Chapter 19
This chapter uses clinical cases to allow you to continue to explore the material you learned from this
book and, at the same time, review some of the basic principles of physiology. More importantly, this
chapter illustrates the concept of
integrative physiology.
In real life, virtually every signifi cant clinical case
involves many different organ systems. The true art of medicine is the ability of clinicians to recall these
basic principles and put them together in the evaluation of the patient. Each case has a section called
“Physiological Integration” to highlight this fact. As you read these sections, you should consider the
relationships among disease, integrative physiology, and homeostasis, the last of which has been a theme
throughout this textbook.
The cases are organized so that they get more complicated and challenging as the chapter proceeds.
For this reason, we encourage you to read the cases in sequence. Furthermore, some of the conditions
described in this chapter are not explicitly described in the book and may be new to you. Interspersed
at key points in the chapter are several places where you will be asked to “Refl ect and Review.” In some
cases, specifi c answers to these questions are not provided in the case itself. We encourage you to answer
these questions as the case unfolds by, if necessary, referring back to the appropriate section of the book.
Furthermore, we have annotated each case with fi gure and table numbers to facilitate review of material
covered in previous chapters. We hope that this will motivate you to synthesize and integrate information
from throughout the book and perhaps even go beyond what you have learned. In fact, you may enjoy
consulting other sources to answer some of the more challenging questions or learn more about specifi c
aspects of each case that interest you.
We hope you enjoy this chapter and we encourage the readers of the book to send us comments and
suggestions for additional cases.
CASE 19–1
A Woman with Palpitations
and Heat Intolerance
Case Presentation
A 23-year-old woman visits her family physician with com-
plaints of a 12-month history of increasing nervousness, ir-
ritability, and
(a noticeable increase in the force
of her heartbeat). Furthermore, she feels very warm in a room
when everyone else feels comfortable. She has lost 30 pounds
of body weight over this period despite having a voracious ap-
petite and increased food intake.
ect and Review #1
Describe the control of body temperature (see
Figure 16–18). What may have contributed to the
woman’s feelings of excessive warmth?
Two years ago, she was jogging about 20 miles per week. How-
ever, she had not done any running for the past year because she
“didn’t feel up to it” and complained of some weakness in her
legs. She said she often felt irritable and had mood swings. Her
menstrual periods have been less frequent over the past year.
Her previous medical history was normal for a person her age.
ect and Review #2
What could cause a change in the frequency of
menstrual periods (see Figure 17–18 and Table 17–7)?
Is there anything that could affect menstrual
periods that might also account for the feelings of
excessive warmth?
Physical Examination
The patient is a 5
(170 cm) tall, 110 pound (50 kg) woman.
Her systolic/diastolic blood pressure is 140/60 mmHg (nor-
mal for a young, healthy woman is about 110/70 mmHg).
Her resting pulse rate is 100 beats/minute. Before she became
ill, her resting heart rate was about 60–70 beats/minute. Her
respiratory rate is 17 breaths per minute (normal for her was ap-
proximately 12–14 breaths per minute). Her skin is warm and
moist. Her eyes are bulging out (
Figure 19–1
). Finally, when she is asked to gaze to the far
right, her right eye does not move as far as does her left eye
and she says she has double vision (
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