PBL Sessions: Immunologic Diseases


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Page 3

Laboratory Findings (James):Serum chemistries show sodium 145 mmol/L, potassium 4.3 mmol/L, chloride 109 mmol/L, CO2 26 mmol/L, creatinine 1.0 mg/dL, and glucose 77 mg/dL.

A CBC shows Hgb 15.1 g/dL, Hct 45.4%, MCV 90 fL, platelet count 258,000/microliter, and WBC count 6110/microliter with differential count of 60 segs, 2 bands, 25 lymphs, 10 monos, 2 eos, and 1 baso.

You explain to James that the rash probably started from an event that occurred 1 to 3 days before. James realizes that it probably resulted from his cleaning up the yard, including weed removal, on the property of the family where the RV was parked. You explain that his rash will probably subside in several days. James remarks that, if the course of the illness is half over, then you should charge only half of the usual fee for an office visit. When you tell him the recommended medication, he refuses a prescription and instead goes to the supermarket drug aisle.


Laboratory Findings (Sarah):Serum chemistries show sodium 143 mmol/L, potassium 4.2 mmol/L, chloride 107 mmol/L, CO2 27 mmol/L, creatinine 0.6 mg/dL, and glucose 80 mg/dL.

A CBC shows Hgb 14.4 g/dL, Hct 43.1%, MCV 83 fL, platelet count 266,000/microliter, and WBC count 8980/microliter with differential count of 63 segs, 4 bands, 20 lymphs, 12 monos, 1 eos.

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?

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