Case Study Help 
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 Case Study Help

A 69-year-old man was a heavy smoker and presented to his doctor with a
painful, black big toe.  This was gangrenous on examination and he was
admitted to hospital urgently for treatment and surgical amputation.  He
made a good recovery and was well for a year.  He then started to develop
pain in the lower back which came and went but was not severe enough to
complain to his doctor.  On one occasion, however, he experienced
excruciating pain in the lower right back and rapidly became shocked and
collapsed with a pulse rate of 120/min and a systolic {*filter*} pressure of 60
mmhg.  He was rushed to hospital but died in the ambulance.

A postmortem examination was performed at which a large abdominal aneurysm
was found ruptured.  There were 3 litres of fresh {*filter*} clot in the
retroperitoneum, tracking up behind the right kidney.  The aorta showed
severe atheroscierosis elsewhere.

1. How might you connect the episode of gangrene in the toe with the final
pathology in this man?
2. What are the main risk factors for atheroscierosis?
3. What are the complications of an abdominal aortic aneurysm?



Tue, 20 Mar 2001 03:00:00 GMT
 Case Study Help

Quote:

> A 69-year-old man was a heavy smoker and presented to his doctor with a
> painful, black big toe.  This was gangrenous on examination and he was
> admitted to hospital urgently for treatment and surgical amputation.  He
> made a good recovery and was well for a year.  He then started to develop
> pain in the lower back which came and went but was not severe enough to
> complain to his doctor.  On one occasion, however, he experienced
> excruciating pain in the lower right back and rapidly became shocked and
> collapsed with a pulse rate of 120/min and a systolic {*filter*} pressure of 60
> mmhg.  He was rushed to hospital but died in the ambulance.

> A postmortem examination was performed at which a large abdominal aneurysm
> was found ruptured.  There were 3 litres of fresh {*filter*} clot in the
> retroperitoneum, tracking up behind the right kidney.  The aorta showed
> severe atheroscierosis elsewhere.

> 1. How might you connect the episode of gangrene in the toe with the final
> pathology in this man?
> 2. What are the main risk factors for atheroscierosis?
> 3. What are the complications of an abdominal aortic aneurysm?

Sounds like YOUR homework assignment.


Tue, 20 Mar 2001 03:00:00 GMT
 Case Study Help

Quote:

>A 69-year-old man was a heavy smoker and presented to his doctor with a
>painful, black big toe.  This was gangrenous on examination and he was
>admitted to hospital urgently for treatment and surgical amputation.  He
>made a good recovery and was well for a year.  He then started to develop
>pain in the lower back which came and went but was not severe enough to
>complain to his doctor.  On one occasion, however, he experienced
>excruciating pain in the lower right back and rapidly became shocked and
>collapsed with a pulse rate of 120/min and a systolic {*filter*} pressure of 60
>mmhg.  He was rushed to hospital but died in the ambulance.

>A postmortem examination was performed at which a large abdominal aneurysm
>was found ruptured.  There were 3 litres of fresh {*filter*} clot in the
>retroperitoneum, tracking up behind the right kidney.  The aorta showed
>severe atheroscierosis elsewhere.

>1. How might you connect the episode of gangrene in the toe with the final
>pathology in this man?
>2. What are the main risk factors for atheroscierosis?
>3. What are the complications of an abdominal aortic aneurysm?

Sounds suspiciously like homework to me....

Martyn

--

http://www.***.com/ ~martyn/  ---- Department of Computer Science,
http://www.***.com/ ~biocomp  ---- University of Liverpool, L69 7ZF, UK
******************** "Carp Diem" -- Fish of the day **************************



Tue, 20 Mar 2001 03:00:00 GMT
 Case Study Help

Quote:



>>1. How might you connect the episode of gangrene in the toe with the final
>>pathology in this man?
>>2. What are the main risk factors for atheroscierosis?
>>3. What are the complications of an abdominal aortic aneurysm?

>Sounds suspiciously like homework to me....

No kidding.  Maybe I'm old-fashioned, but I really think people should
do their own homework, not ask others on the net to do it for them.

  -- David Wright :: wright at ibnets.com :: Not a Spokesman for Anyone
     These are my opinions only, but they're almost always correct.
     While the unexamined life may not be worth living, the over-
     examined life is not being lived.



Tue, 20 Mar 2001 03:00:00 GMT
 Case Study Help

Quote:

> 1. How might you connect the episode of gangrene in the toe with the final
> pathology in this man?

Upon discovering that no one on the internet would do his homework for him, he
became frustrated and kicked his desk, thereby injuring his toe.  This led to
gangrene which produced toxins and damaged his aorta, leading eventually to
the AAA.

Quote:
> 2. What are the main risk factors for atheroscierosis?

Although it's not widely known, misspelling medical terms is one.

Quote:
> 3. What are the complications of an abdominal aortic aneurysm?

Okay, I'll give you two:

1.  Sudden death.
2.  Not completing med school due to #1.

--
Carey Gregory



Wed, 21 Mar 2001 03:00:00 GMT
 Case Study Help
I was hoping that you folks could direct me to help tackle case studies.
Like where do I begin, what are the obvious clues?, etc.....


Fri, 23 Mar 2001 03:00:00 GMT
 Case Study Help
Okay, that puts an interesting slant on it.  Case studies usually
force physicians in training to pursue one or more of four clinical
questions: a) diagnosis b) therapy c) risk factor modification d)
prognosis.   The approach to each of these are lectures in an of
themselves but I will chat about diagnosis.  In my opinion,
there are 6 ways to pursue a diagnosis:  a) statistical - what's
most common in this epidemiological setting?, b) anatomical -
what is the range of organs that rise to the problem
(symptom/sign/abnormal lab or di finding) c) pathological - is
the problem nutritional, metabolic, degerative, neoplastic,
ischemic, inflammatory, endocrinological, infectious, iatrogenic,
toxic, traumatic, psychological? d) physiological - good for
considering the diagnosis of jaundice for example, e) pattern
recognition - what comes to mind immediately? and f) no method.

The usual approach for the beginner is consider one or more
abnormalities and using a Boolean approach make a list of common
associations using one or more of the diagnostic methods.  Once a
list of possibilities is made, other facts are considered that
help to rule in or rule out the diagnostic possibilities.
There's no good way to tease out what is really important and
what is less important early in training.  That is a matter of
experience.

Well, that's my approach.  I suspect there is no science to
support it.

Good luck.

JPS, MD.



Fri, 23 Mar 2001 03:00:00 GMT
 Case Study Help

Quote:

> I was hoping that you folks could direct me to help tackle case studies.
> Like where do I begin, what are the obvious clues?, etc.....

Okay, fair enough.  The way you presented it sounded like you just wanted the
answers.  Like any exam, start simple and make no assumptions.  There are no
"obvious clues" until you understand the material.

Quote:
> 1. How might you connect the episode of gangrene in the toe with the final
> pathology in this man?

This is the only question of the three that requires thought.  The other two
simply require regurgitation of textbook material.  If you understand the
basics of gangrene and aneurisms, and give it just a bit of thought, a couple
of possible connections will come to mind.  

If you come here with a more detailed question to confirm your suspicions
about this case, I think you'll get a better response than you will with the
"what's the answer?" sort of approach you used the first time.

--
Carey Gregory



Fri, 23 Mar 2001 03:00:00 GMT
 Case Study Help
Quote:

> Okay, that puts an interesting slant on it.  Case studies usually
> force physicians in training to pursue one or more of four clinical
> questions: a) diagnosis b) therapy c) risk factor modification d)
> prognosis.   The approach to each of these are lectures in an of
> themselves but I will chat about diagnosis.  In my opinion,
> there are 6 ways to pursue a diagnosis:  a) statistical - what's
> most common in this epidemiological setting?, b) anatomical -
> what is the range of organs that rise to the problem
> (symptom/sign/abnormal lab or di finding) c) pathological - is
> the problem nutritional, metabolic, degerative, neoplastic,
> ischemic, inflammatory, endocrinological, infectious, iatrogenic,
> toxic, traumatic, psychological? d) physiological - good for
> considering the diagnosis of jaundice for example, e) pattern
> recognition - what comes to mind immediately? and f) no method.

> The usual approach for the beginner is consider one or more
> abnormalities and using a Boolean approach make a list of common
> associations using one or more of the diagnostic methods.  Once a
> list of possibilities is made, other facts are considered that
> help to rule in or rule out the diagnostic possibilities.
> There's no good way to tease out what is really important and
> what is less important early in training.  That is a matter of
> experience.

> Well, that's my approach.  I suspect there is no science to
> support it.

> Good luck.

And in the case study you posed, it would seem that anatomical and
pathological factors will be the most important for you to consider.
Ask yourself what event would connect the two pathologic conditions
given in your example?


Sat, 24 Mar 2001 03:00:00 GMT
 
 [ 9 post ] 

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