Problem
Clinical Case A
Cardiovascular
A 61 year old AAF was admitted to the hospital with a worsening of abdominal pain, upset stomach with heartburn, nausea, and vomiting. The pain and symptoms started 2-3 days ago. The antacid medication made her well until the morning of this day.
Physical examination shows tenderness of the RLQ of the abdomen, but soft and no rebound. An ECG shows numerous abnormal beats and marked deviation of the segment S-T. CPP was positive, showing troponin elevation, cardiac CK (creatine kinase), in addition to elevated blood glucose levels. Shortly after admission, she suffered cardiac arrest and died.
Task
a) What is your diagnosis? Diverticulitis, Appendicitis, etc?
b) How is your diagnosis based on the physical examination and ECG?
c) What do the lab data demonstrate?
d) What has caused the cardiac arrest?
e) Are the starting and course of the disease typical or not? Explain.
f) Is it true that there is a "cardioptosis of old age"? The heart migrates down towards the abdomen with age.
Clinical Case B
RESPIRATORY SYSTEM
Barbara Joley was in the bus that was hit broadside. When she was freed from the wreckage,
she was deeply cyanotic and her respiration had stopped
Her heart was still beating, but her pulse was fast and thready
She had a fracture at the level of the C2 vertebra.
Right thorax compressed; ribs 7 to 9 fractured
Right lung atelectasis
Task
a) What might have happened to cause Barbara's cessation of breathing?
b) What procedures should be initiated immediately by the emergency personnel?
c) Why is she cyanotic?
d) Why only the right lung is affected by atelectasis?
e) What is the mechanism of atelectasis?
f) What treatment will be done to reverse the atelectasis?