Question

Part I – Janice Johnson Janice is a 12-year-old female. She is in the 7th grade and has been on the swim team for the past four years. She is a good student and is generally a happy child. Lately, however, Janice’s mother has been worried about her daughter. Janice has been very irritable the past few months and at first Mrs. Johnson just chalked that up to her daughter becoming a teenager. But, in addition to the mood changes, Mrs. Johnson has noted a few other changes in her daughter—she is often too tired to attend swimming practice and has complained of feeling too weak to swim and of having headaches. Despite her decreased physical activity, Janice has been eating almost non-stop but has lost about 5 lbs; she is also drinking more than usual and has been vomiting frequently. Janice saw her primary care physician, and after running some tests, he sent Janice to Dr. Sim for follow-up. Some blood work and patient info is in her chart and details are listed below. Test | Result | Normal Range --- | --- | --- BMI (weight: 106 lbs Height: 5’4’’) | 18.2 | 18.5–24.9 Triglycerides (mg/dl) | 130 | < 150 High-density Lipoprotein (mg/dl) | 66 | ? 40 Low-density Lipoprotein (mg/dl) | 85 | < 100 Blood Pressure (mm Hg) | 110/70 | 90–120/60–80 Pulse | 60 | 60–100 Hematocrit (%) | 45 | 36–50 Hemoglobin (g/100 ml blood) | 12.8 | 11–14 Glucose (mg/dl) | 130 | 75–105 Sodium (mmol/L) | 142 | 135–145 Potassium (mmol/L) | 4.6 | 3.5–5.0 Questions 1. What symptoms is Janice experiencing? 2. Are any of her values on her chart outside normal ranges? If yes, which ones? 3. What additional information about Janice’s history would be useful in understanding her situation? Explain your answer. 4. What additional tests might assist in your understanding of your patient’s situation? Explain your rationale for your choice(s).

          Part I – Janice Johnson
Janice is a 12-year-old female. She is in the 7th grade and has been on the swim team for the past four years. She is a good student and is generally a happy child. Lately, however, Janice’s mother has been worried about her daughter. Janice has been very irritable the past few months and at first Mrs. Johnson just chalked that up to her daughter becoming a teenager. But, in addition to the mood changes, Mrs. Johnson has noted a few other changes in her daughter—she is often too tired to attend swimming practice and has complained of feeling too weak to swim and of having headaches. Despite her decreased physical activity, Janice has been eating almost non-stop but has lost about 5 lbs; she is also drinking more than usual and has been vomiting frequently. Janice saw her primary care physician, and after running some tests, he sent Janice to Dr. Sim for follow-up. Some blood work and patient info is in her chart and details are listed below.

Test | Result | Normal Range
--- | --- | ---
BMI (weight: 106 lbs Height: 5’4’’) | 18.2 | 18.5–24.9
Triglycerides (mg/dl) | 130 | < 150
High-density Lipoprotein (mg/dl) | 66 | ? 40
Low-density Lipoprotein (mg/dl) | 85 | < 100
Blood Pressure (mm Hg) | 110/70 | 90–120/60–80
Pulse | 60 | 60–100
Hematocrit (%) | 45 | 36–50
Hemoglobin (g/100 ml blood) | 12.8 | 11–14
Glucose (mg/dl) | 130 | 75–105
Sodium (mmol/L) | 142 | 135–145
Potassium (mmol/L) | 4.6 | 3.5–5.0

Questions
1. What symptoms is Janice experiencing?
2. Are any of her values on her chart outside normal ranges? If yes, which ones?
3. What additional information about Janice’s history would be useful in understanding her situation? Explain your answer.
4. What additional tests might assist in your understanding of your patient’s situation? Explain your rationale for your choice(s).

Part I – Janice Johnson
Janice is a 12-year-old female. She is in the 7th grade and has been on the swim team for the past four years. She is a good student and is generally a happy child. Lately, however, Janice’s mother has been worried about her daughter. Janice has been very irritable the past few months and at first Mrs. Johnson just chalked that up to her daughter becoming a teenager. But, in addition to the mood changes, Mrs. Johnson has noted a few other changes in her daughter—she is often too tired to attend swimming practice and has complained of feeling too weak to swim and of having headaches. Despite her decreased physical activity, Janice has been eating almost non-stop but has lost about 5 lbs; she is also drinking more than usual and has been vomiting frequently. Janice saw her primary care physician, and after running some tests, he sent Janice to Dr. Sim for follow-up. Some blood work and patient info is in her chart and details are listed below.

Test | Result | Normal Range
— | — | —
BMI (weight: 106 lbs Height: 5’4’’) | 18.2 | 18.5–24.9
Triglycerides (mg/dl) | 130 | < 150
High-density Lipoprotein (mg/dl) | 66 | ? 40
Low-density Lipoprotein (mg/dl) | 85 | < 100
Blood Pressure (mm Hg) | 110/70 | 90–120/60–80
Pulse | 60 | 60–100
Hematocrit (%) | 45 | 36–50
Hemoglobin (g/100 ml blood) | 12.8 | 11–14
Glucose (mg/dl) | 130 | 75–105
Sodium (mmol/L) | 142 | 135–145
Potassium (mmol/L) | 4.6 | 3.5–5.0

Questions
1. What symptoms is Janice experiencing?
2. Are any of her values on her chart outside normal ranges? If yes, which ones?
3. What additional information about Janice’s history would be useful in understanding her situation? Explain your answer.
4. What additional tests might assist in your understanding of your patient’s situation? Explain your rationale for your choice(s).

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