ML Fiji National University by nikeborome


									   Medical Laboratory Science Program
ML440: Integrated Medical Science


Consists of two assessments:
Assessment 1:       15%
Assessment 2:       10%

Total weighting: 25%
Due Date: 10th September, 2010

ML440                      SHIVANJALI SHARMA   BMLS   1
ASSESSMENT 1                                                           15%/45 MARKS
Catherine S., a 50 year old woman, was seen in the A&E complaining of chest pain, which
was moderate to severe. She had been experiencing this pain for the past 6-7 weeks with
dyspnea on exertion. The pain however had become more frequent and severe with
constant pain and pressure for the last 2 – 3 days. She appeared anxious and complained
of weakness, sweating and nausea. Her laboratory results during admission are shown in
the following tables:

                                  CHEMISTRY RESULTS

                  DAY 1               DAY 4           DAY 6             REFERENCE
Na                136                 130             143               135- 145 mEq/L
K                 3.7                 4.3             3.9               3.6-5.0 mEq/L
Cl                94                  107             113               98-107 mEq/L
CO2               -                   24.0            23                24.0-34.0 mEq/L
Anion gap         -                   8.0             7.0               10-20 mmol/L
Glucose           319                 379             310               80-120 mg/dL
BUN               23                  81              99                7-24 mg/dL
Cr                0.9                 2.3             2                 0.5-1.2 mg/dL
Ca                9.7                 -               -                 8.5-10.5 mg/dL
Mg                -                   1.7             1.9               1.3-2.5 mEq/L
Chol              350                 -               -                 0-200 mg/dL
Trig              275                 -               -                 10-190 mg/dL
Bilirubin         0.2                 -               -                 0.2-1.2 mg/dL
AST               76                  -               -                 5-40 IU/L
ALP               84                  -               -                 30-157 IU/L
Total Protein     7.3                 -               -                 6.0-8.4 g/dL
Alb               4.1                 -               -                 3.5-5.0 g/dL
TSH               -                   -               0.72              0.49-4.67µ IU/L

                                 BLOOD GAS ANALYSIS

                              DAY 2                           REFERENCE RANGE
Arterial Ph                   7.20                            7.35-7.45
PCO2                          63.7                            35.0-45.0 mm Hg
PO2                           64.0                            75.0-85.0 mm Hg
HCO3 -                        25.4                            20.0-25.0 mmol/L
TCO2                          27.4                            21.0-27.0 mmol/L
Base excess                   -3.3                            -3.0-3.0 mmol/L
% Saturated                   86

Abbreviations: PCO2, partial pressure of carbon dioxide; PO2, partial pressure of oxygen;
TCO2, total CO2.

ML440                           SHIVANJALI SHARMA                                BMLS   2
                                     CARDIAC PROFILE

                 DAY 2       DAY 2           DAY 3         DAY 4          REFERENCE
TIME             12.25       20.35           12.15         7.15
CK               2461        2743            2117          973            24-170 IU/L
CK- MB           146.6       93.0            24.8          12.1           0.0-3.8ng/mL
Troponin I       4745.0      926.1           NT            NT             0.0-0.4ng/mL

NT- not tested

The ECG was performed and revealed an atrial flutter and the possibility of a true
posterior infarct and lateral ischemia. Her complete blood count indicated a mild
normocytic, normochromic anemia. The WBC was 18.6 X 109 / L (5-10 X 109 / L) on the day
following admission.


                             CATHERINE SPOONER             REFERENCE RANGE
Color                        Yellow                        Colorless to amber
Apperance                    Clear                         Clear
Specific gravity             1.018                         1.001-1.035
pH                           6.0                           5-7
Protein                      Neg                           Neg
Glucose                      2+                            Neg
Ketones                      Trace                         Neg
Bilirubin                    Neg                           Neg
Blood                        Neg                           Neg
Urobilinogen                 Normal                        Normal
Nitrite                      Neg                           Neg
Leukocyte esterase           Neg                           Neg
WBCs                         0-2/HPF                       0-5/HPF
RBCs                         0-1/HPF                       0-2 / HPF
Epithelial cells             Few squamous/ HPF             Few to moderate
Casts                        Neg                           Few hyaline
Bacteria                     Neg                           None

ML440                          SHIVANJALI SHARMA                                BMLS   3

   a. What chemistry test could be ordered from Catherine’s patient history and what are
      the collection times?                                                   (2 marks)

   b. What are the abnormal results in Catherine’s profile?                      (2 marks)

   c. From Catherine’s laboratory results, state the most possible diagnosis.    (1 mark)

   d. Discuss briefly the pathogenesis mentioned in part (c).                    (3 marks)

   e. Define the term isozymes. List the CK isoenzymes and the sites where they are
      found.                                                             (2 marks)

   f. How many hours after a myocardial infarction would you find an elevated CK and CK-
      MB? How long would they remain elevated?                               (2 marks)

   g. Define the CK relative index (RI). Calculate the CK-MB RI for all specimens with total
      CK and CK-MB.                                                             (2 marks)

   h. Discuss the trend of elevation for troponin I and T in post-infarction and also state
      the duration of their elevation.                                         (2 marks)

   i.   State the difference in specificity for myocardial damage between cardiac troponin I
        and cardiac troponin T?                                                 (2 marks)

   j.   State the possible cause leading to elevated AST in Catherine’s Chemistry profile.
                                                                                  (2 marks)

   k. Briefly discuss other biochemical /molecular biology test that can be used to detect
      MI. (Include in your answer the test used and its result interpretation). (5 marks)

   l.   Which acute reaction protein is rapidly gaining acceptance as an indicator of
        increased risk for AMI and stroke? State the advantage and disadvantage of using
        this protein as an indicator for AMI and stroke.                     (2 marks)

   m. What other medical problem/condition does this patient have? What laboratory
      values support your decision?                                    (2 marks)

   n. Do patients with the condition you described in the question (m) have a higher risk
      of MI or stroke than the general? Why or why not?                      (2 marks)

ML440                             SHIVANJALI SHARMA                                BMLS       4
   o. Is the elevated WBC consistent with Catherine’s condition?                  (2 marks)

During the week of Catherine’s admission, Lipid profile was performed on a 12 hour
fasting specimen, and the results are shown in the table below:

                                        LIPID PROFILE

                                CATHERINE S                     REFERENCE RANGE
CHOL                            345                             Recommended       (desirable):
                                                                <200 mg/dL
HDL CHOL                        45                              29-75mg/dL
TRIG                            270                             Recommended       (desirable):
                                                                <250 mg/dL

   p. State why a fasting time of 12- hours is preferable for Lipid profile.      (1 mark)

   q. List at least eight secondary conditions/ disorders associated with the abnormal
      results shown above. (Hint: elevated cholesterol)                      (3 marks)

   r. Given the above information, what is Catherine’s LDL cholesterol? Based on her
      LDLC, is she at high risk for coronary heart disease, moderate risk, or within the
      recommended (desirable) range?                                         (3 marks)

   s. i. If Catherine’s trig were 45 mg/dL, could the LDL be calculated? Why or why not?

                                                                                  (2 marks)

        ii. What would be the next step?                                          (1 mark)

   t. List at least 3 types of drugs used to treat this condition and their effect (how they
      work and what they lower or decrease).                                      (2 marks)

ML440                             SHIVANJALI SHARMA                                BMLS       5
ASSESSMENT 2:                                                                10%
Recombinant Proteins

Write a review on Recombinant proteins. Include in your write- up a description of the
recombinant proteins in general, its principles and method then proceed to write about a
recombinant protein of your choice. Describe the Biochemistry/ Molecular Biology of the
protein of your choice and its uses/ abuses.

Word Limit:                          700-900 words             (excluding reference)

For any queries, contact me on the following:

PHONE: 3311700 (1713) OR DIRECT: 3233713

ML440                            SHIVANJALI SHARMA                             BMLS    6

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