Michael X, a 25-year-old aspiring nursing student with a history of polycystic kidney disease was shot in the chest and abdomen. On admission to the emergency room (ER), the first radiograph of the chest revealed a 6.4 mm bullet in the heart and the second bullet was located in the abdomen.

Using a minimum of 7 references (retrieved from either a science textbook or a scientific peer-reviewed journal) answer the questions below.

1. Upon evaluation of Michael’s condition, the ER physician concluded that the bullet entered between the 4th and 5th intercostal space and lodged into the left ventricle. What is the correct order of serous membranes and body cavities that the bullet could penetrate before lodging into the left ventricle? (10 marks)

2. The detectives assigned to the case were swift in retrieving the 0.25 caliber pistol that was used in the shooting. At the crime scene, they also collected DNA samples and fingerprints on the gun. As part of the team assigned to this case, explain why your team collected these pieces of evidence from the crime scene. (5 marks)

3. The MRI revealed a pericardial effusion. Describe how pericardial effusion can affect the anatomical structures and function of the heart. (10 marks)

4. Michael sustained an ankle injury during the incident. Describe the different types of bone joints that may have been affected. (10 marks)

5. Considering that the bullet hit the phrenic nerve. Describe the effect of the injury to the major muscle supplied by this nerve. Discuss the three types of muscle tissue, (include microscopic slides of these tissues) and classify the type of muscle tissue of the affected muscle. (5 marks)

6. Gunshot wounds to the chest are always associated with major blood loss and disruption of blood flow through the heart. Michael X is AB+. What blood type should he receive and why? (10 marks)

7. Michael X was moved to the ICU due to low oxygen saturation levels as measured by the oximeter and was complaining of dyspnea. A tracheostomy was indicated to mitigate his situation. Based on this information, describe what tracheostomy is and trace the pathway of air to the lungs after the tracheostomy was performed. (10 marks)

8. Michael became paraplegic due to the bullet reaching the lumbar segment of the spinal cord. Describe the transverse section of the spinal cord including the meninges and indicate the affected plexus that caused the loss of function. (10 marks)

9. Several organs in the abdomen were affected due to the second gunshot. The bullet reached the retroperitoneal space; what digestive and endocrine organs may have been affected. Please include the functions of these organs that may have been compromised. (15 marks)

10. Polycystic kidney disease is an inherited disorder in which portions of the nephron become structurally abnormal resulting in the growth of cysts within the kidney. As indicated in this case study Michael X has a medical history of polycystic disease.

Trace the correct pathway of glomerular filtrate from the kidneys (i.e. starting at the renal corpuscle) to the urinary bladder. (10 marks)

References (5 marks)

Minimum 7 references