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Over the next 12-18 hours, her condition worsened. She returned to The
Emergency Department for reassessment. At this juncture, she was triaged for
medicine evaluation. Further inquiry revealed the absence of nausea, vomiting,
diarrhea, bloody stool, swollen glands, photophobia or ocular irritation, but now
revealed a history of dysuria and purulent discharge (present for the past few
weeks; not reported during first check-up). Past medical and family histories were
noncontributory.
Diagnostic Examination
Questions:
1. What is the significance of the Urethral discharge gram stain with regards to
the patients sign and symptoms?
2. What is the most likely diagnosis of the patient?
3. Why is a bulge test performed? Describe the proper procedure for
Arthrocentesis.
4. What is the workup for the diagnosis? What are expected findings in this
condition? Explain
5. How is Cervicovaginal discharge obtained?
6. What is the workup for the CervicoVaginal discharge in this case?
Case B
Volume 3 mL
All other macroscopic parameters Normal
Sperm Concentration 20 million sperm / mL
Sperm Motility Progressive Motility: 20%
Total Motility: 40%
Sperm Morphology (Routine) 5% normal
Volume 3 mL
All macroscopic parameters Normal
Sperm Concentration 25 million / mL
Sperm Motility Progressive Motility: 30%
Total Motility: 50%
Sperm Morphology (Routine) 20% Normal; Sperm agglutination
noted
A 3 year old child presents with chronic, recurrent pancreatitis and frequent bouts of
bronchitis; during these attacks, she expectorates thick mucus. She also suffers from
frequent diarrhea characterized by yellow frothy stools which are foul smelling. The
doctor orders a sweat test and obtains an osmometry reading of 215 mmol/kg.
Questions:
1. Given the constellation of disease presentation, why would the doctor order a
sweat test?
2. What is the most likely condition of the patient? What are its signs and
symptoms? How is it inherited?
3. Explain the process for performing a sweat test.
a. Gibson and Cooke Pilocarpine Iontophoresis
b. Sweat osmometry
4. What is the workup for the patients diarrhea in this case?
5. What pulmonary complications are associated with Cystic fibrosis?
Case D
An 63-year old man was rushed to the emergency department after being seen lying
unconscious on his rented room by the house caretaker. The caretaker had no
information on how long he remained unconscious as the man was alone even at his
age. The only evidence seen in the room was a dent on the tiled floor and some spilt
rum.
Admission findings include:
37.4C, 221/105 mm Hg, unresponsive to various stimuli but with shallow
breathing pattern. Evidence of otorrhea noted by physician.
Three tubes were collected via lumbar tap. Among noted on the physical examination
were as follows:
Tube 1: slightly hazy, pale red
Tube 2: slightly hazy, pink
Tube 3: slightly hazy, pink
Table 1. Chemistry and Serology Findings
CSF Albumin 40 mg/dL
CSF Glucose 3.4 mmol/L
CSF Lactate 2.5 mmol/L
CSF Glutamine 37 mg/dL
Plasma Glucose 5.6 mmol/L
Plasma Albumin 3.8 g/dL
Table 2. Microbiology Findings
CSF Gram Stain No microorganisms seen
CSF Culture Did not perform
2. Explain how these results indicate a traumatic tap, fresh hemorrhage, or old
hemorrhage. How long might have the patient been unconscious?
5. Explain briefly how the findings would account for the patient condition.
6. Suggest a diagnosis consistent with the laboratory results. What other tests, aside
from clinical laboratory tests, that may support your diagnosis?
Case E
A 28-year-old pregnant woman is seen by an obstetrician for the first time during her
2nd pregnancy. She thinks she is around 33 weeks gestation. She is from Philippines
and 3 months ago relocated to Canada with her husband and family. Her patient history
reveals that she has a 6-year old boy. According to her, the first delivery was relatively
normal and uncomplicated but records show that the infant was slightly overweight at
9lb; Her maternity records from the Philippines also revealed the following chemistry
results:
At 24 weeks gestation
Fasting Plasma Glucose 110 mg/dL
1 hour plasma glucose 192 mg/dL
2 hour plasma glucose 165 mg/dL
Urine dipstick: Glucose 3+
Ketones Negative
Routine prenatal blood work is performed. The mother is determined to be type O Rh-
negative and an antibody screen reveals the presence of an anti-Rh(D). Her antibody
titer is positive to a 1:32 dilution. Her husband is determined to be type A Rh-positive.
To assess and monitor the severity of the suspected hemolytic process taking place,
weekly amniocenteses are scheduled.
1. Calculate the A450 for the amniotic fluid obtained at 35 weeks gestation using the
image provided above.
2. Using the Liley graph, at what zone does the A450 value fall at 35 weeks?
3. What clinical implications accompany this result?
4. Using the values for lecithin and sphingomyelin provided at 35 weeks, calculate the
lecithin/sphingomyelin ratio. Compare the findings for each week and interpret if the
lungs are mature or immature.
5. What laboratory results are possibly affected by some other factors in your analysis?
6. What does the Apt test result indicate? Explain its clinical significance
7. Is there any discrepancy on your bilirubin findings? Provide possible sources of error
and preventive action to be placed as policy in testing for bilirubin.
Case F
He was advised to visit the nearest city hospital to seek for treatment. There, he was
immediately placed into an isolation room and immediately taken for thoracentesis. Fluid
taken was sent to the laboratory for testing. The following results were noted.
Differential
Lymphocytes: 65%
Macrophages: 15%
Neutrophils: 3%
Plasma cells: 17%
Mesothelial cells: Rare