Case Scenarios for Final Exam 2025

• These notes cover case scenarios for a final exam in 2025, focusing on various diseases, symptoms, and treatments.
• The cases include scenarios A through F.
• For each scenario, guiding questions are provided to help answer the main questions and supporting questions.
• Four of the six scenarios will be utilized on the Final Exam.

Scenario A

• A 21-year-old patient with a history of depression, tonic-clonic seizures, and recreational drug use is admitted with abdominal pain, nausea, vomiting, diaphoresis, and altered level of consciousness.
• The patient's friend reports that the patient took pills she always carries.
• Begin assessing the patient.
• Define depression and explain its etiology, noting it is often recurrent, familial, and can occur across the lifespan.
• Neurotransmitter theories (serotonin, dopamine) and drug-induced or illness-related depression are mentioned.
• List signs and symptoms of depression, including loss of interest, inability to experience pleasure, hallucinations, sleep and appetite alterations, and suicidal ideation.
• SSRIs (selective serotonin re-uptake inhibitors) as medications used to treat depression are mentioned as the 1st Ln
• Prozac (Fluoxetine) was originally prescribed, then switched to Buproprion (Wellbutrin).
• Explain both mechanisms of action of Prozac and Buproprion.
• Explain the neurotransmitter related side effect that can be life-threatening with either drug, and the need for patient education.
• The patient may experience serotonin syndrome.
• List the signs and symptoms of tonic-clonic seizures.
• Discuss seizures and classify tonic-clonic seizures, explaining airway constriction, loss of consciousness, and possible automatisms.
• Provide medications used for the treatment seizures, explaining their associated mechanisms of action.
• Benzodiazepines (diazepam, lorazepam) can be used IV.
• Anti-convulsants will alter electrolyte movement and delay neuronal activity (phenytoin, carbamazepine, valproic acid).
• Describe the #1 drug of intervention in case of status epilepticus.
• Status epilepticus is unstoppable and becomes life-threatening, a medical emergency.
• Discuss crystal meth and opioids.
• Explain the mechanisms of action for each drug class, as well as the effects of therapeutic and recreational use.
• Compare the physical vs psychological addiction.
• Identify what toxidrome the patients signs and symptoms correlate with
• Discuss the pharmacokinetics and dynamics significant to toxicity
• The patient had too much treatment options
• Describe the kinetics that are targeted by the toxicity treatments
• Explain which organ is involved in this toxicity and its normal functionality.
• Liver failure leads to jaundice, abdominal pain, fatigue, confusion, and dark urine.

Scenario B

• A 63-year-old obese patient with a history of hypertension, angina, and dyslipidemia is admitted to ER with SOB, chest pain, restlessness, diaphoresis and tachycardia and ST elevation on ECG.
• Treat for angina and provide oxygen.
• The patient is placed NPO and taken for an angiogram.
• Treatment includes angioplasty, anticoagulants, and diuretics.
• The patient is discharged on ASA, Metoprolol, Aldactazide and Simvastatin.
• Describe the physiology of BP regulation and how the body compensates for high blood pressure with cardiovascular and renal actions.
• Describe fight or flight, the impact of SNS (sympathetic nervous system) impacts the patient's vital signs.
• Discuss the cause of angina in this patient, and its treatment (drug name, mechanism of action, etc.).
• Nitrates relax blood vessels allowing increased blood flow easily.
• Describe the pathogenesis of atherosclerosis and discuss dyslipidemia related to atherosclerosis.
• Discuss the significance of the ECG findings.
• Which organs are at risk from hypertension and angina?
• Brain, heart, kidneys, and eyes are at risk.
• Describe the angiogram procedure and angioplasty treatment.
• A visualization of blood vessels is needed via x-ray or CT with dye released from a catheter.
• The catheter includes a balloon to improve blood flow.
• Explain the mechanism of action of anticoagulants such as unfractionated heparin or LMWH and name the most used anticoagulant in an urgent procedure.
• Heparin inhibits factor Xa and IIa.
• Explain the benefit of oxygen administration for this patient.
• Oxygen may improve myocardial oxygen supply.
• Which IV fluids are an option for this patient that's currently NPO and provide compositions.
• LR: 130 mEq Na, 4mEq k, 2.7 mEq ca, and 109 Eq cl
• Which IV fluids would be detrimental, knowing their composition (e.g. D5W).
• Explain the medications the patient is prescribed upon discharge (mechanism of action, reasons for prescription as it relates to the pathophysiology, and common side effects).
• ASA inhibits COX-1 and COX-2, preventing thromboxane A2.
• Metoprolol is a Beta Blocker, decreasing HR and BP.
• Aldactazide is a potassium sparring diuretic, managing BP through fluid and Sodium retention.
• Simvastatin is a statin that prevents cholesterol formation which works with cholesterol and liver enzymes to promote CV health.

Scenario C

• A 17-year-old patient, with a history of obesity, is admitted in ketoacidosis seven days ago.
• Arterial blood gas on admission shows pH 7.26, PCO2 30 mmHg, PO2 92 mmHg, oxygen sats 96% on room air, K+ 6.0 mmol/L, Lactate 2.5 mmol/L, blood glucose level 45 mmol/L.
• The patient has since been diagnosed with DM Type 1, and you must complete discharge teaching, what is your knowledge on: DKA, DM Type 1, Insulin administration, obesity and nutrition.
• Interpret the patient's blood gas.
• Blood is acidic.
• The patient is in respiratory alkalosis.
• Super high blood glucose.
• Explain what DKA is.
• DKA: doesn't release insulin, then the body breaks down fat as fuel which causes Ketones to be released in bloodstream Too much Ketones causes DKA.
• The treatment includes IV NaCl, Insulin IV, and KCL.
• Explain what happens to the patient's glucose and potassium levels once insulin is started.
• Insulin helps put glucose into cells and the body will put potassium back into cells.
• Is the patient hypokalemic due to the DKA
• DKA includes absence of insulin causing hyperglycemia.
• Provide S&S of hyperglycemia, and hypoglycemia.
• Hyperglycemia includes an extreme thrist.
• Hypoglycemia includes the hallmark sign of fatigue.
• Glucose is the treatment for hypoglycemia.
• Explain DM type I, and the effects of it:
• Pancreas dose not make insulin, and destroys pancreatic cells
• To insulin from that point on be no Tx leads to death
• Explain carbohydrate counting.
• What is the significance of carbohydrates in Diabetes:
• They are the primary source of fuel, and raise blood sugar.
• Identify what kind of blood draw will be given after DKA treatment.
• Explain the physiology of carbohydrate metabolism & glucose utilization by cells.
• How are carbohydrates digested & absorbed?
• Decribe glycemic regulation
• How is excess intake of carbohydrates stored?
• Explain BMR and calorie excess storage?
• Describe the function of WAT, as an ‘endocrine organ’:
• Explain what the effects are of excessively high WAT:
• Discuss a few of the other major pathologies which the patient at risk for, due to obesity.
• CAD (heart diseases), Cholécystitis (gallbladder diseases), Osteoarthritis (joint pain), and Sleep Apnea.
• The patient is prescribed Insulin Lispro (Humalog) & Insulin Levemir (Detemir).
• Class, mechanism of action, and how these insulins will be used on a daily basis is needed.
• Explain 'intensive insulin treatment/therapy' calculation.
• Estimated daily insuline requirements (U).

Scenario D

• A 42-year-old male forest ranger with a history of Type 2 diabetes mellitus (DM), hypertension, and drug use presents to the emergency department with complaints of severe foot pain, numbness, and skin discoloration after being exposed to freezing temperatures for an extended period.
• The patient also reports ongoing fatigue, dizziness, and episodes of drowsiness over the past few weeks.
• His vital signs are BP 165/95 mmHg, HR 92 bpm, RR 14 bpm, Temp 35.5°C (95.9°F), SpO2 96% on room air.
• Examination reveals blackened toes with clear demarcation, sluggish capillary refill, and decreased sensation in both feet.
• The patient appears withdrawn, and his friend says he has been increasing his opioid use.
• Define frostbite and explain its pathophysiology.
• List the stages of frostbite and describe the clinical manifestations of each.
• Vascular vessels trying to find balance.
• Explain the causes and complications of untreated frostbite, and when is amputation considered?
• Which opioids are highly used recreationally, and what is their effect going to be?
• Give relaxation, euphoria, and altered mood.
• Recreational effects sought by the patient?
• Side effects due to the drug class?
• CNS will depress LOC, bradypnea and hypotension
• Which other drugs are 'downers'?
• What are the signs and symptoms of opioid overdose, and how is it treated?
• What are the symptoms associated with opioid withdrawal?
• The patient asks where he can go for a smoke, tobacco.
• What are the effects of smoking on CV?
• Discuss how DM II and diabetic neuropathy may contribute to poor wound healing and increased risk of frostbite complications.
• Which medication is highly popular for DM II at the moment, and how does it work?
• Name popular hypertension meds for the patient and their likely impacts. Explain the mechanism of action of: beta-blockers along with ACE inhibitors

Scenario E

• A 4-month-old pediatric patient with a previous history of neonatal jaundice and a recent diagnosis of Kawasaki is admitted.
• The patient is breastfeeding, and their only medication prior to admission was vitamin D.
• The patient is currently receiving an IVIG infusion.
• The mother states that the patient has been crying non-stop for the last hour, and the IV infusion pump keeps alarming.
• On assessment, the infants' arm where the IV is infusing is swollen, pale, and the radial pulse is weak.
• The infusion is stopped and note that the patient's IV is 'interstitial' (infused into the tissue instead of venous circulation).
• Concern: tissue damage and compartment syndrome.
• Discuss breastmilk vs formula, and your knowledge of each.
• Which tool is used to determine the growth of this patient?
• Growth Charts.
• Describe the physiology of Vitamin D, when derived from sunlight or nutritional intake.
• What is the role of Vitamin D, in the human body:
• How much Vitamin D is recommended for this age group.
• What are the signs and symptoms of compartment syndrome?
• What is the treatment for compartment syndrome?
• The patient is prescribed Morphine following surgical intervention for treatment of the compartment syndrome.
• The patient receives Morphine, and you note the following: urticaria, SOB, tachycardia.
• Most likely diagnosis is? Anaphaxy
• Explain the pathophysiology of an allergy:
• Explain Anaphylactic shock
• Describe the treatment of each stage of allergic reachtions
• Explain neonatal jaundice
• Kernicterus (bilirubin encephalopathy) concerns.
• When and how is it treated.
• Phototherapy, blue light therapy, exchange of transfusion and infusing blood.
• Explain Kawasaki disease or syndrome
• Give its signs, or causes.
• Explain Immunotherapy:
• What are the major components of the immune system.

Scenario F

• An 80-year-old patient, 70 kg, with a health history of anxiety, newly diagnosed dementia (2 months ago), and Chronic Fatigue Syndrome is admitted to the hospital with appendicitis.
• The patient is placed NPO is and gets IV fluids.
• the appendectomy is completed under General Anesthesia.
• Post-surgery, the patient is started on analgesics, anticoagulants, and IV antibiotics.
• Describe anxiety, describe its treatment
• Is it panic, stress. Fear and the need to be assisted
• What are benzodiezapanies and all the related aspects and effects
• Describe dementia what are the affects, what are the treatments
• Is it the build up amyloid, is it ach. Does one respond in a better way
• Discuss chrinic fatique syndrome
• Discuss what kind of iv fluidd is in place for npo
• discuss its contents, How much IV fluid should this patient be receiving? Calculate it: by volume,
• How will you check renal function on this patient?
• What is normal urine output per hour?
• Renal fx assessment as well
• Discuss General Anesthesia? Which drugs are commonly used