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Breanna N. Harris
Research Assistant Professor
Biological Sciences
Texas Tech University
A Yellow-Bellied Lawyer?: A Case Study in Liver Physiology

This interrupted case study tells the story of Michael, a Harvard law graduate with a stressful job and a seemingly heavy drinking problem. Students are provided with background information, medical history, and lab results in order to guide them towards determining what is wrong with Michael. This study highlights cirrhosis and the effects of alcohol abuse on the liver. Before beginning the case study, students should have a background in the physiological role of the liver and the breakdown of hemoglobin. Students are asked to use the information provided for them in the case study to gather more information about liver cells and their functions, alcohol, and alcoholic liver damage. Ultimately, using multiple blood tests, the Maddrey's discriminant function (DF) score, and results from a magnetic resonance elastography (MRE), they will diagnose Michael with alcoholic cirrhosis. This case was developed for use in a non-majors physiology course, but could easily be used for a majors class.

All or Nothing: A Case Study in Muscle Contraction

In this interrupted case study, students pose as an intern of a neuromuscular/skeletal specialist and discover how sarin and myasthenia gravis influence muscle function. Students are given background information about the patients and their situations, as well as results from blood tests. Students are asked incremental questions that build on each other with the end goal of students describing the process of muscle contraction, from motor neuron to sarcomere shortening, and learning what happens when parts of that process are disrupted. This activity was developed for use in a physiology course where the majority of the students were pre-medical, pre-nursing, or other allied health majors.

Black and Blue with Love: A Case Study in Blood Clotting

In this directed case study students follow a nurse practitioner and work with a diagnostics team to determine what is wrong with Tristan, an infant who comes to the clinic with multiple bruises. Students are given background and patient history, and are then given results of various blood tests ordered by the diagnostics team. The exercise emphasizes the physiological process of coagulation and the importance of various clotting factors, especially factor VIII. Students will be introduced to results from several blood tests, including: complete blood count, partial thromboplastin time, prothrombin time, metabolic panel, and factor VIII assay. The patient is ultimately diagnosed with severe hemophilia A and the case then introduces students to this disorder, the genetic determinants, the incidence, and ways to manage the disease. The data in this case are real and the story represents the medical history of an actual patient. Originally developed for pre-nursing students, this activity would also be suitable for majors in physiology or pre-medical students; it could also be used in an introductory genetics or biology course.

Caught Red-Handed: Hemoglobin, Carbon Monoxide, and a Butcher’s Knife

Was the "Brooklyn Butcher" of 1926 a cold-blooded killer or was something less sinister at play? This interrupted case study introduces students to hemoglobin binding and carbon monoxide poisoning by working through the details of a fictionalized account of a true-crime story. Topics covered include molecule conformational states, binding affinity, deoxyhemoglobin, oxyhemoglobin, carboxyhemoglobin, and oxygen transport. Students also design an experiment to determine the cause of death of the victim. Prior to beginning the activity students should have some knowledge of the respiratory and circulatory systems and be familiar with oxygen binding curves. Detailed understanding of hemoglobin conformational changes is not necessary since this information is covered in the case. Students will also learn briefly about the electromagnetic spectrum and visible light. Originally developed for a non-majors, pre-nursing anatomy and physiology course, the case is also appropriate for use in any of the following courses: introductory biochemistry, introductory biology, introductory chemistry, nursing, exercise physiology, or possibly even introductory physics.

Cracking the Case: The Relationship Between Bones and Hormones

In this directed case study, students shadow Dr. Lee in diagnosing two patients with osteoporosis. The students are given patient history and an initial panel of test results, which they discuss in small groups. After diagnosis, they are asked specific questions about bone remodeling, bone physiology, and the drugs prescribed by Dr. Lee. The ultimate goal is to understand how osteoporosis developed in Shino Yang (post-menopausal osteoporosis) and Eleanor Davis (glucocorticoid-induced osteoporosis), and to understand the mechanism of action of the prescribed treatments. The case study data are fabricated, but the values provided are within physiological ranges and should thus be a good representation of what students would see in patients with these actual diagnoses. This case study was developed for college-level, pre-nursing students in a non-majors anatomy and physiology course, but would also be suitable for majors physiology, animal physiology, pharmacology, pre-medical or exercise physiology students, or likely any biology students with a basic knowledge of bone remodeling.

Going for Gold: Sex, Gender, and Competition

This case study introduces students to the true story of Caster Semenya, an outstanding female mid-distance runner from South Africa.  Caster won the 800 m race at the 2009 Track and Field World Championships when she was just 18. Since then, she has faced scrutiny about her sex and gender. Due to her high levels of endogenous testosterone, she was banned from running for almost a year by the track and field governing body, the IAAF. In this case study, students use information from news reports and Caster's appearance to determine the possible biological underpinnings likely responsible for her anatomy and physiology.  Students are also asked to consider if using circulating testosterone levels to determine if a female can race is a valid method of exclusion. This case asks students to think about how sex and gender are related, and pushes them to discuss societal implications of labeling both of these constructs as binary when in fact they are much better described as spectra.

Honeymoon Havoc : Action Potentials and Venom Pathophysiology

In this interrupted case study, students meet a pair of fictional newlyweds on their way to Australia for their honeymoon. Initially eager to enjoy the sun, sand, and sights, Tanya and Julien Brahim end up more intimately acquainted with the local wildlife than they had planned. Tanya is bitten by a venomous arachnid and Julien has a run-in with a dangerous cnidarian. This case study was created to help students solidify their knowledge about cardiac myocytes, particularly ion movements associated with action potential generation in autorhythmic and contractile cells. As students work through the case, they will complete fill-in-the-blank paragraphs describing the heart, diagram membrane potentials and ion movements, and compare and contrast action potentials from different cell types. Written for a course in human physiology, the case requires some prior knowledge of membrane potentials, equilibrium potentials, ion gradients, neuronal action potentials, and skeletal muscle action potentials. An optional pre-case assignment (included in the teaching notes) can be used to make sure that students are familiar with the necessary concepts.

I Heart Running: A Case Study on Tachycardia in Sam the Runner 

"I Heart Running" is a case study in which students diagnose the cause of exercise-induced tachycardia in an otherwise healthy, 27-year-old female. The patient, Sam, is a long-distance runner and realizes that her exercising heart rate reaches over 200 beats per minute. As the story of Sam's encounters with her physician develops, students are given results from multiple laboratory tests and detailed patient background information.  Students are guided through the material with a series of questions with the ultimate goal of determining the cause of the exercise-induced tachycardia that Sam experiences. The case study is based on actual laboratory results and was designed for students in an upper-level undergraduate Human Physiology course. In this activity students will learn about heart rate, cardiovascular physiology, and oxygen carrying capacity, and factors which influence these concepts, as they try to diagnose Sam.

Living the Sweet Life: An Internship in Endocrinology

In this directed case study, students help “Dr. Gupta” diagnose three patients in an endocrinology clinic who are having problems with blood glucose regulation. In Part I, students are given patient backgrounds and results from laboratory tests generated by a primary care physician. Students are initially asked to evaluate the data presented, come up with a potential diagnosis, and determine what additional tests they would like to run. In Part II, students are given results of additional tests and guided through the material with a series of questions with the ultimate goal of determining a diagnosis for each patient (Patient 1: Type II Diabetes; Patient 2: Type I Diabetes; Patient 3: Cushing’s Syndrome). The case study contains fabricated data, but values are based on realistic physiological ranges and should give students a realistic idea of values they would see in individuals with these conditions. The study was designed for pre-nursing students in a non-majors anatomy and physiology course. Students will learn about insulin, blood glucose regulation, diabetes testing and diagnosis, diabetes management, cortisol, Cushing’s Syndrome, and negative feedback.

No Longer Living the Sweet Life: Losing Control of Diabetes

In this interrupted case study, students will help “Dr. Gupta” investigate and assess complications arising in one of her long-term patients, “Jorge Alvarez.” Jorge was diagnosed with Type II diabetes mellitus ten years ago as documented in “Living the Sweet Life,” an optional prequel case study also in the NCCSTS collection. Jorge has been working with Dr. Gupta to manage his condition, but this year he has come under additional stress, both emotionally and financially, and his health has deteriorated. Jorge now presents with several new signs and symptoms, including numbness, tingling and burning sensations, and a foot sore that just won’t heal. Students will review the nervous system and assess Jorge’s symptoms, vitals, and blood tests to determine if his diabetes has worsened. Students will also learn about tests used to diagnose types of neuropathy and consider which of them would be most beneficial for Jorge. In addition to a non-majors anatomy and physiology course, this case study may be appropriate for an introductory biology, nutrition/dietetics, or a sensory and perception course.

Take a Deep Breath: A Case of Respiratory Illness

This interrupted case study tells the story of “Callie,” a 26-year-old baker from San Francisco who runs a successful new cupcake business with her fiancé, Jeremey. For some time Callie has not felt well, experiencing fatigue, difficulty breathing, stress, and a persistent cough. When at last she visits her physician she is diagnosed with an active tuberculosis (TB) infection. The story provides a context for students to learn about TB infection, including how it impacts the lungs and gas exchange in the alveoli, and how one might contract and treat TB. Students will compare Callie’s symptoms to a list of known respiratory diseases and disorders to narrow down possible causes, walk through a visit with a physician, review blood test results, compare and contrast active vs. latent TB infection, and conclude by applying what they’ve learned about TB to gas exchange in the lung. The case is especially appropriate for use in an introductory anatomy, microbiology, pathophysiology, or general biology course.

Thyroid Troubles: A Case Study in Negative Feedback Regulation

In this interrupted case study, students shadow an endocrinologist as she tries to determine what is wrong with Angela Barber. Angela is a middle-aged woman presenting with symptoms suggestive of a thyroid issue. Students are given background information, patient history, and results from thyroid-specific blood tests. The exercise emphasizes the hypothalamic-pituitary-thyroid axis and particularly highlights the role of negative feedback. Students will use results from serum thyrotropin and thyroid hormone level tests, as well as patient symptoms, to come up with a diagnosis. In preparation for the diagnosis, students are asked to compare the endocrine profiles of patients with Graves' disease, Hashimoto's disease, iodine deficiency (primary hypothyroidism), and various tumors. The case was developed for college-level biology majors in a physiology course, but also has been used successfully for pre-nursing students in a non-majors anatomy and physiology course. Thus, this activity would be suitable for majors in physiology or pre-medical students, as well as allied health majors.