Module 8 Case Studies Case Study 1 History and Physical Examination…

Question Answered step-by-step Module 8 Case Studies Case Study 1 History and Physical Examination… Module 8 Case Studies Case Study 1 History and Physical Examination A 25-year-old woman comes to an ambulatory center with pain in the right side of her pelvis and a slight temperature. She has a history of two episodes of chlamydial cervicitis and herpes simplex vulvitis. Physical examination reveals abundant mucopurulent cervical discharge and a painless genital lesion. The patient also had some swelling of her inguinal lymph glands. Laboratory data A stat pregnancy test is ordered. It is positive. Questions 1. What other laboratory tests would you expect to be ordered? 2. Could this patient have syphilis? 3. If syphilis is suspected, what tests should be ordered? 4. Is there a risk of a congenital infection in this woman’s unborn child? Case Study 2 A 42-year-old executive lived in New York City. Her company annually sponsored a Memorial Day weekend golf outing at a Long Island club. In early June, she noticed a solid, bright red spot on her left thigh. The spot was about 2 inches wide in the bright red area with an overall diameter of about 6 inches, including the surrounding pale area. The ensuing 11 months passed without any further incident. The following Memorial Day weekend, she was stung several times by bees. Both systemic and local reactions followed. About 1 week later, last year’s red ring on the thigh reappeared. During this interval, she experienced fever, malaise, arthromyalgias, headache, and a stiff neck, but recovered completely. In the fall, the woman noticed insidiously progressive fatigue, malaise, memory deficits, irritability, and inattentiveness to the demands of her job. She visited a physician, but no abnormalities were noted. And she was referred to a Manhattan neurologist. The patient was eventually diagnosed with having Lyme disease. Questions 1. Did the patient’s residence or travel history suggest that she may have been exposed to Lyme disease? 2. Why did it take so long for the patient to develop symptoms of Lyme disease?Module 9Case Study 1 History and Physical Examination A female college freshman reports to the infirmary, complaining of extreme fatigue, frequent headaches, and a sore throat. A routine physical examination by the college physician shows that the patient has swollen lymph nodes (lymphadenopathy), redness of the throat, and a slightly enlarged spleen. A complete blood count (CBC), urinalysis (UA), and mononucleosis screening test are ordered. Laboratory Data CBC • Hemoglobin and Hematocrit—within normal range • Total leukocyte count—elevated (13.5 x 109 /L) • Leukocyte differential—elevated lymphocytes (56%) • Many variant forms of lymphocytes (25%) Urinalysis—normal Mononuclear screening test—negative Therapy and Follow-Up The physician prescribes bed rest and medication for the patient’s headache. A follow-up appointment was scheduled for 10 days later. Questions 1. What is this patient’s absolute lymphocyte count? Is this considered normal? 2. What is the most probable diagnosis of this disorder? 3. If repeat testing is performed on the patient after 10 days, could any of the results vary? 4. Discuss the antibodies that could occur in this patient’s condition. 5. What type of antigens could be tested for in this blood? Case Study 2 History and Physical Examination Several workers at a local fast food restaurant call in sick and report to the local ambulatory clinic for treatment. All of them complain of extreme fatigue. In addition, another 26-year-old food handler, who returned from visiting his relatives in Costa Rica a month ago, is sick. Within the last 1 or 2 weeks, he has had no energy and “just doesn’t feel well.” When he recently visited a physician at a local ambulatory clinic, he was slightly jaundiced. Laboratory Data Food handler’s test results—complete blood count, normal Serum bilirubin level—slightly elevated Questions 1. What types of additional laboratory tests could be of value in determining the food handler’s source of illness? 2. What are the immunologic manifestations? 3. What is the prognosis in this disease? 4. What are the methods of prevention and prophylaxis? 5. Because of this patient’s occupation, could particular infectious diseases be of concern?Module 10Case Study 1 History and Physical Examination A 40-year-old man with a history of IV drug use comes to the emergency room because of a rash and fever. In addition, the patient is complaining of a several day history of malaise, fatigue, fever, headache, and now a sore throat. Physical examination reveals a moderately ill-appearing man with a temperature of 38.8°C (102° F). He has a blanching erythematous, macular-papular rash evident over the trunk, back, and upper and lower extremities. In addition, his throat shows enlarged tonsils and broad-based ulcerations of the buccal mucosa. He has a history of an episode of endocarditis 2 years ago. At that time, an HIV serology was performed. It was negative. Laboratory Data A complete blood count and liver function tests are ordered. Results show that the patient is anemic (hematocrit 38%). He also had a severely decreased total leukocyte count and a severely absolute lymphocyte count. Some of his liver function tests are abnormal. Questions 1. What is a likely diagnosis of this patient’s condition? 2. What is the natural history of this disease? 3. What immunologic laboratory tests might be of value in establishing a diagnosis for this patient? Case Study 2 A 60-year-old man was stung by a bee while gardening. He had been stung once before, earlier in the summer. Within a few seconds, his hand began to itch and he began to experience abdominal cramping. He subsequently had difficulty breathing. Fortunately, he was able to reach a first aid kit in his garage. Inside the kit was an Epipen (injectable epinephrine) for his wife because she was allergic to bee venom. He used the pen and began to feel somewhat better. He immediately had his wife drive him to the hospital. He was asymptomatic on arrival at the hospital. RM had no history of adverse reactions to bee venom or antibiotics. Because of the nature of this incident, a diagnosis of anaphylactic shock caused by bee venom sensitivity was made. An IgE level was ordered. The results indicated a level more than twice the (normal) reference range value. In addition, a follow-up skin test was performed. The patient was extremely positive for bee venom. Questions 1. What is the mechanism involved in anaphylaxis? 2. What types of agents can induce anaphylactic shock? Health Science Science Nursing NUR 4295C Share QuestionEmailCopy link Comments (0)