Case 37 Part 1




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What's inside?


 

External exam




This is a "High Independence" case. There is no explanatory audio.
Instructors: For more information, please visit the Case Selector.

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Discussion Questions


 

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1. Summarize the history.
 
 
2. Why were two pacemakers put in?
 
 
3. What do you think of the story that the metallic taste was due to a “corroded pacemaker”?
 
 
4. Why do you think the patient had a metallic taste?
 
 
5. What evidence in the history supports your answer?
 
 
6. What is the difference between a history provided by the family and a history provided in a medical record?
 
 
7. How strongly do you feel the family believed the pacemaker had corroded? What’s your evidence?
 
 
8. Do you think each of the patient’s procedures (removal and replacement of pacemaker) was necessary? Why or why not?
 
 
9. What do you think is the likelihood there was a medical error in this case?
 
 
10. Do you there any part of the history might have been inaccurate?
 
 
11. What are early symptoms of kidney failure?
 
 
12. Do you see any ethical considerations in this case so far?
 
 
13. Some families will pressure clinicians to take certain steps. Some clinicians can pressure themselves to comply with what they think a family wants. What kinds of threats or pressures can clinicians experience from families? Alternatively, what kinds of internal pressures can clinicians experience to “please” a family or comply with what they think the family wants? If these internal or external pressures result in an unnecessary procedure, where is the breakdown in training? How can clinicians strengthen themselves in these situations? How might these issues apply in this case?
 
 
14. How might the second surgery have been avoided while also addressing the family’s concerns about the metallic taste?
 
 
15. How many scars does this patient have on his body?
 
 
16. Where are they?
 
 
17. What was each from?
 
 
18. Which ones are older and which ones are newer?
 
 
19. What is a bunion?
 
 
20. Does the patient have one?
 
 
21. What is name of the condition under the gauze in the left forearm?
 
 
22. Do you see any postmortem changes? Where? And what are they?
 
 
23. The patient has a yellow “FALL RISK” bracelet on the left. What about the physical exam indicates he might have been a fall risk?
 
 
24. How deep is the decubitus ulcer? What is its stage?
 
 
25. What is your assessment of the patient’s muscle mass?
 
 




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