question archive Case Study: F

Case Study: F

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Case Study: F.C. is a 63-year-old African American male who presents to the emergency room with intense left upper quadrant pain radiating to his back and under his left shoulder blade. He states that he has had intermittent, upper abdominal pain for approximately three weeks, but that the pain has been increasing in severity during the last four days."


·  PCN = rash

·  Aspirin = hives and wheezing

·  Cats = wheezing

Review of Systems:

·  States that he has been feeling "very warm" and has experienced several episodes of nausea and vomiting during the past 72 hours.

·  Describes approximate 8-10 pound unintentional weight loss over the last 45 days secondary to intense post-prandial pain and some loss of appetite.

·  He has noted a reduction in frequency of bowel movements.

·  No complaints of diarrhea or blood in the stool.

·  No knowledge of any previous history of poor blood sugar control.

Physical Exam:

·  Vital Signs: 101.4oF, 120, 35, 85/60

·  General: an ill-appearing black male who appears his stated age. He is restless, sweating profusely, and he is bent over, holding his abdomen. He presents with abnormal vital signs.

·  Abdomen: soft and nondistended with voluntary guarding with diminished bowel sounds throughout. Pain with palpation across the entire abdomen, especially over the RUQ and epigastric regions. No rebound, masses, HSM, or bruits noted. + Cullen's sign. Negative Grey-Turner sign.


1)Patient Case Question: Would you order a CBC or a CBC with differential for this patient (choose one or the other) and why?

2)Patient Case Question: Would you order a renal panel (BMP) or a complete renal panel (CMP) (choose one or the other) and why? Discuss what you would be looking for specifically on the panel that you selected.

3)Patient Case Question: Would you order an amylase, lipase, or both for this patient? Explain to me why you made your decision.

4)Patient Case Question: What other electrolyte would you consider checking? There may be more than one, but I am looking at a very specific electrolyte relative to the disease process. Think about what is happening to the patient.

5)Patient Case Question: Would you order a troponin for this patient? Explain why you would or wouldn't.

6)Patient Case Question: Would you order an ECG for this patient? Explain why you would or wouldn't.

7)Patient Case Question: Are the negative Grey-Turner and Cullen's signs evidence of a good or poor prognosis?


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