EBHF Assignments for Week 14
Full Course Overview
Case-Based Written Assignments
Congratulations on your Week 13 Submissions! Answers to week 13 assignments will be reviewed next week (with the week 14 assignment). These cases all go together.
There are TWO questions this week for Week 14 (Case 27 and Case 28). The EBHF Program now requires all fellows to upload their assignments to our server using the simple link below. We no longer permit the emailing of ASSIGNMENT ANSWERS. ASSIGNMENTS ARE ONLY ACCEPTED USING THE LINK BELOW.
If you write your answer in a language other than English, that is perfectly fine (and highly encouraged), but please let us know the language chosen when you submit your answer.
Please be sure to save your assignments if you wish to keep them for your own personal learning journey and learning objectives. We do not save assignments once they have been evaluated by Dr. Donovan and you will not be able to retrieve them again. It is the responsibility of each fellow to save their assignments.
CLICK HERE TO UPLOAD YOUR ASSIGNMENT ANSWERS BY CLICKING HERE
***CLICK HERE TO DOWNLOAD PDF OF CASE 27 and CASE 28***
CASE 27
Agnes is a 63-year-old postmenopausal woman with lichen planopilaris. Her history was reviewed in Case 25, week 13. Please click here to review it.
Agnes is back in the office for an appointment with you today. She tells you that she was diagnosed with stage 2 ovarian cancer recently and has completed surgery and chemotherapy. She lost her hair with chemotherapy and is now starting to grow it back.
QUESTIONS FOR CASE 27
1. Looking back at Agnes’s Case 25 information, can you list eight pieces of information from the week 13 case consistent with someone with ovarian cancer?
2. What is meant by “stage 2” cancer? How does it differ from stage 3 cancer?
3. What chemotherapy medications do you suspect Agnes received?
4. Agnes recently met a patient at her cancer doctor’s office who said that she did not get all her hair back after chemotherapy. What is this phenomenon called when someone does not grow back all their hair after chemotherapy? How often does it occur?
** Please remember to upload your answers to our server as we are no longer able to accept emailed answers **
CASE 28
Alvin is back to see you. His history was reviewed in Case 26, week 13. Please click here to review.
It’s been six months since he visited you, and he wants to update you on everything that has happened.
Alvin went to his local emergency room soon after he visited with you and asked to be assessed for Clostridium difficile colitis. The emergency doctor said he did not think this was needed and sent Alvin home.
Alvin’s diarrhea did not improve on day four, and Alvin went to another emergency room the next day (in a nearby city) and asked to be assessed. He was recorded to have a mild fever, and the doctor said Alvin was dehydrated. Alvin says the doctors at the second emergency room were excellent and very caring and had him collect stool tests for culture. The doctors gave him intravenous fluids and told him to keep drinking a lot at home. His stool results returned a few days later, showing he had E. coli. Overall, it was felt that Alvin had food poisoning from a party he went to just before the diarrhea started.
By the time Alvin got his test results back, he was feeling better, and diarrhea had resolved. However, Alvin was worried that the doxycycline you gave him caused the good bacteria in his bowel to be killed and that this predisposed him to the E coli infection. So, he decided to stop doxycycline.
Alvin said you should have prescribed ‘probiotics’ to prevent this all from happening.
Alvin saw a gastroenterologist the following week and had an upper endoscopy and colonoscopy. The gastroenterologist said everything looked okay and asked him to return in 1 year. Alvin said he no longer trusts doctors after what happened in the first emergency room, so he went online to read his full report about his endoscopy and colonoscopy.
Alvin notes that the endoscopy report said he had “mild esophagitis.” The colonoscopy report said Alvin’s bowel showed “edema, redness, ulceration, and mucosal friability.”
Alvin made an appointment with his gastroenterologist immediately after reading his report. The gastroenterologist was very dismissive and said those findings would be expected in someone with foodborne diarrhea.
Alvin now wants to update you on his folliculitis decalvans. He is using no treatments for it. He has itching and burning, and his scalp is much redder.
Alvin says he is worried he has ulcerative colitis after reading his results online. He gets periods of diarrhea and constipation. He has joined two online ulcerative colitis support groups and really likes the people in these groups. He says he would like to volunteer with one of the groups in the future. He would like you to order a stool test called “fecal calprotectin,” as he says that many people in his support group have had this test done.
Alvin checks his stool every day for blood and consistency. There does not seem to be any blood.
In addition to ordering the “fecal calprotectin” test, Alvin would like you to prescribe a JAK inhibitor because he read that it can help both ulcerative colitis and folliculitis decalvans.
QUESTIONS FOR CASE 28
1. What is likely the cause of Alvin’s esophagitis seen on endoscopy?
2. What is a “fecal calprotectin test” that Alvin mentions?
3. Is there any evidence that “probiotics” are a good idea to give to someone who uses antibiotics?
4. Do you suspect that Alvin has ulcerative colitis?
5. Do you feel a JAK inhibitor is a good idea for Alvin?