In all the chapters the Case Studies represent situations similar to those that the medical assistant may encounter in daily practice. Students are encouraged to consider the case study as they read each chapter.

A 22-year-old woman comes to the family practice office where you work. She complains of tingling sensations in her fingers and toes. She also states that even though she wears thick mittens during cold weather, her fingers and toes turn blue and she experiences a lot of pain. A doctor diagnoses her with Raynaud's disease and tells her that it is an overreaction of the sympathetic nerves in her fingers and toes. She is scheduled for a regional sympathectomy, which will cut the sympathetic fibers to her fingers and toes.

As you read this chapter, consider the following questions:

1. What effect do sympathetic nerves have on blood vessels?

2. Why does Raynaud's disease produce pain and blue coloration in the fingers and toes?

3. How is a sympathectomy going to help this patient's condition?