Curofy in its endeavor to bring doctors on this collaborative platform, brings to you a glimpse of the case discussions on diseases like Pagets, Diabetes  etc that happen on the app and the lives that are getting saved in the process. With more than 60 thousand doctors from more than 350 cities in the country, Curofy has become the go to app for doctors to seek second opinion or to stay updated

1 A 70 years old male come to clinic with complaints of severe pain in bilateral knee and hip joints since 6 months. He also have decreased hearing bilaterally and poor dentition. He has past medical history of HTN, well controlled with Amlodipine. Routine labs are unremarkable, except for increased Alkaline phosphate, with normal GGT. Bone scan was done which shows characteristics lesions. Diagnosis and management ?Pagets

 

Accepted Answer

Pagets disease of bone, tt bisphosphonate and calcitonin anlogue, screening for transformation to sarcoma

2 can u explain how to diagnose diabetic keto acidosis,and treatment of it

Accepted Answer

clinically by taking history like known case of DM,patient coming with missed previous insulin dose,any stressor like infection , injury, etc. patient usually comes with altered sensorium , dehydration , tachycardia,etc should immediately do rbs ketones levels in blood serum electrolytes TC DC treatment fluid with insulin antibiotics supportive treatment .

3 78 year old male with type 2 DM for the last 26 years. patient was initially on OHA’S. now sugar is not getting controlled by OHA’S.HbA1c is 9.8. I have referred patient to endocrinologic but for learning purposes, I would like to know how would insulin be started?

Accepted Answer

Treatment of T2 DM in elderly patients (geriatric) should be lenient. FBS, PLBS and HbA1C goals are different for individual, with life expectancy of more or less than 10 years. For above patient, it’s better to continue OHA and add basal Insulin Glargine, 15 units at bedtime. Below are the guidelines for treating geriatric patients. 1. Healthy patient: Few coexisting chronic illnesses; cognitive, functional status intact. Rationale for recommendations: longer life expectancyA1C goal: <7.5%, FPG or PPG: 90-130 mg/dL. Bedtime glucose: 90-150 mg/dL. BP: <140/80 mm Hg. Lipids: statin (unless contraindicated, not tolerated) 2. Complex/intermediate patient: Multiple coexisting chronic illnesses or 2+ instrumental ADL impairments or mild-to-moderate cognitive impairment; Rationale for recommendations: intermediate life expectancy; high treatment burden; vulnerable to hypoglycemia and falls A1C goal: <8.0%. FPG or PPG: 90-150 mg/dL. Bedtime glucose: 100-180 mg/dL. BP: <140/80 mm Hg,. Lipids: statin (unless contraindicated, not tolerated) 3. Very complex/patient in poor health: LTC or end-stage chronic illnesses or moderate-to-severe cognitive impairment or 2+ ADL dependencies Rationale for recommendations:limited life expectancy; benefit uncertain A1C goal: <8.5%,FPG or PPG: 100-180 mg/dL. Bedtime glucose: 110-200 mg/dL. BP: <150/90 mm Hg. Lipids: consider potential statin benefit (focus on secondary prevention) Consider patient and caregiver preferences when individualizing treatment goals.

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