Mr. Loud snoring Session 2

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Mr. Loud snoring Session 2 by Mind Map: Mr. Loud snoring Session 2

1. Step 6

1.1. Review session 1

1.2. Report new knowledge

1.3. 30 minutes

1.3.1. The scribe does not have to write in this step!

2. Step 8

2.1. Diagnostic decision

2.1.1. uncontrolled Hypertension

2.2. Mechanism

2.2.1. Idiopathi causing increase in BP-> leading to complications like OSA, Grade II retinopathy, LVH.

2.3. Presentation

2.3.1. Fatigue, loss of interest, snoring

2.3.2. decrease in sexual function

2.4. Supporting data

2.4.1. High hemoglobin

2.4.2. ECG findings LVH, PVC, nonspecific ST changes

2.4.3. Increase in urea and cholestrol

2.5. 10 minutes

3. Step 7

3.1. Inquiry plan and info gathering

3.1.1. History of presenting complain 58 y/o truckdriver, his wife made him come to the doctor because of snoring and general lack of energy and he's hypertensive Although he has always snored a little over the past 2-3 years, this has increased in the past 6 months. for hypertension->2 yrs ago->amlopedine was added. carpazide was added 6 months ago. his snoring is loud, his wife has moved to the son's bedroom. noted to have hypertension 14 years ago during a routine examination 185 cm/91 kg (15 years ago) he used to go play tennis when hypertension was first diagnosed, he stopped smoking, and he reduced alcohol, also was on Beta blocker->hypertension was controlled JUST snoring(no apnea) He does not want to have sex with his wife Inspite of the 3rd drug, hypertension is not controlled. No morning headache, no sweating, no palpitations He falls asleep infront of the TV everynight She's worried about his lack of interest Steadely gaining weight over the past years. Now his weight is 122 KG

3.1.2. Previous medical / surgical history No history of renal diseases, no diabetes Vists the dr. twice a years. He's compliant in terms of vists and drugs No prevoius operations

3.1.3. Drug history / allergy No

3.1.4. medications beta blocker atenolol 100 duritic carvizide amlodipin CCB 10 mg per day

3.1.5. Social / occupational history 2-3 chooners of beer untill 6 months ago. currently atleast 3! 25 cigarrates a day until age 44 resumed smoking 8 months ago(a pack aday) Found the job stressfull, found it difficult to be awake They live at their own home. One son, one daughter

3.1.6. Family history his hister,63,hyperlipidemia, 2 MIs other sister died of stroke at 63 father died of 2nd MI at age 55 his mother died young for cancer of ovaries

3.1.7. Systemic review

3.1.8. Physical examination Vital signs Weight height pulse BP Temp RR CV examination Cardiac apex, not palpable JVP normal hearts sounds no periphrel edema Liver 2cm firm liver edge liver span Respiratory Chest clear Percussion Trachea is in the middle line Neurological Optic fundi retinopathy: grade II hypertensive with arterivenous niping

3.1.9. tests results CBC Hemoglobin is elevated Chest xray was norma Biochem elevated cholestrol and urea Trace of proteins is normal ECG LVH, Left axis deviation PVC

3.2. 50 minutes