Clinical Presentation: Constipation and Sinus Issues

Patient Presentation 1

• A 65-year-old woman presented with constipation for two weeks.
• Stool description: hard, bullet-like.
• No significant medical history.
• Social alcohol drinker, but non-smoker.
• Blood pressure: 110/70 mmHg.
• Pulse rate: 70/min.
• Temperature: 37.5°C.
• Used over-the-counter medication for constipation.
• Docusate sodium is a stool softener.

Drug Class

• Docusate sodium is a demulcent.

Teaching Points

• Docusate sodium is a stool softener.
• Often recommended for mild constipation.
• Can be taken orally or as a suppository.
• Acts as a surfactant, inhibiting fluid secretion in the small bowel.
• Demulcent: mucilaginous or oleaginous preparation forming a soothing film over mucous membranes, temporarily relieving pain and inflammation.

Patient Presentation 2

• Right maxillary sinus pain, nasal congestion, thick yellow nasal secretions.
• Used decongestant spray, saline spray, and anti-inflammatories.
• Persistent thick drainage, worsening pain, low-grade fevers, and pain around the right 2nd maxillary molar on day 10.
• No allergies.
• First-line antibiotic: Amoxicillin + clavulanate.

Treatment for Sinusitis

• Empiric treatment with antibiotics targeting S. pneumoniae, H. influenzae, and M. catarrhalis.
• Adults/children without antibiotics in the past 4-6 weeks: high-dose amoxicillin or amoxicillin/clavulanate.

Patient Presentation 3

• 72-year-old female with lower-risk myelodysplastic neoplasms (LR-MDS).
• Symptomatic transfusion-dependent anemia.
• EPO level 200 mU/mL.
• Cytogenetic analysis: deletion on the long arm of chromosome 5 [5q (del(5q))] abnormality.
• Platelets and neutrophil counts are normal.
• Preferred treatment: Lenalidomide.

Myelodysplastic Neoplasms (MDS)

• Group of clonal hematopoietic disorders.
• Characterized by persistent and unexplained cytopenias, morphologic dysplasia, and inadequate blood cell production.
• Can evolve into acute myeloid leukemia (AML).
• Median age at diagnosis: seventh decade.
• Del(5q): chromosomal abnormality in ~10% of MDS patients, characterized by a deletion in the long arm of chromosome 5.
• Often presents with macrocytic anemia and thrombocytosis.

Patient Presentation 4

• 34-year-old woman seeking contraceptive advice.
• Recent vaginal delivery 1 month prior, using condoms.
• Medical history: pulmonary embolism & DVT 4 years prior, chronic liver disease, migraine without aura, coronary artery disease, and PCOS.
• Smoker.
• Absolute contraindication to oral contraceptive pills (OCPs): history of venous thromboembolism.
• Other relative contraindications: liver disease, migraine without aura (with history of migraine), hypertension, and diabetes mellitus.

Patient Presentation 5

• 65-year-old male presenting with fatigue, weight loss, positive fecal occult blood test,
• Colonoscopy revealed a sigmoid colon mass.
• PET scan showed liver metastases.
• Treatment option: monoclonal antibody targeting vascular endothelial growth factor A (VEGF-A).

This quiz covers two patient presentations: one concerning a 65-year-old woman with constipation and the use of docusate sodium as a treatment, and another involving a patient with sinus pain and nasal congestion. It highlights important drug classes and their applications in managing symptoms. Test your understanding of these clinical scenarios and associated treatments.