CEREBROVASCULAR ACCIDENT- CARNATE

CASE SCENARIO

Michael is a 61-year-old Senior Partner in a Law Firm. While eating breakfast

Michael experienced sudden onset slurring of speech, had facial droop on his
left-hand side with weakness in left side upper and lower limbs. Michael's wife
Mary spotted these sudden onsets of symptoms and immediately called for an
ambulance, which arrived within 15 mins.

Vitals:

 BP 145/90 mmHg
 Pulse 82
 RR: 19
 TEMP: 37
 O2 SAT: 96

Physical Exam:

 Confusion
 Left Facial Droop
 Slurred Speech 
 Left Motor Weakness Upper Limb 0/5, Lower Limb 2/5
 Decreased Tone
 Altered Sensation
 Mild Left Sided Neglect

LEVEL OF CONSCIOUSNESS: 19
ACUTE CHOLECYSTITIS- BALLON

CASE SCENARIO

A 45-year-old female presents with a complaint of abdominal pain for the past 3
days. She localizes the pain to her epigastric area and states that it radiates to her
right upper quadrant. She notes that it became markedly worse after eating dinner
last night. She recalls a past history of similar pain, but has never had any
diagnostic workup.
Her past medical history is significant for hypertension and hypercholesterolemia.
She is status post a total abdominal hysterectomy 1 year ago.
She does not smoke, drink alcohol, or use drugs.
Her ROS is positive for abdominal pain, nausea, one episode of vomiting, and a
subjective fever.
Her VS are BP 155/90, HR 110, RR 14, T 100.6, SpO2 98% on RA.
Her physical exam reveals an overweight woman in no acute distress. Her chest
and cardiovascular exams are normal except for mild tachycardia. Her abdominal
exam is significant for tenderness to palpation to her epigastric and right upper
quadrants without rebound tenderness. Bowel sounds are normal.
DIABETES MELLITUS TYPE 2- LUGO
CASE SCENARIO

R.C. is a 57-year-old man with type 2 diabetes first diagnosed 2 years ago. Other
medical problems include obesity and hypothyroidism. He has a history of heavy
alcohol use but quit drinking alcohol 2 years ago. He presents now for routine
follow-up and is noted to have a blood pressure of 168/100 mmHg. He is
asymptomatic.

Physical exam reveals a height of 5 feet, 8 inches, weight of 243 lb, blood pressure
of 160/100 mmHg, and a regular pulse of 84 beats/min, Temp: 36.8, RR: 20, O2
sat: 95%

There is no retinopathy or thyromegaly. There is no clinical evidence of

congestive heart failure or peripheral vascular disease.

Laboratory evaluation reveals trace protein on urinalysis, blood urea nitrogen of 14

mg/dl, serum creatinine of 1.2 mg/dl, random serum glucose of 169 mg/dl, normal
electrolytes, and normal thyroid-stimulating hormone levels. A 24-h urine
collection reveals a urinary albumin excretion rate of 250 mg/day.
ACUTE APPENDICITIS- JOCSON
CASE SCENARIO

 27-year-old woman with no past medical history presents to the emergency room
with 24 hours of abdominal pain. The day prior to presentation, she developed
diffuse, vague abdominal discomfort. She lost her appetite and went to bed early
secondary to malaise. The following morning, the pain worsened in intensity,
became sharp, and localized to the right lower quadrant.

The patient is afebrile, with normal vital signs. On examination, she is focally
tender to palpation in the right lower quadrant with voluntary guarding. Palpation
of the left lower quadrant reproduces pain on the right. Her lab work is
unremarkable with the exception of a mild leukocytosis to 13.

VITAL SIGNS:

BP: 110/80

PR: 83

RR: 18

02 SAT: 98

TEMP: 36.5
CONGESTIVE HEART FAILURE- DEDUQUE
CASE SCENARIO

The patient is a 60-year-old white female presenting to the emergency department with
acute onset shortness of breath.  Symptoms began approximately 2 days before and had
progressively worsened with no associated, aggravating, or relieving factors noted. She
had similar symptoms approximately 1 year ago with an acute, chronic obstructive
pulmonary disease (COPD) exacerbation requiring hospitalization. She uses BiPAP
ventilatory support at night when sleeping and has requested to use this in the emergency
department due to shortness of breath and wanting to sleep.

She denies fever, chills, cough, wheezing, sputum production, chest pain, palpitations,
pressure, abdominal pain, abdominal distension, nausea, vomiting, and diarrhea.

She does report difficulty breathing at rest, forgetfulness, mild fatigue, feeling chilled
requiring blankets, increased urinary frequency, incontinence, and swelling in her
bilateral lower extremities that is new onset and worsening. Subsequently, she has not
ambulated from bed for several days except to use the restroom due to feeling weak,
fatigued, and short of breath.

There are no known ill contacts at home. Her family history includes significant heart
disease and prostate malignancy in her father. Social history is positive for smoking
tobacco use at 30 pack years. She quit smoking 2 years ago due to increasing shortness of
breath. She denies all alcohol and illegal drug use. There are no known foods, drugs, or
environmental allergies.

Vital signs reveals temperature 97.3 F, heart rate 74 bpm, respiratory rate 24, BP 104/54,
BMI 40.2, and O2 saturation 90% on room air.