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Week 2 Discussion: “Recreational” IV drug us

    Week 2 Discussion: “Recreational” IV drug us

    Week 2 Discussion: “Recreational” IV drug us

    Mr. James is a 62 year old male in a primary care practice being seen for a health maintenance visit (last visit was over 10 years ago).  His only complaint of note is fatigue but generally feels well.  He denies any limitations in “doing the things I like to do”, including yard work and fishing.  He works full time as a supervisor for a commercial construction company.  He is married and has 2 daughters.  His oldest daughter is expecting their first grandchild.



    He has a history of “recreational” IV drug use when he was in his early 20s while he was in the military.  Denies any drug use since that time.  He indicates “minimal” alcohol use – generally no more than 2-3 beers or glasses of wine a week.  He has no chronic illnesses and does not take any medicines on a regular basis.



    Physical exam:

    Vitals: 38.1-97-18-183/139

    Normocephalic.  Alert & Oriented x3.

    Eyes: PERL. No nystagmus, no icterus.

    Neck: Supple, no cervical lymphadenopathy

    Cardiovascular: Normal Rate and rhythm. No murmur, gallops. 2+/4+ radial, brachial, dorsalis pedis pulses bilaterally. No jugular venous distension.  No edema.

    Pulmonary: Lungs are clear. No dyspnea or orthopnea.

    Abdomen: Soft and nontender, active bowel sounds. No liver enlargement; abdomen flat. No striae.

    Skin: Warm and dry; no rashes.  Multiple tattoos on both arms.

    Rectal exam: Stool is brown, no rectal masses.

    Lab results:

    CBC:  WBC 9,000; RBC 5.10; Hemoglobin 15.3 g/dL Hematocrit 46%; MCV 90; Platelets 152,000.

    Electrolyte Panel:  Sodium  136 mEq/L; Potassium 3.7 mEq/L; Creatinine 1.1 mg/dL; BUN 12 mg/dL;  Glucose 115mg/dL

    Alanine aminotransferase (ALT) 36

    Aspartate aminotransferase (AST) 50 Week 2 Discussion: “Recreational” IV drug us

    Bilirubin (total) 0.9 mg/dL

    Hepatitis A IgM negative; IgG positive

    Hepatitis B surface antigen negative; surface antibody positive; core antibody negative

    Hepatitis C (HCV) antibody reactive (positive), Hepatitis C RNA positive with an undetectable viral load.

    APA Format

    Information is presented in a scholarly manner (clear, grammatically correct) and reflects synthesis of information from sources.  APA format is correctly used for citations and references. Submission follows assignment guidelines; does not exceed page limit (6 pages, excluding title and reference pages). (15 pts)

    UTA Title page (5 pts)



    Respond to the following questions regarding the Case Study

    1. The clinical scenario is most consistent with which type of hepatitis? Please list your answer below using a bullet point format.  This does not have to be in a complete sentence.  A citation is not required. (10 pts)



    2. What specific data in the clinical scenario supports your diagnosis? You may list your answers below using bullet point format.  This does not have to be in a complete sentence. A citation is not required. (10 pts)



    3. What is the most likely cause of this patient’s diagnosis you noted in Question 1? You may list your answer below using a bullet point format. This does not have to be in a complete sentence.  A citation is not required. (10 pts)



    4. Describe key pathophysiologic concepts that relate to the diagnosis in question 1. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences.  ***Citations are required for each answer to each question using APA format.  You MAY NOT use direct quotes.

    a. How does Hepatitis lead to an increased risk of hepatocellular carcinoma?  Describe how the virus affects the hepatocytes and may lead to cancer.  ( 10 pts)



    b. How does Hepatitis lead to cirrhosis of the liver?  Describe the pathologic steps of how cirrhosis develops and how cellular changes can lead to liver failure.  ( 10 pts)



    c.  One of the negative sequela of liver failure is increased bleeding.  Why do individuals with liver failure experience potentially life threatening bleeding?  Describe how liver failure leads to coagulopathy. ( 10 pts)



    d.  Portal hypertension is also a negative sequela of liver failure.   Describe how liver failure leads to portal hypertension AND how portal hypertension manifests.  (10 pts)



    5. Mr. James is concerned that he will transmit the virus to his new granddaughter after she is born.

    What is the likelihood of transmitting the virus to his granddaughter?  Provide a single sentence that includes your rationale.  A citation is not required.  (10 pts)


    You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

    Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

    Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

    The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

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