Case Study – Cervical Cancer
Case Study – Cervical Cancer
Objectives
1. Explain the risk factors, symptoms, etiology, progression, diagnosis, treatment and prognosis. 2. Demonstrate the ability to access and critically evaluate information from a wide variety of sources (such as Library databases and internet sources). Read the case presentation and answer the questions that follow. The Case Study Rubric will be used to assess your work. The Case Study rubric lists the criteria for each question (required resources, word counts and citation requirements). Case Presentation Tasneem, a 53-year-old woman comes in for her first visit with the obstetrician. She is an immigrant from South Africa who has lived in the United States for 5 years and has not had regular health care. Her past medical history is notable for hyperlipidemia and osteopenia. She takes no medications. She is married with six children; her husband is a long-haul truck driver. Her first sexual contact was at age 14, and she has had five partners in her lifetime. She has been smoking one pack of cigarettes per day for the last 30 years. She reports vaginal spotting after intercourse, which she thinks is related to vaginal dryness after menopause. The obstetrician performs a co-test of HPV DNA and Pap smear of the cervix. Results are positive for HPV 16 and abnormal/precancerous cells. The obstetrician highly recommends a colposcopy and cervical biopsy. Further workup results in a diagnosis of cervical intraepithelial neoplasia (CIN). Tasneem is referred to a gynecological oncologist. Cytological specimen showing cervical cancer, specifically squamous cell carcinoma in the cervix. Tissue is stained with pap stain and magnified x200. [Digital image]. (n.d.). Retrieved from https://www.dovemed.com/diseases-conditions/squamous-cell-carcinoma-of-cervix/ Questions 1. Define the bold terms. 2. Describe the cause of cervical cancer 3. Ovarian cancer is not part of the differential diagnosis in the case of Tasneem, but is another important cancer of the female reproductive system. Compare the etiology, signs and symptoms, diagnosis and treatment of ovarian cancer and cervical cancer. 4. Tasneem needs to be educated about cervical cancer. Consider her cancer to be a Stage 1A CIN. Describe what this staging means and her treatment options. 5. Explain to Tasneem the prognosis of CIN Stage 1A. Discuss with Tasneem how this may have been prevented. Case Study – Pelvic Inflammatory Disease Objectives 1. Explain the risk factors, symptoms, etiology, progression, diagnosis, treatment and prognosis. 2. Demonstrate the ability to access and critically evaluate information from a wide variety of sources (such as Library databases and internet sources). Read the case presentation and answer the questions that follow. The Case Study Rubric will be used to assess your work. The Case Study rubric lists the criteria for each question (required resources, word counts and citation requirements). Case Presentation Janae is a 24-year-old married female who presents to her nurse practitioner reporting lower abdominal pain, cramping, slight fever, and dysuria of four days duration. She had a slight low grade fever in the evening for the past three days, so she took acetaminophen. She hasn’t had any GI problems. She denies vaginal discharge. Her last menstrual period (LMP) was about two weeks ago and was “normal” for her. She has been taking oral contraceptives for three years. She would like to start a family in the next year or so. Janae is happily married win a monogamous relationship with her husband for three years. They do not use condoms. The last time they had intercourse was one week ago. She does not have history of any sexual transmitted infections (STIs). She has occasional yeast infections. Physical examination reveals BP 104/72 mm Hg, HR 84, T 100.1 F. She has slight abdominal tenderness in the lower quadrants and her inguinal nodes are enlarged. An internal exam reveals minimal vaginal discharge. Bimanual exam reveals uterine and adnexal tenderness and pain with cervical motion. The physician orders a vaginal saline wet mount with pH, a nucleic acid amplification test for gonorrhea and chlamydia, urinalysis and culture, and pregnancy test. The pregnancy test is negative, urinalysis for nitrites is negative. The vaginal saline wet mount shows >10+ WBCs under high power microscopy. She is positive for chlamydia. There are no yeast cells present. These findings meet the CDC’s criteria for pelvic inflammatory disease (PID). She receives intramuscular antibiotic injections and oral antibiotics will be given over a period of 14 days. Janae is instructed to follow up in 48-72 hours for a recheck. The physician asks that Janae’s husband be evaluated too. Janae is confused as to why he needs to be seen… [Digital image]. (n.d.). Retrieved from http://www.sbdmedical.org/womens-issues/symptoms-of-pid.htm Questions 1. Define the bold terms. 2. Describe the cause of pelvic inflammatory disease. 3. Compare the etiology, signs and symptoms, diagnosis and treatment of PID with an ectopic pregnancy. 4. Janae needs to be educated about pelvic inflammatory disease. Describe the treatment, including any at home care, over the counter medications and prescriptions for PID. Include in your explanation why it is essential for her husband to be examined. 5. Explain to Janae the prognosis of PID. Include in your prognosis the effects, if any, on fertility. Discuss with Janae and her husband how PID can be prevented. Case Study – Kidney Stones Objectives 1. Explain the risk factors, symptoms, etiology, progression, diagnosis, treatment and prognosis. 2. Demonstrate the ability to access and critically evaluate information from a wide variety of sources (such as Library databases and internet sources). Read the case presentation and answer the questions that follow. The Case Study Rubric will be used to assess your work. The Case Study rubric lists the criteria for each question (required resources, word counts and citation requirements). Case Presentation Mark, a 52 year old male, presents to the emergency department with acute right flank pain, that woke him in the middle of the night. He is experiencing nausea and vomiting and can’t find a comfortable position due to the pain. Mark states he knows he has a kidney stone, because this is “pain no one forgets!” He has a history of two episodes of kidney stones, which did not require medical intervention because he was able to pass them on his own. Mark’s vital signs indicate he is afebrile, tachycardic and has a BP of 136/80. Mark is writhing in pain, making it difficult for the physician to complete an abdominal exam. Urinalysis indicates microscopic hematuria, calcium oxalate crystals and +5 RBCs on high power microscopic examination. A kidney-ureter-bladder (KUB) x-ray reveals a 1.5 cm stone in the ureteropelvic junction. His past medical history and information from examination rule out the concern of an abdominal aneurysm or appendicitis. Calcium oxalate crystals in urine specimen. [Digital image]. (n.d.). Retrieved from https://www.labce.com/spg30208_calcium_oxalate_crystals.aspx Calcium oxalate stone [Digital image]. (n.d.). Retrieved from https://www.stonedisease.org/calcium-oxalate-monohydrate-kidney-stone Due to the size and location of the stone, extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy is recommended for Mark. Mark receives analgesics and a urologist is called to determine which treatment is best. In Mark’s case, removal of the stone should be performed as soon as possible to prevent hydronephrosis or kidney injury. Questions 1. Define the bold terms. 2. Describe the causes of kidney stones. 3. The most common kidney stones is made of calcium oxalate. Differentiate calcium oxalate stones from a urinary tract infection. Compare the etiology, signs and symptoms, diagnosis and treatment. 4. Mark needs to be educated about the treatments for kidney stones. Explain the two treatments the physician mentioned in the case presentation in terms that Mark can understand. Include in your answer over-the-counter treatments, prescriptions or at home care that will help his recovery. 5. Discuss the prognosis of a patient in Mark’s case who has a history of stones. Explain to Mark what he can do to lower his risk to prevent another calcium oxalate kidney stone. Case Study – Glomerulonephritis Objectives 1. Explain the risk factors, symptoms, etiology, progression, diagnosis, treatment and prognosis. 2. Demonstrate the ability to access and critically evaluate information from a wide variety of sources (such as Library databases and internet sources). Read the case presentation and answer the questions that follow. The Case Study Rubric will be used to assess your work. The Case Study rubric lists the criteria for each question (required resources, word counts and citation requirements). Case Presentation Chelsea, a 21 year old college female student home for Thanksgiving break. She presents to her primary care physician complaining of swollen hands for the last week. She also noticed over the last two days she was short of breath. Chelsea does not have any past medical history of note. Her parents and two siblings are healthy. She has not traveled recently, does not have any allergies and does not take any medications. Upon further questioning, she did have strep throat about two weeks ago. She was diagnosed at the on campus clinic and was prescribed antibiotics. She said she felt better within 24 hours of starting the medication. Her physician sees that she has bilateral edema of the hands, feet and mild tachypnea at rest. She is afebrile, BP 160/100 mm Hg, HR 85 bpm and RR is 20 bpm. Bilateral crackles are heard over her lower lung fields. Laboratory results reveal the following are greatly increased; creatinine, blood urea nitrogen, and anti-streptolysin O (ASO) titer. Urinalysis has significant protein and RBCs. Her chest x-ray showed fluid in her lung fields. These tests indicate acute renal failure, resulting in fluid overload in her tissues and lungs. A renal biopsy was performed confirming that immunoglobulins were deposited in the glomeruli. Her presentation and laboratory findings are consistent with poststreptococcal glomerulonephritis (PSGN). “The hypercellularity of post-infectious glomerulonephritis is due to increased numbers of epithelial, endothelial, and mesangial cells as well as neutrophils in and around the glomerular capillary loops. This disease may follow several weeks after infection with certain strains of group A beta hemolytic streptococci. Patients who have had a strep infection typically have an elevated antistreptolysin O (ASO) titer.” [Digital image]. (n.d.). Retrieved from https://library.med.utah.edu/WebPath/RENAHTML/RENAL085.html Chelsea’s treatment consisted of diuretics and dialysis. She will be assessed in three weeks to determine if kidney function has improved. She is concerned that her college roommates could end up with the same condition and asks the physician if it’s contagious. Questions 1. Define the bold terms. 2. Describe the cause of post-streptococcal glomerulonephritis (PSGN). 3. Chelsea’s glomerulonephritis has resulted in acute renal injury, leading to kidney failure. Compare the etiology, signs and symptoms, diagnosis and treatment of acute renal injury with chronic kidney disease. 4. Chelsea needs to be educated about her treatment, such as the purpose of the diuretics. Investigate and explain the two main types of dialysis that are available to patients with kidney injury. 5. Investigate whether PSGN is preventable. Is Chelsea’s concern about her college roommates legitimate? Explain. What is the prognosis of her condition?
