3) While waiting for the final hormone analysis to come back from the lab, Dr. Wasserkrug asks Brandon a few questions. Analyze and provide relevant reasoning behind why Dr. Wasserkrug would find it necessary to ask Brandon the following questions: a) Are you taking a Vitamin D supplement? (2pts) b) Have you been taking more antacids than normal? (2pts) 4. The lab results came in the levels of parathyroid hormone in Brandon's blood was much higher than the normal levels. A. Diagnose this patient. (2pts) B. Why would muscle weakness be a symptom of this diagnosis? (5pts) Explain using you knowledge of the action potential along the motor neuron. Would the action potentials be faster or slower? Would they be as frequent? What are the implications on muscle contraction if the frequency is altered?
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Wasserkrug asks Brandon if he is taking a Vitamin D supplement because Vitamin D plays a crucial role in regulating calcium levels in the body. If Brandon is not taking enough Vitamin D, it could lead to low calcium levels, which can stimulate the release of Show more…
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The patient is a 41-year-old Caucasian female who was admitted to the hospital for treatment of an unknown insect bite which caused her left arm to swell considerably. The physician administered dexamethasone to alleviate the swelling. Her physical examination showed dark stiff hair growth on her chest and back, reddening of her palms with a body weight of 211 lbs in addition to the severely swollen arm, so he decided to investigate any other issues the patient may have been having. She complained of general fatigue, weakness, lethargy, mental concentration, and decreased memory over the last 18 months. She also gained 40 lbs over the last two months with central distribution of weight gain and neck obesity. The physician ordered blood to be taken to run a hormone panel. Blood was taken approximately seven hours later. In addition to the following results, the blood report noted elevated glucose, sodium, and WBC count. HORMONE PATIENT STANDARD VALUE Adrenocorticotropin (ACTH) 18.4 1.3 – 16.7 pmol/L Aldosterone (Normal Sodium Diet Adult) 0.99 0.52 – 0.94 nmol/L Cortisol serum 690 am 110 – 607 nmol/L pm 83 - 469 nmol/L Calcitonin 3.2 Female < 6.4 ng/L Male < 13.8 Parathyroid Hormone (PTH) 1.4 1.2 – 5.8 pmol/L Thyroxine (T4 free serum) 9.5 8.5 – 15.2 pmol/L Thyroid-Stimulating Hormone (TSH) 0.4 0.4 – 5.0 μU/mL Vitamin D3 - Cholecalciferol 84 60 – 105 nmol/L Insulin 57 36 – 179 pmol/L Glucagon 142 50 – 200 ng/L As a follow-up, a magnetic resonance imaging (MRI) examination of her brain did not show any abnormal findings. However, a CT scan of the chest with contrast revealed a left upper lobe lung nodule, measuring 1.5x1.5 cm. 3) What glands could be responsible for this dysregulation? Explain. 4) What might you have expected to see on the MRI? Explain. 5) What effect should dexamethasone have on this blood test? Is this similar or different from the result? 6) What does the dexamethasone tell you about the patient's condition? 7) What is your final diagnosis? Explain exactly what you think is happening in this patient.
Adi S.
1) Assume you are a physician and your patient is a fifteen-year-old male named Kyle. Kyle’s mother has brought him to see you because she is concerned about his inability to perform any kind of strenuous exercise. During his physical education classes, Kyle could not keep up with his classmates and often suffered painful muscle cramps if he attempted to exercise. He appeared to be normal if at rest or performing light to moderate exercise. A fasting glucose test showed that Kyle was not hypo- or hyperglycemic. You suspect Kyle is suffering from a glycogen storage disease. Glycogen storage diseases occur due to a deficiency of one of the enzymes involved in either glycogen synthesis or glycogen degradation. Identification of the deficient enzyme is required before a treatment protocol can be designed. a) You decide to try Kyle’s response to glucagon. This test consists of injecting a high dose of glucagon intravenously and then drawing samples of blood periodically and measuring the glucose content of the samples. Explain the reason behind you prescribing this test. 5 points b) After the glucagon injection, Kyle’s blood sugar rises in the range expected of a normal person. An analysis of liver and muscle biopsies taken from Kyle reveals that while the glycogen content in his liver is normal, the muscle glycogen content is elevated. However, the biochemical structure of glycogen in both tissues appears to be normal. Based on this information, can you start to narrow down the enzyme deficiency that Kyle may be suffering from? Explain your answer. 5 points c) Next, you do another test where you have Kyle perform ischemic exercise for as long as he is able to do so. Blood is withdrawn every few minutes or so during the exercise period. Kyle’s blood samples are tested for lactate and compared with a control sample of a patient who does not suffer from a glycogen storage disease. The results indicate that the lactate concentration increases in the normal patient as expected, but there is no increase in Kyle’s lactate concentration. How does this help you confirm your diagnosis further? Explain your answer. 5 points d) Considering your diagnosis, do you think this will also affect Kyle’s ability to secrete insulin after eating a meal and/or to mount an appropriate biochemical response to insulin? Explain your answer. 5 points
Madhur L.
You are a teaching physician working at a hospital. Your patient is a 30 year old who has been suffering from weak muscles. Lately they have been having difficulty breathing and swallowing. After a blood test, you confirm that the patient is suffering from Myasthenia Gravis, which occurs when the immune system targets the acetylcholine receptors on the muscle sarcolemma reducing the number of receptors. You prescribe the patient Pyridostigmine, which is a molecule that inhibits acetylcholine esterase (the enzyme that breaks down acetylcholine). You ask a resident physician to explain the diagnosis and the prescription. Here is the student's response: 1. Myasthenia Gravis is an autoimmune disease that targets the acetylcholine receptors on your muscle cells. and produce movement. 3. With reduced numbers of functional acetylcholine receptors available your muscles contract continuously, leading to muscle weakness due to muscle fatigue. 4. This muscle weakness is particularly noticeable in muscles that are used frequently, such as those controlling breathing and swallowing. 5. Normally, after acetylcholine causes a muscle contraction, it's broken down by an enzyme called acetylcholinesterase. 6. In the case of Myasthenia Gravis we want to reduce the action of acetylcholine to give it less time to bind to the available receptors and reduce the chance of muscle contraction. 7. Pyridostigmine decreases the breakdown of acetylcholine, reducing its concentration in the space between the nerve and muscle cells. 8. This decreased level of acetylcholine improves the likelihood of it binding to the remaining functional receptors, thereby reducing muscle contraction and strength. Choose the answers that are incorrect in the resident physician's explanation.
Bryan V.
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