Pathophysiology Case Studies

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

K.H. is a 67-year-old African-American man with primary hypertension and diabetes mellitus. He is currently taking an angiotensin-converting enzyme (ACE) inhibitor and following a salt-restricted weight loss diet. He is about 30 pounds over his ideal weight. At his clinic visit his blood pressure is noted to be 135/96. His heart rate is 70 beats/min. He has no complaints. His wife brought a blood pressure cuff and stethoscope with her in the hope of learning to take her husband’s blood pressure at home.

Mr. .J. is a 30 year old Caucasian male presented to the Emergency Department with symptoms of myalgia, fever, rash, swollen glands, leukopenia, and thrombocytopenia. Mr. J. reported fever and sore throat started about a week ago and the rash presented today. Mr. J. stated “I thought I had the flu but I am not feeling any better and now I have a rash, that’s why I decided to come to the E.D.”. (Health and Human Services panel, 2013)

Mr. P, a 27-year-old African American man, was brought to the emergency department (ED) by his wife. The patient reported polyuria for the past three days, few episodes of vomiting prior to arrival and polydipsia. On assessment, the patient appears flushed, and his lips and mucous membranes are dry and cracked. His skin turgor is very poor. He has deep, rapid respirations and there is an acetone smell to his breath. He is alert and oriented X 2 and is having trouble focusing on the questions.

Chweyah, dated 08/11/2017, indicated that the claimant presented for a follow-up visit after his discharge from the hospital on 08/08/2017. He was admitted on 08/04/2017 due to normocytic anemia, pain in both knees, starvation ketoacidosis, hypertension, gout with tophus, and duodenitis. The esophagogastroduodenoscopy revealed erythematous duodenopathy, erythematous mucosa in the antrum, and small hiatal hernia. He had a colonoscopy which revealed internal hemorrhoids. Objective findings showed blood pressure of 112/86 with a pulse of 105. He was diagnosed with quadriceps weakness, pain in both knees, normocytic anemia, type 2 diabetes mellitus, hypertension, stable chronic kidney disease stage III, and bilateral impacted cerumen. It was noted that he can return to work on 08/16/2017 with limitations of not standing for more than 10 minutes at a time for 1

Imaging: High resolution CT scan of the chest dated July 2015, which was compared, to a previous CT in 2013 shows extensive interstitial disease with honeycomb pattern, right lung greater than left with associated bronchial wall thickening. There seems to have been significant progression since 2013.

HPI: Pt presents with c/o increased SOB that has worsen over the last few months. Chronic cough that is occasionally productive with whitish sputum. Hinders his ADLs.

Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored. Diminished breath sounds in all lung fields. Resonant to percussion.

SW is a 65 year old white female who is 5’8” tall and who weighs 155 lbs. Her IBW is 140 lbs. and she has an IBW % of 110.71. She went to emergency department on February 1, 2015 complaining of shortness of breath and coughing since November, 2014. Her medical diagnosis includes multi-drug resistant organism, diabetes, COPD, and lung cancer. Her laboratory result shows that she has an elevated WBC of 17.4 on February 2nd and it increased to a critical level of 32.2 the next day. An elevated WBC usually means an infection is happening in the body. Her RBC is elevated at 6.19 which could mean hemoconcentration or it could be due to her COPD. Her decreased MCH of 25.0 & 24.8, her Neutrophils of 13.8 and her elevated RDW of 18.2 & 18.4 could mean that she’s having some iron deficiency anemia. Her laboratory also shows that her albumin is low which can be from prolonged immobilization, decreased nutritional status or worse it could be due to her lung cancer. Her low Sodium of 132 and Chloride at 93 may be due to her diet or medication side effects. Her serum glucose at 118 is elevated which can be from her diabetes or from stress of being in the hospital. Her Platelet count of 405 is normal and her BUN of 5 is also within range. Her arterial blood gas is showing compensated imbalances. Her pH is 7.35 which is normal on the low side. Her PaCo2 is 65.2 which is very elevated, her PaO2 is 66.4 which is very low, her HCO3 is also very elevated at 35.3.

Pt approached staff 2200 stating, she was having a hard time breathing. Pt also stated her tongue was swollen from an allergic reaction. Mild tongue swelling noted. After assessing the patient, she had bilateral audible wheezes and o2 stat at 96%. No s/s of respiratory distress noted. Pt received a nebulizer treatment at 2205 and was fine after tx, stating "my breathing improved." Prn Bendaryl was also given after a swallow evaluation. No further medical complaints. Slept well through the

This is an 82-year-old gentleman, who was referred from Dr. Gretchen Marsh’s office because the patient’s BUN and creatinine were high, as he has acute kidney injury. The patient went to Dr. Marsh’s office yesterday and was having generalized weakness. He does not have any vomiting. No diarrhea. No fever. No cough with expectoration. No sharpness. No wheezing. No headache. No dizziness. No passing out. No rectal bleeding. No hematemesis. No abdominal pain. No sore throat. No stuffy nose. No cough with expectoration. No burning, frequency, or

Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days. His positive result of

The patient is a 39 year-old male with obesity, sleep apnea, allergic rhinitis who presented to primary care physician with elevated liver enzymes incidentally found on routine employee physical. The patient complained of shortness of breath with exertion, chronic mild productive cough, and occasional wheezing. His shortness of breath improved with an inhaled bronchodilator. He reported snoring as a child, and recurrent ear infections for the past 15 years. Patient experienced hives in reaction to penicillin and tetanus. Of note, the patient worked in a steel mill as a maintenance coordinator and was a member of the Hazmat and Fire Rescue team. He reported exposure to smoke at this job, and he occasionally smoked cigars. He denied any family