1. What are the components of physical examination? Describe each component.
The components of the average physical examination include vital signs check, health history updates, physical examinations and laboratory tests. In certain cases additional tests such as MRI (Magnetic Resonance Imaging) and CT (Computerized Tomography) scans are also performed. Doctors use physical tests to check how well the body is performing. Vital sign checks include heart rate, temperature, blood pressure readings and respiratory rate measurements. Updated health history includes a review of current medication, supplements, pre-diagnosed conditions and any new developments including job and relationship status. Physical examinations includes checking the abdominal area, heart, lungs, head and neck areas, limbs and other parts of the body as required (Ref: http://www.healthline.com/health).
In general, a physical examination gives the doctor an idea of the patient’s overall health. Laboratory tests require a blood draw and the sample is then tested in the laboratory as required. Hemoglobin, potassium, cholesterol levels in the blood can be tested as required as well as platelet counts and other components usually present in the blood. Specialized test such as MRI tests are non-invasive tests performed to obtain high resolution 3-D images of tissues and organs that help diagnose a variety of problems (Ref: http://www.mayoclinic.org/tests-procedures/mri/basics/why-its-done/prc-20012903).
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.
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.
Based on the data provided, blood samples were taken from Mr. Smith in order to measure hemoglobin levels, potassium (K+) levels, and platelet counts. Mr. Smith’s potassium (K+) level of 2.6 mmol/L is low compared to the normal range 3.8-4.9 mmol/L. Low levels of potassium (K+) indicate hypokalemia which can be caused by many factors including chronic kidney disease, vomiting, excessive sweating, diabetic ketoacidosis and primary aldosteronism (Ref: http://www.mayoclinic.org/symptoms/low-potassium/basics/definition/sym-20050632). Mr. Smith’s hemoglobin (Hb) level 7.5 g/dL was also very low compared to the normal range for males 13.8 to 18.2 g/dL indicating that he has anemia. Hematocrit test (HCT) was also performed with Mr. Smith’s blood sample and it is usually performed as part of a complete blood count. Hematocrit tests measure the percentage of red blood cells in the volume of whole blood (Ref: http://www.nlm.nih.gov/medlineplus/ency/article/003646.htm). Mr. Smith’s Hematocrit value of 20.4% was much below the normal range of 45-52%. This indicates that the percentage of Mr. Smith’s red blood cells are low compared to the volume of whole blood. Mr. Smith’s platelet count of 49 x 109/L was below the normal range for platelet counts of 150-400 x 109/L. Thrombocytopenia is the medical term for a low blood platelet count and it usually improves when the underlying medical condition is treated (Ref: http://www.mayoclinic.org/diseases-conditions/thrombocytopenia/basics/definition/con-20027170).
4. 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.
Blood samples were taken from Mr. Smith during the second hospital visit in order to measure hemoglobin levels, potassium (K+) levels, and platelet counts. Mr. Smith’s potassium (K+) level of 2.6 mmol/L is low compared to the normal range 3.8-4.9 mmol/L. Mr. Smith’s hemoglobin (Hb) level 7.3 g/dL was also very low compared to the normal range for males 13.8 to 18.2 g/dL Hematocrit value of 20.4% was much below the normal range of 45-52%. Mr. Smith’s platelet count of 20 x 109/L was considerably below the normal range for platelet counts of 150-400 x 109/L. His HCO3 level of 38 mmol/l was much higher than normal 22-26 mmol/L.
Blood Glucose and Serum Aldersterone levels were also checked during the second hospital admission. Mr. Smith’s Blood Glucose reading of 460 mg/dl was much above the normal Blood Glucose range of 64.8-104.4 mg/dL. His Serum Aldosterone level was 1 ng/dl. Renin levels in the blood were 2.1 ng/ml/hr- this is in the normal range 0.65 to 5.0 ng/ml/hr.
Urinary samples were also obtained from Mr.Smith to test for Urinary Potassium and Urinary Aldersterone. Urinary Potassium (K+) value of 70 mmol/L/24 hr was in the normal range of 25-120 mmol/L/24 hr. A 24 hour urinary sample of all urine voided during a 24 hour period is required in order to measure the levels of Urinary Aldersterone. 24 hour Urinary Aldosterone was 8.4 mcg/24 hr which is in the normal range for Urinary Aldersterone of 2.3-21.0 mcg/24 hr. Aldosterone levels are used to check changes in Aldersterone associated with various disorders (Ref: http://labtestsonline.org/understanding/analytes/aldosterone/tab/test).
ACTH (Adrenocorticotropic hormone) and Cortisol levels test were performed on Mr. Smith’s blood sample. His ACTH level was 1082 pg/ml which is much above normal values 9-46 pg/ml. ACTH levels in the blood are used to help detect, diagnose, and monitor conditions such as Cushing syndrome, Addison disease and secondary adrenal insufficiency associated with excessive or deficient cortisol in the body. Cushing syndrome is associated with excess cortisol and may be caused due to an adrenal tumor. Mr. Smith’s cortisol level of 155.5 microg/dL was much above normal value 0-25 microg/dL. These high levels of circulating cortisol may be the cause of muscle weakness, hypokalemia and hypertension. (Ref: http://labtestsonline.org/understanding/analytes/acth/tab/test/).
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. CONCLUSION and DIAGNOSIS terms define what one means. Discuss, 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.
Overall, the results from laboratory findings, MRI and CT confirmed metastatic prostate adenocarcinoma. Metastatic prostate adenocarcinoma is an advanced form of cancer in which the cancer has spread from the prostate to other parts of the body such as bone, lungs or liver. Since Mr. Smith was diagnosed with prostate cancer five years ago, medical providers were aware that Mr. Smith’s cancer could have spread and be responsible for his many symptoms. The MRI result showed spread of the cancer to the osseous tissues. This result confirmed that Mr. Smith’s cancer had spread and become advanced compared to his diagnosis five years ago. The shortness of breath experienced by Mr. Smith could also indicate spread of the cancer to the lungs. The laboratory results on blood and urinary samples showed hypokaleima, anemia, thrombocytopenia and extremely high circulating cortisol levels. All these scientific methods used helped reach the diagnosis. Despite this serious diagnosis of advanced prostate cancer it is still possible for some patients to live a normal life for some years while managing associated symptoms of cancer.
(Ref: http://www.webmd.com/prostate-cancer/metastatic-prostate-13/metastatic-prostate-cancer)
REFERENCES:
Website http://www.healthline.com/health/getting-physical-examination#Uses2
Website http://www.mayoclinic.org/tests-procedures/mri/basics/why-its-done/prc-20012903
Website http://www.webmd.com/hypertension-high-blood-pressure/guide/diastolic-and-systolic-blood-pressure-know-your-numbers
Website http://www.mayoclinic.org/symptoms/low-potassium/basics/definition/sym-20050632
Website http://www.nlm.nih.gov/medlineplus/ency/article/003646.htm
Website http://www.mayoclinic.org/diseases-conditions/thrombocytopenia/basics/definition/con-20027170
Website http://labtestsonline.org/understanding/analytes/aldosterone/tab/test/
Website http://labtestsonline.org/understanding/analytes/acth/tab/test/
Website http://www.diffen.com/difference/CT_Scan_vs_MRI
Website http://www.webmd.com/prostate-cancer/metastatic-prostate-13/metastatic-prostate-cancer
