| Category | Case study | Subject | Nursing |
|---|---|---|---|
| University | Middlesex University | Module Title | BMS4117 Clinical Disorders |
A female patient comes into the Accident & Emergency department complaining of chest pain which had started 20 minutes earlier. She is a 55 year old executive who is a diabetic and slightly overweight. She reports that she smokes 1 pack of cigarettes per day. She states that the chest pain began suddenly and feels like "an elephant is sitting on her chest". She is pale, diaphoretic, and has cyanotic lips. She states that she has also had some nausea.
| CK | 150U/L | Male 46-171, female 34-145 |
| CK-MB | 5 U/L | <3.9% total |
| Troponin I | 0.05 ng/ml | <0.1 ng/ml |
| Myoglobin | 60 ng/ml | 0-90 ng/ml |
| Alanine aminotransferase (ALT) | 130 U/L | 2.5-53 U/L |
Levels are measured 4 hours and 12h later and are as follows:
| 4 hours | 12 hours | Reference range | |
| CK | 200 U/L | 150 U/L | 15-160U/L |
| Troponin I | 0.9 ng/ml | 3.5 ng/ml | <0.1 ng/ml |
| Myoglobin | 170 ng/ml | 140 ng/ml | 0-90 ng/ml |
1. Discuss the risk factors that place this patient at risk for a myocardial infarction
2. Describe why some aspects of the case history suggests that this patient might not have presented with typical chest pain
3. Explain which OF THESE biomarkers is the most useful cardiac marker for this patient, and why.
4. Explain why the ALT level is raised here and what additional information it may provide here
Middlesex University Hospital is running a routine serum sodium for the local population. The assay includes 2 quality control samples in each run. The recent results from one of these QC samples is shown in the table below. The mean level expected for this QC sample is 150 mg/L and the standard deviation (SD) is 4.
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