Analysis Situations of Different Disease Pacientes - Case Study Example

Case Reports Name Institution Case Report 1 Ms. Catherine is a 48-year-old woman who was presented to our department for a cardiological follow-up examination as a result of cardiovascular disease. Ms. Catherine has been a banker for the last twenty years and lives in a posh neighborhood. According to her file, she has a medical history of hypertension. However, there was no history of coronary artery disease or diabetes mellitus disease in her family. Further, she neither smoked nor took any recreational drugs. According to her file, approximately seven to eight years ago she had been diagnosed with an inferior MI, which was treated with aspirin, systematic thrombolysis, atenolol, unfractioned heparin and intravenous nitroglycerin. After one week she was discharged after laboratory tests such as blood count, liver, kidney, serum glucose and thyroid function tests showed normal limits. When she was presented to our department, the patient had been having chest pains with dyspnea. She also no tolerance for exercise as she would have shortness of breath after walking short distances. She, however, reported that she had good control of her arterial blood pressure due to the frequent therapy sessions and other medications including atenolol 25mg/day, perindopril 5mg/day and aspirin 20mg/day (Palmer, 2008). A physical examination of the patient showed that she had a blood pressure of 135/80 mmHg, heart rate of 63 bpm, BMI of 28 kg/m2, waist circumference of 86 cm with no findings showing congestive heart failure. Laboratory tests, on the other hand, revealed cholesterol of 160 mg/dl, triglycerides of 76 mg/dl, HDL-cholesterol of 56 mg/dl and LDL cholesterol of 88.5 mg/dl with a normal plasma homocysteine and OGTT. Based on these results and her medical records, we confirmed a likely diagnosis of a form of cardiovascular disease known as coronary artery disease. To confirm our findings, we used non-invasive diagnostic tests such as the treadmill exercise test to study the patient further. Based on these tests we identified no high-risk adverse outcomes for the patient. Based on the above findings, we referred the patient to the General Practitioner (GP) for cardiovascular assessment (Kirthi, 2011). The information gathered in the history and examination of the patient leads to the following differential diagnosis; The fact the chest pains did not extend up to the neck and the shoulders eliminates the likelihood of musculoskeletal conditions. Further, the shortness of breath point more towards cardiovascular disease. Case Report 2 Ms. Shore is a 41-year-old female who was presented complaining of constant joint pains that would occur throughout her body as a result of joint pain arthritis. She is business woman who owns a retail shop. The pain was mostly severe in her hands, wrist and knees which made her move with discomfort especially in the morning. There was also occasional numbness and tingling which would affect her hands, wrists as well as elbows. She also complained of significant fatigue. There was no history of arthritis in her family. On examination, the patient was significantly underweight since she weighed 95 pounds at five feet and six inches tall. It was difficult for her to gain weight since the symptoms had made it difficult for her to digest food. As a result, she looked pale and depressed mostly due to the pain and the lack of proper feeding. This also affected her blood pressure which was low at 96/62 mm/Hg while the pulse rate was rapid being at 85 beats per minute. Further tests conducted on her sedimentation rate revealed that the rate was elevated at 69 mm per hour. The patient’s tongue was also bright red with some patchy smooth areas. The examination also revealed abnormal flora present in her stool which was identified as Klebsiella pneumonia (Cochran, 2016).The patient’s laboratory tests revealed that her sedimentation rate was elevated since it was over 60mm/hr and had an increased intestinal permeability. There were also multiple food allergies that were found. Based on the above information and tests, a diagnosis was made that the patient was likely to be suffering from joint pain arthritis. She was referred to a GP for further assessment and directions on treatment. The symptoms for joint pain arthritis could be confused with those of degenerative joint disease (DJD) since the pain manifests in the same areas. However, in the case of joint pain disease, the pain is not relieved by rest as is the case in DJD. The fact that the joint pain was not relieved even after rest point towards joint pain disease. Case Report 3 Peter is a 35-year-old man working as a truck driver presented with shortness of breath and abdominal pain in the right upper quadrant caused by dyspnoea. The patient indicated that he had been experiencing shortness of breath for the past two months and dyspnea on exertion. He also had a decreased tolerance since he now could not walk long distances without limitation as he could previously do. At the time of presentation, the patient could only walk a few steps before becoming short of breath. The patient only slept if he was situated upright in bed rather than lying down. He also had lost weight by 25 pounds in the past three months. The patient denied any coughing, chest pains or hemoptysis. He also denied having had any contact with a person suffering from TB (Majunder, 2015). A physical exam revealed that his temperature was 38.0 ºC, blood pressure was 100/60 mm/Hg, a pulse rate of 110 beats per minute and a respiratory rate of 30 bpm (breaths per minute). There was a notable temporal wasting on his head, moist mucous membranes, pale conjunctiva and no oral thrush on his head. A physical exam on his neck revealed shotty anterior cervical lymphadenopathy and jugular venous pulsations could be seen when the patient was sitting upright. Laboratory tests revealed a normal complete blood cell count. Lungs were, however, clear to auscultation bilaterally. The PMI (Point of Maximal Impulse) was non-displaced while auscultation showed a II/VI systolic injection murmur at the base and tachycardia with a regular rhythm. The patient also underwent an echocardiogram while on the bed using a portable ultrasound machine which revealed massive pericardial effusion (Thongkhamcharoen et al., 2012). The patient was diagnosed with severe dyspnoea and referred to the GP for further assessment and treatment (Thongkhamcharoen et al., 2012). The duration of shortness of breath is the differential diagnosis for severe dyspnea. In this case, the fact that the patient had been experiencing shortness of breath for two months makes the diagnosis for severe dyspnea more likely. This differentiates it from pulmonary and cardiac diseases. Case Report 4 James is a 25-year-old man and a student in his final year who was presented with intermittent diarrhea, excess flatus and abdominal bloating. He complained of mild abdominal pain that occurs several times a week and is normally followed by explosive watery bowel movements. The explosive episodes are sometimes more than seven in a day. There is no pain or associated bleeding. The patient denied any blood in stool, weight loss, fever or fecal inconsistence. The patient has neither taken any type of medications nor any antibiotics. Further, the patient has also not been able to associate diarrhea with dietary triggers. Physical examination of the patient shows normal thyroid, no rashes, and no hepatomegaly. Laboratory tests, on the other hand, show a normal complete blood cell count. Tests of the stool that were performed during one of the explosive episodes of diarrhea showed a sodium level of 80mmo1/L, the stool of pH of 5 and potassium levels of 30 mmo1/L. The fact that the patient was having intermittent diarrhea without any fecal incontinence shows that such diarrhea was not drug-induced. This is further supported by the fact that the patient was taking no medications. The fact that diarrhea had lasted for more than four weeks makes it chronic and unlikely to have been infectious in its origin. Based on the symptoms presented by the patient, his case was one of watery diarrhea (Sweetser, 2012). The patient had a stool osmotic gap that was greater than 50 mmo1/L which suggested that this was a case of acute diarrhea. The stool analysis of the patient revealed a stool pH of 5 which indicated that there was colonic fermentation of malabsorbed carbohydrates. Further examination revealed a correlation between the patient’s diarrhea and consumption of milk products. This showed an intolerance to lactose-containing foods (Sweetser, 2012). The patient was referred to the GP for directions on treatment. The differential diagnosis for acute diarrhea is when a patient passes three or more loose stools per day. Such diarrhea lasts for less than 14 days. In this case, John’s explosive episodes were seven which signifies acute diarrhea. Further, he had experiences the episodes for approximately one week. Case Report 5 Jack is a 45-year-old man working as a beer distributor who was presented with vomiting of blood, fainting, and lightheadedness due to haematemesis. The emesis, according to the patient, contained blood, and the vomit looked brown like coffee grounds. The patient also stated that he had noticed that her stool had become black in the past week. Further, there also was blood on the stool. The stool was also more sticky than usual. The patient is also unable to keep up with her usual schedule due to fatigue. The patient also admitted to taking alcohol frequently especially on weekends. He also smokes two packs of cigarettes in a day and occasionally smokes a cigar. The patient has been treated for hypertension for seven years but denies any known cardiac history. He complained of dizziness upon standing. The patient has had normal bowel habits apart from the black stool that he had observed. The patient denies any abdominal surgery and also bleeding tendencies (Walker et al.,1990). Physical examination reveals that the patient is overweight. He had a blood pressure of 120/80 mmHg and a heart rate of 110 beats per minute. Laboratory tests reveal that the lungs are clear to percussion while the cardiac exam shows regular rhythm. There are peripheral pulses that are present but are rapid and weak. The bowel sounds are hyperactive, and the abdomen shows a rounded abdomen. The rectal exam showed black stool. The symptoms and the tests conducted pointed towards hematemesis due to the amount of blood that was present in the stool (Walker et al.,1990). The patient was referred to the GP for further assessment and treatment. The differential diagnosis for hematemesis is the fact that in most cases it is as a result of infections that lead to gastrointestinal bleeding. This can arise in the case of ulcers as is the case with the patient in this case. This differentiates it from bleeding that arises, for example, from pulmonary venous hypertension. Case Report 6 Sharon is a 50-year-old woman who runs a flower shop near her home. The patient was presented having a history of loss of appetite, nausea, and flu-like symptoms for the past eight days as a result of jaundice. She had also noticed that her urine had darkened over the past three days and on examination she had tenderness in the upper right quadrant. Further, she has become intolerant to fatty foods. There is the yellowing of the patient’s eyes and passage of stool that is clay colored. She was also complaining of pain in the upper abdomen. Laboratory investigations showed that her total bilirubin was 20 mg while her direct bilirubin was 16 mg. Her ALP was 800 U(KA) and SGPT at 90 IU/L. Her urine color was deep yellow. There was an absence of urobilinogen. An examination of the stool showed that it was clay in color and that there was an absence of stercobilinogen. Based on the above symptoms and the findings from the laboratory tests, this was a case of obstructive jaundice/post-hepatic jaundice caused by gallstones. Gallstones are collections of solid material, which are mostly crystals of cholesterol. The physical condition of the patient fits the criteria for gall bladder disease based on the fact that she was female, overweight and middle-aged. The pain in the upper abdomen was as a result of the stones passing through the gallbladder into the cystic duct or the bile duct which blocks the duct. The patient’s condition is one where the jaundice is caused by the gallstones blocking the bile duct. As a result, the liver responds by regurgitating conjugated bilirubin into the blood (Walker et al.,1990). Based on the above findings, the patient was referred to the GP for further directions and selection of a treatment plan. The differential diagnosis for post-hepatic jaundice, which is evident in the present case, is the fact that unlike in hepatic and pre-hepatic jaundice, the pathology causing the disease occurs after the bilirubin is conjugated in the liver due to obstruction of passage such as the blockage of the bile duct. In the other types, the disease results from infections of the cells. Case Report 7 George is a 57-year-old male weighing 84 kg and with a height of 184 cm. George works as an accountant in an insurance company. The patient has a history of a headache and neck pain for the past five days as a result of dysuria. After being presented to the urological department, the patient developed urethral pain and urinary retention during the night. The condition continued until the next day to the extent that he was unable to void. A routine urine examination was conducted which gave normal results. A urological examination was also conducted which ruled out any form of prostatitis or prostate hypertrophy. Based on these initial findings, the patient was referred to the GP who prescribed tamsulosin and at the same time, inserted a bladder catheter. These measures did not show any improvements in the patient’s symptoms as he later was presented to our clinic. He continued to experience increasing urethral pain. As a result, another urological examination was conducted which again showed normal results. He later developed a fever and was admitted to the urological department. Laboratory tests that included blood tests were conducted that revealed mildly elevated C- reactive protein of 11.9 mg/L and 13.3 mg/L. The tests also revealed an elevated liver function. PAP smear of the urethra and urine culture was all negative. The patient had a history of elevated gamma-glutamate-transpeptidase and ocular pressure. His family also had a history of Parkinson syndrome, hyponatremia, and pulmonary embolism. A neurological examination of the patient revealed sore neck muscles and mild bulb protrusion. An ultrasound on the abdominal revealed cholecystolithiasis and steatosis hepatitis (CDC, 2014). These findings led to a diagnosis for dysuria. He was then referred to a GP for further treatment based on the new findings. The differential diagnosis for dysuria is the fact that unlike infections such as suprapubic or retropubic infections, dysuria causes burning or stinging of the urethra which is the reason for the constant pain experienced by the patient. Case Report 8 Anne is a 28-year-old single woman who was presented having had lightheadedness resulting from fainting episodes/syncope. Anne worked in the financial services industry where she had been successful as was evidenced by the promotions she had achieved in the course of her career. She was also athletic and would skate in her free time. Most of the episodes where she felt lightheaded or fainted were mostly as she got ready for the skating derby that she was involved in during her free time. Anne had joined a skating team and had been playing for the past 18 months. During this time, her skating had improved considerably. Her episodes of feeling lightheaded were frequent, and occasionally she would pass out for not more than twenty minutes. Ms. Anne has a medical history of juvenile diabetes which she had been taking insulin since she was diagnosed. Her parents are both athletes having played tennis in their years in college (Pallais et al., 2011). Laboratory tests that included a variety of blood tests were conducted such as Chem-7, complete blood count tests, and thyroid function tests. She was also referred to a cardiologist. The cardiological results were negative for any cardiological condition. A stress test was also conducted and a Holter monitor. The results of the stress test and the Holter monitor were unremarkable. This led to the diagnosis that the syncope episodes were as a result of anxiety, especially just before the patient was engaging in competitive tournaments. In most cases, syncope can be diagnosed through focusing on a patient’s story and history as is the case regarding Ms. Anne. In other cases, further work is needed where the cause of the fainting episodes is not known (Pallais et al., 2011). Once the diagnosis for syncope was made, the patient was referred to the GP for treatment. The differential diagnosis for syncope is the fact that it is an abrupt loss of consciousness with spontaneous return to pre-existing neurological function without the need for resuscitative efforts. Further, the fainting episodes are for only a few minutes. Case Report 9 Ms. Haley is a 21-year-old woman who was presented with a history of a sore throat which had lasted for three days. Haley is a first year student at a local university. The patient denied coughing or any other respiratory symptom. She also does not have any known drug allergies and takes no regular medication. The patient’s throat has become so sore that she cannot swallow any solid food. The patient has a fever (38°C). She also has difficulty in breathing due to the enlarged tonsils. She has exudate on her tonsils and also has tender cervical lymph nodes. Other than these symptoms, the patient is in good health. Based on these symptoms, we did some tests to see if there was the likelihood that the patient has group A β hemolytic streptococcus infection. A throat swab of the patient is taken, and four days later the results show that the patient does not have group A β hemolytic streptococcus infection which has sensitivity to penicillin (Graham & Fahey, 2000). Laboratory tests were conducted which showed that her complete blood cell count was normal. Once the strptococcus infection was ruled out, we diagnosed the case as sore throat. The case was referred to the GP for further diagnosis and treatment. The differential diagnosis for sore throat is the fact that most patients with sore throat will also have pharyngitis which also causes the inflammation of the tonsils due to the infections. Further, patients with sore throat also do not cough or have nasal symptoms. Case Report 10 Joy is a 70-year-old woman who was presented with intensified itching on her body especially during evening hours due to pruritis. Joy is a retired nurse. The patient was a resident at a long-term care facility. She had a medical history which included dementia, peripheral vascular disease, diabetes mellitus, congestive heart failure, hypertension, gastroesophageal reflux disease and a recurrent infection of the urinary tract. Due to these disorders, she was constantly taking multiple medications. The patient’s psychological state was affected by dementia affecting her ability to remember and behave in the normal manner. In the course of a physical examination, pruritic dermatitis lesions were found on her shoulders, arms, and neck. These signs had also be seen in other members of her family over the years. The building where she used to live before moving to the long term care facility was a favorite resting place for pigeons. Laboratory tests which included an examination of the patient’s organ systems were unremarkable, but the patient was in no distress. The patient’s cognition was unchanged though the effects of dementia could be seen. Her laboratory assessments showed that her white blood cells count was low but with a normal differential. However, the other assessments seemed normal (Cohen et al., 2012). The patient was diagnosed with pruritus. She was referred to the GP for treatment and further follow up. The differential diagnosis for pruritus is the fact that the rashes that forms are mainly dry compared to others that are slivery white such as psoriasis and herald patch for pityriasis rosea. References Thongkhamcharoen R., Breaden K., Agar M. & Hamzah E. (2012). Dyspnea management in palliative home care: A case study in Malaysia. Indian Journal of Palliative Care, Vol. 18, No.2, 128-133. Sweetser S. (2012). Evaluating the patient with diarrhea: A case-based approach. Mayo Clinic Proceedings, Vol. 87, No. 6, 596-602. Walker K., Dallas W. and Hurst W. (1990). Clinical methods: The history, physical and laboratory examinations. Butterworths, Boston. 5 and 6 Center for Disease Control (2014). Pelvic inflammatory disease (PID). Retrieved May 28, 2016, from: http://www2a.cdc.gov/stdtraining/ready-to-use/Manuals/PID/pid-casestudy-2014.pdf Pallais C., Schlozman S., Puig A., Purcell J. & Stern T. (2011). Fainting, swooning and syncope. The Primary Care Companion for CNS Disorders, Vol. 13, No. 4. Graham A. & Fahey, T. (2000). Sore throat: Diagnostic and therapeutic dilemmas. BMJ, Vol. 319, 173-174. Cohen K., Frank J., Salbu R. and Israel I. (2012). Pruritus in the elderly: Clinical approaches to the improvement of quality of life. Pharmacy and Therapeutics, Vol. 37, No. 4, 227-232. Cochran N. (2016). A guide to case presentations. Retrieved May 28, 2016, from: https://fd4me.osu.edu/lppreceptors/system/block_resource_items/resources/000/000/048/original/Oral_Presentations_handout.pdf?1384793577 Kirthi V. (2011). How to write a clinical case report. Royal College of Physicians. Majumder K. (2015). A young researcher’s guide to writing a clinical case report. Retrieved May 28, 2016, from: http://www.editage.com/insights/a-young-researchers-guide-to-writing-a-clinical-case-report Palmer S. (2008). Writing case reports. Texas Heart Institute. Read More