Mystery Disease Assignment About the patient: This patient is a Hispanic male. H
ID: 3524908 • Letter: M
Question
Mystery Disease Assignment
About the patient:
This patient is a Hispanic male. He’s 73 years old. He lives in New Hampshire to the clinic complaining of chronic cough, drenching night sweats, fatigue, persistent fever, and weight loss. Twenty-four days prior, he went to the ER and was given azithromycin for pneumonia but has not noticed any improvement in his symptoms.
More about the patient:
GENERAL: 72 y.o., ill appearing Hispanic male, alert and oriented x 3, NAD
SKIN: Warm, pale. Without rashes or suspicious lesions
LUNGS: Mild shortness of breath at rest, decreased breath sounds on right, coarse cough
CARDIOVASCULAR: Heart rate regular, S1S2 intact w/out murmurs, rubs or gallops. No jugular venous distention
ABDOMEN: Soft, nontender, nondistended, normal bowel sounds
VS: BP 110/60, PULSE 103, TEMP 102F, RR 22
Questions asked to the patient:
Does any one else in your family have similar symptoms? Exposures? Any recent trips?
I’m the only one who has been ill in my family. As far as recent trips, I’ve went to Arizona to visit my grandson about 1-2 months ago for a couple of weeks.
Can you tell us about your oral intake? Your appetite?
I have a decreased appetite. I don’t feel like eating that much due to this cough that I have.
Do you smoke?
I quitted 5 years ago. However, I used to smoke 1ppd for about 40 years. I have COPD and use Advair and inhaler . However, they’re not working to improve my breathing.
Do you have any chest pain? Difficulty breathing?
I feel short of breath especially with exertion but no stamina. I feel chest pain with coughing and deep inspiration.
Any current medications?
Yes. I take Advair diskus 1 inh (twice per day), Albuterol inhaler 2 puffs q4h as needed for dyspnea or wheezing, Robitussin Cough syrup, Ibuprofen 200mg, 2 tablets q6h as needed for fever.
QUESTIONS (6 Question)
1. After reading the information about the patient, what 5 specific questions would you ask?
2. (This question is about labs below)
Lab results:
HGB 14.0
WBC 6.8
Normal Neutrophils, lymphocytes
Sodium 144Normal range 135-145
Potassium 3.6Normal range 3.5-5.2
Chloride 110Normal range 98-107
Bicarbonate 24 Normal range 22-28
Creatinine 0.8 Normal range 0.6-1.1
BUN 24Normal range 8-24
ALT 20Normal range 7-45
AST 40Normal range 8-43
TB Quantiferon negative
Sedimentation rate 78 Normal range (0-22)
A) What are the labs that were performed to give the results listed below?
B) Given the results of the CT scan and REVIEWING her history, what other studies would you ask for?.
3. List your findings
4. (diagnoses) list a short list of possible ailments. What is your 3 diagnosis with a rationale why you chose those 3 diagnosis. Your rationale should show a direct relationship to the FINDINGS (from question 3) and ROS.
5. Follow up test/studies. On this question, choose the MOST LIKELY DIAGNOSIS in your opinion from question 4 and follow up with just that one diagnosis only. These tests should be specific in nature and allow you to determine whether or not the patient has that particular problem/disease.
6. Pathophysiology. (this is the most important section/question). Although the diagnosis you picked might not be the actual one, you will get FULL CREDIT if you have a good explanation for the ONE diagnosis you chose. To get full credit on this question, answer these questions below (A,B,C,D)
A) Describe how the disease/disorder you chose going forward MAKE the person feel sick
B) What treatment is
C) How the treatment will counteract the disorder/disease
D) How it will affect the symptoms the patient manifests
Explanation / Answer
1. 5 questions would be *whether sputum was produced or not to.
* Sputum was blood stinged or not..
* Presence of anasarca
* Fever was high degree or not.
* Presence of tumor in the body to rule out carcinoma
2. A- Complete blood count, serum electrolytes level, liver function tests & Erythrocyte Sedimentation Rate (ESR) are the tests done.
B- * Lab culture of sputum if present.
* X ray chest
*Spirometry
* MRI if needed
*Pulmonary function tests & bronchoscopy if needed.
3. Positive findings are- shortness of breath, chronic cough, night sweats, persistent fever & weight loss from history.
From lab investigations ESR is high so probably bacterial or viral infection.
4. Diagnosis - *acute exacerbations of COPD with superadded bacterial infections since past history of COPD & travelling history is present .
* Lung cancer since there is history of old age - 70yrs, past history of smoking & weight loss history is present.
* Miliary tuberculosis & pneumonia since ESR is high & history of weight loss is present.
5. It is probably lung cancer.
Specific diagnosis done- chest X ray, Bronchoscopy, Sputum cytology, Biopsy & histopathological examination.
6. A- Pathophysiology- various risk factors like smoking, industraii hazards, air pollution, genetic factors play a role.
There will be inactivation of .tumor suppressor gene.
Later histologic changes like goblet & basal cell hyperplasia & squamous metaplasia is seen.
Activation of K- RAS oncogene.
Late changes such as dysplasia is seen & finally results in lung cancer.
B- Radiotherapy
Chemotherapy
Both
Surgical removal of cyst or tumor.
Good control of primary disease- COPD.
Treatment for superadded infections.
C- It acts against the tumor cells & suppresses it & stops further spread of tumor.
D- since the extent of tumor growth is restricted, symptoms like cough , dyspnea will be resolved.
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