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VolibearMain

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Aug 13, 2016
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Pre-Podiatry
We have a patient case in biochem that we arent really taught, typically the case scenarios are pretty easy to understand, (sickle cell, gout)
This time its an awkward situation, without directly answering the questions, any idea of what this guy is suffering from?

"

CASE 2: Frederick Broadhead
PART 1: Frederick “Fred” Broadhead is a 75 year old widowed Caucasian male who lives independently in Harmony, New Mexico. Fred is in generally good health (he takes pride in not having had surgery, nor even stepping into a hospital, since having a hip replacement 15 years ago) and excellent mental condition. He has always enjoyed driving and has worked part‐time for the past 12 years delivering for Meals On Wheels and periodically shuttling other retirees and tourists to local attractions. He likes getting out and interacting with others because he feels it “keeps him young”. He maintains a good nutritional diet which consists of eating breakfast at “Jeff’s Egg Emporium” (a local diner), a modest dinner around noon (which he cooks himself) and a sandwich in the evening. He has taken a multivitamin every day since turning 55.


On March 24th Fred went to his regular dentist and needed some periodontic surgery. The dentist prescribed Oracea (Doxycycline – 100 mg/day for 10 days) to avoid infection developing at the wound site. Fred kept the tablets in his nightstand and checked each day to see if his gums looked infected. Since everything looked okay after the first couple of days he stopped taking the pills, and everything worked out just fine.


On May 5th he was cleaning some debris from his yard when he cut his ankle on a sharp piece of metal. After washing out the wound he put a Band‐Aid on and went about his business. Two days later he noticed the wound was red and swollen, with a purulent exudate. This concerned him, so he asked his neighbor, a physician, what she thought. She said it was infected and wrote a prescription for Pen V
(Penicillin V – 250 mg every 6 hours for 10 days) to help clear it up. Fred started taking the pills and over the next week the wound greatly improved.


On May 14th Fred noticed some redness around where he had his gum surgery, and decided he better finish off his prescription for Oracea. Yet, six days later his throat began feeling “scratchy” and sore. He went to his physician, who did a throat culture and informed him that strep throat had been going around the area. The next day the doctor called back, confirming that Fred had “strep” and prescribed a “Z‐Pak”. He told Fred he must complete taking all of the pills in the Z‐Pak, Fred followed directions, and the strep infection was clearing up over the next ten days.


Then, on May 24th, Fred was accidentally scratched while petting his neighbor’s cat. It wasn’t a bad scratch and he thought nothing of it until the following day. When he awoke the next morning he saw that the arm that had been scratched was red, hot and somewhat swollen, with red lines travelling up his arm. He asked his neighbor what she thought, and she told him to get to the hospital immediately. Fred hesitated (his record was at stake!), but finally allowed her to drive him there, where he was admitted overnight and an i.v. antibiotic (Ciprofloxacin) was administered. He left the next day once it was determined his arm was better, and was given a prescription for Sulfamethoxazole (800 mg every 12 hours for 14 days). By the end of this treatment Fred’s infections had all cleared up.





How do the antibiotics work?
Why have different antibiotics?
Why might Fred have contracted strep throat even though he was taking Oracea and Pen V?


PART 2: For the next few weeks Fred regaled his passengers, friends and strangers alike, with how he had always been healthy except for the past month, but that now he was “right as rain” again. Life was good again. Now if he could only get over whatever he had eaten that was giving him diarrhea. He thought maybe he should stay away from spicy food for a bit.


The night of Friday, July 4th was particularly stressful for Fred – anything he ate or drank just seemed to flow right through him. He spent much of the evening and night sitting on the toilet. By morning he was feeling dizzy and disoriented enough that he became concerned. His abdomen was tender and he had intestinal cramping. He had a temperature of 99.8, and he couldn’t remember the last time he urinated.


Fred lay in bed until 11 that Saturday morning before deciding he better call his neighbor. She came over and Fred related what had been happening. She asked him several questions before determining that he should be transported to the hospital (again). Upon his arrival his heart rate was 100 bpm, his blood pressure was 90/55 and his respiratory rate was 24/minute. A blood sample was taken and the results indicated that he had a white cell count of 37,000 cells/µL, no sepsis, abnormal plasma electrolytes, pO2 of 100 mm Hg, pCO2 of 37 mm Hg and pH of 7.49. A colonoscopy revealed the presence of pseudomembranous colitis.


These findings largely confirmed his neighbor’s diagnosis and vancomycin therapy (125 mg q.i.d.) was initiated immediately, along with i.v. electrolytes. Further tests were started for glutamate dehydrogenase (GDH) analysis and PCR amplification of toxin genes.


Fred spent the next several days in the hospital, largely unconscious until Tuesday morning when his neighbor dropped by his room after rounds. She explained to Fred that it had been a “close call”, but that he appeared to be stable and recovering. He could expect to be in the hospital for at least another week, but should once again be back to normal after a fecal transplant. Fred rolled over and went back to sleep.



What was wrong with Fred? Describe the issues with this disorder.
Why the concern for his health (what about his vitals and blood work was abnormal)?
Why was yet another antibiotic administered, and why vancomycin?
Why a fecal transplant?
What TWO major concerns (one a population concern and the other an individual concern) are
apparent in this case?
What could have been done differently?"

PS. For HIPPA concerns this is all made up and fred doesnt actually exist
 
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