MEA2203 MODULE 06 CASE STUDIES

Patient Name: Fiona Miller

Date of Birth: 4/13/1994

Clinical Notes: Patient reports to the clinic with increasing dysmenorrhea. She describes the pain as
cyclical, increasing in intensity during menstruation. The pain started as mild cramps several years ago,
but has progressively become more severe and is now debilitating. The patient denies any abnormal
vaginal discharge.

Current vital signs: BP 110/82, HR 68 bpm, Temperature 98.4°F

Her gynecologist completes a pelvic exam and notes no structural abnormalities of the vagina or cervix.
The gynecologist suspects endometriosis or polycystic ovarian syndrome and recommends imaging
studies for diagnosis and treatment.

Question #1: Why would the physician order imaging tests instead of lab tests?

The Physician would order imaging tests instead of lab tests because an MRI, CT, and ultrasound help
form a better picture on the severity of the disease, identify and confirm any cysts and their size and
location, and to rule out other possible conditions.

Question #2: If Ms. Miller has polycystic ovarian syndrome, what other symptoms might you expect her
to exhibit?

Other symptoms you might expect Ms. Miller to exhibit would be amenorrhoea (missed or irregular
periods), excessive unwanted hair growth (facial region), weight gain, fatigue, depression and/or mood
swings, thinning hair on the scalp, and infertility.

Question #3: Ms. Miller’s MRI report shows lesions surrounding the ureters, round ligaments, and
bladder. Which of the physician’s diagnoses is correct and why?

Endometriosis is the correct diagnosis. Tissues are irritated causing localized pain and inflammation as
well as lesions around the round ligaments, uterus, ovaries, or colon as a result of the endometriosis.
The associated pain and inflammation occur each month with progression.

Question #4: Why might hormonal birth control be a good treatment option for Ms. Miller?

Hormonal birth control might be a good treatment as risks of endometriosis are reduced as ovulation is
suppressed as a result of a reduction In menstrual blood blow. This is a good option for those who do
not have immediate plans for pregnancy.
 MEA2203 MODULE 06 CASE STUDIES

Question #5: Should Ms. Miller be concerned about her chances of becoming pregnant in the future?
Why or why not?

Being diagnosed with any disease would cause worry, especially with women and diseases concerning
infertility. While not directly causing infertility, endometriosis is associated with problems with
infertility. Natural conception is still possible, even with a diagnosis of severe endometriosis.
 MEA2203 MODULE 06 CASE STUDIES

Patient Name: Aboubacar Heinrich

Date of Birth: 2/11/1952

Clinical Notes: Male patient reports difficulty urinating. His symptoms started two weeks ago and were
sporadic at first. He is now urinating more frequently, especially at night, and feels a sense of
incomplete bladder emptying. He reports that he has a weak, interrupted stream of urine.

Current vital signs: BP 122/78, HR 82 bpm, Temperature 98.2°F

The physician suspects prostate issues and suggests a digital rectal exam and prostate-specific antigen
test.

Question #1: If the issue is related to a structural abnormality of the prostate, which other symptoms
(not mentioned here) may he experience?

Other symptoms related to a structural abnormality of the prostate could include urgency to urinate,
recurrent urinary tract infections, delay urination ability, difficulty starting a urine stream, dribbling at
the end of urination, and burning during urination.

Question #2: What is a prostate-specific antigen test and why was it ordered in this case?

A prostate specific antigen test was ordered to rule out prostate cancer. Gammaseminoprotein is
prostate-specific antigen produced by cells of the prostate gland found in both normal cells and those
with cancer. The prostate -specific antigen test (PSA) measures the level of PSA in the blood of men.
Normally, the PSA levels are low. A high PSA level can be a sign of prostate cancer.

Question #3: Mr. Heinrich’s digital rectal exam revealed abnormal bumps. Which other diagnostic
procedures may be recommended as a follow-up?

Diagnostic procedures recommended as a follow up to a digital rectal exam would include a blood test
to check levels of prostate-specific antigen. Even if PSA levels are normal, if a bump or other abnormality
is detected, a biopsy specimen of various parts of prostate tissue will be collected and sent to a
pathologist to check for/rule out prostate cancer.

Question #4: It is determined that Mr. Heinrich has benign prostatic hyperplasia and a procedure called
TURP is recommended. Explain what TURP stands for and how the procedure is completed.

TURP stands for trans-urethral resection of the prostate. TURP is a type of treatment surgery for
enlarged prostate that is making it difficult for a man to urinate., but this invasive surgery requires no
incision. Local anesthesia is used as a resectoscope is inserted through the tip of the penis and into the
prostate. The rectoscope then cuts the enlarged portion of the prostate into small pieces and by an
irrigated fluid that is added to the pieces, the pieces are transferred into the bladder.
 MEA2203 MODULE 06 CASE STUDIES

Question #5: If Mr. Heinrich does not follow through with treatment, what types of complications may
occur and why?

If Mr. Heinrich does not follow through with treatment, complications could include continued
obstruction, distended bladder, dilated ureters, hydronephrosis, and possible renal damage. If
significant obstruction and urinary retention develop, surgical intervention is required. These occur
because the obstruction in the urine flow can cause infection (cystitis), and bladder distention, and
hydronephrosis or swelling of one or both kidneys due to failure of the urinary tract completely
emptying.
 MEA2203 MODULE 06 CASE STUDIES

Patient Name: Deborah Spitzner

Date of Birth: 12/2/1999

Clinical Notes: Female patient reports vaginal pain that increases with sexual intercourse and abnormal
vaginal discharge. She has mild, burning pain during urination. Her symptoms have been present and
progressively worsening for three weeks.

Current vital signs: BP 126/78, HR 66 bpm, Temperature 100.6°F

The physician refers her to a gynecologist for a pelvic exam and orders a complete blood count,
urinalysis, and STD screening panel. Lab tests confirm a diagnosis of chlamydia.

Question #1: What is the etiology of a chlamydial infection?

Etiology of a chlamydial infection is intercourse either orally, anally, or vaginally, with one of the two
participants of sexual activity being infected and transmitting it to the sexual partner that is not yet
infected.

Question #2: How might the symptoms in this case study be different if the patient was male?

The difference in the symptoms of a male verses a female with chlamydial infection is the pain for a
male would be located in the testicles with discharge that has a watery consistency or white and cloudy
appearance.

Question #3: Is chlamydia curable? What type of treatment is usually recommended?

Yes, chlamydia is a curable infection and it is treated with antibiotics to rid the patient of the infection.

Question #4: What type of complications may occur as a result of chlamydia?

Complications that may occur as a result of chlamydia may include reactive arthritis, pelvic inflammatory
disease, joint pain, infections in newborn babies born to mothers with the infection, and infertility.

Question #5: What preventative measures should Ms. Spitzner take to avoid recurrent infections and to
avoid transmitting chlamydia to her partners?

Preventative measures Ms. Spitzner should take to avoid recurrent infections would be to follow the
physicians instructions on dosage and length of time for antibiotic treatment of the infection, refrain
from having unprotected sex, limit her number of sexual partners, and be sure to have both herself and
her sexual partners regularly tested for STD’s.