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Which of the following is most often involved in test produces 75% suppression of cortisol levels best purchase cialis impotence over 60. Ectopic pheochromocytoma may originate from which (d) Increased level of norepinephrine of the following? Assertion: Postpartum thyroiditis presents as a painful (a) Hypokalemia (b) Hypernatremia enlarged thyroid gland (c) Hypertension (d) Edema Reason: Postpartum thyroiditis is preceded by a viral 53 buy cialis master card erectile dysfunction treatment side effects. Dilutional hyponatremia is seen in: infection (measles purchase cialis cheap online does erectile dysfunction cause low libido, mumps etc) (a) Addison’s disease 5 150 mg fildena. Assertion: Graves disease is most common cause of (b) Diabetes insipidus endogenous hyperthyroidism buy viagra professional 50 mg on-line. Assertion: Myocardial infarction is the commonest cause of death in diabetes 1–10. Read Reason: Uncontrolled blood glucose leads to capillary both of them carefully and answer according to these dysfunction in target organs options. Assertion: Non ketotic hyperosmolar is a commoner (d) Both assertion and reason are false. Assertion: C peptide levels are used as a surrogate Reason: Insulin has a ‘fat sparing effect’ preventing fatty marker for insulin secretion acid oxidation. Assertion: Pheochromocytoma is also referred to as ‘rule and parathyroid hyperplasia. Assertion: Amyloid deposition is associated with Reason: Capsular invasion is the defnitive feature medullary variant of thyroid cancer differentiating follicular adenoma from follicular Reason–T he altered cacitonin secreted by parafollicular carcinoma cells gets deposited in the thyroid stroma 624 Endocrine System explanations 1. It reduces food intake and weight gain by acting on central neurons in the hypothalamus. Activation of other insulin receptor signaling pathways induces glycogen synthesis, protein synthesis, lipogenesis, and regulation of various genes in insulin- responsive cells. Glucokinase catalyzes the formation of glucose-6-phosphate from glucose, a reaction that is important for glucose sensing by the beta cells and for glucose utilization by the liver. Type 1 is usually apparently due to viral or immune destruction of beta cells, while type 2 is apparently usually due to increased resistance to insulin; consequently the 65-year-old, rather than the 16-year-old, is more likely to have relatively high endogenous levels of insulin (option D). Type 2 diabetes can often be controlled with oral hypoglycemic agents (option B), while type 1 diabetics generally require insulin. Causes include auto- immune destruction, congenital adrenal hyperplasia, hemorrhagic necrosis, and replacement of the glands by either tumor (usually metastatic) or granulomatous disease (usually tuberculosis). The symptoms can be subtle and nonspecifc (such as those illustrated), so a high clinical index of suspicion is warranted.

Maffucci syndrome

As the fusion occurs very early order 2.5mg cialis overnight delivery erectile dysfunction doctor houston, normal • Bilateral renal lump may be the present- renal pelvis is bigger in size and drain rotation and ascent of the kidney cannot ing feature buy discount cialis 20mg line erectile dysfunction nervous. So the result is a pair of ectopic kidneys knobby feel due to the large cysts on the b buy generic cialis 10 mg erectile dysfunction caused by prostate removal. Partial duplication of ureter-A ure- below the umbilicus with each pelvis lying on surface order 100mg zudena with visa. Double ureter-The ureter may be tion which produces some degree of ureteral capsule by the cysts purchase super p-force oral jelly cheap online. Tere may be associated aber- tion may present with colicky pain due to separate openings in the bladder on rant renal vessels. Tis is less common than the Due to the above two factors, incidence of cyst with clot retention. It is to be noted that the isthmus usually is typically moderate and lasts for a few However, the ureteric orifce is normal. Pressure of patients with polycystic kidneys, the by the vein on the ureter may lead to Clinical Features actual cause of which is not known. Ureterocele- Tis is a cystic dilatation • Tere may be infection and calculus for- phritis is quite common in this condition. The ureters are angulated as they • Uremia-As the loss of renal tissue to congenital atresia but in 1/10th of the pass over the isthmus. The ectopic opening may be Treatment show multiple cysts in both kidneys and located in the apex of trigone, prostate No treatment is usually necessary. Treatment sometimes cysts in the liver and other urethra, vas deferens, rectum or vagina in is required for infection, obstruction and cal- organs. Tis is caused by fusion of lower poles of both Polycystic kidney is an autosomal domi- kidneys by renal tissue of varying thickness nant condition and can be transmitted Treatment or by a fbrous band. Conservative-The patient is advised may lie either in front of or behind the aorta associated with cysts of the liver, spleen high intake of fuid and a low protein and inferior vena cava. Surgery-The standard operative treat- about 30 to 40 days old when the metanephric Pathology ment is Rovsing’s operation. The operation is done on • Some of the cysts are white while oth- one kidney frst and then on the second ers are brown due to hemorrhage inside. Tis results in insufciency becomes life-threatening, gradual renal failure, as the pathology is chronic dialysis or renal transplantation Fig. The causes pelvicaliceal system may contain 400ml to Patients usually live for 5 to 10 years afer the may be: 500 ml of urine. Extramural obstruction Grossly, the kidneys may have moder- • Involvement of the ureter by malignant ate to marked enlargement.

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The lobes of the thyroid gland consist of aggregates of many spherical follicles 20 mg cialis visa erectile dysfunction doctors in sri lanka, lined by a single layer of epithelial cells (Fig buy 2.5mg cialis otc erectile dysfunction doctor in phoenix. Microvilli cover the apical membranes of the follicular cells cheap cialis 10mg online erectile dysfunction medicine reviews, which face the lumen discount super avana american express. Tight junctions purchase propranolol canada, which provide a seal for the contents of the lumen, connect the lateral membranes of the follicular cells. The basal membranes of the follicular cells are close to the rich capillary network that penetrates the stroma between the follicles. The colloid is a solution composed primarily of thyroglobulin (Tg), a large protein that is a storage form of the thyroid hormones. T and T are iodinated derivatives of the amino acid4 3 tyrosine, formed by an ether linkage between the phenyl rings of two iodinated tyrosine molecules. T contains four iodine atoms on the 3, 5, 3′, and 5′ positions of the thyronine ring structure, whereas4 T has only three iodine atoms, at ring positions 3, 5, and 3′ (see 3 Fig. In addition to the epithelial cells that secrete T and T, the wall of the thyroid follicle contains a few4 3 parafollicular cells (see Fig. The parafollicular cell is usually embedded in the wall of the follicle, inside the basal lamina surrounding the follicle, and its plasma membrane does not form part of the wall of the lumen. Follicular cells synthesize and store iodinated thyroglobulin within the follicle. Rather, T and T are4 3 4 3 formed by chemical modification of tyrosine residues in the peptide structure of Tg as the follicular cells secrete it into the follicle lumen. Thus, the T and T formed by this chemical modification are actually4 3 part of the amino acid sequence of Tg. The high concentration of Tg in the colloid provides a large reservoir of stored thyroid hormones for later processing and secretion by the follicle. The synthesis of T and This completed when Tg is4 3 retrieved through pinocytosis of the colloid by the follicular cells. Lysosomal enzymes then hydrolyze Tg to its constituent amino acids, releasing T and T molecules from their peptide linkage for secretion into4 3 the blood. This process involves the synthesis of a thyroglobulin precursor, the uptake of iodide, and the formation of iodothyronine residues. Thyroglobulin precursor protein The first step in the formation of T and This the synthesis of the protein precursor for Tg. This 660-kDa4 3 glycoprotein is composed of two similar 330-kDa subunits held together by disulfide bridges. These vesicles migrate to, and fuse with, the apical membrane of the follicular cell. Thyroglobulin precursor protein is then extruded onto the apical surface of the cell, where iodination takes place. Iodide uptake and release The iodide used for iodination of the thyroglobulin precursor protein comes from the blood perfusing the thyroid gland.

That way buy cialis in india impotence age 40, endothelial cells in capillaries or venules could telegraph upstream information about whether the blood fow is indeed adequate cost of cialis purchase erectile dysfunction pump. In most cases cialis 20 mg discount pomegranate juice impotence, however super avana 160 mg generic, definite information about the relative importance of these substances in cardiovascular regulation is lacking buy 100 mg doxycycline otc. Prostaglandins and thromboxane are a group of several chemically related prod­ ucts of the cyclooxygenase pathway of arachidonic acid metabolism. Certain prostaglandins are potent vasodilators, whereas others are potent vasoconstric­ tors. Despite the vasoactive potency of the prostaglandins and the fact that most tissues (including endothelial cells and vascular smooth muscle cells) are capable of synthesizing prostaglandins, it has not been demonstrated convincingly that prostaglandins play a crucial role in normal vascular control. It is clear, how­ ever, that vasodilator prostaglandins are involved in inflammatory responses. Consequently, inhibitors of prostaglandin synthesis, such as aspirin, are effective anti-infammatory drugs. Prostaglandins produced by platelets and endothelial cells are important in the hemostatic (fow stopping, antibleeding) vasoconstric­ tor and plateletaggregating responses to vascular injury. Hence, aspirin is often prescribed to reduce the tendency for blood dotting-especially in patients with potential coronary fow limitations. Arachidonic acid metabolites produced via the lipoxygenase system (eg, leukotrienes) also have vasoactive properties and may infuence blood fow and vascular permeability during inflammatory processes. Histamine is synthesized and stored in high concentrations in secretory granules of tissue mast cells and circulating basophils. Histamine increases vascular permeability by causing separations in the junctions between the endo­ thelial cells that line the vascular system. Histamine release is classically associated with antigen-antibody reactions in various allergic and immune responses. Histamine can stimulate sensory nerve endings to cause itching and pain sensations. Although clearly important in many pathological situations, it seems unlikely that histamine participates in normal cardiovascular regulation. Bradykinin is a small polypeptide that has approximately ten times the vaso­ dilator potency of histamine on a molar basis. It also acts to increase capillary permeability by opening the junctions between endothelial cells. Bradykinin is formed from certain plasma globulin substrates by the action of an enzyme, kal­ likrein, and is subsequently rapidly degraded into inactive fragments by vari­ ous tissue kinases.

Conjunctivitis with pseudomembrane