Chronic Care

Clinical case 2
Done by salwa bassem
• A68 years old female with history of OA for that she
take endomethacin cap. Admitted to ER by her family
due to sudden fall and impair level of consiosness ,
they give history of epigasric pain and black stool one
day before admission .
• OE / confused , normal reflexes , pale , no jaundice
• BP 110/75 and 85/60 at erect , PR 108 regular , Temp
36.8 c
• CBC : Hb 9 g/l MCV 60 fl , retic count 2 %, WBC
8000 , platelet 550000 ,
• BUN 30 (normal 7-20) , S. creatinine 1 mg/dl , S ALT
36 , S AST 32 , S ALP 100 IU
1- Name the impairment of consciousness ?
2-What is the underlining cause of above condition ?
3- Cause of anemia and throbocytosis?
4- If the patient give history of use iron therapy
( that cause black stool also) , how you differentiate between
two causes of black color clinically ?
5- Explain the discrepancy in the results of renal indices ?
6- Explain the discrepancy in the blood pressure ?
7- Who you manage this case in ER?
8- what is your action about joint pain management later on?
9- next day when the patient is conscious , she complain of
pain when move left lower limb
X-R show
What is the finding in this XR
and how you confirm the underlining
cause? ( S. Ca &S. phosphat are normal )