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Project 5.1.1B Evidence Report #1
General Lab Tests
Blood work
Lab: Auto Differential
Test
Abbrev:
Test Full Name:
Purpose of
Test:
Normal
Range:
Result:
Patient 1
Result:
Patient 2
Result:
Patient 3
Result:
Patient 4
Result:
Patient 5
Neutro %
Percentage of
Neutrophils
40% - 60%
62%
70%
60%
64%
56%
Lymph %
Percentage of
Lymphocytes (T
cells and B cells)
Percentage of
Monocytes
Percent of
neutrophils in
the blood.
Percent of
lymphocytes in
the blood.
Percent of
Monocytes in
the blood.
Percent of
Eosinophils in
the blood.
Percent of
basophils in the
blood.
20% - 40%
35%
25%
33%
30%
40%
2% - 8%
2%
3%
5%
4%
2%
1% - 4%
0.5%
1.3%
1.5%
1%
1.1%
0.5% - 1%
0.5%
0.7%
0.5%
1%
0.9%
Mono %
Eosinophil
%
Percentage of
Eosinophils
Baso %
Percentage of
Basophils
Test
Abbrev:
Test Full Name:
Purpose of
Test:
Normal
Range:
Result:
Patient 1
Result:
Patient 2
Result:
Patient 3
Result:
Patient 4
Result:
Patient 5
WBC
White Blood Cell
Count
4,500 –
10,000
cells/mcL
17,000
68,000
15,600
9,400
21,000
RBC
Red Blood Cell
Count
Measures the
number of
WBCs.
Elevated levels
might indicate
an infection or
allergic
reaction.
Measures the
number of
RBCs to help
diagnose
anemia and
other conditions
affecting RBCs.
Measures the
amount of
hemoglobin in
the blood.
Males: 4.7 –
6.1 million
cells/mcL
5.0
5.0
4.9
5.7
4.7
15
10
14
16
12
52%
62%
54%
60%
47%
100,000
60,100
120,000
140,000
89,000
Lab: Complete Blood Count
Hgb
Hct
Platelet
Hemoglobin
Hematocrit
Platelet Count
Measures the
percentage of
RBCs found in
whole blood.
Measures how
many platelets
are in the
blood.
Females: 4.2
– 5.4 million
cells/mcL
Males: 13.8
– 17.2 gm/dL
Females:
12.1 – 15.1
gm/dL
Males:
40.7% 50.3%
Females:
36.1% 44.3%
150,000 400,000
platelets/mcL
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 1
Lab: Comprehensive Metabolic Panel
Test
Abbrev:
Test Full Name:
Purpose of
Test:
Normal
Range:
Result:
Patient 1
Result:
Patient 2
Result:
Patient 3
Result:
Patient 4
Result:
Patient 5
Glucose
Level
Glucose Level
< 100 mg/dL
67
88
70
72
72
BUN
Blood Urea
Nitrogen
7 - 20 mg/dL
21
32
19
18
24
Creatinine,
Serum
Creatinine,
Serum
0.8 to 1.4
mg/dL
2.0
2.5
1.4
1.3
1.8
GFR
Glomerular
Filtration Rate
90 - 120
mL/min
95
97
100
90
110
Calcium
Calcium
8.5 to 10.2
mg/dL
8.9
8.2
10.0
9.0
8.1
Protein
Level
Total Protein
Level
6.0 to 8.3
gm/dl
5.0
4.9
6.0
5.9
5.5
Albumin
Level
Albumin Level
3.4 - 5.4 g/dL
3.6
3.0
3.1
3.2
3.3
TBil
Total Bilirubin
0.3 to 1.9
mg/dL
0.6
1.2
1.0
1.5
0.8
AST
Aspartate
Aminotransferas
e
10 to 34 IU/L
11
11
15
33
31
ALT
Alanine
Transaminase
7 – 40 IU/L
15
34
31
22
21
Alk Phos
Alkaline
Phosphatase
44 to 147
IU/L
56
76
87
48
49
Sodium
Sodium
(Na+)
135 to 145
mEq/L
136
138
147
140
140
Potassium
Potassium (K+)
Measures the
amount of
glucose in the
blood.
Measures the
amount of urea
nitrogen in the
blood.
Measures the
amount of
creatinine in the
liquid part of
the blood.
Estimates how
much blood
passes through
the tiny filters in
the kidneys,
called
glomeruli, each
minute.
Measures the
total amount of
calcium in the
blood.
Rough
measure of all
the proteins
found in the
fluid portion of
your blood.
Specifically
looks at the
total amount of
two classes of
proteins:
albumin and
globulin.
Measures the
amount of
albumin (a
protein made
by the liver) in
the clear liquid
portion of the
blood.
Measures
bilirubin (a fluid
produced by
the liver) in the
blood.
Measures the
amount of AST
(an enzyme) in
the blood.
Measures the
amount of ALT
in the blood.
Measures the
level of alkaline
phosphatase in
the blood.
Measures the
concentration
of sodium in the
blood.
Measures the
3.7 to 5.2
4.0
4.3
3.8
3.9
5.0
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 2
amount of
potassium in
the blood.
Measures the
amount of
chloride in the
fluid portion
(serum) of the
blood
Measures the
level of
bicarbonate in
the blood.
mEq/L
Chloride
Chloride
96 - 106
mEq/L
100
98
96
105
98
CO2
Carbon Dioxide
20-29 mEq/L
25
25
22
27
21
Test
Abbrev:
Test Full Name:
Purpose of
Test:
Normal
Range:
Result:
Patient 1
Result:
Patient 2
Result:
Patient 3
Result:
Patient 4
Result:
Patient 5
Cholesterol
Total Cholesterol
Measures all
the cholesterol
and
triglycerides in
the blood.
Desirable:
Under 200
milligrams
per deciliter
(mg/dL)
185
170
205
220
159
70
55
89
42
40
56
65
78
35
50
103
90
100
125
89
Lab: Lipid
Borderline
high: 200 to
239 mg/dL
Triglyceride
s
HDL
Triglycerides
High-Density
Lipoprotein Test
Measures the
amount of
triglycerides in
the blood.
Measures the
level of HDL
cholesterol in
the blood.
High risk:
240 mg/dL
and higher
Normal: <50
High: >200
Males high
risk: < 37
mg/dL
Females
high risk:
<47 mg/dL
Low risk: >
59
LDL
Low-Density
Lipoprotein Test
Measures the
level of LDL
cholesterol in
the blood.
Optimal:
Less than
100 mg/dL
Near
Optimal: 100
- 129 mg/dL
Borderline
High: 130 159 mg/dL
High: 160 189 mg/dL
Very High:
190 mg/dL
and higher
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 3
Lab: Additional Blood Tests
Test
Abbrev:
Test Full Name:
Purpose of
Test:
Normal
Range:
Result:
Patient 1
Result:
Patient 2
Result:
Patient 3
Result:
Patient 4
Result:
Patient 5
TSH, High
Sensitivity
Thyroid
Stimulating
Hormone
Lactate
Dehydrogenase
Measures the
amount of TSH
in the blood.
Measures the
amount of LDH
in the blood.
Tests time for
plasma to clot.
Tests time for
blood to clot.
0.4 - 4.0
mIU/L
3.0
0.9
3.2
2.4
2.0
105-133 IU/L
145
245
180
142
130
11 - 14
seconds
25 - 35
seconds
17
18
15
15
18
35
44
30
35
40
LDH,
PT
Prothrombin
Time
Partial
Thromboplastin
Time
PTT
Urinalysis
Macroscopic Analysis
Color:
Clarity (transparency):




Normal urine should be a shade of yellow
ranging from a straw to amber color.
Abnormal urine can be colorless, dark
yellow, orange, pink, red, green, brown, or
black.
Normal urine should be clear.
Abnormal urine can be hazy, cloudy, or
turbid.
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 4
Chemical Analysis
Test:
Leukocytes
Nitrite
Urobilinogen
Protein
pH
Blood
Specific Gravity
Ketones
Bilirubin
Glucose
Normal Results:
Normal urine does not contain leukocytes.
Normal urine does not contain nitrites.
Normally present in urine in low concentrations. It
is formed in the intestine from bilirubin, and a
portion of it is absorbed back into the
bloodstream.
Normal urine levels of proteins (called albumin)
are very small, usually approximately 0 to 8
mg/dl.
Test measures whether urine is acidic, basic, or
neutral. Normal urine ranges from 4.6 to 8.0.
Normal urine does not contain blood.
Test measures the concentration of particles in
the urine and evaluates the body’s water
balance. The more concentrated the urine, the
higher the urine-specific gravity. The most
common increase in urine-specific gravity is the
result of dehydration. Normal urine ranges
between 1.002 to 1.028
Normal urine does not contain ketones, the
endpoint of rapid or excessive fat breakdown, in
the urine.
Normal urine does not contain bilirubin, a fluid
produced by the liver.
Normal urine does not contain glucose.
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 5
Microscopic Examination
Microscopic examination of urine was normal for all patients except for Patient 2. Red
blood cells, leukocytes, and some calcium oxalate crystals were observed in the urine
sample. A trace amount of red blood cells was detected in the urine of Patient 3 and
trace amount of leukocytes were present in the urine of Patient 5.
Normal:
 Presence of epithelial cells, as they are the
cells that line the urinary tract.
 Presence of a few crystals, including
calcium oxalate, triple phosphate crystals,
and amorphous phosphates.
Abnormal:
 Presence of red blood cells.
 Presence of white blood cells and bacteria,
signs of infections.
 Presence of a large number of crystals, or
certain types of crystals, may mean kidney
stones are present or there is a problem
with how the body is using food.
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 6
Clinical Exam Results
Patient Vital Signs
* Values displayed are the average value over a 24-hour period
Date
BP
Patient 1
5/17 5/19
5/21
Date
90/
70
110
80/
60
80
BP
Pulse
120/
84
90
Resp
22
22
Temp
103
103
Date
BP
Patient 4
5/19 5/20
Patient 2
5/15
5/16
5/17
Date
110/
65
105
80/
60
98
BP
Pulse
118/
70
110
27
Resp
24
26
99
Temp
103
5/21
Date
148/
100
125
100/
85
120
BP
Pulse
140/
90
90
Resp
24
28
Temp
101
100
Patient 3
5/1
5/3
5/4
Pulse
100/
74
75
100/
60
120
85/
60
118
30
Resp
20
21
25
102
100
Temp
102
104
100
Patient 5
5/25
5/26
5/27
Pulse
90/
70
80
80/
60
110
72/
50
105
30
Resp
23
25
28
102
Temp
104
103
100
Chart Notes
Due to high WBC counts, all patients were administered broad-spectrum antibiotics.
Patient 1
By second day of admission, patient experiences shortness of breath. By the end of the
day, patient shows signs of acute respiratory distress and requires mechanical
ventilation. Girlfriend shows similar disease progression – suspected person to person
transmission.
Patient 2
On third day of admission, patient begins coughing up yellow sputum with occasional
traces of blood. Oxygen saturation steadily decreases as the patient notes increased
difficulty breathing. Infection is not responding to antibiotics.
Patient 3
The patient’s fever begins to subside; however, patient now complains of severe
nausea and is experiencing frequent vomiting. Patient is extremely fatigued and dizzy
and passes in and out of consciousness. Renal function begins to decline. Physical
exam reveals several infected skin lesions.
Patient 4
Patient shows severe tachypnea. Fever remains high and the patient complains of
nausea. The patient complains of chest pain and overall muscle weakness and has
developed a dry cough. Supplemental oxygen administered.
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 7
Patient 5
The patient experiences vomiting and diarrhea. Blood pressure continues to drop, as
does heart rate. A cough begins to develop on the sixth day of admission. Oxygen
saturation dips below 90. Intubation may be necessary. Rash detected on arm. No
evidence of animal bites.
Heart Studies
Because of declining heart rate and apparent hypotension, a cardiac workup was
ordered for all five patients. EKG and echocardiogram results are found below.
EKG
The diagram below displays a normal EKG (electrocardiogram). An EKG is a graphical
recording of the electrical events occurring within the heart.



The P wave represents the start of the electrical journey as the impulse
spreads from the sinoatrial node downward from the atria through the
atrioventricular node and to the ventricles.
The QRS complex represents ventricular activation.
The T wave results from ventricular repolarization, which is a recovery of the
ventricular muscle tissue to its resting state.
Patients 1, 2, 3, and 5 all showed EKG results similar to those shown below.
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 8
Patient 4 presented with the EKG tracing shown at this link.
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cardio&part=A39&rendertyp
e=figure&id=A119
Echocardiogram
In an echocardiogram, ultrasound or sound waves are used to monitor blood flow in the
heart and create a moving picture. Doctors can monitor blood movement through the
valves and measure overall blood flow to and from the chambers.
Echocardiogram confirms decreased cardiac output in Patients 1, 2, and 4. Cardiac
function is depressed and cardiac output does not seem to respond to the fluid
challenge.
EMG
Each patient complained of some type of muscle weakness, soreness, or pain. An
electromyography, EMG, was performed on all of the patients to check the health of the
muscles and the nerves that control the muscles. Thin needle electrodes were placed
through the skin into patients’ affected muscles, which picked up the electrical activity
given off by the muscles. The EMGs were conducted with repetitive stimulation at 20 50 Hz. Once the electrodes were in place, the patients were asked to contract the
affected muscles. All five patients’ EMGs showed results in the normal range.
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 9
Imaging Results
Because of patient shortness of breath and tachypnea, lung studies were ordered for all
five patients. A normal chest x-ray is shown below. Darker shadows represent the airfilled lungs. Solid, dense, or fluid-filled structures appear white.
All Patients showed similar lung films. Scans from Patient 2 are displayed for analysis.
Compare both the initial and repeat scan to the normal chest x-ray and note any
differences on the Evidence Log.
Initial scan – 2 days post admission
Heart size appears normal. Scan shows minimal changes of interstitial pulmonary
edema.
Repeat scan – 3 days post admission
Heart size appears normal. Scan shows interstitial edema progressing to alveolar
edema. Progression is rapid. Pleural effusions are visible.
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 10
Pathology Report
A patient admitted last week died of similar symptoms. Relevant findings from the
autopsy report are described below.
Internal organs appear normal. Changes are visible in the lungs. Grossly, the lungs are
dense, rubbery, and heavy, usually weighing twice as much as the average lung. They
are often found floating in a pool of yellow serous fluid within the pleural cavity.
Obtain a microscope slide of normal lung tissue from your teacher. View the slide under
the microscope. Draw what you see. Note the appearance of the alveoli, the air sacs.
Compare what you see in the normal slide to the patient tissue sample shown below in
the low power photomicrograph. Describe any differences in the Evidence Log.
No evidence of viral pneumonia or of common bacteria and viruses that attack the lungs. Microscopic
examination of lung tissue shows interstitial pneumonitis and intraalveolar edema.
Image courtesy of Special Pathogens Branch, Division of Viral and Rickettsial Diseases, National Center
for Infectious Disease, CDC.
**The full citation can be found in the lesson document and the associated teacher resources.
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 11
Case Map
You have put out an alert to other hospitals around the country. Doctors have been
asked to review their records from the past two years and evaluate whether any of their
patients have experienced unexplained respiratory illness resulting in death, with an
autopsy examination demonstrating noncardiogenic pulmonary edema without an
identifiable cause. Data begins to pour in and you categorize the information into a map
that displays the number of suspected cases by state.
US Cases of the “Mystery Illness”
Of the reported cases, 65% are male. 75% of the reported cases are White, 15% are
American Indian, 7% are Black, and 3% are Asian.
© 2011 Project Lead The Way, Inc.
Biomedical Innovation Project 5.1.1B Evidence Report #1 – Page 12