Case 1

M.G. is an 8-year-old boy who has been brought to the emergency department by his parents with a fever of 104ºF, lethargy, stiff neck and headache. Laboratory analysis of a spinal tap shows increased white blood cells in the cerebrospinal fluid (CSF).

Discussion Questions

1.  What is the most probable cause of M.G.'s signs and symptoms?

2.  What are general complications of this disorder, and how would one assess for their occurrence?

3.  Find the usual treatment for this disorder? What are the most current guidelines and show your citation(s).

Case 2

J.Y. is a 43-year-old woman who has detected a lump in the upper outer quadrant of her left breast while performing her monthly self-breast examination. She is examined by her primary physician who finds a single mobile, painless lump. A biopsy is done that indicates probable malignancy. J.Y. is scheduled for surgery. There is no evidence of regional lymph node involvement. J.Y.'s tumor is thought to be responsive to estrogen.

Discussion Questions

1. Based on the given information, what type of breast surgery is indicated for J.Y.?

2. What treatment besides surgery is J.Y. likely to receive?

3. What implications does J.Y.'s breast cancer have for the use of estrogen therapy when she becomes menopausal?

4. How often could J.Y. have mammography done? Add the most recent guidelines and include your citation(s).

Case 3

D.W. is a 47-year-old man being evaluated for complaints of fatigue, loss of appetite, and abdominal fullness. Upon examination the skin is noted to be jaundiced and the liver enlarged. D.W. denies significant alcohol or drug use. He denies any known exposure to hepatitis and has never been vaccinated for hepatitis. He is taking no medication. Laboratory tests reveal the following, and a diagnosis of acute hepatitis B is made:

                AST                    142 IU/L

                ALT                    120 IU/L

                GGT                     42 IU/L

                AlkPhos                  84 IU/L

                Total bilirubin      1.0 mg/dl

                Albumin               4.3 g/dl

                HBsAg                 positive

                Anti-HBS              negative

                Anti-HCV             negative

                HIV                     negative

Discussion Questions

1. Analyze and review the laboratory data. Which findings support the diagnosis of acute hepatitis B?

2.  What are the usual modes of hepatitis B transmission? What further risk factor assessment is indicated to check the source of infection?

3.  What precautions should D.W. take to avoid transmitting the disease to others?

4.  How should the disease be managed and monitored? Add your citation (s).