P5.1.1A.EvidenceReport1F



4267200-11430000Project 5.1.1A Evidence Report #1General Lab TestsLab: Auto DifferentialTest Abbrev:Test Full Name:Purpose of Test:Normal Range:Result:Patient 1Result:Patient 2Result:Patient 3Result:Patient 4Result:Patient 5Neutro %Percentage of NeutrophilsPercent of neutrophils in the blood.40% - 60%55%54%53%60%%65Lymph %Percentage of Lymphocytes (T cells and B cells)Percent of lymphocytes in the blood.20% - 40%40%38%31%21%30%Mono %Percentage of MonocytesPercent of Monocytes in the blood.2% - 8%3%3%7%5%3%Eosinophil %Percentage of EosinophilsPercent of Eosinophils in the blood.1% - 4%1.5%4.6%2%2%1.5%Baso %Percentage of BasophilsPercent of basophils in the blood.0.5% - 1%0.5%0.4%1.0%0.6%0.5%Lab: Complete Blood CountTest Abbrev:Test Full Name:Purpose of Test:Normal Range:Result:Patient 1Result:Patient 2Result:Patient 3Result:Patient 4Result:Patient 5WBC White Blood Cell CountMeasures the number of WBCs. Elevated levels might indicate an infection or allergic reaction.4,500 – 10,000 cells/mcL5,5689,8527,4564,98168,000RBC Red Blood Cell CountMeasures the number of RBCs to help diagnose anemia and other conditions affecting RBCs.Males: 4.7 – 6.1 million cells/mcLFemales: 4.2 – 5.4 million cells/mcL4.95.25.66.04.3Hgb HemoglobinMeasures the amount of hemoglobin in the blood.Males: 13.8 – 17.2 gm/dLFemales: 12.1 – 15.1 gm/dL15.212.416.814.314.6Hct HematocritMeasures the percentage of RBCs found in whole blood.Males: 40.7% - 50.3%Females: 36.1% - 44.3%42.7%36.2%47.5%53.4%44.0%PlateletPlatelet CountMeasures how many platelets are in the blood.150,000 - 400,000 platelets/mcL265,874299,475377,661384,112361,333Lab: Comprehensive Metabolic PanelTest Abbrev:Test Full Name:Purpose of Test:Normal Range:Result:Patient 1Result:Patient 2Result:Patient 3Result:Patient 4Result:Patient 5Glucose LevelGlucose LevelMeasures the amount of glucose in the blood.< 100 mg/dL67887010872BUNBlood Urea NitrogenMeasures the amount of urea nitrogen in the blood.7 - 20 mg/dL2132191824Creatinine, SerumCreatinine, SerumMeasures the amount of creatinine in the liquid part of the blood.0.8 to 1.4 mg/dL2.02.51.41.31.8GFRGlomerular Filtration RateEstimates how much blood passes through the tiny filters in the kidneys, called glomeruli, each minute.90 - 120 mL/min959710090110CalciumCalciumMeasures the total amount of calcium in the blood.8.5 to 10.2 mg/dL8.98.210.09.08.1Protein LevelTotal Protein LevelRough measure of all the proteins found in the fluid portion of your blood. Specifically looks at the total amount of two classes of proteins: albumin and globulin.6.0 to 8.3 gm/dl8.96.29.37.56.8Albumin LevelAlbumin Level Measures the amount of albumin (a protein made by the liver) in the clear liquid portion of the blood.3.4 - 5.4 g/dL5.33.84.75.94.0TBilTotal BilirubinMeasures bilirubin (a fluid produced by the liver) in the blood.0.3 to 1.9 mg/dL0.51.71.70.91.0ASTAspartate AminotransferaseMeasures the amount of AST (an enzyme) in the blood.10 to 34 IU/L1119332521ALTAlanine TransaminaseMeasures the amount of ALT in the blood.7 – 40 IU/L632241836Alk PhosAlkaline PhosphataseMeasures the level of alkaline phosphatase in the blood.44 to 147 IU/L5676874849SodiumSodium (Na+)Measures the concentration of sodium in the blood.135 to 145 mEq/L154138147140140PotassiumPotassium (K+)Measures the amount of potassium in the blood.3.7 to 5.2 mEq/L4.04.33.83.95.0ChlorideChlorideMeasures the amount of chloride in the fluid portion (serum) of the blood.96 - 106 mEq/L100989610598CO2Carbon DioxideMeasures the level of bicarbonate in the blood.20-29 mEq/L2525222721Lab: LipidTest Abbrev:Test Full Name:Purpose of Test:Normal Range:Result:Patient 1Result:Patient 2Result:Patient 3Result:Patient 4Result:Patient 5CholesterolTotal CholesterolMeasures all the cholesterol and triglycerides in the blood.Desirable: Under 200 milligrams per deciliter (mg/dL) Borderline high: 200 to 239 mg/dL High risk: 240 mg/dL and higher240120140190 105TriglyceridesTriglyceridesMeasures the amount of triglycerides in the blood.Normal: <50High: >200215464210855HDLHigh-Density Lipoprotein TestMeasures the level of HDL cholesterol in the blood.Males high risk: < 37 mg/dLFemales high risk: <47 mg/dLLow risk: > 595163753971LDLLow-Density Lipoprotein TestMeasures the level of LDL cholesterol in the blood.Optimal: Less than 100 mg/dL Near Optimal: 100 - 129 mg/dL Borderline High: 130 - 159 mg/dL High: 160 - 189 mg/dL Very High: 190 mg/dL and higher168118127131104Lab: TSH, High SensitivityTest Abbrev:Test Full Name:Purpose of Test:Normal Range:Result:Patient 1Result:Patient 2Result:Patient 3Result:Patient 4Result:Patient 5TSH, High SensitivityThyroid Stimulating HormoneMeasures the amount of TSH in the blood.0.4 - 4.0 mIU/L0.91.60.53.41.4Lab: Additional TestsTest Abbrev:Test Full Name:Purpose of Test:Normal Range:Result:Patient 1Result:Patient 2Result:Patient 3Result:Patient 4Result:Patient 5Acetylcholine Receptor Antibody Acetylcholine Receptor Antibody in BloodDetermine how much, if any, acetylcholine receptor is present in the blood.0.00 - 0.05 nmol/L0.010.000.020.000.00CSF Total Protein LevelsCerebrospinal Fluid Collection done by lumbar puncture; commonly referred to as a spinal tapDetermine the amount of protein in the CSF. CSF is a clear fluid that circulates in the space surrounding the spinal cord. An abnormal protein level in the CSF suggests that there is an abnormal process occurring in the central nervous system.15 to 60 mg/dL6222691845UrinalysisMacroscopic AnalysisColor:Clarity (transparency):Normal urine should be a shade of yellow ranging from a straw to amber color.Abnormal urine can be colorless, dark yellow, orange, pink, red, green, brown, or black.Normal urine should be clear.Abnormal urine can be hazy, cloudy, or turbid.Chemical AnalysisTest:Normal Results:LeukocytesNormal urine does not contain leukocytes.NitriteNormal urine does not contain nitrites.UrobilinogenNormally present in urine in low concentrations. It is formed in the intestine from bilirubin, and a portion of it is absorbed back into the bloodstream.ProteinNormal urine levels of proteins (called albumin) are very small, usually approximately 0 to 8 mg/dl. pH Test measures whether urine is acidic, basic, or neutral. Normal urine ranges from 4.6 to 8.0.BloodNormal urine does not contain blood.Specific GravityTest measures the concentration of particles in the urine and evaluates the body’s water balance. The more concentrated the urine, the higher the urine-specific gravity. The most common increase in urine-specific gravity is the result of dehydration. Normal urine ranges between 1.002 to 1.028KetonesNormal urine does not contain ketones, the endpoint of rapid or excessive fat breakdown, in the urine.BilirubinNormal urine does not contain bilirubin, a fluid produced by the liver.GlucoseNormal urine does not contain glucose. Microscopic ExaminationAll patient samples were normal except for Patient 5. Patient 5’s urine contains a few epithelial cells, a few calcium oxalate crystals, a few red blood cells, and some white blood cells.Normal:Abnormal:Presence of epithelial cells, as they are the cells that line the urinary tract.Presence of a few crystals, including calcium oxalate, triple phosphate crystals, and amorphous phosphates. Presence of red blood cells.Presence of white blood cells and bacteria, signs of infections.Presence of a large number of crystals, or certain types of crystals, may mean kidney stones are present or there is a problem with how the body is using food.Clinical Exam ResultsPatient Vital Signs* Values displayed are the average value over a 24-hour periodPatient 1Patient 2Patient 3Date8/68/78/8Date8/38/58/7Date8/48/68/8BP140/88146/90150/90BP120/84118/80118/78BP110/60110/60112/60Pulse110108102Pulse85100110Pulse80105118Resp161818Resp202125Resp242830Temp10099100Temp98.699.399Temp99.899.299.2Patient 4Patient 5Date8/68/78/8Date8/58/68/8BP122/68129/70120/65BP118/70118/70118/70Pulse757680Pulse606060Resp202022Resp192020Temp100.199.698.9Temp10210199Chart NotesPatient 1Patient now complains of nausea and is experiencing intermittent vomiting. Patient is extremely fatigued and dizzy and blood pressure is rising.Patient 2Oxygen saturation has decreased slightly as the patient noted increased difficulty breathing. Supplemental oxygen was administered. Patient complains of a tingling and weakness in the hands, feet, legs, and arms. Patient has difficulty swallowing and requires a feeding tube.Patient 3By third day of admission, patient symptoms are deteriorating quickly. Paralysis is spreading throughout upper extremities. By the end of the day, patient shows signs of acute respiratory distress and requires mechanical ventilation.Patient 4On second day of admission, patient has a difficult time speaking and complains of double-vision. Patient complains of overall muscle weakness and has developed blurred vision. Patient 5 Due to a high WBC count and urinalysis results, patient was administered broad-spectrum antibiotics. The patient’s fever subsides by the second day of admission. Patient complains of tingling in the arms and fingers.Tensilon Test ResultsPatients were given a drug called Tensilon (also called endrophonium) intravenously. Then the patients were asked to perform some repetitive muscular movements, such as crossing and uncrossing their legs and getting up from a sitting position in a chair. Particular attention was paid to whether patients’ muscle strength was improved by the Tensilon. Patient 2 and Patient 3 exhibited partial improvement following the administration of the Tensilon. Patients 1, 4, and 5 showed no improvement following the administration of the Tensilon.EEG Results:An electroencephalogram (EEG), a test used detect problems in the electrical activity of the brain, was performed on all of the patients. All patient results were normal.EKG ResultsExamine the diagram below of a normal EKG (electrocardiogram). Remember that an EKG is a graphical recording of the electrical events occurring within the heartThe P wave represents the start of the electrical journey as the impulse spreads from the sinoatrial node downward from the atria through the atrioventricular node and to the ventricles. The QRS complex represents ventricular activation. The T wave results from ventricular repolarization, which is a recovery of the ventricular muscle tissue to its resting pare the normal EKG above to the EKG measured from Patients 1 – 5 below. Note: because all of the patients’ EKGs were very similar, only one EKG is presented.EMG ResultsAn electromyography, EMG, was performed on all of the patients to check the health of the muscles and the nerves that control the muscles. Thin needle electrodes were placed through the skin into patients’ affected muscles, which picked up the electrical activity given off by the muscles. The EMGs were conducted with repetitive stimulation at 20 - 50 Hz. Once the electrodes were in place, the patients were asked to contract the affected muscles. All five patients’ EMGs showed a potentiated muscle action potential with rapid repetitive stimulation at 20 Hertz.Imaging ResultsMRI ResultsView MRI images of a normal brain, available from the Whole Brain Atlas website at . View different sections of the brain by clicking the up or down buttons found at the bottom left hand side of the screen, as shown below.View MRI images of a brain affected by an acute stroke, available from the Whole Brain Atlas website at . Note any differences between the normal brain images and those of a brain affected by an acute stroke.View MRI images of a brain with a metastatic bronchogenic carcinoma, available from the Whole Brain Atlas website at . Note any differences between the normal brain images, those of a brain affected by an acute stroke, and those affected by a brain tumor.Analyze the MRI images from patients 1 – 5 below to determine if there are any abnormalities. Note: The following images are used with permission of Keith Johnson, M.D.CT Scan ResultsCT scan of the head shows no meningeal enhancement or evidence of intracranial hemorrhage for all patients.Case MapPatients were interviewed to look for a link between their cases. It was discovered that all five patients work on the same floor of an industrial office building. A diagram of the floor plan of the office is presented below. Patient offices are indicated in red. ................
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