Schulich School of Medicine Case Study
Case Study
Chapter 8: Schulich School of Medicine, pp. 210 – 212.
Schulich School of Medicine: Enhancing and Developing a High-Performance Culture, By Ken Mark and Murray J. Bryant
http://www.academia.edu/6138747/Introduction_to_the_SAGE-Ivey_Casebook_Series_viii_Preface_ix_Acknowledgments_xi
How would you help Rylett frame her in group /out group issues?
When you analyze the case be sure to apply the Ellet article’s case analysis process model you read in week 1.
1. Situation – Synopsis of the case
2. Type of case – Problem, evaluation, decision or rules
3. Questions – Questions your have about the case
4. Hypothesis – A clear one or two sentence statement (do not use the chapter theory as your hypothesis)
5. Proof and Action – Evidence from the case supporting your hypothesis
6. Alternative- An alternative action that has less supporting evidence from the case
Reference
Rowe, G., & Guerrero, L. (2013). Cases in leadership (3rd ed.). Thousand Oaks, CA, Sage.
Case Study Report
Introduction (Case study):
A 65 year old woman, Mrs Smith, presented at her GP surgery with fever, a cough and a very sore, swollen and suppurating big toe. Mrs Smith was a known type 2 diabetic and her weight was 74kg, height 5ft 4in. Following a medical examination the GP took two blood samples – one EDTA sample for a full blood count (FBC) and one clotted sample for C-reactive protein (CRP) measurement. The GP also took a swab of her toe and a sputum sample was collected. The GP asked Mrs Smith to return to the surgery after three days for repeat blood tests
Two weeks after beginning her course of antibiotics Mrs Smith returned to her GP surgery. Her chest infection and her toe were much better; however she now had a three day history of diarrhoea.
The results from Mrs Smith’s test are in the tables below. You will need to determine the susceptibility of the organisms using the BSAC standards given in the tables. Use the information in the following tables to complete the case study according to the instructions in the practical handbook and practical PowerPoints on Blackboard.
Results:
Table 1: Identification of the isolated organism from Mrs Smith’s (toe sample):
Cultural appearance Light yellow colour – ß hemolysis present
Gram stain Gram positive
Microscopic appearance Coccus, in clusters
Endospores Negative
Motility Non-motile
Catalase Positive
Oxidase Negative
Coagulase Positive
DNAse Positive
Fermentation of glucose Positive
Identification of organism Staphylococcus aureus
Table 2: Identification of the isolated organism from Mrs Smith’s (sputum sample):
Cultural appearance Dark and greenish colour under the colonies indicate (α hemolysis)
Gram stain Gram positive
Microscopic appearance Coccus, in chains
Endospores Negative
Motility Non-motile
Catalase Negative
Oxidase Negative
Optochin Sensitive
Fermentation of glucose Positive
Identification of organism Streptococcus pneumoniae
Table3: Identification of the isolated organisms from Mrs Smith’s (faeces sample): From XLD plate
Plates Organism 1 Organism 2
Cultural appearance Lactose fermenter, circular and raised colonies Non-lactose fermenter with black centres
Gram stain Gram negative Gram negative
Microscopic appearance Rod-shaped Rod-shaped
Endospores Negative Negative
Motility Motile Motile
Catalase Positive Positive
Oxidase Negative Negative
Fermentation of glucose Positive Positive
Identification of organism Escherichia coli Salmonella sp
Table 4: Antibiotic sensitivities for Mrs Smith’s (toe): Staphylococcus aureus
Antibiotics Zone diameter (mm) Resistant =<
BSAC Susceptible >
BSAC Result
Fusidic Acid (FC 10µg) 27 mm 29 29
Erythromycin (E 5µg) 21.5 mm 19 19
Gentamicin (GM 10µg) 19.5 mm 19 19
Penicillin (PG 1units) 30 mm 24 24
Table 5: Antibiotic sensitivity for Mrs Smith’s (sputum sample): Streptococcus pneumoniae
Antibiotics Zone diameter (mm) Resistant =<
BSAC Susceptible >
BSAC Result
Ampicillin (AP 10µg) 50 mm 17 17
Erythromycin (E 5µg) 30 mm 19 19
Cephalexin (CFX 30µg) 40 mm 23 23
Penicillin (PG 1units) 40 mm 24 24
Table 6: Antibiotic sensitivity for Mrs Smith’s (faeces sample):
Antibiotics Escherichia coli: zone diameter (mm) Salmonella: zone diameter (mm) Resistant =<
BSAC Susceptible >
BSAC Results
Ciprofloxacin (CIP1µg) 26 mm 32mm 16 20
Ampicillin (AP10µg) 30 mm 35mm 16 20
Ceftriaxone(CRO30µg) 34 mm 35mm 23 28
Cotrimoxazole(TS25µg) 22 mm 30mm 15 16
Table 7: Full Blood Count and ESR results
Samples Day 1 (FBC) Day 3 (FBC)
Red cell parameters Normal Normal
White cell count 11.5×109/l 15×109/l
Blood film Showed neutrophilia Showed neutrophilia with many immature neutrophils
ESR (mm) 20mm 24mm
Table 8: CRP ELISA results
Standard curve
CRP standard concentration (mg/L) Result 1 Result 2 Result 3 Mean Result
0 0.07 0.08 0.09
1 0.12 0.16 0.14
3 0.46 0.48 0.50
10 0.93 0.97 0.95
30 1.36 1.35 1.37
100 1.66 1.72 1.78
200 1.50 1.80 2.10
Sample Result 1 Result 2 Result 3 Mean Result CRP mg/L
Positive Control 1.263 1.325 1.333 1.307
Negative Control 0.051 0.082 0.078 0.070
Day 1 of infection 1.010 0.996 1.063 1.023
Day 3 of infection 1.726 1.624 1.762 1.704