Patient Scenario (Upstream/Downstream) Assignment
Addresses Learning Outcomes:
- Use knowledge of biological principles and the Scientific Method to ask and answer relevant questions about human health and disease
- Analyze information to distinguish between diseased and healthy structure and functioning.
- Analyze how internal and external factors cause disruption of healthy body function, leading to disease and disorders.
THE SCENARIO:
Mr. Smith is 60 years old. He was diagnosed with prostate cancer five years ago. Over the past few days, Mr. Smith has been feeling 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.
His blood pressure is 165/100 mmHg. MRI reveals metastasis of prostate cancer to osseous tissue. Abdominal CT shows obstruction of intestine due to nodular enlargement of adrenal glands.
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.
Laboratory results from Mr. Smith’s second hospital admission and medical tests show following findings:
| Mr. Smith | Reference Values |
| K+ | 2.6 mmol/L | 3.8-4.9mmol/L |
| Hb | 7.3 g/dl | 13.8 to 18.2 g/dL |
| Hct | 20.4% | 45-52% |
| Platelet Count | 20×109/L | 150-400×109/L |
| 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. 1.What are the components of physical examination? Describe each component. (See Module 1, Topic 8, Part B.2)
2. 2.Mr. Smith’s blood pressure was 160/100 mmHg.
a. How does a medical provider take or measure blood pressure?
b. What do the top (numerator) and bottom (denominator) numbers mean in the biological sense?
c. What is the significance the size of these two numbers?
d. 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.
e. Discuss the possible health issues anticipated for a person with a blood pressure of 165/100 mm Hg.
3. 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. 4. Analyze Mr. Smith’s values
a.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.
b. Select one of the values outside of normal range from the table above and discuss possible medical concerns related to the identified change in Mr. Smith’s values.
5. 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 five questions and submit it under “Assignments”. 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.
Your grade for the short paper based on presented scenario will be based on the following components:
- Answered all six questions and all sub-parts of each question and provides correct or logical answers to each question—up to 60 points
- Student provides original, detailed responses, written in student’s own words, showing presence of logical reasoning – up to 24 points
- Student incorporates terms and concepts learned from assigned materials – up to 8 points
- Student correctly cites resources in APA format – up to 4 points
- Form – grammar, spelling, style – up to 4 points
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