Anthr 19520243
March 15, 2021
What did Michael Eisner do to rejuvenate Disney? Specifically, how did he increase net income in his first four years?
March 15, 2021

 Lyme Disease 

A 38-year-old male had a 3-week history of fatigue and lethargy with
intermittent complaints of headache, fever, chills, myalgia, and
arthralgia. According to the history, the patient’s symptoms began
shortly after a camping vacation. He recalled a bug bite and rash on his
thigh immediately after the trip. The following studies were ordered: 

Studies Results Lyme disease test, Elevated IgM antibody titers against Borrelia burgdorferi (normal: low) 

Erythrocyte sedimentation rate (ESR), 30 mm/hour (normal: ≤15
mm/hour) Aspartate aminotransferase (AST), 32 units/L (normal: 8-20

Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL) 

Hematocrit (Hct), 36% (normal: 42%-52%) 

Rheumatoid factor (RF), Negative (normal: negative) 

Antinuclear antibodies (ANA), Negative (normal: negative) 

Diagnostic Analysis 

Based on the patient’s history of camping in the woods and an insect
bite and rash on the thigh, Lyme disease was suspected. Early in the
course of this disease, testing for specific immunoglobulin (Ig) M
antibodies against B. burgdorferi is the most helpful in diagnosing Lyme
disease. An elevated ESR, increased AST levels, and mild anemia are
frequently seen early in this disease. RF and ANA abnormalities are
usually absent. 

Critical Thinking Questions 

1. What is the cardinal sign of Lyme disease? (always on the boards) 

2. At what stages of Lyme disease are the IgG and IgM antibodies elevated? 

3. Why was the ESR elevated? 

4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment.

Peripheral Vascular Disease

 A 52-year-old man complained of pain and cramping in his right calf
caused by walking two blocks. The pain was relieved with cessation of
activity. The pain had been increasing in frequency and intensity.
Physical examination findings were essentially normal except for
decreased hair on the right leg. The patient’s popliteal, dorsalis
pedis, and posterior tibial pulses were markedly decreased compared with
those of his left leg. 

Studies Results Routine laboratory work Within normal limits (WNL) 

Doppler ultrasound systolic pressures Femoral: 130 mm Hg; popliteal:
90 mm Hg; posterior tibial: 88 mm Hg; dorsalis pedis: 88 mm Hg (normal:
same as brachial systolic blood pressure) 

Arterial plethysmography Decreased amplitude of distal femoral, popliteal, dorsalis pedis, and posterior tibial pulse waves 

Femoral arteriography of right leg Obstruction of the femoral artery at the midthigh level 

Arterial duplex scan Apparent arterial obstruction in the superficial femoral artery 

Diagnostic Analysis 

With the clinical picture of classic intermittent claudication, the
noninvasive Doppler and plethysmographic arterial vascular study merely
documented the presence and location of the arterial occlusion in the
proximal femoral artery. Most vascular surgeons prefer arteriography to
document the location of the vascular occlusion. The patient underwent a
bypass from the proximal femoral artery to the popliteal artery. After
surgery he was asymptomatic. 

Critical Thinking Questions 

1. What was the cause of this patient’s pain and cramping? 

2. Why was there decreased hair on the patient’s right leg? 

3. What would be the strategic physical assessments after surgery to determine the adequacy of the patient’s circulation? 

4. What would be the treatment of intermittent Claudication for non-occlusion? 
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