Analyze how internal and external factors cause disruption of healthy body function, leading to disease and disorders.

Analyze how internal and external factors cause disruption of healthy body function, leading to disease and disorders.

Patient Scenario
Instructions
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.

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
K+ 2.6 mmol/L 3.8-4.9mmol/L
Hb (Hemoglobin) 7.5 g/dL 13.8 to 18.2 g/dL
Hct (Hematocrit) 20.4% 45-52%
Platelet Count 49×109/L 150-400×109/L

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
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
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, Commentary, Topic 8. Disease Categories, Part B. Steps in Diagnosis)

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.

Explanation & Answer

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