PBL Sessions: Hematology Organ System - 1

Page 4

History of Present Illness:

Over the next day her headaches continue, and she has periods of mental confusion. She describes seeing irregular shaped flashing patterns of light across her visual fields (scintillating scotomata).

Further family history: She has a 22-year-old daughter who is an English major and to whom a Rhodes scholarship was granted. With her permission you access old medical records and find an autopsy report for her deceased husband that describes the following findings:

Figure 3: Cerebrospinal fluid, India ink test

Figure 4: Microscopic slide of meninges, with GMS stain

Additional laboratory findings on the patient show: WBC count 8820/microliter, Hgb 11.9 g/dL, Hct 36.0%, MCV 88 fL, platelet count 74,000/microliter, prothrombin time 12 seconds, partial thromboplastin time 28 seconds, creatinine 1.6 mg/dL, urea nitrogen 24 mg/dL, total bilirubin 3.8 mg/dL, and direct bilirubin 0.7 mg/dL.

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 do you think was the immediate cause of death on the autopsy report?

Stop !! Complete discussions and tasks before moving to the next page.