Case: Negative Lymphadenopathy Noted.

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Case: Negative Lymphadenopathy Noted.

Case: Negative Lymphadenopathy Noted.

Case: Negative Lymphadenopathy Noted.

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NSG530 Module 1: Discussion 3. Mr. B is a 70-year-old man who developed sub sternal chest pains radiating down his left arm while at home. He was taken to the ER via ambulance. His breathing was labored, pulses rapid and weak, and his skin was cold and clammy.An ECG was done which revealed significant “Q” waves in most leads. Troponin level was elevated. Arterial blood was draw with the following results: Ph 7.22 PCO2 30 mm Hg pO2 70 mm Hg O2 sat 88% HCO3 22 meq/liter 1. Aside from the obvious diagnosis of MI, what is Mr. B’s acid base status and what caused this disturbance? Module 2: Discussion Melissa, a 12-year-old girl with cystic fibrosis comes to the primary care office with complaints of increased cough and productive green sputum over the last week. She also complains of increasing shortness of breath. She denies sore throat or nasal congestion. On physical examination her temperature is 101 and she has inspiratory wheezes bilaterally. Negative lymphadenopathy noted. Posterior pharynx is pink without exudate. BP 112/72 HR 96 RR 28. 1. In cystic fibrosis, the airway microenvironment favors bacterial colonization. In a minimum of 150 words explain the pathophysiological reason for this occurrence. Module 3: Discussion Mr. B, a 40-year-old avid long-distance runner previously in good health, presented to his primary provider for a yearly physical examination, during which a suspicious-looking mole was noticed on the back of his left arm, just proximal to the elbow. He reported that he has had that mole for several years, but thinks that it may have gotten larger over the past two years. Mr. B reported that he has noticed itchiness in the area of this mole over the past few weeks. He had multiple other moles on his back, arms, and legs, none of which looked suspicious. Upon further questioning, Mr. B reported that his aunt died in her late forties of skin cancer, but he knew no other details about her illness. The patient is a computer programmer who spends most of the work week indoors. On weekends, however, he typically goes for a 5-mile run and spends much of his afternoons gardening. He has a light complexion, blonde hair, and reports that he sunburns easily but uses protective sunscreen only sporadically. Physical exam revealed: Head, neck, thorax, and abdominal exams were normal, with the exception of a hard, enlarged, non-tender mass felt in the left axillary region. In addition, a 1.6 x 2.8 cm mole was noted on the dorsal upper left arm. The lesion had an appearance suggestive of a melanoma. It was surgically excised with 3 mm margins using a local anesthetic and sent to the pathology laboratory for histologic analysis. The biopsy came back Stage II melanoma. 1. How is Stage II melanoma treated and according to the research how effective is this treatment? Module 4: Discussion Mrs. K is a 60-year-old white female who presented to the ER with complaints of her heart “beating out of my chest.” She is complaining that she is having increased episodes of shortness of breath over the last month and in fact has to sleep on 4 pillows. She also notes that the typical swelling she’s had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she’s been experiencing fatigue and decreased urine output. Her past history is positive for an acute anterior wall myocardial infarction and coronary artery bypass surgery. She was a 2 pack a day smoker, but quit 8 years ago. On physical examination, auscultation of the heart revealed a rumbling S3 gallop and inspiratory crackles. She has +3 edema of the lower extremities. 1. Discuss the pathophysiology of an S3 heart sound and include causes for an S3 gallop? Module 5: Discussion Brian is a 7-year-old boy who presents to the primary care office with his mother. His mom has noticed that Brian has been coughing frequently and seems to have shortness of breath at times. She reports that Brian had a “cold” with a low grade fever and runny nose about 2 weeks ago and the symptoms seem to appear after the cold. On physical examination, Brian appears in moderate respiratory distress, with suprasternal and intercostal retractions. His vital signs include a temperature of 100 A°F, a respiratory rate of 32 breaths per minute, heart rate of 120 beats per minute, and pulse oximetry of 95% on room air. Lung exam is notable for diffuse symmetrical expiratory wheezes. His nasal mucosa is erythematous with boggy turbinates and clear mucus. The remainder of the exam is unremarkable. 1. Based on this case, discuss the differences in the pathophysiology for asthma vs pneumonia. Include your thougths as to the diagnosis for this case. Module 6: Discussion Mike is a 23-year-old white male admitted for severe depression. He has a history of bipolar disorder and is currently taking valproate (Depakote) 500 mg XR daily. His psychiatrist ordered LFT’s to follow the valproate therapy. LFT’s were abnormal: ALT 1178 u/L, AST 746 u/L. the patient was asymptomatic. He denies fever, abdominal pain, nausea, vomiting or jaundice. He denies using other medication or alcohol but admits using illicit IV drugs starting about 8 weeks ago and continuing to present. He never had a blood transfusion. Aside from Depakote he is presently taking clonazepam 1 mg prn and fluoxetine (Prozac) 40 mg qd. Other blood work: Direct bili 1 mg/dL, alkphos 188 u/L, anti-HCV negative on hospital day 1, positive on day 3. HCV-RNA PCR positive. Hep A, B, and D markers negative. Patient diagnosis: Acute Hepatitis C. 1. List some clinical manifestations typically seen in Hepatitis C and major treatment strategies. Module 7: Discussion A nurse practitioner (NP) is talking with a 70-year-old patient who asks if she could discuss a problem that she is embarrassed to talk about with her physician. She states she has been having increasing problems with incontinence. Every time she coughs or sneezes, she notices a loss of urine. She has not had any fever or chills or pain with urination. She asks the NP if this is just a sign of getting older? 1. Discuss the etiology associated with incontinence in the aging adult. Module 8: Discussion Ann is a 32-year-old married female who presents to her nurse practitioner reporting lower abdominal pain, cramping, slight fever, and dysuria of 3 days duration. History includes: LMP 2 weeks ago (regular) Reports oral contraceptive use Reports pain in lower abdomen with cramping and pain on urination for 3 days Denies any GI problems, reports regular bowel movements. Denies vaginal discharge Ann is married and in a monogamous relationship. Has one child age 2 Reports no use of condoms/sexual intercourse 2-3 times per week Denies any history of STDs Physical Exam reveals: Temp 100.6, P 80 BP 100/62 Wt. 125 Ht. 5’3’’ HEENT WNL No CVA tenderness Pain in lower quadrants with light palpation.Positive inguinal lymphadenopathy External genitalia without lesions or discharge Pelvic exam reveals minimal cervical mucopus Bimanual exam reveals uterine and adnexal tenderness and cervical motion pain. Uterus anterior, midline, smooth, not enlarged 1. Based on the above case the diagnosis is PID, What is an appropriate CDC-recommended therapeutic regimen for this patient? Module 9: Discussion A 38-year-old African-American woman was admitted for arthroscopic knee surgery. Her hematocrit was 25%, blood pressure was 140/94 mm Hg, and pulse was 112 beats/minute. She had a history of joint and bone pain, jaundice, and abdominal pain. Due to the presenting symptoms (joint and bone pain, abdominal pain, and jaundice) a diagnosis of Sickle Cell Disease was considered. 1. Provide a brief discussion of the pathophysiology of sickle cell disease and discuss the clinical manifestations and the etiology associated with each manifestation of this disease. Module 10: Discussion A 28-year-old male presents to the primary care office for evaluation of left calf pain, swelling, and redness. He reports that this started one day ago and worsened today. He ran a 27-mile marathon 2 days ago and traveled for 3 hours in a car today. He reports slight pain on walking and a swollen red calf. He took Ibuprofen 600 mg twice today without relief. Patient reports being an experienced runner, running 3-5 miles daily. He trained for the marathon for 4 months. Patient also reports a history of exercise induced asthma and uses albuterol sulfate HFA as needed. On physical exam patient appears in good health T 99 P 68 R 18 BP 118/78 wt. 175 lb, height 72 in. BMI 23.1. Heart rate is regular without murmurs, rubs, or gallops. Lungs clear bilaterally. HEENT WNL.Strength lower extremities +5 and DTRs + 2.Left calf erythematous, edematous, warm and tender on palpation.Pulses 3+. Two possible diagnoses were considered: deep vein thrombosis (DVT) and rhabdomyolysis. Stat ultrasound of left leg to rule out DVT was ordered and read as normal CBC WNL Creatine Kinase (CK) 23,000 U/L (normal 24-170 U/L) BUN and Creatinine WNL A diagnosis of rhabdomyolysis was made. 1. Discuss the pathophysiology of acute renal failure in rhabdomyolysis. Module 11: Discussion Bob, a 38 year old male, has been experiencing severe intermittent headaches for about 10 years. When they occur, he experiences intense burning pain on one side of his head, tearing in his eye, congestion and a runny nose. These headaches generally occur several times a day and last approximately one hour. The headaches are episodic; Bob can be headache free for several months but then experience an attack. 1. Based on the case scenario, provide a diagnosis for Bob. Provide the pathophysiology for this type of headache and discuss current treatment options. Module 12: Discussion How will your clinical practice improve with the integration of the course content? In a minimum of 150 words, provide a main discussion to the questions above by Wednesday at midnight. Respond to one of your classmates on a separate day of the week from your original posting.

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