Case 1: A 60 year old man with long-standing type II diabetes that has been untreated with insulin is admitted to the hospital after reporting noticeably bloody urine. Bilaterally, he has no feeling in the bottoms of his feet and decreased sensitivity mid-shin, while sensation at the knees is normal. Upon examination the clinician notices that the patient’s lenses are cloudy, and the patient is having a difficult time reading his admissions paperwork. The patient’s blood pressure is also elevated.

1. Why might this patient have blood in his urine?

2. What other abnormalities would typically be found in such a patient’s urinalysis?

3. What is causing the bilateral desensitization of the lower limbs?

4. Why are this patient’s lenses cloudy?

5. Why might this patient have difficulty reading his admissions papers?

6. How is the elevated blood pressure related to the other symptoms?

Case 2: Julie Turner, a 27 year old non-pregnant female, has grown increasingly anxious about changes in both her behavior and body recently. She consults her physician and complains of insomnia, gastrointestinal instability, feeling excited, and weight loss. She also reports that even though she has lost weight, her “double chin” has not gone away. Upon examination, the physician notes that, while not pronounced, Julie’s eyes seem larger, and her reflexes are excitable. The physician decides to send Julie to an endocrinologist for a consultation.

1. What does an endocrinologist specialize in?

2. Define hyperthyroidism.

3. Which of Julie’s signs an symptoms are compatible with hyperthyroidism?

4. Does Julie show signs and symptoms specific to Grave’s disease?

5. Why might Julie be mistakenly thinking she has a “double chin”?

6. What is the doctor concerned with when they notices that Julie has “large eyes”?

7. If Grave’s disease is confirmed, what is the most likely treatment?

Case 3: George is a 50 year old man that had a severe motorcycle accident 12 years ago. As a result of the accident, George had one kidney and part of his small intestine removed because they were hemorrhaging. Immediately following recovery, George had some weight loss that he was told to expect because of malabsorption caused by having his intestine removed. George has never returned to work due to his injuries, and mostly sits inside and watches TV and reads. Recently, however, George broke his wrist trying to catch himself from falling. When he was examined, he was told that his bones had become weak.

1. Define osteopenia and osteoporosis. Which does George seem to have?

2. What is the most common type of fracture of the wrist in a person of George’s age?

3. Explain how Vitamin D, calcidiol, and calcitriol are synthesized?

4. How could George’s missing kidney be related to his decreased bone strength?

5. How could George’s partial small intestine be related to his decreased bone strength?

6. If George has a decreasing density of his bones due to his previous injuries, what is the classification of his condition?

7. Could George’s lack of time outside be a factor in his weak bones?

Case 4: Pete is a 250 lb man that played 15 years of professional football. Pete quit football at that age of 38 when his hips and knees became too painful to play. He has tried to manage the pain with OTC antiinflammatory drugs for the past 20 years. Now 58 years old, Pete has a severe limp on his right side and gone to the doctor in hopes to get stronger pain medication. His general doctor orders X-rays, which reveal bilateral narrowing of both hip and knee joints. The right acetabulum shows bony projections extending toward the femoral head.

1. What does Pete suffer from?

2. What are Pete’s risk factors?

3. Explain whether or not the 20 years of OTC antiinflammatory medications has really helped anything?

4. What are the bony projections of the acetabulum called?

5. Does Pete need to see an orthopedic surgeon, or can the general doctor treat Pete’s condition?

6. Is Pete a candidate for joint replacement surgery?
Case 5: A 67 year old African-American male presents to his family physician for a checkup. It has been more than 5 years since his last checkup. A thorough examination including a digital rectal examination and history is unremarkable for a man of his age. The physician orders several different blood tests, including a prostate-specific antigen (PSA) level.

1. Why would a physician order several blood tests for a person with no apparent problems?

2. Does this man have any risk factors for anything in particular?

3. What is a digital rectal exam used to test for?

4. Why is a PSA level an important test for this man?

5. What would an elevated PSA level indicate?

6. If this man has elevated PSA, how would it be treated?
Case 6: A 26 year old women presents at the clinic with a complaint of infertility. She and her husband have tried unsuccessfully for over one year. She reports irregular menses since menarche at age 13. She has never been pregnant, and has always had Pap smears. She reports at least a dozen sexual partners and was treated for gonorrhea 6 years ago. He husband has had normal semen analysis results.

1. What are the risk factors for female infertility?

2. Which of these risk factors may be involved in this case?

3. What hormone levels would be appropriate to ascertain?

4. If the problem is a pituitary hormone imbalance, which hormone(s) might be involved?

5. If the problem is an ovarian hormone imbalance, which hormone(s) might be involved?

6. Define pelvic inflammatory disease.

7. If a pelvic exam is performed and PID is involved, what might be noticed?

8. How might laparoscopy be useful for a definitive diagnosis?
Case 7: A 21 year old female presents to the ER complaining of lethargy, a stiff neck, and a headache. Initial examination reveals a high grade fever, sensitivity to light, and withdrawal from neck flexion. A history uncovers that she is a daycare worker and many students have been absent recently.

1. What do the symptoms suggest?

2. Is this patient at particular risk for the suggested illness?

3. What test needs to be done?

4. How is this test performed?

5. What are the two most likely microorganisms to be found with the test from question #3?

6. Does the daycare need to be notified?

Case 8: A 68 year old African-American male is transported to the ER with rapid onset left sided weakness. He was watering his lawn when he suIDenly dropped the hose and fell to the ground. His speech was slurred when EMS personnel arrived. The man has a history of high blood pressure and hypercholesterolemia. His exam shows left facial areflexia and drooping. CT scan of the head shows no hemorrhage.

1. What is the diagnosis?

2. What is the likely location of the pathology in this instance?

3. What are the risk factors for this condition?

4. What are the possible mechanisms of pathology in this case?

5. Which is the more likely mechanism of the pathology in this case?

6. What is the underlying problem in this case?

7. How did the underlying problem lead to this incident?

Case 9: A 36 year old man is seeing his physician because he is becoming increasingly weak. He reports that the weakness progresses throughout the day. He has a desk job and can hardly keep his eyes open and head up by the end of the day. Other history is unremarkable. Cranial nerve examination shows weak facial muscles, inability to repeat movements, and bilateral ptosis. The patient’s shoulders droop with a very poor posture.

1. What is the likely diagnosis?

2. What is the pathogenesis of this disease?

3. What other deficits might present if untreated?

4. Why do the symptoms seem to worsen later in the day?

5. What other conditions should be ruled out?

6. What treatment should be sought?

Case 10: Tim and Leanne are rushed to the hospital after a car accident. Tim was driving as the car was hit in the driver side door. He sustained a broken humerus from the direct impact. His arm was immobilized and he is resting in his room. Leanne, who was in the front passenger seat sustained a ruptured spleen and four adjacent broken ribs on the left side. Her wounds are from striking the miIDle console of the car. She is in the ICU with her chest wrapped.

1. What are the factors that affect wound production?

2. Which factor is the main difference causing Tim and Leanne to have such different injuries?

3. What is the mechanism that caused the rupturing of Leanne’s spleen?

4. What is the name of the condition in which several adjacent ribs is broken?

5. Due to her broken ribs, what is Leanne at risk of developing?

6. If Leanne’s lung is bruised, what other condition may develop?