Problem
I. The autonomic nervous system (ANS) controls critical physiological processes in the lungs. It functions like a seesaw-when one division is in use, the other is less active. ANS tone may therefore be increased or decreased in response to certain stimuli, resulting in specific physiological responses in the tissues.
A. State the physiological response that occurs in the vascular smooth muscle of the lungs when both the sympathetic nervous system and parasympathetic nervous systems are activated.
B. Using your knowledge of the effects that the ANS has on tissues in the lungs, briefly hypothesise the potential physiological effects of rib raising at levels T1-6. Specifically relate your hypothesis to the proposed therapeutic mechanisms of rib raising.
II. Read the case vignette below and answer the associated questions.
A 39-year-old graphic designer, Megan, presents to the clinic with a two-day migraine on the right temporal region of her head. She has only started experiencing migraines in the past 18 months, but prior to this, she never had headaches at all. Megan is currently very stressed from work, and this morning noted that her eyes can't focus- she is seeing double, but only out of the right eye. Three months ago, Megan had a similar event occur, where she couldn't see properly out of her right eye while working on her computer, which prompted her to get reading glasses.
Megan has intermittent tingling into her little finger, which seems to travel up her arm and into her face. There is no specific pathway of the tingling, instead it feels like the whole arm feels 'weird'. There is no associated dizziness with the current migraine, but Megan says in the past two years she has had a few episodes of losing her equilibrium and overall has become clumsy and unsteady. Megan is otherwise healthy, though has had bouts of excessive fatigue in the previous months.
From the information provided:
A. Briefly outline the importance of the following case information in relation to your potential top differential diagnosis. Reference your answer.
a. Diplopia
b. Clumsiness/unsteadiness
B. State the most likely differential diagnosis (systemic condition) and justify using clinical reasoning related to the case. Reference your answer.
C. Succinctly describe the pathophysiology of your answer to 2b, linking the pathophysiology of the condition to Megan's symptoms. Reference your answer.