Microsoft word - case # 3 - the stressed out college professor.doc

Inquiry Based Learning using iWorx Systems
Case Study #3 – The Stressed Out College Professor
Instructions:

Week # 1: Design Day
After a group discussion of this case, each lab group will develop…
a. A hypothesis to be tested. This may be big or small, but must be related in some way to the case. Remember that you are limited in what you can test. b. You will then develop a set of experiments to test this hypothesis. At the end of the first day, you must turn in your hypothesis and experimental design. Be sure to test your design before you leave, otherwise Week #2 might be very long! c. You should build your experiment around the idea that you will have at least two patients to test, a normal patient (control) and the actual patient who is the focus of the case (your Professor will play this role). You may also test other levels of deficit using a third patient (i.e., sleep or food deprived). However, these are voluntary tests and are up to you. There will be no deduction in points for not having these types of patients
Week #2: Experimental Day

a. You will carry out your experiments, collecting data on the responses of both the control patient (one of your fellow lab partners) and the actual patient. Since there is only one of actual patient, some of you may test him first, then test the control patient. You will also collect data from any other patient you have set up in your experimental design. b. Although you will have nothing to turn in at the end of Week #2, it is a good idea to analyze your data and decide how you will present it during Week #3. You may also want to get a head start on writing your report, which must include: your hypothesis, experimental design (with any revisions from Week #1), data & analysis, conclusions and discussion.
Week #3: Presentation Day

Each group will have 15 minutes to present their work. This includes introducing their hypothesis (and why they chose it), describing their methods, presenting the data, and stating their conclusions. There will be an additional 5 minutes for discussion. This will be followed by a peer review discussion of the presentation & experiment (based on the questions detailed on the original handout for lab). Case Details…

Presentation:

It is your first day at your local Community Hospital and you have just begun your residency in emergency medicine. At about 10:30 am, the first ambulance of the day pulls up. The patient is someone you know from your past as a premedical. You are presented with a 40 year-old Caucasian left handed male (use characteristics which describe the instructor for the course). He has suffered what
appeared to be a fainting spell while answering a particularly difficult question during his
Neurophysiology class this morning. He seems fully recovered, but when you ask him to
stand, he turns pale and passes out.
General Physical Examination:
Upon further examination, tilt testing results in the patient becoming hypotensive and arrhythmic (by more than 30 beats/minute). In addition, the patient showed signs of dizziness, blurred vision, and nausea. He reports a recent decreased tolerance to infection and exercise, along with increased episodes of syncope, dry eyes & mouth, and bloating with early satiety. He also shows an increased tendency for bruising and reduced sweating in the lower extremities. All of his symptoms have occurred in the last few months and are aggravated by heat or exertion. Family history reveals no similar case history or susceptibility to infection (immunodeficiency) or liver disease. There is some history of cardiovascular dysfunction
and neural oncology.
Medications: Claritin D for seasonal allergies.
Neurologic Examination (Additional):
1. Mental Status: The patient is, in general, alert & responsive. His affect is normal. While polite, he does seem slightly uncomfortable during the examination. His cognitive responses to questioning are normal. 2. Cranial Nerves: There is no anosmia for odors. However, he is having problems with ocular focus, slight ptosis in the right eye, and impaired responsiveness to the Valsalva maneuver. Optokinetic reflex testing reveals inappropriate nystagmus. Cardiovagal tests were normal. 3. Motor/Sensory Systems: Sensory function seems intact, while there is some
Laboratory Data:
All laboratories were taken the day of examination at rest. These include blood testing, EEG, ECG & urine analysis. During tilt testing the ECG showed substantive changes in rate, which were accompanied by diminished P-wave activity. As mentioned above, cardiovagal testing was normal. Plasma norepinephrine levels showed a significant rise while standing, but were reduced during cold pressor responses. All other testing was within normal response ranges.

Source: http://site02.dongmen.net/newsletter/Feb10/TheStressedOut%20CollegeProfessorLocked.pdf