Quiz: problem solving:
Kindly analyze the following real case scenarios :( Read the next chapter to guide you through) Falls – immobility- dizziness- fatigue
Case 1:
A.A a 82 yrs. Old male patient- with no significant past medical history –living alone in his village, phoned his grandson (5th year medical student) complaining of forgetfulness. He reassured him, and told him it is normal with aging
1 yr. later, A.A who became 83 yrs. Old phoned his grandson (6th yr medical student) complain of recurrent falls. M. inquired about frequency of falls and it was 3 times in last month, he thought it is insignificant event but he sought medical consultation started by GP, ophthalmologist, neurologist and orthopedic with no significant diagnoses
The grandfather still had falls, and his grandson told him to restrict his mobility
1 yr later, the grandfather neighbors phoned the grandson who became (house officer) and told him that they found the grandfather lying on the ground and had fracture neck femur, orthopedic consultation, no operative intervention.
He transferred to Cairo to live with his daughter family, he became bedridden, had refusal of feeding, poor sleep, pressure ulcers, DVT, incontinent, his primary care giver is M mother (60 yrs old) and she noticed he is not just forgetting, he had delusions of being stolen.
What went wrong? How would you act differently?
Case 2:
An 82-year-old woman is sent to the emergency department after she fell in her home and was unable to get up. She has no history of falls, but is being treated for chronic low back pain due to degenerative disc disease and for mild hypertension.
Her medications include acetaminophen as needed and amlodipine 5 mg daily. In addition, she has chronic urinary urgency with occasional incontinence but has declined medications for this problem.
The patient has been experiencing increasing fatigue over the past 3–4 days. She admits that she has also experienced shortness of breath for some time.
She denies chest pain, dizziness, palpitations, or loss of consciousness, and has no history of asthma, or heart disease. She does not smoke or drink alcoholic beverages. She is a widow but lives near her daughter and has remained physically and socially active.
On physical examination, the patient is alert and oriented. Her blood pressure is 90/60 (hypotensive), her heart rate is 102 and regular (tachycardia), and she has a respiratory rate of 24(tachypnea). Her oxygen saturation is 92% at room air. Jugular veins are not distended. Significant findings include a grade III/VI systolic murmur over the base and left sternal border, bilateral basilar rales, and trace ankle edema.
There are no focal neurologic signs. She has no tenderness or bruising in the hips or buttocks.
Fatigue and fall can be nonspecific manifestations of more serious conditions (mainly when occur as new onset) how would you approach this case?