Long case topics

Question 1

SLE

Answer 1

R/F- female, genetics, OCP use, smoking, UV light, EBV infection, Asian
Features- constitutional, MSK, skin, cardiac, renal, resp, GIT, neuro, psych, haem
Ix- ANA, anti-dsDNA, anti-Sm, C3/4, biopsy
Mx- NSAIDs, hydroxychloroquine, pred, methotrexate, MMF/cyclophosphamide, rituximab, belimumab

Question 2

Diabetes

Answer 2

Diagnosis, symptoms at diagnosis
R/F- FHx, steroid use, metabolic syndrome, autoimmune Hx
Ix- HbA1c, urine ACR, BGL monitoring (self vs. CGM)
Mx- medications, diet, exercise/weight
Cx- micro (eyes, renal, feet), macro (CVS, cerebro, PVD, autonomic), DKA/HHS, hypos, bone health

Question 3

Obesity

Answer 3

Current weight/BMI, waist circumference
R/F- genetics, diet, exercise, medical (DM, OSA, CVS), medications (steroids, antipsychotics), immobility, mental health, non-adherence
Ix- lipids, HbA1c, HTN, fatty liver, Cushing’s
Mx- education, food diary, dietician, exercise, meal replacements, mental health Mx, pharmacological (GLP-1 agonists), surgical

Question 4

CKD

Answer 4

Current stage/eGFR
Cause of disease- DM, HTN, GN, reflux, PCKD, medication-related
R/F- smoking, low birth weight, HTN, diabetes, age, obesity, AKI, pregnancy
Mx- fluid restrict/diet, medications (ACEI/ARB, ESAs, Vit D, phosphate binders), dialysis (modality, access, symptoms, complications), plan for Tx
Cx- HTN, fluid overload, anaemia, MBD, electrolyte imbalances, gout, CVS, peripheral neuropathy, uraemia

Question 5

Long term steroid use

Answer 5

Bone health
BGLs
Mood
Sleep
Proximal myopathy
Weight gain/Cushingoid
Bleeding risk
Infection risk

Question 6

Falls risk

Answer 6

Vision impairment
Poor gait/aids
Medications- analgesia, anti-HTN, anti-psychotics, sedatives, diuretics
EtOH
Arthritis/joint pain
Stroke/neurological disease
Diabetes- hypos, peripheral neuropathy
Postural hypotension
CVS disease
Osteoporosis
Environmental factors- housing

Question 7

HIV

Answer 7

Dx- investigations, symptoms, mode of acquisition, CD4 count/viral load
Co-infections- hepatitis, TB, CMV, syphilis, STIs
Monitoring/control
Mx- which antivirals, adherence, drug interactions, S/E
Cx- opportunistic infections, malignancy, cognitive/neuro, bone health, CVS disease, lipohypertrophy
Psych history- mood, impact of diagnosis
Sexual history- orientation, protection, family plans
SHx- work/relationships, ADLs, finances, smoking/EtOH, family, future plans