Class, in this thread we will be looking at integumentary and endocrine systems and their related patient encounters. The purpose of this thread is to familiarize you with the Key Concepts found in TerminalCourse Objectives (TCOs) 7 and 8. You must address all of the questions located after the examples of case study and patient encounter below. OPERATIVE AND PATHOLOGY CASE STUDY Preoperative Diagnosis: Multiple basal cell carcinoma temporal right lower lid Anesthesia: Local Operation: Pentagonal full thickness excision of multiple basal cells right lower lid; right lateral canthoplasty (surgical repair of the canthus) Procedure: The patient, a 28-year-old Hispanic male, was brought to the operating room and placed in the supine position. Under nasal prong oxygen and cardiac monitoring, the right lower lid and surrounding area were anesthetized. The right face was prepped in the routine manner. The head and body were draped to expose the right eye. Two, approximately 1.5-2.0 mm, round nodular ulcers centrally cratered, indurated lesions were outlined on the right lower lid not extending above the lateral canthal line. Medial to these lesions was a large milium (keratin-filled cyst). A pentagonal incision was outlined incorporating approximately 1 cm of lid margin. A horizontal lateral canthotomy (surgical division of the slit between the eyelids) was made and the tissue below it was undermined. The pentagonal incision, with the base being the lid margin, was then excised by outlining with mosquito forceps followed by scissors excision. Hemostasis was achieved with bipolar cautery. The lateral canthal flap was further undermined and the lateral canthal skin incision was extended approximately 0.5 cm temporally. The medial lid margin was then sutured to the lateral canthal ligament. The horizontal incision of the lateral canthotomy was closed and pentagonal lid gap was closed. Tobradex ointment and Telfa pad was placed and ice applied. The patient tolerated the operation well and left the operating room in satisfactory condition. Pathology Report Clinical Data: Rule out malignancy, lesion of eyelid Diagnosis: Basal Cell Carcinoma Specimen Site: Eyelid Gross Description: The specimen is received in formalin and labeled with the patient’s name. It consists of a 0.1 cm punch biopsy of light tan, wrinkled skin excised to a depth of 0.2 cm. On the surface, there is an irregularly pigmented area measuring 0.1 cm. Entirely submitted. Microscopic Description: Sections of the submitted skin biopsy show a multicentric basal cell carcinoma. The tumor is formed by masses of small, darkly basophilic, ovoid cells that tend to palisade around the periphery. Marked basophilic degeneration of collagen is seen in the dermis. There is focal lymphocytic infiltration of the dermis. The tumor extends to margins of the biopsy. OUTPATIENT OFFICE ENCOUNTER Margaret Smith is a 61-year-old black female who presents with complaints of depression, weight gain, sensitivity to cold, joint and muscle pain, and fatigue. She states that she feels tired even after getting a good night’s sleep. In addition, she has gained 20 pounds over the past 3 months, which she says is atypical for her because she has maintained a relatively constant weight of 140 pounds over the course of the past 30 years. She finds that she must wear a jacket whenever she stays in an air-conditioned room, even if the room temperature is moderate. She also notes dry and cracked skin, especially around her heels and must apply moisturizers twice a day, which have not seemed to alleviate the excessive dryness. DISCUSSION QUESTIONS: 1. Given one or two common medical terms found in the Operative and Pathology reports, deconstruct the components of specific medical terms to identify their meaning. 2. Reviewing the outpatient encounter of Margaret Smith, accomplish the following and report in your findings and comments in your post. A. Go to the A.D.A.M. multimedia encyclopedia and click on Research a disease or condition. Under hypothyroidism, read all the material under the main headings. Look at the four images. B. After reading the material, summarize or paraphrase any information that you use in response to the discussion questions this week. Be sure and cite your source appropriately. Do not copy and paste information. C. Discuss possible causes of Margaret’s hypothyroidism. What are some early symptoms of this disorder? What are the risk factors for developing hypothyroidism? 3. General questions A. Describe the structures of the skin. B. Describe the structures of the end
