cardiovascular pathology i.ppt
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This document contains 5 cases in cardiovascular pathology. Case 1 describes the histology of a normal coronary artery. Case 2 involves a man with chest pain, where imaging shows a blockage in the left anterior descending coronary artery, consistent with a heart attack. Case 3 describes a woman with diabetes who collapsed from cardiac arrest, where autopsy finds changes in the heart muscle and coronary artery. Case 4 involves a young man with shortness of breath, where a biopsy shows inflammatory changes. Case 5 is a man with back pain and a pulsatile abdominal mass, found to have an aneurysm.
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This patient presents with a 3 month history of right leg pain on walking that resolves with rest. Examination finds the right leg cooler with sparse hair and thin skin. All pulses are absent below the femoral pulse. Doppler ultrasound finds softer signals in the right leg arteries and an ankle brachial pressure index of 0.6 on the right and 0.8 on the left. The patient has risk factors of smoking and diabetes. The clinical diagnosis is peripheral arterial disease and the patient is advised on lifestyle changes and medication while further investigation and monitoring is recommended.
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Instructions: In this medical record abstracting assignment you will first need to download and the records (history & physical, surgery consultation, operative report, pathology report and discharge summary) for a patient with digestive system problems. (Recommend reading them in the order listed).
Save your answers to the following related questions in this document and submit them for this module's assignment.
1. Define the terms diverticulosis and diverticulitis.
2. What is the pathophysiology of diverticulitis?
3. What is a hiatal hernia?
4. Describe some of the signs or symptoms a person with a hiatal hernia might have.
5. What is a pulmonary embolus?
6. What was the etiology (cause) of the pulmonary embolus for this patient?
7. What is gastritis?
8. Which problem is likely a contributor to the patient’s Type II diabetes mellitus?
9. What was the purpose of the barium enema?
10. What does the abbreviation HEENT stand for?
11. What is thrombophlebitis?
12. What is a surgical resection?
13. Define anastomosis.
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15. What condition is the drug Darvocet used to treat?
16. What are electrolytes?
17. What is exogenous obesity?
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19. Where is the popliteal pulse found/taken?
20. What is hepatosplenomegaly?
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23. Which condition(s) is/are the drug Lanoxin used to treat?
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· Academic arguments are designed to get someone to agree with the author, who may use pathos (emotion), logos (logic and facts) and ethos (authority and expertise) to persuade.
Academic arguments are not about ranting, screaming or otherwise increasing conflict, but in fact are the opposite: They attempt to help the other person understand what the author believes to be right (opinion) based on the evidence presented (authority, logic, facts).
For your topic for your final paper, what kinds of arguments can you develop for your claim (thesis, main idea)?
Health Record Face Sheet
Record Number:
005
Age:
67
Gender:
Male
Length of Stay:
3 days
Service:
Inpatient Hospital Admission
Disposition:
Home
Discharge Summary
Patient is a 67-year-old male. He saw the doctor recently with abdominal pain and constipation. A barium enema showed diverticulosis and perhaps a stricture near the sigmoid and rectal junction. He was scoped by the doctor, who saw a stricture at that point and sa ...
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· Academic arguments are designed to get someone to agree with the author, who may use pathos (emotion), logos (logic and facts) and ethos (authority and expertise) to persuade.
Academic arguments are not about ranting, screaming or otherwise increasing conflict, but in fact are the opposite: They attempt to help the other person understand what the author believes to be right (opinion) based on the evidence presented (authority, logic, facts).
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Record Number:
005
Age:
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Gender:
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Length of Stay:
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Service:
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Disposition:
Home
Discharge Summary
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1. You are the AGACNP in the emergency room. A 55-year-old Caucasian male with a past medical history of HTN, thyroid cancer, and diverticulitis presents with crushing chest pain. His chest pain developed one hour ago after eating a large steak and potato dinner. He states the pain is 10 out of 10 and is not relieved by antacids. He is also diaphoretic and anxious. You review his 12 lead EKG, as per below.
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c. Lateral
d. Posterior
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b. V1-V3
c. II, III, AVF
d. II, III, AVR
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c. Reciprocal changes in lead IV and V
d. There are No reciprocal changes.
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b. The left anterior descending
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d. none of the above
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Patient Case Analysis Assignment
Grading Criteria
Possible Score
Earned Score
Answers to Questions
1. Demonstrates comprehensive critical analysis of pathology, assessment and diagnostic data, medical and nursing management (points accrued in case study)
30
Format
1. Answers are supported by references
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5
3
2
Total Score
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Paroxysmal nocturnal dyspnea
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Hypopnea
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Bronchiolitis
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EKG Worksheet
Answer each question below. Use complete sentences when providing short answer responses.
1. You are the AGACNP in the emergency room. A 55-year-old Caucasian male with a past medical history of HTN, thyroid cancer, and diverticulitis presents with crushing chest pain. His chest pain developed one hour ago after eating a large steak and potato dinner. He states the pain is 10 out of 10 and is not relieved by antacids. He is also diaphoretic and anxious. You review his 12 lead EKG, as per below.
Using the EKG strip, answer questions A-D.
A. What part of the area of the heart is showing an evolving infarct?
a. Inferior
b. Anterior
c. Lateral
d. Posterior
B. Which leads show ST elevation?
a. II, III, AVL
b. V1-V3
c. II, III, AVF
d. II, III, AVR
C. Where would you expect to find reciprocal changes?
a. Reciprocal changes in at least AVL
b. Reciprocal changes in lead III
c. Reciprocal changes in lead IV and V
d. There are No reciprocal changes.
D. What coronary artery is the likely cause?
a. The Right Coronary artery in most cases as it is usually dominant, however in some patients the left circumflex is dominant and thus the culprit for an inferior MI.
b. The left anterior descending
c. The septal artery
d. none of the above
2. A 67-year-old female is your established cardiology patient. She is following up with you regarding her uncomplicated mitral valve stenosis. During the visit, she happens to mention that she has suffered 9 hours of chest pain and sweating, which takes you by surprise. Your patient further describes the pain as both gnawing and intermittent. She thought she was experiencing heartburn, but admits that she has never experienced heartburn before, so she is not sure. You perform a 12-lead EKG immediately and call 911.
Interpret the EKG recording below.
What area of the heart is involved, what is your diagnosis, and which coronary artery is affected?
a. Anterior part of the heart; this is an ST elevation myocardial infarction (STEMI); and the Left anterior descending is affected
b. Inferior; this is a Non ST elevation MI (NSTEMI), and the right coronary artery is affected
c. Posterior; this is not an MI but does show ischemia, and the circumflex is involved
d. This simply pericarditis and thus the affected coronary arteries are not affected, the heart strain distribution is diffuse and global
3. What qualifies for “significant” ST elevation or depression in a 12 lead EKG- in the limb leads_(i)._____________? What is significant for the or the precordial leads_(ii)._____? These changes must be present in at least_(iii)___________consecutive leads in order to be considered diagnostic of myocardial pathology.
1. (i))1mm in a limb lead, (ii)1mm in precordial lead, (iii)and must be present 3 consecutive leads
1. (i)1mm in a limb lead, (ii)2mm in precordial lead, (iii)and must be present 2 consecutive leads
1. (i) 2mm in a limb lead; (ii)) 2 mm in a precordial lead, (iii) must be present in 3 consec ...
Who needs a pacemaker?
Indications of pacemaker implantation
Presented at the 7th annual institute conference of dysrhythmia.
Cairo, Egypt.
How to present a long case in cardiology bedside discussion
This is a bedside case discussion of a patient presenting with acute myocardial infarction. The symptoms and signs are discussed. The
choices at each stage, the electrocardiogram (ECG), the angiogram, and the therapeutic findings are discussed in detail. The context with
reference to India is also discussed. The differential diagnosis of the history of presentation is also discussed. ECG localization of myocardial
infarction, management of acute coronary occlusion, and medical management of myocardial infarction are discussed
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• Naloxone-Associated Aspiration Pneumonitis & Pulmonary Edema
• Superior Vena Cava Syndrome
• Pulmonary Aspergillosis And The “Air Crescent Sign”
• Needle-Chest Decompression & Recent Pneumothorax Literature
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Case Study Assignment for Unit IIIPurpose The purpose of th.docx
Case Study Assignment for Unit III
Purpose: The purpose of this assignment is to encourage you to analyze pathophysiological processes and mechanisms of human disease, identify clinical signs and symptoms and diagnostic data consistent with the pathology of common health problems and determine appropriate medical treatment and nursing care based on best practices found in the literature. This assignment emphasizes critical thinking and problem-solving through the correlation of cellular and multi-system pathology with related assessment and diagnostic data, medical treatment and nursing management.
The answers to the questions should be complete and include professional literature to support each answer. You should include at least 3 current references (< 5 years old) of which 2 must be journal articles. References should include current nursing journals and other professional health related literature. The assignment should be uploaded electronically into blackboard under the appropriate assignment link.
The paper should be typed using APA format. APA format requires that you use correct grammar and spelling and double-space your entire paper. Use the questions as your headers. Please include the following rubric at the end of your paper.
The assignment will be graded using the following criteria:
Patient Case Analysis Assignment
Grading Criteria
Possible Score
Earned Score
Answers to Questions
1. Demonstrates comprehensive critical analysis of pathology, assessment and diagnostic data, medical and nursing management (points accrued in case study)
30
Format
1. Answers are supported by references
1. Follows APA format
5
3
2
Total Score
35
Necrotizing Fasciitis Case Study
Teri Billings, William Claytor, Krista Gagnon
Introduction
C. S. is a 33-year-old, married, African American male who presented to the ED for progressively worsening body aches, abdominal pain, and swelling and draining in the peri-rectal and perineal area. Patient stated he “developed a pimple on his buttocks a week ago and it broke open today”. Patient also stated his “weakness and pain have been worsening over the past week”.
The only medical history consisted of hypertension and insulin dependent diabetes diagnosed four years ago, but patient reports he has not been taking insulin for at least one week. Patient is employed full-time and denies any family medical history, allergies, or alcohol, tobacco, or drug use. Patient was diagnosed with diabetic ketoacidosis (DKA) and peri-rectal abscess. Upon medical workup, patient was found to have necrotizing fasciitis / Fournier’s gangrene, so both infectious diseases and general surgeon were consulted.
Question 1: Explain the pathophysiology of necrotizing fasciitis? Give details about the cells involved and the process of inflammation. (4 points)
Question 2: Why is diabetes in the patient’s history a risk factor for necrotizing fasciitis, and how does diabetes compound the problem? (3 points)
Question 3: What i ...
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This document discusses cardiovascular disease, specifically a case of a 66-year-old man experiencing chest pain who was diagnosed with an acute myocardial infarction. It describes the patient's medical history, symptoms, examination findings, diagnostic tests and results including ECGs showing ST elevation, and angiogram revealing a 100% blockage of the left anterior descending artery treated with stenting. Differential diagnoses including aortic dissection and pulmonary embolism are also discussed.
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Clinical materials for medicine IV
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Drs. Milam and Thomas's CMC X-Ray Mastery Project: May Cases
Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
• Spontaneous Pneumothorax
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Respond to all the questions and include the questions and answers i.docx
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W hat comprises the lymphatic system
Which set of lymph nodes is a common site of metastatic disease, and why?
Mrs. Kline, a postoperative patient who has just undergone a right modified mastectomy, is found to have edema of the right arm. What is the cause of the edema, and what teaching is necessary to help Mrs. Kline?
Mr. Jackson is a 76-year-old nursing home patient who has persistent wound infections and upper respiratory infections. What is the cause of Mr. Jackson’s recurring infections?
Describe the correct way to examine the lymphatic system
Define
lymphedema
Provide the differential diagnosis of mumps versus cervical adenitis
What is elephantiasis?
JS is a 17-year-old adolescent who presents to the office with complaints of fatigue and overall body aches. He states that several of his classmates have been home sick as well. His past medical history is negative for medical illness, but he had myringotomy tubes placed when he was 5 years old. The patient lives with his mother, stepfather, and two siblings.
What is the most common cause of his diagnosis?
During the history, what positive findings will be in the HPI?
On physical examination of JS, what positive assessment results would you expect to find?
Name the primary muscles of respiration.
What is a normal rate of respiration per minute in an adult?
Prepare a teaching pamphlet on the effects of smoking on the chest and lungs.
Define the following terms and discuss when the examiner might see these conditions:
Dyspnea
Orthopnea
Apnea
Paroxysmal nocturnal dyspnea
Platypnea
Tachypnea
Bradypnea
Hyperpnea
Kussmaul breathing
Hypopnea
Periodic breathing (Cheyne-Stokes)
Air trapping
Biot respiration
Ataxia
Retractions
what they would expect to find when assessing
children or adolescents
with the assigned condition.
Cystic fibrosis
Epiglottis
Croup
Tracheomalacia
Bronchiolitis
Respiratory distress syndrome
Differentiate between a pneumothorax and a hemothorax.
List risk factors associated with respiratory disability.
HG is a 62-year-old man with a significant history of COPD and emphysema. He has a positive PMH of frequent episodes of pneumonia. His social history includes cigarette smoking for 45 years. Identify your findings on HG and the emphysema.
What is the primary etiology of the emphysema?
What are the expected findings on inspection, palpation, percussion, and auscultation?
What are the subjective and objective findings in HG’s presentation?
.
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EKG Worksheet Answer each question below. Use complete
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- 3. Normal coronary artery H&E stain Elastin stain
- 4. High power
- 5. Q1. Describe the histology of a normal coronary artery. Be sure to describe all of the layers of the artery in your discussion. What is the arrow pointing to on the high power image?
- 6. Case History A 57-year old man has experienced chest pain with exertion for the past year. For example, when he walks up a flight of 10 or more stairs he develops a pain in his chest which subsides within several minutes when he sits down and rests.
- 7. Q1. Develop a clinical differential diagnosis.
- 8. The image is that of the patient’s left anterior descending coronary artery
- 9. Q2. Describe the histologic findings in this coronary artery. Q3. What is your pathologic diagnosis?
- 10. Q4. Name at least 3 modifiable and 3 non- modifiable risk factors for the development of this condition. Q5. Correlate the clinical history with the pathology.
- 12. History A 67-year old man presented to the emergency department with 10/10 crushing substernal chest pain. The pain was greatest over his left chest and radiated down his left arm.
- 13. Q1. List 5 life-threatening causes of chest pain.
- 15. Cross sections of coronary artery
- 16. Q2. Describe the gross morphologic findings of the heart. Be specific when describing the area to which the large arrow is pointing. What chambers of the heart are labeled A and B?
- 17. Q3. What is your diagnosis? Q4. Based on the gross findings, when did this event occur? Discuss your rationale.
- 18. Q5. Clinically, what lab tests would confirm the diagnosis? Why? Q6. Discuss potential complications of this disease process.
- 20. History A 45-year old woman with diabetes mellitus, type 1 complained of “not feeling well” for several days. She collapses from a cardiac arrest and cannot be resuscitated. An autopsy is performed. The light microscopic appearance of the left ventricle anterior wall and left anterior descending coronary artery are shown in the figures
- 23. Q1. Describe the histologic findings of the myocardium. Compare to normal. Q2. Describe the histologic findings of the coronary artery.
- 24. Q3. What is your diagnosis? Q4. Based on the histologic findings, when did this event occur? Discuss your rationale.
- 25. Q5. Are the patient’s symptoms typical of this disease process? Provide a rationale to your answer. Q6. Define the term “vulnerable plaque”.
- 27. History A 27-year old man presents with shortness of breath which developed 7 days prior and has been steadily worsening. He has no known medical problems and takes no medications. Physical exam reveals jugular venous distention, bilateral basilar lung crackles and lower extremity edema.
- 28. Q1. Develop a clinical differential diagnosis.
- 29. An endomyocardial biopsy is performed . Low power High power
- 30. Q2. Describe the histologic findings. Q3. What is your pathologic diagnosis?
- 31. Q4. What is the most common cause of this entity in the United States? Q5. Correlate the clinical with the pathologic findings.
- 33. History A 78-year-old man presents with sudden onset of low mid-back pain. His past history is significant for coronary artery disease and coronary artery bypass surgery. He has a 60- pack year smoking history. On examination, a pulsatile mass can be felt in the lower abdomen. On auscultation of the mass a bruit is appreciated.
- 36. Q1. Describe the characteristic pathologic features of this specimen. Q2. Correlate the clinical findings with the pathology
- 37. Q3. What is your diagnosis? Q4. What is/are risk factors for the development of this condition? How do they contribute to its development?