Jenna is an active teenager involved in sports at school and loves playing with her older brothers. Jenna’s mother has noticed that her daughter easily bruises during her activities. Jenna also has had frequent nose bleeds from a young age and has heavy menstrual periods that last longer than usual. Her mother recognizes these symptoms because she has lived with them too. In fact, she remembers Jenna’s grandmother telling her they come from a family of ‘bleeders’.

a. What do these symptoms mean regarding their blood?

b. Would this be a case of hemophilia? Why or why not?

c. What possible condition might they have?

A 26-year-old gymnastics instructor presents with complaints of muscle weakness in her face that comes and goes, but has been getting worse over the past two months. Most notably, she complains that her "jaw gets tired" as she chews and that swallowing has become difficult. She also notes diplopia ("double vision") which seems to come on late in the evening, particularly after reading for a few minutes. At work, it has become increasingly difficult to "spot" her gymnasts during acrobatic moves because of upper arm weakness.

On physical examination, she has notable ptosis ("drooping") of both eyelids after repeated blinking exercises. When smiling, she appears to be snarling. Electromyographic testing revealed progressive weakness and decreased amplitude of contraction of the distal arm muscles upon repeated mild shocks (5 shocks per second) of the ulnar and median nerves. Both her symptoms and electromyographic findings were reversed within 40 seconds of intravenous administration of edrophonium (Tensilon), an acetylcholinesterase inhibitor (i.e. an "anticholinesterase"). Blood testing revealed high levels of an anti-acetylcholine receptor antibody in her plasma, and a diagnosis of myasthenia gravis was made.

Jill was treated with pyridostigmine bromide, which is a long-acting anticholinesterase drug, and was also started on prednisone, which is a corticosteroid drug. She also underwent occasional plasmapheresis when her symptoms became especially severe. She was given a prescription of atropine as needed to reduce the nausea, abdominal cramps, diarrhea, and excessive salivation she experienced as side effects of the anticholinesterase drug.

Questions (1pt each)

1. Why are nausea, abdominal cramps, diarrhea, and excessive salivation all side effects of the anticholinesterase drug she is taking?

2. Why is atropine beneficial in treating the gastrointestinal side effects mentioned in question #2?

3. Why does repetitive nerve stimulation result in decreased amplitude of the muscle contractions?

4. What is plasmapheresis and why must Jill undergo plasmapheresis when her symptoms become especially severe?

5. Jill's doctor advises her that she is at increased risk for respiratory failure. Why?

Jonathan, a 34-year old male, undergoes a vasectomy and the doctor explains it was a complete success. However, two months later Jonathan returns angrily demanding to see the doctor. He explains that the vasectomy was unsuccessful because his wife is now pregnant. He is threatening to sue the doctor for malpractice.

a. Briefly describe a vasectomy procedure.

b. Provide an anatomical and physiological explanation for why his malpractice case will go nowhere.

c. How would this scenario be different if the patient were a female who had a tube ligation procedure?

May 4th is commonly referred to as “Star Wars” day due to the statement of “May the Fourth be with you” and its aural similarity to “May the force be with you.” Within the Star Wars franchise, those who are imbued with the ability to manipulate the force can, after time, manipulate their physiology to reduce their breathing rate and induce bradycardia (reduced heart rate). This can be explained by specialized molecules called “midichlorians” controlling the autonomic nervous system. Assuming that midichlorians truly exist, which branch of the autonomic nervous system do they affect (sympathetic or parasympathetic nervous system (2pts)), what specific receptor would midichlorians bind to in order to do this (2 pts), and what other effects would occur besides reducing breathing rate and induced bradycardia if they bound to this receptor (List at least three other effects; 2 pts per effect). You should also include the origin of the neurons for this branch (2 pts) and whether the pre or post ganglionic neuron is shorter (2 pts). Would the opposing system be affected, if so, how (4 points)? 2 pts for essay formatting, grammar, spelling.

Animal Physiology question

1. The absolute and relative refractory periods of an action potential determine other parameters of action potentials such as causing unidirectional conduction and limiting their frequency (i.e. how often) they can be fired. What is the absolute refractory period and what causes it? What is the relative refractory period and what causes it? How do these two refractory period affect unidirectional conduction? How do these two refractory periods affect the frequency that APs can be generated?

Animal physiology question

1. Neurons use both graded and action potentials to carry electrical signals from one point to another. In a neuron, where do we find graded potentials? Where do we find action potentials? Describe the similarities and differences between these two types of signals that could be seen within an individual neuron.

Step # 1

Emmerson is an active 55-year old male of Asian descent who works as a nurse. About six months ago, his wife commented that he was dropping things and stumbling more commonly when he walked. Within the last few weeks, he has found it hard to work with patients due to weakness in his arms and legs.

What system(s) of the body could Emmerson be experiencing problems with and what diseases or disorders could be responsible for this?

Step # 2

A little more background on Emmerson. Up to this point in his life, he has been active and relatively healthy.  His work as a nurse keeps him active and in his spare time, he enjoys bicycle riding. He is 5'11" and 205 pounds and is a non-smoker.   Recent medical issues include a broken right radius as a result of a bicycle riding accident and the removal of a basal cell carcinoma from his forehead.

As the symptoms progressed, Emmerson visited his health care provider and the physician assistant he works with conducted the following tests:

- heart rate and blood pressure normal
- temperature normal
- mental status check - normal
- arm / hand strength - less than expected
- CBC (Complete blood count which looks at the numbers of blood cells) normal
- Blood chemistry panel - slightly elevated cholesterol, otherwise normal
- Suspecting muscular or neurological issues, the PA ordered an MRI and CT of the brain which were normal.

What types of tests should be done next?

Step #3

You all did a nice job of speculating on the cause, but we cannot reach a diagnosis without further tests. As a result, Emmerson was sent to a neurologist for further testing.  

Electromyogram - normal
Nerve Conduction test - mostly normal
Advanced blood tests - normal
Bone density test - normal
Microscopic examination of muscle tissue (biopsy) - normal

These results were surprising, so the neurologist asked for a more thorough background on Emmerson. At that time, Emmerson remembered a family story about an uncle he never met who died in his early 50's. When Emmerson called to relatives living in the Philippines, they told him that they thought his uncle died from Amyotrophic lateral sclerosis (ALS). What is ALS and could this be what Emmerson is experiencing?

**** I need help on step 3 I have answered step 1 and 2 already but find myself stumped now! thank you!!!

2) Ivan Urtleg took a well deserved trip to Tahiti with his family after a long semester. While there, he discovered that the resort offered a "Snorkel With Sharks" activity. In a moment of poor decision making, he thought that it would be fun to swim with sharks. While swimming with the large predators, he decided to antagonize one by sticking his tongue out and goading it into a fight. The shark immediately bit his right leg in the superior medial region. As a result, two large blood vessels were severed and Mr. Urtleg began to bleed profusely. Thankfully, he stayed calm and made it back to the boat where he made and applied a tourniquet fashioned from a length of anchor rope and snorkel tube. On the way to the ER, Ivan complained of intense thirst.

Explain how Ivan’s blood osmolarity, blood volume, and blood pressure have changed (or not changed) due to his extreme blood loss (3 pts) Which hormone pathways will be triggered by these changes (Note this should only include pathways directly triggered by the changes in blood, NOT pathways triggered by other hormones) (2 pts)? How do these pathways cause the symptom of intense thirst and why would drinking fluid help Ivan (what effects does drinking water have in the blood) (4 pts)? What other ways do these hormones try to account for massive blood loss (what effects do they have and how do these impact blood volume, pressure, and/or osmolarity) (9 pts)? Note that nowhere in this question do we ask for you to brain dump an entire hormone step by step pathways...we are asking about specific effects of the pathways! 2 pts for essay formatting, grammar, spelling.

If it weren’t for the body’s compensatory mechanisms, which of the following would decrease how well an alveolus is ventilated? Select all that apply.

Group of answer choices

A constricted bronchiole leading to the alveolus

A dilated bronchiole leading to the alveolus

A longer-than-average bronchiole leading to the alveolus

A shorter-than-average bronchiole leading to the alveolus

The alveolus is smaller than average

The alveolus is larger than average

The corpus luteum does what?

Select one:

a. releases the secondary oocyte.

b. forms from a Graafian follicle after ovulation and secretes mainly progesterone.

c. degenerates into a zygote if pregnancy does not occur.

d. secretes progesterone.

e. forms from a Graafian follicle after ovulation.

During the female menstrual cycle what hapens?

Select one:

a. the fimbriae wall thickens over the course of the cycle.

b. there are three phases: menarche, amenorrhea, and luteal.

c. estrogen levels peak at ovulation.

d. menstruation occurs 3-5 days before ovulation.

Oogenesis differs from spermiogenesis in all of the following ways EXCEPT:

Select one:

a. Oogenesis does not have 2 meiotic divisions while spermiogenesis does.

b. 5 million oocytes are produced during fetal growth but cannot go through oogenesis until puberty.

c. Division of cytoplasm during meiosis is uneven in oogenesis, creating a polar body.

d. The secondary oocyte is released during ovulation.

Oral contraceptives, commonly referred to as the "pill", typically contain estrogen and progesterone. The combination of these 2 hormones work to prevent pregnancy because:

Select one:

a. They change the pH level of the vagina, causing it to denature sperm.

b. They prevent the proliferative or secretory phase of the menstrual cycle.

c. They cause thickening of the cervical mucus plug, preventing sperm from reaching the ovum.

d. They prevent ovulation by causing the woman's body to mimic pregnancy and disrupt the ovarian cycle.

The female mammary glands:

Select one:

a. are modified sweat glands.

b. may contain large amounts of adipose tissue.

c. are attached to the pectoralis major muscle by suspensory ligaments.

d. contain alveoli that pass milk into lactiferous ducts.

e. All of the above are correct.

All of the following are effects of estrogen EXCEPT:

Select one:

a. High HDL cholesterol levels

b. Fat accumulation in hips and breasts

c. Widening of pelvis

d. Deepening of voice

e. All of the above are effects of estrogen

Describe how a functional sperm is different from a spermatogonium stem cell.

What phase of the ovarian cycle occurs after ovulation and is associated with the secretory phase of the uterine cycle?

The central fluid-filled cavity in a tertiary follicle is known as what?

what contains enzymes necessary for the sperm cell to penetrate the oocyte.?

Describe the Hypothalamic-Pituitary-Gonadal hormonal axis and how negative feedback is used to regulate the release of hormones in males versus females.?

Amy is a 39-year-old full-time working mother. She weighs 175 lbs and is 63 inches tall. She has a family history of Type II diabetes and heart disease on her father’s side. She’s come to you to help her meet her goals. She’d like to lose weight and tone up. She’s heard that lifting weights will make her bulky, so she’s never participated in a strength training program. She’s only walked in the past, but she’s never been consistent with any form of exercise. Her friend has recently
lost weight on a fad diet, and Amy mentions she’d like to try it too. She says she’d like to lose 25 lbs in the next 4 weeks before she goes on her family’s beach
vacation.

1. What would you tell her about fad diets?

2. Do you think a 25 lb loss in 4 weeks is an appropriate goal?

3. She’s hesitant to participate in resistance training because she thinks she’ll
get big and bulky. What would you tell her to ease her mind about RT?

4. Exercise Demonstration/Selection – You’re determined to get the most of
her time with you she’ll need to incorporate combination exercises that will
work the upper and lower body at the same time. What are some of those exercises?

1. If a drug was taken that blocked sodium reabsorption, what changes (if any) would be seen in the reabsorption of water and chloride, and in the secretion of hydrogen ions? Why?

2. Provide a list of all structures that glomerular filtrate will pass through from the time it leaves the bloodstream in the glomerular capsule to the time it leaves the body. Ensure that your structure list is in order.

3. How does the structure of a nephron encourage concentration of urine? What is the name of this process and how does it work? (3pts)