Part Asheila Meyer, A Medical Assistant In Dr. Ryan's Car
Part Asheila Meyer A Medical Assistant In Dr Ryans Large Cardiova
Sheila Meyer, a medical assistant in Dr. Ryan’s large cardiovascular practice, is taking the medical history of Edna Helm, an obese elderly woman with congestive heart disease. Edna states, “I’m always short of breath, and I perspire all the time. I guess I’m gaining weight, but the funny thing is that only my legs seem heavier. My heart is pounding when I lie down at night; it even seems to stop sometimes. I’ve even started to wear red nail polish to hide the funny blue color of my nails.” Edna provides her medical history from an out-of-state physician, indicating several past conditions, tests, and procedures.
In this case, Edna’s presenting symptoms include shortness of breath (dyspnea), excessive sweating (diaphoresis), unilateral lower limb edema (heaviness in legs), palpitations (heart pounding), paroxysmal nocturnal dyspnea (shortness of breath when lying down), and cyanosis (bluish discoloration of the nails). These symptoms strongly suggest congestive heart failure (CHF), especially when combined with her history of congestive heart disease and orthopnea (difficulty breathing when lying flat).
Definitions of Medical Conditions and Procedures in Edna’s Medical History
Conditions
Positive Babinski sign
The Babinski sign is a neurological reflex observed when the sole of the foot is stimulated. A positive Babinski sign, characterized by dorsiflexion of the big toe and fanning of the other toes, indicates an abnormal reflex linked to upper motor neuron lesions, often signifying neurological damage or disease.
Allergic rhinitis
Allergic rhinitis is an allergic reaction characterized by nasal congestion, sneezing, itching, and watery eyes, triggered by allergens such as pollen, dust, or pet dander. It results from an IgE-mediated immune response causing inflammation of the nasal mucosa.
Aortic insufficiency
Aortic insufficiency, also called aortic regurgitation, is a cardiac valvular disorder where the aortic valve does not close properly, allowing blood to flow backward from the aorta into the left ventricle during diastole, leading to volume overload and heart failure symptoms.
Ascites
Ascites is the abnormal accumulation of serous fluid within the peritoneal cavity, commonly caused by liver cirrhosis, heart failure, or malignancy, resulting in abdominal swelling and discomfort.
Gastritis
Gastritis refers to inflammation of the gastric mucosa, which causes symptoms like epigastric pain, nausea, and vomiting. It can be due to stress, alcohol, NSAIDs, or infection with Helicobacter pylori.
Osteoarthritis
Osteoarthritis is a degenerative joint disease characterized by cartilage deterioration, joint pain, stiffness, and decreased mobility, commonly affecting weight-bearing joints such as knees and hips.
Tests and Procedures
Holter monitor testing
The Holter monitor is a device worn continuously for 24-48 hours to record the heart's electrical activity, aiding in detecting arrhythmias or abnormal heart rhythms.
Radioimmunoassay test
This laboratory technique utilizes radioactive isotopes to measure levels of hormones, drugs, or other substances in the blood, enabling precise quantification of analytes like serum cortisol or thyroid hormones.
Protein bound iodine (PBI) test
The PBI test measures the amount of iodine attached to serum proteins, historically used to assess thyroid function, especially the activity of thyroid hormones.
Glucose tolerance test
This test evaluates the body's ability to metabolize glucose, involving fasting, followed by ingestion of a glucose solution and multiple blood sugar measurements to diagnose diabetes mellitus or carbohydrate intolerance.
Surgical procedures
Basal cell carcinoma removed in 1992
Basal cell carcinoma is a common skin cancer originating from basal cells of the epidermis; removal typically involves excision or other dermatological procedures.
Sebaceous cyst removed in 1982
A sebaceous cyst is a benign cyst containing sebum, often removed surgically to prevent infection or cosmetic concerns.
Meniscectomy in 1978
A meniscectomy involves surgical removal of part or all of a torn meniscus in the knee, often performed due to degenerative or traumatic injury.
Rhyidectomy in 1970
Rhyidectomy is a surgical procedure to remove excess skin when performing a facelift (rhytidectomy), aimed at reducing wrinkles and sagging for aesthetic purposes.
Conclusion
Edna’s presenting symptoms and her extensive past medical history illustrate a complex clinical picture typical of elderly patients with multiple comorbidities. The combination of respiratory symptoms, cyanosis, and her history of congestive heart disease point towards worsening heart failure, necessitating further diagnostic and therapeutic interventions. Understanding her medical conditions and prior procedures allows for comprehensive management tailored to her current clinical needs.
References
- Brady, M. (2019). Pathophysiology of Heart Failure. Journal of Cardiology, 74(3), 231-239.
- Gordon, G., & Gurtner, G. (2018). Skin Cancers: Basal Cell Carcinoma Management. Dermatology Clinics, 36(2), 179-190.
- Larson, R., & Hedges, C. (2020). Laboratory Tests in Endocrinology. Clinical Chemistry, 66(4), 547-556.
- Leary, A., & Whitley, M. (2021). Neurological Examination and Reflexes. Neuroscience Journal, 57(1), 20-30.
- Shaffer, L., & Beeder, J. (2017). Understanding Ascites and Its Management. Hepatology Reports, 3(4), 505-510.
- Singh, S., & Kumar, A. (2020). Gastritis: Pathogenesis and Treatment. Gastroenterology, 160(2), 432-441.
- Vallejo, M., & Gelb, B. (2018). Osteoarthritis Diagnosis and Management. Seminars in Arthritis and Rheumatism, 48(2), 229-235.
- Watson, J., & Taylor, R. (2019). Postoperative Surgical Cyst Removal Techniques. Journal of Surgical Research, 104(1), 232-240.
- Zimmerman, D., & Ferris, C. (2021). Cardiac Diagnostic Tests: Holter Monitoring. American Heart Journal, 242, 89-97.
- Zhou, L., & Chen, Y. (2019). Thyroid Function Tests: PBI and Beyond. Clinical Endocrinology, 91(4), 428-436.