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 49x109/L 150-400x109/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 20x109/L 150-400x109/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.

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.

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.

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. Select one of the medical terms from the CONCLUSION and DIAGNOSIS section above and define what it means. Also, discuss, in your own words and based on what you can gather about 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.

You should write a short paper addressing all six questions and submit it into the assignment folder. Your grade will depend upon the content, clarity and originality of responses written in your own words. Good writing practices, including the use of correct grammar, sentence and paragraph structure, and punctuation, and presence of logical reasoning, will account for a portion of your grade.

Cite all sources in APA format within your answer text as well as full citations in APA format at the end of the assignment.

Criteria

Level 1

Level 2

Level 3

Level 4

Question 1. Note: the maximum number of points to be earned for this question is 15. Students may earn between 0 to 15 points for this question. Assigned points may vary.
15 points accurately identifies and describes the components of the physical examination 10 points one component of physical examination is missing, description lacks detail and understanding of the components of physical examination 5 points
2 or 3 components of examination are missing; mistakes in the description and significant lack of understanding of the components of physical examination 0 points factually incorrect or missing response

Question 2. Note: the maximum number of points to be earned for this question is 15. Students may earn between 0 to 15 points for this question. Assigned points may vary.
15 points provides clear answers that demonstrate an understanding of the blood pressure measurement, blood pressure values, and risks associated with abnormal blood pressure values 10 points answer to one of the subquestions is missing, answer contains minor mistakes, but is overall factually accurate 5 points
2 or 3 subquestions not answered; explanation and/or conclusion contain more factually incorrect information 0 points factually incorrect or missing response

Question 3. Note: the maximum number of points to be earned for this question is 10. Students may earn between 0 to 10 points for this question. Assigned points may vary.
10 points accurately identifies the tests performed and provides a clear explanation of why at least one of the tests was ordered; and explains what the results of the test indicates 7 points one sample is not mentioned, discussion to a selected test lack detail and does not show full and accurate understanding 4 points
2 or 3 samples are missing from the answer; analysis of the results shows mistakes 0 points factually incorrect or missing response

Question 4. Note: the maximum number of points to be earned for this question is 15. Students may earn between 0 to 15 points for this question. Assigned points may vary.
15 points accurately compares patient and normal test values; accurately selects at least one abnormal test value and explains the potential health concern related to the result 10 points one value is not compared 5 points two of the subquestions are not answered, provided answers show greater lack in clarity and understanding of the tests performed; too much reliance of quotations 0 points factually incorrect or missing response

Question 5. Note: the maximum number of points to be earned for this question is 10. Students may earn between 0 to 10 points for this question. Assigned points may vary.
10 points accurately identifies the imaging procedures performed on the patient; compares and contrasts these procedures; and explains the results of the patients imaging procedures 7 points one of the subquestions is not answered, provided answers show minor lack in clarity and understanding of the imaging procedures performed 4 points provided answers show greater lack in clarity and understanding of the imaging procedures performed; too much reliance of quotations 0 points factually incorrect or missing response

Question 6. Note: the maximum number of points to be earned for this question is 15. Students may earn between 0 to 15 points for this question. Assigned points may vary.
15 points
Accurately defines medical terms and their meaning as well as discusses Mr. Smith’s condition, how the laboratory or imaging tests helped with drawing a conclusion or making the diagnosis.Accurately discusses how medical providers use the scientific method to come to work through the examination and diagnosis of a patient. 10 points one of the subquestions is not answered, provided answers show minor lack in clarity and understanding of the imaging procedures performed 5 points two of the subquestions are not answered, provided answers show greater lack in clarity and understanding of the patient condition, role of laboratory test, imaging procedures in making the diagnosis; too much reliance of quotations 0 points factually incorrect or missing response

Proper use of citations. Note: the maximum number of points to be earned for this question is 10. Students may earn between 0 to 10 points for this question. Assigned points may vary.
10 points properly cites all resources using APA format 7 points one citations is missing, minor mistakes in listed references (APA style) 4 points
Three or more mistakes in quotations, references 0 points no appropriate use of citations and APA style

Clarity., proper grammar, punctuation, spelling. Note: the maximum number of points to be earned for this question is 10. Students may earn between 0 to 10 points for this question. Assigned points may vary.
10 points no errors of grammar, punctuation, and/or spelling; all responses written in student’s own words 7 points two mistakes 4 points
More than three mistakes. 0 points total lack of clarity, more than 10 grammar, punctuation or spelling mistakes

Overall Score

Level 1
90 or more

Level 2
80 or more

Level 3
70 or more

Level 4
10 or more

Level 1
0 or more