Exercises

Case 1 – rheumatoid arthritis

Patient has rheumatoid arthritis which started in the ankle and progressed to knees and then to hip. It also has progressed from wrists to elbows.

The progression of disease is from below up. How should you expect the symptoms to leave?

You treat the patient and the pain goes away from the ankles first and one elbow gets better but not the other. The patient says “I feel much better, my ankles are the best. My hip seems to be worse. My right elbow is worse but my left elbow is completely better.” There may be a hint that the patient is generally better because of how they describe the pain going away.

Is the direction of cure being followed? Does the susceptibility of joints to deteriorate have an effect on this? Is the one most reversible acting first?

You took the case of this person for about two hours but only managed to cover the presenting complaints.

Would previous conditions that you don’t know about have an effect on this patient? What should you do next?

Case 2 – mentals

Patient, 45 years old, has mostly mental complaints. Maybe, the patient says, when they were 35, they had several years of a serious bout with colitis but is not there now much. Also in their late teens and early twenties they had severe bouts of broncho-pneumonia which put them in bed for two to three years with coughing, shortness of breath, difficulty in exerting themselves and so on. As a child of about six, they had a rheumatic fever that incapacitated them

You treat the mental complaint. What could you expect to see as the mental symptoms are relieved?