A 3-year-old Caucasian boy is brought to the clinic for a chronic productive cough not responding to antibiotics given recently. He has no fever or sick contacts. His medical history is significant for abdominal distention, failure to pass stool, and emesis as an infant. He continues to have bulky, foul-smelling stools. No diarrhea is present. He has several relatives with chronic lung and "stomach" problems, and some have even died at a young age. The examina- tion reveals an ill appearing, slender male in moderate distress. The lung exam reveals poor air movement in the base of lungs bilateral and coarse rhonchi throughout both lung fields. A chloride sweat test was performed and was positive, indicating cystic fibrosis (CF). What is the mechanism of the disease? How might gel electrophoresis assist in making the diagnosis?
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- An 8-year-old girl is brought to the physician with the concern of irregular low-grade fever and gradually increasing fatigue for the last 2 years. She has a history of hearing loss and has not been keeping well since birth. Physical examination shows short stature, frontal bossing, and hepatosplenomegaly. An X-ray shows multiple healed fractures, generalized increased bone density, and widening of the metaphyses of the ulna and radius. Laboratory studies reveal normocytic anemia and thrombocytopenia. Which of the following is the most likely underlying mechanism of these effects? Answers A - E A Decreased osteoblast activity B Impaired synthesis of collagen C Increased osteoclast activity D Inhibition of endochondral growth E Reduced resorption of the bone OA 39 yearold woman comes to the clinic complaining of diarrhea and abdominal pain. “I feel so weak.” She reports having four to five loose, occasionally bloody stools per day for the past two weeks, with abdominal cramping beginning over the past 48 hours. She has been self-treating with occasional other-the-counter (OTC) antidiarrheals without success. She denies recent antibiotic use. She complains of severe fatigue. She gave birth to her third child 6 weeks ago. She is not breast feeding. A complete blood count, blood chemistry (including electrolytes, renal function tests and blood glucose) and serum iron is ordered along with stool cultures, colonoscopy and upper gastrointestinal (UGI) endoscopy with small bowel follow-through. Lab Data: Sodium 140 mmol/L Potassium 3.5 mmol/L Chloride 105 mmol/L Urea 3.57 mmol/L Serum creatinine 115 µmol/L Glucose 7.8 mmol/L Iron 4.3 µmol/L Hb 132 g/L Hct 0.39 L/L WBC 7.68 x 109 with normal differential She…A 38-year-old female presents to the clinic with complaints of alternating diarrhea and constipation. She reports some abdominal discomfort and bloating that are relieved with her bowel movement. She states that her episodes are worse in times of stress. She denies any blood in her diarrhea. She denies any weight loss or anorexia. Her physical exam is all within normal limits. She has been prescribed a cellulose-containing dietary supplement, which her doctor says will increase the bulk of her stools. 1. What is the most likely diagnosis? 2. What is the biochemical mechanism of the dietary supplement’s effect on the intestines?
- A 52-year-old patient has just arrived in the Emergency Department with complaints of severe abdominal pain, nausea, and vomiting over the last few days. His abdomen is distended. He has poor skin turgor and dry mucous membranes. He has not urinated since yesterday. He has felt “dizzy” and “weak” all evening. He thought it might be the flu, but decided to come in because the stomach pains were getting worse. He has signed informed consent for treatment and labs have been drawn. Opening Questions How did the scenario make you feel? Scenario Analysis Questions* PCC/EBP/S When reflecting on the care of Stan Checketts, what are signs and symptoms you can assess in the next patient you care for who might be at risk for dehydration? EBP/QI Discuss signs and symptoms of hypovolemic shock. PCC/EBP Discuss assessment and expected findings in a small bowel obstruction. PCC/S/I/EBP What key questions does the nurse ask in an acute abdominal pain assessment? PCC/EBP/S In evaluating…A woman reports to the emergency room in January with her cyanotic (blue-colored) 10- month-old child. The mother reports that the infant has had a runny nose, fever, and slight cough for a day and has had increasing trouble breathing . The child does not have a history of bronchial disease and was not premature. The mother also states that the infant’s five-year-old brother is recovering from symptoms that resemble a cold. Were the parents irresponsible for not immunizing their child? Is it likely that the infant caught the disease from his older brother? If so, why did the oldest child not display signs of respiratory distress?A 35 year alcoholic male who had a heart surgery before was admitted with a three week history of fever and gum infection which leads to poor appetite since he cannot eat properly. On physical examination, his body temperature is at 39 degrees celsius. Pulse is 96 beats per minute, respiratory rate is 20 breaths per minute, and BP is 120/80 mm. There are many missing teeth with gingivitis and dental caries which gives off an unpleasant breath odor every time he speaks. He has with him a pack of sugar candies that he brought secretly. What type of infection is suggested by his foul breath? What group of organisms could be responsible for this patient's condition? What complications are associated with this infection?v
- A 54-year-old man presents with a 12-hour history of headache, confusion and declining consciousness. His wife says that he has recently completed oral chemotherapy for an ‘indolent form of leukemia’. Examination reveals him to be responding to painful stimuli but not to verbal commands. He has bilateral axillary and inguinal lymphadenopathy. He is clinically jaundiced and anemic. His spleen is palpably enlarged. He has neck stiffness, generalized hyper-reflexia and bilateral up going plantar reflexes. Fundal examination is normal, and there are no focal neurological signs. Full blood count shows: Hemoglobin (Hb) 7.5 g/dL White blood cells (WBC) 37 × 109/L (lymphocytes 86%) Platelets 26 × 109/L What blood component is best to harvest to find out the patient’s disease? Why lymphocytes are prevalently seen in the peripheral blood film? What is the clinical significance of the platelet count?A 54-year-old man presents with a 12-hour history of headache, confusion and declining consciousness. His wife says that he has recently completed oral chemotherapy for an ‘indolent form of leukemia’. Examination reveals him to be responding to painful stimuli but not to verbal commands. He has bilateral axillary and inguinal lymphadenopathy. He is clinically jaundiced and anemic. His spleen is palpably enlarged. He has neck stiffness, generalized hyper-reflexia and bilateral up going plantar reflexes. Fundal examination is normal, and there are no focal neurological signs. Full blood count shows: Hemoglobin (Hb) 7.5 g/dL White blood cells (WBC) 37 × 109/L (lymphocytes 86%) Platelets 26 × 109/L What blood component is best to harvest to find out the patient’s disease? Why lymphocytes are prevalently seen in the peripheral blood film? What is the clinical significance of the platelet count? NOTE: If you could answer all the questions please. Thank you!A 54-year-old man presents with a 12-hour history of headache, confusion and declining consciousness. His wife says that he has recently completed oral chemotherapy for an ‘indolent form of leukemia’. Examination reveals him to be responding to painful stimuli but not to verbal commands. He has bilateral axillary and inguinal lymphadenopathy. He is clinically jaundiced and anemic. His spleen is palpably enlarged. He has neck stiffness, generalized hyper-reflexia and bilateral up going plantar reflexes. Fundal examination is normal, and there are no focal neurological signs. Full blood count shows: Hemoglobin (Hb) 7.5 g/dL White blood cells (WBC) 37 × 109/L (lymphocytes 86%) Platelets 26 × 109/L What blood component is best to harvest to find out the patient’s disease? Why lymphocytes are prevalently seen in the peripheral blood film?
- TM is a 38 year old male with ulcerative colitis admitted to the medical unit at the hospital for acute exacerbation of the disease. This is his second admission in the last six months. TM says he is frustrated with this disease. In the last week TM has had 15-20 diarrhea episodes a day. He needs to hurry to the bathroom often throughout the day and night. He reports sleeping only an hour at a time at night and trouble staying awake at work. He also reports nausea and vomiting in the last three days along with increasing abdominal pain. His bowel movement at time of admission appears loose, bloody and has a large amount of mucous. His vital signs include: BP 98/64, HR 96, RR 22, T 100.8˚F (38.2˚C), O2Sat 98% on RA. He is 5’8” and weighs 125 lbs.1. Which assessment values are indicative of ulcerative colitis?The physician orders the following labs: CBC w/differential, Chem panel, stool analysis.2. What abnormalities do you expect and why?The nurse assigns the nursing diagnosis of…Female patient whose is a 13-year-old, was admitted to the hospital with complaints of progressive weakness and shortness of breath with minimal physical effort. She has experienced recurrent fevers reaching 38.8°C. Physical examination reveals a well developed teenage with good nutritional status and in no acute distress. There is no lymphadenopathy or organomegaly. Many petechial hemorrhages cover her chest and legs. Several bruises are found on her legs and thighs. Laboratory tests were ordered upon admission. The laboratory tests result were as the following: RBC 2.24 X1012 /l Hb 71 g/l PCV 24% Plt 8.0 X109/l WBC 1.2 X109/l Differential Segmented Neutrophils 2% Lymphocytes 94% Monocytes 4% Reticulocyte count 0.7% She was referred to a hematologist who ordered a bone marrow examination. Bone marrow biopsy showed a markedly hypocellular marrow with very few hematopoietic cells and…Female patient whose is a 13-year-old, was admitted to the hospital with complaints of progressive weakness and shortness of breath with minimal physical effort. She has experienced recurrent fevers reaching 38.8°C. Physical examination reveals a well developed teenage with good nutritional status and in no acute distress. There is no lymphadenopathy or organomegaly. Many petechial hemorrhages cover her chest and legs. Several bruises are found on her legs and thighs. Laboratory tests were ordered upon admission. The laboratory tests result were as the following: RBC 2.24 X1012 /1 Hb 71 g/l 24% 8.0 X10/1 PCV Plt WBC 1.2 X109/1 Differential Segmented Neutrophils Lymphocytes Monocytes Reticulocyte count 2% 94% 4% 0.7% She was referred to a hematologist who ordered a bone marrow examination. Bone marrow biopsy showed a markedly hypocellular marrow with very few hematopoietic cells and there were no malignant cells present. 1- Connect these clinical symptoms with her laboratory-screening…