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Stephanie Glover
Human Health and Disease
Patient Scenario:
1.)A physical examination is performed on each patient by
the doctor to gain a better understanding of the
symptoms and other health related issues associated
with their complaints. To begin the physical
examination, the doctor first listens to the patient’s
ailments. The physician observes for physical signs of
the disease such as changes in skin color, posture,
facial expressions, mobility, and alertness. They also
should ask the patient for family history, their personal
medical history, a time frame of the ailments, and if
they have traveled or come into contact with any also
experiencing these ailments. After the physician has a
general understanding of the patients concerns, they
begin their “hands-on” examination. The physician
begins by checking the patient vitals; i.e. blood
pressure, heart rate, breathing rate, and temperature.
Based on their findings, they can determine if any of
these fall out of the normal range. Using a stethoscope,
the physician begins a procedure know as auscultation.
This simply means they listen for abnormal sounds
within the heartbeat, lungs, and bowels. The physician
may then begin a procedure known as percussion,
however is it not often performed. Percussion has the
same idea of auscultation, however, is performed by
the tapping of their fingers along orientation lines to
determine the size of the lungs, the size of the affected
area, and if there is any abnormal sounds with their
tapping. For example, the sound of healthy lungs will
sound different than if the lungs were to have excessive
air or fluid in them. Finally, the physician will palpate
the patient’s body by using their fingers and applying
pressure over different regions of the body. They are
looking to feel that the organs are about the normal
size and consistency, shape, and without tenderness. At
this point, the physician can also feel for abnormal masses within the body. Based on the results of the
physical examination, the physician is able to form a
hypothesis or potential diagnosis of their patient and
order the appropriate laboratory and imaging tests.
2.)Blood pressure is measured using a
sphygmomanometer. This measuring device uses a cuff
that can be inflated and a tube of mercury to measure
your blood pressure. The cuff is wrapped around the
upper arm of the patient. The physician begins to
inflate the cuff, temporarily preventing normal
circulation to the lower part of the arm. The physician
will listen carefully with a stethoscope at the artery
bend of the arm and will gradually release the pressure
of the cuff. At systolic pressure, the blood will begin to
flow again. As the physician listens carefully to the
thumping of the blood heard through the stethoscope,
as the thumping subsides, this is the diastolic pressure
and the blood is no longer obstructed. The systolic
pressure is the numerator. This number measures the
pressure in the arteries when the heart beats. The
diastolic pressure is the denominator and measures the
pressure in the arteries between heartbeats. Mr.
Smith’s blood pressure was 160/100 mmHg. The
American Heart Association recommends a normal
blood pressure of an individual age 20 and older to be
less than 120/80 mm Hg. Therefore, Mr. Smiths blood
pressure was higher than the normal range.
3.)Mr. Smith’s physician ordered blood work, a urinalysis,
MRI and CT. The physician probably ordered the blood
work to compare to the previous blood results and
because Mr. Smiths blood pressure was significantly
high. The blood work confirmed the potassium
deficiency (hypokalemia), metabolic alkalosis and high
levels of circulating cortisol. The headache Mr. Smith is
complaining about could also be a result of his anemia
confirmed by his low Hb, Hct, and platelet count.
4.) Mr. Smith Reference Values
Conclusion 2.6 mmol/L 3.8-4.9mmol/L Low Hb 7.3 g/dl 13.8 to 18.2 g/dL Low Hct 20.4% 45-52% Low Platelet
Count 20x109/L 150-400x109/L Low HCO3 38 mmol/l 22-26 mmol/L High Urinary K+ 70 mmol/L/24 25-120 mmol/L/24 hr Blood
Glucose 460 mg/dl 64.8-104.4 mg/dL Serum
Aldosterone 1 ng/dl 24 hour
Urinary
Aldosterone 8.4 mcg/24 hr Renin 2.1 ng/ml/hr 0.65-5.0 ng/ml/hr Normal ACTH
(Adrenocortic
otropic
Hormone) 1082 pg/ml 9-46 pg/ml High 0-25 microg/dL High High hr Cortisol 155.5
microg/dL High 2.3-21.0 mcg/24 hr
Normal 5.)Mr. Smith had two imagining procedures, and MRI and a
CT. MRI’s (Magnetic Resonance Imaging) are used for
examining soft tissue such as tendons, ligaments, and
brain tumors. CT’s (Computer Axial Tomography) are
used to scan for bone injuries, lung and chest imaging,
and detecting cancers. MRI’s are a safer diagnostic tool because they do not use radiation, however, the
procedure takes at least 30 minutes. A CT uses
radiation but is a much faster procedure, only taking
about five minutes. The results of the imaging
procedures for Mr. Smith are a confirmed metastatic
prostate adenocarcinoma. The MRI confirmed
metastasis of the prostate cancer to osseous tissue.
The CT confirmed an obstruction of the intestine due to
nodular enlargements of the adrenal glands. Because of
this finding, and the results from the blood work, the
physician is able to also conclude the patient is
suffering from hypertension and refractory hypokalemia
due to ectopic ACTH production, high levels of
circulating cortisol which has caused continuous
activation of mineralocorticoid receptors resulting in
hypokalemia, metabolic alkalosis and hypertension.
Essentially, the prostate cancer Mr. Smith was
diagnosed with 5 years ago has begun to spread
throughout his body and into his bones.
6.)Metastatic prostate adenocarcinoma- Adenocarcinoma
is a type of prostate cancer that develops in the
prostate gland cells. Metastasis is the spread of
cancerous cells from organ to organ. Mr. Smith’s
diagnosis of metastatic prostate adenocarcinoma is his
original prostate cancer that he was diagnosed with 5
years prior has begun to spread in his prostate gland as
well as other organs. The MRI and CT were able to
confirm the metastasis. Obstructions were found in his
intestines due to his enlarged adrenal glands. The
cancer was also found his in bone marrow (osseous
tissue.)
Medical providers are able to use the scientific
method to work though examinations and confirmed
diagnosis for patients. Through multiple cases and
similar findings in lab work and imaging, doctors are
able to find patterns of diseases. Doctors are able to
link certain abnormal results to create hypotheses,
which can later be confirmed through imaging. Mr.
Smith’s scenario is an excellent example of doctors using the scientific method. Based on Mr. Smith’s
original symptoms and his doctor knowing his medical
history, lab work and imaging were ordered. Fairly
quickly, the results were able to conclude for the doctor
her original hypothesis was correct and Mr. Smith’s
prostate cancer had begun to spread, causing the
additional symptoms, i.e. fatigue, headaches, and
shortness of breath. Because Mr. Smith already has a
history of prostate cancer and other prostate cancer
scenarios, his doctor was able to recognize the
similarities and order the appropriate testing to confirm
her diagnosis.
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