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Year 2 Metabolism > MET2 OVERVIEW > Flashcards

MET2 OVERVIEW Flashcards

1
Q

Precursors to insulin - insulin production

A

Preproinsulin (110 amino acids) to proinsulin (86 amino acids) to insulin (51 amino acids)

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2
Q

Function of glucokinase enzyme

A

Senses the level of glucose in the beta cell of the pancreatic island - conversion of the glucose to glucose-6-phosphate for release of insulin

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3
Q

Location of GLUT1

A

Beta cell of pancreatic island

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4
Q

Location of GLUT4

A

Muscle cells and adipocytes

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5
Q

Function of insulin at the muscle and the adipocytes

A

Increased glycogesis
Reduced glucogenolysis
Increased lipogenesis
Reduced glygenolysis

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6
Q

Function of insulin at the liver

A

Increased mRNA translation for increased protein production

Reduced breakdown of proteins

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7
Q

Enzyme causing lipolysis

A

Lipase

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8
Q

Ketone bodies are produced from

A

Acetyl CoA

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9
Q

Equation to denote acid being added to water

A

HA –> H+ + A- (conjugate base)

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10
Q

Normal pH for human blood

A

7.35-7.45

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11
Q

pH of human blood leading to death

A

<6.8

>8

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12
Q

Three systems to maintain the blood pH and how long does each one take

A

Chemical system - immediate action
Respiratory system - 1 to 3 minutes
Renal system - hours to days

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13
Q

Three chemical buffer systems

A

Phosphate
Bicarbonate
Proteins e.g. Hb and albumin

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14
Q

Definition of anion gap

A

The difference between the measure anions and the measured cations

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15
Q

Cation

A

Ion with a positive charge

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16
Q

Anion

A

Ion with a negative charge

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17
Q

What is excluded when calculating the anion gap and why?

A

Generally exclude potassium K+ because this value is generally negligible

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18
Q

Normal range for anion gap

A

8-16

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19
Q

Significance of increased anion gap

A

Increased anion gap - metabolic acidosis

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20
Q

Significance of decreased anion gap

A

Decreased anion gap - metabolic alkalosis

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21
Q

General cations measured for the anion gap

A

Na+

Sometimes K+

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22
Q

General anions measured for the anion gap

A

HCO3-

Cl-

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23
Q

Why are veins more acidic than arteries?

A

Veins contain more CO2 - acidic

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24
Q

Enzyme involved in the reabsorption of HCO3- in the proximal convoluted tubule

A

Carbonic anhydrase

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25
Q

Three common causes for metabolic acidosis

A

Diarrhoea
Ketoacidosis
Lactic acidosis

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26
Q

Three common causes for metabolic alkalosis

A

Vomiting
Hypokalaemia
Ingestion of HCO3-

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27
Q

What is the blood supply to the liver?

A

25% - coeliac trunk

75% - hepatic portal system of veins

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28
Q

What is portal hypertension - how does this occur?

A

Due to cirrhosis of the liver - fibrosis of the parenchyma - blood cannot perfuse to the whole of the liver - builds up and there is a state of hypertension

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29
Q

How can you calculate the portal pressure gradient?

A

Difference between the normal portal pressure and the pressure of the IVC - if this is greater than 10: portal hypertension
Normal portal pressure - 9
IVC pressure - 2-6

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30
Q

What is the consequence of cirrhosis on a patient and why?

A

Splenomegaly - increased portal hypertension - increased blood flow to the spleen - causes it to swell

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31
Q

Causes of cirrhosis

A

Alcoholism

Hepatitis B/C

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32
Q

Why does cirrhosis result in ascites?

A

Damage to the liver - cannot produce enough albumin - reduced plasma proteins in the blood - blood has an increased water potential - increased movement of water out of the blood into the extra cellular tissues of the peritoneum - swelling in the abdomen - ascites

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33
Q

Anastomoses of which veins result in oesophageal varices?

A

LEFT gastric vein and oesophageal vein

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34
Q

Cause of caput medusae

A

Blood attempts to leave the portal system due to the increased pressure - formation of this from mass blood movement

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35
Q

Blood supply to the gallbladder

A

Cystic artery

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36
Q

What is contained within the ducts of the biliary tree?

A

Bile

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37
Q

Will a gallstone in the cystic duct cause jaundice?

A

No

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38
Q

Will a gallstone in the common bile duct cause jaundice?

A

Yes

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39
Q

Will a gallstone in the hepatopancreatic ampulla cause jaundice?

A

Yes

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40
Q

What is an adipokine?

A

Cytokine released by adipose tissue

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41
Q

Does insulin resistance mean that diabetes will occur? Why?

A

No - because there is islet compensation to allow for the generation of new beta cells which can also be larger and secrete even more insulin

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42
Q

Metformin - how does this drug act and what is it used for?

A

Drug used for the treatment of diabetes
Increases sensitivity to insulin at the muscle cells and at the adipocytes
Also acts to decrease the levels of gluconeogenesis

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43
Q

Other forms of diabetes, not T1DM or T2DM

A

Gestational
MODY - mature onset diabetes of the young
LADA - late autoimmune diabetes of adults

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44
Q

What is the most common sign of diabetic nephropathy? in a test?

A

Proteinuria i.e. presence of protein in the urine due to insufficient filtration by the glomerulus

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45
Q

What is the significance of raised protein kinase C levels?

A

Increased permeability of blood vessels
Increased occlusion of blood vessels and vasoconstriction
Increased mitochondrial dysfunction

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46
Q

What is the hypothalamo-hypophyseal portal system?

A

System of blood vessels connecting the hypothalamus to the anterior pituitary

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47
Q

What are the vascular connections of the hypothalamus and the pituitary gland?

A

Superior hypophyseal artery from hypothalamus to the APG
Secondary capillary plexus between anterior and posterior PGs
Drainage into the hypophyseal portal vein from the APG

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48
Q

Which nerve runs anteriorly to the thyroid gland?

A

Recurrent laryngeal nerve

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49
Q

What is the blood supply to the pancreas?

A

Coeliac trunk - splenic artery - transverse pancreatic branch
SMA - inferior pancreato-duodenal artery

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50
Q

Blood supply to the adrenal glands

A

Superior adrenal artery from the inferior phrenic
Middle adrenal artery from the abdominal aorta
Inferior adrenal artery from the renal artery

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51
Q

Functions of the kidney

A

Excrete waste products of metabolism
Maintain water and electrolyte balance
Maintain acid/base balance

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52
Q

Which kidney is more superiorly located and why?

A

The left kidney is located more superiorly

The right kidney has the liver directly superior to it and this pushes down

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53
Q

What is situated on top of each kidney?

A

Adrenal glands

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54
Q

What is the hepatorenal recess and where is this?

A

Subhepatic recess/Morrison’s pouch
Separates the live from the right kidney
This is where fluid collects if a patient is lying supine

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55
Q

When might fluid collect in the hepatorenal recess?

A

Ascites

Pancreatitis

56
Q

Which organ lies anterior to both and stretches across from the right to the left kidney?

A

Pancreas - head of the pancreas at the right kidney and tail of the pancreas at the left kidney

57
Q

Is the pancreas retro or intraperitoneal?

A

Pancreas is intraperitoneal apart from the tail which is retroperitoneal

58
Q

What is the shape of the right adrenal gland?

A

Pyramidal/triangular

59
Q

What is the shape of the left adrenal gland?

A

Crescent shaped

60
Q

Are the kidneys retroperitoneal or intraperitoneal?

A

Kidneys are retroperitoneal

61
Q

What is Gerota’s fascia?

A

This is the renal fascia - the kidneys are encapsulated in their own layer of fat

62
Q

Arcuate line

A

Aka. the douglas line
Horizontal line along the rectus abdominis where the inferior epigastric vessels perforate the abdominal rectus sheath
Superiorly to the arcuate line, they are outside of the sheath and inferiorly, they are inside the sheath

63
Q

‘Arcuate nucleus’

A

Main control centre of hunger located in the hypothalamus

64
Q

How does hypothalamus control satiety and hunger?

A

Via usage of neurotransmitters

65
Q

Orexigenic vs. anorexigenic

A

Orexigenic - appetite stimulating

Anorexigenic - appetite suppressing

66
Q

Orexigenic neurotransmitters

A

Neuropeptide Y (NPY)
Agouti related peptide (AgRP)
MHC

67
Q

Anorexigenic neurotransmitters

A

POMC

CART

68
Q

Effect of serotonin on the neurotransmitters and on appetite

A

Reduce NPY and increase POMC

Appetite suppressant

69
Q

Effect of ghrelin on the neurotransmitters and on appetite

A

Decrease NPY

Appetite stimulant

70
Q

Which cells and what organ release GLP-1?

A

L-cells of the small intestine

71
Q

What organ releases ghrelin and which cells?

A

Stomach

Parietal cells

72
Q

What is ghrelin otherwise known as?

A

‘Hunger hormone’

73
Q

Effect of GLP-1 on the neurotransmitters and on appetite?

A

Decrease NPY and increase POMC

Appetite suppressant

74
Q

To what receptor does GLP-1 bind to?

A

Y2R

75
Q

What other hormone does GLP-1 have the same effect as?

A

Serotonin

76
Q

Where is the hormone cholecystokinin secreted from - what organs and which cells?

A

Duodenum and large intestine

Enterendocrine cells

77
Q

Effect of cholecystokinin on appetite?

A

Suppress appetite

78
Q

Effect of PYY on neurotransmitters and on appetite

A

Suppress appetite

Reduces NPY and increase POMC

79
Q

When is PYY released?

A

When there is something in the gut

80
Q

Effect of leptin on neurotransmitters and appetite

A

Reduces the level of AGRP

Appetite suppressant

81
Q

Where are leptin receptors located and which are the most important?

A

Throughout range of tissues

Most important are in the hypothalamus

82
Q

Cells that secrete leptin

A

Adipocytes

NB. white adipose tissue

83
Q

Who secretes more leptin and why?

A

Those with a greater level of body fat - have more adipocytes

84
Q

What is leptin resistance?

A

The idea that people can learn to ignore the feeling of satiety given by leptin release and continue to eat anyway
Results in increased levels of obesity

85
Q

Effect of insulin on neurotransmitters and on appetite

A

Decrease the levels of AGRP

Appetite suppressant

86
Q

Effect of malonyl co-A on neurotransmitters and on appetite

A

Increase POMC

Appetite suppressant

87
Q

What controls malonyl coA levels?

A

AMPK - AMP kinase

Calcium levels - controlled by ghrelin so controlled by gut hormones

88
Q

Effect of gut microbes on appetite

A

Believed to have a role - being researched

Different gut microbes in lean and overweight people

89
Q

Drug which acts to increase appetite

A

Cannabinoids

90
Q

How do you calculate BMI?

A

Weight (kg) / height (m) squared

91
Q

‘Syndromic monogenic obesity’

A

Single gene mutation causing obesity associated with a range of other features e.g. mental retardation and dysmorphic features
30 potential gene mutations

92
Q

‘Non-syndromic monogenic obesity’

A

Single gene mutation causing obesity and no other features

12 potenital gene mutations

93
Q

Apple shape vs. pear shape - which is most dangerous and why?

A

Apple shape - more visceral fat - increased risk of health related issues

94
Q

Blood supply to anterior pituitary gland

A

Supra hypophyseal artery

95
Q

Blood supply to posterior pituitary gland

A

Inferior hypophyseal artery

96
Q

Vascular connection of anterior and posterior pituitary glands

A

Secondary capillary plexus

97
Q

Venous drainage from the anterior pituitary gland

A

Hypophyseal portal vein

98
Q

What structure does the pituitary gland sit in and why is this important to be aware of with a pituitary tumour?

A

Sella turcica - has bone anteriorly and posteriorly but no bone laterally
Tumour will grow out laterally

99
Q

What are the first structures that a pituitary adenoma will cause damage to?

A

CNs III, IV and V1, V2, V3
Optic chiasm
Carotid artery

100
Q

What visual field defect will pituitary adenoma commonly result in?

A

Bitemporal hemianopia

101
Q

What is meant by primary underactivity of a hormone?

A

a

102
Q

What is meant by secondary underactivity of a hormone?

A

a

103
Q

What affects the thyroid hormone levels in the thyroid axis?

A

a

104
Q

What affects the GH hormone levels in the GH axis?

A

a

105
Q

When in life would you have greater secretion of GH?

A

a

106
Q

What is the condition where there are elevated levels of cortisol?

A

a

107
Q

What is the conidtion where there is too little levels of cortisol?

A

a

108
Q

Independent of cortisol hormone production, how might one develop Cushing’s syndrome?

A

a

109
Q

Function of oxytocin

A

a

110
Q

Function of ADH

A

a

111
Q

Hormone released from thyroid gland - name

A

a

112
Q

Active form of thyroid gland

A

a

113
Q

Enzyme responsible for conversion of T4 to T3

A

a

114
Q

Site of conversion of T4 to T3

A

a

115
Q

Isoforms of enzyme that convert T4 to T3

A

a

116
Q

Isoform of enzyme that inactivates T4 (and T3)

A

a

117
Q

Isoform of deiodinase enzyme expressed in the periphery

A

a

118
Q

Isoform of deiodinase enzyme expressed in the brain and pituitary gland

A

a

119
Q

What happens to the levels of T4 and D2 during hypothyroidism?

IMPORTANT FOR EXAM

A

During hypothyroidism, T4 levels go down

D2 gets upregulated SO more T4 is converted into T3

120
Q

What happens to the levels of T4 and D2 during hyperthyroidism?

IMPORTANT FOR EXAMS

A

In hyperthyroidism, there are very high levels of T4

D2 gets down regulated so the brain converts less T4 to T3

121
Q

‘Thyroid binding globulin’ and when does this increase?

A

a

122
Q

Three layers of the adrenal cortex of the adrenal gland and what they release

A

Glomerulosa - Mineralocorticoids e.g. aldosterone
Fasciculata - Glucocorticoids e.g. cortisol
Reticulosa - Androgens e.g. testosterone

123
Q

Three types of hormones

A

Peptide
Steroid
Amine

124
Q

Conn’s syndrome and effect

A

Hyperaldosterone

125
Q

Effect of glucocorticoids on the immune system

A

Inhibition of the immune system

126
Q

‘Cushing’s syndrome’

A

Elevated levels of cortisol

127
Q

‘Addison’s disease’

A

Primary adrenal cortex failure

128
Q

‘Adrenal hyperplasia’

Comes up in exams

A

Adrenal hyperplasia - causes various enzymes to not work congenitally SO lack of production of hormones from adrenal cortex

129
Q

Example of enzyme deficiency in adrenal hyperplasia

A

21-hydroxylase

130
Q

Two signs of adrenal hyperplasia

A

Adrenal insufficiency

Virrilisation - female babies born with male genitalia

131
Q

Hormones released from adrenal medulla

A

Catecholamines e.g. adrenaline and noradrenaline

132
Q

Cells that release catecholamines

A

Chromaffin cells

133
Q

Effect of alpha 1 adrenoreceptor activation

A

Bronchial smooth muscle contraction i.e. vasoconstriction

134
Q

Effect of beta 1 adrenoreceptor activation

A

Positive ionotrophic and chronotrophic effect on the heart

Increased renin

135
Q

Effect of beta 2 adrenoreceptor activation

A

Bronchial, vascular, uterine smooth muscle relaxation

Glycogenolysis

136
Q

Effect of Cohn’s syndrome

A

Increased aldosterone
Reduced plasma renin
Hypertension

Year 2 Metabolism (34 decks)

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