Please help answer 4 questions: 1. Using the information provided thus far by bo
ID: 3164735 • Letter: P
Question
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 I—At 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. “I’m really worried about you, honey,” he said.
“I’m just a little dehydrated; I’ll be ?ne.”
“If this were the ?rst incident, then maybe I’d 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 haven’t exactly been yourself with me lately. Now you’re having fainting spells during games? Something doesn’t seem right.”
“I know things haven’t been going well for me lately, but I don’t 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?” Phyllis said, blinking back tears.
“I think you should see a doctor,” Steven replied, putting his arm around her and drawing her close. “The kids are getting worried, too.”
Phyllis sighed. “Alright, if it will make you feel better. I really just think I need some time to relax, though.” “Well… I could drop the kids of at my sister’s tonight; that would give us a little free time…”
“That’s really thoughtful of you. I could de?nitely use a quiet night at home, maybe even go to bed early.” Steven seemed disappointed.
Part II—The Doctor Visit
“So, what seems to be the problem, Mrs. Jackson?” Dr. Warner asked Phyllis.
“My husband wanted me to come in and see you after I fainted during my soccer game Saturday. I’ve also been having some problems at work, but I think I’m just stressed.”
“What kinds of problems have you been having at work?”
“It’s been hard to concentrate on tasks. I’ve also had some problems typing—I’ve been making more errors than usual, and oftentimes my ?ngers will go numb.”
“I see,” said Dr. Warner, taking a few notes on his clipboard. “According to my records you are not on any long term medication. Have you noticed any problems outside of work?”
“Well, 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. I’ve been feeling really tired lately; even my coordination seems of.”
“How long has this been going on for?”
“A few weeks, but this isn’t the ?rst time. These problems seem to come and go, but it’s getting to the point where I can’t just ignore them anymore. I don’t know, maybe I’m just depressed.”
“Why do you say that?”
“My mother suffered from depression throughout my childhood.”
“Well, depression certainly could cause some of the symptoms you’re experiencing,” Dr. Warner said thoughtfully. “Is there a history in your family of any neurological disorders?” “I don’t think so. I have some vague recollection of my grandfather in a wheelchair when I was really young, but I don’t know what was wrong with him.”
“Okay,” said the doctor, nodding. “Well, the few preliminary tests we’ve run show that you are not pregnant, and that you are not going through menopause. I’d 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.”
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 III—Diagnostic Tests
Dr. Thrush looked over the results of Phyllis’s 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 Phyllis’ brain.
“The machine took pictures of Phyllis’ 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.”
“Is that normal? Am I ok?” Phyllis asked. “And what are those little white dots in the tissue?”
“The white dots are what concerned me,” replied the doctor. “So we did another type of mri, called dark ?uid, so that your cerebrospinal ?uid would not show up white.”
“But I still see the white dots in my brain tissue. What does that mean?”
The doctor looked down, knowing that this was never an easy thing to tell a patient.
“I am afraid that this indicates that there are plaques or scars in your brain, and that you may have multiple sclerosis.”
Tears began to form in her eyes as Phyllis squeezed her husband’s hand.
“I am afraid that the evoked potential test and the elevated levels of myelin basic protein in you cerebrospinal ?uid indicate the same thing.”
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 IV—The 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 body’s 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
Explanation / Answer
1] The stated problems Phylis is facing are : * loss of concentration at work
* forgetfullness
* fainting spells ,and
* disorientation and depression
The unstated problems are : * lethargy and lack of interest in day to day events
* change in her relationship with her husband and kids
* her refusal to accept that there might be some other problem besides fatigue and depression , with her .
Phyllis has a normal family life. She has a caring husband and two loving children. There is no remarkable history of neurological disorders in her family except for some problem with her grandfather who was on wheelchair. But Phyllis does not remember of any specific diagnosis made about her grandfather's illness.
2] The relevant symptoms are those which lead to doctor to perform certain tests and examinations on the patient that might help to diagnose a disease or to rule out the possibility of a disease.
In the case of Phyllis, the relevant symptoms are her bouts of fainting, fatigue, loss of concentration and forgetfulness.
The non relevant symptoms are her lack of interest in her relationship with her husband and kids and her feeling of depression and exhaustion.
The doctor decided to have an MRI done on Phyllis as the first step to confirm or rule out what she suspected about her patient's condition. The MRI showed lesions or plaques on the brain tissues which partly confirmed the doctor's suspicion. The evoked potential tests and the elevated levels of myelin basic protein further gave strength to the doctor's prognosis.
Since multiple sclerosis is a disease in which the body's own immune system begins to attack the myelin sheath covering the axons of the nerve fibers, it interferes with the proper functioning of the nerves. There is no known reason for this disease and also there is no specific cure for the disease either. The evoked action potential results also indicate that the nerve fibers are not functioning properly although they seem to repair themselves at certain times. So, it is the beginning of the disease and maybe some measures will slow down the progress of this disorder.
3] Myelin is a multilayered lipid sheath periodically wrapped aroun the neuronal axons . It helps in conduction of action potentials [AP] along axons . During this type of conduction, the AP travels passively along the myeline covered part of the axon and is recharged at the intermittent nodes of Ranvier.If the myelin sheath is damaged or destroyed, the transmission of nerve impulses is disrupted.
The nerve fibers whose myelin sheath has been damaged ,show as abnormal plaques or lesions on the brain.
This , along with other symptoms, shown by Phyllis point toward the initial stages of multiple sclerosis in her brain.
4] Phylis seems to be suffering from relapsing - remitting MS type. Her treatment will include medication and therapies along with self care. She will be given immunosuppressant drugs to slow down the immune response which is causing the progression of this disease. Beta -interferons, ocrevus, copaxone etc are a few of the medicines commonly prescribed by doctors to slow down relapses of MS.
Along with medication, certain therapies like exercises to restore muscle strength, accupuncture [ insertion of needles into specific points on the body to relieve pain and treat other conditions ] and also councelling and being a member of a support group will go a long way in coping and mental healing.
Self care is also important for slowing the progression of MS. This will include a proper diet, a routine life, exercises, refraining from gaining weight and above all, trying to be happy .
So, support from family [ which she already has ] , proper medication and other therapies will help Phyllis lead a normal life and delay the progression of this disorder.