Angela Cortez (AC) is a 17-year-old high-school senior who presents for a yearly physical at her mother’s insistence for evaluation of fatigue.

Angela Cortez (AC) is a 17-year-old high-school senior who presents for a yearly physical at her mother’s insistence for evaluation of fatigue.

Angela Cortez (AC) is a 17-year-old high-school senior who presents for a yearly physical at her mother’s insistence for evaluation of fatigue. The mother, who accompanies her today, notes that AC is “tired all the time.” AC states that this has been going on for several months and, when questioned further, she acknowledges irritability, tearfulness, decline in grades, and lack of enjoyment and participation in her usual activities (track team, choir). AC has had difficulty falling asleep at night. She has gained approximately 15 pounds over the past few months due to poor dietary habits (skips breakfast, late-night eating, French fries two to three times per week), and lack of physical activity.
AC acknowledges that she has been stressed due to her pending college applications, previous break up with her boyfriend, and loss of a valued part-time job. She has been sexually active in the past, but is not currently. She acknowledges infrequent alcohol and marijuana use, but denies substance abuse. She has been spending increasing amounts of time using the Internet, rather than engaging in social activities. AC acknowledges feelings of hopelessness and states that she feels that she “won’t amount to anything” unless she gets a college acceptance and a scholarship, yet she denies any thoughts of hurting herself. Her mother is very concerned about these behaviors.

1. Evaluate lab results to determine the actual and/or potential diseases for which patient is at risk (SEE LAB RESULTS), PLEASE REFER TO UPLOADED GRADING CRITERIA AS WELL.
2. Explain history and physical assessment results that contribute to ACs risk.
3. Cited lab results correlate with the assessment findings to help determine risk

Select Tests and Diagnosis Association Expert Feedback
Cushing’s syndrome
cortisol, urine
hypothyroidism
thyroid function tests (TFT)
substance use disorder
drug toxicology testing, urine
attention deficit hyperactivity disorder (ADD/ADHD)
depressive disorder
mononucleosis, Epstein-Barr virus (EBV)
complete blood count (CBC)
heterophile antibody test (mononucleosis spot)
anemia
complete blood count (CBC)
pregnancy
human chorionic gonadotropin (hCG), urine
suicidality
diabetes mellitus type 2
glycated hemoglobin (HbA1c)
glucose, blood (BG)
Test results

CBC
Name

Value

Units

Reference Range

White blood cells (WBCs)

6045

mm3

4,000-10,000

Red Blood Cell Count (RBC)

4.7

million/l

4.5-5.9(?), 4.0-5.2(?), adults

Hemoglobin (Hgb)

13.2

g/dl

14-18(?), 12-16(?), adults

Hematocrit (Hct)

40

%

42-54(?), 37-47(?), adults

Mean corpuscular volume (MCV)

92

fl

82-103, adults

Mean corpuscular hemoglobin (MCH)

30

m3

26-34, adults

Mean corpuscular hemoglobin concentration (MCHC)

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