Jim and Jane Magnolia have tried for years to conceive a child, with no success. So instead, they have decided to adopt a child. They have found a beautiful little girl named Emma who has been given up by her mother. The child, only two weeks old, was born at the mother’s home and has not received any medical attention beyond that given by EMS during the birth.
1. Should the parents be particularly concerned with Emma’s lack of medical attention?
2. What perinatal tests should Jim and Jane inquire about?
3. Should Jim and Jane be concerned about PKU?
4. What is PKU?
5. How is PKU screened for?
6. If Emma has PKU, what is the treatment?
Stacey fell down and hurt her knee two days ago. Today she is at the orthopedic surgeon’s office with her knee tender and extremely swollen. The physician tells Stacey that she needs to have the fluid drained from her knee and have an injection to reduce the inflammation. The fluid he drains is watery and bloody.
1. What is the normal fluid in the knee joint?
2. What is the clinical term for the bloody fluid the physician drained?
3. How did this fluid form?
4. Which signs of inflammation is Stacey clearly showing?
5. When the physician gives the “injection to reduce the inflammation,” what is likely in the injection?
6. If the surgeon prescribes a nonselective COX inhibitor for the pain, how does it work?
7. How is a selective COX-2 inhibitor different from a nonselective COX inhibitor?
In September of 2006 Chris Simms, quarterback of the Tampa Bay Buccaneers was rushed to the emergency room after a traumatic collision on the football field. Remarkably, Chris finished the game before going to the hospital. He presented with moderate abrasions to several areas of his body and severe upper left quadrant pain. After full workup it was determined that he had to have emergency surgery to remove his spleen. Fortunately, with modern medical advances, the spleen was removed laparoscopically. Chris lost five pints of blood prior to surgery.
1. What is the name of the surgery to remove the spleen?
2. How is laparoscopy different from normal surgery?
3. What is the classification for the type of healing the abrasions will use to heal?
4. What is the classification for the type of healing the surgical wounds will use to heal?
5. Which wound will be most likely to produce scarring, the abrasions or surgical wounds?
6. Why did Chris lose so much blood without any open wounds?
John, an obese 54-year-old Caucasian male, has gotten a recent yearly checkup at the doctor’s office. He was told that he has elevated blood pressure and several risk factors for atherosclerosis. His urinalysis showed glucosuria, and his LDL levels are elevated.
1. What is the technical term for elevated blood pressure?
2. What is an acceptable range for blood pressure for John?
3. What is atherosclerosis?
4. How are macrophages involved in the formation of atherosclerosis?
5. Why is the glucosuria relevant?
6. What are John’s apparent risk factors for atherosclerosis?
7. What type of pharmacologic treatment would be recommended?
8. What type of lifestyle therapy would be recommended?
Bill Anderson, a 60-year-old Caucasian male of normal build, presents in the emergency room with severely labored breathing. He reports progressively worsening shortness of breath over the past three days. He has been lethargic and has been just “lying around” because of the shortness of breath. The patient also has hypertension and is sweating, but without fever. Upon examining the patient’s medical history, the emergency room doctor learns that Bill has multiple myeloma and has undergone several cycles of chemotherapy, including steroid and high dose thalidomide therapy. The emergency room doctor orders a chest X-ray and echocardiography.
1. What is multiple myeloma?
2. What side effects do multiple myeloma, chemotherapy, immobility, steroids, and thalidomide have in common that could be an issue here?
3. The emergency room doctor suspects a fairly obvious problem, what condition is the doctor trying to confirm?
4. Why is the echocardiogram important?
5. How has the condition caused high blood pressure?
6. Is the heart at risk of failing? If so, what side of the heart, and is it acute or chronic?
7. What is the recommended therapy?
A 53-year-old woman of normal build is having her normal yearly checkup. She has a history of hypertension, arthritis, and skin rashes. Today her physician notices a diastolic murmur with a snap-like opening sound, as well as a systolic murmur. The physician asks the woman if she has ever had strep throat, even as a child.
1. What heart valve typically has the diastolic murmur?
2. What heart valve typically has the systolic murmur?
3. What is the most common type of valvular stenosis?
4. Why did the physician ask about strep throat?
5. Is the arthritis relevant? Why/why not?
6. Are the skin rashes relevant? Why/why not?
7. Is the hypertension relevant? Why/why not?
8. What is it that the physician suspects?
9. What course of treatment is suggested?
Charles is a 56-year-old male who has smoked nearly a pack of cigarettes a day for about 30 years. Today he is having a cardiopulmonary stress test because he has been complaining of exercise-induced dyspnea that is alleviated by an inhaler. Charles will also be receiving the results of prior CBC and arterial blood gas readings. Charles coughs up some mucus before the test. After the test, Charles coughs violently and spits up blood.
1. What is dyspnea?
2. What is the cardiopulmonary stress test going to measure?
3. Does the patient have risk factors for chronic bronchitis?
4. Does the patient have risk factors for emphysema?
5. What would you expect the values for spirometry, cardiac function, and lung elasticity (compliance) to show if this patient has chronic bronchitis?
6. What would you expect the values for spirometry, cardiac function, and lung elasticity (compliance) to show if this patient has emphysema?
7. Which presentation do you expect for Charles? Why?
8. What do you expect the CBC and ABG results to show for this patient?
Sharon is visiting her doctor today, complaining of heartburn. She is a smoker and drinker. Upon taking a history the doctor learns that she and her friends often go out for margaritas and spicy foods, which intensifies the heartburn. However, the heartburn is there almost daily.
1. What is the first and most obvious initial problem the doctor might suspect?
2. What are Sharon’s warning signs for this problem?
3. What type of therapy will likely be suggested?
4. What type of therapy would be suggested if Sharon had the problem only with the spicy food, rather than daily?
5. What problem might Sharon also have in her stomach?
6. Would the same therapy work for this other problem in the stomach?
Heidi, a 43-year-old female, has been an avid triathlete for over 20 years. However, one of the consequences of her extreme athleticism is the chronic pain associated with her training and competition. Therefore, she has taken over-the-counter pain medication daily for years. Five days ago, in the final kick of a race, she rolled her ankle. As a result, she rested in bed for several days. Now she is weak, short of breath, and has general swelling of her entire body. She reports to the hospital and is admitted for renal failure.
1. Did the competition five days ago contribute to the renal failure?
2. Define interstitial nephritis.
3. Did her chronic analgesic use contribute to the renal failure?
4. Define rhabdomyolysis.
5. How is rhabdomyolysis consistent with the facts in Heidi’s case?
6. Since Heidi has gotten prompt medical attention, do you expect treatment to bring about a full recovery? Why/why not?
Richard is a 17-year-old male with type I diabetes mellitus. Today he presented to the emergency room with abdominal pain, weakness, lethargy, and rapid, deep respirations. He reports that he can’t remember if he took his insulin shot that day. The initial thought on triage is diabetic ketoacidosis.
1. Define acidosis.
2. What classification of acidosis is diabetic ketoacidosis?
3. What is the name for the breathing patterns that Richard is having?
4. Why is Richard breathing like this?
5. What do you expect the arterial blood gas measurements to show for pH, carbon dioxide levels, and bicarbonate levels?
6. What will the treatment be for Richard?