Mystery Case Monday: Up, Up, & Away

Welcome back to Mystery Case Monday! We will be posting a hypothetical case every week to get our pre-health students thinking about various clinical issues and the anatomical/physiological causes that underlie them. Join us in the comments section to share your insights and tentative diagnoses, then check back on Friday to read about the diagnosis and recommended treatments of these cases.

This week, our hypothetical patient is a 30-year-old female who traveled from her home in the Black Hills to hike around Denali National Park and Preserve in Alaska. While there, she decided to hike the centerpiece of the park, Denali (formerly known as Mount McKinley). This is the highest mountain peak in North America with a summit at 20,310 ft above sea level. As she made her ascent, she started to experience increasingly severe headaches. She had trouble sleeping along the way and started feeling nauseous, which led to her eating less and less as she traveled. When she reached 14,000 ft, she stopped at the medical camp on the mountain to see a doctor about her symptoms. Upon physical examination, her lungs were clear to auscultation, her neurological exam was normal, and her oxygen saturation was at 84% while breathing ambient air (which is normal). The doctor recommended for her to consider descending, but she refused. She agreed to stay at the camp overnight and was given acetaminophen for her headaches and anti-emetics for her nausea. The doctor also gave her Diamox to take twice a day to help her acclimatize. After a few days, she was forced to stop at the 17,000 ft medical camp because she was having trouble walking and her headache was worse despite the medication. She also reports having vomited a few times before stopping at the camp. The doctor at the 17,000 ft medical camp gave her dexamethasone and ordered her to descend and to be admitted to the hospital.


Thought Questions:

What is the most likely diagnosis for this patient?

Which diagnostic tests would confirm this diagnosis?

What are the anatomical structures involved in this clinical issue?

What are the potential underlying causes for this condition?

What is a good recommended course of treatment for our hypothetical patient?

Leave your comments below and check back with us on Friday to see how our hypothetical patient was diagnosed!

Case Closed Friday: To Sleep, Perchance to Dream

Earlier this week, we gave you a hypothetical patient with the following case:

This week, our hypothetical patient is a 7-year-old girl whose parents brought her into the clinic because she has gained an unusual amount of weight and has been excessively tired during the day, which has caused her to frequently fall asleep at school. When she first wakes up from these episodes, she is unable to speak or move her arms or legs for several minutes. This, in addition to her reports of waking up in the middle of the night and frequently experiencing nightmares, has caused the patient to fear falling asleep.

Today, we reveal that our hypothetical patient was diagnosed as having: 

Narcolepsy

This chronic neurodegenerative disease is relatively rare and can be challenging to diagnose, particularly in cases with patients that do not present with the classic symptoms of excessive daytime sleep and cataplexy. Misdiagnosis among children with narcolepsy can disrupt normal growth patterns and have life-threatening consequences. Narcolepsy is caused by autoimmune dysfunction that destroys neurons that produce hypocretin, a chemical in the brain that prevents REM sleep from occurring indiscriminately and sustains alertness. This disease is often diagnosed through physical examination, reviewing medical history, and conducting sleep studies. Children with narcolepsy usually have shortened average sleep latency on EEGs and sleep onset REM periods. These issues can be detected using video-EEGs, nocturnal polysomnography (PSG), and Multiple Sleep Latency Tests (MSLTs). Narcolepsy is typically treated with a combination of medications and behavioral modifications. Counseling is recommended, particularly for patients with trauma-triggered clinical manifestations of the disease. Changes to diet and sleep patterns as well as noticing, anticipating, and reducing triggers can help improve patient quality of life.

Thanks for joining us for this week's Mystery Case and we hope to see you next week!

WALC Week 6 Winner: Danielle Theis!

Every Wednesday, the Student Success Center holds a
Weekly Anatomical Language Challenge (WALC).

This week's winner is: 

Danielle Theis!

Congratulations on winning WALC for the second week in a row!

This challenge series will be held weekly throughout the semester to give students a chance to showcase their anatomical knowledge for a chance to win prizes!

Mystery Case Monday: To Sleep, Perchance to Dream

Welcome back to Mystery Case Monday! We will be posting a hypothetical case every week to get our pre-health students thinking about various clinical issues and the anatomical/physiological causes that underlie them. Join us in the comments section to share your insights and tentative diagnoses, then check back on Friday to read about the diagnosis and recommended treatments of these cases.

This week, our hypothetical patient is a 7-year-old girl whose parents brought her into the clinic because she has gained an unusual amount of weight and has been excessively tired during the day, which has caused her to frequently fall asleep at school. When she first wakes up from these episodes, she is unable to speak or move her arms or legs for several minutes. This, in addition to her reports of waking up in the middle of the night and frequently experiencing nightmares, has caused the patient to fear falling asleep.



Thought Questions:

What is the most likely diagnosis for this patient?

Which diagnostic tests would confirm this diagnosis?

What are the anatomical structures involved in this clinical issue?

What are the potential underlying causes for this condition?

What is a good recommended course of treatment for our hypothetical patient?

Be sure to leave your comments below and check back at the end of the week to see what our hypothetical patient had and what caused it!

Case Closed Friday: Weather Changes Moods

Earlier this week, we gave you a hypothetical patient with the following case:

This week, our hypothetical patient is a 33-year-old woman who is a professor at SDSM&T. Three years ago, she moved to Rapid City, SD, from her hometown, Sarasota, FL. A few months into her first semester, she began feeling unusually depressed and lethargic. She had not experienced these symptoms in the past and had difficulty in processing these feelings. She began sleeping more than usual and felt more irritable than was normal for her. After her first year of teaching, she stopped having these feelings and assumed that her issues were related to adjusting to her new home. However, her symptoms reappeared during the fall semester of her second year and again subsided by the end of the spring semester. She is now in her third year and is again experiencing feelings of lethargy, depression, and excessive sleeping. She is having increasing difficulty in concentrating and has gained 25 pounds since moving to South Dakota.

Today, we reveal that our hypothetical patient was diagnosed as having: 

Seasonal Affective Disorder (SAD)

While it's pretty normal to experience the "winter blues" or days of feeling "down", people with SAD experience these feelings for extended periods of time and lose their motivation to do things that they normally enjoy. These prolonged feelings of depression and lethargy often lead to disruptions in sleep patterns and eating behaviors. Many patients find concentrating to be increasingly difficult and may begin to feel more easily agitated. Some patients turn to alcohol or other substances for comfort or relaxation. Some cases also involve thoughts of suicide. Most cases occurs during late fall or early winter and subside during the spring and summer; however, some people have summer-onset SAD. SAD is often accompanied by changes in appetite and subsequent changes to a person's weight. Winter-onset SAD is more commonly associated with increases in cravings resulting in weight gain, while summer-onset SAD is more frequently associated with a loss of appetite and subsequent weight loss. Like many psychological disorders, the causes for SAD are not fully understood. Disruptions in normal levels of serotonin (mood-related neurotransmitter) and melatonin (sleep-related hormone) likely play a role in the manifestation of SAD. Changes in exposure to sunlight can also lead to depression by disrupting the body's circadian rhythms. People with family histories or personal medical histories of depression are at risk for the development of SAD. SAD also appears to occur more frequently in populations living further away from the equator. SAD is diagnosed through a combination of physical examinations, lab tests, and psychological evaluations. It is often treated with light therapy first and can begin working within a few days of treatment. If a patient's case is more severe, antidepressants and/or psychotherapy may be prescribed. Other forms of therapy that are effective for some cases include relaxation techniques, such as yoga, tai chi, or meditation, music therapy, and art therapy. Regular exercise and exposure to natural sunlight are helpful both in treating and in preventing SAD in at-risk individuals.

Thanks for joining us for this week's Mystery Case and we hope to see you next week!

Student Spotlight: Matthew Howard

Here at SDSM&T we have a growing and thriving community of pre-health students. Today, we are shining a spotlight on Matthew Howard. Matt is a Mechanical Engineering major. Pre-Medicine has been his pathway here at SD Mines and he has been applying for various medical schools. (In fact, he just recently had his first interview!) We caught up with Matt to ask him about his pre-health journey and how he is preparing for a career in healthcare.

Have you done any shadowing yet? What did you learn from those experiences? 

I have shadowed several doctors over a wide range of specialties including a dermatologist, an orthopedic surgeon, a family practice physician, and a gastroenterologist. While there were considerable differences in the types of problems that each specialty faced, it was the similarities that most impressed me. One surgeon in particular that I shadowed made sure to emphasize that, no matter what specialty you are in, you have to be a doctor first and a specialist second. Those words have stayed with me as I have shadowed other doctors, and I have tried to pay special attention to the common themes that constitute being a doctor, such as genuinely caring for the overall well-being of the patient and treating them with respect and dignity.  

Have you done any research? 

I have not done any dedicated research, but I have worked on various design projects during my time here. I am currently on a multidiscipline senior design team that is working on developing a wearable, flexible array of strain sensors (based on polymer strain sensors developed by Dr. Zhu’s lab) that can be used to track a person’s hand movements. Research is definitely something that I am interested in doing in the future, and one of the primary criteria I looked for when choosing which schools to apply to was the available opportunities for research.

What kinds of volunteering do you do?

Most of the volunteering that I do is through my involvement with my church. I have taught AWANA classes (a children’s Bible study club), ushered, helped with Vacation Bible School (a summer church camp/class), served food, helped with setup/teardown of concerts, and more. I am also usually involved in one or more political campaigns every election cycle.

How did you prepare for taking the MCAT?

During the spring semester leading up to it (I took it in June) I watched some Khan Academy videos whenever I had some spare time. Once classes were done for the semester I spent about four weeks reading through some Kaplan prep books that I borrowed from a friend. For the final two weeks I did a full-length practice exam every other day and then reviewed them the next day.

What do you do when you aren’t studying?

I enjoy hiking, dirtbiking, mountain biking, and skiing. Anything to get outside and enjoy the Hills. I also enjoy reading, usually novels. 

How do you manage stress?

For me, the key to staying stress-free is staying organized and having a definite plan for how I am going to accomplish everything that I need to accomplish. 

What advice do you have for our freshman pre-health students?

Spend enough time in your chosen field to make sure that is where you want to spend your career, and don’t be afraid to switch up your path if you find something you enjoy doing more.

WALC Week 5 Winner: Danielle Theis!

Every Wednesday, the Student Success Center holds a
Weekly Anatomical Language Challenge (WALC).

This week's winner is: 

Danielle Theis!

This challenge series will be held weekly throughout the semester to give students a chance to showcase their anatomical knowledge for a chance to win prizes!