Aquagirl is a 16-year-old female who has decided that she wants to move from synchronised swimming into free diving. She has been practicing free diving for the last 10 months and is excited to be...

Aquagirl is a 16-year-old female who has decided that she wants to move from synchronised swimming into free diving. She has been practicing free diving for the last 10 months and is excited to be taking part in her first national competition. She has a healthy lifestyle and does not smoke or consume alcohol. Aquagirl began a keto diet four months ago, as she looks to improve her performance in competition. Aquagirl reports that she has been experiencing shortness of breath, fatigue, and weakness during her recent free diving training. She notes that these symptoms occur towards the end of her dives, usually after 4-5 minutes of submergence. The symptoms are relieved upon surfacing and taking deep breaths. On physical examination Aquagirl appears healthy with no breath sounds. Arterial blood gas analysis was performed before and after a training dive. Aquagirl tells her trainer that she is experiencing some muscle soreness post training sessions. In the past, she has applied Voltaren Emulgel (containing an NSAID), to her quadriceps and calves immediately after training, hoping to relieve some of her muscle soreness. Aquagirl went on to explain that, as a result of some Googling, she now uses Voltaren in tablet form as she believes it will be “better for the task”. Physical examination: Height 164 cm Weight 49 kg Appearance Clean, neat appearance, fit Blood work Blood group: OArterial blood gas analysis (before dive): pH: 7.35 PCO2: 40 mmHg PO2: 95 mmHg HCO3 - : 24 mEq/L Arterial blood gas analysis (after dive): pH: 7.25 PCO2: 56 mmHg PO2: 48 mmHg HCO3 - : 34 mEq/L BP 110/75 mm Hg Respiratory rate 19 bpm (at rest) Diet Keto diet Past patient history Non-smoker. All previous screenings of blood, urine, and blood pressure within normal ranges. Exercises heavily Social status High school student living at home with parents and one sibling. ©ACU 2023 2 Urinalysis: Blood + Bilirubin - Urobilinogen 0.4 mg/dL Ketone ++ Protein + Nitrite - Glucose - pH 6.5 Specific Gravity 1.015 Leukocytes - All topics and their key points listed below must be discussed in your essay Topic 1: Reproduction (10 marks total) Considering Aquagirl and her current circumstances, describe the role of oestrogen and explain whether you expect her oestrogen levels to be different to normal. Your discussion should include the effect of her level of activity upon homeostatic regulation of female reproductive physiology. Your answer must include all relevant glands and hormones. (10 marks) Topic 2: Respiratory system (5 marks total) Explain the physiological mechanisms responsible for the changes observed in Aquagirl’s arterial blood gas measurements during a training dive. No marks will be awarded for simply listing the changes. (5 marks) Topic 3: Digestion/metabolism (8 marks total) Aquagirl has been on her keto diet for four months now. Discuss absorption of fat across the epithelium of Aquagirl’s small intestine. (2 marks) Aquagirl has ketones present in her urine. Explain how this relates to her adherence to a keto diet. (4 marks) With reference to the relevant steps of urine formation and actions occurring in the tubule system, explain why it is possible to detect ketones in Aquagirl’s urine? (2 marks) Topic 4: Pharmacology (7 marks total) Compare and contrast the two different formulations of Voltaren available to Aquagirl. In your answer you will need to examine the following: (7 marks) • Where the drug is likely to be absorbed in each form • Likely bioavailability of each form and susceptibility to hepatic first pass effect • Why would the oral form be better?