Assignment Task
Case Study
Task: Refer to the following case and answer the associated questions.
Case:
John is a 35- year-old male who was referred to a neurologist by his doctor. About 5 years ago, he suffered a concussion as a result from a fall from a ladder. John works as a painter. John did not experience any further neurological problems until about 2 weeks ago when he reported experiencing a strange sensation, followed by a tonic-clonic seizure lasting around a minute.
The neurologist diagnoses epilepsy and initiates treatment with antiepileptic drug therapy. John is started on a dose of phenytoin PO (oral tablets, 300 mg) daily. After several weeks, John has another tonic-clonic seizure and phenobarbitone (150 mg PO) is added to the treatment program.
About 4 months after starting the treatment program, John complains to his regular doctor that his gums seem to be increasing in size and covering more of his teeth. He thinks it might be related to his medications and makes an appointment to see his neurologist.
1. What is secondary epilepsy? What factors are known to be related to causing secondary epilepsy such as in John’s case?
2. Discuss the mechanism of action of phenytoin and phenobarbitone. Discuss what happens at the molecular target level and how this reduces the incidence/frequency of seizures (you will need to link how the mechanism of action produces a therapeutic effect).
3. Which medication could be responsible for John’s gums increasing in size? Discuss the common adverse reactions of John’s medications.
4. Why should John be advised to avoid alcohol when taking his medications? Discuss at the molecular level, how the mechanisms of action of alcohol could interfere with the action of John’s anti-epileptic medications.
Pathophysiology of chronic kidney diseases (550 – 600 words)
Please see all the details provided carefully
Case Study
Sally, 58-year-old female farmer presents to her GP with generalised weakness and fatigue. She also complains of feelings of pins and needles in her fingertips. She has been a known diabetic for 22 years. On careful history taking, the GP realises that Sally has not been compliant to her diabetes medications for the last 2-3 years. She doesn’t smoke and has no history of intoxicants abuse. Her appetite is good, and according to her she has been gaining some weight during the past few months.
On physical examination, her body weight is 65 kg, pulse is 78/minute, BP is 141/85 mmHg, temperature is 36.8o C.
GP orders a few tests. Sally is called back to the clinic a few days later and after discussing the lab reports (shown below) with her, the GP refers her to a nephrologist.
Please answer the following TWO questions:
Q1. What is the pathophysiological basis of chronic kidney disease in a patient with poorly controlled long-standing diabetes mellitus? (400 words approx.)
Q2. Based on the clinical picture and laboratory investigations provided, what stage of chronic kidney disease this patient is in and what will be the main management approach at this stage? (200 words approx.)
