1. There are four essential components of a physical exam: inspection, palpation, percussion, and auscultation. These parts of the physical exam should take place regardless of what organ system are being evaluated. Inspection involves looking at the patient and diagnosing any non-normal physical findings. A good example of this is bruising seen on the abdomen during an abdominal exam. The next part of the examination is palpation. Here the physician will feel for any abnormal findings, such as masses or abscesses. Following palpation is percussion. During this step, the physician uses their hands to produce a sound and can analyze a hollow body cavity. Percussion can find organs or detect fluid in a cavity. Finally, during auscultation, a physician will use a stethoscope to listen to the organ system (if applicable) to identify any abnormal sounds.
2. Blood pressure is measured with a sphygmomanometer. The physician will wrap the cuff around the arm and increase the pressure to occlude the artery and stop the downstream pulse. This number is the systolic pressure and is the pressure to counteract the force that the blood places on the artery. Once the artery is occluded, the cuff is released, and the physician will listen to the pulse until its turbulent flow ceases. This number is the diastolic pressure and is the minimum pressure that the artery sustains. The higher the reading, the more pressure the vessels are under and increases the risk of a vascular dissection. Mr. Smith’s blood pressure is elevated. The Joint National Committee (JNC 7) issues a report on hypertension and states that anything above a 120 systolic or 90 diastolic is considered hypertensive (Chobanian et al., 2003).
3. Based on the initial patient history, the physician ordered a blood test and blood chemistry to see if there were any abnormalities with the red blood cells in the body or the electrolytes that could cause the patient’s symptoms. On the second visit, the physician repeated the blood tests and orders blood and urine samples to determine the hormones levels in the body. She ordered these tests because they are easy to perform and address the majority of conditions that could have caused Mr. Smith’s complaints
4. In the second set of blood tests, the patient was deficient in potassium, hemoglobin, had a low hematocrit, thrombocytopenia, excess bicarbonate, and hyperglycemic. His urine was significant for elevated ACTH and cortisol.
5. Mr. Smith underwent a CT scan and an MRI scan. Both imaging modalities are useful for viewing the internal structures of the body. CT scans are significant for identifying bone and lung structures. MRIs are optimized for viewing soft tissue structures. Another difference between CT and MRI is the CT uses radiation, whereas MRI does not. Also, a CT is quicker to perform than an MRI. The results of the images are Mr. Smith has a tumor of his prostate gland which grew and metastasized to the bone. There is also nodular enlargement of the adrenal glands which have grown large enough to compress on the bowel, causing an obstruction.
6. Prostate cancer is the second most common cancer in men worldwide (Siegel, Miller, & Jemal, 2016). Often it is diagnosed by a biopsy after a suspicious digital prostate exam. An adenocarcinoma is a common form of prostate cancer. Symptoms usually involve urinary problems, which include decreased urinary stream, incomplete voiding, and feelings of bladder fullness. Treatment could be radiation or chemotherapy. Regarding laboratory tests, prostate specific antigen (PSA) is the most common marker of a potential prostate cancer. Elevated PSA can lead to a prostate biopsy to confirm cancer. Prostate cancer can metastasize to the bone, lung, and brain. Aside from biopsy, and PSA measurement, an MRI could be used to identify an irregular mass in the prostate that would warrant further diagnostic tests.
References
Chobanian, A.V., et al. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA, 289(19), 2560-2612.
Siegel R.L., Miller K.D., Jemal A. (2016). Cancer Statistics, 2016. CA: A Cancer Journal for Clinicians. 66(1), 7-30.
