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Red = important
Violet =
Starling Forces
The osmolarity of the body is about x2 the {} of Na nM 150 = 300 mosmol
Nernst Formula
SKELETAL
Californians Like Girls in String Bikinis ( Corneum, Lucid, Granulosum, Spinosum, Basalis)
Skeletal, Smooth, Cardiac Muscle
Depolarization
RESPIRATORY
ENDOCRINOLOGY
I
Fetal Life: Normal male development requires testosterone, DHT and Mullerian inhibiting
factor.
o hCG + LH = Leydig cells = testosterone = Wolffian ducts=(epididymis, vas
deferentia, seminal vesicles)
o Testosterone + 5-reductase = DHT = urogenital sinus and genital organs
= scrotum, penis, prostate
o Sertoli cells + MIH =Absence of female internal structures
Dependence of Spermatogenesis on Lower Temperatures of the Scrotum
Effects on FSH and LH: In cryptorchid testes high temp prevents adequate
spermatogenesis. Thus there is no proper creation of inhibins and in response FSH is
elevated. Testosterone production goes down, thus elevated LH
Erection, Emission, Ejaculation
Erection: Parasympathetic
Emission: Sympathetic
Ejaculation: Sympathetic
Gonadal Function in the Male
Testosterone deficiency:
o 2-3 month of gestation : Genitalia ambiguity
o 3rd trimester: Testicular descent abnormalities and micropenis
o Pubertal: poor secondary characteristics
o Postpuberal: decreased libido, erectile dysfunction, low energy, decreased facial or
body hair.
Causes of hypogonadism:
o Noonan Syndrome: Low FSH & LH
o Klinefelter Syndrome: High FSH & LH : tall
o Kallmans Syndrome : Hypothalamic disorders: anosmia
o Gonadal/ sex steroid synthesis failure
o
Prostate Cancer? Tx: Complete androgen block ( flutamide and THEN GnRH agonists)
Granulosa cell + FSH + Aromatase = Estrogen and inhibins (FSH is inhibited to prevent
further follicle maturation)
o Estrogen is inhibitory in pituitarys FSH & LH secretion, until a certain
point where concentration is high and magically turns to be excitatory
(positive feedback).
Phases:
o Follicular: Variable: Estrogen, endometrial lining.
LH surge= ovulation
The length of the menstrual cycle minus 14 days is the ovulation
day
o Luteal: Fixed at 14 days, progesterone, secretions in the endometrium lining,
increased temp.
The surge of LH creates ovulation. (and receptors for LH appear everwhere)= broken fallicle
breaks into corpus luteum = progesterone & estrogen = FH n LH inhibition
Corpos luteum involution after 2 weeks= decreases prog & estrogen FSH & LH
Progesterone: Makes cervical mucus thick. Causes endometrium secretions. Increases temp
and appetite.
As long as estrogen levels are still rising, ovulation hasnt happened. ( It happens at peal
levels)
Female Sex Steroid Metabolism and Excretion
Potency : Estradiol>estrone>estriol
Menstrual Irregularities
Hirsutism
o Increased adrenal androgen concentrations
o Abnormal hair growth
o Virilization (breast atrophy, clitorimegaly, muscle bulk)
o Tx: dexamethasone shuts of ACTH = feedback inhibition. Spironolactone is antiandrogen
Pregnancy
Implantation
Baby suckling stimulates the decrease of dopamine = prolactin stops being inhibited and
increases = milk flow = decreased GnRH = decreased FSH, LH release = non ovulation.
(less fertile but NOT infertile)
o
During pregnancy, which of the following statements regarding thyroid hormone is true?
What are Orphan Annie eye nuclear inclusions? What are Psammoma bodies?
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Answer
Colloid: central space in follicle where thyroid hormone is stored as a component of thyroglobulin
Papillary thyroid cancer: common in women, particularly in their 20s or 30s, and in patients with prior
neck radiation
Thyroglobulin is a marker for well differentiated papillary thyroid cancer
Look for characteristic Orphan Annie eye nuclear inclusions (nuclei with uniform staining, which appear
empty), and psammoma bodies (round concentric collection of calcium) on light microscopy.
Treatment of hyperthyroidism:
atients with Hashimoto thyroiditis are at increased risk of developing other autoimmune diseases can you give 4
examples?
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Answer
Clinical presentation:
Nontender thyroid, which often becomes diffusely enlarged insidious development of hypothyroidism,
most commonly in women age 30-50
Presents with all other signs of hypothyroidism.
Risk of developing other autoimmune diseases, for example:
- DM 1 (Type 1 Diabetes Mellitus)
- SLE (Systemic Lupus Erythematosus)
- SS (Sjgrens syndrome)
- MG (Myasthenia Gravis)
Risk of primary thyroid lymphoma:
- B-cell non-Hodgkin lymphomas, especially extranodal marginal zone lymphomas ofMALT (mucosa-associated
lymphoid tissue) type
Treatment: levothyroxine
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Answer
Cardiovascular:
- Peripheral vasoconstriction to maintain body heat cool, pale, dry skin
- Synthesis of cardiac 1 receptors
- HR (bradycardia)
- contractility SV (stroke volume) PP (pulse pressure)
- HR and SV CO (cardiac output) exercise capacity, shortness of breath
- Blunted EKG voltages
- Accelerated atherogenesis: Total cholesterol, LDL
Central Nervous System:
- Slow DTRs with prolonged relaxation phase
- Fatigue
- Lethargy
- Mental slowness
- Mental retardation (perinatal)
Dermatologic:
- Coarse, brittle hair/nails
- Yellow/orange skin
- Myxedema (non-pitting edema due to interstitial accumulation of osmotically active mucopolysaccharides) of
the hands, face, periorbital region.
Gastrointestinal:
- GI motility constipation
Musculoskeletal:
- Carpal tunnel syndrome
Endocrine:
- Hyperprolactinemia (if primary or secondary hypothyroidism): T3, T4 TRH prolactin
Can you name some of the presenting S/Sx of congenital hypothyroidism? (Try to name 8)
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Answer