Mr. Smith is 60 years old. He was diagnosed with prostate cancer five years ago. Over the past few days,

Mr. Smith is 60 years old. He was diagnosed with prostate cancer five years ago. Over the past few
days, Mr. Smith has been feeling weak and increasingly tired and has also been suffering from a
headache that did not respond to over-the-counter medications. He scheduled an appointment with his
physician.
His physician performed a physical examination and recommended a battery of laboratory tests and
imaging procedures.

The table below shows Reference values in the right-hand column. These values reflect the normal
range of values for patients without disease or illness. The center column reflects the resulting values
for medical test results obtained for Mr. Smith.
Take note whether Mr. Smith’s values are within normal limits.
Mr. Smith Reference Values
K+ 2.6 mmol/L 3.8-4.9mmol/L
Hb (Hemoglobin) 7.5 g/dL 13.8 to 18.2 g/dL

Hct (Hematocrit) 20.4% 45-52%
Platelet Count

49×10 9 /L 150-400×10 9 /L

After receiving Mr. Smith’s test results, his physician admits him to the hospital. Hospital staff treated
him and discharged him.
The following week, Mr. Smith returns to his physician with the same complaint of weakness and a
new complaint of shortness of breath. His blood pressure is 160/100 mmHg. MRI reveals the
metastasis of prostate cancer to osseous tissue. Abdominal CT shows obstruction of the intestine due
to nodular enlargement of adrenal glands.

Laboratory results from Mr. Smith’s second hospital admission and medical tests show the following
findings:

Mr. Smith Reference Values
K+ 2.6 mmol/L 3.8-4.9mmol/L
Hb 7.3 g/dl 13.8 to 18.2 g/dL
Hct 20.4% 45-52%

Platelet Count

20×10 9 /L 150-400×10 9 /L
HCO3 38 mmol/l 22-26 mmol/L
Urinary K+ 70 mmol/L/24 hr 25-120 mmol/L/24 hr

Blood Glucose 460 mg/dl 64.8-104.4 mg/dL

Serum Aldosterone 1 ng/dl
24 hour Urinary Aldosterone 8.4 mcg/24 hr 2.3-21.0 mcg/24 hr
Renin 2.1 ng/ml/hr 0.65-5.0 ng/ml/hr
ACTH (Adrenocorticotropic
Hormone)

1082 pg/ml 9-46 pg/ml

Cortisol 155.5 microg/dL 0-25 microg/dL

CONCLUSION AND DIAGNOSIS
Laboratory findings, MRI, and CT confirmed metastatic prostate adenocarcinoma, hypertension and
refractory hypokalemia due to ectopic ACTH production. High levels of circulating cortisol caused
continuous activation of mineralocorticoid receptors resulting in hypokalemia, metabolic alkalosis, and
hypertension.

After reading the provided scenario, answer the following questions:
1. What are the components of physical examination? Describe each component.
2. Mr. Smith’s blood pressure was 160/100 mmHg. How does a medical provider take or
measureblood pressure? What do the top (numerator) and bottom (denominator) numbers mean
in the biological sense? What is the significance of the size of these two numbers? Is Mr. Smith’s
blood pressure within the normal range? Explain how you concluded whether Mr. Smith’s blood
pressure is/is not within the normal range.
3. Based on the data provided, what laboratory tests were performed, and what samples weretaken
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.

4. Compare Mr. Smith’s values with reference values and indicate whether MR. Smith’s values are
below, above, or within the normal range (compare Mr. Smith’s values with the Reference values)
for each laboratory test in the table above from the second set of tests.
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?
6. Select one of the medical terms from the CONCLUSION and DIAGNOSIS section above and
define what it means. Also, discuss, 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. In your own words, discuss how medical providers use the scientific method
to come to work through the examination and diagnosis of a patient.