Mike L., a 47-year-old man, went to his physician for an annual physical that ha
ID: 238043 • Letter: M
Question
Mike L., a 47-year-old man, went to his physician for an annual physical that had been postponed for over 3 years. He had started his own business 4 years ago and had been extremely busy getting it established. Mike’s medical history indicated he was a nonsmoker, and his father and grandfather had histories of myocardial infarctions before age 55. Since she had not seen this patient in a number of years, the physician decided to order routine screening tests.
CHEMISTRY RESULTS:
Test
Patient Results
Reference Range
Sodium
143
136-145 mEq/L
Potassium
4.6
3.6-5.0 mEq/L
Chloride
104
101-111 mEq/L
CO2
29.0
24.0-34.0 mEq/L
Glucose
95
80-120 mg/dL
BUN
19
7-24 mg/dL
Creatinine
1.0
0.5-1.2 mg/dL
Bilirubin Total
0.5
0.2-1.2 mg/dL
AST
35
5-40 IU/L
ALP
70
30-157 IU/L
Total Protein
7.5
6.0-8.4 g/dL
Albumin
4.6
3.5-5.0 g/dL
Calcuim
8.5
8.5-10.5 mg/dL
Cholesterol
305
<200 mg/dL
URINALYSIS:
Macroscopic
Patient Results
Reference Range
Color
Yellow
Colorless to amber
Appearance
Clear
Clear
Specific Gravity
1.014
1.001-1.035
pH
6.0
5-7
Protein
Neg
Neg
Glucose
Neg
Neg
Ketones
Neg
Neg
Bilirubin
Neg
Neg
Blood
Neg
Neg
Urobilinogen
Normal
Normal
Macroscopic
Nitrite
Neg
Neg
Leukocyte esterase
Neg
Neg
1. Indicate the abnormal results
2. Which conditions listed for question 2 can the physician rule out with Mike’s medical history, physical examination, and current laboratory results?
3. What is the most probable cause of the abnormal result in this patient.
Test
Patient Results
Reference Range
Sodium
143
136-145 mEq/L
Potassium
4.6
3.6-5.0 mEq/L
Chloride
104
101-111 mEq/L
CO2
29.0
24.0-34.0 mEq/L
Glucose
95
80-120 mg/dL
BUN
19
7-24 mg/dL
Creatinine
1.0
0.5-1.2 mg/dL
Bilirubin Total
0.5
0.2-1.2 mg/dL
AST
35
5-40 IU/L
ALP
70
30-157 IU/L
Total Protein
7.5
6.0-8.4 g/dL
Albumin
4.6
3.5-5.0 g/dL
Calcuim
8.5
8.5-10.5 mg/dL
Cholesterol
305
<200 mg/dL
Explanation / Answer
1-Abnormal results are cholesterol being 305 mg/dL on the higher side.
2-If asked your medic whether heart illness lurks inaudibly inside you, probabilities are your medic will have no awareness. Besides repeatedly, an effort will be made to forecast your prospect by assessing normal cholesterol examinations.
-As a consequence, your jeopardy, like Marc’s, may be extremely miscalculated. There is marvelous overlay in LDL morals among people intended to have a heart attack and those who will not ever have one.
-Excluding at the extremes, who will grieve a heart attack and who will not, just by observing at cholesterol values. Cholesterol can be a valuable instrument in risk valuation.
-Numerous large trainings have established that cholesterol levels are connected statistically to the danger of heart illness. The advanced cholesterol levels (total and LDL), the superior the probability of heart disease.
3-The Manifold Risk Factor Intercession Trial, or MR FIT, presented that the probability of heart attack in the individuals with cholesterol levels in the maximum 20% was three times that of individuals whose intensities were in the lowermost 20%. The well-known Framingham probationary also exemplified this spectacle.