Scenarios

1
Scenarios

• ES 300
• Spring 2008

2
Scenario 1

• A 25 year old man comes to you for a health
  consultation. He is approximately 510 tall and
  weighs 298 pounds. He has no family history of
  heart disease or diabetes that he can recall. He
  has difficulty climbing and descending stairs,
  often finds himself worn out even though his
  day has not been particularly trying, and
  continually finds himself drinking soda to sate
  his thirst.
• Include
• What do you think might be wrong with him?
• Should he see an MD?
• Should he ask for any specific tests?
• Are there any immediate concerns?
• How might you ask him to modify his lifestyle?

3
Scenario 1 Answer

• The man likely has type 2 diabetes. He should
  see his doctor as soon as possible for further
  work up. He should inquire about a fasting blood
  glucose test and be very aware to the symptoms
  associated with hyperglycemia and diabetic
  ketoacidosis. These symptoms include confusion,
  increased urination, excessive thirst, appetite
  suppression, passing out, nausea, weakness, and
  fatigue. He will likely need to do things to
  control his weight including adjusting his
  overall diet and his daily activity. It would be
  advisable for him to follow up with his doctor
  about his risk factors for heart disease and to
  have a lipoprotein profile done, in addition to a
  blood pressure check.

4
Scenario 2

• A 55 year old African-American woman describes a
  strange occurrence that happened to her last
  night. She woke up from her sleep and felt as
  though she could not move her right arm and that
  the function in her right leg had diminished.
  The sensation, she states, was different from
  that when a limb is asleep. After a few
  minutes the feeling subsided and she thought it
  was nothing. There is no family history of any
  condition like this. After a cigarette and a
  nightcap of bourbon she was able to fall back to
  sleep.
• Include
• What do you thing might have happened to her?
• Should she see an MD?
• What questions should she ask?
• Are there any immediate concerns?
• How might you ask her to modify her lifestyle?

5
Scenario 2 Answer

• This woman could possibly have had a transient
  ischemic attack. This is a very significant risk
  factor for a more severe ischemic stroke and she
  should see her MD as soon as possible. She
  should inquire about other risk factors and how
  she might minimize her risk for a more
  significant stroke. She should probably quit
  smoking and keep her drinking to a minimum. She
  should also have her blood pressure and
  cholesterol monitored by her doctor and inquire
  about what kind of an exercise program would be
  right for her.

6
Scenario 3

• You are having a steak and twice-baked potato
  dinner with a 65 year old man and his wife. The
  man states this is his favorite meal and they eat
  this at least once a week. He then begins to
  discuss some mild chest tightness at the
  beginning of the meal that he admits to getting
  occasionally, but only when he climbs more than a
  flight of stairs and it goes away quickly. After
  a short time the chest tightness becomes worse
  and he starts to feel some jaw and left arm pain.
  By the end of the meal he is in great discomfort
  and his chest has tightened up so that it feels
  as though someone is standing on him.
• Include
• What do you think is happening?
• What makes you think this?
• What should you do at this time?
• How might this person want to change his
  lifestyle in the future?

7
Scenario 3 Answer

• This man is likely having a myocardial
  infarction. The pain in his chest, jaw, and arm
  are red flags for a MI and it is possible that
  the pain hes been feeling that goes away quickly
  after some mild exertion has been angina. At
  this time you need to call 9-1-1 for emergency
  medical help. After he is treated he may want to
  consider changing his lifestyle by minimizing his
  intake of dietary cholesterol and saturated fat.
  In addition, he may need to begin an exercise
  program as he obviously has some issues simply
  climbing a flight of stairs. Additionally, he
  will need to have his blood pressure and blood
  cholesterol monitored regularly. It would be a
  good idea for him to begin taking an aspirin a
  day, as well.

8
Scenario 4

• A 62 year-old white male comes to you to discuss
  his most recent visit with his doctor. He is
  63 tall and weighs 180 pounds with a waistline
  measurement of 33 inches. His father and uncle
  both passed away from myocardial infarctions. He
  says his doctor told him his total cholesterol
  level was 230, his LDL was 172, and his HDL was
  32. In addition, his triglyceride levels were
  210 and his resting blood pressure was 141/94.
  His doctor told him all this information was very
  concerning and that he was at a significant risk
  for a heart attack. The man was given some
  medication to control some of the risk factors,
  but he is not sure exactly what the medicine
  does.
• Include
• What information is concerning?
• Which information is controllable and which is
  not controllable?
• What risks can medication address?
• How would he go about controlling each specific
  risk factor?

9
Scenario 4 Answer

• The age of the man is working against him as he
  is getting on in years. The fact that he is a
  male is also a factor, although his body mass
  index is not too high, nor is his waist
  circumference. In addition, his total
  cholesterol is borderline high, as are his
  triglycerides and LDLs. His HDL cholesterol is
  disturbingly low. Unfortunately, he cannot
  control his family history of heart disease, but
  he can begin working on changing some of his risk
  factors like his high blood pressure and
  cholesterol. Some of the things he should
  consider doing is taking an aspirin a day to thin
  his blood, in addition to the medication he is
  taking to control his hypertension and high
  cholesterol.

10
Scenario 5

• An 18 year old Caucasian female who is 54 and
  185 pounds comes to you to discuss her risk
  factors for cardiovascular disease and diabetes.
  Her waist circumference is 37 inches. This woman
  has a family history of diabetes, but no history
  of cardiovascular disease that she knows of. She
  is not a smoker. She has a lipoprotein profile
  that shows her HDL to be 63 and her LDL to be 98.
  Her blood pressure is 137/88. Her fasting blood
  glucose level is 118.
• Include
• What are her significant risk factors?
• What risk factors can she modify?
• What will her doctor likely want to monitor?
• What changes can she monitor easily at home?

11
Scenario 5 Answer

• This woman has an uncontrollable risk factor of
  family history of diabetes, but she can work to
  control her moderately high blood pressure. Her
  cholesterol levels are okay, but should be
  monitored regularly, especially while her body
  mass index is above 25. It is currently 32. Her
  fasting blood glucose value of 118 is concerning
  because it indicate pre-diabetes. Blood glucose
  levels above 125 indicate diabetes. This value
  should be followed-up on with her doctor on a
  regular basis. In the mean time, she can begin
  an exercise program to bring. Exercising
  regularly will bring down her blood pressure and
  help her control her weight. She can easily
  calculate her BMI with a calculator and can
  monitor her waist circumference with a tailors
  tape. Ideally, her BMI should be below 25 and
  her waist circumference below 35 inches.