Please answer all question fully and be very detailed.

 

1.) How insufficiency of pancreatic hormones can be detected?

 

2.) Why diabetes mellitus is associated with polidypsia, polyphagia and polyuria?

 

3.) How common is gestational diabetes? How can it be diagnosed?

 

4.) What is a meaning of steroid diabetes? How can it be treated?

 

5.) What is a significance of thyroid hormones? What is their general effect of on body’s metabolism?

 

6.) Why patients with hypothyroidism are gaining weight? Give a brief description of symptoms which would be present in patients with hypothyroidism

 

 

7.) What is the significance of adrenal cortex? How different is it from the functions related to adrenal medulla?

 

8.) Briefly present what regiments of menopausal hormone replacement are in use?

 

9.) What is the common usage of testosterone replacement?

 

 

10.) Renin is secreted in response to hypovolemia or to an increase in the osmolality of the blood.

a. Provide three possible mechanisms by which these conditions may stimulate rennin secretion

b. What are the consequences of increased rennin secretion that lead to increased aldosterone secretion? Present this sequence of events.

c. Why are angiotensin converting enzyme inhibitors (ACEIs) used as a common therapy for hypertension? How do they influence blood pressure?

d. Are plasma levels of renin elevated or depressed in a patient with Conn’s disease? Why?

 

 

12.) A physician examines a patient who reports that he has experienced excessive sweating, irritability, and feverish episodes. Assay of hormones in blood reveal that thyroid hormone levels are abnormally high, and TSH levels are low. An RAIU (radioactive iodine uptake scan) reveals a hot spot on the thyroid, indicating a localized region of intense iodine uptake.

What do you predict that this patient’s diagnosis will be?

How would you attempt to treat such a condition?

 

 

13.) A significant drop in blood glucose invariably evokes the release of epinephrine from the adrenal medulla. The reduction in blood glucose is most likely registered by glucose responsive neurons in the brain, which than initiate neural signals that descend through the spinal cord, ultimately reaching the adrenal medulla and prompting release of E. 

Draw a line graph of the serum E and glucose levels that you would expect to see before, and at several time points after, the injection of a bolus insulin in an experimental rat.

Draw a second line to indicate the changes in these variables over time in insulin-injected rat in which the splanchnic nerve is sectioned.

 

 

14.) The symptoms of Cushing’s disease include abdominal obesity, hypertension, glucose intolerance (steroid diabetes), hirsutism, osteoporosis, polyuria, and polydipsia.

a. Describe the consequences of cortisol excess that would produce each of these symptoms.

b. Which tests can be performed to determine if a patient has primary or secondary Cushing’s disease? 

c. What would the results of these tests be for each type of disease?

 

15.) Individuals with Addison’s disease commonly exhibit an increased pigmentation of the skin. Propose a mechanism that can account for the development of this symptom.

 

16.) If a genetic female fetus is exposed to testosterone in utero, would that individual develop a complete male phenotypic sex, partial male phenotypic sex, or a normal female phenotypic sex? Explain your answer, describing the sex phenotype of the gonads, internal genital ducts and external genitalia. What would the developmental outcomes be if the fetus were instead exposed to dihydrotestosterone in utero?

 

17.) How do drugs such as Viagra (Pfizer) act to treat erectile dysfunction? Considering the cellular actions of drugs such as Viagra, why are these drugs not recommended for use by individuals who are taking nitroglycerine tablets for angina? Can you think of any other potential pharmacological strategies that might be used? Which molecules might be targeted for stimulation or inhibition in the arterial or cavernous smooth muscle cells? 

 

 

 

 

18.) T4 rather than T3 is generally thought to be the most appropriate treatment for hypothyroidism. T4 normally is the most appropriate hormone to use because it:

a. is the more potent hormone

b. has a higher binding affinity for the thyroid hormone receptor

c. has a larger extrathyroid pool with a slower turnover rate.

d. is the only form of thyroid hormones that can be transported into cells

e. all of the above.

 

19) Which pathologic condition would most likely cause increased thyroid radioactive iodine uptake?

a. primary hypothyroidism

b. secondary hypothyroidism

c. Grave’s disease

d. Hashimoto thyroiditis

 

20). Mr. Z. is a 27-year-old man with readily apparent thyroid goiter. He comments that he gained 5 pounds in the last year, and you notice that his weight is approximately 20 pounds greater than normal. What can you conclude about this patient’s thyroid function?

a. the goiter indicates that he is hyperthyroid

b. the combination of excessive weight and goiter indicates that he is hypothyroid

c. the combination of excessive weight and goiter indicates that he is hyperthyroid

d. he is probably euthyroid, because the weight gain eliminates the possibility of hyperthyroidism

e. it is not possible to make a conclusion from this information provided.

 

21.). For an answer to be correct, both the symptom and the explanation must be correct. Which answer is incorrect?

a. the resting heart rate increases because circulating levels of catecholamines increase. Excess thyroid hormones stimulate the release of more adrenal catecholamines.

b. myocardial contractility increases because thyroid hormones act directly on the heart and act indirectly by potentiating the effect of catecholamines on the myocardium.

c. peripheral resistance decreases because of cutaneous vasodilation as a thermoregulatory response.

d. the circulating half-lives of most exogenously administered drugs decrease because the rate of metabolism increases and drug inactivation is more rapid.

5. Ms. M. is a 59-year-old postmenopausal woman. The serum T4 is 8 microg/dl (n. 6 – 12); TSH is 4 microg/dl (n. 2 – 10). Body weight – 190 pounds, and she complains of depression. Her physician prescribes a low dosage of T4 to “pep her up”. What changes would you expect to see 4 weeks after the initiation of treatment?

a. the size of thyroid will be reduced

b. serum TSH will decrease

c. serum T4 will decrease

d. the basal metabolism rate will be elevated.

 

22.) Biologic actions of thyroid hormones include all of the following except:

a. stimulate protein synthesis and proteolysis

b. increase Na-K- ATP-ase activity

c. increase oxidative phosphorylation

d. stimulate growth and vascularity of the thyroid gland.

e. stimulate glycogenesis

 

23.) Which pair of symptoms and causes is most appropriate for hypothyroidism?

a. the skin is warm and moist because of peripheral vasodilation

b. diarrhea occurs because of increased GI secretion and motility

c. puberty is delayed or absent because TSH crossreacts LH and FSH receptors

d. myxedema occurs because mucopolysaccarides accumulate in the extracellular spaces.

e. there is a tendency to gain weight because appetite increases.

 

24). If you withdraw insulin from insulin-dependent diabetic patient, you would expect to see all of the following except:

a. a decrease in urinary bicarbonate levels

b. an increase in renal ammonium production

c. an increase release of alanine and glutamate from skeletal muscle

d. a decrease in BUN (blood urea nitrogen)

e. a decrease in PaCO2

 

25). Correct cause-and-effect relationships following insulin withdrawal in a person with diabetes mellitus include:

a. the ratio of K+ concentration inside the cell to K+ concentration outside the cell decreases in untreated diabetes for multiple reasons, including intracellular H+ buffering, which results in a shift of K+ to the extracellular compartment.

b. ketonemia does not increase urine flow because it is entirely reabsorbed in the renal tubule

c. urinary phosphate decreases because renal excretion of H+ results in increased phosphate reabsorption.

d. serum sodium rises because of fluid shift from the extracellular compartment to intracellular compartment.

e. glomerular filtration rate increases as a result of increased serum glucose concentration. 

 

26). The most effective direct stimulus for the release of glucagon is:

a. an increase in serum glucose

b. an decrease in serum glucose

c. somatostatin

d. insulin (direct action on the alpha cells).

 

27). People with non-insulin-dependent diabetes mellitus are generally not ketosis prone. This is thought to be a result of:

a. the lack of increase in glucagons in the se individuals

b. the presence of insulin in the individuals

c. their obesity

d. the fact that, their blood glucose levels do not tend to rise significantly.

 

28) Metabolic actions of insulin include all of the following except:

a. increased glycogenesis

b. decreased gluconeogenesis

c. increased basal metabolic rate

d. increased skeletal muscle amino acid up-take

e. all of the above are metabolic actions of insulin

 

29) The hormone least likely to be diabetogenic in excess is:

a. cortisol

b. GH

c. hCG

d. hPL

 

30). A patient has hypercortisolism, and the MRI results indicate that there is hyperplasia of the right adrenal but the left adrenal appears smaller than normal. What does this generally indicate about the origin of the adrenal disorder?

a. the adrenal hyperfunction most likely results from a secondary or tertiary disorder producing pituitary ACTH hypersecretion.

b. the adrenal hyperfunction is most likely a result of an ACTH-secreting nonadrenal tumor.

c. the adrenal hyperfunction is most likely a primary disorder resulting from malfunction of the adrenal gland.

d. the hypercortisolism is probably not a result of an adrenal disorder but rather is the result of exogenous administration of glucocorticoids.

 

31) Which of the following cause-and-effect relationships is correct?

a. weight gain in Cushing’s syndrome is a result of the lipogenic action of cortisol.

b. a person with adrenal insufficiency has difficulty excreting a water load in a normal period of time because of the actions of aldosterone on sodium and hence water reabsorption.

c. anemia occurs in Addison’s disease because of the action of cortisol on GI iron absorption and on erythropoetin release.

d. skin darkening in Addison’s disease individuals indicates that the site of the disorder is in the pituitary rather than the adrenal.

e. synthetic glucocorticoids are useful in the treatment of arthritis because they stimulate bone growth.

 

32). In humans, total adrenalectomy is fatal without replacement therapy whereas hypophysectomy is not. This is because after hypophysectomy:

a. the adrenal cortex undergoes compensatory hypertrophy

b. the adrenal catecholamines compensate for the metabolic actions of cortisol

c. the secretion of aldosterone is not markedly decreased.

d. tissue requirements for corticosteroids decrease markedly.

e. all of the above

 

33.). Factors that increase serum cortisol concentrations include all of the following except:

a. stress

b. eating a high-carbohydrate meal

c. pregnancy

d. exercise

e. all of the above

 

34). A 72-year-old man is suffering from nocturia, difficulty with urination, including decreased flow, and inability to completely empty the bladder. The prostate is symmetrically enlarged, nontender, and smooth. The predominant androgen associated with this enlargement is:

a. DHEA

b. androstenediole

c. testosterone

d. DHT

e. androsterone

f. a and c

 

35) Which of the following is true regarding the determinants of sexual development:

a. the presence of the gene for HY antigen on the Y chromosome determines whether a testis develops from the gonadal ridge.

b. the presence of MIS determines whether the Wolffian ducts develop.

c. the presence of estrogen determines whether a vagina develops.

d. the presence of DHT determines whether a prostate develops.

 

36). People with androgen insensitivity syndrome show developmental abnormalities. Which of the following primary or secondary sexual characteristics is most likely to be seen in these individuals? The presence of:

a. a prostate

b. a penis

c. breast development at puberty

d. descended testes

e. pubic and axillary hair

 

37.). The most significant source of serum testosterone in the normal woman is:

a. liver production from ovarian estradiol

b. peripheral production from adrenal DHEA

c. ovarian granulose cell production

d. luteal cell production

 

38.) What is the predominant cause of the diabetogenecity of pregnancy?

a. increased pancreatic insulin secretion

b. increased placental hPL secretion

c. increased pancreatic glucagon secretion

d. increased placental ACTH secretion.

 

39). Anabolic steroid abuse can produce a significant reduction in the size of the testes. Provide a plausible explanation for this phenomenon. Discontinuing anabolic steroid abuse may permit the testes to reattain their original size. 

Describe the probable sequence of events that may underlie this regrowth.