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endoII exam2 > Darrow DM > Flashcards

Darrow DM Flashcards

1
Q

What is metabolic syndrome

A 
2 physical findings: waist circumference >40 inches men >35 in women
apple shape
3 labs:
HTN: >130/85
TG: >150
HDL-C 100
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2
Q

what does adipose tissue secrete

A

inflammatory and immune mediators “adipokines”

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3
Q

specific mediators secreted by adipose tissue

A

leptin, adiponectin, resistin, visfatin, TNF alpha, IL-6, thrombospondin, plasminogen activator 1

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4
Q

what does adipose tissue look like in obesity and insuline R

A

many macrophages, tissue secretes high levels adipokines and low levels adiponectin

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5
Q

why are thiazolinediones used in severe obestiy

A 
decrease insulin R
adipocyte differentiation is modified
VEGF induced angiogenesis inhibited
leptin levels decrease
levels of certain IL (IL6) dec
antiproliferative action
adiponectin levels rise
inhibit TSP1 expression
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6
Q

role of TSP1 in adipose tissue

A

activates TGF-beta which activaes PAI-1 which is procoagulant

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7
Q

what is worse

SQ fat or omental

A

omental

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8
Q

uric acid levels in metabolic synfrome

A

hyper

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9
Q

LDL levels in metabolic syndrome

A

low

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10
Q

plasminogen activator inhibitor levels in metabolic syndrome

A

high

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11
Q

levels of homocysteine in metabolic syndrome

A

increased

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12
Q

what is the initial step of tissue damage in DM

A

hyperglycemia mediated mitochondrial superoxide production

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13
Q

Dx criteria DM II

A

Random glucose >200 with Sx!
FBS> 126 repeatable
2 hour post meal BS >200 repeatable
HbA1c>6.5% repeatable

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14
Q

what can cause low HbA1c

A

HbF, hemolytic anemia, acute bleed, Vit C and E

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15
Q

Causes of DM II

A

genetic
TCF7L2 transcription factor for WNT signlaing for beta cell
environmental: visceral obesity, insulin R

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16
Q

causes of polyuria

A 
CDRIPPED
Cortisol escess
DM
Recovery from renal railure
Ions (hyper Ca and hypo K)
Parkinsons
Psychogenic Polydipsia
Enzyme-vasopressinase
Drugs: lithium, demeclocycline, methicillin
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17
Q

What Ab can you detect in DM I

A 
glutamic acid decarboxylase 65
insulin
islet cell cytoplasmic Ab
insulinoma assoc 2 autoAb
zinc transporter Ab
tyrosine phosphatase Abs
18
Q

HLA DM I

A

DR3 DR4

19
Q

Patient was Dx with DM I 20 yrs ago and on insulin since
she went on vacation and forgot insulin but no adverse effects except increased polyuria
most likely?

A

abnormal nuclear transcription factor in beta cells

20
Q

defect in transcription factor hepatic nuclear factor results in what

A

decreased apo M and so decreased clearance of HDL which is not cardioprotective

21
Q

inheritance of MODY (maturity onset diabetes of young)

A

autosomal dominant

22
Q

what drugs are effeective in MODY 3 syndrome

A

sulfonylurea

23
Q

what is defective in MODY2

A

glucokinase

24
Q

how do MODY syndromes lead to diabetes

A

impaired glucose secretion of insulin

25
Q

most common MODY

A

type 3

26
Q

what type of diabetes resemlbles type I without the Ab

A

mutation of mitochondrial DNA

27
Q

what medications can lead to diabetes

A

cyclosporine, tacrolimus, steroids, thiazides, beta blockers, olanzopine

28
Q

what is stiffman synrome

A

immune mediated, R Ab that can lead to diabetes

29
Q

what genetic syndromes can be associated with diabetes

A

downs
turners
klinefelters
friedreichs ataxia

30
Q

Reasons for insulin resistance

A 
aging
endocrine disorders
infections
obesity
uremia and hepatic disease
hyperglycemia
acanthosis nigricans, ataxia telangiectasia
Stress
pregnancy
cortisone
disorders of insulin
31
Q

What drugs can produce hyperglycemia

A 
beta blockers
hormones, HAART
alcohol, antipsycotics
sympathomimetics
thiazides, ticyclics
oral contraceptives, opiates
pentamidine, phenytoin
indocin, isoniazid, imunosuppressants
niacin
32
Q

how does obesity lead to DM II

A

excess calories cause lipogenesis which block FA oxidation adn stimulate TG and LP synthesis with diacylglycerol and ceramide as byproducts that activate PKC that inhibits insulin R activity
TNF alpha is produced and increases insulin R

33
Q

patient has DM and red bympy rash what is this called and what causes it

A

eruptive xanthomas from hyper TG and overproduction VLDL

assoc with DM

34
Q

complications of eruptive xanthomas caused by increased VLDL

A

pancreatitis

35
Q

in type I HLD what do you have increased amounts of

A

chylomicrons

36
Q

in type IV HLD what do you have increased amounts of

A

VLDL

37
Q

What is cheiropathy and what causes it

A

patient can’t bring hands together (prayer)

from glycating collagen

38
Q

if cholesterol is high but TG is not suepr high what type of HLD is it

A

2B

39
Q

what R is messed up in 2B HLD

A

LDL R messed up

40
Q

type III HLD

A

E2/E2

chol=TG

41
Q

what is increased in 2B HLD

A

APO B 100 and VLDL

42
Q

most common type HLD with DM

A

2B the familial combined HLD

endoII exam2 (18 decks)

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