1-Show the Two equations for determining stroke volume. Spell it out

2- What is the equation for the relationship between Total Peripheral Resistance (or SVR) affects mean arterial pressure?

3- What are the 4 ways the sympathetic nervous system increases blood pressure?

4- Define “hematocrit”.

5- A woman with a hematocrit of 40 and 5 L of blood loses 1 L of blood when shot.   The EMT stops the bleed & pumps 1 L of plasma into him to return her to original blood volume. What is her new hematocrit?

Explain how the structure of each connective tissue type relates to its function

Marlise Muñoz, a married mother of one, was found unconscious by her husband due to a blood clot in her lung. After being rushed to the hospital, she was declared brain-dead and discovered to have been 14 weeks pregnant. The family viewed her as having died, since she was brain-dead, and demanded that she be removed from life support. State law prohibited the withdrawal of life-sustaining treatment from a pregnant woman, so the hospital refused the family’s request, insisting that Marlise remain on life support for 4 months until the fetus had some possibility of surviving outside the womb. Over the course of the ensuing months, the unborn fetus was determined to be nonviable due to hydrocephalus, a possible heart problem, and structural defects in the extremities. Nonetheless, the hospital persisted in its refusal until the family successfully obtained a court order requiring the hospital to remove Marlise from mechanical ventilation. Note: This is based upon a real case that received national attention.

Question 1: How would you defend the hospital’s decision to keep Marlise on a ventilator in this scenario on the basis of the wedge principle?

Question 2: How could the ethical principle of beneficence be used to critique the hospital’s decision to keep Marlise on a ventilator in this scenario?

1: What are your thoughts on prone positioning as a clinical therapy? How does prone positioning impact ARDS pathophysiology and clinical manifestations? The authors recommend developing an interdisciplinary team specializing in prone positioning. What training would the team need? What are your thoughts about being on the team?

2: What are your thoughts on prone positioning as a clinical therapy? Which patients are candidates for prone positioning? Discuss prone positioning contraindications. What strategies would you implement to support the “proned” patient and their family/loved ones?

If the outside of a cell has a potassium concentration of 12 mM what must be the inside concentration of potassium for the condition of no net flux of potassium across the membrane at Vm = - 75 mV

1. Discuss hormonal regulation of spermatogenesis and oogenesis. Make sure to include how FSH (2 pts), LH (2 pts), Testosterone (3 pts) and Estrogen (2 pts) contribute to these processes-- DO NOT INCLUDE THE ENTIRE HORMONAL CYCLE. 1 pt for essay formatting, grammar, spelling.

1. Anybody want a peanut? Andre the Giant had gigantism AND acromegaly from a somatotrophic pituitary adenoma. What does a somatotrophic pituitary adenoma do to growth hormone secretion (1 pts)? What specifically occurs on a cellular/physiological level to cause the symptoms of heightened stature, large hands, large feet, large jaw, large internal organs, and increased blood sugar (4 pts)? Which symptom is not associated with acromegaly (1 pts)? What other disorder often occurs alongside gigantism and acromegaly due to the symptom of increased blood sugar (1pts)? What are the two possible courses of treatment for these conditions (2 pts)? (FYI Andre refused treatment to continue his career in wrestling). 1 pts for essay formatting, grammar, spelling.

1. Describe the hormonal changes and regulation that occurs as a result of fertilization (pregnancy). Specifically outline the role that Progesterone (5 pts) and hCG (2 pts) play in the creation of an optimal environment for implantation and development of the fetus. Make sure to include the cells/structure that secretes the hormone. There is no need to go beyond the first trimester in your description. Finally describe what cell/structure will take over secreting hormones (hint provide 2 hormones) after the first trimester AND why it needed to take over in the first place (2 pts). 1 pts for essay formatting, grammar, spelling.

1. Courtney Isol (Court for short) has been experiencing weight gain, high blood pressure, and is frequently sick. Her stress levels have also been through the roof lately as well. When she visited her doctor, blood tests were run. A hormone called cortisol was especially high in her blood, but thankfully still low enough that tumors were ruled out. How does Court’s high levels of stress lead to high cortisol levels (describe this pathway) (3 pts)? Why has Court been frequently sick (1 pts), experiencing high blood pressure (2 pts), and experiencing weight gain (2 pt)? Since Court doesn’t have a pituitary tumor (it’s not a toomah!), cortisol is therefore exhibiting negative feedback on this pathway. So why are her cortisol levels remaining high (1 pts)? 1 pts for essay formatting, grammar, spelling.

1. Glucose is a necessary substrate for ATP production in many cells, particularly the neurons in the nervous system. Inability to maintain blood glucose between meals leads to feelings of fatigue. There are many steps in the extraction of energy from glucose for production of usable energy in a cell. Please discuss the extraction of energy from glucose by cells for both aerobic and anaerobic energy processes. Calculate the energy yield per molecule of glucose for each process (show your work).

2. Glucose is a necessary substrate for ATP production in many cells, particularly the neurons in the nervous system. Inability to maintain blood glucose concentrations between meals leads to fatigue. But it is also true that chronic excess blood glucose concentrations lead to increased risk of chronic disease that can significantly reduce the quality of life cause early mortality. Discuss the regulation of blood glucose in a healthy individual during one’s nightly sleep and then following breakfast.

Now that you have almost completed the course, as a new expert in Anatomy and Physiology, you have been shrunk and placed into a miniature submarine tasked with traveling through the human body.

For this discussion, describe three organ systems that you would visit and tell us which physiological processes you would like to witness first hand. In your description, please use new terms that you learned in the class (for example, you might want to describe a chemical process that breaks down fat in the intestines).

Depression Case Study

Subjective

Mr. AK is a 45 yr old African American male who is referred to begin pulmonary rehabilitation. His chief complaint is worsening shortness of breath with exertion due to sarcoidosis involving the lung. He reports that he can now only walk less than 0.75 mi on a flat surface; he cannot walk more than one and one-half flights of stairs without stopping. He states that prior attempts to improve functional capacity through regular exercise or increasing activity habits have fallen short due to disinterest, fatigue, and his dislike for exercising in front of others.

Mr. AK also suffers from grade I obesity, depression, hypertension, and hyperglycemia. Family history indicates that his father, mother, and both sisters are living. Social history indicates that he is married with one child (14 yr of age). He works part-time from home as a graphic artist, he does not routinely exercise, his daily activities are markedly restricted due to shortness of breath, he does not smoke or drink, he has difficulty falling asleep at night and awakening in the morning, and he denies substance abuse. Patient is being cared for by Behavioral Health Clinic, which includes ongoing psychotherapy to manage depression, and by his primary care physician for management of hypertension and diabetes.

He is allergic to penicillin. Medications include methotrexate, prednisone, hydrochlorothiazide, and glipizide.

Objective and Laboratory Data

Patient is a mildly obese male (BMI = 33.4) in no acute distress. Lung volumes and forced expiratory flow rates are reduced per recent spirometry report in medical record, as is lung diffusing capacity. Skin nodules observed on neck, arms, and legs; lungs clear; and cardiovascular examination unremarkable and without evidence of edema. Resting heart rate 86 beats · min^–1 and resting blood pressure 144/96 mmHg. Spleen and liver enlarged. Depression screening with PHQ-9 scored at 9.

Assessment and Plan

Patient has active sarcoidosis involving lung, with second organ involvement including skin, liver, and spleen. Comorbidities include hypertension, hyperglycemia, obesity, marked deconditioning, and sleep disturbance likely due to depression (PHQ-9 score = 9).

Mr. AK completed an exercise test using a stationary cycle, achieving a peak power output of 87 W, and stopping due to dyspnea. Peak heart rate 145 beats · min^–1 and peak blood pressure 194/100 mmHg. Oxygen saturation fell from 97% at rest to 89% at peak. No ECG ST segment observed, chest pain denied, and isolated PVCs observed.

Plan includes initiating weight management for obesity and enrolling in pulmonary rehabilitation to improve functional capacity and decrease shortness of breath.

In addition to improving functional capacity through aerobic-type large muscle activities, will include respiratory muscle training, as well as upper body strength training to improve skeletal muscle strength and endurance. Monitor oxygen saturation and use oxygen supplementation via nasal cannula, as needed, to maintain oxygen saturation at 90% or greater. To ensure sufficient stimulus and to enhance patient compliance, intensity for aerobic training is set at 3-5 on 10-point Dyspnea scale. Duration of effort should progress to 30 min, but interval work may be needed if patient is initially unable to exercise for 30 continuous min. Frequency of aerobic activity set at 3 times per week and resistance training set at 2 times per week (2 sets of 12-15 repetitions).

Case Study Discussion Questions

1. Take a moment and research the PHQ-9 as a screening tool for depression. In the clinical setting, values of 10 or higher usually warrant referral to Behavioral Services or informing the patient’s primary care provider. With a value of 9, as reported in Mr. AK, what might you draw from this value relative to influencing compliance, patient affect, and group interaction in the rehabilitation setting?
2. What symptoms should you monitor to decide whether Mr. AK’s depression is worsening while he is participating at your center? If he was worsening, how would you handle this situation?
3. Is regular exercise an effective treatment for depression? Is exercise training/rehabilitation more, less, or similarly effective when compared to medical therapy or cognitive–behavioral therapy? Explain.

Chapter 34

Intellectual Disability Case Study

Subjective

Mr. RK is a 45 yr old male who has a mild intellectual disability (ID) and also Down syndrome (DS) and early stage Alzheimer’s disease. He lives in a community group home with 24 h support and assistance. He works 6 h per day at a local fast food restaurant. His favorite activity is to watch TV, and he enjoys eating popcorn while watching movies.

He does not have any history of heart disease or other serious medical conditions. His case worker has noted that over the past year he has experienced increased shortness of breath when walking up the stairs to his bedroom. However, at his last physical examination there was no note on any suggested pulmonary problems. He has started to display the early stage of Alzheimer’s disease and medical record notes abnormal laxity of the left knee. Mr. RK cannot walk or jog for any extended period of time without pain.

Both his physician and case worker have encouraged him to become more physically active, but at present he performs no physical activity outside of work. He is not currently taking any medications. He is referred by his physician with a request that he be provided assistance with beginning a mild exercise regimen.

Objective and Laboratory Data

He is 5 ft 6 in. (168 cm) and 240 lb (109 kg), with a BMI of 38.8 kg · m–2. Recent laboratory data indicates his total cholesterol is 240 mg · dL–1, with high-density lipoprotein (HDL) cholesterol of 35 mg · dL–1. There is no information on triglycerides or low-density lipoprotein (LDL) cholesterol. His blood pressure was 110/70 mmHg. Other findings on the physical examination were unremarkable.

A graded exercise test was ordered and completed. Mr. AK completed 4 min on a standard Bruce treadmill protocol. His maximal heart rate was 148 beats · min–1 (85% of predicted), and his maximal work capacity was predicted from treadmill time to be 4 METs. Oxygen uptake was not measured. His maximal blood pressure was 150/80 mmHg. He exhibited no ECG abnormalities, and the test was interpreted as negative for exercise-induced myocardial ischemia; but it was noted that maximal effort may not have been reached as evidenced by the low maximal heart rate achieved.

Assessment and Plan

Mr. RK has a mild ID with DS and early stage of Alzheimer’s disease. He is obese and presents with several cardiovascular disease risk factors.

A supervised exercise plan is established. Since Mr. RK has a problem with knee instability and knee pain, he was prescribed a stationary cycling program.

Case Study Discussion Questions

4. Provide a more specific exercise program. Include your recommendations for intensity, duration, frequency, as well as how you would progress the exercise.
5. What measures might you use to evaluate progress and outcomes? Explain your rationale for your choices.