CDS 4010- Exam 3 Case Studies

106. Bronchogenic Carcinoma pt 1

-left eyelid droopy

- shortness of breath

- heavy smoking habit

- ptosis and mmiosis of the left eye

- extremely dry skin of left face

- irregular mass in the apex of his left lung

107. Bronchogenic Carcinoma pt 2

-71 year old man

- lower extremity edema and abdominal bloating

- intake matches his output

- shortness of breath and weight loss

- 2 and a half packs of cigarettes per day

- central coin lesion

108. Pneumothorax

-22 year old tall, thin man

- severe chest pain and shortness of breath

- decreased breath sounds

- decreased tactile fremitus

- hyperresonance to percussion over the right chest

- CXR reveals deep sulcus sign over the right costophrenic angle and tracheal deviation

113. Tracheoesophageal Fistula

-newborn choking and coughing up breast milk

- excessively salivating and slightly blue

114. Barrett Esophagus

- 3 years of gastroesophageal reflux

- increasing heartburn and regurgitation after meals

- taking antacids and proton pump inhibitors daily

- orange, gastric-type epithelium extending upward

116. Gastroesophageal Reflux Disease (GERD)

-heartburn 30 mins after eating

-pain worst when he lies down after eating

-treating with baking soda

- denies any regurgitation or dysphagia

117. Esophageal Carcinoma

-decreased ability to swallow solid foods

- smokes 2 packs of cigs for 20 years

- heavy alcohol use

- pain in his throat when swallowing

- coughing up blood on occasion

- cervical lymphadenopathy and hepatomegaly

- hoarse voice

120. Acute and Chronic Gastritis

-several bouts of bloody vomit

- epigastric pain

- osteoarthritis

121. Peptic Ulcer Disease

-epigastric pain after meals

- heavy smoker

- decreased appetite

- stool has been darker

122. Gastric Carcinoma

-epigastric pain

- lost 20 pounds over 2 months

- vomits after meals

- not relieved by the use of over-the-counter antacids

- left supraclavicular lymph node swelling

- upper endoscopy with cytologic brushings and biopsies

123. Crohn's Disease

- intermittent episodes of watery diarrhea

- RLQ pain not associated with meals

- bouts of constipation

- low grade temp (100F)

- several oral aphthous ulcers

- palpable RLQ mass

- occult blood is positive

- small bowel follow-through to look for evidence of ulcers, strictures, or fistulas

125. Meckel Diverticulum

- bright red stool

- tender abdomen

- sausage-like mass in RLQ

-treat patient with air edema

- lower GI series

126. Celiac Disease

- 1 month of diarrhea

- bowel movements 10 times a day

- soft, pale, large, floating, greasy, and foul smelling

- lost 7 pounds

- appetite has been greater than normal

- abdominal distention and hyperactive bowel sounds

128. Hirschsprung Disease

- down syndrome

- abdominal distention consistent with obstruction of the bowel

- bowel perforation

129. Diverticular Disease

- aching abdominal pain in LLQ

- constipated

- loose stol every other day for the past 5 days

- vomitted 3 times

- low grade fever

- LLQ tenderness

-positive stool guaiac test

130. Ulcerative Colitis

- blood-tinged diarrhea

- four episodes of loose stool per day with intermittent rectal bleeding for the last 2 weeks

- always on toilet with urge to defecate

- LLQ tenderness and red blood is visible on digital rectal exams

132. Colon Polyps

- fecal occult blood test that resulted in a positive reading

- pedunculated polyps are visualized and biopsied

134. Colorectal Adenocarcinoma

- weakness and fatigue

- intermittent rectal bleeding and loose stools

- lost 15lbs

- family history of colon cancer

- marked pallor

- positive stool guaiac test

- iron deficiency anemia and elevated CEA levels

135. Acute Appendicitis

- RLQ pain, nausea, and vomiting

- vague, colicky periumbilical pain

- low grade fever and localized tenderness with guarding in the RLQ when palpated

136. Jaundice

- abdominal discomfort

- dull ache in RUQ for a week

- low grade fever and a sense of malaise

- urine getting darker even though well hydrated

- yellow discoloration of skin and eyes

- liver is tender and enlarged

- increased conjugated bilirubin and urine bilirubin

- increased AST and ALT

138. Reye Syndrome

-altered mental status

-flu-like symptoms

- vomiting and lethargy the day before

- confused and barely arousable

- hypoglycemia

- elevated PT level

- hyperammonemia

139. Viral Hepatitis

- intermittent abdominal pain and dark urine

- pain in RUQ for over 6 months

- yellowing of skin and eyes

- hepatomegaly

- sexually active with not safe sex

- IV drug use

141. Hepatic Cirrhosis

- fatigue, abdominal bloating, loss of sex drive

- recovering alcoholic

- painful swelling of breasts bilaterally, ascites, scleral icterus, several capillary telangiectasias on face

- 3+ ankle edema bilaterally

142. Alcoholic Liver Disease

- nausea and abdominal pain after heavy alcohol intake

- binge-drinking often over last 15 years

- lost appetite and is jaundiced

- mild hepatomegaly upon palpation

- AST: ALT ratio of 2.5

- leukocytosis

- serum ALP is elevated

144. Primary Sclerosing Cholangitis

- weight loss

- ulcerative colitis

- itching and greasy stools that float

- sceral icterus and mild hepatosplenomegaly

- elevated ALP levels

145. Hemochromatosis

- weakness and weight loss

- poor appetite

- thirstier and urinating more than normal

- sceral icterus and hyperpigmentation of the skin on trunk and extremities

- mildly elevated LFTs, increased serum iron, decreased TIBC, a transferrin saturation of 85% and a serum ferritin level of 1500mg/L

146. Wilson Disease

- 8 year old boy

- strange, jerky movements and drastic changes in his behavior

- statements out of context

- brownish ring around superior and inferior poles of cornea

- resting tremor in both arms and hands

- decreased serum ceruloplasmin and elevated levels of copper, amino acids, and glycogen in urine

147. Portal Hypertension

- spitting up red blood

- suffering from hemorrhoids with red blood found of toilet paper after bowel movements

- denies significant alcohol use, history of hepatitis or drug use

- BP of 100/50 mm Hg

- pallor, ascites, marked spleomegaly, and external hemorrhoids

-normal LFTs but hypersplenism

148. Budd-Chiari Syndrome

- history of paroxysmal nocturnal hemoglobinuria

- RUQ abdominal pain

- vomiting on and off last 2 weeks

- juandice and painful hepatic enlargment

- mild ascites, visible abdominal and back veins when standing, and pedal edema

- eleavted LFTs

- thrombosis of hepatic veins

151. Cholelithiasis (gallstones)

- 3 month history of RUQ pain

- given birth to 5 kids and is postmenopausal

- hormone replacement therapy

- pain is exacerbated after taking her grandchildren out for fast foods and eats greasy foods

- drinks quite a bit with abdominal pain shortly after

-mild tenderness in RUQ

152. Choledocholithiasis and Cholangitis

- colicky abdominal pain in RUQ, gallstones and obesity

- fever of 101.8F

-slight yellowing of the skin

- elevated WBC with a neutrophilic predominance

- elevated ALP and bilirubin levels

264. Myasthenia Gravis

- intermittent double vision in evening

- ptosis of both eyes that worsens when actively keeping her eyelids elevated

- symptoms improve after edrophonium administration

279. Osteogenesis Imperfecta

- 2 month old male infant

- fussy and cries when left arm is touched

- hypoactivity of left arm

- multiple fractures, blue sclerae

- deficiency in type 1 collagen

280. Osteopetrosis

-pain in left calf following a fall

- broken several bones in the past

- mom has bone disease

- hearing loss and facial asymmetry

- anemia and fractures of both tibia and fibula

- Erlenmeyer flask deformity

- defective osteoclasts

281. Osteoporosis

- aching lower back pain

- getting shorter and hunched forward

- compression of the L4 vertebra

- bone density scan reveals decreased bone mass

- prescribe her a bisphosphonate and calcium and vitamin D supplements

282. Paget's Disease

- bone pain in left thigh

- hearing has deteriorated significantly

- increased serum alkaline phosphate with normal calcium, phosphorus, and PTH levels

- left thigh shows mixed thickening and lucency of the bone

283. Rickets and Osteomalacia

- 4-year-old short, pale boy with protrusion of the sternum and a square-shaped head

- diarrhea

285. Osteomyelitis

- foot pain

- diabetes mellitus, hypertension and peripheral vascualr disease

- deep venous ulcer on the sole of foot

- elevated ESR and CRP levels

- findinsg consistant with necrosis

286. Osteochondroma

- right lower thigh pain following a fall

- fracture in a stalk of bone growth protruding from the end of femur

- autosomal trait

289. Ewing Sarcoma

- painful, swollen mass in right leg

- denies any history of trauma

- lytic tumor with onion skin appearance in medullary cavity of his right femur

288. Osteosarcoma

- pain and swelling in his left knee

- denies trauma to the knee and no fever

- increased serum alkaline phosphate

- mass with sunburst growth pattern and a periosteal elevation by the mass

290. Rheumatoid Arthritis

- swollen finger joints

- swelling and pain are most severe in the morning and resolve in a few hours

- swelling og the PIP

- MCP joints of both hands

- subcutaneous nodules over both elbows

292. Osteoarthritis

- stiffness and pain in both of her knees

- pain becomes worse later in the day after walking around

- bilateral, swollen knees with mild joint effusion and crepitus with flexion

- bony nodules on her DIP and PIP joints

294. Gout

- obese man with a swollen, tender big toe on the right foot but denies trauma to the toe

- large amount of alcohol the night before

- aspirate of synovial fluid from metatarsophalangeal joint of the right big toe demonstrates neutrophils with needle shaped, negatively bifringent crystals

295. Duchenne Muscular Dystrophy

- evaluation of muscle weakness

- maternal uncle died of a muscle disease during adolescence

- enlarged calves and decreased strength in the proximal muscles of the lower extremities

- uses arms to assist himself from crouching positions

- increased creatine kinase levels

296. Myotonic Dystrophy

- generalized muscle stiffness

- mother suffers from a disease with similar symptoms

- delayed relaxation of the hand muscles following prolonged grip and weakness of the distal muscles in the limb

- testicular atrophy and frontal baldness during your exam

300. Myositides (Polymyositis and Dermatomyositis)

- muscle weakness and a rash

- increased difficulty rising from the chairs and climbing stairs over the last 3 months

- malar rash across pt's face that's dusty red

- marked erythema over her neck and shoulders

- frank periorbital edema

- purplish discoloration over eyelids

- hands are scaly patches over the dorsum of the PIP and MCP joints bilaterally

306. Albinism and Vitiligo

- 24-year-old African American male has irregular depigmented patches on his hand and around his mouth

- Hashimoto thyroiditis

- skin biopsy reveals no melanin pigment and absence of melanocytes

308. Atopic Dermatitis (Eczema)

- 1-year-old has a rash

- three episodes of an itchy, red rash, which has affected her face, wrists, and the creases of her elbows and knees

- seasonal allergies and asthma

- crusty, scaly, erythematous plaques on the patient's skin

311. Psoriasis

- chronic skin rash

- well-demarcated coral-colored plaques with silvery scales over the scalp, elbows, and knees

- pinpoint areas of bleeding

- arthritic symptoms

313. Squamous Cell Carcinoma of the Skin

- hard, red, ulcerated nodule on back of left hand

- cellular atypia and anaplasia throughout the epidermis and extends in the dermis

- hyperkeratosis with keratin pearls

- has cancer

314. Basal Cell Carcinoma

- rasied, ulcerated lesion on her right check

- pearly, ulcerated papule with overlying telangiectasias

- biopsy shows cluster of cells with dark blue nuclei surrounded by palisading basal cells

315. Malignant Melanoma

- irregulary shaped lesion on the extensor surface of his left forearm

- changed color from a light brown to a dark reddish purple

- more raised than normal

- poorly defined, hyperpigmenated, multicolored nodule

- axillary lymphadenopathy

- nests of atypical pigmented cells

- metastasized