Exam III Case Studies

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I got a little lazy on some of them and just compied and pasted them from the case study document (like the ones that confused me =/) So feel free to simplify them if you can!

Primary Dysmenorrhea

Sx: Normal vitals, but cramping and back pain. High amounts of endometrium prostaglandin in PAP test.

Patho: More progesterone leads moreprostaglandin F (PGF2α) and leukotrienes. Leads to increased sensitivity of pain fibers and vasopressins and ultimately pain.

Amenorrhea

Sx: Normal vitals, but no breast development and short. Lack of menstrual cycle.

Patho: Compartment III disorder of the anterior pituitary. Low LH, FSH and estrogen.

Polycystic Ovary Syndrome

Sx: Normal vitals, but unable to get pregnant, facial hair, and acne.

Patho: Increased androgen and insulin levels. Increased ovary size. More androgen means more follicle growth. More insulin inhibits apoptosis.

Pre-Menstrual Syndrome

Sx: Slightly high heart rate. Bloating, trouble concentrating, irritable.

Patho: fluctuating estrogen and progesterone levels interact with serotonin, nor-adrenaline, and gamma-aminobutyric acid (GABA). Renin-angiotensin aldosterone system contributes to weight gain. Also hereditary.

Pelvic Inflammatory Disease

Sx: Lower abdominal pain, fever, yellow vaginal discharge with bad odor. Enlarged fallopian tubes. Normal blood work but positive for Gonorrhea.

Patho: Progressed bacterial infection that was sexually transmitted and goes to the columnar mucosal cells in the lower genital tract.

Vaginitis (Trichomoniasis)

Sx: Normal vitals, but Dysuria, fishy yellow vaginal discharge, irritation, slight pain, and burning sensation.

Patho: Alkaline pH in vagina promotes bacterial growth. Candida albicans and glycogen also can increase the risk of growth and virulence.

Ovarian Cancer

Sx: Vaginal bleeding, pain in abdomen and legs. Dyspepsia and vomiting.

Patho: "Silent Killer", No known cause, Inflamed ovaries shown in the MRI. Epithelial form of this cancer is in adults, Germ-cell neoplasm is in children/adolescents.

Testicular cancer

Sx: Swollen lymph nodes. Enlarged testicle. Difficulty swallowing, back/abdominal pain, trouble seeing.

Patho: Increased tumor markers and mass in testicle. Idiopathic. 90% germ-cell. Two types: seminomas(common and not aggressive) and nonseminomas (rare and aggressive) .Risks are genetic predisposition, cryptochordism, and Kleinfeldter's syndrome.

Benign Prostatic Hyperplasia

Sx: Abnormal/painful urination. Slightly high BP.

Patho: Elevated PSA levels. Age and androgen levels increase prostate size. Tissue remodeling will cause local inflammation with altered cytokine, reactive oxygen/nitrogen species, and chemoattractants. The growing cells will increase the demand for oxygen inducing local hypoxia, angiogenesis, and fibroblasts changes.

Prostate Cancer

Sx: Norma vitals, Decreased urinary stream, high fat diet

Patho: Normal PSA but enlarged prostate. Differentiated but oddly shaped cancer cells. Oxidative stress ultimately genetically damages the cells.

Pernicious Anemia

Sx: fatigue, mood swings, stomach pain. Bright yellow skin.

Patho: Low vitamin B12 means less intrinsic factor, This leads to gastric atrophy.

Aplastic anemia (Parvovirus B19)

Sx: SOB, dizzy, pale skin, fever, fatigue, sickle cell disease

Patho: CBC shows low red blood cell levels from bone marrow and can lead to a viral infection.

Hemolytic Anemia

Sx: flu-like symptoms, fever, pale, reddish-brown urine, URI, pronounced facial structures

Patho: IgG autoantibodies against the P blood group antigen in colder portions of the body, like fingers and toes. Cells are destroyed as erythrocyte recirculate and enzymes of the complement cascade are activated.

Thalassemia

Sx: Wide facial features, weakness, elevated BP, no weight gain

Patho: Tachycardia, defect in the synthesis of α- and β- hemoglobin chains due to uncoupling, in which the β-globin chain production is severely depressed. The severe depression is characteristic of a patient who is homozygous and has two recessive alleles. Low β-chain synthesis leads to red blood cells with a decreased amount of hemoglobin and a buildup of free α-chains that precipitate in the cell causing destruction of the erythrocyte by phagocytes while still in the bone marrow.

Infectious mononucleosis

Sx: lymph node swelling, difficulty swallowing, B symptoms, pyrexia and pharyngitis.

Patho: Epstein-Barr virus (EBV), 50% lymphocytes and 10% of atypical lymphocytes in blood, aka 'kissing disease.

Acute Lymphocytic Leukemia (ALL)

Sx: skin discoloration, petechiae and ecchymosis, enlarged lymph nodes, abdominal swelling, difficulty swallowing, fatigue

Patho: transformed precursor B-cells, mostly in children

Chronic Myelogenous Leukemia (CML)

Sx: gouty arthritis, fever, pale, increased heart rate,

Patho: trans-located genes on chromosome 9 and 22, Philadelphia chromosome. Mostly in adults, 3 phases.

Hodgkin Lymphoma

Sx: B symptoms, high body temperature, pruritis, swelling on neck

Patho: Reed-Sternberg cells are present in lymph nodes. B-cell originated

Non-Hodgkin Lymphoma

Sx: leg swelling, swollen femoral lymph nodes, back pain

Patho: mutation on the proto-oncogenes and tumor suppressor genes can occur in B or T cells, natural killer cells and rarely macrophages.

Multiple Myeloma

Sx: Normal vitals, fatigue, weight loss, rib pain, headache followed by blurred vision.

Patho: Increased M protein, Bence Jones protein, malignant plasma cells, osteoclasts are stimulated and cause hypercalcemia and bone lesions.

Thrombocytopenia

Sx: leg pain and swelling

Patho: heparin injections can cause decreased platelet count, IgG complexation initiates coagulation cascade. Positive feedback therefore wastes circulating platelets.

Thrombocythemia

Sx: Normal vitals, burning sensation in feet, headaches, numbness, dizziness, paresthesias

Patho: Elevated platelet count from CBC, hyperplasia in megakaryocyte progenitor cells in the bone marrow, thrombosis can occur.

Disseminated Intravascular Coagulation

Sx: hypoxia, tachypnea, excessive bleeding from the gums and nose, dizzy

Patho: gram-negative endotoxins from bacterial infection, coagulation cascade decreases availability of platelets in blood, severe bleeding can occur,

Deep Vein Thrombosis

Sx: Edema in legs

Patho: Obesity, CHF, and standing for long periods of time leads to thrombus formation. Triad of Virchow promotes this thrombus to grow.

Aneurysm

Sx: Lower back pain, stomach pain

Patho: Smoking/ nicotine/high fat can coat and clog the artery walls with plaque causing atherosclerosis

Hypertension

Sx: dizziness, headache, edema, High BP

Patho: weight, coffee drinking and renal compensation due to long-term NSAID therapy can lead to this. The sympathetic nervous system (SNS) plays an important part in controlling one's blood pressure by maintaining adequate cardiac output. An overactive SNS releases more epinephrine and norepinephrine leading to an elevated heart rate and systemic vasoconstriction. As a result, peripheral resistance increases causing an increase in blood pressure.

Orthostatic Hypotension

Sx: dizziness and blurred vision when standing up.

Patho: physical exhaustion, starvation due to fasting, and probable drug action from antidepressants can cause this. More common in older people. Baroreceptors are sluggish therefore BP maintenance is delayed.

Stable Angina

Sx: High blood pressure, heart disease family history, pallor, diaphoresis, dyspnea, vessel inflammation and thrombosis. Chest pains

Patho: recurrent chest pain resulting from chronic coronary obstruction in myocardial ischemia. More common in men.

Unstable Angina

Sx: High BP, diaphoresis, tachycardia episodes, episodic chest pain.

Patho: acute coronary syndrome that leads to reversible myocardial ischemia. Atherosclerotic plaque leads to periodic episodes of thrombotic vessel occlusion and vasoconstriction at the site of plaque damage.

Myocardial Infarction (STEMI)

Sx: High BP, light headed, high sugar levels, chest pain, heavy breathing, left arm pain

Patho: high levels of troponin differentiates this from unstable angina. Result of prolonged ischemia. Complicated plaques form.

Pericardial Effusion

Sx: Dull chest pain, muffled heart sounds, poor and palpable pulse rate, and dyspnea on exertion. Distention of the jugular veins, edema, and hepatomegaly.

Patho: Effusion with high fluid levels indicates pericardial inflammation This high pressure can cause tamponade.The pressure exerted by the pericardial fluid will eventually equal the diastolic pressure within the heart chambers, preventing right atrial filling.

Aortic Stenosis

Sx: Sever chest pain, loss of consciousness, reduced systolic pressure and heart rate with a faint pulse. Fever, fatigue, weight loss.

Patho: Aortic valve degeneration and narrowing causing diminished blood flow from the left ventricle. hypertrophy develops to compensate for the increased workload. Eventually hypertrophy increases myocardial oxygen demand that the coronary arteries may not be able to supply.

Rheumatic Fever

Sx: SOB, nose bleeds, vomiting, rash, pain in stomach and joints.

Patho: throat culture done to see if she was positive for the group A beta-hemolytic streptococci. Antibodies directed against the M proteins of the streptococci cross reacts with tissue glycoproteins in the heart, joints, CNS, and skin. It causes an abnormal humoral and cell-mediated immune response and the antigens can bind to receptors on cells in the heart, muscle, brain, and synovial joints. Inflammatory lesions will develop in the connective tissues. Overall heart valves will be damaged.

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