Mary Keeper’s Aching Head by Brent J.F. Hill
Part II—The Follow-up Visit
Scenario
Mary has been on “pins and needles ” the past week waiting for her blood results. Finally, Dr. Nee knocked, entered the examination room, and pulled a stool over to Mary. He sat down next to her and opened the manila folder labeled “Keeper, Mary—Blood Results.” On her results were asterisks by her T3 and T4 values. Upon looking at those asterisks, Dr. Nee told Mary that she might be suffering from an endocrine dysfunction and that some additional blood work would help with the diagnosis.
Blood Lab Results
Abbreviated Blood Chemistry
- Total cholesterol: 269 mg/dL
- Osmolality: 280 mOsm/kg/water
- Urea nitrogen: value is within normal limits
- Calcium: value is above the normal limits
Blood Thyroid
- T3-total: value is above the normal limits
- T4-free: value is above the normal limits
- T4-total: value is above the normal limits
- TBG: value is above the normal limits
- TSH: undetectable
Blood Endocrine
- ACTH: value is below the normal limits
- Beta-hCG: value is normal for a non-pregnant female
- Prolactin: value is within normal limits
Physician Comments
Additional hematology tests are ordered and a follow-up appointment is arranged for the following week.
Objectives for Your Group
- Identify the most important “learning issues ” (these are hypotheses, concepts, and ideas) from both Parts I and II that you need to investigate to diagnosis the causes for Mary’s symptoms.
- Divide up the “learning issues ” for each group member to investigate.
- The group leader will need to turn in a list of your “learning issues ” and those group members assigned to each one.
Part II Individual Report
- Define terms and concepts you don’t understand while investigating your “learning issue.”
- Thoroughly explain your “learning issue.”
- Do you have a different hypothesis about the case after investigating your “learning issue”? Provide the reasons or evidence for the change in your thinking, or for why you still consider your initial hypothesis to be the most valid one.
- Cite all the sources you used. Make sure that you include in-text citations as well as a bibliography at the end of your report.
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