Case #1: A 60 year old man with long-standing type II diabetes that has been untreated with insulin is admitted to the hospital after reporting noticeably bloody urine. Bilaterally, he has no feeling in the bottoms of his feet and decreased sensitivity mid-shin, while sensation at the knees is normal. Upon examination the clinician notices that the patient’s lenses are cloudy, and the patient is having a difficult time reading his admissions paperwork. The patient’s blood pressure is also elevated.
Why might this patient have blood in his urine? The patient may be suffering from a bladder or kidney infection.
What other abnormalities would typically be found in such a patient’s urinalysis? Urinalysis may show High Blood Sugar.
What is causing the bilateral desensitization of the lower limbs? It is possible that the patients diabetes is not controlled causing damage to the nerves and hardening of the arteries which can cause decreased sensation and poor blood circulation in the feet.
Why are this patient’s lenses cloudy? The patient may be suffering from glaucoma, or cataracts.
Why might this patient have difficulty reading his admissions papers? The patient may be suffering from Presbyopia, in which the lens of the eye loses its ability to focus, making it difficult to see up close.
How is the elevated blood pressure related to the other symptoms? H causes all these symptoms so there is a chance that the high blood level may be the problem of why there was urine in the blood, numbness, and vision impairment.
Case #2: Julie Turner, a 27 year old non-pregnant female, has grown increasingly anxious about changes in both her behavior and body recently. She consults her physician and complains of insomnia, gastrointestinal instability, feeling excited, and weight loss. She also reports that even though she has lost weight, her “double chin” has not gone away. Upon examination, the physician notes that, while not pronounced, Julie’s eyes seem larger, and her reflexes are excitable. The physician decides to send Julie to an endocrinologist for a consultation.
What does an endocrinologist specialize in? Diagnose and treat diseases related to hormones.
Define hyperthyroidism. Hyperthyroidism or “Overactive Thyroid”, is a condition in which the thyroid gland makes too much thyroid hormone.
Which of Julie’s signs an symptoms are compatible with hyperthyroidism? Weight loss
Does Julie show signs and symptoms specific to Grave’s disease? Yes, Grave’s disease actually causes most hyperthyroidism.
Why might Julie be mistakenly thinking she has a “double chin”? Julie may be mistaken by the fact that her “double chin” is actually her swollen thyroid.
What is the doctor concerned with when they notices that Julie has “large eyes”? Julie may be tired and not getting enough rest.
If Grave’s disease is confirmed, what is the most likely treatment? First beta blockers will be prescribed and once all the results are confirmed they will either give Julie Radioactive iodine or Anti-thyroid medicine.
Case #3: George is a 50 year old man that had a severe motorcycle accident 12 years ago. As a result of the accident, George had one kidney and part of his small intestine removed because they were hemorrhaging. Immediately following recovery, George had some weight loss that he was told to expect because of malabsorption caused by having his intestine removed. George has never returned to work due to his injuries, and mostly sits inside and watches TV and reads. Recently, however, George broke his wrist trying to catch himself from falling. When he was examined, he was told that his bones had become weak.
Define osteopenia and osteoporosis. Which does George seem to have? Osteopenia refers to bone mineral density (BMD) that is lower than normal peak BMD but not low enough to be classified as osteoporosis.Osteoporosis is a progressive disease that causes bones to become thin and brittle, making them more likely to break. George seems to have Osteoporosis.
What is the most common type of fracture of the wrist in a person of George’s age?
Explain how Vitamin D, calcidiol, and calcitriol are synthesized? Calcidiol, or 25-hydroxyvitamin D, is the main storage form of vitamin D, Low calcidiol levels in the blood indicate a vitamin D deficiency, which can lead to weak bones. Your kidneys convert calcidiol into calcitriol, or 1, 25-hydroxyvitamin D, the active form of vitamin D that promotes calcium absorption.
How could George’s missing kidney be related to his decreased bone strength? The lack of vitamin D and calcium absorption which having a vitamin D deficiency will cause bone weakness.
How could George’s partial small intestine be related to his decreased bone strength? It could decrease the calcium you eat from being absorbed into your blood causing your blood calcium to become and stay low.
If George has a decreasing density of his bones due to his previous injuries, what is the classification of his condition? George is suffering from Osteoporosis.
Could George’s lack of time outside be a factor in his weak bones? It’s part of one of the factor’s the other is based on the fact of George laying around and not doing anything which is causing his bones to weaken.
Case #4: Pete is a 250 lb man that played 15 years of professional football. Pete quit football at that age of 38 when his hips and knees became too painful to play. He has tried to manage the pain with OTC antiinflammatory drugs for the past 20 years. Now 58 years old, Pete has a severe limp on his right side and gone to the doctor in hopes to get stronger pain medication. His general doctor orders X-rays, which reveal bilateral narrowing of both hip and knee joints. The right acetabulum shows bony projections extending toward the femoral head.
What does Pete suffer from? Pete is suffering from Osteoarthritis.
What are Pete’s risk factors? Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity, making it more susceptible to damage. As the cartilage deteriorates, tendons and ligaments stretch, causingpain. If the condition worsens, the bones could rub against each other.
Explain whether or not the 20 years of OTC antiinflammatory medications has really helped anything? OTC may have helped with the swelling and mild pain but that’s as far as they help.
What are the bony projections of the acetabulum called? The acetabulum is the socket of the ball-and-socket hip joint. The top of the thigh bone (femur) forms the ball, and the socket (acetabulum) is part of the pelvic bone.
Does Pete need to see an orthopedic surgeon, or can the general doctor treat Pete’s condition? Pete would have to go see an Orthopedic Surgeon for his case.
Is Pete a candidate for joint replacement surgery? One of the alternatives Pete may want to look into is Total hip Arthroplasty (THA) is one of the most successful surgical interventions that leads to improvement in quality of life and provides significant improvements in both pain and function.
Case #5: A 67 year old African-American male presents to his family physician for a checkup. It has been more than 5 years since his last checkup. A thorough examination including a digital rectal examination and history is unremarkable for a man of his age. The physician orders several different blood tests, including a prostate-specific antigen (PSA) level.
Why would a physician order several blood tests for a person with no apparent problems? PSA is detected through a man’s blood and also the patient has not been to a checkup for 5 years.
Does this man have any risk factors for anything in particular? Yes, he is at risk of prostate cancer.
What is a digital rectal exam used to test for? The Rectal exam helps to detect growths or enlargements of the prostate gland in men.
Why is a PSA level an important test for this man? This exam measures the amount of prostate-specific antigen in the blood.
What would an elevated PSA level indicate? Elevated levels would mean inflammation of the prostate gland or prostate cancer.
If this man has elevated PSA, how would it be treated? Depending on the level that the test comes back a urine test may be provided to check for a UTI that may be causing the levels to be elevated if not a biopsy may be suggested to confirm if and where the cancer is.
Case #6: A 26 year old women presents at the clinic with a complaint of infertility. She and her husband have tried unsuccessfully for over one year. She reports irregular menses since menarche at age 13. She has never been pregnant, and has always had Pap smears. She reports at least a dozen sexual partners and was treated for gonorrhea 6 years ago. He husband has had normal semen analysis results.
What are the risk factors for female infertility? Irregular menstrual cycle, age, can be risk factors as well as sexually transmitted diseases such as gonorrhea can cause fallopian tube damage.
Which of these risk factors may be involved in this case? In this case Gonorrhea is the biggest risk factor.
What hormone levels would be appropriate to ascertain?
If the problem is a pituitary hormone imbalance, which hormone(s) might be involved? The hormone Hyposecretion would be involved.
If the problem is an ovarian hormone imbalance, which hormone(s) might be involved? Polycystic Ovarian Syndrome: PCOS is a disruption in communication between the brain, the pituitary gland and the ovaries. PCOS is characterized by irregular or lack of ovulation, irregular or lack of menstrual periods.
Define pelvic inflammatory disease. Pelvic inflammatory disease is a general term for infection of the uterus lining, fallopian tubes, or ovaries.
If a pelvic exam is performed and PID is involved, what might be noticed? Tenderness and possibly a lump next to the uterus may be noticed.
How might laparoscopy be useful for a definitive diagnosis? It will give a clearer picture of the abdomen and pelvis.
Case #7: A 21 year old female presents to the ER complaining of lethargy, a stiff neck, and a headache. Initial examination reveals a high grade fever, sensitivity to light, and withdrawal from neck flexion. A history uncovers that she is a daycare worker and many students have been absent recently.
What do the symptoms suggest? The Symptoms suggest that the female has Meningitis.
Is this patient at particular risk for the suggested illness? People of any age can get meningitis, but because it can be easily spread among those living in close quarters, teens, college students, and boarding-school students are at higher risk for infection.
What test needs to be done? Laboratory tests and a possible spinal tap will be done.
How is this test performed? Taking a needle and collecting a sample of spinal fluid from the lumbar.
What are the two most likely microorganisms to be found with the test from question #3? This test will show any signs of inflammation and whether a virus or bacteria is causing the infection.
Does the daycare need to be notified? Yes immediately and any children that may be exposed or feel like they are sick should seek professional care right away.
Case #8: A 68 year old African-American male is transported to the ER with rapid onset left sided weakness. He was watering his lawn when he suddenly dropped the hose and fell to the ground. His speech was slurred when EMS personnel arrived. The man has a history of high blood pressure and hypercholesterolemia. His exam shows left facial areflexia and drooping. CT scan of the head shows no hemorrhage.
What is the diagnosis? Ischemic Stroke
What is the likely location of the pathology in this instance? Location would be in his brain.
What are the risk factors for this condition? Hypercholesterolemia, high blood pressure, atrial fibrillation diabetes, family history of stroke, age, and race might all be factors.
What are the possible mechanisms of pathology in this case? Possible mechanisms of pathology are Thrombotic Stroke and Embolic Stroke.
Which is the more likely mechanism of the pathology in this case? The Thrombotic Stroke is more likely.
What is the underlying problem in this case? Hypercholesterolemia and Blood Pressure are the underlying problem.
How did the underlying problem lead to this incident? High blood pressure and hypertension can lead to thickening of the arterial walls making the passage way narrow.
Case #9: A 36 year old man is seeing his physician because he is becoming increasingly weak. He reports that the weakness progresses throughout the day. He has a desk job and can hardly keep his eyes open and head up by the end of the day. Other history is unremarkable. Cranial nerve examination shows weak facial muscles, inability to repeat movements, and bilateral ptosis. The patient’s shoulders droop with a very poor posture.
What is the likely diagnosis? Ocular Myasthenia
What is the pathogenesis of this disease? Ocular Myasthenia is a disease of the neuromuscular junction resulting in hallmark variability in muscle weakness and fatigability.
What other deficits might present if untreated? If left untreated it may cause acute respiratory failure.
Why do the symptoms seem to worsen later in the day? Symptoms seem worse later in the day due to physical activity throughout the day. Symptoms aren’t as bad once the person has rested.
What other conditions should be ruled out? Early symptoms can be confused with Psychiatric disorders.
What treatment should be sought? A blood test measuring antibodies to acetylcholine receptors; 80-90 percent of Myasthenic people show these antibodies in their blood.
Case #10: Tim and Leanne are rushed to the hospital after a car accident. Tim was driving as the car was hit in the driver side door. He sustained a broken humerus from the direct impact. His arm was immobilized and he is resting in his room. Leanne, who was in the front passenger seat sustained a ruptured spleen and four adjacent broken ribs on the left side. Her wounds are from striking the middle console of the car. She is in the ICU with her chest wrapped.
What are the factors that affect wound production? The wound-healing process consists of four highly integrated and overlapping phases: hemostasis, inflammation, proliferation, and tissue remodeling or resolution
Which factor is the main difference causing Tim and Leanne to have such different injuries? The main factor that causes the difference in injury here is the fact the driver side door was the one hit in the accident.
What is the mechanism that caused the rupturing of Leanne’s spleen? Leanne struck the middle console of the car.
What is the name of the condition in which several adjacent ribs is broken? Flail Chest
Due to her broken ribs, what is Leanne at risk of developing? Rib Stress
If Leanne’s lung is bruised, what other condition may develop? Leanne may develop a pulmonary contusion or bleeding of the lungs.
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