week 1

· Please read through each of the discussion scenarios offered. Please choose the one that is most interesting to you. This will serve as the basis for your initial response. 

· Label your initial response as follows: First name, last name initial – Discussion #, Scenario # (For example:  Sonya H.- Discussion 1, Scenario 2)

· Your initial post should consist of responses to 
all the required questions within the chosen question set of your selected scenario. 

· You must use and cite at least three reliable sources, two 
other than the course resources, to support your initial responses. (
No references = no credit for initial response.)

· Your initial response must be written 
in your own words and contain at least 100 words.  

· Grammatical errors of spelling, capitalization, punctuation, and sentence structure will be assessed. 

Discussion 1- Scenario 1

Presentation: 65-year-old woman with a loss of appetite, abdominal cramps, constipation, and blood in her stool.

History: Delores Murphy, a 65-year-old white female, was in good health until about 6 weeks ago, when she noted occasional cramps in the left lower quadrant of the abdomen associated with constipation. The episodes of cramping last about 30 minutes each and are most severe in the hour following her meals. She has taken laxatives which have partially relieved her symptoms, but she has had a decreased appetite and 12-pound weight loss over the past four weeks. In addition, she has become increasingly fatigued over this period. When questioned about her bowel habits, she reported bright red blood in her stools and a smaller caliber (i.e., diameter) of stool over the past two weeks.

Physical Examination: She appeared fatigued and distressed. Head and neck exams were normal, as was her thorax. Palpation of the abdomen revealed a 10 x 10 cm mass and tenderness in the left lower quadrant. Percussion over this area revealed a hollow, tympanic sound. Hepatomegaly was noted, and a hard and slightly tender liver edge was felt in the right upper quadrant. Bowel sounds were noticeably reduced. A stool sample was tested with Guaiac paper and was positive for blood.

1. Propose an explanation for Delores’s abdominal cramps and left lower quadrant mass.

2. Propose an explanation for Delores’s reduced bowel sounds and smaller-caliber stools.

3. What is “flexible sigmoidoscopy”?

OR

1. How is an “air-contrast barium enema” performed?

2. Propose an explanation for Delores’s weight loss and decreased appetite.

3. How would the appearance of an adenoma differ from that of a carcinoma under the microscope?

OR

1. Why was it important to biopsy suspicious lesions?

2. What kinds of information can be gained by performing an air-contrast barium enema?

3. Ninety percent of all cancers are carcinomas. Propose an explanation for why such a disproportionately high number of cancers are carcinomas.

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Discussion 1- Scenario 2

Presentation: A 14-year-old girl with cystic fibrosis has complained of an increased cough productive of green sputum over the last week. She also complained of being increasingly short of breath, and she is noticeably wheezing on physical examination.

Arterial blood was drawn and sampled, revealing the following values: