1) Mr. J, age 42, is a construction worker in Las Vegas who lives with his daughter and grandson, Sammy. He recently noticed that a mole on his face seemed to be getting larger and darker. At first, he did not worry because he was in the sun a lot and assumed the change may have been caused by sunburn. After a month, not only was the mole larger and darker, but it appeared to be “bumpy.” His doctor diagnosed a malignant melanoma skin cancer following biopsy of the nevus. Mr. J reports pain in his right shin that does not go away when he puts his feet up or sleeps.
– Relate Mr. J’s skin changes to the warning signs for malignant melanoma.
– Discuss the normal progression of this malignancy. What is the significance of the bone pain that Mr. J is experiencing?
– Discuss the treatment available for this patient and the prognosis for recovery.
2) Mr. J is babysitting his grandson Sammy, age 3 years, who ate his dinner and then said his tummy hurt. Mr. J suggested he lie down in the adjacent room while his parents finished dinner. A few minutes later, Mr. J heard Sammy vomiting. He rushed in to lift Sammy up. When vomiting ceased, he noticed Sammy continued to cough and seemed to be choking. He was struggling to breathe, and a wheezing sound was obvious. It appeared that he had aspirated some vomitus. Mr. J drove him to a nearby hospital for examination.
– Discuss the specific effects of aspirating vomitus on Sammy, including the probable effects on his bronchi and lungs. Why might one lung be affected more than the other?
– Discuss the pathophysiologic changes causing the signs and symptoms and any tests required to clarify the effects on Sammy.
Suggest some reasons for Sammy’s difficulty breathing and wheezing.
– Discuss the potential complications of aspiration of vomitus.
