EBHF Assignments for Week 11
Full Course Overview
Case Based Written Assignments
There are TWO questions this week. The EBHF Program now requires all fellows to upload their assignments to our server using the simple link below. STARTING IN WEEK 11, we not longer permit the emailing of ASSIGNMENT ANSWERS. ASSIGNMENTS ARE ONLY ACCEPTED USING THE LINK BELOW.
If you choose to write your answer in another language besides English, that is perfectly fine but please let us know the language chosen when you submit your answer.
CASE 21
Marie is 55 years old and was diagnosed with lichen planopilaris (LPP) 9 months ago. She was started on topical clobetasol and steroid injections and doxycycline. It helped a little bit - but not perfectly. She started on hydroxychloroquine (Plaquenil) at a dose of 400 mg once daily about 3 months ago
Marie made an urgent appointment to see you today. She is upset that her liver enzymes are rising with the treatment. Her mother had major liver problems when she received an antibiotic for a bladder infection when Marie was a teenager and Marie is very afraid of her test results.
She wants to stop hydroxychloroquine and start oral minoxidil. She has heard so many wonderful things about oral minoxidil! She feels it is worth a try!
PAST MEDICAL HISTORY
Past medical history include type 2 diabetes for which she uses metformin. Marie says she uses Simvastatin 10 mg for cholesterol issues. She says feels fortunate her labs have been good! She says the only problem is her blood pressure which has been “yoyo.” In general, she says her blood pressure has been “up and down” but last week was 155/90 at her family doctors office. Her family doctor wants to start a blood pressure medication but they are trying a treatment plan involving exercise and diet first.
Weight is 177 pounds (80.2 kg) and height is 5 ft 7 (170 cm). Marie does not smoke anymore. She smoked from age 22-29. She does not drink alcohol frequently.
QUESTIONS FOR CASE 21
a) Would you stop hydroxychloroquine given that she has elevated liver enzymes?
b) What are your thoughts about her statin medications? Is this a good one for her? Would you change anything? Is it causing her harm?
c) Do you recommend Marie have any other tests or labs? Which ones?
d) What other changes to her treatment plan do you think are probably needed?
CASE 22
Margaretta is 47 years and started spironolactone for androgenetic alopecia. You started her on 50 mg for one month and then increased the dose to 100 mg. You asked her to check her potassium levels after starting. She was too busy to get blood tests after the first month but got them done at month 3.
Her results are shown here and compared to results from 8 months ago. Margaretta is concerned about her kidney function tests and has stopped spironolactone. Her family doctor told her she has kidney failure and she is very afraid of what this all means.
QUESTIONS FOR CASE 22
a) Would you stop the spironolactone medication?
b) What do you think caused the creatinine to rise?
c) What would you do now? Please provide a detailed answer. What exactly would you do or what do you feel needs to be done?
d) What tests would you order?