End-of-semester worksheet
Instructions for submission
• To identify which question you answer, write Q1/1 answer…, Q1/2 answer…., and do not repeat/copy the questions. This is requested to ensure you do not generate a high similarity score in Turnitin. Note that if we cannot unambiguously identify the questions your answers address, or you repeat the questions in your answer sheet, we will not mark your submission.
• To show your understanding of the content, and that you are answering the questions asked (rather than adding all the information you can find about a topic), we strongly suggest that your answers have a maximum of 250 words per question. Answers that are excessively long will be marked down as they do not clearly show your understanding of the subject matter. Note that for some questions you can write well under 250 words and still appropriately answer them. Importantly, the quality of your answers does not get better if you are verbose, state facts irrelevant to the question, or provide an answer to a question you would have liked to see.
• Most answers cannot be copy-pasted from your notes, workbook, textbooks, or the internet. In fact, we are deliberately asking questions that make you reflect on and piece together information you have learnt throughout the semester. To get full marks, you will need to clearly demonstrate that you understood the learning material and are able to apply the acquired knowledge. When marking, we are looking for connections to be clearly stated, unambiguously written, and well-reasoned. We expect high-quality and convincing writing, where the meaning is clear, relevant terminology is used, and which reflects engagement with the unit. Do not be afraid of using dot points wherever you can; succinct and clear writing is far superior to a word salad or to several paragraphs without essence.
Hints/feedback from previous semesters
• Take care that your answers have the expected level of depth—it will not be enough, for example, to state that ‘drug X decreases blood pressure’; we expect you to explain the mechanism of and describe the chain of events leading to the desired/known effects.
• As an attempt to try to hide blatant plagiarism, some students had just simply replaced certain words in their text they copied from the internet/textbooks. This is not paraphrasing but cheating (i.e., plagiarism). In addition, the ‘replacement’ words tend to alter the meaning and/or may be inappropriate in the context of the answer.
• Any form of academic misconduct (e.g., plagiarism, collusion, or sloppy paraphrasing) will be subject to vigorous academic misconduct investigations resulting in mark deductions, cancellation of the assessment task, and/or disciplinary hearings.
• We are particularly keen on seeing evidence of your critical thinking skills—i.e., you are supposed to assess all information you obtain from various reliable sources (textbooks, lecture material, journal articles). Please be aware that just because Google suggests an answer, it does not mean that it is correct.
Case Study 1 (30 marks total)
Cheryl is a 55-year-old woman, who works long hours for a publishing company. She likes to have a couple of drinks when she gets home from work every night with the take-away meals she picks up on her way home. She loves her job as an editor, but finds it very stressful, and so, has taken to smoking cigarettes to help her relax. What started as a couple everyday has now become a packet a day. She has also increased her alcohol intake to 4 glasses of vodka every night as she has noticed that she no longer gets the same pleasurable feelings from a couple of glasses. Her friends have noticed that she stumbles quite often, forgets things, is moody and is flushed in the face almost all the time. When questioned about the amount she drinks, she denies excessive use.
In the last couple months, Cheryl has lost interest in many things she once enjoyed; dancing, going to the movies, and art class. She finds that she cries at the drop of a hat. She finds it difficult falling asleep at night, and so has started to drink more and more until she passes out. She has no energy to get up for work and wants to stay in bed all day. Her sister is worried she is relying too heavily on alcohol, and fears that she is starting to get short-term memory loss from the alcohol consumption. She forgot her brother’s birthday, an important work meeting, and what day of the week it was. She stops mid-sentence as she cannot find the right words to communicate her thoughts, and she is taking double the time to now complete a task. She is becoming very frustrated with herself and lashes out at the people around her. Her sister decides it is time to book an appointment with the GP to work out what has been going on with Cheryl.
At the medical clinic, the GP listens to all of Cheryl’s signs and symptoms. She prescribes a benzodiazepine (Xanax) and a selective serotonin reuptake inhibitor (Zoloft). She also prescribes an acetylcholinesterase inhibitor after carrying out physical, neurological, and cognitive tests. Cheryl is also given information on counselling and is referred to a counsellor to talk through her problems and help her with coping strategies.
Question 1/1. Identify one disease/condition Cheryl has and justify your answer. (2 marks)
Question 1/2. Using the disease/condition you have identified in Question 1/1, explain the link between the clinical manifestations of the disease and its pathophysiology. (2 marks)
Question 1/3. Discuss the benefits of administration of an SSRI in Cheryl’s condition. To get full marks, you must explain the pharmacodynamics and pharmacological effects of SSRIs and relate them to Cheryl’s clinical picture. (3 marks)
Question 1/4. Describe the effect of chronic alcohol consumption on liver function and explain its consequence on the distribution of water between the interstitial and intravascular compartments. (3 marks)
Cheryl’s family was happy with the management plan established by the doctor as Cheryl was progressing quite well. She was feeling much happier and did not have to rely on alcohol to go to sleep. Cheryl was able to catch up for lunch with her sister, Rose, who mentioned she was experiencing pain in both hands, which now took on a deformed appearance. In fact, Rose’s hands appeared quite swollen as did her knees. She doesn’t understand how this could have happened as she is still quite young at the age of 50. She wonders whether it is her type 1 diabetes mellitus which has caused these problems. She tells Cheryl that she can’t sew as much as she used to as the pain gets worse the more she sews. Cheryl asks her whether she has a cold as she looks a little under the weather, and Rose tells her that she has been felling unwell lately. She admits that she has had so many viruses in the last few years, she just can’t seem to catch a break.
Question 1/5. Name the musculoskeletal disorder Rose suffers from, justify your answer, and identify a risk factor in her history that is specific to the disease you specified. (2 marks)
Question 1/6. Compare and contrast the aetiology of Rose’s joint disease with the other joint disease we covered in BIOL122. In your answer, name both diseases and describe two similarities and three differences. (3.5 marks)
In a quiet Sunday morning, Rose tripped and fell, which resulted in excruciating pain in her back. She could not even get up; her husband called the ambulance and tried to comfort her until they arrived. She was taken to hospital, where the X-ray showed compression fracture at the T11 vertebral level. A bone density test was also completed, which indicated that Rose had a T-score of -2.9.
Question 1/7. Interpret the result of the bone density measurement, indicate what reading would be considered physiological, and name the condition Rose’s finding is associated with. (1.5 marks)
Question 1/8. Describe the aetiology and pathogenesis of the disease you specified in the previous question. (6 marks)
Question 1/9. Name and define the type of fracture you identified in Rose’s case and describe the most likely link between the condition you named under Question 1/7 and her vertebral fracture. (3 marks)
Cheryl approaches you with her concerns about the COVID19 vaccination. She argues that there is no need to get the jab — in fact, it would make more harm than good — because (i) the chances of dying from COVID19 are very low as it is nothing more than a type of flu, and (ii) there are known complications associated with the jab, including recent emergencies and potential fatalities caused by abnormal blood clotting. Cheryl argues that it is an unacceptable risk to vaccinate the entire Australian population because the potential harm far more outweighs the expected benefits.
Question 1/10. Based on what you learnt about vaccinations and infection control in BIOL122, and using any other sources of information you deem relevant and reliable, describe your answer to Cheryl and justify your conclusion. (4 marks)
Case Study 2 (30 marks total)
Greg is a 42-year-old IT-specialist, who lives alone. He has always taken care of his diet and lifestyle; he is on a healthy diet, does not smoke, does not drink excessively, and exercises at least three times a week. He has not had any major medical issues apart from his tonsillectomy that was performed when he was 6 years old. His father has been recently diagnosed with hypertension (which is under control, fortunately). His mother has been struggling with type II diabetes, but her oral medication and healthy diet control it reasonably well.
One day, without any warning, Greg felt really unwell so decided to see his GP right away. It took only a short, 5-minute walk to get to there, but Greg was struggling to make it. His GP instantly noticed that Greg, looked really unwell—he appeared to be a little flushed, looked very skinny, and was feeling a little breathless. On questioning, Greg explained that he had been feeling nauseous and unusually fatigued. He also explained that he had been very thirsty over the past couple of weeks, which he attributed to his unusually intense exercise routine and the unseasonably high temperatures. He also explained that he had recently lost over 8 kg in weight, but again, he had attributed this to his exercise and healthy diet. On questioning, he admitted that he had to get up at night to pass urine almost every hour, but he was not at all surprised about this as he had been drinking copious amounts of water. He also confessed that he had been feeling always thirsty and that his vision often became somewhat blurred. When he was asked about his family history, he could not recall if he had any siblings, which his GP found quite strange. The GP also noticed that Greg’s breathing was laboured; his breathing rate seemed to have increased, and he was taking deeper breaths.
One of the tests that were instantly performed was a urine dipstick test, which was highly positive for glucose and ketones. A subsequent blood test showed a plasma glucose concentration of 16.8 mmol/L, his arterial blood pH was 7.22 (pCO2 = 20 mmHg; bicarbonate: 14.7 mmol/L), and his serum osmolarity was 304 mOsm/L.
After considering his clinical picture and laboratory findings, Greg’s attending physician told him that he had diabetes mellitus, and he required immediate treatment.
Question 2/1. State four pieces of evidence from Greg’s clinical picture/laboratory findings that support the GP’s suggestion. (2 marks)
Question 2/2. Name the complication Greg was suffering from when he visited his GP and identify two laboratory or clinical findings that support your conclusion. (1.5 marks)
Question 2/3. Identify the type of diabetes Greg is suffering from and justify your answer. (0.5 marks)
Question 2/4. Explain the link between Greg’s present condition and his breathing pattern. In your answer, you must also (i) name the characteristic breathing pattern observed in Greg’s case and (ii) explain the consequence of this type of breathing. (6 marks)
Question 2/5. One of the long-term complications of Greg’s condition is accelerated rate of atherosclerosis. Explain three reasons for the increased rate of atherosclerosis in diabetic patients. (3 marks)
Greg’s diabetes is now successfully managed, and everything returned to normal for him. However, one day he is found on the floor, lying unconscious.
Question 2/6. Assuming that Greg’s present state is related to his plasma glucose concentration, identify the reason for Greg’s unconscious state and outline the best course of action in the present scenario. (2 marks)
Greg’s work colleague, Cindy, is a 38-year-old married mother of three girls, who was diagnosed with stage 3 infiltrating ductal cancer of her left breast. Cindy underwent left mastectomy and axillary lymph node dissection 7 weeks ago and is currently undergoing chemotherapy.
Question 2/7. Describe three cancer cell characteristics that allow them to become invasive and metastatic. (6 marks)
Question 2/8. Discuss three potential clinical manifestations that can result from bone marrow suppression and explain how this condition may be linked to Cindy’s treatment. (4 marks)
A few weeks into her treatment, Cindy has contracted a nasty bacterial skin infection, which resulted in a massive swelling of her right hand. In addition to this, since the mastectomy and lymph node dissection, she has also been experiencing an uncomfortable swelling in her entire left arm.
Question 2/9. Considering their most likely aetiology, name the types of swelling in Cindy’s right hand and left arm and describe three differences between them. (5 marks)
Case Study 3 (30 marks total)
Twenty-one-year-old Lisa long has been suffering from asthma and is now experiencing an asthma attack while taking an afternoon walk with her sister. It is a cold, windy, early spring weekend. She complains of acute shortness of breath and has audible wheezing, episodic cough, and chest tightness with itchy red watery eyes and a stuffy, runny, itchy nose. These symptoms become worse within 5 minutes. Her sister called 000 and paramedics promptly attended to Lisa, who was fully conscious, appeared wide-eyed and frightened, and unable to breathe effectively. She was immediately transferred to the nearest hospital for full respiratory function assessment and treatment of acute asthma.
A physical exam reveals a HR of 120/min, RR of 38/min, with signs of accessory muscle use. Chest auscultation reveals decreased breath sounds bilaterally, with inspiratory and expiratory wheezes. Lisa is coughing up small amounts of thin, clear sputum and has an arterial oxygen saturation of 90%.
Nebulised salbutamol, oxygen by facial mask, and systemic corticosteroid were administered. A second small-volume nebuliser treatment was ordered 20 minutes later. Chest auscultation revealed diminished wheezes; RR was 24 at this time and HR was 102. Over the next 24 hours Lisa showed steady improvement and was discharged for follow-up with her local GP to review her asthma action plan and change any medications as needed to help prevent future exacerbations.
Question 3/1. List two factors that could have triggered Lisa’s acute asthma attack and explain the link between the named factors and her asthma. (4 marks)
Question 3/2. Explain the pathophysiological steps leading to acute asthma attack. In your answer, you are expected to link type 1 hypersensitivity reaction to the role of histamine in acute asthma. (4 marks)
Question 3/3. Briefly explain the mechanisms of action of (i) salbutamol and (ii) corticosteroids in the treatment of acute asthma and describe their benefits in Lisa’s condition. (4 marks)
Question 3/4. Explain the mechanism of action of anticholinergic/anti-parasympathetic medications and their potential benefit(s) in asthma treatment. (3 marks)
Lisa’s grandmother, Maria, is a 67-year-old retired, obese woman, who lives with her husband Max. She enjoys sitting down to a movie every night with a bottle of Shiraz and a large packet of salt and vinegar chips or tub of cookies and cream ice cream. She has always loved a glass or two of wine with dinner but now figures she can have a few more since she no longer has to get up for work. Maria doesn’t like to exercise; her only form of exercise is walking around Coles on Friday whilst doing her weekly shopping. Her sister has asked her to join her walking group on numerous occasions, but Maria would rather stay home and bake. Maria’s mother moved in with her many years ago when her father passed away from a heart attack at the age of 60. Her mother isn’t in the best of health, she has type II diabetes and hypertension, which she controls with medication.
One day Maria decides to visit her neighbour, taking with her a batch of freshly baked cookies. Whilst walking to her neighbour’s house, she notices that she is short of breath and is feeling a slight pain in her chest, but when she sits down, she feels fine, so she dismisses it once again, putting it down to her poor fitness. However, on her way home she begins to feel light-headed and weak and feels like she is going to be sick. She notices that she has been feeling like this quite a lot lately, even when resting in the evening, so she decides to make an appointment with her GP for later in the week.
At the medical clinic, the GP takes Maria’s blood pressure reading. It has been elevated on a number of occasions, and today is no different—the reading shows 140/95 mmHg. The GP prescribes an ACE inhibitor and tells Maria she really needs to make some lifestyle changes. He writes a referral for her to see a cardiovascular specialist for an ECG and a coronary angiogram to determine why Maria has been short of breath and unwell.
One day, whilst waiting for her results, Maria starts to feel more nauseous and dizzier than usual. She starts to feel clammy and sweaty, and her face seems gray in colour. The chest pain returns but now feels like a crushing pain, and she can’t breathe. Her husband, Max, dials 000, and she is rushed to hospital. An ECG shows that Maria has an ST elevation, and a blood test indicates that she has high levels of troponin in her blood. Maria is given heparin intravenously as well as an anti-platelet and a fibrinolytic drug. She is taken into surgery, where a coronary angioplasty is performed.
Question 3/5. Explain what Maria’s blood pressure readings suggest and discuss two risk factors that might have contributed to Maria’s present condition. (3 marks)
Question 3/6. Explain the expected benefits of ACE inhibitors in the above case study by referring to their pharmacodynamics and pharmacological effects. (4 marks)
Question 3/7. Name the condition Maria was suffering from when she was rushed to hospital and discuss two clinical findings that support your claim. (3 marks)
As part of her therapy, Maria takes a new, hypothetical medication (called MedX), which has narrow therapeutic index, therefore you (as a health care professional) need to exercise special care when it comes to the determination of her required dosage.
MedX is taken orally and has the following features:
• In healthy adults, the absorbed MedX is subject to first pass liver metabolism, which decreases its bioavailability to 10%.
• The active ingredient that enters the systemic circulation is water-soluble and shows very high protein binding: 98% of the drug molecules present in the plasma are bound to albumin and, to a smaller extent, a1 globulin.
• Most of the drug is excreted by the kidneys, where it is both freely filtered and actively secreted in the proximal tubule.
Question 3/8. Based on the above properties of the drug, explain why you would recommend dose reduction in Maria’s case. In your answer, explain four age-related changes in the pharmacokinetics of MedX to justify why dose reduction is necessary in the present scenario. For each of those age-related changes described, you will need to consider how the free plasma concentration of the drug is expected to change in Maria’s case compared to that of a young or middle-aged individual. (5 marks)
END OF WORKSHEET
