In your future profession, you will likely be working in an environment that focuses on the testing, diagnosis and treatment of human disease. The clinical biochemistry laboratory ensures an accurate diagnosis is developed to help inform the appropriate clinical management of the patient. This task is a little bit of basic clinical biochemistry and a pinch of clinical diagnosis/medical detective work in a case study format. For those of you familiar with the TV series “House M.D.” this is your opportunity to be a “Dr House”. The task will hopefully provide some “time on task” focussed learning on several important sections of clinical biochemistry.

Our Patient

Vol Demort is a 49 year old male who has presented to his GP, Dr Magoo, complaining of some joint aches and pains (particularly the hands) together with gradual weight loss, abdominal pains, weakness and lethargy, skin bronzing and impotence.  Whilst not diabetic, Vol does show mild metabolic syndrome symptoms despite the weight loss, with a slightly raised 2hr glucose tolerance test level.  Vol also indicates that he has been experiencing the occasional heart issue which appears to be random arrhythmias.  In a final detail, Vol also states that he has a red swelling and pain in the back of his right calf.  Dr Magoo clearly needs your help with this patient. He started by using Google and Wikipedia (not good) and progressed to ordering some tests and clinical measurements (better). In the initial round of testing he has missed some important clinically relevant indicators! You should explore several possibilities.

Vol may have more than one cause for his symptoms with several possibilities. Your task has two parts:

• Discuss each biometric/biochemical marker provided under the “clinical measurements” heading below and indicate if a value is outside the typical reference range and what an elevated or decreased reading for each of these markers could indicate (2000 words)
• Diagnose Vol's symptoms (combining the “clinical measurements” and patient description) and provide a recommendation on what further tests you would require to confirm your diagnosis if any. You will need to explain your reasoning and your answer will require at least five primary references (original journal articles) (1500 words)

Total 3500 words

Clinical measurements

• AST - 61 U/L (8-48)
• ALT - 62 U/L (7-55)
• Haemoglobin - 181 g/L (135-180)
• Haematocrit - 0.50 (0.38-0.52)
• MCV - 85 fL (84-99)
• MCHC - 32 g/dL (30-36)
• Fibrin D-dimer - positive 1.1 mg/L (less than 0.5)
• Activated protein C (APC) resistance test sensitivity ratio - 1.3 (2.0-3.4)
• Serum ferritin - 580 ug/L (20-300)
• Transferrin saturation - 68% (10-45%)

Where to start/structure?

A suggested layout is as follows -

Part 1 (2000 words)

• brief introduction paragraph to the assignment and scenario
• dedicate a paragraph to each of the “clinical measurements” and use textbook referenced content to examine the diagnostic importance of the measurements and what an elevated or decreased reading for each of these markers could indicate

Part 2 (1500 words)

• written assignment/review format in paragraphs
• combine the “clinical measurements” and patient symptoms/description to form a rational and supported diagnosis using primary reference material (5-10 journal articles)
• clearly state and articulate your diagnosis
• conclude this section and the assignment with suggestions for Dr Magoo on further testing to correctly confirm Vol’s diagnosis and typical treatments for this condition

The case study questions will be out of a total of 50 marks (3500 word limit).  You should consider the following points when developing your assessment task:

• clarity of expression (spelling and grammar)
• the inclusion of key facts, accurate up-to-date research (i.e. in the last ten years - where appropriate)
• correct referencing
• use of clear and appropriate diagrams

The use of information contained solely within the study or lecture notes will result in the awarding of a passing grade at best. In order to obtain higher marks, information from other sources will be required. Students who use relevant information from other sources in their assignments will be looked upon favourably. The failure to cite references in your assignment will result in your not achieving full value for your efforts. Those students, who plagiarise material from textbooks, internet sites or other student's work will be subject to the standard plagiarism procedures in operation at CQUniversity (remember that such plagiarism will easily be detected using Turnitin). Please refer to the CQUniversity Library website for correct referencing information. Further details will be available in the Assessment block for this item in the unit Moodle site. Total = 50 marks (3500 words) (to achieve full marks, aim for the following) -

Part 1 (25 marks) (2000 words)

• correct clinical description of the "Clinical measurements" provided, indicating what a decreased or increased level of each would indicate (one paragraph for each); correctly referenced from either textbook or primary reference material (journal articles); correctly written paragraphs. (20 marks)
• correctly written and proofed. (5 marks)

Part 2 (25 marks) (1500 words)

• demonstrated scientific review format with a supported clinical diagnosis (primary reference articles). (15 marks)
• referencing (contextual use of 5 primary journal articles). (5 marks)
• written expression and proofing. (5 marks)

The practical report will be evaluated in accordance with the detailed marking rubric available in the Assessment item block located in the unit's Moodle site. A brief overview of the assessment criteria are as follows:

Introduction (20 marks): The introduction should be between 500–700 words in length and will provide the reader with sufficient information to understand why this study was performed and also provide any essential background information (with references to journal articles or text books) that is needed for interpretation of the results and discussion. It should conclude with a specific aim of the study. As a general guide—approximately 3–6 paragraphs with important and interesting background information that has been correctly referenced.

Methods (10 marks): There is no need to completely rewrite the methods section in detail. This section should be a brief summary approximately 1-2 paragraphs in length (100-200 words).

Results (20 marks): This section should contain the experimental results in summary form (means/SD), presented in either tables or graphs, not both. It is not enough just to use tables and graphs—you must also state the results referring to the table or figure. All tables and figures must be labelled appropriately. There should be no interpretation of results in this section—just state the results observed! Leave any interpretation to the discussion (100-200 words).

Discussion (20 marks): This section should be between 500-700 words in length and will provide an analysis and interpretation of the results of the study. The implication of your results should be discussed, referring back to statements made in your introduction. Alternative explanations should be offered if necessary especially for negative or unexpected results. Errors could also be discussed.

References (5 marks): All articles or texts referred to in the report need to be listed in this section. Referencing style should follow either the “Vancouver" or "Harvard” style as listed in the unit profile.

Writing Style/Presentation (25 marks): Reports should be clearly written in full sentences (not point form) using correct spelling and grammar. Abbreviations should be explained when first used. Any diagram (added from reference material) must be of good quality and sources must be acknowledged appropriately. The use of scientific writing style is important—peruse scientific journal entries. Of particular importance is clarity of written expression (clearly stated ideas and outcomes). The document should be in scientific journal format with well designed figures, graphs and tables where appropriate.

Clarity of expression (spelling and grammar), the inclusion of key facts, accurate research, correct referencing, and clear diagrams will be important general criteria for performing well in this assessment item (see below for more detailed criteria and in the associated Assessment item block in the unit Moodle site). The use of information contained solely within the study notes/practical support information will result in the awarding of a passing grade at best. In order to obtain higher marks information from other sources will be required. Students who use relevant information from other sources in their reports will be successful. As a guide, between 8 to 10 journal articles should be used! The failure to cite references in your assignments will result in you not achieving full value for your efforts.

Online version of a traditional written examination - question will be manually marked.