Case Study 1: GERD with Persistent Symptoms Despite Lifestyle Modifications
Case:
Michael, a 48-year-old male, has a 3-year history of GERD. Despite adhering to lifestyle
changes, including elevating his bed, eating smaller meals, and avoiding trigger foods, he
continues to experience frequent heartburn and regurgitation. He takes over-the-counter antacids
but reports breakthrough symptoms.
Key Questions:
1. What additional diagnostic steps should be considered for Michael, given his persistent
symptoms?
a. Evaluate medication effectiveness and treatment plan adherence. Is
the medication being taken before meals?
b. Inconsistent timing can result in breakthrough symptoms
2. How do proton pump inhibitors (PPIs) work, and what factors influence their
effectiveness?
a. Through reducing gastric acid production
b. Promotes healing in the esophageal mucosa
3. When should an endoscopy be recommended in GERD management?
a. If PPI/ Lifestyle modification is not effective
b. Endoscopy : used to allow direct visualization of the esophagus and
stomach
Case Study 2: Complications of Peptic Ulcer Disease
Case:
Sara, a 55-year-old woman, presents with burning epigastric pain that worsens after meals. She
uses NSAIDs regularly for arthritis. Labs reveal H. pylori infection. Despite starting treatment,
she develops signs of anemia, including fatigue and pallor.
Key Questions:
1. What is the difference between a gastric and duodenal ulcer in terms of pathophysiology
and symptoms?
a. Gastric occurs in the gastric mucosa, s/s are similar
b. Duodenal occurs in duodenal bulb/ mucosa, Nocturnal pain, goes
away with eating and returns 2-3 hrs later
2. How do NSAIDs contribute to ulcer formation?
a. Decreases prostaglandin production, and weakens mucosal defenses
3. What steps should be taken if complications such as anemia or perforation are suspected?
a. Anemia : CBC, CMP ,occult stool – endoscopy
b. Perforation : assessment, npo, fluid resuscitation, IV abx
,Case Study 3: Appendicitis with Atypical Presentation
Case:
Andrew, a 30-year-old male, presents with nausea, vomiting, and vague abdominal pain.
Initially, the pain was diffuse but has now localized to the right lower quadrant. He has a low-
grade fever and mild leukocytosis on labs.
Key Questions:
1. How does the pathophysiology of appendicitis progress from obstruction to perforation?
a. Obstruction leads to perforation when there is an increase of
intraluminal pressure
1. Mucus + fluid accumulation
b. Compromised blood flow/ ischemia occurs
c. Ischemia causes inflammation , leads to decrease
2. What is the role of imaging in diagnosing appendicitis, and when is it essential?
1. Atypical presentation
2. Peds/ geriatric paints
3. Pregnant patients
4. Obese patients
3. How would you manage a case of perforated appendicitis?
1. Surgical intervention
2. Sepsis prevention
3. Minimize complication
Case Study 4: Managing Ascites in Cirrhosis
Case:
Maria, a 62-year-old woman with a history of alcohol-related cirrhosis, presents with increased
abdominal girth and shortness of breath. On examination, there is a fluid wave. Paracentesis
confirms the presence of ascitic fluid with no evidence of infection.
Key Questions:
1. What is the underlying mechanism of ascites in cirrhosis?
a. Occurs due to portal hptn, causing increased hydrostatic pressure in
the peritoneal cavity
b. complex hemodynamic and hormonal
disturbances primarily due to portal
hypertension and hypoalbuminemia.
, 2. How do sodium restriction and diuretics alleviate symptoms?Spironalactone
a. Decrease fluid retention in the peritoneal cavity by targeting sodium and
water retention mechanisms
b. Restore fluid balance, and alleviate abdominal distension, and discomfort
3. When is large-volume paracentesis indicated, and what precautions should be taken
during the procedure?
a. Indicated in severe cases
b. remove ascitic fluid from the peritoneal cavity in patients with symptomatic or
refractory ascites, especially in advanced cirrhosis. According to McCance &
Huether (2022) and current clinical practice guidelines, LVP provides rapid relief
of abdominal distension, dyspnea, and early satiety.
Case Study 5: Generalized Anxiety Disorder (GAD)
Case:
Emily, a 35-year-old teacher, reports constant worry about her performance at work. She
experiences fatigue, muscle tension, and difficulty concentrating. Symptoms have persisted for 8
months, and she describes them as debilitating.
Key Questions:
1. How does the imbalance of norepinephrine and serotonin contribute to GAD?
2. What is the rationale for using SSRIs in GAD management?
3. What role do non-pharmacologic treatments like cognitive-behavioral therapy play in
GAD?
Case Study 6: Graves’ Disease and Hyperthyroidism
Case:
Sophia, a 28-year-old woman, presents with a tremor, weight loss, and heat intolerance. She has
a visibly enlarged thyroid and exophthalmos. Labs reveal suppressed TSH and elevated free T4.
Key Questions:
1. How do autoantibodies in Graves’ disease lead to hyperthyroidism?
2. What are the first-line treatments for hyperthyroidism, and when is radioiodine therapy
indicated?
3. What are the complications of untreated Graves’ disease?
Case:
Michael, a 48-year-old male, has a 3-year history of GERD. Despite adhering to lifestyle
changes, including elevating his bed, eating smaller meals, and avoiding trigger foods, he
continues to experience frequent heartburn and regurgitation. He takes over-the-counter antacids
but reports breakthrough symptoms.
Key Questions:
1. What additional diagnostic steps should be considered for Michael, given his persistent
symptoms?
a. Evaluate medication effectiveness and treatment plan adherence. Is
the medication being taken before meals?
b. Inconsistent timing can result in breakthrough symptoms
2. How do proton pump inhibitors (PPIs) work, and what factors influence their
effectiveness?
a. Through reducing gastric acid production
b. Promotes healing in the esophageal mucosa
3. When should an endoscopy be recommended in GERD management?
a. If PPI/ Lifestyle modification is not effective
b. Endoscopy : used to allow direct visualization of the esophagus and
stomach
Case Study 2: Complications of Peptic Ulcer Disease
Case:
Sara, a 55-year-old woman, presents with burning epigastric pain that worsens after meals. She
uses NSAIDs regularly for arthritis. Labs reveal H. pylori infection. Despite starting treatment,
she develops signs of anemia, including fatigue and pallor.
Key Questions:
1. What is the difference between a gastric and duodenal ulcer in terms of pathophysiology
and symptoms?
a. Gastric occurs in the gastric mucosa, s/s are similar
b. Duodenal occurs in duodenal bulb/ mucosa, Nocturnal pain, goes
away with eating and returns 2-3 hrs later
2. How do NSAIDs contribute to ulcer formation?
a. Decreases prostaglandin production, and weakens mucosal defenses
3. What steps should be taken if complications such as anemia or perforation are suspected?
a. Anemia : CBC, CMP ,occult stool – endoscopy
b. Perforation : assessment, npo, fluid resuscitation, IV abx
,Case Study 3: Appendicitis with Atypical Presentation
Case:
Andrew, a 30-year-old male, presents with nausea, vomiting, and vague abdominal pain.
Initially, the pain was diffuse but has now localized to the right lower quadrant. He has a low-
grade fever and mild leukocytosis on labs.
Key Questions:
1. How does the pathophysiology of appendicitis progress from obstruction to perforation?
a. Obstruction leads to perforation when there is an increase of
intraluminal pressure
1. Mucus + fluid accumulation
b. Compromised blood flow/ ischemia occurs
c. Ischemia causes inflammation , leads to decrease
2. What is the role of imaging in diagnosing appendicitis, and when is it essential?
1. Atypical presentation
2. Peds/ geriatric paints
3. Pregnant patients
4. Obese patients
3. How would you manage a case of perforated appendicitis?
1. Surgical intervention
2. Sepsis prevention
3. Minimize complication
Case Study 4: Managing Ascites in Cirrhosis
Case:
Maria, a 62-year-old woman with a history of alcohol-related cirrhosis, presents with increased
abdominal girth and shortness of breath. On examination, there is a fluid wave. Paracentesis
confirms the presence of ascitic fluid with no evidence of infection.
Key Questions:
1. What is the underlying mechanism of ascites in cirrhosis?
a. Occurs due to portal hptn, causing increased hydrostatic pressure in
the peritoneal cavity
b. complex hemodynamic and hormonal
disturbances primarily due to portal
hypertension and hypoalbuminemia.
, 2. How do sodium restriction and diuretics alleviate symptoms?Spironalactone
a. Decrease fluid retention in the peritoneal cavity by targeting sodium and
water retention mechanisms
b. Restore fluid balance, and alleviate abdominal distension, and discomfort
3. When is large-volume paracentesis indicated, and what precautions should be taken
during the procedure?
a. Indicated in severe cases
b. remove ascitic fluid from the peritoneal cavity in patients with symptomatic or
refractory ascites, especially in advanced cirrhosis. According to McCance &
Huether (2022) and current clinical practice guidelines, LVP provides rapid relief
of abdominal distension, dyspnea, and early satiety.
Case Study 5: Generalized Anxiety Disorder (GAD)
Case:
Emily, a 35-year-old teacher, reports constant worry about her performance at work. She
experiences fatigue, muscle tension, and difficulty concentrating. Symptoms have persisted for 8
months, and she describes them as debilitating.
Key Questions:
1. How does the imbalance of norepinephrine and serotonin contribute to GAD?
2. What is the rationale for using SSRIs in GAD management?
3. What role do non-pharmacologic treatments like cognitive-behavioral therapy play in
GAD?
Case Study 6: Graves’ Disease and Hyperthyroidism
Case:
Sophia, a 28-year-old woman, presents with a tremor, weight loss, and heat intolerance. She has
a visibly enlarged thyroid and exophthalmos. Labs reveal suppressed TSH and elevated free T4.
Key Questions:
1. How do autoantibodies in Graves’ disease lead to hyperthyroidism?
2. What are the first-line treatments for hyperthyroidism, and when is radioiodine therapy
indicated?
3. What are the complications of untreated Graves’ disease?
