Tнеме: Pathology of Hypothalamo-Pituitary System

TНЕМЕ: "PATHOLOGY OF HYPOTHALAMO-PITUITARY SYSTEM".Actuality of theme. Differentiation of cells with formation of tissues and organs which execute the specialized physiology functions is the qualificatory feature of human organism. Regulation of all vital functions of an organism carried out by the nervous and endocrine systems. The action of the last will be realized due to a secretion and transporting of specific humoral factors of distance action - hormones. Violation of hormones formation or transporting results in various disorders of the humoral regulation of an organism. It is extraordinarily important to know etiological factors which result in the origin of hvpo- hyper- and dysfunctions of endocrine organs for a future specialist. Understanding of mechanisms of basic manifestations at endocrine pathology development is a necessity for the doctor of any profession, taking into account that violation of the hypothalamus-pituitary regulation results in the origin of pathology from the side of various organs and systems of adult and child organism. Epiphysis also takes place at the endocrine regulation except the hypothalamo- pituitary system. Pathology of epiphysis is well not yet studied enough at human. However the role of gland in regulation of sexual development, management of man daily allowance rhythms is well known. Therefore knowledge of etiology and pathogenesis of hyper- and hypofunction of epiphysis development is a necessity for the specialist of modern level. General purpose of the lesson. To learn reasons and mechanisms of violations development at pathology of hypothalamo-pituitary systems.For this it is necessary to know (the concrete purposes):  To use a basic concept about endocrine function for the characteristics of typical violations of the endocrine glands;  To explain the causes and general mechanisms of primary and secondary endocrinopathology;  To describe neuro-endocrine pathology causes and mechanisms of its development;  To analyze the consequences of violations of adenohypophysis hormones secretion;  To analyze the consequences of violations of neurohypophysis hormones secretion;  To explain the reasons of primary and secondary hyper-and hypofunction of adrenal cortex;For realization of purposes of lesson1 it is necessary to have the base knowledges- skills: 1. To know the structure (anatomy) of hypothalamus and hypophysis (normal anatomy department); 2. To know the mechanisms of hormones action (physiology and bioclemistry departments); 3. To know the hormonal regulation of metabolism and biological functions of cells (biochemistry department).The checking of primary level of knowledges. Give the answers to the following questions: 1. Name the hormones which are produced by the adenohypophysis. 2. Name the hormones which are produced by a neurohypophysis. 3. Name clinical state connected with low level of adenohypophysis hormones? 4. Name clinical state connected with high level of adenohypophysis hormones? 5. Definition of partial hypopituitarism? 6. Name hormone, related with acromegaly? Define the level of this hormone (increased or diminised) 7. Name hormone, related with pituitary gigantism? 8. Name hormone, related with does pituitary nanism? 9. Name hormone, related with Cushing's disease? 10. Name hormone, related with the Parhon's syndrom? 11. Name hormone, related with the diabetes insipidus? 12. Name hormone, related with the long-lasting lactation syndrome?Standards of answers at the theoretical questions of initial level of knowledges: 1. Somatotropin (growth hormone? STH), adrenocorticotropin (ACTH), thyrotropin (TTH), gonadotropic hormones (follicle-stimulating hormone, luteinizing hormone), melanotropic hormone, lactotropic hormone; 2. Vasopressin, oxytocin; 3. Hypopituitarism – low production of certain hormones; panhypopituitarism – low level of all adenjhyphysal hormones 4. Hyperpituitarism; 5. It is diminishing or absence of some of adenohypophysis hormone synthesis; 6. The acromegaly develops as a result of increased production of somatotropin (STH) at adults; 7. The pituitary gigantism develops as a result of increased production of somatotropin (STH) at children; 8. Pituitary nanism develops as a result of diminishing production of somatotropin (STH) at children; 9. Cushing’s disease develops as a result of increased production of adrenocortocothropin (ACTH); 10. The Parhon's syndrome develops as a result of increased production of vasopressin 11. Diabetes insipidus develops as a result of decreased production of vasopressin; 2 12. The long-lasting lactation syndrome develops as a result of increased production of the lactotropic hormone and does not connect with pregnancy and physiological lactation.Theoretical questions for FMC -2. 1. General characteristic of the endocrine system disorders: hypofunction, hyperfunction, dysfunction of the glands, primary, secondary endocrinopathy. 2. Causes and mechanisms of endocrinopathies. Dysregulatory endocrinopathy: disorders of the nervous, neuroendocrine, endocrine and metabolic regulation of the endocrine glands. Violation of direct and inverse regulatory relations. 3. Glandular endocrynopathy: causes and mechanisms of synthesis , deposition and secretion of hormones disorders 4. Peripheral disorders of endocrine function. Violation of transporting and metabolic inactivation of hormones. 5. Violation of the reception of hormones and hormonal mechanisms of resistance (prereceptor, receptor, postreceptor). 6. Pathology of the hypothalamic-pituitary system. Causes and mechanisms of syndromes of excess and lack of pituitary hormones synthesis. 7. General characteristic of the hypothalamic-pituitary-thyroid, hypothalamic- pituitary-adrenal, hypothalamic-pituitary-gonad system. 8. Etiology, pathogenesis, clinical manifestations of panhypopituitarism. 9. Causes, mechanisms of development, clinical manifestations of partial adenohypophysis failure (insufficiency of STH, TTH, ACTH, gonadotropins). 10. Etiology, pathogenesis, clinical manifestations of partial hyperfunction of adenohypophysis (STH, TTH, ACTH, gonadotropins, prolactin). 11. Pathophysiology of the neurohypophysis. 12. Diabetes insipidus: causes and mechanisms of development, clinical manifestations.Themes of reports:  Role of epiphysis in the hormonal regulation.  Pathology of intracellular mediators systems of hormones action.  Psychogenic endocrinopathies.  Parhon's syndrome. Etiology, pathogenesis, charactaristic.  Shihan's syndrome. Etiology, pathogenesis, basic manifestations, consequences.Literature. 1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU, 2005. 2. General and clinical pathophysiology/ Edited by prof.A.V.Kubyshkin, 2011 p.520-546 3. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005 p. 230-237 4. Lectures materials 3 Tests from Open database "KROK-1" (2010) 1. A 32-year-old woman complains about the absence of lactation after parturition. Such disorder might be explained by the deficit of the following hormone: A Prolactin B Somatotropin C Vasopressin D Thyrocalcitonin E Glucagon 2. Examination of a patient revealed overgrowth of facial bones and soft tissues, tongue enlargement, wide interdental spaces in the enlarged dental arch. What changes of the hormonal secretion are the most likely? A Hypersecretion of the somatotropic hormone B Hyposecretion of the somatotropic hormone C Hypersecretion of insulin D Hyposecretion of thyroxin E Hyposecretion of insulin 3. A patient has a decreased vasopressin synthesis that causes polyuria and as a result of it evident organism dehydratation. What is the mechanism of polyuria development? A Reduced tubular reabsorption of water B Reduced tubular reabsorption of Na + ions C Reduced tubular reabsorption of protein D Reduced glucose reabsorption E Acceleration of glomerular filtration 4. A man after 1,5 liter blood loss has suddenly reduced diuresis. The increased secretion of what hormone caused such diuresis alteration? A Vasopressin B Corticotropin C Natriuretic D Cortisol E Parathormone 5. Rentgenological examination of skull base bones revealed enlargement of sellar cavity, destruction of different parts of sella turcica. Such bone destruction might be caused by a tumor of the following endocrine gland: A Hypophysis B Epiphysis C Thymus gland D Adrenal glands E Thyroid gland 4 6. A 46 year-old patient has complained of headache, fatigue, thirst, pains in the spine and joints for the last 2 years. Clinically observed disproportional enlargement of hands, feet, nose, superciliary arches. He notes that he needed to buy bigger shoes three times. What is the main reason of such disproportional enlargement of different parts of the body? A Cartilaginous tissue proliferation under growth hormone influence B Increased sensitivity of the tissues to growth hormone C Joints dystrophy development D Increased sensitivity of the tissues to insulin E Joints chronic inflammation development7. A woman after labor lost 20 kg of body weight, her hair and teeth fall out, she has muscle atrophy (hypophysial cachexia). Synthesis of what hypophysis hormone is disturbed? A Somatotropic B Corticotrophic C Thyreotropic D Gonadotropic E Prolactin 8. Examination of a patient revealed enlargement of some body parts (jaw, nose, ears, feet, hands), but body proportions were conserved. It might be caused by intensified secretion of the following hormone: A Somatotropin B Somatostatin C Tetraiodothyronine D Triiodothyronine E Cortisol Testing according system “Krok-I” (2006-2010)1. Analysis of urine from a 24-year-old man revealed the following changes: daily diuresis-10 l, relative density – 1,001, qualitative changes are absent. A patient complains of excessive thirst, frequent urination. What is the most likely cause of this disease? A. Relative insulin insufficiency B. Aldosteron hypersecretion C. Vasopressin hypersecretion D. Glucocorticoid hypersecretion E. *Vasopressin hyposecretion2.A 35 year old patient complains about permanent thirst, poor appetite. He drinks 9 liters of water per day. Daily diuresis is increased, urine is colorless, its specific gravity is 1,005. The most probable cause of this pathology development is damage 5 of: A. Epithelium of renal tubuli B. Basal membrane of glomerular capillaries C. Hypothalamic nuclei D. Epiphysis E. *Hypothalamic nuclei 3.A 20 y.o. patient complains about morbid thirst and profuse urination (up to 10 1 a day. Glucose concentration in blood is normal, in urine glucose is absent. Such condition may be caused by deficiency of the following hormone: A. Oxytocin B. Cortisol C. Insulin D.*Vasopressin E. Triiodthyronine4. A patient has a decreased vasopressin synthesis that causes polyuria and as a result of it evident dehydratation. What is the mechanism of polyuria development? A *Reduced tubular reabsorption of water B Reduced tubular reabsorption of Na- ions C Reduced tubular reabsorption of protein D Reduced glucose reabsorption E Acceleration of glomerular filtration 5. X-ray examination of skull base bones revealed enlargement of sellar cavity, destruction of parts of sella turcica. Such bone destruction might be caused by a tumor of the following endocrine gland: A *Hypophysis B Epiphysis C Thymus gland D Adrenal glands E Thyroid gland 6. In a patient, 40 years old, polyuria (10 - 12 liters per day) and polidypsia occurred due to the damage of supraoptic and paraventricular nuclei of the hypothalamus. Lack of which hormone causes these disorders? A. * Vasopressin B. Oxytocin C. Cortikotropin D. Somatotropin E. Thyrotropin7. Patient K., aged 35, complained of constant thirst, decreased appetite. Amount of liquid drunken in a day - 9 liters.6 Daily urine output increased, discolored urine, the relative density - 1005. The most likely cause of this pathology in a patient is damaged: A. * hypothalamic nuclei B. epithelium of renal tubules C. adenohypophysis D. epiphysis E. basal membrane of glomerular capillaries 8. Patients V., 46 years, displayed a disproportionate increase in the hands, feet, nose, ears, superciliary arches and the zygomatic bone. Blood test - hyperglycemia, breach of glucose tolerance test. The most likely cause of this pathology is: A. * hypersecretion of somatotropin B. hypersecretion of adenohypophysis hormones C. hyposecretion of insulin D. .hyposecretion of vasopressin E. hypersecretion of glucocorticoids9. A 27 year old man came to the doctor. Examination revealed increased size of palms, feet and lower jaw. Also, deformation of the joints (kiphosis), hormonal disorders (impotence, testicular atrophy) were observed. Functions of which gland are affected? A. * Front pituitary B. Adrenal glands C. epiphysis D. Thyroid E. Parathyroid10. A patient with damage to the back of pituitary developed increased daily diuresis to 10-15 liters. What is the principal mechanism in the polyuria development? A. * Deficiency of vasopressin B. Increased secretion of vasopressin C. Increased secretion of aldosterone D. Malfunction of atrial natriuretic factor E. Reduced corticotropin level11. A woman following the childbirth has lost 20 kg of weight, teeth and hair are falling out, there is muscle wasting [hypophysial cachexia]. With synthesis dysfunction of which pituitary hormone is this connected? A. * Somatotrophic B. Kortykotrophic C. Thyrotrophic D. Gonadotrophic E. Prolactin 7 Situation tasks: 1. Examination of a teenager revealed that his height lower than age norm, mental development is normal. 1. Name the reasons of this state? ______2. Name the functions of this hormone. ______2. Examination of a 60 years old patient revealed increasing of separate parts of body - bottom jaw, nose, tongue, arms and feet, intervals between the teeth of bottom jaw are increased 1. Name the reason of such state? ______2. Mechanisms of development of the clinical signs. ______3. Woman, 25 years, through 2 months after difficult delivery complicated with considerable bleeding, appealed to doctor-endocrinologist with complaints about acute weight loss, decline of appetite, absence of lactation, apathy, somnolence, weakening of memory, fragility of nails, dryness of skin. Objectively: AP - 90/60 mm. Hg, pulse - 55/min, signs of senilism (ageing). 1. Name this pathology? ______2. Identify main reasons and mechanisms of development of the indicated signs. ______4. Parturient woman on the 5 day after the labor has an agalactia (absence of breast milk). I. Name the place of this hormone production and its biological effects. ______8 ______5. Absence of labor activity is observed at the expectant mother after discharge of amniotic fluid. 1. Reasons of this pathology? ______2. Name the place of this hormone production and its biological effects. ______6. Polydipsia, polyuria (day's diuresis is 25 litres), specific gravity of urine - 1002 is observed at a boy after the viral infection. 1. Name the pathology for a patient? ______2. Specify the reasons and mechanisms of the indicated signs development. ______7. Parents, disturbed by the extraordinarily high height of the 15-years-old son (205 sm) and delay of the puberty, appealed to doctor-endocrinologist. 1. With what hormone related this pathology? Name possible reasons? ______2. Name the place of this hormone production and its biological effects. ______8. A district pediatrician at a duty prophylactic review educed two children with a low height. In first case - a boy with the low height, but mental development is corresponding to age. In second case - a girl has low physical and mental deviation. 1. What pathology is observed in first and second case? ______2. What are the reasons and mechanisms of development? 9 ______9. The doctor educed a 3-years-old boy who was higher than all 6-years-old children at the examination. 1. Name hormone, related with this state? ______2. Name pathology? Reasons and mechanisms of development. ______10. A man appealed to the doctor with complaints about the increasing of nose, ears, tongue, superciliary arcs, bottom jaw and arms. Objectively - glucose on an empty stomach is 7,4 mmoI/1, after the glucose overloading -15,2 mmol/1. 1. What pathology is observed for a patient? ______2. What are the reasons and mechanisms of it development? ______11. Bradycardia, oliguria, edema appeared at a man, 20 years, in 2 months after he carried craniocerebral trauma. At laboratory research: Na+ of blood - 108 mmol/1, K+ - 7,3 mmol/l. I. Name hormone, related with this state? ______2. Name the reasons and mechanisms of the indicated signs development. ______12. Exhaustion, dry and wrinkled skin observed at the 27 years old woman, after labors complicated by massive bleeding. Body temperature - 36°C, AP - 100/60 mmHg., glucose in the blood - 3,3 mmol/l, level of 17- ketosteroids in the urine is 10 decreased. I. Name the pathology. ______2. What are the basic mechanisms of it development? ______Practical work: Object of work: to show influence of the hypophysis posterior lobe on the urine excretion. EXPERIMENT № 1. Put three white mouse on the wire netting envisaged into glass watering-cans with diameter 10-15 sm. Put the watering-cans into the test tubes for collection of urine. Enter 2 ml of the distilled water in an abdominal region to two mouses. Enter additionaly 0,2 ml of pituitrin (antidiuretic hormone, vasopressin) under a skin one of them. The third mouse is control. Loading by water Loading by water Control +pituitrinDetermine a diuresis in all three mouses every 20 min. Diuresis after 1 our: Control mouse ml of urine Mouse with the water loading ml of urine Mouse with water loading and pituitrin ml of urine Conclusion: ______11 THEME: "PATHOLOGY of THYROID AND PARATHYROID GLANDS". Actuality of theme. The height of thyroid gland pathology is observed in the economic developed countries; in Ukraine it occupies one of the leading places. Principal reasons of it origin is an action of ionizing radiation, deficiency of iodine in an organism, genetic predisposition, age. Pathology of the endocrine system occupies one of leading places in the structure of diseases, which the doctor of any speciality meets with, first of all, physician and pediatrician. Knowledge of reasons of origin, mechanisms of development, external displays, features of motion, consequences matters in preparation of future specialists. General purpose of the lesson: to learn principal reasons and mechanisms of thyroid and parathyroid glands pathology development.For this it is necessary to know (the concrete purposes):  To explain the reasons of origin and mechanisms of development of basic violations at the hyperfunction of thyroid and parathyroid glands.  To expose reasons and mechanisms of development of basic violations at hypofunction of thyroid and parathyroid glands.For realization of purposes of lesson it is necessary to have the base knowledges- skills: 1. To know the structure of thyroid and parathyroid glands (department of normal anatomy, department of physiology) 2. To know the mechanisms of these glands action (department of physiology) 3. To know the methods of estimation of the functional state of thyroid and parathyroid glands (department of physiology).The checking of primary level of knowledges. 1. Name the hormones which are produced by a thyroid gland. 2. Physiological action of thyroid hormones. 3. What hormone is produced by parathyroid glands? 4. Physiological action of parathyroid gland hormone. 5. Regulation of thyroid gland hormones production. 6. Name the biological effects of thyroid gland hormones? 7. Reasons of thyrotoxicosis 8. What is endemic goitre? 9. Name the basic clinical sighs of thyrotoxicosis. 10. What violation develops as a result12 of insufficiency of thyroid hormones at children? 11. What are the reasons of acute hypoparathyroidism? 12. What are the reasons of chronic hypoparathyroidism? 13. Basic displays of chronic insufficiency of parathyroid glands. 14. Definition of hypoparathyroid tetany? 15. Name the complications of chronic hypoparathyroidism? 16. Name the reasons of hyperparathyroidism? 17. Name the basic displays of hypercalciemia? 18. What is the basic metaboism? 19. Level of calcium in the blood? 20. Level of phosphorus in the blood?Standards of answers at the theoretical questions of initial level of knowledges: 1. Triiodothyronine (T3). thyroxine (T4), calcitoninum 2. Plays important role in regulation of height and differentiation of tissues, influence on metabolism, and influence on CNS. 3. Parathormone. 4. Activation of osteoclasts function, oppression of phosphorus reabsorption, activating of vitamin D transformation in active hormonal form. 5. By the thyreotropin (TTH) by the mechanism of direct and reverse connection. 6. Anabolic action, activation of protein synthesis, activation of metabolic, increase reactivity of immune system and activation of antibodies production. 7. Main reason of thyrotoxicosis is the inherited predisposition; factors of risk are: psychical trauma, infections, overcooling. 8. It is an enlargement of thyroid gland, connected with insufficiency of iodine in water and earth, concern to some geographical region (mountains f.e.) 9. Enlargement of thyroid gland, exophtalmus, tachicardia, increase of basic metabolism, decline of body mass, tremor of hands fingers, sweating, increased nervous excitability, speed-up of intestine peristalsis. 10. Cretinism 11. Complete surgical removal of parathyroid glands, strumectomy concerning a cancer. 12. Incomplete surgical removal of parathyroid glands, inherited hypoplasia, intoxications, autoimmune damage, hemorrhages, tumors, inflammatory processes, influence of ionizing radiation, intoxication, rachitis, for pregnant, in the period of lactation. 13. Weight loss, anorexia, increased neuro-muscular excitability, dyspepsia, trophic violations of skin and her appendages: dryness, thickening of skin, defects of dental enamel, caries, and breaks of teeth. 14. It is arisen up at the complete surgical removal of parathyroid glands. It is characterized by the increased neuro-muscular excitability as a result of diminishing content of calcium in the blood: muscular rigidity, clonic and tonic convulsions. 15. Hypoparatliyroid cachexy. 16. Adenoma or hyperplasia of parathyroid gland. 13 17. Calcification of soft tissues, formation of calcium stones in kidneys, hyperpiesis, strengthening of gastric secretion. 18. Amount of energy, which is needed for maintenance of normal organism functions at the minimum processes of metabolism (on empty stomach, t°C of environment -18-19°C). For female - 1600-1700 ccal, for male - 2000 ccal. 19. 2,1-3.1 mmol/1 20. 0,0,9-1,2 mmol/1Theoretical questions for FMC-2. 1. Thyroid gland. Hypothyroidism: causes and mechanisms of development, pathogenesis of main disturbances in the organism. 2. Hyperthyroidism: Causes and mechanisms of development, pathogenesis of main disturbances in the organism. 3. Goiter: kind (endemic, sporadic, diffuse and nodular toxic), their etiology and pathogenesis, characteristic of functional state of the gland. 4. Parathyroid gland dysfunction: types, causes, mechanisms of development, clinical and pathophysiological manifestations. 5. Hypofunction of parathyroid glands. Kinds. Reasons, mechanisms of development. Basic manifestations. 6. Hyperparathyroidism. Reasons, mechanisms of development. Manifestations. 7. Hypothyroidism at children. Etiology, pathogenesis, manifestations. Consequences.Themes of abstracts:  Autoimmune Hasimoto's thyroiditis.  Radiation muddiness of Ukraine and pathology of thyroid gland.  Pseudohypoparathyroidism. Reasons. Mechanisms of development.  Thyrostimulating autoantibodies and their role in pathology of thyroid gland.Literature. 1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU, 2005. 2. General and clinical pathophysiology/ Edited by prof.A.V.Kubyshkin, 2011 p.520-546 3. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005 p. 230-237 4. Lectures materialsTesting according Open database "KROK-I" (2010) 1. A 5-month-old boy was hospitalized for tonic convulsions.. Examination revealed coarse hair, thinned and fragile nails, pale and dry skin. In blood: calcium – 1,5 millimole/l, phosphor -1,9 millimole/l. These changes are associated with: a. Hypothyroidism b. Hypoparathyroidism c. Hyperparathyroidism 14 d. Hypoaldosteronism c. Hyperaldosteronism 2.A child has abnormal formation of tooth enamel and dentin as a result of low concentration of calcium ions in blood. Such abnormalities might be caused by deficiency of the following hormone: A. Thyroxin B. Parathormone C. Thriiodothyronine D. Thyrocalcitonin E. Somatotropic hormone3.Clinical examination of a female patient revealed reduction of basal metabolism by 40%, gain in body mass, drop of body temperature, face puffines, sexual disfunctions, inertness and apathy, lowered intelligence. These symptoms are caused by dysfunction of the following endocrine gland: A. Hypofunction of parathyroid glands B. Hyperfunction of thyroid gland C. Hypofunction of thyroid gland D. Hypophysis hyperfunction E. Epiphysis hypofunction4.A 40 year old female patient has enlarged thyroid gland. On palpation the gland is dense, its dense, its surface is slightly tuberous. Histological examination of flag sample revealed diffuse in infiltration of tissue by the cells, formation of lymphoid follicles. What disease is it? A. Diffuse toxic goiter B. Riedel’s disease C. Autoimmune thyroiditis D. Sporadic goiter E. Endemic goiter5.Clinical examination of a female patient revealed reduction of basal metabolism by 40%, gain in body mass, drop of body temperature, face puffiness, sexual disfunction, inertness and apathy, lowered intelligence. These symptoms are caused by disfunction of the following endocrine gland: A. Epiphysis hypofunction B. *Hypofunction of thyroid gland C. Hyperfunction of thyroid gland D. Hypofunction of parathyroid glands E. Hypophysis hyperfunction 6.A 9 y.o. boy was admitted to the endocrinological15 department. This boy has already had fractures of his extremities due to bone brittleness. The function of the following endocrinal glands (gland) is disturbed: A. Thymus B.Thyroid С Adrenal D. *Parathyroid E.Epiphysis7.After a surgical procedure an experimental animal died from intense convulsions. What endocrinal glands were extracted? A.Adrenal B.Ovaries С Thyroid D. *Parathyroid E.Testicles8.A patients from near Carpathians is suffering from the endemic goiter, turned to the doctor with complaints on gum suppuration and loosened teeth. What is the cause of parodontosis in this case? A. * Endocrine malfunction B. Stress influences C. Hypersialosis D. Swallowing malfunction E. Malnutrition9.Female, 53 years old, height 163 cm, body weight 92 kg, , edemata face, sedentary, apathetic. When pressure is applied to the leg, the hollow remains. Which gland dysfunction can cause such a state? A. * Thyroid B. Pituitary C. Adrenal D. Sexual E. Parathyroid10. A woman, 46 years, after the operation on the thyroid gland, soon experienced fibrous muscles twitch of hands, legs and face. These dysfunction can be eliminated by introducing A. * Parathyroid hormone B. Triiodothyronine C. Thyrotropin D. Thyroxin E. Thyrotropic hormone11.A woman, aged 45, a few years after moving to Trans-Carpathians developed 16 weakness, drowsiness, apathy, memory decrease and swelling. After examination, was diagnosed with endemic goiter. Lack of what substance in water and food could lead to this disease? A. * Iodin B. Fluoride C. Iron D. Calcium E. Magnesium12.In patient, 20 years, following the surgical thyroid removal, enamel hypoplasia and dentin formation malfunction were observed. Lack of which hormone has caused the said diseases? A. * PTH B. thyroxin C. thyrotropin D. thyrotropin releasing factor E. Thyrocalcytonin13.A woman, aged 45, a few years after moving to Trans-Carpathians developed weakness, drowsiness, apathy, memory decrease and swelling. After examination, was diagnosed with endemic goiter. Lack of what substance in water and food could lead to this disease? A. * Iodin B. Fluoride C. Iron D. Calcium E. Magnesium14.Patient D., 50 years, was diagnosed with myxedema. Malfunction of which hormone formation leads to the development of this pathology? A. * thyroxin and triiodothyronine B. cortisol and aldosterone C. ACTH and STH D. oxytocin and vasopressin E. insulin and glucagons15.Clinical examination of a woman found: increased sweating, tachycardia, weight loss, and tremor. What endocrine pathology can cause this? A. * Hyperthyroidism B. Hypothyroidism C. Hypergonadism D. Hypogonadism E. Hypoaldosteronism16. A 40 year old female patient has enlarged thyroid gland. On palpation the gland is 17 dense, its surface is slightly tuberous. Histological examination of biopsy sample revealed diffuse infiltration of tissue by the cells, formation of lymphoid follicles. What disease is it? A. Diffuse toxic goiter B. Riedel’s disease C. Autoimmune thyroiditis D. Sporadic goiter E. Endemic goiter17. A child has abnormal formation of tooth enamel and dentin as a result of low concentration of calcium ions in blood. Such abnormalities might be caused by deficiency of the following hormone:A. Somatotropic hormone B. Thyroxin C. Parathormone D. Thyrocalcitonin E. TriiodothyronineSituation tasks: 1. Acute worsening of the state, fever 39°C developed at a patient after the subtotal resection of thyroid gland concerning toxic goitre of 3 degree. A patient is excited, there are hallucinations, AP - 120/40 mm.Hg, heart rate - 180 /min, breathing - 32 /min, arrhythmia. 1. What complication arises at a patient? ______2. Explain the mechanisms of development. ______2. Weakness, irritability, sweating arise up at a patient after the carried flu. A patient became skinny; shaking of hands, goggle-eyedness appeared. At a review: redness of face, skin moisture, exoftalmus, pulse - 120 /min, thyroid gland is enlarged, soft, and painless. 1. What pathology takes place at a patient? ______2. What reasons of this disease origin? ______18 ______3. Explain the mechanism of development ______3. A woman, 60 years, long time was living near Carpatian mountains. She complains on a presence of "tumor" on a neck during last 20 years. She is displaced at swallowing. The tumor does not make any unpleasant feeling. At research the bilateral diffuse goitre of 3 degrees was educed. 1. Name the pathology which takes place at a patient. ______2. Does this disease connected with the place of living? ______3. Name a "tumor" which grew in a woman. Explain the mechanism of it development. ______4. What treatment should be used in this case? ______4. Woman, 68 years, hospitalized with the break of backbone. During 5 years repeatedly there were breaks of backbone, bones of extremities. She feels weakness, rapid fatigueability, gradually loses of weight. 2 years ago the stones in the kidneys were educed. Objectively: pulse - 62 /min, respiratory rate - 17 /min, AP - 165/105 mmHg 1. Name the pathology which takes place at a patient. ______2. What test she need to make? ______3. Reasons of origin, mechanisms of development of this pathology? 19 ______5. A patient was operated concerning diffuse toxic goitre of 3rd degree. In 2 weeks after operation convulsions of extremities muscles, paresthesia appeared on hands and feet. Objectively: pulse - 72 /min, AP- of 120/80 mmHg, Skin is moist. Tones of heart are rhythmic. Breathing is vesicular. From the side of internals any deviations are not founded. 1. What complication did arise up at a patient? ______2. What test it is necessary to make for confirmation of diagnosis? ______3. What changes of homoeostasis did result this postoperative complication? ______4. Was it possible to prevent it? ______6. A patient, 46 years, long time felt fatigueability, bradycardia, pain in a backbone muscles. At an inspection the level of calcium in blood more than 10 mmol/1, specific gravity of urine -1002-1009. Person use a meal rich on a calcium. 1. Name the possible pathology. ______2. What examination it is necessary to make for confirmation of diagnosis? ______3. Does it dangerously for patient to use the meal rich on a calcium? ______Practical work: Object of work: to define the amount of calcium in the blood at experimental hypoparathyroid tetany. EXPERIMENT № 1. Determining the amount of calcium in blood. Principle of method consists in sedimentation of serum calcium from by a lemon salt ammonium. Lemon salt calcium that20 is formed in a sediment determine by manganese salt 0.0IN solution titration. PROGRESS OF WORK. Pour the test tube by 1 ml of serum, add 0,5 ml of the lemon salt ammonium saturated solution. Mix the content of test tube and abandon on 30 min, centrifuge after it. Rack a liquid above sediment. Add to sediment 3 ml of 2% NH4OH, mix with test tubes content and centrifuge again. Rack a liquid above sediment, wash by ammonia and centrifuge once again. Add to sediment 1 ml of 10% of sulphuric acid, heat the test tube on an water bath for dissolution of sediment and titrate it by 0,0 IN solution of permanganate to the poorly-pink color, which does not disappear during 2 min. Every ml of a 0,01N permanganate solution expended on titration conform to 0,2 mg of Ca. Calculate the amount of calcium in 100 ml of the investigated blood serum. At the same time determine the amount of calcium in a control test tube.Results: Control: for titration of control standard 0, 25ml of a 0,0 IN permanganate solution were used. 1 ml - 0,2mg of Ca2+ 0,25 ml - x mg of Ca2+ x =0,05 mg of Ca2+ (In 100 ml of control serum there is 5 mg of Ca2+).Experiment: for titration of experimental permanganate solution were used, lml - 0,2 mg of Ca2+ ______ml - x mg of Ca2+ x=______mg of Ca2+ (In 100 ml of the investigated serum there is For translation the mg in mmol/1 use the coefficient 0,5. In the control standard ______x 0,5 =_____mmol/1 Experimental model -______x 0,5 = mmol/1 Conclusion ______THEME: "PATHOLOGY OF ADRENAL GLANDS"./ Actuality of theme. Production of hormones, which play an important role in maintenance of vascular tone, regulation of water-salt, carbohydrate, lipid metabolism take place in adrenal glands. It is extraordinarily important for future specialist to know etiologic factors which result in development of adrenal glands hypo-, hyperfunction. Development of acute insufficiency of adrenal gland is especially dangerous for life. Adrenal gland pathology results in the pathology from the side of various organs and systems, both organism of the grown man and child. Therefore understanding of mechanisms of endocrine pathology basic manifestations21 development is a necessity for the doctor of any profession. A separate important question is a hypercorticoidism which develops as a result of application of synthetic analogues of adrenal gland hormones during antiinflammatory therapy. Knowledge of circadian rhythms of hormones production will assist to the future doctors to make the correct setting of these hormones analogues to prevent development of hypercorticoidism and "syndrome of abolition" after stopping of medications reception. General purpose of the lesson.  To learn the reasons and mechanisms of adrenal gland pathology development.  For this it is necessary to know (the concrete purposes):  Pathology of the adrenal glands.  Lack of adrenal cortex: types (primary, secondary, acute, chronic), etiology, pathogenesis, clinical manifestations.  Adrenal cortex hyperfunction: types (primary, secondary), etiology, pathogenesis, clinical manifestations.  Cushing's syndrome, Conn’s syndrome, congenital adrenal hyperplasia (adrenogenital syndrome).  Types, causes, mechanisms of development, clinical manifestations of the medullar substance of adrenal glands disorders For realization of purposes of lesson it is necessary to have the base knowledges- skills: 1. To know the structure (anatomy) of adrenal gland (department of anatomy); 2. To know the mechanisms of adrenal gland hormones action (department of physiology and biochemistry); 3. To know the hormonal regulation of metabolism and biological functions of adrenal gland (department of biochemistry).The checking of primary level of knowledges. 1. Name the layers (parts) of adrenal gland. 2. How many adrenal glands at human in a norm? 3. What hormone of hypophysis regulates an activity of adrenal gland cortex? What hormones are produced by the cortex of adrenal gland? 4. What hormones are produced by the medullar of adrenal gland? 5. Name the zones of adrenal gland cortex. 6. What hormones are produced by the zona fasciculata of adrenal gland? 7. What hormones are produced by the zona glomerulosa of adrenal gland? 8. What hormones are produced by the zona reticularis of adrenal gland? 9. Violation of what hormone synthesis results in Cushing's disease? 10. Violation of what hormone synthesis results in Cushing's syndrome? 11. Violation of what hormone synthesis results in pheochromocytoma? 12. Violation of what hormone synthesis results in Con's syndrome? 13. Violation of what hormone synthesis results in adrenogenital syndrome? 14. Violation of what hormone synthesis results in Addison's disease? 15. Name the Addison's disease by other22 name. 16. Does the level of ACTH increase at Cushing's syndrome? 17. Does the level of ACTH decrease at Cushing's syndrome? 18. Does the level of ACTH increase at Cushing's disease? 19. Does the level of ACTH decrease at Cushing's disease? 20. Does the hyponatriemia develop decrease at Cushing's disease? 21. Does the hvperkaliemia develop decrease at Cushing's disease? 22. Does the edema develop at primary hyperaldosteronism? 23. Does the edema develop at secondary hyperaldosteronism? 24. Does the hypokaliemia develop at hyperaldosteronism? 25. Does the hyponatriemia develop at hyperaldosteronism? Standards of answers at the theoretical questions of initial level of knowledges: 1. Cortex and medullar. 2. Two. 3. Adrenocorticitropin (ACTH) 4. Glucocorticoids, mineralocorticoids, sex hormones. 5. Adrenaline, noradrenaline. 6. Zona fasciculata zona glomerulosa zona reticularis. 7. Glucocorticoids. 8. Mineralocorticoids. 9. Sex hormones. 10. Increase of ACTH production. 11. Increase of glucocorticoids production. 12. Adrenaline and noradrenaline. 13. Increase of aldosterone production. 14. Increase of sex hormones production. 15. Diminishing of adrenal cortex hormones production. 16. Bronze disease. 17. No. 18. Yes. 19. Yes. 20. No.21. No. 22. No. 23. No. 24. Yes. 25. Yes. 26. No. 23 Theoretical questions for FMC 2. 1. Pathology of the adrenal glands. 2. Insufficiency of adrenal cortex: types (primary, secondary, acute, chronic), etiology, pathogenesis, clinical manifestations. 3. Adrenal cortex hyperfunction: types (primary, secondary), etiology, pathogenesis, clinical manifestations. 4. Cushing's syndrome, Conn’s syndrome, congenital adrenal hyperplasia (adrenogenital syndrome). 5. Types, causes, mechanisms of development, clinical manifestations of the medullar substance of adrenal glands disorders.Themes of abstracts:  Primary and secondary aldosteronism. Reasons of origin. Characteristics.  Adrenogenital syndrome, its nosotropic variants.  Stress and general adaptation syndrome.  Violation of sex differentiation and puberty.. Literature. 1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU, 2005. 2. General and clinical pathophysiology/ Edited by prof.A.V.Kubyshkin, 2011 p.520-546 3. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005 p. 230-237 4. Lectures materialsTesting according Open database "KROK-1" (2010) 1. Osmotic pressure of blood plasma is 350 mosmole/l (standard pressure is 300 mosmole/l). First of all it will results in high secretion of the following hormone: A Vasopressin B Aldosteron C Cortisol D Adrenocorticotropin E Natriuretic 2. A concentrated solution of sodium chloride was intravenously injected to an animal. This caused decreased reabsorption of sodium ions in the renal tubules. It is the result of the following changes of hormonal secretion: A Aldosterone reduction B Aldosterone increase C Vasopressin reduction D Vasopressin increase E Reduction of atrial natriuretic factor 3. A patient with android-type of obesity had been suffering from arterial hypertension, hyperglycemia, glycosuria24 for a long time and died from the cerebral hemorrhage. Pathalogonatomic examination revealed pituitary basophilic adenoma, and hyperplasia of adrenal cortex. What is the most likely diagnosis? A Cushing's syndrome B Diabetes mellitus C Acromegalia D Pituitary nanism E Adiposogenital dystrophy 4. Patient used glucocorticoids for a long time, discontinuation of using caused decreased BP, weakness. How can you explain it? A Insufficiency of adrenal glands B Adaptation to the medicine C Sensitization D Hyperproduction of ACTH E Cumulation5. The person has decreased diuresis, hypernatremia, hypokalemia. Hypersecretion of what hormone can cause such changes? A Aldosterone B Vasopressin C Auricular sodiumuretic factor D Adrenalin E Parathormone6. A 50-year-old patient complains about general weakness, appetite loss and cardiac arrhythmia. The patient presents with muscle hypotonia, flaccid paralyses, weakened peristaltic activity of the bowels. Such condition might be caused by: A Hypokaliemia B Hypoproteinemia C Hyperkaliemia D Hypophosphatemia E Hyponatremia 7. A 44-year-old woman complains of common weakness, heart pain, and considerable increase of body weight. Objectively: moon-like face, hirsute syndrome, AP- 165/100 mm Hg, height - 164 cm, weight - 103 kg; fat is mostly accumulated in the region of neck, shoulders, stomach. What is the main pathogenetic mechanism of obesity? A Increased production of glucocorticoids B Decreased production of thyroidal hormones C Increased production of insulin D Decreased production of glucagon 25 E Increased production of mineralocorticoids 9. A 45 y.o. woman suffers from Cushing's syndrome - steroid diabetes. Biochemical examination revealed: hyperglycemia, hypochloremia. Which of the under-mentioned processes is the first to be activated? A Gluconeogenesis B Glycogenolysis C Glucose reabsorption D Glucose transport to the cell E Glycolysis 10. The patient with complaints of permanent thirst applied to the doctor. Hyperglycemia, polyuria and increased concentration of 17-ketosteroids in the urine were revealed. What disease is the most likely? A Steroid diabetes B Insulin-dependent diabetes mellitus C Myxoedema D Type I glycogenosis E Addison's disease11. On some diseases it is observed aldosteronism with hypertension and edema due to sodium retention in the organism. What organ of the internal secretion is affected on aldosteronism? A Adrenal glands B Testicle C Ovaries D Pancreas E Hypophysis 12. Examination of a patient revealed hyperkaliemia and hyponatremia. Low secretion of which hormone may cause such changes? A Aldosteron B Vasopressin C Cortisol D Parathormone E Natriuretic 13. A patient has been given high doses of hydrocortisone for a long time. This caused atrophy of one of the adrenal cortex zones. Which zone is it? A Fascial B Glomerular C Reticular D Glomerular and reticular E -26 Situation task: 1. Arterial hypertension, hyperglycemia, lipopexia of upper part of body appear at a patient suffered from adenoma of adrenal cortex. 1. Name the pathology. ______2. Name the reasons and mechanisms of the indicated signs development. ______2. The diagnosis of Con's syndrome made for a patient. 1. What are the reasons and mechanisms of this syndrome development? ______2. Name the symptoms, that characteristic for this syndrome and mechanism of their development. ______3. A man, 40 years, appealed to the doctor with complaints about the decline of vision, periodic headache, arterial hypertension, polyuria. AT - 130/110 mm Hg. Electrolytes of blood: Na+ - 175 mmol/I, K+ - 2,8 mmol/1. 1. Name the pathology for a patient? ______2. Name the reasons and mechanisms of indicated signs development. ______4. A patient with chronic right ventricle insufficiency and cirrhosis of liver has edema and arterial hypertension. At laboratory research a hypernatremia, kaliopenia. 1. Name the reasons of this situation? ______2. Identify mechanisms of development. 27 ______5. Increase of aldosterone level in the blood was found at a patient with arterial hypertension. 1.Name the reasons of this situation? ______2.Name the biological effects of aldosterone. ______6. A woman, 45 years, who used prednisolone for a long time due to bronchial asthma. She complaints about the increase of blood pressure, appearance of stretch strias at the abdomen, obesity of upper part of trunk. 1. Name the pathology for a patient? ______2. Name reasons and mechanisms of it development. ______7. A woman with tuberculosis, suffered from general weakness, adynamia, arterial hypotension, polyuria, diarrhea - appealed to the district doctor. Objectively: hyperpigmentation of skin, glucose of blood of 3,5 mmol/1. 1. Name the pathology for a patient? ______2. Name the reasons and mechanisms of the indicated signs development. ______9. A woman, 50 years, appealed to the doctor with complaints about the increase 28 of arterial pressure, especially after stress situations. At the USI there is increase of right adrenal gland ( a medullar part). 1. Name the pathology for a patient? ______2. Name the reasons and mechanisms of the indicated signs development. ______29 THEME: "PATHOLOGY of SEX GLANDS".Actuality of theme. Pathology of sex glands results in violation of the main function of human - generative. Thus there can be fruitlessness, violation of pregnancy motion, delivery motion and other. Taking into account close connection of hormonal function of sex glands with metabolism, violations of their function play an important role in an origin of many organs diseases. That is why knowledge of sex glands pathology (reasons of origin, mechanisms of development) has an important practical value for the doctor of any profession.General purpose of the lesson. For this purpose it is necessary to be able (concrete aims): 1. To know biological effects and physiological action of sex hormones. 2. To explain the reasons of origin and mechanisms of basic manifestations development at the hyperfunction of sex glands. 3. To explain the reasons of origin and mechanisms of basic manifestations development at the hypofunction of sex glands.For this it is necessary to know (the concrete purposes): To know the structure of sex glands (department of human anatomy, department of histology) To know the mechanisms of these glands hormones action (department of physiology) To know the methods of the functional state of sex glands diagnostics (department of physiology).The checking of primary level of knowledges. 1. Name the hormones which are produced by the ovaries. 2. Name the cells which are responsible for the female hormones synthesis. 3. Physiological action of the female hormones. 4. What physiological value of progesterone? 5. Name the hormones which are produced by the testis. 6. Name the cells which are responsible for the male hormones synthesis. 7. Physiological action of the male hormones. 8. Name the age of puberty formation. 9. What does behave to the primary sex signs? 10. Significance of primary sex signs. 11. What belongs to the secondary sex signs? 12. Name the extragenital effects of sex glands. 30 13. Explain the regulation of synthesis of sex hormones. 14. Physiological action of placenta hormones. 15. What belongs to the protein hormones of placenta? 16. What belongs to the steroid hormones of placenta? 17. Name the biological effects of chorionic gonadotropin. 18. Name the biological effects of somatomammotropin. 19. What is virilism? 20. What are the reasons of virilism? 21. Name the main clinical sign of virilism? 22. What is castration? 23. Name the reasons of castration? 24. What are the main clinical sign of castration? 25. What do the consequences of castration depend on? 26. What is postcastration syndrome?Standards of answers at the theoretical questions of initial level of knowledges: 1. Estrogenes (estradiol, estrone, estriole). progestines (progesterone). 2. Cells of yellow body and placenta. 3. Growth and maturation of genital organs, growth of oviducts, uterus, vagina, formation of internal layer of uterus (endometrium), formation of secondary female signs and manifestations of sex reflexes, acceleration and uterus muscles contraction, sensitisation of uterus to oxytocine, growth and development of mammary glands. 4. Provides normal motion of pregnancy, growth of endometrium which assists to implantation of the impregnated ovule in an uterus, creates favorable conditions for development of decidual membrane, brakes contraction of pregnant uterus muscles, diminishes the sensitiveness of uterus to oxytocine and estrogenes, brakes growth and maturation of follicles, assists to the accumulation of water and electrolytes in the uterus tissues and in the all organism, promotes growth and uterus stretching, formation of mammary gland. 5. Androgens (testosterone). 6. Interstitial cells (Leydig's cells). 7. Growth and maturation of genital organs, normal maturation of spermatozoons, maintenance of their motive activity, exposure and realization of sexual behavioral reactions, influence on metabolism, strengthening of proteins synthesis in different tissues, especially in muscles, diminishing of fat content in the organs, increase of basic metabolism, influence on the CNS functional state. 8. 12-16 years 9. Sex glands (testis, ovaries), genital organs. 10. Determine possibility of coitus and procreation realization 11. Change of body form, timbre of voice, growth of hair, development of mammary glands, and also psychical behavior. 12. Anabolic action of androgens, catabolic action of progesterone, influence of androgens and gestagenes on the bones growth, increase of basal body temperature 13. With help of folliculostimulating hormone and luteinizing hormone by the principle of positive and negative feed-back. 31 14. Connection of maternal organism with a fetus, formation of enzymes, proteolysis, lipolysis, protein and steroid hormones formation. 15. Chorionic gonadotropin, somatomammothropin, relaxine 16. Progesteron and estriole 17. Luteinizing action, stimulates the growth of ovaries follicles, determines ovulation of mature follicles, assists of yellow body formation in ovaries, stimulates formation of progesterone in a yellow body, and prevents premature detachment of embryon, antiallergic action. 18. Influences on the mammary gland of pregnant, promotes a proteins synthesis and detains nitrogen in the organism of mother, increases content of free fat acids, promotes resistance of an organism to the hypoglycemic action of insulin. 19. Appearance of the secondary male sex signs at female. 20. Androgenic-productive tumors of ovaries and adrenal gland increase synthesis of this hormones at the diseases of untumour origin (Cushing's disease. acromegaly. Shtain- Levental's syndrome). 21. Hair distribution on a male type, rough voice, male constitution, atrophy of mammary glands 22. Influence that causes the complete and unrevised stopping of sex glands function. 23. Trauma, infection that are accompanied with destruction of sex glands tissues, surgical removal, hormonal and radial influence. 24. Malignant tumors of testicles and prostate, malignant tumors of ovaries, cervix of uterus, mammary glands. 25. Depends from the age in which the endocrine function was disturbud - before the puberty or after it. 26. Complex of pathological changes which arise up in an organism as a result of castration.Theoretical questions for FMC 2 1. Male hypogonadism, reasons, mechanisms of development, basic manifestations. 2. Female hypogonadism, reasons, mechanisms of development, basic manifestations. 3. Male hypergonadism, reasons, mechanisms of development, basic manifestations. 4. Female hypergonadism, reasons, mechanisms of development, basic manifestations. 5. Hypogonadism at a boys. Reasons of origin. Description. 6. Hypogonadism at a girls. Reasons of origin. Description. 7. Adrenogenital syndrome. Reasons of origin. Mechanisms of development. Description. 8. Hermaphroditism. Kinds. Reasons, mechanism of development, basic manifestations. Consequences.Themes of abstracts :  Adrenogenital syndrome, its nosotropic variants. Violation of sex differentiation 32and puberty.  Hyperandrogcnism.  Primary and secondary amenorrhea.  Gynecomastia. Literature 1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU, 2005. 2. General and clinical pathophysiology/ Edited by prof.A.V.Kubyshkin, 2011 p.520-546 3. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005 p. 230-237 4. Lectures materialsTesting according Open database "KROK-1" (2010) -1. A girl has been diagnosed with adrenogenital syndrome (pseudohermaphroditism). This pathology is caused by hypersecretion of the following adrenal hormone: A. *Androgens B. Glucocorticoids C. Catecholamines D. Estrogens E. Mineralocorticoids2. A young man aged 17 has the signs of retention of sexual development; his height is 184 cm; he is asthenic; his secondary sexual characters are weakly developed. Sex chromatin is absent in this patient's cells. At the age of 4 he endured epidemic parotitis. What was the cause of hypogonodism? A. Deficiency of gonadoliberine B. Deficiency of gonadotropin C. Cryptorchism D. * Orchitis E. Chromosomal anomalies (XXY)3. Removal of cancer tumor of the testis in a patient before the period of sexual maturity resulted in the development of eunochoidism and was accompanied by the deficiency of the production of: A. * Androgens B. Estrogens C. Kinines D. Prostaglandins E. Cytokines4. A boy, 14 years old, visited endocrinologist. His mother complains of his being 33 behind in physical development and growth. The boy has proportional constitution, his is 104 cm tall, and his secondary sexual characters are not marked. The cause of this pathology is hyposecretion of: A. * Gonadotropic hormone B. Growth hormone C. All hormones of adenohypophysis D. ACTH E. Thyroid stimulating hormone5. When stomatological examining the patient the following symptoms were revealed: woman features of his face, anomalies of form of crowns in some teeth, catarrhal gingivitis, and resorption of interdental junctures. Cytological examination of mucous membrane epithelium discovers that cells contain 1 Barr's body. What endocrine pathology are these manifestations the most probably connected to? A* Hypogonadism B. Hypergonadism C. Cretinism D. Thyrotoxicosis E. Chronic hypoparathyroidism6. What pathological conditions the tumor growing from reticular zone of adrenal gland may lead to? A. * Virilization of female organism B. Elevation in content of glucocorticoids in blood C. Tachycardia D. Elevation of content of mineralocorticoids in blood E. –7. Parents of a 10 y.o. boy consulted a doctor about extension of hair-covering, growth of beard and moustache, low voice. Intensified secretion of which hormone must be assumed? A. Of progesterone B. *Of testosterone C. Of oestrogen D. Of somatotropin E. Of Cortisol8. A girl is diagnosed with adrenogenital syndrome (pseudohermaphroditism). This pathology was caused by hypersecretion of the following adrenal hormone: A. Cortisol B. Adrenalin C. Aldosterone D. Estrogen E. *Androgen34 9. Parents of a 10 year old boy consulted a doctor about extension of hair-covering, growth of beard and moustache, low voice. Intensified secretion of what hormone must be assumed? A. *Of testosterone B. Of somatotropin C. Of progesterone D. Of Cortisol E. Of oestrogenSituation task:1. The patient, 16 years, complained of obesity, headaches, dizziness. These complaints appeared about 2 years ago. During the previous period they increased. In anamnesis there is chronic tonsillitis. On examination: height - 168 cm, weight 95 kg. On the sides of the abdomen, inner surface of the thighs, the waist area, there are blue and purple striae. Folliculitis. Obesity of android type. BP - 150/100 mm.Hg. 1. What is the disease at the patient? ______2. Level of what hormones should designate a patient? ______2. The woman, 37 years, proportionale constitution, female type, complaining of irregular menstruations (delay of 4-6 months), deterioration of health: frequent feeling of stuffy and hot, "hot flash", transient increase of blood pressure, weight gain. In anamnesis - 2 pregnancies that ended in normal births. 1. Put a preliminary diagnosis. ______3. What is the mechanism of these symptoms? ______3. The patient, 19 years, as a child was often ill on infectious diseases. Objective: height 180 cm, asthenic physique, secondary sexual characteristics are underdeveloped, the primary sex characteristics do not satisfy the age, the testes atrophied. Testosterone levels in the blood is reduced. 1. Put a preliminary diagnosis. ______35 2. What is the mechanism of these symptoms? ______Practical work: Object of work: to show activation of sex apparatus of a frog ander the action of gonadotropic hormones. EXPERIMENT № 1. Identification of pregnancy early terms. Enter into the spinal lymphatic sack of two frogs-males with the absent sperm cell 3-4 ml urine of pregnant woman urine by the syringe. Take the liquid from the frog's cloaca by the pipette after 1-1,5 hours from and prepare the specimen - the "hanging drop". Look over it under a microscope. Presence of sperm cell confirms the pregnancy. Watch the motion of с sperm cell and infusoria. As opposed to the infusoria the sperm cells do not make the direct motions, but pendulous. For comparison examine the liquid from cloaca that was taken before the entrance of pregnant woman urine (control test). Conclusion: ______EXPERIMENT 2. Influence of pregnant woman urine at the sex development of the infantile mouse (Aschheim-Zondek test). Macropreparations got on early conducted experiment on the infantile mise with the pregnant woman urine are demonstrated to the students. Aschheim-Zondek test Enter 0,3 ml of urine under the skin to the infantile mise-females during 3th days. Prepare the smears from vagina content in 100 hours after the first injection. Fix the smears by the alcoholic ether. Paint 36them by the Romanovskyy's method or by the 0,5% solution of methylene blue Investigate the smears under a microscope. Expose a characteristic microscopic picture. Then mise it is hammered in, unseal an abdominal region and determine the state of the sex system. Megascopic horns of uterus and the megascopic ovaries with the areas of fresh hemorrhages and in less yellow bodies are appear that testifies to the premature ripening of follicles. For control mise - the horns of uterus are very thin, ovaries are pale and barely noticeable among fatty tissue.Students examine the smears under a microscope, sketch changes, characteristic for the different stages of estrus. - resting stage (dioestrus) - prooestrus - oestrus - metoestrus37 THEME: "PATHOLOGY OF NERVOUS SYSTEM. PATHOPHYSIOLOGY OF PAIN". Actuality of theme. The nervous system regulates not only motive activity and sensitiveness of an organism, makes the regulation of all systems and organs, forming of human output, conditioned reflex, but also provides protective reactions. For example, pain is the unpleasant sensory and emotional feeling, related to the threat or damage of tissues. Understanding of mechanisms of pain forming is very important for an practical doctor, as the important aspect of diseases nosotropic treatment and pathophysiological basis of anesthesiology. General purpose of the lesson. To learn the reasons and mechanisms of pain. For this it is necessary to know (the concrete purposes): 1. To know general descriptions of the nervous system. 2. To know physiological basis of pain. 3. To know basic electro-physiological processes in the neurons. 4. To know the features of blood supply of cerebrum.For realization of purposes of lesson it is necessary to have the base knowledges- skills: 1. Structure (anatomy) of the nervous system (normal anatomy department); 2. Physiology mechanisms of pain (physiology department); 3. Electro-physiology processes in the brain (physiology department)Checking of primary level of knowledges. Give the answers to the following questions. 1. What is the pain? 2. Name types of pain? 3. What is somatic pain, its characteristics. 4. What is visceral pain, its characteristics. 5. Name the basic models of motive function violations in an experiment. 6. Name the basic syndromes of motive function violations. 7. What is the paralysis, paresis? 8. Types of the paralyses, paresises? 9. What is the myasthenia? 10. What is the Parkinson's disease? 11. Name the hyperkinetic violations of motive function? 12. What is die convulsions? Name the kinds. 13. What is the vasoneurosis ?ВСД на англ.? 14. What is the neurogenic dystrophy? 15. What is the stroke? 38 16. Name the chronic violations of cerebral blood circulation. 17. Name the violations of integrative function of CNS? Standards of answers at the theoretical questions of initial level of knowledges: 1. Pain is the unpleasant sensory and emotional feeling, related to the threat or damage of tissues. 2. According to clinical manifestations the pain can be: acute, dull locate and diffuse, to have the character of pricking, aches and other. According to duration the pain can be: acute and chronic. According to the value for an organism: physiological and pathological. According to the mechanism of development the pain can be: somatic and visceral. According to the location the pain can be: local, projective, radiating pain. 3. Somatic profound pain - is the kind of pain that is forming in the profound tissues. F.ex.: headache, dentalgia, myalgia, pain in the joints. Somatic superficial pain - is the kind of pain that is forming in the skin. 4. Visceral pain - is the kind of pain that is forming in the internal organs. 5. Basic models: cutting of peripheral nerves and ventral root of spinal nerve (peripheral paralyses); damage of spinal cord (spinal shock); cutting of brainstem between of mesencephalon and medulla oblongata (decerebrative rigidity); removal of cerebellum; cutting of pyramidal tracts; damage of extrapyramidal structures; removal or electric stimulation of motive zone of brain cortex. 6. Basic syndromes of violation of motive functions: violation of neuromuscular transmission, peripheral paralyses and paresises, central paralyses and paresises, Parkinson's disease, hyperkinesias, cerebellar tentorial syndrome. 7. Paralysis - it complete, and paresis is a partial loss of voluntary movement. 8. A central paralysis arises up at the damage of central motive neuron. It is characterized by muscular hypertension, hyperreflexia, appearance of pathological reflexes. A peripheral paralysis arises up at the damage of peripheral motive neuron. Signs: hypo- or atony, areflexia, atrophy of muscles. 9. Myasthenia is the inherited disease which appears as a muscular weakness; rapid fatigueability resulted by the blockade of neuromuscular transmission. In the base of it there is diminishing of acetylcholine receptors amount. 10. Parkinson's disease is the one from hyperkineticohypertonic syndrome, based on violation of dopamine synthesis. Basic displays are: hypokinesia, tremor, muscular rigidity. 11. Hyperkinetic violations of motive function are chorea, athetosis, hemiballism. 12. Convulsions are voluntary contractions of skeletal muscles that have paroxysmal character. There are tonic and clonic convulsions, combined. Depending on prevalence - general and local. 13. Vasoneurosis is the generalized violations of the vegetative nervous system. 14. Neurogenic dystrophy is a complex of trophic violations in organs and tissues 39 that arises up at the damage of nerves or other structures of the nervous system. Combined with the structural violations, functional changes, metabolic disturbance. 15. Stroke is the acute disorder of cerebral blood circulation that results in proof violations of cerebrum functions. There are hemorrhagic stroke (hemorrhage in a brain) and ischemic stroke (ischemia of brain). 16. Chronic violations of cerebral blood circulation are vascular encephalopathy that arises up as a result of atherosclerosis, results in dystrophic changes. 17. Violation of integrative function are agnosia (violation of feeling and perception), aphasia (disorder of consciousness, thought, speech), violation of behavioral responses, emotions, motivations, violation of capacity for studies, amnesia, parahypnosis.Theoretical questions for FMC -2. 1. General characteristic of the nervous system pathology, principles of classification of nervous system violations. Features of typical pathological processes of the nervous system. 2. Violation of sensory functions of the nervous system. Disorders of mechanical, thermal, and proprio-, nociception. Violation of sensory information. Brown-Sekar’s syndrome. Manifestations of thalamic centers and sensory structures of the cerebral cortex injury. 3. Pain. Features of pain as a kind of sensitivity. Principles of pain classification. Somatic pain. Visceral pain. Modern conceptions about the causes and pathogenesis of pain: theory of impulses redistribution (“gate theory”), theory of specificity. Pathological pain: neuralgia, causalgia, phantom, thalamic. Peripheral, peripheral - central and central mechanisms of pathological pain. Emotional, autonomic, motor body's response to the pain. Emotional-painful stress, pain shock. Natural antinociceptive mechanisms. Principles and methods of analgetic therapy. 4. Disorders of motive function of the nervous system. Experimental modeling of movement disorders. Peripheral and central paresis and paralysis: causes, mechanisms of development, main manifestations. Spinal shock. Movement violation of subcortical origin. Violations related to lesions of the cerebellum. Convulsions and their kind. Violation of neuromuscular transmission. Myasthenia. 5. Disorders of vegetative nervous system functions, methods of experimental modeling. Vegetovascular dystonia syndrome. 6. Violation of trophic function of the nervous system. Neurogenic dystrophy. Etiology and pathogenesis. 7. Violation of integrative functions of the central nervous system (CNS). Causes and mechanisms of electrophysiological processes in neurons disorders. Disruption of ion channels. Causes and mechanisms of the neurochemical processes disorders. Disorders of neurotransmitters, neuromodulators, neurohormons functions. Morbid excitation and inhibition of pathological nerve centers. Neuroses. 8. Damage of the neurons as one of the reasons of violations of integrative functions of the CNS. 9. Acute and chronic disorders of cerebral circulation. Stroke. Edema of the brain, causes and mechanisms of development. Intracranial hypertension. Damage of neuroglia in the development of pathological processes40 of the CNS. Brain barrier damage and autoimmune brain injury.Literature. 1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU, 2005. 2. General and clinical pathophysiology/ Edited by prof.A.V.Kubyshkin, 2011 p.520-546 3. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005 p. 230-237 4. Lectures materialsTesting according Open database "KROK-1" -2010 1. A patient after hypertension stroke does not have voluntary movements in his right arm and leg with the increased muscle tone in these extremities. What type of dysfunction of nervous system is it? A Central paralysis B Peripheral paralysis C Peripheral paresis D Reflex paresis E Central paresis 2. Four months ago a 43 year old patient had a traumatic amputation of his lower extremity. Now he complains of sensing the amputated extremity and having constantly grave, sometimes unbearable pain in it. What type of pain does he have? A Phantom B Causalgia C Neuralgia D Thalamic E Reflex 3. After poisoning with an unknown drug a 37 year old patient has stereotypical face muscle contractions that imitate blinking and squinting. What form of motor function disorder of nervous system is it? A Hyperkinesia B Hypokinesia C Akinesia D Ataxy E - 4. After traumatic tooth extraction a patient complains of a severe dull pain without accurate localization in his gum, body temperature rise up to 37,50С. He was diagnosed with alveolitis. What type of pain does the patient have? A Protopathic 41 B Epicritic C Visceral D Referred E Phantom Testing according system “Krok-I” (2006-2010) 1.After amputating the upper extremity a patient had a bad pain in it. Which mechanism of the pain feeling formation is more possible in this case? A. *Phantom B. Reflex C. Hyposecretion of endorphin D. Hypersecretion of endorphin E. Hyposecretion of encephalin2. After a road accident a patient was diagnosed with a trauma of the brachium with incomplete rupture of the median nerve. Besides, disorders of the motor and sense functions, the patient complains of sharp, stinging, intolerable pain. What kind of pain is it? A. Somatic. B. Projective. C. Reflected. D. Phantom. E. *Causalgia.3. A patient, complaining of pain in the region of the left scapula, was diagnosed with myocardial infarction. What kind of pain is it? A Phantom. B. Visceral. С *Irradiating (reflected). D. Early (protopathic). E. Late (epycritical).4.An experimental rat with extremity paralysis has no tendon and cutaneous reflexes, muscle tone is decreased, but muscles of the affected extremity maintain their ability to react with excitation to the direct action of continuous current. What type of paralysis is it? A Flaccid peripheral В Flaccid central С Spastic peripheral D Spastic central E Extrapyramidal5.A 28 year old man had a gunshot wound of shin that resulted in an ulcer from the side of the injury. What is the main factor of neurodystrophy pathogenesis in this 42 case? A *Trauma of peripheral nerve В Psychical stress С Microcirculation disturbance D Infection E Tissue damage 6. After a hypertonic crisis a patient presents with lacking spontaneous movements in his right arm and leg, muscle tone of these extremities is increased. What type of motor dysfunction has developed in this case? A. Peripheral paralysis B. *Central paresis C. Central paralysis D. Peripheral paresis E. Reflectory paresisName the pathology of motive function of nervous system and reasons of origin?43 ______Situate task:1. Myocardium infarction was diagnosed at a patient, 48 years, who complains on pain in an abdominal region. 1. Name the type of pain? ______2. What are the basic mechanisms of it origin? ______2. A patient, complaints on a general weakness, nausea, pain at the bottom of abdomen. Acute appendicitis was diagnosed after the review. 1. Name the type of pain? ______44 2. What are the basic mechanisms of it origin? ______

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