case study

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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 Study

Case Study 1

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:

1) 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?

2) 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

3) Provide at least 3 (questions) you would ask your patient RELATED to the case presented and

provide rationale.

4) Please explain whether you would request any laboratory or screening tests for this patient

and why (if any)

5) How would you achieve the B/P goal recommended for this patient according to the

guidelines provided above?

6) Provide References in APA style

Testicular Cancer

Case Studies

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

1. What impact did an undescended testicle have on this young man’s risk for developing
testicular cancer?

2. What might be the side effects of cytotoxic chemotherapy?

3. What was the purpose of preserving his sperm before chemotherapy?

4. Is this young man’s age typical for the development of testicular carcinoma?