Case Study – Diabetes Mellitus Mohinder, a 28 year old male, had been diagnosed with diabetes mellitus when he was 12 years old. He started experiencing polydipsia, polyuria and polyphagia and his parents noticed that he was very lethargic and seemed continuously fatigued. They would occasionally detect the sweet, “fruity” smell of acetone on his breath. Their PA informed them that this was a sign of ketoacidosis associated with the diabetes. At the time, high fasting glucose levels and islet cell antibodies (ICA) had been detected in his blood. His doctors had him carry out a regimen to control his fluctuations in blood glucose which included diet, exercise and administration of exogenous insulin. At first he was administering insulin 1-3 times a day as indicated by measuring the glucose concentrations in small blood samples obtained from pricking his finger. When he was 22, he got a small battery-powered infusion pump that continuously infused insulin subcutaneously. Now he is considering an experimental treatment that involves implantation of beta-cells derived from donated pancreases. These cells implant in the liver and produce insulin in response to blood glucose levels.

1. Is Mohinder suffering from Type I or Type II diabetes mellitus? How can you tell?

2. What are polydipsia, polyuria and polyphagia? Why are these symptoms of diabetes?

3. What is ketoacidosis? Why is it a consequence of diabetes mellitus?

3. What do the ICA suggest about the etiology of his condition?

4. Why is an insulin infusion pump superior to periodic insulin injections? Why would donated beta-cells be superior to the infusion pump if they can be successfully implanted? (Think about the negative feedback loops for control of blood glucose as you answer this question. How do the concepts of sensitivity, gain and lag time relate to this question?)

5. What are the drawbacks to donated pancreas cells? How might embryonic stem cells be used to avoid these problems?

Case Study - Cholera A 25 year old woman is brought into a clinic in Bangladesh during the monsoon season. She is almost comatose, her pulse is weak and she is experiencing tachycardia. She has severe diarrhea, and is producing watery stool at a rate of 950 ml/hr. Her skin appears shriveled, and when a fold of skin is pinched it remains so for several minutes. Microscopic examination of the patient’s stool reveals the presence of a large number of Vibrio cholerae bacteria. The patient cannot drink, so intravenous isotonic NaCl is administered. When the patient is conscious, she is given an oral rehydration solution to drink. It contains NaCl, KCl, NaHCO3 and glucose. After 5 days she is sufficiently recovered to leave the hospital.

1. How did she most likely encounter the bacteria?

2. Why does she exhibit weak pulse and tachycardia? Why is she almost comatose?

3. How did the cholera toxin enter the cells and how did it affect intracellular signal transduction pathways and membrane transport.

4. How do intravenous fluids immediately improve the patient’s condition? Why isotonic NaCl?

5. What is the rationale for the ingredients in the oral rehydration solution?

6. Why does the patient recover in 5 days with this treatment and without antibiotics?

Patt has been having difficulty maintaining his balance lately. He is visiting a neurologist to find out what’s wrong. The neurologist is taking him through some simple movement tasks and notices that his movements look very jerky and clumsy. When he points to targets, he over-reaches the target every time. When he’s asked to rapidly alternate between his palm and back of hand, his movements are very slow with lots of failed alternations.What is the diagnosis? Choose details from the question above to support your decision. What brain structure has likely been affected?

1. How can athletes improve motor skills using deliberate practice?

2. What can future studies investigate about how can athletes improve motor skills using deliberate practice?

Fill in the blank with the appropriate medical term. Please “BOLD” the terms that you insert.

Mary just had a baby; therefore, she is in the 6-week period after birth, better known as _________. Since this was Mary’s first viable child, she was termed_________. Before the birth, or during the ________ portion, she was worried that her baby would be born dead, or ______________. She was also worried she may develop metabolic disturbances such as eclampsia, which is known as ________. This worrisome attitude lasted the first 12-week-period, or ____________. When her baby was born healthy, Mary’s fears subsided until she noticed the cheesy white substance on her newborn called ______________. Mary herself developed a vaginal discharge during the first week or two after childbirth which her doctor called ____________ and told her it was quite normal. Mary discussed the dark green stool that her baby had and the doctor told her it was ____________ and that, too, would pass. Mary hopes her next child will not have to be an __________ labor, where it is initiated artificially.

A 60-year-old male patient has a condition called "prostatic hypertrophy."

• Why does this cause problem, both with starting a stream of urine, as well as with ejaculation?
• Identify the anatomical location as to why the doctor performed a "digital exam" to identify this prostatic hypertrophy?
• What anatomical structure is removed during a "vasectomy?"
• At what anatomical location would removing it be the least invasive to the man having the surgery?

Which of the following reflexes is most likely a short reflex?

A. inhibition of gut motility during stress

B. all of these

C. none of these

D. parasympathetic reflex of defecation

E. intrinsic reflex of defecation

Describe in your own words the steps of the knee jerk reflex and how this is an example of a negative feedback mechanism.

Pertaining to the coronavirus, can the antibodies found in the plasma from a transfusion of a coronavirus survivor save the cells that have already been infected with virus, such as ciliated pseudostratified columnar cells in the trachea?