1. 1 Case Histories Dr. Essam H. Aljiffri

2. 2 Case # 1 A 54-year-old man with a past history of myocardial infarction was admitted following the onset of acute central chest pain 3 h previously. The patient was given an intramuscular injection of an analgesic by his general practitioner before admission to the hospital. The results of his ECG were equivocal. The following serum enzyme results were obtained. TimeCK (U/L)AST (U/L) On admission115085 After 24 h56040 After 48 h20025 1) Do these results suggest that the patient had suffered a myocardial infarction? 2) What is the most likely abnormality? 3) What other analyte may be measured to confirm diagnosis ?

3. 3 Case # 2 A 54-year-old woman presented to the accident room with acute abdominal pain of 4 h duration. The pain was epigastric and radiated through to the back. On examination the patient was distressed and hypotensive, and there was epigastric tenderness. Investigation showed that the serum amylase was 6500 U/L. 1) What is the most probable diagnosis? 2) What is the most likely abnormality? 3) What other analyte may be measured to confirm diagnosis ?

4. 4 Case # 3 A 79-year-old man was investigated for abdominal discomfort and constipation. Investigations were unremarkable except for an abnormal alkaline phosphatase result which was detected in the liver function tests. These showed: Bilirubin17 umol/L ALT42 U/L alkaline phosphatase550 U/L The serum alkaline phosphatase isoenzyme determination showed an increase in the bone isoform. 1) What are the possible explanations for these findings? 2) What is the most likely abnormality? 3) What other analyte may be measured to confirm diagnosis ?

5. 5 Case # 4 A 32year-old man decided to train for an amateur boxing match. He trained on his own and discovered, during the match, that he was not very well prepared. He was knocked out late in the fight and, upon regaining consciousness, experienced some tightness in his chest. He was taken to the hospital. Upon admission, the following abnormal laboratory results were obtained. Total CK 210 U/L LD336 U/L AST45 U/L ALT47 U/L 1) What could be causing these enzyme elevations ? 2) How do you know from the laboratory data whether the man suffered a myocardial infarctions ? 3) When should these abnormal results return to normal ?