Physiology clincial cases (1)

Clinical Cases in Physiology

Iron Deficiency Anemia

  • Patient Profile: 24-year-old mother of three present with fatigue, giddiness, breathlessness, pallor

  • Blood Investigation Results:

    • RBC count: 3 million cells/cmm

    • Hemoglobin content: 6 g/dl

    • Peripheral smear: Microcytic hypochromic red cells

  • Diagnosis: Iron-deficiency anemia

  • Pathological Basis of Signs and Symptoms:

    • Decreased oxygen carrying capacity → anemic hypoxia → leads to fatigue, giddiness, breathlessness

    • Low RBC count → pallor

  • Laboratory Findings Indicating Iron Deficiency Anemia:

    1. Low RBC count (Normal: 4.5 – 5.5 millions/cumm)

    2. Low Hb content (Normal: 12 – 16 g/dl)

    3. Microcytic hypochromic RBCs on peripheral smear

  • Line of Treatment:

    • Iron-rich diet

    • Oral iron supplements

    • Injectable iron

    • Blood transfusion (if necessary)

  • Preventive Advice for Recurrence:

    • Avoid further conception (as it aggravates anemia)

    • Regular iron-rich diet

    • Avoid exertions; take rest

Pernicious Anemia

  • Patient Profile: 50-year-old woman with anemia, diarrhea, anorexia, weight loss

  • Blood Picture:

    • Macrophages, anisocytes, poikilocytes

    • Low vitamin B12, elevated serum gastrin levels

  • Diagnosis: Pernicious anemia

  • Pathological Basis of Signs and Symptoms:

    • Anorexia, weight loss, diarrhea, elevated gastrin levels due to chronic gastritis → pernicious anemia

  • Investigation Results:

    • Low vitamin B12 → macrocytic hypochromic anemia

    • Elevated gastrin indicates gastritis, leading to decreased B12 absorption (megaloblastic anemia)

  • Treatment Modalities:

    • Injectable vitamin B12

    • Diet rich in vitamin B12

    • Treat underlying gastritis

Hemophilia

  • Patient Profile: 2-year-old boy with knee joint swelling after a trivial fall

  • Blood Investigations: Normal blood count but prolonged partial thromboplastin time and prothrombin time

  • Diagnosis: Hemophilia

  • Pathological Basis of Signs and Symptoms:

    • Boy child (X-linked recessive)

    • Continued bleeding, joint swelling indicates hematoma

  • Further Investigations: Assay of Factor VIII

  • Treatment Options:

    • Fresh blood transfusion

    • Factor VIII concentrate

    • Fresh frozen plasma

    • Avoid aspirin, NSAIDs

  • Long-term Management:

    • Monitor for similar conditions (e.g., hemophilia B, von Willebrand disease, DIC)

ABO Incompatibility

  • Scenario: Nurse transfuses A+ blood to B+ patient, resulting in adverse reactions

  • Diagnosis: Mismatched blood transfusion (ABO incompatibility)

  • Immediate Actions Required:

    • Stop further blood transfusions

    • Administer antipyretics

    • Administer antihistamines

  • Immediate Complications:

    • Febrile reactions

    • Hemoglobinemia, hemoglobinuria

    • Hemolytic jaundice, acute renal failure

    • Hyperkalemia

  • Karl Landsteiner’s Law:

    • Agglutinogens on RBC membranes must correspondingly have absent agglutinins in plasma, and vice versa.

Myasthenia Gravis

  • Patient Profile: 50-year-old male with muscle weakness, drooping eyelids, diplopia

  • Diagnosis: Myasthenia gravis

  • Pathophysiology: Autoantibodies against Ach receptors → decreased Ach receptors → reduced end plate potential → muscle weakness

  • Management Principles:

    1. AChE inhibitors

    2. Thymectomy

    3. Immunosuppressive drugs

    4. Plasmapheresis

Anaphylactic Shock

  • Scenario: Nurse administers antibiotic leading to severe allergic reaction

  • Diagnosis: Anaphylactic shock

  • Clinical Features: Itching, rashes, shortness of breath, hypotension, tachycardia, loss of consciousness

  • Immediate Compensatory Changes: Allergic reaction leading to mediator release (IgE, histamine), swelling and vasodilation

  • Management Principles:

    • Hospitalization

    • IV Epinephrine, IV fluids

    • Head low position, IV antihistaminics

Septicemic Shock

  • Scenario: Diabetic patient with urinary tract infection brought unconscious

  • Diagnosis: Septicemic shock

  • Clinical Features: High-grade fever, abdominal pain, tachycardia, oliguria

  • Compensatory Changes: Endotoxins release leading to vasodilation and blood pooling

  • Management Principles:

    • Strict bed rest

    • IV antibiotics, norepinephrine, IV fluids

    • Analgesics, control blood sugar

Congestive Heart Failure

  • Patient Profile: 60-year-old male with worsening dyspnea

  • Diagnosis: Congestive heart failure

  • Clinical Features:

    • Dyspnea on exertion, pedal edema, fatigue

    • Orthopnea, hepatosplenomegaly

  • Pathophysiology: Low cardiac output leads to organ hypoperfusion, backward blood damming causing congestion

  • Management Principles:

    1. Bed rest

    2. Light meals

    3. Diuretics, vasodilators, digitalis

Myocardial Infarction

  • Patient Profile: 55-year-old male with chest pain and sweating

  • Diagnosis: Myocardial infarction

  • Investigations Required: ECG (ST elevation), serum cardiac markers, echocardiography, angiography

  • Physiological Basis for Symptoms: Chest pain due to substance P accumulation and referred pain patterns

  • Pathophysiology: Coronary artery blockage due to atherosclerosis → ischemia → necrosis

  • Management Principles:

    • Rest, oxygen therapy

    • Pain relief, antiplatelets, thrombolytics, angioplasty

Infant Respiratory Distress Syndrome (IRDS)

  • Patient Profile: Newborn from a diabetic mother with breathing difficulties

  • Diagnosis: IRDS

  • Cause of Symptoms: Prematurity leading to surfactant deficiency

  • Treatment Options: Oxygen therapy, surfactant administration, positive pressure ventilation

Bronchial Asthma

  • Patient Profile: 35-year-old man with history of breathing difficulty

  • Diagnosis: Bronchial asthma

  • Triggering Factors: Smoking, pollutants, allergens, hereditary

  • Explanation of Signs and Symptoms: Inflammation and obstruction of airways leading to difficulty breathing

  • Spirometry Findings Explanation: Reduced FEV1 and PEFR due to airway narrowing

  • Treatment Options: Oxygen therapy, IV fluids, corticosteroids, bronchodilators

Peptic Ulcer

  • Patient Profile: 35-year-old male with epigastric pain

  • Diagnosis: Peptic ulcer

  • Investigations: Upper GI endoscopy, barium swallow study

  • Complications: Bleeding, perforation, obstruction

  • Treatment Modality: Diet modification, antacids, H2 blockers, proton pump inhibitors

Acute Cholecystitis

  • Patient Profile: 50-year-old female with severe right-side pain

  • Diagnosis: Acute cholecystitis

  • Cause for Jaundice: Obstructive jaundice due to stone blockage

  • Management Steps: Hospitalization, IV fluid, pain management, cholecystectomy

Renal Calculi

  • Patient Profile: Male with severe back pain and hematuria

  • Diagnosis: Renal calculi

  • Investigations: X-ray abdomen, intravenous pyelography, ultrasound

  • Complications: Hydronephrosis, pyelonephritis, hematuria

  • Management Principles: Hospitalization, pain relief, surgical removal

Brown-Sequard’s Syndrome

  • Cause: Half spinal cord injury from a stab

  • Clinical Features: Loss of pain/temperature sensation on opposite side, loss of fine touch on the same side, UMN paralysis below the lesion

Parkinsonism

  • Provisional Diagnosis: Parkinsonism

  • Clinical Features: Tremors, bradykinesia, rigidity

  • Pathophysiology: Dopaminergic neuron degeneration

  • Management Principles: Levodopa, surgical destruction of globus pallidus

Cerebellar Disorder

  • Diagnosis: Cerebellar dysfunction

  • Clinical Features: Dysmetria, dysdiadochokinesia, hypotonia

  • Tests for Diagnosis: Finger-nose test, tandem walking, etc.

  • Pathophysiological Basis for Symptoms: Incoordination due to cerebellar damage

Endocrine System

Gigantism

  • Patient Profile: 15-year-old boy with abnormal height and blurred vision

  • Diagnosis: Gigantism

  • Cause of Symptoms: Pituitary tumor compressing optic nerves

  • Treatment: Surgical removal of tumor

Acromegaly

  • Patient Profile: 45-year-old male with headache and facial changes

  • Diagnosis: Acromegaly

  • Cause of Symptoms: Pituitary tumor effects

  • Treatment: Surgical removal of the tumor

Myxedema

  • Patient Profile: 43-year-old female with facial puffiness and weakness

  • Hormone Involved: TSH, low T3 and T4

  • Signs and Symptoms: Weight gain, cold intolerance, depression

  • Treatment: Iodine-rich diet, oral thyroxine

Hypoparathyroidism

  • Scenario: Patient post-thyroidectomy with muscle cramps and twitching

  • Diagnosis: Hypoparathyroidism

  • Hormones Regulating Calcium: Parathormone, vitamin D, calcitonin

  • Symptoms Cause: Hypocalcemia from parathyroid removal

  • Lab Values: Low serum calcium and high phosphate in urine

Addison's Disease

  • Patient Profile: 40-year-old male with symptoms of weakness and pigmentation

  • Diagnosis: Addison’s disease (primary adrenal insufficiency)

  • Cause for Symptoms: Decreased glucocorticoids and mineralocorticoids

  • Treatment: Exogenous steroids, manage electrolyte imbalance

Best of luck!

  • Final Note: Review symptoms, diagnostic criteria, and management strategies for each condition to prepare effectively for exams.