EPBIOL130 Introduction to Biology

A 2/1- Four pieces of evidences from Greg’s clinical picture and/ or laboratory findings that support the GP’s suggestion include the following: Greg got fatigued very easily and was struggling to finish only a short 5- minute walk, he was feeling extremely thirsty since a few weeks, he was passing urine more frequently and a urine dipstick revealed he was positive for glucose and ketones and his plasma glucose concentration was 16.8 mmol/L which was much higher compared to the normal range of 4-8 mmol/L.

A 2/2- Greg was suffering from diabetes mellitus. Two laboratory findings that support this complication was a highly positive urine dipstick test which revealed presence of glucose and ketones in his blood and a plasma glucose concentration that was 16.8 mmol/L.

A 2/3- Greg is suffering from type 2 diabetes. This type of diabetes occurs during the adult life. Both types of diabetes 1 and 2 are inherited but if genes for type 2 are present then there is a greater chance of developing the disease. Greg is in his 40s and maintained a lifestyle that was not at all unhealthy. He took care of his diet, did not smoke, did not drink excessively and exercised at least thrice per week. His mother is struggling with diabetes type 2. All these factors indicate that Greg received the genes for type 2 diabetes which led him to this condition.

A 2/4- Greg was facing difficulty in breathing. His breathing was laboured and rate of breathing was also increased. He took deeper breaths. This was linked to diabetes and increased presence of ketones in his blood which caused acidosis. Greg’s body was trying to restore this imbalance by taking deeper and longer breaths so that more amounts of acidic carbon dioxide could be expelled from the lungs than normal which would reverse the acidosis condition. This type of characteristic breathing pattern is called Kussmaul breathing which is an emergency response of the lungs in response to acidosis. This type of breathing usually occurs in response to metabolic acidosis which occurs in diabetes. Blood gases of patient with Kussmaul breathing show low partial pressure of carbon dioxide along with low bicarbonate due to forceful increased rate of breathing. An urge to breathe deeply occurs in the patient which is involuntary. Consequence of this type of labored and deep breathing ensures expulsion of more carbon dioxide to rebalance the levels of acidic content in blood thereby maintaining state of homeostasis.

A 2/5- Three reasons that cause increased rate of atherosclerosis in diabetic patients include insulin resistance, hyperglycemia and induction of inflammation. Insulin resistance increases the rate of atherosclerosis by stimulating de novo lipogenesis which leads to increased secretions of low density lipoproteins (LDL), causes vascular smooth muscle growth and proliferation, activates genes involved in inflammation process and enhances transport of LDL cholesterol into the arterial smooth muscle cells. Hyperglycemia causes alteration at cellular tissue levels which potentially accelerates the process of atherosclerosis. Diabetes also drives inflammation and slows the flow of blood. This leads to accumulation of macrophages which die at the site and produce a necrotic core. Smooth muscle cell proliferation is induced next and migration of lesion forms a fibrous cap thereby leading to atherosclerotic lesions.

A 2/6- Greg went into an unconscious state, which is known as a diabetic coma due to hypoglycemia where his blood sugar levels fell below normal due to his medications. The best course of action would be to administer fast acting carbohydrates to Greg such as sugary food items such soft drinks, fruit juice or a sugar candy. These food items lack protein or fat content and are converted easily into sugar in the blood. Quick administration of such items will raise Greg’s glucose concentration and relieve him from the state of diabetic coma.

A 2/7-  Cancer cell characteristics that allow them to get invasive and metastatic are: loss of cell adhesion property, ability to digest the basement membrane and enter the blood circulation and acquisition of motility. In cancer cells, the adherens junctions are lost which are responsible for cell- cell adhesion. Cancer cells undergo epithelial- mesenchymal transition (EMT) which renders them motile and invasive by turning a polarized epithelial cell into a mobile mesenchymal cell. Epithelial markers such as E- cadherin, cytokeratin, laminin-1, entatcin, ZO-1, syndecan, MUC1, desmoplakin are lost and mesenchymal markers such as N- cadherin, fibronectin, syndecan-1, Slug, Snail, Twist, vimetin etc are gained which causes the normal cells to lose their orderness and start growing disorderly. They become less adhesive and hence do not stick together anymore and spread to various regions of the body which is called metastasis. They also gain the capacity to degrade the basement membrane and invade the blood or lymphatic system. By degrading their surrounding extracellular matrix (ECM), cancer cells create their own tracks which they follow to migrate and reach distant parts of the body.

A 2/8- Three potential clinical manifestations from bone marrow suppression are anemia that is lack of red blood cells, excessive fatigue and pale skin. Chemotherapy causes the circulating red blood cells to destroy along with the cancerous cells. This leads to anemia. Excessive fatigue is commonly observed after chemotherapy since healthy cells are also destroyed. Pale skin after chemotherapy occur when blood capillaries near the surface of the skin enlarge and expand. These clinical manifestations also occur in chemotherapy and in this way Cindy’s treatment is linked to the above mentioned manifestations.

A 2/9- Type of swelling which occurred in Cindy’s right arm due to bacterial infections is called cellulitis whereas the type of swelling which occurred in Cindy’s left arm post her mastectomy and lymph node dissection is called lymphedema. .

A 3/1- Two factors that could have triggered Lisa’s asthma attack is the spring season and cold, windy weather. During the spring season the tress and grasses release pollen into the air. Inhalation of this pollen acts as a trigger for asthma attack. Lisa during her walk might have inhaled pollen particles which causes led her to experience an acute episode of asthma exacerbation. The cold winds could have also led to asthma flare ups because cold air is dry. It enters the nostrils and causes irritation which leads to inflammatory responses and asthma symptoms appear.

A 3/2- Asthma is a type 1 hypersensitivity reaction which is mediated by IgE immunoglobulin. It is an immediate and exaggerated response of the immune system in response to allergens and environmental triggers. The antigens (triggers) when inhaled cause an inflammatory response of the airways. The antigens stimulate mast cells which are residents of the airways and cause cross- linking of IgE molecules on their surface. This causes release of histamines along with leukotrienes, prostaglandins and other enzyme. Histamine is the primary mediator that is synthesized from mast cells. Histamine causes inflammatory reaction in the airways which leads to airway hyperresponsiveness, remodeling of airways and also causes airway obstruction due to contraction of smooth muscles, bronchial secretion and mucosal edema of the air passages. Vascular permeability and mucus secretion also increases. Narrowing of the airways causes manifestation of characteristic pathophysiological features of an asthma attack such as breathlessness, coughing, wheezing and tightness of chest.

A 3/3- Salbutamol is a beta 2 adrenergic receptor agonist which acts on beta 2 adrenergic receptor and causes relaxation of smooth muscles. Salbutamol is a type of bronchodilator. It relieves symptoms of asthma by promoting production of intracellular cyclic adenosine monophosphate (cAMP) that enhances binding of intracellular calcium to the cell membrane. Calcium binding decreases its concentration within the cells and relaxes the smooth muscles leading to bronchodilation where airways dilate. This makes breathing easier and helps in coping with symptoms of asthma. Since Lisa’s oxygen saturation levels dropped below normal to 90% and wheezing sounds were heard hence nebulised salbutamol was provided to Lisa via face mask that would cause dilation of her air passages and make breathing easier for Lisa. Relief from breathlessness and wheezing is expected for Lisa after administration of salbutamol.

Corticosteroids suppress inflammation of the airways and thereby cause anti- inflammatory effects which relieves muscle spasms and reverses mucosal edema. They act by interacting with steroid receptors in the cytoplasm. The corticosteroid- receptor complex then enters the nucleus where protein synthesis is controlled. This includes regulation of enzymes that are involved in inflammatory processes. Phospholipase A2 enzyme is inhibited. The enzyme is needed for synthesis of arachidonic acid which is an essential inflammatory mediator. Inhibition of the enzyme thus prevents inflammation. In this way corticosteroids acts as anti- inflammatory agents. Administration of corticosteroids to Lisa will help her by suppressing her airway inflammation which caused changes in the airway vasculature. Reduction of airway inflammation and increased airway responsiveness is the expected clinical response.

A 3/4- Anticholinergic medications block binding of neurotransmitter, actelycholine to its receptor on nerve cells. They inhibit the parasympathetic nerve impulses and hence are called anti- parasympathetic drugs. These medications relax the airways and prevent narrowing of air passages which makes breathing easier. They also protect the airways from spasms and reduce mucus production thereby keeping the airway patent and allows breathing which gets difficult during an asthma attack.

A 3/5- Maria’s blood pressure(BP) was on the higher side at 140/90 mmHg compared to normal BP of 120/60. This indicated Maria was suffering from hypertension. Two risk factors that caused Maria’s hypertension are: physical inactivity and excessive alcohol consumption. Physical inactivity causes build up of fatty materials in the arteries which causes heart to pump blood with more pressure. With each contraction the heart has to apply much stronger forces which causes increased blood pressure. Excessive alcohol consumption decreases vasodilators such as nitric oxide in the vascular endothelium. It also breaks down triacylglycerids into cholesterol. All these cause increased BP.

A 3/6- ACE inhibitors dilate the veins and the arteries by inhibiting angiotensin II formation which is formed by action of rennin. Renin causes angiotensinogen to form angiotensin I which is again converted to angiotensin II by angiotensin converting enzyme. They inhibit the rennin-angiotensin-aldosterone system. ACE also breaks bradykynin which is a vasodilator. ACE inhibitors prevent breakdown of bradykynin and thereby causes vasodilation actions. ACE inhibitors thus relax the veins and arteries and lower the blood pressure. Administration of ACE inhibitors would thus cause Mary’s BP to fall back into the normal range.

A 3/7- Maria was suffering from myocardial infarction when she was rushed to the hospital.  Two clinical findings that support the claim include: ST elevation and high levels of troponin in blood. ST segment is the interval between ventricular depolarization and repolarization. ST elevation indicates blockage of major arteries of the heart. With damage of heart, troponin is released into the bloodstream. Increased damage reveals increased troponin levels in blood. Thus these two findings indicated myocardial infarction.

A 3/8- Dose reduction is recommended for Maria since she was suffering from cardiovascular issues. A high dose can lead to another episode of heart attack or cause other signs which can affects Maria’s health adversely. 4 age related changes include: reduction in first pass metabolism, reduction in liver mass and blood flow, inability of kidneys to function effectively in excreting drugs into urine, and less effectivity of liver to metabolize drugs. These factors make dose reduction necessary else the bioavailability of drug would increase and lead to severe side effects and complications. Reduction in first pass metabolism would cause Maria to have an increased bioavailability of drug compared to young adults who would have less than 10% drug in their system. Reduction in blood flow would cause drug to not reach desired site of action but in younger women the drug would reach the preferred location and act. Inability of kidneys would cause less excertion of drugs increasing drug amount in Maria but keeping it low in younger women. In Maria, the drug would also not metabolize effectively due to less effectivity of liver however younger women would not face this difficulty.

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