a-team_casestudy1.docx

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Alex Bamford, John Calabrese (Leader), Jordan Ervin, Manan Jain, Niral Shah, StefanNakollariBiology 288- Introductory PhysiologyMs. Judith GoodenoughFebruary 14, 2013

Case Study 1- JosiePart I- The Apartm ent

Q1. What is wrong with Josie? Why do you think so?Josie is a 21 year old white female working as a prostitute. All we know about her

family is that she has a brother named Patrick. Upon arriving back at her apartment, Josiesuffers from several symptoms, some of which presumably, have occurred before. WhenJosie tried to open her apartment door, she felt tingling in her fingers, pins and needles,and she switched the key to her other hand. Josie leaned against the door as nauseawashed across her body, pounding and retreating like waves on the Sunderland beach ofher childhood. She was getting irritated. She was sweating and shivering. She seems to be

obsessive about keeping her things in order. She prefers living in darkness. She also fearsdying. Her heart started to race and pound againsther breastbone. It was hard for her tobreathe. Josie started to feel a sharp pain in her lower abdomen and she was bleeding. Shevomited violently and felt weak.

Josie suffers from a wide array of symptoms including, tingling in fingers (can beindicative of muscle fatigue/weakness), nausea, shivering (can be due to a fever), sharpabdominal pain, obsessive behavior, irritability (mood swings or depression can be acause), rapid heartbeat, and shortness of breath. After having created a list of Josiessymptoms, we used the WebMD symptom checker(http://symptoms.webmd.com/#./introView) to help us with our diagnostic differential andmake a list of diseases/complications that could explain her symptoms. We concluded that

Josie might be suffering from several diseases including food poisoning, pregnancy, panicattack, and vitamin B12 deficiency.Pregnancy

According to our diagnosis, there is a strong probability that Josie is pregnant. She isan escort and engages in casual sex and that puts her at an increased risk of becomingpregnant. Pregnancy can cause most of Josies symptoms including nausea, vomiting,irritability (mood swings), and shortness of breath. We can confirm whether Josie ispregnant by conducting a simple pregnancy test/exam. Also, looking at the severeabdominal pain and fast heart rate, if Josie is found to be pregnant then she should go tothe hospital and not take the symptoms lightly considering that they are due to herpregnancy. She might be having complications with the pregnancy. (References-

http://www.mayoclinic.com/health/symptoms-of-pregnancy/PR00102,http://www.whattoexpect.com/pregnancy/symptoms-and-solutions/short-breath.aspx,http://www.whattoexpect.com/pregnancy/pregnancy-health/complications/abdominal-pain.aspx, http://www.webmd.com/baby/features/8-early-signs-of-pregnancy).Food poisoning

Another possible diagnosis is food poisoning. Symptoms of food poisoning include-nausea, vomiting, fever, severe abdominal pain/cramps, and muscle weakness. While it is
http://symptoms.webmd.com/#./introViewhttp://www.mayoclinic.com/health/symptoms-of-pregnancy/PR00102http://www.mayoclinic.com/health/symptoms-of-pregnancy/PR00102http://www.whattoexpect.com/pregnancy/symptoms-and-solutions/short-breath.aspxhttp://www.whattoexpect.com/pregnancy/symptoms-and-solutions/short-breath.aspxhttp://www.whattoexpect.com/pregnancy/pregnancy-health/complications/abdominal-pain.aspxhttp://www.whattoexpect.com/pregnancy/pregnancy-health/complications/abdominal-pain.aspxhttp://www.whattoexpect.com/pregnancy/pregnancy-health/complications/abdominal-pain.aspxhttp://www.webmd.com/baby/features/8-early-signs-of-pregnancyhttp://www.webmd.com/baby/features/8-early-signs-of-pregnancyhttp://www.whattoexpect.com/pregnancy/pregnancy-health/complications/abdominal-pain.aspxhttp://www.whattoexpect.com/pregnancy/pregnancy-health/complications/abdominal-pain.aspxhttp://www.whattoexpect.com/pregnancy/pregnancy-health/complications/abdominal-pain.aspxhttp://www.whattoexpect.com/pregnancy/symptoms-and-solutions/short-breath.aspxhttp://www.whattoexpect.com/pregnancy/symptoms-and-solutions/short-breath.aspxhttp://www.mayoclinic.com/health/symptoms-of-pregnancy/PR00102http://www.mayoclinic.com/health/symptoms-of-pregnancy/PR00102http://symptoms.webmd.com/#./introView


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possible that Josie might have food poisoning, it does not explain the nausea that Josie hasbeen suffering from (presumably) a long time. But regardless, there is a possibility of foodpoisoning being the cause for Josies symptoms. Considering Josies condition, a blood testas well as a physical exam must be conducted to confirm food poisoning. Food poisoning isusually a result of eating food contaminated by a infectious organism and a stool culture canhelp identify which organism caused the food poisoning while at times the cause cannot bedetermined (http://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-treatment, http://www.mayoclinic.com/health/food-poisoning/DS00981/DSECTION=tests-and-diagnosis, http://www.webmd.com/food-recipes/food-poisoning/food-poisoning-and-safe-food-handling-symptoms,http://www.mayoclinic.com/health/food-poisoning/DS00981/DSECTION=symptoms,http://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-symptoms, http://www.webmd.com/food-recipes/food-poisoning/food-poisoning?page=2,http://www.umm.edu/altmed/articles/food-poisoning-000064.htm).Panic attack

Josie can also be suffering from a panic attack. A panic attack is not general fear or

anxiety. A panic attack is a sudden feeling of terror that strikes a person without anywarning. A person having a panic attack may believe that they are having a heart attack.The attack generally last for 10 minutes and can develop into panic disorder. The symptomsof panic attack are racing and pounding heart, feeling weak or dizzy, tingling in hands andfingers, sense of death, sweating and shivering, hyperventilating, chills, and nausea. It ishighly likely that Josie was having a panic attack. Considering that Josie is a prostitute andmight be using drugs, she is at a risk for developing panic disorder/attack. There are nospecific tests than can confirm panic attacks, however, a doctor or a psychiatrist canperform physical exams and conduct an assessment through a questionnaire. (References-http://www.webmd.com/anxiety-panic/guide/panic-attack-symptoms,http://www.webmd.com/anxiety-panic/guide/mental-health-panic-disorder,http://www.mayoclinic.com/health/panic-attacks/DS00338/DSECTION=tests-and-diagnosis,

http://www.medicinenet.com/script/main/art.asp?articlekey=55002,http://www.helpguide.org/mental/panic_disorder_anxiety_attack_symptom_treatment.htm).

General anxiety disorder (GAD)Generalized anxiety disorder (GAD) is very similar to panic disorder and other

anxiety disorders, however they are different. GAD is characterized by excessive,exaggerated anxiety and worry about everyday life events with no obvious reasons forworry. People with GAD worry unrealistically and out of proportion for the situation. Thesymptoms of GAD are irritability, obsession about small concerns, sweating and nausea,shortness of breath and rapid heartbeat, feeling twitchy, and fatigue. Stressful environmentcan lead to GAD and considering Josies living conditions and situation, it is likely that Josie

has GAD. GAD can be diagnosed if a person meets all the criteria in the Diagnostic andStatistical Manual of Mental Disorders (DSM). A diagnosis of GAD required at least thefollowing criteria: symptoms must persist for at least six months, difficulty controllingemotions, and anxiety is not related to any other disorder. Josie can be diagnosed withGAD and can be treated through psychotherapy and medication. (References-http://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502/DSECTION=tests-and-diagnosis, http://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/how-is-gad-treated.shtml, http://www.webmd.com/anxiety-panic/guide/generalized-anxiety-disorder).
http://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-treatmenthttp://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-treatmenthttp://www.mayoclinic.com/health/food-poisoning/DS00981/DSECTION=tests-and-diagnosishttp://www.mayoclinic.com/health/food-poisoning/DS00981/DSECTION=tests-and-diagnosishttp://www.webmd.com/food-recipes/food-poisoning/food-poisoning-and-safe-food-handling-symptomshttp://www.webmd.com/food-recipes/food-poisoning/food-poisoning-and-safe-food-handling-symptomshttp://www.mayoclinic.com/health/food-poisoning/DS00981/DSECTION=symptomshttp://www.mayoclinic.com/health/food-poisoning/DS00981/DSECTION=symptomshttp://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-symptomshttp://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-symptomshttp://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-symptomshttp://www.webmd.com/food-recipes/food-poisoning/food-poisoning?page=2http://www.umm.edu/altmed/articles/food-poisoning-000064.htmhttp://www.umm.edu/altmed/articles/food-poisoning-000064.htmhttp://www.webmd.com/anxiety-panic/guide/panic-attack-symptomshttp://www.webmd.com/anxiety-panic/guide/panic-attack-symptomshttp://www.webmd.com/anxiety-panic/guide/mental-health-panic-disorderhttp://www.webmd.com/anxiety-panic/guide/mental-health-panic-disorderhttp://www.mayoclinic.com/health/panic-attacks/DS00338/DSECTION=tests-and-diagnosishttp://www.mayoclinic.com/health/panic-attacks/DS00338/DSECTION=tests-and-diagnosishttp://www.medicinenet.com/script/main/art.asp?articlekey=55002http://www.medicinenet.com/script/main/art.asp?articlekey=55002http://www.helpguide.org/mental/panic_disorder_anxiety_attack_symptom_treatment.htmhttp://www.helpguide.org/mental/panic_disorder_anxiety_attack_symptom_treatment.htmhttp://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502/DSECTION=tests-and-diagnosishttp://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502/DSECTION=tests-and-diagnosishttp://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502/DSECTION=tests-and-diagnosishttp://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/how-is-gad-treated.shtmlhttp://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/how-is-gad-treated.shtmlhttp://www.webmd.com/anxiety-panic/guide/generalized-anxiety-disorderhttp://www.webmd.com/anxiety-panic/guide/generalized-anxiety-disorderhttp://www.webmd.com/anxiety-panic/guide/generalized-anxiety-disorderhttp://www.webmd.com/anxiety-panic/guide/generalized-anxiety-disorderhttp://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/how-is-gad-treated.shtmlhttp://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/how-is-gad-treated.shtmlhttp://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502/DSECTION=tests-and-diagnosishttp://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502/DSECTION=tests-and-diagnosishttp://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502/DSECTION=tests-and-diagnosishttp://www.helpguide.org/mental/panic_disorder_anxiety_attack_symptom_treatment.htmhttp://www.helpguide.org/mental/panic_disorder_anxiety_attack_symptom_treatment.htmhttp://www.medicinenet.com/script/main/art.asp?articlekey=55002http://www.medicinenet.com/script/main/art.asp?articlekey=55002http://www.mayoclinic.com/health/panic-attacks/DS00338/DSECTION=tests-and-diagnosishttp://www.mayoclinic.com/health/panic-attacks/DS00338/DSECTION=tests-and-diagnosishttp://www.webmd.com/anxiety-panic/guide/mental-health-panic-disorderhttp://www.webmd.com/anxiety-panic/guide/mental-health-panic-disorderhttp://www.webmd.com/anxiety-panic/guide/panic-attack-symptomshttp://www.webmd.com/anxiety-panic/guide/panic-attack-symptomshttp://www.umm.edu/altmed/articles/food-poisoning-000064.htmhttp://www.umm.edu/altmed/articles/food-poisoning-000064.htmhttp://www.webmd.com/food-recipes/food-poisoning/food-poisoning?page=2http://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-symptomshttp://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-symptomshttp://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-symptomshttp://www.mayoclinic.com/health/food-poisoning/DS00981/DSECTION=symptomshttp://www.mayoclinic.com/health/food-poisoning/DS00981/DSECTION=symptomshttp://www.webmd.com/food-recipes/food-poisoning/food-poisoning-and-safe-food-handling-symptomshttp://www.webmd.com/food-recipes/food-poisoning/food-poisoning-and-safe-food-handling-symptomshttp://www.mayoclinic.com/health/food-poisoning/DS00981/DSECTION=tests-and-diagnosishttp://www.mayoclinic.com/health/food-poisoning/DS00981/DSECTION=tests-and-diagnosishttp://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-treatmenthttp://www.webmd.com/food-recipes/food-poisoning/understanding-food-poisoning-treatment


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Vitamin B12 Deficiency

Based on Josies symptoms we concluded that another disease/affliction that shemight be suffering from could be Vitamin B12 Deficiency. Vitamin B12 is required by thebody for the production of red blood cells (RBCs). If a person suffers from Vitamin B12

deficiency then the person lacks enough vitamins to produce the required amount of RBCs.Vitamin B12 deficiency can thus lead to anemia. Some of the symptoms of the diseaseinclude weakness, diarrhea and constipation, tingling in fingers and toes, paranoia, andbalance problems. A blood test can confirm whether Josie has Vitamin B12 deficiency ornot. (References- http://www.webmd.com/a-to-z-guides/vitamin-b12-deficiency-anemia-topic-overview, http://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780, http://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780).

The diseases and disorders listed above are the most likely to be responsible forJosies symptoms. The recommended tests can confirm what the exact cause for Josiesaffliction is. There is a possibility that Josie might be suffering from something not on the listhowever. Considering the severity of the symptoms, Josie should be taken to doctor for a

complete physical exam as well as a psychiatric exam.Part II- The Hospit al

Q1. What do you now think is wrong with Josie? Why do you think this?It was concluded that Anemia, Generalized Anxiety Disorder, Multiple Sclerosis and

panic attacks are the major causes/diseases leading to her symptoms.Anemia is a condition that comes about when your body is lacking healthy red blood

cells or hemoglobin or even both. Hemoglobin is responsible for carrying oxygen from thelungs to the rest of the body. This disease can be temporary or long term and can alsorange from being mild to severe (Mayoclinic). Lacking oxygen from having too few RBCscan cause fatigue because your organs will not receive the oxygen needed to function

normally. Anemia can be hereditary (depending on the type of anemia) and from birth, someinfants may be affected by it. It is also quite prevalent in women during childbearing years.During this time, they become iron deficient due to the blood loss from menstruation. Themost common anemia is iron deficiency, this is easily treatable using iron supplements andspecific diet alterations.

Although the doctor claimed Josie is only a touch anemic, it explains her fatigue,rapid heartbeat/shortness of breath and her difficulty concentrating as her eyes dartedaround aimlessly when she was in her apartment earlier. Moreover, miscarriages usuallycome with a vast loss of blood, this can also lead to lower levels of RBCs resulting inanemia.

Symptoms of Anemia include: Easy fatigue and loss of energy Unusually rapid heartbeat, particularly with exercise Shortness of breath and headache, particularly with exercise Difficulty concentrating Iron deficiency Significant loss of blood during pregnancy (in Josies case, miscarriage)

Dizziness Pale skin
http://www.webmd.com/a-to-z-guides/vitamin-b12-deficiency-anemia-topic-overviewhttp://www.webmd.com/a-to-z-guides/vitamin-b12-deficiency-anemia-topic-overviewhttp://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780http://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780http://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780http://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780http://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780http://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780http://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780http://www.webmd.com/a-to-z-guides/vitamin-b12-deficiency-anemia-topic-overviewhttp://www.webmd.com/a-to-z-guides/vitamin-b12-deficiency-anemia-topic-overview


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Leg cramps Insomnia

It was assumed that her symptoms from the previous part persisted while she was inthe hospital. According to her current condition, multiple sclerosis could be a possible causeof Josies symptoms. MS is an autoimmune disease; the immune system attacks the myelinsheath which encases the nerves in the central nervous system. Myelin aids in speeding upthe process of efficiently transmitting information from the brain and/or spinal cord to othernerves in other parts of the body. MS is also two to three times as common in females as inmales (WebMd). The disease can result in inflammation of the myelin sheath causingdelayed or even blocking of nerve signals. This usually leads to the loss of muscle control,vision, balance and sensation. Currently, there is no test that directly diagnoses MS.However, basing the diagnosis off of medical history and a neurological exam is quite anaccurate yet imperfect method. Other specialized procedures that can help diagnosing thedisease include MRI (checking for inflammation in the brain), spinal taps or lumbarpunctures (examination of the cerebrospinal fluid running through the spinal column),evoked potentials (electrical tests to aid in determining if the disease affected the nerve

pathways) and lab analysis of blood samples (WebMd).The tingling/numbness in Josies fingers and toes would explain why MS could be apossible cause/disease.

Symptoms of Multiple Sclerosis include: Numbness or weakness in one or more limbs Partial or complete loss of central vision, usually in one eye Double vision or blurring of vision

Tingling or pain in parts of your body Electric-shock sensations that occur with certain head movements Tremor, lack of coordination or unsteady gait

Slurred speech Fatigue Dizziness

Drug Induced symptomsJosie admitted to the doctor that she has been taking Klonopin and Tofranil, which

as a result, came up on her blood test. Klonopin (Clonazepam) is prescribed to people thatneed to prevent and control seizures and does so by enhancing effects of GABA (gamma-aminobutyric acid) in the brain. It may also be used to aid in treating manic bipolar disorderadjunct treatment, essential tremor, and feeling of restlessness with inability to sit still(WebMd). Therefore, is an anticonvulsant or antiepileptic drug and is also utilized to treatpanic attacks. It is a benzodiazepine that helps relax the brain and nerves (providing short-

term relief of and controlling anxiety attacks). Because Josie was admitted to the hospital,she was no longer taking the drug during her visit, that sometimes worsens the condition ofthe patient. This drug is supposed to be taken regularly for it to be most effective, suddendiscontinuation may lead to adverse effects and withdrawal reactions. Physical dependenceis a major issue correlated with benzodiazepines like Klonopin. Withdrawal symptomsinclude: seizures, mental/mood changes, sweating, shaking, tremors, vomiting andstomach/muscle cramps. This drug could have potentially caused Josies abdominal painand mental mood changes, for example saying Just let me die, while at the hospital. Side


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effects of Klonopin include sedation, which is reported in approximately half of patients,dizziness which is reported in one-third of patients, weakness, and unsteadiness. Otherside-effects include a feeling of depression, loss of orientation, suicidal thoughts/attemptsheadache, and sleep disturbance (medicinenet.com).

http://www.webmd.com/drugs/mono-6006-CLONAZEPAM+-+ORAL.aspx?drugid=920&drugname=Klonopin+Oral&source=3&pagenumber=4http://www.medicinenet.com/clonazepam/article.htm

Tofranil (Imipramine) is an antidepressant medication used to treat depression andvarious other mood/mental disorders. It is a tricyclic antidepressant and balances outneurotransmitters such as, norepinephrine and other natural substance. Tofranil can also beused to control bed-wetting by blocking effects of acetylcholine on the bladder. Most likelyfor Josies case, this drug was probably used to treat anxiety, panic disorder or a form ofrecurring pain. Possible side effects of tofranil include: dry mouth, blurred vision, headache,drowsiness, dizziness, constipation, nausea, vomiting, loss of apetite, diarrhea, stomachcramps, weight gain/loss and increased sweating. Other uncommon but potentially fatal

side effects include: mental/mood changes (e.g., confusion, depression, memoryproblems), enlarged/painful breasts, unusual breast milk production, irregular/painfulmenstrual periods, muscle stiffness, restlessness, ringing in the ears, sexual problems (e.g.,decreased sexual ability, changes in desire), shakiness (tremors), numbness/tingling of thehands/feet, pain/redness/swelling of arms or legs, severe stomach/abdominal pain troubleurinating. Because this drug increases serotonin levels, it can cause serotoninsyndrome/toxicity. This can lead to symptoms such as: fast heartbeat, hallucinations, lossof coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, andunusual agitation/restlessness (WebMd). Josie had several symptoms that were also listedabove, some include, severe nausea, violent vomiting, sharp abdominal pain,numbness/tingling of hands and feet, rapid heartbeat, headache, and unusual

agitation/restlessness. This proves that Tofranil could have potentially caused some ofthese symptoms or withdrawal from the drug could have also induced these side effects.http://www.webmd.com/drugs/drug-7047-Tofranil+Oral.aspx?drugid=7047&drugname=Tofranil+Oral&source=2Q2. If you changed your mind from what you thought after reading Part I, whatfactors made you change your mind?

Based on the new information given, pregnancy was ruled out as one of the possiblecauses for her issues because the doctor had confirmed that Josie actually had a

miscarriage. Even after her miscarriage, the symptoms seemed to persist. Although foodpoisoning would explain her vomiting, severe abdominal pain and muscle weakness, thiswas eliminated because it would not explain her other symptoms and this would have beendetected from a blood test. Vitamin B12 deficiency was also ruled out because the doctorwould have also been able to see this issue after performing a blood test. Panic attacksremains on the list because it was assumed that her, fatigue, numbness/tingling in fingersand toes, shortness of breath and rapid heartbeat, continue to prevail. Thus, Anemia,Generalized Anxiety Disorder, Multiple Sclerosis, drug induced symptoms and panic attackswere the corrected possible causes/diseases that Josie may be affected by.
http://www.webmd.com/drugs/mono-6006-CLONAZEPAM+-+ORAL.aspx?drugid=920&drugname=Klonopin+Oral&source=3&pagenumber=4http://www.webmd.com/drugs/mono-6006-CLONAZEPAM+-+ORAL.aspx?drugid=920&drugname=Klonopin+Oral&source=3&pagenumber=4http://www.webmd.com/drugs/mono-6006-CLONAZEPAM+-+ORAL.aspx?drugid=920&drugname=Klonopin+Oral&source=3&pagenumber=4http://www.medicinenet.com/clonazepam/article.htmhttp://www.medicinenet.com/clonazepam/article.htmhttp://www.webmd.com/brain/tic-disorders-and_twitcheshttp://www.webmd.com/drugs/drug-7047-Tofranil+Oral.aspx?drugid=7047&drugname=Tofranil+Oral&source=2http://www.webmd.com/drugs/drug-7047-Tofranil+Oral.aspx?drugid=7047&drugname=Tofranil+Oral&source=2http://www.webmd.com/drugs/drug-7047-Tofranil+Oral.aspx?drugid=7047&drugname=Tofranil+Oral&source=2http://www.webmd.com/drugs/drug-7047-Tofranil+Oral.aspx?drugid=7047&drugname=Tofranil+Oral&source=2http://www.webmd.com/drugs/drug-7047-Tofranil+Oral.aspx?drugid=7047&drugname=Tofranil+Oral&source=2http://www.webmd.com/brain/tic-disorders-and_twitcheshttp://www.medicinenet.com/clonazepam/article.htmhttp://www.webmd.com/drugs/mono-6006-CLONAZEPAM+-+ORAL.aspx?drugid=920&drugname=Klonopin+Oral&source=3&pagenumber=4http://www.webmd.com/drugs/mono-6006-CLONAZEPAM+-+ORAL.aspx?drugid=920&drugname=Klonopin+Oral&source=3&pagenumber=4


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http://www.webmd.com/a-to-z-guides/understanding-anemia-symptomshttp://www.webmd.com/a-to-z-guides/understanding-anemia-basicshttp://www.mayoclinic.com/health/anemia/DS00321http://www.mayoclinic.org/anemia/http://www.mayoclinic.org/multiple-sclerosis/

http://www.webmd.com/multiple-sclerosis/guide/multiple-sclerosis-diagnosinghttp://www.webmd.com/multiple-sclerosis/default.htm

Part III- Bloo dQ1. What do you now think is wrong with Josie? Why do you think this?

We now believe that Porphyria, Multiple Sclerosis, and Generalized Anxiety Disorderare all possible causes for her condition.The symptoms for porphyria include:

Chest pain

Abdominal pain, often severe Increased heart rate and blood pressure Limb and back pain

Muscle weakness Tingling Loss of sensation Cramping Vomiting and constipation Personality changes or mental disorders Agitation, confusion, and seizures

Q2. If you changed your mind from what you thought after reading Parts I and II, whatfactors made you change your mind?

At this time we do not believe the cause for her symptoms could have been anemiaor panic attacks. Anemia and panic attacks do not explain the hallucinations very well.These two are therefore removed from the list. After taking her new symptoms intoconsideration, we decided Generalized Anxiety Disorder and Multiple Sclerosis are stillpossibilities. Hallucinations and the mental problems she is having are slightly rare withthese two disorders but there have been a few cases of people having reported seeinghallucinations with these two conditions. They are less likely to be the cause but we cannotrule them out completely until we have some better evidence against them. The severesymptoms in this part seem to be something more than a drug induced situation, so we canput drug induced symptoms to the side and look at other conditions. Porphyria doesaddress all her symptoms including the mental disorders she is having therefore, at thistime it is the most likely of the three choices we have made so far. We will have to run sometests to be certain.

Referenceshttp://www.mayoclinic.com/health/schizophrenia/DS00196/DSECTION=symptomshttp://www.mayoclinic.com/health/porphyria/DS00955/DSECTION=symptomshttp://www.mayoclinic.com/health/multiple-sclerosis/DS00188/DSECTION=symptoms
http://www.webmd.com/a-to-z-guides/understanding-anemia-basicshttp://www.webmd.com/a-to-z-guides/understanding-anemia-basicshttp://www.mayoclinic.com/health/anemia/DS00321http://www.mayoclinic.com/health/anemia/DS00321http://www.mayoclinic.org/anemia/http://www.mayoclinic.org/anemia/http://www.webmd.com/multiple-sclerosis/guide/multiple-sclerosis-diagnosinghttp://www.webmd.com/multiple-sclerosis/guide/multiple-sclerosis-diagnosinghttp://www.webmd.com/pain-management/default.htmhttp://www.webmd.com/heart/picture-of-the-hearthttp://www.webmd.com/heart/anatomy-picture-of-bloodhttp://www.mayoclinic.com/health/multiple-sclerosis/DS00188/DSECTION=symptomshttp://www.mayoclinic.com/health/multiple-sclerosis/DS00188/DSECTION=symptomshttp://www.mayoclinic.com/health/multiple-sclerosis/DS00188/DSECTION=symptomshttp://www.webmd.com/heart/anatomy-picture-of-bloodhttp://www.webmd.com/heart/picture-of-the-hearthttp://www.webmd.com/pain-management/default.htmhttp://www.webmd.com/multiple-sclerosis/guide/multiple-sclerosis-diagnosinghttp://www.mayoclinic.org/anemia/http://www.mayoclinic.com/health/anemia/DS00321http://www.webmd.com/a-to-z-guides/understanding-anemia-basics


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http://www.ehealthme.com/cs/generalized+anxiety+disorder/hallucination,+visualPart IV- Patric k

Q1. Finally, whats wrong with Josie? Why do you think this?The final diagnosis for Josie is Porphyria. Porphyria is a genetically based disorder

caused by a problem with the bodys production of heme. Heme is an oxygen carryingmolecule found throughout the body, but especially in the blood and bone marrow.Porphyria affects the nervous system as well as the skin of a patient. Some of the mostcommon symptoms of this disorder are: abdominal pain, numbness or tingling, sensitivity tolight, mental disturbances, muscle weakness, and darkening (red/brown coloration) of urine.

All of these symptoms are consistent with what is wrong with Josie. Not only does Josiepossess all of these symptoms, but Porphyria encompasses all of her symptoms as well asexplain her brothers condition. Porphyria is known to be genetically inherited by a singleautosomal dominant mutation. There is a strong probability that both Josie and her brotherPatrick suffered from Porphyria. Although we do not know much about Patricks condition, itis a very good assumption to make.Q2. What clues from the story led you to this thinking?

While looking back, you can see that all of Josies symptoms are consistent withthose of Porphyria. For example, in the first part she experienced abdominal pain andmuscle fatigue. In the second part she began to have numbness and tingling in herextremities, another symptom of Porphyria. In the third part, her symptoms became morespecific. She showed mental disturbances, sensitivity to light, and dark urine. All of theseare symptoms that Josie experienced and are symptoms of Porphyria.Q3. What outside information did you gather in supporting your hypothesis?

In supporting our hypothesis, we gathered information from websites such asWebMD. We used these websites to research Josies symptoms, possible diagnoses, and

the effects of her medication. We also consulted a professional in Emergency MedicalServices. We provided him with information about Josies symptoms and medications andasked for his professional input.Q4. What information would you like that you do not presently have?

We would have liked to have information concerning Josies family history, includingher brothers illness. The most common tests for active Porphyrias are blood tests. Thesetests check for the unusual and extremely high accumulation levels of porphyrin precursorsand porphyrins. Also, we would have liked to see Josies medical history and more specificresults from her tests. Also, we would like to know more about Patricks condition. We wouldlike to look at his old medical records and we would have liked to conduct an autopsy whenPatrick died. Finally, we would have liked to see Josies sample history- her breathing rate,pupil dilation, breath odor, and lung sounds.

It would also be very helpful if we could have run the tests ourselves and been able

to verify the results. By running blood and urine tests, we could not only rule out the majority

of the conditions, but also confirm porphyria as the cause of her symptoms with certainty.

We could also run a urine test more specific to porphyrins after confirmation of porphyria to

find the specific type of porphyria she has.


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Part I- The Apartment

Josie is a 21 year old female.

She works as a prostitute.

She has a brother named Patrick.

Symptoms/Comments Possible Causes/Diseases

Pregnancy

Food Poisoning

Generalized Anxiety disorder (GAD)

Vitamin B12 Deficiency

Panic Attacks

Tingling in fingers

Nausea

Shivering

Is a prostitute

Light sensitivity

Sharp abdominal pain

Vomited violently

Pool of blood

Irritability

Constant worrying or obsession about small

or large concerns

Rapid heartbeat/shortness of breath

Part II- The Hospital

Doctor said it was miscarriage.

Symptoms Possible Causes/Diseases

Miscarriage Panic attacks

Multiple Sclerosis

GAD

Anemia

Abdominal pain history

Touch anemic

Terrible headaches

Tingling in fingers and toes

Toxicology:

Klonopin (panic

attacks/schizophrenia)


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Tofranil (anti-depression/panic

attacks)

Elevated blood pressure

Unconsciousness

Fear of dying

Part III- Blood

Infection after miscarriage


Infection GAD

Porphyria

Multiple sclerosis

Taking antibiotics

Fast pulse

Wanted to die/isolation

Crying, confusion, memory loss

Wants blood, thinks shes a vampire

Loss sensation in arm

Mental deterioration

Toxicology:

Klonopin- panic attacks/schizophrenia

Tofranil- anti-depression/panic attacks

Tegretol- nausea, vomiting, dizziness

Clonidine- High BP, withdrawal

syndrome, intractable pain

Hydralazine- High BP, Pre-eclampsia

Depressed

Panic attacks

B.P.- 120/70, Temp= 99.3

Clean CT scan, no UTI

Reddish-purple urine


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Light sensitivity

Smells rotting flesh

Vomit

Twitching

Hallucinations

Arm and leg spasms

Part IV- Patrick

Brother died 10 months ago

Had genetic disorder that made him soft in the head


Hallucinations Porphyria

Euthymic mood

a-team_casestudy1.docx

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