Studied by 1 PersonTags & Description
A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness.
*Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12)
What condition does our BCTC student have?
Diabetes Mellitus (shown by high blood sugar)
A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness.
*Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12)
Why might he lose weight when his plasma glucose is up?
Because his body either does not produce or does not respond to insulin, his cells do not absorb glucose from your bloodstream, which causes him to have high blood-glucose levels. Because his cells have no glucose coming into them from his blood, his body "thinks" that it is starving, a condition called polyphagia. This causes the body to consume its fat and protein storage for metabolism instead of glucose.
A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness.
*Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12)
What is his acid-base disturbance?
Metabolic acidosis/Ketoacidosis; breakdown protein/fat for metabolism releases H+, this release of H+ causes acidosis
A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness.
*Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12)
. Explain his respiratory rate, how does it relate to his acid-base disturbance?
Respiratory compensation for ketoacidosis: rapid, increased H+ leads to increased CO2, increased respiratory drive to blow off CO2 and get rid of H+.
A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness.
*Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12)
Explain what causes his high urine output.
Glucose acts as an osmotic diuretic. The body will try to get rid of glucose (glucose pulls fluid, lose excess H2O).
A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness.
*Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12)
Explain his hematocrit.
Loss of H2O causes increase RBC concentration; leaves RBC's behind, increased ratio of RBCs to H2O.
A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness.
*Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12)
Explain why his pulse rate is high upon standing.
Fluid loss leads to decreased blood pressure, stimulates the arterial baroreflex which leads to an increase in SNS activity and an increased heart rate
A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness.
*Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12)
Discuss his ADH levels. Explain why they are high or low.
High ADH levels - increase in solute/solvent concentration leads to increased plasma osmolarity and decreased blood volume which stimulates ADH
A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness.
*Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12)
What would be a possible treatment for his condition?
Insulin injections
A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3
He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated.
What endocrine organ is the site of the malfunction?
Adrenal Cortex. If cortisol were present, there would be an inhibitory effect on ACTH production, and if the adrenal cortex were functional, cortisol would be released. The lack of cortisol combined with the elevated levels of ACTH means that the problem is in the adrenal cortex.
A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3
He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated.
Is this a primary or secondary disturbance? How do you know?
Primary disturbance, problem is at the adrenal gland, cortisol did not rise with ACTH.
A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3
He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated.
What is the name of this disorder?
Addison's Disease
A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3
He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated.
Discuss the electrolyte disturbances resulting from this disorder (normal vs. diseased).
Low sodium levels, high potassium levels. Adrenal cortex is also the site of aldosterone release, so decrease in aldosterone.
A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3
He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated.
Discuss the glucose disturbances resulting from this disorder (normal vs. diseased).
Cortisol is not being released from adrenal cortex (glucogenesis); normally cortisol levels increase blood sugar
A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3
He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated.
What is the cause of the tanning?
Pituitary gland produces more ACTH in an attempt to stimulate adrenal gland, ACTH stimulates MSH production which causes the tanning.
A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3
He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated.
What type of replacement therapy would be required for this individual?
Corticosteroids, synthetic aldosterone
A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3
He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated.
Describe the feedback loop for this endocrine disorder. Where is the loop broken?
Decreased aldosterone and cortisol -> hypothalamus -> CRH -> anterior pituitary -> ACTH -> adrenal cortex -> increased aldosterone and cortisol. The loop is broken at the adrenal cortex.
A 38-year old female visits her doctor complaining of chronic fatigue and weakness, especially in her legs. Upon greeting the patient, the doctor notes that although she is mildly obese, there is an unusually round contour to her face. During questioning, he learns that at her recent 20-year high school reunion, nobody recognized her because her face looked so different. Physical examination yields an unusual fat distribution consisting of a hump on the upper back and marked centripedal obesity. Blood pressure is also abnormally high.
What is your diagnosis? Explain how you reached this diagnosis.
Cushing's Disease. Increased blood pressure, increased cortisol leads to centripedal obesity, moon face, and buffalo hump.
Mr. Jessup, a 55-year old man, is operated on for a cerebral tumor. About a month later, he appears in his physician's office complaining of excessive thirst. He claims to have been drinking about 20 liters of water daily for the past week and voiding nearly continuously. A urine sample is collected, its specific gravity is reported at 1.001.
What is your diagnosis?
Diabetes insipidus
Explain both types of diabetes and how they are different.
Insipidus: ADH deficiency causes huge urine output, thirst (urine specific gravity is low) Mellitus: Insulin deficiency causes loss of glucose in urine, increased urine osmolarity and increased specific gravity.
Explain both types of diabetes insipidus.
Nephrogenic: Decreased response to ADH, retain fluid, headache, disorientation due to brain edema Neurogenic: Decreased ADH secretion, kidney not stimulated to retain water
Sharon went to her doctor with the following symptoms: dull facial expressions; droopy eyelids; puffiness of the face; sparse, dry hair; scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (Hct 27); constipation and hypothermia. Plasma concentrations of T3 and T4 were low and TSH levels were elevated. Following administration of exogenous TSH, plasma T3 and T4 did not rise after 2 hours.
What is the disorder?
Hypothyroidism
Sharon went to her doctor with the following symptoms: dull facial expressions; droopy eyelids; puffiness of the face; sparse, dry hair; scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (Hct 27); constipation and hypothermia. Plasma concentrations of T3 and T4 were low and TSH levels were elevated. Following administration of exogenous TSH, plasma T3 and T4 did not rise after 2 hours.
Is this a primary or secondary disorder?
Primary - problem is with the target organ, no T3 and T4 even though increase in TSH.
Sharon went to her doctor with the following symptoms: dull facial expressions; droopy eyelids; puffiness of the face; sparse, dry hair; scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (Hct 27); constipation and hypothermia. Plasma concentrations of T3 and T4 were low and TSH levels were elevated. Following administration of exogenous TSH, plasma T3 and T4 did not rise after 2 hours.
Would you expect to find a palpable goiter? Explain
Yes - high TH and low T3 and T4 levels, the follicles keep producing more and more tyrosine which binds to colloid causing the swelling.
Sharon went to her doctor with the following symptoms: dull facial expressions; droopy eyelids; puffiness of the face; sparse, dry hair; scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (Hct 27); constipation and hypothermia. Plasma concentrations of T3 and T4 were low and TSH levels were elevated. Following administration of exogenous TSH, plasma T3 and T4 did not rise after 2 hours.
Describe the feedback loop involved. Where is the loop broken?
Hypothalamus -> TRH -> Anterior Pituitary -> TSH -> Thyroid -> T3 and T4. The loop is broken at the thyroid gland.
Sharon went to her doctor with the following symptoms: dull facial expressions; droopy eyelids; puffiness of the face; sparse, dry hair; scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (Hct 27); constipation and hypothermia. Plasma concentrations of T3 and T4 were low and TSH levels were elevated. Following administration of exogenous TSH, plasma T3 and T4 did not rise after 2 hours.
Describe a suitable treatment for Sharon.
Synthroid or iodine
left ovary
a
uterine horn
b
vagina
c
uterus
d
uterine horn
e
right ovary
f
thyroid
a
cervical thymus
b
thoracic thymus
c
adrenal gland
d
pancreas
e
ureter
1
uterus
2
uterine tube
3
cervix
4
urinary bladder
5
ovary
6
ostium of uterus
7
labium minus
8
labium majus
9
clitoris
10
urethra
11
vagina
12
mons pubis
13
ureter
1
uterus
2
ureterine tube
3
ovary
4
urinary bladder
5
vagina
6
labium minus
7
labium majus
8
clitoris
9
mons pubis
10
pubic bone
11
vas deferens
a
scortum
b
testes
c
epididymis
d
ureter
a
ureter
b
ductus deferens
c
seminal vesicle
d
prostate
e
testicular artery
f
epididymis
g
testis
h
scrotum
i
glans penis
j
penis
k
pubic bone
l
urinary bladder
m
ureter
a
urinary bladder
b
prostate
c
pubic bone
d
spongy urethra
e
external urethral orifice
f
