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Case Study - the Children with Lead Poisoning

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CASE STUDY 1 – THE CHILDREN WITH LEAD POISONING
A physician working for the US Public Health Service moves to Los Angeles to assume the directorship of an inner-city health care facility for the disadvantaged. Over a period of time, she notices that an unusually large number of children brought to clinic are experiencing joint pain, difficulty walking and excessive salivation. Some have had seizures. Also many of their parents note that the children’s personalities have changed, with normally outgoing children becoming shy and withdrawn.
The physician decides to investigate the situation and contacts the CDC, which sends an epidemiologist to assist her. They obtain more complete medical histories for 15 children, ranging from 6-15 years of age and perform blood and urine tests on each. In addition to the signs and symptoms already noted, the children frequently report numbness and tingling in their limbs; they perform poorly on hearing, vision and intelligence tests; their lab results how reduced RBC counts and traces of lead in blood and urine.
All of these children live in the same housing project, play together in the same neighborhood and contribute a little to the family finances by salvaging scrap metal from a closed manufacturing plant nearby and selling it to recyclers. When the epidemiologist inspects the site, he finds paint peeling from the factory walls and dust on the floor composed in large part of pulverized paint chips. Analysis of the paint chips and dust reveals a high lead content. Lead and other heavy metals are also found in soil samples taken around the factory yard.
Suspicious of lead poisoning, the physician initiates a broader campaign of medical examination. Among children under 16 living in the area she finds a very high prevalence of lead poisoning. Specifically, of the 112 children examined during the course of the study, over 70 show at least some signs and symptoms. By contrast, she finds relatively little evidence of lead poisoning among adults 25 years and older. The only adult with significant indications of lead poisoning is an elderly woman with pica – a compulsive habit of chewing on nonnutritive substances, in this case, the lead foil wrapped around wine bottle corks. Pica is often associated with a dietary iron deficiency and with iron deficiency anemia. The physician treats the affected patients for lead poisoning, and the CDC enlists the EPA to demolish the old factory and decontaminate the soil
Based on the above case study and other information (which may involve some personal research) answer the following questions 1. What is the etiology of the mental and physiological signs shown by these patients? (1) 2. What risk factors for lead poisoning can you identify in the case study? (3) 3. Is lead a toxin? Justify your answer (3) 4. Do any of the people in this story exhibit idiopathic lead poisoning? Why or Why not? (2) 5. Would you consider lead poisoning a syndrome? Why or why not? (2) 6. At what point in this case does histopathology become relevant? 7. Based on the information presented, does the lead poisoning in this community show a high (8) morbidity? A high mortality?. A high prevalence? A high incidence? For each term, anwer yeas or no, or state that there is insufficient information on which to base your answer. Explain your answers. 8. Would you consider the lead poisoning in this case an epidemic? Would you consider it an infectious disease? Explain your answer (2) 9. Identify each of the following as either a sign or symptom of lead poisoning. (8) a. Joint pain b. Difficulty walking c. Excessive Salivation d. Personality changes e. Low RBC count f. Subnormal Intelligence g. Dimness of Vision h. Lead in urine 10. The elderly woman with pica lives with her daughter’s family. Her daughter says she can’t get her mother to stop chewing the foil from the wine in the bottles and the mother says she likes the metallic feel on her teeth. If you were the physician, what might u suggest to control her lead poisoning? (2) 11. Why do you think the other adults did not suffer from lead poisoning? (2)

CASE STUDY 2 – THE SINGER WITH A SORE THROAT
Ellen, a 19 year old college sophomore, arrives back at her dorm room after taking her last semester exam, but she is in no mood for celebrating. She’s worried that she got a C on the test, or maybe even worse, because she is not feeling well. Her throat is so sore that she can hardly talk and it hurts to swallow. She also feels exhausted and has a headache, although she blames these conditions on that fact that she has stayed up late every night in the past week studying for finals. She’s also been kept awake by the incessant coughing of her roommate.
Ellen longs to be home, but she has a 3 hour drive ahead of her and hasn’t even begun to pack. She skips lunch and sips a can of soda while throwing her dirty laundry and other belongings into assorted boxes, bags and suitcases. Loading up requires several trips to her car, which is parked in a 1-hour zone a block away. During one trek, Ellen realizes that it is starting to snow, and this puts her in an even worse mood. She has to get home as soon as possible because she has promised to sing at her cousin’s wedding tomorrow. Slippery roads will really top off her day.
During the drive home, Ellen thinks the heater in her car must be broken because she can’t seem to get warmed up. When she arrives at last, her mother takes one look at her flushed face and watery eyes and settles her on the couch with a cup of hot tea and a comforter. She takes Ellen’s temperature, which registers 39 degrees centigrade. In view of tomorrow’s plans, this is definitely not good news. Ellen and her mother decide to make a quick trip to an acute care health facility in hopes of getting a diagnosis and some mediation that will help Ellen feel well enough to sing the next day. 1. List Ellen’s symptoms. What specific sings indicate that Ellen is ill? (6) 2. What is Ellen’s chief complaint? (2) 3. Assume that you are the clinician responsible to obtaining Ellen’s medical history. In addition to identifying date, formulate at least 3 questions that you would ask to help diagnose her disease? 4. What risk factors in Ellen’s recent history may have contributed to her illness? (3) 5. Since Ellen is young and her general health appears good, will a sphygmomanometer be needed during the examination? Justify your response? (2) 6. After looking into Ellen’s throat, the acute care physician feels both sides of her neck. What physical examination technique is he applying? (2) 7. The physician listens to Ellen’s heartbeat and then applies a stethoscope to various points on her back, asking her to take deep breaths and release them as he does do. This is an example of_______? (2) 8. To look in Ellen’s ears, the physician uses a/an ____________________ (2) 9. The physician uses a long swap to remove a sample from the back of Ellen’s throat. What is the purpose of this? (2)

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