Case Study 1
An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5'2" older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:
Eyes: + pallor conjunctiva
Cardiac: irregular rhythm. No S3 S4 or M. NO JVD
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding
Rectal: no stool in rectal vault
Case Study 2
A 28-year old female presents for a routine physical. She has no complaints. Her personal medical history reveals asthma that is well controlled with an albuterol inhaler prn and Advair 250/50 1 puff BID. Social history reveals she is a nursing student who is a non-smoker, rarely uses alcohol, and is mostly vegetarian. Her physical exam is negative, and she is sent for a CBC/differential and lipid profile. Laboratory results reveal the following: Hemoglobin 10, Hematocrit 30.1, MCV increased.
Case Study 3
A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal.
To prepare:
Review Chapter 213 in Part 18 of the Buttaro et al. text.
Select one of the three case studies. Reflect on the provided patient information including history, physical exams, and lab reports.
Think about a differential diagnosis. Consider the role the patient history, physical exam, and lab reports played in the diagnosis.
Reflect on the pathophysiology of the type of anemia that you diagnosed, as well as potential treatment options. Consider the causes of this type of anemia. Think about whether the patient should be referred for specialized care.