Case studies Flashcards
Willis is a 28 year old male who presents to you with intermittent pain lasting several days. He states the pain “is worse with deep breaths” and “seems to radiate around my chest.” Willis is worried about a heart attack as his grandfather died from that about 2 years ago. PE shows point tenderness over the sternal junctions and is unilateral. Dx?
Costochondritis
An elderly patient in your ER suddenly collapses on the floor and begins to cries out because her chest and jaw is in pain. Dyspnea sets in and she is feeling nauseous.
1) What is her DD at this point?
She is rushed to the ER and her blood is drawn immediately. Her test come back positive for CRP but the lab spills the blood sample and wasn’t able to test for Troponin, LDH, CK/MB and Myoglobin levels.
2) What is her DD at this point?
You press your stethoscope against her chest and hear a fast, dull heartbeat. The EKG kicks in you notice immediately that her T-wave is below threshold.
3) What is her diagnosis at this point? How do you know?
4) How can you be absolutely sure?
5) What is the immediate treatment for this condition?
6) What would the post-op treatment be?
1) Myocardial Infarction or Angina Pectoris
2) Myocardial Infarction or Angina Pectoris
3) Subendocardial Myocardial Infarction; her T wave is below threshold which is the signature for subendocardial MI.
4) You perform an emergency angiography and x ray to see where the blockage has occurred.
5) If the clot is small and the MI has occurred within a 90 minute period, an angioplasty can be performed. If it has been longer, then Thrombolytic therapy would be the next best option. If the clot is massive or an angioplasty/thrombolytic therapy cannot be guaranteed to clear up the clot, then a CABG would be performed.
6) Beta-Blockers, ACE Inhibitors, Calcium Antagonists,
A patient comes in with severe abdominal pain. His entire abdomen is rigid, red, and swollen. You take a CBC and notice that his WBC count is astronomical.
1) What are your two DDs at this time?
You ask the patient when the pain started and he says that he had a really bad stomach ache two weeks ago. He took some old over-the-counter painkillers and went to bed. The next morning, he felt much better; but as the days progressed he felt himself getting worse and worse. His skin seems dry and is not reacting to an elasticity test. After performing a CT scan, you see that his nearly every organ in his abdomen is swollen; and a small mass around his cecum.
2) What has likely happened to this patient?
3) What would be the treatment?
4) What is causing his skin to not respond to the elasticity test?
1) Appendicitis or Peritonitis
2) The patient had appendicitis, but because he took painkillers; they numbed the pain enough to where he didn’t realize when his appendix ruptured. The initial rupture could initially cause a sense of relief, but the hole in his cecum has allowed fecal matter to enter into the abdominal cavity; seeping in between all the internal organs.
3) Surgery to close the perforation and clear out any remaining floating fecal matter; major antibiotics, and IV fluids to replenish water directly into the bloodstream.
4) Extreme dehydration
Billy bob is a 24 year old male and is taking a prescription diuretic. this diuretic is potassium sparing. His serum potassium level is at 7.2. What is the normal serum potassium level? Will he be in a state of acidosis or alkalosis? Why is the person feeling weakness? Why might he be taking a diuretic? What would his EKG look like? 1)
- 5-5 mEq/L
2) Acidosis
3) It is a symptom of hyperkalemia
4) He probably has high blood pressure
5) Widened QRS and Tall T Wave
A patient is 72 years old and was admitted to the hospital for severe shortness of breath and edema to her lower extremities. She was diagnosed with heart failure. Which side of the heart failed, and how did this cause edema?
The right side of the heart failed, causing edema in her lower extremities. The failure to pump blood around the pulmonary circulation caused pooling of blood in the systemic circulation, leading to edema.
