Problem 1: A 92-year-old male presented to the urgent care clinic complaining that "something doesn't seem right in my head." The nurse noticed that he was struggling to find words and was becoming frustrated about it. The physician concluded that he was suffering from a transient ischemic attack with aphasia. He was admitted for observation at the local hospital, where within 24 hours his language problem gradually improved, and he was discharged home.
a. When the patient had trouble speaking, which side of his cerebrum was likely affected?
b. Though the patient showed no signs of dementia during this episode, he had trouble with language. What is the name of this condition?
c. What about this condition makes the diagnosis of TIA correct, rather than CVA?
d. Is this patient at risk for a future cerebrovascular accident? Why?
Problem 2: A 5-year-old boy has chronic bilateral otitis media. The decision is made to insert tubes in his ears.
a. Is this procedure a myringotomy, a tympanostomy or tympanoplasty?
b. How will the procedure help resolve the patient's condition?
Problem 3: A mother brings her 10-year-old daughter to the pediatrician because the child has been complaining of ear pain for two days accompanied by fever, and home remedies are not giving any relief. On examination, the physician notes a discharge from the girl's ear. A CT scan shows a swollen mastoid bone.
a. What is his diagnosis?
b. Which categories of medications would the physician order to treat this condition?
Problem 4: A 38-year-old female presents to her physician's office after she felt a lump in her breast. She is in apparent good health otherwise; does not smoke and drinks only socially. She gives a family history that her parents and two sisters are all living and in good health. Her grandparents are deceased, none from cancer. On examination, the physician identifies a mobile, nontender mass about 2 cm in diameter in the upper outer quadrant of the left breast. He finds no abnormalities in her right breast, nor could he palpitate axillary lymph nodes on either side. A mammogram showed a 2 cm mass suspicious for carcinoma. The patient was referred to a surgeon for a needle biopsy. The needle biopsy revealed "poorly differentiated invasive carcinoma." A lumpectomy and a sentinel lymph node biopsy were performed the following week and confirmed the original diagnosis. Tumor cells were negative for estrogen and progesterone receptors. In the sentinel node specimen, two of the three lymph nodes were metastatic. A bone scan and chest X-ray were negative for distant metastasis.
a. Why is it significant to know if there is a family history of cancer?
b. What kind of surgery is a lumpectomy?
c. What is a sentinel node biopsy and why is it done?
d. Why is it important to know that the tumor cells were negative for the hormones estrogen and progesterone?
e. Has the cancer spread? How do you know?