MEQ Session 4: CLA B
Mdm Lee YT 75yo Chinese Female; PMHx DM, HTN, Hyperlipidemia, Depression. She now comes in for a fall, family noted stiffening of limbs associated with jerking movements for 2min . On examination she was noted to be minimally responsive, groaning. Initial investigations at the ED were as follows: Hb 13 TW 10.2 Plt 250; Ur 10 Na 110 Cl 97 K 4.0 Cr 89 Hc 5.0. CT brain shows no significant abnormalities. Which of the following would be the most appropriate measures
Run NS 0.5 L of Normal Saline over 4hours; aim for Na rise 0.5mg/H
Run 3% hypertonic saline 100ml over 4 hours recheck and aim for sodium rise of 1mmol.h
3% hypertonic saline 100ml fast aim for a rise of sodium 2mmol/h fors first 2-3 hours
Fluid restriction 1L / day
You noted from family that her GP has recently started her on some new medications. All of the following medication can cause hyponatremia except..
Q3Following appropriate treatment Mdm Lee is now more alert and able to speak to family members. She is clinically euvolemic. Investigations were ordered to investigate cause of hyponatremiaUr 8 Na 117 Cl100 Serum Osm 250 Urine Na 40 Urine Osm 180 fT4 15 TSH 3 8am cortisol 100. Which of the following will be the most appropriate.
Fluid restriction 1L per day
Start Nacl tablets
screen 11pm serum cortisol
Advise for high salt diet
Q4: Mdm Lee continues to be monitored on the ward and undergoes physiotherapy on the ward. She is noted to have episode of shouting at night and occasionally aggressive towards staff. You noted one episode when staff nurse was bitten. Collaborating history from family did not note similar behaviors at home previously. Which of the following are appropriate measures
Start low dose lorazepam 0.5mg PRN
Start low dose haloperidol 0.5mg PRN
Q5. . You revisted cognitive history with Mdm Lee’s family- noted a gradual decline in short term memory. She used to be able to go to run errands in the supermarket but have stopped for the past 1 year in view of episodes of wondering behaviour. There were episodes when Mdm Lee was noted to have forgotten names of family members. MMSE was done 18/20. Which of the following points towards a diagnosis of Alzheimer's dementia
Step wise progression of memory lost
Prominent visual hallucinations
Marked memory deficients with preserve executive function
Replied " dont know" during MMSE
Disinhibited speech and behaviours
Q6 A multimodal intervention to prevent falls is initiated, and the patient is referred to physical therapy for an individualized exercise program. A home safety evaluation is ordered to optimize his home environment, and he is educated on proper footwear.Which of the following additional treatments is most likely to decrease this patient's risk of falls?
Vitamin D supplementation
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