Pathophysiology

Module 09 Written Assignment

Directions: Reads each of the following case studies and provides a minimum of a one page paper for each that addresses the issues.

1.    My Knees!

Sandy is a 45 y.o. women who works transporting patients at the local hospital.  She has noticed stiffness in her hands when she wakes up for several months.  Recently Sandy has been feeling very depressed, fatigued, and nauseated at times.  One morning she wakes up and both knees are sore, swollen, red, and warm to the touch.  She decides it is time to go to the doctor.

The doctor takes Sandy’s history, examines her knees and hands, and runs some tests.  Here are the results of the lab tests.

CBC:   RBC 3.9 million/mcL

          WBC 7,000/mcL

          Platelets  375,000/mcL

ESR:  23mm/hr

CRP:  normal

RF:  seropositive

ANA:  negative

After several visits and more lab tests, Sandy is diagnosed with arthritis.  She is sent home with medications and told to balance rest with exercise.

a)     What type of arthritis does Sandy have?  What signs/symptoms support this diagnosis rather than a different type?  What lab tests indicate this type of arthritis?

b)    Is there a test available that would completely confirm this type of arthritis?

c)    What medications might Sandy be prescribed for pain control (give at least two possibilities)? 

d)    She is also given a low dose of glucocorticoid to be taken qod.  What are the benefits of this medication for Sandy and what are the possible complications? 

2.    What’s Wrong?

Jimmy is a 4 y.o. boy who has a quick smile and has always been very active.  Lately, however, his mother notices that he is more awkward when he walks or runs.  In addition Jimmy is having trouble getting up from the floor and often pushes on his legs as he stands up.  Jimmy’s mother makes an appointment with his pediatrician.

The pediatrician takes a family history and tests Jimmy’s muscles, takes a muscle biopsy and then does a DNA test.  Jimmy’s CK (creatine kinase) levels are elevated and the muscle biopsy confirms that the muscles themselves are causing the problem.  The DNA testing confirms that Jimmy has Duchenne Muscular Dystrophy (DMD).  The pediatrician recommends to Jimmy’s mother that Jimmy’s two older sisters have DNA testing done also. 

a)    What signs/symptoms does Jimmy have that are consistent with DMD? What kind of disease is DMD?

b)    Why does the pediatrician want to do DNA testing on Jimmy’s two older sisters?  

c)    Give some treatment options for Jimmy.  Include at least one medication he might be started on (you will need to do further research to find this information).

d)    What is Jimmy’s prognosis (again, please do further research to obtain this answer)?