Final Review Flashcards
1
Q
Glucose uses what to be absorbed in the body from kidney tubules and from gut?
A
Sodium gradient
2
Q
Glut 4 is regulated by insulin and is found where?
A
skeletal and cardiac muscles and fat
3
Q
What is the fasting glucose cutoff for diabetes of any kind including MODY?
A
126mg/dl
4
Q
What are the HOMA score ranges for Insulin Resistance and for Type 2 diabetes?
A
IR - 1.5-3.9
Type 2 - above 4
5
Q
How do we treat MODY? What can we never give a MODY patient?
A
We treat it with sulfonylureas because they stimulate the beta cell insulin production.
NEVER give them insulin.
6
Q
What are glucose levels for HYPOglycemia?
A
below 40mg/dl
7
Q
What are the complications of hyperglycemia?
A
damages blood vessels
promotes infections
promotes tumors
causes neuropathies
8
Q
How do blood vessels and nerves get damaged because of hyperglycemia?
A
1) AGE/RAGE activiation leading to insulin
2) absorption of glucose into cells which is converted to sorbitol which gives the cell osmolarity issues
9
Q
What changes in the liver when it becomes insulin resistant? and what stays the same?
A
insulin still inhibits ketogenesis and still stimulates lipogenesis but begins to activate gluconeogenesis even though insulin is present.
10
Q
What is the difference between ketosis and ketoacidosis?
A
Ketosis is elevated ketone levels without a change in blood pH
Ketoacidosis is elevated ketone levels that have exhausted the blood’s buffering capacity and thus lowers the pH
11
Q
T/F: Ketones are not needed during diabetes Mellitus
A
True. The body has plenty of glucose
12
Q
What is trisomy 13 called and what are the distinguishing characteristics?
A
Patau Syndrome
mental retardation, microcephaly, polydactyly
13
Q
What is trisomy 18 called and what are the distinguishing characteristics?
A
Edwards Syndrome
Kidney Malformations, Protruding intestines, Mental retardation, small size
14
Q
What is XO aneuploidy called and what are the hallmarks?
A
Turner Syndrome Undeveloped ovaries small stature underdeveloped breasts (shield chest) turned out arms at elbows Edema
15
Q
What is XXY aneuploidy called and what are the hallmarks?
A
Klienfelter syndrome male appearance long limbs underdeveloped male gentalia can be fertile
16
Q
Robertsonian translocation involves which specific parts of chromosomes?
A
exchange between the short arm of 14 and the long arm of 21
17
Q
What is wrong with the chromosomes of someone who has Cri du Chat? What are the symptoms?
A
deletion of short arm of Chromosome 5
mental retardation, microcephaly,
18
Q
in genetics, what is expressivity?
A
Variation in phenotype for a particular genotype
19
Q
What does leptin do?
A
increases insulin sensitivity by reducing ceramide
controls appetite
induces lipolysis
20
Q
if someone is leptin deficient and then you give them leptin, what happens?
A
they lose weight
21
Q
what does the peptide MC4R do? and know that a mutation here is the leading monogenic cause of obesity
A
Inhibit food intake and stimulate energy expenditure
22
Q
Aldosterone increases what absorption and what secretion?
A
increases water and sodium absorption and potassium secretion
23
Q
What is the function of ANP in the realm of blood pressure and fluid?
A
it is released from the right atrium when it is stretched and decreases the amount of sodium and water that is reabsorbed as well as inhibits Angiotensin II
24
Q
What is the cause of the edema if it is unilateral limb?
A
Venous or lymph obstruction
25
What is the cause of the edema if it is bilateral limb?
Congestive heart failure with widespread edema as condition continues
26
What is the cause of the edema if it is face/eyes?
Hypoproteinemia with abdomen edema as condition worsens
27
what does insulin do to blood potassium levels?
insulin decreases blood potassium levels by making the potassium go into the cells
28
What does hypokalemia do to the excitability of cardiac nerves?
it hyperpolarizes them so it is harder to get an action potential
29
What does hyperkalemia do to the excitability of cardiac nerves?
it hypopolarizes them and makes it easier to get to an action potential
30
At low ECF pH (high H+ conc.) what happens to potassium levels?
causes more potassium to leak out quicker and leads to hyperkalemia in the ECF acutely
31
At high ECF pH (low H+ conc.) what happens to potassium levels
cause the slow leak of potassium out of cells to become even slower leading to hypokalemia in the ECF acutely
32
T/F: inulin clearance = GFR
True
33
What happens in rapidly progressing glomerulonephritis?
Antibodies form against the basement membrane and cause inflammation
34
What happens in acute postinfectious glomerulonephritis?
2-3 weeks after a strep infection, antibody-antigen complexes form and collect on the basement membrane and cause inflammation there
35
what happens in chronic glomerulonephritis and what 2 things should you remember cause it?
it is slow loss of renal function. remember that diabetes (due to glucose levels) and hypertension cause this.
36
what conjugates unconjugated bilirubin in the blood?
The liver takes it up and conjugates it using glucuronyl transferase.
37
What kind of jaundice expresses with light feces and light urine?
intrahepatic obstructive jaundice
38
What are Xanthomas? What causes it?
They are fat deposits near the eyes caused by an obstruction in the bile duct
39
What is relative polycythemia? What is absolute polycythemia?
Relative is just dehydration
Absolute is when you have increased red blood cells due to increased erythropoetin due to hypoxemia, ischemia, kidney disease stuff like that that makes the body think it doesn't have enough oxygen
40
What are the symptoms of polycythemia?
splenomegaly, ruddy cyanosis, hyperplastic bone marrow
41
What is the treatment for absolute polycythemia?
bleed patient or give asprin if young
| give radioactive P if old
42
What is the hallmark of hemolytic anemia?
increased reticulocytes (trying to replace the lost ones)
43
What causes anemia when you have a chronic disease?
Hepcidin in the liver
44
What kind of anemia is pernicious anemia? What causes it?
Macrocytic normochromic; caused by low B12 that is caused by low intrinsic factor
45
Where are Alpha Thallasemmius patients from? Beta?
A: S and Se Asia
B: Mediterranean
46
What is Hemosiderosis?
the storage of too much iron because of a transfusion
47
what is Mono caused from?
Epstein Barr Virus
48
What kind of Leukemia is associated with the Philadelphia Chromosome?
Chronic Myeloid Leukemia
49
What kind of Leukemia only occurs in adults?
Chronic Lymphoblastic leukemia
50
What are the features of Multiple Myeloma?
```
CRAB
Calcium Elevated
Renal Failure
Anemia
Bone Lesions
```
51
Which Hodgkin lymphoma is associated with skipping around?
Non-Hodkin
52
What is released when the matrix in blood vessels is damaged that platelets bind to?
Von Willebrand Factor
53
What does thrombin do in a clot?
it converts fibrinogen to fibrin
54
What do platelets release to encourage more platelet accumulation and activation?
Calcium and ADP
55
What breaks up a clot? What activates that?
plasmin activated by t-PA(tissue plasminogen activator)
56
What coagulation factors are dependent on vitamin K?
7, 9, 10,
57
What coagulation factor is associated with hemophilia A and hemophilia B?
```
A = 8
B = 9
```
58
Plasminogen activator inhibitor is produced by endothelial cells and what other source?
Fat tissue
59
What does Partial Thromboplastin Time measure?
Intrinsic Clotting pathway
60
What does Prothrombin Time measure?
Extrinsic Clotting pathway
61
Von Willebrand disease is associated with which coagulation pathway and which coagulation factor?
intrinsic
| factor 8
62
What do we need to remember about Disseminated Intravascular Coagulation (DIC) ? What is it caused by?
```
MOST
Malignancy
Obstetric complications
Sepsis
Trauma
```
Caused by infection
63
Which sex hormone is associated with higher blood clotting risks?
estrogens
64
What compound in the body causes vascular response leading to inflammation and how does it cause inflammation?
Histamine
| by causing increased vasodilation and permeability
65
which cell makes the most histamine?
mast cell
66
what causes the inflammation in asthma and allergic rhinitis?
leukotrienes
67
What is good about omega 3 fatty acids?
they decrease inflammation
68
What kills people in anaphylactic shock?
vasodilation
69
What is it called when you have a predisposition for allergies?
atopy
70
What mediates each of the 4 types of hypersensitivities?
1 - allergies
2 - antibodies
3 - antibody-antigen complexes
4 - cells
71
What do we need to know about Lupus?
it has antibody antigen complexes that form because of antibodies against DNA and RNA
72
What is Mallory Weiss Syndrome?
tearing of the GE junction
73
What is Peptic Ulcer Disease?
ulcers in the esophagus, stomach, and intestines
74
What is diverticulosis?
When the intestine herniates through the muscle wall
75
How do we test liver function?
Test levels of transaminases, AST and ALT because if they are present in hight levels in the blood then it is most likely because the hepatocytes are bursting
76
what causes gall stones?
hyperinsulinemia
77
What do we measure instead of LDL-B levels usually? and what do we want that level to be?
TG/HDL ratio of 1.5 or lower
78
What does sugar do to LDL molecules?
makes them smaller and denser
79
Do insulin and glucagon affect cholesterol absorption or de novo synthesis?
absorption
80
T/F: Insulin is the most potent activator of de novo cholesterol synthesis
True
81
T/F: Insulin causes inhibition of Plasminiogen Activator Inhibitor thus increasing clotting
True
82
T/F: insulin contributes to hypertension and high TG/HDL ratios
True
83
H2O2 created from reactive oxygen is normally turned into water via what enzymes?
Glutathione and Catalase
84
Antioxidant treatment does what to Atheromas?
reduces development of atheromas
85
T/F: exercise increases antioxidant capacity of the body
True
86
A ketogenic diet does what to glutathione levels in the mitochondria?
increases them. thus leading to the slowing of the development of atheromas
87
what do statins do?
inhibit the production of cholesterol by inhibiting HMG-Coa reductase.
88
when should statins be used?
after someone has already had a cardiovascular event (like a heart attack)
89
What are the side effects of statins?
increase risk of T2DM
kidney failure
liver failure
muscle pain (because of less ubiquinone due to less cholesterol)
90
what do statins not decrease?
LDL-B which means they are pretty much worthless
91
what should you prescribe before a statin?
asprin
92
what 5 things does cholesterol take part in forming?
```
ubiquinone
vitamin D
steroid synthesis
bile salts
cell membranes
```
93
what is the difference between primary and secondary hypertension?
primary is a mix of genetics and the environment
secondary is when you have another problem that leads to hypertension like kidney issues, structural, or endocrine problem
94
How does insulin relate to aldosterone secretion?
insulin increases aldosterone secretion and thus leads to primary hypertension
95
How does insulin relate to growth of the vascular tissue?
insulin increases the growth of vascular tissue into the lumen of the vessel thus narrowing it and causing primary hypertension
96
How does insulin relate to the sympathetic nervous system?
it increases heart rate and causes vaso constriction leading to primary hypertension
97
How does insulin relate to dyslipidemia?
it increases the levels of LDL-B and thus you have a higher chance of atheromas forming and thus primary hypertension
98
how does insulin relate to Nitric Oxide?
under normal conditions, insulin activates endothelial cells to secrete NO which will cause vasodilation. when you are insulin resistant however, insulin cannot have this effect
99
What is isolated systolic hypertension?
increase in blood pressure because of increased cardiac output, vasoconstriction, or both
100
what is complicated hypertension?
damage to vessel walls leading to smooth muscle proliferation and thus hypertension
101
what is malignant hypertension?
rapidly increasing blood pressure; can cause brain and organ damage
102
What is the leading cause of maternal death?
preeclampsia
103
What actually hurts the mother with preeclampsia?
she has a problem filtering in her kidney and thus has hypertension because of that leading to edema an seizures
104
what is the theory of preeclampsia?
the placenta becomes hypoxic, releases soluble vegf receptors which soak up all the vegf. vegf normally maintains the fenestrations in the glomerulus and now because there is less free vegf the fenestrations begin to close and cause less flitration but still filter more albumin
105
What are the three Peripheral Artery Diseases?
Thromboangitis obliterans
DVT
Raynaud
106
what is intermittent claudication?
pain with movement do to Peripheral Artery Diseases
107
What is thromboangitis obliterans?
a disease where you get nonatherotic lesions in the peripheral blood vessels leading to the destruction of small and medium arteries and hair loss in the affected area along with the potential for gangrene
108
What is the difference between raynaud disease and raynaud syndrome?
disease - the cause is unknown
| syndrome - cause is known, like smoking or pulmonary hypertension
109
What are the three kinds of angina pectoris?
Stable - pain during effort
Prinzmetal - pain at rest
Unstable - pain anytime
110
T/F: stress can induce ischemia in the heart in predisposed individuals
True
111
what is diastolic heart failure?
the stiffening of the LV leads to not being able to fill well
112
what is systolic heart failure?
the inability of the LV to generate adequate cardiac output
113
what is right heart failure?
increased pressure in the RV causing it to fail. usually from backup from the lungs
114
what is tricuspid atresia?
when the right atria and the right ventrical don't connect
115
When do you get pneumoconiosis? and what does it cause?
When you breath in particles of crud like dust, causes pulmonary fibrosis
116
what is the difference between extrinsic and intrinsic asthma?
extrinsic is allergy related
| intrinsic is induced some other way
117
what disease of chloride channels can patients with cystic fibrosis not get?
cholera
118
how do we test for cystic fibrosis?
sweat test for elevated chloride levels in sweat
119
what is cor pulmonale?
when pulmonary hypertension causes problems for the RV
120
What happens to the ST and T wave during ischemia?
ST wave depression or a T wave inversion
121
What is the cause of Diabetes insipidus?
insufficiency of ADH
122
what are the symptoms of hypersecretion of oxytocin?
amenorrea, galactorrhea, reduced libido
123
TRH can stimulate the release of what two hormones from the pituitary?
prolactin and TSH
124
TSH is inhibited by what 3 things?
Somatostatin and Dopamine and T3/T4
125
Myxedema is associated with what? what is it?
hypothyroidism - creates edema in the throat causing a deep voice
126
Cortisol relates to catecholamines how?
it increases the sensitivity of the body to catecholamines
127
what test is used to determine the source of high ACTH levels and what do the results mean?
Dexamethazone test -
first give low dexamethazone, if cortisol goes down it is just stress
if ACTH stays the same give them a high dexamethasone dose; if ACTH goes down then it is a pituitary hypersecretion of ACTHand if it doesn't go down then it is a ACTH secreting tumor
128
What is a pheochromocytoma?
a hypersecreting adrenal gland secreting catecholamines
129
addison's disease is what? what is destroyed?
too little cortisol and mineralocorticoids; usually the entire adrenal cortex is destroyed
130
what tells the body where to store fat?
Lipoprotein Lipase (LPL) receptors
131
what affects the distribution of LPL receptors?
sex hormones which is one reason why we get male and female figures as adults
132
What is necessary for pubic hair growth?
at least some sensitivity to testosterone
133
What is adenomyosis?
growth of the endometrium into the myometrium
134
What are the 3 stages of stress?
alarm
resistance
exhaustion
135
what is the key molecule involved in the stress response that begins to be transmitted in the alarm stage?
CRH is the key
136
What does CRH do?
increase release of ACTH
increase activation of sympathetic nervous system
increase anxiety
but also decrease anxiety
137
What is also released from the hypothalamus during the stress response besides CRH?
ADH which helps to activate ACTH release
138
what stage of the stress response are catecholamines released?
Alarm Stage
139
in what stage of the stress response do you begin to feel the affects of cortisol?
stage 2 - resistance
140
what class of compound mediates Stage 2 of the stress response?
hormones - ADH, ACTH, Cortisol
141
What is the effect of Prolactin in stress response?
increase immune function
142
What is the effect of GH in the stress response?
counters insulin and increases immune function
143
What is the effect of endorphins in the stress response?
it increases the feeling of well being
144
T/F: Cortisol increases the number of catecholamine receptors
True
145
How does cortisol affect sex steroid function?
Cortisol decreases sex steroid synthesis
146
how does cortisol affect the liver?
increases gluconeogenesis
147
how does cortisol affect proteins in most places?
causes their breakdown so the AA's can be used for gluconeogenesis in the liver
148
in stage 3 how does cortisol affect immunity?
it severely decreases immunity because it inhibits inflammation
149
nonspecific damage to the pituitary gland causes what condition where all anterior pituitary hormones minus prolactin are decreased?
Panhypopituitarism
150
what two hormones stimulate prolactin release?
TRH and Oxytocin
151
T/F: GH can be stimulated to be released by sex hormones
True
