Please answer BOTH questions 3 and 4. There are many examples of both vertebrate

Question

Please answer BOTH questions 3 and 4.

There are many examples of both vertebrates and invertebrates that use toxins to subdue and predigest their prey. Many of these toxins are neurotoxins that influence both the central nervous system and affect the function of the neuromuscular junction to cause paralysis. Many venoms are hemo- or cytotoxic causing bleeding, clotting or necrosis of tissues. The following medical case is a real story of a Canadian woman returning from a trip to Peru.

A 22-year-old woman who was previously healthy presented with a 4-day history of expanding ecchymoses. She had no other bleeding manifestations and denied any other symptoms such as muscle or joint pain, rashes, and had undergone no physical trauma. Her medical history
was unremarkable. She was not taking any medication, and she had no family history of bleeding problems or hematologic disorders. Her last normal menstrual period was 2 weeks before admission. The patient had no fever or inflammation of the lymph nodes, normal vital signs, and results of her cardiovascular, respiratory and abdominal examinations were normal.

Seven days before admission the patient had returned from northeastern Peru, where she had stepped barefoot on 5 caterpillars. Immediately after contact with the caterpillars, she experienced burning pain in her foot, radiating proximally to her thigh. The pain worsened when she walked. A headache also developed. Both the foot pain and headache resolved over the subsequent 12 hours and she did not seek medical care at that time. Initial laboratory tests are summarized in Table 1 below.

3. Examine the blood values in Table 1. The following tests from Table 1 were found to have abnormal values. Indicate whether the test value is higher or lower than normal, and if the result indicates an increased or decreased ability to form clots

4. What step in the clotting pathway appears to be disrupted in this patient? Explain what evidence led you to this conclusion.

Table 1: Results of initial laboratory tests performed for a 22-year-old woman who presented with a 4-day history of expanding ecchymoses Test Hemoglobin, g/L Platelet count, x 10 /L Leukocyte count, x 10'/L Haptoglobin, mg/L Total bilirubin, mol/L Lactate dehydrogenase, U/L Creatinine, mol/L International normalized ratio Partial thromboplastin time, s Fibrinogen, g/L D-dimer, ng/mL FEU 1:1 mixing of patient's plasma with normal pooled plasma Coagulation factor II, U/mL Coagulation factor V, U/mL Coagulation factor XIII, U/mL Peripheral blood smear Human chorionic gonadotropin, U/L Pelvic ultrasound Result (reference range) 125 (120-160) 216 (140-450) 7.9 (4.0-11.0) 610 (650-1900) 16 (

Explanation / Answer

4. The defect is between the common pathway on the last step of fibrinogen stabilizing. reduced amount of coagulation factor xiii to reduce the amount of fibrinogen. Increase in the value of D dimer indicates that but lot is being found but the degradation product is more and leading to this conclusion

Higher decrease Lower decrease Lower decrease drastically Higher No , effect but it's a indicator Lower decrease.

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