TEST BANK FOR : PATHOPHYSIOLOGY 1 0 0 CASE STUDIES VERIFIED QUESTIONS AND ANSWERS WITH RATIONALES GRADED A+ GUARANTEED PASS UPDATED VERSION

, 100 C ASE STU D I ES
I N P AT H O P H Y S I O L O G Y
VERIFIED QUESTIONS AND
ANSWERS WITH RATIONALES
GRADED A+ GUARANTEED PASS

Harold J. Bruyere, Jr., Ph.D.
P ROF ESSOR EM ER
ITU S U N IVER SIT Y OF
W YOM I NG
LARAMIE, WYOMING

,
, CONTENTS




Case Study 28 Ulcerative Colitis 128
Case Study 29 Viral Hepatitis 133
PART 1 ■ CARDIOVASCULAR
PART 4 ■ RENAL DISORDERS 139
Case Study 1 Acute Myocardial Infarction 2
Case Study 30 Acute Renal Failure 140
Case Study 2 Aneurysm of the Abdominal Aorta 7
Case Study 31 Chronic Renal Failure 145
Case Study 3 Congestive Heart Failure 10 Case Study 32 Dialysis and Renal Transplantation 149
Case Study 4 Deep Venous Thrombosis 14 Case Study 33 Renal Cell Carcinoma 154
Case Study 5 Hypertension 18 Case Study 34 Urinary Stone Disease 159
Case Study 6 Hypovolemic Shock 23 Case Study 35 Urinary Tract Infection 162
Case Study 7 Infective Endocarditis 26
Case Study 8 Peripheral Arterial Disease 31 PART 5 ■ NEUROLOGICAL
Case Study 9 Pulmonary Thromboembolism 34
Case Study 10 Rheumatic Fever and Rheumatic Case Study 36 Acute Pyogenic Meningitis 168
Heart Disease 39
Case Study 37 Acute Viral Encephalitis 172
Case Study 38 Alzheimer Disease 177
PART 2 ■ RESPIRATORY Case Study 39 Cluster Headache 182
Case Study 40 Complex Partial Seizure 187
Case Study 11 Asbestosis 44 Case Study 41 Generalized Tonic-Clonic Seizure192
Case Study 12 Asthma 49 Case Study 42 Intracranial Neoplasm 197
Case Study 13 Bacterial Pneumonia 54 Case Study 43 Migraine Headache 203
Case Study 14 Chronic Obstructive Pulmonary Case Study 44 Multiple Sclerosis 206
Disease 60 Case Study 45 Parkinson Disease 211
Case Study 15 Cystic Fibrosis 65
Case Study 16 Lung Cancer 71 PART 6 ■ PSYCHIATRIC

PART 3 ■ GASTROINTESTINAL Case Study 46 Attention Deficit/Hyperactivity
Disorder 218
Case Study 17 Acute Pancreatitis 78 Case Study 47 Bipolar Disorder 222
Case Study 48 Generalized Anxiety Disorder 228
Case Study 18 Cirrhosis 83
Case Study 49 Major Depressive Disorder 232
Case Study 19 Colorectal Cancer 88 Case Study 50 Schizophrenia 237
Case Study 20 Constipation 93

PART 7 ■ NEUROENDOCRINE
Case Study 21 Crohn Disease 98 Case Study 51 Addison Disease 244
Case Study 22 Diarrhea 102 Case Study 52 Cushing Syndrome 249
Case Study 23 Esophageal Varices 107 Case Study 53 Diabetes Mellitus, Type 1 253
Case Study 24 Gastric Cancer 111 Case Study 54 Diabetes Mellitus, Type 2 258
Case Study 25 Gastroesophageal Reflux Disease 116 Case Study 55 Hyperparathyroid Disease 265
Case Study 26 Nausea and Vomiting 120 Case Study 56 Hyperprolactinemia 269
Case Study 27 Peptic Ulcer Disease 125 Case Study 57 Hyperthyroid Disease 273




xiii

, CONTENTS
Case Study 58 Hypoparathyroid Disease 278 Case Study 83 Malignant Melanoma 396
Case Study 59 Hypothyroid Disease 282 Case Study 84 Psoriasis 400



PART 8 ■ CHROMOSOME ABNORMALITY
PART 14 ■ DISEASES OF
Case Study 60 Down Syndrome 286
Case Study 85 Acute Lymphoblastic Leukemia 406
Case Study 61 Klinefelter Syndrome 291
Case Study 86 Chronic Myelogenous Leukemia 411
Case Study 62 Turner Syndrome 295
Case Study 87 Folic Acid Deficiency Anemia 416
Case Study 88 Iron Deficiency Anemia 421
Case Study 89 Sickle Cell Anemia 426
PART 9 ■ FEMALE REPRODUCTIVE Case Study 90 Vitamin B12 Deficiency Anemia 431

Case Study 63 Cancer of the Female Breast 300
Case Study 64 Cervicitis 305
Case Study 65 Endometriosis 310 PART 15 ■ DISORDERS OF THE EYES,
Case Study 66 Menopause and Hormone EARS, NOSE, AND THROAT 437
Replacement Therapy 313 Case Study 91 Acute Otitis Media 438
Case Study 67 Ovarian Cancer 318 Case Study 92 Acute Streptococcal Pharyngitis 442
Case Study 68 Pelvic Inflammatory Disease 322 Case Study 93 Allergic Rhinitis 445
Case Study 69 Premenstrual Syndrome 327 Case Study 94 Cataracts 449
Case Study 95 Open-Angle Glaucoma 454

PART 10 ■ MALE REPRODUCTIVE
PART 16 ■ NUTRITIONAL
Case Study 70 Benign Prostatic Hyperplasia 334
Case Study 71 Erectile Dysfunction 340
Case Study 72 Prostate Cancer 345 Case Study 96 Anorexia Nervosa 458
Case Study 73 Prostatitis 348 Case Study 97 Bulimia Nervosa 464
Case Study 74 Testicular Cancer 351
Case Study 98 Obesity 469

PART 11 ■ IMMUNOLOGIC
PART 17 ■ SEXUALLY
TRANSMITTED DISEASES 473
Case Study 75 Acquired Immunodeficiency Case Study 99 Genital Herpes 474
Syndrome 356 Case Study 100 Gonorrhea 479
Case Study 76 Systemic Lupus Erythematosus
362


PART 12 ■ MUSCULOSKELETAL
PART 18 ■ APPENDICES 485
Case Study 77 Gout 366 Appendix A Table of Clinical Reference Values 486
Case Study 78 Osteoarthritis 370 Appendix B Table of Normal Height and Weight in
Case Study 79 Osteoporosis 376 Children Ages 1–18 Years 494
Case Study 80 Rheumatoid Arthritis 382 Appendix C Table of Blood Pressure in Children by
Gender and Age 495
Appendix D Table of Karnovsky Performance Status496
PART 13 ■ DISEASES OF THE SKIN 387 Appendix E Table of Common Medical Abbreviations
Appendix F 497
Table of APGAR Scoring for Newborns 509
Case Study 81 Acne Vulgaris 388 Appendix G Questionnaire of Quality of Life
Case Study 82 Basal Cell Carcinoma 392 in Epilepsy (QOLIE-31) 510

, PART




1
C AR DIOVASCU L AR
DISORDERS

, CASE STUDY 1 ■ A CUTE MY OC AR DIAL I N
FARCTION 3
E

ACUTE MYOCARDIAL
1 INFARCTION




For the Disease Summary for this case study,
see the CD-ROM.


PATI ENT C ASE

Patient’s Chief Complaints
“I’m having pain in my chest and it goes up into my left shoulder and down the
inside of my left arm. I’m also having a hard time catching my breath and I
feel somewhat sick to my stomach.”


History of Present Illness
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort
while playing tennis with a friend. At first he attributed his discomfort to the
heat and having had a large breakfast. Gradually, however, discomfort
intensified to a crushing sensation in the sternal area and the pain seemed to
spread upward into his neck and lower jaw. The nature of the pain did not
seem to change with deep breathing. When Mr. G. complained of feeling nau-
seated and began rubbing his chest, his tennis partner was concerned that his
friend was having a heart attack and called 911 on his cell phone. The patient
was transported to the ED of the nearest hospital and arrived within 30 minutes
of the onset of chest pain. En route to the hospital, the patient was placed on
nasal cannulae and an IV D5W was started. Mr. G. received aspirin (325 mg
po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has
eased slightly in the last 15 minutes but is still significant; was 9/10 in severity;
now 7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He
denies chills.


Past Medical History
• Ulcerative colitis × 22 years
• HTN × 12 years (poorly controlled due to poor patient compliance)
• Type 2 DM × 5 years
• S/P AMI 5 years ago that was treated with cardiac catheterization and PTCA; chronic stable
angina for the past 4 years
• BPH × 2 years
• Hypertriglyceridemia

, CASE STUDY 1 ■ A CUTE MY OC AR DIAL I N
• Adenomatous colonic polyps FARCTION 4



Family History
• Father died from myocardial infarction at age 55, had DM
• Mother died from breast cancer at age 79
• Patient has one sister, age 52, who is alive and well and one brother, age 44, with HTN
• Grandparents “may have had heart disease”


Social History
• 40 pack-year history of cigarette smoking
• Married and lives with wife of 29 years
• Has two grown children with no known medical problems
• Full-time postal worker for 20 years, before that a baker for 8 years
• Occasional alcohol use, average of 2 beers/week
• Has never used street drugs


Review of Systems
Positive for some chest pain with physical activity “on and off for a month or
so,” but the pain always subsided with rest


Allergies
• Meperidine (rash)
• Trimethoprim-sulfamethoxazole (bright red rash and fever)



Medications
• Amlodipine 5 mg po Q AM
• Glyburide 10 mg po Q AM, 5 mg po Q PM
• EC ASA 325 mg po QD
• Gemfibrozil 600 mg po BID
• Sulfasalazine 1.5 g po BID
• Terazosin 1 mg po HS



Physical Examination and Laboratory Tests

General Appearance

The patient is an alert and oriented white male who appears to be his stated age.
He is anx- ious and appears to be in severe acute distress.

Vital Signs

See Patient Case Table 1.1


Patient Case Table 1.1 Vital Signs
BP 160/98 right arm sitting RR 18 HT 5'101⁄2”
P 105 with occasional T 98.2°F WT 184 lbs
premature beat

, CASE STUDY 1 ■ A CUTE MY OC AR DIAL I N
FARCTION 5

Skin

Cool, diaphoretic, and pale without cyanosis


Neck

Supple without thyromegaly, adenopathy, bruits, or jugular venous distension


Head, Eyes, Ears, Nose, and Throat
• Pupils equal at 3 mm, round, responsive to light and accommodation
• Extra-ocular muscles intact
• Fundi benign
• Tympanic membranes intact
• Pharynx clear


Chest and Lungs
• No tenderness with palpation of chest wall
• No dullness with percussion
• Slight bibasilar inspiratory crackles with auscultation
• No wheezes or friction rubs


Cardiac
• Tachycardia with occasional premature beat
• Normal S1 and S2
• No S3, soft S4
• No murmurs or rubs


Abdomen
• Soft and non-tender
• Negative for bruits and organomegaly
• Bowel sounds heard throughout


Musculoskeletal/Extremities
• Normal range of motion throughout
• Muscle strength on right 5/5 UE/LE; on left 4/5 UE, 5/5 LE
• Pulses 2+
• Distinct bruit over left femoral artery
• No pedal edema


Neurological
• Cranial nerves II–XII intact
• Cognition, sensation, gait, and deep tendon reflexes within normal limits
• Negative for Babinski sign



Laboratory Blood Test Results (31⁄2 hours post-AMI)

See Patient Case Table 1.2

, CASE STUDY 1 ■ A CUTE MY OC AR DIAL I N
FARCTION 6

Patient Case Table 1.2 Laboratory Blood Test Results
Na 133 meq/L Mg 1.9 mg/dL CK-MB 6.3 IU/L
K 4.3 meq/L PO4 2.3 mg/dL Troponin I 0.3 ng/mL
Cl 101 meq/L Chol 213 mg/dL Hb 13.9 g/dL
HCO3 22 meq/L Trig 174 mg/dL Hct 43%
BUN 14 mg/dL LDL 143 mg/dL WBC 4,900/mm3
Cr 0.9 mg/dL HDL 34 mg/dL Plt 267,000/mm3
Glu, fasting 264 mg/dL CPK 99 IU/L HbA1c 8.7%



Arterial Blood Gases
• pH 7.42
• PaO2 90 mm
• PaCO2 34 mm
• SaO2 96.5%


Electrocardiogram

4 mm ST segment elevation in leads V2–V6

Chest X-Ray

Bilateral mild pulmonary edema (<10% of lung fields) without pleural disease
or widening of the mediastinum

Clinical Course

Patient history showed no contraindications to thrombolysis. The patient
received IV reteplase, IV heparin, metoprolol, and lisinopril. Approximately
90 minutes after initiation of reteplase therapy, the patient’s chest pain and ST
segment elevations had resolved and both heart rate and blood pressure had
normalized. The patient was stable until two days after admission when he
began to experience chest pain again. Emergency angiography revealed a 95%
obstruction in the left anterior descending coronary artery. No additional
myocardium was at risk—consistent with single-vessel coronary artery disease and
completed AMI. Percutaneous transluminal coronary angioplasty of the vessel
was successfully per- formed, followed by placement of a coronary artery
stent. After the stent was placed, the patient received abciximab infusion.
Ejection fraction by echocardiogram three days post- AMI was 50% and the
patient’s temperature was 99.5°F. The remainder of the patient’s hospital stay
was unremarkable. He was gradually ambulated, physical activity was slowly
increased, and he was discharged eight days post-AMI.



Patient Case Question 1. Cite six risk factors that predisposed this patient to acute myocardial
infarction.
Patient Case Question 2. In which Killip class is this patient’s acute myocardial infarction?
Patient Case Question 3. For which condition is this patient taking amlodipine? Patient
Case Question 4. For which condition is this patient taking glyburide? Patient Case
Question 5. For which condition is this patient taking gemfibrozil? Patient Case Question
6. For which condition is this patient taking sulfasalazine? Patient Case Question 7. For
which condition is this patient taking terazosin?
Patient Case Question 8. Are there any indications that this patient needed oxygen