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Year 2 Metabolism > Overview 2 > Flashcards

Overview 2 Flashcards

1
Q

Major risk factors for atherosclerosis? x4

A

Hypercholestrolaemia
Hypertension
Smoking
Diabetes

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2
Q

Outcome of the Framingham study? x2

A

Obesity is a risk for heart failure

Hypertension is a risk for CVD

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3
Q

Diabetes increases the risk of CVD by what amount?

A

Causes x3 increased risk of CVD

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4
Q

Metabolic syndrome is?

A

Syndrome including increased risk of CVD consisting of four particular factors

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5
Q

Four factors included in metabolic syndrome?

A

Insulin resistance/DM2
Abdominal obesity
Dyslipidaemia
Hypertension

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6
Q

Ethnicity most sensitive to the effects of obesity are?

A

South Asians

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7
Q

Major factor increasing insulin resistance/DM2 is?

A

Hypertriglyceridaemia/increased intracellular fatty acids

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8
Q

Rectors associated with increased transport of fatty acids is?

A

CD36

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9
Q

Effect of flavonoids on CVD?

A

Beneficial effect on MI and stroke

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10
Q

Flavonoids are found in what food groups? x3

A

Fruit
Veg
Tea

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11
Q

Two beneficial effects of flavonoids?

A

Reduces ROS

Reduces CVD

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12
Q

Effect of folate/B12 on CVD? x2

A

Reduces methionine and homocystokine - these are toxic and damage endothelial cells
SO reduces CVD

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13
Q

Effect of low birthweight on CVD?

A

Increased rate of CHD

Increased LDL
Increased fibrinogen
Increased BP

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14
Q

BMI of underweight?

A

<18.5

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15
Q

BMI of normal weight?

A

18.5-24.9

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16
Q

BMI of overweight?

A

25-29.9

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17
Q

BMI of obese?

A

> 30

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18
Q

BMI of morbidly obese?

A

> 40

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19
Q

Way to measure BMI?

A

Weight (kg) / height (m) squared

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20
Q

Healthy BMI of individuals may differ according to what factor?

A

Ethnicity

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21
Q

Alternative measurement for healthy weight x2 and why is this necessary?

A

Waist circumference
Waist/hip ratio

Can distinguish muscular people

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22
Q

Prevalence of obesity in Tower Hamlets when starting primary school?

A

One in eight

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23
Q

Prevalence of obesity in Tower Hamlets when leaving school (age 11)?

A

One in four

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24
Q

What percentage of weight issues are related to medications?

A

10-15%

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25
Q

Drugs causing weight issues x6

A 
Mood stabilisers
DM
Corticosteroids
Beta blocker
Allergy relievers
Drugs preventing seizures and migraines
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26
Q

The thrifty gene is?

A

Genes that predispose to obesity have a selective advantage in populations that previously experienced starvation

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27
Q

Two ethnicities mainly effected by the thrifty gene?

A

Asian

African

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28
Q

Gene associated with thrifty gene hypothesis?

A

CREBRF

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29
Q

Four features of syndromic monogenic obesity?

A

Mental retardation
Dysmorphic features
Organ specific abnormalities
OBESITY

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30
Q

Main site of adaptive thermogenesis?

A

Brown adipose tissue

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31
Q

Effect of brown adipose tissue on obesity?

A

Protection against obesity

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32
Q

Effect of white adipose tissue on obesity?

A

Increased rates

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33
Q

Apple/pear shape - which has greater risk of weight-related health problems and why?

A

Apple shape - more visceral fat

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34
Q

Obesity related diseases could cut the lifespan by how many years?

A

11

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35
Q

Main drug used to treat obesity?

A

Orlistat

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36
Q

Action of orlistat?

A

Lipase inhibitor - reduces the amount of fat absorbed from food that is eaten

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37
Q

What must first be undertaken prior to surgery for weight loss?

A

Weight management course - diet and nutrition, fitness and exercise

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38
Q

Indications for surgery in those that are obese? x2

A 
Morbid obesity (BMI >40)
Or BMI > 35 and obesity related complications once conventional medical treatments have failed
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39
Q

Three surgery types for the treatment of obesity?

A

Restrictive procedures - gastric band
Malabsorptive procedures
Restriction plus malabsorption

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40
Q

Problems associated with malabsorptive procedures to cause weight loss? x3

A

Cause nutrient deficits and malnutrition and also dumping syndrome

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41
Q

Functions of the hypothalamus x7

A 
Pituitary function
Feeding - appetite and satiety
Stress response
Water balance
Sleep-wake cycle
Thermoregulation
Emotions
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42
Q

Six hormones released by the anterior pituitary

A 
Growth hormone
TSH
LH
FSH
PRL
ACTH
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43
Q

Two hormones released by the posterior pituitary

A

Oxytocin

AVP/ADH

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44
Q

Blood comes to the anterior pituitary via which artery?

A

Superior hypophyseal

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45
Q

What travels from the hypothalamus to the anterior pituitary via the superior hypophyseal artery?

A

Hormones

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46
Q

Pituitary gland sits in?

A

Sella turcica

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47
Q

Enlargement of pituitary gland causes which deficit most commonly?

A

Bitemporal hemianopia

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48
Q

Bitemporal hemianopia is?

A

Loss of vision in the lateral half of each eye

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49
Q

Cause of bitemporal hemianopia is?

A

Compression of the optic chiasm

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50
Q

Hypothalamic hormone causing release of growth hormone?

A

GHRH - growth hormone releasing hormone

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51
Q

Hypothalamic hormone causing release of thyroid stimulating hormone TSH?

A

Thyroid releasing hormone

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52
Q

Hypothalamic hormone causing release of prolactin?

A

Thyroid releasing hormone

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53
Q

Hypothalamic hormone causing release of ACTH? x2

A

AVP and CRH

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54
Q

Hypothalamic hormone causing release of FSH? x2

A

Kisspeptin

Gonadotrophin releasing hormone GnRH

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55
Q

Hypothalamic hormone causing release of LH? x2

A

Kisspeptin

Gonadotrophin releasing hormone GnRH

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56
Q

Thyroid releasing hormone is secreted from where?

A

Hypothalamus

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57
Q

Thyroid releasing hormone causes the release of which two hormones from the pituitary gland?

A

TSH

Prolactin

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58
Q

Hypothalamic hormone somatostain inhibits the release of which pituitary hormones? x2

A

Growth hormone

TSH

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59
Q

Hypothalamic dopamine hormone inhibits the release of which pituitary hormone? x1

A

Prolactin

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60
Q

Growth hormone causes the release of what from where?

A

IGF-1 from the liver

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61
Q

TSH causes the release of what from where?

A

T3 and T4 from the thyroid gland

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62
Q

Prolactin has an effect where? x2

A

Mammary glands

Immune system

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63
Q

ACTH releases what from where

A

Glucocorticoid cortisol from the adrenal gland

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64
Q

Cortisol is released fro which part of the adrenal gland?

A

zona fasciculata

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65
Q

FSH and LH release what from where?

A

Ovaries - oestrogen and progesterone

Testes - testosterone

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66
Q

Negative feedback of thyroid hormone works via which two pathways?

A

Thyroxine on TSH - pituitary gland

Thyroxine on TRH - hypothalamus

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67
Q

Thyroxine is T4 or T3?

A

T4

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68
Q

Primary underactivity is?

A

Damage to the target organ so lack of production of the target hormone

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69
Q

Secondary underactivity is?

A

Damage to the pituitary gland - lack of production of the pituitary hormone AND the target hormone

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70
Q

Primary underactivity of thyroid - lack of which hormone?

A

T4/T3

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71
Q

Secondary underactivity of thyroid - lack of which hormone?

A

TSH AND T4/T3

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72
Q

Hormone that can also stimulate the release of GHRH and GH?

A

Ghrelin

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73
Q

Pituitary hormone that has circadian rhythm is?

A

Growth hormone GH

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74
Q

GH relation to puberty?

A

Increased release during puberty

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75
Q

Inheritance of McCune-Albright syndrome?

A

Mosaic mutation

NOT inherited

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76
Q

Mutation associated with McCune-Albright syndrome?

A

R201

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77
Q

Diagnostic criteria for McCune-Albright syndrome?

A

Fibrous dysplasia
Cafe au lait spots
Endocrine dysfunction

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78
Q

Four examples of endocrine dysfunction in McCune-Albright syndrome?

A

Precocious puberty
Hyperthyroid goitre
Adrenal hyperplasia
Somatotroph hyperplasia

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79
Q

What is the main pathology of McCune-Albright syndrome?

A

Excess release of growth hormone

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80
Q

Excess levels of cortisol results in what condition?

A

Cushing’s syndrome

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81
Q

Persistently low levels of cortisol results in what condition?

A

Addison’s disease

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82
Q

What are the two types of Cushing’s syndrome?

A

ACTH independent

ACTH dependent

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83
Q

Causes of ACTH independent Cushing’s syndrome? x2

A

Adrenal hyperplasia
Adrenal tumour

Essentially increased adrenal release of cortisol

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84
Q

Cortisol is released from which part of the adrenal gland?

A

Zona fasciculata of the adrenal cortex

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85
Q

Cause of ACHT-dependent Cushing’s syndrome?

A

Pituitary adenoma causing excess release of ACTH

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86
Q

Kisspeptin stimulates the release of?

A

GnRH

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87
Q

GnRH stimulates the release of?

A

Oestrogen/progesterone

Testosterone

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88
Q

Oestrogen has a negative feedback effect on what?

A

On kisspeptin

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89
Q

Breast/prostate cancer - why treat with long acting GnRH analogue?

A

To activate receptor desensitisation

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90
Q

Which receptor type do you want to desensitise with long acting GnRh analogues?

A

G-protein coupled receptors

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91
Q

Oxytocin released during which two physiological actions?

A

Giving birth

Milk ejection

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92
Q

Vasopressin is otherwise known as?

A

ADH

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93
Q

Lack of ADH causes which condition?

A

Diabetes insipidus

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94
Q

Three features of diabetes insipidus

A

Massive thirst
Polyuria
Nocturia

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95
Q

Nocturia is?

A

Waking at night to void urine

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96
Q

Two groups of micronutrients are?

A

Organic - vitamins

Inorganic - trace elements

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97
Q

Four fat soluble vitamins?

A

A
D
E
K

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98
Q

Four water soluble vitamins?

A

B
Folate
Biotin
C

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99
Q

Fat/water soluble vitamins - which can be stored?

A

Fat soluble

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100
Q

Fat/water soluble vitamins - which is excreted in urine?

A

Water soluble

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101
Q

Presentation of lack of calcium? x3

A

Osteoporosis
Parastehesis
Muscle spasms

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102
Q

Presentation of lack of phosphorus?

A 
Bone pain 
Pseudofractures
Proximal muscle weakess
Rickets/short stature
Neurological complications
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103
Q

Presentation of lack of Iron?

A

Anaemia

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104
Q

Presentation of lack of Selenium?

A

Cardiomyopathy

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105
Q

Presentation of lack of Zinc?

A 
Growth retardation
Alopecia
Dermatitis
Diarrhoea
Congenital malformations
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106
Q

Presentation of lack of Copper?

A

Growth retardation

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107
Q

Source of calcium?

A

Dairy products

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108
Q

Source of phosphorus?

A

Seeds and nuts
Lentils
Soya

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109
Q

Source of iron?

A

Red meat
Dark vegetables
Watermelon

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110
Q

Source of selenium?

A

Seafood
Red meat
Cereal

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111
Q

Source of zinc?

A

Meat
Shellfish
Nuts
Legumes

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112
Q

Source of copper?

A 
Shellfish
Liver
Nuts
Legumes
Bran
Offal
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113
Q

Malnutrition contributes to what proportion of child deaths worldwide?

A

1/3

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114
Q

Kwashiorkor is due to?

A

Lack of protein and sufficient carbs

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115
Q

Masasmus is due to?

A

Lack of all nutrient groups

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116
Q

Number of adults in UK that are malnourished?

A

2 milllion

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117
Q

Presentation of vitamin A deficiency?

A

Xeropthalmia

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118
Q

Presentation of vitamin D deficiency?

A

Rickets

Osteomalacia

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119
Q

Presentation of vitamin E deficiency?

A

Peripheral neuropathy

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120
Q

Presentation of vitamin K deficiency?

A

Coagulopathy

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121
Q

Presentation of vitamin C deficiency?

A

Scurvy

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122
Q

Presentation of vitamin B1 deficiency?

A

Beri beri

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123
Q

Presentation of vitamin B2 deficiency?

A

Angular stomatitis

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124
Q

Presentation of vitamin B3 deficiency?

A

Pellagra

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125
Q

Presentation of vitamin B6 deficiency?

A

Neuropathy

Anaemia

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126
Q

Presentation of vitamin B12 deficiency?

A

Anaemia

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127
Q

Presentation of vitamin folate deficiency?

A

Anaemia

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128
Q

Vitamin B1 also known as?

A

Thiamine

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129
Q

Vitamin B3 also known as?

A

Niacin

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130
Q

Vitamin D2 known as and source?

A

Ergocalciferol - plant sources

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131
Q

Vitamin D3 known as and source?

A

Cholecalciferol - synthesised in the skin

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132
Q

Four lifestyle factors causing reduced levels of vitamin D?

A

Obesity
Smoking
Alcohol
Exercise

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133
Q

Target level of vitamin D in patients is?

A

> 75nmol/l

134
Q

What is osteomalacia?

A

Reduced bone strength

135
Q

What is rickets?

A

Osteomalacia in children- expansion of the growth plate

136
Q

Gait of someone with osteomalacia described as?

A

Waddling gait

137
Q

Two types of thiamine deficiency?

A

Wernicke’s encephalopathy

Korsakoff’s psychosis

138
Q

Where is B1/thiamine absorbed?

A

Jejunum

139
Q

Commonly see B1/thiamine deficiency in? x2

A

Malignancy

Alcohol deficiency

140
Q

Three other conditions B1/thiamine deficiency si seen in?

A

Anorexia/weight loss
Cognitive impairment
Muscle weakness - proximal

141
Q

Proximal muscle weakness means that what movement is often difficult?

A

E.g. getting up from a chair

142
Q

What is thiamine specifically required for, biochemically?

A

For the removal of pyruvate from the Kreb’s cycle

143
Q

Lack of thiamine results in what biochemically?

A

Build up of pyruvate and hence, build up of lactic acid - death of neurones

144
Q

Function of thiamine

A

Conversion of pyruvic acid to acetyl-coA

145
Q

Beri-beri is caused by?

A

Thiamine B1 deficiency

146
Q

The two types of beri-beri are?

A

Wet

Dry

147
Q

Dry beri-beri causes?

A

Sympathetic peripheral neuropathy

148
Q

Wet beri-beri causes?

A

Cardiac complications - enlarged heart, tachycardia, peripheral oedema
Neurological conditions

149
Q

Triad of signs in Wernicke’s/Korsakoff’s are?

A

Horizontal nystagmus
Opthalmoplegia
Cerebellar ataxia

Mental impairment also

150
Q

Vitamin B3/Niacin deficiency causes?

A

Pellagra

151
Q

Three causes of vitamin B3 deficiency?

A

Vegetarianism
Alcoholism
Other vitamin deficiency states

152
Q

Early symptoms of pellagra are? x6

A 
Loss of appetite 
Generalised weakness
Irritability
Abdominal pain
Vomiting
Bright red glossitis
153
Q

Late signs of pellagra? x6

A 
Casal's necklace
Vaginitis
Oesophagitis
Diarrhoea
Depression
Seizures
154
Q

The four D’s of late pellagra are?

A

Dermatitis
Diarrhoea
Dementia
Death

155
Q

Why does Casal’s necklace occur around the neck?

A

Area typically exposed to sunlight

156
Q

Vitamin B12 also known as?

A

Cobalamin

157
Q

What percentage of B12 is absorbed?

A

50%

158
Q

How is vitamin B12 excreted?

A

In the urine or the bile

159
Q

Four conditions B12 deficiency may be seen in?

A

Inadequate intake - vegans
Disorders of the terminal ileum
Inadequate production of IF
Defective release of cobalamin from food c

160
Q

Common treatment for the prevention of refeeding syndrome is?

A

Pabrinex

161
Q

Three types of transplant rejection are?

A

Hyperacute
Acute
Chronic

162
Q

Hyperacute rejection occurs how soon after transplant?

A

Minutes to hours

163
Q

Acute rejection occurs how soon after transplant?

A

One week to six months after

164
Q

Chronic rejection occurs how soon after transplant?

A

Months to years after

165
Q

Acute rejection is mediated through what?

A

Immune-mediated damage

166
Q

Acute cellularly mediated rejection involves which cell types? x3

A

CD4+ T-lymphocyte
CD8+ T-lymphocyte
Macrophage

167
Q

Acute antibody mediated rejection involves which cell type?

A

B-lymphocyte - antibodies

168
Q

Two types of acute rejection are?

A

Cellularly mediated

Antibody mediated

169
Q

Primary target in acute antibody mediated rejection is?

A

Endothelium of arteries and capillaries

170
Q

Three criteria for acute AMR is?

A

Evidence of acute renal injury on histology
Evidence of antibody activity e.g. CD4 staining
Circulating anti-donor antibodies

171
Q

What is the cause of hyperacute rejection?

A

Preformed antibodies due to prior pregnancy, transplant or transfusion

172
Q

Ig commonly associated with hyperacute rejection is?

A

IgM

173
Q

Other than immunology/rejection - three other reasons a graft may fail are?

A

Damaged prior to transplantation
Surgical complications
Recurrence of the original disease

174
Q

How can you prevent hyperacute rejection?

A

Screen for the presence of pre-formed antibodies

175
Q

Four consequences of ischaemia in transplant rejection?

A

Upregulates adhesion molecules
Increases adhesion of leucocytes
Increases non-specific damage
Increases acute rejection

176
Q

Four factors to prevent chronic rejection?

A

Choose best possible organ
Minimise surgical damage
Minimise acute rejection
Minimise drug toxicity

177
Q

Just anterior to the infundibulum is?

A

Optic chiasm

178
Q

Just posterior to the infundibulum is?

A

Pituitary gland in sella turcica

179
Q

Pituitary tumour pressing on central part of the optic chiasm causes which visual field defect?

A

Bitemporal hemianopia

180
Q

Anterior and posterior clinoid processes are located where?

A

Laterally - anterior and posterior to the sella turcica

181
Q

Clivus of the sphenoid bone is?

A

Between the sella turcica and the foramen magnum

182
Q

V1 opthalmic exits through which foramina?

A

Superior orbital fissure

183
Q

V2 maxillary exits through which foramina?

A

Foramen rotundum

184
Q

V3 mandibular exits through which foramina?

A

Foramen ovale

185
Q

Flashcards of foramina of the skull!!

A

Flashcards of foramina of the skull!!

186
Q

Embryology of the kidney - the mesonephric duct is also known as?

A

Wolffian duct

187
Q

Paramesonephric duct is also known as?

A

Mullerian duct

188
Q

Mesonephric (wolffian)/paramesonephric (mullerian) - which is male and which is female?

A

Mesonephric - male

Paramesonephric - female

189
Q

Paramesonephric duct goes on to form?

A

Oviduct

190
Q

Mesonephric duct does on to form?

A

Uretic duct

191
Q

How many embryonic kidneys are there?

A

Three

192
Q

What are the three stages of kidney development?

A

Pronephric
Mesonephric
Metanephric

193
Q

So the metanephric kidney develops from what?

A

The mesonephric kidney

194
Q

Which of these three embryonic kidneys goes on to be the functional kidney?

A

Metanephric kidney

195
Q

Metanephric kidney is developed from which two structures?

A 
Uteric bud (mesonephric duct)
Metanephric bud
196
Q

Metanephric bud is derived from where?

A

The mesenchyme

197
Q

The uteric bud develops into which part of the kidney?

A

The collecting system - pelvis, calyces, collecting ducts, ureters

198
Q

The metanephric bud develops into which part of the kidney

A

Excretory system of the kidney i.e. the nephron - glomerulus, capsule, convoluted tubules, loop of Henle

199
Q

Development of the kidney starts at which vertebral level?

A

S1

200
Q

Final location of the kidney is at which vertebral level?

A

T12

201
Q

Failure of the kidney to ascend to position is known as?

A

Ectopic kidney

202
Q

What happens to the renal arteries as the kidney ascends to position?

A

Renal arteries continually degenerate and regenerate

203
Q

What is kidney agenesis?

A

Failure of the kidney to form - unilaterally OR bilaterally

204
Q

Kidney agenesis is associated with which mutation?

A

Defect in uteric bud formation

205
Q

Uteric bud develops from what?

A

Mesonephric duct

206
Q

Will the baby survive in bilateral agenesis?

A

No

207
Q

Effect of bilateral agenesis on the amniotic fluid?

A

Reduced amniotic fluid

208
Q

Reduced amniotic fluid is known as?

A

Oligohydramnios

209
Q

Two birth defects developing from bilateral agenesis are?

A

Failure of lung development

Club foot

210
Q

Bifid ureter is?

A

Ureter splits into two OR duplicate ureter

211
Q

What is an ectopic kidney?

A

When the kidney remains in the pelvic region - does not asence

212
Q

What is a pancake kidney?

A

When the kidneys come together and fuse as one - does not then ascend

Type of ectopic kidney

213
Q

Is a pancake kidney functional?

A

Yes

214
Q

What is a horseshoe kidney?

A

Kidneys fuse in pelvic region and form singe U shape

Type of ectopic kidney

215
Q

Is a horseshoe kidney functional?

A

Yes

216
Q

What is a polycystic kidney?

A

Kidneys develop fluid filled cysts

217
Q

Inheritance of polycystic kidney is?

A

Autosmal dominant OR autosomal recessive

218
Q

Prevalence of kidney failure in those with polycystic kidneys is?

A

50% kidney failure by the age of 60

219
Q

Two histological changes in kidney cysts?

A

Change in epithelium to secretory

Increased proliferation of the cyst epithelium

220
Q

Arcuate blood vessels are between what?

A

Between the cortex and the medulla

221
Q

Stages of the renal arteries

A

Renal artery - segental artery - interlobar arteries - arcuate arteries - interlobular arteries

222
Q

Which of the renal arteries bend around the medullary pyramids?

A

The arcuate arteries

223
Q

Renal corpuscle is what?

A

Bowman’s capsule and glomerular capillaries

224
Q

Vascular pole of the renal corpuscle is?

A

Site of afferent and efferent arterioles

225
Q

Urinary pole of the renal corpuscle is?

A

Where the proximal convoluted tubule begins

226
Q

Podocytes are which layer of the Bowman’s?

A

Visceral layer of Bowman’s capsule

227
Q

Channel protein located in the proximal convoluted tubule is?

A

Na+/K+ ATPase

228
Q

What is reabsorbed in the proximal convoluted tubule and how much? x6

A 
Water - 70-80%
Na+ - 70-80%
Cl- - 70-80%
Amino acids - 100%
Glucose - 100%
Bicarbonate - small amount
229
Q

How can you differentiate between proximal and distal convoluted tubules histologically?

A

The PCT will have many microvilli sticking out into the lumen whereas the DCT will have a much clearer lumen

230
Q

Epithelium of thin limb of loop of Henle?

A

Simple squamous epithelium

231
Q

Epithelium of thick limb of loop of Henle?

A

Simple cuboidal epithelium

232
Q

Functions of the distal convoluted tubule x2

A

Reabsorotion of water via ADH

Electrolyte and acid base balance - Na+, K+, H+

233
Q

Juxtaglomerulosar cells are located where?

A

Afferent arterial

234
Q

Juxtagomerulosa senses what? secretes what?

A

Changes in BP

Secretion of renin

235
Q

Macula densa sense what?

A

Decreased Na+ content of distal tubule

236
Q

Function of collecting duct? x2

A

(Similar to DCT)
Final concentration of urine - ADH
Electrolyte and acid-base balance - aldosterone

237
Q

Muscle of internal sphincter of bladder is?

A

Smooth muscle

238
Q

Renal corpuscles are located in which part of the kidney?

A

Renal cortex

239
Q

What are the only arteries that go into the renal cortex?

A

Arcuate arteries

240
Q

The colon is what?

A

Large intestine

241
Q

What is Hirschsprung’s disease?

A

Dilation of the large intestine (megacolon) causing obstruction in infant

242
Q

Three symptoms of Hirschsprung’s disease?

A

Failing to pass meconium within 48 hours
Swollen belly
Vomiting green fluid i.e. bile

243
Q

Four muscles of the pelvic floor?

A

Levator ani - pubococcygeus, iliococcygeus, ischiococcygeus

Puborectalis

244
Q

Internal/external anal sphincters - which is voluntary and which is involuntary?

A

Internal - involuntary

External - voluntary

245
Q

Internal/external anal sphincters - which is stimulated first?

A

External - voluntary and then the involuntary opens

246
Q

Which pelvic floor muscle forms a U shaped loop?

A

Puborectalis

247
Q

Where does the puborectalis form a loop from and to?

A

Loop that slings around the rectum TO the pelvis

248
Q

Puborectalise supports which anal sphincter?

A

External - closure

249
Q

Function of puborectalis?

A

Maintain angle between anal canal adn rectum

250
Q

Nervous innervation of continence is via (and nerve roots)?

A

S2, S3, S4 (keeps the 3 P’s off of the flood - penis, poo, pee)

Pudendal nerve

251
Q

Innervation of external anal sphincter is via?

A

Inferior rectal nerves from pudendal nerve

252
Q

Innervation of internal anal sphincter is via? x2

A

Hypogastric nerves L1, L2 - sympathetic

Pelvic nerves S2-S4 - parasympathetic

253
Q

Three components essential for foecal continence

A

Internal anal sphincter
External anal sphincter
Puborectalis muscle

254
Q

Which two structures make up the anorectal angle?

A

Puborectalis muscle

External anal sphincter

255
Q

What is meant by reservoir continence?

A

The ability of the rectum to retain stool

256
Q

What is meant by rectal compliance?

A

The elastic component of the rectum that allows it to stretch/expand

257
Q

Function of the IAS?

A

Responsible for closure of the rectum and the maintenance of the resting pressure

258
Q

Function of the EAS?

A

Squeezing and the pressure during contraction

259
Q

What is the rectoanal inhibitory reflex (RAIR)?

A

Reflex enabling you to relax your IA sphincter and empty the rectum

260
Q

What initiates RAIR?

A

Progressive rectal filling

261
Q

What is the valsalva manouvre?

A

Person holds breath and forcibly tries to exhale a closed glottis - pushing down to excrete foecal matter

262
Q

What does the valsalva manouvre result in?

A

Increases the abdominal pressure

263
Q

Closing reflex of the rectum involves which sphincter?

A

EAS

264
Q

Two groups constipation effects the most?

A

Females

Elderly

265
Q

What is foecal incontinence?

A

Involuntary passage of rectal content - gas or stool

266
Q

What is passive incontinence?

A

When the IAS is not working - you have no idea that you are passing stools until you feel it

267
Q

What is urge incontinence?

A

When the EAS is not working - feel immediate urgency to pass stool but do not make it to the toilet in time

268
Q

When are cortisol levels the highest?

A

Morning

269
Q

When are cortisol levels the lowest?

A

Evening

270
Q

Normal plasma cortisol levels are in the range of?

A

30-100ug/100ml

271
Q

What can cause cortisol levels to increase?

A

Stress

272
Q

What is Hans Selye’s general adaptation syndrome?

A

Following acute stress there is chronic stress and then there is exhaustion and pathogenic stress

273
Q

Drug given to patients to increase cortisol levels is?

A

Cortizone

274
Q

Name some side effects of long term cortisol treatment

A 
Oedema
Weight gain
Glaucoma
Hypertension
Insomnia 
Depression
Thrombosis
275
Q

Two forms of glucocorticoid receptor is? How do these differ?

A

Alpha - binds steroid

Beta - does not bind steroid

276
Q

Two ways in which glucocorticoid receptors can work are?

A

Genomic - slow - acting on the DNA

Non-genomic - fast - not acting on the DNA but on the receptors

277
Q

Three types of stress causing a release of glucocorticoids x5

A 
Metabolic disturbance
Tissue damage
Infection 
Fluid loss 
Neural disturbance
278
Q

Why can steroid treatment not be suddenly stopped?

A

Patient stops producing steroid when on treatment - must slowly lower the dose

279
Q

Most of the calcium in the blood is in what form?

A

Bound to albumin

280
Q

Calcium is bound to albumin at the expense of?

A

H+

281
Q

Changes to albumin bound calcium in acidosis?

A

Acidosis - less calcium bound to albumin so more H+ can be bound
SO more ionise calcium in teh blood

282
Q

Changes to albumin bound calcium in alkalosis?

A

More calcium bound to albumin for increased release of H+ SO less ionised calcium in the blood

283
Q

Main role of calcium in cells?

A

Cell signalling

284
Q

Majority of phosphate in the body is where?

A

85% body phosphate mineralised in bone

285
Q

Calcium levels are controlled by which hormone?

A

Parathyroid hormone

286
Q

Parathyroid glands develop from where embryologically?

A

Pharyngeal pouches

287
Q

What are the cells responsible for the secretion of PTH?

A

Chief cells

288
Q

Two cells of the parathyroid glands are?

A

Chief cells

Oxyphilic cells

289
Q

What are the three types of hormone?

A

Peptide hormone
Steroid hormone
Amine hormone

290
Q

What hormone type is thyroid hormone?

A

Peptide hormone

291
Q

Pathway of thyroid hormone production?

A

Same way as insulin - pre, pro…

292
Q

Major stimulus for the release of PTH is?

A

Low levels of ionised calcium

293
Q

Low levels of ionised calcium causes what change to chief cells?

A

Hyperplasia of chief cells

294
Q

Normal serum calcium levels are?

A

2.2-2.6

295
Q

Three functions of the calcium sensing receptor?

A

Reduces PTH secretion
Increases the breakdown of stored PTH
Suppresses the transcription of the PTH gene

296
Q

What type of receptor is the calcium sensing receptor?

A

G-protein coupled receptor

297
Q

PTH has a role at which part of the kidney?

A

Distal tubule

298
Q

What is the role of PTH at the distal convoluted tubule?

A

Increased reabsorption of calcium

299
Q

Calcium reabsorption at the proximal convoluted tubule is dependent/independent of PTH?

A

Independent

300
Q

What stimulates calcium reabsorption at the proximal convoluted tubule?

A

Voltage gradient

301
Q

What stimulates calcium reabsorption at the loop of Henle?

A

Voltage dependent

302
Q

What stimulates calcium reabsorption at the distal convoluted tubule?

A

PTH

303
Q

What is Barter’s syndrome?

A

Mutation in the calcium channel of the loop of Henle

304
Q

What is Gitelman syndrome?

A

Mutation in the Na+/Ca2+ channel of the kidney

305
Q

Effect of vitamin D on the parathyroid gland is?

A

Reduces PTH transcription

306
Q

Effect of vitamin D on bone is? x2

A

Reduces expression of type I collagen

Increases RANKL levels

307
Q

What is FGF23?

A

Phosphatonin - hormone that reduces serum phosphate levels

308
Q

Where is calcitonin produced?

A

Chief cells of the thyroid

309
Q

Where are vitamin D2/D3 obtained from?

A

D2 - from vegetables

D3 - from meat

310
Q

What is familial hypocalciuric hypercalcemia? FHH?

A

A mutation that inacivates CaSR

311
Q

What happens in FHH?

A

Parathyroid cannot sense high calcium so PTH is not supressed by high calcium
CaSR in kidney not activated

312
Q

Change in ion levels due to FHH is? x3

A

High serum Ca2+
Low urine Ca2+
High serum Mg

313
Q

Pituitary adenoma is of the anterior or the posterior pituitary?

A

Anterior pituitary

314
Q

Goitre of thyroid involves infiltration of what cell type?

A

Lymphocyte

315
Q

Hashimoto’s thyroditis - what structure is formed histologically?

A

Lymphoid follicle

316
Q

Hashimoto’s thyroditis - is this hyper or hypothyroidism?

A

Hypothyroidism

317
Q

Grave’s disease - is this hyper or hypothyroidism?

A

Hypothyroidism

318
Q

Hyperthyroidism has what effect n the sympathetic nervous system?

A

Overactivity of the sympathetic nervous system

319
Q

Adrenal gland - cortex/medulla is brown or yellow?

A

Cortex - pale yellow

Medulla - brown

320
Q

Two cell types in the parathyroid gland are?

A

Chief cells

Oxyphill cells

321
Q

Most abundant cell type in the parathyroid gland is?

A

Chief cells

322
Q

Cells of the thyroid gland are?

A

Follicular cells

323
Q

Chief cells produce what hormone?

A

Parathyroid hormone

324
Q

Parafollicular/C cells are in which gland?

A

Thyroid gland

325
Q

Parafollicular/C cells produce what hormone?

A

Calcitonin

326
Q

Which endocrine structure has a tricornate/three horned appearance?

A

Adrenal gland

327
Q

Portal triad of the liver - which structure is teh largest?

A

Portal vein

328
Q

Portal triad of the liver - which structure is the smallest?

A

Hepatic artery proper

329
Q

Renal cell carcinoma tend to invade which renal structure?

A

Renal vein

330
Q

What type of carcinoma is commonly found in teh kidney?

A

Transitional cell carcinoma

331
Q

Renal corpuscles are only found in the cortex or in the medulla?

A

In the cortex

Year 2 Metabolism (34 decks)

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