Judy is a 40-year-old white woman born and raised in Ontario, Canada, who presen
ID: 3519711 • Letter: J
Question
Judy is a 40-year-old white woman born and raised in Ontario, Canada, who presents to her primary care clinic with concerns regarding periodic memory loss, impaired vision, urinary incontinence, stumbling when walking, numbness in her feet and hands, slurred speech, fatigue, and pain in her legs and arms. She undergoes magnetic resonance imaging (MRI) and is told that she has multiple sclerosis (MS), an autoimmune disease against myelin causing progressive degeneration of the nerves in the central nervous system and peripheral nervous system. There is no known cause. She is told that 211,000 Americans and 1.1 million people worldwide are currently diagnosed with MS and that genetic and environmental factors play a role in an individual’s risk for developing MS. She is also informed that the characteristics of people most likely to develop MS include women of northern European ancestry, age 20 to 40 years, with a family history of MS. Finally, she is told to expect periods of acute neurologic symptoms alternating with periods of symptom relief or return of neurologic function.
1. Would you define Judy as healthy or ill? Explain.
2. What risk factors were mentioned in this case study related to the development of MS?
3. What is the etiology of MS? Would MS be considered either nosocomial or iatrogenic? Explain.
4. Identify the symptoms that Judy reports.
5. Identify signs leading to the diagnosis of MS.
6. How would you categorize this illness, acute or chronic? Describe the expected course of the illness.
7. Which of the manifestations are local, and which are systemic?
8. What is the prevalence and incidence for MS? What is the prognosis for Judy?
9. What aspects related to human diversity and disease would be important to consider with regard to Judy?
10. What additional dimensions of the health history would you need to explore in order to provide holistic health care?
Explanation / Answer
1. Judy is considered to be ill. As per medical definition, healthy is complete state of physical and mental well being. As this criteria is not met, Judy is considered ill.
2. Risk factors mentioned are -
North European women, of 20-40 yrs of age with prominent family history.
3. Etiology of MS relates to genetic relation probably mutation or loss of gene, however the exact cause is not known. The disease is considered to be more of a iatrogenic origin. This could be induced to other drugs and causes but not acquired in hospital and thus not considered nosocomial.
4. Symptoms are urinary incontinence, numbness, pain in arms and legs, loss of vision.
5. The most probably signs of diagnosis are memory loss, loss of vision and other CNS abnormalities like stumbling gait etc.
6. MS is a chronic disease. It is a progressive disorder with increase in severity with time and intermediate episodes of exaggerating symptoms and signs.
7. The local manifestations are memory loss, impaired vision, pain and urinary incontinence and stumbling. Systemic manifestations are fatigue.
8. The prevelance of MS is 211,000 Americans and 1.1 million people all over the world per year. This rate however changes every year with an increasing behaviour generally. Prognosis for Judy Is familial history along with origin.
9. It is very important to consider familial history and genetics. Getting a proper family chart is important for prognosis.
10. Additional information of Family history is required. Proper possibilities using Punnet squares and other methods have to be found . This will help to get a better result.
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