This thread is directed to DR Renorenal and company.
Oh dear, you closed the thread just before I can quiz you! Why do
you do that?
My questions can be answered by any medical students in their
clinical years.
Nevertheless, I appreciate your private mail to me, and your
answer.
You thought Prazosin is a good anti-hypertensive for a 30 year old
male with Gout and 2nd degree heart block.
Heres my 5 cents worth:
30 y.o. sexually active Male, gout, 2nd degree block: Ideally ACE
inhibitors or Angiotensin II receptor antagonists. I believe any
MRCPs would agree with me. BTW, this is Singapores guideline for
HTN.
With regard to alpha blockers (i.e. Prazosin) best drugs for
elderly with BPH or prostatic symptoms, but not a 30 y.o.
sod.
Prazosin personally, i dont use this anymore. Try some of the
newer alpha blockers i.e. Hytrin or Pencor. As urologists use to
say, Give Prazosin to your enemies. Nevertheless, its dirt cheap
to feed the poor old sod Prazosin, at least until you sign him off
to the mortuary.
The following OSCE is a very basic bread-and-butter question for
any house officer.
If you are a bona fide "doctor", answer me. Don't
feed your fantasy by deleting my replies in your thread,
and subsequently closing the thread under the guise of
peace.
I refer to our previous question for discussion: The same 30 y.o.
buddy (male with gout, 2nd degree block, sexually active) has the
following parameters on your morning rounds today. The following is
what your house officer wrote after having been up all night doing
on-call:
Date 13 Dec 2005
Time 6:28am
c/o dizziness, non-vertiginous x 2/7
No GI symptoms
No weakness/numbness
Smoker 40 cigarettes/day
BP 200/95 HR 60 RR 12
Temp 36.8 C
HS1 HS2 Lungs clear
Abd L0S0K0 SNT
PEARL
Fundus NAD
CNS NAD
Cranial nn intact
Negative Rombergs
Neck supple
Blood tests: CCT 40ml/min, UTP 1500 g/day, ALT 20 u/L, LDL 5.72
mmol/L, TG 3.2 mmol/L, Fasting Glucose 8.0 mmol/L, K 3.0
mmol/L.
ECG: ST depression on V4-V6, delta wave present. Sinus
rhythm.
Your house officer prescribed Stugeron 1/1 stat. No further ix
ordered.
Questions:
What would be your choice of medication for his hypertension after
reading his medical record today?
What other crucial physical examination did your HO left out for
dizziness?
Would you order further ix? If so, what ix?
