Select all of the true statements:

When we are at rest, are both branches of the ANS active at the same time with each exhibiting variable degrees of stimulation such that one is more dominant than the other, OR is only one branch of the ANS completely active while the other is completely shut off? Explain.

A 70-year old diabetic woman came into the ER with a fever of 104°F, chills, and labored breathing. She produced thick sputum flecked with blood. The woman reported a recent history of a mild cold to the examining physician. A chest X-ray revealed extensive infiltration in the lower lobes of both lungs. The sputum was collected for microscopy and culture on blood agar. The gram-stain revealed gram-positive diplococcic and muccoid colonies with no hemolysis on the blood agar.

7. From the information given how can the causative bacterium be identified?

8. What virulence factor allows this bacterium to be more invasive?

A 20-year old college student who lives on campus was recently back home visiting his parents. His mother, who had attempted to awaken him the next morning, but had found him listless and difficult to rouse, brought him to the emergency room. Upon questioning by the attending physician, the mother reported that he had complained of a headache, stiff neck, and fever the day he arrived home. An examination of the patient revealed purpuric skin lesions on his chest and abdomen, a fever of 103°F, and low blood pressure (hypotension).

13. What would be your presumptive diagnosis for this patient?

14. What is the causative organism?

15.What diagnostic test & result would indicate a positive (confirmatory) diagnosis?

16.What populations are most at risk for contracting this disease

A few days following a severe sore throat, a young child developed a red, papular rash with a sandpaper texture on the chest, which spread across most of her body. Although her cheeks were red, the area around her mouth appeared white. Her tongue developed a white coating, which desquamated (skin peeled off), producing a “strawberry tongue” appearance.

17. What is the name of the disease?

18.  What is the name of the causative bacterium

19. What virulence factor led to the development of this disease?

20. What is the mechanism of action of this virulence factor? (how does it work)

A 4-year-old child was taken to the doctor with high fever, runny nose, watery eyes, and a cough. Upon examination the doctor noted tiny white spots on the inside of the child’s cheek and a raised red rash along the child’s hairline, neck, and trunk. A throat swab tested negative on a rapid strep test and was negative for culturable bacteria. Upon speaking with the mother the doctor found out the child had not received the MMR vaccine.

22. What is the likely diagnosis?

23. Which symptom(s) of the child is characteristic of this disease? What is the proper name of this symptom?

24. How can this disease be treated?

Mary is a healthy 3-year-old child living in Central Texas. She spends 4 days a week at daycare while her parents work. The daycare calls and she has developed a low-grade fever of 101-102. The fever persists for the next 4 days. She also is drowsy and complains that her head and tummy hurt and she does not want to eat. The parents call the doctor and he recommends Tylenol and fluids, keep the fever down and her body hydrated. By the fifth day her parents noticed that Mary has developed a rash on her head and chest that is spreading to her back. The lesions are red and raised and some even contain fluid. Mary’s parents become concerned and bring her to their primary care physician for a diagnosis.

25. Based on the information given, what is your initial diagnosis?

26. Will the organism be cleared from Mary's body

27. What disease is Mary at risk for developing later in life as a result of this infection?

28. What is the best way to prevent this disease

An infant born at 36 weeks' gestation and weighing 4.2 lbs was noted at birth to have congenital heart defects, hyperpigmented skin lesions, cataracts, swelling of the brain, and fluid around the heart. Hearing impairment was suspected after the infant failed a hearing screening test before hospital discharge. The mother, in her late 20s, was from urban Tanzania. She reported having received all of her childhood vaccinations in Tanzania, but rubella-containing vaccine had not been part of the routine vaccination schedule. She had no prenatal care in Tanzania. She reported having a rash around the time of her first missed menstrual period while in Tanzania. After the mother arrived in the United States approximately 46 days later she developed a varicella-like rash. She visited several clinics but no molecular tests were done to confirm the cause of her rash.

33. What is your diagnosis for the child?

34.. What is your diagnosis of the mother?

35. What is the best treatment for this child?

36.What is the best way to prevent this disease in unborn children?

Describe the 4 main ligaments and 2 cartilaginous structures of the knee. Include: The location, function and tissue type of each structure.

1.Explain how carbonic acid and bicarbonate are formed in the blood and the functions they serve.

2. Define the terms acidosis and alkalosis, and explain how they relate to hypoventilation and hyperventilation.

3. Explain how ventilation is adjusted to help maintain acid-base balance.

The endocrine system consists of several different glands, pineal, thyroid, adrenal glands, and the gonads (ovaries for women, and testes for men). Please answer the question: which of these glands do you believe is most important? Explain why and defend your answer. Your response should be a minimum of 100 words, with in-text citations and references.

How Does the Urinary and respiratory systems work together? Make sure to list organs Ions and Hormones used.

Characteristics of the EKG waveforms:

1. A normal PR interval has a normal duration __________________
   1. ST segment is measured from: __________________________________

Describe the histology of the urinary tract and how that changes between the ureter and the renal tubules.

1. Which wave of the QRS-complex has the largest amplitude in Lead II and why is this so?

Ms. Bewcyk is a 31 year old office worker with recurrent back pain since the age of 18. She initially was injured, as a result of a fall, while playing softball with friends. Diagnosis was “muscle strain” and was treated with pain killers and muscle relaxants. Her back improved quickly, but the pain never subsided. Ms. Bewcyk feels better when active, but has had a hard time keeping active due to the varying nature of her back pain. Just recently she had some test done. The results are as follows:

X- Ray – Normal
MRI – bulging disk between L4-5
Radiating pain from right buttock to right knee

1. What contraindication must you be aware of with Ms. Bewcyk?

2. What, if any, issues should you inquire of, or modify of her current employment?

3. Develop a core program for Ms. Bewcyk.

4. Develop a cardiovascular conditioning exercise program for Ms. Bewcyk to compliment the

   core strength program developed in question 3.

You have been contracted by a triathlete to determine their maximal aerobic capacity. As the athlete arrived at your laboratory, you realized that your metabolic chart had stopped functioning, and you need to measure blood gasses to perform the test. The data you obtain are as follow:

-Age: 35 years old

-Height: 1.75m

-Weight: 73kg

-Speed at VO_2max: 16.2 km/h

-Heart Rate at VO_2max: 192 bpm

-End Diastolic Volume: 242mL

-End Systolic Volume: 90mL

-Hemoglobin concentration: 163g/L (16.3 g/100mL)

-Arterial PO₂: 95mmHg (O2 sat: 97%)

-Venous PO₂: 20mmHg (O2 sat: 35%)

-Arterial PCO₂: 35mmHg

-Venous PCO₂: 40mmHg

Can you provide your triathlete with their maximal aerobic capacity? Include all your calculations (20 points) (Fick's equation)

How is it that we urinate different amounts everyday but our body is able to keep the glomerular filtration stabled?

Children Case Study

Subjective

Medical History

Mr. ST, a 16 yr old Caucasian boy, who was previously diagnosed with juvenile idiopathic arthritis (JIA) at the age of 12, has recently been determined to be in remission. Previously this patient did not respond well to a number of nonsteroidal anti-inflammatories. After a period of trial and error, the patient responded well to azathioprine and seems to have better control of his disease now. Is has been a concern of the parents and primary care physician that, although this patient seems to be in remission, he has failed to increase his activity and has poor dietary habits, and as such he is beginning to develop other potential chronic health issues. Mr. ST’s latest physical exam and lab work has noted that body weight status is in the 95th percentile, with elevated resting blood glucose and triglycerides. The parents are concerned that if these poor health indicators continue, their son will have to deal with more than his JIA. The family physician wants the boy to begin a structured exercise program as well as to begin following the DASH diet plan.

Objective and Laboratory Data

Exercise testing was not requested.

Assessment and Plan

Diagnosis

JIA with overweight/obese weight status and prediabetes

Exercise Prescription

Mr. ST was referred to Exercise Medical Clinic to meet with an exercise physiologist. In consultation with the child’s parents it was determined that the child would begin with a programmed exercise routine developed by the exercise physiologist and would be administered here at the clinic. The patient will come to the clinic 3 d per week for the first 4 wk. At week 5 the child will move to completing his exercise program from home. At week 8 the child will come to the clinic to be assessed on his ability to maintain his at-home exercise program. If the child is compliant then adjustments will be made to the program for intensity, duration, frequency, and mode. If the child is struggling then it may be appropriate to have him exercise in the structured environment for 2 wk to help him get back on track.

Finally, it would be beneficial to have the child’s parents begin an exercise program as well. This will help them but would also provide positive role models for their child. Additionally, the parents and child should be referred to a dietitian to help them with their meal planning and diet plans.

Discussion

A patient such as this, with JIA, is often in poor physical condition due to the adoption of a sedentary lifestyle, possibly due to the discomfort accompanying the disease. Although drug therapy has improved the quality of life for children with JIA, increasing physical activity may help to enhance it further.

Case Study Discussion Questions

1. What would your initial exercise prescription look like for this patient? Include the mode, intensity, and duration (or volume) you would prescribe. Include your rationale for your choices.
2. What modifications to your program would you make at week 5 when the patient starts a home based exercise program? Explain.
3. Assuming the patient is making progress at week 8, how would you progress your program. Explain.