Case Study #1 Chapters 5,6 & 9 1. Mary noticed a large, brown spot on her shin.

She has been playing tennis in the sun for several years without sun protection. She reported the discovery to a friend, who told her to apply the ABCD rule to determine whether or not she had malignant melanoma. Her friend told her if her answer was no to the questions that were asked by the ABCD rule, she had nothing to worry about. What is the ABCD rule and should she ignore the spot if her answers are negative. The American Cancer Society recommends that people who spend time in the sun should regularly check their skin for signs of cancer. They suggest using the ABCD or ABCD(E) rule to recognize melanoma skin cancer spots. A. B. C. D. E. Asymmetry-sides do not match Border irregularities- edge of spot is indented not smooth Color-spot has many different colors Diameter-spot is larger than 6mm in diameter (size of a pencil eraser) Elevation-spot raised above the level of the surrounding skin

Even if Mary answers are negative to the questions for ABCD rule she should never just ignore the spot because melanoma skin cancer can appear spontaneously, rapidly spreads and usually results from a mole. If her answers are negative she should still keep a close eye on the spot and report to her doctor if she notices any changes in the spot or any of her answers to the ABCD rule changes from negative to positive. When considering ones own health they should always air on the side of caution because. Even if her answers to the ABCD rule are negative she might want to have a doctor examine the spot for a second opinion. The key to beating any form of cancer is early detection and treatment.
2. Johnny fractured the lower third of his right tibia in a skiing accident. The soft tissues in

the area were severely damaged and their surgical removal was necessary. After prolonged immobilization, it was found that Johnny was healing very poorly. The explanation offered by the orthopedic surgeon was that vascularization of the fracture site was still inadequate and good healing was absolutely dependent upon adequate blood supply. Describe how long bone receives its blood supply and trace the path of nutrient delivery to the osteocytes. Long bones receive its blood supply from blood vessels in the periosteum that enter in to the long bone through microscopic openings in the outer layer called nutrient foramens. Nutrients are delivered to ostercytes in bones the same way that nutrients are delivered to most other mature cells in the body. The nutrient rich foods are first eaten and delivered to the stomach were digestion begins by mixing the food with stomach acid and enzymes. From the stomach the food enters into the small intestine were the majority of digestion and absorption of the different nutrients occur. The nutrients are absorbed from the small intestine into the blood. The blood then enters into blood vessels were they are delivered to cells throughout the body as they are needed.

3. Pam contracted polio before she had an opportunity to vaccine and found that the disease affected the neural innervations of her legs. She experienced significant muscle atrophy. Why did this happen? In some cases the virus that causes Polio enters the central nervous system where it attacks and kills nervous tissue. When this virus enters the nervous system, it attacks and destroys muscle neurons. These muscle neurons are responsible for carrying messages from our brain to muscles making muscles work, causing movement. When muscle neurons are destroyed muscles are in turn under used or not used at all. When muscles are not used they shrink and weaken or atrophy. 4. A long-distance runner is about to enter a five-mile race. Beforehand, he spends several minutes warming up. During the warm-up period, the phenomenon of treppe is occurring in body muscles being used. What is treppe and why does it occur? Treppe is a staircase pattern that muscles go through after a long rest. Treppe is the basis of the recommended warm up period before doing any strenuous activity such as longdistance running. As a muscle begins to work it generates heat, its enzymes work better and the muscle becomes more flexible. As a muscle warms up it becomes able to work better and stronger. The levels of Ca2+ in the sarcoplsm increase exposing more active sites for neuron transmission. During the beginning phases of muscle activity the muscles contract stronger with each successive stimulus. This is why it is important for athletes to warm up before an event so their muscles will be working at their maximum potential from the start.
5. Lynn has been waking up each night with intense pain in her calves. She does not feel

that it is serious enough to seek medical attention but would like to know what is causing the pain. What would you tell her concerning this problem? She has been playing tennis all summer for several hours each day. Could this have anything to do with the night pain? The nightly intense pain in her calves is more than likely muscle spasms also know as muscle cramps. Muscle cramps are usually caused by muscle fatigue, insufficient stretching and/or dehydration. Muscle fatigue is caused by overworking muscles resulting in a buildup of lactic acid and chemical imbalances. Muscles will return to their relaxed state if given plenty of time to rest. To prevent these muscle cramps, Lynn should warm-up and stretch thoroughly before playing tennis and stretch and cool-down after playing. She should also drink plenty of fluids and avoid playing during the hottest parts of the day. To treat a cramp, Lynn should stretch the cramped muscle and hold it in the stretched position until the cramping stops. If stretching does not relieve the cramp she could try hot and/or cold compresses and antiinflammatory medications. If the nightly cramping continues it is advised that Lynn seek medical attention to rule out more serious causes of the intense leg pain other than muscle fatigue and dehydration.