Hello PBS students, Once again, I miss you all and hope you are well! The second two weeks of doing school from home will occur from April 16th – April 30th. Packets are attached to this document as well as posted on eschools and schoolwires. Also, keys have been posted on eschools so that you may check and add to your answers. Unfortunately, once again, some of these are lab based and obviously we cannot do the labs at this time, but I have attached expected lab results for analysis. You should be able to complete most of the packets since you are given this data. Also, I will post upcoming assignments on eschools so that if you’d like to work ahead you may. Working ahead is only for enrichment purposes and will not be graded yet. The packets that are due by April 30th and will be graded at that time are:

1. What is Cholesterol 2. Hypercholesterolemia 3. Unblocking the Vessels

Please take pictures of your packets or hand written work once you have done all you can. Once you have pictures of all three packets, please put all pictures into ONE google doc and share with me. This will work best since many times pictures on their own are large files and have a difficult time coming through by email, so if you are able, please use google doc as means for submitting your work. My email is Sandra.Fisher@bvasd.net. Please let me know if any technical difficulties arise and we will work something out! And please feel free to email me with any questions or concerns that you may have. In the meantime, stay safe! I hope to see you soon, Miss Fisher

Name ____________________________

What is Cholesterol? – 40 Informal Points (Independent Research Activity) Introduction

In Unit 2: Diabetes, you learned that there are different types of lipids. Lipids are a necessary component in your diet; however, it is important that your diet includes the right lipids in the correct amounts. One important lipid, cholesterol, is needed for the proper functioning of cells and for maintaining a healthy body. However, too much cholesterol can lead to health problems, including heart disease and blocked arteries, which can lead to strokes and heart attacks. Cholesterol is naturally produced in the liver and also absorbed from food as it passes through the intestines. Regardless of where cholesterol originates, it must be transported to all the cells in the body. As with most substances transported through the body, it is carried by the blood stream. Cholesterol is needed by all cells in the body. One type of lipoprotein (a combination of lipid and protein), LDL, is responsible for transporting cholesterol to the cells. Another type of lipoprotein, HDL, is responsible for removing excess cholesterol from the blood stream and transporting it to the liver. Too much cholesterol in the blood can cause a build-up inside the arteries. Therefore, a balance of these two molecules keeps circulating lipids from becoming trapped inside arteries. You most likely know someone who has dealt with high cholesterol, or you have probably seen the ads for foods or medications that may help lower cholesterol. Many people have misconceptions about cholesterol, LDL, and HDL. Because of pharmaceutical and food marketing, much misinformation has been spread about these molecules. It is not uncommon to hear LDL referred to as “bad cholesterol” and HDL as “good cholesterol.” In reality, neither is actually good or bad. But a balance needs to exist as they both do their jobs. In this activity you will research cholesterol, LDL, and HDL. This packet will serve as a resource and study sheet. You will use what you learn to analyze Anna Garcia’s cholesterol test results and make recommendations about her cardiac care.

Procedure

1. Refer to the Nutritional Terms Chart you completed during the food portion of the diabetes unit. Review the connection between unsaturated fats, saturated fats, trans fats, and cholesterol with overall health. Write 2-4 sentences in the space below to describe this connection.

2. Access the webpage Cholesterol and Health—Functions and Food written by Chris Masterjohn at http://www.cholesterol-and-health.com/cholesterol-and-health.html. Use the links on the left side of the webpage to read about the many functions cholesterol has in our cells and body. List and describe these functions in the table below.

Function Description

Cell Membrane

Learning

and

Memory

Digestion

and

Bile Acids

Vitamin D

Steroid Hormones

3. Use appropriate Internet search strategies to access reliable sources and research information that provide answers to the questions listed below. Write 2-4 sentences for each.

1. What are LDL and HDL?

2. How do LDL and HDL differ structurally and functionally?

3. Why do doctors monitor the concentrations of LDL and HDL in patients’ blood?

4. How are the concentrations of LDL and HDL associated with the risk for heart disease and associated disorders?

5. What other molecules in a patient’s blood are monitored along with LDL and HDL? Why?

6. What do the results of a cholesterol test mean? How do patients interpret each value?

7. What can patients do to change the levels of LDL and HDL in their blood?

8. How does intake of unsaturated, saturated, and trans fats affect cholesterol levels and overall health?

4. Obtain an Anna Garcia Cholesterol Medical History Resource Sheet. Note that Anna’s bloodwork is back

from the laboratory.

5. Use what you have learned in the project to interpret Anna’s results. In the Follow-up/Diagnosis section, write a paragraph that explains whether each number in the panel is considered high, low, or borderline.

6. Pretend you are Anna’s physician. Add information to the Recommendations section regarding a potential plan for Anna to address her cholesterol values.

Conclusion Questions 1. Explain how cholesterol plays an important role in at least two different human body systems.

2. List five factors or behaviors that affect cholesterol levels in the body, how these factors affect cholesterol levels, and whether the effect is positive or negative with regards to a person’s health.

3. Explain how cholesterol levels could be linked to health events such as strokes and heart attacks.

4. What is a statin and how does it work to lower cholesterol?

5. What do you feel are the pros and cons of using cholesterol-lowering drugs to treat high cholesterol?

Anna Garcia’s Cholesterol Medical History Patient’s Name: Age: Date: Anna Garcia 37 May 14th Height: Weight: Temperature: 5’4” 158 lbs 98.7°F Blood Pressure: Pulse: Respiration Rate: 140/72 98 bpm 22 bpm Chief Complaint Anna is a 37 year old Hispanic woman with both Type 1 diabetes and sickle cell disease who was referred to a

cardiologist for a full cardiac evaluation after two incidents of self-resolved chest pain. Anna is a non-smoker

who admits to eating a diet high in both calories and fat. Anna consumes three glasses of wine each day after

work. Anna used to be an athlete, but has not kept up with formalized exercise. Anna takes a daily aspirin and

does do a Yoga home video as needed to help her deal with the stress of her illnesses and her job.

Anna has a family history of early heart disease as well as uncontrolled hypertension. Her father had a heart

attack when he was only 41 years old.

Patient was evaluated by physical exam, blood work, cardiac stress test with electrocardiogram (EKG), and an

echocardiogram. Results later prompted an angiogram. Laboratory Analysis

• CBC results are normal – no abnormalities in red blood cells, white blood cells, or platelets. • Full cholesterol panel

o Total Cholesterol – 389 mg/dL

o LDL – 243 mg/dL

o HDL – 60 mg/dL

o Triglycerides – 145 mg/dL

• Fasting blood sugar – 85 mg/dL

• Hemoglobin A1c – 7.1%

Findings/Diagnosis Genetic Analysis (consider family history) Recommendations

Name _____________________________

Hypercholesterolemia – 60 Informal Points (If you are not here for the gel electrophoresis a make-up assignment will be given.) Introduction

In the previous activity, you learned that Anna Garcia has abnormally high cholesterol levels. Because of this result, Anna was sent back to the lab for additional testing. In the last activity, you researched the functions of cholesterol in the body and the roles LDL and HDL play in regulating cholesterol in the blood. Remember that LDL transports cholesterol to the cells. In some families the risk of heart disease is increased due to a genetic mutation that leads to very elevated levels of LDL in the blood. The genetic defect causes the LDL receptor on cells to be deformed and inefficient at binding LDL. The inefficient uptake or binding of LDL by the receptor results in elevated LDL in the bloodstream. This in turn leads to the accumulation of a fatty substance called plaque in the blood vessels. The plaque accumulation in the arteries can cause blockages in the blood flow which results in heart attacks or strokes. One genetic disorder affecting the LDL receptor is called familial hypercholesterolemia. In many cases the defect is due to a single mutation in the receptor gene and is inherited as an autosomal dominant trait. Often this mutation is referred to as the FH mutation, because it is the mutation that is most closely associated with familial hypercholesterolemia. Whereas diet and exercise play a huge role in regulating cholesterol levels, more invasive interventions such as medications may be needed to keep this genetic disorder under control. To detect the FH mutation, DNA is obtained from the patient’s blood or saliva; the section of DNA containing the LDL receptor gene is then amplified by the polymerase chain reaction (PCR). The amplified DNA is analyzed to see if there is a mutation. To analyze the DNA, investigators use restriction enzymes to cut the DNA in specific places. By examining the sizes of the DNA fragments obtained after exposing the DNA to the restriction enzymes, it is possible to detect mutations or changes in the DNA. This detection is possible because of Restriction Fragment Length Polymorphism or RFLP. RFLP simply means that when different DNA samples are exposed to the same restriction enzyme, the DNA fragments produced by the enzyme may be different lengths. The different lengths are due to differences in the DNA sequences of the two samples; the DNA sequence differences are a polymorphism. A mutation or change in the DNA sequence can change where the enzyme cuts the DNA, so the DNA fragments are different sizes, or are greater or lesser in number, than in the normal DNA. The resulting DNA fragments can be visualized and analyzed through gel electrophoresis. In past activities you have analyzed the results of gel electrophoresis experiments. In this activity you will actually use DNA electrophoresis to separate and analyze DNA fragments. Use your final gel to determine if Anna and members of her family have familial hypercholesterolemia.

Procedure 1. Complete the worksheet provided by your teacher to review materials from past units to refresh

your memory on restriction fragments, gel electrophoresis, DNA analysis, and the inheritance of dominant and recessive disorders. As discussed in the introduction the new disorder we will be considering is Familial Hypercholesterolemia (FH) and the information below is important.

• Familial Hypercholesterolemia (FH) is an autosomal dominant disorder. The mutation is carried on chromosome 19 (one of the 22 pairs of autosomes, or non-sex chromosomes), and a person needs to only inherit one affected copy to have the disorder.

2. Draw a Punnett square below that illustrates the likelihood that a man with FH and a woman who is unaffected would have a child with FH. Show and explain your work. Use the letter “F” to designate your alleles.

3. In order to load a gel you will need to know how to properly use a micropipette. Follow your teacher’s instructions to practice using the micropipette and loading a plastic practice gel. Note: The real gel will be trickier given it is made of gelatin and can be punctured.

4. Next, as a class, load and run the actual gel according to your teachers directions and the key given below. Once the gel is set up and running it will take approximately 45 minutes to run to completion. It will then need to be stained for results to appear. For this reason your teacher will take care of the ending and have your gel results ready for you to view tomorrow!

• Gel Key:

• A= DNA Standard Markers

• B= Normal DNA Sample

• C = FH control (FF)

• D = Patient #1 – Carlos (Anna’s father)

• E = Patient #2 – Anna Garcia

• F = Patient #3 – Eric (Anna’s brother)

• G = Patient #4 - Jason (Anna’s brother-in-law)

• H = Patient #5 – Erin (Anna’s niece, Jason and Juanita’s daughter)

5. Reference Anna Garcia’s family tree shown below. Now that you have run your real gel, you will determine the genotype of each individual tested and deduce the genotype of those who were not tested and fill out this family tree.

6. Examine the DNA fragments. Sketch your finished gel with the stained DNA fragments in the space below. Clearly label each lane and refer to the key in #4 to know which lane represents each person.

7. Write the genotype of each individual in #’s 4 & 5. Then, fill in the pedigree.

8. You had to deduce the genotype of those individuals who were not tested. Create Punnett squares in the space below to show how you determined Maria and Juanita’s genotypes.

9. Fill in the following table to describe the Familiar Hypercholesterolemia disorder and the associated treatment.

Hypercholesterolemia Disorder Description Hypercholesterolemia Treatment

Conclusion Questions 1. Explain how you could determine which individuals were heterozygous by looking at the gel.

2. Explain how the use of Restriction Fragment Length Polymorphisms to diagnosis genetic disease differs from its use in forensic investigations.

3. Why did the DNA migrate to the positive pole of the electrophoresis chamber? In your response, discuss the chemical structure and charge of DNA.

4. Erin is only 17 years old and her total cholesterol is 600 mg/dL. Why do you think her cholesterol is so much higher than the others in her family who have familial hypercholesterolemia?

5. Explain how the class of medications called statins works to lower cholesterol levels in the body.

Name _________________________________ Unblocking the Vessels – 40 Informal Points Introduction

Heart disease is a broad term used to refer to the range of diseases that can affect the heart. This may include diseases of the blood vessels, heart rhythm problems, heart infections, and problems in the heart a person is born with, called congenital heart defects. Many forms of heart disease can be treated, and even prevented, with lifestyle modifications. Unfortunately, advanced disease may need to be treated with medication or medical procedures. In this activity you will study what happens to the body when blood vessels fail to deliver oxygen to the tissues. You will investigate medical procedures used to treat blocked blood vessels. You will also return to both Anna’s medical history documents as well as her autopsy report and brainstorm how issues of the heart may have played a role in Anna’s final demise.

Procedure 1. Visit the Public Broadcasting Service website for the science television show NOVA and

examine the pictures of hearts following events called myocardial infarctions, or heart attacks. The site is available at: http://www.pbs.org/wgbh/nova/heart/troubled.html. In the space below, take notes on the appearance of the heart following a heart attack and describe how it differs from a healthy heart.

2. Refer to the Anna’s Medical History Resource Sheet. Note that due to her multiple instances of chest pain, the doctors decided to look at the blood flow in the coronary vessels. Doctors recorded X-ray images called angiograms to get a better picture of overall circulation. If doctors can find blocked vessels and open them before blood flow is diminished, they may be able to prevent incidents such as a heart attack.

3. Read the Society for Vascular Surgery article Angiogram available at http://www.vascularweb.org/vascularhealth/pages/angiogram.aspx or the Mayo Clinic article Coronary Angiogram available at http://www.mayoclinic.com/health/coronary-angiogram/MY00541to learn more about this test. You have previously learned that an angiogram is an X-Ray used to visualize blood vessels, such as arteries. Provide a detailed description of how and why an angiogram is obtained in the space below.

4. Go to the PLTW website to view Anna’s angiogram images. Note that dye is injected into the vessels and shows how blood moves through the arteries. (We have watched this together in class in the past.)

5. Use the Internet to find an image of how a blocked artery shows up on an angiogram. Draw a sketch in the space below. Make sure to include an arrow that points out the blockage.

6. Note that depending of the severity of the condition, a doctor may recommend various medical procedures to open a blocked vessel. Research each method listed below fill in the table to describe how each will help the problem.

Method Description

Angioplasty

Stent Insertion

Coronary Artery Bypass Graft (CABG) surgery

7. Reread the information presented on Anna’s medical history documents as well as her autopsy report. Pay attention to conditions affecting heart anatomy, the function of heart valves, and the passage of blood through vessels. Review the findings in the documents and think about changes that occurred in Anna’s body over time. Using what you have learned, add additional possible causes of death to the autopsy sheet. Also, list these possible causes as well of a reason why they are possible causes below.

8. Research each of the following careers. Fill in the table below to describe how each of these career areas may help in the diagnosis or treatment of cardiovascular disease. Write career journals for any two of your choosing.

Career Description

Cardiovascular Technologist or Technician

Nuclear Medicine Technologist

Clinical Laboratory Technologist or Technician

Cardiac or Cardiovascular Nurse

Conclusion Questions 1. What is the function of the coronary arteries?

2. Explain how blocked coronary vessels can lead to a myocardial infarction, a heart attack.

3. Explain why a patient would most likely prefer their blocked vessels be treated by angioplasty and stents versus bypass surgery.

4. A person may experience a stroke, a rapid loss of brain function due to a decreased blood supply to the brain. Explain how a stroke can be linked to cholesterol and conditions such as atherosclerosis.