Case Study Three
Mr. Tompkins is a 62-year-old Native American male. He comes in because of increasing dyspnea on minimal exertion (DOE) and swelling in his legs for the past week. He has also noticed that his lower legs are red, warm to the touch, and mildly painful—4 out of 10 on a pain scale. His blood sugars have been high: 190 fasting in the morning and 290 before evening meal. His diet has not changed, although he has been less active the past week due to the swelling in his legs. He denies chest pain, cough, fever, hemoptysis, taking any over-the-counter medications, polyuria, polydipsia, and polyphagia.
Diabetes mellitus (DM) type II for 5 years
His wife, children, and four living siblings have DM type II. His father and two brothers, now deceased, had hypertension and DM type II; causes of deaths are not known.
Metformin increased to 1 Gm bid 30 days month ago to bring his sugars down about 20 to 30 points in the morning and evening.
Patient does not smoke or drink.
Weight 225 lbs +10 pounds since his last visit 1 month ago, BMI 30
BP - 158/100, P - 100, T - 98, O2 sats - 94% room air at rest
S3 & S4 gallop, + JVD, bibasilar crackles, 3+ pitting edema.
The skin on his ankles to mid-calf is red, warm, slightly scaly, and tender to the touch.
TSH -5.2 (0.5- 4.5)
Free T4 - 0.8 (0.8-1.7)
Free T3 - 1.8 (2.0-4.8)
A1C - 9 (<5.7)
Hemoglobin - 12 (13.8 - 17.2)
Hematocrit - 38 (41 - 50)
RBC indices are normal
WBC - 12 (4.5 - 10.5)
BUN - 22 (7 - 20)
Creatinine - 0.6 (0.8 - 1.4)
Total cholesterol - 240
HDL - 35
LDL - 180
Triglycerides - 400
Results of a recent chest X-ray are pending.© BrainMass Inc. brainmass.com October 17, 2018, 1:20 pm ad1c9bdddf
The patient most likely suffers from
1. Peripheral edema (result of volume overload ...
We discuss a case study about a patient suffering from diabetes and congestive heart failure, complicated by cellulitis of both legs.
Organ System Case Studies
Please help me so I can complete the following questions:
Answer the following clinical questions using your knowledge of basic anatomy and physiology obtained in this unit.
Case Study 1
You are a young research assistant at a pharmaceutical company. Your group has been asked to develop an effective laxative that (1) provides bulk and (2) is nonirritating too the intestinal mucosa.
Explain why these requests are important by describing what would happen if the opposite conditions were presented.
Case Study 6
Every year dozens of elderly people are found dead in their unheated apartments and listed as victims of hypothermia.
What is hypothermia and how does it kill?
Why are the elderly more susceptible to hypothermia than the young?
Case Study 7
Frank Moro has been diagnosed as having severe atherosclerosis and high blood cholesterol levels. He is told he is at risk for a stroke or heart attack.
What foods would you suggest he avoid like the plague?
What foods would you suggest he add or substitute in his diet program?
What activities would you recommend?
Case Study 9
For each of the following sets of blood values, name the acid-base imbalance, determine its cause (metabolic or respiratory), decide whether the condition is being compensated, and cite at least one possible cause for the imbalance.
HC03-: 19.5 mEq/l
acidosis or alkalosis?
Metabolic or respiratory?
pC02= 30 mm Hg
HC03-= 12.0 mEq/l
acidosis or alkalosis?
Metabolic or respiratory?
Case Study 16
Harry, a sexually active teenager, appears at the hospital complaining of penile drip and pain upon urination. An account of his recent sexual behavior was requested and recorded.
What is the cause of the disorder?
What is the causative agent of this disorder?
How is it treated?
What can happen if not treated?
Case Study 17
Lucy had both her left ovary and her right uterine tube removed surgically at age 17. Now, at age 32, she remains healthy and is expecting her second child. How could Lucy conceive a child with just one ovary and one uterine tube widely separated?
Case Study 19
During Mrs. Jones's labor, the obstetrician decided that it was necessary to perform an episiotomy. What is an episiotomy and why is it done?
Case Study 27
What in substantial pain called her doctor and explained (between sobs) that she was about to have her baby"right here". The doctor clamed her and asked her how she had come to this conclusion. She said that her water had broken and that her husband could see the baby's head.
Was she right?
If so, what stage of labor was she in? Do you think she had time to make it to the hospital 60 miles away? Why or why not?
1. Mrs. Bigda, a 60-year old woman, was brought to the hospital by the police after falling to the pavement. She is found to have alcoholic hepatitis. She is put on a salt and protein-restricted diet and diuretics are prescribed to manage her ascites (accumulated fluid in the peritoneal cavity). (Chp 26)
a. How will diuretics reduce this excess fluid?
b. Name and describe the mechanism of action of two types of diuretics.
c. Why is her diet salt-restricted?
a. Think of the kidney tubules, the blood, the interstitial space (where fluid is accumulating), and the intracellular space as continuously connected compartments in the body. If diuretics are used and encourage fluid to leave the body, via the kidneys, the fluid is leaving essentially from the blood. Because of simple mass action/osmosis effects, this water tends to be replaced by water leaving the (swollen) interstitial space, reducing swelling.
b. Several different diuretics exist. Lasix is a loop diuretic that inhibits the Na/K/Cl symporter in the ascending limb of the loop of Henle, reducing the amount of these ions recovered from the nephrons, thus also reducing water recovery.
Thiazide diuretics inhibit Na/Cl transport in the DCT, thus limiting recovery of water.
c. Sodium in the blood is a general attractant of water. A high-sodium diet tends to increase blood fluid levels, and if not effectively discarded by the kidney, tends to end up in the tissues, increasing fluid buildup/retention there.
2. Why does use of a spermicide increase a woman's risk for urinary tract infections? (Chp 26)
Spermicides tend to kill off endogenous bacterial colonies in the female reproductive tract, and raise the pH, which makes the area more hospitable to the harmful bacteria (especially E. coli from the digestive tract).
3. Mr. Jessup, a 55-year old man, is operated on for a cerebral tumor. About a month later, he appears at his physician's office complaining of excessive thirst. He claims to have been drinking about 20 liters of water daily for the past week and that he has been voiding nearly continuously. A urine sample is collected and its specific gravity is reported as 1.001. (Chp 27)
a. What is your diagnosis of Mr. Jessup's condition?
b. What connection might exist between his previous surgery and his present problem?
a. He has diabetes insipidus, due to a failure of appropriate levels of ADH production. His specific gravity value of 1.001 is very low, because he is urinating almost pure water. The volume of urine reported is extremely high, and cannot be explained by diabetes mellitus (no history of this form of diabetes reported anyways).
b. Some tumors impact on the posterior pituitary gland, either by damaging it directly, or originating inside it. The surgery may have also damaged this structure (accidentally).
4. Explain how emphysema and congestive heart failure can lead to acid-base imbalance. (Chp 27)
Emphysema patients are unable to expel carbon dioxide effectively, and must work extra hard to exhale. They tend to retain carbon dioxide, and their blood acidity tends therefore to rise, making the blood approach lower pH values.
Congestive heart failure is a very common disorder that arises from an inability to effectively circulate blood, secondary to cardiomyopathy, heart attacks, or persistent high blood pressure. The effect is reduced effective circulation to the lungs, in many cases, which can lead to retention of carbon dioxide and a drop in blood pH.
5. A 36-year old mother of four is considering tubal ligation as a means of ensuring that her family gets no larger. She asks the physician if she will become "menopausal" after the surgery. (Chp 28)
a. How would you answer her question and explain away her concerns?
b. Explain what a tubal ligation is.
a. Tying the tubes off has no influence on her menstrual cycles, or her production of sex hormones - it only prevents her ovulated eggs from being fertilized. The ovaries, where estrogen and progesterone are made, dump their hormones into the blood, not the oviduct.
b. See above
6. Compare the success/failure rates of the six leading forms of birth control, by making a simple table that ranks them in order, starting from the most effective to the least effective. Make sure you define exactly what you mean by "effective." You may have to send a student to the library to work on this question. (Chp 28)
Success rate is usually defined as the percentage of couples who do not get pregnant over the course of some defined time period (usually six months or a year), using a specific birth control method consistently.
The list is fairly long, and I hope students didn't list all the 99.5% options out there, since they are not quite as interesting as comparing the success rates to some less advanced methods (withdrawal, rhythm method).
Find a reference.
Some logical candidates, in roughly the correct order of success:
Birth control pill
Spermicical jelly w/sponge
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