Adam is a 57 year old businessman who travels regularly to China and other south-east Asian countries in regards to his business. He admits to having a less than perfect diet, often eating on the run and avoiding vegetables. He presents for treatment of bowel issues. Adam says that over the last 10 years his bowel has regularly gone through bad patches. These bad patches can last from weeks to months and cause Adam to have alternating diarrhoea and constipation. Over the last four months he has had a particularly bad episode consisting of regular diarrhoea with very occasional constipation. Adam has occasionally noticed frank blood in his stools. Sometimes Adam has low levels of abdominal pain associated with his bowel, but the pain is never severe. Adam admits to being fairly unfit and is notably over weight. Primary Investigation: Vital signs: Test Result Blood pressure 150/90 mm of Hg normal range (100/60 140/85) mm of Hg (for this age group) Pulse rate 100, per minute normal range 60-100 per minute Respiratory rate 16 per minute normal range 12-16 per minute Temperature 37 ??C normal range 36.6 37.2 ??C Questions 1) List the most important signs, symptoms and information that Adam presents with. 2) For each sign and symptom that you have listed suggest three (3) conditions (disorders) that would present with similar signs and symptoms. 3) Suggest two (2) investigative tests that would help you to make a diagnosis. In your answer explain the rationale for selecting those tests and the expected results. 4) Of the three (3) conditions that you have suggested that Adam may be suffering from, select one of those conditions as the most likely. 5) Having selected the most likely condition, you need to advise Adam any about complications he may possibly develop due to this condition. Outline three (3) complications that may develop in Adam due to this condition. 6) What advice would you give Adam to help him manage his condition? Page 3 MARKING CRITERIA: CRITERIA MARKS Appropriate differential diagnoses Illustrate and analyse the role of symptomatology in the process of differential diagnosis Conceptualise how mechanisms of disease pathology contribute to the loss of normal functions, the clinical presentations and the investigation results. Demonstrate an understanding of the functioning of the gastrointestinal tract system Demonstrate a knowledge of disease complications Appropriate referencing and bibliography Presentation CASE STUDY 2 (25 MARKS) Word Count: 750 words (including in-text citations) A sixty two year old opal miner, presents to his GP clinic with haematuria, frequency and burning while urinating. He also complains of bilateral loin pain, radiating down into his groin. He has lived in the outback for all of his adult life, and his only water supply comes from a subterranean aquifer that he pumps out by hand. The GP takes some urine for culture and sensitivity along with a sample for dip-stick testing. He also takes blood for a Full Blood Count, and the results are below. He also takes an abdominal x-ray on a very old, but still functional, x-ray machine, and the x-ray image is below. Image Source: https://images.search.conduit.com/ImagePreview/?q=Renal%20calculi%20images&ctid=CT3008668&searchsource=13&start=70&pos=9 Page 4 Full Blood Count: Haematology: Test Result Haemoglobin 120 g/L normal range (115-160) g/L White cell count 13,500 (X106/L) normal range 4000 11000 (X106/L) Packed cell volume 0.38 normal range 0.37 0.47 Platelets 395 (X106/L) normal range 150-400 (X106/L) Questions: a) When considering his symptoms, list two findings on a urine dip-stick that you would expect to discover in this patient, and what is the rationale for these findings. b) From the x-ray above, it is clear that this man has renal calculi. What type of calculi is visible in this X-ray, and name two types of mineral deposits that can produce such calculi? c) Apart from the symptoms that this man has presented with, describe three additional clinical signs and symptoms of renal calculi. d) Explain four (4) causes of renal calculi. e) The region that this man comes from in central Australia, is a desert land and has very hard water. Explain how the geographical location of may have contributed to the development of his renal stones. What could he do to help prevent a recurrence of calculi in the future? f) What is the likely course of treatment for this patient? MARKING CRITERIA: CRITERIA MARKS Demonstrate an understanding of blood and urine testing to aid in disease diagnosis. Demonstrate an understanding of how symptomatology aids in the diagnosis of disease. Demonstrate an understanding of the underlying mechanisms that contribute to the development of renal disease. Demonstrate an understanding of medical treatment Appropriate referencing and bibliography
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