Case 1: A 60 year old man with long-standing type II diabetes that has been untreated with insulin is admitted to the hospital after reporting noticeably bloody urine.

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Case 1: A 60 year old man with long-standing type II diabetes that has been untreated with insulin is admitted to the hospital after reporting noticeably bloody urine.

Bilaterally, he has no feeling in the bottoms of his feet and decreased sensitivity mid-shin, while sensation at the knees is normal. Upon examination the clinician notices that the patient’s lenses are cloudy, and the patient is having a difficult time reading his admissions paperwork. The patient’s blood pressure is also elevated.

1. Why might this patient have blood in his urine?

2. What other abnormalities would typically be found in such a patient’s urinalysis?

3. What is causing the bilateral desensitization of the lower limbs?

4. Why are this patient’s lenses cloudy?

5. Why might this patient have difficulty reading his admissions papers?

6. How is the elevated blood pressure related to the other symptoms?

Case 2: Julie Turner, a 27 year old non-pregnant female, has grown increasingly anxious about changes in both her behavior and body recently. She consults her physician and complains of insomnia, gastrointestinal instability, feeling excited, and weight loss. She also reports that even though she has lost weight, her “double chin” has not gone away. Upon examination, the physician notes that, while not pronounced, Julie’s eyes seem larger, and her reflexes are excitable. The physician decides to send Julie to an endocrinologist for a consultation.

1. What does an endocrinologist specialize in?

2. Define hyperthyroidism.

3. Which of Julie’s signs an symptoms are compatible with hyperthyroidism?

4. Does Julie show signs and symptoms specific to Grave’s disease?

5. Why might Julie be mistakenly thinking she has a “double chin”?

6. What is the doctor concerned with when they notices that Julie has “large eyes”?

7. If Grave’s disease is confirmed, what is the most likely treatment?

Case 3: George is a 50 year old man that had a severe motorcycle accident 12 years ago. As a result of the accident, George had one kidney and part of his small intestine removed because they were hemorrhaging. Immediately following recovery, George had some weight loss that he was told to expect because of malabsorption caused by having his intestine removed. George has never returned to work due to his injuries, and mostly sits inside and watches TV and reads. Recently, however, George broke his wrist trying to catch himself from falling. When he was examined, he was told that his bones had become weak.

1. Define osteopenia and osteoporosis. Which does George seem to have?

2. What is the most common type of fracture of the wrist in a person of George’s age?

3. Explain how Vitamin D, calcidiol, and calcitriol are synthesized?

4. How could George’s missing kidney be related to his decreased bone strength?

5. How could George’s partial small intestine be related to his decreased bone strength?

6. If George has a decreasing density of his bones due to his previous injuries, what is the classification of his condition?

7. Could George’s lack of time outside be a factor in his weak bones?

Case 4: Pete is a 250 lb man that played 15 years of professional football. Pete quit football at that age of 38 when his hips and knees became too painful to play. He has tried to manage the pain with OTC antiinflammatory drugs for the past 20 years. Now 58 years old, Pete has a severe limp on his right side and gone to the doctor in hopes to get stronger pain medication. His general doctor orders X-rays, which reveal bilateral narrowing of both hip and knee joints. The right acetabulum shows bony projections extending toward the femoral head.

1. What does Pete suffer from?


 

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