Assignment : Sub Sternal Chest Pains
Module 1: Discussion
3. Mr. B is a 70-year-old man who developed sub sternal chest pains radiating down his left arm while at home. He was taken to the ER via ambulance. His breathing was labored, pulses rapid and weak, and his skin was cold and clammy.An ECG was done which revealed significant “Q” waves in most leads. Troponin level was elevated. Arterial blood was draw with the following results:
PCO2 30 mm
Hg pO2 70 mm
Hg O2 sat 88%
HCO3 22 meq/liter
1. Aside from the obvious diagnosis of MI, what is Mr. B’s acid base status and what caused this disturbance?
Module 2: Discussion
Melissa, a 12-year-old girl with cystic fibrosis comes to the primary care office with complaints of increased cough and productive green sputum over the last week. She also complains of increasing shortness of breath. She denies sore throat or nasal congestion. On physical examination her temperature is 101 and she has inspiratory wheezes bilaterally. Negative lymphadenopathy noted. Posterior pharynx is pink without exudate. BP 112/72 HR 96 RR 28.
1. In cystic fibrosis, the airway microenvironment favors bacterial colonization. In a minimum of 150 words explain the pathophysiological reason for this occurrence.
Module 3: Discussion
Mr. B, a 40-year-old avid long-distance runner previously in good health, presented to his primary provider for a yearly physical examination, during which a suspicious-looking mole was noticed on the back of his left arm, just proximal to the elbow. He reported that he has had that mole for several years, but thinks that it may have gotten larger over the past two years. Mr. B reported that he has noticed itchiness in the area of this mole over the past few weeks. He had multiple other moles on his back, arms, and legs, none of which looked suspicious. Upon further questioning, Mr. B reported that his aunt died in her late forties of skin cancer, but he knew no other details about her illness. The patient is a computer programmer who spends most of the work week indoors. On weekends, however, he typically goes for a 5-mile run and spends much of his afternoons gardening. He has a light complexion, blonde hair, and reports that he sunburns easily but uses protective sunscreen only sporadically.
Physical exam revealed: Head, neck, thorax, and abdominal exams were normal, with the exception of a hard, enlarged, non-tender mass felt in the left axillary region. In addition, a 1.6 x 2.8 cm mole was noted on the dorsal upper left arm. The lesion had an appearance suggestive of a melanoma. It was surgically excised with 3 mm margins using a local anesthetic and sent to the pathology laboratory for histologic analysis. The biopsy came back Stage II melanoma.
1. How is Stage II melanoma treated and according to the research how effective is this treatment?
Module 4: Discussion
Mrs. K is a 60-year-old white female who presented to the ER with complaints of her heart “beating out of my chest.” She is complaining that she is having increased episodes of shortness of breath over the last month and in fact has to sleep on 4 pillows. She also notes that the typical swelling she’s had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she’s been experiencing fatigue and decreased urine output. Her past history is positive for an acute anterior wall myocardial infarction and coronary artery bypass surgery. She was a 2 pack a day smoker, but quit 8 years ago.
On physical examination, auscultation of the heart revealed a rumbling S3 gallop and inspiratory crackles. She has +3 edema of the lower extremities.
1. Discuss the pathophysiology of an S3 heart sound and include causes for an S3 gallop?
Module 5: Discussion
Brian is a 7-year-old boy who presents to the primary care office with his mother. His mom has noticed that Brian has been coughing frequently and seems to have shortness of breath at times. She reports that Brian had a “cold” with a low grade fever and runny nose about 2 weeks ago and the symptoms seem to appear after the cold.
On physical examination, Brian appears in moderate respiratory distress, with suprasternal and intercostal retractions. His vital signs include a temperature of 100 A°F, a respiratory rate of 32 breaths per minute, heart rate of 120 beats per minute, and pulse oximetry of 95% on room air. Lung exam is notable for diffuse symmetrical expiratory wheezes. His nasal mucosa is erythematous with boggy turbinates and clear mucus. The remainder of the exam is unremarkable.
1. Based on this case, discuss the differences in the pathophysiology for asthma vs pneumonia. Include your thougths as to the diagnosis for this case.
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