Reference no: EM132669361

Case Study:

Jane Jane is a 38yo marathon runner who has presented to her GP clinic after completing a training run. She trains three days per week, and has experienced light-headedness, and significant muscle pain after her last three runs. Whilst talking to the clinic nurse, Jane admits to feeling lethargic, and like her "heart is racing". She has also been a little unsteady on her feet and stumbled climbing the stairs in her home the previous evening. She reveals her fluid intake has been lower than usual, and although she is still eating well, her caloric intake has been less than usual. She has lost 2kg in the last month. She also states her resting heart rate used to be 51 bpm according to her Garmin watch. Jane applied Voltaren Emulgel, a topical non-steroidal anti-inflammatory drug (NSAID), to her quadriceps and calves immediately after this morning's run, hoping to relieve some of her muscle soreness. A medical history was taken, a physical examination and urinalysis were conducted. Results below.

Physical examination:

Height : 173 cm

Weight : 61 kg

Appearance : Dry lips, poor skin turgor, dark circles under eyes

Temperature : 38.6? C

Blood Group : O

HR : 86 bpm

BP : 87/58 mm Hg

Respiratory rate : 25 bpm

Diet : High protein, high intake of fruit and vegetables

Body composition : Low body fat Past patient history Torn meniscus in right knee, surgically repaired; one caesarean delivery 14 years ago. Takes fish oil and calcium supplements. Amenorrhea for two years

Social status : Married with two teenaged children.

Urinalysis:

Colour Dark yellow

Blood +

Bilirubin -

Urobilinogen 0.2

Ketone +

Protein ++

Nitrite -

Glucose -

pH 5.5

Specific Gravity 1.035

Leucocytes -

Question 1

A. Describe the changes in volume and pressure that will be occurring in Jane's chest cavity to achieve exhalation during a long run. Explain why these changes are occurring, and the effect upon airflow.

B. Describe the gas exchange occurring between air in Jane's alveolar air and pulmonary blood. Will the rate of gas exchange change during exercise? Explain your answer.

Question 2

A. Which ANS response would you expect to dominate during Jane's runs? Explain your answer.

B. Which hormone associated with glucose homeostasis would you expect to be most active during this ANS response? Why? Using your knowledge of glucose homeostasis, explain your answer.

Question 3

A. Describe the role of the kidneys in maintaining fluid balance with reference to the role of antidiuretic hormone (ADH). Is Jane at risk of not maintaining homeostatic fluid mechanisms? Why/why not?

B. What is a urinalysis and what is its significance for this case? With respect to the specific gravity (SG) component of Jane's urinalysis result, and using your knowledge of normal kidney function, would you expect this result? Why/why not?

Question 4

A. Consider Jane's blood pressure result and discuss whether the mean arterial pressure is likely to be varied from normal. In your answer you must include reference to a possible change in blood volume and briefly mention the consequences of any change in BP upon kidney function.

B. In this circumstance, do you think the renin-angiotensin-aldosterone system or natriuretic peptides will dominate in the maintenance of Jane's blood pressure. Discuss the role of your chosen system in blood pressure homeostasis to explain your answer.

Question 5

A. Jane suffered a significant haemorrhage during her caesarean delivery and required a blood transfusion. Which blood type(s) could have been safely administered to Jane? Explain the potential consequences if Jane had been administered A+ blood.

B. At the time of her caesarean delivery, Jane was found to have a calcium deficiency. How would this have affected the ability of her blood to clot? Explain your answer.