Responsive
Cardiovascular System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M33_F1.jpg"}},{"insert":"\n\n"},{"insert":"Stethoscope draped around your neck, you allow yourself one last swig of the freshly brewed Italian roast you\u0027d picked up on the way to work today.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M33_F2.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Please let our first patient in!\u0022 you request the nurse cheerily.\r\n\r\n\u0022Sure, she\u0027s on the way,\u0022 comes the reply.\n\nMrs. Clemens is 81 years old and visiting your clinic for the first time.\r\n \r\nA retired teacher and widow of 25 years, she recently sold her old house and moved to a small apartment near your hospital, to which her medical records have been transferred.\n\nExplaining that she\u0027s here for her regular monthly visit, she also complains of feeling very tired for the last three weeks.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M33_F3.jpg"}},{"insert":"\n\n"},{"insert":"Mrs. Clemens\u0027 medical records speak of ongoing treatment for hypertension for 15 years, a history of osteoarthritis of the neck and both hips for 10 years, and a hysterectomy for uterine prolapse 20 years ago.\r\n \r\nShe is also on potassium replacement therapy.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M33_F4.jpg"}},{"insert":"\n\n"},{"insert":"Her recent bloodwork reads as follows:\r\n\r\nHgb: 12.5 g\/dL (12.3-15.3)\r\nWBC: 7,000 mcL (4,500 to 10,000)\r\nESR: 5 mm\/hr (0-29)\n\nTotal cholesterol: 6.5mmo\/L (\u003C 5.2)\r\nLDL: 2.5 mmol\/L (\u003C2.59)\r\nHDL: 0.6 mmol\/L (\u003E1.5)\r\nFasting blood glucose: 5.9 mmol\/L (3.9-5.5)\r\neGFR: 75 mL\/min\/1.73 m2\n\nAn immaculate note from her previous physician reads:\r\n \r\n\u0027Recommendations regarding diet and exercise were conveyed to the patient. Kindly follow-up with a lipid profile and blood glucose a month from today.\u0027\n"}]}
4
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M33_F5.jpg"}},{"insert":"\n\n"},{"insert":"A brief systems review reveals no complaints.\r\n \r\nMrs. Clemens weighs 60 kg, with a BMI of 24. There have been no recent changes in her appetite or weight.\n\nHer BP is 115\/80 mmHg and respiratory rate 24 cycles\/min, with a pulse of 60 bpm. She is afebrile.\r\n \r\nThe cardio-respiratory and abdominal examinations are normal. You find no palpable masses or lymphadenopathy.\n"}]}
5
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M33_F6.jpg"}},{"insert":"\n\n"},{"insert":"\u0022This recent move has absolutely exhausted me! I just fall asleep thoughout the day. I\u0027m not normally this lazy. Can you recommend something for my energy levels?\u0022 she asks.\n"}]}
6
{"ops":[{"insert":"How do you respond?\n"}]}
1. "You'll be fine soon, Mrs. Clemens, your tiredness may be age-related. Try and rest up a bit more."
2. "I think we'll need to review your medications, Mrs. Clemens."
8
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9
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7
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