Question

A patient presented to the emergency room with chief complaint of a “racing heartbeat.” She is

an overweight, 69-year-old female, who has been experiencing increasing shortness of breath during the past two months and marked swelling of the ankles and feet during the past three weeks. She feels very weak and tired most of the time and has recently been waking up in the middle of the night with severe breathing problems. She has been sleeping with several pillows to keep herself propped up. Five years ago, she suffered a transmural (i.e., through the entire thickness of the ventricular wall), anterior wall (i.e., left ventricle) myocardial infarction. She received two-vessel coronary artery bypass surgery 4 1 ⁄2 years ago for obstructions in the left anterior descending and left circumflex coronary arteries. Her family history is positive for atherosclerosis as her father died from a heart attack and her mother had several CVAs. She had been a three pack per day smoker for 30 years but quit smoking after her heart attack. She uses alcohol infrequently. She has a nine-year history of hypercholesterolemia. She is allergic to nuts, shellfish, strawberries, and hydralazine. Her medical history also includes diagnoses of osteoarthritis and gout. Her current medications include celecoxib, allopurinol, atorvastatin, and daily aspirin and clopidogrel. The patient is admitted to the hospital for a thorough examination.

 

1.    Based on the case above, what is the likely cause of the patient’s heart failure? Justify or give rationale to support your answer.

 

 

 

 

 

 

 

 

 

2.    From the information given above, identify three (3) risk factors that probably contributed to the patient’s heart attack five years ago.  Justify or give rationale for each answer.

 

 

 

 

 

 

 

 

 

 

 

 

3.    What is the rationale for administering celecoxib to the patient?

 

A.   Mr. Yousef an 80-year-old man has been admitted after falling from the top of the stairs while trying to carry a load of books to his room. After he regains his consciousness, he was unable to recall and say how he got admitted and failed to provide any necessary medical history details of his family and his own. He was living with his wife named Alice. As per his wife’s information he was suffering from dementia for last 15 years. Based upon first-hand information facilitated a mini mental status examination was carried out. The score was just 18 out of 30 which is below than the cut off score of 24. This implies he has cognitive impairment. His shoulder has been dislocated following the fall which has been reduced under anesthesia.

      ***NOTE: Indicate references properly. For example:  complete sentence (Robins 2019). ***

 

1.       Discuss the cause of dementia briefly in relation to the patient’s case.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.       Discuss the most important risks related to dementia and point out the main reason associated with the patients’ case leading to fall thus the shoulder dislocation.

 

 

 

 

 

 

 

 

 

 

 

 

 

3.       Discuss your communication strategy with the patient above.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B.      A 32-year-old woman with a 14-year history of Crohn’s disease presents with a three-day history of diarrhea and steady abdominal pain. She has been referred to the GI clinic. The clinical course of her disease has included obstruction due to small intestine stricture and chronic steroid dependency with disease relapse when attempting to taper steroids. Endocrine tests reveal that she has developed adrenal insufficiency as a result of steroid use and a DEXA scan has demonstrated significant demineralization of bone. Medications include Prednisone, 40 mg po QD • Trazodone, 100 mg po BID • Cyanocobalamin, 250 µg IM every month.

 

1.       Explain the pathologic mechanism of adrenal insufficiency for this patient.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discuss the rationale for giving cyanocobalamin 250 µg IM monthly to the patient