Describe the basics of nervous control of ventilation relative to the brain and 3 main kinds of lung receptors.

In tubular secretion from the peritubular capillary,

-what substances are secreted?

-if penicillin is found in the filtrate, why is it not filtered at the renal corpuscle?

-what is creatinine? is it secreted by the nephrons?

-where in the nephron does most secretion occur?

1. Henry is a 60 year-old, white college man who woke due to intense and worsening pain in his right flank this morning. He came to your emergency room in a state of distress, with diaphoresis (sweating) and pallor (pale appearance). He was unable to sit still or become comfortable in the ER cot, groaning and stating that he was nauseated. His past medical history includes diabetes, gout, and controlled hypertension. He takes medications for his diabetes, gout, and hypertension; he reports no difficulties in affording his medications and does not have difficulties in taking them as prescribed. His vital signs are as follows: temperature mildly elevated at 99.5℉, BP mildly elevated at 138/85, heart rate increased at 110, Respiratory rate normal at 20. His height is 5’9”, and his weight is 205 pounds; his BMI is 30.3

   • What two main diagnoses do you suspect for Henry? Provide supporting evidence using his clinical manifestations.
   • What risk factors does Henry have for the diagnoses you have chosen? List two risk factors for each diagnosis, and briefly explain how that increases an individual’s risk for that disease.
   • What tests do you suspect will be ordered to confirm Henry’s diagnosis, and what value do they add to confirming or excluding your chosen diagnoses? Include at least three tests.

There is the conventional dental crown making process. However, recently, new crown-making methods have been originated. Explain and compare the various crown making processes.

Case Study – Diabetes Mellitus Mohinder, a 28 year old male, had been diagnosed with diabetes mellitus when he was 12 years old. He started experiencing polydipsia, polyuria and polyphagia and his parents noticed that he was very lethargic and seemed continuously fatigued. They would occasionally detect the sweet, “fruity” smell of acetone on his breath. Their PA informed them that this was a sign of ketoacidosis associated with the diabetes. At the time, high fasting glucose levels and islet cell antibodies (ICA) had been detected in his blood. His doctors had him carry out a regimen to control his fluctuations in blood glucose which included diet, exercise and administration of exogenous insulin. At first he was administering insulin 1-3 times a day as indicated by measuring the glucose concentrations in small blood samples obtained from pricking his finger. When he was 22, he got a small battery-powered infusion pump that continuously infused insulin subcutaneously. Now he is considering an experimental treatment that involves implantation of beta-cells derived from donated pancreases. These cells implant in the liver and produce insulin in response to blood glucose levels.

1. Is Mohinder suffering from Type I or Type II diabetes mellitus? How can you tell?

2. What are polydipsia, polyuria and polyphagia? Why are these symptoms of diabetes?

3. What is ketoacidosis? Why is it a consequence of diabetes mellitus?

3. What do the ICA suggest about the etiology of his condition?

4. Why is an insulin infusion pump superior to periodic insulin injections? Why would donated beta-cells be superior to the infusion pump if they can be successfully implanted? (Think about the negative feedback loops for control of blood glucose as you answer this question. How do the concepts of sensitivity, gain and lag time relate to this question?)

5. What are the drawbacks to donated pancreas cells? How might embryonic stem cells be used to avoid these problems?

Case Study - Cholera A 25 year old woman is brought into a clinic in Bangladesh during the monsoon season. She is almost comatose, her pulse is weak and she is experiencing tachycardia. She has severe diarrhea, and is producing watery stool at a rate of 950 ml/hr. Her skin appears shriveled, and when a fold of skin is pinched it remains so for several minutes. Microscopic examination of the patient’s stool reveals the presence of a large number of Vibrio cholerae bacteria. The patient cannot drink, so intravenous isotonic NaCl is administered. When the patient is conscious, she is given an oral rehydration solution to drink. It contains NaCl, KCl, NaHCO3 and glucose. After 5 days she is sufficiently recovered to leave the hospital.

1. How did she most likely encounter the bacteria?

2. Why does she exhibit weak pulse and tachycardia? Why is she almost comatose?

3. How did the cholera toxin enter the cells and how did it affect intracellular signal transduction pathways and membrane transport.

4. How do intravenous fluids immediately improve the patient’s condition? Why isotonic NaCl?

5. What is the rationale for the ingredients in the oral rehydration solution?

6. Why does the patient recover in 5 days with this treatment and without antibiotics?

Patt has been having difficulty maintaining his balance lately. He is visiting a neurologist to find out what’s wrong. The neurologist is taking him through some simple movement tasks and notices that his movements look very jerky and clumsy. When he points to targets, he over-reaches the target every time. When he’s asked to rapidly alternate between his palm and back of hand, his movements are very slow with lots of failed alternations.What is the diagnosis? Choose details from the question above to support your decision. What brain structure has likely been affected?