Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GIR Test 1 > B5.001 Big Case > Flashcards

B5.001 Big Case Flashcards

1
Q

what is acanthosis nigricans

A

velvety, hyperpigmented plaques on the skin
commonly on neck and axilla
non-irritable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

pathophys of acanthosis nigricans

A

elevated levels of insulin may stimulate keratinocyte and dermal fibroblast proliferation via interaction with IGFR1
result in plaque like lesions
associated with multiple disorders characterized by insulin resistance/hyperinsulinemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are screening recommendations for diabetes in asymptomatic persons

A

begin at 45 years of age, every 3 years

screen at any age and more frequently if BMI is >25 or person has additional risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ADA sanctioned risk factors for diabetes

A 
family history
high risk race
HbA1c >5.7% or impaired glucose levels on previous testing
polycystic ovary syndrome
HTN
HDL < 35, TG > 250
CVD history
physical inactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is IFG and how does it manifest

A

impaired fasting glucose (baseline too high)

fasting plasma glucose 100-125

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is IGT and how does it manifest

A

impaired glucose tolerance (doesn’t return to baseline very easily)
2 hour post prandial glucose 140-199

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

test values for normal glucose metabolism

A

HbA1c <5.7
fasting glucose < 100
OGTT <140

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

test values for type 2 diabetes

A

HbA1c <6.5
fasting glucose >126
OGTT >200

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

best way to reduce the incidence of DM2

A

lifestyle intervention (exercise and dietary restrictions)
reduced incidence more than metformin alone or placebo
58% vs 31% reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

3 primary components leading to pre-diabetes and/or DM2

A

`insulin resistance
relative insulin deficiency
impaired incretin action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how does insulin level change over the natural course of DM2

A

initially very high levels

at onset of diabetes, begins to decrease to below normal levels and continue to decrease over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how is obesity implicate din the development of DM2

A

abdominal adipose more metabolically active than subcutaneous fat
increased release of FFA, TNFa and other hormones can lead to increased insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is central obesity

A

waist to hip ratio >1
waist > 40 in in med
waist > 35 in in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

definition of metabolic syndrome

A 
any 3 of the following:
abdominal obesity
TG > 150
HDL <40 for men, <50 for women
BP >135/85
fasting glucose >100
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

normal function of insulin

A

inhibit lipolysis
inhibit glucose production
stimulate glucose uptake by muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what portions of the brain is insulin thought to act on

A

hypothalamus

prefrontal cortec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

discuss the reduction of B cells in DM2

A

the human pancreas is incapable of renewing B cells after age 30
glucolipotoxicity and amyloid deposition result in B cell apoptosis through oxidative and endoplasmic reticulum stress

18
Q

discuss the role of a cell dysfunction in DM1

A

abnormal glucagon release
elevated fasting glucagon (increases glucose production from hepatocytes and contributes to hyperglycemia)
non-suppression after meal ingestion

19
Q

what is the incretin effect?

A

oral glucose provides a much greater C-peptide response than IV glucose

20
Q

what is C-peptide

A

measure of innate insulin production

only created by the body and longer lasting than insulin

21
Q

what is incretin

A

substance released by the gut in response to food that stimulates insulin secretion

22
Q

two well described incretins

A

glucagon-like peptide-1 (GLP-1)

glucose-dependent insulinotropic peptide (GIP) (minor, not as potent and GLP-1)

23
Q

discuss the role of the GI tract in hormonal dysfunction in DM2

A

meal stimulated levels of GLP-1 are reduced
deficient GLP-1 response contributes to a rise in plasma glucagon secretion and impaired suppression of hepatic glucose production after a meal
deficient GLP-1 response leads to reduction in insulin secretion

24
Q

discuss the role of the a cell in hormonal dysfunction in DM2

A

elevated basal glucagon leads to increased rate of hepatic glucose production
possible liver hypersensitivity to stimulatory effect of glucagon in hepatic gluconeogenesis

25
Q

fasting state function of normal liver

A

increased HGP

26
Q

fed state function of normal liver

A

decreased HGP

27
Q

discuss the role of the liver in hormonal dysfunction in DM2

A

failure of insulin to suppress glucagon secretion
increased glucagon leads to elevated basal hepatic glucose production despite hyperinsulinemia
enhanced hepatic sensitivity to glucagon

28
Q

effects of GLP-1 on liver, a cells, stomach, B cells, and CNS

A 
liver: less glucagon = less HGP
a cell: decreases post prandial glucagon
stomach: slows gastric emptying
B cell: increases insulin 
CNS: promotes satiety and reduction of appetite
29
Q

which enzyme degrades GLP-1 and at what pace

A

DDP2

half life = 60-90 s

30
Q

what is the role of DDP4

A

ubiquitous serine protease
high levels in lumen of intestine, liver, lung, and kidney
multiple substrates including GLP-1 and GIP
expressed on surface of T cells to play a role in activation and immunological responses

31
Q

effects of blood sugar alterations on macrocirculation

A

atherosclerosis

coronary, peripheral, and cerebral arteries

32
Q

effects of blood sugar alterations on microcirculation

A

affects BM of small blood vessels and capillaries

eyes and kidneys

33
Q

discuss the risk of CVD in diabetic pts

A

major source of mortality
2/3 of diabetics die of heart disease or stroke
increased risk of MI and CHF

34
Q

discuss diabetic nephropathy

A

glomerulosclerosis
first indicator is microalbuminuria
DM1 - evidence after 10-15 y with uncontrolled disease
DM2- evidence sooner since may have gone years without diagnosis

35
Q

discuss diabetic retinopathy

A 
major cause of blindness in adults 20-74
affects almost all DM1 after 20 years
affects 60% of DM2 patients
progressive, irreversible vision loss
hemorrhages on the retina of an eye
36
Q

non-proliferative diabetic retinopathy vs proliferative

A

both due to hyperglycemia
difference - VEGF expression
proliferative has upregulated VEGF and growth of abnormal blood vessels
non-proliferative has aneurysms, hemorrhage, and exudate in existing vessels

37
Q

sensory motor (peripheral) neuropathy

A 
paresthesias primarily in lower extremities
decreased deep tendon reflexes
numb feet
decreased proprioception
decreased sensation
unsteady gait
increased risk of foot injury
38
Q

autonomic neuropathy

A

not as common

can affect almost any system

39
Q

what is hypoglycemic unawareness

A

lack of autonomic response to recognize/correct hypoglycemia

results from an autonomic dysfunction of adrenal glands

40
Q

best treatment for diabetic neuropathy

A

prevention with glycemic control

41
Q

misc complications associated with DM

A

increased susceptibility to infection
periodontal disease
foot ulcers and infections

42
Q

what 2 major complications increase risk of foot infections

A
  1. neuropathy decreases sensation and increases dryness and fissures
  2. peripheral vascular disease decreases circulation which contributes to poor wound healing and susceptibility to antibiotics leading to gangrene

GIR Test 1 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions