Physical Exam: Case Study
1. What are the components of a physical examination? Describe each component.
After listening to the patient's description of the history of the symptoms, a physician will conduct a physical examination, which includes:
Observing the physical signs of a disease and evaluating, the physician will talk to Mr. Smith about what he has been experiences. Ask him what his day-to-day lifestyle is and what medications he is on. Mr. Smith was complaining about being tired all the time and that is a symptom to start with.
Taking the patient's vital signs, including blood pressure, this is a great first step to see how Mr. Smith is doing. They will check his temperature to make sure he is not overheating.
Using a stethoscope in a procedure called auscultation to listen to the lungs, heart, and bowel movement. A healthy heartbeat sounds different than a heartbeat of a heart with valve damage. …show more content…
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.
a. How does a medical provider take or measure blood pressure?
A medical provider will use a sphygmomanometer or blood pressure cuff. The examiner wraps the cuff around the patient’s upper arm and inflates it with air until the brachial artery is compressed and the blood flow is cut off. Then, listening with a stethoscope, he/she slowly lets air out of the cuff until the first pulsations are heard. At this point, the pressure in the cuff is equal to the systolic pressure, and this pressure is read. Then, more air is let out gradually until a characteristic muffled sound indicates that the vessel is open and the diastolic pressure is read.
b. What does the top and bottom numbers mean in the biological sense?
Systolic Pressure: is the maximum pressure that develops in the arteries after heart muscle contraction.
Diastolic Pressure: is the lowest pressure measured in the arteries after relaxation of the heart muscle.
c. What is the significance of the size of these two numbers?
The size of the numbers determine if your blood pressure is normal, low (hypotension), or high (hypertension).
d. Is Mr. Smith’s blood pressure within normal range? Explain how you concluded whether Mr. Smith’s blood pressure is/is not within normal range.
Mr. Smith’s blood pressure is not within normal range. His blood pressure is 140-90 and is considered to be high blood pressure (hypertension).
e. Discuss the possible health issues anticipated for a person with a blood pressure of 160/100 mmHg.
High blood pressure can cause major health issues. Some of these issues can be stroke, heart attack, and kidney failure.
.
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.
The following were all the lab tests that were performed on Mr. Smith.
K+ blood test, Total CO2 with Electrolyte Panel, K+ urine test, Comprehensive Metabolic Panel (CMP), Aldosterone/Renin Activity Calculation or Ration, ACTH Stimulation test, Complete Blood Count (CBC), Urine Aldosterone Test.
Samples Taken
Urine and Blood were the samples taken from Mr. Smith.
Select one of the tests ordered and discuss why the physician might have ordered the test and the information she might have expected to obtain from that particular test.
I have chosen the K+ urine test, which can also be called the potassium urine test. This test checks the level of potassium in your urine. Potassium is a fundamental element in cell metabolism. Excessive potassium (hyperkalemia) can cause nausea, fatigue, and muscle weakness. If it goes undetected and is left untreated, hyperkalemia can be dangerous and possibly even fatal. Common causes for high potassium include kidney dysfunction or injury and diseases of the adrenal gland. Mr. Smith has high blood pressure and this could lead to kidney failure. Too little potassium is called hypokalemia. A severe loss or drop in potassium can cause heart arrhythmia, muscle weakness or spasms, and paralysis. (Holland, 2013). The physician ordered this test to ensure that Mr. Smith’s body was not producing too much potassium.
4. Analyze Mr. Smith’s values:
a. Compare Mr. Smith’s values with the reference values and indicate whether Mr. Smith’s values are below, above, or within normal range for each laboratory test in the table above for the second set of tests.
K+ ------------------Low Blood Glucose----------------High
Hb-------------------Low Serum Aldosterone-----------Normal
Hct------------------Low 24hr Urinary Aldosterone---Normal
Platelet Count-----Low Renin---------------------------Normal
HCO3--------------High ACTH--------------------------High
Urinary K+--------Normal Cortisol-------------------------High
b. Select one of the values outside of normal range from the table above and discuss possible medical concerns related to the identified change in Mr. Smith’s values.
I have chosen Blood Glucose, in which Mr. Smith’s test came back high. High blood glucose can lead to diabetes. Blood sugar actually coats red blood cells (hemoglobin), causing them to become stiff. These “sticky cells” interfere with blood circulation, causing cholesterol to build up on the inside of your blood vessels. Controlling high blood sugar may help prevent or decrease many long-term diabetes complications such as, heart attack, stroke, and kidney problems (including kidney failure). (Davidson,N & Moreland P, 2011)
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?
Mr. Smith had to do an MRI (magnetic resonance imaging) and CT scan (computerized tomography). A CT scan is best suited for viewing bone injuries, diagnosing lung and chest problems, and detecting cancers. An MRI is suited for examining soft tissue in ligament and tendon injuries, spinal cord injuries and brain tumors. A CT scan is a specialized type of x-ray that sends x-ray beams through the body as it moves through an arc taking many pictures. A CT scan sees different levels of density and tissues inside a solid organ, and can provide detailed information about the body, including the head, chest, skeletal system, pelvis and hips, reproductive system, bladder and gastrointestinal tract. Unlike CT scans, which use X-rays, MRI scans use powerful magnetic fields and radio frequency pulses to produce detailed pictures of organs, soft tissues, bone and other internal body structures. Differences between normal and abnormal tissue is often clearer on an MRI image than a CT. (Sanjeev, 2012)
What were the results of imaging procedures in Mr. Smith’s case?
The MRI revealed metastasis of prostate cancer to osseous tissue and the Abdominal CT shows obstruction of intestine due to nodular enlargement of adrenal glands.
6. Select one of the medical terms from the CONCLUSION and DIAGNOSIS section above and define what it means.
I have chosen metastatic prostate adenocarcinoma.
Prostate cancer cells can spread anywhere in the body. Prostate cancer metastasis occurs when cells break away from the tumor in the prostate. The cancer cells can travel through the lymphatic system or the bloodstream to other areas of the body. Common prostate cancer metastasis can occur in the bones, lymph nodes, lungs, liver and brain.
Explain 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.
The MRI revealed the metastasis of prostate cancer to osseous tissue, and the CT scan revealed the obstruction of intestine due to nodular enlargement of the adrenal glands. All of the blood tests were used to show how he had abnormal signs within his body which in turn caused his body to start to break down. Low levels of potassium within the body are a clear sign of why Mr. Smith was feeling weak.
Discuss how medical providers use the scientific method to come to work through the examination and diagnosis of a
patient.
Medical providers use the scientific method by having certain steps in place in order to treat and diagnosis patients in a timely manner. No matter how simple or complex the situation or diagnosis might be the scientific method is there to help medical providers. The first thing a medical provider will do after meeting a patient is look for signs that he/she can see that will help with his/her diagnosis of the problem. The medical provider will then ask the patient his/her symptoms so the medical provider can try to put his/her observations together with what the patient is telling them. The provider may ask how long these symptoms have been occurring along with other family related history or illness. The provider will then come to a conclusion about what he/she thinks might be wrong with the patient. The provider may order blood test, MRI and CT scans in order to pin point the region where the problem may be stemming from. This is how the scientific method is put into action on a daily basis. The scientific method is not only used for medical concerns, but can be used for almost all daily activities.
REFERENCES
http://www.healthline.com/health/potassium-urine#Overview1 (Holland, 2013)
http://www.mayoclinic.org/diseases-conditions/diabetes/expert-blog/high-blood-sugar/bgp-20056519 (Davidson, N & Moreland, P, 2011)
http://hanfordsentinel.com/lifestyles/health-med-fit/a-tale-of-two-scans-which-is-better--/article_82dce24a-0d87-11e2-bb76-0019bb2963f4.html (Sanjeev, 2012)
After listening to the patient's description of the history of the symptoms, a physician will conduct a physical examination, which includes:
Observing the physical signs of a disease and evaluating, the physician will talk to Mr. Smith about what he has been experiences. Ask him what his day-to-day lifestyle is and what medications he is on. Mr. Smith was complaining about being tired all the time and that is a symptom to start with.
Taking the patient's vital signs, including blood pressure, this is a great first step to see how Mr. Smith is doing. They will check his temperature to make sure he is not overheating.
Using a stethoscope in a procedure called auscultation to listen to the lungs, heart, and bowel movement. A healthy heartbeat sounds different than a heartbeat of a heart with valve damage. …show more content…
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.
a. How does a medical provider take or measure blood pressure?
A medical provider will use a sphygmomanometer or blood pressure cuff. The examiner wraps the cuff around the patient’s upper arm and inflates it with air until the brachial artery is compressed and the blood flow is cut off. Then, listening with a stethoscope, he/she slowly lets air out of the cuff until the first pulsations are heard. At this point, the pressure in the cuff is equal to the systolic pressure, and this pressure is read. Then, more air is let out gradually until a characteristic muffled sound indicates that the vessel is open and the diastolic pressure is read.
b. What does the top and bottom numbers mean in the biological sense?
Systolic Pressure: is the maximum pressure that develops in the arteries after heart muscle contraction.
Diastolic Pressure: is the lowest pressure measured in the arteries after relaxation of the heart muscle.
c. What is the significance of the size of these two numbers?
The size of the numbers determine if your blood pressure is normal, low (hypotension), or high (hypertension).
d. Is Mr. Smith’s blood pressure within normal range? Explain how you concluded whether Mr. Smith’s blood pressure is/is not within normal range.
Mr. Smith’s blood pressure is not within normal range. His blood pressure is 140-90 and is considered to be high blood pressure (hypertension).
e. Discuss the possible health issues anticipated for a person with a blood pressure of 160/100 mmHg.
High blood pressure can cause major health issues. Some of these issues can be stroke, heart attack, and kidney failure.
.
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.
The following were all the lab tests that were performed on Mr. Smith.
K+ blood test, Total CO2 with Electrolyte Panel, K+ urine test, Comprehensive Metabolic Panel (CMP), Aldosterone/Renin Activity Calculation or Ration, ACTH Stimulation test, Complete Blood Count (CBC), Urine Aldosterone Test.
Samples Taken
Urine and Blood were the samples taken from Mr. Smith.
Select one of the tests ordered and discuss why the physician might have ordered the test and the information she might have expected to obtain from that particular test.
I have chosen the K+ urine test, which can also be called the potassium urine test. This test checks the level of potassium in your urine. Potassium is a fundamental element in cell metabolism. Excessive potassium (hyperkalemia) can cause nausea, fatigue, and muscle weakness. If it goes undetected and is left untreated, hyperkalemia can be dangerous and possibly even fatal. Common causes for high potassium include kidney dysfunction or injury and diseases of the adrenal gland. Mr. Smith has high blood pressure and this could lead to kidney failure. Too little potassium is called hypokalemia. A severe loss or drop in potassium can cause heart arrhythmia, muscle weakness or spasms, and paralysis. (Holland, 2013). The physician ordered this test to ensure that Mr. Smith’s body was not producing too much potassium.
4. Analyze Mr. Smith’s values:
a. Compare Mr. Smith’s values with the reference values and indicate whether Mr. Smith’s values are below, above, or within normal range for each laboratory test in the table above for the second set of tests.
K+ ------------------Low Blood Glucose----------------High
Hb-------------------Low Serum Aldosterone-----------Normal
Hct------------------Low 24hr Urinary Aldosterone---Normal
Platelet Count-----Low Renin---------------------------Normal
HCO3--------------High ACTH--------------------------High
Urinary K+--------Normal Cortisol-------------------------High
b. Select one of the values outside of normal range from the table above and discuss possible medical concerns related to the identified change in Mr. Smith’s values.
I have chosen Blood Glucose, in which Mr. Smith’s test came back high. High blood glucose can lead to diabetes. Blood sugar actually coats red blood cells (hemoglobin), causing them to become stiff. These “sticky cells” interfere with blood circulation, causing cholesterol to build up on the inside of your blood vessels. Controlling high blood sugar may help prevent or decrease many long-term diabetes complications such as, heart attack, stroke, and kidney problems (including kidney failure). (Davidson,N & Moreland P, 2011)
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?
Mr. Smith had to do an MRI (magnetic resonance imaging) and CT scan (computerized tomography). A CT scan is best suited for viewing bone injuries, diagnosing lung and chest problems, and detecting cancers. An MRI is suited for examining soft tissue in ligament and tendon injuries, spinal cord injuries and brain tumors. A CT scan is a specialized type of x-ray that sends x-ray beams through the body as it moves through an arc taking many pictures. A CT scan sees different levels of density and tissues inside a solid organ, and can provide detailed information about the body, including the head, chest, skeletal system, pelvis and hips, reproductive system, bladder and gastrointestinal tract. Unlike CT scans, which use X-rays, MRI scans use powerful magnetic fields and radio frequency pulses to produce detailed pictures of organs, soft tissues, bone and other internal body structures. Differences between normal and abnormal tissue is often clearer on an MRI image than a CT. (Sanjeev, 2012)
What were the results of imaging procedures in Mr. Smith’s case?
The MRI revealed metastasis of prostate cancer to osseous tissue and the Abdominal CT shows obstruction of intestine due to nodular enlargement of adrenal glands.
6. Select one of the medical terms from the CONCLUSION and DIAGNOSIS section above and define what it means.
I have chosen metastatic prostate adenocarcinoma.
Prostate cancer cells can spread anywhere in the body. Prostate cancer metastasis occurs when cells break away from the tumor in the prostate. The cancer cells can travel through the lymphatic system or the bloodstream to other areas of the body. Common prostate cancer metastasis can occur in the bones, lymph nodes, lungs, liver and brain.
Explain 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.
The MRI revealed the metastasis of prostate cancer to osseous tissue, and the CT scan revealed the obstruction of intestine due to nodular enlargement of the adrenal glands. All of the blood tests were used to show how he had abnormal signs within his body which in turn caused his body to start to break down. Low levels of potassium within the body are a clear sign of why Mr. Smith was feeling weak.
Discuss how medical providers use the scientific method to come to work through the examination and diagnosis of a
patient.
Medical providers use the scientific method by having certain steps in place in order to treat and diagnosis patients in a timely manner. No matter how simple or complex the situation or diagnosis might be the scientific method is there to help medical providers. The first thing a medical provider will do after meeting a patient is look for signs that he/she can see that will help with his/her diagnosis of the problem. The medical provider will then ask the patient his/her symptoms so the medical provider can try to put his/her observations together with what the patient is telling them. The provider may ask how long these symptoms have been occurring along with other family related history or illness. The provider will then come to a conclusion about what he/she thinks might be wrong with the patient. The provider may order blood test, MRI and CT scans in order to pin point the region where the problem may be stemming from. This is how the scientific method is put into action on a daily basis. The scientific method is not only used for medical concerns, but can be used for almost all daily activities.
REFERENCES
http://www.healthline.com/health/potassium-urine#Overview1 (Holland, 2013)
http://www.mayoclinic.org/diseases-conditions/diabetes/expert-blog/high-blood-sugar/bgp-20056519 (Davidson, N & Moreland, P, 2011)
http://hanfordsentinel.com/lifestyles/health-med-fit/a-tale-of-two-scans-which-is-better--/article_82dce24a-0d87-11e2-bb76-0019bb2963f4.html (Sanjeev, 2012)