Estudiante: Marco Antonio Rivera Perez

Carrera: Medicina

Año: 4to

Brigade: 76

Case report
Appendicitis

A 32-year-old men whose name is Fernando Torrez was admitted to the hospital complaining

of to the right iliac fossa pain of sudden onset, of increasing severity and discomfort. He said

that the pain began in epigastrium. His father suffer from hypertension and his mother suffer

from constipation. The patient had been well, when she began to have fever and three vomits.

On physical examination on palpation revealed that the abdomen is very tender whit

predominance in right iliac fossa and periumbilical pain. On investigations colonoscopy showed

signs of peritonitis, and the ultrasonography showed inflammation of the appendices in right

iliac fossa. The patient was diagnosed whit appendicitis. In the differential diagnosis was ruled

out endometriosis, ovarian cyst or torsion and renal colic. The doctor recommended the

patient urgent appendectomy and antibiotics like aminoglycosides.

Peptic Ulcer

A 64-year-old man whose name is Roberto Almirante was admitted to the hospital complaining

of severe epigastric pain burning type of one month of evolution. During the curse of the

examination, he said that he could also feel the pain in the right superior cuadrant. His father

suffer from hiatal hernia and his mother suffer from Diabetes. The patient had been well until

four months earlier, when he began to have pain, vomits, epigastric discomfort and episodes

of hematemesis. The patient had a 26-pack-year history of cigarette smoking and he drank

alcohol. He suffers from Gouty Arthritis and have to take many medications like naproxen, and
gastritis by H. pylori. On physical examination revealed painful faces whit normal vital signs

except the pulse was 112, soft abdomen whit medium and deep tenderness in all of the

abdomen and peritoneal irritation data. On investigations white blood cell count showed

12,100 /uL, neutrophilia and Rx abdomen showed ground glass image. The patient was

diagnosed whit peptic ulcer. In the differential diagnosis was ruled out angina pectoris,

pancreatitis and gastritis. The doctor recommended the patient a triple therapy whit

omeprazole, clarithromycin and amoxicillin and a balance diet whit fruits and vegetables low in

salt, without coffee, alcohol and acids food.

Breast cancer

A 47 year-old women whose name is Angela Duran was admitted complaining of increased left

breast volume and pain in her breast. During the curse of the examination, she said that she

could also feel the pain in the right arm. His father suffer from gastritis and his mother suffered

from breast cancer, she died ten years ago. The patient had been well until 4 months earlier,

when she began to have asthenia, anorexia, weight loss, and vomiting.

On physical examination revealed four hard and painless nodules in the right breast, changes

in the coloration of the breast giving the appearance of orange peel and axillary

lymphadenopathy. On investigation mammography and ultrasound showed malignant-looking

tumor masses in the right breast. The patient was diagnosed whit left breast cancer. In the

differential diagnosis was ruled out breast lymphomas, mastitis, ceulitis. The doctor

recommended the patient to perform a breast biopsy and if it is positive to perform radical

axillary emptying with an adjuvant chemotherapy scheme, plus radiation therapy to the breast

and ganglion chains, reserving hormonal treatment.

Dialogues:

Peptic ulcer

Doctor: Good morning. I`m Doctor Marco A Rivera

Patient: Good morning

Doctor: What`s your full name?

Patient: My name is Roberta Acosta Martinez

Doctor: What`s your age?

Patient: I`m 53 years old

Doctor: Do you live alone?

Patient: No, I live whit my husband

Doctor: What`s your occupation?

Patient: I`m a cook

Doctor: What brings you to the hospital today?

Patient: I have epigastric pain very strong

Doctor: Are there any other problems?

Patient: Yes, I have nausea, three vomits, epigastric discomfort and anorexia

Doctor: When did the pain begin?

Patient: The pain began four days ago and after the pain, come up the epigastric discomfort
Doctor: How bad is the pain?

Patient: It is a moderate pain

Doctor: Do you suffer from any chronic disease?

Patient: Yes, I suffer from Gouty Arthritis

Doctor: Do you take any medications?

Patient: Yes, I have to take many NSAID like naproxen

Doctor: Do you drink coffee?

Patient: Yes, I drink coffee

Doctor: How many cups a day do you drink?

Patient: I drink 10 cups per day

Doctor: Do you drink alcohol ?

Patient: Yes, I drink alcohol in the weekends

Doctor: What makes it worse?

Patient: It better when I eat food like fruits

Doctor: I think that you suffer from peptic ulcer. You should eat a balance diet whit fruits and

vegetables without coffee and acids food. You shouldn`t drink alcohol.

You have to take omeprazole 20mg/d for four weeks and cimetidine 200mg three times a day

for eight weeks.

Appendicitis

Doctor: Good afternoon. I`m Doctor Marco A. Rivera

Patient: Good morning Doctor

Doctor: What`s your full name?

Patient: My name is Javier Hernandez

Doctor: What`s your age?

Patient: I`m 32 years old

Doctor: Are you married?

Patient: Yes, I am married

Doctor: What`s your occupation?

Patient: I`m a teacher

Doctor: What brings you to the hospital today?

Patient: I have a pain in the right iliac fossa

Doctor: Any other problems?

Patient: Yes, I had five vomits and fever

Doctor: What were you doing when you had the pain?

Patient: I were sleeping this tomorrow in my house

Doctor: Does the pain move?

Patient: The pain began in epigastrium and after it becomes localized in right iliac fossa.

Doctor: How bad is the pain?

Patient: The pain is very terrible

Doctor: Is there anything that makes the pain better?

Patient: I feel better when I flex my lower right limb

Doctor: Is there anything that makes the pain worse?

Patient: I feel bad when I change position or path

Doctor: I think that you suffer from appendicitis. I order to make you an urgent appendectomy.
 Breast cancer

Doctor: Good morning. I`m Doctor Marco A Rivera

Patient: Good morning Doctor Marco

Doctor: What`s your full name?

Patient: My name is Julia Toledo

Doctor: What`s your age?

Patient: I`m 67 years old

Doctor: Are you married?

Patient: Yes, Iam married

Doctor: What`s your occupation?

Patient: I`m a housewife

Doctor: What brings you to the hospital today?

Patient: I have nodules on my right breast when I touch myself just like under the right armpit

Doctor: Do you also pain?

Patient: Yes, I have pain sometimes when I touch myself very deep

Doctor: Does the pain move?

Patient: Yes, It move to my right arm

Doctor: Can you describe your pain?

Patient: Is a moderate pain

Doctor: Have you lost weight in the last months?

Patient: Yes, I lost 18 kg

Doctor: Any other problems?

Patient: Yes, I have vomits and asthenia

Doctor: Do you suffer from any disease?

Patient: Yes, I had cancer of lung five years ago

Doctor: Does anyone in your family have any illness?

Patient: Yes, my mother died of breast cancer 10 years ago

Doctor: I think that you suffer from breast cancer, but don't worry because maybe I wrong

I order to make you a mammography and ultrasound and a breast biopsy and if it is positive to

perform radical axillary emptying with an adjuvant chemotherapy scheme, plus radiation

therapy to the breast and ganglion chains, reserving hormonal treatment. You should a healthy

diet and practice sport to lose weight. We will do everything possible for your complete

recovery.