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Tony is a 56-year-old, Hispanic male that presented to the Emergency Room with complaints of shortness of breath, which he has been experiencing for the past two days. He states “I haven’t felt good for about a week, but couldn’t afford to miss work.” He complains of a cough, fever, and feeling exhausted. Past medical history includes asthma, chronic obstructive pulmonary disease and diabetes. Upon physical examination, you notice that Tony is struggling to breathe, his respiratory rate is 36 breaths per minute and labored, heart rate 115 beats per minute, blood pressure 90/40 mm Hg, and his pulse oximetry is 84% on room air. You notify the MD. He orders oxygen at 2 L via NC and an arterial blood gas.
Tony’s ABG results:
pH 7.28
PaCO2 – 55 mm Hg
PaO2 – 70 mm Hg
HCO3 – 30 mEq/L
1)Determine Tony’s acid-base imbalance and Describe possible causes of the imbalance
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- Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time, he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough, hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years but quit 3 years ago. The ABG analysis of Mr. H suggests uncompensated respiratory alkalosis with mild hypoxemia, with base excess of -1 in her arterial side, whereas -4 in her venous side. Part 1: Her actual arterial-venous oxygen content difference (Ca-vO2) is 5.31 mL/dL. (Normal range considered here is 3.5 to 5 mL/dL) Part 2: Patient's actual oxygen extraction ratio (O2ER) was 29%. (Say normal range is 20-28%) What is clinically happening to the patient?Mr. Abgenyegah is a 49-year-old man, married man with only one child, a male. He is in the hospital with fever, a three months old cough, which is productive with brownish phlegm, this according to him has resulted in some challenge in breathing. He initially tries some antibiotics and some cough syrup but does not remember its names, he experiences night sweats and has recently realize that he has to increase his belt hole one step tighter to fit. He said he has once had a bad itch when he took Augmentin 4 years ago (i) Which organ system(s) could be involved in this presenting complain and why? (ii) What other questions would you ask to help you have a working diagnosis (iii) What investigations can you think of as a helpful tool in helping you arrive at a diagnosis (iv) Re- write the above history in a structured manner (v) What is your likely diagnosis? (vi) What will be your holistic advice to the patient?A 4-year-old boy has massive nosebleeds, post-traumatic inflammations of the knee and elbow joints, extensive hematomas. After the examination, the diagnosis "Hemophilia" was made. Questions: 1. What type of hemostasis is disrupted in hemophilia? 2. What the other kind of hemostasis do you know? 3. Indicate the causes of hemostasis.
- A lethargic 22-month old black female was presented by her mother to the emergency room at 2:15am on a Sunday. The child had a history of a runny nose, hoarse cough and low-grade fever (-99F) for the past 48 hours. The mother was concerned about the forced and noisy breathing of the child. The pediatrician examined the child and found cloudy eyes and mild inflammation of the ears, but no overt signs of bacterial infection (no significant changes in the eardrums). The throat of the child was red and coated with mucus. The larynx was swollen and raw. The physician performed a rapid Strep test and found it was negative. Throat swabs were taken for culture. The physician placed the child in a room with a warm vaporizer for about 30 minutes. This dramatically improved the breathing of the child. 1. What is the infectious agent that caused this case? 2. Do you believe that this is a bacterial or viral disease? Why? 3. What further treatment is indicated for this case?Mary Brown [MB] is a healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, her vital signs: heart rate (HR), 118 beats/min; blood pressure (BP), 110/60 mm Hg; oral temperature, 37°C; and respiratory rate (RR), 26 breaths/min. Her skin, conjunctiva and nail beds are pale. Laboratory results: hematocrit (Hct), 27%; hemoglobin (Hb), 9 g/dL and hypochromatic red blood cells (RBCs) are present. What other history data would be helpful in determining the cause of this disorder?Mary Brown [MB] is a healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, her vital signs: heart rate (HR), 118 beats/min; blood pressure (BP), 110/60 mm Hg; oral temperature, 37°C; and respiratory rate (RR), 26 breaths/min. Her skin, conjunctiva and nail beds are pale. Laboratory results: hematocrit (Hct), 27%; hemoglobin (Hb), 9 g/dL and hypochromatic red blood cells (RBCs) are present. Which of MB’s clinical signs are reflective of the body’s effort to compensate for the decreased oxygen carrying capacity seen with this condition?
- Mary Brown [MB] is a healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, her vital signs: heart rate (HR), 118 beats/min; blood pressure (BP), 110/60 mm Hg; oral temperature, 37°C; and respiratory rate (RR), 26 breaths/min. Her skin, conjunctiva and nail beds are pale. Laboratory results: hematocrit (Hct), 27%; hemoglobin (Hb), 9 g/dL and hypochromatic red blood cells (RBCs) are present. What type of hematologic disorder would you suspect based on MB’s laboratory values? Why?Mary Brown [MB] is a healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, her vital signs: heart rate (HR), 118 beats/min; blood pressure (BP), 110/60 mm Hg; oral temperature, 37°C; and respiratory rate (RR), 26 breaths/min. Her skin, conjunctiva and nail beds are pale. Laboratory results: hematocrit (Hct), 27%; hemoglobin (Hb), 9 g/dL and hypochromatic red blood cells (RBCs) are present. MB is counseled to increase her dietary intake of iron-containing foods. What kinds of food would be recommended?Please give an explanation on the answer that was picked. Thank You. A mother brings her 20-month-old son to the pediatrician. She suspects that he has a sinus infection. During the visit, the mother voices her concern that her son has been having frequent infections since he was around 6 months old. She states that he recovers only briefly before he has another ear infection, sinus infection, or even pneumonia. The pediatrician reviews the chart and acknowledges to the mother that her son has had more infections than the average child. 1. The pediatrician orders laboratory analysis targeted at an immunodeficiency diagnosis. Which of the following tests would be most beneficial in diagnosing this patient? A). Red blood cell count B). Immunoglobulin levels C). Metabolic panel D). Gram stain and culture 2. The child’s IgG, IgM, and IgA levels are very low, indicating a lack of immunoglobulins. Taking into account the child's age and sex, which primary immunodeficiency is most likely?…
- What is a pneumothorax? Provide a brief definition, no more than one paragraph.J.W. is a 15-year-old high school student who is in the clinic for a sports physical prior to beginning football practice. He has no known significant medical history, takes no medications, and has no allergies. J.W. states “I get really winded, really easily and it’s embarrassing. Sometimes, I get so winded that I feel dizzy and like I want to throw up. The other guys on the team don’t have that problem.” He attributes this to needing to get into better physical condition. The physical exam is unremarkable except for a grade III systolic murmur heard over the entire precordium. Select a potential diagnosis for J.W. and describe the pathophysiology of that diagnosis. How does the pathophysiology explain J.W.’s reported symptoms and physical exam findings?Clinical history: A 52-year-old homeless, alcoholic man had a fever and a cough productive of thick sputum that worsened over several days. His temperature is 38.2°C. Diffuse crackles are heard at the right lung base. Laboratory studies are as follows: hemoglobin: 13.3 g/dL, hematocrit: 40%, platelet count: 291,8000/mm3, WBC count: 13,240/mm3with 71 segmented neutrophils, 7% bands, 16% lymphocytes, and 6% monocytes. Sputum sample stain photo. What technique would you use to put the sputum sample on the slide? How would you stain the slide? What PPE should you have on while working in the lab? When noting the results above, what would be the correct way to report the results? Looking at the stain, what microbe might be the causative agent? No references, just homework Please include references
