เฉลย NL 2010 CU

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3 ii () iii 64 1. A.Purine Uric acid is the final breakdown product of dietary or endogenous purines and is generated by xanthine dehydrogenase (xanthine oxidase), primarily in the liver and intestine. Exogenous purines also represent an important source of uric acid, and approximately 50% of RNA purines and 25% of DNA purines are absorbed in the intestine and subsequently excreted in urine.

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The Essential Contents for National Licensing Examination 2010 MDCU 64 CHULALONGKORN

http://www.medscape.com/viewarticle/472684_2 2. E.Alpha-tocopherol

Alpha-tocopherol terminal chain reaction 2 (tocopheryl quinine) (tocopheryl radical) 3. C.Mitochondria ( heme synthesis human )

Heme is synthesized in all human nucleated cells. It involves a series of enzymatic reactions taking place partly in the mitochondrion and partly in the cytoplasm (Fig. 2). Heme requirements vary significantly among various cells and tissues. The most rapid rates of heme synthesis occur in the erythroid cells in the bone marrow [75% of total body heme and the hepatocytes in the liver. http://pharmrev.aspetjournals.org/content/55/3/551.full#F2 4. D.Single base deletion

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A frameshift mutation is a type of mutation involving the insertion or deletion of a nucleotide in which the number of deleted base pairs is not divisible by three. "Divisible by three" is important because the cell reads a gene in groups of three bases. Each group of three bases corresponds to one of 20 different amino acids used to build a protein. If a mutation disrupts this read 5. E. ( ) X=linked dominant A B C D X Y X 6. A.Testis ( (Parotid gland) ) 1) 2) 1 6,000 3) 4) : 7. A.Osteoporosis estrogen in CVS total cholesterol and LDL HDL bone resorption ( menopause = ovarion tissue gradually ceases to respond to stimulation by anterior pituitary gland ) osteoporosis CVS ex hypertension dyslipidemia 8. E.Cobalamin Terminal ileum vitamin B12 Terminal ileum vitamin B12 deficiency megaloblastic anemia ileum bile salt entero-hepatic circulation

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9. A. 135,3.5,32 Congenital hypertrophy pyloric stenosis Nonbilious projectile vomiting electrolyte abnormalities hyponatremic, hypokalemic, hypochloremic metabolic alkalosis Potassium level: 3.55 mmol/L Bicarbonate level: 2226 mmol/L Sodium level: 135 - 145 mmol/L 10. 26C 37C Decreased glycogenolysis Decreased oxegen consumption Increased gluconeogenesis Increased thyroid hormone secretion Increased lipolysis of brown adipose tissue BROWN ADIPOSE TISSUE The main function of the multilocular adipose cells is to produce heat by nonshivering thermogenesis. In newborn mammals (including humans) that are exposed to an environment colder than the mother's uterus, nerve impulses liberate norepinephrine into brown adipose tissue. As in white fat, this neurotransmitter activates the hormonesensitive lipase present in adipose cells, promoting hydrolysis of triglycerides to fatty acids and glycerol. However, unlike white fat, liberated fatty acids of multilocular adipocytes are quickly metabolized, with a consequent increase in oxygen consumption and heat production, elevating the temperature of the tissue and warming the blood passing through it. REF: Junqueira's Basic Histology: Text & Atlas, 12e 11. 55 10 Decreased deep tendon reflexes and light touch vitamin Retinol : Thiamine Ascorbic acid Calciferol Tocopherol Patients with chronic alcoholism may have poor dietary intakes of thiamine and impaired thiamine absorption, metabolism, and storage. Dry beriberi involves both the peripheral and the central nervous systems. Peripheral nerve involvement is typically a symmetric motor and sensory neuropathy with pain, paresthesias, and loss of reflexes. Retinol (Vit A) : Night-blindness, Hyperkeratosis,dry skin Thiamine (Vit B1) : Wet beriberi, dry beriberi

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Ascorbic acid (Vit C) : Scurvy Calciferol (Vit D) : Rickets, Osteomalacia, hypocalcemic tetany Tocopherol (Vit E) : hemolytic anemia 12. Adrenergic agonist dilated pupil sympathetic sympathomimetic Adrenergic agonist 13. b.depression SSRIs antidepressant 14 B. Acinetobacter baumannii gram neg-coccobacilli (pneumonia) ventilator-associated (Intensive Care Unit, ICU) Klebsella pneumoniae rods alcoholism UTI Pseudomonas aeruginosa rods pneumonia in cystic fibrosis Haemophilus influenzae pediatric infection 15 A. Anaerobes anaerobes 16. D. Aspergillus fumigates branching septate hyphae hyaline mold brain abscess Fusarium filamentous fungi species opportunistic infections fusarium (onychomycosis) cornea (keratomycosis or mycotic keratitis) Rhizopus non-septate mold order Mucorales mucormycosis Penicillium marneffei dimorphic fungi 25 mold hyphae conidia 37 intracellular fission yeasts clinic umbilication molluscum like lesion skin Histoplasma capsulatum dimorphic fungi intracellular budding yeast cell capsule yeast cell 17. A.Epidermophyton floccosum -- often causes tinea pedis, tinea cruris, tinea corporis and onychomycosis --slow growing, greenish-brown or khaki coloured with a suede-like surface, raised and folded in the centre -- Microscopic morphology shows characteristic smooth, thin-walled macroconidia B. Candida albicans-- Microscopic morphology shows spherical to subspherical budding yeast-like cells or blastoconidia -- occurs naturally as a commensal of mucous membranes and in the digestive tract c. Malassezia furfur -- Malassezia furfur in skin scale from a patient with tinea versicolor

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-- yeast cells and short pseudohyphal

d.Microsporum canis -- Macroconidia are typically spindle-shaped with 5-15 cells, verrucose, thick-walled and often have a terminal knob -- zoophilic dermatophyte of world-wide distribution which is a frequent cause of ringworm in humans, especially children. Invades hair, skin and rarely nails. E. Trichophyton rubrum -- Typical slender clavate microconidia downy type. Typical cigar shaped macroconidia of T. rubrum granular type. -- anthropophilic dermatophyte, causes chronic infections of skin, nails and rarely scalp

18. B A. Clostridium botulinum : Food Poisoning B. Clostridium tetani : usually enters a host through a wound. C. Clostridium difficile : competing bacteria are wiped out by antibiotics. > Diarrhea D. Clostridium perfringens : Food Poisoning > Gas gangrene E. Clostridium septicum : Hematogenous spread from the GI tract > Gas gangrene spore Clostidium spore ? 19. C. Ancylostoma spp. Reasons : iron deficiency anemia, eosinophilia, Ancylostomiasis Necator americanus Ancylostoma duodenale 6000-20000 1-2 rhabditiform larvae 5-10 filariform 5-10 1-2

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rhabditiform 20. B (Trichuris trichiura) - Size 50-54 x 22-23 micron - Shape (barrel shape) - Color - Egg shell 2 bipolar mucous plug - Content yolk sac 21. A - (Paragonimus westernmani) - 2nd IH

22. E. Taenia solium A. Diphyllobothrium latum ()

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B. Hymenolepis nana(dwarf tapeworm) / autoinfection/ , day-care C. Hymenolepis diminuta

23. E. T lymphocyte Digeorge Syndrome ( deletion 22q11.2 ) - absence of thymus => T cell defect - parathyroid hypoplasia => hypocalcemia - birth defect congenital heart disease , cleft palate - hypertelorism(), micrognathia(), short philtrum with fish-mouth appearance, antimongoloid slant( ), telecanthus with short palpebral fissures

24. D (IgE- mediated)

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IgE

Cytotoxic(Anti body): IgM, IgG

Immune Complex

Delayed (Tcell mediated)

USMLE 2010 209 25. D.T lymphocyte thymus gland T lymphocyte thymus gland T lymphocyte tonsil Mature B cell tonsil B lymphocyte B lymphocyte B lymphocyte T lymphocyte Severe combined immunodeficiency (SCID)

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26. D Antigen-antibody complex deposition abnormal urinalysis BUN creatinine > "" renal blood flow GFR hematuria, hypertension, edema > "glomerulonephritis" Hx infection (pharyngitis) dx : "Acute poststreptococcal glomerulonephritis" (APSGN) "Acute poststreptococcal glomerulonephritis" (APSGN) - Acute proliferative glomerulonephritis - group A beta hemolytic streptococci - antigen antigen M T antigen nephritogenic - M-type 1, 3, 4, 12, 25 49 APSGN streptococcal pharyngitis M-type 2, 49, 55, 57 60 APSGN - circulating immune complex - = delayed-type hypersensitivity , superantigens M proteins and pyrogenic exotoxins .. - Acute glomerulonephritis bacteria, virus parasite Staphylococcus aureus, Staphylococcus epidermidis, Mycoplasma sp., Leptospira sp., Ebstein-Barr virus, Human immunodeficiency virus Toxoplasma - - 2-6 Streptococci - pharyngitis 1-3 3-6 - APSGN acute nephritis 4-7 references : - ,, Acute proliferative glomerulonephritis >> http://qsnichpediatrics.com/node/175 - eMedicine ,, Acute poststreptococcal glomerulonephritis >> http://emedicine.medscape.com/article/980685overview 27. A. IgA IgA mucosal antibody secretory IgA (sIgA), subclass IgA2 dimer J chain

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28 E Deep vein thrombosis Rate of flow -> The consistency (thickness) of the blood Qualities of the vessel wall Rate of flow stasis 29 A (Pb) sulfhydryl groups enzyme delta-aminolevulinic acid dehydratase

39. A. Midbrain : Parkinsons disease bradykinesia, resting tremor, hypertonia, shuffling gait, cogwheel rigidity, postural instability, poker face(slow facial expression, showing no emotions), micrographia dopaminergic neuron in substantia nigra located in midbrain 40. C. Carbamazepine : Diabetic neuropathy (most common of all the late complications of diabetes, Symmetric sensory diabetic neuropathy is the most common form of diabetic neuropathy 2 ) painful sensation Medications(Uptodate) - Duloxetine(SNRIs), Pregabalin(Analgesic/Anticonvulsant) are only drugs approved by FDA to control pain from DM neuropathy ( choice)

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- TCA Nortriptyline, Amitryptyline, Fluoxetine - Anticonvulsant Pregabalin, Gabapentin, Carbamazepine, Lamotrigine - Capsaicin - Other anesthetic drugs 41. B. Acetylcholine Delirium (Disturbance of consciousness and cognition + hallucination from medical condition or substance toxicity) acetylcholine sedative agent ( anticholinergic effect) 42. B. Dopamine Schizophrenia neurotransmitter Dopamine imbalance positive symptoms(increased dopamine in mesolibic) + negative symptoms(decreased dopamine in mesocortex) 43. A. Folic acid Valproic acid neural tube defect folic acid neural tube defect 44. A. enhanced GABA activity Diazepam Benzodiazipine enhanced GABA activity 45. B. Tyrosinase Albinism melanin eyes, skin, hair follicle + (occulocutaneous albinsim) (squamous cell CA) Tyrosinase oxidation phenol (tyrosine) melanin 46. B sweat gland choice A. Micrococcus luteus B. Staphylococcus aureus C. Streptococcus pyogenes D. Propiobacterium acnes E. Staphylococcus epidermidis

normal flora skin infect involve sebaceous gland normal flora skin Prosthetic device

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47. E free nerve endings nociceptor free nerve endings epidermis dermis subcutaneous tissue 48. A Triamcinolone - corticosteroid 387 First aid USMLE 2010

Phospholipase inhibitor: Corticosteroid (ex Benclomethasone, Prednisolone) Cyclooxygenase inhibitor: NSAIDs, acetaminophen, COX-2 inhibitor(-coxib), Aspirin Lipoxygenase inhibitor: Zileuton Leukotriene antagonist: -lukast: zafirlukast, montelukast Mast cell stablizer: Cromolyn 49. E Gnathostomiasis second intermediate host

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* (Gnathostoma spinigerum) Accidental Host (encysted advanced third stage larvae) Second intermediate host * intermediate host 2 cyst common Subcutaneous, , Definite host First intermediate host (Cyclops) Second intermediate host choice A. Filariasis Lymphatic Filariasis Subcutaneous Filariasis Loa loa, M ozzardi, M perstans, M streptocerca B. Toxocariasis Toxocara visceral larva migrans C. Trichinellosis tissue fever,muscle edema,myalgias , D. Strongyloidiasis (Strongyloides stercolaris) (Strongyloides papillosus) Lung migration filaria form ( first aid) Filariasis: Wuchereria Bancrofti Toxocariasis: Toxocara canis Transmission - > Female mosquito Transmission - > Food contaminated with egg Disease -> lymphatic blockage(elephantiasis) 9mo-1yr Disease -> Granuloma ( retina -> blindness), visceral larva migrans Trichinellosis: Trichinella spiralis Strongyloidiasis: Strongyloides stercoralis Transmission - > Undercooked meat, usaually pork Transmission - > larvae in soil penetrate to skin Disease - > Muscular inflammation(larvae encysts in Disease - > intestinal infection, vomiting, anemia, muscle), Periorbital edema diarrhea Gnathostomiasis - > Gnathostoma spinigerum Transmission - > larvae (advance 3rd stage larvae) in , , Disease - > (Subcutaneous migratory swelling)

50. -E epithelium basement membrane connective tissue squamous cell carcimoma Stratum germinativum (stratum basale) epidermis epithelium cell

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51. -A KOH preperation septate hyphae C,D E Tinea versicolor Budding yeasts&Short hyphae candida Budding yeasts & pseudohyphae Tinea cruris Tinea corporis Dermatophyte forming irregular rings with inflammatory borders & clearing in the central area Tinea cruris Tinea corporis 52. -Bcelecoxib selective COX-2 inhibitor side effect NSAIDS COX-1 NSAIDs Non-selective side effect Non-selective COX-1 ( PGE2, PGI2 cytoprotective ) 53 B. -Acinetobacter spp.: Gram-negative coccobacilli, non-motile, oxidase negative, strictly aerobic ; A. baumannii nonfermenting bacteria nosocomial infection lateonset VAP

A. baumannii http://www.buddycom.com/bacteria/gnr/gnrfastid.html) -Neisseria gonorrhoeae: Gram-negative coffee-bean shaped diplococci bacteria, facultative intracellular with fastidious growth requirements chocolate agar with carbondioxide Thayer-Martin agar, oxidase & catalase positive; Outer surface with multiple antigens: pili protein; Por proteins; Opa proteins; Rmp protein; protein receptors for transferrin, lactoferrin, and hemoglobin; lipooligosaccharide; immunoglobulin protease; -lactamase Neisseria gonorrhoeae Gonorrhea: characterized by purulent discharge for involved site (e.g., urethra, cervix, epididymis, prostate, anus) after 2- to 5-day incubation period Disseminated infections: spread of infection from genitourinary tract through blood to skin or joints; characterized by pustular rash with erythematous base and suppurative arthritis in involved joints Ophthalmia neonatorum: purulent ocular infection acquired by neonate at birth

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(N. gonorrhoeae http://archive.microbelibrary.org/ASMOnly/details_print.asp?id=2965&lang=) -Haemophilus influenzae: Hib (encapsulated type b), small, pleomorphic, gram-negative rods or coccobacilli, facultative anaerobes, fermentative, most species require X and/or V factor for growth Haemophilus influenza Meningitis: primarily a disease of unimmunized children; characterized by fever, severe headache, and systemic signs Epiglottitis: primarily a disease of unimmunized children; characterized by initial pharyngitis, fever, and difficulty breathing, and progressing to cellulitis and swelling of the supraglottic tissues, with obstruction of the airways possible Pneumonia: inflammation and consolidation of the lungs observed primarily in the elderly with underlying chronic pulmonary disease; typically caused by nontypeable strains

(Gram stains of Haemophilus influenzae. A, Small coccobacilli forms seen in sputum from patient with pneumonia. B, Thin, pleomorphic forms seen in 1-year-old, unvaccinated child in Africa with overwhelming meningitis Murray Medical Microbiology, 6th edition) -Salmonella enteric (nonthyphoidal salmonella): Gram-negative rod-shaped, flagellated, facultative anaerobe, fermenter, oxidase negative poultry, pork, egg

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(S. enteric http://bioweb.uwlax.edu/bio203/s2009/meinhard_jaso/Phylogenetic%20Tree.htm) -Burkholderia pseudomallei: Gram-negative, bipolar, aerobic, molite, rod-shaped bacteria, "safety pin" appearance melioidosis Ashdowns medium

(Burkholderia pseudomallei http://www.nature.com/nrurol/journal/v4/n2/fig_tab/ncpuro0713_F3.html) 54 B C

table 348-1 (from Harrison Online)) 40 SLE prednisolone 3 Choice A B C E estrogen 3 early menopause A Uptodate online Musculoskeletal manifestations of systemic lupus erythematosus OSTEOPOROSIS

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Loss of trabecular bone density is a significant problem in patients with SLE. Trabecular bones (eg, ribs, vertebrae) are more likely to be involved than long cortical bones. There are no symptoms unless fractures occur. Thus prevention, recognition, and treatment of bone mineral loss are important for the prevention of fractures. calcium 3 bone mineral loss fracture D E Prednisolone Prednisolone Corticosteroid chronic glucocorticoid therapy serious side effects Osteoporosis glucocorticoid-induced osteoporosis C ( Harrison online Chapter 348. Osteoporosis Glucocorticoid-Induced Osteoporosis) B (Low exercise) C (Corticosteroids) 55. B asbestos 56. E 57. D 58. A beta-2 adrenegic agonist 59. A surfactant 60. D Squamous cell carcinomas are more likely to be associated with hypercalcemia due to parathyroid like hormone production. 61. B 62. B tetralogy of fallot = right ventricular hypertrophy + overriding aorta + pulmonary stenosis + VSD 63. C 64 E. CAD MAJOR risk factors from NCEP: CAD 1. Age (e.g., >45yo for men, >55yo for women unless premature menopause w/o HRT) 2. Family history (e.g., MI or sudden death at 7 if plasma HCO3 concentration is normal, and a urine pH < 5.5 if plasma HCO3 concentration is already depleted from ongoing losses. This syndrome may occur as part of a generalized dysfunction of proximal tubules and can be associated with increased urinary excretion of glucose, uric acid, phosphate, amino acids, citrate, Ca, K, and protein. Osteomalacia or osteopenia (including rickets in children) may develop. Mechanisms may include hypercalciuria, hyperphosphaturia, alterations in vitamin D metabolism, and secondary hyperparathyroidism. Type 2 RTA is very rare and most often occurs in patients who have one of the following: Fanconi syndrome Light chain nephropathy due to multiple myeloma Various drug exposures (usually acetazolamide SOME TRADE NAMES DIAMOX, sulfonamides, ifosfamide SOME TRADE NAMES IFEXMITOXANA, outdated tetracycline SOME TRADE NAMES ACHROMYCIN V TETRACYN TETREX, or streptozocin SOME TRADE NAMES ZANOSAR) It sometimes has other etiologies, including vitamin D deficiency, chronic hypocalcemia with secondary hyperparathyroidism, kidney transplantation, heavy metal exposure, and other inherited diseases (eg, fructose intolerance, Wilson's disease, oculocerebrorenal syndrome [Lowe syndrome], cystinosis). 90. furosemide furosemide acts by inhibiting the Na-K-2Cl symporter in the thick ascending limb of the loop of Henle 91. B Acute tubular necrosis proximal tubule cell necrosis 92. A. Acute tubular necrosis

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CAUSES

True volume depletion - Volume depletion may be caused from gastrointestinal disease (vomiting, diarrhea, bleeding), renal losses (diuretics, glucose osmotic diuresis), skin or respiratory losses (insensible losses, sweat, burns), and third space sequestration (crush injury or skeletal fracture) Hypotension Edematous Selective renal ischemia Drugs affecting autoregulation

Urine volume the urine volume is typically, but not always, low (oliguria) in prerenal disease due to the combination of sodium and water avidity. In comparison, patients with ATN may be either oliguric or nonoliguric. Rate of rise of plasma creatinine concentration the plasma creatinine concentration tends to rise progressively in ATN. 93. E ADH permeability distal tubule collecting duct 94. A. Lupus nephritis Systemic lupus erythematosus (SLE) The American College of Rheumatology 1982 revised criteria for the classification of SLE Any 4 of the 11 criteria are required to classify a patient as having SLE. These criteria can be present serially or simultaneously during any interval of observation. 1. Malar rash o Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds. 2. Discoid rash o Erythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur in older lesions. 3. Photosensitivity o Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation. 4. Oral ulcers o Oral or nasopharyngeal ulceration, usually painless, observed by physician. 5. Arthritis

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Non-erosive arthritis involving 2 peripheral joints, characterised by tenderness, swelling, or effusion. 6. Serositis (one of the following): o Pleuritis: convincing history of pleuritic pain, pleural rubs on auscultation, or evidence of pleural effusion. o Pericarditis: documented by ECG, pericardial rub, or evidence of pericardial effusion. 7. Renal disorder (one of the following): o Persistent proteinuria >0.5 g/day or >3+ if quantification not performed. o Cellular casts: may be red cell, haemoglobin, granular, tubular, or mixed. 8. Neurological disorder (one of the following): o Seizures: in the absence of offending drugs or known metabolic derangements; for example, uraemia, ketoacidosis, or electrolyte imbalance. o Psychosis: in the absence of offending drugs or known metabolic derangements; for example, uraemia, ketoacidosis, or electrolyte imbalance. 9. Haematological disorder (one of the following): o Haemolytic anaemia: with reticulocytes o Leukopenia: 90%). Papillary tumors are the most common of all thyroid cancers (>70%). Papillary thyroid carcinoma Intranuclear pseudoinclusion Psammoma bodies

Malignant

Papillary pattern

Orphan Annie eye nuclear inclusions (nuclei with uniform staining, which

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Nuclear groove

appear empty)

DIAGNOSIS: Papillary thyroid carcinoma is usually discovered on routine examination as an asymptomatic thyroid nodule that appears as a neck mass. In some instances, the mass may have produced local symptoms. This mass is normally referred to a fine needle aspiration biopsy (FNA) for investigation. FOLLOW-UP: In addition to the usual cancer follow up, patients should receive a yearly chest x-ray as well as thyroglobulin levels. Thyroglobulin is not useful as a screen for initial diagnosis of thyroid cancer but is quite useful in follow up of well differentiated carcinoma (if a total thyroidectomy has been performed). A high serum thyroglobulin level that had previously been low following total thyroidectomy especially if gradually increased with TSH stimulation is virtually indicative of recurrence. A value of greater than 10 ng/ml is often associated with recurrence even if an iodine scan is negative. PROGNOSIS: Most patients fall into the low risk category and are cured of the cancer at the time of surgery.http://www.endocrineweb.com/conditions/thyroid-cancer/papillary-cancer http://reference.findtarget.com/search/papillary%20thyroid%20cancer/ .. , Biochemistry of Hormone

110. D. Somatotroph

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X. Cell > Hormone secreted by the cell (diseases caused by hypersecretion) A. Lactotroph > Prolactin (amenorrhea,galactorrhea) B. Thyrotroph > TSH (Hyperthyroidism) C. Corticotroph > ACTH (Cushing: moon face, red cheeks, buffalo humps, trunkal obesity, purple striae) D. Somatotroph > GH (Gigantism, Acromegaly: , carpal tunnel syndrome, OA) E. Gonadotroph > FSH, LH (Amenorrhea)

Acromegaly

Cushings syndrome

113. C. Vasopressin (Antidiuretic hormone ;ADH) ADH () Hypothalamo neurohypophyseal System ADH cAMP ( tuble collecting duct) ( : http://www.medtechzone.com/data/sero/ADH.php)

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B Oxytocin 1. 2. myoepithelial cell alveolus alveolar duct A,D,E Renin-Angiotensin-Aldosterone System 1.Sympathetic stimulation 2.Hypotension 3.Decreased Sodium delivery

: http://www.merck.com/media/mmhe2/figures/MMHE_03_022_01_eps.gif 112. Problem list - hyperthyroid diffuse thyroid enlargement (60g) 25 g. rubbery consistency - CA CA TSH T4 - euthyroid goiter A. Idiopathic cause B. Decreased hormone production - T4 TSH feedback C. Iodine deficiency Simple nontoxic goiter, which may be diffuse or nodular, is noncancerous hypertrophy of the thyroid without hyperthyroidism, hypothyroidism, or inflammation. Except in severe iodine deficiency, thyroid function is normal and patients are asymptomatic except for an obviously enlarged, nontender thyroid. Diagnosis is clinical and with determination of normal thyroid function. Treatment is directed at the underlying cause, but partial surgical removal may be required for very large goiters. T4 compensate TSH TSH normal early Simple nontoxic goiter normal thyroid hormone Severe Iodine deficiency hypothyroidism D. Autoimmunity - autoimmune Hashimoto's thyroiditis Graves' disease ( Hyperthyroid ) Hashimoto autoimmune thyroiditis

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Hashimoto's thyroiditis chronic autoimmune inflammation of the thyroid with lymphocytic infiltration painless thyroid enlargement and symptoms of hypothyroidism thyroid peroxidase antibodies antithyroglobulin antibodies lymphocyte transient hyperthyroid normal Hypothyroid thyroid E. Decreased TRH release - TSH T4 early iodine deficiency normal Hashimoto's thyroiditis early iodine deficiency common Hashimoto's thyroiditis Hyper Hypo autoAb 113 E pheochromocytoma adrenal medulla catecholamine 1. Heart rate 2. Blood pressure 3. Blood glucose blood glucose hepatic gluconeogenesis pheochromocytoma 1. Malignant hypertension 2. Resistant to treatment with standard antihypertensive drug 3. Tachycardia 4. Palpitation 114 E Hypertension for young age Na+ (135-145) K+ (3.5-5.0) Cl- (100-110) hypokalemia 24-hour K+ urine Normal 24-hour K+ urine pathology Renal hyperaldosteronism E primary hyperaldostronism 115 A dopamine agoinist dopaminergic neuron inhibitory signal pituitary gland 116. A Propylthiouracil Mechanism of Action: thyroid peroxidase (TPO) coupling DIT&MIT deiodination peripheral tissue T4 T3 5-monoiodination A iodothyrosine deiodination MIT DIT

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117. C Diabetes insipidus Primary polydipsia Primary polydipsia (also called psychogenic polydipsia) is characterized by a primary increase in water intake. This disorder is most often seen in anxious, middle-aged women and in patients with psychiatric illnesses Central DI Central DI (also called neurohypophyseal or neurogenic DI) is associated with deficient secretion of antidiuretic hormone (ADH). Nephrogenic DI ADH (vasopressin) DI 118. A 119. D hormone thyroxine hormone thyroxine metabolism thyroxine myopathy muscle atrophy muscle weakness hypokalemia thyroxine sympathetic Na+-K+ ATPase K+ shift cell Na+ K+ metabolism 120. A Cushings syndrome cortisol cortisol zona fasiculata adrenal cortex , moon face, buffalo hump, hyperpigmentation, muscle weakness, , abdominal striae, emotion psychosis, depression cushings syndrome exogenous ( steroid steroid ) endogenous ( cortisol pituitary adenoma, adrenal adenoma)

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121. A. melatonin B. luteinizing hormone C. testosterone D. parathyroid E. thyroid hormone A melatonin : is produced by the pineal gland, a gland about the size of a pea, located in the center of the brain but outside the blood-brain barrier. The melatonin signal forms part of the system that regulates the sleep-wake cycle. Light dependence Production of melatonin by the pineal gland is inhibited by light and permitted by darkness. For this reason melatonin has been called "the hormone of darkness". Its onset each evening is called the Dim-Light Melatonin Onset (DLMO) , peaks in the middle of the night. (circadian Rhythm) luteinizing hormone : is a hormone produced by the anterior pituitary gland. In females, an acute rise of LH called the LH surge triggers ovulation and development of the corpus luteum. In males, where LH had also been called interstitial cell-stimulating hormone (ICSH), it stimulates Leydig cell production of testosterone.

testosterone :

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Parathyroid : parathyroid gland calcium phosphate metabolism calcium phosphate osteoclast activity GI calcium vitamin D

Hyperparathyroid : Ca2+ increase , Phosphate desease

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osteopenia : osteitis fibrosa cystica , PTH osteclast peptic ulcer pancreatitis : calcium pancreatic enz. Nephrocalcinosis : calcium phosphate renat stone renal failure E. thyroid hormone The thyroid hormones, thyroxine (T4) and triiodothyronine (T3), are tyrosine-based hormones produced by the thyroid gland primarily responsible for regulation of metabolism. An important component in the synthesis of thyroid hormones is iodine. The major form of thyroid hormone in the blood is thyroxine (T4), which has a longer half life than T3. The ratio of T4 to T3 released into the blood is roughly 20 to 1. Function: They act to increase the basal metabolic rate, affect protein synthesis, help regulate long bone growth (synergy with growth hormone), neuronal maturation and increase the body's sensitivity to catecholamines (such as adrenaline) 122. E Dx: Graves disease caused by autoantibodies to the TSH-receptor (TSHR-Ab) that activate that TSH-receptor (TSHR), thereby stimulating thyroid hormone synthesis and secretion, and thyroid growth (causing a diffusely enlarged goiter). CVS : sympathetic activity - arrhythmia tachycardia, heat failure left ventricle hypertrophy Edema : heart failure Neuromuscular system : muscle weakness , hypoK CNS : neuropsychitis sympathetic over activity agitation GI : diarrhea GI motility thyroid hormone

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เฉลย NL 2010 CU

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