Appendix F

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Associate Level Material

Appendix F
Review the following two case studies. Each patient is being referred to a specialist for further
evaluation of a nervous system disorder. Outline characteristics of the disease each patient is
suffering from by answering the questions associated with each case study. Answer in your own
words.
Case Study 1
Interoffice Referral Form
Ray D. Ology, M.D.
A Doctors Office, North Campus
1515 N. Medical Plaza #151
Anytown, Anywhere 12345

Name
Patient #
Physician

Myelin S. Heath
12312312
Dr. Delgadillo

DOB:
Date:

03/05/1986
02/16/20XX

Dear Ray,
Myelin visited my office yesterday complaining of numbness in his right leg and face. He has also
been experiencing muscle weakness and mild depression. I noticed a delay in his visual
response in both eyes. I have referred Myelin to your facility because of possible multiple
sclerosis, and I am requesting an MRI of the brain and spine. Please fax the results to me as
soon as possible.
Regards,
Ruben Delgadillo, M.D.
Answer the following questions.

1. What could have caused Myelins disease?

The multiple sclerosis (MS) was probably caused from his immune system attacking
its own tissues, perhaps various viruses or immunologic reactions to a virus, bacteria,
or trauma and heredity (Zelman et al., 2010). His MS could have been caused by age,
sex, family history, certain infections, race, climate, certain autoimmune diseases, or
smoking (Multiple Sclerosis, 2014).
2. What structure(s) and function(s) of the nervous system are affected by multiple sclerosis?

In MS nervous tissues degenerate through destroying myelin by breaking up or

destroying the fatty substance that coats and protects nerve fibers in the brain and
spinal cord (Multiple Sclerosis, 2014). The patchy areas of demyelination do not
degenerate in a regular pattern or the same degree, which is the cause for impaired
nerve conduction (Zelman et al., 2010).
3. What can be done to treat this disease?

Since there is no specific treatment for MD that will work for extended periods of
time three treatments can used for attacks, modify progression, and symptoms
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(Multiple Sclerosis, 2014). To help with attacks corticosteroids can reduce nerve
inflammation or plasma exhanges for attacks that dont respond to steroids.
Medicines have shown benefits of slowing progress or relaspings are beta interferons,
glatiramer acetate, dimethyl fumarate, fingolimod, teriflunomide, teriflunomide,
natalizumab, and mitoxantrone (Multiple Sclerosis, 2014). For signs and symptoms,
physical therapy enables the person to use the muscles that are controllable (Zelman
et al., 2010); but muscle relaxants might be needed for painful uncontrollable muscle
stiffness or spasms (Multiple Sclerosis, 2014). Lastly medications for fatigue, pain,
bladder or bowel control problems, and psychological depression to help with MS.
Reference
Multiple Sclerosis. (2014, June 10). Retrieved March 20, 2015, from
http://www.mayoclinic.org/diseases-conditions/multiplesclerosis/basics/causes/con-20026689
Zelman, M., Tompary, E., Raymond, J., Holdaway, P., & Mulvihill, M. (2010). Human
diseases: A systemic approach (7th ed.). Upper Saddle River, NJ: Pearson

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Case Study 2
Interoffice Referral Form
Melissa Neidermayer, M.D.
A Doctors Office, North Campus
1515 N. Medical Plaza #203
Anytown, Anywhere 12345

Name
Patient #
Physician

Jimmy Schwimmer
45645645
DOB:
Dr. Raychee
Date:

11/03/2002
04/21/20XX

Dear Melissa,
Im sending Jimmy over for a stat spinal tap to evaluate suspected meningitis. He has had a fever
for a couple of days, which increased to 102 degrees today. Since yesterday, hes been
complaining of a headache and stiff neck. His mother said last week he had gone swimming in
the pond by their barn and started feeling ill a few days later. Fax results ASAP.
Best,
Terrie Raychee, M.D.
Answer the following questions in your own words.
1. What could have caused Jimmys disease?

There two common forms of meningitis: bacterial and viral; however lesser forms of
meningitis derive from fungus. Bacterial are the most serious and can be lifethreatening (Meningitis, 2013). The most common bacterial causes are haemophilus
influenza, Meisseria meningitides, and Streptococcus pneumonia; while viral
infection can be either enteroviruses or viral condition (Zelman et al., 2010). Jimmy
could have caught bacterial meningitis from sneezing or cough, nonimmunized
individual and mumps (Zelman et al., 2010). Or if his meningitis is viral it could have
been caused by waning polio viruses, herpes simples, and noninfectious cases may
result from lymphoma, brain cancer, or leukemia (Zelman et al., 2010).
2. What structures and functions of the nervous system are affected by meningitis?
Meningitis is an acute inflammation of the first two meninges that cover the brain and spinal
cord: the pai mater and the arachnoid mater (Zelman et al., 2010). The infecting organisms
can reach the meninges from the middle ear, upper respiratory tract, or frontal sinuses; in
addition they can also be carried in the blood from the lungs or other infected sites (Zelman et
al., 2010). This poses risk of complications such a hearing loss, memory difficulty, learning
disabilities, brain damage, gait problems, seizures, kidney failure, shock and death
(Meningitis, 2013).
3. What can be done to treat this disease?

Treatment for meningitis depends upon the type Jimmy has. For bacterial meningitis
requires prompt treatment with intravenous antibiotics such as Rifampin and
ciprofloxacin to ensure recovery and reduce the risk of complications such as brain
swelling and seizures (Meningitis, 2013). If not treated, about 15% of those affected
suffer permanent brain damage that manifests by sight or hearing loss, paralysis,
mental retardation, or death (Zelman et al., 2010). With viral organisms bed rest,

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plenty of fluids, over-the-counter pain medications the meningitis improve on its own
since antibiotics cant cure viral forms (Meningitis, 2013). For other forms of
meningitis such as fungal, allergic reaction or autoimmune disease; medication such
as antifungal and cortisone medications are used for treatment.
Preventive measures include viral vaccines like Hib or MPSV4 (meningococcal
polysaccharide vaccine, recommended for ages above 2 years) and a conjugate
vaccine (MCV4) for ages 11 to 55 (Zelman et al., 2010). In addition to the vaccine
washing your hands, practicing good hygiene, staying healthy and covering your
moth when coughing or sneezing can protect yourself from catching the contagious
infection (Meningitis, 2013).
Reference
Meningitis. (2013, March 19). Retrieved March 20, 2015, from
http://www.mayoclinic.org/diseases-conditions/meningitis/basics/symptoms/con20019713
Zelman, M., Tompary, E., Raymond, J., Holdaway, P., & Mulvihill, M. (2010). Human
diseases: A systemic approach (7th ed.). Upper Saddle River, NJ: Pearson

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