Question

Case study 1 part 1- 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.

Question 1 Based on the clinical picture presented above, you should have identified three diseases/conditions we have covered in BIOL122. • 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 2 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.

Question 3 a) 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. b) Explain what specific considerations need to be made in the present scenario, when two drugs are administered simultaneously.

Question 4 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.

Case study 1 part 2- Musculoskeletal disorders (20 marks total) 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.

Question 5 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.

Question 6 Discuss how the aetiology of Mary Lou’s joint disease differs from the other joint disease we covered in BIOL122.

Question 7 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. .

Question 8 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.

Answer 1

1) ●Two diseses identifyed in patient is depresssion and alzheimers disease.

Depression is charecterised by depressed mood or loss of interest in daily doing activities, which affects the daily life.

Alzheimers disease is a progressive disease which leads to loss of memory and other mental illness.

● alzheimers disease

The patient show charecterist symptom of alzheimers

▪ memory loss: a common symptom of alzheimers is found in patient.

▪chages in personality behavior like

mood swings, apathy , wandering ,depression

here she forgets her way to home and wandered around aimlessly. She has mood swings,depression and apathy.

Depression

Loss of interest; she lost her interest in activities like gardening and going bingo

Sleep problem : mary lou faced sleeping problem.

●Pathophysiology

Alzheimers disease

It is cause by lifestyle,environmental or genetic factors. Alzheimer is caused when the brain cell get damages leading to memory loss.

People who living with depression have incresed risk of developing alzheimer. Here the patient face chronic depression which increse her chance of getting alzheimers. Another reason in this patient which causes alzheimers is the excess intake of alcohol. Too much alcohol intake can damage the brain cells that leads ri alzheimers or other form of dementia. Alcohol affects cognition and memory funcation.

Sign and symptoms of alzheimers include meomry loss , difficulty thinking and understanding, disoriebtation,agitation, irritability, lack of interest wandering and getting lost,confusion,depression

Here patient have symptoms memory loss,disorientation, lack of interesr, wandering ,depression

Depression

Depression can be caused due to various resons like enviromental, social or biolologic factors

Here the patient lost her husband and she enter into the stage of chronic depression.

Sign and symptoms of depression include a depressed mood, lack of interest , sleeping problem agitation, difficulty thinking, mood swings, anxiety, fatigue ,

Here mary have depressed mood, lack of intersest, mood swings ,sleeping problems.

2) fluoxetin is an anti depressant which  inhibit the reuptake of serotonin from presynaptic meurons and increse the level of 5ht . By balancing the neurotansmitter these reduce the symptoms of depression.

By giving this drugs patient get relieve from symptoms like mood changes, can improve sleeping problem and provide godd sleep.

Cholinesterase inhibitor

It inhibit the acetyl choline esterase enzyme. By blocking this enzyme it increase the level of acetylcholine. This improve brains memory and cognitive function which is helpful in case of diseases like dementia and alzheimers.

In mary lou cholinesterase inhibitor increase the communication between nerve cell by increasing ACh level. This inprove the symptoms of alzheimers like memory loss.

Diazepam is benzodiazepine drug it is given to reduce alcohol withdrawal symptoms like anxiety, agitation tremor etc