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    Physiology Endo

    Uploaded by

    BiswarupDas

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 54
    ‘A 1. yoaleonager presents tthe cic wth hr pants complain of hoadeches and poor von wich bon sido 3 morths aga. She dere her hesdsene ob trobing, nosy on het terahend ans severe enough to aac hee rnoncentitory She takes ao motion. Bath other parents re alive ond wel “oc, he bod presse O70 my Hg, har at fe Bn, repeat nto ‘im, 2 temperature 37C 98.6". Breass and putichai development een Synthesis of which the fllowing hormones would be Fs affected a a es of the underhing pathology? 8. Tryldtinulatg hormone ‘A 1. yoaleonager presents tthe cic wth hr pants complain of doches and poo! vision which bogon insist 3 monte age She deserbes soehee to bethatbing, momy an her forehead and saves enought Fistor = noncontibutony Sho es no medcaten Both of er pres ae are ‘it wel Today, her sod pessine 1070 mam Hg art ate fe 0m, mio end temperate is 37°C 8.57), Beasts and pubic hal (the eel shown blo Synthesis of which the flowing hormones would be Fs affected a a es of the underhing pathology? 8. Tryldtinulatg hormone Result: ea Valo} Explanation: Comet newer The patent stterng fom anentineonng ptitany _acenema hat sinhibingpreducton and screuon ofthe gonedovepins FSH ‘and LH tis also casing mass effect esulg in headaches Typical smptons ‘nota: headaches, val dekarbancesaendorne dsntion di tothe comptessv—e effects othe umot Seton of endocive dystunction nce Sularo not ied to weight gain nd caldinaerance de to hypothyroid _anorova, nausea, vomting. a ehargy deo adrenal inset: layed ‘puberty aueto secondary hypogonadism: and ronth retardation. ‘Option A: Antec hormone (asopresissythested inthe ypattaamus and vansported tee postever puta fr rinse. ADH Insuficency causes dabetes stds hypemetemia, pours ane ‘alyips).The patients symptoms ae mere in ine wih FSH and LH ‘ateiony ‘Option B: Tyo stmuletng nomonedaticiancy causes Secondary typothyodem wth both on TS ne low T3 and 4 Symptoms elude ‘etary, weakness, cod intolerance, and constton. Tis patients ‘spe are more nine wth FSH and LH deficiency, ‘Option: Proletndeflency presents wth puerpeaalactoganei but this eal} First Aid References: Fat Aid forthe USMLE Stop 12018, 20h 0: 349,515 Fst Ad forthe USMLE Stop 12018, 280 oa: 349,512 Fst Ad for tho USMLE Stop 1 2017 27 od) 335,438 Incl: headaches, val deturbances and endocrine deknction de tothe Fst Ad forthe USMLE Stop 12017, 27 ed) 335, 498 Sularo rot ied o weight gain nd caldinaerance dv to hypotyton anoroea, nausea, voming. a ehargy deo adrenal nse layed oa comptessne effects oe unex Srstons of endocive dystunction nce i puberty aueto secondary hypogonadism: and ron etardaton. ‘Option A: Antec hormone (asopresissytheszed inthe Pypataiamus and vansported tee poset puta fr rise. ADH Insuficency causes dabetes stds hypematreia, pours ane elvis. The patients symptoms ate mere in ine wih FSH and LH ‘ateioney ‘Option: Myrot stnuletng nomonedeticiancy causes Secondary typothyodem wth both on TS ne low T3 and 74 Symptoms elude lethargy, weakness, cod intolerance, and consteton. Ts patients symptoms are more nina wh FH and LM otcioncy ‘Option EProlsctn decency present wth puerperal lactogen. bit his ‘uly prsont ring ej afr prognanc. Tipton spmptoms re ‘more inne wth FSH ana Lo deancy. ‘Option: Astenocereotropc hormone decency presents wth weakness, weight ss and typolycemia. Ths pants symptoms are mee ne with FSHand LN doelney ‘Loaming objective: Nonsunctoning pity adenomas cen it proton or release of ntror ond posterior tary hormones, FSH and LH ‘Sefieney resus m primary amenorhea, The adenomas can also cause mass ‘eect ncucing a neacache and mpingement of he psc nerve Bsc the tines monte 290, uses um TSH} Toa 74 Noa Fro 74 Noma Uptake | Navmal Serum TSH, Teta F4, Normal 100 4, Noval ™ Uptake 6% Result: sti tt Result: Explanation: CCemect answer C: This the hyo function resus saan nthe carly phases cof supscute yess whichis consistent wit e cca vente pesertod lbove, Subocut hyo typlal rus its course in 3 phases nl phase ‘ot thyotoccri so nereaaed elonse of stores tyro hormanes, ‘reby suppressing TSH release, the Second phase of ypothyoiisn due to depltion of stored tyridhormenes anda final euthyroid phase subacute hyo, te ant necks usualy tender and may be swollen {and tere may be a str of preceding upper espratry act infection. The noun as de Guerains throbs. Related Videos: “Thyra —Hypetyrocm Thotaecost) © Bim First Aid References: Fst Ad fr the USMLE Stop 12019, 29th of): 338 Fst Afr the USMLE Step 1 2018, 25h ea: 336 Fat Ad forthe USMLE Step 1 2017, 270 ch 228 Pa - Serena st Ad forthe USMLE Step 12019, 29h od 238 Fst Ad forthe USMLE Step 12018, 28 of 396 The smotoms of thyctxicode deserted inthe vignate-paptatons, rronolodetrosine (Th one stocetyosine (1) 2uping two aederyesine OA) residues espoctivaly. These residues ao emo {he dond.13(Inodothyonie and TA (Thyroxine ene thet effct on he ea Valo} non jose escuos ef tyrotebutn react with he cana tappea wshiN the gan 13 [Tnodothyonine and T (Thyroxine exert tht ff on the folowing badly processes: ‘LMatabotc rato. Thyroldhermanes erence the basal metabotrta of ‘most sues nthe body by creasing ho acy NK ATPa30 transporter presenton thek membranes, hence Weeasng tor demand ‘er ATP They ao enhance celeste metabolism ane he rt of (ucoso absorption rom te smal stn. 2. Grow and Dovlopmert Tyrol hormones have aspera eflecton ‘the acton of growth harmane and somtomedins to prometabone (gw, They also help in the maturaton ofthe CNS an ho pednata ard otf, thorlere ter deficiency dng this tie rests in reversible metal retrsaon, | Condiazcular System & Autonomic nervous system: Thyroid homones cethititsome ofthe same actons a the sypathaic env yer Thoy ato ncease the expression of 1 akenerge receptors onthe heartand cause anincease heat ate and toe vlume: resign ineresed conic output ‘Option A: Ts ho picture Seon neonetans whore hod bing lobe (76) increased sch an presrancy. ‘Optom B: This tho picture seen Groves’ doace- the commence oie of ‘hyretoccots ypeny cecrsfemles Bete the Bea th decade of fo. n Graves disease, MyfoKd stating nmunoclobuts (15) stimulate TSH receptors present on th thre gland aedincease to actiy ofthe land wth 3 ecnsequert increased production of hye homenes he ncreased {2ctvty of te land enhances 11 Uptake. TSH eel howeve iow due eg ecco the typaidhanmanes othe ptatary lan eats Increased carne opi . . ‘Option A: Ts ihe pcre seen in concen where hyo binding obi 7 (TG increased sch an pregnancy. ‘Option B: This tho pcture seen n Graves’ dsease- the commonest cause of myretocosis. ypiealyaccrs emales between the Band Ah decade oF We. in Groves disease, hyrok-stmadatinginmunodlebulrs 1) stilts TSH ecepors present on th hye land ancdinceage the acy ofthe land wah a corsoquertncossed production of tek harman. he ncieased ety ofthe alone enhances it Uptake. TSH levels however ow de © ‘sega feeasace othe tyros hemanes onthe pita lon, ‘Option D: This he pete seen in conditions where had bing globulin (8G) decreased such as in Wve faa or nababe use of trac. ‘OptonE:Thisisthe picture sen n secondary hyperthycm such as occus In pata adenomas ncoasod TSH scrtion fm he ptr gland Incrensesthe overall acy ofthe and Learing objective: Thyroid hormones cease the basal metabo rate of ‘most sues inte bogy by increasing the acti of Nak ATPase wenspoter ‘Present on tee membranes,Rence increasing te Seman fr ATP Tey 30 ‘rhonc colestoral metabolism athe rte of hcaee abortion rm the ‘mallntestne, Thyroid hormones hve a synergistic eect onthe acton of ‘tonthnarmane ana somatoneans to prometa bone grow. They a0 lp Inthe maturation ofthe CNS ding the perinatal porod of Mo Thyroid ormnes seh ome ofthe sane setone athe sympathetic narwoue system onthe crcovascar system Bsc . ‘A S7.year-od man's usheato the emergency department by ambulance aot . being ound on the floor gasp oar wth severe shoriness of brat by his z Parner Pastmeceal Mistery sigan for congestve heart fare rypertercien, s {and ypenisdomia. He normaly takes clerhalidone, atorvastatin, metro and = \alsran bute recent eh job andireurance and has not been bf to aftr hie meson m2 months. Upon aval at the hosp He blood poesia {0560 mm Hg, neatrate som esate rates 24min oxygen saturation 80% on 100% oxygen, ane temperature 377°C 9ST. On phyeal exam, he appears obese and can only ansner questions in shor gasps ashe sugges © brenhe Hisar ot tachycardia mildyhreguy ym ond ausctation Physiologie changes canbe seen inthis patient? ‘A. rasa renin and angiotensin atify blood preset, noma ‘onal perusion pressure," Stun pl 18, Plasma rnin and angiotensin I acti, loc prseie, noma ‘renal persion pressure, serum pH ‘Nawal plasma ronan angiotensin acy, blood presse, ‘rena persion posse, serum pH 1. Pasa enn an nctotensn actay blood eerste, | ona person pressure, serum pH £1 Pima ronn and angotnsin lacy, lod pressure ran peruson presse, serum pH ea Valo} ‘A S7.year-od man's usheato the emergency department by ambulance aot being ound on the floor gasp oar wth severe shoriness of brat by his Parner Pastmeceal Mistery sigan for congestve heart fare rypertercien, {and ypenisdomia. He normaly takes clerhalidone, atorvastatin, metro and \alsran bute recent eh job andireurance and has not been bf to aftr hismedcation 2 months. Up aval atthe spt Hs blood pressure | {0560 mm Hg, neatrate som esate rates 24min oxygen saturation 80% on 100% oxygen, ane temperature 377°C 9ST. On phyeal exam, he appears obese and can only ansner questions in shor gasps ashe sugges © brenhe Hisar ot tachycardia mildyhreguy ym ond ausctation Physiologie changes canbe seen inthis patient? [A Plasma erin and angiotensin ety, Blood presi, normal 9% ‘onal perusion pressure," Stun pl 18, Plasma rnin and angiotensin I acti, blood presse, normal 22% ‘renal persion pressure, serum pH ‘€ Nonmal plasma ron and angiotensin acy blood pressure, 2% ‘rena esion posse, serum pH 1. Plasma ronin and angiotensin act, Hood press, | onal 28% person pressure enum pH {© 1 Plasma ron and angotansin acy, blood pressure, renal 2% eruson pressure, eran pH ee, Result: Explanation: CComect answer *Plsma rela an angiotensin acy, ood pressure, ren persion presse Ths pint sitenng om leftida hea fre wth dopa systemic blod pressure. The cop in ood pressure outs in fn hctease nronin and anglterin I act whieh increduee Dood posse nd eho teal pakson Paints th a story of congestive heat are have conical ecthated ren angitensinaldoserone system GAAS), Consequenty ma 2 step process catalyzed tia by rnin anton by angiotensin converting enzyme (ACE) anglctensn Is produced fom ngotersinegen wna wien acs nospenaenay o he mypomalanc peu ‘cron als to caus scration of alestrone tam tho zona glomeruoes ot the aronal cortex. Fecal hat akostorone casos net sium reabsorption trough epithet sodium channels (ENaC) inthe esta convoluted table and NaNK ATPase ‘pumpin the collecting tubule n exchange for potassium. Aldosterone aso causes secretion af hydrogen ons though the meralsted cella Thus ‘ondtion of hyperakoteront. tere hyena, rypokais,ad ‘metalic alas Secondary hypealostetensm wth hypotension s seen Related Videos: Omnm First Aid References: Fst A forthe USMLE Step 12019, 2%h e335 Fst Ad forthe USMLE Sop 1 2018, 28h od 332 Fst A forthe USMLE Stp 12017, 27th ch 324 Recah akosterone causes et sium reabsorption trough epithet sodium channels (ENaC) inthe dst convoluted tubule and NaMK ATPase pumpsin te collecting tubule exchange for possum Aldon aso ‘ounes secretion of hydrogen ons hraigh he feralted cls Thos condos of hyperaldsteronsm, toe hyeenatemi, hypokalemia, and ‘motabetc aalos. Socendary hypeaostetonsm wth hypaarsion © seen condtons such as congestive hear fale, hepatic ness ard ther ‘oncon that caves vens ca tase orenatrcin, Fst Ad forthe USMLE Step 12017, 27 ec 328 ‘Opto A: arene and angitanin act, ood presse, emi ral petusion pressure, 7 SBSerum pt are saenn primary yperaldosteranam (Corns sypcome} Excessive acreton of adostrene Biscotti ‘Option A: Plasma renin and angictensin act, ood pressue, pou ‘onal persion presaure,1 SBeerum pl are saan in panary ypetatosteroesm (Corissyctome) Excessive secretin of aldosterone ‘foma uniatoraladenemais mst conmelyseonin tis condon. The aldosterone socoted acs a noghve odback to sappess renin Fleas. However aldestrone coe sa an water retention andlads ton erense In blood pressure in thes patients. ‘Option B:7Piosma rein and angetensin ach, bod pressure, noms ‘eral potion presse, stump are son nonin secreting mas 8 Hormone edited fbrous replacement of bone re Chole 104 mE uN, 22mgia Caktum —— S2mai Uneackd — 3Ampia. Powe — S2meq Blerbenate 1 mmol Creatinine | img. IMagnesian LaMEGL Hemodiobin 86 | perpen blood smear shows namecyte nomochromle anemia. radiograph of to umbar spine shows multe wet dane ys estos wth aves oF :ubperostel hiring, Which of he folowing tho most ely underlying cause of {the recographisnangs ve pent? | Germine maton ofa tuner sunpressr gene |. pated caonic amyerase acy in ostaodsts Detecoe minralzaton of esto seconary to hormone ‘elceney 21g ancbody binding to Fercoptor of igs Hormone medisted fbrousrplocemnt of bone a Bbsctcto tt Explanation: ‘Comact answor E: This pation’ cial oatures are consstont with ena ‘osteodtropy seen in chor renal flare. ‘This patent with a tary of pathologic acires, uncon hypertension and ype 2cabetes melts th symptoms of bone pan oor appett. dy ‘on, prmus, sn scteraton, and hiccup shouldbe ivestoated accordingly. Laboratory ndings may show hypedtalemia, metabose acdoris, _azotemi,hypocaicomia, ane nermochrom nomecyc anemia. (One of he functions ofthe Kneys the htonfation of 254ydromyamin D tots actve fom 125 dnyony vlaminD (alo by the action of yroxyso i the posal conus te. Caleo fates to esa brorton fea from the di theteby moraning is taroet ‘oncenwton m body sues. weve in cron rnal fale, here fan ‘mpated sythats of activ vain Duo tos of eal paenchyma. Tis loads to detective absorption of ak, "Not also that in chronic ronal lure thor is poor excretion of phosphate ‘ea decraare in GFR anda docreace i bua funcon. The ‘accumulate phosphate ne bloodstream can bind to fee cacum and ‘ithe eduee toned eau serum ves he reauing hyperphoephateia, and hypocalcemia causo an nceaee evel of secration of parahyrotd eal} Related Videos: ‘Secondary Hyperpaatyolsm(SHPT| and Tartar Hyperparatexten | Omen © hvrsvoy tea ate First Aid References: Fst Ad forthe USMLE Sep 1 2018, 29h e590 Fst Ad forth USMLE Step 1 2018, 28th 0 536 Fst A forthe USMLE Step 12017, 27h ed 57 ‘Not also that in chore anal fare ther is poot excretion of phosphate ‘vet decreore in GFR and a decrease tba function. The ‘accumulate phosphate nthe Boodstrean can bind fee calcum and ‘ure educeeizedcalum sum vols, The resutng ryparposphatenia ‘and hypocalcomiacauso an nzeae evel of secretion of parahyotd ‘ermene PTH om the parathyad glands. Parathyroid hormena ses the ‘towing uncrs (S20 mage bol “Lincrease resorption of calelum and phosphate om bone by nceasing the production of RANKL (eceptor atvatr of FEB Hoar om ostocjes and osteoblasts. RANKL binds #5 receptor RANK on estoasts and strates tem loci to esteoctast- mediated bone resorption 2 Increase cakum rabsorpten rom the tal comets tub 13 Increase phosphate excretion by educing Is reabsorption atthe proumal convoluted wou 4 Ierese eal production by erasing he activ of Whose Inthe prosnal convoluted tubule eee ue i snectainenntn crema wide > eR Fst Ad forthe USMLE Step 12017 27th dh 57 Ine overall eect ot PH ina norma pysoogical sate sa decrease serum hesphte an ncraoe in sarum acm, and an increase in nay exraton ‘of phosphite, However chronic rera ok, he hypocalcemia resting ‘tem impated vam D acy ee the ypeephoephatemia resulting fom ‘paves nat excatn ood to secondary ryparpuratyrlds at moat: ‘osteoclast desctonotone, ‘This pation’ radiograph ngs are consitont wth eta Rosa eysticn richie chractonizedby wol efned cyte sons row tumors duet the ‘yous roplzcoment of bone and subpeistal ini, ‘icnischoractonzedby wot efned cys sens rou Tumors auto the ‘rou roplcomont of bono and subperiosteal ining, ‘Option A: Germine mutations of tumor suppressor genes such a the ‘etinebartoma gene andthe p53 gone ars impsted nthe development of ‘osteogenic rarcomn, Pests! elevation (Cdan Wenge ora saber pate is ypcly seen aciogiaphs. ‘Option B:moated caloric ahyaiase acy osteolssrests an Inaoaay to crete motoca cde mczoononment tat needed ot ‘osteoclast resorton of bone. This leads tothe detective ostecciaste action ‘bone overronth and coral bone steals sen in esteopetst. ‘Option c: Dette neralation of ote second te hormone deiency ‘sseenin osteomalacia co to vlaminD etincy. liough ostoralcia ‘on gear in ron rn fare, the odographieAndnge show ears of ‘osteopenia and pseudtractres. ‘Option Da antbody bing othe Fe recep of laG is sen in patents wh heumatotd ares fa). Typcal symptoms ofA include jor pan. fave, ‘Learing objective: Secondary hyperparathytedsm occurs in chon renal

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