History of increasing dyspnea

1. Mr. J is a 52 year old male presenting to the clinic with a 2 week history of increasing dyspnea, exercise intolerance, swelling of the feet and a 6 pound weight gain. On exam he has an irregular heart rate and cardiomegaly. Based on these signs and symptoms what is the best explanation of what is happening to Mr. J: (filling in the blanks below will answer this)

Diagnosis:___________ (I am looking for the overall diagnosis not the irregular heart rate. Realize that the irregular heart rate is contributing to a more extensive disease process). Explain the underlying pathophysiology (what is going wrong at the tissue, organ or cellular level) that is causing the cardiomegaly ________, the dyspnea________, and the weight gain_______ (specifically where is the weight gain coming from- hint it has nothing to do with over eating).

How does the fluid leave the capillaries and why is it not all returning for Mr. J ? ______________

His irregular heart rate is diagnosed as atrial fibrillation. Blood clots are a risk with atrial fibrillation. During his hospital stay he begins having difficulty understanding what his family and health care providers are trying to tell him. Given his new diagnosis of atrial fibrillation, what complication might he be starting to develop? ____________ and why? ____________ Tell me where EXACTLY (based on the description of his symptoms) it is occurring. If you have the new diagnosis correct you would know this could occur in different regions, I want a specific location within the organ (as specific as possible) and not the organ in general?__________________.

2. Ms. X is a 68 year old who has smoked 2 packs a day for 40 years (an 80 pack year smoker). She presents to the ER with extensive mucous production, tachypnea, wheezing, and an oxygen saturation of 88%. This is a sign of low oxygen in the blood which is called _________. She is diagnosed with COPD with symptoms of bronchial mucous obstruction (in other words excessive, thick mucus production partially blocking the bronchi and bronchioles) and scaring of the alveoli.

What part(s) of the process of respiration does this interfere with?______________ Explain how it interferes with each part that you identify (leading to her signs and symptoms) _______________. CO2 build up in the blood often occurs as a result of the pathogenic processes described above which leads to one of the signs/symptoms she presents with, which one? ________________. Explain IN DETAIL how increased CO2 causes this symptom.______.

While in the ER, her blood pressure remained about 175/95, what stage of hypertension is she currently? __________

What are some processes in the body that might be contributing to this increased blood pressure (think about normal homeostatic mechanisms that contribute to elevated BP and tell me what might be faltering this will need incorporation of multiple chapters/systems that influence control blood pressure including blood volume) ___________.

The ER doctor tells her that she needs to stop smoking. He reports that on the CXR he could see small fractures in her vertebrae and recommends a bone density testing. What diagnosis is the doctor concerned about? ________________, What are her risk factors for this disease (based on what you know about Ms. X)? _____________ What are some preventative measures the doctor might advise Ms. X in regards to her bone changes? __________

3. Mr. K is a 22 year old male who has been experiencing numbness of his feet which has been causing him to trip occasionally. What condition in general is this (based solely on what he is experiencing here)? ______

Lab work shows autoantibodies. What type of disease category is this? _________ Explain to me how antibodies form (walk me through all the steps please from antigen to antibody formation) ______, what is the antibody function is (in general)_______? He is diagnosed with Multiple Sclerosis, what specifically are the autoantibodies attacking? _______.

A few years later he has begins experiencing decreased appetite and early sensation of fullness after eating only part of his meals. He has read that MS can put a person at risk for gastric paresis which slows the motility and emptying time of stomach content. What other gastric disease could this slowing put him at risk for?__________ explain why? ____________.

4. Jenny is a 16 year old gymnast who presents to her doctor with left foot and heal pain. She is told that there is inflammation in her achilles tendon what is her diagnosis ________ .

The doctor notes that her BMI is 16 and asks about her menses. She reports menarche at age 14 (what is menarche? _______) but has not had a menses in 4 months. Based on her examination what specifically in her body is resulting in this lack of menstrual cycle ? I want to know first what specifically is causing it ______________ (hint something about the original detail suggests a specific thing that affects somthing else that helps regulate the menstrual cycle- connect the original information to the product that contributes to the menstrual cycle)

Then I want to see the details of how the answer above negatively affects the menstrual cycle_________________ (I should be able to see your understanding of the connection of the answer above and its entire role in creating a menstrual cycle and how its deficit results in no menses).

5. Mr. K is a 40 year old male. His BMI is 32, would this be considered overweight or obese? _______ He has had the following symptoms for the last year: increased urination, increased thirst, and a 10 pound unintentional weight loss. He is being tested for diabetes, which type of diabetes is he at higher risk for based on his history? ________

Why , specifically, would he be experiencing these increased thirst and urination? __________, How does the body “sense” dehydration and what exactly happens in response to the the body “sensing” this? __________________________________________________________________________

On exam his blood sugar is 200, describe the normal homeostatic process that lowers blood glucose levels___________________, What two mechanisms are contributing to the abnormal homeostasis of glucose (the underlying pathophysiology)?___________________________

He presents to the clinic 2 years later, BMI is now 34 and his HgA1c which is a lab value that indicates average blood sugars for the last 3 month was elevated at 9. He notes episodic chest pain and decreased vision: What complications of diabetes is occurring with Mr. K _____________ and what is happening at the tissue/organ level resulting in these symptoms?________________ (explanation of the changes that occur that bring about this disease is indicated here). What are his two most likely diagnoses? For the eye symptoms ________________ and the chest symptoms _______________ _____________.

What is some educational advise you would give Mr. K? _____________________________

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