Human Anatomy at Colby

Alexandria Lucas: Meeting with High School Anatomy Students

February 24th, 2015 · Comments Off on Alexandria Lucas: Meeting with High School Anatomy Students

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In high school, I never had an opportunity similar to this one in which I was able to visit a college science class and interact so directly with the college students and the material they are learning. Not only did they get to come and visit, but they were able to dissect a pig’s heart and we were there to help them do it! I do not know what have been a cooler fieldtrip in high school than this one.

It was very interesting and engaging because as we walked around and took them through the lab exam we had just taken, they could identify some of the anatomy and share knowledge about things we may not have learned because they too were currently in an anatomy class. In addition, it was helpful to be in the teaching role as we described and identified the anatomy on the different models. I think this truly works as a way to understand and learn the material better, and is not often a position that us college students are in. This particular lab test was on the heart, eye, ear, and the brain.

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After taking them around our lab exam, we went downstairs to dissect the pigs’ hearts. Each group had their own heart to dissect, and it was both an opportunity for the students to learn about some of the anatomy we had just reviewed as well as to explore whatever pieces of the heart they found intriguing further. Some groups dove right into ripping apart the heart, while others took more reserved action and precise cutting to open the heart.

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The purpose of this field trip was initially supposed to be meeting with the students to help them come up with ideas for the Maine Math and Science Alliance Science Fair. Because of our current class, we brainstormed ideas that directly related to anatomy and physiology, such as do different styles of music have an effect on the heart rate, or do different color filters of light effect pupil dilation in similar or varying ways.

Perhaps my favorite part of the day, which was the only unplanned part as it happened, was answering questions the group of students I was showing around had on college science classes, premed requirements, college class schedules, and more. Before I came to Colby, I truly had no idea what college was like, and needless to say I also had no idea how classes, lectures, exams, etc. operated. They were very curious about what a typical day looks like and what is different about high school classes versus college classes, and the two biggest things I shared were that exams make up very large portion of your grade particularly in science class, for very infrequently do you have daily homework assignments that significantly contribute to your grade like in high school. I also shared the much greater need for independent learning and studying in college, for it is your responsibility to make sure you understand the material covered in class during lecture and to study outside of class if you don’t. It was fun to be able to reflect on the time I have had here at Colby so far and share my learning and knowledge with students who will soon be headed off to college themselves.

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Alexandria Lucas: Grand Rounds / Oligoastrocytoma

February 22nd, 2015 · Comments Off on Alexandria Lucas: Grand Rounds / Oligoastrocytoma

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The grand rounds project, which consists of research on a particular topic and a final group presentation that is open to the public, I think was perhaps one of the most valuable parts of this class, for it really did require a lot of individual learning and the students really had to take things into their own hands, be independent, and put a final product together all outside of class, much like the way things will happen in medical school. I very much appreciate that Dr. K always pushed us to work hard in this way to prepare us for much harder tasks that are to come in the future in our post-Colby years, and the Grand Rounds project was easily one of those things.

My group wanted to do a case study for our project, so we first began by looking through a list of different case study articles when one caught our attention titled: “32 year old woman with episodes of unconsciousness.” We were very curious what was causing these episodes, because it really could be a wide range of things, so we choose this as our topic because of its very intriguing symptoms.

The next part of the project consisted of breaking up the material into sections, such as symptoms, differential diagnosis, diagnostics tests, and more, and then each group member doing research on their assigned sections. We then worked on putting together a PowerPoint presentation and a one-page synopsis on the topic. Some groups did a lot of this work together, but it is always hard to find a time that everyone can meet, so we ended up doing most of this work alone and communicating over email and Google docs which I think actually worked really well.

On the second to last day of class, each group presented their PowerPoint on their topic for about 15 minutes. I found this to be one of my favorite class times throughout the whole semester. I really enjoyed hearing about medical cases that I know nothing about, as well as see the different groups be so intrigued and excited about the topic they choose to research, and in addition seeing how much knowledge we had all gained over the past few weeks.

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It was, however, a little nerve-racking to be put in front of the class speaking about something that is often quite advanced and perhaps a little over a college students’ head, but having the class there and Dr. K in front being very supportive, the presentation did not end up being as scary as I thought it was going to be. Our case, of the 32 year old woman with episodes of unconsciousness, was mainly a result of an Oligoastrocytoma, which is a tumor consisting of mixed cells. It was located in the temporal part of her brain, which was causing her unconscious episodes. However, what makes this case even more interesting is that she had a genetic predisposition to neurocardiogenic syncope (fainting, loss of muscle both due to abnormal control of the brain over the heart), which led to her case being complicated by ictal asystole (stopping of the heart during her epileptic seizures, which is very rare). Not only during this Grand Rounds project did I have the opportunity to be an independent learner as well as a group member, but I also learned a significant amount about this woman’s case and Oligoastrocytoma’s, as well as recognizing the fact that although certain medical cases can easily explained by one disease, that does not mean that is always the only thing going on.

Tags: Bi265j · Grand Rounds · Human Health

Alexandria Lucas: Overall Experience

February 22nd, 2015 · Comments Off on Alexandria Lucas: Overall Experience

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Coming into this class, I had heard it was going to be a lot of work and was certainly not going to be a walk in the park. With that said, I had significant interest in Anatomy and Physiology, mostly because I have never had the chance to take a class on this subject material. Thus, going into it I know I was driven to work hard and I would enjoy putting effort into it to take on the challenge of learning so much anatomy and physiology in the four-week period. I have to say the first week of this class was certainly the hardest of all the four weeks, and definitely scared me a little. Yet, I know that in that first week I probably had my time of greatest learning as far as how to study the material most efficiently while still maintaining healthy life habits, which is one of the main goals of Dr. Klepach’s in this class. With 3 quizzes that week and a lab exam on tissue, bones, and muscles, it was nowhere near an easy first week. However, making it through that first week was incredibly rewarding.

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In addition, during that first week of class we actually ended up trying a flipped lecture. This meant we would watch recorded lectures from last year and then go into class and do review, answer practice questions, and activities for engraining the material in our head and helping us to understand it better. I had never done a class like this before, so it was very interesting to experience. However, the next week the class vetoed to have normal lectures.

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Overall, I think that the lab tests were definitely the most stressful part of this class. For the first one, I truly believe I did not understand the amount of time you had to put into studying the anatomy nor had I yet realized what studying method was going to work best for me. For that first lab exam, I really only looked over the PowerPoints for a decent amount of time. I soon learned that was not going to cut it for studying for the exams, in which you walk around the room and identify not just major muscles on the models, but rather the small muscle that goes around the top of your eye or the specific name of a vertebra, for example. It is not meant to be easy. Needless to say, that first lab exam did not go very well for me at all. However, for the second exam I realized it may help to interact with the models, since after all, that’s exactly what we were going to have to recognize anatomical features on for the exam. Although I still did not do incredibly well on the exam, I made a clear improvement in my grade from the first exam, which was definitely an accomplishment as well as what Dr. K hopes students to do during his Janplan class; find what studying tactics work best for your and improve over the course of the month.

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Grand Rounds: Oligoastrocytoma

January 28th, 2015 · Comments Off on Grand Rounds: Oligoastrocytoma

Grand Rounds: Oligoastrocytoma

Alex Lucas, Yvette Qu, Rachel Bird

 

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Oligoastrocytoma

Oligoastrocytomas are brain tumors that consist of oligodendrocytes and astrocytes, the two cell types in the brain that support and insulate nerve cells. Unlike many brain tumors, which typically present initially with headaches, seizures are a common initial symptom of oligoastrocytomas.

The patient presented with episodes of “a feeling of walking through a cloud,” receptive, or Wernicke’s aphasia (the inability to understand spoken words), Aphasia (inability to speak), and vertigo. She also suffered from brief seizures, which worsened in severity over the course of the next eight years, and began to involve loss of consciousness and muscle tone, occasional incontinence, and overwhelming confusion. Three months prior to admittance, the patient struck her head during an episode, but MRI, ECG, echocardiography, Holter monitoring, EEG and multiple blood tests all appeared normal. The patient did not respond to triptans or beta-blockers, but the frequency of her seizures increased to at least one per day.

An MRI was performed on the patient, which showed a mass in the left occipitotemporal region of the brain. A biopsy helped to determine the grade of the tumor – grade II, which is a low grade tumor – and also presents the pathology which helps to determine the growth patterns of the tumor cells. Fluorescence in situ hybridization (FISH), which allows for reliable and accurate detection of chromosomal deletions, showed deletions in 1p and 19q tumors.

Similar to most tumors, the exact cause of an oligoastrocytoma is unknown. It is understood that normal cells become abnormal in the sense that they may produce the wrong number of proteins or enzymes or be lacking certain genetic material. In the case of an oligoastrocytoma, deletions of genetic information in chromosomes 1p and 19q are the reason for the tumor cell’s abnormalities. This certain type of tumor is a result of a mixture of oligodendrocytes and astrocytes. Genetic material losses in 19q occur in 60-80% of oligodendrogliomas and 30-40% in astrocytomas, which demonstrate that there may be a shared variation in the formation of gliomas. Losses in the 1p chromosome are frequent with oligodendrogliomas at about 50-80%, however are less apparent with astrocytomas, which is detected only 10-18% of the time. However, the combination of genetic material losses of the 1p and 19q chromosomes is detected in 60-80% of oligoastrocytoma cases.

A gross resection was performed to remove the patient’s low-grade oligoastrocytoma tumor. Standard radiotherapy and antiepileptic medications were given after the resection. Lifelong MRI was suggested instead of permanent pacemaker due to the low-grade of the tumor. Following MRI shows only postsurgical changes, implying good prognosis. During the 24-month following the resection, no seizure has occurred with reduction in medication, indicating great possibility of freedom from seizure in 10 years and absence of intractability.

The patient’s case is complicated by ictal asystole (stopping of the heart during her epileptic seizures, which is very rare) in a patient with a predisposition to neurocardiogenic syncope (fainting, loss of consciousness, loss of muscle tone due to an abnormal control mechanism of the brain over the heart) due to a genetic disorder, and with the asystole being triggered by the seizures caused by her oligoastrocytoma make this case very interesting and unique. The important information the case conveys is that a patient’s symptoms are not always indications of a single disease, and sometimes the symptoms need to be closely examined and can suggest more than one disease. Perhaps screening for relationships between cardiac dysfunction and neurologic mechanisms could help identify rare cases such as this one, which would allow for earlier diagnosis and treatment.

References:

(1) Paleologos, N A, ed. Oligodendroglioma and Oligoastrocytoma. Am Br Tum Assoc 2014: 3-8.

(2) Oligoastrocytoma. Univ CO Sch of Med Neusrgy 2015.

(3) Meenakshi G, MD, Azita Djalilvand, MD, Daniel J. Brat, MD, PhD. Clarifying the Diffuse Gliomas. Am J Clin Pathol. 2005;124(5):755-768.

(4) Cole, AJ, M.D., Eskandar, E. M.D., Mela, T, M.D., Noebels, J.L. M.D., Ph.D., Gonzalez, R.G. M.D., Ph.D., McGuone, D, M.B., Ch.B. Case 18-2013 — A 32-Year-Old Woman with Recurrent Episodes of Altered Consciousness. N Engl J Med 2013; 368:2304-2312.

(5) Ucdenver.edu. Department of Neurosurgery [Internet]. 2015 [cited 2015 Jan 15]; Available from:http://www.ucdenver.edu/academics/colleges/medicalschool/departments/Neurosurgery/patientcare/multi-disciplinaryprograms/AdultBrainTumorProgram/Pages/Oligoastrocytoma.aspx

 

 

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