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Lesson 3


The Difficulty of Diagnosis

X-ray of human body with question marks around it

Explain


At a Glance

Overview

Some people who have a rare disease struggle to obtain a proper diagnosis. In Lesson 3, students become involved with a case study of a boy with the rare genetic disease Marfan syndrome. Because Marfan syndrome shares symptoms with other, more-common diseases, it can take a long time for patients to receive the correct diagnosis. Students observe how problems with a single gene can affect many different body systems. The lesson concludes with students considering comments made by young people with Marfan syndrome.

Major Concepts

  • Because some rare diseases have symptoms similar to more-common diseases, obtaining a correct diagnosis can be difficult.
  • A rare disease may have a genetic cause.
  • A rare disease, like some common diseases, may affect many different body systems at the same time.
  • People with rare diseases may sometimes be viewed as being “different” by their peers and other members of society.

Objectives

After completing this lesson, students will have


Teacher Background

Consult the following sections in Information about Rare Diseases and Scientific Inquiry:

2.0 The Impact of Genomics on Rare Diseases
5.2 Marfan Syndrome


In Advance

Web-Based Activities
Activity Web Component?
1 Yes
2 No
3 Yes
Photocopies, Transparencies, Equipment, and Materials
Photocopies and Transparencies
Activity 1: A Parent’s Dilemma
For Classes Using the Web-Based Version:
1 transparency of Master 3.1
1 copy of Master 3.2 for each student
For Classes Using the Print-Based Version:
1 transparency of Master 3.1
1 copy of Master 3.2 for each student
1 copy of Masters 3.3, 3.4, 3.5, and 3.6 for each group of 4 students (each group member gets a different master)
Activity 2: Connective Tissue
1 transparency of Master 3.7
Activity 3: A Common Thread
For Classes Using the Web-Based Version:
1 copy of Master 3.8 for each pair of students
For Classes Using the Print-Based Version:
1 copy of Masters 3.8, 3.9, and 3.10 for each pair of students
1 transparency of Master 3.11
Equipment and Materials

For Activities 1 and 3, the Web-based versions, you’ll need computers with Internet access.

For Activity 2, you’ll need, per student pair:

  • 1 new (never-before-stretched) rubber band from a dish labeled “A”
  • 1 previously stretched rubber band from a dish labeled “B”
  • 1 paper clip
  • 1 soda can containing about 2 ounces of water*
  • 1 meter stick

*Any weight of 2–3 ounces (55–85 grams) that can be easily attached to the paper clip will work.

Preparation

Activity 1

WWW Logo

For classes using the Web version, verify that the computer lab is reserved for your class or that classroom computers are set up for the activities. Refer to Using the Web Site for details about hardware and software requirements for the Web site. Check that the Internet connection is working properly.

Log on to the Web Portion of Student Activities section of the Web site:

http://science.education.nih.gov/supplements/rarediseases/student

Select “Lesson 3: The Difficulty of Diagnosis.”


Activity 2

Each pair of students will need a meter stick, a rubber band that has been repeatedly stretched (about 25 times), and a rubber band that hasn’t been stretched. Use the same color rubber band for both stretched and nonstretched rubber bands so they look identical. Place the nonstretched rubber bands into a dish labeled “A” and the stretched rubber bands into a dish labeled “B.”

Activity 3

WWW Logo

For classes using the Web version, verify that the computer lab is reserved for your class or that classroom computers are set up for the activities. Set the computers to the opening screen for Activity 3, as you did for Activity 1.



Procedure

Note: This is an Explain lesson. It is designed to build on students’ common experience learning about the causes of rare diseases. Students assume the roles of staff working for a medical geneticist. The scenario gives students a chance to apply their understandings about disease and scientific inquiry to explain the underlying cause of diverse symptoms displayed by a patient. In this lesson, students will use what they learned in the first two lessons about diagnosing disease. At this point, students should be able to construct more strongly supported explanations. They should focus on scientific principles as opposed to simply expressing their ideas and offering preliminary explanations.

We chose Marfan syndrome for this lesson because it is a rare disease caused by mutations in a single gene. It affects different body systems and can be difficult to diagnose. Patrick, the fictional patient, is a teenager who wants to play sports but has medical problems that cause his parents to worry about his participation. This realistic scenario is designed to be engaging to middle school students.

The mutations associated Marfan syndrome affect connective tissue. Realizing that students have little knowledge about connective tissue and its functions, we designed Activity 2 to give students a simple model that illustrates how the connective tissue of people with Marfan syndrome differs from that of healthy people.

Activity 1: A Parent’s Dilemma

Estimated time: 25 minutes

1.

Begin the lesson by explaining that you will investigate a case study of a child who has a rare disease. In addition to the difficulty of obtaining a correct diagnosis, students will see how patients and their families cope with this particular rare disease.

2.

Display Master 3.1, To Play or Not to Play? Ask for different volunteers to read each paragraph aloud to the class.

3.

Ask students to place themselves in the position of Patrick’s parents and then ask, “Would you allow Patrick to try out for the basketball team?”

Students’ responses will vary. Many students will conclude that Patrick should be allowed to play basketball since none of the doctors said that he shouldn’t play. Some students may know of a friend or family member with one of the conditions described and base their opinion on that example. At this time, don’t express an opinion yourself about whether Patrick should be allowed to play basketball.

Exclaimation mark

Tip from the field test: Consider taking a poll of the students in the class. Ask how many would allow Patrick to play basketball. Later, at the end of the lesson, poll students again and discuss why their opinions have changed or stayed the same.

4.

Comment that this discussion about playing basketball and health prompted Patrick’s parents to look into the family’s medical history. Especially on his father’s side of the family, some relatives have had medical problems similar to Patrick’s. Several have had serious heart problems. The parents are worried that an inherited disease might run in the family.

If necessary for your students, relate the idea of inherited disease to genes and mutations. You may need to explain that some diseases that run in families are caused by mutations to a single gene and that by looking at a family tree, doctors can sometimes see evidence for a genetic cause for the disease. This connection will be important later in the lesson.

NSES Logo

Content Standard C: Every organism requires a set of instructions for specifying its traits. Heredity is the passage of these instructions from one generation to another.

5.

Explain that Patrick and his parents next visited a medical geneticist, a doctor who specializes in diagnosing people with genetic diseases. A medical geneticist works with other doctors when it appears that a patient’s disease may have a genetic cause.

Again, if necessary, you may want to explain that many (though not all) genetic diseases are rare. This means that a family doctor may never have seen a patient with the rare disease and not think of it when making a diagnosis.

6.

Explain that for the rest of Activity 1, students will work in groups of four. They will assume the roles of medical specialists assisting the medical geneticist in diagnosing Patrick. Because Patrick has medical problems that affect different body systems, each member of the group will be responsible for a different body system. The four specialties (and their body systems) are

Note: During Lesson 5, students will create an informational poster about either Marfan syndrome or childhood leukemia. With this in mind, you might want to stress the need to take good notes during Lessons 3 and 4.

NSES Logo

Content Standard C: The human organism has systems for digestion, respiration, reproduction, circulation, excretion, movement, control, and coordination, and for protection from disease. These systems interact with each other.

WWW Logo

(For print version, skip to Step 7-p.)

In classrooms using the Web version of the activity:

7-w.

Give each student one copy of Master 3.2, Medical Specialty Report Form. Direct students to their computer stations.

Web browsers should be at

http://science.education.nih.gov/supplements/rarediseases/student

This is a menu page that contains a link for this activity.

8-w.

Instruct students to click on “Lesson 3: The Difficulty of Diagnosis,” and then “Activity 1: A Parent’s Dilemma.” Then they should click on one of the medical specialties (“Activity 1: Orthopedist,” “Activity 1: Ophthalmologist,” “Activity 1: Cardiologist,” or “Activity 1: Pulmonologist”).

Each group member must obtain information about Patrick that corresponds to the medical specialty the group is assigned. Each medical specialty contains a report from Patrick’s doctor. To help them make sense of this report, each medical specialty includes a link to a Medical Reference Manual: Disorders of Connective Tissue, which provides helpful background information. If you have enough computers for each student, then the process will move quickly.

9-w.

Explain that information about Patrick’s medical history and physical exam is provided for each medical specialty. Instruct students to

  • review their assigned medical specialty;
  • record on Master 3.2 what they learn about Patrick’s medical history;
  • record on Master 3.2 what they learn from Patrick’s physical exam; and
  • use the Medical Reference Manual to learn about possible causes of Patrick’s medical problem, and then record them on Master 3.2.

Continue with Step 10.



In classrooms using the print version of the activity: open book

7-p.

Give each student one copy of Master 3.2, Medical Specialty Report Form.

8-p.
Give each group one complete set (four masters total) of these masters about Patrick’s physical and medical history:
  • Master 3.3, Heart and Circulatory System
  • Master 3.4, Visual System
  • Master 3.5, Respiratory System
  • Master 3.6, Skeletal System

Each group member receives a set of handouts corresponding to that person’s assigned medical specialty. The information in the Medical Reference Manual section of each handout should help students make some sense of this information.

NSES Logo

Content Standard A: Students should base their explanations on what they observed, and as they develop cognitive skills, they should be able to differentiate explanation from description–providing causes for effects and establishing relationships based on evidence and logical argument.

9-p.
Instruct students to
  • read the information on the handouts,
  • record on Master 3.2, the patient form, what they learn about Patrick’s medical history,
  • record on Master 3.2 what they learn from Patrick’s physical exam, and
  • use the Medical Reference Manual section from each handout to learn about possible causes for Patrick’s medical problem and record them on Master 3.2.
10.
Give students about 20 minutes to complete the task. Then, re-form the groups and instruct students in each group to
  • share their findings with each other and
  • discuss whether they believe that Patrick’s various medical problems are connected and what evidence they have to support their conclusions.

Students should be able to use specific information from the doctors’ reports and from the Medical Reference Manual to support their conclusions.

11.

Ask for volunteers from each group to share their conclusions about whether Patrick’s various medical problems are connected.

Students should see a pattern: Patrick has problems with four different body systems. For each body system, the Medical Reference Manual mentions that the problem may be associated with connective tissue or, more specifically, with Marfan syndrome or Ehler-Danlos syndrome.

12.
Congratulate the groups on their good work and agree that there might be a common cause for Patrick’s medical problems that involves connective tissue.

Activity 2: Connective Tissue

Estimated time: 25 minutes

NSES Logo

Content Standard A: Different kinds of questions suggest different kinds of scientific investigations. Some investigations involve observing and describing objects, organisms, or events; some involve collecting specimens; some involve experiments; some involve seeking more information; some involve discovery of new objects and phenomena; and some involve making models.

1.

Ask, “What is connective tissue?”

Students will probably not be able to answer this question. Since the name is descriptive, some students may venture guesses that connective tissue somehow holds parts of the body together. Accept all answers and explain that you will investigate the role of connective tissue in this and the next activity.

2.

Explain that connective tissue is largely made of proteins. Further explain that it forms tissues that help hold organs in place, and it connect muscles to bones and bones to bones.

Note: You may point out to students that our skin is largely made of connective tissue and that this allows the skin to be elasticócapable of stretching. Also mention that as we age, the elasticity of skin decreases. You can simply demonstrate this by asking students to pinch some of the skin on the back of their hands and notice how long it takes the skin to return to its normal position. Then, repeat the demonstration using your own hand. Because you are older, the skin on your hand will take longer to return to its normal position.

3.

Explain that for this demonstration, rubber bands will represent connective tissue. Each student pair will compare the elasticity (or looseness) of two rubber bands.

4.

Display Master 3.7, Measuring Elasticity. Read the instructions aloud and make sure that students understand how to perform the elasticity measurements.

5.
Arrange the students in pairs. Give each pair
  • 1 meter stick
  • 1 rubber band from dish A (nonstretched)
  • 1 paper clip
  • 1 soda can containing about 2 ounces of water (or other 2–3-ounce weight)
6.
Instruct pairs to record in their notebooks
  • the question they are investigating and
  • how far down the meter stick the rubber band stretched.

Pairs should write in their notebooks a question such as, “Is one rubber band more elastic than the other?” Give students about five minutes to complete the measurements.

7.

Collect the rubber bands from each pair and set them aside. Next, give each pair one rubber band from dish B (previously stretched). Instruct students to make and record measurements as before.

8.

After students have made and recorded their measurements, ask for volunteers to state their conclusions. Specifically, ask if the two rubber bands performed the same or differently—and if differently, how so.

Students should report that rubber band B (the previously stretched one) stretched further than rubber band A (the nonstretched one).

9.

Explain that the rubber band from dish A (the nonstretched one) represents normal connective tissue. Ask, “What do think the rubber band from dish B represents?”

Students may have trouble answering this question. If so, guide the discussion to Patrick and the possible association of his symptoms to connective tissue. Before moving on, make sure students understand that rubber band B represents the connective tissue in a person whose cells contain DNA that has a mutation that causes the connective tissue to be looser than it should be.

10.

Ask, “How might looser connective tissue affect the body? Think about Patrick and his medical problems.”

Mentioning Patrick may cause students to bring up mitral valve prolapse or a dislocated eye lens. If not described by a student, ask guiding questions to bring out the role of connective tissue. For example, the looser connective tissue causes the heart valve flaps to change shape and not make a tight seal, or the looser connective tissue can’t hold the eye lens tightly in place.

11.
Explain that in the final activity of the lesson, students will return to Patrick and his family and investigate whether he may have a rare disease affecting his connective tissue.

Activity 3: A Common Thread

Estimated time: 25 minutes

1.

Remind students that in the previous analysis they found that Patrick’s medical symptoms involve more than one body system and that these symptoms seem to be related to connective tissue. Explain that they will now investigate some disorders that affect connective tissue and try to decide whether one rare disorder is more likely than the others to be responsible for Patrick’s medical condition.

WWW Logo

In classrooms using the Web version of the activity:

2-w.

Arrange the class into pairs. Give each pair one copy of Master 3.8, Diagnosing a Connective Tissue Disorder.

3-w.

Direct the student pairs back to their computers. Instruct them to click on “Lesson 3: The Difficulty of Diagnosis,” then “Activity 3: A Common Thread,” and then “Activity 3: Medical Reference Manual.”

Students should follow the instructions on Master 3.8 to compare Patrick’s medical symptoms to those expected for four different disorders of connective tissue. Give students about 10 minutes to complete the tasks.


In classrooms using the print version of the activity: open book

2-p.

Arrange the class into pairs. Give each pair one copy of Master 3.8, Diagnosing a Connective Tissue Disorder, and one copy of Master 3.9, Medical Reference Manual: Disorders of the Connective Tissue.

3-p.

Instruct student pairs to follow the instructions on Master 3.8 to compare Patrick’s medical symptoms with those expected for four different disorders of connective tissue. Allow about 10 minutes for students to complete the tasks.

4.

After students have finished, ask for volunteers to report their conclusions.

Students should report that, although some of Patrick’s symptoms fit more than one disorder, virtually all of his symptoms are consistent with Marfan syndrome.

Patrick’s medical history Ehlers-Danlos syndrome Marfan syndrome Osteogenesis imperfecta Scleroderma
Myopia Yes
Detached eye lens Yes
Asthma Yes
Collapsed lung Yes
Heart murmur Yes
Leaky heart valve Yes Yes
Long arms and legs Yes
Curvature of spine Yes Yes
5.
Agree that Marfan syndrome is the best explanation for Patrick’s symptoms. Ask,
  • “What is the cause of Marfan syndrome?”
  • “What evidence is there to suggest that Patrick may have Marfan syndrome?”

Students should recall that Marfan syndrome runs in families and results from mutations in a gene that codes for a connective tissue protein.

Students should report that Patrick has many of the Marfan symptoms listed in the Medical Reference Manual.

WWW Logo

In classrooms using the Web version of the activity:

6-w.

Explain that to complete Patrick’s diagnosis, you want to see whether there is evidence of Marfan syndrome in Patrick’s family. Direct the student pairs back to their computers and instruct them to click on “Lesson 3: The Difficulty of Diagnosis,” then “Activity 3: A Common Thread,” and then “Patrick’s Family Tree.” Students should look at the information about Patrick’s family and record in their notebooks any evidence they find that suggests a history of Marfan syndrome in the family.

Students can roll over or tab through photos of each family member and read a brief description of the person’s medical history. They will see a diagram of a family tree that shows only the father’s side of the family. If students ask about the mother’s side, explain that it is free of medical symptoms associated with connective tissue disorders and, therefore, not of interest.

Students also may notice that that Patrick has six uncles but no aunts. They may conclude that Marfan syndrome is sex-linked. This is a real family tree, and it’s just by chance that the family tree has so many males.



In classrooms using the print version of the activity: open book

6-p.

Explain that to complete Patrick’s diagnosis, you want to see if there is evidence of Marfan syndrome in Patrick’s family. Give each student pair one copy of Master 3.10, Patrick’s Family Tree. Instruct students to look at the information about Patrick’s family and record in their notebooks any evidence they find that suggests a history of Marfan syndrome in the family.

They will see a diagram of a family tree that shows only the father’s side of the family. If students ask about the mother’s side, explain that it is free of medical symptoms associated with connective tissue disorders and therefore not of interest.

Students also may notice that Patrick has six uncles but no aunts. They may conclude that Marfan syndrome is sex-linked. This is a real family tree, and it is just by chance that the family tree has so many males.

7.

After students have finished, remind them of the three major causes of disease: infectious agents, heredity (genetics), and exposure to environmental toxins. Ask,

  • “Did you find any evidence of Marfan syndrome in Patrick’s family?”
  • “Is there evidence to suggest that Patrick’s symptoms may have a different cause?”

Give students 5–10 minutes to complete the task. Students should report that Patrick’s father, two uncles, and grandfather have had heart problems. Heart problems have many causes other than Marfan syndrome; however, students should also note that other Marfan-related symptoms are mentioned such as scoliosis, a detached eye lens, and a collapsed lung.

Some students may believe that Patrick’s symptoms come from another cause. As in Lesson 2, they may mention that people living in close quarters can pass on infections or may be exposed to the same environmental toxins. Acknowledge the truth of these observations, but point out that the members of Patrick’s extended family did not live together.

check mark

The process of diagnosing Patrick with Marfan syndrome requires students to apply understandings about scientific inquiry. You can assess these understandings by noting how well students sift through various forms of evidence to find what is relevant to answering the question. Also note how well students evaluate alternative explanations for Patrick’s symptoms.

8.

Explain that today, an early diagnosis of Marfan syndrome allows people to take steps to protect their health and live long lives. Ask, “In what ways might having Marfan syndrome affect your life?”

Students’ responses will vary. If necessary, remind students of the symptoms of Marfan syndrome and ask how these symptoms would affect their daily lives.

WWW Logo

In classrooms using the Web version of the activity:

9-w.

Conclude the lesson by explaining that students will now watch a brief video of young people who have Marfan syndrome discussing their experiences. Instruct students to first write in their notebooks some questions they would like to ask a person with Marfan syndrome about what it is like to live with the condition.

10-w.

Direct students to their computers and instruct them to click on “Lesson 3: The Difficulty of Diagnosis,” then “Activity 3: A Common Thread,” and then “Activity 3: Patient Video.”

The video is brief, just 3.5 minutes long. If you have the ability to project the computer image, it may be simpler to watch the video as a class.

11-w.

After students have watched the video, reconvene the class. Ask for volunteers to describe their reactions to the video and how it addressed (or did not address) the questions they wrote in their notebooks.

The video will not answer all of the questions asked by the students. Suggest that they perform a Web search to access information from foundations and patient support groups that can answer their questions.

Note: Students could also explore the Marfan syndrome section of the Positive Exposure site (www.positiveexposure.org/marfan.html). Fashion photographer Rick Guidotti and Diane McLean, MD, PhD, MPH, wanted to share the beauty of rare disease patients, so, in 1997, they founded Positive Exposure, starting with photos of some people with albinism. The site now features people with almost 30 diseases.

exclaimation mark

Tip from the field test: If you took a poll of the students in the class at the beginning of the lesson, take another now. Discuss why their opinions have changed or stayed the same.

End of Web-based activity.



In classrooms using the print version of the activity: open book

9-p.

Conclude the lesson by explaining that students will now consider how Marfan syndrome affects the lives of those who have it. Ask students to take a moment to reflect on what they have learned about Marfan syndrome. Instruct them to write down in their notebooks

  • one question they would ask a doctor about having Marfan syndrome and
  • one way they think having Marfan syndrome might affect their lives.

10-p.

After students have completed the tasks, ask for volunteers to report what they wrote in their notebooks.

Consider displaying a couple of questions and comments that students wrote in their notebooks.

exclaimation mark

Tip from the field test: If you took a poll of the students in the class at the beginning of the lesson, take another now. Discuss why their opinions have changed or stayed the same.

11-p.

Display Master 3.11, Living with Marfan Syndrome. Explain that this master includes some comments from teenagers who have Marfan syndrome. Give students a couple of minutes to read the master.

Reveal the questions and comments on Master 3.11 one at a time, as you talk about them.

12-p.
Instruct students to reflect on the questions and comments from the young people who have Marfan syndrome. Ask,
  • “Were their questions and comments similar to or different from yours?”
  • “How would you want to be treated by your classmates if you had Marfan syndrome?”

Answer key for questions on Master 3.11, Living with Marfan Syndrome

  1. “Is there any possible way for the Marfan gene to be detected before a child is born and maybe find a way to prevent it from mutating itself?”

    At present, prenatal testing is not available for Marfan syndrome. The mutated gene associated with Marfan syndrome is found in every cell of the body. Today’s technology cannot replace the mutated gene with a nonmutated gene.
  2. “When they measured my heart with the echocardiogram, they told my mom they don’t think I should do marching band. I was wondering, if I don’t exert myself too much, if I take it at my own pace, do you think I will still be able to do it?”

    The student asking the question was advised that she might be able to continue with marching band if after a practice or a performance, she didn’t feel exhausted and wasn’t short of breath and sweating.

Lesson 3 Organizer: Web Version

WWW Logo
Activity 1: A Parent’s Dilemma
Estimated time: 25 minutes

Page and Step

Explain that you will explore a case study about a child who has a rare disease. Display Master 3.1. Ask volunteers to read paragraphs aloud to the class.

Page 78
Steps 1
and 2
Transparency

Ask, “Would you allow Patrick to try out for the basketball team?” Page 78
Step 3
Explain that Patrick’s parents looked into their family history and found relatives on his father’s side who have had medical problems similar to Patrick’s. Page 79
Step 4
Explain that the family visited a medical geneticist to see if Patrick’s problems have a genetic cause. Page 79
Step 5

Explain that students will assume the roles of medical specialists and work in groups of four. Each group member will be responsible for one of the following body systems:

  • orthopedist (skeletal system)
  • ophthalmologist (vision system)
  • cardiologist (heart and circulatory system)
  • pulmonologist (respiratory system)

Page 79
Step 6

Direct the students to their computer stations in their groups. Give each student one copy of Master 3.2.

Page 80
Step 7-w
Master

Instruct students to click on “Activity 1: A Parent’s Dilemma” and then on one of the medical specialties. Page 80
Step 8-w
WWW Logo

Instruct students to review their medical specialty and record on their handouts what they learn

  • about Patrick’s medical history,
  • from Patrick’s physical exam, and
  • about the possible causes of Patrick’s medical problems, based on the information in the link to “Activity 3: Medical Reference Manual.”

Page 80
Step 9-w
WWW Logo

Instruct group members to share their findings and discuss whether Patrick’s medical problems are connected to each other and the evidence to support their conclusion. Page 81
Step 10
Ask volunteers from each group to share their conclusions about whether Patrick’s medical problems are connected. Congratulate students on their good work and agree that there might be a common cause for Patrick’s medical problems that involves connective tissue. Page 81
Steps 11 and 12

 

Activity 2: Connective Tissue
Estimated time: 25 minutes
Page and Step
Ask, “What is connective tissue?” Explain that it’s mostly made of proteins and forms tissues that help hold organs in place and that connect muscles to bones and bones to bones. Page 82
Steps 1 and 2
Explain that students will use rubber bands to represent connective tissue and will compare the elasticity of two rubber bands. Page 82
Step 3
Display Master 3.7, read the instructions aloud, and make sure students understand how make the measurements. Page 82
Step 4
Transparency

Arrange students in pairs. Give each pair

  • 1 meter stick
  • 1 rubber band from dish A (nonstretched)
  • 1 paper clip
  • 1 soda can containing about 2 ounces of water (or other 2–3-ounce weight)

Page 82
Step 5

Instruct pairs to record in their notebooks

  • the question they are investigating and
  • how far down the meter stick the rubber band stretched.

Page 82
Step 6

Collect the rubber bands. Give each pair a rubber band from dish B (previously stretched), and instruct pairs to make and record measurements as before. Page 82
Step 7
Ask volunteers to report their conclusions. Did the two rubber bands perform differently and if so, how? Page 83
Step 8
Explain that the rubber band from dish A (nonstretched) represents normal connective tissue. Ask,
  • “What do you think the rubber band from dish B represents?”
  • “How might looser connective tissue affect the body?”
Page 83
Steps 9 and 10
Explain that now they will investigate whether Patrick has a rare disease affecting his connective tissue. Page 83
Step 11

 

Activity 3: A Common Thread
Estimated time: 50 minutes

Page and Step

Remind students that Patrick’s symptoms involve more than one body system and seem to have connective tissue in common. They will decide which, if any, rare disorder of connective tissue Patrick may have. Page 83
Step 1

Arrange the class in pairs. Give each pair a copy of Master 3.8.

Page 84
Step 2-w
MAster

Direct the pairs to their computers to click on “Activity 3: A Common Thread” and then “Activity 3: Medical Reference Manual.”

Page 84
Step 3-w
WWW Logo

Ask volunteers to report their conclusions. Page 84
Step 4

Agree that Marfan syndrome best explains for Patrick’s symptoms. Ask,

  • “What is the cause of Marfan syndrome?”
  • “What evidence is there to suggest that Patrick may have Marfan syndrome?”

Page 85
Step 5

Explain that students will look for evidence of Marfan syndrome in Patrick’s family and record what they find in their notebooks. They should click on “Activity 3: A Common Thread” and then “Activity 3: Patrick’s Family Tree.”

Page 85
Step 6-w
WWW Logo

Remind students of the three major causes of disease. Ask,

  • “Did you find any evidence of Marfan syndrome in Patrick’s family?”
  • “Is there evidence to suggest that Patrick’s symptoms may have a different cause?”

Page 86
Step 7

Explain that an early diagnosis of Marfan syndrome allows people to take steps to protect their health. Ask, “In what ways might having Marfan syndrome affect your life?” Page 86
Step 8

Explain that the lesson concludes with a brief video about young people who have Marfan syndrome. Instruct students to first write in their notebooks questions they would like to ask a person with Marfan syndrome.

Page 86
Step 9-w
WWW Logo

Instruct pairs to watch the video: click on “Activity 3: A Common Thread” and then “Activity 3: Patient Video.”

Page 87
Step 10-w
WWW Logo

Ask volunteers to describe their reactions to the video and how the video related to their questions.

Page 87
Step 11-w
WWW Logo

 

Transparency = Involves making a transparency.     WWW Logo = Involves using the Internet.

Master = Involves copying a master.

Lesson 3 Organizer: Print Version

Activity 1: A Parent’s Dilemma
Estimated time: 25 minutes
Page and Step

Explain that you will explore a case study about a child who has a rare disease.

  • Display Master 3.1.
  • Ask volunteers to read paragraphs aloud to the class.

Page 78
Steps 1 and 2
Transparency Icon.eps

Ask, “Would you allow Patrick to try out for the basketball team?” Page 78
Step 3
Explain that Patrick’s parents looked into their family history and found relatives on his father’s side who have had medical problems similar to Patrick’s. Page 79
Step 4
Explain that the family visited a medical geneticist to see if Patrick’s problems have a genetic cause. Page 79
Step 5

Explain that students will assume the roles of medical specialists and work in groups of four. Each group member will be responsible for one of the following body systems:

  • orthopedist (skeletal system)
  • ophthalmologist (vision system)
  • cardiologist (heart and circulatory system)
  • pulmonologist (respiratory system)

Page 79
Step 6

Give each student a copy of Master 3.2.

Page 81
Step 7-p

Give each group of four one complete set of masters of doctors’ reports: Masters 3.3, 3.4, 3.5, and 3.6

Page 81
Step 8-p

Instruct students to review their medical specialty and the information on the Medical Reference Manual section and record on Master 3.2 what they learn
  • about Patrick’s medical history,
  • from Patrick’s physical exam, and
  • about the possible causes of Patrick’s medical problems, based on the information Master 3.9.

Page 81
Step 9-p

Instruct group members to share their findings and discuss whether Patrick’s medical problems are connected to each other and the evidence to support their conclusion. Page 81
Step 10
Ask volunteers from each group to share their conclusions about whether Patrick’s medical problems are connected. Congratulate students on their good work and agree that there might be a common cause for Patrick’s medical problems that involves connective tissue. Page 81
Steps 11 and 12

 

Activity 2: Connective Tissue
Estimated time: 25 minutes
Page and Step
Ask, “What is connective tissue?” Explain that it’s mostly made of proteins and forms tissues that help hold organs in place and that connect muscles to bones and bones to bones. Page 82
Steps 1 and 2
Explain that students will use rubber bands to represent connective tissue and will compare the elasticity of two rubber bands. Page 82
Step 3

Display Master 3.7, read the instructions aloud, and make sure students understand how make the measurements.

Page 82
Step 4
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Arrange students in pairs. Give each pair

  • 1 meter stick
  • 1 rubber band from dish A (nonstretched)
  • 1 paper clip
  • 1 soda can containing about 2 ounces of water (or other 2–3-ounce weight)

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Step 5

Instruct pairs to record in their notebooks

  • the question they are investigating and
  • how far down the meter stick the rubber band stretched.

Page 82
Step 6

Collect the rubber bands. Give each pair a rubber band from dish B (previously stretched), and instruct pairs to make and record measurements as before. Page 82
Step 7
Ask volunteers to report their conclusions. Did the two rubber bands perform differently and if so, how? Page 83
Step 8

Explain that the rubber band from dish A (nonstretched) represents normal connective tissue. Ask,

  • “What do you think the rubber band from dish B represents?”
  • “How might looser connective tissue affect the body?”

Page 83
Steps 9 and 10

Explain that now they will investigate whether Patrick has a rare disease affecting his connective tissue. Page 83
Step 11

 

Activity 3: A Common Thread
Estimated time: 50 minutes
Page and Step
Remind students that Patrick’s symptoms involve more than one body system and seem to have connective tissue in common. They will decide which, if any, rare disorder of connective tissue Patrick may have. Page 83
Step 1

Arrange the class in pairs. Give each pair a copy of Master 3.8 and Master 3.9. Instruct students to use information on Master 3.9 to complete Master 3.8.

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Steps 2-p and 3-p
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Ask volunteers to report their conclusions. Page 84
Step 4

Agree that Marfan syndrome best explains for Patrick’s symptoms. Ask,

  • “What is the cause of Marfan syndrome?”
  • “What evidence is there to suggest that Patrick may have Marfan syndrome?”

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Step 5

Explain that students will look on a handout for evidence of Marfan syndrome in Patrick’s family and record in their notebooks what they find. Give each student pair a copy of Master 3.10.

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Step 6-p
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Remind students of the three major causes of disease. Ask,

  • “Did you find any evidence of Marfan syndrome in Patrick’s family?”
  • “Is there evidence to suggest that Patrick’s symptoms may have a different cause?”

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Step 7

Explain that an early diagnosis of Marfan syndrome allows people to take steps to protect their health. Ask, “In what ways might having Marfan syndrome affect your life?” Page 86
Step 8

Conclude by explaining that students will now consider how Marfan syndrome affects the lives of people who have it. Ask students to write in their notebooks

  • one question they would like to ask a doctor about Marfan syndrome and
  • one way they think having Marfan syndrome might affect their lives.

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Step 9-p

Ask volunteers to report what they wrote. Page 87
Step 10-p

Display Master 3.11, and give students time to read it. Ask,

  • “Were the questions and comments from the young people on the master similar to yours?”
  • “How would you want to be treated by your classmates if you had Marfan syndrome?’

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Steps11-p and 12-p
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Transparency Icon.eps = Involves making a transparency.    Master Icon.eps = Involves copying a master.

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