Day-to-day medicine for medical students, interns and enthusiastic doctors!

A 55 years old male patient admitted to medical casualty with a febrile illness for 3 days with myalgia. Examination was unremarkable. He was previously well except for chronic bilateral knee joint osteoarthritis. He consumed liquor quarter to half a bottle on a daily basis. Investigations revealed. WBC - 5.6 Hb - 11.2 Plt - 135 AST - 45 ALT - 42 S.Cr - 54 He was managed as viral fever and became fever free the next day. However the platelet count was persistently low around 130. Further investigations arranged. Blood picture - Thrombocytopenia probably due to liver disease S. Bilirubin, ALP - Normal S. Albumin - 38, S globulin - 37 USS abdomen - Coarse echogenicity of liver. Mild portal hypertension. Mild splenomegaly. Compatible with chronic liver cell disease. This patient has Cirrhosis with portal hypertension. Now the obvious cause for his cirrhosis is alcohol, isn't it? NO! Just because of the history of significant alcohol consumption you ca

A 48 years old female patient came to a GP for a routine check up. She was asymptomatic. BMI - 25.8kg/m2 Blood pressure - 135/85 FBS - 145 HbA1C - 7.6% She was started on metformin 500mg three times a day. A month later she was reviewed with following investigations. Lipid Profile Total C - 255 LDL C - 168 HDL C - 38 TG C - 215 FBS - 96mg/dl ALT - 56 u/l AST - 38 u/l How are you going to approach this patient? (Please note the following discussion is fairly superficial as it is intended to be read by medical students. They hardly ever read though!) What are the problems this patient has got? She has diabetes mellitus which is under reasonable control. She has obesity. She has hypercholesterolemia. She has abnormal liver functions. Her blood pressure is just around the margin for hypertension. What are you going to do about her diabetes? With metformin alone her blood sugar is controlled. Therefore, I shall continue it. However I would review

A 52 years old patient with well controlled diabetes mellitus came to see his family doctor on a Sunday morning. He has developed a mild chest pain last night which lasted only for a few minutes. Pain was central, without any radiation or autonomic features. However, he had experienced a similar pain about a month back when he was running to catch a train. At the time of consultation there was no pain whatsoever. An ECG was taken. In view of the mild T inversions, the GP asked to check a troponin level, which was normal. He started the patient on Aspirin and increased his usual atorvastatin dose to 40mg. He also prescribed sublingual GTN to be used SOS. If you were the GP, what would you have done? This is Wellens syndrome! What is it? It is a characteristic ECG pattern which indicates critical stenosis of the proximal Left Anterior Descending artery. What would happen if you miss it? Unless proper intervention is done, it will progress into a anterior ST ele