MHS1102 Cardiovascular Case Studies

This assignment presents five medical case studies focusing on various aspects of the human body. Case 1 involves a 63-year-old man diagnosed with congestive heart failure, requiring analysis of his symptoms and their relation to the condition. Case 2 details an ice skater with a kidney injury, demanding an understanding of kidney anatomy, its relation to surrounding structures, and the interpretation of diagnostic imaging. Case 3 focuses on a 12-year-old boy with a patent ductus arteriosus, necessitating knowledge of the ductus arteriosus's structure, function, and complications. Case 4 examines a 60-year-old woman with uterine prolapse and stress incontinence, requiring an understanding of pelvic organ support structures and the mechanisms of prolapse and incontinence. Finally, Case 5 involves a 65-year-old man with urinary difficulties, prompting an analysis of prostate anatomy, the male urethra, and the PSA test. The assignment tests the student's knowledge of anatomy, physiology, and diagnostic procedures.

MHS1102 CASE STUDIES
Case 1
Mr Andrews is a 63-year old man who has had variety of medical problems during the past 5
years. He has been treated for two myocardial infarctions, hypertension, non-insulin
dependent diabetes and dermatitis of the left leg. He had an aorto-coronary bypass one year
ago.
Most recently he has been experiencing shortness of breath which has been more noticeable
over the past five days. He tires easily and reports that the ‘has lost the energy to do
anything’. He also complains of anorexia. Last night he awoke suddenly from sleep because
he could ‘catch his breath’ and developed a dry cough. The breathing problem improved
when he sat on the edge of his bed for an hour. He generally sleeps with two, sometimes
three pillows. He has not experienced chest pain, leg pain or fainting spells. When he
presents at the GP, his breathing is laboured and his lips have a blue tinge and his hands are
cold to the touch. He is also noticeably sweating [diaphoretic].
His blood pressure is 98/82mmHg and he has a heart rate of 110/minutes. The GP also notes
that his heart sounds [S1, S2] are diminished and she detects an abnormal third hear sound.
Examination of the cardiovascular system showed that his neck veins are prominent and
pulsatile, and distended to the mandible when the patient is sitting upright. The apex beat of
the heart is palpated in the 5th intercostal space. Examination of this lungs shows dullness at
the base of each lung.
Examination of the abdomen showed that the anterior wall is round and soft. The liver edge
is palpable and tender, but the spleen is not palpable. Examination of the extremities
revealed diminished irregular peripheral pulses, and there is pitting oedema of both lower
extremities.
The patient is diagnosed with congestive heart failure.
Choose 10 [ten] of the symptoms experienced by the patient and, using your anatomical and
physiological knowledge of the cardiovascular system, explain these symptoms and outline
how each of these is indicative of, and would support a diagnosis of congestive heart failure.
[20 marks]

Case 2
An ice skater and her partner are practising their routine in preparation for upcoming local
championships. Part of their routine involved an aerial spin, after which her partner would
catch her.
Unfortunately, the pair mistimed the routine and the skater fell heavily on her left side onto
the ice. The skater was doubled up in pain. She described particularly severe pain in the
lateral posterior region of her trunk, between the left costal margin and the iliac crest.
She was taken to the emergency room and examined. Plain film X-rays showed a fracture of
Rib11, and that the margin of the left psoas major muscle was not distinguishable. Urinalysis
showed blood in her urine. An intravenous pyelogram [IVP] and CT scans were done. The
IVP showed leakage of contrast media into the tissue immediately around the kidney. The
haemorrhage was confined to the area immediately around the kidney and extended medially
toward the abdominal aorta.
The diagnosis was laceration or rupture of the kidney. Surgery was performed to close the
laceration.
Questions
1. Describe the gross anatomy of the left kidney. Outline its anatomical location and its
relations to explain how this injury could also involve Rib 11 and the psoas major muscle. [9
marks]
2. Explain why pain in the kidney would be experienced in the area described by the skater.
[1]
3. Explain why the margin of the psoas major muscle was not visible on the x-ray. [2 marks]
4. Based on your knowledge of kidney anatomy, explain how or why blood was found in the
urine. [2 marks]
5. Briefly outline the process involved in performing an IVP. [2 marks]
6. Using your anatomical knowledge of the kidney, explain how the haemorrhage was
confined to the area around the kidney. [3 marks]
7. Explain why it is possible to perform surgery on the kidney without penetrating the
peritoneal cavity. [1 mark]

Case 3
During a routine physical exam for participation in school sports, the physician noted that a
twelve-year-old boy had a long continuous heart murmur at the second intercostal space near
the left sternal border. When questioned, the boy's mother recalled that her son had periods
of cyanosis and breathlessness as an infant, but that his previous paediatrician said that the
murmur and the symptoms were nothing to be concerned about.
The boy also mentioned that he tires easily during physical activity. Chest films and Doppler
ultrasound were ordered. The radiographs indicated slight left ventricular hypertrophy and
ultrasound revealed a patent ductus arteriosus. The physician scheduled surgery to ligate the
patent ductus arteriosus. The surgery resulted in successful ligation of the ductus arteriosus
but the boy experienced hoarseness when speaking following the procedure. Laryngoscopy
revealed paralysis of the left vocal fold.
1. Describe the anatomical structure and function of the ductus arteriosus. [4 marks]
2. Explain what happens to the ductus arteriosus after birth. [3 marks]
3. Explain the consequences of a patent ductus arteriosus in infants and in adults, and outline
the complications that can arise, relating the boy’s symptoms to your explanation. [6 marks]
4. Explain the likely cause of paralysis of the left vocal fold. [4 marks]
5. Why would Doppler ultrasound be used to diagnose a patent ductus arteriosus? Outline
two advantages of this method over traditional angiography. [3 marks]

Case 4
A 60-year-old mother of four, visited her family doctor complaining of back pain and the
sensation of something ‘coming down’ her vagina, especially when she was standing. In
addition, she was troubled by stress incontinence when she coughed, sneezed, or lifted a
heavy object, and by the need to urinate up to ten times per day and five times each night.
Pelvic examination revealed a first degree uterine prolapse (the cervix was still inside the
vagina) and prolapse of the bladder base. The physician referred the woman to a
gynaecologist, who recommended surgery. A vaginal hysterectomy and a procedure to
correct the prolapse and stress incontinence were performed, relieving the woman of her
symptoms.
1. Describe the anatomical support structures in place for the uterus. [6 marks]
2. Explain two main causes of uterine prolapse in women. [2 marks]
3. Briefly outline the other types, and the anatomical mechanism of pelvic organ prolapse in
females. [6 marks]
4. Describe the sphincter that controls urinary flow and identify its anatomical location. [3
marks]
5. Describe the mechanism of stress incontinence, and explain why coughing, sneezing, or
lifting can cause it. [3 marks]

Case 5
A 65 year old man visits his local medical clinic complaining of progressive difficulty in
urinating over the past 6 months. He reports that he has a frequent need to urinate, and that
the urine stream is weak and typically only ‘dribbles’ out. The problem seems to be worse at
night. He also reports that he has a burning sensation during urination.
The GP orders a PSA test and the results indicate that levels PSA are higher than normal.
1. State the most likely diagnosis/diagnoses in this case. [2 marks]
2. Describe the gross anatomy of the prostate gland. [10 marks]
3. Describe the anatomy of the urethra in males from its origin in the bladder to its
termination. Explain why the patient is having difficulty urinating and why the urine stream
is weak? [6 marks]
4. Describe the basis of the PSA test. [2 marks]