1. There are several components to the physical examination. Initially, the patients will have their vitals accesses (heart rate, temperature, blood pressure, respiratory rate, and oxygen saturation) This will give the physician an overall picture of the status of the patient. Next, the doctor will consider the general appearance of the patient, noting any abnormalities. After the general appearance, the physician will assess each organ system (cardiovascular, pulmonary, GI, integument, etc.) individually. To evaluate each system, the physician will first inspect the system for any abnormalities. After the inspection is auscultation where, if applicable, the physician will use a stethoscope to listen to the system for any deviations from normal (lungs, heart, bowel). This aspect is followed by palpation, where the physical feels each organ system and then percussion, where the physician produces audible noise to determine if a cavity is hollow.
2. Medical professionals take blood pressure with a sphygmomanometer. To take blood pressure, the specialist would wrap the pressure cuff around the patient’s arm. Then they would listen to the brachial artery with a stethoscope while inflating the cuff, listening to the flow through the vessel. Once the flow is occluded, the specialist records the pressure. This is the systolic pressure. At this point, the technician deflates the cuff and listens to the turbulence as flow resumes through the vessel. When the flow returns to normal, the there is not turbulence heard then the technician records the pressure. This is the diastolic pressure. These two numbers consist of the blood pressure. Physicians do not want their patients to have high blood pressure because it can lead to a stroke. The American Heart Association (AHA) provides recommendations on blood pressure. According to the AHA (American Heart Association, 2016), this patient has elevated blood pressure and is a stage II hypertensive.
3. Mr. Smith had several laboratory tests performed. He has his blood drawn, and from that blood, the lab was able to determine his level of red blood cells and platelets. They were also able to determine the amount of potassium, sugar, and level of several hormones in his bloodstream. He also provided a urine sample to determine if there was any aldosterone being secreted in his urine. Mr. Smith had his hemoglobin levels tested by the physician. The reason for this lab test was for the doctor to rule out anemia. Fatigue and weakness are symptoms of anemia, a condition when there is decreased production of red blood cells (Maakaron et al., 2015). By knowing the red blood cell count, the physician would know if anemia is causing these symptoms or another condition.
4. With regards to Mr. Smith’s laboratory results, his hemoglobin, hematocrit, and platelet count are below normal. His potassium is elevated. His bicarbonate is elevated. His urinary potassium is normal. His blood sugars are high. His urinary aldosterone and renin are normal. He elevated ACTH and cortisol.
5. Mr. Smith received an MRI and a CT. Both imaging studies are frequently used. CT scans use radiation to assess the bone injuries, lung fields, and some cancers. MRIs do not use radiation and are primarily used for soft tissue diagnosis. CT scans are quick, while an MRI can take up to thirty minutes and is more expensive. The results of the imaging showed a mass in Mr. Smith’s prostate with metastasis the adrenals and the bone.
6. Based on the imaging and the laboratory values, Mr. Smith has metastatic prostate carcinoma. Prostate cancer is the second most common cancer in men worldwide (Siegel et al. 2016). The prostate is an organ in the male reproductive system that produces seminal fluid. It is at risk to develop an abnormal growth of cells. These cancerous cells can grow and break off and travel to other parts of the body via the bloodstream in a process called metastasis. Bones are the most common location for metastasis in prostate cancer (Smith et al., 2011). Treatment can be with chemotherapy to kill the cancerous cells.
Using the scientific method, the physician was able to diagnose Mr. Smith’s condition. By taking a good history, the doctor can start to make a list of possible diagnoses that was causing Mr. Smith’s weakness and headache. The physician then ordered the blood tests that could prove their initial diagnosis, which was anemia. When Mr. Smith was admitted to the hospital, for a headache, hypertension, and shortness of breath, the physicians ordered new tests to identify the cause of the anemia. The CT and MRI showed the masses in the adrenal gland and the bone. The extra blood tests determined that excess ACTH was causing hypertension and the headache. If these diagnoses were proved incorrect by the labs, then the physician would order new tests to prove the next potential diagnosis. This is how the scientific process works in medicine.
References
American Heart Association (2016, March 23). “Understanding Blood Pressure Readings” Retrieved from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure Readings_UCM_301764_Article.jsp#.V4A6ApMrJsN
Maakaron J., et al. (2015, May 15). “Anemia” Medscape. Retrieved from http://emedicine.medscape.com/article/198475-overview
Siegel R. L. et al. (2016). “Cancer Statistics” CA: A Cancer Journal for Clinicians 66, 7-30
Smith M.R. et al. (2011). “Disease and host characteristics as predictors of time to first bone metastasis and death in men with progressive castration-resistant nonmetastatic prostate cancer” Cancer. 117:10, 2077-2085
