Fisher's Snoring

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Fisher's Snoring by Mind Map: Fisher's Snoring

1. investigations

1.1. BP measurment

1.2. fundoscopy

1.3. ECG

1.4. ECHO

2. Step1: identify cues and difficult words

2.1. A/ identify cues

2.1.1. over weight 58 yomale

2.1.2. hypertensive for 10 yrs , on treatment

2.1.3. snoring

2.1.4. general lack of energy

2.1.5. worried about BP medication

2.1.6. over last 5 yrs change the distance of driving on work gainning weight loss of interest

2.2. B/ difficult words

2.2.1. long haul: long distance

3. Step2: problem formulation

3.1. 58 yo hypertensive, overweight male patient, presented with worrying of snoring and general lack of energy.

4. Step3: hypothesis generation

4.1. suspected underlying cause for hypertension. stroke , kidney problems(Adeeb)

4.2. the HTN medications are the cause of loss of interest and depression (Sulami)

4.3. all the symptoms are consequences of exposure to poisons facing in his work as a truck driver(Ghannam)

4.4. tending to sleep as consequence of his condition forced him to do some changes in his work (hassan)

4.5. use of substances to be awake for long time may cause HTN

4.6. the weight gained is bcz the edema that caused by kidney problem affected HTN(homoud)

4.7. caffien is the cause of HTN. gaining weight bcz the medecations.(essam)

4.8. gaining weight>>snoring. working time changes>>lack of energy. phsychological problem may be (faris)

4.9. work requirements > low muscular tone> affecting breath while sleeping > snoring . both aggrevates each other(kashi)

4.10. hear failure and LVH are complications(adeeb)

5. Step4: hypothesis organization

5.1. primary

5.1.1. HTN causes risk factors or aggrevating factors consequences(short and long term)

5.1.2. snoring and general lack of energy

5.2. secondary

5.2.1. dysfunctional impact

5.2.2. less interest

6. Step5: learning objectives

6.1. 1-to know about HTN(definition, causes, risk factors, types, manifestation, mechanisms and complications)

6.1.1. emphasis on relation between HTN and OSA

6.2. 2-complications of antihypertensive drugs

6.3. 3- criteria of diagnosing depression.

7. Step6 : review

7.1. 1-to know about HTN(definition, causes, risk factors, types, manifestation, mechanisms and complications)

7.1.1. definition Isolated HTN Grade 1 Grade 2 HTN Grade 1 Grade 2 Grade3 MORE THAN ONE READING ARE NEEDED TO CONFIRM THE diagnosis of HTN 2 or more reading comparing the both arms also, compare with a normal person

7.1.2. causes essential HTN unknown cause multifactorial Secondary HTN renal endocrine drugs cohn's syndrom pregnancy vascular disease coarctation of the aorta low sodium intake metabolic syndrome

7.1.3. types

7.1.4. manifestation mostly asomptomatic headache blurred vision angina(in some patients) dizziness sweating palpitation

7.1.5. complications angina hypoperfusion to the kidney renal infraction sodium retention heart failure retinopathy stroke malignant hypertension

7.1.6. mechanism BP=COP IN P.resistance increase in after load sympathetic activation increased volume stenosis of the artery more contraction chamber enlargment return to eccentric LVH (on long term) arterioles are most affected new set point increase COP

7.2. 2-complications of antihypertensive drugs

7.2.1. diuretics HYPOkalemia

7.2.2. ACEI coughing nasuea

7.2.3. AT1 antagonist

7.2.4. Ca channel blockers ankle edema and constipation

7.2.5. beta blocker bradychardia, fatique

7.2.6. alpha1 adrenoceptor antagonist p.hypotension

7.3. 3- criteria of diagnosing depression.

7.3.1. ICD-10 CRITERIA


8. Step 7: inquiry plan

8.1. present history

8.1.1. diagnosed hypertensive 13 years ago

8.1.2. snoring become noiser over the last 6months

8.1.3. 185cm, 91kg

8.1.4. play tennis most of the time

8.1.5. 25cigarittes since age 15

8.1.6. amlodipine and carvesidwas described two yrs ago

8.1.7. BP=165/105 after addition of treatment

8.1.8. 150/100 is BP 6 months ago

8.1.9. carviside

8.1.10. less intresen in

8.1.11. lethargy

8.1.12. fall asleep in a day time

8.2. past history

8.2.1. no surgical history

8.3. family history

8.3.1. both of his parents are dead

8.3.2. his sister died from stroke

8.4. personal and social history

8.4.1. atenelol 1mg

8.4.2. 3 shooners per night and more on weekend

8.4.3. now is122 kg

8.5. vital signs

8.5.1. 165/105

8.5.2. 80/m PR

8.5.3. RR 20/M

8.5.4. TM= 37


8.6.1. cardiac apex beat not palpable

8.6.2. no murmurs,

8.6.3. jvp=2cm

8.6.4. 2 cm liver palpable below the costal margin

8.6.5. unattentive

8.6.6. grade retinopathy

9. Step 8: diagnosis

9.1. LVH and ischemia

9.2. OSA

9.3. HTN


10. objectives

10.1. managment of complicated HTN(LVH and ishcemia)

10.2. epidemiology of HTN

10.2.1. 25.5%

10.2.2. in 1999 was 22-24 %

10.3. managment of OSA

11. step9:review

12. step10:managment

12.1. HTN

12.1.1. NON PHARMACOLOGICAL goal less than 140/90 modifying risk factors obecity diabetes sedentary life style alcohol consumption regular aerobic exercise low sodium intake physical therapy

12.1.2. pharmacological younger than 55 more than 55 step1 step2 step3 step4 acei +diuretics(thiazide)+b blocker+CCB are recommended for the this patient start with low dose diuretics hypokalemia and hyponatremia thiazide and thiazide like diuretics are good choice in HTN acei cough hypotension CCB generalized edema constipation alpha blocker decrease the peripheral resistance ganglionic blocker in HTN crisis in the presence of adverse effects, it is better to change the treatment instead of adding other drugs ARB is effective in decreasing LVH than b blocker

12.2. OSA

12.3. renal artery stenosis

12.3.1. hypoperfusion

12.3.2. causes atheromatous plaque fibromuscular dysplasia

12.3.3. managment stent

12.4. depression

12.4.1. serotonin reuptake inhibitors

13. step 11: feedback

14. resources

14.1. 1- medscape

14.2. 2- kumar

14.3. 3-

14.4. 4- davidson