Bruyere_FM_i-xiv.qxd 5/6/08 12:44 PM Page iv This page intentionally left blank. Bruyere_FM_i-xiv.qxd 5/6/08 12:44 PM Page i 100 CASE STUDIES IN PATHOPHYSIOLOGY Harold J. Bruyere, Jr., Ph.D. PROFESSOR EMERITUS UNIVERSITY OF WYOMING LARAMIE, WYOMING Bruyere_FM_i-xiv.qxd 5/6/08 12:44 PM Page ii Acquisitions Editor: David Troy Managing Editor: Meredith L. Brittain Marketing Manager: Allison M. Noplock Associate Production Manager: Kevin P. Johnson Designer: Teresa Mallon Compositor: International Typesetting and Composition Copyright © 2009 Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street 530 Walnut Street Baltimore, MD 21201 Philadelphia, PA 19106 Printed in the United States of America All rights reserved. This book is protected by copyright. No part of this book may be reproduced or trans- mitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, via email at [email protected], or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Bruyere, Harold Joseph, 1947- 100 case studies in pathophysiology / Harold J. Bruyere Jr. p. ; cm. ISBN 978-0-7817-6145-1 1. Physiology, Pathological—Case studies. I. Title. II. Title: One hundred case studies in pathophysiology. [DNLM: 1. Pathology—Case Reports. 2. Clinical Medicine—Case Reports. 3. Physiology—Case Reports. WB 293 B914z 2009] RB113.B79 2009 616.07—dc22 2008014719 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omis- sions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publi- cation. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations. 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To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. Bruyere_FM_i-xiv.qxd 5/6/08 12:44 PM Page iii Dedication This case studies workbook is dedicated to my beloved wife, Kathy, my son, Travis, and my daughter, Kimberly, who have been an inspiration to me and whom I love very much. Case Study 32 is dedicated to my friend, Merrill Buckley, who passed away on July 6, 2007 after a long and courageous battle with chronic renal failure. Case Study 45 is dedicated to my late friend, Eddie Alwin, who struggled with Parkinson disease for many years. Case Study 49 is dedicated to my father, who passed away in July 1993 after a long and courageous battle with depression. Bruyere_FM_i-xiv.qxd 5/6/08 12:44 PM Page iv This page intentionally left blank. Bruyere_FM_i-xiv.qxd 5/6/08 12:44 PM Page v ABOUT THE AUTHOR Professor Bruyere has 30 years of experience teaching students in human medicine, pharmacy, nursing, and the allied health professions. He has been a member of the faculty at the University of Wisconsin, the University of Wyoming, and the University of Washington. v Bruyere_FM_i-xiv.qxd 5/6/08 12:44 PM Page vi This page intentionally left blank. Bruyere_FM_i-xiv.qxd 5/6/08 12:44 PM Page vii PREFACE he primary purpose of 100 Case Studies in Pathophysiology is to provide stu- dents beginning their formal education in the health sciences with a resource they can use to begin to develop their clinical problem-solving and critical thinking skills. This workbook, which provides a strong link between theory T and practice, was designed for use by medical, pharmacy, nursing, and allied health educators and their students. The basic concept that underlies this workbook is that clinical manifestations of an illness are directly associated with the patho- physiology of human disease. This workbook provides a straightforward approach to integrating basic pathophysiology, risk factors, physical examination findings, and clinical laboratory data for 100 significant health problems in the United States today. Some of the case studies were written from com- prehensive interviews with patients, some are composites of case studies reported in the med- ical literature, and others are drawn from my personal experiences. Review summaries of selected major health problems allow students to develop effective methods of clinical assess- ment and disease management. In addition, the principles and concepts of underlying disease processes presented here will further prepare students for the study of basic pharmacology. Goals of This Workbook The three major goals of this workbook are: • To provide a basic, straightforward, and current resource tool for medical, pharmacy, nursing, and allied health students who have minimal experience interpreting a medical case study or a patient’s medical record; • To provide students in the health sciences with an opportunity to develop their clinical problem-solving skills by identifying clinical manifestations, abnormal clinical laboratory data, and risk factors for a variety of significant health disorders; • To provide an opportunity for students in the health sciences to develop their clinical crit- ical thinking skills by selecting appropriate disease management options through a case study approach. The Audience This workbook is unique in that it was designed for students in human medicine, pharmacy, nursing, and the allied health sciences to support early courses in basic pathophysiology or general pathology. I made the assumption that students who would use this workbook had not completed courses in pharmacology and were novices regarding drug treatment. I also assumed that students would be learning for the first time how to problem solve and think critically with a medical case study before them. The use of case studies in this workbook does not require extensive knowledge and expe- rience in human medicine, pharmacy, or nursing. Case studies are basic, concise, and intro- duce the student to new medical terms and medical abbreviations that are commonly used by health professionals. Each patient case also incorporates important clinical signs, symp- toms, and laboratory data that are consistent with a specific health problem. The student will use tables of clinical laboratory reference values (e.g., normal white blood cell count, normal serum sodium or potassium concentrations) to recognize data collected from case study patients that are abnormal and suggestive of specific disease states. The workbook can be used to complement a variety of basic pathophysiology or pathol- ogy textbooks. 100 Case Studies in Pathophysiology also can be used by itself as a concise and effective review of concepts previously learned. vii Bruyere_FM_i-xiv.qxd 5/6/08 12:44 PM Page viii viii PREFACE Organizational Philosophy This book uses the organ systems approach to categorize human diseases and other health con- ditions. This approach allows the instructor to cover conditions in a logical and efficient manner (e.g., cardiovascular disorders, gastrointestinal disorders, or respiratory disorders). However, instructors must ensure that an anatomic and physiologic review of the appropriate organ sys- tem has been completed before students begin each of the case studies. Success in working through each case presentation presupposes fundamental knowledge of the normal anatomy and physiology of the appropriate organ system. For example, a complete review of the anatomy and physiology of the heart is essential before completing the case studies in Part 1, Cardiovascular Disorders, such as “Acute Myocardial Infarction” and “Congestive Heart Failure.” This workbook contains a wide range of pertinent clinical information so that students may better interpret and assess