Question;Case;Studies Weeks 5-7;Advanced Anatomy and Physiology;Name;Student ID#;Case;Studies ?Instructions: Type your;answers IN RED and;use your textbook and other resources such as the ones listed below to help you;answer the questions.;Merck Manual of Diagnosis and Therapy: http://www.merck.com/mmpe/index.htmlMedlinePlus;Medical Dictionary: http://www.nlm.nih.gov/medlineplus/mplusdictionary.html;E-medicine from WebMD: http://emedicine.medscape.com/;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.;1.;Why might this patient have blood in his urine?;2.;What other abnormalities would typically be found in such a patient?s;urinalysis?;3.;What is causing the bilateral desensitization of the lower limbs?;4.;Why are this patient?s lenses cloudy?;5.;Why might this patient have difficulty reading his admissions papers?;6.;How is the elevated blood pressure related to the other symptoms?;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.;1.;What does an endocrinologist specialize in?;2. Define hyperthyroidism.;3. Which of Julie?s signs an symptoms are;compatible with hyperthyroidism?;4. Does Julie show signs and symptoms specific;to Grave?s disease?;5. Why might Julie be mistakenly thinking she;has a ?double chin??;6. What is the doctor concerned with when they;notices that Julie has ?large eyes??;7. If Grave?s disease is confirmed, what is the;most likely treatment?;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.;1. Define osteopenia and osteoporosis. Which;does George seem to have?;2. What is the most common type of fracture of;the wrist in a person of George?s age?;3.;Explain how Vitamin D, calcidiol, and calcitriol are synthesized?;4. How could George?s missing kidney be related;to his decreased bone strength?;5. How could George?s partial small intestine be;related to his decreased bone strength?;6. If George has a decreasing density of his;bones due to his previous injuries, what is the classification of his condition?;7.;Could George?s lack of time outside be a factor in his weak bones?;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.;1.;What does Pete suffer from?;2.;What are Pete?s risk factors?;3. Explain whether or not the 20 years of OTC;antiinflammatory medications has really helped anything?;4. What are the bony projections of the;acetabulum called?;5.;Does Pete need to see an orthopedic surgeon, or can the general doctor;treat Pete?s condition?;6.;Is Pete a candidate for joint replacement surgery?;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.;1.;Why would a physician order several blood tests for a person with no;apparent problems?;2. Does this man have any risk factors for;anything in particular?;3. What is a digital rectal exam used to test;for?;4. Why is a PSA level an important test for this;man?;5.;What would an elevated PSA level indicate?;6. If this man has elevated PSA, how would it be;treated?;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.;1.;What are the risk factors for female infertility?;2.;Which of these risk factors may be involved in this case?;3.;What hormone levels would be appropriate to ascertain?;4.;If the problem is a pituitary hormone imbalance, which hormone(s) might;be involved?;5.;If the problem is an ovarian hormone imbalance, which hormone(s) might;be involved?;6. Define pelvic inflammatory disease.;7.;If a pelvic exam is performed and PID is involved, what might be noticed?;8.;How might laparoscopy be useful for a definitive diagnosis?;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.;1.;What do the symptoms suggest?;2.;Is this patient at particular risk for the suggested illness?;3.;What test needs to be done?;4.;How is this test performed?;5. What are the two most likely microorganisms;to be found with the test from question #3?;6. Does the daycare need to be notified?;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.;1.;What is the diagnosis?;2.;What is the likely location of the pathology in this instance?;3.;What are the risk factors for this condition?;4. What are the possible mechanisms of pathology;in this case?;5. Which is the more likely mechanism of the;pathology in this case?;6. What is the underlying problem in this case?;7. How did the underlying problem lead to this;incident?;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.;1.;What is the likely diagnosis?;2.;What is the pathogenesis of this disease?;3. What other deficits might present if;untreated?;4.;Why do the symptoms seem to worsen later in the day?;5. What other conditions should be ruled out?;6. What treatment should be sought?;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.;1.;What are the factors that affect wound production?;2.;Which factor is the main difference causing Tim and Leanne to have such;different injuries?;3.;What is the mechanism that caused the rupturing of Leanne?s spleen?;4.;What is the name of the condition in which several adjacent ribs is;broken?;5. Due to her broken ribs, what is Leanne at;risk of developing?;6. If Leanne?s lung is bruised, what other;condition may develop?
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