Anatomy & Physiology ch 16
Anatomy & Physiology ch 16 Biol 2301
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Human Anatomy & Physiology, 8e (Marieb/Hoehn) Chapter 16 The Endocrine System Matching Questions Figure 16.1 Using Figure 16.1, match the following: 1) Produces the hormones that promote the development of the female secondary sexual characteristics at puberty. Answer: D Diff: 1 Page Ref: 623; Fig. 16.1 2) Storehouse for the hormones produced by the hypothalamus of the brain. Answer: B Diff: 1 Page Ref: 605; Fig. 16.1 3) Produces the hormones that direct the production of the secondary male sex characteristics. Answer: E Diff: 1 Page Ref: 623; Fig. 16.1 1 Copyright © 2010 Pearson Education, Inc. 4) Produce steroid hormones and glucocorticoids and mineralocorticoids. Answer: C Diff: 1 Page Ref: 614; Fig. 16.1 5) Produces hormones and is considered a neuroendocrine organ. Answer: A Diff: 1 Page Ref: 601; Fig. 16.1 Figure 16.2 Using Figure 16.2, match the following hypothalamic hormones with the pituitary hormone targets: 6) Growth hormonereleasing hormone (GHRH). Answer: A Diff: 1 Page Ref: 603604 7) Gonadotropinreleasing hormone (GnRH). Answer: C Diff: 1 Page Ref: 605 8) Prolactinreleasing hormone (PRH). Answer: B Diff: 1 Page Ref: 605 2 Copyright © 2010 Pearson Education, Inc. 9) Corticotropinreleasing hormone (CRH). Answer: E Diff: 1 Page Ref: 605 10) Thyrotropinreleasing hormone (TRH). Answer: D Diff: 1 Page Ref: 605 Match the following: A) Addison's disease B) Acromegaly C) Diabetes mellitus D) Pituitary dwarfism E) Graves' disease 11) An autoimmune problem involving the thyroid gland. Diff: 1 Page Ref: 611 12) Hyposecretion of growth hormone. Diff: 1 Page Ref: 604 13) Hyposecretion of the pancreas. Diff: 1 Page Ref: 622 14) Hyposecretion of the adrenal cortex. Diff: 1 Page Ref: 618 15) Hypersecretion of growth hormone. Diff: 2 Page Ref: 604 Answers: 11) E 12) D 13) C 14) A 15) B 3 Copyright © 2010 Pearson Education, Inc. Match the following: A) Cushing's disease B) Myxedema C) Acromegaly D) Cretinism 16) Hyposecretion of the thyroid in adults. Diff: 1 Page Ref: 611 17) Hypersecretion of the adrenal cortex. Diff: 1 Page Ref: 617618 18) Hypersecretion of growth hormone. Diff: 1 Page Ref: 604 19) Hyposecretion of the thyroid in infants. Diff: 1 Page Ref: 611 Answers: 16) B 17) A 18) C 19) D Match the following: A) Thyroid B) Adrenal medulla C) Hypophysis D) Parathyroid E) Pancreas 20) The size and shape of a pea; produces hormones that stimulate other endocrine glands. Diff: 1 Page Ref: 601 21) The gland that controls the fightorflight reaction. Diff: 1 Page Ref: 619; Fig. 16.16 22) Produces hormones that regulate glucose levels in the body. Diff: 1 Page Ref: 621; Fig. 16.18 23) Produces a hormone that controls blood levels of calcium and potassium by their removal from bone tissue. Diff: 1 Page Ref: 612; Fig. 16.12 24) Produces the body's major metabolic hormones. Diff: 1 Page Ref: 609; Tbl. 16.2 4 Copyright © 2010 Pearson Education, Inc. Answers: 20) C 21) B 22) E 23) D 24) A 5 Copyright © 2010 Pearson Education, Inc. Figure 16.3 Using Figure 16.3, match the following: 25) Produces glucocorticoids. Answer: B Diff: 2 Page Ref: 614; Fig. 16.13 26) Produces epinephrine. Answer: D Diff: 1 Page Ref: 618; Fig. 16.13 27) Produces aldosterone. Answer: A Diff: 2 Page Ref: 614; Fig. 16.13 28) Excess hormone levels result in Cushing’s syndrome. Answer: A Diff: 2 Page Ref: 617; Fig. 16.13 29) Hormones mimic sympathetic nervous system neurotransmitters. Answer: D Diff: 2 Page Ref: 619; Fig. 16.13 30) Produces androgens. Answer: C Diff: 2 Page Ref: 614; Fig. 16.13 6 Copyright © 2010 Pearson Education, Inc. True/False Questions 1) In humans, melatonin may inhibit sexual maturation. Answer: TRUE Diff: 2 Page Ref: 620 2) The antagonistic hormones that regulate the blood calcium level are calcitoninparathormone. Answer: TRUE Diff: 1 Page Ref: 611613 3) The hormone that raises blood sugar levels is insulin. Answer: FALSE Diff: 1 Page Ref: 621 4) Addison’s disease is due to a deficit output of glucocorticoids only. Answer: FALSE Diff: 1 Page Ref: 618 5) Both "turn on" factors (hormonal, humoral, and neural stimuli) and "turn off" factors (feedback inhibition and others) may be modulated by the activity of the nervous system. Answer: TRUE Diff: 1 Page Ref: 600 6) ACTH stimulates the adrenal cortex to release corticosteroid hormones. Answer: TRUE Diff: 1 Page Ref: 605 7) LH is also referred to as a gonadotropin. Answer: TRUE Diff: 1 Page Ref: 605 8) With age, chronic stress increases blood levels of cortisol and appears to contribute to memory deterioration. Answer: TRUE Diff: 2 Page Ref: 626 9) Oxytocin is a strong stimulant of uterine contractions. Answer: TRUE Diff: 1 Page Ref: 606 10) Follicle cells of the thyroid gland produce thyroglobulin, while follicle cells of the parathyroid produce calcitonin. Answer: FALSE 7 Copyright © 2010 Pearson Education, Inc. Diff: 2 Page Ref: 608 8 Copyright © 2010 Pearson Education, Inc. 11) Type 2 diabetics may reflect declining receptor sensitivity to insulin rather than decreased insulin production. Answer: TRUE Diff: 2 Page Ref: 626 12) The prime metabolic effect of cortisol is gluconeogenesis. Answer: TRUE Diff: 2 Page Ref: 616617 13) The beta cells are the pancreatic islet cells that produce insulin. Answer: TRUE Diff: 1 Page Ref: 621 14) Most type 2 diabetics do not produce insulin. Answer: FALSE Diff: 1 Page Ref: 627 15) Aldosterone is the most potent mineralocorticoid produced in the adrenals but the least abundant. Answer: FALSE Diff: 1 Page Ref: 614 16) Atrial natriuretic peptide is a hormone that controls blood pressure in part by increasing the urinary excretion of sodium. Answer: TRUE Diff: 1 Page Ref: 615 17) Although glucagon is a small polypeptide, it is nevertheless very potent in its regulatory effects. Answer: TRUE Diff: 1 Page Ref: 621622 18) The thyroid gland is a large gland that controls metabolic functions throughout the life of an individual. Answer: TRUE Diff: 1 Page Ref: 609 19) Many hormones synthesized in the gastrointestinal tract are chemically identical to brain neurotransmitters. Answer: TRUE Diff: 1 Page Ref: 624 20) All of the following hormones are secreted by the adenohypophysis: ACTH, FSH, and LH. Answer: TRUE Diff: 2 Page Ref: 605; Tbl. 16.1 9 Copyright © 2010 Pearson Education, Inc. 10 Copyright © 2010 Pearson Education, Inc. 21) Iodine is an essential element required for the synthesis of thyroxine. Answer: TRUE Diff: 2 Page Ref: 609610 22) The endocrine gland that is probably malfunctioning if a person has a high metabolic rate is the parathyroid. Answer: FALSE Diff: 2 Page Ref: 609, 612613 23) Growth hormone always exerts its influence by targeting other endocrine glands to produce hormones. Answer: FALSE Diff: 2 Page Ref: 603604 24) Glucocorticoids are steroid hormones that usually enhance the immune responses when an individual is suffering from severe stress. Answer: FALSE Diff: 2 Page Ref: 616617 25) Direct gene activation involves a secondmessenger system. Answer: FALSE Diff: 3 Page Ref: 598 26) All peptide hormone synthesis requires gene activation that produces mRNA. Answer: TRUE Diff: 3 Page Ref: 596598 27) All adenohypophyseal hormones except GH affect their target cells via a cyclic AMP second messenger. Answer: TRUE Diff: 3 Page Ref: 603 11 Copyright © 2010 Pearson Education, Inc. MultipleChoice Questions 1) Gluconeogenesis occurs in the liver due to the action of ________. A) aldosterone B) insulin C) secretin D) cortisol Answer: D Diff: 1 Page Ref: 616617 2) Normal development of the immune response is due in part to hormones produced by the ________. A) adrenal medulla B) pancreas C) thyroid gland D) thymus gland Answer: D Diff: 1 Page Ref: 624; Tbl. 16.5 3) Virtually all of the protein or amino acidbased hormones exert their effects through intracellular ________. A) ions B) deactivators C) nucleotides D) second messengers Answer: D Diff: 2 Page Ref: 596 4) Which of the following is not a category of endocrine gland stimulus? A) enzyme B) humoral C) neural D) hormonal Answer: A Diff: 1 Page Ref: 600 5) Chemical substances secreted by cells into the extracellular fluids and that regulate the metabolic function of other cells in the body are called ________. A) enzymes B) antibodies C) proteins D) hormones Answer: D Diff: 1 Page Ref: 596 12 Copyright © 2010 Pearson Education, Inc. 6) The hypothalamichypophyseal tract ________. A) connects the hypophysis to the pituitary gland B) is partly contained within the infundibulum C) conducts aldosterone to the hypophysis D) is the site of prolactin synthesis Answer: B Diff: 2 Page Ref: 603 7) Which of the following is not a cardinal sign of diabetes mellitus? A) polyuria B) polydipsia C) polyphagia D) All of these are signs. Answer: D Diff: 2 Page Ref: 622 8) Which of the choices below is not a factor required for target cell activation by hormone receptor interaction? A) blood levels of hormone B) type of hormone C) number of receptors for that hormone D) strength of the bond between the receptor and hormone Answer: B Diff: 2 Page Ref: 598 9) Oxytocin ________. A) release is an example of a positive feedback control mechanism B) is an adenohypophyseal secretion C) exerts its most important effects during menstruation D) controls milk production Answer: A Diff: 1 Page Ref: 606607 10) ADH ________. A) increases urine production B) promotes dehydration C) is produced in the adenohypophysis D) is inhibited by alcohol Answer: D Diff: 1 Page Ref: 608 13 Copyright © 2010 Pearson Education, Inc. 11) Thyroid hormone exerts its influence by ________. A) entering some cells and binding to intracellular receptors within the nuclei B) exerting only a minor effect on body metabolism C) causing a reduction in the number of blood vessel adrenergic receptors, and therefore decreasing blood pressure D) acting to decrease basal metabolic rate Answer: A Diff: 2 Page Ref: 609 12) Gonadocorticoid(s) ________. A) synthesized by the adrenal medulla are primarily androgens B) production by the adrenal gland is insignificant compared with sex hormone release from the gonads during late puberty C) secretion inhibition is highly dependent on a negative feedback loop involving ACTH D) hypersecretion can result in adrenogenital syndrome, also called feminization Answer: B Diff: 2 Page Ref: 618 13) Sometimes prolonged excessive exposure to high hormone concentrations causes a phenomenon known as ________. A) diabetes mellitus B) cellular inhibition C) downregulation D) metabolism of protein kinases Answer: C Diff: 1 Page Ref: 598 14) Which of the following is not a change that may be caused by hormonal stimulus? A) a change in membrane potential B) the stimulation of a genetic event resulting in protein synthesis C) an increase in enzymatic activity D) direct control of the nervous system Answer: D Diff: 2 Page Ref: 596 15) The ability of a specific tissue or organ to respond to the presence of a hormone is dependent on ________. A) the location of the tissue or organ with respect to the circulatory path B) the membrane potential of the cells of the target organ C) the presence of the appropriate receptors on the cells of the target tissue or organ D) nothingall hormones of the human body are able to stimulate any and all cell types because hormones are powerful and nonspecific Answer: C Diff: 1 Page Ref: 598 14 Copyright © 2010 Pearson Education, Inc. 16) Several hormones are synthesized in the hypothalamus and transported to the anterior pituitary gland. The mechanism of transportation from hypothalamus to anterior pituitary gland is through the ________. A) hepatic portal system B) general circulatory system C) hypophyseal portal system D) feedback loop Answer: C Diff: 1 Page Ref: 603 17) The neurohypophysis or posterior lobe of the pituitary gland is not a true endocrine gland because ________. A) it is strictly a part of the neural system and has little or nothing to do with hormonal release B) embryonically it was an endocrine tissue, but in the adult human it is no longer functional C) it is unable to function as an endocrine tissue because it is actually part of the neural system due to its location D) it is only a hormone storage area that receives hormones from the hypothalamus for release Answer: D Diff: 2 Page Ref: 601, 605 18) Steroid hormones exert their action by ________. A) entering the nucleus of a cell and initiating or altering the expression of a gene B) finding an appropriate cell receptor and initiating cAMP activity C) stimulating the synthesis of a glycogen D) increasing blood pressure Answer: A Diff: 2 Page Ref: 598 19) The secondmessenger mechanism of hormone action operates by ________. A) synthesizing more of the hormone than is actually needed B) increasing the basal metabolic rate in the target organ C) not responding to a feedback mechanism D) binding to specific receptors and employing the services of G proteins and cAMP Answer: D Diff: 2 Page Ref: 596 20) Hormones often cause a cell to elicit multiple responses; this is because ________. A) there are thousands of receptors on the cell membrane B) the receptors bind to several hormones at the same time C) the protein kinases are rapidly metabolized D) during protein kinase activation, enzymes phosphorylate many other enzymes Answer: D Diff: 2 Page Ref: 597 15 Copyright © 2010 Pearson Education, Inc. 21) Cells that respond to peptide hormones usually do so through a sequence of biochemical reactions involving receptor and kinase activation. In order for cells to respond, it is necessary for first and second messengers to communicate. This is possible because ________. A) peptide hormones always enter the cell membrane and elicit a response without assistance from other messengers B) hormones alter cellular operations through stimulation of a gene directly C) G protein acts as the link between first and second messengers D) the hormone receptor complex moves into the cytoplasm as a unit Answer: C Diff: 2 Page Ref: 597 22) Thyroid hormone (a small iodinated amine) enters target cells in a manner similar to ________. A) insulin, because insulin is a small peptide B) steroid hormones, because both diffuse easily into target cells C) growth hormone, because the thyroid works synergistically with thyroid hormone D) glucagon, because the structure of glucagon is similar to that of thyroid hormone Answer: B Diff: 2 Page Ref: 609 23) When it becomes necessary to enlist the fightorflight response, a hormone that is released during the alarm phase of the general adaptation syndrome is ________. A) estrogen B) epinephrine C) angiotensinogen D) renin Answer: B Diff: 1 Page Ref: 619; Fig. 16.16 24) One of the least complicated of the endocrine control systems directly responds to changing blood levels of ions and nutrients. Which of the following describes this mechanism? A) the rapid oxidation of carbohydrates B) catabolic inhibition C) protein synthesis D) humoral stimulation Answer: D Diff: 1 Page Ref: 600 25) The major targets of growth hormone are ________. A) the blood vessels B) the adrenal glands C) the liver D) bones and skeletal muscles Answer: D Diff: 1 Page Ref: 603604 16 Copyright © 2010 Pearson Education, Inc. 17 Copyright © 2010 Pearson Education, Inc. 26) The parathyroid glands maintain adequate levels of blood calcium. This is accomplished through ________. A) blocking the action of growth hormone B) targeting the bone and activating osteoclasts so that calcium will be released C) antagonizing the synthesis of calcitonin D) slowing the activity of tissues that require calcium for activity Answer: B Diff: 1 Page Ref: 613 27) Which organ is responsible for synthesizing ANP? A) the heart B) the kidney C) the skin D) the spleen Answer: A Diff: 1 Page Ref: 615; Tbl. 16.5 28) Mineralocorticoid is to aldosterone as glucocorticoid is to ________. A) testosterone B) estrogen C) cortisol D) epinephrine Answer: C Diff: 2 Page Ref: 614, 616 29) Leptin is secreted by ________. A) lymphocytes B) adipocytes C) goblet cells D) fibroblasts Answer: B Diff: 2 Page Ref: 624; Tbl. 16.5 30) The most important regulator of electrolyte concentrations in extracellular fluids is ________. A) insulin B) aldosterone C) glucagon D) cortisol Answer: B Diff: 2 Page Ref: 614615 18 Copyright © 2010 Pearson Education, Inc. 31) Which of the following is not a steroidbased hormone? A) estrogen B) aldosterone C) epinephrine D) cortisone Answer: C Diff: 2 Page Ref: 596 32) Which of the following would be associated with the action of steroids on cells? A) extracellular receptors with a specificity for only a single amino acid sequence on the hormone B) an enzyme that catalyzes the formation of cyclic AMP C) secondmessenger systems D) a hormonereceptor complex that interacts directly with the cell's DNA Answer: D Diff: 2 Page Ref: 598 33) Cellular responses to hormones that initiate secondmessenger systems include ________. A) possible activation of several different secondmessenger systems B) cyclic AMP phosphodiesterase formation of an active second messenger C) formation of a specific protein kinase that acts on a series of extracellular intermediates D) hormone binding to intracellular receptors Answer: A Diff: 2 Page Ref: 596597 34) Regulating hormones from the hypothalamus ________. A) enter venous circulation and travel to the heart, which pumps the hormonecontaining blood to the pituitary B) enter the hepatic portal system, which feeds the pituitary C) travel by arteries to the pituitary D) first enter into the hypophyseal portal system Answer: D Diff: 2 Page Ref: 603 35) ACTH ________. A) is secreted by the posterior pituitary B) secretion is regulated by a hypothalamic secretion C) causes the release of hormones from the adrenal medulla D) is not a tropic hormone Answer: B Diff: 2 Page Ref: 605 19 Copyright © 2010 Pearson Education, Inc. 36) Which of the following is true about calcium homeostasis? A) Increased calcitonin levels will cause increased blood calcium levels. B) High calcium levels cause bone resorption. C) Parathyroid hormone causes an increase in osteoblast activity. D) Parathyroid hormone is the single most important regulator of calcium levels in the blood. Answer: D Diff: 2 Page Ref: 612 37) Aldosterone ________. A) is secreted by the neurohypophysis B) functions to increase sodium reabsorption C) presence increases potassium concentration in the blood D) production is greatly influenced by ACTH Answer: B Diff: 2 Page Ref: 614615 38) The only amine hormone to act like a steroid is ________. A) TH B) ACTH C) GH D) ADH Answer: A Diff: 2 Page Ref: 598 39) Which organ does not have hormone production? A) heart B) kidney C) liver D) skin Answer: C Diff: 2 Page Ref: 624; Tbl. 16.5 40) In circumstances where the body requires prolonged or increased levels of a hormone, the DNA of target cells will specify the synthesis of more receptors on the surface of the cells of the target organ. This is known as ________. A) the cell's sensitivity reaction B) cellular affinity C) upregulation D) a reaction to a stressor Answer: C Diff: 2 Page Ref: 598 20 Copyright © 2010 Pearson Education, Inc. 41) Eicosanoids do not include ________. A) paracrines B) leukotrienes C) hydrocortisones D) prostaglandins Answer: C Diff: 2 Page Ref: 596 42) A man has been told that he is not synthesizing enough folliclestimulating hormone (FSH), and for this reason he may be unable to father a child. Choose the correct statement to explain this problem. A) FSH stimulates estrogen secretion by ovarian cells; therefore it is not synthesized by males. B) The physician is wronga hormone made in the adenohypophysis could not influence fertility. C) FSH stimulates sperm production in the testes. D) The man must be producing progesterone, which inhibits the synthesis of FSH. Answer: C Diff: 2 Page Ref: 605 43) Which of the following organs is affected by thyroid hormone in adults? A) liver B) spleen C) thyroid gland D) brain Answer: A Diff: 3 Page Ref: 609; Tbl. 16.2 44) Thyroxine is a peptide hormone, but its mechanism is different from other peptide hormones. Which of the following statements is true concerning this difference? A) It causes positive feedback. B) It does not require a second messenger to effect a response. C) It is very specific in the cell type it targets. D) It is a stimulant of cellular metabolism and targets all cells. Answer: B Diff: 3 Page Ref: 598 45) How do glucocorticoids enable the body to deal appropriately with stress? A) by increasing blood glucose, fatty acid, and amino acid levels and enhancing blood pressure B) by decreasing the heart rate, thus decreasing blood pressure C) by stimulating the pancreas to release insulin D) by blocking the neurotransmitters that prepare the body for the stress response Answer: A Diff: 3 Page Ref: 616617 21 Copyright © 2010 Pearson Education, Inc. 46) What ion is sometimes used as a second messenger of amino acidbased hormones? A) iron B) calcium C) sodium D) chlorine Answer: B Diff: 1 Page Ref: 598 FillintheBlank/Short Answer Questions 1) ________ are hormones synthesized from cholesterol. Answer: Steroids Diff: 1 Page Ref: 596 2) ________ is a hormone that has only one known effect: to stimulate milk production by the breasts. Answer: Prolactin Diff: 1 Page Ref: 605; Tbl. 16.1 3) ________ are the result of hypersecretion of growth hormone. Answer: Acromegaly and gigantism Diff: 1 Page Ref: 604 4) The largest pure endocrine gland in the body is the ________. Answer: thyroid Diff: 1 Page Ref: 608 5) Which hormone stimulates production of RBCs and which organ or structure produces it? Answer: erythropoietin; kidney Diff: 1 Page Ref: 624; Tbl. 16.5 6) Alpha islet cells produce ________, an extremely potent hyperglycemic hormone. Answer: glucagon Diff: 1 Page Ref: 621 7) The ________ gland may influence our day/night cycles and even regulate the onset of sexual maturity. Answer: pineal Diff: 1 Page Ref: 620 8) The ________ gland declines in size and function with age. Answer: thymus Diff: 1 Page Ref: 624 9) Endocrine gland stimuli include hormonal, ________, and ________ stimuli. 22 Copyright © 2010 Pearson Education, Inc. Answer: humoral; neural Diff: 2 Page Ref: 600 10) As a result of stress the adenohypophysis releases ________, which stimulates release of hormones from the adrenal cortex that retain sodium and water, increase blood sugar, and begin breaking down fats. Answer: ACTH Diff: 2 Page Ref: 605 11) Compare the structure and function of endocrine and exocrine glands. Answer: Endocrine glands are ductless glands that release hormones into the blood to be transported to other organs. Exocrine glands have ducts through which products are released. Diff: 3 Page Ref: 595 12) Why should the hypothalamus instead of the adenohypophysis be called the "master endocrine gland"? Answer: Although the adenohypophysis has many hormonal products, the hypothalamus controls anterior pituitary activity through regulatory factors. Diff: 3 Page Ref: 601, 603 13) Why would one not expect to continue increasing in height with age? Answer: The amount of growth hormone secreted declines with age and the closure of the epiphyseal plates prohibits further growth in length of the long bones. Diff: 3 Page Ref: 603604 14) A woman with excessive body hair, a deep voice, and an enlarged clitoris shows the outward symptoms of which hormonal dysfunction? Answer: The hormonal dysfunction is hypersecretion of gonadocorticoids. Diff: 2 Page Ref: 618 15) A person who drinks a lot of alcoholic beverages must urinate frequently. Why? Answer: Alcohol inhibits ADH secretion. Diff: 3 Page Ref: 608 16) How is the heart involved as an endocrine gland? Answer: A few cardiac cells secrete atrial natriuretic peptide (ANP), which helps regulate salt output by the kidney. ANP inhibits aldosterone and signals the kidney to remove more salt. Diff: 3 Page Ref: 615; Tbl. 16.5 17) Briefly discuss target cell activation by hormonereceptor interaction. Answer: The first step is hormonereceptor binding to target cells, but interaction depends on blood levels of the hormone, relative number of receptors for that hormone on or in the target cells, and the strength of the union between the hormone and the receptor. Diff: 3 Page Ref: 598 23 Copyright © 2010 Pearson Education, Inc. 18) Glucagon and insulin both target the cells of the liver and are both made in the pancreas, yet they have very different effects on the cells they target. What accounts for this fact? Answer: Glucagon and insulin use different cell surface receptors. Diff: 3 Page Ref: 620622 19) Basal metabolism declines with age. What factors contribute to that decline? Answer: Thyroid follicles fill with colloid and gland fibrosis occurs, resulting in hormone synthesis and release diminishing. Increase in body fat relative to muscle also contributes because muscle tissue is more active metabolically than fat. Diff: 2 Page Ref: 609611 20) List the four mechanisms involved in the regulation of aldosterone secretion. Answer: The four mechanisms are: (1) the reninangiotensin mechanism, (2) plasma concentration of sodium and potassium ions, (3) control exerted by ACTH, and (4) plasma concentration of atrial natriuretic peptide. Diff: 3 Page Ref: 615 21) What is the difference between autocrines and paracrines? Answer: Autocrines are selfregulating chemical messengers because their target is the cell from which they are manufactured. Paracrines are chemical messengers that act locally. They tend to affect only the cells immediately around them. Diff: 2 Page Ref: 595 22) Give an example of synergism in hormones. Answer: The liver will release glucose in the presence of glucagon or epinephrine. If both hormones are present the amount of glucose released is increased 150%. Diff: 2 Page Ref: 600 23) Growth hormones act indirectly to make the epiphyseal plate cartilage grow. What then acts directly to make it grow? Answer: The growth hormone stimulates the liver to release a growth factor called somatomedin, which in turn controls the epiphyseal plate cartilage. Diff: 3 Page Ref: 603604 24 Copyright © 2010 Pearson Education, Inc. Clinical Questions 1) Mrs. James appeared at the clinic complaining of extreme nervousness and sweating, saying that she could feel and hear her heart thumping when she tried to sleep at night. Laboratory testing revealed hyperglycemia and increased basal metabolic rate. Although she also proved to have high blood pressure, tests of thyroid function were normal. What is your diagnosis? What treatment should be used? Answer: The diagnosis is hypersecretion of catecholamines, sometimes arising from a rare chromaffin cell tumor called a pheochromocytoma. Treatment is removal of the tumor and/or irradiation of the adrenal medulla. Diff: 3 Page Ref: 620 2) Mr. Sanchez makes an appointment to see his doctor for pain in his abdominal area. Tests and X rays reveal kidney stones as well as bones with a motheaten appearance. Further questioning reveals a medical history of abnormal reflexes and weakness. What is the problem and what treatment would be recommended? Answer: The problem is hyperparathyroidism resulting from a parathyroid gland tumor. The treatment is removal of the tumor. Diff: 3 Page Ref: 613 3) It was often rumored that one of our deceased presidents was suffering from Addison's disease (inadequate synthesis of mineralocorticoids and glucocorticoids). What symptoms may have led to the diagnosis of this condition? Answer: Hypoglycemia, a bronzing of the skin, low body weight, low plasma glucose and sodium levels, high potassium levels, hypotension, and some dehydration would all have been observed in the patient. Diff: 3 Page Ref: 618 4) Due to a recent head injury, a patient is told that his pituitary is hypersecreting prolactin. Is there need for concern about this young man? Answer: Yes; there should be great concern, because hypersecretion of prolactin will lead to impotence. Diff: 2 Page Ref: 605 5) The parents of a 17yearold boy are concerned about his height because he is only 5 feet tall and they are both close to 6 feet tall. After tests by their doctor, certain hormones are prescribed for the boy. What is the probable diagnosis, and what hormones were prescribed? Why might the child still expect to reach his growth potential? Answer: The diagnosis is insufficient growth hormone. The prescription is commercial pituitary growth hormone. The reason the child might reach his growth potential is that the epiphyseal plates of the long bones have not yet closed, allowing additional growth of the long bones. Diff: 3 Page Ref: 603604 25 Copyright © 2010 Pearson Education, Inc. 6) John is a 26yearold man who begins to notice a progressive enlargement of feet, hands, cranium, nose, and lower jaw bone. His doctor recommends irradiation of the pituitary gland. What is the most likely diagnosis? Why? Answer: The diagnosis is acromegaly. The condition results from excess secretion of growth hormone from the pituitary gland postpuberty and after the epiphyseal plates of the long bones have fused. Diff: 3 Page Ref: 604 7) Explain how antidiuretic hormone can help regulate an abnormal increase in solute concentration in the extracellular fluid. Answer: The release of antidiuretic hormone can regulate an increase in solute concentration by causing reabsorption of water by the kidney. With reabsorption, blood water volume increases, decreasing solute concentration. Diff: 3 Page Ref: 608 8) What is the most important nursing intervention when caring for a patient with Cushing's syndrome? Answer: Because of enhanced antiinflammatory effects, infections may become overwhelmingly severe. Therefore the nurse should protect the patient from infection. Diff: 3 Page Ref: 617618 9) A 25yearold male was admitted to the medical/surgical unit with a blood glucose of 600 mg/dl. On assessment, the nurse observed his breathing was deep and rapid, and his breath smelled of acetone. His face was flushed and his skin was dry. His pH was low. Describe the physiological response that is occurring. Answer: In severe cases of diabetes mellitus, blood levels of fatty acids and their metabolites rise dramatically. The fatty acid metabolites, collectively called ketones, are strong organic acids. When they accumulate faster than they are used or excreted, the blood pH drops, resulting in ketoacidosis, and ketones begin to spill into the urine. The nervous system responds by initiating rapid deep breathing to blow off carbon dioxide from the blood and increase pH. Diff: 3 Page Ref: 622, 626627 10) Thomas is a diabetic. While at work, he began to tremble, was somewhat disoriented, and showed signs similar to that of a drunk. One of his colleagues gave him some hard candy, which seemed to help him return to normal functions. Why? Was this a proper action, considering that Thomas is diabetic? Answer: Thomas was suffering from hypoglycemia. The candy raised his blood sugar back up to a normal level. This was a proper action because he was hypoglycemic. If he had been hyperglycemic, the small amount of glucose in the piece of candy would not have made any difference. Diff: 3 Page Ref: 622623 26 Copyright © 2010 Pearson Education, Inc.