Week 7 Part 1 Case Study

Week 7 Case Study Part 1
The following activity includes several case presentations of edema. Make a diagnosis for each case, remembering the following questions:

1. Is the edema acute/sudden or chronic (e.g., duration, progression)?
2. Is it unilateral or bilateral? Is the edema generalized or localized?
3. Is it pitting or nonpitting?
4. Is it dependent?
5. In addition to edema, what other characteristics are associated with the edema (e.g., redness, pain)?
6. What is the pertinent past or coexisting medical history? What medications is the patient taking?
You may want to refer to chapter 3 and chapter 4 to help determine the diagnosis.

Case 1
45-year-old Mrs. Rodriguez is complaining of intermittent mild bilateral feet/ankle swelling for the past 2 months, but it is worse on her right leg. She denies leg pain, but she does describe her legs as feeling heavy at times and reports standing for long periods worsens the swelling. She notes her veins are getting larger in her legs. For the past 8 months, she has been experiencing intermittent numbness in her feet and reports her left knee has been achy. She is a server at a busy restaurant and sometimes works 10-hour days. She denies any fever, warmth, erythema, or trauma.
o Past medical history: obesity (BMI 31); type 2 diabetes mellitus.
o Medications: metformin.
o Physical examination: vital signs are within normal limits; exam is unremarkable except for bilateral tortuous veins in both lower extremities, which are worse on the right leg, and decreased sensation in both feet.

Note: Assume history and examination is within normal limits if not listed.

Activity
1. Identify the probable diagnosis and what data support your decision.
2. Describe the pathogenesis for the diagnosis.
3. What data are inconsistent with your diagnosis?
4. What diagnostic tests would you order, if any, and how would you treat this patient?

Case 2
40-year-old Mr. Jason is complaining of right leg swelling, pain, erythema, and warmth for the past 2 days. The swelling started after he accidentally cut the front of his leg with a pocketknife while fishing.
• Past medical history: hypertension.
• Medications: amlodipine.
• Social history: drinks four to five beers on the weekends and has smoked one or two cigarettes a day for the last 15 years (he states he is trying to quit).
• Physical examination: temperature 100°F; pulse 88 beats per minute; respirations 18 per minute; blood pressure 140/92 mmHg; examination unremarkable except for edematous anterior right leg with open linear wound approximately 1-inch long; wound with scant purulent drainage; and area is warm and tender with blanching erythema that extends 3 inches around the wound.

Note: Assume history and examination is within normal limits if not listed.

Activity
1. Identify the probable diagnosis and what data support your decision.
2. Describe the pathogenesis for the diagnosis.
3. What data are inconsistent with your diagnosis?
4. What diagnostic tests would you order if any, and how would you treat this patient?