Assignment: To prepare an individual paper (2-3 pages) and a group presentation
for one of the following cases.
Paper: 25 pts
Presentation 25 pts
Due: Wednesday Aug 11
Probable cause of symptoms: what is happening in the body that could account for the
each of the observed symptoms? Be specific. For example: a runny nose observed in a
person who has the flu is the result of the body attempting to rid itself of the respiratory
cells that have been damaged and ruptured by the influenza virus. 8 pts
What homeostatic set points have been altered?
8 pts
How is the body attempting to restore homeostasis?
8 pts
Diagnoses: What is the overall causative agent.
10 pts
Treatment: What would advise the patient to do and how would this help alleviate
the symptoms
8 pts
Paper/Presentation: Organization, clarity, citations, slide effectiveness: 8 pts
Case #1:
Ann, who is 35 years old, complains of progressively worsening, fluctuating pain at her
knees and joints of her hand for several weeks. The pain is at its worst early in the
morning. The symptoms are symmetrical- the same joints on both sides of her body are
affected. She reports a low grade fever and fatigue at times. Physical examination revels
limited of her wrists and inflammation with spongy swelling around her knee joints.
Slight ulnar deviation of the fingers at the painful metacarpophalangeal joints of her
hands is noted. There are no skin lesions present. Many different disorders can cause
joint pain. Medical tests revealed:
1. Synovial fluid analysis: cloudy, reduced viscosity, absence of bacteria, no uric
acid crystals.
2. X-ray studies of the hand: detectable deterioration of articular cartilages in
metacarpophalangeal joints
3. Serum rheumatoid factor: 1”60 titer, elevated Erythrocyte sedimentation rate
Case #2
Jose, a 50 year old office worker, is brought to the E.R. by his wife. Jose complains of
shortness of breath on exertion over the last few months; it has become so severe that he
now needs to rest after walking only a short distance. He recently almost fainted in the
front yard after he checked the mailbox. Jose had been a heavy smoker for 25 years; he
has a persistent cough with heavy mucus production. He has had several respiratory
infections over the last few months.
Jose is placed on oxygen. A chest X-ray and the following blood tests results were
obtained:
1. RBC count: 6.2 million/mm3
2.
3.
4.
5.
6.
7.
HCT: 55
MCV 98 mm3
MCV: 30 pg
WBC: 10,000 / mm3
Platelets: 250,,/ mm3
Arterial Blood gases: before oxygen was given:
pH: 7.25
Pco2 48 mm Hg
Po2 55 mm Hg
HCO3 > 30 mEq/ L
Chest X- ray: normal with expanded lungs with small areas of probable fibrotic
changes
Case #3:
Nicole Smith, a 32 housewife living in Tucson Arizona. She is pregnant with her
second child- late in her first trimester. During the last two weeks she has been tried
and often becomes short of breath from even the slightest exertion. Nicole has been
prone to periods of light-headedness, but has not fainted. She has also noticed
cramping in her legs, thirst, and a sore tongue. Her physician notes tachycardia, pale
gums and nail beds, and a enlarge tongue. Her doctors orders a blood sample be
taken. These are her test results:
Table 1. Blood Sample Results
Red Blood Cell Count
3.3 million/mm3
Hemoglobin (Hb)
6.8 g/dl
Hematocrit (Hct)
32%
Serum Iron
low
Mean Corpuscular Volume (MCV)
low
Mean Corpuscular Hb Concentration (MCHC)
low
Total Iron Binding Capacity in the Blood (TIBC)
high
Case #4
Jane, a 27 year old woman, awakens one morning with blurred vision and pain in
her right eye. She sees her family physician, who determines that her sclera,
conjunctiva, cornea, and ocular tension are normal, but her visual acuity is markedly
reduced in that eye. An ophthalmologist is consulted and, after an exam, diagnoses
optic neuritis Jane is then referred to a neurologist, who learns that she had earlier
forgotten episode of weakness and clumsiness of her left arm. The problem persisted
for only two days, and Jane attributed it to lifting heavy suitcases on a trip. An MRI
of her brain revealed several plaque type lesions in the white matter of the brain but
no other abnormalities. A lumbar puncture is preformed, and the results are:
Pressure: 150 cm/H20
Color: clear, colorless
Protein: 50 mg/dl
Gamma globulin: 20 of the total protein level
Cells: no RBC’s WBC count 6/ mm3
IgG: high ratio of IgG to other proteins
Culture: no bacteria
Case #5
Theresa, a 20 year old woman lost consciousness while in a shopping mall. She
had no identification with her. In the emergency room the physician assessed her
comatose state, noting among other physical findings, rapid respirations, and then
ordered blood and urine studies. The following results were obtained:
CBC: with normal limits
Serum electrolytes:
Sodium: 135 mEg/L
Pco2 30 mmHg
Potassium: 4.1 mEg/L
HCO3 : 12 mEg/L
Chloride: 100 mEg/L
Blood urea nitrogen (BUN) 9mg/dl
Blood glucose: 800 mg/dl
Urinalysis: pH 4.6
Blood ph: 7.23
Glucose (+)
Protein (-)
Blood (-)
Ketones (+)
Case #6
Michael, a 32 old man, was feeling pain in his chest after eating his dinner, which he
attributed to heartburn. The pain was often more server at night and after exertion.
He sometimes also felt pain shooting down his back after eating.
His doctor ordered X-rays, which show small section of Michael’s stomach
protruding the diaphragm. The doctor also preformed an endoscopic biopsy, which
indicated mucosal inflammation. An esophageal manometry showed decreased lower
esophageal pressure.(LES). The pH in the esophagus was 5.5.