Directions
Students should complete one (1) case (your choosing) from Part 1. All students should complete one (1) case (your choosing) from Part 2. Note: All case studies are provided as a learning tool for students who wish to have them.
Part 1: Choose 1
Review the various conjunctivitis cases and determine the most likely cause, including pathogen and mode of transmission. Discuss data that supports your decision and treatment strategies.
Case 1
A 5-year-old girl has had a cough and runny nose (yellowish discharge) for the past 3 days. Her mother brought her for an evaluation as her left eye became pink and the right eye is also starting to get pink. Her daughter keeps rubbing them. The mother says there was a little discharge that was like mucus, but she wiped it away before coming to get checked. The physical examination reveals an active, alert girl. Her ears and lungs are within normal limits (WNL). Yellowish discharge is noted from the nose, and her oropharynx is mildly erythematous; however, there is no tonsillar enlargement or exudate. Her eyes have conjunctival erythema and mild edema—the left eye greater than the right eye. Mild crusting at the lid but no discharge is noted.
Provide responses to the items below.
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- Most likely cause including pathogen –
- Mode of transmission –
- Discuss data that supports your decision –
- Treatment strategies –
Case 2
A 40-year-old woman is complaining of itching, redness, and watery discharge in both her eyes. She feels like she has sand in her eyes. She also starting sneezing and has a clear nasal discharge. She thinks the symptoms started after petting a cat 2 days before at a friend’s house. She stated this reaction never happened before around animals, but she does get hay fever a few times a year. She has a past medical history of eczema. The physical examination reveals alert woman in no acute distress. Her ears, nose, throat, and lungs are WNL. There is evidence of bilateral stringy “ropelike” discharge and conjunctival erythema.
Provide responses to the items below.
-
- Most likely cause including pathogen –
- Mode of transmission –
- Discuss data that supports your decision –
- Treatment strategies –
Case 3
An 18-month-old boy has a runny nose (yellowish discharge) and has been rubbing his left ear for 3 days. His parents kept him home from day care and brought him in for an evaluation as both his eyes became pink and were full of crust and yellowish discharge this morning. He has been fussy, not eating well, and had a temperature of 100°F. The physical examination reveals a fussy, alert boy. His throat and lungs are WNL. There is evidence of yellowish discharge from the nose, and his left ear canal is clear, but the tympanic membrane is bulging and red, and fluid is noted behind the tympanic membrane. His eyes have a yellowish discharge and conjunctival erythema bilaterally.
Provide responses to the items below.
-
- Most likely cause including pathogen –
- Mode of transmission –
- Discuss data that supports your decision –
- Treatment strategies –
Part: Choose 1
Review the various hearing disorder cases and determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss. Once you identify the type of hearing loss, explain the part of the ear that is affected and describe the disorder.
Case 1
A 45-year-old woman noticed that she feels like her left ear is full and she cannot hear as well from her left ear as from her right. She states these symptoms started after she was cleaning the inside of her ears with a cotton-tip applicator. Physical exam reveals a right ear that is WNL. Her left ear canal has dark cerumen occluding her ear canal.
Provide responses to the items below.
- Determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss.
- Explain the part of the ear that is affected and describe the disorder.
Case 2
A 15-year-old is complaining of right ear pain and a feeling of fluid in his right ear for the past 3 days. He feels likes it is getting worse. He says his hearing is slightly decreased in the right ear in comparison to the left. He stated these symptoms started after he came back from a camping trip where he went swimming in a lake several times. Physical exam reveals a left ear that is WNL. His right ear is painful when the auricle is tugged. The ear canal is edematous and erythematous. Whitish exudate is present in the right ear, and due to the amount of exudate, the tympanic membrane was only partially visible. The portion seen was intact and nonerythematous.
Provide responses to the items below.
- Determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss.
- Explain the part of the ear that is affected and describe the disorder.
Case 3
An 80-year-old man states that he has been gradually having a harder time understanding what people are saying when he is with several people (e.g., like a party). He also states that he has a harder time understanding his grandchildren, and some words he hears well and other he does not. He states his hearing loss is equal in both ears. Physical exam is noncontributory and WNL.
Provide responses to the items below.
- Determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss.
- Explain the part of the ear that is affected and describe the disorder.
Expert Solution Preview
Introduction: In this assignment, students are required to analyze and answer questions based on different medical cases related to conjunctivitis and hearing disorders. The objective is to assess the students’ understanding of the causes, pathogenesis, mode of transmission, and treatment strategies for conjunctivitis cases, as well as their ability to determine the type and describe the affected part of the ear in hearing disorder cases. This assignment aims to enhance students’ problem-solving skills and knowledge in the field of medicine.
Answer to Part 1, Case 1:
– Most likely cause including pathogen: Based on the symptoms described, the most likely cause of conjunctivitis in this case is viral conjunctivitis. The pathogen responsible for this condition is usually adenovirus.
– Mode of transmission: Viral conjunctivitis is highly contagious and can be transmitted through direct contact with an infected person’s eye secretions, respiratory droplets, or contaminated objects.
– Data that supports your decision: The presence of a cough, runny nose, and yellowish discharge from the nose suggests a viral respiratory infection, which can be associated with viral conjunctivitis. The absence of tonsillar enlargement or exudate supports the viral etiology rather than bacterial conjunctivitis. The mild crusting at the lid indicates viral involvement.
– Treatment strategies: Treatment for viral conjunctivitis is primarily supportive, including symptomatic relief with cold compresses and artificial tears. Anti-inflammatory eye drops may be used to alleviate discomfort. It is important to emphasize good hygiene practices to prevent the spread of the infection.
Answer to Part 1, Case 2:
– Most likely cause including pathogen: The most likely cause of conjunctivitis in this case is allergic conjunctivitis. The underlying pathogen is an allergen that triggers an immune response.
– Mode of transmission: Allergic conjunctivitis is not contagious and cannot be transmitted from person to person.
– Data that supports your decision: The patient’s symptoms of itching, redness, and watery discharge in both eyes, along with a history of eczema and known hay fever, strongly suggest an allergic etiology. The bilateral stringy discharge is characteristic of allergic conjunctivitis.
– Treatment strategies: Treatment for allergic conjunctivitis focuses on managing symptoms and avoiding triggers. This may involve the use of antihistamine eye drops, cold compresses, and oral antihistamines. Identifying and avoiding allergens is crucial in preventing recurrences.
Answer to Part 1, Case 3:
– Most likely cause including pathogen: The most likely cause of conjunctivitis in this case is bacterial conjunctivitis. The pathogen commonly involved in bacterial conjunctivitis is usually a bacteria such as Streptococcus pneumoniae or Haemophilus influenzae.
– Mode of transmission: Bacterial conjunctivitis can be transmitted through direct contact with eye secretions from an infected person or contaminated objects.
– Data that supports your decision: The presence of a runny nose with yellowish discharge, along with the characteristic symptoms of pink eyes, crusting, and yellowish discharge, suggests bacterial involvement. The accompanying symptoms of fussy behavior, not eating well, and a temperature of 100°F further support this diagnosis.
– Treatment strategies: Treatment for bacterial conjunctivitis typically involves the use of antibiotic eye drops or ointments to eradicate the bacterial infection. It is important to complete the full course of antibiotics and practice good hygiene measures to prevent the spread of infection.
Answer to Part 2, Case 1:
1. Determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss: The disorder in this case is most likely conductive hearing loss.
2. Explain the part of the ear that is affected and describe the disorder: The part of the ear affected in conductive hearing loss is the external or middle ear. In this case, the accumulation of dark cerumen occluding the left ear canal is causing the conductive hearing loss. Cerumen impaction prevents sound waves from reaching the tympanic membrane and passing into the middle ear, resulting in reduced hearing acuity.
Answer to Part 2, Case 2:
1. Determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss: The disorder in this case is conductive hearing loss.
2. Explain the part of the ear that is affected and describe the disorder: The part of the ear affected in conductive hearing loss is the middle ear. The swimmer’s ear (otitis externa) caused by exposure to water during the camping trip has resulted in edema and inflammation of the ear canal. The presence of whitish exudate further obstructs sound transmission, leading to conductive hearing loss.
Answer to Part 2, Case 3:
1. Determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss: The disorder in this case is sensorineural hearing loss.
2. Explain the part of the ear that is affected and describe the disorder: Sensorineural hearing loss is caused by damage to the cochlea or auditory nerve. In this case, the age-related degeneration of the cochlear hair cells or the auditory nerve is leading to difficulty in understanding speech and decreased hearing acuity. This type of hearing loss affects both ears equally and may be associated with presbycusis, a common age-related hearing loss.
