Case Studies PDF
| Title | Case Studies |
|---|---|
| Course | Pathophysiology |
| Institution | 香港理工大學 |
| Pages | 19 |
| File Size | 1.9 MB |
| File Type | |
| Total Downloads | 65 |
| Total Views | 175 |
Summary
Case Studies...
Description
15/16HTI34015 Casestudies‐suggestedanswer
CaseStudy–1 SuddenChestPainina55‐year‐oldManwithDiabetes
1. What is the pathogenesis and what are the possible causes of chest pain of suddenonset? Answer: Some common causes of
include
, myalgia of thoracic muscles, disease,
, disorders,
pneumonia,pleuritis,andaorticaneurysm.
2. Whatisthesignificanceofprecordialpain thatoccursduringeffort incontrast toprecordialpainthatoccursatrest? Answer: Precordial pain
is more suggestive of
frequency and intensity of pain along with precordial pain at p1ofp19
. Progressive is most
15/16HTI34015 Casestudies‐suggestedanswer
suggestive of
angina. Unstable angina is more likely to progress to a andisthuspotentiallymoredangerousthanstableangina.
3. Isthehistoryofdiabetesandhypertensionimportantfor theunderstandingof thepresentillnessofthispatient? Answer: is most commonly
. Both
and
,increasingtheprobabilityandspeeding
cancause
the progression of atherosclerosis. Diabetes
via the
and subsequent formation of .
through
candirectly
4. Whywashegivenaspirin? Answer: in platelets and thus interferes with platelet and platelet‐mediated likelyduetoa a
angina is most
andform
.Softatheromasaremorelikelyto
which may cause
at the
siteof theatheromaorfurtherdownstream.Bygivingaspirin thepatient is
iftheatheromadoeshappentorupture.Aspirinwill alsohelp
intheeventofplateletactivation.
5. Whydoeshehavetachycardiaandhypotension? Answer: The
resultingina
. This decreased ejection fraction translates to a
and thus
. With less blood leaving the
heart, there is hypotension.The
resulting in issensedandcauses
thedeficiencyincardiacoutput. Hints:youmaylisttherelevantequationsinansweringthisquestion. p2ofp19
to
15/16HTI34015 Casestudies‐suggestedanswer
6. IsitpossiblethatthispatienthasanMIeventhoughthelaboratoryfindingsdo notsupportthatdiagnosis? When could one expect a rise in serum levels of myoglobin, troponin, and CreatinekinaseMB(CK‐MB)? Answer: It is possible that the patient may have a myocardial infarction. His
startedat
andhe wastransferredtothecoronary
.Hisadmissionbloodworkwasusedfor serummarkerlevels.This
I.A
maybe suggestedtolook
forchangesintheserummarkerlevels. Theearliestmarker is
which
later. Creatine kinase MB ( andpeakswithinthe post‐MIandpeakat
aftercell injuryand ) begins to increase .Troponinsincrease
Extra:Whichoneofthemistheearliestmarker?Anyspecificmarker,andwhy?
p3ofp19
15/16HTI34015 Casestudies‐suggestedanswer
CaseStudy–2 ChronicCough&ExpectorationinaSmoker
1. Whatarethepossiblecausesofchroniccoughandexpectorationinasmoker? Answer: Some possible causes of infection,
and and
p4ofp19
in a smoker include
15/16HTI34015 Casestudies‐suggestedanswer
2. Whatistheimportanceof thedurationof thecoughingepisodesandthecolor ofthesputum?Whatisthemostlikelydiagnosisinthepresentpatient? Answer: The
episodescanhelpidentify themostlikelydisease
ofthe
process.
durationcoughs(afewweeks)aremorelikely
(common cold, etc.) whereas
and recurrent coughs can help make the
There is some debate about the significance of the butwhenit isa orbacterial).
color itmay bean
of the
process(viral
(thepresence ofblood)signalstheclinicianthat there
isbleedingof
foronereasonoranother.
is clinically defined as prolonged or thatlastsatleast
during thattime
andis
foradurationofatleast
peryear. Thispatientthenmeets
thecriteriaforchronicobstructivebronchitis.Thepresence of coloredsputum is commoninchronicobstructive bronchitis.Thefeversuggests thepossibilityfor ontopofthebronchitis. 3. Whatisthesignificanceofdistendedjugularveinsandpedaledema?Arethese findingsrelatedtotheclubbingoffingers? Answer: The distended jugular veins are the “poor man’s indicator” of central venous pressure.The
,the
the .
is usually due to
abnormalities (blockage, laceration, etc), whereas maybe dueto
asin in
the
pedal pitting edema or
.
of the fingers occurs under conditions of may be either due to
. This hypoxia
or inadequate blood
With right heart failure, less blood is making it to the lungs to get oxygenated andthuslessoxygenatedbloodismakingittotheextremities(fingers)leadingto p5ofp19
15/16HTI34015 Casestudies‐suggestedanswer
clubbing. One would also see gravity dependent (pedal) pitting edema and increasedcentralvenouspressure. 4. Whyisitimportanttonotenonodulesormasseswerevisibleonradiograph? Answer: It is important to mention no nodules or masses were visible in light of the history of smoking. and should be
is the number one cause of
in the US
as a diagnosis in a smoker with
especially with
5. Whataretheconsequencesofthearterialbloodgas(ABG)abnormalities? Answer: Both the
and
in the blood
the oxygen
saturation curve of hemoglobin (you may refer to the oxyyhemogloibin dissociation curve), making
. The relaxed
binding of oxygen by hemoglobin will allow the oxygen to more readily diffuse into the hypoxic tissue. Since this patient is also dueto
p6ofp19
they are at risk for
15/16HTI34015 Casestudies‐suggestedanswer
CaseStudy‐3 ProlongedJaundiceandItchinginanadultwoman
1. Ispruritusjustafancynameforitching? Whatcouldcauseitching? Whatisthe pathogenesisofitchinginajaundicedperson? Answer: isthetechnicallycorrectmedicaltermforitching.Itchingmaybecaused by various disease states including hypersensitivity),
reactions (
type
typehypersensitivity(e.g. poisonivy),toxins(e.g.bug
bites), psychiatric disorders, and cutaneous deposits or stimulation by endogenousmaterials.Injaundicethereisan acton
tocausepruritus. p7ofp19
which
15/16HTI34015 Casestudies‐suggestedanswer
2. Howcouldhypothyroidismbelinkedtoliverproblemsinthiswoman? Answer: The liver is the major producer of proteins in the blood including albumin. servesasa hormone (
formanyhormonesincludingthyroidstimulating
When the liver does not function correctly it will produce less
albumin which leads to fewer binding sites for TSH and other hormones. These hormones are much more likely to be and
in the
at the
than albumin bound hormones. The
increased excretion and metabolism of TSH results in ultimatelycausing
of the
3. Whatisxanthelasmas?Dotheydifferfromxanthomas? Answer: is more the
found around the
termforan
A xanthoma is a anywherein
of
4. Couldhyperbilirubinemiaandhyperlipidemiahavethesamepathogenesis? Answer: The hyperbilirubinemia and hyperlipidemia may have the same pathogenesis if the liver were damaged.
would be
sufficiently resulting in hyperbilirubinemia. Damaged hepatocytes would also be
whichwouldresultsinhyperlipidemia. Remarks:Liverproblemcanbereflectedas: 1. Hyperlipidemiadamagedhepatocytesunabletouptakesufficientserumlipid 2. Hyperbilirubinemia damaged hepatocytes unable to conjugate and excrete bilirubin 3. Hypoalbuminemia damaged hepatocytes unable to synthesize sufficient proteinincludingalbumin. p8ofp19
15/16HTI34015 Casestudies‐suggestedanswer
5. Do the liver biopsy results explain the pathogenesis of jaundice? Is this hyperbilirubinemiacausedbyconjugatedorunconjugatedbilirubin? Answer: The liver biopsy results explain the pathogenesis of the jaundice, namely causedbydestructionof thebileducts.With the
in the hepatocyte, but never reaches the
bileresultinginconjugatedhyperbilirubinemia. 6. Couldthisportalfibrosisprogresstocirrhosis? Answer: If liver damage continues, the
outcome of
p9ofp19
will be
15/16HTI34015 Casestudies‐suggestedanswer
Casestudy‐4 EnlargedPainfulLiver
1. Cirrhosis that develops after viral infection is called “posthepatic.” Do you knowanyotherformsofcirrhosis?Whatisthename forthecirrhosis that has noobviouscause? Answer: There are many types of cirrhosis and cirrhosis may be due to many causes. Someothercausesofcirrhosis include , (
diseases,
(alcoholic cirrhosis),
,andcirrhosisduetonoobviouscause
cirrhosis). p10ofp19
15/16HTI34015 Casestudies‐suggestedanswer
2. Whatisthecauseofprogressiveabdominalswellinginapatientwithcirrhosis? Couldsimilarsymptomsoccurinapersonwhodoesnothavecirrhosis?Makea listofconditionsthatcouldcause“abdominalswelling.” Answer: Abdominal swelling in cirrhosis is most likely due to withoutcirrhosissuchasin
ascitesduetobacterialinfection.Othercauses
of “abdominal swelling” besides ascites include n,and
Ascites may occur
.
3. Whatarethepossiblecausesofliverenlargement?Whywouldacirrhoticliver enlarge? Answer: Possible causes of liver enlargement include Acirrhoticliver
,
and
as moreand
formtotrytomakeupfordecreasingliverfunction. 4. Whydidthispatientdevelophepaticveinthrombosis? Answer: Hepatocellular carcinoma (
has many possible metabolic and hormonal
effects on the body as well as invasive potential. This patient most likely had bythecancercells.Thecancercellsthen whichresultedinthe
p11ofp19
.
15/16HTI34015 Casestudies‐suggestedanswer
Casestudy‐5 Depressedwomanwithend‐stagekidneydisease whorefusedtohavehemodialysis
1. Whyisdialysisperformed? Answer: In chronic
the kidneys do not function correctly and
substances, such as urea, begin to
in the blood.
from thebloodto
is needed to to
thebody. 2. Whydidthiswomanloseconsciousness? Answer: Herlackofdialysisallowedforan leadingto
and .
and
p12ofp19
tooccur,
15/16HTI34015 Casestudies‐suggestedanswer
3. Whydoesshehavehypertension?Isshedehydratedor doesshe showsignsof waterretention?Whydoesshehaveableedingtendency? Answer: Thispatienthasbecome
duetothelackofkidney functionand
skippingdialysis.Theexcessfluidiscausingher
and
Signsof
she displays include edema, hypertension, and fluid in the . In pleural or pericardial
a patient will usually
have
. Her
but will
is due to
. Her bone marrow is producing
platelets, but the platelets and clotting factors are diluted into an
duetothefluidoverload.Indilutionalcoagulopathythereis
of any of clotting cascade factors or platelets to satisfactorilystopbleeding. 5.
Please interpret these laboratory findings. What are the possible
consequencesofhyperkalemiaandtheotherelectrolytedisturbances? Answer: The laboratory findings point towards
. Normally the kidneys
will
, while
from the filtered plasma.
in the
bloodso
willalsocontribute todecreasedlevelsofcalcium
in solution (
in cardiac .Additionally,in
may cause and
resulting in a
theextracellularpotassiumwillbe
and
leadingtoan
influxofpotassiumand otherelectrolytesinto plasma fluid content, will cause
The
alongwiththeincreased (brain swelling) which can be
lethal. p13ofp19
15/16HTI34015 Casestudies‐suggestedanswer
6.
Whatisthecauseofacidosis? Answer: Theacidosisis
Firstoff,herkidneysarenot
(protons, phosphorus, etc.) leading to a dysfunctional kidneys are the potential to
. Secondly, her
leading to a decrease in
the increasing acid load. Finally, in
extracellular potassium is
the to further
decreasethepHoftheblood. 7.
Doesthispatienthaveazotemia? Answer: Azotemia isdefinedas an , such as
and
of
Using this definition the patient has
azotemia.
p14ofp19
15/16HTI34015 Casestudies‐suggestedanswer
Casestudy–6 Overweightwomanwithfamilyhistoryofdiabetes
Miss Lazy Bone, a 47‐year‐old overweight woman, has gradually increasing dyspnea and mild chest discomfort on exertion, fatigue, and weight gain. She has no children and is not now pregnant. Furtherhistoryrevealsafamilyhistoryofdiabetes.
1. In addition to questions about her chest discomfort, what other assessment questionsshouldyouaskMissBone?Why? Answer: With Miss Bone’s overweight condition and family history of diabetes, she may have changes in
. You should ask her about itching
rash or
frequent
,
, recent history of
and intermittent
Thesequestionsaddressmanifestationsof
and of
of
long‐term diabetes, which may be present by the time type 2 diabetes is diagnosed. Complications of long‐term diabetes including pronetohave
.
Footnote:Foryourreference! Claudication refers to the
thatoccurs withexertion.Thispainor cramping iscaused by dueto
ofthe
p15ofp19
15/16HTI34015 Casestudies‐suggestedanswer
2.MissBonehaspolyuria,paresthesiasinherfeet,anitchingrashinhergroin,and blurry vision. Why is it important to measure her blood pressure and the pain andvibrationsensationinherhandsandfeet? Answer: Shemayhave
Herparesthesiasindicatesomedegreeof
3.Hernursepractitionerorderedbloodtests forglucoseandHbA1C.Whatdoyou expectthesevaluestobeifMissBonehastype2diabetes? Answer: Bothblood glucoseandHbA1Cwillbe
Indeed,theywereelevated, and
shewasdiagnosedwithtype2diabetes. 4.WhatinformationdoesHbA1Cprovidethatthebloodglucoseleveldoesnot? Answer: provides information about
.
informationaboutthebloodglucoseoverthepastseveral
provides
5. Miss Bone’s evaluation reveals Candida infection and mild coronary artery disease.Whydoesdiabetesincreasetheriskofinfection? Answer: , including
and
Elevated glucose in the tissue also provides a culture
.
and
6. What physiological mechanisms contribute to peripheral (diabetic) neuropathy intype2diabetes? Answer: inthe
cause . Microvascular disease also .
p16ofp19
and to
15/16HTI34015 Casestudies‐suggestedanswer
Extra:Whataboutdiabeticnephropathy?Diabeticretinopathy? 7.WhydidhernursepractitionerreferMissBonetoanophthalmologist? Answer: Complicationsoflong‐termdiabetesinclude
and
8.Whyis itimportanttoteachMissBoneabout diet,weightloss,andappropriate exercise, home glucose monitoring, and other ways (possibly including medications)tomanageherbloodsugar? Answer: willhelp the
the
oflong‐termdiabetes.
p17ofp19
andpossibly the
of
15/16HTI34015 Cas...
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