Case Study 1 & 2 Lyme Disease and Peripheral Vascular Disease

Lyme Disease  A 38-year-old macho had a 3-week history of fatigue and apathy with alternate complaints of headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’s affection began anon afterwards a camping vacation. He recalled a bug chaw and adventurous on his thigh anon afterwards the trip. The afterward studies were ordered:  Studies Results Lyme ache test: Animated IgM antibiotic titers adjoin Borrelia burgdorferi (normal: low)  Erythrocyte sedimentation amount (ESR), 30 mm/hour (normal: ≤15 mm/hour) Aspartate aminotransferase (AST), 32 units/L (normal: 8-20 units/L)  Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL)  Hematocrit (Hct), 36% (normal: 42%-52%)  Rheumatoid agency (RF), Abrogating (normal: negative)  Antinuclear antibodies (ANA), Abrogating (normal: negative)  Diagnostic Analysis  Based on the patient's history of camping in the dupe and an insect chaw and adventurous on the thigh, Lyme ache was suspected. Aboriginal in the advance of this disease, testing for specific immunoglobulin (Ig) M antibodies adjoin B. burgdorferi is the best accessible in diagnosing Lyme disease. An animated ESR, added AST levels, and balmy anemia are frequently apparent aboriginal in this disease. RF and ANA abnormalities are usually absent.  Critical Thinking Questions  1. What is the basal assurance of Lyme disease? (always on the boards)  2. At what stages of Lyme ache are the IgG and IgM antibodies elevated?  3. Why was the ESR elevated?  4. What is the Therapeutic ambition for Lyme Ache and what is the recommended treatment. Peripheral Vascular Disease  A 52-year-old man complained of affliction and airtight in his appropriate dogie acquired by walking two blocks. The affliction was adequate with abeyance of activity. The affliction had been accretion in abundance and intensity. Concrete assay allegation were about accustomed except for decreased beard on the appropriate leg. The patient’s popliteal, dorsalis pedis, and afterwards tibial pulses were clearly decreased compared with those of his larboard leg.  Studies Results Routine class assignment Within accustomed banned (WNL)  Doppler ultrasound systolic pressures Femoral: 130 mm Hg; popliteal: 90 mm Hg; afterwards tibial: 88 mm Hg; dorsalis pedis: 88 mm Hg (normal: aforementioned as brachial systolic claret pressure)  Arterial plethysmography Decreased amplitude of distal femoral, popliteal, dorsalis pedis, and afterwards tibial beating waves  Femoral arteriography of appropriate leg Obstruction of the femoral avenue at the midthigh level  Arterial bifold browse Apparent arterial obstruction in the apparent femoral artery  Diagnostic Analysis  With the analytic account of archetypal alternate claudication, the noninvasive Doppler and plethysmographic arterial vascular abstraction alone accurate the attendance and area of the arterial occlusion in the adjacent femoral artery. Best vascular surgeons adopt arteriography to certificate the area of the vascular occlusion. The accommodating underwent a bypass from the adjacent femoral avenue to the popliteal artery. Afterwards anaplasty he was asymptomatic.  Critical Thinking Questions  1. What was the account of this patient's affliction and cramping?  2. Why was there decreased beard on the patient's appropriate leg?  3. What would be the cardinal concrete assessments afterwards anaplasty to actuate the capability of the patient's circulation?  4. What would be the analysis of alternate Claudication for non-occlusion? 

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