1 answer

Dale is 55 year old man who has been feeling ill over the last week. He...

Question:

Dale is 55 year old man who has been feeling ill over the last week. He has had episodes of vomiting and sweating. He assumes that he is suffering from the stomach flu that his grandchildren had two weeks ago. After not being able to “kick” the bug, he sees his family physician. The only other symptom he reports is a pulled muscle in his chest while shoveling snow about a week ago. Below are his chemistry results.

NA+

139 mmol/L

AST

70 U/L

K+

3.8 mmol/L

ALT

49 U/L

Cl-

104 mmol/L

CK

502 U/L

CO2

23 mmol/L

LD

365 U/L

Calcium

10.0 mg/dL

ALP

72 U/L

Phosphorus

3.9 mg/dL

Cholesterol

178 mg/dL

Glucose

105 mg/dL

HDL

19 mg/dL

BUN

24mg/dL

Triglycerides

424 mg/dL

Creatinine

0.9 mg/dL

Questions:

  1. What laboratory tests are abnormal? BUN, glucose, AST, CK and triglycerides are increased and HDL is decreased
  2. What other tests would be beneficial in the diagnosis of this patient?
  3. Can we determine if this patient has had an AMI? Why or why not?
  4. What were some factors that would increase Dale’s risk of an AMI?

Part III:

Samuel is a 38-year-old male gardener. He visited his family physician because of skin lesions on his hands that began as mild erythematous changes which developed into painful blisters. The blisters first began erupting during the late spring months. The patient indicated no history of allergic contact dermatitis or other drug or food allergies. The patient consumed about 3-4 12 oz. bottles of beer daily. He showed signs of facial hyperpigmentation with some scarring predominantly in regions of the forehead.

Na+

136 mmol/L

K+

4.5 mmol/L

Cl-

102 mmol/L

HCO3-

26 mmol/L

Glucose

163 mg/dL

BUN

13 mg/dL

AST

115 U/L

ALT

154 U/L

ALP

176 U/L

Questions:

  1. What clinical symptoms suggest porphyria is present in this patient?
  2. What lab data are consistent with a presumptive diagnosis of porphyria?
  3. What is the most likely type of porphyria present in this patient? Why?
  4. What additional lab data would be helpful in confirming the diagnosis?

Answers

The following laboratory tests are abnormal

  • BUN:increased (7 _20mg/dL)
  • AST:increased (10_40 U/dL)
  • CK:increased (22_198 U/L)
  • HDL:Decreased(40_59mg/dL)
  • Triglycerides :increased (<150mg/dL)

The lab test like increased level of ALT ,AST and ALP are presumptive diagnosis of porphyria

The other test which can be used in diagnosis are

  • ECG:to know the cardiac activity mainly its rhythm and heart beat. Any abnormality inbthe conduction due to muscle damage
  • Trop T and Trop I (more specific) can be beneficial to identify the exact diagnosis

The patient AST level and CK levels are increased which usually happens after an insult or injury to the heart muscles.This remains elevated for a specific period of time after infarction.This level indicates the patient might had a acute myocardial infarction

The decreased level of HDL ,increases  Mr.Dale at risk of an AMI

Part III

Porphyria refers to the presence of excess porphrin which is needed to give red colour to the heme.The symptoms like painful blister, hyperpigmentation,skin lesions on hands are typical symptoms associated with skin porphyria

There are two types of porphyria acute porphyria (affects nerves) and cutaneous porphyria (affects skin).Here the patient is having cutaneous porphyria

Checking porphyria levels in the urine and red blood cells can confirm cutaneous porphyria. DNA test can be done to specify the genetic mutation

.

Similar Solved Questions

1 answer
What is the distance to the closest galaxy, aside from our Milky Way?
What is the distance to the closest galaxy, aside from our Milky Way?...
1 answer
Utilization management is a set of methods to: a. Reduce unnecessary care b. Reduce physician-induced demand...
Utilization management is a set of methods to: a. Reduce unnecessary care b. Reduce physician-induced demand c. Reduce hospital length of stay d. A. and B. only e. All of the above...
1 answer
Solve the following system again using the addition method. Multiply the appropriate equation by the appropriate...
Solve the following system again using the addition method. Multiply the appropriate equation by the appropriate factor to eliminate x and solve for y first. x+y=1.3 3x+5y=5.5...
1 answer
Shown in the figure below is an electrical circuit WW Та 1 + 4 R2 OT...
shown in the figure below is an electrical circuit WW Та 1 + 4 R2 OT + Ey WWW 13 R/SR0617- write down the Kirchhoff Junction equation and solve it for 1, in terms of 1, and 13. Write the result here: 12-1₂ Write down the Kirchhoff Loop equation for a loop that starts at the low...
1 answer
Given #K= 1/2 mv^2#, what is #m#?
Given #K= 1/2 mv^2#, what is #m#?...
1 answer
A solid, insulating sphere of radius a has a uniform charge dens ty throughout its volume...
A solid, insulating sphere of radius a has a uniform charge dens ty throughout its volume and a total charge of Q. Concentric with this sphere is an uncharged, conducting hollow sphere whose inner and outer radii are D and c as shown in the fiqure below, Wewish to understand opely the chargas and cl...
1 answer
How many mL of 0.250 M NaOH are needed to completely react with 50.00 mL of...
how many mL of 0.250 M NaOH are needed to completely react with 50.00 mL of 0.400 M HNO3? NaOH + HNO3 => NaNO3 + H2O...
1 answer
HW A 2000-kilogram limousine going east at 22 meters per second strikes a 1 200-kilogram sports...
HW A 2000-kilogram limousine going east at 22 meters per second strikes a 1 200-kilogram sports car going west at 30 meters per second. How fast are the two cars going together after the collision?...
1 answer
1 - 3.(20 points) The three problems that follow are about the following differential equations a....
1 - 3.(20 points) The three problems that follow are about the following differential equations a. (x + 1)y'= y. In x b. y' = y sinx c. y' = x + y 1. Which of the differential equations are separable and which are not? If an equation is separable, separate it, but DO NOT SOLVE...
1 answer
Credits 13 12 6 9 15 9 15 15 13 16 15 10 12 ...
Credits 13 12 6 9 15 9 15 15 13 16 15 10 12 16 15 10 13 15 6 13 7 9 12 13 16 8 4 10 13 15 12 13 3 10 13 16 12 10 14 13 Use the student ...
1 answer
Task 1 (7 points). The probability of successful solving a Math test by the first student...
Task 1 (7 points). The probability of successful solving a Math test by the first student is 0.9, by the second student is 0.6, by the third student is 0.8. What is the probability of solving this test by: a) one student only; b) only the third student; c) all of the students; d) at least one of stu...
1 answer
Please explain why.. Thank you! 1. (6 points) Indicate the direction of the induced current in...
Please explain why.. Thank you! 1. (6 points) Indicate the direction of the induced current in each loop by writing clockwise, counterclockwise or none. d a) The current in the wire is increasing. CCW ) The loop is moving to the right. The arrows indicate the magnetic field. none 1111 В. b) T...
1 answer
Kids are more at risk to develop? A) Neuroblastoma B) Wilms Tumor C) Leukemia D) Astrocytoma...
kids are more at risk to develop? A) Neuroblastoma B) Wilms Tumor C) Leukemia D) Astrocytoma cars fa - this 5. Which injection babies need to get as soon as they are born in order to avoid hemorrhagic disease of newborn? A) Penicillin B) Hepatitis B C) Vitamin K D) Heparin th to a wing for his 5 hea...
1 answer
Predict the structure of A Refluxing Xylene OMOM How would you make B from a Diels...
Predict the structure of A Refluxing Xylene OMOM How would you make B from a Diels Alder Reaction? Show the relative stereochemistry of the diene and dienophile and show the other product (the exo product) Me029 Me...
1 answer
The grades on a statistics midterm exam were normally distributed with a mean of 72 and a standard deviation of 8
2. The grades on a statistics midterm exam were normally distributed with a mean of 72 and a standard deviation of 8. a. What is the proportion of students received a B grade. b. What is the proportion of students that failed the exam? c. What is the grade of the 92nd percentile?...
1 answer
Different ages of mrs. wilson's children
Mrs. Wilson had three children: Edgar, James, and John. Their combined ages were half of hers. 5 years later, during which time Ethel was born, Mrs. Wilson'sequalled the total of all her children's ages. 10 years more have now passed, Daisy appearing during that interval. At the latter event...
1 answer
There is not information missing. I provided the entire question. At the end of the second...
There is not information missing. I provided the entire question. At the end of the second quarter of 20X1, Malta Corporation assembled the following information The first quarter resulted in a $106,000 loss before taxes During the second quarter, sales were $1,216,000; purchases were $666,000; a...
1 answer
List the electrochemical series you developed from this lab based on the experimental values you obtained....
List the electrochemical series you developed from this lab based on the experimental values you obtained. Compare this to a published electrochemical series list, like the one in your eScience lab manual. Is yours different? If so, in what way is it different? Metal | Al (Trial 1) 2.5 g Al (Trial...