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29 May 2018

A patient is visiting the gynecologist because her Pap smear indicated the presence of atypical cells. She is very concerned because she has never had this diagnosis before. Explain and define the classification system for atypical cells in a PAP smear. How can the medical assistant help her feel more comfortable about this diagnosis.

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Jean Keeling
Jean KeelingLv2
31 May 2018

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Related questions

Case Study 1:

Medical History:
Ms. JR is a 22 yr old Caucasian college senior. Throughout high school she was active in competitive sports including soccer, swimming, and field hockey. On occasion throughout high school she would develop an increase in shortness of breath and a cough. Her primary care physician told her that she had bronchitis and that she should not worry about it. After entering college, she continued with competitive soccer and swimming. At the end of a long run during soccer games she would note an increase in cough and slight wheeze. She did not note any symptoms following her swimming practice. She continued to exercise but noticed an increase in coughing and wheezing over the ensuing year.

Diagnosis:
Her parents became concerned about her discomfort and tried to convince her not to exercise because “it makes you feel much worse and could be dangerous.” With ongoing symptoms, she withdrew from soccer. She sought advice of the college physician, who told her that she might have asthma given the symptoms of wheezing. Spirometry revealed an FEV1 of 3.09 L (96% predicted), an FVC of 3.54 L (95% predicted), a peak expiratory flow rate (PEFR) of 6.97 L (95% predicted), and an FEV1/FVC ratio of 87%. Given these results, showing “normal” pulmonary function, the patient was told that she did not have asthma but rather bronchitis and was advised to continue her exercise (after a course of antibiotics). She continued to swim but would note that at the end of a training session she was slightly more short of breath than usual and had anterior chest heaviness.

Exercise Test Results:
Ms. JR sought the advice of another physician, who ordered an exercise test with the measurement of expired gases during progressive incremental bike exercise. Spirometry was performed at 15, 30, and 60 min following the exercise test. Maximal oxygen consumption was 3.13 L · min−1 (52.2 ml · kg−1 · min−1). Flow rates were as follows:
• FEV1 (L): preexercise = 3.09; 15 min postexercise = 2.87; 30 min postexercise = 2.20; 60 min postexercise = 2.24
• FVC (L): preexercise = 3.54; 15 min postexercise = 3.32; 30 min postexercise = 2.97; 60 min postexercise = 3.03
• PEFR (L/s): preexercise = 6.97; 15 min postexercise = 6.00; 30 min postexercise = 5.25; 60 min postexercise = 5.26

Exercise Prescription:
As a result of these studies, a diagnosis of asthma (exercise induced) was made. The patient was started on a short-acting b-agonist (albuterol sulfate) administered 30 min before exercise. She was instructed to warm up for 15 min with low- to moderate-intensity exercise or swimming before starting a high-intensity swim practice. Exercise tolerance subsequently improved while exercise-associated symptoms became rare (for the most part abated).

Questions:
1. Why was the initial diagnosis of asthma not entertained?

2. How was the actual diagnosis of asthma (exercise induced) made? What tests should be useful in this determination?

3. How did the recommendations improve the patient’s exercise tolerance? Why was swimming initially better tolerated than soccer?

4. Discuss the intensity, frequency, and duration of exercise training for patients with asthma.

5. How would the development of asthma symptoms at the end of a 3 h practice session influence the choice of medication (e.g., short-acting vs. long-acting b-agonist)?

Personal Information

Name: Mrs. Paula Johnson

Age: 65 years old

Gender: Female

Description

Mrs. Paula Johnson is a 65-year-old white woman with a previous history of a sedentary lifestyle, hypertension, hypercholesterolemia, and diabetes mellitus type II. She is a heavy smoker since she was 20 years old. She was brought to the emergency room because her family found her unresponsive on the floor. She was diaphoretic. Her family thought she had her diabetes decompensated. Mrs. Johnson’s daughter indicated her mother was complaining of nausea and epigastric pain the day before. Also, her blood pressure was high.

On the physical examination we found:

Remarkable Signs on Physical Exam by Regions

Chest: Palpitation

Remarkable Signs on Physical Exam by Systems

Integumentary system: Profuse diaphoresis, coldness, and pallor

Respiratory system: Tachypnea

Cardiovascular system: Weak pulse, tachycardia, and hypotension

Nervous system: Unconsciousness. No other neurologic signs.

Lab Tests

Complete blood count (CBC)

Cardiac enzymes

Glucose level

Lipid panel

EKG

Cardiac catheterization

Diagnosis

Silent myocardial infarction

Other Diagnoses

Essential hypertension

Dyslipidemia

Diabetes mellitus

Supporting Material

Mrs. Johnson has been diagnosed with silent myocardial infarction. As we learned last module, the first step in pathophysiology is observation of noticeable changes, but what do we do when the patient does not outwardly experience symptoms? Chest pain is a scary symptom that usually alerts the physician and patient. However, if the patient or the physician is not alerted, the medical practitioner has to dig deeper to understand the cause or set of causes that contribute to the condition.

What are your initial reactions related to the case?

What is a heart attack?

Considering Mrs. Johnson’s case, why does she have an increased risk of having a heart attack?

What is tissue perfusion? Which of the patient’s conditions can alter tissue perfusion? How?

What is hypertension? How does hypertension alter tissue perfusion?

Describe pneumonia. What risk factors does the patient have for pneumonia?

Amanda Richards is a 20-year-old junior in college. She is majoring in biology and hopes someday to be a pediatrician. Beginning about a month ago, Amanda noticed that she was waking up once, sometimes twice a night, by the need to go to the bathroom. More recently, she has noticed that she needs to go to the bathroom during her school day much more frequently than before, sometimes as often as once every hour. At first Amanda thought that her increased frequency of urination was due to the coffee she drank, but when she reduced her coffee consumption to one cup in the morning, she still needed to go to the bathroom just as often. In addition, Amanda was buying bottled water by the case, and she found herself never without a beverage in her hand or nearby. She also noticed that her urine seemed pale and colorless. When Amanda told her mother of her problem, her mother became very concerned and arranged for Amanda to see the family physician. Her physician found no abnormalities on physical examination. However, a blood chemistry profile revealed Amanda’s plasma sodium level to be 149 mEq/L, plasma osmolarity was 308 mOsm/L, and her fasting plasma glucose was 85 mg/dl. An analysis of Amanda’s urine showed a urine osmolarity of 200 mOsm/L. The urine sample was negative for the presence of glucose. An extensive history revealed that no other member of the family had ever displayed Amanda’s symptoms. Amanda had no history of traumatic head injury and an MRI of her brain was normal. Next, a two-hour water deprivation test was performed on Amanda. After two hours of not being able to drink water, the osmolarity of her plasma and urine were measured a second time. This time her urine osmolarity was unchanged; however, the osmolarity of her plasma increased to 315 from 308 mOsm/L. She was then injected with a drug called DDAVP, a synthetic analogue of vasopressin. One hour after the injection, the osmolarity of her plasma decreased to 290 mOsm/L and the osmolarity of her urine increased to 425 mOsm/L. Based upon the results above, Amanda’s medical history, and the results of the MRI, a diagnosis of idiopathic pituitary diabetes insipidus (a form of central diabetes insipidus) was made.

Why was a form of central or pituitary diabetes insipidus diagnosed in Amanda’s case? (Assume she is not pregnant). Make sure to explain why the other types were ruled out.

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