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.
How to present a long case in cardiology bedside discussionRamachandra Barik
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
How to present a long case in cardiology bedside discussionRamachandra Barik
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
An assignment to write a case study for medical terminology as if I were responsible for writing the patient\'s medical record. An assignment at Colorado Technical University online.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
An assignment to write a case study for medical terminology as if I were responsible for writing the patient\'s medical record. An assignment at Colorado Technical University online.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Name Add name hereHIM 2214 Module 6 Medical Record Abstractin.docxgilpinleeanna
Name: Add name here
HIM 2214 Module 6: Medical Record Abstracting
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.
14. What is ferrous gluconate and what is it used to treat?
15. What condition is the drug Darvocet used to treat?
16. What are electrolytes?
17. What is exogenous obesity?
18. Where is the femoral pulse found/taken?
19. Where is the popliteal pulse found/taken?
20. What is hepatosplenomegaly?
21. Which condition(s) is/are the drug Humulin used to treat?
22. What is an adenocarcinoma?
23. Which condition(s) is/are the drug Lanoxin used to treat?
24. What is the purpose of ordering the blood test PTT?
25. What is a colon stricture?
26. What is/are the etiologies associated with colorectal cancer?
27. What is the medical term for gallstones?
28. Which condition(s) is the drug Zantac used to treat?
29. What does the pathology report indicate about the spread of the carcinoma in this patient?
30. What is the etiology of Type II diabetes mellitus?
· 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 ...
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docxbartholomeocoombs
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.
Case Study Assignment for Unit IIIPurpose The purpose of th.docxwendolynhalbert
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 ...
A 32-year-old female presents to the ED with a chief complaint of fe.docxsodhi3
A 32-year-old female presents to the ED with a chief complaint of fever, chills, nausea, vomiting, and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative.
Labs: CBC-WBC 18, Hgb 16, Hct 44, Plat 325, Neuts & Lymphs, sed rate 46 mm/hr, C-reactive protein 67 mg/L CMP wnl
Vital signs T 103.2 F Pulse 120 Resp 22 and PaO2
99% on room air. Cardio-respiratory exam WNL with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Abdominal exam + for LLQ pain on deep palpation but no rebound or rigidity. Pelvic exam demonstrates copious foul-smelling green drainage with reddened cervix and + bilateral adenexal tenderness. + chandelier sign. Wet prep in ER + clue cells and gram stain in ER + gram negative diplococci.
Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following as it relates to the case you were assigned (omit section that does not pertain to your case, faculty will give full points for that section).
The sections that you are to omit are for the above case study are: 1. Explain why prostatitis and infection happen. Also explain the causes of systemic reaction, 2. Explain why a patient would need a splenectomy after a diagnosis of ITP, and 3. Explain anemia and the different kinds of anemia (i.e., micro and macrocytic).
In your Case Study Analysis related to the scenario provided, explain the following:
The factors that affect fertility (STDs).
Why inflammatory markers rise in STD/PID.
Why prostatitis and infection happens. Also explain the causes of systemic reaction.
Why a patient would need a splenectomy after a diagnosis of ITP.
Anemia and the different kinds of anemia (i.e., micro and macrocytic).
PLEASE ANSWER IN DETAIL ALL OF THE ABOVE
.
Instructions· This week’s case study will introduce concepts r.docxmariuse18nolet
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.
It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management guidelines and recommendations. Sources such as Wikipedia or other generic websites are not considered professional references and should not be used to complete the case studies.
· Reason for Consultation:
Desaturation to 64% on room air 1 hour 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. 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 to be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 20, 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 91-92% on 4L NC. The patient was seen and examined at 10:10 a.m. She reported that she has had mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of this visit was 20 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiatio.
1. Revision [1]
A 60-year-old man presents with 3 months’ duration of pain in right leg on walking.
How would you elicit further details in his history?
He experiences pain in the Rt thight and calf after walking about 100 metres but this
resolves after a short rest about 2 to 3 minutes.
He has been smoking 30 cigarettes a day for last 15 years. He has type II diabetes and
hypertension, but no angina or transient ischaemic attacks, no story suggestive of
previous myocardial infarct or cerebrovascular accident.
What relevant physical signs would you look for?
On examination, his pulse rate is 82/min and regular rhythm, BP is 160/90 mmHg.
The Rt leg is colder than the Lt, and has scanty of hair and thin shiny skin. In the Rt leg,
all peripheral pulses are not palpable. The Lt femoral pulse is normal to palpation but no
distal pulses are palpable below this level.
What is the most likely clinical diagnosis?
What is the most important, non-invasive investigation to assess the severity for
this patient?
Doppler examination reveals audible signals in both leg arteries but softer in the Rt.
The ankle brachial pressure index (ABPI) is 0.6 on the Rt and 0.8 on the Lt.
How can ABPI assess the severity of the disease clinically?
How would you interpret on the clinical findings along with the mentioned ABPI?
What other investigations would you suggest in this patient? (with your
justification)
The duplex arterial scan shows a short stenosis (70% narrowing) in the Rt common
iliac artery and a further short occlusion in the Lt superficial femoral artery.
Fasting sugar 130mg/dl; Lipid profile: S cholesterol 280mg/dl, S triglyceride 240mg/dl,
HDL 120mg/dl, LDL 220mg/dl; ECG-Lt bundle branch block; CXR normal.
Based on his history, clinical findings and the above results, what treatment will
you suggest for him?
The patient is instructed to carry out a regular exercise within his limitations. He is
also strongly advised to stop smoking. His diabetic control and hypertension treatment
are reviewed and monitored closely. Statins are commenced to treat hyperlipidaemia.
Why is any interventional treatment not considered in this condition?
What are the indications to consider definitive limb revascularization
procedures?
Six months later, the patient is admitted urgently with discoloration of his Rt big toe
and pain in the Rt foot which has kept him awake at night for 1 week. He has not stopped
smoking.
What is the next step of management?
2. REVISION- 2
A 68-year-old lady had an anterior resection for a rectal tumor 5 days ago. Her
postoperative recovery has been unremarkable. On 6th post operative day, she develops
low grade fever. You are asked to review the patient.
Q1. What are the possible causes of postoperative fever in this lady?
Q2. What are the relevant questions and physical findings that you must elicit in order to
help you to narrow your differential diagnosis?
Upon enquiry, she complains of pain and swelling of the left leg. There is no history of
trauma to the leg. On examination, her temperature is 38’C, pulse 99/min, O2 saturation
97%, chest is clear, abdomen is soft and non-tender, left calf feels warm, swollen and
tender, the measurement of the calves shows a 6 cm difference in circumference. The
pulses of lower limbs are normal.
Q3. What is the most likely diagnosis? What are the differentials?
Q4. What risks factors are associated with this condition in this patient?
Q5. What relevant investigations would you do in this patient and justify your answer?
Hb 11.5g/dl, total WBC 16.7x10’9/L, Platelets 360x10’9/L, Na 143mmol/L, K
4.6mmol/L, Urea 9.5mmol/L, Creatinine 71umol/L, C-reactive protein 100 mg/L
The D-dimer assay is positive.
An urgent duplex scan shows an adherent clot in the left femoral vein.
Q5. How useful is a D-dimer assay in the diagnosis of DVT?
Q6. How should this condition be treated?
Q7.Could her DVT be predicted and
prevented?
How would you do DVT prophylaxis / thromboprophylaxis?
Q8. What are the long term sequelae of this condition?
Q9. How would you detect and treat the pulmonary embolism?
REVISION [3]
A 49 year old male presents to an A&E with a 2-hour history of severe upper
abdominal pain associated with persistent nausea and vomiting, that began after returning
home from a party.
Q1. List the differential diagnosis of acute upper abdominal pain associated with nausea
and vomiting.
(List the causes of acute abdominal pain.)
Q2. What questions would you like to ask him? (with justification)
He describes the pain is sudden onset, located in the mid-epigastrium, constant, knife-
like in character. Approximately 1 hour after onset of pain, he vomited a large amount of
undigested food, but the emesis did not relieve his pain.
3. Q3. What important histories are missing?
Pain radiates through to the back. It is not made worse by movement but he does seem
more comfortable by leaning forward.
He consumed pizza and eight beers at party.
He denies any past surgical procedures but he has a history of peptic ulcer disease treated
medically.
He consumes alcohol 2 to 3 mixed drinks per day and 8 to 12 beers each weekend.
Q4.What relevant physical findings would you look for?
Physical examination reveals he is in acute distress, temperature is 38.5’C, pulse 110/
min,
BP 96/60 mmHg without orthostatic changes, and respiratory rate 28/min with signs of
dehydration
and breath smelling of alcohol.
Abdomen is mildly distended. There is involuntary guarding and tenderness particularly
in the epigastrium with rebound and no palpable mass. Bowel sounds are 2/min.
On chest examination, diminished breath sounds at lower zone of Lt lung field and
coarse crackles above it.
Q5. What physical finding/s you want to know more to support P/Dx and exclude D/Dx?
He has tinge of jaundice in sclera.
Liver dullness is in 5th intercostal space at right mid clavicular line.
Minimal fluid in the abdomen is demonstrated.
Q6. What is the most likely diagnosis?
(with reasons)
Q7. Mention the specific investigations you like to do for the confirmation of the
diagnosis (and to rule out D/Dx).
Q8. How would you rule out the peptic ulcer
perforation?
Q9. How would you assess the severity of
this patient’s disease?
(What Laboratory and diagnostic
studies do you need initially in acute
pancreatitis?)
Chest X-ray and Abdominal X-ray are done.
Q10. Describe the findings in this chest X-ray.
Q11. Describe the findings in these abdominal X-rays.
Chest x-ray reveals obliteration of left costo-phrenic angle and no evidence of free gas
under diaphragm.
Abdominal x-ray shows:
4. -air in duodenal loop
-sentinel loop (local ileus)
-the lower abdomen shows “ground glass ” appearance.
- dilated transverse colon, with colon “ cut off ” sign
Q12. In view of your diagnosis, explain these radiological features.
Laboratory results are as follows:
WBC 18,000/mm3, Hb 14.2 g/dl, Hct 48%,
Serum amylase 4280 IU/L, Creatinine 140umol/L,
BUN 25 mmol/L, electrolytes within normal limits,
Glucose 13mmol/L,
total bilirubin 3.2 mg/dl, AST 380 U/L ,
ALT 435 U/L, LDH 300 U/L, Albumin 35 g/L,
Q13. what significant lab data are missing to do severity assessment?
Ca 1.8 mmol/L,
ABG studies (room air) pH 7.25, PaCO2 40mmHg, HCO3 16 meq/L, PaO2 60mmHg.
He was admitted in ICU and resuscitation measures were started with central vein
infusion of fluid, naso-gastric aspiration and monitoring of parameters. Bladder
catheterization revealed oliguria.
Q14. Describe the clinical status along with above parameters.
Q15. How can his present metabolic abnormalities be rectified?
Q16. Name the scoring system that predicts
the severity of acute pancreatitis.
Q17. What are the etiologic factors involved
in acute pancreatitis?
What is/are the possible etiology of
acute pancreatitis in this patient?
Q18. How would you explain the hypotension,
pleural effusion and jaundice in case of
acute pancreatitis?
Q19. What is the pathophysiology of the
5. development of adult respiratory distress
syndrome (ARDS) in acute pancreatitis?
Q20. What are the other possible clinical
manifestations in acute pancreatitis?
Q21. If this case proves to be severe, what
early complications (first 3 days) and late
complications(7-10 days) might develop?
Q22. What are other diagnostic tools in acute
pancreatitis?
With 5 days of intensive medical treatment, the patient Apache scoring deteriorated
and there was elevation of C-reactive protein levels to > 320mg/l.
Q23. What investigation can differentiate necrotizing from non-necrotizing pancreatitis?
What abnormalities will be seen in necrotising pancreatitis by that investigation?
Outline the principle of treatment of infective necrosis of the pancreas.
Q24. What is the role of ERCP in acute pancreatitis?
Q25. Give the outline of treatment for acute
pancreatitis.
Q26. Is there a role for surgery in acute pancreatitis?
What are the indications for surgery?
Q27. How do you understand the pseudocyst of
pancreas and its management?
REVISION (4)
A 52 yr old woman presents with several episodes of bright red blood per rectum over
the past 8 weeks.
Q1. List the common causes of bleeding per rectum in adult and in older-aged patients.
Q2. What questions would you ask this patient? (Give your answer with justification.)
Q3. What are the characters of bleeding (color of blood and its relation with the faeces,
etc.) according to the causes of bleeding PR?
Upon inquiry about the character of blood, it is bright red and seen on the surface of
the faeces.
She also describes urgency with tenesmus as well as feelings of incomplete
evacuation.There are no other complaints and family history is negative.
Q4. What physical examination findings would you search for (with justification)?
6. Abdominal examination is normal. Rectal examination reveals ulcerated lesion at 7 cm
from the anal verge on posterior rectal wall.
Q5. What is your provisional diagnosis?
Give the reasons to support your P/Dx.
Q6. What are the next steps in evaluation
and management?
Biopsy is taken and histology reveals adenocarcinoma of rectum.
CT scan shows rectal wall thickening in distal third of rectum with irregularity of the
mesorectal fat, otherwise unremarkable and liver is normal.
Chest X-ray and blood works are normal.
An endoanal ultrasound is performed. This demonstrates transmural extension with
two hypo-echoic nodes in meso-rectum suspicious for metastases.
Q7. What important information in missing which is needed to consider the type of
operation?
Q8. What are the modes of spread in colorectal carcinoma? What are the staging
systems? What is the stage in this patient?
Q9. What are the modalities of treatment in rectal carcinoma?
What are the factors influencing the decision of type of surgery in carcinoma at
lower rectum?
What type of surgery would you choose in this patient?
Q10. If you decide to do abdominoperineal resection (APR), how would you explain the
patient before obtaining informed consent? And what other procedure does this patient
need before elective operation of APR?
Q11. How would you plan follow-up
management in this patient?
Q12. What are the roles of CEA in colorectal
carcinoma?
REVISION [5]
۞A 60 year-old male patient presents with a three-month history of difficulty in
swallowing.
Q1. List the common causes of dysphagia?
Q2. What are your preliminary D/Dx in this patient?
Q3. What questions would you ask this patient?
7. ۞On taking a history, he points out at the mid-sternum where he feels the foods are
stuck. Initially only solid foods were getting stuck but now he has trouble swallowing
even liquids.
He also gives a previous history of dyspepsia and heartburn in last 5 years, which was
associated with water brash (sour taste) and sometimes chest pain radiating up to the jaw
and down to the arms.
He smokes 20 cigarettes per day and is a heavy social alcohol drinker. He was
overweight and now he has lost 15 kilos in 3 months.
He looks pale otherwise physical examination is unremarkable.
Q4. What is the likely Dx?
Give the reasons to support your Dx.
Q5. How would you proceed with the work-up?
۞The complete work-up points to a carcinoma in the distal esophagus with no
evidence of obvious metastasis.
Q6. What is the aetiology of carcinoma esophagus?
Q7. What is the possible aetiology in this patient and likely cell type for carcinoma
in this location?
Q8. If you met this patient 3 year earlier (i.e. when he was having dyspepsia, heart
burn and water- brash only), what other investigations would you recommend?
Q9. What are the factors preventing gastro-esophageal reflux in normal individual?
What are the complications of GORD?
What are the principles of treatment for GORD?
Q10. What is Barret’s esophagus? Describe diagnostic plan work-up and treatment for
Barret’s esophagus?
Q11. What are the possible cell types of carcinoma according to the site of esophagus?
Q12. What are the modes of spread of carcinoma esophagus? Describe the lymphatic
spread.
Q13. What are the therapeutic options available for esophageal carcinoma?
Q14. What is the prognosis of carcinoma esophagus?
REVISION [6]
A 58-year old woman presents with a complaint of jaundice for 2 weeks and epigastric
discomfort for 1 week.
Q1. What questions would you ask her?
Upon inquiry, jaundice was initially noticed in her eyes by her husband 2 wks ago. It
gradually increased last week and is now spreading to skin all over the body.
8. She has no specific pain but since last week she has noted post prandial epigastric
discomfort which has not responded to antacids.
Recently she has noticed that her urine has changed to the color of coca-cola. She also
noted that stool color is getting pale and also developed generalized itchiness since last
week.
She has lost 10 Kg over the past 3 months.
She recently developed diabetes and is presently on insulin. Other than that, her past
medical and surgical histories are non-contributory.
She smokes one pack of cigarettes a day but does not consume alcohol.
Q2. What physical signs would you expect in this patient?
Physical examination reveals an obviously icteric woman with slight pallor. Her
temperature and vital signs are within normal limits.
Abdomen is soft and non-tender. A globular mass is palpable in the right upper quadrant
of abdomen which is not tender.
Rectal examination reveals the presence of clay colored stool.
Q3. What is the most likely diagnosis?
Q4. What are the differential diagnoses of jaundice in this patient?
Q6. What are the causes of obstructive jaundice?
Q7. Explain the reasons for the change in urine and stool color, generalized itchiness, and
palpable gallbladder in this patient.
(Courvoisier’s Law)
Q 8. How would you confirm the diagnosis in this patient?
(What further diagnostic work-up would you do for this patient?)
(State one investigation that can confirm the diagnosis.)
USG reveals 3.5cm mass in head of pancreas with dilated common bile duct and dilated
gall bladder with no biliary stones. No free fluid seen in peritoneal cavity.
9. Q 9. What investigations would you order next?
Contrast-enhanced CT shows 3.5 cm mass in pancreatic head without vascular invasion
and no enlarged lymph node. No evidence of metastasis to liver.
Q10. What diagnostic procedure can be done together with CT scan?
Q11. List the other investigations you would like to do?
Liver function test reveals total bilirubin 305 umol/l, direct bilirubin 273 umol/l, ALT 55
U/L, Alkaline phosphatase 364 U/L
Q12. Interpret the LFT results.
Q13. What is the role of ERCP in this case?
Q14. What are the treatment priorities and options for this case?
Q15. Discuss the management of a patient with localized pancreatic cancer and a patient
with metastatic pancreatic cancer.
Q 16. What is prognosis of carcinoma pancreas?