Case History Topics for Oral Presentations

1.     Neurophysiology Case Histories - Case 3 Oct 19

A 42-year-old male complained of severe, lower (lumbosacral) back pain which radiated to his left buttock, leg, and foot. This dull pain was intensified during coughing, sneezing, and bending. He also experienced muscle spasms in the left leg. There was mild sensory and motor loss in the left buttock and leg as well.

 

2.     Muscle Physiology Case Histories - Case 6 Oct 21

A 17-year-old male was working vigorously on a summer construction crew building a new section of a freeway. In the intense heat of the day, he began to experience severe pain in the muscles of his limbs and carpopedal spasms. The cramping made his muscles feel like hard knots. The foreman of the crew instructed the young man to drink some salt water he had available and rest a while.

 

3.     Hematology Case Histories - Case 10 Oct 21

A 62-year-old male complained of weakness, headache, light-headedness, and fatigue. Upon physical examination, the following information was available:

Erythrocytes 8.5 million/cu mm

Leukocytes 12,500/cu mm

Thrombocytes 400,000/cu mm

Hct 58%

O2 saturation (arterial) 94%

Serum erythropoietin Undetectable

The erythrocytes and leukocytes were immature in the peripheral blood smear. The spleen was enlarged. The determined therapy of choice was phlebotomy, 300-500 mL every other day, until the hematocrit was <45% with the possibility of myelosuppressive therapy, if needed.

 

4.     Cardiovascular Case Histories - Case 12 Oct 26

A 50-year-old airline pilot complained of severe, intense, precordial, crushing sensation with pain radiating to the left shoulder and down the inside of the left arm, triggered by an off-duty tennis match. The chest discomfort brought on by the exertion was relieved by rest. Emergency room examination resulted in the following information:

Heart rate (HR) 98 b/min

Blood pressure (BP) 160/110 mm Hg

ECG: ventricular extrasystole arrhythmia (premature ventricular contraction [PVC])

as well as S-T segment depression and decreased R wave height.

The following day an exercise tolerance test was performed to test the functional response to graded stress. This symptom-limited test gave an ischemic ECG response during exercise, characterized by a downward-sloping S-T segment. Mild exertion resulted in chest pain, which was relieved by sublingual nitroglycerin. Coronary angiography showed lumenal obstruction >70% (88%) in three major coronary vessels, including the left anterior interventricular (descending) coronary artery. Nitroglycerin, beta-blockers, and calcium channel blockers were tried as pharmacologic therapy. Angioplasty, the procedure in which a balloon-tipped catheter is inserted into the partially obstructed vessels, was able to increase coronary flow to near normal values.

 

5.     Respiratory Case Histories - Case 16 Nov 2

A 17-year-old student has experienced reversible, periodic attacks of chest tightness with coughing, wheezing, and hyperpnea. She states that expiration is more difficult than inspiration. She is most comfortable sitting forward with arms leaning on some support. X-rays revealed mild overinflation of the chest. Results from laboratory and pulmonary function tests are as follows:

Frequency 20 breaths/min

Vital capacity (VC) 2.9 L

FEV1.0 1.4 L

FEV1.0/FVC 56%

Functional residual capacity (FRC) 3.89 L

Total lung capacity (TLC) 6.82 L

PaO2 70 mm Hg

PaCO2 26 mm Hg

Pulse 108 b/min

BP 120/76 mm Hg

Intermittent use of a bronchial smooth muscle dilator (1:1000 epinephrine by nebulizer) for several days caused marked improvement, resulting in the following laboratory and pulmonary function tests:

VC 4.15 L

FEV1.0 3.1 L

FEV1.0/FVC >75%

FRC 3.7 L

TLC 5.96L

PaO2 89 mm Hg

PaCO2 38 mm Hg

Pulse 129 b/min

BP 122/78 mm Hg

 

6.     Respiratory Case Histories - Case 17 Nov 4

A 150 lb., 62-year-old man had a chronic productive cough, exertional dyspnea, mild cyanosis, and marked slowing of forced expiration. His pulmonary function and laboratory tests follow:

Frequency 16 breaths/min

Alveolar ventilation 4.2 L/min

Vital capacity (VC) 2.2 L

Functional residual capacity (FRC) 4.0 L

Total lung capacity (TLC) 5.2 L

Maximum inspiratory flow rate 250 L/min

Maximum expiratory flow rate 20 L/min

PaO2 62 mm Hg

PaCO2 39 mm Hg

Pulmonary function tests after bronchodilator therapy:

Frequency 16 breaths/min

Alveolar ventilation 4.35 L/min

VC 2.4 L

FRC 4.0 L

TLC 5.2 L

Maximum inspiratory flow rate 250 L/min

Maximum expiratory flow rate 23 L/min

PaO2 62 mm Hg

PaCO2 38 mm Hg

 

7.     Renal Case Histories - Case 23 Nov 9

A 45-year-old construction worker complained of excruciating intermittent pain in the kidney area, radiating across the abdomen and into the genital area. He also had chills, fever, and nausea. He noticed increased frequency of urination and moderate hematuria. Pertinent 24-hour urinalysis findings indicated crystalline substances in the sediment identified as calcium in nature and a urinary calcium of 300 mg/day. X-ray findings indicated localized stones in the renal pelvis. This person was encouraged to increase his water intake to at least 1.01.5 L/day and slightly decrease his dietary calcium.

 

8.     Gastrointestinal Case Histories - Case 19 Nov 11

A 26-year-old business executive complained of a dull pain (heartburn) behind the sternum. The pain was postprandial (occurred after meals) and disappeared within a few minutes to an hour. It was often associated with belching and often was worse on lying down or on exertion after heavy meals. Sometimes it radiated to the back, jaws, shoulders, and down the inner aspects of the arms, simulating angina pectoris. X-rays revealed a small portion of the stomach above the diaphragm, and an endoscopic biopsy revealed mucosal inflammation. Esophageal manometry (determining pressures at the lower esophageal sphincter, LES) revealed decreased LES pressure. Esophageal pH monitoring showed reflux of gastric contents into the esophagus and provided direct evidence of gastroesophageal reflux. Recommended treatment for this individual is avoidance of strong stimulants of gastric acid secretion (e.g., coffee, alcohol) and avoidance of certain drugs (e.g., anticholinergics), and specific foods (fats, chocolates, whole milk, and orange juice), and smoking, all of which reduce LES competence. Elevation of the head of the bed by about six inches is also recommended. Suggested treatments also include the use of cholinergic agonists (e.g., bethanechol) and the use of histamine (H2) antagonists (cimetidine).

 

9.     Hematology Case Histories - Case 9 Nov 18

A 14-year-old girl complained of fatigue and loss of stamina. Her appetite was marginal, as she was very conscious of maintaining her body weight at 96 pounds. Her monthly menstrual flow was always heavy and long from its onset at twelve years of age. Relevant laboratory findings included the following:

Hematocrit (Hct) 28%

Hemoglobin (Hgb) 9 g/dL

Iron 16 g/dL

Bone marrow iron Absent

Erythrocytes Small and pale

Suggested treatment included ferrous sulfate or ferrous gluconate for six months orally between meals, since food may reduce absorption. A well-balanced diet was also suggested, as well as a gynecological examination.

 

10.  Reproductive Case Histories - Case 30 Nov 23

Parents were concerned about their 16-year-old son for the following reasons: he had no deepening of his voice, scanty pubic and axillary hair growth, absence of beard and mustache growth, small penis, poor muscular development, and psychosocial immaturity.

Laboratory evaluation indicated the following:

Serum testosterone 100 ng/dL

Sperm count 10 million/mL semen

The following tests were performed:

Clomiphene (a nonsteroidal, weak estrogen agonist that stimulates the release of gonadotropins)
100 mg/day for seven days: 0% increase in LH (50% is normal)

Gn-RH (100 g I.V.): 0% increase in LH in twenty minutes (300% is normal)

HCG (5000 I.U., I.V.): 50% increase in plasma testosterone one to three days after injection

This person was subsequently treated with FSH at 25-75 U three times/week and HCG as described above. Sperm count and testosterone levels were both near normal after two months of treatment, and primary and secondary sex characteristics appeared.