Najögren's Syndrome Case Studies

GROSS DESCRIPTION: Exam of the specimen designated “left fallopian tube” reveals the presence of a fallopian tube measuring 6 cm in length and 2.3 cm in average diameter. Sectioning of the tube shows it to be

According to the provider, the claimant's cough has been improved. His review of systems was positive for fatigue, malaise, sleep difficulty, shortness of breath, wheezes, and a cough. His blood pressure was 115/71 mmHg and his BMI was 30.35 kg/m2. The physical examination revealed wheezes. Clonazepam was prescribed for agitation. Atorvastatin, Nystatin, Citalopram, and a probiotic were prescribed. Continued use of Aspirin and a regular inhaler were suggested. Further, a follow-up visit with Endocrinology, Cardiology, and Pulmonology. As it relates to a spot in his lung, a repeat CT scan was recommended. The bronchial washes were negative for

On Exam:  BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across the

Fibroids are becoming more and more common in women in the United States. It is estimated that 171 million women in the U.S. were affected by this condition in 2013(6). About 20% to 80% of women develop fibroids by age 50 (6). As many as three out of four women may have uterine fibroids in her lifetime (4). Fibroids, also known as uterine leiomyoma, are benign tumors that can be found in women of childbearing age due to its dependence on estrogen and progesterone (7). They are made of muscle cells and other tissues that can grow around or in the uterus or womb. With fibroids, a single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue (2). Some fibroids even go through growth spurts where they grow and shrink on their by itself. There are women with fibroids who have no symptoms at all. If they do, it may consist of heavy or painful periods, frequent

She reports a history of back pain, ovarian cysts excision, and breast tumor. She denies chest pain, shortness of breath, or palpitations. Patient reports that her immunizations and preventive care are up to

Respiratory: Patient denies having history of lung diseases such as asthma, emphysema, bronchitis, pneumonia, or tuberculosis. She also denies having chest pain with breathing, wheezing or noise breathing, shortness of breath, hemoptysis, sputum, toxin or pollution exposure. Patient states that she had common cold with some productive cough for about a week last month. Also, patient states that occasionally she experiences shortness of breath when she runs for more than 40 minutes. Patient states that her last chest x-ray was 1 years ago, and the results were negative.

Presently, experiencing a cough, fatigue, fever of 100°F, and increased shortness of breath with activity for the past 5 days. Patient reports productive, “cough is a large amount of thick, tan sputum occurring day, and night, worse at night when lying on my back”. In the mornings John K has a thick, productive cough of “whitish sputum” for the last 18 months. Admits to sleeping with two pillows at night for comfort. John K, has difficulty breathing with climbing one flight of stairs and intercourse. In evaluating John K, presented sitting in tripod position with active mild respiratory distress, physically fatigued, oxygen saturation of 92% room air, respirations 24 (shallow), and temperature 99.8°F. Further physical findings identify early finger nail clubbing, moderate use of the abdominal muscles as evidence in compensating to breath, bilateral tympany on percussion, diffuse coarse crackles and few scattered end expiratory wheezes throughout bilateral lung fields. Electrolyte lab values within normal limits (no evidence of infection), ruling out pneumonia and chronic bronchitis. Chest x ray results COPD confirmed, ruling out pneumonia and chronic bronchitis. Sputum sample results normal flora congruent to COPD with no evidence to bacteria growth or pathogens identified, ruling out pneumonia and chronic bronchitis. Diagnostic

History of Present Illness: Ms. Domingos is a very pleasant 56-year-old woman who was previously evaluated by Elvira Aguila, MD over the last year for short of breath in the setting of pleural effusion and chest pain. She had abnormal CT and chest x-ray done at Exeter Hospital in 2014. She has had positive rheumatologic workup and is being evaluated by Daniel Kunz, MD for Sjögren's disease. She states that at this time, she has stable dyspnea on exertion prior to her acute illness one year ago. She has minimal dry nonproductive cough. She is currently walking for exercise and realizes she does need to lose weight. She is also being evaluated by ophthalmology and recently finished a course

Don was seen today for his six-month interval scan to reassess his 5mm pulmonary nodules. Reassuringly, on the scan the nodules are stable, but the scan has shown the unexpected finding of some right upper lobe consolidation. Don has certainly bee symptomatic with this and three weeks ago had two days of a very high fever. Once the fever broke he has had a dry cough ever since then. Of note, this has never been productive. He does recall some viral symptoms preceding his high fevers and has had exposure to his grandkids. He is still quite troubled by the cough and of note, has not had any return of his sinus symptoms with post-nasal drip or any symptoms of GORD.

Sjogren’s Syndrome is an auto-immune disorder that affects the entire body. The immune system protects our bodies from disease and infection, but with an autoimmune disease, the immune system attacks healthy cells in the body by mistake (Autoimmune Diseases, 2017). In Sjogren’s syndrome, the immune system attacks the glands that make tears and saliva. (Sjogren’s Syndrome, 2017). Pathogenic organisms and other foreign substances are detected by T-lymphocytes and B-lymphocytes because they contain antigens (McKinley, et al, p. 684). The immune system is generally very effective in distinguishing a self-antigen from foreign antigens; however, a malfunction involves the immune system reacting to self-antigens as if they

A fibroid is “a tumor or lump made of muscle cells and other tissue that grow within the wall of the uterus” (Illinois Department of Public Health, 2015). According to the UCLA Obstetrics and Gynecology team, “fibroids are the most frequently seen tumors of the female reproductive system… twenty to fifty percent of women of reproductive age have fibroids, although not all are diagnosed. Some estimates state that up to thirty to seventy-seven percent of women will develop fibroids sometime during their childbearing years… in ninety-nine percent of fibroid cases, the tumors are benign” (UCLA Health, 2016). Uterine fibroids are the most common cause for a hysterectomy. A hysterectomy is the surgical removal of the uterus. “Hysterectomy is the second most frequently performed surgical procedure (after cesarean section) for U.S. women who are of reproductive age… By the age of sixty, more than one third of all women have had a hysterectomy” (National Women’s Health Network, 2015).

The patient is a 22-year-old female who does tell me she graduated from Dartmouth College recently, will be going to Europe, leaving in two days for a three week tour. She states she wanted to make sure she is okay prior to leaving. She does tell me one week ago she began having a sore throat, which then developed into rhinorrhea and a cough, which is productive of yellow sputum. She does tell me the sore throat has now gone away. She denies any sinus pain or pressure, no ear pain, she has not had any fevers and overall feels fairly well. She is not waking because of the cough, she is taking an over-the-counter cough syrup. She also thinks she might have a component of allergies, as she was having some sneezing

Thank you for arranging a CT chest scan that reveals extensive emphysematous change with lower zone bronchiectasis but no active infective changes. I gather Rod has also had a stress echocardiogram, the results of which were not available today.

This enabled the accurate diagnosis of dermoids, hemorrhagic cysts, endometriomas, uterine fibroids, and fibrous tumors of the ovary.

She doesn’t recall any sick contacts, but her husband is a minister, and she mingles with members of his congregation three to four days a week. On physical exam her oral pharynx is slightly erythematous but there is no cobblestoning and her nasal turbinates are neither pale nor inflamed. She has no lymphadenopathy, and her lungs sound clear without any wheezing or crackles.