Reference no: EM133273740
Scenario 1: Gout
A 68-year-old obese male presents to the clinic with a 3-day history of fever, chills, and Lt. great toe pain that has progressively worsened. The patient states this is the first time that this has happened, and nothing has made it better, and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.
HPI: hypertension treated with Lisinopril/HCTZ.
SH: Denies smoking. Drinking: "a fair amount of red wine" every week. General appearance: Ill-appearing male who sits with his right foot elevated.
PE: remarkable for a temp of 100.2, pulse 106, respirations 20, and BP 158/92. The right great toe (first metatarsal phalangeal [MTP]) is noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.
Diagnoses the patient with acute gout.
Question:
Explain the pathophysiology of gout
Scenario 1: Gout
A 68-year-old obese male presents to the clinic with a 3-day history of fever, chills, and Lt. great toe pain that has progressively worsened. The patient states this is the first time that this has happened, and nothing has made it better, and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.
HPI: hypertension treated with Lisinopril/HCTZ.
SH: Denies smoking. Drinking: "a fair amount of red wine" every week. General appearance: Ill-appearing male who sits with his right foot elevated.
PE: remarkable for a temp of 100.2, pulse 106, respirations 20, and BP 158/92. The right great toe (first metatarsal phalangeal [MTP]) is noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.
Diagnoses the patient with acute gout.
Question:
Explain why a patient with gout is more likely to develop renal calculi.
Scenario 2: Osteoporosis
A 78-year-old female was out walking her small dog when her dog suddenly tried to chase a rabbit, making her fall. She attempted to try and break her fall by putting her hand out, and she landed on her outstretched hand. She immediately felt severe pain in her right wrist and noticed her wrist looked deformed. Her neighbor saw the fall and brought the woman to the local ER for evaluation. Radiographs revealed a Colles' fracture (distal radius with dorsal displacement of fragments) and radiographic evidence of osteoporosis. A closed reduction of the fracture was successful, and she was placed in a posterior splint with an ace bandage wrap and instructed to see an orthopedist for a follow-up.
Question:
Discuss what is osteoporosis and how does it develop pathologically?
Scenario 3: Rheumatoid Arthritis
A 48-year-old woman presents with a five-month history of generalized joint pain, stiffness, and swelling, especially in her hands. She states that these symptoms have made it difficult to grasp objects and have made caring for her grandchildren problematic. She admits to increased fatigue but thought it was due to her stressful job.
FH: Grandmothers had "crippling" arthritis.
PE: remarkable for bilateral ulnar deviation of her hands and soft, boggy proximal interphalangeal joints. The metatarsals of both of her feet also exhibited swelling and warmth.
Diagnosis: rheumatoid arthritis.
Question:
The pt. had various symptoms, explain how these factors are associated with RA and what is the difference between RA and OA?
Scenario5: Multiple Sclerosis (MS)
A 28-year-old obese, female presents today with complaints for several weeks of vision problems (blurry) and difficulty with concentration and focusing. She is an administrative para-legal for a law firm and notes her symptoms have worsened over the addition of more attorneys and demands for work. Today, she noticed that her symptoms were worse and were accompanied by some fine tremors in her hands. She has been having difficulty concentrating and has difficulty voiding. She went to the optometrist, who recommended reading glasses with small prism to correct double vision. She admits to some weakness as well. No other complaints of fevers, chills, URI, or UTI
PMH: non-contributory
PE: CN-IV palsy. The fundoscopic exam reveals edema of the right optic nerve causing optic neuritis. Positive nystagmus on positional maneuvers. There are left visual field deficits. There was short-term memory loss with listing of familiar objects.
DIAGNOSIS: multiple sclerosis (MS).
Question:
Describe what is MS and how did it cause the above patient's symptoms?