20.2: Case Studies for the Final Lab Project

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Case Study A

A 66-year old female with a history of recurring urinary tract infections and multiple antibiotic therapies presents with frequency and urgency of urination, dysuria, suprapubic discomfort, unilateral costovertebral angle (CVA) tenderness, fever and chills, and nausea. She currently has a temperature of 103°F. A complete blood count (CBC) shows leukocytosis with a left shift. A urine dipstick shows a positive leukocyte esterase test, a negative nitrite test. Microscopic examination of centrifuged urine shows 30 white blood cells, as well as 7 red blood cells and 18 bacteria per high-power field.

Assume that your unknown is from the urine of this patient.

Case Study B

A 61-year old male who has type 2 diabetes, a history of alcoholism, and is a heavy smoker was admitted to the hospital with a leg wound that is not healing - for which he was previously treated for two weeks ago but was subsequently released against medical advice. He was brought to the ER by a brother who noticed he was febrile and appeared confused, disoriented, and anxious. He exhibits flushing and peripheral vasodilatation. He has a temperature of 102° F, a heart rate of 130 beats per minute, a respiration rate of 42 breaths per minute, a blood pressure of 90/40 mm Hg, a urine output of only 110 cc for the last 8 hours, and a total white blood cell count of 2500/µL with a marked left shift. Lactic acid levels measure 3.5 mmol/L.

Assume your unknown is from a blood sample.

Case Study C

A 78-year old female who for several days had a severe productive cough and chest pain when breathing deeply, is admitted to the hospital by her sister with whom she lives. Symptoms include confusion and agitation, difficulty in breathing, peripheral edema, and shaking and chills. She has a temperature of 96.1° F, a heart rate of 112 beats per minute, a respiration rate of 45 breaths per minute, a blood pressure of 105/60 mm Hg, and a total white blood cell count of 13,000/µL. chest X-ray reveals a right lower lobe infiltrate.

Assume your unknown is from a blood sample.