CASE STUDY DISCUSSIONS*)% W^dad\nd[Y^hZVhZ
two years ago she still has a higher risk of lung cancer than somebody
who has not smoked. Since she gave up smoking she would still have been
passively inhaling smoke from her husband’s cigarettes.DISCUSSION OF CASE STUDY 17.3
Fatigue and lethargy in an adolescent boy is not in itself unusual but the
leukocytosis might indicate an infectious disease such as glandular fever.
The bruising and anemia are more worrying signs, especially as blast cells
were seen, and may well indicate that Giles has developed a leukemia. Acute
lymphoblastic leukemia is more common in children than adults and could
be confirmed by microscopic examination of a sample of his bone marrow.
Further tests include immunohistochemical staining of leukocytes in order
to ascertain whether ALL is present and if it is a B or a T cell leukemia.CHAPTER 18
DISCUSSION OF CASE STUDY 18.1
The high random plasma glucose is diagnostic of diabetes mellitus type 2.
The classic symptoms of polyuria and polydipsia of diabetes are not always
present in the elderly where the renal threshold for glucose is often elevated
due to a decline in the glomerular filtration rate. This may be due to declining
renal function with age, but can be made worse by the presence of renal
failure, which is a chronic complication of diabetes.DISCUSSION OF CASE STUDY 18.2
Harry is possibly (probably?) suffering from early stage Alzheimer’s disease.
He and his family should be advised of this and its consequences. He could
be treated with acetylcholinesterase inhibitor therapy but this will only delay
the progress of the symptoms.