Assignment
Case Study I
Mr. JS presents today to your office for a follow up appointment after a BP reading at home of 166/95 last week. He is a 52 y/o male with a PMH of HTN and Angina secondary to CAD, which is well controlled, experiencing less than 1 attack per month. On today examination, MR JS's vital signs are as follows: Temperature: 96.8º Heart Rate: 68 bpm Blood Pressure: 168/92 Respiration: 14 Ox Sat: 95% at room air Pain: denies pain. Labs: Last LDL on records (6 months ago): 189 Current Medications: Atorvastatin 40 mg/day Metoprolol tartrate 10 mg/twice/day
CASE STUDY QUESTIONS:
o According to the recently released American Heart Association guidelines on hypertension, what should be the BP goal for a patient with chronic stable angina and hypertension?
o In addition to diet and lifestyle modifications, what is the medication of choice to control the BP of a patient with chronic stable angina? Provide rationale
o Provide at least 3 (questions) you would ask your patient RELATED to the case presented and provide rationale.
o Please explain whether you would request any laboratory or screening tests for this patient and why (if any)
o How would you achieve the B/P goal recommended for this patient according to the guidelines provided above?
Case Study II: Testicular Cancer
A 21-year-old male noted pain in his right testicle while studying hard for his midterm college examinations. On self-examination, he noted a "grape sized" mass in the right testicle. This finding was corroborated by his healthcare provider. This young man had a history of delayed descent of his right testicle until the age of 1 year old. Studies Results Routine laboratory studies Within normal limits (WNL) Ultrasound the testicle Solid mass, right testicle associated with calcifications HCG (human chorionic gonadotropin) 550mIU/mL (normal: <5) CT scan of the abdomen Enlarged retroperitoneal lymph nodes CT scan of the chest Multiple pulmonary nodules Diagnostic Analysis At semester break, this young man underwent right orchiectomy. Pathology was compatible with embryonal cell carcinoma. CT directed biopsy of the most prominent pulmonary nodule indicated embryonal cell carcinoma, compatible with metastatic testicular carcinoma. During a leave of absence from college, and after banking his sperm, this young man underwent aggressive chemotherapy. Repeat testing 12 weeks after chemotherapy showed complete resolution of the pulmonary nodules and enlarged retroperitoneal lymph nodes.
Critical Thinking Questions
o What impact did an undescended testicle have on this young man's risk for developing testicular cancer?
o What might be the side effects of cytotoxic chemotherapy?
o What was the purpose of preserving his sperm before chemotherapy?
o Is this young man's age typical for the development of testicular carcinoma?
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