Assessment
Clinical Case
Studies
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Level
2 |
Level
3 |
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Cells Tissues Organs
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LO3,4,5 |
Level
3 |
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Diseases, Genes,Inheritance Outcomes 4
(all) |
Level
3 |
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Look at
each of these clinical case studies and answer the
questions
Case Study
1.
Jack.
Diagnosing
- Jack - a scaffolding contractor - visited
his GP worried about his high rate of urination per day (up to 20 litres) and his constant raging thirst.
- His GP suspected Jack was deficient in a
peptide pituitary hormone responsible for regulating water retention by
the kidneys.
- The question was,
why had Jack suddenly developed this condition?
- The GP noticed a work related injury some
months ago recorded in Jack's medical notes. While supervising a contract Jack
had been struck on the skull by a heavy scaffold clip falling from the upper
floor of one of his contracts. Although wearing a safety helmet he had
suffered a fracture of the base of the skull and was still off work.
- The GP then made the connection between the
hormone and the injury and diagnosed a condition called Diabetes insipidus.(DI)
- This was confirmed by a hospital consultant
following tests.
Jack's
Treatment.
- Patients with this form of DI are
prescribed a medicine called desmopressin which is
similar to the peptide hormone they are deficient in. Modern forms may be
available as tablets, nasal spray or injection.
- The chemical structure of the hormone (and
desmopressin) means that only small amounts of the
tablet form of the hormone actually get into the bloodstream via the gut.
- This was the case with Jack, so he now
self-administers the drug using a nasal spray-quick, easy and for him,
effective.
Clinical
questions:
- Name the peptide hormone Jack's GP
suspected he was deficient in.
- Name the precise part of the kidney nephron where this hormone acts.
- What process takes place in this part of
the nephron?
- How does the hormone act on this structure?
- Why should Jack's accident at work have
resulted in the hormone deficiency?
- Explain why "the chemical structure of the
hormone" limits its usefulness for some individuals.
- Why might a nasal spray be
"quick"?
Case Study
2.
Serena.(aged 12)
Diagnosis
- Serena and her mum visited their GP in
considerable distress. Serena had been passing rusty coloured urine which was occasionally strangely 'frothy'.
Mother suspected that the colour was due to blood in
the urine.
- The GP wanted to know what else was
happening, so she used a test strip to test a sample of Serena's urine. This
revealed the presence of protein as suspected by the GP..
- She also thought Serena looked a little
puffy around the face and took her BP. This revealed that Serena's blood
pressure was on the high side.
- The GP also noticed that one of her
partners had recently prescribed a course of antibiotics for a sore throat.
This was very likely due to a streptococcal infection.
- The combined efforts of the antibiotics and
Serena's immune system seemed to conquer the throat infection.
- The GP suspected some form of glomerulonephritis. This is a disease of the
kidneys.
- A hospital visit was arranged and tests
confirmed the Doctor's diagnosis. Blood tests suggested an autoimmune response
had damaged part of the kidney nephrons.
Treatment
- Many cases of glomerulonephritis don't require any treatment, but
patients must be carefully nursed and their blood pressure monitored,
especially if the output of urine is very scanty. This is a danger sign.
- Immunosuppressive drugs and steroids may be
necessary in more serious cases.
- Fortunately, Serena's condition cleared up
after a few months.
Clinical
questions:
- Why had the GP suspected that protein might
be present in the urine?
- What dos the presence of erythrocytes and
protein in urine indicate is happening?
- Which part of the kidney nephron is affected here?
- What process normally takes place in this
region of the nephron?
- What is an autoimmune response?
- What then might have triggered Serena's
glomerulonephritis?
- Why is scanty urine 'a danger sign' in
terms of blood pressure?
- Explain the drug treatment for 'more
serious cases'.
Case Study
3.
Tom
Diagnosis
- Tom had felt weak and under the weather for
some days, and had started passing foul smelling, pitch black stools one
Sunday. Frightened he visited casualty late at night in considerable
discomfort.
- The hospital doctor suspected a GI(gastro-intestinal) bleed, carried out an examination and
admitted him for tests.
- Apart from the usual blood tests, Tom also
underwent endoscopy.
- The tests confirmed that Tom had an ulcer
in his duodenum
- The doctor explained that this was often
linked to infection by Helicobacter pylori(H.pylori), a bacterium that can thrive in the conditions
found in the stomach. This was also the culprit in Tom's
case
Treatment
- The hospital doctor put Tom on a
combination of drugs.
- He explained to Tom what each was for. The
drugs included the following:
- an antacid,
- cimetidine to reduce acid secretion,
- a drug called omeprazole to also suppress acid production and another
drug to aid healing,
- an antibiotic
Tom made a good recovery,
but was advised to stop smoking, and to avoid taking aspirin in the future.
Clinical
questions
- Why had Tom felt weak and under the
weather?
- Why had his GI bleed resulted in stools of
the type mentioned rather than bright red ones?
- What was the purpose of the endoscopy?
- Where is the duodenum located?
- What are the 'conditions in the
stomach' ?
- Acid is not freely produced in the
duodenum. Why then was Tom taking antacids and acid suppressants?
- Give two reasons for the antibiotic
treatment
- Tom was at first reluctant to take
antibiotics because he had read they could lead to vitamin deficiency. How
could this occur?
- Why the advice to avoid
aspirin?
Case Study
5.
Dexter.
Diagnosing
- Dexter – a farm manager had to go into
hospital for a hernia repair.
- The following day the ward doctor mentioned
that the routine blood test had shown high levels of sugar in Dexter’s blood
and that Dexter was diabetic.
- “So will I have to inject myself with
insulin?” asked Dexter.
- The doctor said this wouldn’t be necessary,
but that Dexter was overweight and needed to control his food intake in order
to manage his diabetes.
Clinical
questions
1.
Where did the sugar in Dexter’s
blood come from?
2.
The substance is in fact a
specific form of simple sugar. What is its name?
3.
Why did Dexter mention
insulin?
4.
Where is insulin made?
(Specific location needed)
5.
Why is insulin usually injected
rather than taken orally?
6.
The doctor said insulin was
unnecessary; why?
7.
Where is the liver
located?
Case Study - Dirk (50)
For a few months Dirk had been experiencing increasing pain around his lower left mid-region. He had found he had to visit the toilet more frequently, and often felt sick. He was spurred to go to his GP when he noticed evidence of blood in his stools over a period of several days. He feared colorectal cancer.
Diagnosis
Dirk’s GP carried out a careful external examination and notice Dirk exhibited guarding when the lower left quadrant was palpated. The GP suspected a large intestine problem and immediately arranged an appointment with a specialist.
The consultant wanted to avoid giving Dirk a barium meal and was able to quickly establish that Dirk had diverticulitis. The doctor explained that up to 50% of people develop diverticula’s - pouches in the large intestine wall where the muscle has become flabby and weakened. Food becomes trapped in these sacs, and may set up infection. The surgeon said this was very much a disease related to western diets low in fibre.
Treatment
Dirk did not need surgery but spent a few days in hospital “resting the bowel”. This entailed avoiding eating. He was also given antibiotics. The consultant explained that the location of the diverticulitis made bacterial infection leading to perforation and peritonitis a real and potentially fatal danger. Dirk was surprised that he did not need antacids to prevent acid damage.
Dirk recovered well and changed to a higher fibre diet. He also started walking more and as an added plus found that these two simple steps also reduced his blood pressure and resting heart rate.
Questions- for practice purposes-
Where would colorectal cancer be found?
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Why did Dirk not need antacids?
-
Dirk was given antibiotics to kill bacteria. Explain the nutritional implications of antibiotics in terms of vitamins...