Question

Part III – Samson Taylor

A 33-year-old entrepreneur, Samson Taylor, has not been feeling like himself lately. He has been feeling quite tired and his co-workers have commented on his droopy eyelids. Additionally, he is experiencing weakness in his arms and legs, has difficulty talking clearly and even clients and customers have been concerned that Samson hasn’t been looking very happy at work. One day at lunch, Samson started to choke on his food, causing one of his coworkers to perform the Heimlich maneuver on him. While this didn’t cause any permanent damage, Samson is convinced that it is time to go see a doctor.

When he finally arrives at his appointment with Dr. Williams, he explains to Dr. Williams what has been going on, and the doctor decides to run a few blood tests. Samson’s blood work results are presented in Table 2 below, the top line represents his initial readings; the following three rows are for other time points. You must work with your team members to interpret all clinical values.

11. Examine Table 2 below. Fill-in the normal range of values for each of the variables in the last (blank) row.

Table 2. Lab Values for Samson Taylor. (Serum)

Time Point

BP

Temp.

(°F)

Hemat.

(%)

Glucose

(mg/dL)

Na+

(mEq/L)

K+

(mEq/L)

AChE

Activity

(% of normal)

Thyroxine

(pmol/L)

Serum

Triiodothyronine

(FT3)

(pg/dL)

Antibodies for Ach Receptors

1

115/73

100.4°F

36.5%

94 mg/dL

144 mEq/L

4.3 mEq/L

100%

11.3 pmol/L

154 pg/dL

present

2

120/79

101.2 °F

40.0%

100 mg/dL

140 mEq/L

3.8 mEq/L

99%

11.0 pmol/L

154 pg/dL

present

3

135/88

99.5 °F

37.9%

108 mg/dL

138 mEq/L

3.9 mEq/L

99%   

10 pmol/L

150 pg/dL

present

4

118/80

98.2 °F

35.9%

72 mg/dL

138 mEq/L

4.9 mEq/L

100%   

8.2 pmol/L

100 pg/dL

none

Normal Values

Questions [Critical Thinking, Communication and Quantitative]

12. What symptoms is Samson experiencing?

13. What levels from his blood work are abnormal and at what time point?

14. How would antibodies against ACh receptors affect the neuromuscular junction?

15. How would antibodies against the ACh receptors affect the influx of Na+ into the cell?

16. How would antibodies against the ACh receptors affect the levels of Ca2+ inside the sarcoplasmic reticulum? What effect does this have on the actin and myosin filaments?

17. What disorder does Samson have? How do we treat/manage this diagnosis?

18. Use a graphing program to create two line graphs. Each graph should compare the lab values between Joyce and Samson for time points 1-4. Graph #1 should compare Joyce and Samson’s acetylcholinesterase activity and hematocrit; Graph #2 should compare their Na+ and K+. Place time points 1-4 on the x-axis and the lab values on the y-axis.

19. Fill out Table 3 below, compare the lab values that accompanied the muscle contraction problems faced by Joyce and Samson at time point #3 to that of a normal person. Use the terms normal, increased, or decreased to complete the table.

Table 3. Comparison of Lab Values for Joyce Snyder, Samson Taylor, and a normal patient. (Serum)

ACh

AChE

ACh Receptors

Na+ influx

SR Ca2+ release

Cross bridge formation

Frequency of muscle contraction

Healthy person

Joyce

Samson

Part IV

Assume the role of a medical practitioner and communicate your findings and prognosis to the patients and their families.

Note: As you assume the role of the practitioner, be mindful of what expectations you would have of the medical professionals if you were the patient or the caregiver. Be thorough in your explanation of the findings, the prognosis, and the treatment regimens. Remember, these family members are scared, anxious, and confused. Throwing complex medical jargon at them with no explanation as to what it means will terrify them even more. On the other hand, if you use too simple or a minimal explanation, they will get angry and lose all faith in you!

Questions [Critical Thinking and Communication]

20. Write two paragraphs, one for each patient, that communicates your findings and prognosis to the patients and their families.

Part V

21. Write an alphabetized list of all sources referenced in your answers in proper APA format.

References please!!

Answer 1

11) Normal values :-

BP - 120/80mmg

Temperature - 98.6 °F

Hematocrit - 40 -54%

Glucose - 60 to 110 mg/dl

Na+ - 135- 145 mEq/L

K+ - 3.5-5.1 mEq /L

AChE Activity- >30%

Thyroxine - 4.6 - 12 ug/ dl

SerumTriiodothyronine - 80-180 ng/dl

Antibodies for Ach Receptors - less than 0.05 nmol /L

12) Symptoms experienced by Samsung :-

- droopy eyelids

- weakness in his arms and legs

- difficulty talking clearly

13) At time point 1 :-

Temperature and hematocrit are abnormal

At time point 2 :-

Temperature is abnormal

At time point 3 :-

Temperature and hematocrit are abnormal

At time point 4 :-

Abnormal hematocrit and antibodies for Ach receptors

14) The binding of antibodies reduces synaptic transmission at the neuromuscular junction by preventing receptors from binding acetylcholine or causing the cell to endocytose the receptor. The net effect is that there are fewer available receptors to bind acetylcholine.