Medical Physiology: Integration Using Clinical Cases
685
R
e
ect and Review #4
What structure might be responsible for the
swelling in the patient’s lower neck (see Figures 11–21
and 11–31, and Figure 15–15)? What are the major
functions of this structure?
Her patellar tendon (knee jerk) refl exes are hyperactive. When
she holds her hands out straight, she exhibits fi ne tremors
(shaking).
Refl
ect and Review #5
What are the neural pathways involved in the
knee jerk refl ex (see Figure 10–6)? Could the enlarged
structure in her neck account for the abnormal refl exes
observed?
Laboratory Tests
The family physician considers the history and physical exam
and decides to order some blood tests. The results are shown
in
Table 19–1
.
R
e
ect and Review #6
Describe the feedback control loops of the
hormones whose values were abnormal (see Figure
11–23 and Figure 17–20). Which, if any, of these
hormones might account for the symptoms in this
patient?
Figure 19–1
Patient showing (a) proptosis and (b) goiter.
Table 19–1
Laboratory Results for Patient
Blood
Measurements*
Result
Normal Range
Sodium
136 mEq/L
(135–145 mEq/L)
Potassium
5.0 mEq/L
(3.8–5.2 mEq/L)
Chloride
102 mEq/L
(95–105 mEq/L)
pH
7.39
(7.38 –7.45)
Calcium (total)
9.6 mg/dL
(9.0–10.5 mg/dL)
Parathyroid
hormone
15 pg/mL
(10–75 pg/mL)
Glucose (fasting)
80 mg/dL
(70–110 mg/dL)
Prolactin
10.4 ng/mL
(1.4–24.2 ng/mL)
Estrogen (midcycle)
100 pg/mL
(150–750 pg/mL)
Total T
4
20 μg/dL
(5–11 μg/dL)
Free T
4
2.8 ng/dL
(0.8–1.6 ng/dL)
Thyroid-stimulating
hormone (TSH)
0.01 μU/mL
(0.3–4.0 μU/mL)
T
4
, thyroxine
*In actuality, these measurements are performed in blood serum.
R
e
ect and Review #3
Briefl y describe the control of systemic blood
pressure, heart rate, and respiratory rate (see Figures
12–23 and 12–51, and Figure 13–32). What might be
causing her hypertension,
tachycardia
(increased heart
rate), and
tachypnea
(increased respiratory rate)?
Describe the muscles that control eye movement
(see Figure 7–32). Based on Figure 7–32, what eye
muscles do you think are affected in this woman?
Upon further examination, the physician notes an enlarge-
ment of a structure in the front, lower part of her neck (see
Figure 19–1). It is smooth (no bumps or nodules felt) and
painless. When the patient swallows, this enlarged structure
moves up and down. When a stethoscope is placed over this
structure, the physician can hear a swishing sound (called a
bruit
[pronounced BREW-ee]) with each heartbeat.
(b)
(a)
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