Question

1. In people with diabetes mellitus type 1, explain the reason for ketoacidosis and ketonuria.
2. Compare the effects of hypocalcemia on cardiac and skeletal muscle, and explain the rationale for each.
3. Explain the function of vitamin D and the possible effects of a deficit of this vitamin.
4. List several factors that would predispose a pregnant woman with diabetes to cystitis.
5. Explain how decreased fluid intake or dehydration predisposes to calculi in the urinary tract.
6. Why is there an increased risk of drug toxicity in the later stages of renal failure?
7. List the factors predisposing patients to testicular cancer.
8. Differentiate the following terms from one another: dysmenorrhea, premenstrual syndrome, and menorrhagia.
9. Compare the early manifestations of chlamydial infection, syphilis, and genital herpes.
10. Explain why genital herpes tends to recur.

Answer 1

1. Type 1 Diabetes mellitus is a condition in which pancreas produces little or no insulin. Ketoacidosis arises because of a lack of insulin in the body that causes release of free fatty acids from adipose tissue ( liposlysis), which are converted through a process callled beta oxidation, again in the liver, in to ketone bodies ( aceto acetate and Beta - hydroxybutyrate).

The ketone bodies turns the blood acidic. This leads the ketone to be excreted through the urine called ketonuria.

2. A decrease in the blood calcium level is Hypocalcemia.

A Decrease in extracellular Ca2+ levels leads to negative membrane potential on the outside. Action potential requires only less amount of depolarization which leads to increased excitability of muscles and nerve tissue.

The calcium helps in cardiac muscle contraction and metabolism. The low level of calcium results in cardiac decomponsationand heart failure. It causes numbness and tingling sensation in the arm, hand, feet, legs and mouth due to decreased nerve sensitivity.

3. Functions of Vitamin D

• It plays an essential role as a hormone in the regulation of calcium & phosphorus metabolism.
• It maintains the normal plasma level of calcium and phosphorus by acting on intestine, bone and kidneys.
• In the intestine, it increases plasma calcium & phosphorus concentration, increases synthesis of calcium binding proteins, calbindins, and increase absorption of calcium & phosphorus from the intestine.
• In the bone, it promotes the mineralization of bones, D3 along with PTH stimulates the mobilization of calcium & phosphorus frm bone.
• In the kidneys, it increases the reabsorption of calcium & phosphorus from the kidney, and decreases excretion of calcium and phosphorus.

Deficiency

• Rickets in children -

1. Decreased serum calcium
2. soft & pliable bones
3. bone deformities - bowed leg, knocked knee, rickety rosary, pigeon chest
4. delayed dentition
5. delayed closure of anterior fontanelle - bossing of frontal bonesDe

• Osteomalacia in adults ( Adult Rickets) -

1. Decreased serum calcium
2. Insufficient mineralization
3. soft & pliable bones
4. increased osteoporosis
5. bone deformities

4. During gestational diabetes, there is incresed chance of developing cystitis and urinary tract infection.

• An increased level of sugar provides a favourable environment to the bacterias to increase in number
• Increased bladder volume
• Decreased bladder tone
• Growing fetus exerts pressure on the bladder and urinary tract causing bacteria and urine to trap resulting in infection.
• GDM along with left over urine
• Low fluid intake due to morning sickness
• Hormonal and mechanical changes leading to urinary stasis and vesicoureteral reflux