Instructions: After reading the clinical description, assign words or phrases from the paragraph to the term that best describes that concept. Note: Not all terms will have a match. IMPORTANT: As you review and identify items, please note you are not coding the scenario; coding has many rules associated with how an encounter is coded. This exercise is purely about your ability to recognize the pathophysiology and pharmacology concepts that are found within the excerpts.

Contents Excerpt 1 2 Excerpt 2 3 Excerpt 3 4 Excerpt 4 5 Excerpt 5 6 Excerpt 6 7 Excerpt 7 8 Excerpt 8 9 Excerpt 9 10 Excerpt 10 11

Excerpt 1

Kimberly is a 37-year-old white female who presented to her family doctor and was referred to radiation oncology department for consultation. While with the oncologist, Kimberly reported that both her mother and sister had breast cancer. She describes feeling heartburn for “a long time” and difficulty swallowing during the past 4 or 5 months. She feels like food occasionally seems to ‘catch’ in her throat, and describes pain immediately below the sternum that feels like a gnawing or burning. Other complaints include weight loss of 30 lbs. in the past 6 or 7 months, weakness and coughing at night. After performing an endoscopy and a biopsy of the esophageal tract, a cancerous tumor was identified and staged, and plans for radiation and an esophagectomy are underway.

Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History

Excerpt 2

Jane is a 12 year old female who presents is being treated today for hypertension related to Congenital Adrenal Hyperplasia (CAH), which was discovered when a biopsy done of Jane’s mother’s placenta for genetic screening showed that both her parents were carriers for the gene. Fetal blood work completed confirmed an enzyme deficiency blocking gluticosteriod and mineralocorticoid hormones. Jane regularly receives hormonal treatment and future genitoplasty is being considered. Normal sexual functioning is anticipated with continued treatment.

Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History

Excerpt 3

James is a 43 y.o. male who complains of chest congestion and dry cough for 30 days. He has had a history of similar problems, but was not exhibiting symptoms when he went to Buffalo to visit brother who has dogs. Patient reports experiencing shortness of breath while sleeping in the guest room bed; reports that brother is a smoker. Unsure if he has seasonal allergies. On ordering a CBC with differential, the higher presence of lymphocytes suggested an allergic reaction. The doctor prescribed oral steroids and an albuterol inhaler and recommended him to return if the cough didn’t decrease.

Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History

Excerpt 4

“Michelle” was admitted to the hospital because of facial swelling, fever and hypotension. She has relapsing and remitting multiple sclerosis associated with severe fatigue. Her neurologist prescribed modafinil to treat the fatigue. One week later, periorbital erythema and a clear conjunctival discharge developed on her face and scalp. She discontinued the modafinil and used over-the-counter diphenhydramine, but the rash did not improve. Elevated steroid presence lowered the patient’s immunity and she contracted MRSA while in the hospital.

Diagnoses
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History

Excerpt 5

Betty, a 29 y.o. female was given a PillCAM to swallow after she presented to her gastroenterologist with continued stomach pains after her cholecystectomy in order to rule out Crohn’s Disease. She was born with infantile hypertrophic pyloric stenosis which was corrected with a pyloromyotomy when she was 3 weeks old. Review of images showed no identified pathological changes within the intestine, and a laparoscopy was planned to review the original surgical site.

Diagnosis
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History

Excerpt 6

Frank is a 73-year-old white male with history of multiple hospital admissions for COPD exacerbation and pneumonia who presented to the emergency room on 09/03/2015, complaining of severe shortness of breath and difficulty swallowing. He received 3 nebulizers at home without much improvement. Frank’s chest x-ray on admission revealed some vascular congestion and bilateral pleural effusions. There was also patchy alveolar opacity, which appeared to be, “mass like” in the right suprahilar region. After three days, Frank was discharged to home health on a dysphagia diet, with ample thin liquids use. Frank’s discharge provider also ordered a dietary and speech therapy evaluation, to treat for chronic dysphagia and aspiration pneumonia in the setting of severe chronic obstructive pulmonary disease.

Diagnosis
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History

Excerpt 7

Peter, a 63 year old obese male, was eating breakfast when he experienced the sudden onset of weakness and numbing in his left arm and leg. Brushing off his symptoms, the next morning he felt worse and noticed his vision begin to blur. Noticing her husband’s confusion, his wife quickly phoned 911 and he was taken by ambulance to the nearest Emergency Department. Peter’s history was notable for a 30-year, half-pack a day smoking habit. A CT scan confirmed a cerebrovascular event (Ischemic stroke) and interarterial t-PA was given. Peter was admitted to the hospital, and several days into his care he began treatment for paralysis.

Diagnosis
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History

Excerpt 8

“A 27 year old male of Middle Eastern-descent diagnosed with hemophilia when he was 4 or 5 years old, who presented to the Emergency Department due to excessive bleeding from an accidental knife cut. He reports a history of prolonged bleeding episodes post-teeth extraction and excessive bruising since childhood, and has a sister that reports similar excessive bleeding issues. Because of poor continuity of care, his disease has not been monitored or treated on an outpatient basis, and is uncertain which of the hemophilia types he may have. The results of the coagulation studies, the clinical presentation, and the family history for the patient described in this case indicate F5F8D as the most likely diagnosis. Molecular genetic testing would be needed to absolutely confirm this diagnosis. For treatment purposes, however, fresh frozen plasma is sufficient.”

Diagnosis
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History

Excerpt 9

“Zoe” was brought in by her husband, who reports that she has had slowly progressive cognitive decline for around 2 years. The initial symptoms were memory loss, forgetting conversations, repeating herself, and asking the same question within a short period. She had been working as a mortgage underwriter for 20 years and was laid off from her job 18 months ago. Zoe has had difficulty remembering names of characters in the TV shows she watches and is having problems looking things up on the Internet. She is no longer able to write checks, and her husband has taken over the bills and finances. She is taking over-the-counter vitamin supplementation and is not on any prescription medications. She denies any focal neurologic symptoms and has not had any headaches, fevers, or seizures. She is alert and afebrile. Her blood pressure is 121/70 mm Hg, and her pulse is regular, with a rate of 70 beats/min. On cognitive testing, she scores a 24/30 on the Folstein Mini-Mental State Examination, missing 4 points on orientation, 1 point on recall, and 1 point on intersecting pentagon drawing. The physician began a laboratory panel workup to include a CBC and a B-12 review to rule out any hematologic reasons for the problems.

Diagnosis
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History

Excerpt 10

“Donald,” a 46-year-old man went in for a follow-up visit after being discharged from hospital after a 35 day stay, after falling from a ladder approximately 20 feet high and landing on a concrete apron. During the follow-up visit, the patient was noted to have a serum sodium concentration of 128 mEq/L and was referred to nephrology for evaluation for hyponatremia.

During his visit to the nephrology clinic, the patient complained of occasional dizziness and continued pain in the neck area but had no other complaints. The patient declined hospital admission for investigation and treatment of his hyponatremia because he had urgent personal matters to attend to, however, 2 days later, the patient is brought to the emergency department because of increased confusion and seizure. A workup involving a serum Na+ and Plamsa osmolality confirmed hyponatremia associated with measured serum hypo-osmolality, (SIADH). A corrective saline infusion was started after consult with a nephrologist.

Diagnosis
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History

 

Cabot, R. C., Harris, N. L., M.D., Shepard, J. O., M.D., Rosenberg, E. S., M.D., Cort, A. M., M.D., Ebeling, S. H., . . . Frosch, M. P., M.D. (2007). Case 36-2007. The New England Journal of Medicine, 357(21), 2167-2178. doi:http://dx.doi.org/10.1056/NEJMcpc079030

Khani, F. & Roshil, M. (2012). 24 year old man previously diagnosed with hemophilia. Clinical Chemistry. 58:7 Retrieved from: http://www.clinchem.org/content/58/7/1086.full.pdf

Excerpt 9

Sibert, L.C. & Erten-Lyons, D. (2015, September 3). A 51-Year-Old Woman With Cognitive and Functional Decline. Medscape. Retrieved from http://reference.medscape.com/viewarticle/850363 .

Excerpt 10

Teran, F., Simon, E., & Batuman, V. (2015, March 10). Hyponatremia in a 46-Year-Old Man After Head Trauma. Medscape. Retrieved from http://reference.medscape.com/viewarticle/840976