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Physio block 1 case studies

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Physio block 1 case studies

Olutunmise Ebunl 191

Name: Olutunmise Ebunlomo

Done: 7/7 Your last selection: Question #: 1. A 75-year-old man is brought to hospital with an episode of dizziness. He still feels unwell when he is seen 30 min after the onset. He was well until the last 6 months, since when he has had some falls, irregularly. On some occasions he lost consciousness and is unsure how long he has been unconscious. On a few occasions he has fallen, grazing his knees,and on others he has felt dizzy and has had to sit down but has not lost consciousness. These episodes usually happened on exertion, but once or twice they have occurred while sitting down. He recovers over 1015 min after each episode. He lives alone and most of the episodes have not been witnessed. Once his granddaughter was with him when he blacked out. Worried, she called an ambulance. He looked so pale and still that she thought that he had died. He was taken to hospital, by which time he had recovered completely and was discharged and told that he had a normal electrocardiogram (ECG) and chest X-ray. There is no history of chest pain or palpitations. He has had gout and some urinary frequency. A diagnosis of benign prostatic hypertrophy has been made for which he is on no treatment. He takes ibuprofen occasionally for the gout. He stopped smoking 5 years ago. He drinks 510 units of alcohol weekly. The dizziness and blackouts have not been associated with alcohol. There is no relevant family history. He used to work as an electrician. Examination He is pale with a blood pressure of 96/64 mmHg. The pulse rate is 33/min, regular. There are no heart murmurs. The jugular venous pressure is raised 3 cm with occasional rises. There is no leg oedema; the peripheral pulses are palpable except for the left dorsalis pedis. The respiratory system is normal.

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The blood pressure and pulse rate of this man show s he is suffering from a first de This is confirmed by the ECG above. The PR interval here is roughly 0.3 sec.

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2. History A 43-year-old woman presents to her general practitioner (GP) complaining of diplopia,more marked in the evenings, for the last 3 months. She has noticed difficulty holding her head up, again especially in the evenings. She has problems finishing a meal because of difficulty chewing. Her husband and friends have noticed that her voice has become quieter. She has lost about 3 kg in weight in the past 6 months. The woman has had no significant previous medical illnesses. She

lives with her husband and three children. She is a non-smoker and drinks about 15 units of alcohol per week. She is taking no regular medication. Examination She looks well, and examination of the cardiovascular, respiratory and abdominal systems is normal. Power in all muscle groups is grossly normal but seems to decrease after testing a movement repetitively. Tone, coordination, reflexes and sensation are normal. Bilateral ptosis is present and is exacerbated by prolonged upward gaze. Pupillary reflexes, eye movements and funduscopy are normal.

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This w oman is suffering from Myasthemia gravis. The sympptoms described above The hallmark of M.G is fatigueabbility. The muscles that control eye and eyelid move The muscles that control breathing, and neck and limb movement can also be affect This w as confirmed in this case by asking her to guaze upw ard and sidew ard for 3

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3. Two teenagers, Adam and Ben, are involved in an automobile accident and both suffer significant blood loss. They are taken to the nearest trauma center. Adam has a Pa of 55 mmHg , a pulse pressure of 20 mmHg and a heart rate of 120 beats/min. He is anxious but alert, has a slightly decreased urine output and cool pale skin. Ben has a Pa of 40mmHg a barely measurable pulse pressure and a heart rate of 160 beats/min. He is comatose has no urine output and is cold and cyanotic. Adam is treated by stopping the bleeding and administered Ringers lactate solution intravenously and a blood transfusion. The physicians are prepared to administer a positive inotropic agent but find it unnecessary since Adam shows improvement. During the next 5 hours Adams Pa increases back to normal and his heart rate simultaneously decreases to a normal value of 75 beats/min. His skin gradually warms and the normal pink color returns. Ben is treated in the same way as Adam but despite the physicians efforts, he dies.

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Adam Pa= 55mmHg Pulse pressure= 20mmHg Heart rate= 120beats/min Anxous but alert slightly decreased urine output and cool pale skin. Treatment 1) Stopping the bleeding 2) admitting ringer's lactate solution 3) Blood transfusion Result 1)In 5hr, Pa increases back to normal 2) H.R decreases back to normal value of 75beats/min 3) His skin gradually w arms and returns to normal pink colour Ben Pa= 40mmHg Pulse pressure= Absent Heart rate= 160 beats/min he is comatose No urine output He is cold Cyanotic Treatment Same treatment as Adam
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4. A 60 year old woman is admitted to the hospital after complaining of extreme fatigue and weakness, shortness of breath (dyspnea) and swelling of her ankles. Her clothes no longer fit around the waist and she has gained 3 kg in the past month. She finds that breathing is particularly difficult when lying down ( Orthopnea). Sleeping propped on several pillows no longer brings relief. She has a history of chest pain and shortness of breath upon exertion. Her physical examination reveals cyanosis ( blue skin tone ), rapid respirations, rapid pulse, distended neck veins, ascites in the abdomen, edema in the ankles, and cold clammy skin. Her ventricular ejection fraction is 0.30. Her systolic pressure is 100mmHg with a reduced pulse pressure. She is treated with digoxin and a diuretic and placed on a low sodium diet.

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SOME COMPLAINTS AMONG OTHERS 1) Extreme fatigue 2) shortness of breath 3) Sw elling in her ankles PHYSICAL EXAMINATION REVEALS: 1) 2) 3) 4) 5) 6) 7) Cyanosis Rapid respirations Rapid pulse Distended neck veins Ascites in the abdomen oedema in the ankles Cold clammy skin

Ventricular ejectn fractn- 0.30 systolic pressure- 100mmHg reduced pulse pressure Treated w ith: 1) digoxin 2) Diuretics 3) Placed on low Na diet EXPLANATION The w ay I w ould like to explain it is this w oman has mitral valve stenosis w hich has The atrial fibrillation is caused by the abnormal electrical impulse generated in the ro
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5. A 72 year old woman with hypertension is being treated with propanolol, a beta-adrenergic blocking agent. She has experienced several episodes of light-headedness and syncope ( fainting ). An ECG shows sinus bradycardia; normal regular P waves, followed by normal QRS complexes; however the frequency of P waves is decreased at 45/min. The physician tapers off and eventually discontinues the propanolol and then changes the womans medication to a different class of antihypertensive drugs. Upon discontinuation of propanolol, a repeat ECG shows a normal sinus rhythm with a frequency of P waves of 80/min.

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Ailment: Hypertension Treatment: Propranolol(beta adrenergic blocking agents) Symptoms: light headedness, sycope (fainting) ECG show s: 1) sinus bradycardia 2) normal regular P w aves 3) Normal QRS complexes 4) Frequency of P w aves is decreased at 45/ min The physician reduces thee propranolol gradually and eventualy discontinues changes medication: to a different class of anti hypertensive drugs. A repeat of ECG after discontinuation of propranolol show s: 1) normal sinus rhythm 2) frequency of P w aves of 80/min EXPLANATION This w oman w as given propranolol, a beta adrenergic blocking agent w hich has dra Beta adrenergic blocking agents decrease the contracting ability of the heart as w e

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6. A 65 year old woman visits her physician complaining of not feeling well and decreased urination. Her diastolic blood pressure is elevated at 115 mmHg and she has abdominal bruits (sounds). She is immediately admitted to the hospital and has a workup for hypertension. Laboratory test reveal the following information. Her blood pressure continues to be dangerously elevated and her glomerular filtration rate (GFR) is significantly decreased, at 30 ml/min. Renal vascular disease is suspected. Renal angiography shows 90% stenosis of the right renal artery. Her plasma renin activity is elevated and renin levels are much higher in right renal venous blood than in left renal venous blood. An attempt to dilate the right renal artery with angioplasty is unsuccessful. The woman is treated with captopril ,an ACE inhibitor.

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Complaints: 1) "Not feeling w ell" 2) decreased urination 3) diastolic B.P- 115mmHg 4) Abdominal bruits Tests Reveals: 1) 2) 3) 4) 5) blood pressure continues to be dangerously elevated GFR is significantly decreased at 30ml/min Plasma-renin activity elevated Renal angiography- 90% stenosis of the right renal artery Renin levels much higher in right venous blood than in left.

Suspected: Renal vascular disease Attempt at treatment via Angioplasty is unsuccessful. She w as treated w ith captopril, an ACE inhibitor. EXPLANATION 90% stenosis of thee right renal artery w ill decrease blood volume reaching the affe Treatment given is ACE inhibitor w hich prevents the conversion of angiotensin 1 into

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7. History A 34-year-old male accountant comes to the emergency department with acute chest pain. There is a previous history of occasional stabbing chest pain for 2 years. The current pain had come on 4 h earlier at 8 pm and has been persistent since then. It is central in position, with some radiation to both sides of the chest. It is not associated with shortness of breath or palpitations. The pain is relieved by sitting up and leaning forward. Two paracetamol tablets taken earlier at 9 pm did not make any difference to the pain. The previous chest pain had been occasional, lasting a second or two at a time and with no particular precipitating factors. It has usually been on the left side of the chest although the position had varied. Two weeks previously he had an upper respiratory tract infection which lasted 4 days. This consisted of a sore throat, blocked nose, sneezing and a cough. His wife and two children were ill at the same time with similar symptoms but have been well since then. He has a history of migraine. In the family history his father had a myocardial infarction at the age of 51 years and was found to have a marginally high cholesterol level. His mother and two sisters, aged 36 and 38 years, are well. After his fathers infarct he had his lipids measured; the cholesterol was 5.1 mmol/L (desirable range 5.5 mmol/L). He is a non-smoker who drinks 15 units of alcohol per week. Examination His pulse rate is 75/min, blood pressure 124/78 mmHg. His temperature is 37.8C. There is nothing abnormal to find in the cardiovascular and respiratory systems.

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ponsible for this condition. Pericarditis is the inflammation of the sac surrounding the heart, the pericardium usually la ith sitting up and leaning forw ard w hile it is w orsened by lying dow n.

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