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Project 5.1.1A Evidence Report #1General Lab Tests

Lab: Auto DifferentialTest Abbrev:

Test Full Name:

Purpose of Test:

Normal Range:

Result:Patient 1

Result:Patient 2

Result:Patient 3

Result:Patient 4

Result:Patient 5

Neutro % Percentage of Neutrophils

Percent of neutrophils in the blood.

40% - 60% 55% 54% 53% 60% %65

Lymph % Percentage of Lymphocytes (T cells and B cells)

Percent of lymphocytes in the blood.

20% - 40% 40% 38% 31% 21% 30%

Mono % Percentage of Monocytes

Percent of Monocytes in the blood.

2% - 8% 3% 3% 7% 5% 3%

Eosinophil %

Percentage of Eosinophils

Percent of Eosinophils in the blood.

1% - 4% 1.5% 4.6% 2% 2% 1.5%

Baso % Percentage of Basophils

Percent 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 1

Result:Patient 2

Result:Patient 3

Result:Patient 4

Result:Patient 5

WBC White Blood Cell Count

Measures the number of WBCs. Elevated levels might indicate an infection or allergic reaction.

4,500 – 10,000 cells/mcL

5,568 9,852 7,456 4,981 68,000

RBC Red Blood Cell Count

Measures the number of RBCs to help diagnose anemia and other conditions affecting RBCs.

Males: 4.7 – 6.1 million cells/mcL

Females: 4.2 – 5.4 million cells/mcL

4.9 5.2 5.6 6.0 4.3

Hgb Hemoglobin Measures the amount of hemoglobin in the blood.

Males: 13.8 – 17.2 gm/dL

Females: 12.1 – 15.1 gm/dL

15.2 12.4 16.8 14.3 14.6

Hct Hematocrit Measures 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%

Platelet Platelet Count Measures how many platelets are in the blood.

150,000 - 400,000 platelets/mcL

265,874 299,475 377,661 384,112 361,333

© 2011 Project Lead The Way, Inc.Biomedical Innovation Project 5.1.1A Evidence Report #1 –

Lab: Comprehensive Metabolic PanelTest Abbrev:

Test Full Name:

Purpose of Test:

Normal Range:

Result:Patient 1

Result:Patient 2

Result:Patient 3

Result:Patient 4

Result:Patient 5

Glucose Level

Glucose Level Measures the amount of glucose in the blood.

< 100 mg/dL 67 88 70 108 72

BUN Blood Urea Nitrogen

Measures the amount of urea nitrogen in the blood.

7 - 20 mg/dL 21 32 19 18 24

Creatinine, Serum

Creatinine, Serum

Measures the amount of creatinine in the liquid part of the blood.

0.8 to 1.4 mg/dL

2.0 2.5 1.4 1.3 1.8

GFR Glomerular Filtration Rate

Estimates how much blood passes through the tiny filters in the kidneys, called glomeruli, each minute.

90 - 120 mL/min

95 97 100 90 110

Calcium Calcium Measures the total amount of calcium in the blood.

8.5 to 10.2 mg/dL

8.9 8.2 10.0 9.0 8.1

Protein Level

Total Protein Level

Rough 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/dl

8.9 6.2 9.3 7.5 6.8

Albumin Level

Albumin 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/dL

5.3 3.8 4.7 5.9 4.0

TBil Total Bilirubin Measures bilirubin (a fluid produced by the liver) in the blood.

0.3 to 1.9 mg/dL

0.5 1.7 1.7 0.9 1.0

AST Aspartate Aminotransferase

Measures the amount of AST (an enzyme) in the blood.

10 to 34 IU/L 11 19 33 25 21

ALT Alanine Transaminase

Measures the amount of ALT in the blood.

7 – 40 IU/L 6 32 24 18 36


Alk Phos Alkaline Phosphatase

Measures the level of alkaline phosphatase in the blood.

44 to 147 IU/L

56 76 87 48 49

Sodium Sodium (Na+)

Measures the concentration of sodium in the blood.

135 to 145 mEq/L

154 138 147 140 140

Potassium Potassium (K+) Measures the amount of potassium in the blood.

3.7 to 5.2 mEq/L

4.0 4.3 3.8 3.9 5.0

Chloride Chloride Measures the amount of chloride in the fluid portion (serum) of the blood.

96 - 106 mEq/L

100 98 96 105 98

CO2 Carbon Dioxide Measures the level of bicarbonate in the blood.

20-29 mEq/L 25 25 22 27 21

Lab: LipidTest Abbrev:

Test Full Name:

Purpose of Test:

Normal Range:

Result:Patient 1

Result:Patient 2

Result:Patient 3

Result:Patient 4

Result:Patient 5

Cholesterol Total Cholesterol

Measures 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 higher

240 120 140 190 105

Triglycerides

Triglycerides Measures the amount of triglycerides in the blood.

Normal: <50

High: >200

215 46 42 108 55

HDL High-Density Lipoprotein Test

Measures the level of HDL cholesterol in the blood.

Males high risk: < 37 mg/dL

Females high risk: <47 mg/dL

Low risk: > 59

51 63 75 39 71

LDL Low-Density Lipoprotein Test

Measures the level of LDL cholesterol in the blood.

Optimal: Less than 100 mg/dL

Near Optimal: 100 - 129 mg/dL

Borderline High: 130 -

168 118 127 131 104


159 mg/dL

High: 160 - 189 mg/dL

Very High: 190 mg/dL and higher

Lab: TSH, High SensitivityTest Abbrev:

Test Full Name:

Purpose of Test:

Normal Range:

Result:Patient 1

Result:Patient 2

Result:Patient 3

Result:Patient 4

Result:Patient 5

TSH, High Sensitivity

Thyroid Stimulating Hormone

Measures the amount of TSH in the blood.

0.4 - 4.0 mIU/L

0.9 1.6 0.5 3.4 1.4

Lab: Additional TestsTest Abbrev:

Test Full Name:

Purpose of Test:

Normal Range:

Result:Patient 1

Result:Patient 2

Result:Patient 3

Result:Patient 4

Result:Patient 5

Acetylcholine Receptor Antibody

Acetylcholine Receptor Antibody in Blood

Determine how much, if any, acetylcholine receptor is present in the blood.

0.00 - 0.05 nmol/L

0.01 0.00 0.02 0.00 0.00

CSF Total Protein Levels

Cerebrospinal Fluid Collection done by lumbar puncture; commonly referred to as a spinal tap

Determine 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/dL

62 22 69 18 45

UrinalysisMacroscopic Analysis


Color: 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 Analysis

Test: Normal Results:Leukocytes Normal urine does not contain leukocytes.Nitrite Normal urine does not contain nitrites.Urobilinogen Normally 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.

Protein Normal 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.

Blood Normal urine does not contain blood.Specific Gravity Test 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 1.028

Ketones Normal urine does not contain ketones, the endpoint of rapid or excessive fat breakdown, in the urine.

Bilirubin Normal urine does not contain bilirubin, a fluid produced by the liver.

Glucose Normal 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 period

Patient 1 Patient 2 Patient 3Date 8/6 8/7 8/8 Date 8/3 8/5 8/7 Date 8/4 8/6 8/8

BP 140/88

146/90

150/90

BP 120/84

118/80

118/78

BP 110/60

110/60

112/60

Pulse 110 108 102 Pulse 85 100 110 Pulse 80 105 118

Resp 16 18 18 Resp 20 21 25 Resp 24 28 30

Temp 100 99 100 Temp 98.6 99.3 99 Temp 99.8 99.2 99.2

Patient 4 Patient 5Date 8/6 8/7 8/8 Date 8/5 8/6 8/8

BP 122/68

129/70

120/65

BP 118/70

118/70

118/70

Pulse 75 76 80 Pulse 60 60 60

Resp 20 20 22 Resp 19 20 20

Temp 100.1 99.6 98.9 Temp 102 101 99

Chart Notes

Patient 1Patient now complains of nausea and is experiencing intermittent vomiting. Patient is extremely fatigued and dizzy and blood pressure is rising.

Patient 2© 2011 Project Lead The Way, Inc.

Biomedical Innovation Project 5.1.1A Evidence Report #1 –

Oxygen 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 Results1. Examine the diagram below of a normal EKG (electrocardiogram). Remember that

an EKG is a graphical recording of the electrical events occurring within the heart


o The 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.

o The QRS complex represents ventricular activation. o The T wave results from ventricular repolarization, which is a

recovery of the ventricular muscle tissue to its resting state.

2. Compare 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 Results

1. View MRI images of a normal brain, available from the Whole Brain Atlas website at http://www.med.harvard.edu/AANLIB/cases/caseM/mr1_t/024.html.

2. 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.


http://www.med.harvard.edu/AANLIB/cases/caseM/mr1_t/024.html

3. View MRI images of a brain affected by an acute stroke, available from the Whole Brain Atlas website at http://www.med.harvard.edu/AANLIB/cases/case20/mr3/015.html. Note any differences between the normal brain images and those of a brain affected by an acute stroke.

4. View MRI images of a brain with a metastatic bronchogenic carcinoma, available from the Whole Brain Atlas website at http://www.med.harvard.edu/AANLIB/cases/case28/mr1-tc1/014.html. Note any differences between the normal brain images, those of a brain affected by an acute stroke, and those affected by a brain tumor.

5. 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.


http://www.med.harvard.edu/AANLIB/cases/case28/mr1-tc1/014.html

http://www.med.harvard.edu/AANLIB/cases/case20/mr3/015.html

p5.1.1a.evidencereport1f · web viewon second day of admission, patient has a difficult time...

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