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BSN IV-1 SCENARIOS A. CANCER Julian Smithers is a 68-year-old man with a history of smoking for 7 years.

He had radiotherapy to a large hilar mass at the time of diagnosis. He was relatively well for two months when he developed thoracic back pain. This was secondary to bone metastases and spinal cord compression. He received further radiation and morphine for pain control. He is now on 260mg of sustained release morphine every 12 hours with reasonable pain control. Other symptoms include anorexia and cachexia, generalized weakness and mild dyspnea.

B. Metastasis A 39-year-old female underwent modified radical mastectomy for left breast cancer. Postoperative diagnosis suggested papillotubular carcinoma Stage II. Vascular or lymphatic invasion was detected. After surgery, the patient underwent radiotherapy. Xeloda and Ixempra was taken. On the first month, general fatigue and swelling of the abdomen developed. After one month, physical examination showed liver dysfunction. Computed tomography (CT) and ultrasonography (US) revealed liver metastasis from breast cancer. The patient consulted the hospital and was admitted. Ultrasonography showed remarkable enlargement of the liver and the multiple foci appeared to be metastatic nodules. There was yellow coloring in the skin, lymph node swelling on the body surface or palpable nodes in soft tissues. In the liver, palpation revealed swelling. Ultrasonography of the liver on admission revealed multiple diffuse foci in the whole liver. To treat the liver metastasis of the patient, systemic chemotherapy and arterial injection chemotherapy with a catheter inserted into the hepatic artery was performed.

C. Neoplasia ANNIE, 38 years old, was experiencing symptoms of remitting fever, fatigue, loss of appetite, and an unexplained weight loss in the past three (3) weeks. She has been living with her husband for three years when he ended their relationship with annulment papers. He left Annie as the lone financer of their five children. Since their break-up, Annie has been taking large amounts of alcoholic beverage and has been a chain smoker. Annie was rushed to the ER of a local hospital when she fainted after a week of heavy menstrual flow. On interview, she stated that she usually experiences menorrhagia, usually saturating two (2) pads per hour for two to three days. A Papanicolau (Pap) smear was ordered by the physician. Results revealed neoplasia of the cervical cells. She was then referred for further evaluation.

D. normal vagina and cervix. which lead to the final diagnosis of Cervical Dysplasia. have had multiple sex partners. The lesion was treated by hysteroscopy without complications. and C. During bimanual examination. particularly spotting after intercourse and lower back pain. Metaplasia A 33-year-old Caucasian woman was admitted with a history of secondary infertility and with a regular menstrual cycle. On examination. with a coral-like white plaque 1. back. Certain lab tests were performed and revealed that she has dietary deficiencies in Vitamin A. the uterus feels slightly enlarged and with palpable masses. she has normal vital signs. she has normal external genitalia. Due to the signs and symptoms present. a 30 year old female has been experiencing occasional signs and symptoms of abnormal vaginal bleeding.5 cm in length on the right horn and posterior wall of the uterus. On pelvic examination. Her heart. She has history of using contraceptives when she was young because of irregular menstrual periods. . as well as Pap smear. A transvaginal ultrasound was ordered and results obtained show a 10 cm uterus. and pelvic examination. the patient became pregnant spontaneously. She had her first check up with her physician. thus she was unable to become pregnant. lungs and abdominal exams are normal. F. Her mother has history of uterine cancer. E. She also has undergone laparoscopic cholecystectomy. Her past medical history indicates borderline diabetes for which the patient is on a diet to which she is minimally ad-herent. She started smoking when she was 19 and stopped when she was 40 yrs old. her history reveals that she has been smoking since she was 16 years old. she weighs 247 pounds. the physician performed abdominal. Nine months after the procedure. She reported a miscarriage at 12 weeks of gestation 7 years previously and subsequent dilatation and curettage in another medical facility. Hyperplasia A 56 year-old female. Office hysteroscopy revealed a wide endometrial cavity and proliferative endometrium. Endometrial biopsy reveals complex hyperplasia with atypia. and has been using birth control pills for almost 10 years. Pap smear results showed precancerous cells in the cervix. She went through the menopause two years ago and had no vaginal bleeding until 6 months ago when she had a three-day episode of light bleeding. Caucasian. G0P0 presents to the clinic with complaints of intermittent vaginal bleeding. Microscopic examination showed endometrial tissue with osseous metaplasia in the stroma. E. Dysplasia Probin Syana. Vaginal ultrasound was performed and showed an intrauterine structure described as a hyperechogenic image suggesting calcification related to chronic endometritis.

knowing her mother died of breast cancer. She underwent genetic screening and it was found out that he carries BRCA1 and BRCA2. genetic markers for breast cancer. Lumbar puncture confirmed subarachnoid hemorrhage (SAH). She went to the clinic for a check up. Three months later. there is a noticeable lump on her right breast. . The situation remained stable for a few months. Six months ago. Carcinogenesis Nina is a 36 year old woman diagnosed with breast cancer. Cerebral CT scan and MRI were negative.G. In the interview. temozolomide chemotherapy. she often goes to the beach to tan herself. the patient presented with paraparesis. Anaplasia A 41 year old man presented with violent thunderclap headache and a bilateral proprioceptive sensibility deficit of the upper limbs. The patient went through a D5-D8 laminectomy. anaplastic extramedullary C7-D10 ependymoma with memningeal carcinomatosis considered the source of hemorrhage. She is also fond of eating char grilled foods. Her mammogram came back inconclusive. and thorough work-up revealed a diffuse. but cerebral angiography was negative. H. and radiotherapy. Presently. she noticed a small lump on her breast while showering.