Case Study 1 & 2 (10 Points)

Students must review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Study 1 & 2 topics change every semester. Topic TBA

The answers must be in your own words with reference to the journal or book where you found the evidence to your answer. Do not copy-paste or use past students' work as all files submitted in this course are registered and saved in turn it in the program.

Answers must be scholarly and be 3-4 sentences in length with rationale and explanation. No Straight forward / Simple answer will be accepted.

Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

All answers to case studies must have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites) per case StudyPagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 5th Edition Systemic Lupus Erythematosus (SLE)

Case Studies A 24-year-old woman had been complaining of multiple joint and muscular pains and stiffness in the morning. She also noted some hair loss and increased skin sensitivity to light. Her physical examination showed slight erythema around the cheek bones and some swelling in the joints of her hands. Studies Results Routine laboratory work Within normal limits (WNL), except for mild anemia Urinalysis, p. 956 Profuse proteinuria and cellular casts Antinuclear antibody (ANA), p. 88 1:256 (normal: <1:20) Anti-DNA 398 units (normal: <70 units) Anti-ENA Positive (normal: negative) Anticardiolipin antibody (ACA), p. 68 Immunoglobulin (Ig) G 96 g/L (normal: <23 g/L) IgM 78 mg/L (normal: <11 mg/L) Erythrocyte sedimentation rate (ESR), p. 221 75 mm/hour (normal: ≤20 mm/hour) Immunoglobulin electrophoresis, p. 312 IgG 1910 mg/dL (normal: 565-1765 mg/dL) IgA 450 mg/dL (normal: 85-385 mg/dL) IgM 475 mg/dL (normal: 55-375 mg/dL) Total complement assay, p. 172 22 hemolytic units/mL (normal: 41-90 hemolytic units/mL) Diagnostic Analysis The positive ANA and ACA tests strongly supported the diagnosis of systemic lupus erythematosus (SLE). The patient also had a facial rash suggestive of SLE. The elevated ESR indicated a systemic inflammatory process. The immunoelectrophoresis results were compatible with either RA or SLE; however, a decreased complement assay is commonly associated with SLE. The abnormal urinalysis indicated that the kidneys also were involved with the disease process. The patient was treated with steroids and did well for 7 years. Unfortunately, her renal function deteriorated, and she required chronic renal dialysis.

Critical Thinking

Questions

1. Explain the significance of the urinalysis results as they relate to renal involvement with SLE.

2. Why is the ESR increased in inflammatory conditions?

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 5th Edition AIDS (Acquired Immunodeficiency Syndrome)

Case Study 2

The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed right-sided pneumonitis. The following studies were performed: Studies Results Complete blood cell count (CBC), p. 174 Hemoglobin (Hgb), p. 259 12 g/dL (normal: 14-18 g/dL) Hematocrit (Hct), p. 256 36% (normal: 42%-52%) Chest X-ray, p. 1014 Right-sided consolidation affecting the posterior lower lung Bronchoscopy, p. 587 No tumor seen Lung biopsy, p. 738 Pneumocystis jiroveci pneumonia (PCP) Stool culture, p. 855 Cryptosporidium muris Acquired immunodeficiency syndrome (AIDS) serology, p. 297 p24 antigen Positive Enzyme-linked immunosorbent assay (ELISA) Positive Western blot Positive Lymphocyte immunophenotyping, p. 306 Total CD4 280 (normal: 600-1500 cells/L) CD4% 18% (normal: 60%-75%) CD4/CD8 ratio 0.58 (normal: >1.0) Human immune deficiency virus (HIV) viral load, p. 297 75,000 copies/mL Diagnostic Analysis The detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP is an opportunistic infection occurring only in immunocompromised patients and is the most common infection in persons with AIDS. The patient's diarrhea was caused by Cryptosporidium muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his prognosis is poor. The patient was hospitalized for a short time for treatment of PCP. Several months after he was discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually and died 18 months after the AIDS diagnosis. Case Studies 2 Copyright 2014 by Mosby, Inc., an imprint of Elsevier Inc.

Critical Thinking Questions

1. What is the relationship between levels of CD4 lymphocytes and the likelihood of clinical complications from AIDS?

2. Why does the United States Public Health Service recommend monitoring CD4 counts every 3 to 6 months in patients infected with HIV?