Case study anatomy 232 (1)
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School
Portland Community College *
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Course
232
Subject
Anatomy
Date
Jan 9, 2024
Type
Pages
5
Uploaded by MegaNightingale3800
Case study anatomy 232
C
ASE
S
TUDY
#1 - CNS
B
RAIN VS
. S
PINAL
C
ORD
Dr. Green and Dr. Carter were nearing the end of the first year of their medical residency in the
emergency department of County General Hospital. It had been a long year and a long week. They had
been on duty for the last 12 hours and things were not slowing down.
"What are your plans for the weekend, Ken? " Dr. Green asked.
"Sleep, what else? " Dr. Carter replied.
"I hope things slow down a bit," Dr. Green said to himself.
Suddenly, a call came over the radio. Paramedics were bringing in a young man with injuries sustained in
a diving accident. A minute later, the doors to the department burst open and the paramedics wheeled in
a young man.
"What gives?" Dr. Green asked.
The senior paramedic, Jim Morrison, reported that the patient was swimming at the local quarry and did a
forward flip into the water, striking some submerged rocks.
"Which part of his body struck the rocks?" asked Dr. Carter.
"He was in a hyperflexed-tucked-position when he hit the rocks, lacerating the right side of his head and
neck and upper back. The patient indicated he had severe pain upon impact and loss of sensation and
movement in his arm and leg. He may have lost consciousness, but he's not sure. He also complains of a
severe headache, dizziness, and nausea. When we arrived at the scene we immobilized, stabilized and
transported him immediately," Jim explained.
Looking at the patient, Jim continued. "His name is Mike Smith, and he's 22 years of age. His vital signs
include slightly lowered blood pressure (100/70), heart rate of 75 beats per minute, respiration normal,
and he is conscious and alert."
As the patient was being prepped for examination, Dr. Carter and Dr. Green discussed how they should
approach their evaluation. Dr. Carter started by saying, "After seeing the head wound and the amount of
blood loss, and hearing his complaints, I want to confirm my suspicion that this patient has a brain injury."
Dr. Green disagreed: "I think that the other signs and symptoms indicate a spinal cord injury, and that's
what we should investigate."
The following table summarizes the findings of the evaluation, which included a physical exam, X-rays,
magnetic resonance imaging (MRI), and neurological tests.
Table 1
Summary of Diagnostic Testing for Mike Smith
Sensory Testing
• Decreased sensation to touch, pressure, and vibration in the right upper/lower extremities
• Decreased temperature discrimination (cold vs. warm) in the left upper/lower extremities
Motor Testing
• Decreased strength and movement of the right upper/lower extremities during muscle testing
• Decreased strength and movement of left abdominal muscles
• Absence of triceps and biceps reflexes in the right upper extremity
• Abnormal response of patellar, Achilles (hyper) reflexes in the right lower extremity
• Positive Babinski sign on the right foot
• Abnormal cremasteric reflex in the right groin region
General Examination
• Abnormal pupil response of right eye (constriction)
• Other vital signs within normal limits
• Cognitive testing normal (counts backward from 100 by 7s; knows name, date, place)
X-Ray and MRI Examination
• No fractures present in the skull
• Fracture in the 7th cervical vertebra
• Significant swelling present in the spinal canal in the C7-T2 region
• Spinal cord appears to be intact
Discussion Questions
1. Based upon the findings presented, which doctor made the correct initial prediction?
I believe that Dr. Green made the correct initial prediction because of the loss of sensation in his
limbs. The test showed there is a fracture to his vertebrae and there are no fractures present or
signs of damage to the skull which houses the brain. But there is significant swelling to the
C7-T2 region making me side with Dr. Green's assessment that it was the correct one.
2. Based upon previous knowledge of brain function, what results from the testing were
consistent with a brain injury?
Results from the testing that is consistent with brain injury are the abnormal pupil constriction
with the right eye. The positive Babinski test shows that there is an abnormal reaction which is a
sign of an upper motor neuron injury, and, all other symptoms suggest spinal cord injury
3. Based upon previous knowledge of spinal cord function, what results from the testing were
consistent with a spinal cord injury?
Based on previous knowledge of the function of the spinal cord, the results from the motor and
sensory exam were consistent with that of a spinal cord injury. such as the decreased sensation to
touch, pressure, and vibration in the right upper/lower extremities and decreased strength and
movement of the right upper/lower extremities during muscle testing. This would explain the
numbness and inability to feel his arm and leg. Likewise, the significant swelling present in the
spinal canal in the C7-T2 region which connects the neck with the upper back indicates a form of
inflammatory response in that area. This is consistent with the patient's severe neck pain and
ache and could suggest some form of spinal injury in that area.
4.
Based upon previous knowledge of CNS function, what results could be consistent
with both types of injury?
Spinal cord injury
• Abnormal response of patellar, Achilles (hyper) reflexes in the right lower extremity
• Absence of triceps and biceps reflexes in the right upper extremity
• Decreased strength and movement of left abdominal muscles
• Decreased strength and movement of the right upper/lower extremities during muscle testing
• Fracture in the 7th cervical vertebra
-Brain injury
• Decreased sensation to touch, pressure, and vibration in the right upper/lower extremities
• Decreased temperature discrimination (cold vs. warm) in the left upper/lower extremities
• Abnormal pupil response of right eye (constriction)
• Cognitive testing normal (counts backward from 100 by 7s; knows name, date, place)
5. Assuming the incorrect diagnosis is true, predict how the findings would be
different.
If it was a brain injury instead as Dr. Carter suggested, the findings would show the patient
exhibiting problems with their sense of smell and taste. This could be due to damage to the
olfactory nerves that is responsible for transporting the smell sensation from the nose to the
brain, as well as, damage to the processing of smell located in the olfactory center of the brain.
C
ASE STUDY
#2 – T
HE
E
NDOCRINE
S
YSTEM
# 2
A
H
ISTORY
A 50-year-old man presents with enlargement of the left anterior neck. He has noted
increased appetite over past month with no weight gain, and more frequent bowel
movements over the same period.
Physical Exam
He is 5'8" tall and weighs 150 lb. The heart rate is 82 and the blood pressure is 110/76.
There is an ocular stare with a slight lid lag. The thyroid gland is asymmetric to
palpation, weighing an estimated 40g (normal = 15-20g). There is a 3 x 2.5 cm firm
nodule in the left lobe of the thyroid.
Questions
1.What do you think the patient's primary problem is?
The patient's primary problem is likely thyroid-related, specifically thyroid gland enlargement or
goiter, as indicated by the asymmetric enlargement of the thyroid gland and the presence of a
thyroid nodule.
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2. What gland or glands do you think is or are involved?
The thyroid gland is involved in this case, and it is asymmetrically enlarged. The left lobe of the
thyroid also contains a firm nodule.
3. Which hormones could be responsible?
The hormones that could be responsible for the symptoms are primarily thyroid
hormones, including thyroxine (T4) and triiodothyronine (T3), as well as
thyroid-stimulating hormone (TSH) from the pituitary gland.
4. If it is hormonal, could this be a case of hypersecretion or hyposecretion?
Explain There is more than one possibility and there are many interconnection
s.
Hypersecretion is most likely caused by a tumor. If it is Hyposecretion that is usually caused by
diabetes and that causes the destruction of hormone secreting cells which leads to low insulin
production.
# 2b
History
A 40-year-old woman presents with a 6-month history of increasing fatigue. For
the past three months she had suffered recurrent upper respiratory infections,
poor appetite, abdominal cramps and diarrhea. During this time, she lost 25 lb.
She had also noted joint pains, muscle weakness, a dizzy spells following
exercise, and she had not menstruated for the past 3 months.
Physical Exam
She was 5'4" tall and weighed 102 lb. Her heart rate was 86 and the blood
pressure was 120/65 when she was supine. After one minute of quiet standing,
the heart rate was 120, the blood pressure was 90/58, and she became dizzy. Her
neck was swollen and her bowel sounds were hyperactive.
Questions
1.What can you say about the patient's problems so far?
Fatigue is generally considered a more long term condition than sleepiness. Sleepiness could be a
symptom of other medical issues or other things wrong with the body. It usually results from a
lack of restful sleep or a lack of stimulation. Anxiety, which can cause insomnia can lead to
persistent fatigue. Menta; health issues such as depression and anxiety can make you more tired
2. What endocrine gland is most likely the cause?
The endocrine glands are the body's main hormone producers, but mostly the “adrenal gland”
insufficiency causes weakness, fatigue, abdominal pains etc..
3.What hormones or hormones could cause this problem?
Thyroid, pituitary, parathyroid and adrenal hormone levels can cause the problem.
C
ASE STUDY
#3 – C
ARDIOVASCULAR SYSTEM
A high school soccer athlete with asthma is experiencing an asthma attack while
at practice. This student decides to use his inhalant (a beta-receptor agonist) to
treat his asthma however; he forgets the instructions from his physician and uses
the inhalant twice in a short time period. Assume that the drug reached the
cardiac cells through the circulation.
What effect would this drug have on the following:
(Explain your answers for each.)
1. Heart rate?
When the beta receptor agonist is given, it increases the heart rate as it acts as cardiac
stimulator and hence tends to increase the arterial pressure. as the drug to the beta
receptors, it increases the heart contraction and hence that heart rate is increased.
2. Stroke volume?
As the drug binds to the beta receptors, it tends to increase the stroke volume along
with the increase in the heart rate. Stroke volume is the blood that is ejected from the
ventricle in every cardiac cycle and hence with the heart rate increase, the stroke
volume increases in the presence of the beta agonist.
3. Cardiac output?
The cardiac output becomes abnormal and hence it increases the overall cardiac output
tends to become abnormal.