Endocrine & Reproduction Mini-Case Studies – 30 points
Make a copy of your answers before coming to lab.
Directions: Read the following case studies and answer each accurately and completely. Answers should be typed and will be graded for content, grammar, spelling, etc. Avoid plagiarism – students who copy directly from the book, another student’s paper, or “cut & paste” from an internet source, will receive a “0.” Papers must be typed. Late papers will not be accepted. These are due at the beginning of Lab 12.
1. A 36-year old mother of four is considering tubal ligation as a means of ensuring that her family gets no larger. She asks the physician if she will become “menopausal” after the surgery. How would you answer her question and explain away her concerns. (2 points)
2. A woman who is taking birth-control pills that consist of only progesterone experiences the hot flash symptoms of menopause. Explain why. (1 point)
3. Dr. Adams 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.
a. What is the disorder? (1 point)
b. Is this a primary or secondary disorder? (1 point)
c. Would you expect to find a palpable goiter? Explain (2 points)
d. Describe the feedback loop involved. (2 points)
e. Describe a suitable treatment for Dr. Adams. (1 point)
4. Dr. Davis had a total thyroidectomy followed by thyroid hormone replacement therapy. A few days later she developed laryngeal spasms, a mild tetany, and cramps in the muscles of the hands and arms. The following tests were performed:
Urinary calcium 20 mg/dL
Urine phosphorus 0.1 g/day
Plasma calcium 7.0 mg/dL
Plasma phosphorus 5.0 mg/dL
Calcium and vitamin D were given orally each day and the tetany and laryngeal spasms were alleviated.
a. What endocrine disorder does Dr. Davis have? (2 points)
b. What caused the tetany and laryngeal spasms? ( 2 points)
c. What is the purpose of the vitamin D administration with the calcium? (2 points)
5. Dr. Whitescarver presented to her physician with a chief complaint of polyuria and excessive polydipsia. Her polyuria began abruptly two weeks prior when she was operated on for a cerebral tumor. Prior to that time, Dr. Whitescarver voided approximately five times per day. She estimated that she was now voiding twenty times per day. Two days prior to her visit to the doctor's office she was advised to collect her urine in order to check its volume in a 24 hour period; her total urine volume measured 12 liters. Dr. Whitescarver’s doctor performed a physical exam and ordered lab tests. Review the results.
Blood glucose: 95 mg/dL (normal)
Urine specific gravity: 1.001 (dilute)
Dry oral mucus membranes & skin tenting (skin remains elevated when pinched)
Do the above test results support a diagnosis of diabetes mellitus? Be sure to explain plasma glucose level and urine osmolarity. (2 points)
6. Malcolm is a 42-year old male who visits his doctor complaining of chronic fatigue, especially in his legs. Upon greeting the patient, the doctor notes that although he is mildly obese there is an unusually round contour to his face. During questioning, he learns that at his recent 20 year college reunion, nobody recognized him because his face looked so different. Physical examination yields an unusual fat distribution consisting of a hump on the upper back and marked centripetal obesity. Blood pressure was also high. Explain your diagnosis. (2 points)
7. Dr. Jackson has been diagnosed with primary Addison’s disease.
a. Explain why her plasma sodium and glucose levels are elevated and her plasma potassium levels are low. (2 points)
b. Why is Dr. Jackson’s skin tanned even in the winter? (2 points)
8. Dr. Frisbie has just been brought into the emergency room of Central Baptist Hospital. She is perspiring profusely and is breathing rapidly and irregularly. Her breath smells like acetone (sweet and fruity), and her blood glucose levels are 650 mg/100 ml of blood. Her blood pH is 7.33.
a. What hormone drug should be administered and why? (2 points)
b. Why is her blood pH low? (2 points)
c. Why is she breathing rapidly? (2 points)