Example Case Study Questions 2 PDF

Case Study Question: Liver Function Diseases Scenario: A 56-year-old male presents to the clinic with complaints of fatigue, jaundice, dark urine, and abdominal discomfort. His medical history includes heavy alcohol use for the past 20 years. On examination, he has scleral icterus and palpable hepa...

Case Study Question: Liver Function Diseases Scenario: A 56-year-old male presents to the clinic with complaints of fatigue, jaundice, dark urine, and abdominal discomfort. His medical history includes heavy alcohol use for the past 20 years. On examination, he has scleral icterus and palpable hepatomegaly. Initial laboratory tests reveal elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, along with an increased alkaline phosphatase level. Question: Based on the presented symptoms and laboratory findings, what is the most likely diagnosis, and what further tests would be appropriate to clarify the diagnosis and assess liver function? Answer: The clinical presentation suggests the most likely diagnosis is alcoholic liver disease, particularly alcoholic hepatitis or cirrhosis, given the patient's history of heavy alcohol consumption. Further Tests: 1. Liver Function Tests (LFTs) : To assess the overall functioning of the liver and note if bilirubin levels are elevated, which could indicate cholestasis. 2. Complete Blood Count (CBC) : To evaluate for signs of anemia or thrombocytopenia which can occur in chronic liver disease. 3. Coagulation Profile : To assess for coagulopathy, which might be impaired in liver disease. 4. Serum Albumin : To evaluate the synthetic function of the liver. 5. Imaging Studies : An ultrasound of the abdomen can help assess liver architecture and detect any focal lesions or ascites. 6. Liver Biopsy (if indicated): To confirm the diagnosis and evaluate for the degree of fibrosis or cirrhosis. These tests will help validate the diagnosis of liver disease and guide appropriate management strategies while also allowing assessment of the degree of liver damage. Case Study Question: Liver function diseases A 52-year-old male presents to the clinic with complaints of fatigue, jaundice, and abdominal discomfort. On further examination, the patient also noted dark urine and clay-coloured stools. His medical history is significant for chronic alcohol use and non- compliance with prescribed medications for hypertension. Laboratory tests reveal the following results: Total Bilirubin: 4.5 mg/dL (normal: 0.1-1.2 mg/dL) Alkaline Phosphatase: 300 U/L (normal: 44-147 U/L) Alanine Aminotransferase (ALT): 120 U/L (normal: 7-56 U/L) Aspartate Aminotransferase (AST): 150 U/L (normal: 10-40 U/L) Gamma-Glutamyl Transferase (GGT): 75 U/L (normal: 9-48 U/L) Hepatitis A, B, and C serologies: Negative Serum Albumin: 3.2 g/dL (normal: 3.5-5.0 g/dL) Prothrombin Time: 15 seconds (normal: 11-13 seconds) Based on the information provided, what is the likely diagnosis, and what further investigations should be conducted to confirm your diagnosis and assess the severity of the liver disease? Case Study Answer: Based on the laboratory findings and clinical presentation of jaundice, fatigue, dark urine, and clay-colored stools, the most likely diagnosis is cholestatic liver disease. The elevated levels of total bilirubin, alkaline phosphatase, and bilirubin suggest an obstruction in the bile duct system or intrahepatic cholestasis. Given the patient's history of chronic alcohol consumption, alcohol-related liver disease or primary biliary cholangitis should also be considered. To confirm the diagnosis and evaluate the severity of the liver disease, the following further investigations are recommended: 1. Ultrasound of the Abdomen: This imaging study will help identify the presence of gallstones, biliary obstruction, or liver lesions. 2. Magnetic Resonance Cholangiopancreatography (MRCP): If ultrasound findings suggest biliary obstruction, MRCP can provide a detailed view of the biliary tree.  3. Autoimmune Markers: Since the serologies for viral hepatitis are negative, testing for autoimmune hepatitis (e.g., anti-nuclear antibodies (ANA), anti- smooth muscle antibodies (ASMA)) could be indicated. 4. Transaminases and Comprehensive Metabolic Panel: To further assess liver function and rule out any additional causes of the liver disease. 5. Liver Biopsy: If non-invasive tests are inconclusive or if there is a need to evaluate the extent of liver damage, a liver biopsy might be performed. These investigations will provide insight into the underlying cause of the liver dysfunction and help guide appropriate management for the patient. Case Study Question: Kidney function diseases A 45-year-old woman presents to the emergency department with complaints of persistent headaches, shortness of breath, and swelling of her legs and ankles. She reports a recent increase in urination, particularly at night (nocturia). Her medical history is significant for obesity and type 2 diabetes mellitus. The physical exam reveals hypertension (BP 160/95 mmHg) and bilateral pedal oedema. Laboratory tests yield the following results: Serum Creatinine: 2.1 mg/dL (normal: 0.6-1.2 mg/dL) Blood Urea Nitrogen (BUN): 35 mg/dL (normal: 7-20 mg/dL) Estimated Glomerular Filtration Rate (eGFR): 40 mL/min (normal: >90 mL/min) Urinalysis: Protein: 3+ (normal: negative) Hematuria: 2+ (normal: negative) Glucose: negative Serum Electrolytes: Potassium: 5.5 mEq/L (normal: 3.5-5.0 mEq/L) Sodium: 138 mEq/L (normal: 135-145 mEq/L) What is the likely diagnosis, and what further tests or management strategies should be employed? Case Study Answer: Based on the clinical findings and laboratory results, the most likely diagnosis for this patient is chronic kidney disease (CKD) due to diabetic nephropathy. The presence of hypertension, elevated serum creatinine and BUN levels, decreased eGFR, significant proteinuria, and hematuria are indicative of kidney dysfunction. The patient's type 2 diabetes and obesity further increase the likelihood of diabetic nephropathy as the underlying cause. Further Tests: 1. Urine Protein-to-Creatinine Ratio: To quantify the degree of proteinuria and assess kidney function more accurately. 2. Renal Ultrasound: To evaluate kidney structure and size, and rule out any obstructive pathology or other abnormalities in the urinary tract. 3. Serum Anti-neutrophil Cytoplasmic Antibodies (ANCA) and Double-Stranded DNA: To rule out any autoimmune processes such as glomerulonephritis. 4. Lipids Profile: To evaluate cardiovascular risk and consider statin therapy. Management Strategies: 1. Blood Pressure Control: Initiation of an ACE inhibitor or angiotensin receptor blocker (ARB) would help manage hypertension while providing renal protection. 2. Glycemic Control: Tight control of blood glucose levels through lifestyle modifications and/or medications to slow the progression of diabetic nephropathy. 3. Dietary Modifications: Referral to a dietitian for a renal diet plan that may involve sodium restriction and protein moderation. 4. Monitoring: Regular monitoring of kidney function, blood pressure, and urine protein levels to assess disease progression. 5. Consider Referral to Nephrology: If the patient has persistent eGFR