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Pathology

Terms in this set (533)

3918.13

A 78-year-old man is brought to the hospital from a nursing home by paramedics. The patient has been complaining of pain and has been clutching his left lower abdomen since this morning. His temperature was measured at 101.3°F (38.5°C) at the nursing home. The paramedics state that his nursing home attendant reported that the patient has been "more constipated than usual" for 2 days; his last normal bowel movement was more than 2 days ago. The attendant stated that the patient "is always constipated; it's just worse than usual now." The attendant was unable to recall the date of the patient's last colonoscopy, and the doctor at the nursing home was unavailable to speak to the paramedics to provide this information before they left.
The patient's medical history is significant for severe Alzheimer dementia, hypertension, hyperlipidemia, diabetes mellitus, and peripheral vascular disease. He also has a recent history of painless rectal bleeding, evaluated by the nursing home physician. The patient takes memantine, donepezil, lisinopril, and atorvastatin; he is also given insulin injections. His surgical history is significant for below-the-knee amputation of his right limb 5 years ago and bilateral cataract removal 2 years ago. Physical examination of the abdomen reveals hypoactive bowel sounds and exquisite tenderness to palpation in the left lower quadrant with involuntary guarding. His abdomen is soft. The result of a guaiac test is positive. Laboratory tests reveal the following:

RBC count: 5 million/mm3
Hematocrit: 36%
Hemoglobin: 12 g/dL
WBC count: 16,000/mm3
Mean corpuscular volume: 75 fL

A computed tomography (CT) scan is performed with IV contrast and a very small amount of oral contrast (patient was unable to drink the quantity required), and a diagnosis is made.


What is the next diagnostic step after the patient's condition has been stabilized?
1665.22

A 34-year-old woman visits the physician because of progressive shortness of breath of several years' duration. She says that she has not been able to walk to work as she did previously because of the increased shortness of breath and fatigue she experiences while walking. The patient reveals that she occasionally smokes cigarettes during social gatherings. She drinks one to two cans of beer every weekend. She has no history of illicit or recreational drug use. She has never traveled outside of the United States and works as a secretary at an auditing firm. Her mother is healthy, and her father recently died from liver complications. On physical examination, the patient appears alert and oriented and is in no apparent distress. She has a plethoric face and palmar erythema on both hands. Pulse is is 84/min, blood pressure is 135/78 mm Hg, respiratory rate is 21/min, and temperature is 36.5°C (97.7°F). She is using accessory muscles during respiration. Lung auscultation reveals hyperresonance to percussion, and diffuse wheezes are heard during expiration. The patient is given a combination nebulizer treatment of albuterol and ipratropium with only modest relief of symptoms. Laboratory test results are as follows:

WBC count: 8600/mm3
Hemoglobin: 13.3 g/dL
Hematocrit: 39%
Platelets: 250,000/mm3
Alanine aminotransferase 139 U/L (nl 7-55)
Aspartate aminotransferase 125 U/L (nl 8-48)
Alkaline phosphatase 55 U/L (nl 45-115)

A chest x-ray is obtained, and a similar image is shown.

Which of the following parts of the respiratory pathway is most affected by this patient's disease?