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SP16- Gen Path Exam 3 > Parathyroid and Pancreas (Endocrine System) > Flashcards

Parathyroid and Pancreas (Endocrine System) Flashcards

1
Q

How many parathyroid glands are there? Where are they located?

A

four

on the posterior surface of the thyroid gland

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2
Q

The parathyroid glands are mostly composed of ____ cells.

A

chief

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3
Q

What is the function of the parathyroid’s chief cells?

A

to secrete parathyroid hormone

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4
Q

Parathyroid Hormone is an important regulator of blood ______ levels.

A

calcium

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5
Q

True or False: In addition to chief cells, the parathyroid glands contain chlorophyll cells.

A

False (that’s plants!), parathyroid = OXYPHIL cells

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6
Q

True or False: The parathyroid glands are stimulated by the pituitary gland and hypothalamus.

A

FALSE, no they are not

parathyroid glands are stimulated by decreases in blood calcium levels

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7
Q

What is the net effect of PTH?

A

increased level of blood calcium

feedback inhibition of further PTH secretion

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8
Q

How does PTH increase the level of blood calcium (what are the actions of PTH)?

A

increase renal tubular REABSORPTION of calcium
increase urinary phosphate EXCRETION
increase OSTEOCLASTIC activity
increase renal CONVERSION of vit.D into its active form
(vitamin D increases GI calcium absorption)

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9
Q

Hyperparathyroidism is an important cause of ______. Explain.

A

Hypercalcemia

= excess secretion of PTH = excessive increase in free calcium without feedback regulation

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10
Q

What are the two types of hyperparathyroidism?

A

Primary

Secondary

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11
Q

What is the difference between Primary and Secondary Hyperparathyroidism?

A

Primary = autonomous/spontaneous overproduction of PTH

Secondary = low blood calcium triggers the parathyroid to excrete PTH = too much is excreted due to hyperplasia of the gland = usually occurs in patients with chronic renal failure (bad kidneys can’t convert vitamin D to its active form and calcium is not well-absorbed in GI)

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12
Q

Is Primary Hyperparathyroidism more common in males or females?

A

females (4:1)

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13
Q

Primary Hyperparathyroidism is usually the result of parathyroid _________ or an ________.

A

hyperplasia (multiglandular)

adenoma (solitary)

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14
Q

What are the classic clinical features of Primary Hyperparathyroidism?

A

“Painful Bones, Stones, Abdominal Groans, and Psychic Moans”

Bones: increased PTH increases osteoclasts
Stones: increased PTH increases renal calcium abs.
Abdominal: constipation, gall stones, peptic ulcers
Psychic: seizures, lethargy, depression

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15
Q

What are the two common dental radiographic signs of Primary Hyperparathyroidism?

A
  1. Ground Glass appearance of alveolar bone

2. Generalized loss of lamina dura

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16
Q

What type of tumor can be found in the mouth of a patient with primary hyperparathyroidism?

A

brown tumor

brown due to hemosiderin pigmentation; it is not neoplastic!

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17
Q

Secondary Hyperparathyroidism is usually due to _______ which leads to increased amounts of ______ in the blood.

A

renal failure

phosphate (hyperphosphatemia)

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18
Q

What does “excess phosphate in the blood” stimulate?

A

stimulates PTH production because serum calcium decreases

what will PTH lead to??? excretion of phosphate in the urine and increased free calcium

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19
Q

Renal failure causes excessive secretion of PTH by the parathyroid glands because:

  1. phosphate isn’t excreted through the urine
  2. ______________________________
A

damaged kidneys can’t produce Vitamin D

no vitamin D = less absorption of Calcium
less calcium = more secretion of PTH

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20
Q

True or False: A patient with Secondary Hyperparathyroidism will have normal calcium levels.

A

True

kidneys suck at doing their job = PTH increases = more calcium is pulled from bone, GI, and renal tubes to COMPENSATE

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21
Q

True or False: The “bones, stones, groans” are more severe in secondary hyperparathyroidism.

A

False: Primary has more severe symptoms bc secondary is dominated by symptoms of kidney failure

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22
Q

How does Secondary Hyperparathyroidism manifest in the oral cavity?

A

Renal Osteodystrophy- bony mass of the palate due to increased levels of PTH

(the mass is bony and fibrotic with lots of osteoclasts)

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23
Q

How is Hyperparathyroidism treated? What is the prognosis?

A
  • surgical removal of the hyperplastic parathyroid glands
  • kidney transplant if applicable

Prognosis: GOOD (guarded if secondary + kidney failure)

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24
Q

True or False: Hypoparathyroidism is very common.

A

False

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25
What are the possible causes of hypoparathyroidism?
- surgically induced via excision of thyroid tissue - congenital absence (Di George) - Autoimmune
26
How does hypoparathyroidism affect calcium levels?
decreased serum calcium
27
How does hypoparathyroidism affect the heart and neuromusculature?
1. causes heart arrythmias | 2. increases neuromuscular excitability (think of spasms related to decreased calcium and this makes sense)
28
True or False: Hypoparathyroidism may increase intracranial pressure and seizures.
True
29
True or False: The Pancreas has both endocrine and exocrine functions.
True exocrine: secretes into ducts endocrine: secretes into blood
30
The EXOcrine pancreas makes ______.
gastric enzymes
31
What are the "cell clusters" that make up the ENDOcrine pancreas?
Islets of Langerhans
32
Islets of Langerhans are microscopic clusters of cells that include the four cells types: ____, ____, ___, and ___.
Beta Cells Alpha Cells Delta Cells PP Cells
33
What do Beta cells produce?
insulin -allows glucose to be stored after meals
34
What do Alpha cells produce?
glucagon - mobilizes carbs from the liver when needed - promotes glycogenolysis and gluconeogenesis
35
What do Delta cells produce?
somatostatin -suppresses both insulin and glucagon/regulates glucose levels
36
What do PP cells produce?
the pancreatic polypeptide VIP -exerts effects on the GI system
37
_______ is a group of metabolic disorders resulting in hyperglycemia (excess blood glucose levels)
Diabetes Mellitus
38
Type ___ Diabetes is the deficient production of insulin; Type ____ Diabetes is the defective response to insulin.
``` 1 = production 2 = response ```
39
Diabetes Mellitus is the leading cause of _____, _____, and ______ in the United States.
End Stage Renal Disease (ESRD) Blindness Lower Limb Amputation
40
What percent of the US population is affected by Diabetes?
7% (over 20 million people)
41
What is considered the normal blood glucose level? What is the diagnostic "fasting glucose level" for diabetes? What is the diagnostic "random glucose level" for diabetes?
Normal: 70 to 120 mg/dL DM Fasting: 126 mg/dL or higher DM Random: 200 mg/dL or higher
42
Diagnosing diabetes requires (1) random blood glucose level greater than 200 mg/dL, OR (2) fasting glucose above 126 mg/dL on more than one occasion, OR (3)_______
an abnormal glucose tolerance test
43
Glucose homeostasis depends on what three processes?
- Gluconeogenesis - Glucose uptake by tissues - Actions of insulin and glucagon
44
Insulin increases the rate of _____ transport into certain _____ of the body.
glucose | cells
45
What causes the absolute deficiency in insulin production that is seen with DM Type 1?
beta cells of the pancreas get destroyed by self-reactive T cells and auto-antibodies (chronic autoimmune)
46
When is Type 1 DM typically diagnosed?
before age 20 (patients usually have a normal weight)
47
True or False: Both types of DM are characterized by a decrease in blood insulin.
False: Type 1 = decreased insulin in the blood Type 2 = increased or normal insulin in the blood
48
Auto-antibodies are detectable in the blood of ____% of patients.
70-80%
49
Symptoms of DM Type 1 appear when ____% of beta cells have been destroyed.
90
50
What are the four common symptoms of DM Type 1?
Polydipsia (increased thirst/fluid intake) Polyuria (increased urination) Polyphagia (increased food intake/hunger) Ketoacidosis (excessive fat breakdown/ketones in blood)
51
True or False: Insulin therapy is critical to survival of DM Type 1 patients.
True
52
Why is the prognosis of DM Type 1 considered "guarded"?
there are many complications involved
53
True or False: DM Type 2 is an autoimmune disease.
False
54
DM Type 2 can be the result of ______ or ______.
``` insulin resistance (target tissues don't respond) decreased insulin secretion (inadequate for that patient) ```
55
Type 2 diabetes is usually diagnosed after age ____.
40
56
Which form of diabetes does NOT typically show clinical signs of ketoacidosis?
type 2 does NOT
57
What is the typically treatment regimen for Type 2 diabetes?
- weight loss and diet modification - oral hypoglycemic drugs - insulin
58
True or False: DM Type 2 patients are more likely to die from the disease thatn Type 1.
False, Type 1 more likely to die from disease
59
Which form of DM is more common?
Type 2: 90% | Type 1: 10%
60
How does diabetes manifest in the pancreas?
- destruction of islets - heavy inflammatory infiltrate - amyloid accumulation (protein fragments)
61
__________ associated with diabetes is responsible for 80% of DM-related deaths.
Vasculopathy
62
Describe "microangiopathy" as it pertains to diabetes.
thickening of the basement membrane, especially around small blood vessels (seen with PAS stain)
63
Diabetic _______ is the second leading cause of death.
nephropathy
64
Glomerular lesions that result from diabetes will be _____ or _____, both forms may lead to total renal failure.
diffuse glomerulosclerosis | nodular glomerulosclerosis
65
Which form of glomerulosclerosis is specific to diabetes?
Nodular (long-term diabetes only)
66
True or False: Diffuse Glomerulosclerosis is specific to diabetes.
False, it affects 90% of diabetics but is not specific to that disease
67
True or False: Diabetes retinopathy is the fourth leading cause of blindness.
True, microangiopathy and microaneurysms lead to retinal detachment and vision loss
68
Diabetic neuropathy can affect the _____ or _____ nerves.
peripheral sensorimotor nerves | autonomic nerves
69
Diabetics have an enhanced susceptibility to _______.
Skin infections (TB, pneumonia, pyelonephritis, etc)
70
Islet Cell Tumors may be _____ or ______.
Functional | Non-functional
71
Most Islet Cell Tumors are from the _______.
exocrine pancreas
72
True or False: Islet Cell Tumors are common.
False
73
What is Zollinger-Ellison Syndrome?
a condition in which a gastrin-secreting tumor (gastrinoma) of the islet cells in the pancreas causes overproduction of gastric acid, resulting in recurrent peptic ulcers

SP16- Gen Path Exam 3 (12 decks)

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