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MBBS > 202 ES - Biochemistry > Flashcards

202 ES - Biochemistry Flashcards

1
Q

Hormonal regulation of pituitary gland is primarily ______ feedback

A

negative

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2
Q

Polyuria

A

Excretion of large volume of dilute urine

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3
Q

Central vs nephrogenic DI

A

Central: deficiened ADH
Nephrogenic: ADH normal but renal resistance

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4
Q

Polydipsia

A

Abnormal great thirst

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5
Q

The majority of hypothyroidism cases are?

A

Primary causes

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6
Q

3 types of primary hypothyroidism

A

Iatrogenic - drugs/radiotherapy
Autoimmune - chronic autoimmune thyroiditis
Other - postpartum thyroiditis

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7
Q

Patients of chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) have ______ levels of thyroid peroxidase (TPO) & thyroglobulin (Tg) antibodies

A

high

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8
Q

Causes of iatrogenic hypothyroidism

A

Amiodarone

Lithium

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9
Q

TSH & fT4 levels of primary, subclinical, secondary/tertiary hypothyroidism

A

Primary - ↑ TSH, ↓ fT4
Subclinical - ↑ TSH, normal fT4
Secondary/tertiary - normal/↓ TSH, ↓ fT4

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10
Q

Hyperthyroidism more commonly affects which gender?

A

Women

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11
Q

Most common cause of hyperthyroidism

A

Grave’s disease

- autoimmune disorder involving the production of autoantibodies against TSH receptor

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12
Q

Toxic multinodular goitre

A

2nd most common cause of hyperthyroidism

Caused by iodine deficiency

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13
Q

TSH & fT4 levels of primary, subclinical, pituitary adenoma hyperthyroidism

A

Primary - ↓ TSH, ↑ fT4
Subclinical - ↓ TSH, normal fT4
Secondary/tertiary (Pituitary adenoma) - ↑ TSH, ↑ fT4

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14
Q

4 stages of nonthyroidal illness

A
  1. Low T3
  2. High T4
  3. Low T4
  4. Recovery
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15
Q

Physiological functions of calcium (6)

A 
Bone formation
Brain function & neurotransmission
Heart function
Muscle function
Blood clotting
Cellular metabolism
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16
Q

______ dissolve bone;

______ form new bone.

A

Osteoclast; Osteoblast

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17
Q

Where is intracellular calcium stored?

A 
Endoplasmic reticulum (ER)
Sarcoplasmic reticulum (SR)
Mitochondria
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18
Q

Factors affecting blood Ca2+

A

Changes in plasma protein concentration
Changes in anion concentration
Acid-base abnormality

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19
Q

Causes of hypercalcemia

A

Hyperparathyroidism
Malignancy
Vitamin D intoxication
Medication-induction

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20
Q

Causes of hypocalcemia

A 
Hypoalbuminemia
Hypoparathyroidism
Poor intake or impaired absorption of calcium
Vitamin D deficiency/low calcitriol
Liver & renal diseases
Osteoblastic metastases
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21
Q

Hypothalamus-pituitary-adrenal gland (HPA) axis regulates?

A

Cortisol

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22
Q

Renin-angiotensin system regulates?

A

Aldosterone

23
Q

The sympathetic system regulates?

A

Hormones secreted from adrenal medulla

24
Q

Adrenal gland disorders of too much hormones

A

Cushing’s syndrome
Congenital adrenal hyperplasia
Pituitary tumor
Hyperaldosteronism

25
Q

Adrenal gland disorders of too little hormones

A

Addison’s disease

26
Q

Diagnostic strategies of adrenal hormone disorders

  • Suspected hypofunction
  • Suspected hyperfunction
A

Suspected hypofunction - Stimulation test

Suspected hyperfunction - Suppression test

27
Q

What is Addison’s disease?

A

Long-term disorder
Insufficient production of all steroid hormones
Lack of aldosterone & cortisol

28
Q

Presentation of gluocorticoid (cortisol) insufficiency (Addison’s disease)

A

Weight loss & long-fasting fatique
Weakness & malaise
Low bp

29
Q

Androgen insufficiency (Addison’s disease)

  • male
  • female
A 
Male: do not express signs of ↓ androgens
Female:
- ↓ body hairs
- reduced libido
- hot flushes
30
Q

Presentation of mineralcorticods (aldosterone) insufficiency (Addison’s disease)

A

Hypotension
Hyponatremia & hyperkalemia
Shock

31
Q

Clinical features of Addison’s disease

A

Pigmentation - bc excess ACTH
- sun-exposed & pressured areas
Knuckles, elbow, knees, palmar creases

32
Q

Diagnostic strategy for Addison’s disease (3 stages)

A
  1. Demonstration of inappropriately low cortisol level
  2. Determination the level of adrenal dysfunction (primary vs secondary)
  3. Identification of specific cause of adrenal insufficiency
33
Q

In Addison’s disease:

Cortisol levels are ______; ACTH levels are ______

A

low; high

34
Q

Presentation:

Cushing’s vs Addison’s

A

Cushing’s:

  • hypotension
  • hypernatremia
  • weight gain
  • hair overgrowth

Addison’s:

  • hypotension
  • hyponatremia
  • weight loss
  • hair loss
35
Q

Diagnostic strategy for Cushing’s disease (2 stages)

A
  1. Confirmation of raised blood cortisol

2. To establish cause of observed cortisol excesss

36
Q

Normal fasting blood sugar level?

A

72 - 99 mg/dL

37
Q

How is glucose transported into the cell?

A

Na+ & ATP-independent transporter
Na+ & ATP-dependent transporter

  • glucose cannot diffuse into cell directly
  • once inside cell, glucose phosphorylated to G6P and cannot leave cell
38
Q

Na+ & ATP-independent transporter

A

GLUT1-GLUT14

Facilitated transport, uniporter

39
Q

Low Km, ______ affinity;

High Km, ______ affinity

A

high; low

40
Q

Na+ & ATP-dependent transporter

A

SGLT1
SGLT2

on epithelial cells of intestine, renal tubules, choroid plexus

Secondary active transport, energy required, symporter

41
Q

Which 3 hormone regulates blood sugar?

A

Glucagon - ↑ blood glucose
Insulin - ↓ blood glucose
Stress hormones (epinephrine) - “fight or flight”

42
Q

Synthesis of insulin

A

Preproinsulin (ER) → proinsulin (Golgi apparatus) → insulin + C-peptide (stored in secretory vesicles)

43
Q

How is insulin secretion regulated?

  • high blood glucose
  • low blood glucose
A

High blood glucose:
ATP ↑ → K+ efflux ↓ → hyperpolarization↓ → Ca2+ influx ↑ → insulin release ↑

Low blood glucose:
ATP ↓ → K+ efflux ↑ → hyperpolarization↑ → Ca2+ influx ↓ → insulin release ↓

44
Q

How is insulin degraded?

A

Insulinase (found in liver & kidney)

45
Q

Insulin effect on glucose transporters

A

Insulin ↑ glucose transport into insulin-sensitive cells - GLUT4

46
Q

GLUT4 mechanism

A
  1. Insulin binds to receptor
  2. Signal transduction cascade
  3. Exocytosis
  4. Glucose enters cell
47
Q

Insulin effect on carbohydrate metabolism

A

Stimulation

  • Glucose uptake by cells through GLUT4
  • glycogenesis

Inhibit

  • glycogenolysis
  • gluconeogenesis
48
Q

Insulin effect on fat metabolism

A

Stimulation

  • transport of FA into adipose tissue
  • conversion of excess glucose into FA
  • synthesis of FA & TAG

Inhibit

  • FA release from adipose tissue
  • ketogenesis
49
Q

Insulin effect on protein metabolism

A

Stimulation

  • a.a. entry to cells
  • protein synthesis (translation)

Inhibit

  • protein catabolism & a.a. release from cells
  • gluconeogenesis
50
Q

What depends on insulin for glucose uptake?

A

GLUT4

- found in muscle & adipose

51
Q

Type 1 DM

A

Deficiency of insulin

  • destruction of β cells in islets of Langerhans by T-cells & autoantibodies
  • insulin-dependent DM
52
Q

Type 2 DM

A

Insulin resistance

  • failure of insulin receptors to response
  • body unable to use insulin
  • non-insulin-dependent DM
53
Q

Insulinoma

A

High secretion of insulin due to β cell tumor

- associated with type 2 DM

54
Q

rT3 in nonthyroidal illness & hypothyroidism

A

Nonthyroidal illness: rT3 ↑

Hypothyroidism: rT3 ↓

MBBS (28 decks)

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