General Medicine Case Discussion.

A 42 year old female with multiple health issues.

May 16 , 2020.

Neha Purohit
Roll No. 115

I have been given this case to solve in an attempt to understand the topic of  "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history , clinical findings , investigations and come up with a diagnosis and treatment plan.

Following is my analysis of this patient's problem :
The problem in the order of priority are :

1) Migraine with associated aura

2) Potential Sensory Disorder

3)  Swelling of the face and abdomen

4) Sleep Disturbances

5) Increased pain tolerance 

6) Increased Fatigue


Each problem is described in detail here :

 1) Migraine with associated aura :

  Onset : sudden
  Since the age of 2  which gradually worsened after the onset of menarche which was at 14 years of age
  which was more towards the left side.
  The headache was gradually progressive.
   At 34 years of age , the headache increased and aura intensified with associated loss of vision for shorter duration.
The headache was usually associated with 
  • Left hand numbness and the left face felt as cold as ice water.
  • Intensification of aura obscuring vision.
  • Loss of vision with stuttering along with memory loss and severe cramps in the left arm.
  • Aura was like a small flicker and eventually becomes a crescent covering the entire center of vision.
   The migraine relieved on ingestion of  Triptans.

2) Potential Sensory Disorder:
Onset : At the age of 4 years
Physical contact is uncomfortable
the types of potential sensory disorder include vision , smell , taste , hearing and touch.

3) Swelling of the face and abdomen:
Onset : 1 year of age
Site : Usually on the face and the abdomen.
The edema aggrevated on standing or working and relieved on rest.

Causes of edema :
  • Hemolytic anaemia associated with G6PD deficiency.
  • Kidney Infections.
  • Ingestion of Fava beans due to G6PD deficiency.
  • Emotional stress might also be cause.
Edema relieved on taking 400mg of Cimetidine.

4) Sleep Disturbances :
Onset : Since 1 year
2 - 4 hours once a day with nearly no REM sleep.
Possible causes are Adenosine Mono phosphate Deaminase  1 deficiency G6PD deficiency.
L- Serine and Cimetidine where administered.

5) Increased pain tolerance :
Onset : Since 4 years of age till the present date
Associated with multiple falls and sprained ankles.
Osteoarthritis can be possible cause of multiple fractures and sprains.

6) Increased Fatigue :The causes of increased fatigue are :
  • Adenosine monophosphate Deaminase 1 deficiency which leads to excessive adenosine.
  • It is associated with severe cramps .
OTHER ASSOCIATED PROBLEMS OF THE PATIENT :
  • Severe Jaundice at birth.
  • Chronic urinary tract infections 
  • Kidney infections
  • Lung infections
  • Cervical Degeneration and Scoliosis.
  • Ectopic Pregnancy at 21 years of age.
  • Multiple ovarian cysts - PCOS
  • Decreased urination
  • Hair loss
  • Difficulty in breathing.


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