Case study notes – Cardiovascular
In this section you will find notes to guide the responses for each question of the case studies.
Case Study on Cerebral Arterial Circle: Case of a Stroke
QUESTION 1: Discuss the consequences to the patient if the stroke was caused by an occluding lesion in the left vertebral artery, left internal carotid artery or left anterior cerebral artery.
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QUESTION 2: Describe the anatomical variation phenotype present in this patient case (examine arteriogram on the right). What impact does the anatomical variation phenotype of the patient have on the outcomes of a lesion in each case?
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QUESTION 3: What impact does the position of the lesion have on the outcomes in each case? Consider the following scenarios:
- lesion in cavernous part of internal carotid artery compared to lesion in cerebral part of internal carotid artery
- lesion in A1 segment of anterior cerebral artery compared to A2 segment of anterior cerebral artery
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Case Study on Coronary Arterial Circulation: Myocardial Infarction
QUESTION 1: Significant atherosclerosis of the right coronary artery was identified in the posterior interventricular artery and circumflex artery.
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QUESTION 2: Describe the anatomical variation phenotype present in the patient. What impact does the anatomical variation phenotype of the patient have on the outcomes of an occlusion in this case compared to other phenotypes such as right dominant branching pattern?
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QUESTION 3: Consider the patient now has two occlusions – one in the posterior interventricular artery and one in the circumflex artery, again with reference to the patient’s phenotypic variation. What impact does the position of the occlusion have on the patient outcomes? Consider:
- Occlusion in circumflex artery proximal to anterior interventricular artery branch compared to distal to anterior interventricular artery branch
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Case Study on Pulmonary Veins: Atrial Fibrillation
QUESTION 1: Review the course of the catheter via the femoral vein and femoral artery to access the left atrium of the heart. Draw a flowchart to demonstrate the blood vessels the catheter would pass through in each procedure.
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QUESTION 2: Describe the anatomical variation phenotype of the pulmonary veins present in the patient using the Shukla et al. (2012) classification system/ phenotype types above.
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QUESTION 3: Atrial fibrillation may result in the formation of blood clots. Describe how this can result in patient stroke if left untreated.
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Case Study on Renal Arteries: Percutaneous transluminal angioplasty
QUESTION 1: Review the course of the catheter via the femoral artery and brachial artery to access the right renal artery. Draw a flowchart to demonstrate the blood vessels the catheter would pass through in each procedure.
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QUESTION 2: In what circumstances would you perform a retrograde versus an antegrade procedure for renal artery angioplasty? Refer to Smith et al. (2022) to examine the following related questions.
- In terms of the patient’s angle, would you recommend a retrograde or antegrade approach for catheterisation? Justify your answer.
- Does the sex of the patient influence the procedural approach?
- Does the age of the patient influence the procedural approach?
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Case study notes – Skeletal
Case Study on Bony Pelvis: Pelvic Variation and Childbirth
QUESTION 1: Discuss the morphological features that indicate this patient presents a typical female bony pelvis.
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QUESTION 2: Pelvimetry is a technique used to assess the size of the female pelvis to determine whether the patient may be able to deliver vaginally. Consider what diameter measurements may be relevant and where these diameter measurements could be conducted. What bony landmarks could be used when performing pelvimetry?
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QUESTION 3: The shape of the bony birthing canal is highly variable between females. What may be the implications of variation in morphology of the pelvic inlet and pelvic outlet? What bony features in this region may impact delivery of a foetus?
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Case Study on Skeletal Growth and Fusion: Craniosynostosis
QUESTION 1: Fusion of the metopic suture was identified, with bony ridging in the midline of the frontal bone. Consider the impact of premature fusion of cranial sutures on the development of the nervous system. How could craniosynostosis (premature fusion) impact the brain?
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QUESTION 2: Compare this patient’s scan with the anterior fontanelle diagrams above, and identify if this patient has presented with premature fusion of the anterior fontanelle. If premature closure of the fontanelles occurred in-utero, what impact would this have on parturition?
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QUESTION 3: In most cases, craniosynostosis requires surgery for aesthetic and psychosocial reasons. How may a surgeon remodel cranial bones to treat skull malformation?
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Case study notes – Muscular
Case Study on Biceps Brachii: Case of supernumerary head of biceps brachii
QUESTION 1: Would a supernumerary head of the biceps brachii result in any functional advantage to the patient?
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QUESTION 2: Why is an accessory head of the biceps brachii sometimes mistaken for a tumour?
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QUESTION 3: Compare and contrast the anatomy of the anterior muscle compartment of the brachium between humans and primates, and hypothesise why supernumerary heads of the biceps brachii suggest an evolutionary trait. Refer to Oxnard and Franklin (2008) for guidance.
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Case study notes – Nervous
Case Study on Sciatic Nerve: Case of Peripheral Anaesthetic Blockade of the Sciatic Nerve
QUESTION 1: Which muscles and cutaneous regions should be numbed following peripheral anaesthetic blockade of the sciatic nerve in the popliteal fossa?
- Considering the patient received the nerve block at the apex of the popliteal fossa, what variation in the sciatic nerve could explain a lack of anaesthesia in the lateral compartment of the crural region (leg)?
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QUESTION 2: In some cases a more distal nerve block is more appropriate such as a tibial nerve block. As reported by Byun et al. (2019) the location of the tibial and common fibular nerves is significantly correlated with age and becomes sexually dimorphic after puberty. Using the regression equation proposed by Byun et al. (2019) estimate the location of the tibial nerve in this patient to safely insert the needle to perform a tibial nerve block. The bicondylar femoral width of the patient is 7.2cm.
- 6.2072cm from most medial point of the femur
Case Study on Corpus Callosum: Case of Corpus Callosum Dysgenesis
Case study notes – Respiratory
Case Study on Lung Fissures: Case of Pneumonia
QUESTION 1: Draw a flowchart of the passageway of the Streptococcus pneumoniae from the nasopharynx to the middle lobe of the right lung by naming each anatomical structure it passes through.
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QUESTION 2: Once colonised in the middle lobe of the right lung, what prevents the bacteria from spreading to the other lobes of the right lung?
- Refer to the population frequencies of phenotypic variation table above: What is the likelihood that the patient has an incomplete horizontal fissure?
- Consider the consequences if the patient had an incomplete or absent horizontal fissure
- Would the depth of the oblique and horizontal fissures affect the patient’s case?
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