Case 1: (Cited partially from Wikipedia) Q1 and Q2 are based.

Case 1: (Cited partially from Wikipedia) 


Q1 and Q2 are based on the following paragraph: “Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[9] It was first identified in December 2019 in Wuhan, China.[10][11] The first case may be traced back to 17 November 2019.[12] As of 16 June 2020, more than 8.03 million cases have been reported across 188 countries and territories, resulting in more than 436,000 deaths. More than 3.87 million people have recovered.[8]”


1. “It was first identified in December 2019 in Wuhan, China.[10][11] The first case may be traced back to 17 November 2019.[12]” This statement indicates COVID-19 is ______ disease. 

a. An Endemic; b. an epidemic; c. a pandemic


2. “As of 16 June 2020, more than 8.03 million cases have been reported across 188 countries and territories, resulting in more than 436,000 deaths. More than 3.87 million people have recovered.[8]” This following statement indicates COVID-19 is developing into _____disease. 

a. An Endemic; b. an epidemic; c. a pandemic


Q3 is based on the following statement: “Common clinical manifestations include fever, cough, fatigue, shortness of breath, and loss of smell and taste.[5][6][13] While the majority of cases result in mild signs and symptoms, some progress to acute respiratory distress syndrome (ARDS) possibly precipitated by cytokine storm,[14] multi-organ failure, septic shock, and blood clots.[15][16][17]”


3. Based on your understanding on the concept of sign and symptoms, and sequela, please classify the clinical information listed in the above statement:

Signs or COVID including ______

Symptoms for COVID including____

Sequela for COVID including______


Read the following statement and answer Q4: “The time from exposure (to COVID virus) to onset of symptoms is typically around five days, but may range from two to fourteen days.[5][18]”


4. Please identify what is the disease stage in the above statement.


a. Acute

b. Chronic

c. Prodromal

d. Latent

e. Subclinical

f. Exacerbation

g. Remission

h. Sequela

i. Convalescence


Read the following paragraphs and answer Q5: “A minority of cases do not develop noticeable symptoms at any point in time.[53] These asymptomatic carriers tend not to get tested, and their role in transmission is not fully known.[54][55] Preliminary evidence suggested they may contribute to the spread of the disease.[56] In June 2020, a spokeswoman of WHO said that asymptomatic transmission appears to be “rare,” but the evidence for the claim was not released.[57] The next day, WHO clarified that they had intended a narrow definition of “asymptomatic” that did not include pre-symptomatic or paucisymptomatic (weak symptoms) transmission and that up to 41% of transmission may be asymptomatic. Transmission without symptoms does occur.[53]”

“The virus is primarily spread between people during close contact,[a] most often via small droplets produced by coughing,[b] sneezing, and talking.[6][19][21] The droplets usually fall to the ground or onto surfaces rather than travelling through air over long distances.[6] Less commonly, people may become infected by touching a contaminated surface and then touching their face.[6][19] It is most contagious during the first three days after the onset of S/S, although spread is possible before signs and symptoms appear, and from people who do not show any signs or symptoms.[6][19] The standard method of diagnosis is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab.[22] Chest CT imaging may also be helpful for diagnosis in individuals where there is a high suspicion of infection based on symptoms and risk factors; however, guidelines do not recommend using CT imaging for routine screening.[23][24]”

“Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others (especially from those with symptoms), quarantine (especially for those with symptoms), covering coughs, and keeping unwashed hands away from the face.[7][25][26] The use of cloth face coverings such as a scarf or a bandana has been recommended by health officials in public settings to minimise the risk of transmissions, with some authorities requiring their use.[27][28] Health officials also stated that medical-grade face masks, such as N95 masks, should only be used by healthcare workers, first responders, and those who directly care for infected individuals.[29][30]”


5. Please read the paragraphs and identify the methods for

a. primary prevention

b. secondary prevention


Case 2: 

Peter, a 55 yo white male, has been on a demanding busyness trip for a month while his wife planed a ‘surprise” party for his belated birthday.  After arriving at home around 8 pm, he was shouted by all his family and friends with “Surprise”!  He was so thrilling that his face turned red. Later he felt dizzy and had to sit on the sofa.  His iWatch showed his BP 175/96 mmHg, and his heart beat was 119/min. Peter’s wife called ambulance which ended the party.

Based on the above information, please answer the following questions:


  1. What is normal BP range and what is normal HR range? Were Perter’s vitals within the normal range? Why Peter had such a shift in his vitals? 
  2. If we consider the “surprise party” as a “good stress”, what’s the nature of the stress in term of its timing? What was the stage of stress reaction when Peter “was so thrilling that his face turned red”?  What molecule(s) and receptor(s) are primarily responsible for such a reaction? 
  3. What was the stage of stress reaction when Peter has “BP 175/96 mmHg, and his heart beat was 119/min” and he ended in the ambulance? What molecule(s) and receptor(s) induce such reactions? 
  4. What would be the metabolism changes in term of the energy substrate glucose, protein, and lipid, induced by such molecules? 


Case 3: 

A 66-year-old male complaining of chest pain is brought to the emergency room by ambulance. The pain began six hours ago and has become more severe over the past hour prompting him to call emergency services. He describes the pain as retro-sternal, pressure-like, and non-radiating. He had some mild dyspnea and nausea accompanying the pain. He has also noted intermittent palpitations since last evening.

He has a past medical history of hypertension (not currently under treatment) and tobacco use of one pack per day of cigarettes for the past 47 years. Vital signs on arrival to the emergency room show a blood pressure of 160/100 mmHg, a heart rate of 92 beats per minute, and a respiratory rate of 18 per minute. His physical exam is unremarkable. He reports no allergies and no medication use.

Both EKG and cardiac enzymes are pointing towards “anterolateral infarction”.  At hospital he got thrombolytic treatment. In the first 4-5 hours post-thrombolytic treatment his chest pain and other sign and symptoms were disappeared. However, two days after the onset of the chest pain he had a cardiac arrest and died. His cardiac pathology image is seen here:

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