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
|
20x109/L
|
150-400x109/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.
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.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. 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.
4.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. 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?
You should answer all five questions concisely and complete all parts of each question.
Submit your completed answers as a document (.doc, .rtf, or .txt preferred) into your 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.
2. Physical Examination
After listening to the patient's description of the history of the symptoms, physicians generally conduct a physical examination, which includes:
- Observing the physical signs of a disease and evaluating, for example, posture, facial expression, mobility, alertness, responsiveness to stimuli, changes in skin color.
- Taking the patient's vital signs, including blood pressure, heart rate, and breathing rate, along with temperature and comparing them to the reference ranges.
- Using a stethoscope in a procedure called auscultation to listen to the lungs, heart, and bowel movement. A healthy heartbeat sounds different than a heartbeat of a heart with valve damage.
- Tapping on the chest and abdomen in a procedure called percussion produces a specific sound under normal conditions. If there is fluid or excess air in the lungs, this sound will change. By tapping along orientation lines, a physician can determine the size of the lungs and the size of the area affected by a disease. (This procedure may not be used very often.)
- Using the fingers and applying pressure in a procedure called palpation to feel the body regions and the organs within them. Palpation provides information about the size of an organ and changes in its consistency, shape, and tenderness, and can help determine the presence of a foreign mass.
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.