course material

1. Case Study 5 & 6 Glomerulonephritis and Cervical Cancer
Review the case study and answer all questions with a scholarly response using APA and
include 2 scholarly references. Answer both case studies on the same document and upload
1 document to Moodle. Cervical Cancer Case Studies The patient, a 28-year-old woman, has
been sexually active with multiple partners since she was 14 years old. She is now married
and wants to have children. She has intermittent breakouts of vulvar ulcers/sores but no
other complaints. Her pelvic examination during a routine visit with her gynecologist was
normal. She had a lump in her left breast. Studies Results Sexually transmitted infections
(STIs), p. 756 Herpes simplex test, p. 731 Positive for herpes simplex virus-2 (HSV-2)
(normal: negative) No change in serology 4 weeks later Cytomegalovirus, p. 200 No
antibodies detected Chlamydia, p. 722 No antibodies detected Gonorrhea, p. 761 Culture
negative Syphilis serology, p. 473 No antibodies detected Pap smear, p. 743 Adequacy of
specimen Adequate Category Epithelial abnormality Epithelial cell abnormalities Squamous,
atypical cells Human papillomavirus (HPV) testing, p. 745 Positive for HPV 16 Breast
sonogram, p. 871 Benign fibroadenoma Diagnostic Analysis The patient was informed of her
test results. Her herpes titers indicated that the disease was rather chronic, not acute. No
treatment was recommended. Because of her age, mammograms were contraindicated. A
breast ultrasound indicated the lesion was not cancerous. A fibroadenoma is common in
this age-group. Because of her positive HPV results and suspicious Pap smear, further
evaluation was recommended. Studies Results Colposcopy, p. 595 Several suspicious areas
Biopsy Squamous cell carcinoma Cervical cone biopsy, p. 720 Invasive squamous cell
carcinoma Hysteroscopy, p. 614 No extension to the endocervical canal or uterus Pelvic
ultrasound, p. 887 No extension of tumor beyond the cervix The patient was advised to have
a radical hysterectomy. She refused because she wanted to have a family. She began
psychologic counseling for guilt over her past promiscuity, which had increased her risk for
cervical cancer. She became pregnant 1 year later and lost the Case Studies 2 pregnancy
during the second trimester. One year later, she developed a large pelvic mass, which
represented progressive, inoperable cervical cancer. Despite radiation therapy and
chemotherapy, she died at age 31 of cervical cancer. Critical Thinking Questions 1. Why was
mammography contraindicated for this patient? 2. How is sexual promiscuity related to the
risk for cervical cancer? Glomerulonephritis Case Studies A 7-year-old boy was brought to
his pediatrician because he had developed hematuria, which required hospitalization.
Approximately 6 weeks before his admission, he had a severe sore throat but received no
treatment for it. Subsequently, he did well except for complaints of mild lethargy and

2. decreased appetite. Approximately 3 weeks before admission, he had a temperature of 101°
F daily for 7 days. He complained of minimal bilateral back pain.Physical examination
revealed a well-developed young boy with moderate bilateral costovertebral angle (CVA)
tenderness. The remainder of the physical examination results were negative. His blood
pressure was 140/100 mm Hg in both arms and legs. Studies Results Urinalysis, p. 956
Blood +4 (normal: negative) Protein +1 (normal: negative) Red blood cell casts Positive
(normal: negative) Specific gravity 1.025 (normal: 1.010-1.025) Color Red-tinged (normal:
amber-yellow) Urine culture and sensitivity (C&S), p. 973 No growth after 48 hours Blood
urea nitrogen (BUN), p. 511 42 mg/dL (normal: 7-20 mg/dL) Creatinine, p. 190 1.8 mg/dL
(normal: 0.7-1.5 mg/dL) Creatinine clearance test, p. 193 64 mL/min (normal:
approximately 120 mL/min) Renal ultrasound, p. 866 No tumor; kidneys diffusely enlarged
and edematous Intravenous pyelogram (IVP), p. 1057 Delayed visualization bilaterally;
enlarged kidneys, no tumor; no obstruction seen Renal biopsy, p. 751 Swelling of
glomerular tuft, along with polymorphonuclear leukocyte infiltrates in Bowman’s capsule
(findings compatible with glomerulonephritis); immunofluorescent staining, positive for
IgG Anti-DNase-B (ADB) titer, p. 79 200 units (normal: ≤170 units) Total complement assay,
p. 172 33 units/mL (normal: 75-160 units/mL) Case Studies 2 Diagnostic Analysis The
blood, protein, and RBC casts in the boy’s urine indicated a primary renal disorder. The
elevated creatinine and BUN levels indicated that the problem was severe and markedly
affecting his renal function. Both kidneys were probably equally impaired. Intravenous
pyelogram (IVP) was helpful only in ruling out Wilms tumor or congenital abnormality.
Normally an IVP would not be performed in light of this patient’s impaired renal function. It
is presented here for demonstration of the information it can provide. Renal ultrasound is a
much safer test to visualize the kidney to exclude neoplasm. The ultrasound findings were
compatible with an inflammatory process involving both kidneys. Renal biopsy was most
helpful in suggesting glomerulonephritis. The history of recent pharyngitis, fever, the
positive ASO titer, the positive ADB titer, and the finding of immunoglobulin IgG antibodies
on the immunofluorescent stain all suggested poststreptococcal glomerulonephritis. The
patient was placed on a 10-day course of penicillin. He was given antihypertensive
medication, and his fluid and electrolyte balance was closely monitored. At no time did his
creatinine or BUN level rise to a point requiring dialysis. After 6 weeks, his renal function
returned to normal (creatinine, 0.7 mg/dL; BUN, 7 mg/dL). His antihypertensive
medications were discontinued, and he remained normotensive and returned to normal
activity. Critical Thinking Questions 1. At what point would the BUN and creatinine have
signified the need for dialysis? 2. What was the cause of the patient’s hypertension? 3. What
would you do if this patient had developed a swollen mouth and neck after the IVP?#Case
#Study #amp #Glomerulonephritis #Cervical #Cancer