Case Studies in Biochemistry and Physiology

Case Study 1: A Director of International Affairs with Abdominal Pain and Concentration Issues

Case Study 1 

A 60-year-old male Director of International Affairs at a car manufacturing company has a consultation with his GP since he has been complaining of tiredness, lacking in energy and concentration. He was encouraged to see the GP after his wife noticed a change in his mental status and he had missed several important meetings both at home and abroad.

During his consultation, he admitted to the GP that these problems had arisen a few months back after visiting Singapore and Thailand for a business meeting. He also complained of a vague pain especially towards the right side of his abdomen and some loss of appetite. A general physical examination revealed a borderline enlargement of the liver. A blood sample was taken and the clinically relevant findings are reported below.

Q1. Give a detailed biochemical and physiological background to each of the tests and relate these to the patient’s symptoms. 60%)

Q2. Provide an explanation for the levels of glucose and uric acid observed in this patient. (25%)

Q4. What is your final diagnosis and can this patient be treated? If so, give an outline of your strategy for treating this patient. (15%)
 
Case Study 2

A 50 year old woman presented her herself to A+E at her local hospital. She was admitted with severe symptoms of general malaise and a significant loss in weight. She had no signs of palpable lymphendopathy or hepatosplenomegaly. However, there was a history of hypothyroidism and no sign or history of excess alcohol consumption. The patient was not receiving any vitamin B12 supplementation and the bone indicated megaloblastic changes. A range of laboratory tests were performed as stated below:

Q1. Determine the red cell count (state formula and show your calculations).  (10%)  

Q2. State the diagnosis.  (10%)

Q3. Using the information in the case study and from the laboratory tests, account for the vitamin B12 concentration. (40%)

Q4.  Why is the red cell count so low? (20%)

Q5.  Explain the treatment and how it would be monitored?  (20%)

Case Study 3 

A 28-year-old man went on a 3-month backpacking trip across India. He drank bottled water and reportedly ate well-cooked food in hotels and restaurants. While in India, his stools were looser than normal. In the week before his return, he developed frequent watery, nonbloody diarrhoea.

This settled enough for him to fly home. He immediately went to his doctor and a stool culture grew Campylobacter. His bowels improved over 10 days without treatment but 2 weeks after his return he developed more diarrhoea, with loss of appetite, bloating, nausea, fatigue, fever and flatulence.

For the first time his stools failed to flush away completely in the toilet and were particularly offensive in smell. He began to lose weight. His doctor requested three stool specimens for culture and also microscopy for ova, cysts, and parasites. One out of the three specimens contained Giardia cysts. He was treated with a course of metronidazole and his symptoms improved.

Questions:

Q1. What is the causative agent?    (15%)

Q2. What is the mode of transmission?      (15%)

Q3. What tests would you carry out upon the faeces samples?   (20%) 

Q4. How is the disease managed and prevented?  (20%)

Q5. Why do you think his bowels improved over 10 days without treatment after being diagnosed with Campylobacter, but 2 weeks after his return he developed more diarrhoea, with loss of appetite, bloating, and flatulence? (30%)