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1) 80 year old patient with fever, dispnoea, vomiting and diarrhoea since two weeks (from medscape).
Laboratory results:
White blood cell count: 2500 cells/μL (reference range, 3500-10,500 cells/μL), with 65% neutrophils (reference range, 30%-60% neutrophils) and 18% bands
Hemoglobin: 5.8 g/dL (reference range, 12-15.5 g/dL)
Platelet count: 88,000 cells/μL (reference range, 150,000-400,000 cells μL)
Serum creatinine: 2.9 mg/dL (reference range, 0.6-1.2 mg/dL)
Serum urea: 54 mg/dL (reference range, 7-26 mg/dL)
Serum alanine aminotransferase: 124 U/L (reference range, 0-55 U/L)
Serum aspartate aminotransferase: 673 U/L (reference range, 5-34 U/L)
Serum bilirubin: 2.8 mg/dL (reference range, 0.2-1.2 mg/dL)
Serum lipase: 167 U/L (reference range, 8-178 U/L)
Serum lactate: 4.6 mmol/L (reference range, 0.5-2.2 mmol/L)
Serum ferritin: >21,000 ng/mL (reference range, 13-24 ng/mL)
Serum triglycerides: 385 mg/dL (reference range, <150 mg/dL)
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2) 50 year old patient with chronic liver cirrhosis presents with sudden abdominal distension and dispnoea (from medscape)
Laboratory findings:
Hematocrit 24%
platelet count 94,000 /μL
INR 1.95
total serum bilirubin 6.9 mg/dL (118 μmol/L)
fibrinogen 136 mg/dL (4 μmol/L)
serum potassium 2.9 mEq/L
lactate 26.1 mg/dL (2.9 mmol/L).
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3) 40 year old patient with weakness, fatigue, mental confusion, blood pressure 80/50 mmHg. Gradual onset since three months (from Merck).
Laboratory findings:
Hemoglobin 13 g/dL
sodium 125 mEq/L
potassium 5.7 mEq/L
sodium/potassium ratio 22 (normal value 30)
fasting glycemia 50 mg/dL
BUN 40 mg/dL
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4) 76 year old patient with fatigue, generalized weakness, lethargy, and > 10% unintentional weight loss. (from the Journal of Medical Case Reports)
Laboratory findings:
white blood cell count of 24,200 cells/μL (reference interval 4,000-10,000)
hemoglobin 12.6 g/dL (reference interval 12.0-15.0 g/dL)
platelets 119x103/μL (reference interval 150-450x103)
potassium 5.6 mmol/L (reference interval 3.5-5.0 mmol/L)
blood urea nitrogen (BUN) 55 mg/dL (reference interval 6-20 mg/dL)
creatinine 1.63 mg/dL (reference interval 0.80-1.20 mg/dL)
glucose 29 mg/dL (reference interval 64-100 mg/dL)
alkaline phosphatase 202 units/L (reference interval 20-130 units/L)
aspartate aminotransferase (AST) 273 units/L (reference interval 8-33 units/L)
alanine transaminase (ALT) 75 units/L (reference interval 4-36 units/L)
total bilirubin 2.1 mg/dL (reference interval 0.1-1.2 mg/dL) (direct bilirubin 1.7 mg/dL)
albumin 3.1 mg/dL (reference interval 3.4-5.4 mg/dL)
Hemogas analysis:
pH 6.93 (reference interval 7.35-7.45)
total CO2 7 mmol/L (reference interval 23-29 mmol/L)
lactate 19 units/L (reference interval 0-2 units/L)
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5) 9 months old baby (male) with stunted growth, pallor.
Laboratory findings:
hemoglobin 9 g/dL
erythrocytes 2.4x106/μL
mean corpuscular volume 106 fL (normal value 80-95 fL)
sodium 130 mEq/L
potassium 4.4 mEq/L
blood urea nitrogen (BUN) 15 mg/dL
creatinine 0.8 mg/dL
glucose 75 mg/dL
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6) Routine blood test in an asymtpomatic adult reveals:
Hemoglobin 11 g/dL
Erithrocytes 3x106/μL
Mean Corpuscular Volume MCV 73 fL (reference range 80-95 fL)
White Blood Cell 6,000/μL
Platelets 220,000/μL
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7) Routine blood test in an asymptomatic adult reveals:
Sodium 130 mEq/L
Potassium 4.2 mEq/L
Chloride 98 mEq/L
Triglycerides 140 mg/dL
Total cholesterol 380 mg/dL
Glycemia 85 mg/dL
BUN 16 mg/dL
Creatinine 0.7 mg/dL
Total bilirubin 0.8 mg/dL
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8) Fatigue and unintentional weight loss in a 67 years old patient.
Laboratory results of initial screening:
Hemoglobin 11.5 g/dL
Erythrocytes 3.2x106/μL
Mean Corpuscular Volume MCV 90 fL (reference range 80-95 fL)
White Blood Cell 3,500/μL
Platelets 180,000/μL
Sodium 134 mEq/L
Potassium 4.2 mEq/L
Chloride 102 mEq/L
Triglycerides 160 mg/dL
Total cholesterol 230 mg/dL
Glycemia 88 mg/dL
BUN 55 mg/dL
Creatinine 2.4 mg/dL
Total bilirubin 1.1 mg/dL
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9) Intense abdominal pain irradiating to the back in a young adult woman. Modest signs of peritoneal involvement.
Laboratory results of initial screening:
Hemoglobin 13.5 g/dL
Erythrocytes 4.0x106/μL
Mean Corpuscular Volume MCV 90 fL (reference range 80-95 fL)
White Blood Cell 8,500/μL
Platelets 240,000/μL
Sodium 138 mEq/L
Potassium 4.1 mEq/L
Chloride 101 mEq/L
Triglycerides 140 mg/dL
Total cholesterol 280 mg/dL
Glycemia 88 mg/dL
BUN 15 mg/dL
Creatinine 0.9 mg/dL
Total bilirubin 0.8 mg/dL
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10) 5-years old child with peripheral oedemas, overweight.. (from the Journal of the Int. Fed. Clin. Chem. and Laboratory Medicine)
Laboratory findings:
Sodium 131 mEq/L
Chloride 96 mEq/L
Potassium 4,6 mEq/L
Creatinine 0,6 mg/L
Protidemia 4,6 g/dL (serum albumin 2 g/dL; normal values 3.5-5 g/dL)
Total Cholesterol 340 mg/dL
Triglycerides 330 mg/dL
Fasting glycemia 110 mg/dL
PTT 48 s (normal values 24-30 s)
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11) Convulsive episode in a 70 years old woman.. (from the World J. of Pharm. Med. Res.)
Laboratory findings:
Hemoglobin 10.3 g/dL,
Platelet count was 150,000/μL
WBC 4,200/μL
Protidemia 4.8 g/dL (serum albumin 2.5 g/dL)
Sodium 130 mEq/L
Potassium 4.20 mEq/L
Fasting glycemia 70 mg/dL
BUN 28 mg/dL
Creatinine (serum) 1.35 mg/dL
Plasma ammonia 112µmol/L (reference range 9.00-30.00)
Total bilirubin 2.70 mg/dL (conjugated 1.7 mg/dL; unconjugated 1.0 mg/dL)
AST 37 U/L
Alkaline phosphatase (ALP) 115 U/L (ref. range 38-126)
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12) 15 years old boy with fever and seizure. A 15 years-old boy, was brought to emergency with a 10-day history of fever, severe headache, and generalized tonic clonic fits for one day, accompanied by an arching posture and nucal rigidity. His vitals were, BP: 90/55 mmHg, pulse: 140 beats per minute, temperature: 39oC, O2 saturation: 99% at room air. CNS examination revealed drowsy child with Glasgow Coma Scale of 10/15, increased muscle tone, reduced muscle power, brisk reflexes and positive Babinski. Upon auscultation of the chest harsh vesicular breathing sounds were detected. Examination of the abdomen and cardiovascular system (CVS) did not reveal any abnormalities.
Laboratory findings:
Red blood cells 4x106/mmc, normocytic normochromic
Hemoglobin 13.5 g/dL
Platelet count 330,000/mmc.
White cell count 21.000/mmc
Neutrophil count 85% of the total white blood cell count
C-reactive protein 19.6 mg/dL (normal value < 30 mg/dL)
Erythrocyte sedimentation rate 60 mm/h (normal value 15-20 mm/h)
Bilirubin 0.8 mg/dL
BUN 16 mg/dL
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13) 31 years old woman, post-partum hypertension and muscle weakness. A 31 year-old woman comes to the hospital 2 months after the delivery of her second child. She had a history of type 2 diabetes mellitus and hypertension in the past 2 years prior to her presentation. Refers an episode of falling and muscle weakness; presents tachypnea, tachycardia, and dyspnea. Vital signs were: blood pressure 155/100 mm Hg, heart rate: 130 bpm, and respiratory rate: 22 bpm, temperature: 39°C.
Laboratory findings:
Hemoglobin 12 mg/dL
Red cell count 3.5x106/mmc
White blood cell 11,000/mmc
Platelet count 130,000/mmc
Fasting glycemia: 315 mg/d
Blood gas analysis: pH: 7.5, bicarbonate: 44.7 mM, pCO2: 51.7 mm Hg
Electrolytes: K=2.7 mEq/L [normal range: 3.5-5.1 mEq/L]), Na=140 mEq/L, Cl=80mEq/L.
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14) Amenorrhea since 5 years, irsutism, incipient baldness in a 32 years old woman (from Medscape).
Laboratory results of endocrinological screening:
Dehydroepiandrosterone sulfate (DHEA-S): 193.2 µg/dL (reference range, 98.8-340 µg/dL)
Luteinizing hormone: 0.16 mIU/mL (reference range, 0.61-56.6 mIU/mL [depending on phase of menstrual cycle])
Follicle-stimulating hormone: 0.24 mIU/mL (reference range, 1.09-17.2 mIU/mL [depending on phase of menstrual cycle])
17-hydroxyprogesterone: 339 ng/dL (reference range, < 285 ng/dL)
Free testosterone: 176.3 pg/mL (reference range, 0.6-6.8 pg/mL)
Total testosterone: 673 ng/dL (reference range, 14-53 ng/dL)
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