Case Study: 1.10 days old boy was in the clinic for regular checkup visit (full-
ID: 3524813 • Letter: C
Question
Case Study:
1.10 days old boy was in the clinic for regular checkup visit (full-term infant, vaginally delivered with no complications, discharged 24h after birth). On physical exam, no testis was palpable on his left side.
Question: What is the name of this condition?
2.Surgery was performed and went very well with no major medical complications. Fourteen years later at normal physical exam (to join the school football team), nurse practitioner discover that the boy did not practice his testicular self-examination. Which procedure should/must/will be included in this future procedure?
3.At age of 24 he got married and a few years later he visits the clinic because his wife was not able to conceive a child. Lab results indicates that he has a low-level sperm counts. Please provide your best answer to the question “why is this result important in the process of fertility?
4.Now he is 65 years old and is happy to be a new grandfather. He visit the clinic for the following compliant – “blood in his semen”, doctor’s suspicion was a “possible prostate problem”. Please provide your best understanding and suggestion about possible diagnosis of prostate cancer.
Case Study:
Mr. Bauman, a 42-years farmer from Texas noticed in the morning a “twinges” in the R lower back, extraordinary pain in his back (not responding to the over the counter pain killer or hot water in bottle applications), vomiting. Here what was recorded on his chart at ER:
· Good health in the past, no trauma or surgeries
· No prescription medicines
· Do not use any alcohol, tobacco
· Active life, working 12-14 hours/day
· Taking (from time to time) Tylenol, or similar
· Normal T, 140 b/s, BP=138/78, cool moist skin, R flank pain, abdominal pain,
· X-Ray of the kidney, urethra, and bladder indicates a stone blocking the R ureter
· Lab work – RBC too many to count, WBC – 8-10 to count, Ca oxalate crystals
Questions:
1. What is the most probable cause of Mr. Bauman’s pain?
2. The blockage, unless immediately removed, can lead to which problem? Explain.
Explanation / Answer
Case study 1
Question 1) What is the name of this condition?
Answer : undescended testis -
one of the more common causes for an absent testis in a infant is undescended testis.
the testis develops in the posterior abdominal wall and descend to the testicule by the action of the gubernaculum. the pathway takes it from the posterior abdominal wall along the inguinal canal to the testicule ,so if the process is interrupted it maybe found anywhere along this path.
Question 2) Which procedure should/must/will be included in this future procedure?
Answer : ultrasound scan -
undescended testes increases the chances of a patient developing inferitlity and cancer. as a result routine examination of the testes by slef is important m here as the patient has not done this an ultrasound scan will help exclude such a problem.
Question 3) Please provide your best answer to the question “why is this result important in the process of fertility?
Answer: undescended testis can result in later inferitlity. but it is rare in unilateral cases. in this instance the patients sperm count is low as such his feritlity is affected. a low sperm count leads to lower chances of a successful pregnancy.
Question 4) Please provide your best understanding and suggestion about possible diagnosis of prostate cancer.
Answer: prostate cancer is very common in older males. the usual symptoms include poor stream of urine and problems such as urgency , hesitancy and dribbling. diagnosis will include an initial digital rectal examination followed by ultrasound scan and blood tests to check the prostate specific antigen levels add to that..blood in the semen maybe a red flag sign which needs more vigilence as it may be due to more aggressive disease.
Case study 2
Question 1) What is the most probable cause of Mr. Bauman’s pain?
Answer : ureteric calculi -
Ureteric calculi or stones are those lying within the ureter, at any point from the ureteropelvic junction (UPJ) to the ureterovesical junction (UVJ). They are the classic cause of renal colic-type abdominal pain. They are a subtype of the broader pathology of urolithiasis.
Question 2) The blockage, unless immediately removed, can lead to which problem? Explain.
Answer : a ureteric calculus blocking the ureter leads to formation of back pressures within the pelvicayceal system. this leads to blunting of the renal pyramids and expansion leading to hydronephrosis