension. The general examination is found to be cachectic with tachypnoea. He also has a raised jugular venous pulse. He is also found to have severe normocytic normochromic anemia, hypoalbuminemia, proteinuria, raised creatinine. He is put on regular hemodialysis. His previous chest xray showed a large right sided pleural effusion which on aspiration is found to be hemorrhagic and exudative with lymphocytic pleocytosis with normal pleural fluid ADA and negative CBNAAT. His Echocardiography assessments reveal severe concentric left ventricular hypertrophy LVH with preserved ejection fraction.

Which of the following is likely responsible for his severe anemia?

Blood loss during hemodialysis
Chronic inflammation
Folic acid deficiency
Vitamin B12 deficiency
Erythropoietin resistence.

Which of the following should be checked before starting him on erythropoietin for severe anemia?

Serum vitamin B12 levels
Peripheral blood smear
Iron deficiency anemia
Serum folic acid levels
Hb electrophoresis

Which of the following is most likely involved to cause his anemia?

Peritubular capillaries in nephron
Juxtaglomerular cells
Bone marrow
Macula densa
Messengium

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55 years Old male with Bipolar affected disorder moving from depression to Manic to depression phase

Disclaimer:- This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here December 2017 after collecting informed patient consent (form downloadable Click Here) This is a case of a 55 years old, diabetic, hypertensive patient who was diagnosed with Bipolar affected disorder since 1995. In 1995 due to financial loss he was attacked by this condition. He was seen by Dr. D. K Agarwala and diagnosed as BPAD-Depression phase and treated with lithium, sodium valporate, propranolol, Zeptol cr, Nitrosum - S. With the treatment he was reasonably well but every 6 months of interval he appeared to have some disturbance like didn't want to talk to anybody, forgot to smile etc. They went to the doctor and treated accordingly and was continuing the treatment. In the year of 2013, August he was diagnosed with BPAD-severe depression phase but, he was not responding well to the medications and then they went to NIMHANS for

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drugs to avoid or use in terms of their pregnancy category

The optimal AEDs therapy of women with epilepsy who are of childbearing age is unclear because of a lack of conclusive data on the comparative teratogenicity of different antiseizure drugs and no antiepileptic drug has proven safe in pregnancy in terms of teratogenesis. Data on the comparative efficacy of various antiseizure drugs for controlling seizures during pregnancy are also quite limited, and there are no randomized trials in this setting. Treatment must be individualized for all patients. Women with epilepsy are classified as high risk during pregnancy and as there are no clear data indicating that any drug is without risk in pregnancy therefore, the antiseizure drug regimen should be optimized six months prior to planned conception. Choice of antiepileptic drugs in women of childbearing age and pregnant women with epilepsy: 1. T he antiseizure drug that stops seizures in a given patient is the one that should be used with an exception of valproate. 2.

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