Ms. Camel is a 39 year old woman who’s
husband brought her to the emergency room because she passed out at the
office. Her husband explained that they had just had a three course lunch,
including 2 martini’s and a bottle of red wine. They each had a house salad,
a 16 ounce prime rib of beef, a baked potato with sour cream and creamed
corn. For dessert they shared a crème brulee and cheese cake.
They were celebrating their fourth wedding anniversary. Additionally, Ms.
Camel had told her husband that she was one month pregnant. When Mr. Camel
dropped his wife at her office, she had forgotten her briefcase. He parked
the car and walked to her office. When he arrived she was lying on the
floor next to her desk. Her assistant had called an ambulance. By
the time the ambulance arrived Ms. Camel was conscious. She complained
of chest pains radiating down her left arm. She said that her gallbladder
was probably flaring up from the big lunch. She asked her husband for some
tums. Her complexion was bluish and she was sweating profusely. The EMT
administered nitroglycerin, which relieved her pain immediately. Ms. Camel
said that she would be OK, but her husband insisted that she go to the
emergency room to be checked out.
Dr. Finali was on call that day. Before
entering the examining room, he checked Ms. Camel’s vital signs as recorded
by the EMT and ER nurse on admission.
Blood Pressure 160/110 mm Hg
Heart Rate 98 b/min
EKG: prolonged P-R interval, intermittent
PVC’s
Edema: hands, legs and feet
Height: 5’3" Weight: 175 pounds
|
Dr. Finali began his exam by asking Ms.
Camel how she was feeling. She says that she has numbness in her left arm.
Dr. Finali notes that her left eye and let side of her mouth are drooping.
Ms. Camel said that she has been short of breath lately. She used to climb
the stairs at work, but she can no longer make it to the second floor without
stopping a couple of times. She has begun to rely on the elevator. Her
husband adds that she has an annoying cough in the morning. After she wakes
up, she coughs until she spits up blood. This has happened for the past
two weeks. Mr. Camel adds that he has tried to get her to stop smoking,
but she still smokes 2 packs of cigarettes a day. Ms. Camel explains that
she has smoked cigarettes since she was 14 years old, and that they relax
her. Every time she tries to quit smoking, she gains another 10 pounds.
At this point, she’d rather continue smoking. Dr. Finali uses a stethoscope
and asks Ms. Camel to take a deep breath. When she does, she complains
of chest pain. She presses against her chest to relieve the pain. She coughs
so hard that sputum is expelled. Dr. Finali sends the sputum away for culture
and sensitivity (C&S) testing as well as general cytology. Percussion
of the chest revealed sounds with increased resonance.
Dr. Finali asks Ms. Camel if she has had
any surgery in her lifetime. Ms. Camel explains that she underwent a "D
and C" procedure following a spontaneous abortion in the first trimester
of her pregnancy. This was three months ago. She and her husband were thrilled
that she was pregnant again. They had been trying to become pregnant for
the past two years, but couldn’t. Ms. Camel had a laparoscopy and endoscopic
surgery to remove endometriosis from her abdominal cavity and uterus one
year ago. Dr. Finali asks if she has been to her Obstetrician for an initial
pregnancy visit. Ms. Camel says that she has an appointment for the next
day.
Dr. Finali admits Ms. Camel for observation.
Additionally, Dr. Finali prescribes a series of tests. Test results for
Ms. Camel. All tests completed within 1 hour of admission to the
hospital.
C&S test no pathogenic bacteria
found in sputum
Cytology of sputum malignant cells
found
Alpha1-antitrypsin determination
35 mg/dl
Arterial Blood gases
PO2 60 mmHg
PCO2 60 mmHg
pH 7.20
CBC Results
RBC count 3.0 million/mm3
Hemoglobin 10 g/dl
Hematocrit 30%
RBC Indices
Mean Corpuscular Volume 85 um3
Mean Corpuscular Hemoglobin Concentration
28%
WBC count 20,000/mm3
Differential WBC count - Normal
Platelet count 250,000/mm3
Serum Bilirubin 1.0 mg/dl
CPK (creatine phosphokinase) Normal
CK-MM Normal
CK-MB Normal
CK-BB Normal
SGOT (aspartate aminotransferase) 30 U/I
LDH (lactate dehydrogenase) 55 U/I
Serum cholesterol: 280 mg/dl
Serum triglycerides: 180 mg/dl
Serum lipoproteins
HDL: 27 mg/dl
LDL: 200 mg/dl
Serum Electrolytes
Sodium 175 mEq/l
Potassium 2.5 mEq/l
Urinalysis
pH: 4.5
Glucose: trace
Protein: positive
Blood: negative
Ketones: negative
hCG: positive
|
|
What
do you need to do . . . .
How would you proceed if you were Dr.
Finali?
Explain the anatomical and physiological
aspects of Ms. Camel’s symptoms. Be sure to cover each system of the body
that is affected. Your analysis may lead to several diagnoses, but be sure
to support your decisions and explanations with valid reasoning.
You may suggest further tests or further questioning of the patient and
the husband.
E-mail your responses directly to Dr.
Henry on or before midnight on Wednesday, April 14th.
|
|
On-line Activity #12
