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. 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 49x10 9 /L 150-400x10 9 /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 20x10 9 /L  150-400x10 9 /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. After listening to the patient's description of the history of the symptoms, physicians generally conduct a physical examination, which includes: .

1. 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.
Mr. Smith
Reference Values

2. 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
49x10
9
/L
150-400x10
9
/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

3. Hb
7.3 g/dl
13.8 to 18.2 g/dL
Hct
20.4%
45-52%
Platelet Count
20x10
9
/L
150-400x10
9
/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

4. 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.
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

5. 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 disorder and
order appropriate laboratory and imaging tests.
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

6. 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.
(GOOD SOURCES, READ WHOLE ASSIGNMENT)