Patient Scenario Paper to include:
Addresses Learning Outcomes:
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.
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:
13.8 to 18.2 g/dL
70 mmol/L/24 hr
25-120 mmol/L/24 hr
24 hour Urinary Aldosterone
8.4 mcg/24 hr
2.3-21.0 mcg/24 hr
ACTH (Adrenocorticotropic Hormone)
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, Commentary, Topic 8. Disease Categories, Part B. Steps in Diagnosis)
The first step in determining a correct diagnosis is collecting the history of the symptoms starting from the most recent. Patients should have an opportunity to tell their own story. However, the physician should listen carefully and elicit all relevant information pertaining to the symptoms such as the onset, duration, and possible relief. The physician should ask appropriate questions, not only about the patient’s medical history, but also about family, social, and work history because some disorders tend to run in families or are related to social behaviors or workplace conditions.
After listening to the patient’s description of the history of the symptoms, physicians generally conduct a physical examination, which includes:
The results of the physical examination allow the physician to limit the number of possible causes of the patient’s disorder and order appropriate laboratory and imaging tests.
Laboratory tests, ultrasound, imaging procedures, nuclear scans, and clinical procedures play important roles in differential diagnosis (a process of distinguishing between diseases with similar signs and symptoms)—that is, they allow the doctor to narrow the diagnoses (see Table 1.7).
Examples of Tests and Procedures
Tests and ProceduresExamples
Complete blood count, concentration of electrolytes in blood, amount of cholesterol in plasma, glucose tolerance test, skin tests, urinalysis
Ultrasound, magnetic resonance imaging (MRI), computer tomography (CT), X-rays
Positron emission tomography (PET), thyroid scan, bone scan
Biopsy, electrocardiogram (ECG), electroencephalogram (EEG), Pap smear, endoscopy, colonoscopy
A sore throat is a common complaint and is most commonly caused by the viruses responsible for the common cold. Another frequent cause is a bacterial infection. According to Principles of Internal Medicine, about 15 percent of bacterial infections are caused by group A Streptococcus pyogenes (Braumwald, 2001, p. 191). Ways of determining whether a sore throat is caused by a bacterial infection or by a viral infection are shown in Table 1.8 below.
You may wonder why it is important to differentiate between viral and bacterial infections. First of all, the treatment for bacterial infections differs from the treatment for viral infections. Antibiotics are effective only for bacterial infections. Second, if the sore throat is caused by group A streptococci, an untreated infection may lead to severe complications including abscesses at the site of the infections (tonsils and throat) and rheumatic fever.
Differential Diagnosis between Bacterial and
Viral Infection of the Throat
Etiology: Bacterial (streptococci, Groups A, C, and G)Etiology: Viral (rhinovirus, coronavirus, parainfluenza virus)
Possible exposure in social or work setting
Symptoms: sore throat, painful swallowing, tiredness, fever, and muscle ache
Possible exposure in social or work setting
Symptoms: sore throat, painful swallowing, tiredness, fever, sneezing, difficulty breathing through the nose
Vitals within norm, possible high-grade fever
Vitals within norm, possible low-grade fever
Inspection and signs
Heart, lungs normal
Heart, lungs normal
Lungs, abdomen normal
Lungs, abdomen normal
Enlarged tonsils, lymph nodes
Positive for presence of streptococci
Negative for presence of streptococci
Figure 1.9 displays the most common differences between sore throats caused by viral infections and sore throats caused by bacterial infections.
Differences between Bacterial and Viral Infection
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.
You should write a short paper addressing all six questions and submit it into the assignment folder. Your grade will depend upon the content, clarity and originality of responses written in your own words. Good writing practices, including the use of correct grammar, sentence and paragraph structure, and punctuation, and presence of logical reasoning, will account for a portion of your grade.
Cite all sources in APA format within your answer text as well as full citations in APA format at the end of the assignment.
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