Case Study: Neurological and Musculoskeletal Disorders & Respiratory Case Study

Neurological Disorders (20 marks total)

Mary-Lou is a 75-year-old widow, who lost her husband to cancer over a year ago. Her family and friends have noticed that she has been very teary, has low self-esteem and has lost interest in the things she used to love such as going to bingo with her friends and gardening. Her family initially put this down to the loss of her husband and thought it would pass with time. However, they are now getting really concerned as they have noticed that her mood is not improving still. When asked by her daughter if she is sleeping well, she says she has been drinking wine every night to help her go to sleep. It makes her feel happy and relaxed. What started as one glass a night has now increased to two or three glasses a night, and she has also started drinking during the day. Her daughter has noticed that her mum’s face always appears flushed and that she has had quite a few colds lately. Mary-Lou is also losing her balance and experiencing mood swings. Her daughter is worried that she is relying too heavily on alcohol and fears that she is starting to get short-term memory loss from the alcohol consumption. She has been forgetting things such as where she put her keys, whether she turned on the washing machine, why she opened the fridge and forgetting the topic of conversation when talking with her daughter on the phone. Mary-Lou has also been getting disorientated and getting lost when she goes out on her daily walks. A neighbor rang her daughter one day to tell her that she found Mary-Lou wandering around aimlessly, and when questioned what she was doing Mary-Lou snapped and said she was trying to get home. Her daughter decided it was time to take Mary-Lou to the local GP to work out what was going on with her. After listening to the signs and symptoms Mary-Lou was experiencing, the GP diagnosed her with depression and prescribed 50 mg of Fluoxetine/Prozac daily. Based on the results of clinical and radiological assessments, the GP determined that she had early onset Alzheimer’s disease. He prescribed a cholinesterase inhibitor and gave them information on support groups and tips on what to do from here on in. He also prescribed 10 mg of Diazepam daily to help with the withdrawals from alcohol abuse.

Based on the clinical picture presented above, you should have identified three diseases/conditions we have covered in BIOL122. (5 marks)

• Name two of the diseases/conditions you identified, and
• List two characteristic signs or symptoms (per disease) that you noted in Mary-Lou’s history and clinical picture.
• Finally, explain the pathophysiology of both diseases/conditions you named (i.e., explain the changes that cause the disease and relate the typical signs and symptoms of the disease to the clinical picture).

Question 1: Identify three diseases/conditions based on the presented clinical picture (5 marks)

Explain the mechanism of action of two drug types Mary-Lou is prescribed with and describe how these drug actions help mitigate some of her symptoms. In you answer, make references to the pathophysiology of the relevant diseases. (5 marks)

1. Identify and explain two pharmacokinetic factors that are characteristic of/specific to MaryLou’s antidepressant medication. Discuss how her age impacts the pharmacokinetics of her medication. (3 marks)
2. Explain what specific considerations need to be made in the present scenario, when two drugs are administered simultaneously. (2 marks)

Based on her clinical picture and history, explain if Mary-Lou suffers from alcohol addiction. Support your answer with relevant evidence from the case study.

Define physical and psychological dependence and explain if signs and symptoms of either can be observed in Mary-Lou’s case. (5 marks)

Mary-Lou’s family was happy with the management plan established by the doctor as Mary-Lou was progressing quite well. She was using notepads to jot down reminders, a pillbox to keep her medication organized and a calendar to record appointments. Her family members were helping her with routine tasks such as cooking and paying bills. She was feeling much happier and did not have to rely on alcohol to go to sleep. On one particular day she was feeling so good she decided to walk to her GP appointment alone. On her way there she stumbled over a branch and fell. She felt excruciating pain in her hip. A passer-by called an ambulance and she was taken to the emergency department at the Royal Melbourne hospital. An X-ray revealed that she had broken the neck of her femur and had to have surgery to repair it. Mary-Lou wondered whether this was linked to the crepitus she had been experiencing in her joints. Her joints did feel quite stiff and painful lately. The specialist explained to Mary-Lou that the crepitus was likely due to degeneration of her cartilage and said that the fracture might have been due to weakened bones. He told her he would like her to have a bone mineral density test to measure her bone density. The DEXA scan gave a T-score of -3.0. Mary-Lou is now given bisphosphonates and told to increase her daily intake of calcium.

Discuss the pathophysiology of the condition causing the crepitus Mary-Lou is experiencing in her joints. In your answer, list at least two more signs and symptoms associated with the disease. (5 marks)

Discuss how the aetiology of Mary Lou’s joint disease differs from the other joint disease we covered in BIOL122. (5 marks)

Discuss why Mary-Lou’s fracture may take longer to heal than it would for someone who was half her age. In your answer, you are expected to name and discuss three physiological factors that are needed for healing to take place and explain how each of the factors you identified is affected by ageing. Finally, name two complications of hip fracture that are prevalent in the elderly. (5 marks).

Question 2: Explain the mechanism of action of two drug types used in the treatment and how they help mitigate the symptoms (5 marks)

Considering Mary-Lou’s T-score, identify the condition she suffers from, briefly describe the pathogenesis of this disease, and explain why bisphosphonate administration is helpful in this condition. (5 marks)

Hilda Wilde is a 45-year-old woman who was diagnosed with asthma as a child. She recalls her first asthma attack being horrendous; chest tightness, difficulty breathing, wheezing, feeling anxious and sweating profusely. She was rushed to hospital and spent many days in hospital as a child until she managed to work out the triggers and control it early. The triggers for her asthma were cold temperatures, pollen, smoky environments and respiratory infections/colds, which continue to be the triggers throughout her adult life. She also developed hay fever and an allergy to penicillin in her 20’s, which didn’t surprise her as her mum also had these conditions. One cold Spring day Hilda is outside gardening as she is finding herself stressed by the current coronavirus and gardening usually relaxes her. Hilda is making good progress on weeding when she starts to experience those dreaded sensations she knows only too well; tightness in the chest, shortness of breath and dizziness. She starts to wheeze and cannot stop coughing. Her husband notices Hilda is struggling and brings Hilda’s inhaler (Ventolin) for her. Hilda’s wheezing and shortness of breath does not ease off, even with her inhaler. She finds it hard to talk or get up and walk. Her lips start to turn blue. Hilda’s husband calls an ambulance and Hilda is taken to hospital where she is given corticosteroids. She is told she has to stay in hospital a few days so that her condition can be monitored. However, Hilda is worried about staying in hospital due to the novel coronavirus outbreak. Her GP has previously told her that if she contracts the virus, she is at a greater risk of developing more serious symptoms such as pneumonia or acute respiratory distress. The hospital staff have assured her that they take all the necessary precautions. All coronavirus affected patients are isolated in private rooms, and all healthcare staff practice proper hand hygiene and appropriate use of PPE. A few days later, Hilda’s asthma is under control and she is discharged from hospital. She is told to take her preventer medicine every day, even when she is feeling well. She is also told to follow routine practices and precautions to lessen her risk of contracting coronavirus.

Choose two of Hilda’s triggers and discuss how they contribute to the pathophysiology of her condition. (5 marks)

Choose 2 signs or symptoms that are characteristic of Hilda’s respiratory disease and link them to the pathophysiology of her condition (i.e., explain how the pathophysiological changes cause the signs and symptoms you specified).(5 marks)

Select one of Hilda’s anti-asthma medications and discuss how it helps with her condition. In your answer, discuss the pharmacodynamics of the chosen drug and explain how the drug’s actions help in Hilda’s disease (5 marks).

Discuss two measures that may minimize Hilda’s chances of contracting coronavirus. In your answer, identify which part of and explain how the chain of infection is broken. (5 marks