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Med Prep > endo-all > Flashcards

endo-all Flashcards

0
Q

Mechanism of cortisol

A

Glucocorticoid receptor

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1
Q

Degradation enzyme of catecholamine that predominates in neuronal mitochondria

A

MAO

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2
Q

Biochemical diagnosis of pheochromocytoma

A

Catecholamine excess

Urinary fractionated metaphrenine or plasma free metaphrenine will predict size and location of tumor

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3
Q

In the absence of cortisol, GR stays I. Cytoplasm bound to molecular chaperone such as

A

Heat-shock protein 90

Cyclophilin

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4
Q

Regulation of aldosterone secretion

A

RAAS

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5
Q

Stimulators of aldosterone

A

Angiotensin II = increase STAR and cyp11b2 (potent vasoconstrictor)
Extracellular K
Acute elevated ACTH

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6
Q

Reaction 2 in modification of FC to cortisol

A

Pregnenolone to progesterone by 3B-HSD or

Pregnenolone to 17-OH-pregnenolone by CYP17 (hydroxylase func)

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7
Q

Results from continuous administration of aldosterone in 2-3days

A

Aldosterone escape

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8
Q

Synthesis of epinephrine

A
  1. Transport of tyrosine into chromaffin cells cytoplasm
  2. Hydroxylation of tyrosine into DOPA
  3. DOPA to dopamine
  4. Transport of dopamine into chromaffin granules (secretory vesicles)
  5. Dopa to norepi within chromaffin granules as chromogranins
  6. Norepi diffuses out of granule thru facilitated diffusion
  7. Methylation of norepi to epi
  8. Transport of epi back into granules
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9
Q

Imaging of choice in pheochromocytoma if there is metastasis, previous operation or for familial, multiple pheochromocytoma

A

MIBG - 1st choice, gets into cell but not metabolized in cell
PET scan - metabolized further in cell

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10
Q

Complex of N/NE with ATP, Ca and proteins inside the granules.

A

Chromogranins

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11
Q

Renin is produced by

A

Juxta glomerular cell

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12
Q

Tissue distribution and potency agonist:

B2 receptor

A

Liver

Epi>norepi

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13
Q

Zona glomerulosa is primarily regulated by

A

RAS
Extracellular K
ANP

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14
Q

Largest and most Steroidogenic zone in adrenal Cortex

A

Zona fasciculata

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15
Q

ACTH binds to what receptor in zona fasciculata

A

Melanocortin-2 receptor

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16
Q

Metabolism of catecholamine

A

Draw!

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17
Q

Steroidogenic pathways in zona glomerulosa

A

Pregnenolone to progesterone (3B-HSD) to 11-doc (cyp21b) to corticosterone to 18-OH-corticosterone to aldosterone (cyp11B2)

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18
Q

Rate-limiting enzyme in Steroidogenesis

A

Cyp11A1

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19
Q

Inhibitors of aldosterone

A

ANP (directly inhibits aldosterone production / indirectly inhibits renin release)
Chronic elevated ACTH

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20
Q

Mechanism of action of catecholamine

A

Exerted thru adrenergic receptor

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21
Q

Congenital adrenal hyperplasia usually due to

A

Cyp21

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22
Q

Zona glomerulosa is secondarily regulated by

A

ACTH

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23
Q

Important in biogenesis on secretory vesicles and organization of components within vesicles

A

Chromogranins

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24
Q

DHEAS/DHEA: has high affinity binding to albumin

A

DHEAS

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25
Q

Tissue distribution and potency agonist:

B3 receptor

A

Adipose tissue

Norepi>epi

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26
Q

How is blood collection done in diagnosis of pheochromocytoma?

A

Supine for 20min
Overnight fast
No nicotine, alcohol within 12hrs
Avoid acetaminophen, TCA and phrnoxybenzamine

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27
Q

Conn’s disease results in

A 
K depletion 
Na retention 
Ms weakness
Hypertension
Polyuria
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28
Q

Reduces osmotic burden of storing individual molecule of epi with chromaffin granules

A

Chromogranins

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29
Q

Metabolic action of chronically elevated cortisol in healthy individuals

A

Increase cortisol
Increase insulin/glucagon ratio
Decrease epi and norepi

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30
Q

Reaction 4 in modification of FC to corticosterone

A

17-Oh-progesterone to 11-deoxycorticosterone by cyp21B

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31
Q

What happens when there is Hypervolemia

A

Hypervolemia means high Na level, this will inhibit the renin release which will lower aldosterone secretion resulting back to normovolemia

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32
Q

Reaction5 in modification of FC to corticosterone

A

11-deoxycorticosterone to corticosterone by cyp11B1

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33
Q

Degradation enzyme of catecholamine that is predominant

A

COMT

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34
Q

Primary hyperaldosteronism

Usually due to aldosterone- secreting tumor

A

Conn’s syndrome

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35
Q

Reaction 3 in modification of FC to cortisol

A

Progesterone to 17-OH-progesterone by cyp17(hydroxylase) or

17-OH-pregnenolone (^5) to 17-OH-progesterone(^4) by 3B-HSD

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36
Q

Unique features of zona glomerulosa

A
  1. Absence of cyp17

2. Presence of cyp11b2 (aldosterone synthase)

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37
Q

In pheochromocytoma, lability of Bp is caused by

A

Episodic catecholamine release
Impaired Symphathetic reflex
Unrecognized chronic volume expansion

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38
Q

Chronic effect of ACTH

A
  1. Increase transportation of genes encoding Steroidogenic enzyme and coenzyme
  2. Increase LDL and HDL receptor
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39
Q

Secretion of noepi and epi is regulated by

A

Descending sympa signals in response to stress.
Hypothalamus and brain stem send a chemical signal as ACTH to bind to nicotinic receptor in chromaffin cells which increases acty of tyrosine hydroxylase and B-hydroxylase in which stimulates exocytosis of granules

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40
Q

Imaging of choice in pheochromocytoma preferred for extra adrenal, pregnant, children and those allergic to contrast.

A

MRI

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41
Q

Tissue distribution and potency agonist:

a2 receptor

A

Adrenergic pre synaptic terminals

Norepi=epi

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42
Q

Zona glomerulosa has low affinity binding to transport proteins

A

True

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43
Q

Presence of this enzyme converts cortisol to cortisone (inactivates)

A

11B-HSD2

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44
Q

Steroidogenic pathway in zona reticularis

A

Pregnenolone to 17-OH-pregnenolone (CYP17) to DHEA (CYP17 -lyase) to DHEAS (SULT2A1) or
DHEA to aldrostenedione (3B-HSD)

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45
Q

DHEAS/DHEA: low affinity binding to protein

A

DHEA

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46
Q

Degradation enzyme of catecholamine that predominates as methylation of Norepi/epi in non-neuronal tissue

A

COMT

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47
Q

Reaction 4 in modification of FC to cortisol

A

17-OH-progesterone to 11-deoxycortisol by CYP21B

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48
Q

In pheochromocytoma, hypertension is mainly due to

A

Increased peripheral resistance

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49
Q

Tissue distribution and potency agonist:

B1 receptor

A

Heart

Epi=norepi

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50
Q

Increase ACTH due to any enzyme block decreasing cortisol synthesis.
May cause masculinization of female fetus or incomplete masculinization of male fetus

A

Congenital adrenal hyperplasia

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51
Q

Cortisone is converted back to cortisol in liver, skin and other tissues by

A

11B-HSD1

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52
Q

1st reaction in Steroidogenic pathway

A

Free cholesterol transported in inner mitochondria thru STAR protein, and converted into pregnenolone by CYP11A1

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53
Q

Cortisol serves as negative feedback thru

A
  1. Inhibition of pomc gen expression at corticotropes.

2. Inhibition of pro-CRH gene expression at hypothalamus

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54
Q

Clinical features of pheochromocytoma

A 
Sweating 
Hypertension
Headaches
Anxiety/fear
Forceful heartbeat with or without tachycardia 
Flushing
Fatigue 
Tremors
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55
Q

Renin is release in response to

A

Low bp

Low Na delivery to macula densa

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56
Q

Zona reticularis begins to appear after birth at..

A

5 year old

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57
Q

Physiologic action of aldosterone in kidney

A

Increase NA reabsorption

Increase K and H secretion

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58
Q

Zona glomerulosa almost all inactivated by

A

Liver (conjugated to glucoronide)

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59
Q

Acute effect of ACTH

A
  1. Rapid transport of cholesterol to OMM
  2. Increase STAR protein gene expression
  3. Resulting to increase pregnenolone activity
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60
Q

2 primary degradation enzymes of catecholamine

A
  1. Monoamine oxidase MAO

2. Catechol-O-methyltransferae COMT

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61
Q

Tissue distribution and potency agonist:

a1 receptor

A

Adrenergic post synaptic nerve terminals

Norepi=epi

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62
Q

Pheochromocytoma is majorly bilateral/ unilateral?

A

90% unilateral and sporadic

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63
Q

Chromaffin cell tumor that produce, store, metabolize and secrete catecholamine (in excess).
Causing irregular secretion of epi and norepi leading to attacks of raised bp, palpitations, and headache.

A

Pheochromocytoma

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64
Q

Imaging of choice for pheochromocytoma

A

CT scan

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65
Q

Regulation of cortisol production

A

Thru Hypothalmus-ant. Pituitary-adrenal axis

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66
Q

Reaction 5 in modification of FC to cortisol

A

11- deoxycortisol to cortisol by cyp11B1

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67
Q

Metabolic action of cortisol in response to stress

A

Increase cortisol
Decrease insulin/glucagon ratio
Increase epi and norepi from sympathoadrenal output

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68
Q

Adrenal androgens (DHEAS) appear in circulation at

A

6 year old

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69
Q

Mechanism of action of zona glomerulosa

A

Intracellular mineralocorticoid receptor

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70
Q

Regulation of menstrual cycle when there is high freq GnRH pulses

A

LH production

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71
Q

Normal internal genitalia but incomplete masculinized external genitalia - ambiguous genitalia. Mistaken for females at birth

A

5a reductase deficiency

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72
Q

Primary defect of PCOS

A

Inappropriate signals between HP axis and ovary

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73
Q

Loophole in male repro axis..

A

Intratesticular T level should be >100x more than circulating T level to maintain normal spermatogenesis

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74
Q

Short stature, webbed neck, low se tears, shield-shaped chest, short 4th metacarpals and sexual infantilism

A

Turner syndrome

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75
Q

Androgen negative feedback effect on FSH and LH ..more on

A

LH

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76
Q

Primary isolated gonadotropin deficiency due to inability of GnRH neurons to migrate to medico basal hypothalamus from nasal placode. With undescended testes (CRYPTORCHIDISM) and microphallus. Asso with anosmia

A

Kallmann syndrome

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77
Q

Most common cause of congenital hypogonadism

A

Gonadal dysgenesis or Turner syndrome

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78
Q

Genetic disorder in men with extra X chromosome.

Phenotypically male but with small testis and decreased germ cell

A

Klinefelter syndrome

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79
Q

Due to decreased DHT formation

A

5a reductase deficiency

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80
Q

Functional connections are established between GnRH neurons and portal system by

A

16wks AOG

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81
Q

Testosterone and DHT synthesis

A

Aldrostenedione to testosterone (17B-HSD) to DHT (5a-reductase)

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82
Q

Seminiferous tubular dysgenesis

A

Klinefelter syndrome

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83
Q

isoform of 5a-reductase:
Found in male urogenital tract, skin, hair follicles and Liver
For masculinization of ext genitalia in utero

A

Type 2

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84
Q

isoform of 5a-reductase:

Expression starts at puberty

A

Type 1

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85
Q

Regulation of development of external genitalia in female

A

Absence of DHT

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86
Q

GnRH neurons have been demonstrated in the feral hypothalamus by

A

9wks gestation

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87
Q

In adult male, LH is secreted in pluses approx every

A

2 hrs

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88
Q

Female repro cell which expresses LH receptor

A

Theca cells

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89
Q

60% of androgen is bound to

A

sex hormone binding globulin SHBG

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90
Q

Regulation of menstrual cycle when there is low freq GnRH pulses

A

FSH production

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91
Q

Chronically a ovulation women with high androgen, estrogen, and LH levels

A

PCOS

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92
Q

Regulation of development of internal genitalia in male

A

Wolffian duct-Testosterone and presence of MIS

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93
Q

Results from hereditary defect of X chromosome gene controlling androgen receptor expression
Phenotypically female but male internal genitalia
Male pseudo hermaphroditism

A

Androgen insensitivity syndrome

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94
Q

Characterized by a striking increase in amplitude of LH pulses with a lesser change in frequency

A

Puberty

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95
Q

Female repro cell which produces androgen (primarily androstenedione)

A

Theca cells

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96
Q

Granulosa cells expresses what enzymes

A

17b-HSD, cyp19

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97
Q

Theca cells expresses what enzyme

A

Cyp11a1, 3b-HSD, cyp17

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98
Q

Regulation of Sertoli cell function

A

Stimulated by both testosterone and FSH
Expresses FSH receptor
FSH stimulates synthesis of inhibin

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99
Q

Characterized by low amplitude GnRH secretionas mirrored by LH secretion

A

Childhood period

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100
Q

Regulation of development of internal genitalia in female

A

Mullerian duct - absence of MIS

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101
Q

Leydig cell produces estrogen peripherally. Effects…

A

Bone maturation
Insulin sensitivity
Improves lipoprotein profile (increase HDL)

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102
Q

Exogenous T level increases circulating T only

A

True

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103
Q

Regulation of development of external genitalia in male

A

Presence of DHT

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104
Q

isoform of 5a-reductase:

Found in skin - contributes to sebaceous gland activity and acne formation

A

Type 1

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105
Q

Female repro cell which expresses FSH receptor

A

Granulosa cells

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106
Q

Diagnosis of PCOS requires 2 out of 3 of

A
  1. Amenorrhea
  2. Evidence of excess androgen secretion (acne, hirsutism)
  3. Polycystic ovaries by ultrasound
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107
Q

Hormonal Rhythm with a 24hr cycle

A

Circadian rhythm

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108
Q

Type of secretory transport that involved release of neurohormone from axonal endings and regulation of nearby cell by diffusion

A

Neurocrine

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109
Q

Sites of impairment in dwarfism

A

Reduced GH secretion
Decreased IGF production
Deficient IGF action

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110
Q

Zone of adrenal cortex composed of straight cords of large cells with foamy cytoplasm which is filled with droplets representing stored cholesterol ester

A

Zona fasciculata

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111
Q

Pineal gland secretes what hormone?

A

Melatonin

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112
Q

ADH are synthesized as preprohormones:

A

Preprovasophysin - co secreted peptide - neurophysin I

Preprooxyphyxin - cosecreted peptide - neurophysin II

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113
Q

In embryology of hypothalamus. Division where the cells makes up almost all the adenohypophysis

A

Pars digitalis

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114
Q

Type of DI wherein there is normal ADH production but abnormal renal ADH response

A

Nephrogenic DI

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115
Q

Nursing stimulates PRL production and hence asso with decreased fertility during phase of nursing

A

Excess PRL in male results in testosterone deficiency and impotence

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116
Q

Eicosanoids

A

Prostaglandins
Leukotrienes
Thromboxanes
Prostacyclin

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117
Q

GH induce placenta to produce ___ .

By increasing maternal blood glucose and FA level! this increases the availability the nutrients for fetus.

A

Somatomammotropin

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118
Q

Steroid hormones are administered orally

A

Yes

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119
Q

Iodothyronines circulate the blood bound or unbound

A

Bound to serum binding proteins

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120
Q

Steroid hormone categories

A
  1. Progestins - progesterone
  2. Mineralocorticoids - aldosterone, 11-deoxycorticosterone
  3. Glucocorticoids - cortisol, corticosterone
  4. Androgens - testosterone, dihydrotestosterone
  5. Estrogen - estradiol-17B, estriol, secosteroid (vitD active metabolite)
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121
Q

Blood supply of testis

A

Testicular artery (from branches of internal spermatic artery)

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122
Q

Funnel shaped swelling superior to the infundibulum

A

Median eminence

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123
Q

Hypothalamic nuclei that func as:

Focal point of info processing

A

Dorsomedial nucleus

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124
Q

Iodothyronine have intracellular receptors

A

True

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125
Q

Hormonal rhythm with a 1/2 to 2 hr cycle

A

Pulsatile rhythm

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126
Q

Proteins or peptide hormones are administered orally

A

False

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127
Q

2 types of bv carrying blood from adrenal cortex to medulla

A

Medullary arterioles - provide high O2 and nutrient to chromaffin cells
Cortical sinusoids - into which cortical cells secrete steroid hormone

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128
Q

Pineal gland also contains other bio active peptides such as

A

TRH, GnRH, somatostatin, norepi

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129
Q

Component of pituitary gland composed mainly of neural cells and the site of release of neuro hormones.

A

Posterior pituitary or neuro hypophysis

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130
Q

Hyperprolactinemia is asso with amenorrhea and infertility.
Can have gynecomastia and galactorrhea.
May have visual disturbance (bite,portal hemianopsia) and decreased libido

A

True

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131
Q

Venous drainage of adrenal gland

A

R adrenal v - post aspect of IVC

L adrenal v - L renal v - IVC

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132
Q

Parafollicular cells are usually located where in the lobe?

A

Upper 2/3 of lobes

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133
Q

Age of gestation where rathke’s pouch arise

A

5th wk

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134
Q

Hypothalamic nuclei that func as:
Regulation of appetite
GNHR, GnRH, dopamine, somatostatin

A

Arcuate nucleus

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135
Q

In DI, they are unable to concentrate the urine normally, resulting in large volume of urine excreted.

A

True

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136
Q 
Tropic hormone secreted of: 
Corticotrope
Thyrotrope
Gonadotrope
Somatorope
Lactotrope
A

Tropic hormone secreted of:
Corticotrope - adenocorticotropic hormone ACTH
Thyrotrope - thyroid stimulating hormone TSH
Gonadotrope - follicle-stimulating hormone FSH and leutinizing hormone LH
Somatorope - GH
Lactotrope - prolactin

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137
Q

Secretion of ACTH is pulsatile

A

True

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138
Q

Venous drainage of thyroid gland

A

Superior thyroid vein
Middle thyroid vein
Inferior thyroid vein

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139
Q

GH excess that occurs after puberty or after closure of epiphyses

A

Acromegaly

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140
Q

Hypothalamic nuclei that func as:
Magnocellular PVN: ADH, oxytocin
Parvicellular PVN: TRH, CRH, VIP

A

Paraventricular nucleus

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141
Q

PRL inhibitors

A

Dopamine agonist (bromocriptine)
Somatostatin
TSH
GH

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142
Q

4 cell types of adenohypophysis

A

Basophils:
Gonadotropes FSH, LH
Corticotropes ACTH
Thyrotropes TSH

Acidophils:
Lactotropes Prolactin
Somatotropes GH

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143
Q

GH excess that occurs before puberty

A

Gigantism

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144
Q

GH is a ___ aa peptide

A

191 aa

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145
Q

Metabolic actions of GH on lipids

A

Lipolytic

Keratogenic after long term admin’n

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146
Q

Hypothalamus is a dorsal/ventral derivative of neural tube.

A

Ventral

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147
Q

Hormone that increases during pregnancy, promoting development of breast

A

PRL

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148
Q

Proteins /peptide hormones are stored in

A

Membrane-bound granules

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149
Q

Half life of oxytocin

A

3-5 min

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150
Q

Hypothalamus develops from lateral wall of diencephalon thru ventral extension to a groove in about __wk of gestation

A

5 1/2 wks

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151
Q

Type of secretory transport where in some peptides/amines secreted directly into the gut (ie somatostatin, GASTRIN, secretin, subs P)

A

Solinocrine

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152
Q

Weight of adrenal gland

A

8-10 gm

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153
Q

Nucleus of Mammillary region of hypothalamus

A

Posterior nucleus

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154
Q

Smaller,dendritic and well granulated cells of pancreas

A

Delta cell

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155
Q

Hormone that Stimulates breast myoepithelial cell to contracts thereby ejecting the milk that has been stored in breast

A

Oxytocin

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156
Q

Catecholamine are polar/non polar

A

Polar

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157
Q

SIADH is common in what disease

A

PTB, pulmonary Ca

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158
Q

In suppression test, the administration Of suppressor is to test the..

A

Autonomy of hormonal secretion

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159
Q

Venous drainage of hypothalamus

A

Majority of hypothalamus - ant.cerebral and basal vein
Dorsal portion - internal cerebral vein

Both reaching the great vein of Galen (rosenthal)

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160
Q

Sertoli cells forms these junctions with all stages of sperm cell, allowing sperm cells to be guided towards the lumen

A

Adherens-type junction

Gap junction

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161
Q

Endocrine hormones that do not have their own personal glands

A

Gastrin, secretin, cholecystokinin - by GI wall
Erythropoietin - kidney
Prostaglandin

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162
Q

LH in female stimulates ___ produces what hormone

A

Follicle Ovulation and maturation into corpus luteum

Produces estrogen and progesterone

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163
Q

Which is larger? Right or left lobe of thyroid gland?

A

Right lobe. 2x larger

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164
Q

Zona reticularis begins to appear after birth at

A

5 y/o

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165
Q

Aldosterone in zona glomerulosa is regulated primarily by

A

Renin-angiotensin system

Extracellular K and ANP

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166
Q

Aldosterone in zona glomerulosa is regulated secondarily by

A

ACTH

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167
Q

In embryology of hypothalamus. Division where the cells facing away from infundibulum.

A

Pars digitalis

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168
Q

Regulation of development of external genitalia in the presence of DHT

A

Male geniality is formed (penis, scrotum,prostate)

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169
Q

In stimulation test, the administration of specific stimulators to test the ..

A

Hormonal secretory reserve to the gland p

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170
Q

Hormones that secretes in an Ultradian rhythm

A

FSH
LH
Testosterone

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171
Q

FSH in female stimulates ___ produces what hormone.

A

Follicular growth

Produces estradiol

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172
Q

Two principal hormones of follicular cells

A

Thyroxine T4

Triiodothyronine T3

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173
Q

GH is stimulated during deep, slow-wave sleep (stages 3 and 4).
Sleep wake patterns

A

Pulsatile secretion

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174
Q

Metabolic actions of GH on IGF

A

Stimulates IGF production
Stimulates growth
Mitogenic

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175
Q

Exocrine function of Sertoli cells

A

Production of fluid to move immobile sperm put of testis towards epididymis
Production of androgen-binding protein (ABP)
Determination of release of spermatozoa from seminiferous tubules

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176
Q

Hormone that stimulates contraction of uterine myometrium

A

Oxytocin

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177
Q

TRH is inhibited by

A

Stress

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178
Q

Required for homeostasis of all cells
Influence cell differentiation growth and metab
Considered as a major metabolic hormone because they target virtually every tissue

A

T3 and T4

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179
Q

Seat of the soul

A

Pineal gland

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180
Q

In embryology of hypothalamus. Division which is the lower expansion of infundibular process. And becomes the posterior pituitary.

A

Pars nervosa

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181
Q

Steroid hormones are derived form

A

Cyclopentanoperhydrophenanthrine (CPPP) ring

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182
Q

The cells in adrenal cortex develops into

A

Steroidogenic cells (GC, MC, androgens)

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183
Q

Medullary arterioles and cortical sinusoids fuse into ___ of vessels that drains into suprarenal vein and into IVC

A

Medullary plexus

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184
Q

Importance of endocrine system

A

Allows normal growth and development of organism
Maintains internal homeostasis
Regulated the onset of reproductive maturity at puberty and the func of the repro system in adults

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185
Q

A cells of pancreas produces what hormone

A

Glucagon

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186
Q

Which extends higher and lower in the neck? Right or left lobe of thyroid gland?

A

Right lobe

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187
Q

Site of release of ADH and oxytocin

A

Neurohypophysis

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188
Q

The mass of islets of langerhans in pancreas differs with age. Is it greater in adult?

A

Greater in fetus and young

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189
Q

Cell pop in thyroid parenchyma

A

Follicular cells
Parafollicular C cells
Epithelial cells

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190
Q

Gf resistant due to genetic defect in the receptor (total absence of IGF response)

A

Laron dwarfs

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191
Q

PRL is stimulated by

A

Nursing or breast stimulation which promotes onset and maintenance of milk production

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192
Q

Iodothyronine is derived from what aa

A

Tyrosine

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193
Q

Neuroendocrine reflex stimulating the regulation of oxytocin

A

During labor, Stretching of vagina and cervix

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194
Q

LH in male stimulates ___ produced by ___ cell

A

Testosterone stimulation by leydig cells

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195
Q

Catecholamine are have short/long half life

A

Short half life (1-2min)

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196
Q

Age of gestation where pars nervosa arise.

A

8th wk.

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197
Q

The outer part of adrenal glands

A

Adrenal cortex (90%)

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198
Q

Iodothyronines can be administered orally

A

True

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199
Q

Organs which secrete subs in response to stimuli

A

Glands

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200
Q

Type of DI wherein there is destruction of pituitary or hypothalamus resulting to:
High urine volume and low urine osmolality
High plasma osmolality and low ADH levels

A

Neurogenic DI

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201
Q

Cell in peri tubular compartment that produces testosterone

A

Interstitial cells of leydig

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202
Q

Bld supply of hypothalamus

A 
Terminal branches of circle of Willis:
Internal carotid artery
Ant.cerebral artery
Post. Cerebral artery 
Ant. Comm. artery
Post. Comm. artery
Basilar artery
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203
Q

Catecholamine are stored in

A

Membrane soluble granules

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204
Q

2 types of neuron in hypothalamus

A

Magnocellular (large) neuron

Parvicellular (small) neuron

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205
Q

Columnar and caller cells of pancreas with granules

A

A cells

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206
Q

Precursor of Eicosanoids

A

Arachidonic acid

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207
Q

Nucleus of Tuberal region of hypothalamus

A

Arcuate nucleus
Dorsomedial nucleus
Ventromedial nucleus

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208
Q

Half life of ACTH

A

10 min

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209
Q

Polyhedral cells of pancreas arranged in tubes around capillary

A

B cells

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210
Q

Largest single organ specialized for hormone production

A

Thyroid gland

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211
Q

ADH and oxytocin are similar in structures but only differs in only 2 aa.

A

ADH - Phenylephrine (phe)

Oxytocin - isoleucine (ile)

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212
Q

Hyper or hypo secretion of a hormone due to tumor or disease of an endocrine gland itself.

A

Primary hypo or hyper function

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213
Q

Important in early vasodilators shock

A

Antidiuretic hormone

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214
Q

Neuron of hypothalamus with neuro peptides and biogenic amines

A

Parvicellular

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215
Q

Stimulation test is useful in diagnosing hypofunction/hyperfunction

A

Hypofunction

For detecting impaired secretory reserve

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216
Q

Regulation of secretion of ADH is inhibited by

A

Alcohol
Cortisol
Atrial natriuretic peptide ANP

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217
Q

Pp cells of pancreas produces what hormone

A

Pancreatic polypeptide

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218
Q

Proteins or peptide hormones has short/ long half life

A

Short half life

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219
Q

PRL stimuli

A

Stress and sleep

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220
Q

Largest and most Steroidogenic zone of adrenal cortex

A

Zona fasciculata

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221
Q

Catecholamines are synthesized by

A

Adrenal medulla

Neurons

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222
Q

Sertoli and sperm cells are located in what Component of testicular lobule

A

Intra tubular compartment

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223
Q

In embryology of hypothalamus. Division which is composed of thin layer of cells which wrap around the infundibular stalk

A

Pars tuberalis

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224
Q 
Target endocrine gland of: 
Corticotrope
Thyrotrope
Gonadotrope
Somatorope
Lactotrope
A

Target endocrine gland of:
Corticotrope - zona fasciculata and reticularis of adrenal cortex
Thyrotrope - thyroid epith
Gonadotrope - ovary (theca&granulosa); testis (leydig&sertoli)
Somatorope - liver
Lactotrope - none (not part of endocrine axis)

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225
Q

Steroid hormones are polar/non polar

A

Nonpolar - not readily soluble in blood thus curculates bound to transport proteins

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226
Q

Adrenal androgen (DHEAS) appear in circulation at what age

A

6 y/o

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227
Q

Hyper or hypo secretion of a hormone produced by excessive or deficient stimulation from its tropic hormone or its physiologic stimulators: no disease of gland per se.

A

Secondary hyper or hypofunction

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228
Q

Most abundant cell type in pancreas

A

Beta cells

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229
Q

Type of glands which secretes salts, water, immunoglobulin and enzymes conveyed to a major lumen via a duct

A

Exocrine gland

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230
Q

Most abundant circulating hormone in young male adult (negligible to female)

A

Androgen

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231
Q

Domain in follicular cell that faces the follicle lumen (colloid) with micro villi and pseudopods

A

Apical domain

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232
Q

Iodothyronines have short or long half life

A

Long half life

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233
Q

Neural crest-derived cells of adrenal ,medulla asso with sympathetic ganglia

A

Chromaffin cells

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234
Q

GnRH is released in pulsatile secretion

A

True

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235
Q

Nurse cell

A

Sertoli cells

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236
Q

Blood supply of pituitary gland

A

Internal carotid arteries branches:
Superior hypophysial arteries
Middle and inf hypophysial arteries - supplies pituitary stalk and post pituitary

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237
Q

Bld supply of thyroid gland

A

Superior thyroid arteries
Inferior thyroid arteries
Thyroid ima arteries

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238
Q

Pineal gland secretes melatonin in response to

A

Hypoglycemia and darkness

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239
Q

Axonal swelling in neuro hypophysis due to storage of secretory granules.

A

Herring bodies

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240
Q

Protein bound fraction of hormone are physiologically inactive fraction

A

Free or unbound fraction of hormone are physiologically active fraction

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241
Q

Steroid hormone is synthesized by

A

Adrenal cortex
Ovaries
Testes
Placenta

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242
Q

In embryology of hypothalamus, the rathke’s pouch may persist and becomes

A

Craniopharyngioma

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243
Q

Catecholamine circulates in the blood in unbound/bound form

A

Both

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244
Q

Major difference in between male and female repro tract:
Testosterone exerts neg feedback on secretion of pituitary FSH and LH
Estrogen exerts neg and pos feedback

A

Major difference in between male and female repro tract:
M: activity does not show rhythm
F: activity based on monthly menstrual cycle or length of pregnancy

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245
Q

Contributes to __% active androgen in males for axillary and pubic hair growth and libido

A

50%

246
Q

Inability to initiate postpartum lactation

A

PRL deficiency

247
Q

GHRH has a diurnal pattern

A

Peak - early morning

Valley - day

248
Q

In embryology of hypothalamus. Division where the cells on the side of the rathke’s punch facing the infundibulum.
Lost in adult.

A

Pars intermedia

249
Q

Target cell of ADH

A

Cells lining Distal renal tubule

Principal cells of collecting duct

250
Q

Eicosanoids are short lived compound formed from

A

Polyunsaturated fatty acids

251
Q

Parafollicular cells produces what hormone

A

Calcitonin

Which plays minimal role in Ca metab

252
Q

Regions of hypothalamus

A

Chiasmatic (preoptic region)
Tuberal region
Mammillary region

253
Q

In gigantism, it may be due to pituitary tumor which may compress the anterior pituitary

A

In acromegaly, Appositional growth occurs instead of lengthening of long bones.
“Acro” means end/extremity
“Megaly” means enlargement

254
Q

Hypertension, hypokalemic alkalosis are found in excess/deficient ACTH

A

Excess ACTH (Cushing’s disease)

255
Q

The outer cortex of ovary is composed of densely cellular stroma, and within resides ovarian follicles which is covered by

A

Tunica albuginea

Ovarian surface epith cells

256
Q

Functional unit of ovary

A

Ovarian follicle

257
Q

Type of secretory transport that secretes hormones to regulate its cell of origin thru membrane receptor

A

Autocrine

258
Q

Regulation of development of external genitalia in the absence of DHT

A

female genitalia is formed (labia majora,minora, clitoris, lower 2/3 of vagina)

259
Q

Milk let down

A

Oxytocin

260
Q

Endocrine axis

A 
Hypothalamus
Releasing hormone
Endocrine cell type
Tropic hormone
Peripheral endocrine gland (adrenal,thyroid, gonads, liver) 
Peripheral hormone
Physiologic response
261
Q

Type of secretory transport which is the production of an intracellular hormone that binds to an intracellular receptor without leaving the cell

A

Intracrine

262
Q

Infundibulum + pars tuberalis

A

Pituitary stalk

263
Q

Proteins/peptide hormones are polar/nonpolar

A

Polar

264
Q

Hypothalamic nuclei that func as:

Thermoregulation (heating center)

A

Posterior hypothalamus

265
Q

Steroid hormones have intracellular receptors

A

True

266
Q

ACTH has a diurnal pattern

A

Peak - early morning

Valley - late afternoon

267
Q

Hormones that have intracellular Receptors

A

Steroid hormones and Iodothyronines

268
Q

Hypothalamic nuclei that func as:
Thermoregulation (cooling center)
Regulation of thirst

A

Anterior hypothalamus

269
Q

Regulation of secretion of ADH is released in response to

A

Cellular dehydration

  1. Increase ECF osmolality
  2. Decrease blood vol and pressure
  3. Na, sucrose, mannitol
  4. Drugs: barbiturates, nicotine, opiates
  5. Nausea (protective effect)
270
Q

Hormone that maintains the normal osmolarity of body fluids and blood vol

A

Antidiuretic hormone

271
Q

Effects of SYndrome of inappropriate secretion of ADH

A

High urine osmolality
Hyponatremia
Low serum osmolality

272
Q

Type of neurocrine wherein the msgr is carried to local or distant site of action via ECF or blood

A

Nonsynaptic neurocrine

273
Q

Proteins or peptides are synthesized as

A

Prehormones or preprohormones

274
Q

Catecholamine are derived from what aa

A

Tyrosine

275
Q 
Primary hypothalamic regulator of: 
Corticotrope
Thyrotrope
Gonadotrope
Somatorope
Lactotrope
A 
Primary hypothalamic regulator of: 
Corticotrope - corticotropin-RH 
Thyrotrope - thyrotropin-RH
Gonadotrophs - Gonadotropin-RH
Somatorope - Growth hormone-RH
Lactotrope - dopamine and prolactin-RH
276
Q

Hypothalamic nuclei that func as:

Somatostatin

A

Periventricular nucleus

277
Q

Inhibin in males is produced by what cell and cause decrease/increase FSH or LH

A

Inhibin in males is produced by Sertoli cells which decreases FSH

278
Q

GH is under dual control by hypothalmus. It is stimulated and inhibited by..

A

Stimulation by GHRH

Inhibition by somatostatin

279
Q

Biochemical classification of hormones

A

Proteins and peptides
Catecholamines
Steroid hormones
Iodothyronines (aa derivatives)

280
Q

Chemical msgr/signals secreted into the blood stream to act on distant tissues

A

Hormones

281
Q

Neural down growth

A

Infundibulum

282
Q

Weight of pituitary gland (hypophysis)

A

400-800 mg

283
Q

Metabolic actions of GH on proteins

A

Increase tissue aa uptake
Increase incorporation into proteins
Decrease urea production
Produces positive Nitrogen balance

284
Q

Normal GH level but lack normal rise in IGF during puberty

Partial IGF response

A

African pigmy

285
Q

Half life of ADH

A

15-20 min

286
Q

Stress also triggers CRH release

A

True

287
Q

Hormone that Stimulates development of breast duct system, breast fat deposition and breast stroma

A

Estrogen

288
Q

TRH has a diurnal pattern.

A

Peak - overnight

Valley - dinner time

289
Q

Weight of thyroid gland

A

15-25 gm

290
Q

Hypothalamus originates from

A

Embryonic basal plate

291
Q

Endocrine function of Sertoli cells

A

Expression of androgen receptor and FSH-receptor
Production of mullerium-inhibiting subs (MIS)
Aromatic action of testosterone to estradiol-17B
Produce inhibin (keeps FSH level within specific range)

292
Q

Hypotension, hyperkalemic acidosis are found in excess/deficient ACTH

A

Deficient ACTH (Addison’s disease)

293
Q

If PRL suppress GnRH release

A

Lactational amenorrhea

294
Q

Domain in follicular cell that faces extracellular matrix (blood) which contains (+) TSH and NIS

A

Basal domain

295
Q

Iodothyronines are stored in

A

Follicle (part of thyroglobulin)

296
Q

FSH in male stimulates ___ produced by ___ cell

A

Facilitates spermatogenesis

Produced by Sertoli cells

297
Q

Major difference in between male and female repro tract:
m: gametes contiguous with repro tract
F: gamers not contiguous with repro tract

A

Major difference in between male and female repro tract:
m: gametic reserve replenished throughout life
F: finite gametic reserve, exhausted by menopause

298
Q

Adrenal medulla synthesize

A

Catecholamine:
Epi (80%)
Norepi (20%)

299
Q

Supportive function of Sertoli cells

A

Maintaining, breaking and reforming multiple junctions with developing sperm
Maintaining blood-testis Barrier
Phagocytosis
Transfer of nutrients and other subs from blood to developing sperm cells
Expression of paracrine factors and receptors for sperm-derived paracrine factors

300
Q

Leydig cells synthesize and stores

A

Cholesterol as cholesterol esters

301
Q

Hormone that keeps FSH level within specific range.

A

Inhibin

302
Q

Proteins or peptide hormones have cell membrane receptors (2nd msgr)

A

True

303
Q

TSH is heterodimer. What subunit is common to TSH, FSH and LH

A

Alpha-Glycoprotein subunit

304
Q

PRL is a ___ aa peptide

A

199 aa

305
Q

Hormone that Stimulates development of breast glandular tissue, the secretory structure of the breast

A

Progesterone

306
Q

Sertoli cells contains major secretory products such as

A

Protease and protease inhibitors.

307
Q

Type of gland that are ductless to which it secretes hormones directly into the circulation.

A

Endocrine gland

308
Q

Primary endocrine cell of testis

A

Leydig cells

309
Q

There is no cortisol/androgen synthesis if this particular enzyme is..

A

Absence of CYP17

310
Q

Neuron of hypothalamus with arginine vasopressine and oxytocin

A

Magnocellular

311
Q

This enzyme catalyzes the last 3 reactions from DOC to form aldosterone

A

Presence of CYP11B2 (aldosterone synthase)

312
Q

Catecholamine have cell membrane receptors

A

True

313
Q

Stage of ovarian follicle growth where that start of ovarian hormone production

A

Growing antral (tertiary) follicle

314
Q

Cell bodies producing ADH and oxytocin located in what nucleus

A

Supra optic (SON) and paraventricular nucleus (PVN)

315
Q

Effect of ADH

A

Decrease urine flow
Increased urine osmolality
Increased mesangial cell contraction - decrease GFR
Inhibits renin release

316
Q

Iodothyronines are polar or nonpolar

A

Polar

317
Q 
Peripheral hormone involved in negative feedback of: 
Corticotrope
Thyrotrope
Gonadotrope
Somatorope
Lactotrope
A

Peripheral hormone involved in negative feedback of:
Corticotrope - cortisol
Thyrotrope - T3
Gonadotrope - estrogen, progesterone, testosterone, inhibin
Somatorope - IGF-1
Lactotrope - none

318
Q

Delta cells of pancreas produces

A

Somatostatin

319
Q

B cells produces what hormone

A

Insulin

320
Q

Nucleus of Chiasmatic region of hypothalamus

A

Suprachiasmatic
Supra optic
Paraventricular nucleus
Anterior nucleus

321
Q

Isthmus crosses the trachea between rings”

A

Tracheal rings I and II

322
Q

PRL is under tonic inhibitory control by hypothalamus by

A

Dopamine

323
Q

Hormone that Stimulates milk secretion into the alveoli in pregnancy and nursing

A

PRL

324
Q

Normal gametogenesis and development and physiology of male and female repro tract are absolutely dependent on gonadal endocrine func

A

True

325
Q

GH deficiency

A

Dwarfism

326
Q

GnRH is a ___ aa peptide

A

10aa

327
Q

Incrd Skin pigmentation may occur in Addison’s disease if

A

The disease is not of pituitary origin

328
Q

Component of testicular lobule composed of seminiferous tubules

A

Intratubular compartment

329
Q

Classes of hormones based on structure: glycoproteins

A

FSH
LH
TSH
HCG

330
Q

The inner part of adrenal glands

A

Adrenal medulla (10%)

331
Q

Hypothalamic nuclei that func as:
Hunger center
MCH, anorexins

A

Lateral hypothalamus

332
Q

GH excess

A

Gigantism and acromegaly

333
Q

Regulates salt and volume homeostasis

A

Zona glomerulosa

Aldosterone

334
Q

GH indirectly induce liver to produce

A

Somatomedin

335
Q

Proteins/peptide hormones circulate the blood in bound/unbound form

A

Unbound

336
Q

what are the dopamine agonist drugs that cause shrinkage of prolactinomas?

A

Bromocriptine
Cabergoline

“BRO, you call ur TITS a CAB”

337
Q

ACTH is a ___ aa peptide

A

39 aa

338
Q

Type of neurocrine wherein the msgr traverses a structure synaptic space

A

Synaptic neurocrine

339
Q

Suppression test is useful in diagnosing hypofunction/hyperfunction

A

Hyperfunction

Hyperfunctioning gland is not operating under normal control mechanism

340
Q

Type of secretory transport that involves secretion of hormone from endocrine cell, its diffusion into capillaries and regulation of distant cells

A

Hemocrine/ endocrine

341
Q

Cell in thyroid parenchyma where it could be the origin of subset of papillary thyroid Ca

A

Epithelial cells

342
Q

Inhibin in females is produced by what cell and cause decrease/increase FSH or LH

A

Inhibin in females is produced by corpus luteum and causes decrease in FSH and LH

343
Q

Beta cells of pancreas are found in

A

Body
Tail
Anterior portion of head

344
Q

Steroid hormones are stored in

A

Endocrine gland

345
Q

Deficiency in ADH production

A

Diabetes insipidus

346
Q

The last 3 reactions from DOC to aldosterone

A

11-hydroxylation: DOC to corticosterone
18-hydroxylation: corticosterone to 18-hydrocorticosterone
18-oxidation: 18-hydrocorticosterone to aldosterone

347
Q

ANS modulates islet hormone secretion. What stimulation increases insulin, glucagon and PP?

A

Cholinergic and beta-adrenergic stimulation

348
Q

Blood supply of adrenal gland

A

Inf suprarenal artery (from renal artery)
Middle suprarenal artery (from aorta)
Superior suprarenal artery (form inf phrenic artery)

349
Q

Hyperprolactinemia is secondary to post/ant pituitary tumor

A

Anterior pituitary

350
Q 
Receptor of: 
Corticotrope
Thyrotrope
Gonadotrope
Somatorope
Lactotrope
A 
Receptor of: 
Corticotrope - melanicortin-2 receptor MC2R
Thyrotrope - TSH receptor 
Gonadotrope - FSH and LH receptor
Somatorope - GH receptor
Lactotrope - prolactin receptor
351
Q

Hypothalamic nuclei that func as:

Regulator of circadian rhythm and pineal function.

A

Suprachiasmatic nucleus

352
Q

Metabolic actions of GH on carbohydrates

A

Increase blood glucose
Des peripheral insulin sensitivity
Increase hepatic output of glucose
Admin’n results in increased serum insulin levels

353
Q

Component of testicular lobule that represents true epithelial cells of seminiferous epith and surrounds the sperm cells

A

Peritubular compartment

354
Q

Components of testicular lobule

A

Intra lobular compartment

Peritubular compartments

355
Q

A cells of pancreas are found in

A

Body

Tail

356
Q

Catecholamine

A

Norepi, epi, dopamine

357
Q

Type of DI common in compulsive water drinkers

A

Psychogenic DI

358
Q

Hypothalamic nuclei that func as:
ADH: osmoregulatioh
Oxytocin: regulation of uterine contraction and milk ejection

A

Supraoptic nucleus

359
Q

Major difference in between male and female repro tract:
Testis reside outside abdominal cavity
Ovaries reside within abdominal cavity

A

Major difference in between male and female repro tract:
M: Continuous release of gametes from gonads
F: release of gametes occurs once a month

360
Q

Basic roles of gonadal hormone in male

A

Support of spermatogenesis
Maintenance of male repro tract and semen production
Maintenance of secondary sex characteristics
Maintenance of libido

361
Q

Dwarfism occurs after or before puberty

A

Before puberty

362
Q

F or PP cells of pancreas are found in

A

Post or ventral part of head

363
Q

TSH stimulate the proliferation of Tg synthesizing cuboidal cells of thyroid follicles. Thus an excess TSH will cause enlarged thyroid or..

A

Goiter

364
Q

Causes of retarded growth in children

A 
GH deficiency 
Thyroid deficiency
Insulin deficiency
Malnutrition / under nutrition
Physical growth retardation 
Constitutional delay
Chronic disease
Genetic disorders charac by short stature 
Cortisol excess
365
Q

Major difference in between male and female repro tract:
Testosterone always the primary gonadal steroid
Estrogen is the primary steroid in first half of cycle, progesterone in 2nd half

A

Major difference in between male and female repro tract:
M: repro system does not prepare for NB
F: prepare for NB with breast development and milk production

366
Q

Hormonal rhythm with periodicity <24 hr

A

Ultradian rhythm

367
Q

Hyperprolactinemia may occur with excess TRH production stimulates PRL secretion in addition to TSH secretion

A

True

368
Q

Hypothalamic nuclei that func as:
Satiety center
GHRH, somatostatin

A

Ventromedial nucleus

369
Q

Component of pituitary gland composed mainly of epithelial cells with 5cell types excreting 6 hormones.

A

Anterior pituitary or adenohypophysis

370
Q

Hypothalamus is composed of gray/white matter

A

Gray mater

371
Q

Type of secretory transport that release hormone into ECF and its regulation of surrounding cells by diffusion

A

Paracrine

372
Q

Functional unit of thyroid gland

A

Follicular cells

373
Q

Hypothalamic nuclei that func as:

Few GnRH neurons

A

Preoptic nucleus

374
Q

Circulating ab in graves disease

A

TRAbs

375
Q

Metabolic effects of T3

A
  1. Lipolysis- FA + glycerol
  2. expression of lipogenic enzymes
  3. cholesterol catabolism into BA
  4. Rapid removal of LDL from plasma
  5. Carbohydrate and protein catabolism
376
Q

T3/4: Produced only in thyroid gland

A

T4

377
Q

During first trimester, ___ is at its highest conc and can stimulate thyroid cells to produce new thyroid hormones.

A

B-HCG

378
Q

Most frequent cause thyrotoxicosis in iodine-sufficient countries

A

Graves disease

379
Q

Indication for radioactive iodine treatment

A

Female planning a pregnancy in the future
Pts with increase ping surgical risk
Pts previously operated or externally irradiated neck
Pts with CI to ATD

380
Q

In some pts with HAshimoto’s thyroiditis, they may stay hypothyroid because of inability to escape this effect

A

Wolff-chaikoff effect

381
Q

TSH level and T4 level of:

True hyperthyroidism

A

Low TSH

High T4

382
Q

Thyroid hormone is critical for normal bone Growth and development

A

T3 regulates sk maturation at growth plate.
T3 participates in osteoblasts differentiation and proliferation and chondrocytes maturation loading to bone ossification.

383
Q

Patients undergoing surgery (thyroidectomy) should be rendered

A

Euthyroid

384
Q

RAI therapy or RAI ablation:

Low dose

A

RAI therapy

385
Q

Major extrathyroidal T4 conversion site for production of T3

A

Liver

Some occurs in liver and other tissue

386
Q

Half life of t3

A

One day

387
Q

Myxedema is due to

A

Accumulation of hyaluronic acid which alter the composition of the subs of the dermis and other tissue

388
Q

PTU / MMI:

More binding to albumin

A

PTU

389
Q

Half life of t4

A

7 days

390
Q

Severe hypothyroidism in infancy with irreversible mental and grocery retardation

A

Cretinism

391
Q

Iodine intake not more than

A

1100 ug/d

392
Q

Indications for thyroidectomy

A 
Planning for pregnancy (<4-6 mos)
Thyroid malignancy
Large goiter (>80gms)
Low RAIU
Coexisting hyperparathyroidism
393
Q

Thyroxine therapy must be considered in subj (age) if TSH is ___ and/or TPO ab is (present/absent)

A

<65 yrs old if TSH >10mU/L and/or TPO ab is present

394
Q

During pregnancy, there is an increased Renal iodine clearance, therefore..

A

Increased 24-hr RAIU

395
Q

Hallmark of classic HAshimoto’s disease

A

Goiter

396
Q

TSH level, T3 or t4 level in subclinical hypothyroidism

A

High TSH

Normal t4 and t3

397
Q

3-8x more potent

A

T3

398
Q

During pregnancy, there is an decreased plasma iodine and placental iodine transport to the fetus, therefore..

A

In deficient women, decreased T4, increases TSH then leads to goiter formation

399
Q

Treatment of choice in HAshimoto’s disease and /or large goiter

A

Levothyroxine

400
Q

Mechanism of action of ATDs

A

Inhibition of organification (iodine binding to Tg)
Inhibition of coupling of Iodothyronines
Inhibition of T4 to T 3 conversion (PTU)
Possible immunosuppressive effects (MMI)

401
Q

Potential complication of thyroidectomy

A

Hypoparathyroidism
Hypothyroidism
Vocal cord paralysis

402
Q

AOG when fetus is completely dependent on maternal thyroid hormones

A

First 3 mos

403
Q

Pathologic feature of HAshimoto’s thyroiditis

A

Presence of both mononuclear cells and thyroid follicle destruction

404
Q

During pregnancy, there is an increased serum TBG, therefore..

A

Increased total T3 and T4

405
Q

T3 is derived from 2 processes

A
  1. 80% of circulating T3 comes from deiodination of T4 on peripheral cells
  2. 20% comes directly from thyroid secretion.
406
Q

PTU / MMI:

Lower conc in breast milk

A

PTU

407
Q

T4 is converted to T3 by

A

5-deiodination of outer ring of T4

408
Q

Main ag in graves disease

A

TSHR

409
Q

Life threatening clinical condi in pts with long standing severe untreated hypothyroidism

A

Myxedema coma

410
Q

ATD that is used in all patients

A

MMI

Except those in 1st tri in pregnancy, treatment for thyroid storm

411
Q

Little or no placental transfer

A

TSH

412
Q

PTU / MMI:

With peculiar toxicity - aplastic cutis embryopathy

A

MMI

413
Q

Excess iodine

A

Wolff chaikoff effect

Jodbasedow phenomenon

414
Q

Conditions that increase TBG

A 
Pregnancy
Infectious/chronic active hepatitis
HIV infection 
Biliary cirrhosis
Acute intermittent porphyria 
Genetic factors
415
Q

TSH level and free T4 level of:

Secondary or central hypothyroidism

A

Low TSH

Low T4

416
Q

Most common cause of hyperthyroidism

A

Graves disease

417
Q

TPO uses ___ as the oxidant to activate I- to hypoiodate the iodination species

A

H2O2

418
Q

PTU / MMI:

Less placental passage

A

PTU

419
Q

Thyroid hormone stimulates mitochondrial activity in most tissue

A

T3 increases basal metabolic rate, body heat production and O2 consumption.

420
Q

PTU / MMI:

Blocks thyroid hormone production and secretion

A

Both

421
Q

RAIU level in thyrotoxicosis

A

Decreased

422
Q

Mechanism of action do radioactive iodine

A

Destroys the thyroid and stops the excess production of hormone

423
Q

First line therapy for hyperthyroidism or graves disease

A

Radioactive iodine

424
Q

During pregnancy, there is an increased O2 consumption, therefore..

A

Increased BMR

425
Q

During pregnancy, there is an increased plasma type 3 deiodinase, therefore..

A

Accelerates rates of t3 and T4 degradation and production.

426
Q

Thyroid hormones that appear in fetal serum

A

TSH

T4

427
Q

TSH level and RAIU level of:
TSH-secreting pituitary tumor
TH hormone resistance

A

Elevated or normal TSH

428
Q

Dietary iodine reaches the circulation as

A

Iodide anion

429
Q

DIT plus DIT

A

Tetraiodithyronine or T4

430
Q

RAI is used by elderly and cardiac pts

A

True.

431
Q 
TSH level and RAIU level of:
Graves disease 
Toxic multinodular goiter
Toxic adenoma
Gestational hyperthyroidism
A

Low TSH

High RAIU

432
Q

Iodination of tyrosyl residues then forms monoiodotyrosine and diiodotyrosine which are then coupled to form either T3 or T4. Both reactions are catalyzes by

A

Thyroperoxidase

433
Q

It functions as iodide concentrating mechanism that enables iodide to enter the thyroid for hormone biosynthesis

A

NIS

434
Q

TSH level and T4 level of:

Sick euthyroid syndrome

A

Low TSH

Low T4

435
Q

There is transient low TSH during 1st trimester due to increased thyroid hormone production.

A

True

436
Q

Thyroid hyperfunction induced by excess iodine ingestion in pts with various thyroid disorder (grave’s disease)

A

Jod-basedow phenomenon

437
Q

Normal circulating concentration of t3

A

60-180 ng/dl

438
Q

Lab diagnosis for thyrotoxicosis and hyperthyroidism

A

Suppressed TSH <0.1 mU/L
Elevated T4
RAIU

439
Q

Major regulator of mitochondrial activity

A

T3

440
Q

Decrease or increase TBG effects on total serum T3 and T4 level and free T3 and T4.

A

Decrease or increase TBG will decrease/increase total serum T3 and T4 level.
While free T3 and T4 remain unchanged

441
Q

PTU / MMI:

Blocks peripheral conversion of T4 to T3

A

Porpylthiouracil

442
Q

Pregnancy must be postponed for at least ____ after RAI therapy

A

6 mos

443
Q

Anti thyroid drugs

A

Methimazole
Propylthiouracil
Carbimazole
Thiamazole

444
Q

TSH level and T4 level of:

Graves disease

A

Low TSH

High T4

445
Q

Graves disease is a syndrome characterized by

A

Hyperthyroidism
Ophthalmopathy
Dermopathy
Pretibial myxedema

446
Q

Thyroid hormone is a major regulator of mitochondria activity

A

T3 induces early transcription and increases TFA expression.
T3 stimulates O2 consumption.

447
Q

In cases wherein TSH <10mU/L and/or TPO ab is absent, thyroxine therapy still might be warranted in individual with high background for

A

Cv risk, pregnancy and infertility

448
Q

Reserved for disorders that results from sustained overproduction of hormone by the thyroid gland itself

A

Hyperthyroidism

449
Q

Indispensable component of thyroid hormone comprising 65% of T4 and 58% of T3’s weight.

A

Iodine

450
Q

DIT plus MIT

A

Triiodothyronine T3

451
Q

Treatment of choice for recurrent hyperthyroidism after ATD therapy

A

RAI

452
Q

During pregnancy, there is an increased plasma volume, therefore..

A

Increased T3 and T4 pool size

453
Q

T3/T4 which is biologically active responsible for the majority of thyroid hormone effects

A

T3

454
Q

Increased thyroid hormone requirements during pregnancy

A

Increase free TH binding to TBG - marked fall in serum free T4 - if no compensatory increase in thyroid secretion leads to hypo.
Transplacental transfer of T4 - placental degradation of T4 - if no compensatory increase in thyroid secretion leads to hypo.

455
Q

Signs and symptoms in hypothyroidism

A 
Constipation
Puffy eyes
Muscle weakness
Weigh loss gain
Bradycardia
Cold intolerance 
Dry, patchy skin
Heavy period 
Hairloss
Tiredness
Forgetfulness
Depression
Elevated cholesterol 
Goiter
Hoarseness 
Infertility
Irritability
Dry/sore throat
Dysphagia
456
Q

AOG when fetal pituitary gland differentiates

A

10-12 wks

457
Q

Pro hormone for T3

A

T4

458
Q

Iodide must be first ___ to be able to iodinate tyro sly residues of Tg

A

Oxidized

459
Q

Most common cause of thyrotoxicosis

A

Thyroiditis

460
Q

Most common case of hypothyroidism in areas wherein dietary iodine is sufficient

A

HAshimoto’s thyroiditis

461
Q

To liberate t3 and t4, Tg is resorted into follicular cells in the form of ___ which fuse with lysosomes to form phagolysosome

A

colloid droplets

462
Q

Thyroid hormone influences cv hemodynamics by

A 
Increase HR and decrease systemic vascular resistance thus increase CO = improve cardiac performance 
Elevate blood volume 
Local vasodilators 
Decrease diastolic blood pressure 
Cardiac chronotropy and inotropy
463
Q

T3/4: 80% are from peripheral conversion

A

T3

464
Q

T3/4: only free hormones are active

A

T4

465
Q

Excess iodine with transient shut down of thyroid hormone production (normally).
When increasing doses of iodide inhibit organification and hormonogenesis of thyroid hormone.

A

Wolff chaikoff effect

466
Q

TSH level, T3 or t4 level in subclinical hyperthyroidism

A

Low TSH
Normal t4 and t3
Asymptomatic

467
Q

Required daily intake of iodine in 7-12y/o.

A

120 ug/d

468
Q

Environmental triggers of graves disease

A

Stress
Tobacco use
Infection
Iodine exposure

469
Q

Normal disposition of T4

A

41% is converter to T3
38% is converter to rT3
21% is metabolized via other pathways (conjugation on liver and excretion in bile)

470
Q

RAI therapy or RAI ablation:

With intention to destroy all thyroid remnant and metastasis in well diff Ca

A

RAI ablation

471
Q

Required daily intake of iodine in teenager and adults

A

150 ug/d

472
Q

Primary secretory product of thyroid gland

A

T4

473
Q

RAI has no effect on fertility, no increased incidence of congenital malformation and no increased risk of cancer

A

True

474
Q

T4 is biologically inactive in target tissues

A

True. Until converted to T3

475
Q

AOG when fetal thyroid begins to conc iodine and synthesize Iodothyronines

A

10-12wks

476
Q

Signs and symptoms of hyperthyroidism

A 
Freq bowel movement
Bulging eyes
Sudden paralysis
Weigh loss / gain
Tachycardia
Heat intolerance 
Warm, moist palm
Light period

Increase sweating
Insomnia
Nervousness, tremors

Goiter
Hoarseness 
Infertility
Irritability
Dry/sore throat
Dysphagia
477
Q

What would be given in immediate preop period in thyroidectomy

A

Potassium iodide
To diminish vascularity to suppress the thyroid hormone production becoz patients undergoing surgery should be rendered euthyroid.

478
Q

Iodide trapping by the aid of

A

NIS

479
Q

Placental transfer without difficulty

A

Iodide
Thionamides
Thyroid ab
TRH

480
Q

Biosynthesis of T3 and T4

A
  1. Dietary iodide ingestion by follicular cells
  2. Active transport and uptake of iodide into colloid by thyroid gland
  3. Oxidation of I and iodinatiob of Tg tyrosine residues
  4. Coupling of Iodotyrosine residues (MIT & DIT) to form T3 and T4
  5. Proteolytic of Tg with release of T3 and t4 into circulation
481
Q

Thyroid secretes approximately how many grams of thyroxine daily

A

70-90 ug/d

482
Q

TSH level and T4 level of:
T3 thyrotoxicosis
Sub clinical hyperthyroidism

A

Low TSH

Normal T4

483
Q

Rare disorder of chronic sclerosing thyroiditis

A

Riedel’s thyroiditis

484
Q

Normal circulating concentration of t4

A

4.5-11 ug/dl

485
Q

Thyroperoxidase Catalyzes oxidation steps involved in:

A

I- activation
Iodination of Tg tyrosyl residues
Coupling of iodotyrosyl residues

486
Q

Required daily intake of iodine in pregnant and lactating women

A

25o ug/d

487
Q

Decreased thyroid hormone concentration may lead to alteration of ___. May develop impairment of attention, slowed motor function, and poor memory

A

cognitive function.

488
Q

Dermopathy in graves disease

A 
Plummer's nail
Hyperpigmentation
Hyperhidrosis
Alopecia 
Acropachy (triad of digital clubbing, soft tissue swelling of hands and feet and periosteal new bone formation)
489
Q

Drugs that increase TBG

A 
Oral contraceptives
Methadone
Clofibrate
5-fluorouracil
Heroin 
Tamoxifen
490
Q

PTU / MMI:

Long half life

A

MMI

491
Q

Refers to classic physiologic manifestations if excessive quantities of the thyroid hormones

A

Thyrotoxicosis

492
Q

Lab diagnosis to differentiate thyrotoxicosis and hyperthyroidism

A

RAIU

493
Q

During 1st tri in pregnancy, there is an increased HCG, therefore

A

Increased free T4 and T3

Decreased basal TSH

494
Q

Thyroid hormone influences the female repro system

A

Hypothyroidism may be asso with menstrual disorder, infertility, risk of miscarriage and other complications of pregnancy.

495
Q

RAI therapy or RAI ablation:

To destroy some thyroid tissue in graves disease or toxic nodules.

A

RAI therapy

496
Q

Total daily production rate of t3

A

15-30 ug/d

497
Q

RAI is contraindicated during

A

Lactation and pregnancy

498
Q

More than 99% of circulating T3 and t4 is bound to plasma protein Carrier proteins which are

A

TBG 75%
Transthyretin TTR / thyroxine-binding prealbumin TBPA 10-15%
Albumin 7%
HDL 3%

499
Q

Drugs that decrease serum t3 and t4 by decreasing binding

A

Antiseizure medications

Salicylates

500
Q

Required daily intake of iodine in 0-7y/o.

A

90 ug/d

501
Q

Graves disease is an autoimmune disease with a strong familial disposition more common in male/female.

A

Female

502
Q

Atrial fibrillation is characteristically manifested in what thyroid disorder

A

Graves disease

503
Q

Self limited anti-inflammatory disorder of thyroid and the most common cause of pain from thyroid origin

A

Subacute thyroiditis

504
Q 
TSH level and RAIU level of:
Iodine induced hyperthyroidism 
Amiodarone- induced hyperthyroidism 
Struma ovarii 
Metastatic thyroid Ca 
Thyroiditis
A

Low TSH

Low RAIU

505
Q

Drugs that decrease serum t3 and t4 by decreasing TBG conc

A 
Glucocorticoids 
Androgens 
L-asparaginase
Mefenamic acid
Furosemide
506
Q

Some placental transfer

A

T3

T4

507
Q

Iodide active transport by thyroid Is mediated by this membrane protein

A

Sodium-iodide symporter or NIS

508
Q

Primary stimulating signal of PTH

A

Low circulating Ca level

509
Q

Hormones and minerals found in bones

A 
PTH
Vit D
Calcitonin
Calcium
Phosphorus
510
Q

Inhibits bone resorption

A

Calcitonin

As decreases Ca and Pi

511
Q

PTH receptor that is abundant in bones (osteoblasts) and kidneys (prox and distal convoluted tubules)

A

PTH1R

512
Q

Circulating forms of calcium

A

Ionized - 50%
Protein-bound - 40%
Complexed with anion - 10%

513
Q

Major regulator of calcium and phosphorus metabolism

A

PTH

514
Q

Calcitonin is produce by what cell

A

Parafollicular C cell

515
Q

Calcitonin release is stimulated by

A

Vit D

Ingestion of food due to GASTRIN

516
Q

Effect of PTH to phosphate and Ca level

A

Increase Ca

Decrease phosphate

517
Q

Low Ca stimulates renal 1a-hydroxylase thru increased PTH

A

High Ca inhibits 1a-hydroxylase thru CaSR in proximal tubule

518
Q

Hypoparathyroidism is due to PTH and vitD deficiency. It has high/low Ca and high/low Pi.

A

Low Ca and high Pi

519
Q

The most important effect of PTH is to increase/decrease plasma calcium level

A

Increase plasma calcium level

520
Q

PTH decrease /increase plasma phosphate

A

Decrease plasma phosphate

521
Q

As in chronic renal disease with high Pi and low Ca due to high PTH and low vit D

A

Renal osteodystrophy

522
Q

Vit D3

A

Cholecalciferol

523
Q

Calcitonin excess does not produce hypocalcemia (MTC).

Calcitonin deficiency does not produce hypercalcemia (post total thyroidectomy for thyroid Ca )

A

Calcitonin plays a very minimal or negligible physiologic role in Ca and phosphate homeostasis

524
Q

PTH receptor that does not bind to PTHrP

A

PTH2R

525
Q

Very active vit D preparation

A

Calcitriol

526
Q

Percentage of active vit d that circulates as free steroid

A

0.4%.

Other binds to DBP from liver

527
Q

What kind of receptor is vit D receptor

A

Nuclear receptor

528
Q

PTH stimulation

A 
Phosphodieasterase inhibitors 
Epinephrine
Dopamine
Histamine
Lithium
Thiazides diuretics
529
Q

High Mg level inhibits PTH

A

True

530
Q

Useful histo chemical marker for MEdullary thyroid Ca

A

Calcitonin

531
Q

Calcitonin is regulated by

A

CaSR and high Ca level

532
Q

PTH inhibition

A

A-adrenergic agonists
Prostaglandins
Aluminum
Chromogranin

533
Q

Normal calcitonin plasma level

A

10-20pg/mL

Any increase In plasma Ca by 1mg/dl will result to 2-10fold acute rise in calcitonin

534
Q

Low circulating Ca level is sensed by principal cells thru

A

Ca-sensing receptor (CaSR)

535
Q

VitD deficiency leads to defective bone mineralization in adults

A

Osteomalacia

536
Q

Major stimulus of calcitonin

A

Hypercalcemia

537
Q

Larger, mitochondria-rich, eosinophilic cell type of parathyroid gland

A

Oxyphil cell

538
Q

PTH decrease plasma phosphate by

A

Inhibiting renal tubular phosphate reabsorption

539
Q

Rate limiting enzyme in vit d synthesis

A

1a-hydroxylase (CYP1a)

540
Q

Vit D synthesis

A

7-dehydrocholesterol -(skin UV light)- cholecalciferol - (liver vitD 25-hydroxylase)- 25hydroxycholecalciferol -(kidney 1a-hydroxylase)- 1,25dihydroxyvitamin D

541
Q

Effect of vitD to phosphate and Ca level

A

Increase Ca

Increase phosphate

542
Q

Hyperparathyroidism is an excessive production of PTH that is usually due to single adenoma. It has high/low Ca and high/low Pi.

A

High Ca and low Pi

543
Q

Bone cell type for production of matrix

A

Osteoblast

544
Q

Predominant parenchymal cell type and a primary endocrine cell of parathyroid gland

A

Chief/principal cell

545
Q

Facilitates absorption of Ca in duodenum and jejunum

A

Vit d

546
Q

Ergocalciferol, secosteroid produced in plants. Enters the liver for hydroxylation via portal circulation and chylomicrons

A

Vit D2

547
Q

PTH receptor that activates adenylyl cyclase and PLC

A

PTH1R

548
Q

VitD deficiency leads to secondary increase in PTH

A

Osteoporosis

549
Q

Parathyroid cell type that secretes PTH

A

Chief cell

550
Q

Calcitonin is expressed in

A

Osteoclast (inhibits bone resorption)

Nephrons (inhibits Ca and Pi reabsorption)

551
Q

Effect of calcitonin to phosphate and Ca level

A

Decrease Ca and decrease phosphate

552
Q

Rare familial disorder charac by tissue resistance to PTH.

A

Pseudo hypoparathyroidism

553
Q

Pty receptor that bonds both PTH and PTHrP

A

PTH1R

554
Q

Inhibitors of calcitonin

A

Low vit D

Somatostatin

555
Q

Bone is not affected in hypoparathyroidism

A

True

556
Q

PTH receptors

A

PTH1R (hPTH/PTHrP)
PTH2R
CPTH

557
Q

Mechanism of action of PTH in kidneys

A

Stimulates Ca reabsorption
Inhibits Pi reabsorption
Stimulates conversion to 1,25 dihydroxy vitamin D

558
Q

High Ca and low Pi in hyperparathyroidism is due to

A

Bone demineralization
High GI Ca absorption
High renal Ca reabsorption

559
Q

There is high PTH secretion, low Ca and congenital defects of skeleton.

A

Pseudo hyperparathyroidism

560
Q

The most important effect of PTH is to increase plasma Ca level by

A

Stimulate bone resorption
Increase renal tubular reabsorption
Stimulate renal 1,25 dihydroxy- D synthesis

561
Q

VitD deficiency leads to defective bone mineralization in children

A

Rickets

562
Q

Mg and Ca in vit D deficiency

A

Low mg and Ca

563
Q

Bone cell type for resorption of matrix

A

Osteoclasts

564
Q

The low Ca and high Pi in hypoparathyroidism is due to

A

Impaired GI Ca absorption
Decreased renal reabsorption
Decreased bone Ca mobilization

565
Q

Results in bone deformities due to increase bone resorption ff by increase bone formation.
It has high alkaline phosphatase, osteocalcin and urinary hydroxyproline.
It produces pain, bone deformation and bone weakness.

A

Paget’s disease

566
Q

Bone remodeling is regulated by

A

PTH

567
Q

PTH receptor that reacts with the carboxylate terminal rather than amino terminal of PTH

A

CPTH

568
Q

Primary target of PTH

A

Bone

Kidneys

569
Q

PTH receptor that is found in brain, placenta and pancreas

A

PTH2R

570
Q

Secosteroid (class of steroid with 1 open cholesterol ring)

A

Vit D3

571
Q

Calcitonin is primarily inactivated in what organ

A

Kidney

572
Q

Insulin receptor has a and B subunit. Which subunit spans the cell membrane.

A

Beta subunit

573
Q

Insulin receptor has a and B subunit. Which subunit contains hormone binding site?

A

Alpha subunit

574
Q

Somatostatin has 2 forms

A

Somatostatin-14

Somatostatin-28

575
Q

Insulin receptor has a and B subunit. Which subunit is external to cell membrane?

A

Alpha subunit

576
Q

IRS phosphorylation leads to activation of..

A

Protein kinase B (PKB) dependent pathway

Resulting to metabolic effects of insulin.

577
Q

Insulin mechanism of action

A

Insulin binds to IR
Initiates series of phosphorylation reaction and gene expression
Glut-4 transports glucose from outside to inside
Glycogen, lipid and protein synthesis

578
Q

Termination of Insulin/IR signaling

A
  1. Insulin down- regulates own receptor by receptor-mediated endocytosis and degradation pathways
  2. Inactivation of IRS protein by serine/threonine protein kinase
  3. Activation of “suppressor cytokines signaling” SOCS which reduces acty levels of IR and IRS proteins.
579
Q

Biphasic phase of insulin that involves release of newly formed insulin.

A

2nd or late phase

580
Q

Insulin is catabolic/anabolic

A

Catabolic

581
Q

Insulin is catabolic/anabolic

A

Anabolic

582
Q

Biphasic phase of insulin that is short lived and prompt.

A

1st (early phase )

583
Q

Regulation of insulin

A 
Glucose enters Bcells by glut-2 
Glucose to G6P by glucokinase
Send signals to increase ATP/ADP ratio
Closes K channel
Depolarize
Opens Ca channel
CA entry 
Stimulates insulin secretory granule 
Release insulin thru exocytosis
584
Q

Secreted in equinolar amts as insulin.

Measured in the blood to quantify endogenous insulin production

A

C-peptide

585
Q

Insulin receptor has a and B subunit. Which subunit contains tyrosine kinase on cyto solid surface?

A

Beta subunit

586
Q

Importance of somatostatin is not clearly established but..

A

It can inhibit insulin and glucagon secretion thru paracrine mechanisms depending in what the body needs

587
Q

Major stimulus of glucagon

A

Low blood glucose

588
Q

Pancreatic polypeptide is stimulated by

A

Various GIT hormone

Vagal stimulation

589
Q

Determines net flow of hepatic metabolic pathway

A

Insulin/glucagon ratio

590
Q

Primary target organ of glucagon effect

A

Liver

591
Q

Insulin action

A 
Promotes protein synthesis
Inhibits protein degradation
Ptromotes TGL synthesis 
Inhibits lipolysis 
Has effects on satiety
592
Q

Glucose sensor of B cells

A

Glucokinase

593
Q

Somatostatin is also found in

A

Hypothalamus and GIT

594
Q

Primary site of degradation of glucagon

A

Liver

80% in single pass

595
Q

Stimulates glucagon secretion

A 
Low blood glucose
High aa (arginine, alanine)

Sympa NS stimulation (B2 adrenergic)
Stress
Exercise

596
Q

Peak of first or early phase

A

5 min

597
Q

Insulin is stored in secretory granules in Zn-bound crystals. It is released by exocytosis of granule contents ff by endocytosis. It has 2 biphasic release

A

1st (early phase)

2nd (late phase)

598
Q

Primary stimulus and regulator of insulin

A

Glucose

599
Q

Glucagon circulates in bound/ unbound form

A

Unbound form

Thus has short half life of 6min

600
Q

Duration of 2nd phase

A

10 min - 1 hr

601
Q

Insulin is degraded by what enzyme found in liver, kidney and other tissue

A

Insulinase

602
Q

Biphasic phase of insulin that is responsible to peak insulin secretion after meal

A

First or early phase

603
Q

Entry kg glucose into B-cells is facilitated by

A

Glut-2 transporter

604
Q

Action of insulin

A

*Glucose uptake (by GLUT-4 availability in ms and fats)
*Glucose use
Glycogenesis
*Glycolysis
Decrease glycogenolysis

Specific in liver
FA synthesis and VLDL
decrease gluconeogenesis 
Decrease x
Decrease urea cycle activity

Specific in ms
Aa uptake
Protein synthesis
Decrease proteolysis

Specific in adipose tissue
Production of a-glycerol phosphate
Esterification of fats
Decrease lipolysis

605
Q

Glucose is phosphorylated into G6P by what enzyme

A

Glucokinase

606
Q

Half life of insulin

A

5-8min

607
Q

Glucagon is a primary counter regulatory hormone by

A

Increase bld glucose thru hepatic glucose output
Increase glucose production thru (increase glycogenolysis, gluconeogenesis, and decrease glycolysis, glycogenesis and inhibits FFA synthesis from glucose)

608
Q

Insulin + receptor results to cross phosphorylation of B subunits leading to recruitment of adaptor proteins such as..

A

IRS (insulin-receptor substrates)
SHC protein
APS protein

609
Q

Biphasic phase of insulin that involves release of preformed insulin.

A

First or early phase

610
Q

Inhibits glucagon secretion

A

Somatostatin
Insulin
High blog glucose

611
Q

Primary counter regulatory hormone of insulin

A

Glucagon

612
Q

Biphasic phase of insulin that is slower onset and maintained for considerable periods

A

2nd or late phase

613
Q

Insulin is responsible for maintaining the upper limit of blood glucose and FFA by

A

Promoting glucose uptake and utilization by muscle and adipose tissue
Increase glycogen storage in liver and ms
Decrease glucose output by liver

Med Prep (52 decks)

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