Patient Scenario

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.

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:

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.

After listening to the patient’s description of the history of the symptoms, physicians generally conduct a physical examination, which includes:

·         Observing the physical signs of a disease and evaluating, for example, posture, facial expression, mobility, alertness, responsiveness to stimuli, changes in skin color.

·         Taking the patient’s vital signs, including blood pressure, heart rate, and breathing rate, along with temperature and comparing them to the reference ranges.

·         Using a stethoscope in a procedure called auscultation to listen to the lungs, heart, and bowel movement. A healthy heartbeat sounds different than a heartbeat of a heart with valve damage.

·         Tapping on the chest and abdomen in a procedure called percussion produces a specific sound under normal conditions. If there is fluid or excess air in the lungs, this sound will change. By tapping along orientation lines, a physician can determine the size of the lungs and the size of the area affected by a disease. (This procedure may not be used very often.)

·         Using the fingers and applying pressure in a procedure called palpation to feel the body regions and the organs within them. Palpation provides information about the size of an organ and changes in its consistency, shape, and tenderness, and can help determine the presence of a foreign mass.

The results of the physical examination allow the physician to limit the number of possible causes of the patient’s disorderReply to at least one other student with a 100-150 word response.,English,,

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