pre final OSCE Learning points

PRE FINAL OSCE LEARNING POINTS 
05/12 /23 


OSCE QUESTIONS :
 1) Dialysis Disequilibrium syndrome?   

 Dialysis disequilibrium syndrome (DDS)   refers to an array of neurological           manifestations seen during or following   dialysis, primarily after the new initiation   of dialysis.However, it can also be seen in   chronic dialysis patients who miss their   regular dialysis treatments. This   syndrome is thought to arise from fluid   shifts during hemodialysis, causing   cerebral edema and a wide variety of   neurological symptoms. In continuous   renal replacement therapies (CRRT),   where fluid shift is limited, dialysis   disequilibrium syndrome is rarely     reported.

The common risk factors that predispose a patient to dialysis dysequilibrium syndrome are 
First hemodialysis treatment
High blood urea nitrogen (BUN) (above 175 mg/dL or 60 mmol/L) before initiation of dialysis
Extremes of age – children and elderly
Sudden change in dialysis regimen
Pre-existing neurological diseases such as stroke, malignant hypertension, head trauma, or seizure disorder
Presence of other conditions causing cerebral edema (hyponatremia, hepatic encephalopathy)
Conditions causing increased permeability of the blood-brain barrier (sepsis, meningitis, encephalitis, hemolytic uremic syndrome, vasculitis) 

 2) 
 How spironolactone cause       gynecomastea? 
 Spironolactone induces gynecomastia by   decreasing testosterone production,   increasing peripheral conversion of   testosterone to estradiol, and displacing   estradiol from sex hormone-binding   globulin. 

Learning points :

How to approach the patient and take detailed history and link the past history with the present illness.

Learnt about the Dialysis Disequilibrium syndrome

How spironolactone cause the gynaecomastia 

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