1). Mr. Smith was lifting a heavy piece of furniture when he experienced crushing pain in his chest, began sweating heavily, and was nauseated. His wife drove him to the hospital, where he was diagnosed with myocardial infarction (MI, also called a heart attack) and given intravenous drugs to dissolve a clot that was obstructing a major coronary artery. After his hospitalization, Mr. Smith’s doctor told him that some of his heart muscle had died.
1. Explain the pathological processes associated with the statement, “heart muscle died.”
2. Discuss and contrast reversible and nonreversible cell injury.
Case Study 2)
Rachel comes from a family with a history of breast cancer on her mother’s side. Rachel’s mother died of breast cancer when she was very young. Rachel has two sisters, Lisa and Kristin. Rachel has remained close to Lisa, but she no longer has a relationship with Kristin. At a routine checkup, Rachel is told about the availability of genetic testing for identifying a predisposition to breast cancer. Her doctor recommends the test to Rachel given her family history. Rachel has the genetic testing done and finds that she has a mutated breast cancer 1, early onset (BRCA1) gene. Her doctor tells her she is at high risk for developing breast and ovarian cancer. Rachel’s doctor suggests she ask her sisters to be tested also, so they can take the proper preventative measures. Rachel feels comfortable sharing this information with Lisa, but she has not spoken to Kristin in many years. Rachel tells her doctor that she is not in contact with Kristin and will not make an effort to tell her about BRCA1 and genetic testing. Rachel’s doctor feels confident that she can locate Kristin but worries about breaching patient confidentiality if she goes against Rachel’s wishes.
1. If you were Rachel’s healthcare professional, what would you do? Provide a rationale for your response. Include the pathological processes associated with breast cancer.
2. What role does the BRCA1 gene contribute to managing the patient’s care? Describe and explain the role of the BRCA1 and breast cancer 2, early onset (BRCA2) gene in contribution as a risk factor for breast cancer.
Case Study 3)
Endocrine System Case Study
Joan Barker, age fifty-six years, comes for a routine physical examination. She states that she has been in perfect health and has no complaints. She has a history of asthma but currently requires no medications of any kind. Her physical examination is completely normal, except for a 2-cm firm, nontender, nonmobile mass in the upper outer quadrant of her left breast. She indicates that she does not perform regular breast self-examination and that she did not know the mass was there. She has no family history of breast cancer and has never been pregnant.
1. What term is used to describe the benign condition that may have caused Ms. Barker’s breast mass?
2. What is inside the cysts of fibrocystic breast disease?
3. Mammography and ultrasonography reveal a solid lesion (not cystic). What is the most common type of breast cancer?
4. Biopsy determines that Ms. Barker has invasive carcinoma of the breast. What is the difference between ductal carcinoma in situ and invasive carcinoma of the breast?
Case Study 4)
Cardiovascular Case Study
PJ is a sixty-seven-year-old man with a long history of stable angina. He is treated with nitroglycerin tablets as needed for chest pain. He has mild hypertension, which is well controlled by diet and an angiotensin-converting enzyme (ACE) inhibitor. PJ has noticed that his chest pain is occurring with increasing frequency and less activity is required to initiate the symptoms; however, the pain subsides quickly with rest and one or two nitroglycerin tablets.
1. PJ’s symptoms are consistent with what diagnosis?
2. What education would you provide to PJ?
One morning, at about 4:00 a.m., PJ is awakened from sleep with chest pain and shortness of breath. The pain is much more severe than his usual anginal pain and radiates to the jaw and the left arm. He is diaphoretic and pale. His wife calls for emergency assistance, and PJ is transported to the local emergency department. Upon admission, the electrocardiogram (ECG) shows significant ST-segment elevation.
1. According to the ECG findings, what is the differential diagnosis?
At the time of admission, a blood sample is taken to determine whether PJ has suffered an MI.
1. Which laboratory findings would indicate MI?
