case study 5-6

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Question Description

Please answer the critical thinking question base on the upload documents

Critical Thinking Questions ( Cervical -Cancer)

1. Why was mammography contraindicated for this patient?

2. How is sexual promiscuity related to the risk for cervical cancer?


Critical Thinking Questions 1 ( Gumerulonephritis)

. At what point would the BUN and creatinine have signified the need for dialysis?

2. What was the cause of the patient's hypertension?

3. What would you do if this patient had developed a swollen mouth and neck after the IVP?

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Cervical Cancer Case Studies The patient, a 28-year-old woman, has been sexually active with multiple partners since she was 14 years old. She is now married and wants to have children. She has intermittent breakouts of vulvar ulcers/sores but no other complaints. Her pelvic examination during a routine visit with her gynecologist was normal. She had a lump in her left breast. Studies Sexually transmitted infections (STIs), p. 756 Herpes simplex test, p. 731 Cytomegalovirus, p. 200 Chlamydia, p. 722 Gonorrhea, p. 761 Syphilis serology, p. 473 Pap smear, p. 743 Adequacy of specimen Category Epithelial cell abnormalities Human papillomavirus (HPV) testing, p. 745 Breast sonogram, p. 871 Results Positive for herpes simplex virus-2 (HSV-2) (normal: negative) No change in serology 4 weeks later No antibodies detected No antibodies detected Culture negative No antibodies detected Adequate Epithelial abnormality Squamous, atypical cells Positive for HPV 16 Benign fibroadenoma Diagnostic Analysis The patient was informed of her test results. Her herpes titers indicated that the disease was rather chronic, not acute. No treatment was recommended. Because of her age, mammograms were contraindicated. A breast ultrasound indicated the lesion was not cancerous. A fibroadenoma is common in this age-group. Because of her positive HPV results and suspicious Pap smear, further evaluation was recommended. Studies Results Colposcopy, p. 595 Several suspicious areas Biopsy Squamous cell carcinoma Cervical cone biopsy, p. 720 Invasive squamous cell carcinoma Hysteroscopy, p. 614 No extension to the endocervical canal or uterus Pelvic ultrasound, p. 887 No extension of tumor beyond the cervix The patient was advised to have a radical hysterectomy. She refused because she wanted to have a family. She began psychologic counseling for guilt over her past promiscuity, which had increased her risk for cervical cancer. She became pregnant 1 year later and lost the Case Studies pregnancy during the second trimester. One year later, she developed a large pelvic mass, which represented progressive, inoperable cervical cancer. Despite radiation therapy and chemotherapy, she died at age 31 of cervical cancer. Critical Thinking Questions 1. Why was mammography contraindicated for this patient? 2. How is sexual promiscuity related to the risk for cervical cancer? 2 Glomerulonephritis Case Studies A 7-year-old boy was brought to his pediatrician because he had developed hematuria, which required hospitalization. Approximately 6 weeks before his admission, he had a severe sore throat but received no treatment for it. Subsequently, he did well except for complaints of mild lethargy and decreased appetite. Approximately 3 weeks before admission, he had a temperature of 101° F daily for 7 days. He complained of minimal bilateral back pain. Physical examination revealed a well-developed young boy with moderate bilateral costovertebral angle (CVA) tenderness. The remainder of the physical examination results were negative. His blood pressure was 140/100 mm Hg in both arms and legs. Studies Urinalysis, p. 956 Blood Protein Red blood cell casts Specific gravity Color Urine culture and sensitivity (C&S), p. 973 Blood urea nitrogen (BUN), p. 511 Creatinine, p. 190 Creatinine clearance test, p. 193 Renal ultrasound, p. 866 Intravenous pyelogram (IVP), p. 1057 Renal biopsy, p. 751 Anti-DNase-B (ADB) titer, p. 79 Total complement assay, p. 172 Results +4 (normal: negative) +1 (normal: negative) Positive (normal: negative) 1.025 (normal: 1.010-1.025) Red-tinged (normal: amber-yellow) No growth after 48 hours 42 mg/dL (normal: 7-20 mg/dL) 1.8 mg/dL (normal: 0.7-1.5 mg/dL) 64 mL/min (normal: approximately 120 mL/min) No tumor; kidneys diffusely enlarged and edematous Delayed visualization bilaterally; enlarged kidneys, no tumor; no obstruction seen Swelling of glomerular tuft, along with polymorphonuclear leukocyte infiltrates in Bowman’s capsule (findings compatible with glomerulonephritis); immunofluorescent staining, positive for IgG 200 units (normal: ≤170 units) 33 units/mL (normal: 75-160 units/mL) Case Studies 2 Diagnostic Analysis The blood, protein, and RBC casts in the boy's urine indicated a primary renal disorder. The elevated creatinine and BUN levels indicated that the problem was severe and markedly affecting his renal function. Both kidneys were probably equally impaired. Intravenous pyelogram (IVP) was helpful only in ruling out Wilms tumor or congenital abnormality. Normally an IVP would not be performed in light of this patient’s impaired renal function. It is presented here for demonstration of the information it can provide. Renal ultrasound is a much safer test to visualize the kidney to exclude neoplasm. The ultrasound findings were compatible with an inflammatory process involving both kidneys. Renal biopsy was most helpful in suggesting glomerulonephritis. The history of recent pharyngitis, fever, the positive ASO titer, the positive ADB titer, and the finding of immunoglobulin IgG antibodies on the immunofluorescent stain all suggested poststreptococcal glomerulonephritis. The patient was placed on a 10-day course of penicillin. He was given antihypertensive medication, and his fluid and electrolyte balance was closely monitored. At no time did his creatinine or BUN level rise to a point requiring dialysis. After 6 weeks, his renal function returned to normal (creatinine, 0.7 mg/dL; BUN, 7 mg/dL). His antihypertensive medications were discontinued, and he remained normotensive and returned to normal activity. Critical Thinking Questions 1. At what point would the BUN and creatinine have signified the need for dialysis? 2. What was the cause of the patient's hypertension? 3. What would you do if this patient had developed a swollen mouth and neck after the IVP? ...
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