Online Case 3-22-11

Online Case 3-22-11 - Week 1 Clinical Case I. HISTORY A...

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Week 1 Clinical Case I. HISTORY A 45-year-old white female is seeking medical attention for fatigue that developed during the last month. She reports no chest pain. However, she does feel mildly short of breath with exertion such as walking up a flight of stairs. She notes no bright red blood per rectum or melena, but she has had heavy menstrual periods for about a year. Past medical history: She was treated for anemia following her third pregnancy 10 years ago. She has not been taking any prescribed medications. Family history: Her parents were born in Italy and died when she was in grade school. She does not know their medical history. Question 1: The following are the patient’s answers to additional questions. Select the statements that provide useful information. She is taking aspirin 81 mg daily. Yes, this is useful. COMMENT: Aspirin can cause GI oozing of blood. She is a vegetarian who eats a lot of cereal. Yes, this is useful. COMMENT: Vegetarian diets that include milk products and eggs usually provide sufficient folate and vitamin B12, but vegan diets that do not include milk products and eggs may not provide adequate vitamin B12. These diets provide iron, but they contain non-heme iron that is not as readily absorbed as heme iron (from red meat, fish and poultry). Additionally, phytates in cereals, tannins in herbal teas, and antiacids can inhibit iron absorption. However, simple dietary deficiency usually does not lead to iron deficiency. She does not have an urge to eat ice. Yes, this is useful. COMMENT: Pagophagia is a variant of pica in which ice is obsessively consumed. Some forms of pica like clay or starch ingestion can contribute to iron deficiency by binding iron and preventing its absorption. Ice does not contribute to iron deficiency but is a symptom of the mucosal changes in the mouth from severe iron deficiency. Question 2: Does this patient have symptoms and signs of anemia? No Incorrect. COMMENT: This patient does have symptoms and signs that could be consistent with anemia. Fatigue is a common presenting symptom of anemia. Heavy menstrual periods suggest a mechanism for the development of anemia may be present (blood loss). Pale conjunctiva and a soft systolic ejection murmur are signs that are consistent with, but not diagnostic of anemia. The heart rate and blood pressure are within the normal range, indicating physiologic compensation for the anemia. Yes Correct! COMMENT: Fatigue is a common presenting symptom of anemia. Heavy menstrual periods suggest a mechanism for the development of anemia may be present (blood loss). Pale conjunctiva and a soft systolic ejection murmur are signs that are consistent with, albeit not diagnostic of anemia. The heart rate and blood pressure are within the normal range, indicating physiologic compensation for the anemia.
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Question 3: Which of the physical findings listed below would be consistent with anemia due to iron, vitamin B12 or folate deficiency? Click the appropriate box(es) for each finding. (N/A = not consistent with anemia due
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This note was uploaded on 09/14/2011 for the course PHARM HEM taught by Professor Staff during the Spring '11 term at UCSD.

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Online Case 3-22-11 - Week 1 Clinical Case I. HISTORY A...

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