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Scenario 1: A 32-year-old Female with a Chief Complaint of Fever

Scenario 1: A 32-year-old Female with a Chief Complaint of Fever

Scenario 1: A 32-year-old female presents to the ED with a chief complaint of fever, chills, nausea, vomiting, and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative.

Neurological and Musculoskeletal processes

The neurological processes are linked to the pain experienced by the patient. The pain is most likely to be linked with gout and attributed to the production of prostaglandins and bradykinin (Igel et al., 2017). The stimulation of the unmyelinated nerve fibers results in the production of the neuropeptides that eventually lead to vasodilation (Ragab et al., 2017). The musculoskeletal processes involved include the precipitation of the urate needle-shaped monosodium urate in the avascular tissues. Also, the crystals affect the skins around the distal joints. The pain experienced by the patient could be attributed to the crystal deposits in the joints.

Racial and Ethnic Variables

Gout is more common among the African American population. Therefore, there could be a genetic factor correlated with the high burden of gout among the population group. Studies have indicated that genetic variations in the renal urate could be the reason why different ethnic groups have varying risk levels for high uric acid levels in the blood (Ragab et al., 2017). The variations in the risk for diabetes and high blood pressure could also explain the differences. People with diabetes have a higher risk for gout. Similarly, the risk of diabetes and hypertension is higher among African Americans compared to whites and other ethnic groups.

Interaction of the Processes to Affect the Patient

The patient has a medical history of both diabetes and high blood pressure which increases the risk for gout. Gout is a condition characterized by the accumulation of the crystal in the joint leading to inflammation. The C-reactive protein levels are elevated in the patient and this is an indication of the high inflammatory reactions. The inflammation is characterized by reddening, pain, swelling, and heat (Towiwat et al.,  2019). The patient’s history makes him more susceptible to disease development and progress. Furthermore, the patient is on hydrochlorothiazide 59 mg PO Q am and metformin 500 mg PO bid for managing diabetes. The hydrochlorothiazide increases the risk for accumulation of the uric acid in the blood and so could also be contributing to gout.

Scenario 1: A 32-year-old Female with a Chief Complaint of Fever


Understanding the patient’s medical history helps in guiding the clinician to make the right diagnosis. In this case, the patient was diabetic and this increased his risk of developing gout. Furthermore, the medications used also influenced his health outcomes. Both neurological and musculoskeletal systems are directly involved in the pathogenesis of the condition. The nerve system sense pain. On the other hand, the accumulation of uric acid crystals in the joints affects the cartilages, tendons, and other components of the musculoskeletal system. Finally, African Americans have a higher risk of developing gout. The patient, in this case, is white, though, the medical history makes him vulnerable to the disease.

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Ragab, G., Elshahaly, M., & Bardin, T. (2017). Gout: An old disease in new perspective – A review. Journal of Advanced Research8(5), 495-511. https://doi.org/10.1016/j.jare.2017.04.008

Towiwat, P., Chhana, A., & Dalbeth, N. (2019). The anatomical pathology of gout: A systematic literature review. BMC Musculoskeletal Disorders20(1). https://doi.org/10.1186/s12891-019-2519-y

Igel, T. F., Krasnokutsky, S., & Pillinger, M. H. (2017). Recent advances in understanding and managing gout. F1000Research6, 247. https://doi.org/10.12688/f1000research.9402.1


According to the given case study, it is evident that the patient is suffering from a bacterial infection. The most probable diagnoses for the patient include trichomoniasis, which is attributed with greenish-yellow, foul smelling discharge. The secretion is foul smelling due to anaerobic overgrowth in the disease. If left untreated, the inflammatory condition might mimic the symptoms or appearance of an invasive cancer (Serdaroglu & Kutlubay, 2017). This can be seen from the overexpression of the systems of the infection alongside the cervical distortion secondary to the healing process through fibrosis.

Fertility is affected by a number of factors. One of them is sexually transmitted infections. According to the Center for Disease Control, sexually transmitted infections such as gonorrhea and chlamydia cause pelvic inflammatory disease. They also cause significant asymptomatic infections of the fallopian tubes. The infection can extend to the uterus as well as the surrounding tissues, thereby, leading to irreversible damage to these organs, hence, infertility. According to Tsevat et al., (2017), the bacterial infections in sexually transmitted diseases also cause tubal factor infertility. Tubal factor infertility arises from the acute pelvic inflammatory disease that causes tubal scaring and ultimate blockage, limiting the possibilities of fertility taking place. There is also the evidence that sexually transmitted diseases cause inflammation that can result in blockage. The blockage hinders fertilization, hence, infertility. The last mechanism in which sexually transmitted diseases cause infertility is increasing the risks of ectopic pregnancies. Recurrent ectopic pregnancies cause tubal scaring, which is associated with infertility.

Pelvic inflammatory disease and sexually transmitted diseases are associated with a significant rise in inflammatory serum biomarkers. According to Park et al., (2017), pelvic inflammatory disease and sexually transmitted infections are associated with release of inflammatory mediators such as cytokines and interleukins. There is also the marked release of plasma cells and neutrophils in the inflammatory process. The consequence of the increased release of these cells is the rise in biomarkers that include CA-125, CRP, and ESR (Park et al., 2017).

The risk of prostatitis and systemic infections are high in cases of sexually transmitted infections. Accordingly, the bacterial infections can be disseminated to other body parts including the prostate gland that is in close proximity with the sexual organs and glands. The involvement of this gland results in the inflammation of the prostate gland, hence, prostatitis. Besides the direct involvement, infections with agents such as Neisseria gonorrhoeae can induce the inflammation of the prostate. Incidences of chronic inflammation can lead to the development of benign prostatic hyperplasia nodules of the prostate gland (Magri et al., 2018). The systemic reactions that become evident in the affected patients have been attributed to the immune responses to the disease. Therefore, the reactions can be used in diagnosing the disease.

Splenectomy is considered a therapeutic treatment for ITP. This is attributed to a number of reasons. Firstly, it plays a critical function in the pathogenesis of the disease. This can be seen in its role as the primary site used in platelet clearance. It is also uses as a niche for the immune cells that up-regulate the formation of anti-platelet antibodies. The spleen forms the niche for the differentiation of plasma cells that are involved in the production of autoantibodies. This makes it the main reservoir for anti-platelet antibody producing plasma cells that cause recurrence in ITP (Chaturvedi, Arnold & McCrae, 2018). Therefore, splenectomy remains an effective way of treating the disease.

Anemia exists in different types that can be identified based on criteria such as morphology and etiology. The morphological classification gives types of anemia that include microcytic, normocytic, and macrocytic. Microcytic arises from inadequate production of hemoglobin. Normocytic anemia occurs due to a reduction in blood volume or erythropoiesis. Macrocytic anemia is attributed to inadequate cells production or maturation secondary to defects in DNA repair and synthesis. The etiological classification gives rise to primary and secondary anemia (Lanzkowsky, Lipton & Fish, 2016). Primary anemia does not have a direct attributable cause. Secondary anemia has direct attributed cause such as injury or post-partum hemorrhage.




Chaturvedi, S., Arnold, D. M., & McCrae, K. R. (2018). Splenectomy for immune thrombocytopenia: down but not out. Blood, The Journal of the American Society of Hematology131(11), 1172-1182.

Lanzkowsky, P., Lipton, J. M., & Fish, J. D. (Eds.). (2016). Lanzkowsky’s manual of pediatric hematology and oncology. Academic Press.

Magri, V., Boltri, M., Cai, T., Colombo, R., Cuzzocrea, S., De Visschere, P., … & Leli, C. (2018). Multidisciplinary approach to prostatitis. Archivio Italiano di Urologia e Andrologia90(4), 227-248.

Park, S. T., Lee, S. W., Kim, M. J., Kang, Y. M., Moon, H. M., & Rhim, C. C. (2017). Clinical characteristics of genital chlamydia infection in pelvic inflammatory disease. BMC women’s health17(1), 5.

Serdaroglu, S., & Kutlubay, Z. (2017). Fundamentals of Sexually Transmitted Infections.

Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted diseases and infertility. American journal of obstetrics and gynecology216(1), 1-9.

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