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In this interrupted case study, students shadow an endocrinologist as she tries to determine what is wrong with Angela Barber. Angela is a middle-aged woman presenting with symptoms suggestive of a thyroid issue. Students are given background information, patient history, and results from thyroid-specific blood tests. The exercise emphasizes the hypothalamic-pituitary-thyroid axis and particularly highlights the role of negative feedback. Students will use results from serum thyrotropin and thyroid hormone level tests, as well as patient symptoms, to come up with a diagnosis. In preparation for the diagnosis, students are asked to compare the endocrine profiles of patients with Graves' disease, Hashimoto's disease, iodine deficiency (primary hypothyroidism), and various tumors. The case was developed for college-level biology majors in a physiology course, but also has been used successfully for pre-nursing students in a non-majors anatomy and physiology course. Thus, this activity would be suitable for majors in physiology or pre-medical students, as well as allied health majors.

This flipped clicker case study explores the fascinating relationship between the Arizona Bark Scorpion (the most venomous scorpion in North America) and the Southern Grasshopper Mouse. Initially it would seem that the grasshopper mouse is no match for the scorpion's venom; however, the grasshopper mouse is easily able to eat the scorpion and is largely immune to the scorpion's sting. By working through this case study, students learn about neuron anatomy and physiology as they explore how the grasshopper mouse is able to survive the scorpion's venom. This case study was developed for an introductory biology course for majors, but it could also be used in an introductory biology course for non-majors or in an anatomy and physiology course. The case requires that students learn basic neuron anatomy and action potential physiology prior to class by reading their textbook or by watching videos on the subjects. An optional set of guided questions tailored to Campbell Biology (10th ed.) is included in the teaching notes.

"I Heart Running" is a case study in which students diagnose the cause of exercise-induced tachycardia in an otherwise healthy, 27-year-old female. The patient, Sam, is a long-distance runner and realizes that her exercising heart rate reaches over 200 beats per minute. As the story of Sam's encounters with her physician develops, students are given results from multiple laboratory tests and detailed patient background information.  Students are guided through the material with a series of questions with the ultimate goal of determining the cause of the exercise-induced tachycardia that Sam experiences. The case study is based on actual laboratory results and was designed for students in an upper-level undergraduate Human Physiology course. In this activity students will learn about heart rate, cardiovascular physiology, and oxygen carrying capacity, and factors which influence these concepts, as they try to diagnose Sam.

This interrupted case study tells the story of Michael, a Harvard law graduate with a stressful job and a seemingly heavy drinking problem. Students are provided with background information, medical history, and lab results in order to guide them towards determining what is wrong with Michael. This study highlights cirrhosis and the effects of alcohol abuse on the liver. Before beginning the case study, students should have a background in the physiological role of the liver and the breakdown of hemoglobin. Students are asked to use the information provided for them in the case study to gather more information about liver cells and their functions, alcohol, and alcoholic liver damage. Ultimately, using multiple blood tests, the Maddrey's discriminant function (DF) score, and results from a magnetic resonance elastography (MRE), they will diagnose Michael with alcoholic cirrhosis. This case was developed for use in a non-majors physiology course, but could easily be used for a majors class.

Signaling at the neuromuscular junction (NMJ) is a complex process that is required for many actions that sustain life within humans. Toxins that act upon the NMJ, both natural and synthetic, act in a variety of ways to inhibit this function. This case study examines how a variety of toxins can act to disrupt the normal mechanism of function of the NMJ  by placing a protagonist ("Unlucky Chucky") at an eco-spa in Colombia with his good friend Melody. Unfortunately, during their time at the eco-spa, things don't always turn out well for Chucky. A variety of neuromuscular toxins are discussed including curare (d-tubocurarine), Botox (botulinum toxin A), physostigmine and sarin gas (GB). This case was designed to be used in a variety of classrooms ranging from an undergraduate introduction to biology course in a module focused on neuromuscular functioning, to an introduction to physiology course as an introduction to the NMJ; it could also potentially be used in a nursing course that is examining NMJ physiology.

In this directed case study students follow a nurse practitioner and work with a diagnostics team to determine what is wrong with Tristan, an infant who comes to the clinic with multiple bruises. Students are given background and patient history, and are then given results of various blood tests ordered by the diagnostics team. The exercise emphasizes the physiological process of coagulation and the importance of various clotting factors, especially factor VIII. Students will be introduced to results from several blood tests, including: complete blood count, partial thromboplastin time, prothrombin time, metabolic panel, and factor VIII assay. The patient is ultimately diagnosed with severe hemophilia A and the case then introduces students to this disorder, the genetic determinants, the incidence, and ways to manage the disease. The data in this case are real and the story represents the medical history of an actual patient. Originally developed for pre-nursing students, this activity would also be suitable for majors in physiology or pre-medical students; it could also be used in an introductory genetics or biology course.

An elderly woman living independently with some help from her family is brought to the local emergency room because she is confused and vomiting. While her son suspects a stroke, a quick battery of laboratory tests indicates that her current problems are the result of impaired kidney function, an old-fashioned home remedy for ulcers, and her prescribed blood pressure medication. The combination of patient- and drug-related factors produces an acid-base disorder responsible for her confusion. This disorder further disrupts her kidney function. The case illustrates secretion and reabsorption processes in the kidney tubule which regulate plasma and urinary electrolytes (including calcium) and pH. The role of bicarbonate in maintaining systemic pH is emphasized. Interactions among the renal, respiratory and nervous systems in the regulation of systemic pH are also illustrated. Further, basic principles of pharmacotherapy and issues related to the appropriate use of medications are introduced. The case was developed for use in a physiology or human anatomy and physiology course, but it might be used in undergraduate nursing courses as well (e.g., pharmacology, pathophysiology).

This case study explores the topics of diffusion, osmosis, membrane transport, and the physiological significance of glucose and insulin in the human body. The story begins with a high school athlete, Timmy, who is incredibly efficient at metabolizing carbohydrates for energy; this is where the reader is introduced to normal carbohydrate digestion and metabolism for energy within skeletal muscle cells. As Timmy enters college, he withdraws from sports and physical activity but continues to consume massive amounts of highly soluble carbohydrates, resulting in insulin resistance and ultimately type II diabetes. Throughout the case students are prompted with conceptual questions and interactive figures that require the application and transfer of information they have been introduced to. Originally written for intermediate and advanced physiology courses that cover foundational and complex concepts in science, the case is also appropriate for courses in intermediate biology, nutritional sciences, animal sciences, and exercise sciences.

Was the "Brooklyn Butcher" of 1926 a cold-blooded killer or was something less sinister at play? This interrupted case study introduces students to hemoglobin binding and carbon monoxide poisoning by working through the details of a fictionalized account of a true-crime story. Topics covered include molecule conformational states, binding affinity, deoxyhemoglobin, oxyhemoglobin, carboxyhemoglobin, and oxygen transport. Students also design an experiment to determine the cause of death of the victim. Prior to beginning the activity students should have some knowledge of the respiratory and circulatory systems and be familiar with oxygen binding curves. Detailed understanding of hemoglobin conformational changes is not necessary since this information is covered in the case. Students will also learn briefly about the electromagnetic spectrum and visible light. Originally developed for a non-majors, pre-nursing anatomy and physiology course, the case is also appropriate for use in any of the following courses: introductory biochemistry, introductory biology, introductory chemistry, nursing, exercise physiology, or possibly even introductory physics.

This case study describes the daily osmotic struggle for survival faced by hummingbirds. The narrative is written from the viewpoint of a human observer who sees an Anna's hummingbird feeding on flowers outside of her window.  She notices that the birds mostly feed early in the morning and again in the evening at dusk; midday encounters are rare.  The case raises questions about floral nectar production, how this correlates to feeding bouts, and how this in turn correlates to the daily osmotic challenges faced by these nectarivorous birds and their allies (sunbirds). Students will learn about renal adaptations for survival and how they operate. Finally, since hummingbirds have a high metabolic rate and cannot feed overnight they undergo torpor during this time, an energy saving physiologic state.  Students read journal articles to answer case questions, which should lead them to a better understanding of the related physiological processes of osmoregulation, metabolic rate and torpor.

Loss of species richness is often due to anthropogenic activity. The global decline of amphibians is one such example. This case study examines the impact of road deicing agents on amphibians living near bridges and roads treated heavily with salt during the winter months. Concepts explored in this case include changes to the aquatic environment as a result of road deicing applications, bioaccumulation, osmoregulation in amphibians living in clean freshwater, and the impact of increased aquatic salinity levels on the ability of amphibians to adequately osmoregulate in an environment for which they are not adapted. Three short videos created by the author can be shown in class or assigned for viewing in advance for a "flipped" classroom approach. Originally developed for a general education/introductory biology course, the case could also be used with introductory level animal anatomy and physiology courses as part of a deeper exploration of the renal system.

In this "clicker case," students learn about sex determination, meiosis, and chromosomal "crossing over" through the story of Santhi Soundararajan, an athlete from Kathakkurichi, India, who was stripped of a medal at the 2006 Asian Games after failing to pass a sex test. The case is called a clicker case because it combines the use of student personal response systems (clickers) with case teaching methods and formats. The case itself is a PowerPoint presentation (~2 MB) shown in class that is punctuated by questions students respond to using their clickers. It can be adapted for use without these technologies. Developed for an introductory biology class for both majors and non-majors, the case could also be used in an anatomy and physiology course or an endocrinology course.

In this "clicker case," students learn about sex determination, meiosis, and chromosomal "crossing over" through the story of Santhi Soundararajan, an athlete from Kathakkurichi, India, who was stripped of a medal at the 2006 Asian Games after failing to pass a sex test. The case is called a clicker case because it combines the use of student personal response systems (clickers) with case teaching methods and formats. The case itself is a PowerPoint presentation (~2 MB) shown in class that is punctuated by questions students respond to using their clickers. It can be adapted for use without these technologies. Developed for an introductory biology class for both majors and non-majors, the case could also be used in an anatomy and physiology course or an endocrinology course.

In this case study, a college student named "Blake" winds up in the emergency room after he experiences a panic attack brought on by drinking a mixture of beverages containing caffeine and alcohol. His panic attack results in a severe episode of hyperventilation. The alcohol he has consumed has the added effect of making the situation worse by impairing Blake's perception and judgement. Through this case study, students learn about acid/base chemistry as they explore hyperventilation, the Bohr effect, the Haldane effect, and how alcohol and stimulants such as caffeine can affect the acid-base balance in the body. This case was originally designed for a flipped classroom, and the associated videos, including one developed by the author, contain foundational information to lead students through basic chemistry and help them connect daily activities to homeostasis and the Bohr effect. Originally written for a general biology course in which general chemistry concepts are discussed, the case could easily be modified for use in an anatomy and physiology course.

In this interrupted case study, students meet a pair of fictional newlyweds on their way to Australia for their honeymoon. Initially eager to enjoy the sun, sand, and sights, Tanya and Julien Brahim end up more intimately acquainted with the local wildlife than they had planned. Tanya is bitten by a venomous arachnid and Julien has a run-in with a dangerous cnidarian. This case study was created to help students solidify their knowledge about cardiac myocytes, particularly ion movements associated with action potential generation in autorhythmic and contractile cells. As students work through the case, they will complete fill-in-the-blank paragraphs describing the heart, diagram membrane potentials and ion movements, and compare and contrast action potentials from different cell types. Written for a course in human physiology, the case requires some prior knowledge of membrane potentials, equilibrium potentials, ion gradients, neuronal action potentials, and skeletal muscle action potentials. An optional pre-case assignment (included in the teaching notes) can be used to make sure that students are familiar with the necessary concepts.

8:19 video The Nobel Prize in Physiology or Medicine 2015 goes to William Campbell & Satoshi Ōmura "for their discoveries concerning a novel therapy against infections caused by roundworm parasites" and Youyou Tu "for her discoveries concerning a novel therapy against Malaria".

Hyper-IgM syndrome is an X-linked genetic disorder more commonly affecting males than females. It is caused by the lack of heavy chain class-switching from IgM to other isotypes. Patients with hyper-IgM syndrome are susceptible to a variety of infections as demonstrated in this medical case study. Students are presented patient information, symptoms and a diagnosis that must be interpreted. The case was written for use with the team-based learning (TBL) format involving groups of 4-5 students per group, but it could also be completed as an individual project. The case is targeted to premedical/allied health advanced students and is appropriate for any immunology course at the undergraduate or graduate level in a biomedical science program, or health-related professional courses such as advanced physiology, pathophysiology, microbiology, or histology and cytology.

This case study was developed for an introductory biology course with the goal of integrating content (specifically, structure/function, signaling pathways, and homeostasis) while reinforcing general critical thinking skills and the scientific method (generating hypotheses, evaluating evidence, and making predictions). The case is suitable for a flipped classroom and there are several videos associated with it. The case revolves around an obese two-and-a-half-year-old boy who won't stop eating. Students become familiar with some basic concepts related to obesity and leptin signaling through the videos that they watch before class. They then use class time to work through the case (delivered as an interactive slide show, including several clicker questions) to determine the genetic basis for this child's obesity and possible therapies to manage his weight. The case could also be adapted and expanded to be used in a physiology course to explore the interaction of various hormones that regulate appetite and metabolic rate or in a cell biology class to explore JAK-STAT signaling.

This directed case study follows two college roommates, Darrell and Anthony, who have just returned to school after winter vacation. They share that their ageing fathers are concerned about their declining faculties and are amused by their fathers' efforts to reverse the process.  Darrell's dad plays "brain games" on the computer while Anthony's father believes running will slow his memory decline. Intrigued, the roommates search through their biopsychology class notes to find out whether their fathers are correct. They review the topics of synaptic formation and plasticity, including axonal and dendritic development, and chemical factors in the brain that promote the survival and growth of neurons or stop the genetically programmed death of neurons. Based on research findings, students reading this case will decide whether Darrell and Anthony's fathers are correct in their assertions. The case is appropriate for a wide variety of courses including introductory anatomy or physiology, or for upper-division biopsychology, biology, or neuroscience courses.

This clicker case study follows a dialogue between two college students, Lucy and Dan, as they discover how alternative splicing of mRNA molecules can allow a single gene to code for multiple proteins. Dan is participating in a clinical trial for a drug that may treat his migraines by inhibiting calcitonin gene-related peptide, and Lucy is working in a summer research lab that studies the protein calcitonin. They soon realize that the two proteins are both encoded by the same gene, and through their questioning and dialogue they come to understand the phenomenon of alternative splicing. They also learn about other steps of mRNA processing and about monoclonal antibodies. This case was designed to be taught in a flipped classroom, but could easily be adapted for a more traditional classroom setting if content covered in the pre-class videos is covered during the case study instead. It was designed for an introductory-level molecular biology course, but could be adapted for higher levels by including more information about the physiology and regulatory mechanisms involved.

This case study explores the recent (2010 - 2016) outbreak of neural tube defects, specifically anencephaly, in a rural three-county region of Washington state, particularly Yakima, WA. The case study focuses on the biological aspects of teratogens that may cause birth defects as well as epidemiological investigations of disease outbreaks. By the end of the case, students will have explored how our environment may have severe biological consequences on the human body during pregnancy and will have evaluated governmental and scientific investigations of a rare outbreak of birth defects. This clicker case study was developed for a non-majors biology course entitled "Human Development: Conception to Birth," although it could be taught in any introductory biology course for majors or non-majors during a unit on human reproductive biology or developmental biology. The case assumes that students have no prior knowledge of developmental biology or birth defects. The case study could also be adapted for upper-division courses by getting more in-depth on the specifics of teratogen mechanisms, the developmental biology and physiology of neural tube defects, or more complex epidemiological analyses.