CSIM 1.85 Multisystem Disease

Question 1

Function of insulin

Answer 1

Convert blood glucose to glucagon or lipids.

Question 2

Function of insulin

Answer 2

Convert glycogen or lipids to glucose

Question 3

Symptoms of ketoacidosis

Answer 3

Sweet smelling breath, ketonuriea, ketonaemia, tachycardic, hypotensive, weight loss.

Question 4

Effects of insulin deficiency

Answer 4

Hyperglycaemia
Conversion of lipids to fatty acids (ketones)
High cortisol which leads to ketogenesis

Question 5

Causes of T1DM?

Answer 5

Autoimmune - antibodies which attack beta islets cells

Question 6

Which MHC gene is associated with T1DM?

Answer 6

MHC class II DR3 and DR4

Question 7

What is T2DM?

Answer 7

Insulin resistance leading to relative lack.

Question 8

What are some macroangiopathy effects of DM?

Answer 8

Diseases in large vessels, like atheromatosis.

Question 9

What are some microangiopathy diseases related to DM?

Answer 9

Nephropathy, retinopathy and neuropathy

Question 10

How does diabetes cause complications in pregnancy?

Answer 10

Diabetes causes larger fetuses which can lead to birthing complications, often requiring caeserans

Question 11

Why does DM increases infection risks?

Answer 11

High blood glucose is conducive for organism proliferation, with increased ischaemia tendencies lead to even high infection risks

Question 12

Why does diabetic foot occur?

Answer 12

Neuropathy of feet causes repeated injuries which impairs wound healing and increases infection risks. Eventually leading to gangrene

Question 13

On a retinal image of someone suffering from DM, describe what flare haemorrhage, hard exudates and cotton wool spots are.

Answer 13

Flare haemorrhages causes by local bursting of blood vessels in the eye, often in the vitreous humor

Hard exudates formed by deposition of glycated substances in the eye

Cotton wool spots are more diffused deposits which occur before hard exudates begin.

Question 14

What risks increase with metabolic syndrome?

Answer 14

5x increase in developing T2DM. Increase CVS and CBVS risk.

Question 15

Explain what advanced glycation end products are and their effects

Answer 15

High glucose content reacts with proteins like collagen. These form glycated proteinaceous compounds which get deposited widely around the body.

This leads to reduced BV elasticity, LDL trapping leading to atheromas and thickening and altered function of capillaries.

Question 16

Describe the structure of an amyloid protein

Answer 16

Anti-parallel beta pleated sheets

Question 17

What stain is used on amyloid?

Answer 17

Congo red stain, shows up green

Question 18

How does myeloma cause amyloidosis?

Answer 18

Myeloma causes excessive production of plasma cells and antibody light chains. This leads to deposition of light chain is termed “AL-typed” amyloid

Question 19

Why should a liver biopsy never be done on an amylodotic patient

Answer 19

Because amyloid impairs capillary contraction, which is necessary to stop bleeding.

Inserting a needle into a liver that cannot stop bleeding can cause profuse bleeding.