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80 THE AMERICAN BIOLOGY TEACHER, VOLUME 69, NO. 2, FEBRUARY 2007


$PPQFSBUJWFMZ4PMWJOH$BTF Figure 1. Strategies for teaching with case studies.
)JTUPSJFTJO4NBMM(SPVQT Start Every Case With a Narrative.
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drawn into the narrative.)
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discussing it with peers. Attention is heightened by the social setting,
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Allow Students To Make Connections to Their Own Experiences.
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SOLVING OF CASE HISTORIES 81


Figure 2. Strategies for assessing & motivating cooperative Figure 3. Students in the problem-solving section continued to
learning teams. improve their exam scores during the semester while the stu-
While the college class discussed here was primarily motivated by social
dents in the traditional review sections performed at the same
pressure and the anticipation of questions that would appear on quizzes level through the semester.
98
and exams, we have used a more concrete incentive when teaching with
96
cooperative groups at a suburban St. Louis high school.
94
Proportional Credit Problem-Solving Section Scores

Exam Score (percent)


92
The most common system for assigning credit for work in cooperative 90
groups is to divide credit for group projects based on peer assessments 88
of the contributions of all other group members. Hence, if three mem-
86
bers of a group report that the fourth member contributed less than
84
25% of the effort, that fourth member would likely receive a grade Traditional Review Section Scores
82
that was lower than the grade the other three members received. This
80
method is basically a stick to prod students to help their peers; we have
used a method that is more of a carrot. 78
1 2 3
Exam
Bonus Credit
Jensen et al. (2002b) describe a system of awarding bonus points to
group members based on peer assessment but since our case study JOUIFGBMMTFNFTUFS4FWFOTUVEFOUTBUUFOEFEUIFQSPCMFN
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dents took subsequent quizzes and exams. Nonetheless, when teaching
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82 THE AMERICAN BIOLOGY TEACHER, VOLUME 69, NO. 2, FEBRUARY 2007


B TPDJBM EJNFOTJPO UP MFBSOJOH BOE NBZ FOIBODF UIF BUUFOUJPO Appendix 1. Respiratory System
TUVEFOUTHJWFUPUIFTUVEZPGDPVSTFDPOUFOU5IFDPNCJOBUJPO
PGQSPCMFNTPMWJOHFYFSDJTFTVTFEJOBTNBMMHSPVQDPPQFSBUJWF Your friend, Tess, has been regaling you with
MFBSOJOHTFUUJOHOPUPOMZPGGFSTBGPDVTGPSUIFHSPVQEJTDVTTJPO  her summer adventures in Colorado. She has
CVUBMTPPGGFSTTUVEFOUTBDPNGPSUBCMFFOWJSPONFOUJOXIJDIUP boasted that she climbed four “fourteeners”
PGGFSBOEDPNQBSFTPMVUJPOT
(a fourteener is a mountain over 14,000
0VS TVDDFTT XJUI UIFTF FYFSDJTFT JT DPOTJTUFOU XJUI PUIFS feet in altitude) in the last two summers.
QVCMJTIFE SFQPSUT +FOTFO FU BM  B  C 3BN   She always devotes two weeks to acclimate
8BUFSNBO 
)FODF BTBSFTVMUPGUIFQPTJUJWFFWBMVBUJPOT
PG UIF TUVEFOU FYQFSJFODF JO UIF DBTF TUVEZ TFDUJPO SFQPSUFE
before a climb.
IFSF BMMTFDUJPOTPGPVS)VNBO#JPMPHZDPVSTFIBWFVTFEUIFTF On one of her climbs last year, she met up
DBTFTUVEJFTTJODF with a party of rookie climbers. These inexpe-
rienced climbers almost met with disaster. As
3FGFSFODFT the two groups climbing together reached 12,880 feet, an athletic young
#BOOFSNBO %. -FNBJSF . #FHHT 4 3BXMJOT +/*WFSTFO 4% man, named Scott, became dizzy and fell. Scott was conscious but was

$ZUPUPYJDMFTJPOTPGUIFIJQQPDBNQVTJODSFBTFTPDJBMJOWFT having a great deal of trouble breathing. He had just arrived in Colorado
UJHBUJPOCVUEPOPUJNQBJSTPDJBMSFDPHOJUJPONFNPSZ'ZRGTKOGPVCN from Kansas City that morning and was upset with himself for possibly
$TCKP4GUGCTEJ 
ruining the whole vacation.
#SBVEF 4 (PSBO %.BYGJFME 4 
%CUG5VWFKGUHQT7PFGTUVCPFKPI
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#VSUPO  4  .VSQIZ  %  2VSFTIJ  6  4VUUPO  1  0µ,FFGF  + 
 pressure in Kansas City (where pressure is around 750 mmHg). Since
$PNCJOFEMFTJPOTPGIJQQPDBNQVTBOETVCJDVMVNEPOPUQSPEVDF oxygen makes up 21% of the gas in the atmosphere, what is the par-
EFGJDJUT JO B OPOTQBUJBM TPDJBM PMGBDUPSZ NFNPSZ UBTL ,QWTPCN QH tial pressure of oxygen in Kansas City? What is the partial pressure of
0GWTQUEKGPEG 
oxygen at 12,880 feet? How would this affect Scott’s ability to absorb
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oxygen from the air he breathes?
HFOF0CVWTG)GPGVKEU  2. Explain the concentration gradients of O2 and CO2 in the alveoli and
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 your text. How does the concentration gradient affect the rate of gas
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5IFOFXTDIPPM²MFDUVSF³$PPQFSBUJWF exchange in the lungs? What physical parameters determine the rate at
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5 8PSTIBN  &EJUPST
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which a gas will dissolve in a liquid?
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/FX:PSL5FBDIFST$PMMFHF1SFTT 3. Scott fell on the right side of his chest. He complained of severe pain
'SFEFSJLTFO / 
*NQMJDBUJPOTPGDPHOJUJWFUIFPSZGPSJOTUSVDUJPO in the area of his ribs. Explain the forces involved in inflating the lungs.
JOQSPCMFNTPMWJOH4GXKGYQH'FWECVKQPCN4GUGCTEJ  
 If a broken rib pointed inward and punctured a lung, how would that
(BSEOFS  )  )BUDI  5 
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'FWECVKQPCN4GUGCTEJGT 
 and punctured the thoracic wall, how would Scott’s breathing be
+FOTFO . .PPSF 3)BUDI + B
$PPQFSBUJWFMFBSOJOH±1BSU*
affected? If he had only bruised his pectoral and intercostal muscles,
$PPQFSBUJWFRVJ[[FT6JG#OGTKECP$KQNQI[6GCEJGT 
 how would that affect his breathing?
+FOTFO . .PPSF 3)BUDI + C
$PPQFSBUJWFMFBSOJOH±1BSU 4. Scott failed to tell his friends that he also has exercise-induced asthma.
 &MFDUSPOJD DPPQFSBUJWF RVJ[[FT 6JG #OGTKECP $KQNQI[ 6GCEJGT Could the altitude have triggered an asthma attack? Why? How would
 

this affect his breathing? Explain asthma with reference to the conduct-
+PIOTPO  %  +PIOTPO  3  )PMVCFD  & 
 $PPQFSBUJPO JO UIF
DMBTTSPPN VJ'FKVKQP&EJOB ./*OUFSBDUJPO#PPLT ing division of the respiratory tract.
,OBCC . 
%JTDPWFSJOHUFBNXPSL"OPWFMDPPQFSBUJWFMFBSOJOH 5. As the afternoon wore on, Scott began to panic that he would have to
BDUJWJUZUPFODPVSBHFHSPVQJOUFSEFQFOEFODF6JG#OGTKECP$KQNQI[ spend the night on the mountain. Fearing he might begin to hyper-
6GCEJGT 
 ventilate, Tess tried to calm him down. Explain how the central and
.B[VS  & 
 2GGT +PUVTWEVKQP 6QQFS 4BEEMF 3JWFS  /+ 1SFOUJDF peripheral chemoreceptors regulate the rate of respiration. Why is pH
)BMM
an indication of CO2 in the blood? Why does rebreathing CO2 help stop
3BN  1 
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,QWTPCNQH%JGOKECN'FWECVKQP  

the hyperventilation cycle?
8BUFSNBO  ." 
 *OWFTUJHBUJWF DBTF BQQSPBDI GPS CJPMPHZ MFBSO 6. What else might you have done if you had been on the mountain that day?
JOH$KQUEGPG 
 Explain the physiological basis for any measures you would have taken.
EQPVKPWGFQPVJGHQNNQYKPIRCIG

SOLVING OF CASE HISTORIES 83


Appendix 2. Write-Up Your Own Case Study
To enrich your understanding and application of anatomy and physiology,
you will be asked to write up to two case studies. These reports can be
actual cases that you have encountered in your clinical experience or your
personal life. Each one that is graded as “satisfactory” can replace a low
quiz score. The assignment must be typed to receive credit.
Part I: You are to give the patient’s age, gender, and a brief history of the
chief complaint that brought the patient to the hospital or to your
attention. Note the important physical observations and assessments
that were reported or observed when the patient entered your care or
came to your attention. If your were involved with patient care, explain
your role in the care of the patient. Write down your impressions of the
patient’s problems and what information you will need to fully under-
stand the medical condition of this individual.
Part II:
Part II: Focusing on the chief medical complaint and any interesting associ-
ated problem, discuss the underlying anatomy and physiology that 1. The boy had chronic ear infections and his hearing was impaired. Why
explain the physical conditions of this patient. would his hearing be diminished? An ear infection most commonly
occurs in the middle ear. If the middle ear is filled with fluid, the sound
Here is an example of a well-written student case study:
waves entering the auditory canal would be able to strike the eardrum
Part I: A six-year-old boy had a history of chronic ear infections. For years, but the eardrum would not move. For one to hear, the vibrations of the
he was treated by his doctor with antibiotics with immediate success but sound waves must be changed to mechanical movement of the eardrum.
the ear infections recurred. When the boy was four years old, the boy’s The eardrum moves and transduces the vibrations to mechanical energy
parents noticed that he had difficulty hearing and were concerned about as the eardrum vibrates the three bones of the middle ear. The stapes
his language development. At this time, the boy was referred to an Ear, bone is attached to the oval window and again the movement is passed
Nose and Throat specialist who recommended that ear tubes be inserted along to the cochlea. Hair cells in the cochlea send action potentials to
into the boy’s ears to prevent fluid build-up and consequent infections in the brain to be interpreted as sounds of different pitch and loudness.
the middle ear. The boy underwent minor surgery and tubes were placed
2. Fluid draining out of the ear tube is not normal. This indicated an on-
through the eardrums. After a course of antibiotics, the boy’s ear infec-
going infection even with several courses of antibiotics. What would
tions cleared and he commented on how loud everything seemed.
allow bacteria to continue to thrive? The doctor suspected that the
Several years later while the ear tubes were still in place, the boy told infection was resistant to the prescribed antibiotic, but excess sugar is an
his parents that he had “stuff coming out of his ears.” He was immedi- excellent environment for bacterial growth.
ately taken to the doctor and he was put on a course of antibiotics. The
3. The child complained of a stomach ache. With diabetes the body is
diagnosis was that the boy had ear infections again despite the fact that
starving although the individual consumes a lot of food. As part of
the tubes were doing their job. His ears continued to drain fluid and he
a preservation mechanism, the body breaks down fat and muscle for
returned to the doctor. The doctor changed the antibiotic. Several days
energy instead of using the carbohydrates of food. The by-product of fat
later the parents noticed that this rather active and robust six-year-old
and muscle breakdown is a chemical called ketone. Excess ketones in the
boy appeared thinner and that he had become lethargic even though he
body can cause vomiting and abdominal pain.
had a ravenous appetite. He did not want to go to camp and complained
of having a stomach ache. One evening after dinner the boy threw up his 4. The child lost weight even with a good appetite. The food was not being
entire dinner. He was again taken to the doctor and the doctor said that used by his cells. The child was starving although he was eating a lot of
he was probably sensitive to the new antibiotics. food. The metabolic pathway to get glucose to his cells was not working.
He lost weight because his cells could not absorb glucose.
One day when the boy stayed home from camp, his mother noticed that
he was going in and out of the house to go to the bathroom and to get a 5. The boy’s urine was positive for glucose. Glucose is normally unde-
lot of water to drink. This pattern occurred throughout the day and the tectable in the urine. Because of his lack of insulin, the glucose from
mother became concerned that this behavior was unusual even on hot digested food was not transported to his body cells. The excess glucose in
summer days. The boy’s urine was tested for sugar. The test was positive his blood was not reabsorbed by the proximal convoluted tubule of the
indicating diabetes. nephron and was therefore lost in the urine.

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