Please help answer 4 questions:
1. Using the information provided thus far by both Parts I and II, answer the following questions.
What problems both stated and unstated does Phyllis seem to be experiencing? What pieces of background information (patient environment and social/family history) have been provided by the family?
2. Distinguish between the relevant and non relevant symptoms/lab results needed to form a diagnosis. Of the relevant symptoms/lab results, rank them in priority and defend your answer.
3. Given what you know about the role of myelin in action potential propagation and the key information previously identified in questions 1 and 2, explain why multiple sclerosis is the appropriate diagnosis.
4. Consider you are the physician, what would be your strategy to slow progression of the disease and compensate for reduced neuronal function? What is the long-term prognosis with treatment?
The Soccer Mom:
A Case Study on the Nervous System
by
Jennifer Bolognese, Misti Coronel, Anita Intorre, and
Phil Stephens Biology Department Villanova University
Part IΓ’ΒΒAt the Soccer Game
Thirty-two-year-old Phyllis Jackson was sitting on the bench at the side of the soccer ?eld, sipping a bottle of
Gatorade. Her husband, Steven, sat next to her with a concerned expression. Γ’ΒΒIΓ’ΒΒm really worried about you, honey,Γ’ΒΒ he said.
Γ’ΒΒIΓ’ΒΒm just a little dehydrated; IΓ’ΒΒll be ?ne.Γ’ΒΒ
Γ’ΒΒIf this were the ?rst incident, then maybe IΓ’ΒΒd agree with you. But your boss has been on your case about your lack of concentration at work, you forgot to pick up the kids from school last week, and quite frankly, you havenΓ’ΒΒt exactly been yourself with me lately. Now youΓ’ΒΒre having fainting spells during games? Something doesnΓ’ΒΒt seem right.Γ’ΒΒ
Γ’ΒΒI know things havenΓ’ΒΒt been going well for me lately, but I donΓ’ΒΒt know why. I try so hard at work, at home, with the kids, to be a good wife. So maybe all this stress has made me a little unfocused and disoriented. What do you want me to do about it?Γ’ΒΒ Phyllis said, blinking back tears.
Γ’ΒΒI think you should see a doctor,Γ’ΒΒ Steven replied, putting his arm around her and drawing her close. Γ’ΒΒThe kids are getting worried, too.Γ’ΒΒ
Phyllis sighed. Γ’ΒΒAlright, if it will make you feel better. I really just think I need some time to relax, though.Γ’ΒΒ Γ’ΒΒWellΓ’ΒΒ¦ I could drop the kids of at my sisterΓ’ΒΒs tonight; that would give us a little free timeΓ’Β¦ÒΒΒ
Γ’ΒΒThatΓ’ΒΒs really thoughtful of you. I could de?nitely use a quiet night at home, maybe even go to bed early.Γ’ΒΒ Steven seemed disappointed.
Part IIΓ’ΒΒThe Doctor Visit
Γ’ΒΒSo, what seems to be the problem, Mrs. Jackson?Γ’ΒΒ Dr. Warner asked Phyllis.
Γ’ΒΒMy husband wanted me to come in and see you after I fainted during my soccer game Saturday. IΓ’ΒΒve also been having some problems at work, but I think IΓ’ΒΒm just stressed.Γ’ΒΒ
Γ’ΒΒWhat kinds of problems have you been having at work?Γ’ΒΒ
Γ’ΒΒItΓ’ΒΒs been hard to concentrate on tasks. IΓ’ΒΒve also had some problems typingΓ’ΒΒIΓ’ΒΒve been making more errors than usual, and oftentimes my ?ngers will go numb.Γ’ΒΒ
Γ’ΒΒI see,Γ’ΒΒ said Dr. Warner, taking a few notes on his clipboard. Γ’ΒΒAccording to my records you are not on any long term medication. Have you noticed any problems outside of work?Γ’ΒΒ
Γ’ΒΒWell, my husband has been complaining about our personal life lately. And last week, I completely forgot that I was supposed to pick up our two daughters after school. IΓ’ΒΒve been feeling really tired lately; even my coordination seems of.Γ’ΒΒ
Γ’ΒΒHow long has this been going on for?Γ’ΒΒ
Γ’ΒΒA few weeks, but this isnΓ’ΒΒt the ?rst time. These problems seem to come and go, but itΓ’ΒΒs getting to the point where I canΓ’ΒΒt just ignore them anymore. I donΓ’ΒΒt know, maybe IΓ’ΒΒm just depressed.Γ’ΒΒ
Γ’ΒΒWhy do you say that?Γ’ΒΒ
Γ’ΒΒMy mother suffered from depression throughout my childhood.Γ’ΒΒ
Γ’ΒΒWell, depression certainly could cause some of the symptoms youΓ’ΒΒre experiencing,Γ’ΒΒ Dr. Warner said thoughtfully. Γ’ΒΒIs there a history in your family of any neurological disorders?Γ’ΒΒ Γ’ΒΒI donΓ’ΒΒt think so. I have some vague recollection of my grandfather in a wheelchair when I was really young, but I donΓ’ΒΒt know what was wrong with him.Γ’ΒΒ
Γ’ΒΒOkay,Γ’ΒΒ said the doctor, nodding. Γ’ΒΒWell, the few preliminary tests weΓ’ΒΒve run show that you are not pregnant, and that you are not going through menopause. IΓ’ΒΒd like to send you to see Dr. Thrush, a friend and colleague of mine. She is a neurologist at the local hospital and she will run a few tests to explore your symptoms a little further.Γ’ΒΒ
Questions: Analyze
1. Using the information provided thus far by both Parts I and II, answer the following questions.
What problems both stated and unstated does Phyllis seem to be experiencing? What pieces of background information (patient environment and social/family history) have been provided by the family?
Part IIIΓ’ΒΒDiagnostic Tests
Dr. Thrush looked over the results of PhyllisΓ’ΒΒs Magnetic Resonance Imaging (mri) and evoked potential tests. She was thinking how glad she was that Steven had accompanied Phyllis on this visit as she showed them the MR images of PhyllisΓ’ΒΒ brain.
Γ’ΒΒThe machine took pictures of PhyllisΓ’ΒΒ brain in slices. The dark areas are the brain tissue, Phyllis, and the white areas in the middle and around the outside are the cerebrospinal ?uid.Γ’ΒΒ
Γ’ΒΒIs that normal? Am I ok?Γ’ΒΒ Phyllis asked. Γ’ΒΒAnd what are those little white dots in the tissue?Γ’ΒΒ
Γ’ΒΒThe white dots are what concerned me,Γ’ΒΒ replied the doctor. Γ’ΒΒSo we did another type of mri, called dark ?uid, so that your cerebrospinal ?uid would not show up white.Γ’ΒΒ
Γ’ΒΒBut I still see the white dots in my brain tissue. What does that mean?Γ’ΒΒ
The doctor looked down, knowing that this was never an easy thing to tell a patient.
Γ’ΒΒI am afraid that this indicates that there are plaques or scars in your brain, and that you may have multiple sclerosis.Γ’ΒΒ
Tears began to form in her eyes as Phyllis squeezed her husbandΓ’ΒΒs hand.
Γ’ΒΒI am afraid that the evoked potential test and the elevated levels of myelin basic protein in you cerebrospinal ?uid indicate the same thing.Γ’ΒΒ
Questions: Evaluate and Apply
2. Distinguish between the relevant and non relevant symptoms/lab results needed to form a diagnosis. Of the relevant symptoms/lab results, rank them in priority and defend your answer.
3. Given what you know about the role of myelin in action potential propagation and the key information previously identified in questions 1 and 2, explain why multiple sclerosis is the appropriate diagnosis.
Part IVΓ’ΒΒThe Diagnosis
Dr. Thrush informed Phyllis that she was probably suffering from the relapsing-remitting form of multiple sclerosis (ms), in which relapses of symptoms are separated by periods of remission. ms is a disorder in which the myelination of axons is degraded due to unknown factors. The most commonly accepted explanation is that ms is an autoimmune disorder in which myelin in the central nervous system is attacked by the bodyΓ’ΒΒs own immune system. There is no known cure for multiple sclerosis. During remission, axons affected by the disorder regain their function. Voltage-gated sodium channels are concentrated in the nodes of Ranvier and the distribution changes at disease onset.
Questions: Create
4. Consider you are the physician, what would be your strategy to slow progression of the disease and compensate for reduced neuronal function? What is the long-term prognosis with treatment?
Thank you for your time with this
