PBL Sessions: Musculoskeletal Organ System


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Page 3

History of Present Illness:

A CBC shows WBC count 6320/microliter with differential count of 58 segs, 3 bands, 25 lymphs, 12 monos, 1 basophil, and 1 eosinophil, Hgb 12.4 g/dL, Hct 37.3%, MCV 82 fL, and platelet count 319,000/microliter. Serum chemistries show sodium 143 mmol/L, potassium 4.2 mmol/L, chloride 105 mmol/L, CO2 26 mmol/L, creatinine 1.1 mg/dL, glucose 131 mg/dL, calcium 8.2 mg/dL, phosphorus 3.3 mg/dL, total protein 5.5 g/dL, albumin 3.6 g/dL, alkaline phosphatase 100 U/L, AST 45 U/L, ALT 25 U/L, and total bilirubin 1.0 mg/dL.

Past medical history reveals that he had an appendectomy at age 22. He smoked a pack of cigarettes per day for 20 years, but stopped about 5 years ago with a nicotine patch, which he still uses.

Figure 1: Peripheral blood smear

Figure 2: Chest radiograph

Figure 3: Radiograph of hand

Tasks

  • What do these findings indicate?

  • What hypotheses explain these findings?

  • Explain your reasoning for the hypotheses you choose.

  • What learning issues are being identified?

  • What additional information might you request?

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