Patient Case Question 1.

What is the pathophysiologic mechanism for adrenal insufficiency in this

patient?

Patient’s adrenal glands fails to synthesize and release adrenocortical hormone. The impairment results
from the dysfuction of adrenal cortex because of steroid use.

Patient Case Question 2. What is the potential cause of the abnormal DEXA scan in this patient?

Crohn’s Disease may affect the absorption of Vit D and calcium. Patient is in steroid therapy,this can
cause loss of bone density. The potential cause of abnormal DEXA ( Dual Energy Xray Absorptiometry) is
skeletal weakness that may lead to osteoporosis.

Patient Case Question 3. For which condition has trazodone been prescribed for this patient?

Trazadone has been prescribed to this patient to treat major depression.

Patient Case Question 4. Why is this patient taking cyanocobalamin IM?

The patient is taking cyanocobalamin IM due to vitamin B deficiency. Vitamin B deficiency is the most
common deficiency among people with Crohn’s dse

Patient Case Question 5. Based on your analysis of this patient's medication profile alone, what can you
deduce about the degree of severity (mild to moderate or severe) of Crohn's disease in this patient?
Based on the patient's profile analysis, the degree of severity is severe, according to the CDAI score.

Patient Case Question 6. What is likely the cause of this patient's cushingoid facial appearance?

The patient is under steroid therapy for a long term , so the likely cause of cushingoid facial appearance
is the use of steroid.

Patient Case Question 7. Briefly describe a cushingoid facial appearance

Extra fat build up on the sides of the face, this is known as moon face. This cushingoid facial appearance
is often related to cushing’s syndrome.

Patient Case Question 8. What is the most likely cause of the abnormal vital sign of most concern above?

The patient's blood pressure reading of 165/95. One of the serious side effects of
prednisone(corticosteroid) is elevated blood pressure.

Patient Case Question 9. What do the examination findings in the skin suggest?

The examination findings were poor turgor with dry and flake skin. These signs suggest that there is a
fluid volume deficit
Patient Case Question 10. What does the phrase "sclera without icterus" suggest?

Anicteric Sclera (Sclera without icterus) means that the white part of the eye is still white and there’s no
yellowing

Patient Case Question 11. Identify the two abnormal HEENT findings above and provide a
pathophysiologic explanation for each of them.

Two abnormal HEENT findings: mild arteriolar narrowing on the funduscopic exam and dry mucous
membrane. BP elevation cause vasoconstriction in retinal blood vessel, this results to mild arterial
narrowing.

Dehydration causes the salivary gland to produce inadequate enough saliva which results to dry mucous
membranes.

Patient Case Question 12. What is a likely cause of "truncal obesity with striae"?

Hyperadrenocorticism or Cushing’s Syndrome is likely the cause of truncal obesity this is due to increase
adipose tissue accumulating in the trunk and face.

Patient Case Question 13. What are striae?

Striae are indented streak on the skin with a silvery-white hue. Striae are caused by tearing of the
dermis that includes darkening skin tone and thinning of skin.

Patient Case Question 14. What is meant by guarding?

Abdominal guarding is the tensing of the abdominal wall muscles to guard inflamed organs within the
abdomen from the pain of pressure associated with Crohn's disease.

Patient Case Question 15. Identify the four abnormally elevated laboratory findings above and provide a
brief and reasonable pathophysiologic explanation for each of them.

WBC 11,700/mm3 s/s of inflammation

Platelets 180,000/mm3 s/s of inflammation

Fasting Glucose reading of 120 mg/dL may include a sign of diabetes

ESR 24 mm/hr s/s of inflammation

Patient Case Question 16. Identify the four abnormally low laboratory findings above and provide a
brief and reasonable pathophysiologic explanation for each of them

Potassium 3.0 meq/L: irregular heartbeat due and necessary for nerve and muscle functioning of the
body.

Calcium 8.7 mg/dL: osteopenia and vitamin d malabsorption in the body./ skeletal weakness
Albumin 2.4 g/dL: malnutrition or Crohn’s disease

Hemoglobin level of 13.8 g/dL: possible anemia/ iron deficiency