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(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

These 5-month-old female twins were referred to a Genetic Counselor shortly after birth for developmental delay and dysmorphic features.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 19-year-old male with history of narcolepsy, but otherwise healthy with normal development and cognition, presented with one month of daily headache and a single unprovoked transient confusional episode consistent with a seizure. During the episode, the patient experienced right upper extremity incoordination, orolingual automatisms and aphasia. Physical examination was notable only for macrocephaly. MRI of the brain revealed multiple heterogeneously enhancing dural-based masses and dural nodularity with mild parenchymal volume loss, thinning and remodeling of the calvarium, remodeling of the skull base, and sagging appearance of brainstem (Figures 1a, 1b). There was no lesion in the spinal canal. Cerebrospinal fluid analysis was normal except for elevated protein content. Electroencephalography (EEG) showed left temporal focal slowing with sharp transients. Extensive serologic testing was within normal limits, notable for normal ANA, ANCA, RF, RPR, Quantiferon Gold, FSH, LH, prolactin, TSH, SPEP, antigliadin antibody, and IgG4, as well as negative HIV. CT scans of the chest, abdomen, and pelvis did not identify any visceral lesions and ophthalmologic and dermatologic examinations were essentially normal. A biopsy of the left parietal dural-based nodule was performed, but did not yield a definitive diagnosis. The patient was treated with levetiracetam and corticosteroid therapy and discharged home with planned outpatient follow up. Approximately four weeks later, he presented with recurrence of severe retro-orbital headache and emesis. A second biopsy, this time of a left frontal dural-based nodule was performed.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A previously healthy 24-year-old white female patient presented to the emergency room with back pain. The pain, which had been ongoing for the past four days, started in her lower back and wrapped around her left leg down below the knee. It was constant and worsened with any activity. Bladder and bowel function were unaffected. The patient denied any prior history of back pain or back injury. She did not have any history of trauma. On physical examination, no focal neurological findings were noted.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

GROSS DESCRIPTION

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

In 1995, at the age of 29, a woman presented with headache and visual disturbances. She was found to have a capillary hemangioblastoma of the brainstem, which was then resected and pathologically confirmed. The diagnosis of von Hippel-Lindau disease was suspected at this time. One year later, she presented with worsening headache, nausea, vertigo, photophobia, and episodes of unresponsiveness. CT and MRI revealed a 4 cm mass in the right cerebellar hemisphere with effacement and displacement of the fourth ventricle. A VP shunt was placed semi-emergently, and two days later she underwent a second craniotomy for tumor resection. The diagnosis of hemangioblastoma was once again confirmed. In 2004, follow-up MRI of the brain and spine revealed multiple brainstem and cervical and thoracic cord lesions consistent with hemangioblastomas. An abdominal scan showed cystic kidneys with bilateral enhancing heterogeneous renal masses, suspicious for malignancy, as well as multiple pancreatic cysts and a paraaortic nodule of possible left adrenal origin; however a bone scan was normal. It is unclear whether or not the patient was treated for the presumed renal cell carcinoma at this time. In 2007, the then 41-year-old patient presented with a three-day history of falls and disequilibrium, progressive quadriparesis and difficulty swallowing. An MRI of the brain was performed. Axial T2 (Figure 1) and contrast enhanced T1-weighted (Figure 2) images showed a partially cystic (thick arrow) enhancing cerebellar mass, dorsal to the fourth ventricle. Extensive T2 hyperintensity was present in the pons, medulla (thin arrows) and middle cerebellar peduncles. Sagittal unenhanced (Figure 3) and contrast enhanced (Figure 4) T1-weighted images showed a markedly enhancing (black arrowhead) solid mass inferior to the fourth ventricle. Nodular leptomeningeal enhancement on the anterior surface of the pons was consistent with a leptomeningeal tumor. The patient underwent a posterior fossa craniotomy with gross total resection of the mass in April 2007.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 63 year-old man initially presented in February 2003 with 3 episodes of syncopes accompanied by nausea, vomiting and sweating. Starting June 2003, the patient became indifferent and showed a weight loss of 15 kg over a period of the following 6 months. In July 2003, beginning ataxia, visual and cognitive decline were reported. Neurological examination in October 2003 revealed a right VI nerve palsy, ataxia, dysarthria and dementia as the main clinical features. One month later, he suffered a cardiac arrest with resuscitation, but he eventually died of a cardio-respiratory insufficiency in November 2003 showing the clinical picture of brainstem encephalitis. Final clinical report suggested a metastatic neoplasm with unknown primary.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 76-year-old man presented with progressively worsening vertigo, memory and concentration impairment, spatial disorientation and mild expressive dysphasia for 6 months. His medical history included hypertension and a surgically treated abdominal aortic aneurysm. A few weeks before admission, headache, fatigue, weakness of the lower limbs and left arm, a tendency to fall to the left, incontinence, and episodes of confusion occurred. Upon admission the patient showed marked fatigue, confusion and apathy, and a contrast-enhancing round lesion, 1 cm in diameter, was seen in the left temporal lobe on magnetic resonance imaging (MRI). Repeated cognitive testing demonstrated fluctuating deficits in language, working and episodic memory, visuospatial ability, attention and psychomotor speed. A second MRI, performed one month after the first, showed attenuation of the previous lesion, with general signal enhancement in the leptomeninges, a heterogeneous contrast-enhancing lesion measuring 1x2 cm in the left frontal lobe, and a smaller lesion near the left sylvian fissure (Figure 1).

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a 7 year old boy of Turkish descent who was diagnosed in Russia with splenomegaly and anemia at the age of 8 months. He began having seizures, usually associated with fever, at the age of 6 months. These continued every two to four months until the age of five. He has not had any seizures for two years, and his medications have been discontinued. He was hospitalized at an outside hospital in the fall of 2005 due to severe anemia.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

Immunodeficient individuals in general are prone to various infections, including viral. In the setting of acquired or congenital immunodeficiency, certain viruses are associated with specific tumors such as HHV8 associated Kaposi sarcoma and EBV-associated post-transplant lymphoproliferative diseases (PTLD) (Hussein, Rath, Ludewig, Kreipe, & Jonigk, 2014). A rare and lesser known entity is immunodeficiency associated smooth muscle tumors. In 1970 Pritzker et al described a smooth muscle tumor of the bowel metastatic to the liver in an immunosuppressed patient, later on Chadwick et al associated smooth muscle tumors with AIDS in three children (Chadwick, 1990; Pritzker, Huang, & Marshall, 1970). In 1995 the association between EBV and smooth muscle tumors was described in immunosuppressed patients following organ transplantation and in children with AIDS (Lee et al., 1995; McClain et al., 1995).

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a gentleman in his 60s with a clinical history of chronic pulmonary disease, status post double lung transplant and receiving tacrolimus, prednisone, and prophylactic valganciclovir treatments. He presented with recurrent epigastric to diffuse abdominal pain, nausea, vomiting and bouts of watery diarrhea for three months. CT imaging study demonstrated small bowel wall thickening and fat stranding concerning for duodenitis.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A female in her 60s general practitioner first noticed muscular atrophy of both arms 10 years ago. She also experienced difficulties standing in an upright position because of weakness of her paraspinal muscles, and difficulties walking downhill. She uses walking canes and is exhausted after walking more than 500 m. Creatine kinase was slightly elevated (95 U/l). There is no family history of muscular diseases. On physical examination she showed facial weakness and reduced muscular strength of the shoulder and upper arm muscles, with scapular winging. There was also weakness of limb girdle muscles with Gowers' maneuver, atrophy of upper leg muscles, and hyperlordosis. The EMG of her right medial vastus muscle revealed a myopathic pattern whereas nerve conduction velocities were normal. A tentative diagnosis of facioscapulohumeral dystrophy (FSHD) was made. A biopsy was taken from the left deltoid muscle. Vaccination against hepatitis A and B into the left deltoid muscle had been performed 4 weeks prior to biopsy.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

An 11-year-old boy presented with a 10 month history of lumbar back pain and paresthesia in his thighs to the knees bilaterally, left greater than right. This pain exacerbated two weeks after falling out of a pickup truck directly onto his back. The pain was 8/10 in severity, worse at night and while supine, and typically lasted 20 minutes in duration. Relieving factors included warm baths, massage, and acetaminophen or ibuprofen. The pain was not exacerbated with physical activity and no appreciable motor weakness. There was no bladder or bowel incontinence. Since the accident, he noticed the pain was worsening in intensity and duration. Neurological exam did not reveal any objective sensory deficit.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

This is a newborn female with trisomy 21 who also had abnormal newborn screening test showing elevation of C5-hydroxy acylcarnitine. Urine organic acid analysis revealed elevation of 3-hydroxyisovaleric acid and 3-methylcrotonylglycine. Further testing included skin biopsy for fibroblast cultures and assay of 3-methylcrotonyl-CoA carboxylase activity that was significantly below the control range (6% of normal).

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

CASE 1

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a woman in her 70s who was referred to a head and neck surgeon for evaluation of a left thyroid nodule. On ultrasound, the nodule measured 2.3 cm with calcifications. She subsequently underwent fine needle aspiration biopsy and specimens were sent for cytology, the result of which prompted molecular testing on the FNA specimen.

Revising a team-based academic research paper presents multiple challenges. Students are often given general advice to improve their prose: create a logical narrative, be concise, use the active tense and a variety of verbs, make references clear, use effective topic sentences, etc. Yet, for new writers, a laundry list of good writing practices can seem overwhelming, even debilitating, to improve their paper. Complicating matters is the challenge of writing a coherent document within a team and tactfully offering constructive criticism for co-authors. The team-based peer review guides are intended to address these challenges by sensitizing students to common writing errors and offering a straightforward approach to revise them, while providing direction on how to offer thoughtful comments for co-authors. The peer review guides contain four exercises that offer a step-by-step approach to support student’s revision process as they move from macro-level, big picture structural revisions to meso-level scrutiny at the paragraph level to micro-level line-editing. The four exercises are designed to be completed sequentially as students progress through their writing, but they can also be completed independently on an as needed basis.

Play with one or two pendulums and discover how the period of a simple pendulum depends on the length of the string, the mass of the pendulum bob, and the amplitude of the swing. It's easy to measure the period using the photogate timer. You can vary friction and the strength of gravity. Use the pendulum to find the value of g on planet X. Notice the anharmonic behavior at large amplitude.

Play with one or two pendulums and discover how the period of a simple pendulum depends on the length of the string, the mass of the pendulum bob, and the amplitude of the swing. It's easy to measure the period using the photogate timer. You can vary friction and the strength of gravity. Use the pendulum to find the value of g on planet X. Notice the anharmonic behavior at large amplitude.

In the fall 2019 semester, the students of the Liberal Arts and Management Program class Black Markets: Supply and Demand explored many types of black markets and examined many perspectives related to such illicit markets. Through careful discussion and reading the students discovered four prevalent themes throughout the course: the role of government in creating the context for black market activity, elements of demand, elements of supply, and varying levels of social implications. The thirteen articles in this volume provide rich takes on these themes. We placed each article with the theme we believe it most exemplifies; however, each article conveys facts and context that relate to each theme. We believe that these themes interact and work together like strands of a rope strengthening each other. Please note that authors of a couple of the articles personally observed others engaging in illicit activities. The authors did not. And the authors have not revealed true names of the persons they observed.