Patient Case Study: Constipation & Sinus Pain

Patient Case Study (Constipation)

• A 65-year-old woman presented with constipation for two weeks.
• Stool description: Hard, bullet-like.
• Medical history: No significant past medical history.
• Lifestyle: Social alcohol drinker, non-smoker.
• Vital signs: Blood pressure 110/70 mmHg, pulse 70/min, temperature 37.5°C.
• Physical examination: Within normal limits.
• Medication use: Over-the-counter constipation medication.
• Drug class of docusate sodium: Demulcent (stool softener).

Teaching Points (Constipation)

• Docusate sodium: A stool softener often recommended for mild constipation.
• Administration: Oral or suppository.
• Mechanism of action: Acts as a surfactant and inhibits fluid secretion in the small bowel, creating a smoother stool.
• Demulcent: A preparation that forms a soothing film over a mucous membrane, providing relief from minor pain and inflammation (typically temporary).

Patient Case Study (Sinus Pain)

• Patient with right maxillary sinus pain, nasal congestion, and thick yellow nasal secretions (post-nasal drip).
• Symptoms: Persistent thick drainage, worsening pain, low-grade fever, and pain around the right second maxillary molar.
• Duration of symptoms: Several days.
• Treatment: Nasal decongestant spray, saline spray, and anti-inflammatories.
• Diagnosis: Sinusitis.
• First-line antibiotic: Amoxicillin/clavulanate (assuming no allergies).

Patient Case Study (Myelodysplastic Neoplasms)

• A 72-year-old woman with lower-risk myelodysplastic neoplasms (LR-MDS).
• Symptoms: Symptomatic anemia, transfusion dependent.
• EPO level: 200 mU/mL.
• Cytogenetic analysis: Deletion on the long arm of chromosome 5 (del(5q)) abnormality.
• Platelets and neutrophil counts: Normal.
• Treatment: Lenalidomide is the preferred treatment given the EPO level.

Patient Case Study (Contraceptive Options)

• A 34-year-old woman seeking contraceptive options.
• Recent pregnancy: Gave birth one month ago via spontaneous vaginal delivery.
• Contraceptive use: Condoms since delivery.
• Medical history: Pulmonary embolism and DVT four years prior, chronic liver disease, migraine without aura, coronary artery disease, and polycystic ovarian syndrome (PCOS).
• Smoking: Tobacco smoker.
• Contraindications for oral contraceptives: History of venous thromboembolism (VTE), liver disease.

Patient Case Study (Eye Infection)

• A 23-year-old woman with a left eye infection.
• Symptoms: Itching, gradually worsening.
• Medical history: Cystic fibrosis, type 2 diabetes mellitus, and IgA nephropathy.
• Assessment needed prior to tobramycin ophthalmic solution prescription: Renal function.

Patient Case Study (Drug Toxicity)

• Patient experiencing drug toxicity after 3 days of Gentamicin therapy.
• Possible side effects: Elevated creatinine and protein in the urine, which is a common side effect of Gentamicin due to nephrotoxicity.

Patient Case Study (Pneumonia)

• An 84-year-old man with community-acquired pneumonia (CAP).
• Cause of infection: Streptococcus pneumoniae.
• Medical history: Atrial fibrillation controlled by Class III antiarrhythmic sotalol.
• Treatment: Doxycycline is the better option for this case, given its use against pneumonia-causing bacteria as well as its lack of interaction with sotalol.

Patient Case Study (Oral White Plaques)

• A 55-year-old man with oral white plaques and dysphagia (difficulty swallowing).

• Positive HIV test.

• Treatment: Antifungal for thrush and lamivudine monotherapy for HIV.

• Cause of resurgence of infection: Lamivudine resistance.

Patient Case Study (Fatigue and Weight Loss)

• A 65-year-old man presenting with fatigue and weight loss, positive fecal occult blood test, mass in the sigmoid colon and liver metastases detected through PET scan.
• Treatment: Monoclonal antibody infusion targeted against VEGF-A.

Explore a patient case study focusing on constipation and sinus pain. This quiz highlights key teaching points regarding treatment options like docusate sodium and the associated mechanisms. Test your knowledge on managing these common patient concerns.