Challenge Biomedical Science Immunology

Transcription

1 You and your team specialise in infectious disease. There is an emergency situation in Cambodia and doctors are baffled as their usual method of swab testing is not available at present. Six patients with similar symptoms have died and they now have 2 more cases. Other countries have reported similar cases. The government wants the help of your team in identifying the disease using your knowledge of infectious diseases. If the disease cannot be identified the situation may become much more serious and develop into a pandemic. In order to prevent this, the disease must be treated and stopped from spreading. The folder contains Jackie Montgomery s medical notes and some information on the disease. Jackie is currently in quarantine and is being monitored. Assign each of the results to your specialists and have them read the information and complete the task. Your team need to report back to you with their findings. Record them onto the Diagnosis Form. Your Team: 2 Doctors 2 X-Ray specialist (Radiographer) 2 Nurses 1Disease control officer 1 Team Leader

2 Write a description for each. Temperature: Respiration: Pulse: X- Ray: Others in family with similar symptoms: Other Findings: Team Diagnosis Patient: Jackie Montgomery Lab results will take a further 12 hours to inform you of the disease. You need to decide on the appropriate action to keep your staff and other patients in the hospital safe. Diagnosis: Reason: Further action needed:

3 Date: 21 st February Time: 15:05 Odyssey Hospital Belfast Name: Jackie Montgomery Age: 35 DOB: 12/05/70 Sex: Female Occupation: Poultry factory operative Case History 4 days ago patient experienced a fever, sore throat and a cough. She is now experiencing shortness of breath. Two other family members are experiencing symptoms as well as other workers. Vaccinations: Diphtheria, tetanus, pertussis (whooping cough) and polio. Measles, mumps and rubella (MMR) including this years Flu vaccination and BCG (Tuberculosis) Initial Examination Doctor Jaffa Complaints: Breathless at rest Diarrhoea

4 Nurses Patient Monitoring Information

5 Nurses Report Use the tables on the patient s temperature, respiration and pulse rate to plot out lines graphs on the graphs provided. How has each changed? Complete the report below when you have finished. Normal Body Temperature: 36.5 C 37.2 C Normal Pulse Rate: bpm (beats per minute) Normal Respiration rate: 15 to 20 breaths per minute. Please complete the report Full Name (Patient) Age Nurses Names(You) How did each change? Respiration Temperature Vital Signs Report Pulse Date: Consultants 1 Signature: Consultants 2 Signature:

6 Disease Control Officers Below are the current statistics for the unknown infectious disease. You need to think about how dangerous this disease is. To help you, using the highlighted numbers, draw a bar graph for the number of total cases each year and on the same graph compare it to the number of deaths. Then complete the report for your team leader World Health Organisation 12 th Nov 07 Country Total C D C D C D C D C D C D Azerbaijan Cambodia China Djibouti Egypt Indonesia Iraq Lao People's Dem.Rep Nigeria Thailand Turkey Viet Nam Total

7 Disease Control Officers Draw a bar graph using the information given. Key Complete the report Disease Control Officers Report Percentage of people who die after infection Number of countries affected Procedures needed:

8 X- Ray Specialists Report Go to the light boxes where you will see two X-Rays. A. Healthy patients lungs B. Jackie Montgomery s Lungs How To read a Chest x-ray Air in lungs will appear dark Fluid in lungs will appear white. (infection) Complete the report for your team leader Full name Age Consultants X-Ray Report What do you think of patients X-Ray compared to a normal X- Ray CHEST: Date Consultant 1 signature Consultant 2 signature

9 Doctors Blood Results Look at the results from the lab. Use the information below and note down the problems the patient may have. Leukocyte count (White Blood Cells) Low Level: due to the bone marrow producing fewer white blood cells. This may be caused by infection. Lymphocyte count (type of white blood cell) Low Level: lymphocytes help to make antibodies to fight disease. It can be caused by a number of things such as immune disorders, lupus, types of flu, burns and surgery. Haemoglobin (in red blood cells) Low level: therefore the transport of oxygen through the body isn t normal. A person with low haemoglobin is said to be anaemic. There is no one cause for this condition. Platelet count Low Level: vulnerable to bleeding even without injury. This can be brought on by viral infections or chemotherapy etc. Urea Nitrogen Low Level: indicates kidneys that are not working properly Creatinine High levels: shows the amount of waste is in you blood is high, therefore your kidneys aren t working properly.

10 Please complete Challenge Biomedical Science Doctors Blood Results Full Name (Patient) Age (Patient) Consultants Names (You) Laboratory Results Report (Circle correct word) LUEKOCYTE COUNT Decreased LYMPHOCYTE COUNT Increased Normal Decreased Increased Normal HEMOGLOBIN Increased Normal Decreased PLATLET COUNT Increased Normal Decreased UREA NITROGEN Increased Normal Decreased CREATINE Increased Normal Decreased Possible Date: causes include: Consultants 1 Signature: Consultants 2 Signature: Possible problems::

11 Urinalysis Urine tests are typically evaluated with a reagent strip that is briefly dipped into your urine sample. The technician reads the colors of each test and compares them with a reference chart. These tests are semi-quantitative; there can be some variation from one sample to another on how the tests are scored. ph : This is a measure of acidity for your urine. Specific Gravity (SG) : This measures how dilute your urine is. Water would have a SG of Most urine is around 1.010, but it can vary greatly depending on when you drank fluids last, or if you are dehydrated. Glucose: Normally there is no glucose in urine. A positive glucose occurs in diabetes. There are a small number of people that have glucose in their urine with normal blood glucose levels, however any glucose in the urine would raise the possibility of diabetes or glucose intolerance. Protein: Normally there is no protein detectable on a urinalysis strip. Protein can indicate kidney damage, blood in the urine, or an infection. Up to 10% of children can have protein in their urine. Certain diseases require the use of a special, more sensitive (and more expensive) test for protein called a microalbumin test. A microalbumin test is very useful in screening for early damage to the kidneys from diabetes, for instance. Blood: Normally there is no blood in the urine. Blood can indicate an infection, kidney stones, trauma, or bleeding from a bladder or kidney tumor. The technician may indicate whether it is hemolyzed (dissolved blood) or non-hemolyzed (intact red blood cells). Rarely, muscle injury can cause myoglobin to appear in the urine which also causes the reagent pad to falsely indicate blood. Bilirubin: Normally there is no bilirubin or urobilinogen in the urine. These are pigments that are cleared by the liver. In liver or gallbladder disease they may appear in the urine as well. Nitrate: Normally negative, this usually indicates a urinary tract infection. Leukocyte esterase: Normally negative. Leukocytes are the white blood cells (or pus cells). This looks for white blood cells by reacting with an enzyme in the white cells. White blood cells in the urine suggests a urinary tract infection. Sediment: Here the lab tech looks under a microscope at a portion of your urine that has been spun in a centrifuge. Items such as mucous and squamous cells are commonly seen. Abnormal findings would include more than 0-2 red blood cells, more than 0-2 white blood cells, crystals, casts, renal tubular cells or bacteria. (Bacteria can be present if there was contamination at the time of collection.) Complete Blood Count (CBC) The CBC typically has several parameters that are created from an automated cell counter. These are the most relevant: White Blood Count (WBC) is the number of white cells. High WBC can be a sign of infection. WBC is also increased in certain types of leukemia. Low white counts can be a sign of bone marrow diseases or an enlarged spleen. Low WBC is also found in HIV infection in some cases. (ed. note: The vast majority of low WBC counts in our population is NOT HIV related.) Hemoglobin (Hgb) and Hematocrit (Hct) : The hemoglobin is the amount of oxygen carrying protein contained within the red blood cells. The hematocrit is the percentage of the blood

12 volume occupied by red blood cells. In most labs the Hgb is actually measured, while the Hct is computed using the RBC measurement and the MCV measurement. Thus purists prefer to use the Hgb measurement as more reliable. Low Hgb or Hct suggest an anemia. Anemia can be due to nutritional deficiencies, blood loss, destruction of blood cells internally, or failure to produce blood in the bone marrow. High Hgb can occur due to lung disease, living at high altitude, or excessive bone marrow production of blood cells. Mean Corpuscular Volume (MCV) - This helps diagnose a cause of an anemia. Low values suggest iron deficiency, high values suggest either deficiencies of B12 or Folate, ineffective production in the bone marrow, or recent blood loss with replacement by newer (and larger) cells from the bone marrow. Platelet Count (PLT) : This is the number of cells that plug up holes in your blood vessels and prevent bleeding. High values can occur with bleeding, cigarette smoking or excess production by the bone marrow. Low values can occur from premature destruction states such as Immune Thrombocytopenia (ITP), acute blood loss, drug effects (such as heparin), infections with sepsis, entrapment of platelets in an enlarged spleen, or bone marrow failure from diseases such as myelofibrosis or leukemia. Low platelets also can occur from clumping of the platelets in a lavender colored tube. You may need to repeat the test with a green top tube in that case.

13

14

15 50 Respiration Rate Breaths per Minute Number of Hours

16 160 Challenge Biomedical Science Patients Pulse Rate Beats per Minute Number of Hours

17 Patient Temperature Over 24 hours of monitoring Temperature (Celsius) Number of Hours

18 Disease Smallpox H5N1 virus (Avian Flu) Tempera t-ure Increased Heart Rate Increased Respirati on Varies with different cases Increased Increased Increased Tuberculosis Increased Increased Increased Inhalation Anthrax Increased Increased Varies with different cases Measles Increased Increased Risk of complication s Other Symptoms Tiredness, headache, severe back pain, abdominal pain, vomiting, extreme thirst and rash. (Pustules on the skin) Cough, sore throat, muscle ache, eye infections, diarrhoea and vomiting Nausea, weakness, fatigue, rapid weight loss, cough and chest pain First symptoms resemble cold. Then severe breathing problems. First few days develop white spots in mouth. Rash, cough, red, watery eyes. Chest X-ray Clear Foggy Spots on lungs Fluid surround ing lungs Clear Treatment No cure. Only a vaccine discovered by Edward Jenner No highly effective treatment some drugs may inhibit the spread. Variety of drugs available. Need to be taken for 6 months. Vaccine available Antibiotics for approx. 60 days No cure but there is a vaccination available Contagio us Contagious Contagious Highly contagious No Contagious 4 days before and after rash appears Potentia l source of germ From others infected Infected birds From others infected Biological weapons attack From others infected Spread Droplets in the air sneezing and coughing From animals to humans. But may have mutated so able to spread from human to human Droplets in the air sneezing and coughing Anthrax spores in the air Droplets in the air sneezing and coughing Type of germ Virus Virus Bacteria Bacteria Virus