Case Study Assignment – Sickle Cell Disease
Instructions: Read the case study and answer the questions that are included at the end of this document and in Sakai.
Make sure you support your answers with details/data from the case presentation. All answers need to be submitted to the
corresponding assignment in the “Test & Quizzes” tab in Sakai.
Sickle Cell Disease Case Study
Patient’s Chief Complaints:
“My arms & legs hurt a lot more than usual today. The ibuprofen has stopped working and I need something stronger. I
may have overdone it at the gym.”
History of Present Illness:
Carla is an 18 yo female with sickle cell disease who presents with a one-day history of increasing pain localized to her
arms and legs. Her pain has not been relieved with 400 mg of ibuprofen every 6 hours for the past 24 hours. She rates her
current pain intensity level as 8 out of 10. She reports that she always seems to have some pain in her arms, legs, and
back, but recently with the cold weather it has gotten worse. The pain really intensified approximately 36 hours after a
workout at the gym that was more vigorous than usual. “I know that I shouldn’t have done that,” she confesses, “but the
girls needed a 6th player for a game of 3-on-3. And, on top of that, I forgot to take my water bottle to the gym and haven’t
been good about drinking water since.”
Past Medical History:
The patient was diagnoses with homozygous HbSS disease (HbSS genotype) at age 11 months. She first presented with a
severe case of dactylitis at 10.5 months with significant swelling and pain in both hands and fee.
At age 16 months, the patient was hospitalized with acute sequestration syndrome and splenomegaly, treated, and
released. At age 30 months and again at age 34 months, the patient was hospitalized for Streptococcus pneumoniae
pneumonia, treated with IV antibiotics, and released. She also experienced one episode of acute staphylococcal
osteomyelitis of the left knee at age 13. Since the age of 3 years, the patient has averaged three painful crises per year but
has had as many as 10 attacks in a year. She has experienced chronic low-grade pain in his arms, legs, and back since
becoming a teenager but has been able to cope by taking ibuprofen when needed.
Other medical conditions and surgeries of note include:
Tonsillectomy as a child
Childhood asthma that resolved at puberty
Chronic sinus drainage/rhinitis x 2 years
Family & Social History:
Single female who lives at home with her mother and brother during the summer and will reside in a college
dormitory during the next academic year
Patient identifies as African American; she has Nigerian genetic ancestory.
Recently graduated from high school with honors and hopes to pursue a college education and major in business
Works part-time at Chipotle
Does not smoke, drink alcohol, or use illicit drugs “except for one trial of pot 2 years ago”
Tries to maintain a healthy and balanced diet
Consumes 2-3 caffeinated soft drinks per day
Review of Systems:
Denies headache, cough, fever, chills, dizziness, lightheadedness, nausea, vomiting, diarrhea, shortness of
breath, blurred vision, chest pain, blood in the urine, abdominal pain, and painful urination
, Admits to feeling tired much of the time but has generally been able to tolerate it
Physical Examination and Laboratory Tests:
General Appearance
The patient is a tall, thin, African American female in moderate-to-severe pain.
Vital Signs
BP 95/60 RR 18 BMI 17.7
P 58 T 98.5 O2 Sat 96% on room air
Skin & Hair
Warm and dry with poor turgor/some tenting
(-) rashes, bruises, or lesions
Hair quantity, distribution, and texture unremarkable
Head, Eyes, Ears, Nose, & Throat
Normocephalic and atraumatic
Pupils equal at 3 mm, round, and reactive to light
Extra-ocular muscles intact without nystagmus
Normal sclerae
Funduscopic exam revealed sharp optic disc margins with no arteriolar narrowing or hemorrhages
External auricular canals clear
Tympanic membranes gray and reveal good cone of light bilaterally
Nasal mucous membranes dry
Oral mucosa dry and without erythema
No oropharyngeal lesions
Lips dry
Neck & Lymph Nodes
Neck supple
(-) cervical, axillary, and inguinal nodes bilaterally
(-) thyromegaly, nodules, carotid bruits, and jugular vein distension
Lungs and Thorax
Clear to auscultation throughout with good breath sounds
No costovertebral angle tenderness or spinal tenderness
Heart
Regular rate & rhythm
(-) rubs and gallops
Systolic ejection murmur is prominent
Abdomen
Normoactive bowel sounds in all four quadrants
Soft, non-tender, and non-distended without guarding
(-) organomegaly, masses, and bruits
Musculoskeletal & Extremities
Instructions: Read the case study and answer the questions that are included at the end of this document and in Sakai.
Make sure you support your answers with details/data from the case presentation. All answers need to be submitted to the
corresponding assignment in the “Test & Quizzes” tab in Sakai.
Sickle Cell Disease Case Study
Patient’s Chief Complaints:
“My arms & legs hurt a lot more than usual today. The ibuprofen has stopped working and I need something stronger. I
may have overdone it at the gym.”
History of Present Illness:
Carla is an 18 yo female with sickle cell disease who presents with a one-day history of increasing pain localized to her
arms and legs. Her pain has not been relieved with 400 mg of ibuprofen every 6 hours for the past 24 hours. She rates her
current pain intensity level as 8 out of 10. She reports that she always seems to have some pain in her arms, legs, and
back, but recently with the cold weather it has gotten worse. The pain really intensified approximately 36 hours after a
workout at the gym that was more vigorous than usual. “I know that I shouldn’t have done that,” she confesses, “but the
girls needed a 6th player for a game of 3-on-3. And, on top of that, I forgot to take my water bottle to the gym and haven’t
been good about drinking water since.”
Past Medical History:
The patient was diagnoses with homozygous HbSS disease (HbSS genotype) at age 11 months. She first presented with a
severe case of dactylitis at 10.5 months with significant swelling and pain in both hands and fee.
At age 16 months, the patient was hospitalized with acute sequestration syndrome and splenomegaly, treated, and
released. At age 30 months and again at age 34 months, the patient was hospitalized for Streptococcus pneumoniae
pneumonia, treated with IV antibiotics, and released. She also experienced one episode of acute staphylococcal
osteomyelitis of the left knee at age 13. Since the age of 3 years, the patient has averaged three painful crises per year but
has had as many as 10 attacks in a year. She has experienced chronic low-grade pain in his arms, legs, and back since
becoming a teenager but has been able to cope by taking ibuprofen when needed.
Other medical conditions and surgeries of note include:
Tonsillectomy as a child
Childhood asthma that resolved at puberty
Chronic sinus drainage/rhinitis x 2 years
Family & Social History:
Single female who lives at home with her mother and brother during the summer and will reside in a college
dormitory during the next academic year
Patient identifies as African American; she has Nigerian genetic ancestory.
Recently graduated from high school with honors and hopes to pursue a college education and major in business
Works part-time at Chipotle
Does not smoke, drink alcohol, or use illicit drugs “except for one trial of pot 2 years ago”
Tries to maintain a healthy and balanced diet
Consumes 2-3 caffeinated soft drinks per day
Review of Systems:
Denies headache, cough, fever, chills, dizziness, lightheadedness, nausea, vomiting, diarrhea, shortness of
breath, blurred vision, chest pain, blood in the urine, abdominal pain, and painful urination
, Admits to feeling tired much of the time but has generally been able to tolerate it
Physical Examination and Laboratory Tests:
General Appearance
The patient is a tall, thin, African American female in moderate-to-severe pain.
Vital Signs
BP 95/60 RR 18 BMI 17.7
P 58 T 98.5 O2 Sat 96% on room air
Skin & Hair
Warm and dry with poor turgor/some tenting
(-) rashes, bruises, or lesions
Hair quantity, distribution, and texture unremarkable
Head, Eyes, Ears, Nose, & Throat
Normocephalic and atraumatic
Pupils equal at 3 mm, round, and reactive to light
Extra-ocular muscles intact without nystagmus
Normal sclerae
Funduscopic exam revealed sharp optic disc margins with no arteriolar narrowing or hemorrhages
External auricular canals clear
Tympanic membranes gray and reveal good cone of light bilaterally
Nasal mucous membranes dry
Oral mucosa dry and without erythema
No oropharyngeal lesions
Lips dry
Neck & Lymph Nodes
Neck supple
(-) cervical, axillary, and inguinal nodes bilaterally
(-) thyromegaly, nodules, carotid bruits, and jugular vein distension
Lungs and Thorax
Clear to auscultation throughout with good breath sounds
No costovertebral angle tenderness or spinal tenderness
Heart
Regular rate & rhythm
(-) rubs and gallops
Systolic ejection murmur is prominent
Abdomen
Normoactive bowel sounds in all four quadrants
Soft, non-tender, and non-distended without guarding
(-) organomegaly, masses, and bruits
Musculoskeletal & Extremities
