Assignment: Mr. K.P. is a 71-year-old male, who presents to your office with a 3-day history of more than 103F with chills. The patient reports, “I don’t feel well, and I think that I may have the flu.” He also complains of “some painful bumps on my fingers and toes that came on last night.” He denies IVDA. When asked about recent medical or dental procedures, he responds: “I had an infected tooth removed about 2 weeks ago.” He does not recall receiving any antibiotics either prior to or after the procedure

Assignment: Mr. K.P. is a 71-year-old male, who presents to your office with a 3-day history of more than 103F with chills. The patient reports, “I don’t feel well, and I think that I may have the flu.” He also complains of “some painful bumps on my fingers and toes that came on last night.” He denies IVDA. When asked about recent medical or dental procedures, he responds: “I had an infected tooth removed about 2 weeks ago.” He does not recall receiving any antibiotics either prior to or after the procedure

Assignment: Mr. K.P. is a 71-year-old male, who presents to your office with a 3-day history of more than 103F with chills. The patient reports, “I don’t feel well, and I think that I may have the flu.” He also complains of “some painful bumps on my fingers and toes that came on last night.” He denies IVDA. When asked about recent medical or dental procedures, he responds: “I had an infected tooth removed about 2 weeks ago.” He does not recall receiving any antibiotics either prior to or after the procedure

Please answer the two questions:

Mr. K.P. is a 71-year-old male, who presents to your office with a 3-day history of more than 103F with chills. The patient reports, “I don’t feel well, and I think that I may have the flu.” He also complains of “some painful bumps on my fingers and toes that came on last night.” He denies IVDA. When asked about recent medical or dental procedures, he responds: “I had an infected tooth removed about 2 weeks ago.” He does not recall receiving any antibiotics either prior to or after the procedure.

PMH:

Asthma since childhood

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Rheumatic fever as a child x 2 with mitral valve replacement 2 years ago

HTN x 20 years

DM type 2, x 9 years

COPD x 4 years H/O tobacco abuse

Alcoholic liver disease

Urinalysis: The urine was pale yellow, clear, and negative for proteinuria and hematuria. A urine toxicology screen was also negative.

ECG: Normal

Transthoracic ECHO: A 3-cm vegetation on the aortic valve was observed. No signs of ventricular hypertrophy or dilation were seen.

Blood Cultures: 3 of 3 sets (+) for Streptococcus viridans (collection times 1030 Tuesday, 1230 Tuesday, 1345 Tuesday)

Laboratory Blood Test Results

Na 135 meq/L

K 3.7 meq/L

Cl 100 meq/L

HCO3 22 meq/L

BUN 17 mg/dL

Cr 1.0 mg/dL

Glu, random 145 mg/dL

Hb 14.1 g/dL

Hct 40%

Plt 213,000/mm3

WBC 19,500/mm3

Neutros 80%

Bands 7%

Lymphs 12%

Monos 1%

Alb 4.0 g/dL

ESR 30 mm/hr

Ca 8.9 mg/dL

Questions

Which type of infective endocarditis is suggested by the patient’s clinical manifestations—acute or subacute? Explain your answer. (50 words and one citation within the past four years)

Which three of the illnesses in this patient’s medical history may be contributing to the onset of infective endocarditis, and why are these diseases considered risk factors? Explain each of the factors. (50 words and one citation within the past four years).

Please answer the following questions:

Explain the underlying pathophysiology associated with hypertensive conditions. What are the associated pathological complications? (50 words and one citation within the past four years).

Detail a common congenital defect associated with the cardiovascular system of a pediatric patient. (50 words and one citation within the past four years).

Explain the differences between irritable bowel syndrome and inflammatory bowel disease. (50 words and one citation within the past four years).

Gastric cancers require meticulous management. Choose a gastrointestinal cancer that is primary-sourced in an organ of the gastrointestinal system and discuss the epidemiological characteristics and pathological ramifications of the condition. (50 words and one citation within the past four years).

Explain the differences between irritable bowel syndrome and inflammatory bowel disease. (50 words and one citation within the past four years).

Gastric cancers require meticulous management. Choose a gastrointestinal cancer that is primary-sourced in an organ of the gastrointestinal system and discuss the epidemiological characteristics and pathological ramifications of the condition. (50 words and one citation within the past four years).

Answer all of the questions below.

Scenario

A.O. is a 28-year-old woman who presents to your clinic with complaints of rectal bleeding and weakness. Five days ago, she noticed bright red blood in her stools. Furthermore, she reports that her daily bowel movements have increased to five or six with significant diarrhea. She has been weak for approximately 3 days. She has not traveled outside of the city, been hospitalized, or received antibiotics recently.

A proctosigmoidoscopy was conducted 3 days after the patient’s discharge from the acute care clinic. A significant pseudopolyps formation could be seen. Biopsies of the colon revealed erosions of the mucosa and ulcerations into the submucosa with mixed acute (i.e., neutrophils) and chronic (lymphocytes and macrophages) inflammatory cells. No dysplastic cells suggesting the development of colon carcinoma were seen. No multinucleated giant cells suggesting Crohn’s disease were seen. Inflammation and ulceration were limited to the rectum and sigmoid colon only. Crypts of Lieberkühn were intensely inflamed. Marked hemorrhaging of capillaries in the mucosa was also observed.

Laboratory Blood Test Results

Na+ = 143 meq/L

BUN = 20 mg/dL

Plt = 315,000/mm3

AST = 33 IU/L

K+ = 3.2 meq/L

Cr = 1.1 mg/dL

PO4-3 = 4.0 mg/dL

ESR = 24 mm/hr

ALT = 41 IU/L

Cl- = 108 meq/L

Hb = 10.8 g/dL

CRP = 1.5 mg/dL

T bilirubin = 0.9 mg/dL

Alb = 3.1 g/dL

HCO+3 = 18 meq/L

Hct = 36%

Ca+2 = 8.9 mg/dL

PT = 11.3 sec

Glu, fasting = 132 mg/dL

WBC = 9,400/mm3

Questions

What is the relevance of the last sentence in the first paragraph of the scenario provided above: “She has not traveled outside of the city, been hospitalized, or received antibiotics recently”? Explain your answer in detail. (50 words and one citation within the past four years).

What is the diagnosis? Explain your answer. Why and how did you come up with this diagnosis? (50 words and one citation within the past four years).

Identify eight abnormal laboratory blood test values and provide a brief pathophysiological explanation for each of them. (50 words and one citation within the past four years).

Please answer the following questions:

Explain the differences between restrictive and obstructive respiratory disorders. Choose one disorder for each and explain the pathophysiological changes seen and alterations in pulmonary function tests that aid diagnosis. (50 words and one citation within the past four years).

Explain the manifestations of congenital pulmonary disorders seen in children. (50 words and one citation within the past four years).

Discuss the differences between respiratory acidosis and respiratory alkalosis. Provide a case study or presentation associated with respiratory acidosis or respiratory alkalosis. (50 words and one citation within the past four years).

Clinicians have developed an appreciation for obstructive sleep apnea. Explain the pathophysiological problems a patient could experience associated with obstructive sleep apnea (OSA). (50 words and one citation within the past four years).

Explain the concept of azotemia (including prerenal, renal, and postrenal), causes, and diagnostic measures used to identify each. (50 words and one citation within the past four years).

Identify and discuss the pathophysiology underlying one pediatric urological disorder. (50 words and one citation within the past four years).

A patient presents with flank pain. You suspect renal calculi. What is the pathophysiological reason for development of renal calculi and associated treatment considerations to rid renal stones and prevent future development of others? (50 words and one citation within the past four years).

Explain the common conditions associated with proteinuria and hematuria. Discuss the rationale for potential complications. (50 words and one citation within the past four years).