58-year-old nuclear power plant worker presented to his family physician complaning of increasing fatigue and weakness....

58-year-old nuclear power plant worker presented to his family physician complaning of increasing fatigue and weakness. He also reported pain in his lower back and arms when he walks. Physical examination revealed pale mucous membranes and hepatosplenomegaly. The physician ordered a complete blood count (CBC) and urinalysis (UA). A follow-up appointment was scheduled for the following week.

Laboratory Data:

The CBC revealed that the patient had anemia. His leukocyte count and differential count were normal, except for a rouleaux (rolled coin) appearance of the RBCs. The UA was normal. The patient was called and requested to return to the laboratory for additional tests. The physician ordered an ESR, kidney screening profile, liver blood profile, and radiographic skeletal survey, with the following results:

• ESR—50 mm/hr

• Kidney profile—normal

• Liver profile—normal, except for increased globular protein

• Skeletal survey—bone lesions in various sites

Questions:

1. What follow-up laboratory tests might be ordered to assist in establishing a definitive diagnosis?

2. What is the nature of the urine protein found in this disorder ?

3. What is the most significant laboratory finding in this disorder?

4. What type of immunologic defect exists in this disease process?

5. Does this patient have a risk of occupational exposure?

Expert Solution

gladiator answered 1 year ago

A 43-year-old woman presented to her family physician with a two-year history of fatigue, diarrhea, and...

A 43-year-old woman presented to her family physician with a two-year history of fatigue, diarrhea, and constant dull abdominal discomfort. Stools were described as normal in frequency and intermittently loose in consistency. The patient, a marine biologist with an extensive travel history, noticed that her symptoms began after a busy year of fieldwork in Iceland, Denmark, and the Arctic, during which she began regularly consuming raw sushi and sashimi. Serum vitamin B12 was 157 pmol/ L, compared to a level...

A 63 year old male visits his primary care physician complaining of fatigue and shortness of...

A 63 year old male visits his primary care physician complaining of fatigue and shortness of breathe, upper back pain, and a cough that has become productive in the last 2 days. The patient was febrile and appeared acutely ill. A chest x-ray revealed pnuemonia and the following significant laboratory results were found: RBC count: 4.1 x 10 ^12 / L (reference range: 4.6 - 6.0 x10^12/ L) HGB: 13g/dL (reference range: 14.0 -18.0 g/dL) WBC count: 4.8 x 10^9...

Marvin, a 42 year old factory worker, comes to his physician complaining of an open sore...

Marvin, a 42 year old factory worker, comes to his physician complaining of an open sore on his left shin that does not seem to be healing. As the doctor unwrapped the bandage the patient had applied, a strong odor was detected. She identified the wound as an infected venous stasis ulcer. She noticed that the lower leg was edematous and the skin of the foot and ankle was somewhat discolored. Portions of the saphenous vein were visibly distended and...

Liam is a 17-year-old male who is being seen by his family physician for his annual...

Liam is a 17-year-old male who is being seen by his family physician for his annual physical examination. Liam’s sexual maturation rating is estimated to be 3. He weighs 114 lbs and stands 5’6” tall. When he was 16 y.o., his height was 5’5” and weight was 106 lbs. At 15 y.o., Liam was 5’3” tall and weighed 98lbs. During the visit, Liam reports that he has been experimenting with a vegan diet since his visit last year. He explains...

A 10-year-old boy presented to a new pulmonary physician for evaluation. His mother stated that his...

A 10-year-old boy presented to a new pulmonary physician for evaluation. His mother stated that his primary condition was asthma. He had developed respiratory symptoms at 2 months of age, had been seen by many specialists, and had been on multiple medications since that time. The pregnancy was uneventful. When he was 2 months old, he developed a recurrent cough. He was started on albuterol and then, at 6 years of age, switched to levalbuterol hydrochloride. At various times he...

Tim goes to his family physician complaining of worsening angina, shortness of breath, and extreme fatigue....

Tim goes to his family physician complaining of worsening angina, shortness of breath, and extreme fatigue. Tim is 5’11”, 240 lbs, and 68 years old. He has a history of smoking (one pack a day for 40 years), and is on the verge of Type II diabetes. Tim has been previously diagnosed with atherosclerosis, and has had bypass surgery to correct 2 blocked coronary arteries. A year ago, Tim had a heart attack and spent a couple of months in...

Mr. Alvis, age 57, presented to his physician with marked fatigue, nausea with occasional diarrhea, and...

Mr. Alvis, age 57, presented to his physician with marked fatigue, nausea with occasional diarrhea, and a sore, swollen tongue. Lately, he also has been experiencing a tingling feeling in his toes and a feeling of clumsiness. Microscopic examination of a blood sample indicated a reduced number of erythrocytes, many of which are megaloblasts, and a reduced number of leukocytes, including many large, hypersegmented cells. Hemoglobin and serum levels of vitamin B12 were below normal. Additional tests confirm pernicious anemia....

John, a 22 year old construction worker, presented to his primary care doctor with a swollen...

John, a 22 year old construction worker, presented to his primary care doctor with a swollen red spot on his upper back. John is overweight and has high blood pressure, for which he takes a diuretic daily. He works outdoors and since it is summer he gets hot and sweaty and will often change his shirt during the day at work. He states over the last few days he has had a sore spot on his back that has gotten...

A 50 year-old male patient presented to his physician with a resting blood pressure of 160/100....

A 50 year-old male patient presented to his physician with a resting blood pressure of 160/100. He had no other medical concerns. He was prescribed Losartan, 50mg per day. This medication is an angiotensin II receptor antagonist. Discuss how a drop in renal blood flow will result in the formation of angiotensin II, and why Losartan will prevent a blood pressure increase.

A 32-year-old Asian American construction worker visits his primary care physician with a 2-inch cut on...

A 32-year-old Asian American construction worker visits his primary care physician with a 2-inch cut on the anterior aspect of his right hand. He lacerated his hand while fixing a barbed-wire fence 5 days ago. He told his wife that he did not have time to go to his primary care provider for such a small cut. The primary care provider noted the wound bed to be erythemic, swollen, and with a small amount of purulent greenish drainage on the...

Question