Patient is a nursing home resident who presents with vesicular lesions in a linear pattern on his neck

Patient is a nursing home resident who presents with vesicular lesions in a linear pattern on his neck

Patient Name:Luka Silva

Date of Birth: 11/3/1943

Clinical Notes: Patient is a nursing home resident who presents with vesicular lesions in a linear pattern on his neck (pictured here). The lesions are on the left posterior neck and do not cross the midline.

He describes the area as itchy and painful. The itching started 3 days ago and the vesicles appear two days ago. Since then he has also developed a moderate headache and mild fever (100.1° F).

Herpes zoster is suspected. Acyclovir-Hydrocortisone is prescribed.

Question #1:Why might the physician ask Mr. Silva if he experienced chickenpox as a child? How would that relate to this scenario?

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Question #2:How is the varicella zoster virus spread?

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Question #3:Should Mr. Silva be worried about transmitting shingles to other residents of his nursing home? (Can the other residents “catch” shingles from Mr. Silva?)

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Question #4:If Mr. Silva follows the prescribed treatment, what will his recovery look like? How would you explain to Mr. Silva what to expect during his recovery?

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Question #5:What preventative measure can be taken to prevent shingles?

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Patient Name:Mohammed Kumar

Date of Birth:10/3/1966

Clinical Notes:Male patient presents with increasing weakness in his upper extremities. He first noticed the weakness when attempting to lift his grandchildren a couple months ago. Since then, he reports that the weakness has progressed and he “feels clumsy” and trips multiple times a day. When he talks to his children on the phone, they ask if he is sick because his voice sounds different to them.

DDX: Multiple sclerosis, Amyotrophic Sclerosis

Question #1:Are Mr. Kumar’s symptoms related to motor dysfunction or sensory dysfunction? Explain your answer.

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Question #2:The physician suspects that Mr. Kumar’s symptoms are related to Multiple Sclerosis or Amyotrophic Lateral Sclerosis. Name three diagnostic tests that may help to determine the correct diagnosis and explain how each would assist with diagnosis with these specific diseases. What would be found in these diagnostic tests if MS or ALS were found?

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Question #3:If Mr. Kumar is diagnosed with ALS, what is his prognosis? Provide statistics to support your answer.

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Question #4:If Mr. Kumar is diagnosed with MS, what additional symptoms might he experience in the future? List and describe at least three additional symptoms.

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Question #5:Diagnostic tests determine that ALS is most likely. Explain the pathophysiology to Mr. Kumar in terms that a typical patient would understand.

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Patient Name:Valentina Silva

Date of Birth:6/6/1994

Clinical Notes:Female patient reports depression, low blood pressure, muscle weakness, unexplained weight loss, and sensitivity to cold. She states that she can’t pinpoint a time when the symptoms started, but they have been getting worse over the last two months. She has also noticed abnormalities with her menstrual cycles, but initially attributed that to her age and assumed she was approaching menopause.

Endocrine dysfunction is suspected and several lab tests are ordered.

Question #1:If Ms. Silva’s lab tests showed decreased levels of cortisol and aldosterone and increased levels of ACTH (adrenocorticotropic hormone), which endocrine disorder is most likely?

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Question #2:Which of Ms. Silva’s symptoms are consistent with hypothyroidism? Please list all.

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Question #3:It is determined that Ms. Silva has Addison’s disease. What is the cause of this disorder?

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Question #4:What complications will occur if Addison’s disease is not treated? List and describe at least three complications.

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Question #5:How is Addison’s disease typically treated?

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