Posted: October 27th, 2022

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Hints/suggestions from earlier semesters
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CASE STUDY ONE (25 marks)
Mrs. G is an 87-year-old retired English instructor of 41 years and semi-professional piano participant, who began taking part in early in her childhood. Sadly, after the dying of her beloved husband, it grew to become more and more troublesome to look after herself, and due to this fact Mrs. G’s kids made the troublesome determination to maneuver her right into a retirement residence to make sure that she was well-supported and adequately cared for.
Over the past month, the nursing employees at her retirement residence have observed a big decline in Mrs. G’s cognitive perform involving short-term reminiscence deficits, confusion, paranoia, and recurrent irritability. Her long-term reminiscence, then again, has not turn into a problem. Additional to this, Mrs. G has additionally expressed that she had been experiencing difficulties when taking part in the piano. She stories feeling as if her arms should not capable of transfer like they used to, making it difficult to play intricate songs. Mrs. G additionally demonstrates a lack of steadiness when strolling across the retirement residence, which makes it very troublesome for her to take part in every day walks and health courses. Mrs. G’s household physician referred her to an MRI mind scan, which offered the outcomes demonstrated in Determine 1 (see the picture on the suitable). For comparability, Mrs. G’s earlier scan can also be offered (on the left), which was taken 15 years in the past after she suffered a nasty head trauma.
Determine 1: MRI scan after head trauma 15 years in the past (left) and most up-to-date MRI scan (proper)
Question Assignment 1 (four marks)
Identify the illness that’s most probably answerable for Mrs. G’s scientific image and articulate your rationale. In your reply, you’re anticipated to make significant references to Mrs. G’s MRI picture and describe adjustments there that Help your opinion in regards to the nature of her pathology.
Question Assignment 2 (5 marks)
In your individual phrases and writing not more than 5 (5) brief dot factors, describe the pathogenesis of the illness you recognized above.
Question Assignment Three (1 mark)
One of many drugs Mrs. G has been prescribed is an acetylcholine esterase inhibitor. In your individual phrases, clarify how the pharmacodynamic properties of this medicine Help handle her situation.
Question Assignment four (1 mark)
It’s identified that the bioavailability of the drug she has been prescribed with is 36%. She takes a pill that incorporates 1.5 mg of the lively ingredient twice a day. Decide the every day quantity (mg) of lively ingredient that reaches her systemic circulation. (Present your calculations.)
Question Assignment 5 (1 mark)
Contemplating that 95% of the lively ingredient is absorbed from her gastrointestinal system, decide the every day quantity (mg) of the drug that undergoes first cross metabolism. (Present your calculations.)
CASE STUDY continued
One sunny day, Mrs. G decides to go for a stroll within the gardens of the retirement residence, when she stumbles over a department and falls. She feels excruciating ache in her hip. A fellow resident calls out to the nursing employees, and Mrs. G is taken to the emergency division on the Royal Melbourne Hospital. An X-ray reveals that she had hip fracture and should have surgical procedure to restore it. Mrs. G wonders whether or not that is linked to the ache she had been experiencing in her left knee the previous few years. The specialist explains to Mrs G that the ache in her left knee is because of lack of cartilage between bones on the knee joint and that the fracture may need been because of weakened bones. A blood check exhibits damaging for rheumatoid issue. He tells her he would love her to have a bone mineral density check to measure her bone density. The DEXA scan gave a T-score of -Three.zero. Mrs. G is now given bisphosphonates and advised to extend her every day consumption of calcium and take vitamin D dietary supplements.
Question Assignment 6 (5 marks)
Identify the most probably situation Mrs. G had on her left knee and record two scientific indicators/ signs of the situation that Help your declare. Describe the pathogenesis of your recognized situation.
Question Assignment 7 (5 marks)
Contemplating Mrs. G’s T-score, determine the illness she suffers from, briefly describe the pathogenesis of this illness, describe the mechanism of motion of bisphosphonate, and clarify the advantages of this therapy in her current situation.
Question Assignment eight (Three marks)
Based mostly on its aetiology and contemplating Mrs. G’s DEXA scan in addition to the situation you recognized below Question Assignment 6, determine the kind of fracture she most probably suffered from as the results of her current accident.
Identify and talk about adjustments in TWO physiological components related to getting older that make bone fracture therapeutic in aged tougher and slower than in youthful people.
CASE STUDY 2 (eight marks)
Hilda Wilde is a 45-year-old lady, who was recognized with bronchial asthma as a toddler. She recollects her first bronchial asthma assault being horrendous; chest tightness, respiration problem, wheezing, feeling anxious, and sweating profusely. She was rushed to and spent many days in hospital as a toddler till she managed to determine the triggers for her bronchial asthma assaults and management them early. The triggers she recognized had been chilly temperature, pollen, smoky atmosphere, and respiratory an infection/chilly, which proceed to be the triggers all through her grownup life. She additionally developed hay fever and an allergy to penicillin in her 20’s, which didn’t shock her as her mum additionally had these circumstances.
One spring day, Hilda is touring along with her husband as she is discovering herself confused by her work. Nevertheless, within the afternoon, a thunderstorm approaches and he or she shortly develops the wheeze and tightness she dreads. Her husband notices Hilda is struggling and helps her along with her bronchodilator inhaler. Nevertheless, Hilda’s wheezing and shortness of breath doesn’t ease off, even along with her inhaler. She finds it arduous to speak or stand up and stroll. Her lips begin to flip blue. Hilda’s husband rushes her to hospital the place she is given corticosteroids. She is advised she should keep in hospital just a few days in order that her situation will be monitored.
A number of days later, Hilda’s bronchial asthma is below management, and he or she is now discharged from hospital. She is advised to take her preventer medicine each day, even when she is feeling effectively.
Question Assignment 1 (four marks)
Hilda has been advised to take her ‘preventer’ medicine each day. o Identify the broad drug class preventer drugs belong to, describe their mechanism of motion, and clarify their advantages in Hilda’s case. (2 marks)
o Describe the good thing about topically administered preventers in Hilda’s case. (2 marks).
Question Assignment 2 (2 marks)
Hilda has been suggested about the opportunity of oral thrush. Clarify how Hilda can stop oral thrush from occurring by discussing remedy choices.
Question Assignment Three (2 marks)
Describe how the thunderstorm may have contributed to Hilda’s bronchial asthma. In your reply you could talk about the hyperlink between allergen publicity and an bronchial asthma assault.
CASE STUDY Three (16 marks)
Bruce is a 47-year-old journalist, who decides to go to his physician because of some gastrointestinal signs. At first, he skilled some minor belly ache and cramping, which was then adopted by diarrhea, and due to this fact Bruce satisfied himself that it was only a minor abdomen bug. Nevertheless, he had additionally been noticing that he’d been getting sick extra usually just lately. Weeks glided by, and the diarrhea simply elevated in frequency, and he additionally skilled durations of constipation in between the diarrhea durations, which he discovered relatively odd. As well as, as a substitute of feeling higher, he began to really feel actually fatigued. This had been happening for eight months earlier than his spouse lastly satisfied him to make an appointment together with his household physician, who then referred him to a gastroenterologist. A few months later, when he lastly goes to his specialist appointment, Bruce admits after questioning that he has had blood in his stool, however he didn’t wish to inform the physician as he was embarrassed and didn’t wish to get checked for hemorrhoids. The gastroenterologist additionally asks many questions on Bruce’s food plan and his weight and discovers that Bruce has misplaced 15 kg up to now yr regardless of consuming plenty of sizzling chips and mashed potatoes – the one factor Bruce feels doesn’t make his diarrhea worse. The gastroenterologist then tells Bruce he might want to carry out a colonoscopy to analyze additional.
After the colonoscopy, the surgeon tells Bruce that they discovered a number of polyps in his bowel, which isn’t essentially a trigger for concern as many polyps are benign, however they should wait on the outcomes of the biopsies to ensure none of them had been malignant. Per week later the surgeon calls Bruce – the biopsy exhibits proof that the expansion is malignant and anaplastic, and that they will’t rule out metastatic growths. Bruce is known as again in for follow-up exams, and so they discover that there’s an irregular development in his liver.
Bruce is now despatched to an oncologist, who recommends that he has surgical procedure to take away any remaining polyps, a portion of his bowel, and the irregular development from his liver. Based mostly on the recommendation from his oncologist, Bruce additionally decides to endure chemotherapy therapy. While performing some routine checks after his therapy, Bruce is knowledgeable he has neutropenia.
Question Assignment 1 (2 marks)
Outline and describe the phrases malignant and anaplastic and talk about what this implies for Bruce’s prognosis
Question Assignment 2 (2 marks)
Clarify why Bruce has an elevated danger of an infection because of his situation and its therapy.
Question Assignment Three (Three marks)
Clarify the rationale for Bruce’s oncologist recommending chemotherapy on this occasion and describe the mechanism of motion of chemotherapeutic brokers.
Question Assignment four (Three marks)
Identify the gene household p53 belongs to and describe doable penalties of p53 gene mutation(s).
CASE STUDY continued
Bruce’s good friend Greg has been attempting to Help him all through his journey. Greg is a 42-year-old ITspecialist, who suffers from Kind II diabetes mellitus, which has been below management utilizing an oral anti-hyperglycaemic medicine and a fairly nutritious diet. Moderately disturbingly, nonetheless, Greg has been experiencing numbness and a few awkward tingling in his left foot just lately.
Question Assignment 5 (four marks)
Assuming that Greg’s current signs are related together with his Kind II diabetes mellitus, clarify the hyperlink between:
• Kind II diabetes mellitus and Greg’s peripheral neuropathy (2 marks), and
• peripheral neuropathy and the potential for formation of leg ulcers (2 marks)
Question Assignment 6 (2 mark)
Though Greg takes an oral anti-hyperglycaemic medicine, within the later levels of his situation, he might have to take insulin as effectively. Clarify why insulin administration can be beneficial in his case.
CASE STUDY four (11 Marks Complete)
Maria is a 67-year-old retired, overweight lady, who lives along with her husband Max. She enjoys sitting right down to a film each evening with a bottle of Shiraz and a big packet of salt and vinegar chips or tub of cookies and cream ice cream. Maria doesn’t wish to train, significantly since she will get chest ache upon exertion. Maria’s father handed away from a coronary heart assault on the age of 60. Maria’s mom has sort II diabetes and hypertension, which she controls with drugs.
Maria has observed that her chest ache has turn into extra frequent and is lasting for an extended time period. Extra just lately, it has been occurring whereas she is watching tv within the night or while studying her guide in mattress. She decides to make an appointment along with her GP for later within the week.
On the medical clinic, the GP appears at Maria’s medical historical past. She was recognized with hypertension 4 years in the past, for which she was placed on an ACE inhibitor. The GP worries about Maria’s newest signs so writes a referral for her to see a cardiovascular specialist for an ECG and a coronary angiogram to find out why Maria has been in need of breath and unwell.
In the future, while ready for her outcomes, Maria begins to really feel extra nauseous and dizzier than ordinary. She begins to really feel clammy and sweaty, and her face appears gray in color. The chest ache returns, however now appears like a crushing ache, and she will’t breathe. Her husband, Max, dials 000, and he or she is rushed to hospital. An ECG exhibits that Maria has ST elevation, and a blood check signifies that she has excessive ranges of myocardium-specific troponin in her blood. Maria is given heparin intravenously in addition to aspirin and tissue plasminogen activator. She is taken into surgical procedure, the place a coronary angioplasty is carried out.
Question Assignment 1 (5 marks)
Earlier than her present issues, Maria was prescribed with an ACE inhibitor for her hypertension. Clarify the advantages of ACE inhibitor administration within the therapy of hypertension with particular emphasis on how this therapy reduces blood strain.
Question Assignment 2 (Three marks)
Maria observed that ‘her chest ache has turn into extra frequent and is lasting for an extended time period…’ Identify the situation Maria was most probably experiencing and clarify its pathogenesis.
Question Assignment Three (Three marks)
Contemplating her scientific signs and laboratory findings, title the situation Maria is affected by when admitted to the hospital and clarify the advantages of tissue plasminogen activator administration in her current state.
END OF ASSESSMENT
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