Question 1

what is POEMS?

Accepted Answer

It is a cause of hypothyroidism. Polyneuropathy. Organomegaly (hepatomegaly, splenomegaly, or lymphadenopathy). Endocrinopathy (hypogonadism, hypothyroidism, diabetes, hyperparathyroidism). Edema. M protein. Skin abnormalities: hyperpigmentation, hypertrichosis, acrocyanosis, plethora, haemangioma/telangiectasia. It is a rare multisystemic disease that occurs in the setting of a plasma cell dyscrasia. Myeloma is the most common plasma-cell proliferative disorder associated with POEMS syndrome, present in more than half of all cases.

Question 2

How many times does insulin increase glucose transport?

Accepted Answer

10 times

Question 3

Where is glucose phosphatase only found?

Accepted Answer

liver cells, renal tubular epithelial cells, intestinal epithelial cells.

Question 4

what enzyme is affected by thiamine deficiency?

Accepted Answer

Pyruvate dehydrogenase - Thiamine pyrophosphate is a coenzyme - pyruvate builds up - beri beri etc

Question 5

name 2 places where gluconeogenesis takes place?

Accepted Answer

kidneys and liver

Question 6

what are the 3 most common fatty acids in triglycerides in humans?

Accepted Answer

stearic acid, oleic acid, palmitic acid

Question 7

Name 2 stimuli for lipolysis?

Accepted Answer

Low glucose - glucose needed to produce alpha glycerophosphate so will be low - and it is needed to maintain glycerol portion therefore stimulates triglyceride breakdown Hormone sensitive cellular lipase

Question 8

under normal conditions how many free fatty acids can combine with albumin and in extreme conditions?

Accepted Answer

3 and in extreme 30 fatty acids

Question 9

How are triglycerides used for energy?

Accepted Answer

glycerol - glycerol3phosphate - glycolytic pathway FA - carried to mitochondia via carnitine - degraded by Beta oxidation - CoA binds to 2C on FA chain which then splits and CoA binds to next 2 Cs and process continues generating Acetyl coA.

Question 10

what do 2 molecules of acetyl coA form and what can they be turned into?

Accepted Answer

acetoacetic acid and B hydroxybutyric acid and acetone

Question 11

Why are cells limited in amount of ketone bodies they can metabolise?

Accepted Answer

oxaloacetate produced from carb metabolism decreases which decreases acetyl coA usage therefore ketones build up.

Question 12

where is most triglycerides made from carbs? Describe the process?

Accepted Answer

Liver. Carbs - acetyl coA - malonyl coA and NADPH are used to form fatty acids which bind with alpha glycerophosphate from glycolytic pathway - triglyceride.

Question 13

how long do liver glycogen stores last?

Accepted Answer

No more than 16 hour fast

Question 14

How can proteins be used to make fat?

Accepted Answer

aa - acetyl coA - Fat

Question 15

why is glucose metabolised first over fat metabolism if fat metabolism yields more energy?

Accepted Answer

glucose forms alpha glycerophosphate which is needed for triglyceride synthesis. Also low conc of free fatty acids in adipose tissue stimulates carb to fatty acid synthesis

Question 16

Name 5 hormones that regulate fat utilization?

Accepted Answer

epinephrine and norepinephrine - acts on hormone sensitive triglyceride lipase in adipocytes glucocorticoids - acts on same as above - high amount in cushings - ketosis results GH similar but weaker effect as above Thyroid hormone - rapid fat mobilisation - increases metabolism - decreases coA. Insulin - dephosphorylates (inactivates) glycogen phosphorlyase and activates glycogen synthase (dephosphorylates)

Question 17

What affect does diet have on cholesterol levels? why?

Accepted Answer

rise in conc of cholesterol - inhibits 3-hydroxy-3-methylglutaryl coA reductase - decreasing endogenous synthesis. So altering diet only causes +- 15% change in plasma.

Question 18

what is cholesterol formed from? what is the effect of increased fat deposition on cholesterol production? What do lack of thyroids and insulin do to blood cholesterol levels?

Accepted Answer

multiple acetyl coA molecules. Increased fat breakdown increased acetyl coA molecules more cholesterol synthesis. Lack of insulin or thyroid would increase plasma levels.

Question 19

where is large amounts of cholesterol precipitated?

Accepted Answer

corneum of the skin

Question 20

Describe how familial hypercholesterolemia works?

Accepted Answer

defective gene for LDL receptors - liver cannot absorb IDL or LDL due to lack of receptors - no more negative feedback - new cholesterol molecules produced - plasma levels are x4 normal levels.

Question 21

What is key process in making and breaking down protein? what enzymes are involved ? what vitamin are they formed from?

Accepted Answer

transamination. Aminotransferases. Vit B6

Question 22

describe how proteins are used for energy? where does it take place?

Accepted Answer

occurs in liver. 1. deamination - removal of amino group to alpha ketogluturate. aa is now alpha keto acid which can be modified slightly then entered in krebs. Alpha ketoglutarate then goes to glutamate which can then via ALT or AST be given an amino group and made into different aa. glutamate also loses NH3 which is converted to urea.

Question 23

Where is all urea in the body formed? describe the ornithine cycle?

Accepted Answer

Liver. Ornithine + CO2 + NH3 which leads to citrulline which loses H20 and urea to form arginine which leads to ornithine.

Question 24

Describe the effect of insulin and GH and testosterone and thyroxine on protein metabolism?

Accepted Answer

insulin - increases protein synthesis, increases available glucose decrease protein degradation GH stimulates protein synthesis - long term Testosterone - increases deposition of protein in tissue throughout the body - short term. estrogen has weaker effect Thyroxine - if inadequate fats and carbs rapid protein breakdown if not increases protein synthesis

Question 25

What cells release PYY? and what does it do?

Accepted Answer

L cells in distal gut and suppresses food intake and is increased with increased fat ingestion.

Question 26

Where is GLP-1 secreted? what does it do?

Accepted Answer

L cells in intestine. Reduces food intake, suppresses glucagon secretion, delays gastric emptying, stimulates insulin secretion.

Question 27

What mineral aids insulin in transporting glucose into the cells? what does lack of it cause? name 2 foods its found in ?

Accepted Answer

chromium. elevate blood lipid levels. Nuts and mushrooms

Question 28

Name 3 thyroid hormone carriers in the blood? what % of T3, T4 are bound protein in blood?

Accepted Answer

thyroxine binding globulin, transthyrein and albumin 99%

Question 29

What are the 2 key ingredients for thyroid hormone synthesis and the ksy enzyme?

Accepted Answer

tyrosine - is provided by thyroglobulin which is secreted by thyroid epithelial cells into the lumen Iodine - taken up by Na iodide symporters or iodine trap. Thyroid peroxidase - on colloid facing membrane catalyses iodination of tyrosines and synthesis of T3 and T4 from T1 and T2

Question 30

how are thyroid hormones released from their thyroglobulin scaffold?

Accepted Answer

digestion in lysosomes of thyroid epithelial cells

Question 31

What does TSH do?

Accepted Answer

stimulates synthesis of iodine transporter, thyroid perioxidase and thyroglobulin

Question 32

what is a diagnostic indication of hypothyroidism?

Accepted Answer

elevated cholesterol levels

Question 33

Describe the hormonal control in TH synthesis and secretion?

Accepted Answer

TRH stimulates TSH which stimulates thyroid hormone release (T3 and T4) which inhibits TSH and TRH.

Question 34

name what environmental conditon that stimulates TRH release?

Accepted Answer

cold

Question 35

Where is calcitonin synthesised? what does it do?

Accepted Answer

thyroid, lungs and intestinal tract Inhibits oesteoclast activity and inhibits tubular reabsorption of calcium and phosphorus

Question 36

Name 3 things PTH does?

Accepted Answer

increases osteoclast activity enhances calcium absorption from small intestine indirectly through stimulating vit D production stimulates tubular reabsorptionof calcium and stimulates loss of phosphate

Question 37

What is the conc of calcium relative to phosphate?

Accepted Answer

practically the same

Question 38

what are the 3 active forms of vit A?

Accepted Answer

retinoic acid- binds to chromatin and increases the synthesis of proteins controlling cell growth and differentiation of epithelial cells, retinal - binds with opsin forming rhodopsin - rod visual pigment, beta carotene -antioxidant

Question 39

What is a cause of vit A deficiency? is it common? 2 features?

Accepted Answer

fat malabsorption, rare and night blindness, Xerophthalmia =dryness of cornea and conjuctiva which if untreated causes keratomalacia (cornea becomes thin and soft) which results in corneal ulceration and cataracts and irreversible blindness

Question 40

why should liver be avoided in pregnancy?

Accepted Answer

Too much vit A can cause congenital defects

Question 41

How does vit D increase absorption of calcium from intestinal cells?

Accepted Answer

increases the synthesis of calcium binding protein - calbindin

Question 42

What is vit E also called? 2 sources? source of vit D? what does vit E deficiency cause in newborns?

Accepted Answer

tocopherol - green vegetables, vegetable oils. vit d - fish liver oil Antioxidant Haemolytic anaemia of the newborn - vit E only crosses placenta in last trimester - erythrocyte membranes are fragille and susceptible to free radical damage

Question 43

what can cause a vit K deficiency?

Accepted Answer

long term antibiotics - decrease bacteria which synthesise vit K

Question 44

What is Vit B1 also called? 3 sources? whats its function? what does a deficiency in it cause?

Accepted Answer

Thiamine, pork, liver cereal. cofactor for pyruvate dehydrogenase and alpha ketoglutarate dehydogenase - deficiency causes accumulation of pyruvate and lactate - acetyl coA decreases and ATP production decreases less Ach. decreases pentose phosphate pathway - less NADPH - decreased myelin synthesis. - peripheral neuropathy. Deficiency causes beriberi and wernickes korsakoffs syndrome

Question 45

What is Beri beri and wernickes encephalopathy and korsakoffs?

Accepted Answer

Beri beri wet - oedema and CV symptoms and CCF. beri beri dry - muscle wasting and peripheral neuropathy. Wernicke's encephalopathy- acute confusional state, ataxia, nystagmus and opthalmoplegia. Acute neuropsychiatric syndrome classically presenting with the triad of acute confusion, ataxia, and ocular abnormalities (e.g., nystagmus, strabismus). Secondary to acute deficiency. Dry beriberi: A distal peripheral polyneuropathy characterised by paraesthesia, reduced knee jerks and other tendon reflexes, and progressive severe weakness with muscle wasting. Secondary to chronic deficiency. Wet beriberi: High-output cardiac failure with peripheral vasodilation, peripheral oedema, and orthopnoea; or low-output cardiac failure with lactic acidosis and peripheral cyanosis. Secondary to acute or chronic deficiency. Shoshin beriberi: Rapid onset of low-output cardiac failure with lactic acidosis and peripheral cyanosis. Secondary to acute or chronic deficiency. korsakoffs - severe loss of short term memory. Beri means weak in sri lankan.

Question 46

What are the 2 active forms of vit B2 (riboflavin? what are 2 signs of deficiency?

Accepted Answer

FMN, FAD, and angular stomatitis, glossitis

Question 47

whats vit B3 other name? 3 sources? 2 active forms? deficiency causes what?

Accepted Answer

niacin - cereals, fish and meat. NAD and NADP. pellagra - rare - 3Ds - dermatitis, diarrhoea and dementia and eventually death. Deficiency of vitamins B2 (riboflavin) and/or B6 (pyridoxine) reduces the synthesis of niacin from tryptophan and may lead to secondary vitamin B3 deficiency.

Question 48

what is vit B6 active form in the body?

Accepted Answer

aminotransferases. can cause 2 pellegra as vit B3 is synthesised from aa tryptophan so less B6 less aa and less vit B3.

Question 49

whats vit B7 other name? and what 3 things is it a coenzyme for?

Accepted Answer

biotin, gluconeogenesis, fatty acid syntesis, beta oxidation.

Question 50

whats vit b5 other name and what is its active form?

Accepted Answer

panthothenic acid and coA

Question 51

what is B12 other name? How is it absorped? what is its function? what does deficiency cause 2 things?

Accepted Answer

cobalamin. binds to intrinsic factor which binds to receptors on mucosal cells in ileum. assists in beta oxidation. accumulation of fatty acids - affect nerves means more folate is trapped as methyl THF which causes decreased nucleotide synthesis - megoblastic anaemia.

Question 52

what is most common vit b12 deficiency? how many vits in humans?

Accepted Answer

pernicious anaemia and 13.

Question 53

what is vit b9 also called? 3 sources? what are its active forms? name 3 things it helps synthesise?

Accepted Answer

folate, cereal, liver, green vegetable 5,6,7,8-THF. aa, purines and AMP

Question 54

what is vit C other name? 3 sources? functions -4? who requires x2 daily intake? what does deficiency result in?

Accepted Answer

Ascorbate citrus fruits, tomatoes, green vegetables coenzyme in collagen synthesis and E and NE synthesis. Reduced Fe3+ to Fe2+ Phagocytes and T cells need it to function Antioxidant smokers scurvy - poor wound healing, swollen sore spongy guns

Question 55

name 2 features of rickets?

Accepted Answer

craniotabes - skull bones easily indented with finger rickety rosary - expansion or swelling at costochondral junction

Question 56

what does deficiency in phosphate result in? What does role does Mg have in the body?

Accepted Answer

muscle weakness and osteomalacia, structural role in bones and teeth.

Question 57

Describe what happens in diabetes to fat metabolism?

Accepted Answer

No insulin no glucose in liver and fat cells so lack of acetyl coA and NADPH needed for fat synthesis, also lack of alpha glycerophosphate.

Question 58

What % of dietary iron is absorbed? whats the total body iron?

Accepted Answer

10% 3-5g

Question 59

whats zinc a cofactor for? name 3 features of a deficiency?

Accepted Answer

cofactor for carbonic anhydrase, enzymes for DNA and protein synthesis deficiency - growth retardation, hypogonadism, delayed wound healing

Question 60

How is copper transported to other tissues? what mineral is part of B12? How is copper normally excreted ?

Accepted Answer

by caeruloplasmin - produced by liver normally excreted in bile. Bile. cobalt

Question 61

What are NICE guidelines about who is eligible for bariatric surgery?

Accepted Answer

any patient with BMI over 40 or BMI over 35 if have other problems

Question 62

Name 2 things that causes glycogen breakdown during exercise? what is the syndrome called causes exercise intolerance?

Accepted Answer

adrenaline - activates phosphorlyase calmodulin in cytoplasm activated by calcium release from SER. It activates phosphorylase. McArdle syndrome - ineffective phosphorylase

Question 63

What substrate is used for high intensity exercise? and prolonged exercise?

Accepted Answer

glycogen fat

Question 64

What is the cycle which converts lactate to glucose called? where does it occur?

Accepted Answer

Cori and in the liver

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2.08 Weighty issues: Endocrine cases, Beri Beri, Pellagra, Bariatric surgery, Refeeding syndrome, Anorexia, Hyperthyroidism, Hypothyroidism. Hypoparathyroidism, Hyperparathyroidism. Flashcards

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