Pathology and clinical science case study

CASE STUDY 1 Joshua is a marine biologist who travels frequently to attend conferences. He has presented to his GP complaining of stabbing pain in the epigastrium and discomfort in his chest, which he says has been getting worse over the past three months. This discomfort increases after meals, especially if he eats fatty or spicy food that cause a burning sensation in the epigastric region which is relieved by further eating or a glass of milk, along with bloating and dyspepsia. Because of his frequent travelling, he admits that his eating habits are pretty irregular. His symptoms started about 5 months ago with discomfort in the abdomen and recurrent flatulence and disturbed sleep. This situation progressed gradually, and has exaggerated over the past month. Sometimes Joshua is nauseated, but it is unrelieved by belching. Family History:  Mother suffers from pernicious anaemia Vital signs: Test Result Normal range Blood pressure 125/90 (110-130/70-80) mm of Hg (for this age group) Pulse rate 92 per minute 60-100 per minute Respiratory rate 18 breaths / minute 12-16 breaths per minute Temperature 36.9 ˚C 36.6 – 37.2 ˚C Haematology: Test Result Normal range Haemoglobin 125 gms/L (140-160) gms/L Hematocrit 28 36 – 49 Mean Cell Volume (MCV) 105 fl 76 – 100 Mean Cell Haemoglobin (MCH) 32 pg 27 – 32 pg Fasting blood sugar 4.4 mmol/L 3.6 - 5.3 mmol Platelets 420 (x106 /L) 150-400 (x106 /L) Questions: 1) List all the signs and symptoms from the given case study. Identify which ones are signs and which ones are symptoms? 2) Outline three (3) possible conditions for Joshua, and provide the rationale for the conditions that you have chosen. These conditions will represent your differential diagnosis. 3) Briefly explain the haematology test results for Joshua. 4) Apart from the signs and symptoms presented in this case, name four (4) other clinical findings that may be discovered if a physical examination was conducted on Joshua? 5) Select two (2) further investigative tests that you would you like to order to help you arrive at a definitive diagnosis? Explain how these tests can help the diagnosis? 6) Select one of your differential diagnoses as the most likely reason for Joshua’s complaints. What are the conventional treatments used for this condition? 7) How could this condition be managed apart from the treatments? CASE STUDY 2 (30 MARKS) Word Count: 750 words (including in-text citations) Alf is a 67 years old male who presents to you with haematuria, swollen ankles and puffiness of his face. He diagnosed with high blood pressure three years ago, possibly due to some underlying kidney disease. His BP is currently 180/115. His GP prescribed anti-hypertensives, but Alf admits that he doesn’t take his medications on a regular basis. Alf has a very poor diet. He consumes too much fat in his diet, and not enough fruits and vegetables. He admits that he isn’t much of a cook, and his diet has worsened since his wife passed away, and he now has to cook for himself. He is very busy with volunteering for the Animal Welfare League, and often eats on the run, grabbing the most convenient ‘fast-food’. Alf admits to doing very little regular exercise, preferring to spend time with the animals under his care. Alf’s doctor has warned him that his diet could lead to vascular disease, along with his tardiness in taking his blood pressure medication. Alf was also diagnosed with Type ll diabetes five years ago and takes Metformin 500mgs tds. Blood analysis Test Result Normal range Serum Creatinine 3.8mg/dL 0.6-1.2 mg/dL Serum Urea nitrogen (BUN) test 80 mgs/dL 7-20 mgs/dL Fasting Glucose 7.9 mmols/L 3.5-6.6 mmols/L Urine examination Test Result Normal range Colour Pale Pale amber pH 7.9 4.6 – 8.0 (average – 6.0) Protein 45 mg/dL Negative Glucose + Negative Blood +++ Negative Questions: 1) Identify the signs and symptoms that Alf is presenting with. 2) From the information given in this scenario, propose three conditions that you would put forward as your differential diagnoses for Alf. What is the rationale for your choice? 3) Describe the pathophysiology underlying the mechanism of developing hypertension due to kidney disease. 4) What is the significance of high serum creatinine and urea levels in kidney diseases? 5) What three (3) investigative tests would you propose for Alf to establish a definitive diagnosis, giving your rationale for each? 6) Having investigated Alf’s case, what condition most likely explains Alf’s signs and symptoms? 7) Alf has asked for your advice. He wants to know the following:  What are the complications that may arise from this condition  What are the treatments for his condition?  What steps can he take to help manage his condition?