Think about the formation of urine. Imagine that you are describing the journey of a drop of blood, from the hepatic artery, to the production of glomerular filtrate, to the excretion of urine. What are the structures that the blood/GFR/urine will pass through, and what processes is the product exposed to? In other words - how is urine produced from the vantage point of a single drop of blood in the hepatic artery? Once you have described the normal process for this, pick one of the pathologies below and describe how the process of urine formation would be different in an individual with your chosen pathology.

Choose one:

Polycystic kidney disease

Urinary tract infection

Glomerulonephritis

Lupus nephritis

Diabetic kidney disease

You eat a piece of fatty foods. Describe the digestion (chemical, mechanical) that occurs in the mouth, stomach and intestines. Include a comment on CCK, bile and enzymes from the pancreas. Also talk about absorption into the blood/lacteal. Lots to this answer!

What is the pathway in a reflex like grabbing a hot handle of a pan on the stove? What are the chemicals our body uses to deal with pain without medication? What neurotransmitters are involved in feeling pain? What is Parkinson’s Disease? What area of the brain is affected? Which neurons are involved? What therapies are available to treat Parkinson’s Disease? Who is Henry Molaison? What are the different types of Amnesia?

Describe air breathing via a four stroke buccal pump (for each step say what physical event happens and what happens to the air). How is this modified in frogs for sound production? (6 points) Please answer quickly I will upvote immediately after. Thank you in advance!!!!!

Part III – Something's Not Right

“It’s good to have you home, honey. I missed you. How was the flight?” Stacey had come to the airport to pick Frank up and she leaned over to kiss him as he climbed into the car with his luggage. “How were the meetings? You look tired,” she added.

“The past week was intense and I am exhausted. I thought I would manage some R & R during the trip, but no such luck. John and Dan were fired and we were told that there would be more layoffs in the future if business doesn’t pick up. Everyone is feeling stressed. “

“You’re one of the hardest workers they have Frank, they can’t let you go.”

“I hope you’re right. They gave us tomorrow off in lieu of making us work for 7 days straight, but I can’t help but think I should go in and get a jump on the week.”

“I know you don’t want to hear this, but you have an appointment for that glucose tolerance test first thing in the morning. We’ll need to eat soon because the instructions say you are not allowed to eat for 8 hours before the test.”

Frank felt miserable. “I’m really not hungry. Maybe it was the change in diet, but I’ve had a persistent stomach ache and I didn’t eat much when I was away.

“Well, we need to take extra special care of you until we find out what’s wrong. I am sure everything’s going to be okay.”The next morning the alarm went off and Frank felt refreshed after a good night’s sleep.

“What’s the matter Stacey? You look like you’ve seen a ghost.”

Stacey brought him her pocket mirror so that he could see for himself. “Forget the glucose tolerance test. I think we need to go to the Emergency Room right now.”

* ************

Doctor Smithers looked into Frank’s eyes. “It’s a good thing you came in because even a first year medical student could see that you are jaundiced.”

Stacey looked concerned. “What does that mean? Is he going to be okay?”
“Well it could mean a few different things,” replied the doctor, “so we are going to have to run some tests to be sure.”

Fill in Flow Chart 1 with the best choices from the provided word list.

Questions

5. Use Flow Chart 1 to suggest possible reasons for Frank’s jaundiced appearance.

6. Do you think that Frank’s jaundice is connected to the high blood glucose levels seen on the morning before his business trip? Why or why not?

7. Would you like to make a diagnosis to explain Frank’s jaundiced appearance?

8. What tests would you run to determine or confirm any of your diagnoses?

Part IV – The Test Results

“What does it mean to be jaundiced, doctor? Why did the whites of my eyes turn yellow?” “It’s usually caused by a high level of a molecule called bilirubin in your blood, Frank.”
“I was a biology major in college, but I don’t remember where bilirubin comes from.”

“Your blood has cells called erythrocytes or red blood cells; they contain hemoglobin which gives blood its red color. Cells in the spleen break down red blood cells and the products are reused by your body. The heme portion of hemoglobin is converted to bilirubin, which is the molecule that is responsible for your yellow color.”

“I remember now, isn’t bilirubin involved in digestion?”

“Yes. Bilirubin leaves the spleen in the blood and, because it’s not soluble in water, it binds with blood proteins called albumens to form unconjugated bilirubin. This bilirubin is taken up by the cells in the liver, where it combines with glucuronic acid to form conjugated bilirubin. It is one component of the bile, which travels down the bile duct to the gall bladder and the small intestine. When you eat, the gall bladder contracts and pushes the stored bile into the small intestine to aid in the digestion of fat.”

“So what do my tests show?”
“Your hematocrit and your liver enzymes are at normal levels.” “So, my liver’s okay?”

“These enzymes are normally confined to the liver cells and would only be found in large amounts in the blood if your liver was damaged. So these results indicate that there is no liver damage; that’s good. But I am concerned that there is tenderness in the upper left quadrant of your abdomen ... sorry, around your stomach,” the doctor smiled at Frank and Stacey.

“As I explained before, a jaundiced appearance is often produced by a buildup of bilirubin in the blood and your results confirm this (Table 3).”

Table 3 – The Level of Bilirubin in Blood

“One more thing concerns me,” continued the doctor. “There is almost no urobilinogen or urobilin in your urine.”

“What are they?” asked Frank.

“Bacteria in your intestines change bilirubin to urobilinogen. This urobilinogen can be reabsorbed back into your body and some is converted to urobilin. These two molecules circulate in your blood and are excreted in your urine; it is the urobilin that produces the straw color of urine. The low level of these two molecules in your urine plus the high level of bilirubin in your blood and the pale color of your stools indicates to me that, for some reason, bilirubin is staying in your body instead of going into your intestines.”

Questions

1. Where is unconjugated bilirubin formed?
2. Is the level of unconjugated bilirubin in Frank’s blood within the normal range? 3. Where is conjugated bilirubin formed?
4. Is the level of conjugated bilirubin in Frank’s blood within the normal range?

5. Using Flow Chart 1, outline some possible reasons for the high level of conjugated bilirubin; remember Frank’s liver enzymes are normal.

6. Frank experienced tenderness in the upper left quadrant of his abdomen. Use the word list in Figure 1 to label the major organs in this area.

7. Consider your diagnosis for Frank’s high blood glucose levels. Which gland secretes insulin?

8. Which organs are involved in creating Frank’s jaundiced appearance?

9. Look at Figure 1 and determine whether this gland and these organs (answers to Questions 7 and 8) are connected in any way.

10. Can you think of a reason that would explain the high levels of glucose and conjugated bilirubin in Frank’s blood?

11. Would you like to make any adjustments to your diagnoses?

Discuss the composition of bone and name 5 type

Add reference

provide a summary of the respiratory system from the perspective of inhaled air. Your description should include:

- An organized progression of travel. What organs does the air travel through? What types of tissues and structures are seen within them? What purposes do those structures serve?

- Orientation of those organs within the body using correct directional and regional terminology. For example - it is not adequate to say that air is inhaled via the nose, you should include a description of where the nose is found and where air will progress (i.e. Air is inhaled via the nares in the facial region, and progresses posterior through the nasal cavity towards the naso-pharynx.)

A neuron can use glucose created from a non-carbohydrate source.  This reaction is termed:

1. glycogenolysis  b) glycogenesis  c) photosynthesis  d) glycolysis  e) none of the above

Which of the following statements is (are) true about epithelial tissue?

      a)  epithelial cells secrete collagen    b)  epithelial tissue functions in absorption

      c)  epithelial tissue has each of the 4 tissue types     d)  epithelial cells are always ciliated

      e)  two of the above are true

Which of the following require “active” transport processes?

1. movement of glucose from a region of high concentration to a region of low concentration
2. osmosis    c)  simple diffusion       d) a and b         e)  none of the above

A bundle of axons in the central nervous system is called a _________ and a bundle of axons in the peripheral nervous system is called a ______________

        a) tract; nerve   b) nerve; tract  c) ganglia; nucleus  d) nucleus, ganglia  e) ganglia; nerve

Which of the following binds to the active site of an enzyme?

            a) non competitive inhibitor       b) water   c) another enzyme    d) substrate   e) pro

In the para sympathetic nervous system, the ganglia containing the post ganglionic somas are located ____________.

      a) adjacent to the spinal cord   b) in the CNS   c) near or on the effector organ

      d) in the spino-cerebellar tract     e) none of the above

When Robin kicks a soccer ball, her leg makes contact with the ball by _______ of the knee.  This is an example of a/an __________ contraction of the quadriceps.

       a)  flexion; concentric         b)  flexion; eccentric      c)  extension; eccentric

       d) extension; concentric      e)  flexion; isometric     

Physiology

-Discuss the three metabolic pathways that supply ATP for muscle contraction

-Explain how navigational abilities promote reproductive success. Provide an example.

Mr. Puffy. This gentleman is 65 years old. He has smoked two packs of non-filter cigarettes per day since he was 15 years old. His face is ruddy with a nose like WC Fields. His lips and nose are blue and he is breathing through pursed lips, having trouble evacuating the air from his lungs. He has a barrel chest. The expiratory area of his respiratory center is fully activated. He sips a small glass of port wine and reminisces about the old days.

Questions: What is your understanding of Mr. Puffy’s respiratory diagnosis? Is Mr. Puffy at risk for respiratory or metabolic / alkalosis or acidosis? What is the compensatory mechanism working to rectify his self-induced condition?

Young couple with their first baby. This is their first excursion out of the house with baby. They’ve been unable to sleep because baby is awaking all-night and asleep all day. Baby has been vomiting for the past 2-3 days, unable to keep down clear liquid or formula. Her mother told them not to worry; “spitting up” is normal. They're both exhausted and trying to enjoy their first restaurant dinner together for months. Baby is in her car seat trying to sleep but appears fidgety.

Questions: Is baby at risk for an acid- base imbalance? If so, is it respiratory or metabolic alkalosis or acidosis? What is the compensatory mechanism working to rectify this condition?

Aquarius. She's sitting alone at a table drinking distilled water hoping to be discovered by a famous movie producer. She has the lead role in a small off-Broadway play. Directors in the past have often told her that she should drink a lot of water before a performance to help with her voice quality. Her aesthetician recommends 4-5 liters of pure water per day for her skin hydration. Taking this to heart, she has been drinking at least this much water a day and more. She will only eat protein, no carbohydrates, and takes laxatives to maintain a slender figure. She's also a novice jogger with great determination, putting in at least five miles per day. She rehydrates with pure water only. The only thing she has had to drink today is distilled water.

Questions: Is Aquarius at risk for water intoxication, dehydrated, or in fluid balance? What factors are affecting her body fluid level and which hormones are affected by her lifestyle? Is her fluid volume dropping? If so, which hormones are released to compensate for this loss? Is Aquarius at risk for respiratory or metabolic / alkalosis or acidosis? What is the compensatory mechanism working to rectify her self-induced condition?

Mr. Bud. He is a construction worker that has been working on the Cape Cod Canal for the past ten years. He has been working outdoors in the direct sunlight where the temperature is 95 degrees Fahrenheit and humidity is 80%. He's sitting at the bar at 4 PM drinking 16 oz. Bud Lite beers with an equal number of bourbon shots. He's not eating the salty bar snacks because he is watching his weight although he's on his third Budweiser and weighs 255 pounds, 5’ 8” tall. His lunch also consisted of 3 Bud Lites.

Questions: Is Mr. Bud at risk for water intoxication, dehydration, or in fluid balance? What factors are affecting Mr. Bud's body fluid level and which hormones for fluid balance are affected by his lifestyle? Is his fluid volume dropping? If so, which hormones are released to compensate for this loss?

Mrs. Lovely and Mr. Money. Mrs. Lovely is closing in on 40 years old. She's the first one at the exercise club in the morning at 6 AM (the nanny takes the kids to school) and performs aerobic exercise for no less than two hours, five days a week. She does not believe in rehydration because she's afraid of water weight gain. She wants to return to a size O before her 40th birthday. Her percentage body fat is around 5%. Following her workout, she spends 20 minutes in the dry heat sauna then has a 45-minute massage. Her total caloric intake for a typical day is 1300 calories with few carbohydrates. She's sipping Lady Grey black tea.

Questions: Is Mrs. Lovely at risk for water intoxication, dehydrated, or in fluid balance? What factors are affecting her body fluid level and which hormones for fluid balance are affected by her lifestyle? Is her fluid volume dropping? If so, which hormones are released to compensate for this loss? Is Mrs. Lovely at risk for respiratory or metabolic alkalosis or acidosis? What is the compensatory mechanism working to rectify her self-induced condition?

Mr. Money works 60 hours per week and does not pay much attention to what he eats or drinks. Breakfast consists of two cups of black coffee. He suffers from a hiatal hernia and despite his doctor's advice he continues to work long stressful hours, drink coffee and alcohol, and eat fatty foods. Consequently, he experiences vomiting first thing in the morning and several times per day. His BP is 145/90 and higher during stress. He also has a mild heart condition for which he takes diuretics. He takes Prilosec and a handful of over-the-counter antacids daily. He drinks a glass full of sodium bicarbonate and water each night before bed to quell the heartburn. He and Mrs. Lovely usually eat out together for dinner (nanny cooks and puts the kids to bed too) at which time he tries to impress Mrs. Lovely with a show of concern for healthful eating by ordering a salad with grilled salmon for dinner accompanied by several glasses of white wine.

Questions: Is Mr. Money at risk for water intoxication, dehydrated, or in fluid balance? What factors are affecting his body fluid level and which hormones for fluid balance are affected by his lifestyle? Is his fluid volume dropping? If so, which hormones are released to compensate for this loss? Is Mr. Money at risk for respiratory or metabolic / alkalosis or acidosis? What is the compensatory mechanism working to rectify his self-induced condition?

Describe the role of the autonomic nervous system in controlling heart rate (include neurotransmitters, whether it increases and/or decreases heart rate and what specific part of the brain exerts the most control over heart rate). Include neurotransmitters and receptors.

Mariselle is a 42-year-old woman that visits your clinic for a routine appointment. Two years ago, she was diagnosed with early stage (3a) chronic kidney disease associated with hypertension. Her kidney disease and hypertension are managed by a combination of drugs that includes an ACE inhibitor, and dietary restriction. Mariselle is complaining of ‘the heads of mine’ that she says make her feel poorly, and a discomfort in her back and abdomen She reports eating fast food for the last two weeks because she was too tired to cook at home.

Medical History

Her notes show that a previous doctor has prescribed Mariselle benzodiazepines for nervous complaints. You have treated her mother in the past for depression.

On examination

Mariselle describes her symptoms in a flat, monotonous voice and looks anxious and ill at ease. You find that she uses vague phrases such as ‘these heads of mine’ without properly describing them. During the consultation, she attributes her symptoms to her chronic kidney disease. Further exploration reveals that Mariselle is describing headaches which she attributes to her kidney problems.

Questions:

1. Identify both the diagnosis and the prognosis of your patient, and explain the difference between these two