MNP6103 CASE STUDIES PART ONE:
Answer the following questions related to several cases presentations, and in each case give rationales for your answers. Provide references after each case to back up your answers. References should be up to date and evidence based. Websites will not be acceptable.
MNP6103 Case Studies Part One Assignment-Edith Cowan University Australia.
1.A 55-year-old businessman presents to the emergency department with altered vision and a headache. He has been told for 10 years that his blood pressure is ‘borderline’ and, although treatment has been suggested, he has declined medications. He drinks 6 standard alcoholic drinks per night, every night of the week. Which of the following features suggests that he has a hypertensive emergency?
A A reading of 180/110 mm
B Chronic pancreatitis
C Peptic ulceration
D Protein-losing enteropathy
E Gastritis
3.A 42-year-old woman is referred with uncomfortable abdominal fullness which has been present for 6 weeks. She is alcohol-dependent, drinking 100 g of alcohol daily for the past 12 years. Her background medical history is positive for diabetes mellitus and thyroid disease, and she takes metformin as well as thyroxine. She has significant family history and denies intravenous drug use. On examination her blood pressure is 110/80 mmHg with a pulse rate of 80 beats/min. She has scleral icterus and spider nevi across the precordium. The abdomen is distended, with 8 cm shifting dullness. There is no palpable hepatomegaly or splenomegaly- Blood tests reveal thrombocytopenia and an elevated bilirubin level of 76 micro mol/L (reference range [RR] 3-15). Her coagulation profile is abnormal with an INR (international normalized ratio) of 2.0. There is mild transaminitis. The creatinine is 280 micro mol/L (RR 45-85). An abdominal ultrasound confirms the presence of ascites. The liver has increased echotexture and is small. No portal or hepatic vein obstruction is seen. What is the next most appropriate step in management?
MNP6103 Case Studies Part One Assignment-Edith Cowan University Australia.
A. Perform a diagnostic paracentesis.
B. Commence ceftriaxone intravenously and give intravenous albumin.
C. Commence fluid restriction along with frusemide and spironolactone.
D Perform urinary electrolyte analysis.
E Arrange transjugular intrahepatic shunting (TIPS)
4.A 70-ysar-old woman presents to her family physician for an annual health check. Routine full blood count reveals hemoglobin 125 g/L (reference range [RR] 115-165), white cell count 23.5 x lo9/L (RR 4.0-11.0) with differential of neutrophils 7.0 x 109/L (RR 2.0-7.5), lymphocytes 15.0 x 109/L (RR 1.5-4.0), normal numbers of monocytes, eosinophils and basophils, and platelets 395 x 109/L (RR150-400). Blood film findings report the presence of ‘smear cells’. She has no particular symptoms. Clinical examination does not identify any lymphadenopathy or hepatosplenomegaly- Routine biochemical tests, including lactate dehydrogenase, are within normal limits. Which of the following is the best next in her management?
A. Request serological evidence for infectious mononucleosis.
B. Arrange for bone marrow biopsy to confirm lymphoma/leukemia.
C. Verify the presence of abdominal lymphadenopathy by computed tomography (CT).
D. Request peripheral blood flow cytometry
E. Arrange a time to discuss chemotherapy options.
MNP6103 Case Studies Part One Assignment-Edith Cowan University Australia.
5.A 70 year-old man presents with pleuritic chest pain and shortness of breath developing after 90 minute flight. He has symptoms of dry cough and runny nose without fevers in the preceding 3 days. He had partial colectomy for cancer 2 years ago and is currently on chemotherapy for new hepatic metastasis. He has complained of a sore right calf for the past week but attributed it to his cycling sessions on a stationary bike at home which he has commenced to remain fit while on chemotherapy- He is known to have prior smoking- related chronic obstructive pulmonary disease (COPD) requiring bronchodilator therapy. Clinical examination reveals a swollen right calf with mild pedal edema, mild wheeze, a pulse rate of 100/min (regular) and normal blood pressure. Which of the following is the most correct statement?
MNP6103 Case Studies Part One Assignment-Edith Cowan University Australia.
A pulmonary embolism is likely, caused by his plane flight.
B pulmonary embolism is likely, provoked by his malignancy
C pneumothorax is likely, due to the COPD and the plane flight.
D Respiratory tract infection is the most likely explanation for his pleuritic pain and preceding cough.
E Pre-test probability for venous thromboembolism is low, and another diagnosis such as lung metastasis should be considered.
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