Please answer the critical thinking question base on the upload documents Critical Thinking Questions ( Cervical -Cancer)
1. Why was mammography contraindicated for this patient? 2. How is sexual promiscuity related to the risk for cervical cancer?Critical Thinking Questions
1 ( Gumerulonephritis). At what point would the BUN and creatinine have signified the need for dialysis?
2. What was the cause of the patient’s hypertension? 3. What would you do if this patient had developed a swollen mouth and neck after the
IVP?
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Cervical Cancer
Case Studies
The patient, a 28-year-old woman, has been sexually active with multiple partners since she
was 14 years old. She is now married and wants to have children. She has intermittent
breakouts of vulvar ulcers/sores but no other complaints. Her pelvic examination during a
routine visit with her gynecologist was normal. She had a lump in her left breast.
Studies
Sexually transmitted
infections (STIs), p. 756
Herpes simplex test, p. 731
Cytomegalovirus, p. 200
Chlamydia, p. 722
Gonorrhea, p. 761
Syphilis serology, p. 473
Pap smear, p. 743
Adequacy of specimen
Category
Epithelial cell
abnormalities
Human papillomavirus (HPV)
testing, p. 745
Breast sonogram, p. 871
Results
Positive for herpes simplex virus-2 (HSV-2) (normal:
negative)
No change in serology 4 weeks later
No antibodies detected
No antibodies detected
Culture negative
No antibodies detected
Adequate
Epithelial abnormality
Squamous, atypical cells
Positive for HPV 16
Benign fibroadenoma
Diagnostic Analysis
The patient was informed of her test results. Her herpes titers indicated that the disease was
rather chronic, not acute. No treatment was recommended. Because of her age,
mammograms were contraindicated. A breast ultrasound indicated the lesion was not
cancerous. A fibroadenoma is common in this age-group. Because of her positive HPV
results and suspicious Pap smear, further evaluation was recommended.
Studies
Results
Colposcopy, p. 595
Several suspicious areas
Biopsy
Squamous cell carcinoma
Cervical cone biopsy, p. 720 Invasive squamous cell carcinoma
Hysteroscopy, p. 614
No extension to the endocervical canal or uterus
Pelvic ultrasound, p. 887
No extension of tumor beyond the cervix
The patient was advised to have a radical hysterectomy. She refused because she wanted to
have a family. She began psychologic counseling for guilt over her past promiscuity, which
had increased her risk for cervical cancer. She became pregnant 1 year later and lost the
Case Studies
pregnancy during the second trimester. One year later, she developed a large pelvic mass,
which represented progressive, inoperable cervical cancer. Despite radiation therapy and
chemotherapy, she died at age 31 of cervical cancer.
Critical Thinking Questions
1. Why was mammography contraindicated for this patient?
2. How is sexual promiscuity related to the risk for cervical cancer?
2
Glomerulonephritis
Case Studies
A 7-year-old boy was brought to his pediatrician because he had developed hematuria, which
required hospitalization. Approximately 6 weeks before his admission, he had a severe sore
throat but received no treatment for it. Subsequently, he did well except for complaints of
mild lethargy and decreased appetite. Approximately 3 weeks before admission, he had a
temperature of 101° F daily for 7 days. He complained of minimal bilateral back pain.
Physical examination revealed a well-developed young boy with moderate bilateral
costovertebral angle (CVA) tenderness. The remainder of the physical examination results
were negative. His blood pressure was 140/100 mm Hg in both arms and legs.
Studies
Urinalysis, p. 956
Blood
Protein
Red blood cell casts
Specific gravity
Color
Urine culture and sensitivity (C&S), p. 973
Blood urea nitrogen (BUN), p. 511
Creatinine, p. 190
Creatinine clearance test, p. 193
Renal ultrasound, p. 866
Intravenous pyelogram (IVP), p. 1057
Renal biopsy, p. 751
Anti-DNase-B (ADB) titer, p. 79
Total complement assay, p. 172
Results
+4 (normal: negative)
+1 (normal: negative)
Positive (normal: negative)
1.025 (normal: 1.010-1.025)
Red-tinged (normal: amber-yellow)
No growth after 48 hours
42 mg/dL (normal: 7-20 mg/dL)
1.8 mg/dL (normal: 0.7-1.5 mg/dL)
64 mL/min (normal: approximately 120
mL/min)
No tumor; kidneys diffusely enlarged and
edematous
Delayed visualization bilaterally; enlarged
kidneys, no tumor; no obstruction seen
Swelling of glomerular tuft, along with
polymorphonuclear leukocyte infiltrates in
Bowman’s capsule (findings compatible
with glomerulonephritis);
immunofluorescent staining, positive for
IgG
200 units (normal: ≤170 units)
33 units/mL (normal: 75-160 units/mL)
Case Studies
2
Diagnostic Analysis
The blood, protein, and RBC casts in the boy’s urine indicated a primary renal disorder. The
elevated creatinine and BUN levels indicated that the problem was severe and markedly
affecting his renal function. Both kidneys were probably equally impaired. Intravenous
pyelogram (IVP) was helpful only in ruling out Wilms tumor or congenital abnormality.
Normally an IVP would not be performed in light of this patient’s impaired renal function. It
is presented here for demonstration of the information it can provide. Renal ultrasound is a
much safer test to visualize the kidney to exclude neoplasm. The ultrasound findings were
compatible with an inflammatory process involving both kidneys. Renal biopsy was most
helpful in suggesting glomerulonephritis. The history of recent pharyngitis, fever, the
positive ASO titer, the positive ADB titer, and the finding of immunoglobulin IgG antibodies
on the immunofluorescent stain all suggested poststreptococcal glomerulonephritis.
The patient was placed on a 10-day course of penicillin. He was given antihypertensive
medication, and his fluid and electrolyte balance was closely monitored. At no time did his
creatinine or BUN level rise to a point requiring dialysis. After 6 weeks, his renal function
returned to normal (creatinine, 0.7 mg/dL; BUN, 7 mg/dL). His antihypertensive medications
were discontinued, and he remained normotensive and returned to normal activity.
Critical Thinking Questions
1. At what point would the BUN and creatinine have signified the need for dialysis?
2. What was the cause of the patient’s hypertension?
3. What would you do if this patient had developed a swollen mouth and neck after the
IVP?

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