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Table of Contents

Case Study Part 1-Neurological disorders

Case Study 1 Part 2-Musculoskeletal disorders

Case study 2 - Respiratory and microbiology case study

Case Study Part 1-Neurological Disorders

Question 1

  • The two diseases and conditions that have been identified in this case depression and Alzheimer’s disease.

  • The two characteristics and signs that were noted in the case are: Depression: Mary Lou was seen depressed after the death of her husband. She had lost interest in everything after her husband’s death and relied on alcohol to get sleep. This can be observed from her mood swings and sleep patterns. The major symptoms of depression subjects mood swings, restlessness, lack of sleep cognitive abilities like concentration difficulty, not completing tasks and others. Alzheimer’s disease: This condition was very much prevalent in the case study as Mary Lou. Memory loss is a common symptom in this case and Lou was suffering from memory loss. Her alcohol consumption pattern was changing throughout. She was consuming alcohol during the day and night as well. Alcoholism causes mental problems as well as health complications which can be related to her state of memory loss.

  • Pathophysiology of depression: to entail depression it is very important that all the symptoms are identified in a patient. The pathophysiology of depression includes depressed mood, weight loss, loss of interest, insomnia, loss of energy, diminished ability to think and psychomotor agitation. These changes were very much present in Lou and the GP had also prescribed her with 50 mg of Fluoxetine/Prozac daily to deal with depression.

Pathophysiology of Alzheimer’s disease: this generally happens in the late adult life. The changes that caused this disease in her is memory loss, alcohol consumption, problems with speaking and confusion.

Question 2

50 mg of Fluoxetine/Prozac daily: these medications are used to deal with depression, disorders in eating and panic attacks. Functional changes that occur with this drug are that it increases the suicidal thoughts and behavior. Other changes of this drug can include Serotonin syndrome, Low salt levels and mania warnings. Fluoxetine subjects by increasing the quantity of serotonin in the brain. It helps to maintain the mental health.

Cholinesterase inhibitor: these drugs are prescribed for a patient who is dealing with Alzheimer’s disease. Cholinesterase inhibitors help in blocking the action of acetylcholinesterase. These medicines can treat moderate to severe condition of this disease. The common side effects in context to this drug are associated with insomnia, nausea, weightless, fainting, confusion and others. In the case of Mary Lou it was quite evident as she was going through some of these symptoms.

10 mg of Diazepam daily: this drug was prescribed to her so that she could leave alcohol. Mary Lou was consuming alcohol regularly which was taking a toll on her health. The GP prescribed this drug so that she could get out of alcohol. Insomnia, nausea, fainting, anxiety are common symptoms of alcoholism which can lead to further problems. Diazepam controls these behaviors and helps to relax the muscles.

Question 3

a) Fluoxetine subjects a nonlinear pharmacokinetic profile. Therefore, the drug needs to be used with caution in healthcare users with a reduced metabolic capability (i.e. hepatic dysfunction). Pharmacokinetics of fluoxetine is not exaggerated by either obesity or renal impairment. This drug can be used for all ages as it has a better tolerability profile compared to other antidepressants. However, these drugs have other severe symptoms like suicidal tendency or thoughts, mania warnings in the first few days of taking it.

b) Mary Lou needs to be administered by her family (daughter) in this regard so that she does not harm herself. The medications definitely have side effects but monitoring the health and behavior of Mary can be significant to understand her. Mary Lou had been going through a tough time as she had already been diagnosed with other health problems. Antidepressants can further deteriorate her health condition. Management of depression is very much important in context to Mary Lou. Effective management in context to depression confers the education of the patient in effective terms. If the patient is not well educated enough then it is certain that there will be problems. Follow up is very much required for patients like Mary Lou. Consultation with the GP in regular intervals will help in her care. Discussing problems and behavior tendencies in regular intervals with the GP will help Mary to monitor her health condition effectively. however the antidepressant given to Mary is safe for her age group and taking it daily will help her to deal with depression.

Question 4

By reading the case study it can be stated that Mary Lou definitely suffers from alcohol addiction. The symptoms of alcoholism are different from person to person and vary with age. She suffers from alcohol addiction as she had been drinking wine throughout the day and night. She also had been drinking wine to help her sleep. All these are symptoms that she is addicted to alcohol. Insomnia is a major symptom that is caused by alcohol and this symptom has been observed in Mary Lou. Other symptoms of alcohol abuse that is very much pertinent in Mary low are; experiencing blackouts and short terms memory loss, mood swings and irritability. Alcoholism can lead to very serious health complicacies so it is very vital to take a help of a healthcare expert who can prescribe medications to deal with the problem.

Physical dependence is subjected by the withdrawal of symptoms that make one feel physically ill. On the other hand, psychological dependence is subjected by a persistent, strong urge to use drugs despite negative consequences. In Mary Lou’s case psychological dependence can be observed as she has been consuming alcohol regularly after her husband’s death. First she only uses to consume alcohol at night to help with sleep but later she started to consume alcohol every time even during the day time. However when her daughter took her to the GP, he prescribed her with medications to help in context to the withdrawal from abuse of alcohol.

Case Study 1 Part 2-Musculoskeletal Disorders

Question 5

Crepitus is generally a popping sound of the bones. The sound is heard when two rough surfaces of an animal come in contact - for example, in osteoarthritis or rheumatoid arthritis when the cartilage around the joints is damaged and the surfaces of the joints are pressed against each other. The other, or when two broken surfaces are rubbed together. Crepitus is a common symptom of bone fractures. Crepitus can be easily created and observed by applying a small amount of force to a joint, so it is "cracked". This is due to the bursting of nitrogen bubbles in the synovial fluid. Crepitus is often heard loudly by the human ear, although a stethoscope may be needed to detect events caused by respiratory disease. Dexa scan that is of -2.5 or less subjects that the person is entailing a medical condition called osteoporosis.

When bone becomes weak and fragile this kind of medical condition arises. Bone density is generally reduced due to the lack of adequate minerals like calcium Phosphates. This further reduces the bone density. The two symptoms that Mary Lou was experiencing in this regard were her join pain and stiffness. These two are the main symptoms of Crepitus. The DEXA scan gave a T-score of -3.0 which meant that she can get the medical condition of osteoporosis in the near future if she does not consume calcium and phosphates properly. Bones become weak with age and Mary Lou was already 75 years old. Her bones were weak and fragile that was also a major reason in this context.

Question 6

Mary Lou’s joint disease is different from the other joint diseases as her joint disease is the result of her old age. Osteoarthritis (OA) is an age-related disorder. It is often described as a chronic degenerative disease and many believe it can be an inevitable consequence of aging. In osteoarthritis, the loss and loss of articular critique is a central feature sometimes known as “wear”. However, unlike car tires that become thinner over time, osteoarthritis-infected tissue contains living cells that respond to mechanical stimulation and work to maintain joint homeostasis. Instead of the common consequence of joint aging and recurrent wear and tear of osteoarthritis, the current conceptual structure of the relationship between aging and osteoarthritis is that an increase in the muscular system increases the susceptibility to osteoarthritis but it is not the only cause.

The notion that adults contribute but do not directly cause osteoarthritis is consistent with the perennial nature of osteoarthritis and proves that not all older people develop osteoarthritis and not all joints in the body are affected to the same degree. Her bones became weak and fragile due to lack of calcium and phosphates. Her joint pain had aroused from the condition called crepitus that was majorly due to the degeneration of her cartilage. The present fracture of Mary Lou is due to her weakened bones. Osteoporosis often causes the bones to be weak and brittle and it was found from the case study that she was on the verge of getting that medical condition. The other joint diseases included in the course were that of Rheumatoid arthritis, Lupus, Gout, Spondyloarthritis.

Question 7

Since Mary Lou is an aged lady so her fracture will take a longer time to heal than another lady who is half her age. Bone repair or the healing of a fracture is generally faster in young people as old bones are weak and brittle. The three physiological process of healing are haematoma formation, formation of soft and then hard callus and finally remodeling. Bone density and muscle mass decrease with age. Osteoporosis is a major cause, more common in the elderly and more common in women. This disease makes the bones brittle and brittle and no new bone is formed with the removal of old bone tissue.

Osteoporosis-related fractures are a common type of hip fracture. Bone fractures can easily occur with any type of fracture. The physiological process of healing is often low due to these factors. The two complication sin context to hip fracture that is present in the elderly is trauma of the surgery and pre existing medical conditions. In this case since Mary Lou is 75 years old and also has other health complications like she have been taking antidepressants and other medications, the surgery can be a bit complicated. Her calcium intake is also less and calcium deficiency is very much common in older population which makes it very difficult to operate old people.

Question 8

Dexa scan that is of -2.5 or less subjects that the person is entailing a medical condition called osteoporosis. When bone becomes weak and fragile this kind of medical condition arises. Mary-Lou’s T-score in this regard is -3.0 which means in the near future she can be diagnosed with osteoporosis of not treated well with medications. Crepitus is generally a popping sound of the bones. Crepitus is a common symptom of bone fractures. Crepitus is often heard loudly by the human ear. Mary Lou was given Bisphosphonates by the GP. They are a group of drugs that generally helps in the treatment of bone loss. These groups of drugs are generally prescribed for people who have brittle bones.

Bisphosphonates can be used to reduce the risk of hip and spinal fractures in osteoporosis. These can be used in different doses to treat bone marrow transplantation. Bisphosphonates can be taken orally (orally), by infusion (intravenous infusion) or by injection. The most common side effects of bisphosphonates are heartburn and heartburn, but these problems can often be avoided by taking the medicine properly. Other common side effects include:

  • Bone or joint pain, or generalized pain

  • Nausea, constipation, diarrhea, or other stomach discomfort

  • Muscle cramps or aches

  • Headache or dizziness

  • Bladder infections

  • Head colds, sinus or throat infections, or the flu

  • Tiredness or trouble sleeping

Case Study 2 - Respiratory and Microbiology Case Study

Question 9

The triggers of Hilda that are chosen in this context are cold temperatures and respiratory infections. Asthma is a respiratory problem that can be life threatening and the pathophysiology in this regard is considers to be very complicated. Hilda had this health condition (asthma) from her childhood. This condition can be very harmful to her especially in this time of COVID 19. Lungs are often affected by respiratory infections which further triggers the asthma attacks in the individuals. The respiratory infections are generally caused when viruses come in contact with respiratory tract (hands play a vital role in spreading the virus attacks). These infections can often result in severe attacks of asthma. Cold temperatures can subject asthma attack as cold air is often dry.

The cold air often induces inflammation and triggers the asthma symptoms. Histamine is often the reason that is considered for the asthma attacks. Hilda in this context needs to avoid going outdoors as this particular time is not safe for her. If she contracts the COVID 19 virus then it will be very difficult for her. In cold weather conditions, inhaling the cold air makes the airways to tighten as a result breathing becomes a problem. The lungs become tighter when cold air hits the airways. Humidity is low in cold air and the airways can dry out. It causes fungal infections of the respiratory tract and coughs can be the cause of asthma attacks.

Question 10

The 2 signs or symptoms that are characteristic of Hilda’s respiratory disease are tightness in the chest and shortness of breath. In this context it has been observed that Hilda had experienced trigger in her asthma as the day was very cold and cold temperatures are often prone to dryness. In this context it can be stated that cold air which is very dry might have had irritated her and blocked the airways which triggered her attack of asthma. The inflamed and irritated lungs might have triggered the asthma attack. Inflammation is very common in asthma and also a main concern for patients like Hilda who had been suffering with asthma from a long time. Pathophysiology of asthma mainly confers the trachea, respiratory tract, bronchial tree, mouth, larynx and others.

If these become inflamed or irritated then it is very likely that there will be attacks in asthma. Stress and anxiety can also be a cause of asthma attack and in the case of Hilda it was found that she was quite stressed about the COVID 19 Pandemic. Tightness in the chest and shortness of breath both are symptoms of the asthma attack. These changes are the root cause of her attack and her deteriorating health condition. Hilda’s respiratory disease is a matter of great concern in the present situation and her changing dynamics can cause major heath complexities if not treated properly.

Question 11

Corticosteroids were given to Hilda when she was taken to the hospital by her husband. These are the drugs that are generally given to the healthcare users of asthma. This dug was given to Hilda in the form of an inhaler. This kind of drug generally reduces the irritation in the lungs. Corticosteroids are given to the users for a long term use. It has been considered that Corticosteroids are very much vital for the prevention of asthma attacks and is one of the best medications that can be offered to an asthma patient. Complex cases in terms of bronchial asthma can be treated effectively with the help of this drug. This medicine works by reversing the pathological condition of asthma. Corticosteroids expand the beta adrenergic reaction and discharge myocytes. These converse mucosal edemas and decline vascular penetrability over the span of vasoconstriction and decrease bodily fluid release by restraining the arrival of secretogens from macrophages.

Corticosteroids keep down fiery reactions and hinder late-stage responses by meddling with chemotaxis. This impact might be because of restraint of articulation in context to LTB4. The eosinopenic impacts of corticosteroids may help neutralize the cytoxic impacts of the significant essential proteins communicated by eosinophils and extra fiery mediators. Immediate sensory response is not adhered by the corticosteroids. It also does not play a pivotal role in the direct response in bronchial terms. There are several side effects in context to the usage of corticosteroids like hypertension, weight gain, diabetes, increasing in the vulnerability to infections and others.

Question 12

In this context Hilda has a very rare chance of contracting in context to the COVID 19 virus. It is because in the esteemed hospital all the healthcare staff and the specialists are maintain proper hygiene standards and use PPE suits. In context to the world health organization the novel corona virus can be eliminated if people maintain social distancing, sanitise their hands and wash hands at regular intervals. In the hospital all the staffs abides by the standards of WHO. Washing hands and sanitising can be very vital for the healthcare users like Hilda as they are prone to respiratory infections. Hands are often acted as a medium for the virus to enter the body so if hands are washed and sanitized at regular intervals, the risk becomes low. Apart from these Corticosteroids that were given to Hilda is a very vital drug that helps prevent respiratory infections.

When the Sars virus broke out in China in 2003 there were evidences that the healthcare specialists used Corticosteroids for the contaminated patients and there were certain positive results of it. However, in this situation the more importance is needed to be laid on breaking the chain of virus through practicing hand hygiene for patients like Hilda and also others who are prone to respiratory infections. In context to the WHO standards and other medical boards it has been conferred that this pandemic can only be eliminated if hand hygiene and social distancing is practiced. In this context it can be stated that once Hilda is out of the hospital she needs to stay indoors and practice social distancing so that she says safe.

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