olo Cw

A patient presents with a history of

weight loss associated with increased
appetite, increased thirst and
increased frequency of urination
a 1 . What is the most likely cause of t h e
above clinical condition ?
a2. Explain the pathophysiological
changes leading t o weight loss in such
patient?
Q3. What are the various laboratory
investigations necessary in t h e above
patient ?

Ans 1) a) Diabetes mellitus

b) hypergiycaemia in blood but inabiity to utiiise it causes

protein and fat breakdown leading to wt loss

c) urinary glucose, fasting blood glucose in early morning
glycated Hb (HbA1c) ,GTT

A chronic diabetic patient under

t r e a t m e n t for d i a b e t e s a n d
hypertension presents w i t h t h e
complaint of n u m b n e s s and tingling in
t h e l o w e r limb . In a d d i t i o n t o n e r v e
c o n d u c t i o n s t u d i e s , t h e p a t i e n t is
r e c o m m e n d e dfundoscopy and kidney
function tests.
Q1. What is t h e rationale behind t h e
above investigations
Q2. How w o u l d y o u a s s e s s t h e s h o r t
t e r m a n d long t e mc o n t r o l o f d i a b e t e s
in s u c h p a t i e n t ?
Q3. E n u m e r a t e s o m e d r u g s u s e d in thee
t r e a t m e n t o f d i a b e t e s mellitus
 o tome

IcreaseS
A
AnS 2) a) long term complications cause neuropathy, retinopathy and
C)e

nephropathy
b)short term - random blood sugar, fasting blood sugar

long term - HbA1c

c) tolbutamide , metformine and sulphonylurea are orally

nypoglycaemic drugs which increase insulin secretion

nsulin deficiency
( a n d gliucagon e x c e s s )

Decreased Increased increased

9uCOSE protein
uptake catabolism lipolysis

os
Hyperglycemia,
Sosuria.
increased
plasrma
Increased
plasrma FFA.
Osmotic diuresis.
amino acids,
electroiyte nitrogen ioss keto9enesiS.
depetionn n urane
Ketonuriaa
ketone Ia

Dehydration.|
acidoSis

Coma,
death

T h e effects of insulin deficiency a r e s h o w n in

t h e a b o v e diagram
What is the physiological basis for the following:
1. Glycosuria a n d o s m o t i c diuresiis?
Increased protein catabolism?
3. Diabetic ketoacidosis?

4. Dehydration ?

a) excess glucose levels In blood crosses the renal threshold

Ans 3)
excreted in urine, waterfollows
value of 180mg/dl and glucose is
osmotic diuresis
glucose and hence
 b) to meetthe body requirements, protein and fat catabolism
ncreases

c)excessacetylcoA formation, ketosis increases

d) osmotic diuresis leads to loss of water and hence dehydration
results

200
Diabetes
180

160

140

120
Normal
100

80
O 1 2 3
Hours

The above diagram shows the oral glucose

tolerance test (GTT) observations
1. How is GTT conducted?
2. What the criteria for normal GTT,
are
Diabetic GTT and impaired GTT?
3
3. What is the reason for
hyperglycemia in
diabetes mellitus?

Ans 4) a) glucose load of 75 g in 300 ml water is administered orally.

b) less than 140mg/dl is normal, 140-200 is impaired and more
than 200 is diabetic

c) uptake by cells does not take place, decreased peripheral

utilisation
 vorma

Oral Glucose Tolerance Test.

ATin

300
ra_

in
D i s o r d e r e d plasma.glucose homeostasis
insulin deficiency.

Glucose tolerance test.

Q - 1 . W r i t e in brief

Diabetes Mellitus.
W H O c r i t e r i a for diagnosis of
Q-2.Write

v a l u e of g l y c o s y l a t e d H e m o g l o b i n .
Q-3.Write
the normal

book
Ans 5) a)
or equal to 126 mg/dl, 2 hr oral gtt has value
hEPG is greater
200 mg/dl
than
more

than 6 %
less
c)
 ay

The above
diagrams show the insulin
secretion and action
1. What a r e the
various
the insulin secretion?P factors which affect
2. What are the metabolic actions of insulin
the on
following: (a) Liver (b) Muscle
(c)
adipose tissue

Ans 6) a) hyperglycaemia , amino acids,glucagon,

- stimulators sulphonylurea, ACn
Potassium depletion, somatostatin inhibitors
-

b) book

A patient presents with complaint of

spasms after a recent thyroid irritability and muscle
surgery. His hand is
presented a s in above shown typicalposition at the
of examination: time
Q1. Vhat is the clinical sign shown
above?
Q2. What is the physiological c a u s e of
the above
abnormality?
Q3. Give the treatment options along with
their
physiological basis in above condition?
Ans 7) a)
carpopedal spasm
b) in hypocalcemia, sodium channels are not stabilised, thera.
hyperexcitability hereis
(9uri
C calcium and vit d supplements ( vit d helps in calcium abs)

Pla calcumi
P T R O ag i a n d e

Pasma PTH

KIdrnyS
12s(9 z Bone
reso7puorn
reabsorPUOn
Unnay axereon
ohoaphaato

Reieas eof caicium

Dnto Dasn
***
Caieur
Caicu tne
absorpti n

hate
1. asmacalcur
What are the effects of
o n following: parathormone excess
(a) Bone
(b) Serum calcium &
(c)
phosphate
Urinary calcium &
phosphate
2. What are the clinical manifestations
by: caused
(a) Parathormone e x c e s s and
(b) Vitamin D deficiency deficiency

Ans 8) a) i) increase bone resorption

ii) increase

iii) calcium decrease and phosphate increases in

urine
b)i) hyperpara causes hypercalcemia and depresses
nervous system
hypo causes hypocal and spasm of muscles, laryngeal stridor
ii) rickets and osteomalacia

trousseau sign, chovstek sign and erb sign (hyperexcitability of skeletal muscle
even to a mild stimulus)
(D

cted a a t y a s t
growm normone

Canod

200

Days

Effect of Growth hormone injection is shown in a rat model of

hormone a r e also
growth. The direct and indirect a c t i o n s of growth
shown
a 1 . Explain the effects of graowth hormone in the above animal
model?
a2. w n a t complications may ar1se in the above an1mal model if thee
GH i n j e c t i o n s a r e c o n t i n u c d ?
a3 what is the role of hypothalamus in the GH secretion and its
feedback regulation?

Ans 1) a) effect of gh - increase body weight in proportion

until epiphyseal plate fuses afterwords only soft tissue grows

B) complications- decrease insulin sensitivity which

will lead to diabetes, sodium retention, hypertension,
edema ,epiphyseal growth continues, hypertrophic muscle

C) feedback regulation by hypothalamus

he above figure shows
haracteristic features a
patient with
21.
22.
identify the
condition
What is the
most
resentation? likely c a u s e of the above
23. What is the
possible cause of the
omplications in above following
iisturbances [b] patient:[a]
Diabetes
visual
24.
24. Discuss the Mellitus
egulation mechanism
of the
of feedback
atient? hormone concerned in above

Ans 2)a) acromegaly

B) gh excess after
puberty
Ci) visual disturbance
pituitary adenoma is the most
=

common cause of acromegaly which

chiasma
compresses optic

ii) DM excess gh causes insulin

insensitivity, blood
glucose increases, uptake by cells decreases
D) hvpothalamus releases ghrh and somatostatin
 9

prgstanes ercytomn

The above diagram shows the overview of

thyroid hormone production
Q1. What are the steps involved in the following
processes:

(a)Thyroglobulin synthesis
(b)lodine uptake and thyroid hormone synthesis
(c) Thyroid hormone secretion
Q2. How is the feedback regulation of thyroid
hormone secretion maintained?
Q3. What are the sites of action of following

antithyroid drugs: (a) perchlorate/

(b) iodides (c) propranolol (d)
thyocyanatye
radioactive iodine -n:

tyrosine
ER releases derived protein and sends it
Ans 3) a)i)
to golgi body for packaging,
this is released as thyroglobulin

iodide trapping causes iodine uptake

i)
ii) refer to Guyton

B) book
C) i) iodide uptake
ii) same as above
 i i )
p o s

beta blocker, to prevent excess t3 t4

ii) it is a

effects.Before thyroid surgery. propanalol is given

iv) same as i)

rane
P

Tyo

CNS

The above aiagram shows the actions of the thyroid hormone:

1 elucidate the importance / actions of Thyroid Hormone on A)
the Growth and deveiopment (b) Blood pressure and cardiac
output (c) on Metabolism of proteins and carbohydrates
during normal and excess activity of gland
2. How is hypothyroid dwarf different as compared to
hypopititiutary dwarf

Ans 4) a) i} csscntial for normal growth and development

ii) increase protein synthesis. In case of
hvperthvroidism. proximal muscle are atrophied, muscle
wasting. increase urinarv urea and creatinine
ii) positive lusiotropic (shortened diastolic time) effect,
positive chronotropic effect, increase
increase co pulse pressure,
iv) increase uptake of glucose
by cells, increase
gluconeogenesis, increases glycogenolysis, increase insulin
secretion, increase glycolysis
No substantial change in
plasma glucose level
B) head is slightly larger than body, no
deformity and
mental growth is normal,
reproductive function is normal-
hypopituitary dwarf
Obese, protruded tongue, disproportionate growth,
mental retardation hypothyroid dwarf

Q1. identify the above clinical condition .

Q2. Give the salient features associated with the

above clinical condition?
Q3. hat a r e the laboratory tests
recommended in the above condition?
 Ans 5)a) exophthalmos
C tsh levels (decrease). free thvroxine, bmr (raised)

Q1. identify the above clinical

condition
Q2. Give the salient features associated
with the
above clinical condition?
Q3. Vhat a r e the laboratory tests
recommended in the above condition?

Ans 6 ) a) myxedema
B) non pitting edema etc

C) tsh level (increase)

 Aoste rome
00

00

10 12
Time (day+)

The effect of aldosterone infusion

o n various
parameters
is shown here:
Q1. How does aldosterone affect the Sodium levels in the
body?
Q2. Explain the effect of aldosterone on the Extra cellular
fluid volume(ECFV) and the Mean arterial
pressure
(MAP)?
03. What will happen to the ECFV & MAP if the
aldosterone infusion continues
indefinitely?

Ans 7)a) increases sodium level but the concentration does

not change much because water is reabsorbed also

B) increases ecfv and blood volume, increases mean

arterial pressure

C) prolonged aldosterone level causes pressure

natriuresis and decrease ecfv
 2

--

AT

The above
diagram shows the
action of aldosterone: physiological
1. what is the site of
the nephron?P
action of aldosterone in
2. What are the various
physiological stimuli
release of aldosterone? for
3. Describe the
aldosterone. physiological actions of
4. What is Conn's syndrome?

Aas 8)a) dct and collecting duct

B) decrease ecfv, decrease sodium and
potassium, acth
stimulation. angiotensin 2
C) reabs of sodium, excretion of
potassium, secretion
of proton into tubule

D) primary hyperaldosteronism , escape phenomena is

seen, anp causes diuresis
 NO
E

150

100

30

35 40
15 20
Time min
Norep.nephrne
Epnephnne Nor =
Ep
the
observations
regarding
Give your catecholemines

cardiovascular
effects of the
as
follows:
humans and answer

in effects
the reasons for differential
1. What are
CVS?
norepinephrine on
of epinephrine and

Which catecholemine is secreted

2.
predominantly in humans?

catecholemines physiologically
3. How do the
contribute to fight and flight response?

Ans 9)a) it maintains glucose levels, cns function, cvs

function duringfasting, it increases glucose during stress
 B) cortisol cannot express it effects in absence of
dtecholaminesC) hepatic eluconeogenesis increases.release
of
gluconeogenic substrates from peripheral tissue so,
Iucose levels increase and causes adrenal diabetes.

Give your observations

and the circadian
regarding the regulation
rhythm with respect to
Glucocorticoid secretion and answer:
1. Why are the glucocorticoids called stress
hormones and How they
provide resistance
to stress?

2. What are the

permissive actions of
glucocorticoids? What is their relevance in
emergency nmedicine?
3. What is adrenal diabetes? What are the
metabolic reasons for the same?

Ans 10)a) different receptors, ep on beta 1,2,3 and norep on

alpha receptors
B) epinephrine
cl increase blood flow to muscles,increase cellular metab

Ac face

Perdulous
atb3omen
Brusab bty
wth ecchymoses
Trun sn

STr

Poor muscie
Ceveicoment

Poor wOund
heang

the
observations o n the findings in
1. Give your
shown above and identify the
patient
conditior?
reasons for the
2. What are the physiological
following observations
abdomen and moon face shown
(a) pendulous
above?
wound
development and poor
(6) poor muscle

healing?
from diabetes?
3. Why do such patients suffer

Ans 11)a) cushing syndrome

B) excess protein catabolism and hence thin skin and

Subcutaneous fat moves towards the centre causing
pendulous abdomen, thin skin causes purple stria

C) insulin resistant DM