Name that disease. C.J. Wolf, MD, CPC, CPC-H. University of Texas System Case #1

Transcription

1 Name that Disease C.J. Wolf, MD, CPC, CPC-H Asst. Systemwide Compliance Officer University of Texas System Case #1 17 year old girl who has lost 20 lbs in the last six months Thin and pale appearing Complains that her breath smells funny Increasingly thirsty Increased frequency of urination

2 Which of the following is most closely associated with the described condition? Hypercholesterolemia, hypothyroidism, hypertriglyceridemia, obesity, cholelithiasis Answer: Both types of are associated with macrovascular and microvascular disease. Name types of each Macrovascular Disease: Atherosclerotic Heart Disease Coronary Artery Disease Peripheral Vascular Disease Cerebrovascular Disease Microvascular Disease: Retinopathy Nephropathy Peripheral neuropathy

3 Case #2 35 year old black female who complains of general malaise, fatigue and weight loss with gradual onset (getting worse) ROS positive for skin sensitivity (esp. to light) and intermittent arthritis with severe pain Slightly febrile on exam and erythematous raised patches noted on skin; joints seem slightly swollen btd but do not correlate lt to reported tdpain severity A malar rash it also noted What classification of disease is this? Which organ is almost always adversely affected and is usually the cause of death?

4 Case #3 40 yr old man presents to the ED with severe, constant, abdominal pain Pain radiates to the back and is worse when supine ROS positive for nausea and vomiting Reluctantly he admits to moderate alcohol use, but he doesn t have a problem. Vitals: low grade fever, tachycardic, hypotensive Exam: basilar rales, rigid abdomen, decreased bowel sounds CXR: pleural effusions Labs show a markedly increased Amylase and Lipase What are the most common causes of? Alcohol (chronic alcoholism as well as binging) Cholelithiasis (stones) What are some other causes? Trauma (blunt abdominal) Drugs (eg, thiazide diuretics, furosemide, estrogens, tetracycline, valproic acide, sulfonamides, azathioprine) Post ERCP Post op state Metabolic (electrolytes, renal failure)

5 Case #4 39 yr old male complains of malaise, nausea, vomiting and diarrhea Low grade fever and dark urine Recent business trip to India On exam: tender RUQ Jaundice Hepatomegaly Labs elevated ated AST and ALT Case #5 38 year old female complaining of weight gain, muscle weakness and fatigue. Husband complains she is really moody. ROS is positive for amenorrhea, hirsutism and abdominal striae. BP today is 154/92 General appearance is similar to the following

6 What is the underlying etiology of this syndrome? What is the most common cause? Name some endogenous causes: Case #6 52 y.o. man brought to ER by wife when she found him groggy and really out of it in garage. He was confused and walked clumsily when she found him. He was nauseated and had tunnel vision originally. By the time they reached the ER he was feeling a little better and was less confused. He was working on an old car in the garage. Winter, so doors and windows were closed.

7 What are some common causes? What happens at the molecular level? Name some treatment options: Case #7 42 y.o. male who has felt increasingly weak and tired over the last few years. Greets with moist & doughy handshake Patient complains of increased sweating and joint pain in the shoulders, back and knees. ROS positive for headaches and weight gain. This astute physician asks if the patient has noticed that his gloves, hat and shoes fit tighter lately. The patient responds, Yes, how d you know?

8 . What is the underlying physiologic cause? is excessive in both and. What is the main difference between these two conditions? What typically is the cause of the excessive? What is the treatment of choice? CPT code(s)?