Case Presentation Using

Progressive Disclosure

Florida State University College of Medicine Sample Case Presentation

Paciente que acude a consulta

externa por tamizaje de Cancer

Varon de 65 aos de raza negra

Refiere tener un hermano de 69 con Cancer prostatico
en tratamiento
No refiere molestias urinarias
Casado con 2 hijos y trabaja como obrero C.Civil
Que otras preguntas pertinentes le haria Ud?

Florida State University College of Medicine Sample Case Presentation

History

Operado de Apendicitis hace 15 aos

Toma alcohol moderado fines de semana
Pesa 70 Kg y mide 168cm
No alergias conocidas
Toma Captopril 25mg bid por HTA hace 5 aos

Florida State University College of Medicine Sample Case Presentation

Physical Exam
Paciente LOTEP REG REN REH
Abdomen blando depresible no visceromegalia,no
se palpa globo vesical
Genitales externos normales
TR: esfinter Normotonico prostata con surco
medio delimitado de 3x4cm sin anormalidades
definidas no doloroso

Que le solicita entonces ?

Florida State University College of Medicine Sample Case Presentation

Labs/X-ray

Hb = 15.1 g/dL
Urea = 25 mg/dL
Creatinine = 0.9 mg/dL
Urianalisis= normal sin
bacterias o celulas
inflamatorias

Florida State University College of Medicine Sample Case Presentation

PSA Total 3.5

PSA libre 0.5
Volumen prostatico por ECo
es 35cc
Testosterona total 4.7

What is your differiential diagnosis?

Litiasis vesical?
Cancer vesical?
Cancer prostatico?
Vejiga neurogenica?
Hiperplasia prostatica?

Florida State University College of Medicine Sample Case Presentation

Hiperplasia prostatica
Se caracteriza por STUI acompaado de
CPB
OVV
Disfuncion miccional
Otros como RPM elevado

Florida State University College of Medicine Sample Case Presentation

Cancer prostatico

Fase asintomatica que precede en 5 aos con

aumento sostenido del PSA

Florida State University College of Medicine Sample Case Presentation

Litiasis Vesical

Asociado con dieta elevada en carbohidratos y

malnutricion
Tambien se lo ve acompaando a la presencia de
diverticulos vesicales
Clinicamente con hematuria aociada con la
actividad fisica
Si hay ITU asociado entonces considerar uropatia
obstructive
Baja asociacion con litiasis renoureteral

Florida State University College of Medicine Sample Case Presentation

CUAL ES SU PLAN TERAPEUTICO?

Siempre de acuerdo con el dx clinico
hallado

Florida State University College of Medicine Sample Case Presentation

Treatment Plan

Hospitalization, hydration, and diuresis

Discontinue injestion of calcium
IV Lasix and fluids
If life threatening: short course high dose calcitonin
(Calcimar) (8 IU per kg IM Q 6-8)

Consult?

Florida State University College of Medicine Sample Case Presentation

Consult?
Consult if renal failure might require dialyses.

Florida State University College of Medicine Sample Case Presentation

Prevention
Milk-alkali syndrome might easily be prevented by
restricting calcium intake to 1.2 to 1.5 g/day or by
using a supplement that does not contain absorbable
alkali.

Florida State University College of Medicine Sample Case Presentation

Recent Articles
Medline search of 94-present yielded 10 hits.

Brandwein SL, Sigman KM, Case report: milk-alkali syndrome

and pancreatitis., Am J Med Sci 308: 3, 173-6, Sep, 1994.
The authors describe a patient with pancreatitis and the milkalkali syndrome who had the classic triad of hypercalcemia,
alkalosis, and renal insufficiency. The authors also review the
literature for all the reported cases of pancreatitis associated with
hypercalcemia.

Florida State University College of Medicine Sample Case Presentation

How do you ICD9 code this?

275 Disorders of mineral metabolism

275.40 Disorders of calcium metabolism

hypercalcemia, calcilosis, . .
276 Disorders of fluid, electrolyte, & acid-base balance
276.30 Alkalosis

NOS, respiratory, metabolic

276.50 Volume depletion disorder
276.9 Electrolyte & fluid disorders not elsewhere classified

Florida State University College of Medicine Sample Case Presentation