endocrine-pancreas

Question 1

what cells secrete insulin? where in the islets are these cells

Answer 1

insulin

in the center of islets

Question 2

what receptor does insulin up-regulate on skeletal muscle and adipose tissue

Answer 2

GLUT4

Question 3

what cells secrete glucagon? what are glucagon’s major functions

Answer 3

alpha cells

increase blood glucose levels via glycogenolysis and lipolysis

Question 4

what are the two HLA types assoc with T1DM

Answer 4

HLA-DR3 and HLA-D4

Question 5

what causes T1DM

Answer 5

autoimmune destruction of beta cells by T lymphocytes

Question 6

stress in a person with poorly controlled T1DM can cause…

why?

Answer 6

diabetic ketoacidosis
epi stimulates glucagon secretion increasing lipolysis (along with gluconeogenesis and glycogenolysis)
lipolysis increase FFA which are converted to ketone bodies

Question 7

what are the 2 ketone bodies seen in diabetic ketoacidosis

Answer 7

b-hydroxybutyric acid and acetoacitic acid

Question 8

how does diabetic ketoacidosis present

Answer 8

kussmaul respirations, dehydration, nausea, vomitting, mental status changes and fruity smelling breath (due to acetone)

Question 9

how does obesity linked to T2DM

Answer 9

obesity leads to decreased numbers of insulin receptors

Question 10

what are some T2DM glucose measurements for the diagnosis
random glucose
fasting glucose
glucose tolerances test

Answer 10

random glucose >200 mg/dL
fasting glucose >126 mg/dL
glucose tolerances test greater than 200 mg/dL two hours after glucose loading

Question 11

if T2DM don’t really get diabetic ketoacidosis, what type of serious complication are you worried about

Answer 11

hyperosmolar non-ketotic coma

very high glucose levels can lead to life threatening diuresis with hypotension and coma

Question 12

what is the leading cause of death in ppl with DM

Answer 12

cardivascular disease

Question 13

what does non-enzymatic glycosylation of small vessels (arterioles) cause

Answer 13

hyaline arteriolosclerosis

Question 14

tell me about the NEG on the small vessels of the kidney

Answer 14

perferential hyaline atherosclerosis on the efferent arterioles leads to glomerular hyperfiltration injury with microalbuminuria that will eventually progress to nephrotic syndrome (will see kimmelstiel wilson nodules in glomeruli)

Question 15

what enzyme converts glucose to sorbital

Answer 15

aldose reducatse

Question 16

list some consequences to the osmotic damage seen in DM

Answer 16

peripheral neuropathy, impotence, blindness & cataracts

Question 17

tumors of islet cells are assoc with what syndrome

Answer 17

MEN1

Question 18

besides tumors of islet cells, what 2 other things do you seen in MEN1

Answer 18

the 3 Ps

pancreatic neoplasm
parathyroid hyperplasia
pituitary adenoma

Question 19

how do you diagnose an insulinoma

Answer 19

decreased serum glucose
increased insulin
increased c-peptide

Question 20

what tumor

“presents with treatment resistant peptic ulcers (zollinger-ellison syndrome”

Answer 20

gastrinomas

Question 21

what tumor

“presents as achlorhydria and cholelithiasis with steatorhea”

Answer 21

somatostatinomas

Question 22

why does somatostatinomas cause achlorhydria

Answer 22

due to inhibition of gastrin

Question 23

why does somatostatinomas cause cholelithiasis with steatorrhea

Answer 23

inhibition of CCK

Question 24

what are the 3 presenting symptoms of VIPomas

Answer 24

watery diarrhea
hypokalemia
achlorhydria