Biomedical Science Assignment: Clinical Case Analysis, Semester 1

This biomedical science assignment presents five clinical case studies, each requiring a detailed analysis of patient history, examination findings, differential diagnoses, and recommended laboratory tests. The cases cover a range of conditions, including atopic dermatitis, rheumatoid arthritis, iron deficiency anemia, type 2 diabetes, and celiac disease. For each case, the assignment explores key points in history taking, potential diagnoses, and the rationale behind them. It also identifies possible differential diagnoses and explains how to distinguish between them. Furthermore, the assignment specifies relevant laboratory tests, expected results, and pharmacological treatments, including adverse effects and contraindications. Finally, it delves into the underlying pathology of each condition and considers potential contraindications to assessment findings. The assignment demonstrates a comprehensive understanding of diagnostic processes and treatment approaches in biomedical science.

Running head: BIOMEDICAL SCIENCE 1
BIOMEDICAL SCIENCE
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Question 1
a) In the history and examination, some of the key points to consider for proper
diagnosis include; location of lesions, family history, and a genetic tendency of
development of allergic condition such as asthma. One should also consider the place
of residence of the client, gender, and socioeconomic status. Some of the conditions
or diseases are influenced by family history meaning that they run across the family
lineage. Place of residence influences the development of certain allergic diseases and
the presence of pets in a family may lead to allergies which may lead to the
development of a particular disease (Arkwright et al, 2013).
It is also important to consider the history of allergies to medications and foods. Some
diseases are associated with allergies to different nutrients such as proteins,
carbohydrates or vitamins. It is also essential to consider the type and location of
flexures or other patient manifestations. Nature and location of lesions help in making
a diagnosis since certain different diseases affect different parts of the body. For
example, in a condition like eczema the lesions are usually located on flexural
surfaces while in psoriasis they tend to be on extensor regions (Arkwright et al.,
2013).
b) The main diagnosis for this case is atopic dermatitis.
c) The most possible differential diagnoses are scabies, pemphigus foliaceus and contact
dermatitis. In atopic dermatitis, the levels of immunoglobulin E (IgE) are usually
normal to high while in contact dermatitis and pemphigus are usually normal and
slightly elevated in scabies. Eosinophilia is very common in scabies and atopic
dermatitis but very rare and uncommon in contact dermatitis and pemphigus foliaceus
(Arkwright et al., 2013).

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In atopic dermatitis, the eczema has a typical distribution and morphology, often
excoriated and pruritic while in contact dermatitis eczema is often localized. In
pemphigus foliaceus the eczema is superficial and atypical in seborrheic areas while
in scabies it involves the genitalia, finger webs and flexor wrists with typical burrows.
White dermographism is very common in atopic dermatitis and very rare in all the
three differential diagnoses. Pruritis is typical in both atopic dermatitis and scabies
and uncommon in contact dermatitis and pemphigus foliaceus. Additionally, atopic
dermatitis involves food and respiratory allergies but they are uncommon in the three
differential diagnoses (Katayama et al, 2014).
d) A blood test would be a recommendable laboratory test for atopic dermatitis whose
expected results would be high levels of immunoglobulin E (IgE) and eosinophils.
The second test is buccal swabs which should show mutations of Filaggrin gene
which leads to eczema. The third test would be a skin biopsy which would help in the
detection of other similar skin conditions such as psoriasis (Katayama et al, 2014).
e) The commonly used pharmacological agent for atopic dermatitis is tacrolimus
ointment whose adverse effects include; flu-like symptoms, headaches, itching,
redness, hypersensitivity, and burning. Its contraindications include allergies to
macrolide immunosuppressant and conditions like shingles, swollen lymph nodes,
malignant lymphoma, herpes simplex infection, incompatibility reaction after Bone
Marrow Transplant and skin conditions due to Herpes Simplex Virus (Arkwright et
al., 2013).
f) Atopic Dermatitis is attributed to complex interactions of environmental triggers,
genetic predispositions, and immune dysregulation. Disturbed epidermal barrier
causes dryness of the skin following high trans-epidermal loss of water hence
enhancing penetration of allergens and initiative substances into the skin. Allergies,

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deviation of immune responses and impairment of the innate immunity may also
contribute to development of atopic dermatitis (Katayama et al, 2014).
g) Contraindications to assessment findings include; placebo, age, genetic profile, and
environmental exposures.
Question 2
a) The key points to consider in history taking and examination include; signs and
symptoms, family history, social history particularly smoking, age and gender. There
are certain signs and symptoms which are specific to a particular condition. There are
some medical conditions which are common in a particular gender within a particular
age bracket. Social history like smoking is a risk factor for various health conditions.
Family history is also important since some of the health conditions are genetically
inherited and run across a family lineage (Gibofsky, 2012).
b) The main diagnosis is Rheumatoid Arthritis.
c) The most possible differential diagnoses include osteoarthritis, fibromyalgia and
systemic rheumatic disease. The common joints affected by rheumatoid arthritis
include metacarpophalangeal (MCP) and proximal interphalangeal (PIP) hand joints
at the base and middle of the finger, wrists (ulnar-styloid articulation), ankles,
shoulders, knees, elbows and the metarsophalangeal (MTP) joints at the toes
(Gibofsky, 2012).
Morning joint stiffness lasting for more than one hour is the hallmark of rheumatoid
arthritis. Osteoarthritis affects the distal interphalangeal joints and carpometacarpal
joint (at the thumb) and involves the Heberden’s nodes. Joint swelling in osteoarthritis
is bony and hard while in rheumatoid arthritis involves warm, soft, tender and boggy

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joints. Osteoarthritis also involves narrowing of the joint space following osteophytes
in bone remodeling and loss of cartilage (Choy, 2012).
Systemic rheumatic diseases present with systemic features like, dry mouth, rashes,
dry eyes, nephritis and myositis on top of joint inflammation and stiffness.
Fibromyalgia involve joint tenderness at non-articular sites and chronic pain with no
signs of synovitis like warmth, swelling and diminished range of motion (Choy,
2012).
d) C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR) and Rheumatoid
Factor tests. The tests would indicate positive rheumatoid factor, elevated CRP and
ERS.
e) NSAIDs such as ibuprofen would be used to relieve pain and inflammation. The
common adverse effects of ibuprofen include; blood in urine, low platelet count,
urinary tract infection, heartburn, constipation, dizziness and tinnitus. Its
contraindications include alcoholism, pregnancy, high blood pressure, gastrointestinal
bleeding, smoking, hypersensitivity, smoking and chronic kidney dysfunction or
disease (Choy, 2012).
f) Rheumatoid arthritis (RA) is an idiopathic chronic systemic inflammatory disorder.
External triggers such as cigarette smoking, trauma or infection stimulate the immune
system leading to an autoimmune reaction which results in synovial hypertrophy,
chronic inflammation of joints and other potential extra-articular manifestations.
Genetic susceptibility is also associated with the development of rheumatoid arthritis
(Gibofsky, 2012).
Question 3
a) The key points to note in the examination and history of this patient include signs and
symptoms, laboratory investigations, physiological status such as pregnancy, history

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of trauma which led to excessive bleeding, history of gastrointestinal disorders that
presents with bleeding and nutritional patterns. Some of the manifestations are
specific to particular diseases.
Low levels of ferritin (iron) in the blood are attributed to increased requirement of
iron in pregnancy, excessive loss in bleeding and poor dietary intake. Gastrointestinal
disorders may present with bleeding which leads to loss of iron following low levels
of ferritin in the blood (Naigamwalla, Webb, & Giger, 2012).
b) The main diagnosis for this case is Iron Deficiency Anemia (IDA).
c) The most possible differential diagnoses are anemia of chronic disease, beta
thalassemia minor, and sideroblastic anemia. Anemia of chronic disease is attributed
to chronic inflammatory, neoplastic, and infectious disorders such as tuberculosis,
endocarditis or osteomyelitis and it presents with reduced count of reticulocytes.
Sideroblastic anemia is commonly hereditary and induced by drugs (ant TBs) and
alcoholism (Naigamwalla et al., 2012).
Peripheral blood smear indicates marked poikilocytosis and anisocytosis with
normocytic normochromic microcytes and target cells. In Sideroblastic anemia, serum
ferritin is often elevated but in IDA serum ferritin is usually low. Beta thalassemia
minor is genetically inherited and presents with increased RBC count, uniformly
microcytic hypochromic RBCs without polychromasia in peripheral blood smear.
Biochemical tests indicate normal serum iron, transferrin saturation, serum TIBC, and
ferritin (Naigamwalla et al., 2012).
d) Deficient iron in the body leads to hypochromic and microcytic Red Blood Cells and
depletion of iron stores leading to low levels of serum ferritin of 8 ug/L against a
normal range of 20-220ug/L (Naigamwalla et al., 2012).

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e) The most common pharmacological agent used in treatment of Iron Deficiency
Anemia is ferrous sulfate whose common adverse effects include stomach upset and
cramping, constipation, diarrhea and bloody or black stool. Contraindications of
ferrous sulfate include hypersensitivity and conditions like burning stomach, ulcers,
ulcerated colon, hemolytic anemia, several blood transfusions, iron metabolism
disorders and diverticular disease (Camaschella, 2015).
f) Iron Deficiency Anemia is caused by various factors. Decreased iron intake especially
in the elderly, infants, decreased iron stores in babies whose mothers had iron
deficiency and poor nutritional intake are associated deficient amount of iron for body
physiological processes. Iron deficiency in the body results from increased/excessive
loss of iron through chronic gastrointestinal bleeding, excessive periods, infestation
by hookworms, and frequent/multiple pregnancy (Camaschella, 2015).
Decreased iron absorption of due to duodenal and stomach and malabsorption may
lead to iron deficiency. Increased iron requirements in pregnancy, adolescents and
growing children and infants may also contribute to deficiency of iron in the body.
Low levels of iron in the body are associated with dizziness, fatigue, poor
performance status, breathlessness and pallor (Camaschella, 2015).
g) Contraindications include severity, knowledge deficit of the client and low
socioeconomic status.
Question 4
a) The key points to consider in examination and history of the client in this case include
history of smoking, obesity, overweight, sedentary lifestyle, and chronic illnesses.
These factors could be the possible risk factors for the client’s main diagnosis.
Laboratory findings and investigations should also be considered in order to make a
differential diagnosis and the main diagnosis for the client. Manifestations should also

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be considered because some signs and symptoms are unique and specific to particular
health conditions (Forbes, & Cooper, 2013).
b) The main diagnosis for this case is severe type 2 diabetes.
c) The most possible differential diagnoses for type 2 diabetes are Latent Autoimmune
Diabetes in Adults (LADA), non-diabetic glycosuria and ketosis-prone diabetes.
Latent autoimmune diabetes in adults (LADA) occurs at an above 30 years on non-
obese clients. Insulin production gradually reduces within a timeframe of 7 months
and 5 years hence necessitating for insulin treatment. LADA is positive for one of the
antibodies such as ICAs, GAD65, IA-2, and insulin). Ketosis-prone diabetes is
idiopathic and involves variation in the degree of insulin deficiency while type 2
diabetes commonly involves insulin resistance, obesity and metabolic syndrome
(American Diabetes Association, 2014).
d) Total cholesterol level of 7.2 mmol/Lit and high LDL 4.8 (bad cholesterol) shows
obesity. The HbA1c 9% (high, normal-6.5%) shows the glucose levels of the patient
for the past three months indicating diabetes while the Lymphocytes count of 48%
was produced by the body in an effort to fight infections (Forbes, & Cooper, 2013).
e) The pharmacological agent for this condition would be metformin whose common
adverse effects include hypoglycemia, flatulence, abdominal pain, diarrhea and
weakness. Its contraindications include renal impairment, congestive heart failure and
hyposensitivity (American Diabetes Association, 2014).
f) Type 2 diabetes is attributed inadequate production of insulin leading to elevated
levels of blood glucose. It also results from insulin resistance whereby the body cells
such as the liver, muscle, and fat cells do not respond to insulin even at its high levels.
Triglycerides are broken down in the fatty cells to produce free fatty acids for

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generation of energy while the muscle cells which are deprived of an energy sources
fails to build up glycogen stores (Forbes, & Cooper, 2013).
g) The contraindications to the health assessment findings are severity and complexity of
the condition, genetic profile, religious/ cultural beliefs and norms of the client, and
level of knowledge of the client.
Question 5
a) In this case, the key points to consider in examination and history is serologic tests
and findings. Some tests are very specific for particular medical conditions. One
should also consider patient manifestations for differential diagnosis. One should also
consider genetics since there are some genes for particular disorders run across a
family lineage (Fasano, & Catassi, 2012).
b) The main diagnosis is celiac disease.
c) The most possible differential diagnoses are bacterial gastroenteritis, Crohn disease
and giardiasis. Manifestations of celiac diseases does not necessarily involve the
gastrointestinal system but the three diagnoses do. Giardiasis affects the small
intestine and presents with greasy floating stool on top of other gastrointestinal
manifestations such as flatulence, diarrhea, and dehydration (Fasano, & Catassi,
2012). Crohn disease and bacterial gastroenteritis are Inflammatory Bowel Disorders.
Crohn disease involves the entire alimentary canal from the mouth to the anus while
bacterial gastroenteritis affects intestines and the stomach. Autoimmune response in
celiac disease is specific to gluten. This acts as a hallmark for Celiac disease (Rubio-
Tapia, Hill, Kelly, Calderwood, & Murray, 2013).
d) Genetic and serology testing can be recommended for diagnosis of celiac disease.
Genetic testing would help in checking for Human Leukocyte Antigen (HLA-DQ2)
which is positive in celiac disease. On the other hand, serology testing would help in

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looking for antibodies in the blood since high levels of particular antibodies shows an
immune reaction to gluten protein. The most common antibody is anti-tissue
transglutaminase antibodies (Ig-tTG) (Fasano, & Catassi, 2012).
e) The most applicable pharmacological agent for celiac disease is Larazotide Acetate
whose common adverse effects are nausea, vomiting, constipation, abdominal
discomfort, and diarrhea. Contraindications of Larazotide Acetate is hypersensitivity
(Rubio-Tapia et al., 2013).
f) Celiac disease (CD) is an hereditary autoimmune gastrointestinal disorder. It is
usually triggered by exposure of genetically susceptible individuals to dietary gluten
which is a storage protein found in rye, wheat, and barley. CD is often characterized
by chronic inflammation of the mucosa of the small intestines leading to atrophy of
the villi and microvilli of the small intestines and subsequent malabsorption. Intestinal
manifestations are diarrheal and weight loss following malabsorption (Fasano, &
Catassi, 2012). The extraintestinal manifestations of CD include neuropathy, iron
deficiency anemia, decreased bone mineral density. Most cases of celiac disease are
diagnosed in persons with extraintestinal manifestations. It does not necessarily
involve the gastrointestinal system (Fasano, & Catassi, 2012).
g) Contraindications include client’s genetic profile and socio-cultural beliefs and norms
of the client.

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References
American Diabetes Association. (2014). Diagnosis and classification of diabetes
mellitus. Diabetes care, 37(1), 81-90.
Arkwright, P. D., Motala, C., Subramanian, H., Spergel, J., Schneider, L. C., & Wollenberg,
A. (2013). Management of difficult-to-treat atopic dermatitis. The journal of allergy
and clinical immunology: In Practice, 1(2), 142-151.
Camaschella, C. (2015). Iron-deficiency anemia. New England journal of medicine, 372(19),
1832-1843.
Choy, E. (2012). Understanding the dynamics: pathways involved in the pathogenesis of
rheumatoid arthritis. Rheumatology, 51(5), 3-11.
Fasano, A., & Catassi, C. (2012). Celiac disease. New England Journal of Medicine, 367(25),
2419-2426.
Forbes, J. M., & Cooper, M. E. (2013). Mechanisms of diabetic complications. Physiological
reviews, 93(1), 137-188.
Gibofsky, A. (2012). Overview of epidemiology, pathophysiology, and diagnosis of
rheumatoid arthritis. The American journal of managed care, 18(13), 295-302.
Katayama, I., Kohno, Y., Akiyama, K., Aihara, M., Kondo, N., Saeki, H., ... & Nakamura, K.
(2014). Japanese guideline for atopic dermatitis 2014. Allergology
International, 63(3), 377-398.
Naigamwalla, D. Z., Webb, J. A., & Giger, U. (2012). Iron deficiency anemia. The Canadian
Veterinary Journal, 53(3), 250.

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Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). ACG
clinical guidelines: diagnosis and management of celiac disease. The American journal of
gastroenterology, 108(5), 656.