Addison disease.docx
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(1) A 48-year-old woman presented with fatigue, weakness, nausea, and dizziness. Her blood pressure dropped when moving from sitting to standing. (2) Laboratory tests revealed low sodium, high potassium, low blood cells, and very high ACTH levels. Imaging showed atrophy of the adrenal glands. (3) She was diagnosed with Addison's disease based on her symptoms, labs, imaging and positive antibody testing. Treatment involved replacing her glucocorticoids and mineralocorticoids.
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Instructions
· This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.
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Case 1
HISTORY: Patient Presentation
A four-year-old African American male diagnosed with sickle cell disease in the newborn period was admitted to the hospital with abdominal pain. Two days prior to admission, he was seen in the emergency room for abdominal pain and sent out on pain medicine.
PHYSICAL EXAM
Height
100 cm (25th percentile on growth chart)
Weight
15 kg (25th percentile on growth chart)
Temperature:
38.9ºC
Heart Rate:
135
Respiratory Rate:
40
Blood Pressure
100/60 mmHg
Oxygen Saturation Level:
87% (normal range: 92%-98%)
HEENT:
Normocephalic, pupils reactive, tympanic membranes clear, oropharynx clear
Neck:
No adenopathy
Chest:
Mild subcostal retractions. Audible rales at lung bases.
Heart:
Tachycardic with III/VI murmur
Abdomen:
Mild distension, diffusely tender to palpation
Genitourinary:
Circumcised male, no priapism
Extremities:
Warm
Neurologic:
Crying, alert boy. Face was symmetric. Moved all extremities.
LABORATORY DATA
Patient Value
Normal Value
WBC
15,000
4,000-12,000/μL
HGB
6.3
11.5-13.5 g/dL
HCT
18
34%-40%
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2 What does a prior history of abdominal pain reflect? What does Bone pain and swollen, painful fingers (dactylitis) reflect in this disease?
3 He had a temperature of 101 degrees Fahrenheit yesterday.what does that indicate?
4 He has been coughing 2-3 times a day and intermittently through the night.what does that indicate??
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8 Discuss MCV, MCH, RDW, ESR, Hematocrit and red cell morphology in this disease
9 What was your differential diagnosis when you first saw the patient? Discuss the following in diagnosing the disease
Cholecystitis; Pneumonia; Upper respiratory tract infection; Vaso-occlusive pain crisis
10 what are the differences between sickle cell disease, HbC, HbE and Thalassemia diseases?
11 Discuss Iron deficiency anemia, thalassemia syndromes and sickle cell anemia
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Clinical Scenario:
REASON FOR CONSULTATION:
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HISTORY OF PRESENT ILLNESS:
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REVIEW OF SYSTEMS:
Constitutional:
Negative for diaphoresis and chills.
Positive for fever and fatigue.
HEENT:
Negative for hearing loss, ear pain, nose bleeds, tinnitus.
Positive for throat pain secondary to her laryngeal cancer.
Eyes:
Negative for blurred vision, double vision, photophobia, discharge or redness.
Respiratory:
Positive for cough and shortness of breath
. Negative for hemoptysis and wheezing.
Cardiovascular:
Negative for chest pain, palpitations, orthopnea, leg swelling or PND.
Gastrointestinal:
Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool or melena.
Genitourinary:
Negative for dysuria, urgency, frequency, hematuria and flank pain.
Musculoskeletal:
Negative for myalgias, back pain and falls.
Skin:
Negative for itching and rash.
Neurological:
Negative for dizziness, tingling, tremors, sensory changes, speech changes.
Endocrine/hematologic/allergies:
Negative for environmental allergies or polydipsia. Does not bruise or bleed easily.
Psychiatric:
Negative for depression, hallucinations and memory loss.
PAST MEDICAL HISTORY:
Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric.
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Paeds
A 9-year-old boy presented with a history of cough, breathlessness, palpitations and fever for the past 15 days along with joint pain. On examination, he was found to have tachycardia, pallor, elevated apex beat and a pansystolic murmur. His history was suggestive of previous rheumatic fever. The clinical findings indicated acute rheumatic carditis with mitral regurgitation and pulmonary hypertension. Investigations were ordered to confirm the diagnosis and evaluate organ function.
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celiac disease
learn about excellent case article published in NEJM regarding celiac disease,its rare presentation and approach for the same along with discussion ..we should always think about this rare presentations
AKI with Hypernatraemia.pptx
This document summarizes a clinical case presented by Dr. Aklima involving a 9-month-old male patient admitted with respiratory distress, cessation of urination, diarrhea and vomiting. On examination, the patient was found to be dehydrated with low blood pressure and oxygen levels. Laboratory tests showed signs of anemia, thrombocytopenia, electrolyte imbalances, and metabolic acidosis. The patient was diagnosed with acute watery diarrhea with severe dehydration, hypovolemic shock, acute kidney injury, hypernatremia, metabolic acidosis, and sepsis. Management involved fluid resuscitation, antibiotics, bicarbonate and calcium supplements. Follow up included monitoring vitals and watching for rash
Walden Module 7 Pathophysiology Knowledge Check.docx
The document describes 10 clinical scenarios involving various pathophysiological conditions. The first scenario describes a case of polycystic ovarian syndrome (PCOS) in a 28-year-old woman presenting with irregular periods and excess hair growth. The second scenario involves a college student with pelvic inflammatory disease (PID) presenting with abdominal pain and vaginal discharge. The third scenario is a man with a sore on his penis diagnosed with syphilis.
addison disease
Addison disease
just random collection of topic Addison's
warnnning iam just human ,not all content 100 percent correct
source Harrison
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The following case studies are not actual patients. They combine elements from different cases to emphasize important aspects
Case 1
HISTORY: Patient Presentation
A four-year-old African American male diagnosed with sickle cell disease in the newborn period was admitted to the hospital with abdominal pain. Two days prior to admission, he was seen in the emergency room for abdominal pain and sent out on pain medicine.
PHYSICAL EXAM
Height
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Weight
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Temperature:
38.9ºC
Heart Rate:
135
Respiratory Rate:
40
Blood Pressure
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Oxygen Saturation Level:
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HEENT:
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Neck:
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LABORATORY DATA
Patient Value
Normal Value
WBC
15,000
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HGB
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HCT
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34%-40%
PLT
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MCV
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She denies any history of previous trauma, diplopia, dysphagia, vertigo, vision loss, loss of consciousne ...
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This document describes a case of an 11-month-old female child presenting with incomplete Kawasaki disease. She had a 10 day history of fever and a 7 day history of cough. On the 2nd day of illness she experienced a seizure. Examination found pallor, tachycardia, and oral thrush. Investigations showed elevated inflammatory markers, thrombocytosis, and echocardiogram revealed coronary artery dilatation consistent with incomplete Kawasaki disease. She was treated with IV immunoglobulin and aspirin and her condition improved with no symptoms at discharge.
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docx
Clinical Scenario:
REASON FOR CONSULTATION:
Desaturation to 64% on room air 1 hours ago with associated shortness of breath.
HISTORY OF PRESENT ILLNESS:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago and is now working properly. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 22, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91% on 4L NC. The patient was seen and examined at 10:10 a.m. She reports that she has been having mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of visit was 22 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago. She reports that she has 2 to 3 treatments left. She denies any chest pain at this time and denies any previous history of CHF. Review of her vital signs show that she has been having intermittent fevers since yesterday morning. Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems. The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.
REVIEW OF SYSTEMS:
Constitutional:
Negative for diaphoresis and chills.
Positive for fever and fatigue.
HEENT:
Negative for hearing loss, ear pain, nose bleeds, tinnitus.
Positive for throat pain secondary to her laryngeal cancer.
Eyes:
Negative for blurred vision, double vision, photophobia, discharge or redness.
Respiratory:
Positive for cough and shortness of breath
. Negative for hemoptysis and wheezing.
Cardiovascular:
Negative for chest pain, palpitations, orthopnea, leg swelling or PND.
Gastrointestinal:
Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool or melena.
Genitourinary:
Negative for dysuria, urgency, frequency, hematuria and flank pain.
Musculoskeletal:
Negative for myalgias, back pain and falls.
Skin:
Negative for itching and rash.
Neurological:
Negative for dizziness, tingling, tremors, sensory changes, speech changes.
Endocrine/hematologic/allergies:
Negative for environmental allergies or polydipsia. Does not bruise or bleed easily.
Psychiatric:
Negative for depression, hallucinations and memory loss.
PAST MEDICAL HISTORY:
Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric.
SEIZURE-FINAL.pptx
Epilepsy and other seizure brain disorders were discussed. Generalized seizures are caused by near simultaneous activation of the entire cerebral cortex from an electrical discharge originating deep in the brain. Partial seizures are due to electrical discharges beginning in a localized brain region. Status epilepticus refers to prolonged seizure activity lasting more than 5 minutes or multiple seizures without regaining consciousness. Seizures have various types and presentations depending on their origin and spread in the brain. Physical examination, history, and diagnostic workup are important for evaluating patients presenting with seizures.
Diabetic ketoacidosis by Dr.Taniful.pptx
A 37-year-old female with a history of type 1 diabetes was admitted to the ICU unconscious for 12 hours with respiratory distress and abdominal pain. Laboratory tests found ketones in her urine and blood glucose of 20.7 mmol/L, indicating diabetic ketoacidosis. She was treated with intravenous fluids, insulin therapy, and potassium supplementation to correct dehydration, hyperglycemia, and electrolyte imbalances. Diabetic ketoacidosis is a life-threatening complication of diabetes that occurs when there is not enough insulin to control blood glucose levels, leading to the breakdown of fat as an alternative energy source and producing ketone bodies that accumulate and cause metabolic acidosis.
Postpartum cardiomyopathy case
- A 20-year old female presented with shortness of breath, chest pain, fever and cough 1 week after a normal vaginal delivery.
- On examination, she was in respiratory distress with tachycardia and fever. Chest examination revealed dullness and decreased breath sounds.
- Echocardiogram showed severe left ventricular systolic dysfunction with an ejection fraction of 35%.
- She was diagnosed with peripartum cardiomyopathy based on developing heart failure within 5 months of delivery in the absence of other identifiable causes and left ventricular systolic dysfunction.
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Dr. Maimuna Sayeed presented the case of 2 year old Diya who presented with rashes on her body for 2 months along with swelling all over her body for 5 days and decreased urination. Her physical exam showed purpuric rashes, edema, and joint tenderness. Tests showed mild anemia, proteinuria, and normal electrolytes. Her ultrasound was normal. The provisional diagnosis was Henoch-Schönlein purpura with nephritis based on her rash, joint pain, abdominal pain, edema, and proteinuria. She was started on medications but had worsening symptoms on follow-up, so additional medications and a renal biopsy were planned.
Hemolytic anemia by dr maaz seerat
This document presents the case of a 20-year-old female student who was admitted to the hospital with a 6-month history of progressive weakness and shortness of breath, as well as fever, body aches, and vomiting for the past week. On examination, she was found to be pale and spleen was palpable. Differential diagnoses included various types of anemias, portal hypertension, leukemias, and lymphomas. Further investigations including Coomb's test and hemoglobin electrophoresis were planned to determine the cause of anemia, and initial treatment included blood transfusion and corticosteroids.
A Case presentation on fever cough with breathlessness
This document summarizes a case presentation of a 65-year-old man admitted to the hospital with fever, cough, and breathlessness. On examination, he had impaired sense of smell and respiratory abnormalities. Imaging showed bilateral lung consolidation and COVID-19 pneumonia. He was diagnosed with COVID-19 pneumonia complicated by diabetes and bronchial asthma. He received treatment and showed signs of improvement on follow up.
Community Health Nursing.pdf
R.M. is an 83-year-old woman with probable Alzheimer's disease who has shown worsening symptoms over several years. She has a family history of Alzheimer's and cardiovascular disease. A recent exam found confusion, lip twitching, anemia, and deteriorated neurological function. Lab tests showed abnormalities in her CBC and hyperlipidemia. Her condition has progressed to requiring consideration of long-term nursing care.
NURS It All.docx
The patient is a 58-year-old woman presenting with fatigue, frequent urination, increased thirst and fluid intake, and headaches over the past three months. The three most likely diagnoses are diabetes type 2, diabetes insipidus, and hypothyroidism. Diabetes type 2 is the most likely diagnosis given the patient's risk factors of age, family history, and presentation of classic symptoms like fatigue and polyuria.
Pediatric Community Acquired Pneumonia
This document summarizes information about cough from Feigin & Cherry's Textbook of Pediatric Infectious Diseases. It classifies cough based on anatomy, etiology, age, and whether it involves the upper or lower respiratory tract. For the upper respiratory tract, common causes are viral infections like RSV, adenovirus, and rhinovirus or bacterial infections such as H. influenzae and S. pyogenes. For the lower respiratory tract, main causes include viral and bacterial pneumonia. Signs differ between upper vs lower respiratory tract infections.
Paeds
A 9-year-old boy presented with a history of cough, breathlessness, palpitations and fever for the past 15 days along with joint pain. On examination, he was found to have tachycardia, pallor, elevated apex beat and a pansystolic murmur. His history was suggestive of previous rheumatic fever. The clinical findings indicated acute rheumatic carditis with mitral regurgitation and pulmonary hypertension. Investigations were ordered to confirm the diagnosis and evaluate organ function.
Adrenocortical insufficiency case study .pptx
This ppt contains the information of a patient with Adrenocortical Isnufficiency.
celiac disease
learn about excellent case article published in NEJM regarding celiac disease,its rare presentation and approach for the same along with discussion ..we should always think about this rare presentations
AKI with Hypernatraemia.pptx
This document summarizes a clinical case presented by Dr. Aklima involving a 9-month-old male patient admitted with respiratory distress, cessation of urination, diarrhea and vomiting. On examination, the patient was found to be dehydrated with low blood pressure and oxygen levels. Laboratory tests showed signs of anemia, thrombocytopenia, electrolyte imbalances, and metabolic acidosis. The patient was diagnosed with acute watery diarrhea with severe dehydration, hypovolemic shock, acute kidney injury, hypernatremia, metabolic acidosis, and sepsis. Management involved fluid resuscitation, antibiotics, bicarbonate and calcium supplements. Follow up included monitoring vitals and watching for rash
Walden Module 7 Pathophysiology Knowledge Check.docx
The document describes 10 clinical scenarios involving various pathophysiological conditions. The first scenario describes a case of polycystic ovarian syndrome (PCOS) in a 28-year-old woman presenting with irregular periods and excess hair growth. The second scenario involves a college student with pelvic inflammatory disease (PID) presenting with abdominal pain and vaginal discharge. The third scenario is a man with a sore on his penis diagnosed with syphilis.
addison disease
Addison disease
just random collection of topic Addison's
warnnning iam just human ,not all content 100 percent correct
source Harrison
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- 1. Addison disease Case Study #1 AddisonCC:I’ve been feeling weaker and more tired over the past 4 months, but it has taken a more severe turn for the worst since last week. I haven’t been able to enjoy any outdoor activities with my family but, for some strange reason, I’ve been getting an unusual tan”HPI:C.K is 48-year-old white woman who presents o her sister’s primary care provider with loss of appetite, progressive fatigue, and mild nausea for the past five days. Ck and her husband are visiting her sister in Wyoming for 2 weeks but she has not felt well enough to bicycle, hike, or climb for the past week. Her sister has insisted that she see a health care professionalPMHAppendicitis 10 years agoSeroconverted to PPD (+) 6 years ago: treated for 12 month with INHPernicious anemia X5 yearsHypercholesterolemia X1 year, controlled with diet and exerciseFH2 sister with Hashimato thyroiditis and 1 sister with graves diseaseSHDrinks wine with dinnerDenies tobacco use with IVDUTravelsWalksMedicationCyanocobalamin 200 ug IM on the 15th of every month (recently increased dose)ROSSwelling of the faceBig red rash that covered her torso and face, repeated feversDenies chills, SOB, night sweats and cough. + weight loss of 6 LBS, + salt cravings, + dizziness, one fainting spell 6 months ago, +aches and pains, -recent changes in vision, – changes in menstrual cycle, +prominent tanning of the skin although denies sun exposure.Gen:Tired lookedVital signsBP 95/75 P 83sitting rt armBP 80/60 P 110 standing rt armRR 14T 98.0HT 5’6WT 124 LBsSkinIntact, warm and very drySubnormal turgorPigmented skin cr3eases on palms of hands and knucklesGeneralized tanned appearanceSparse axillary hairHEENTDry mucous membranesNectSupple with normal thyroid and no massesShotty lymphadenopathyLungsClear, normal vesicular and bronchial lung soundsBreastHyperpigmentation prominent along brassiere linesVery dark areolaeCardiacNormalABDSoft+ BSGULMP 2 weeks agoMSPigmented skin creases on elbowsPedal pulses moderately weak at +1LabNa 126Hct 33.2%Alk Phos 115 IU/LK 5.2RBC 4.1Bilirubin 1.2Cl 97MCV 85Protein 8.0HCO3 30Plt 41Albumin 4.7Bun 20WBC 6,800Cholesterol 202CR 1.2Neutros 49%Triglycerides 159Glu 55Lymph 36%Fe 89Ca 8.8Monos 7%TSH 3.2Phos 2.9Eos 7%Free T4 16Mg 2.9Baso1%Uric acid 3.6AST 33ACTH 947Hb 11.4ALT 50Vitamin B12UAClear and yellow, SG 1.016, pH 6.45, - BloodImagingAbdominal CT scan revealed moderate bilateral atrophy of the adrenal glandsRapid ACTH stimulation testConditionCortisol AssayAldosterone AssayPre- cosyntropin2.03.830 Min post cosysntropin1.93..8Antibody testing+ 21- hydroxylaseNegative: 17-hydroxylaseNegative: C-P450Question:1. What is the significance of the varying BP and HR readcing with change in position by the patient2. What is the
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