Question

The patient's history for update purposes

Patient A age 70. He is obese and 100% sedentary. He needs to do physical exercises, to lose weight, to decrease stress and to eat better (but he does not do that). He has diabetes: 25 years ago, he was diagnosed with diabetes type 2 and he has to take insulin.

Diet: He eats meat 3 times a day and does not eat dietary fiber.

Emotional: He is stressed and anxious, and works hard.

Parents: The mother and father died young because of complications of diabetes. Father: died at age 53 of myocardial infarction.

Symptoms now: shortness of breath, chest pain due to physical exertion (angina).

Has high blood pressure: 140/90. Never had hypertension before. His doctor prescribed for hypertension: Vasotec (enalapril).

He must take the following exams/tests:

FSC: red blood cells, white blood cells and platelets

Lipid profile

Creatinine test

Uremia test (urine in the blood)

Electrolytes test (usually sodium or potassium or an acid-base imbalance)

Clearance of creatinine test

HbA1c test (also called glycated hemoglobin test, and glycohemoglobin)

Stress ECG test

Urine analysis

3 weeks later, the results:

Clearance of creatinine test show to us the GFR (Glomerular Filtration Rate) results:
GFR 55mL/min (normal: 90-125mL/min)

Lipid profile: low level HDL, high level LDL

Plasma creatinine level (creatinine test): 150 mmol/L (normal: 50-110 umol/L)

Uremia test : 8 mmol/L (N : 3 - 6,5 mmol/L)

Urine analysis: 120 mg/L of proteins (normal: < 80 mg/L)

Stress ECG test: Anomalies related to unstable angina

Doctor's conclusion: chronic renal insufficiency (CRI), unstable angina. Needs to do an emergency angiography.

Angiography test results: several atheroma plaques in the coronary arteries. He had to put four stents during the procedure.

He had to take these medicaments:

Clopidogrel (Plavix), Aspirine (acide salicylique, for 1 year), and Crestor (is a statine). And also, the insulin and Vasotec (énalapril).

Question B: Do a reflection on why the doctor prescribed all these 9 tests (have to do links with disease of the organs of the body, like behavior of cells with according to diagnosis, organ failure, blood circulation, heart cell oxygenation, kidney and lung compensations, involvement of the pancreas, liver and bile with the diagnosis, the diabetes and anything that is relevant to and important to this case).

Answer 1

Reason to prescribe the 9 tests are
1.FSC: red blood cells, white blood cells and platelets to screen,monitor/diagnose any disease conditions that affect blood cells such as anemia,infection,inflammation bleeding disorder or cancer.
2.Lipid profile to rule out High blood pressure,Diabetes,overweight,stress and high total cholesterol
3.Creatinine test to rule out congestive heart failure,diabetes where decreased blood flow to the kidneys causes CHF and diabetes.
4.Uremia test (urine in the blood) to rule out kidney disease,when kidney fails to filter the waste products it enters into blood stream.
5.Electrolytes test (usually sodium or potassium or an acid-base imbalance) to evaluate kidney disease,high blood pressure or heart failure.Mainly mechanism of reabsorption and secretion throughout the renal tubule and collecting duct,that potassium remains normal limit.
6.Clearance of creatinine test to test kidneys ability to filter the blood,as it declines,creatinine clearance also goes down.
7.HbA1c test (also called glycated hemoglobin test, and glycohemoglobin) to find out the Diabetes and average level of blood sugar over the past 2 to3 months as red blood cell live for about 3 months..The glucose builds up in blood ,it binds to te hemoglobin in red bllod cells.A1c test measures how much glucose is bound.
8.Stress ECG test to identify abnormal heart rhythms,coronary heart disease.
9.Urine analysis to find out certain illnesses in earlier stage such as kidney disease,liver disease and Diabetes.