Tutorial Modul NefroUrologi

A 50-year old man with headache and malaise

Session I
Part I on 1st day
Mr. Ryan, a 50-year-old man, admitted to Jakarta Hospital with a 9-month history of
headache and malaise. He told that he has felt lethargic and lacking in energy for around
months. !his has "een much worse recently and has "een associated with mild nausea
and itchiness. !he headache has "een occurring for much longer pro"a"ly around #0
months. He gets it e$ery day, descri"es it as thumping of gradual onset and responsi$e to
parasetamol. He has no associated neurological symptoms such as num"ness or weakness
in the arms and legs, and no $isual distur"ance. He has not "een short of "reath on
e%ertion, nor does he gi$es any history of orthopneual or paro%ysmal nocturnal dyspnoea.
His ankles ha$e "een mildly swollen for a few weeks.
Mr. Ryan was pre$iously $ery fit and healthy and has ne$er had any heart, li$er or kidney
pro"lems. He has no that any urinary or prostatic symptoms. He does not take any regular
medications and is a non-smoker who drinks no alcohol. He works as a salesman, "ut is
finding the daily tra$elling re&uired more and more difficult.
iscussion Acti!ities
#. 'hat is Mr. Ryan(s medical pro"lems)
. *ook for the medical history to define your working diagnosis+
,. 'hat is your hypothesis) -%plain your answer+
.. 'hat do you do to assist the history for getting working diagnosis) /More
information+0
Session I
Part II on 1st day
Mr. Ryan is afe"rile, with no peripheral signs of an autoimmue or inflammatory process.
He is clinically anemic with pale palmar creases and con1uncti$ae. His pulse is 2. "pm
and regular. 3lood pressure is ele$ated at #904#00 mmHg, cardio$ascular e%amination is
otherwise normal. 5ll pulses are easily palpa"le and there are no o"$ious "ruits. His chest
is clear with no signs of pulmonary oedema. !here is no li$er or spleen palpa"le and no
signs of chronic li$er disease in the peripheries. He has minimal pitting oedema affecting
only his feet "ilaterally.
iscussion Acti!ities
#. Make medical pro"lem list of Mr. Ryan+
. 'hat is your hypothesis ) -%plain your answer+
,. 'hat is your working diagnosis)
.. 'hat is your first aid management for Mr. Ryan)
5. More information for diagnosis.
Session II
"n the #nd day
*a"oratory results show hemoglo"in 6.# g4dl, mean corpusculum $olume 6, white "lood
cell 6004mm,, platelets ,72.0004mm,, sodium #,6 mmol4*, potasium ..6 mmol4*,
calsium 2,7 mg4d*, phosphor inorganic 7. mg4d*, urea 66 mmol4*, creatinine ##.
mg4d*, al"umin 9g4d*, glucose random 9 mg4dl, 585! . 94*, 5*! 7 94*, intack
parathyroid .67 pg4m*. 9rine dipstick shows protein ::, "lood :, negati$e for
leucocytes, nitrites and glucose. . hours urine collection #000 g4. h
iscussion Acti!ities
#. Make your interpretation of la"oratory results, and features of -;<, ;=R and
98<.
. 'hat is your hypothesis ) -%plain your answer+
,. 'hat is your working diagnosis)
.. 'hat is your education for Mr. Ryan and his family)
5. How is the prognostic patient)
Right kidney
*eft >idney