Running head: PATHOPHYSIOLOGY2 SECTION 1 1.Have you ever been tested for HIV? If yes, when did you test? 2.Have you ever experienced night sweats, chills, chest and lower back pain? If yes, for how long have you experienced this? 3.How long have you ever been hospitalized following any chronic illness? 4.Do you smoke? If yes, since when have you been smoking? 5.What are some of the environmental exposures in your place of work? SECTION 2 Part 2: Findings Complete Blood Count (CBC): Low compared to the reference range for women. WBCcount3.8x109/L4.8–10.8x109/L RBCcount3.2x1012/L4.0–5.0x1012/L Hemoglobin10.6g/dl12.0–16.0g/dl Hematocrit32.8%36–46% Plateletcount140x109/L150–450x109/L ESR (Sedimentation Rate) was high at 61mm/hr (Reference range for women -0-20mm/hr).Chem Panel Findings-High glucose at 101mg/dl against a reference range of 70- 99mg/dl and high iron at 189ug/dl against a reference range of 30-150ug/dl in women. Immunology: C - reactive protein was high at 5.8mg/L against a normal range of 3-5mg/L, Positive Venereal Disease Research Laboratory test (VDRL) and a positive Antinuclear Antibodies (ANA) test with a ratio of 1:640.
Running head: PATHOPHYSIOLOGY3 SECTION 3: POSSIBLE AILMENTS Autoimmune diseases such as Rheumatoid Arthritis (RA) because of the positive Antinuclear Antibodies (ANA) test which shows presence of antibodies which fight body tissues. RA is associated with fever, fatigue, painful joints, soreness, rash and feeling of tiredness. Based on the review of systems, the patient has a high temperature of 101F, complaints of fatigue, painful joints, neck rash and cold sores. The C-reactive protein of 5.8mg/L indicates inflammation which is present in RA. High ESR is also present in RA (Singh et al,2012). Syphilis could be another possible diagnosis for this patient due to the Positive Venereal Disease Research Laboratory (VDRL) test. Signs and symptoms of syphilis include painless skin rashes, fatigue, fever, weight loss and swollen lymph nodes. With reference to the case scenario, the patient presented with these complaints (Fuchs et al, 2016). The third possible diagnosis for this patient is anemia. This is because it associated with low hemoglobin, low RBC count and low hematocrit. Signs of symptoms of anemia include reduced exercise tolerance, shortness of breath, fatigue, lightheadedness and weakness. Based on observations and patient history, he following manifestations are noted (Schett & Gravallese,2 012) SECTION 4: PLAN AND FOLLOW UP TESTS/STUDIES As per me, the most likely diagnosis is Rheumatoid Arthritis (RA). The tests I will use for follow up are ESR to monitor inflammation process and rheumatoid disease, C-reactive protein (CRP) test to monitor inflammation associated with RA, Rheumatoid factor test, Anti- cyclic citrullinated peptide (anti-CPP) antibodies. I can also do imaging studies such as X-ray and Magnetic Imaging Resonance (MRI) to check the severity of the condition (Schett & Gravallese, 2012)
Running head: PATHOPHYSIOLOGY4 SECTION 5: PATHOPHYSIOLOGY OF RHUEMATOID ARTHRITIS It is a systemic inflammatory condition characterized by destruction of joints and synovitis. Cytokines perpetuate synovial inflammation which persists leading to joint destruction (Singh et al, 2012).Consequently, this leads to joint swelling, fever, painful joints, tiredness and fatigue. RA is treated using Non-steroidal Anti-inflammatory drugs which relieve fever, joint pain and inflammation, immunosuppressants are also to reduce immune responses and steroids which modify hormones hence reducing inflammation (Choy, 2012). SECTION 6: FOLLOW UP In a follow up appoint with the patient, I would ask about various things which include feelings of tiredness and fatigue, joint pain, joint swelling and fever. Asking about these factors will be useful in determining the efficiency of the pharmacological management implemented on the patient and find out signs of deterioration in order to implement alternative techniques.
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Running head: PATHOPHYSIOLOGY5 References Choy, E. (2012). Understanding the dynamics: pathways involved in the pathogenesis of rheumatoid arthritis.Rheumatology,51(suppl_5), v3-v11. Fuchs, F., Michaux, K., Rousseau, C., Ovetchkine, P., & Audibert, F. (2016). Syphilis infection: an uncommon etiology of infectious nonimmune fetal hydrops with anemia.Fetal diagnosis and therapy,39(1), 74-77. Schett, G., & Gravallese, E. (2012). Bone erosion in rheumatoid arthritis: mechanisms, diagnosis and treatment.Nature Reviews Rheumatology,8(11), 656. Singh, J. A., Furst, D. E., Bharat, A., Curtis, J. R., Kavanaugh, A. F., Kremer, J. M., ... & Bridges, S. L. (2012). 2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease‐modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis.Arthritis care & research,64(5), 625-639.