Case Histories

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Case Histories

• Dr. Essam H. Aljiffri

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• Case 1
• A 54-year-old man with a past history of
  myocardial infarction was admitted following the
  onset of acute central chest pain 3 h previously.
  The patient was given an intramuscular injection
  of an analgesic by his general practitioner
  before admission to the hospital. The results of
  his ECG were equivocal. The following serum
  enzyme results were obtained.
• Time CK (U/L) AST (U/L)
• On admission 1150 85
• After 24 h 560 40
• After 48 h 200 25
• 1) Do these results suggest that the patient had
  suffered a myocardial infarction?
• 2) What is the most likely abnormality?
• 3) What other analyte may be measured to confirm
  diagnosis ?

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• Case 2
• A 54-year-old woman presented to the accident
  room with acute abdominal pain of 4 h duration.
  The pain was epigastric and radiated through to
  the back. On examination the patient was
  distressed and hypotensive, and there was
  epigastric tenderness. Investigation showed that
  the serum amylase was 6500 U/L.
• 1) What is the most probable diagnosis?
• 2) What is the most likely abnormality?
• 3) What other analyte may be measured to confirm
  diagnosis ?

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• Case 3
• A 79-year-old man was investigated for abdominal
  discomfort and constipation. Investigations were
  unremarkable except for an abnormal alkaline
  phosphatase result which was detected in the
  liver function tests. These showed
• Bilirubin 17 umol/L
• ALT 42 U/L
• alkaline phosphatase 550 U/L
• The serum alkaline phosphatase isoenzyme
  determination showed an increase in the bone
  isoform.
• 1) What are the possible explanations for these
  findings?
• 2) What is the most likely abnormality?
• 3) What other analyte may be measured to confirm
  diagnosis ?

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• Case 4
• A 32year-old man decided to train for an amateur
  boxing match. He trained on his own and
  discovered, during the match, that he was not
  very well prepared. He was knocked out late in
  the fight and, upon regaining consciousness,
  experienced some tightness in his chest. He was
  taken to the hospital. Upon admission, the
  following abnormal laboratory results were
  obtained.
• Total CK 210 U/L
• LD 336 U/L
• AST 45 U/L
• ALT 47 U/L
• 1) What could be causing these enzyme elevations
  ?
• 2) How do you know from the laboratory data
  whether the
• man suffered a myocardial infarctions ?
• 3) When should these abnormal results return to
  normal ?