Human Anatomy at Colby

Emma Roberts: My Human A&P Experience

February 14th, 2014 · Comments Off on Emma Roberts: My Human A&P Experience

DSC00726 The trip to Maine General Augusta hospital was the highlight of the Anatomy and Physiology janplan. Besides touring the hospital and giving a talk to a room full of 40+ doctors, we were given the chance to spend over an hour talking personally with medical students. A friend and I toured the hospital with three medical students, two fourth years and one third year. Since I got to Colby I’ve been back and forth deciding if I want to follow a pre-med track or not. Talking with the medical students completely changed my perspective on medical school and made me sure that’s what I want to do, and so I’m really grateful that I had the chance to take this class and take advantage of this opportunity. I’m a French major and so I have interests other than necessarily pursuing the sciences. However, talking with the medical students made me realize that taking time off between undergrad and med school and learning in depth about another topic is a really valuable asset to bring to the classroom. One of the fourth years told us that he went to graduate school to study theology and become a teacher and after a few years of that went back to finish his pre-med requirements and take the MCAT. Another fourth year told us that she spent a couple years off doing research before med school. The third year student told us that she went straight to med school, but sometimes wishes she had taken time off, and really appreciates what the students who did take time off can contribute. I loved being able to hear about the paths they took to get to medical school, and I know now that it may actually benefit me in the long run to pursue other interests before finally applying to med school.

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One of the other highlights from the janplan was the trip to the Boston Body World Vitals exhibit. There were dozens of different dissections of bodies and we were able to see so many parts of the body that we had just learned about on an actual human. Thom spent a good 15 minutes showing a friend and I all the different nerves in a dissection and how they relate to each part of the body which was really cool because we hadn’t had the chance to cover them all in lab. It was also fascinating to see how the dissections had been made. For example, there were many models of exactly where all the veins, arteries, and capillaries were in a structure in the body. This type of model would have probably been impossible to recreate, it needed to be made from a real human body. These were made by filling the vasculature with plastic and then melting away the tissues covering it. There were also bodies that had been dissected into three parts so you could see both halves of the body and the bones and organs all separately. It was really amazing what the different angles in the body could expose.

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This janplan was great because we were given many opportunities to explore different career paths in the medical field, which is unlike most science classes that I have seen offered at Colby. This class was clearly geared towards the interests of the students, which is not always the case and which is why I really appreciated taking this class, regardless of the workload. I didn’t come into this class expecting to have such unique opportunities like take field trips to Boston or talk with current medical students and those were the aspects of the class that made really enjoy it.

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Grand Rounds: Epstein-Barr Virus and Infectious Mononucleosis Induced Acute Post-infectious Cerebellar Ataxia

January 29th, 2014 · Comments Off on Grand Rounds: Epstein-Barr Virus and Infectious Mononucleosis Induced Acute Post-infectious Cerebellar Ataxia

By:  Laurel W, Emma R, Peter W

One month before admission to Massachusetts General Hospital, a previously healthy 19 year old male presented with fatigue, fever, pharyngitis, and lymphadenopathy. A streptococcal pharyngitis (strep throat) test was found to be negative, and a heterophile antibody test (rapid test for mononucleosis) was found to be positive. The diagnosis of infectious mononucleosis due to Epstein-Barr virus (EBV) was made 17 days before admission.

Two weeks prior to admission, the patient presented with additional symptoms, including dysphagia and pain and difficulty hearing in the right ear. A diagnosis of otitis media was made and was treated with prednisone, amoxicillin, and azithromycin. 8 days prior to admission, the patient presented with severe ear pain, a perforated right tympanic membrane, and a bloody purulent in the external auditory meatus. The patient was treated with oral cefurozime and ciprofloxacin (antibiotics). Several days after visiting the ENT, the patient returned for a myringotomy (procedure to relieve pressure in ear by making incision in ear drum). Then, 6 days prior to admission, the patient experienced unsteadiness, slurred speech, and increasing gait imbalance.

Upon arrival the patient had experienced weight loss, decreased hearing, enlarged tonsils, falling, and truncal ataxia. Over the first four days of admission the patient was found to have opacification (indicating fluid in these areas) of right mastoid air cells and middle ear (as shown from MRI and CT scans), impaired ability to perform simple arithmetic, continued deterioration of speech, and balance. The CT scans of the cerebrum and cerebellum showed no abnormalities. The coordination test showed impairment in his motor functions. Slurred speech, clumsiness, ataxia (lack of coordination of movements) and otitis media led to the admission of the patient to neurology services.

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Although Guillian-Barre syndrome is the most common cause of post-infectious ataxia, it is accompanied by loss of reflexes, which were intact in this case. Although cerebral involvement due to executive dysfunction was considered, it could not explain all of the patient’s signs and symptoms. Hereditary and neurodegenerative diseases were ruled out due to lack of family history, normal imaging, and patient’s age. However, the patient’s symptoms, along with the diagnoses of infectious mononucleosis, led to the clinical diagnoses of an upper respiratory tract infection complicated by otitis media. The neurological symptoms also led to the diagnoses of post-infectious acute cerebellar ataxia (ACA) associated with Epstein-Barr virus. ACA is presumed to be an auto-immune response causing inflammation of the cerebellum leading to motor dysfunction.

Plasmapheresis and intravenous immunoglobulin (IVIG) were recommended for treatment as this course is directed at the immune response and therefore more effective. IVIG is administering a solution containing antibodies from the plasma of thousands of people and Plasmapheresis is the process of removing, treating, and returning blood plasma to a patient. Both techniques are common treatments for autoimmune disorders. On the fourth day in Massachusetts General Hospital a five day course of IVIG was begun; the patient responded rapidly and his symptoms improved. After the fifth day of treatment the patient had recovered 90% of his function. He then spent one day in a rehabilitation center and was discharged on the eighth day after admission with a full recovery.
Tracey A. Cho, M.D., Jeremy D. Schmahmann, M.D., and Mary E. Cunnane, M.D., et al. A 19-Year-Old Man with Otalgia, Slurred Speech, and Ataxia. N Engl J Med 2013;369:1253-1261

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