It Must Be a Bad Year for My Allergies It is an idyllic March day...

Question

It Must Be a Bad Year for My Allergies

It is an idyllic March day on the Midwestern university campus as Dr. Bob Johnston walks to his 8:00 philosophy lecture section. As he is walking across campus he notices that his typical spring cough, headache, hoarseness and nasal stuffiness are more noticeable than they have been for the past 7-10 days. As Bob turns the corner towards Old Main he notes that the Dogwoods are beginning to bloom, which confirms his symptoms and reminds him that it is the start of allergy season once again.

As the day progresses Bob notes his prescription antihistamines aren't doing the trick-his head feels unusually full, his voice is unusually hoarse for this time during the day, and he felt slightly nauseous and light-headed. By the completion of office hours Dr. Johnson posts a sign on the door of his office and heads home earlier than normal.

By the start of the next day the symptoms persist, and so Bob calls his physician and asks for an increase in the dosage of his prescribed antihistamine. An appointment is made for the end of the business day. Upon completion of a perfunctory examination Dr. Strangelove writes a prescription for a slightly stronger antihistamine and sends Bob on his way, saying the proverbial "Call me if you don't feel better in a week or so."

Spring semester is coming to a close and the first weekend in May and the accompanying spring commencement is rapidly approaching. En route to a faculty meeting Bob bumps into a departmental colleague that has been on sabbatical and off campus for most of the academic year. John is quite taken aback by Bob's appearance, in that it appears as if Bob has put on weight, especially in the face and neck. Bob states that it has been a horrible spring for his allergies, and the noticeable facial swelling is probably an undesirable side effect of his new prescribed anti-histamine medication. Upon questioning Bob notes that he has wanted to get back in to see his physician but hasn't found the time as he is in the midst of his publisher's various deadlines as Bob prepares a new book on Plato.

Bob awakens that night experiencing chest pain, difficulty in breathing while lying flat, and difficulty in swallowing. He dials 911 and is transported to the local trauma center where he is examined by the chief E.R. resident.

Upon questioning Bob relates his reason for calling the ambulance. In addition he tells the attending physician that he has chest pain, distorted vision, significant hoarseness, headache, nasal stuffiness, nausea and light-headedness.

Patient History:
- Patient is a 5'10", 175-pound 55-year-old-Caucasian male.
- Patient is a smoker and has been since the age of 18. However, in the last year or so, at the advice (nagging?) of his wife he has cut back to less than 1/2 of a pack a day.
- Patient gets little physical exercise other than his daily walk to and from campus, which totals slightly less than 2 miles per day.
Physical Examination:
- HENT examination is normal
- Blood pressure is 140/85 with a resting pulse of 80
- Chest demonstrates slight congestion upon auscultation
- Blood pressure is 145/65 with a resting pulse of 95
- The patient is exhibiting dysphagia, orthopnea and stridor.
- Chest examination by auscultation demonstrates significant congestion.
- The physician confirms significant facial swelling and notes significant swelling in both upper limbs.
- Bending forward and lying down aggravate all of the patient's signs and symptoms.
A chest X-ray and CT scan are ordered for the patient, demonstrating a cavitating right lower pulmonary lobe.

Utilizingsound anatomical logic, consider the following questions:
1. The examination of this patient will yield a secondary pathology resulting from another (primary) pathology. What are your diagnoses for both of these pathologies?
1. Explain the pathophysiology of the symptoms that initially caused Bob to feel that his allergies were acting up more than normal but ultimately caused him to dial 911.
1. One of the possible treatments for Bob's underlying (primary) pathology is surgery. Explain the anatomical considerations the surgeon must take into account as he/she prepares for the patient's surgery.
1. What is the lifetime risk of Bob's primary pathology among smokers?

PBL#1 grading rubric

	*Instructional*	*Rubric*	*For*	*Problem Based Learning*
Criteria	Excellent (10 points awarded)	Sufficient (7 points awarded)	Evolving (5 points awarded)	Poor (1 point awarded)
Diagnosis Question 1	The correct diagnosis is made, and student supports this diagnosis using patient history, signs and symptoms. Student used this information to provide a valid argument toward the diagnosis.	An incorrect diagnosis is made. However, student supports this diagnosis with patient history, signs and symptoms making a valid argument.	An incorrect diagnosis is made. Student supports this diagnosis with signs and symptoms, but does not provide a valid argument for that diagnosis.	An incorrect diagnosis is made. Student does not use patient history, signs and symptoms to support diagnosis. A valid argument for that diagnosis is not provided.
Pathophysiology Question 2	Student provided a detailed discussion of pathologic condition and why this is causing the shortness of breath.	Student provided a solid discussion of pathologic condition and why this is causing the shortness of breath; some detail is missing.	Student provided a basic discussion of pathologic condition and why this is causing the shortness of breath; moderate detail is missing.	Student provided a minimal discussion of pathologic condition and why this is causing the shortness of breath. There is little detail in the discussion.
Anatomy *(primary pathology)* Question 3	A detailed discussion of all related anatomical features is discussed. Specific emphasis is placed upon the patient’s surgery and its anatomical considerations.	A solid discussion of all related anatomical features is discussed. Specific emphasis is placed upon the patient’s surgery and its anatomical considerations. A little detail pertaining to the anatomy, or the surgical relationship, is missing.	A discussion of some related anatomical features is discussed. There is little emphasis placed upon the patient’s surgery and its anatomical considerations. Significant detail pertaining to the anatomy, or the surgical relationship, is missing.	Very little discussion is given. Only a few of the anatomical structures are mentioned, and little to no attention is given to the surgical considerations.
Lifetime Risk *(primary pathology)* Question 4	A detailed discussion of this patients lifetime risk is provided.	A strong discussion of this patients lifetime risk is provided.	A basic discussion of this patients lifetime risk is provided.	A weak discussion of this patients lifetime risk is provided.
Sources and use Of Citation Within Paper Excellent	Student uses at least three scholarly sources to support the diagnosis. Student cited all sources in paper using proper parenthetical format.	Student uses two scholarly sources to support the diagnosis. Student cited all sources in paper using proper parenthetical format.	Student uses inappropriate sources to support the diagnosis. These sources are not scholarly, journal published items. Student cited all sources in paper using proper parenthetical format.	Student did not provide cited resources, either in text or in a literature cited section. Student did not properly cite sources in paper.

Soumi · Accepted Answer

Last Name: 	7
Name:
Professor:
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Date:
Title: Allergies
It Must Be a Bad Year for My Allergies
Contents
Q1. Diagnosis	3
Q2. Pathophysiology	3
Q3. Anatomy	4
Q4. Lifetime Risk	5
Works Cited	7
Q1. Diagnosis
	The patient, Bob, is suffering from superior vena cava syndrome. He is a chain smoker. He shows symptoms such as dysphagia, orthopnea and stridor. He has chest pain, distorted vision, significant hoarseness, headache, nasal stuffiness, nausea and light-headedness. He demonstrates significant chest congestion and shortness of breath. There is a facial swelling and swelling in right upper limbs. This disease is occurred when there is significant pressure or blockage in superior vena cava (Varela Pose et al.). In chest X-ray and CT scan, there is cavity in right lower pulmonary lobe. Bending of the body aggravated the symptoms. Cancer is the main cause of the disease. 
Cavity in lungs can be due to tumor or infection. Location, size and color of the cavity determines the cause of the cavity. For example, cavity due to carcinoma are smooth and have irregular inner contour while cavities due to infection are shaggy. Cavity lesion with the wall thickness of 1mm is considered as benign (Holliday et al.). Primary diagnosis of Bob shows cavity in pulmonary lobe as he reported persistent chest pain and shortness of breath. The secondary diagnosis give certainty that he was suffering from superior vena cava (SVC) syndrome as all the symptoms shown by Bob are result due to SVC syndrome, which ultimately occur due to cancer. Cancer is a possibility in Bob as he is chain smoker.
Q2. Pathophysiology 
	The initial cause of Bob to call 911 was chest pain, shortness of breath and difficulty in breathing, which give him certainty that his allergies are gear up. He believed this because in history also whenever Bob’s allergies gear up, he suffered from cough, headache, hoarseness, nasal stuffiness, congestion and chest pain. 
	The superior vena cava is the part of the low-pressure venous system. It contains thin walls that make them susceptible to the attack of variety of pathogens and it can be damaged by a variety of pathological mechanisms. These mechanisms can be divided into three groups.

It Must Be a Bad Year for My Allergies It is an idyllic March day on the Midwestern university campus as Dr. Bob Johnston walks to his 8:00 philosophy lecture section. As he is walking across campus...

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