Patient Scenario Information (copied from syllabus).
Mr. Smith is 60 years old. He was diagnosed with a prostate cancer five years ago. Over the past few days, Mr. Smith has been feeling weak and increasingly tired and has also been suffering from a headache that did not respond to over-the-counter medications. He scheduled an appointment with his physician.
His physician performed a physical examination and recommended a battery of laboratory tests and imaging procedures.
The table below shows Reference values in the right-hand column. These values reflect the normal range of values for patients without disease or illness. The center column reflects the resulting values for medical test results obtained for Mr. Smith.
Take note whether Mr. Smith’s values are within normal limits.
|Mr. Smith||Reference Values|
|Hb (Hemoglobin)||7.5 g/dL||13.8 to 18.2 g/dL|
After receiving Mr. Smith’s test results, his physician admits him to the hospital. Hospital staff treated him and discharged him.
The following week, Mr. Smith returns to his physician with the same complaint of weakness and a new complaint of shortness of breath. His blood pressure is 160/100 mmHg. MRI reveals metastasis of prostate cancer to osseous tissue. Abdominal CT shows obstruction of intestine due to nodular enlargement of adrenal glands.
Laboratory results from Mr. Smith’s second hospital admission and medical tests show following findings:
|Mr. Smith||Reference Values|
|Hb||7.3 g/dl||13.8 to 18.2 g/dL|
|HCO3||38 mmol/l||22-26 mmol/L|
|Urinary K+||70 mmol/L/24 hr||25-120 mmol/L/24 hr|
|Blood Glucose||460 mg/dl||64.8-104.4 mg/dL|
|Serum Aldosterone||1 ng/dl|| <31 ng/dL|
|24 hour Urinary Aldosterone||8.4 mcg/24 hr||2.3-21.0 mcg/24 hr|
|Renin||2.1 ng/ml/hr||0.65-5.0 ng/ml/hr|
|ACTH (Adrenocorticotropic Hormone)||1082 pg/ml||9-46 pg/ml|
|Cortisol||155.5 microg/dL||0-25 microg/dL|
CONCLUSION AND DIAGNOSIS
Laboratory findings, MRI and CT confirmed metastatic prostate adenocarcinoma, hypertension and refractory hypokalemia due to ectopic ACTH production. High levels of circulating cortisol caused continuous activation of mineralocorticoid receptors resulting in hypokalemia, metabolic alkalosis and hypertension.
After reading provided scenario, answer the following questions:
1. What are the components of physical examination? Describe each component. (See Module 1, Topic B, Part B.2 – found after week 8 in the Content tab) Please use the answers from this module only and not from another source- easy points here!
2. Mr. Smith’s blood pressure was 160/100 mmHg. How does a medical provider take or measure blood pressure? What do the top (numerator) and bottom (denominator) numbers mean in the biological sense? What is the significance the size of these two numbers? Is Mr. Smith’s blood pressure within normal range? Explain how you concluded whether Mr. Smith’s blood pressure is/is not within normal range.
3. Based on the data provided, what laboratory tests were performed and what samples were taken from the patient? Select one of the laboratory tests ordered for Mr. Smith and discuss why Mr. Smith’s physician might have ordered the test and the information she might have expected to obtain from that particular test.
4. Compare Mr. Smith’s values with reference values and indicate whether MR. Smith’s values are below, above, or within normal range (compare Mr. Smith’s values with the Reference values) for each laboratory tests in the table above from the second set of tests.
5. What imaging procedures did Mr. Smith undergo? Discuss the distinctions and similarities between the two different imaging approaches. What were the results of imaging procedures in Mr. Smith’s case?
6. Select one of the medical terms from the CONCLUSION and DIAGNOSIS section above and define what it means. Also, discuss, in your own words and based on what you can gather about Mr. Smith’s condition, how the laboratory or imaging tests helped with drawing a conclusion or making the diagnosis. In your own words, discuss how medical providers use the scientific method to come to work through the examination and diagnosis of a patient.
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