Koan “the Bone” Larczy, a 55 year old woman, is admitted to your floor. She says
ID: 15151 • Letter: K
Question
Koan “the Bone” Larczy, a 55 year old woman, is admitted to your floor. She says that she was riding her bike, hopped off to take a drink of water, and her pelvis fractured “all by itself”. When they took her to the ED for xrays, they found that she also had advanced non-small cell lung cancer. She asks you “how can lung cancer make my pelvis break?” There are two different mechanisms that might cause this. Please explain them to her.2. Explain how lung cancer leads to respiratory acidosis.
Penny Lony has a thyroid tumor, that results in a thyroidectomy.
3. What hormones is she no longer producing?
4. If Lony does not take enough replacement hormones, what symptoms will she develop?
5. What pathogen causes Tuberculosis? and how is it transmitted?
6 There are two main reasons why TB is a very difficult disease to cure. What are they?
Explanation / Answer
1) a) metastasis:- lung cancers can spread when cells break off from the tumor, and travel through the bloodstream or the lymphatics vessels in the body through which lymph and white blood cells travel to distant regions of the body and grow. b) endometriosis:-a gynecological medical condition in which cells from the lining of the uterus (endometrium) appear and flourish outside the uterine cavity, most commonly on the ovaries. The uterine cavity is lined by endometrial cells, which are under the influence of female hormones. These endometrial-like cells in areas outside the uterus (endometriosis) are influenced by hormonal changes and respond in a way that is similar to the cells found inside the uterus. Symptoms often worsen with the menstrual cycle. 2) When lung cancer happens, the body's acid-base balance becomes unstable, causing body fluids, particularly blood, to become too acidic. Acute respiratory acidosis is the rapid buildup of carbon dioxide before the kidneys can compensate. Chronic respiratory acidosis occurs over a longer period, allowing the kidneys to compensate by increasing the body's level of bicarbonate. resulting of too much carbon dioxide in the body causing respiratory acidosis. 3)Thyroid hormones 4)affecting heart rate, cholesterol level, body weight, memory etc. 5)Mycobacterium tuberculosis A person can become infected with tuberculosis bacteria when he or she inhales minute particles of infected sputum from the air. The bacteria get into the air when someone who has a tuberculosis lung infection coughs, sneezes, shouts, or spits.People who are nearby can then possibly breathe the bacteria into their lungs. 6)tuberculosis bacteria is resistant to two or more 'first-line' antibiotic drugs it is called multi-drug resistant TB or MDR-TB. When it is resistant to three or more 'second-line' antibiotics as well, it is classed as extreme drug resistant tuberculosis, or XDR-TB. MDR-TB:-patients take the drugs isoniazid and rifampicin (the most effective tuberculosis drug available) plus other drugs for around six to eight months. If a person is resistant to isoniazid and rifampicin however, they are said to have MDR-TB, and will need to change to a regime containing newer and often less widely-available 'second-line' drugs. Treatment with second-line drugs can take a very long time, and is usually far more expensive than standard DOTS therapy because most of the drugs are still under patent. XDR-TB:-XDR-TB is even more serious. If someone has XDR-TB, it means they are not only resistant to isoniazid and rifampicin, but to three or more of the six available second-line drugs too. This can make it virtually impossible to formulate an effective treatment regime for them. Many people with XDR-TB will die before it is even realised that they have the extreme resistant strain.
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