MEDISCOPE | ISSUE 2 | 02 DECEMBER 2020

THE CASE OF MR REID - PBL CASE
By Sethujah Gangatharan 12S
Mr Thomas Reid is a 66-year-old male who lives with his wife, Eleanor. Both his two children are going
through difficult divorces and so this has been causing him a lot of stress over the past few months. He
has been experiencing a feeling of breathlessness, a pounding in his chest and both these symptoms get
worse when he goes up the stairs. He found that he had to rest for a few minutes to catch his breath
after each step and often felt lightheaded. Eleanor became concerned after he nearly fainted one
morning, and took him to the hospital the next day for a check-up.
There, the doctors ran an ECG and took blood and urine samples. His serum creatinine was higher than
normal, and his urine was low in volume and very dark. His liver function and troponin levels were
normal however. Thomas had a raised BMI and his capillary refill time was more than 5 seconds. His
mouth and mucus membranes were very dry, and his legs were slightly swollen. His blood pressure was
80/50. His heart sounds were: I + II + 0 and there were fine crackles at the base of each lung.
The doctors decided to put Thomas on Warfarin and other medications to control his heart rate and
heart rhythm. He was given plenty of fluids and kept in hospital for monitoring. He started to feel better
however a few days later, as he was reaching for a glass of water on the table next to him, he realised
that he couldn’t move his right arm properly and he accidentally knocked the glass over onto the floor.
He also experienced tingling and numbness in his right hand and said that he felt as though he was
drunk, even though he had not had consumed any alcohol recently. He said to his doctors ‘I can’t see
much - I can’t see anything on the sides, top or bottom. I only see what’s exactly in front of me.’ The
doctors were alerted immediately, and Jack was taken for a CT scan of his head.
RESEARCH TASK:
1) Research what Serum Creatinine is and what it could help to diagnose.
2) Suggest why Jack’s liver function and serum creatinine had been checked and why his serum
creatinine was raised.
3) Thomas’ urine volume and colour showed that he was dehydrated. What could have been the cause of
this?
4) Find out the condition that Thomas describes when he says, ‘I can’t see much - I can’t see anything on
the sides, top or bottom. I only see what’s exactly in front of me.’
5) Research what his symptoms, i.e. the inability to move his right arm; tingling and numbness in right
hand; and a lack of clear, good vision could have been a result of.
6) Shown below are two MRI scans. The MRI on the left shows a healthy brain and an MRI on the right is
similar to Thomas’ MRI (note: it is not entirely accurate or exact). What do you think the MRI on the right
shows and thus what do you think happened to Thomas?
PBL CASE
7) Discuss the positives and negatives of a CT scan. Why was it used in this case?
8) Thomas was given thrombolytic therapy. Research what this therapy is used for and now rethink
question six - has your view on what could have happened to Thomas changed?
9) What are the impacts of chronic stress on health and wellbeing?
10) What other treatments and help could have been given to Thomas to help him manage his stress and
wellbeing?
THE ANSWERS TO THE PBL CASE WILL BE FEATURED IN THE NEXT ISSUE OF THE JOURNAL HOWEVER WE ARE
EAGER TO SEE EACH AND EVERY ONE OF YOUR ANSWERS SO PLEASE DO EMAIL THEM TO US!
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