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Physiology Flashcards

1
Q

Hormones: Examples of Amino Acid Derived

A

Adrenaline
Melatonin

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2
Q

Hormones: Examples of Lipid Derived Hormones

A

Testosterone
Oestradiol

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3
Q

Hormones: Adrenaline is derived from what?

A

Tyrosine

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4
Q

Hormones: Melatonin derived from what?

A

Tryptophan

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5
Q

Hormones: Testosterone and Oestradiol are derived from what?

A

Cholesterol

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6
Q

Receptors: G-protein Coupled Receptors - Structure

A

7 Transmembrane associated G-protein complex

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7
Q

Receptors: G-protein Coupled Receptors - Examples of Loss of function diseases of the Luteinizing hormone receptor (3)

A

Familial Hypogonadism
Leydig Cell Hypoplasia
Primary Amenorrhoea

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8
Q

Receptors: G-protein Coupled Receptors - Loss of function disease of the Thyrotropin-Releasing Hormone Receptor

A

Central hypothyroidism

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9
Q

Receptors: G-protein Coupled Receptors - Loss of function diseases of Growth Hormone Releasing Hormone Receptor

A

Short stature

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10
Q

Receptors: G-protein Coupled Receptors - Loss of function diseases of Calcium Sensing Receptor (2)

A

Benign familial hypocalciuric hypercalcaemia
Neonatal Severe Primary Hyperparathyroidism

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11
Q

Receptors: G-protein Coupled Receptors - Gain of function disease of the Luteinizing Hormone Receptor (Germ Line)

A

Male-limited Precocious Puberty

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12
Q

Receptors: G-protein Coupled Receptors - Gain of function disease of the Luteinizing Hormone Receptor (Somatic)

A

Leydig Cell Adenomas with precocious puberty

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13
Q

Receptors: G-protein Coupled Receptors - Gain of function disease of Follicle Stimulating Hormone Receptor

A

In Females - spontaneous ovarian hyperstimulation syndrome

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14
Q

Receptors: G-protein Coupled Receptors - Gain of function disease of Calcium Sensing Receptor (2)

A

Familial Hypocalcaemic Hypercalciuria
Bartter Syndrome Type V

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15
Q

Receptors: G-protein Coupled Receptors - Gain of function disease of Thyroid Stimulating Receptor (Germ line)

A

Non-autoimmune or pregnancy-limited familial hyperthyroidism

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16
Q

Receptors: G-protein Coupled Receptors - Gain of function disease of Thyroid Stimulating Receptor (Somatic)

A

Autonomous Thyroid Adenomas

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17
Q

Receptors: Tyrosine Kinase Receptor - Examples (3)

A

Insulin
Growth Hormone
Prolactin

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18
Q

Receptors: Steroid Hormone Receptors Examples (2)

A

Oestrogen
Androgen

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19
Q

Hypothalamic-Pituitary Axis: What is the main concept of this?

A

Hormones produced by the Anterior Pituitary Gland act as negative feedback on the hypothalamus to alter output of Releasing hormones and Release-Inhibitory factors

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20
Q

Thyroid Axis: Raised TSH shows what?

A

Hypothyroid

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21
Q

Thyroid Axis: Raised TSH shows what?

A

Hypothyroid

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22
Q

Thyroid Axis: Suppressed TSH shows what?

A

Hyperthyroid

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23
Q

Thyroid Axis: When may TSH not be a reliable marker of Thyroid Function (3)

A

Secondary hypothyroidism
TSHoma
Sick Euthyroid Syndrome - low/normal TSH with low free hormone levels

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24
Q

Hormones: Cortisol - When is this measured?

A

9am

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25
Hormones: What can be measured to indicate GH hypersecretion?
IGF-1
26
Hormones: How to measure the function of the sex hormone axis in men?
Measure testosterone at 9am
27
Hormones: Prolactin - Produced from what cells?
Lactotroph cells of the anterior pituitary gland
28
Hormones: Prolactin - Secretion is under tonic inhibition by what?
Hypothalamic dopamine
29
Hormones: Prolactin - Effects are mediated by what?
Prolactin Receptor
30
Hormones: Testing Pituitary Hormones - What test is used if there is a hormone excess?
Suppression test
31
Hormones: Testing Pituitary Hormones - What test is used if there is a hormone deficiency?
Stimulation test
32
Cortisol: Deficiency demonstrates what?
Adrenal insufficiency
33
Cortisol: Excess demonstrates what?
Cushing's Syndrome
34
Cortisol: Test if there is a deficiency?
Synacthen Test
35
Cortisol: Test if there is an excess?
Dexamethasone Suppression Test
36
Insulin: Functionnsulin:
Regulates glucose levels within the blood - encourages breakdown of glucose
37
Alzheimers Disease Insulin Resistance: Pathophysiology
Defective pathway as receptors and PI3K cannot be phosphorylated
38
Insulin Resistance: 3 components
Impaired insulin signalling Inflammation Pathway-selective Hepatic Insulin Resistance
39
Insulin Resistance: Impaired Insulin Signalling - Pathophysiology involves reduced activity of what?
INSR Tyrosine Kinase Activity
40
Insulin Resistance: Impaired Insulin Signalling - Reduced INSR Tyrosine Kinase Activity causes a reduction in what? (5)
IRS1 Tyrosine phosphorylation IRS1-associated PI3K activity AKT phosphorylation Glycogen synthesis GLUT-4 translocation
41
Insulin Resistance: Inflammation - Induced by what?
Obesity
42
Insulin Resistance: Inflammation - Inflammatory response activates what? (2)
JNK NF-KB
43
Insulin Resistance: Inflammation - JNK impact
Causes serine phosphorylation of IRS-1 to cause reduced glucose uptake into cells
44
Insulin Resistance: Inflammation - NF-KB and JNK impact
Translocate to the nucleus to increase TNF-alpha, IL-6 and MCP-1 (pro-inflammatory cytokines) to increase FFA
45
Insulin Resistance: Overall impacts on hepatocytes (3)
Reduces glucose uptake - reduce glycogenesis Increased gluconeogenesis from lactate and glycerol Increased VLDL secretion due to increased TTG esterification
46
Insulin Resistance: Causes remodelling of what?
ECM
47
Insulin Resistance: Pathway of ECM remodelling (5)
1. Obesity and High fat diet 2. Inflammation 3. Increased collagen and Hyaluronan 4. Increased ECM receptor signalling 5. Muscle insulin resistance
48
Insulin Resistance: Matrix Metalloproteinase 9 - Genetic deletion has what impact?
Increased muscle collagen IV
49
Hyperinsulinaemic-Euglycaemic Clamp: Function in practice
Gold standard for measurement of insulin sensitivity
50
Hyperinsulinaemic-Euglycaemic Clamp: Physiological Function
Aims to maintain glucose concentration at the same level but an increase of insulin
51
Hyperinsulinaemic-Euglycaemic Clamp: What does this tell us about a patient?
How sensitive a patient is to glucose and how efficient their metabolism is
52
PEGPH20
PEGylated Hyaluronidase
53
PEGPH20 mechanism of action
Reduces muscle hyaluronan in mice and ameliorates insulin resistance on a high diet
54
CLT-28643 mechanism of action
Novel integrin alpha-5-Beta-1 inhibitor to inhibit fibrosis and inflammation
55
Insulin: Normal concentration when fasting
<4mM
56
Insulin: Risks when fasting (2)
Hypoglycaemia Coma
57
Insulin: Normal glucose concentrations
4-6mM
58
Insulin: High glucose concentration
6-7mM
59
Insulin: Diabetic glucose concentration
>7mM
60
Insulin: Structure - Synthesised where and in what cell?
Rough Endoplasmic Reticulum in Pancreatic Beta Cells
61
Insulin: Structure - Initially synthesised as what?
Pre-proinsulin
62
Insulin: Structure of Pre-proinsulin
Two polypeptide chains linked by a disulphide bond
63
Insulin: Structure - What is synthesised after pre-proinsulin?
Cleaved to form insulin + C-peptide
64
Insulin: Preparations - Insulin Lispro structure
Lysine [B28] and Proline [B29]
65
Insulin: Preparations - Insulin Lispro speed of action
Ultra-fast with short action - inject within 15 minutes of starting a meal
66
Insulin: Preparations - Insulin Lispro - how does this structure impact action?
The switching of Lysine and Proline induces greater instability of the molecule to reduce half life
67
Insulin: Preparations - Insuline Glargine - Structure
Glycine [alpha21] and Arginine [B31-32]
68
Insulin: Preparations - Insuline Glargine - Length of action
Long-acting
69
Insulin: Preparations - Insuline Glargine - Time of administration
Single administration before bed
70
Insulin: Synthesis - Synthesised by what overall structure?
Pancreatic islets
71
Insulin: Synthesis - Alpha cell function
Secrete glucagon
72
Insulin: Synthesis - Beta cell function
Secrete insulin
73
Insulin: Synthesis - Delta cell function
Secrete somatostatin
74
Insulin: Synthesis - PP cell function
Secrete pancreatic polypeptide
75
Insulin: Synthesis by Beta Cell - Glucose enters cell how?
GLUT-2
76
Insulin: Synthesis by Beta Cell - Glucose becomes phosphorylated by what enzyme?
Glucokinase
77
Insulin: Synthesis by Beta Cell - Glucokinase function (2)
Phosphorylation of Glucose Acts as a glucose sensor
78
Insulin: Synthesis by Beta Cell - How is insulin released?
Glycolysis increases intracellular ATP concentration to inhibit the ATP-sensitive K+ channel causing depolarisation of the membrane Calcium channels open leading to secretion of insulin
79
Insulin: Biphasic Synthesis - 1st phase
Readily releaseable pool - 5% of insulin is immediately available for release
80
Insulin: Biphasic Synthesis - 2nd phase
Reserve pool undergoes preparatory reactions to become mobilised and available for release - only occurs if 1st phase is not sufficient to reduce glucose
81
Insulin: Signalling - Activates what processes in muscle?
Glycogen synthesis Amino acid uptake Glucose uptake
82
Insulin: Signalling - Activates what processes? (2)
DNA and protein synthesis Growth responses
83
Insulin: Signalling - Activates what processes in adipose tissue?
Glucose uptake Lipogenesis
84
Insulin: Signalling - Activates what processes in the liver?
Lipogenesis Glycogen synthesis
85
Insulin: Signalling - Inactivates what process? (2)
Lipolysis Gluconeogenesis in the liver - from Lactate and Amino Acids
86
Insulin Resistance
Reduced ability to respond to physiological insulin levels due to reduced insulin sensing and or signalling
87
Leprechaunism: Alternate name
Donohue Syndrome
88
Leprechaunism
Rare autosomal recessive genetic mutation in the gene of insulin receptors that induces severe insulin resistance
89
Leprechaunism: Symptoms (4)
Elfin facial appearance Growth retardation Absence of subcutaneous fat Increased muscle mass
90
Rabson Mendenhall Syndrome: Genetic Pattern
Autosomal recessive genetic mutations
91
Rabson Mendenhall Syndrome: Clinical Presentation (4)
Severe insulin resistance - hyperglycaemia and hyperinsulinaemia Acanthosis nigricans - hyperpigmentation Fasting hypoglycaemia Diabetic Ketoacidosis
92
Diabetic Ketoacidosis: Who is at risk of this?
Type I diabetics that do not take insulin correctly
93
Diabetic Ketoacidosis: Symptoms (4)
Vomiting Dehydration Increased heart rate Distinctive acetone smell on breath
94
Diabetic Ketoacidosis: Ketone Bodies - Formed by what?
Liver mitochondria
95
Diabetic Ketoacidosis: Ketone Bodies - Derived from what?
Acetyl CoA
96
Diabetic Ketoacidosis: Ketone Bodies - Important for energy metabolism where?
Heart Renal cortex
97
Diabetic Ketoacidosis: Ketone Bodies - How is this used as energy in the heart and renal cortex?
Converted back to Acetyl CoA by the TCA cycle
98
Diabetic Ketoacidosis: Risk in Type I DM when?
If insulin supplementation is missed
99
Insulin: K-ATP Channels - Consist of what two proteins? (2)
Kir6 pore subunit SUR1 Regulatory subunit
100
Insulin: K-ATP Channels - Kir6 pore subunit function
Inward rectifier subunit
101
Insulin: K-ATP Channels - SUR1 Regulatory subunit function
Sulphonylurea Receptor
102
Insulin: K-ATP Channels - Neonatal Diabetes Involvement
Kir6.2 mutations cause activated K-ATP channels or increase in channel numbers
103
Insulin: Neonatal Diabetes Mellitus - May be responsive to what treatment?
Sulphonylurea Receptor 1 e.g. Tolbutamide
104
Insulin: K-ATP Channels - Congenital Hyperinsulinaemia involvement
Kir6.2 and SUR1 mutations cause hyperinsulinaemia
105
Insulin: Congential Hyperinsulinaemia may respond to what?
Diazoxide
106
Diabetes: Type I - Pathophysiology
Autoimmune destruction of pancreatic Beta cells
107
Diabetes: Type II - Pathophysiology
Insulin resistance presenting with hyperinsulinaemia and hyperglycaemia as a result of resistance
108
Diabetes: Gestational Diabetes
Impaired glucose tolerance that is diagnosed during pregnancy
109
Diabetes: Gestational Diabetes - Diagnostic criteria
Fasting Blood Glucose >5.5 (lower than other forms)
110
Diabetes: Gestational Diabetes - Risk on child
Increased birth weight of child
111
Diabetes: MODY
Maturity Onset Diabetes of the Young
112
Diabetes: Maturity Onset Diabetes of the Young
Monogenic disease with common clinical features of both Type I and II Diabetes Mellitus
113
Diabetes: Maturity Onset Diabetes of the Young - Pathophysiology
Genetic Beta Cell dysfunction but no autoimmune destruction
114
Diabetes: Maturity Onset Diabetes of the Young - Management
Oral Sulphonylurea
115
Diabetes: Neonatal Diabetes
Mongenic diabetes present within the first 6 months of life
116
Diabetes: Neonatal Diabetes - Pathophysiology
Due to mutations in the glucose sensing mechanism of K-ATP channel
117
The Pancreas: Epsilon cell function
Secrete ghrelin
118
GSIS
Glucose Stimulated Insulin Secretion
119
The Pancreas: Biogenesis of Insulin - Insulin gene undergoes what?
Transcription to generate insulin mRNA
120
The Pancreas: Biogenesis of Insulin - Translation of insulin mRNA generates what?
Pre-proinsulin in the Rough Endoplasmic Reticulum
121
The Pancreas: Biogenesis of Insulin - What generates pro-insulin?
Golgi apparatus
122
The Pancreas: Biogenesis of Insulin - Pro-insulin cleaved by what?
Prohormone convertase
123
The Pancreas: Biogenesis of Insulin - Prohormone Convertase function
Pro-insulin cleavage to form a reserve pool of C-peptide and Insulin
124
The Pancreas: Glucose Sensing - Glucose uptaken by what?
GLUT-1/2
125
The Pancreas: Glucose Sensing - How is ATP generated?
Activation of Glycolysis and Oxidative Phosphorylation
126
The Pancreas: Glucose Sensing - ATP inactivates what?
K-ATP channels
127
The Pancreas: Glucose Sensing - Inactivation of K-ATP has what impact?
Causes membrane depolarisation to active L-type Voltage dependent calcium channels
128
The Pancreas: Glucose Sensing - How is insulin exocytosed?
Calcium moves inwards
129
The Pancreas: K-ATP Channel - Open when?
At a low glucose concentration - to maintain a hyper-polarised plasma membrane
130
The Pancreas: K-ATP Channel - Closed when?
At a high glucose concentration - causes depolarisation of the membrane
131
Sulfonylureas: Mechanism of Action
Bind to SUR1 subunit of the K-ATP Channel to cause closure of the channel to trigger insulin secretion independent of glucose concentration
132
Alpha Cells: Glucose Sensing - Low glucose impact on Glucose Uptake
Low
133
Alpha Cells: Glucose Sensing - Low glucose impact on Metabolism
Low
134
Alpha Cells: Glucose Sensing - Low glucose impact on K-ATP Channels
Open
135
Alpha Cells: Glucose Sensing - Low glucose impact on P/Q-type Voltage-gated Calcium Channels
Enables calcium influx
136
Alpha Cells: Glucose Sensing - Low glucose impact on Glucagon
Exocytosis triggered
137
Alpha Cells: Glucose Sensing - High glucose impact on Glucose uptake
High
138
Alpha Cells: Glucose Sensing - High glucose impact on Metabolism
High
139
Alpha Cells: Glucose Sensing - High glucose impact on K-ATP Channels
Closed - depolarises the cell
140
Alpha Cells: Glucose Sensing - High glucose causes the closure of what channels?
NaV and CaV channels
141
Alpha Cells: Glucose Sensing - High glucose impact on Glucagon?
No exocytosis
142
Alpha Cells: Glucagon function
Acts on the liver to promote hepatic glucose production to increase blood glucose
143
Paracrine function
Communication between adjacent cells via signalling molecules
144
The Pancreas: Somatostatin secreted by what?
Delta cells
145
The Pancreas: Somatostatin secreted when?
In response to nutrient or hormonal stimulation - to suppress beta cell and alpha cell function
146
Hypoglycaemia: Why have hospitalisations over 70 increased?
Decreased renal function and insulin use
147
Hypoglycaemia: Symptoms - General (3)
Complaint of hunger Sense of weakness or fatigue Profuse sweating
148
Hypoglycaemia: Symptoms - Brain (5)
Cognitive dysfunction Hemiparesis Seizures Coma Psychological fear of hypoglycaemia
149
Hypoglycaemia: Symptoms - Musculoskeletal (4)
Falls Fractures Joint dislocation Driving accidents
150
Hypoglycaemia: Symptoms - Cardiac (3)
Myocardial infarction Cardiac arrhythmia Cardiac failure
151
Hypoglycaemia: Symptoms - Circulation (4)
Inflammation Blood coagulation abnormalities Haemodynamic changes Endothelial dysfunction
152
Hypoglycaemia: Classification - Level 1
Glucose alert of 3.9 mmol/L (70 mg/dL) or less
153
Hypoglycaemia: Classification - Level 2
Glucose level <3.0 mmol/L (<54 mg/dL) is sufficiently low to indicate serious clinical importance
154
Hypoglycaemia: Classification - Level 3
Severe hypoglycaemia denoting severe cognitive impairment requiring external assistance for recovery
155
Hypoglycaemia: Counter-regulation - Generated by what?
Glucagon
156
Hypoglycaemia: Counter-regulation - Function of glucagon during hypoglycaemia
Acts on the liver to increase hepatic glucose production
157
Hypoglycaemia: Counter-regulation - Concern of prolonged hypoglycaemia
Raised threshold for counter-regulatory response due to high insulin and poor glucagon release
158
Hypoglycaemia: Counter-regulation - Concern of prolonged hypoglycaemia
Raised threshold for counter-regulatory response due to high insulin and poor glucagon release
159
Hypoglycaemia: Risk Factors - Impact of alcohol
Alcohol lowers blood glucose
160
Hypoglycaemia: Risk Factors - Exercise impact
High insulin and exercise encourage increased glucose uptake into muscles as this is insulin-independent
161
Diabetic Emergencies: Diabetic Ketoacidosis
Disordered metabolic state during absolute or relative insulin deficiency accompanied by an increase in counter-regulatory hormones e.g. Glucagon/Adrenaline/Cortisol/GH
162
Diabetic Emergencies: Diabetic Ketoacidosis - Aetiologies (2)
Insulin deficiency Increased insulin demand
163
Diabetic Emergencies: Diabetic Ketoacidosis - Insulin deficiency can occur due to what? (2)
Non-adherence to insulin Poor self management
164
Diabetic Emergencies: Diabetic Ketoacidosis - Causes of Increased Insulin Demand (5)
Infections - Pneumonia, UTI and Cellulitis Inflammatory - Pancreatitis and Cholecystitis Intoxication - Alcohol, Cocaine, Salicyclate and Methanol Infarction - Acute MI and Stroke Iatrogenic - Surgery or Steroids
165
Diabetic Emergencies: Diabetic Ketoacidosis - Impact on Lipolysis
Increased - due to reduced glucose and demand for alternate energy resource
166
Diabetic Emergencies: Diabetic Ketoacidosis - Increased FFA and Glycerol undergo what?
Enter ketogenic pathways to form Ketone bodies and thus Acidosis
167
Diabetic Emergencies: Diabetic Ketoacidosis - Impact on proteolysis
Increased - to utilise AA
168
Diabetic Emergencies: Diabetic Ketoacidosis - Impact on Glycogenolysis
Increased
169
Diabetic Emergencies: Diabetic Ketoacidosis - Hyperglycaemia excreted via what?
PCT of the kidney
170
Diabetic Emergencies: Diabetic Ketoacidosis - Why does dehydration and electrolyte loss occur?
As glycosuria induces osmotic diuresis
171
Diabetic Ketoacidosis: Clinical Presentation - Osmotic Related (3)
Thirst Polyuria Dehydration
172
Diabetic Ketoacidosis: Clinical Presentation - Ketone Body Related (4)
Flushed Vomiting Abdominal pain and tenderness Breathlessness
173
Diabetic Ketoacidosis: Clinical Presentation - Vomiting induced why?
Ketones trigger the CT2 zone of the medulla
174
Diabetic Ketoacidosis: Clinical Presentation - Breathlessness occurs why?
Ketones stimulate peripheral chemoreceptors to increase respiratory rate via the vagus and glossopharyngeal nerves
175
Diabetic Ketoacidosis: Clinical Presentation - Kussmauls Respiration
Fast deep breaths in response to metabolic acidosis
176
Diabetic Ketoacidosis: Clinical Presentation - Smell of breath
Acetone - smells fruity
177
Diabetic Ketoacidosis: Clinical Presentation - Associated Conditions (2)
Sepsis Gastroenteritis
178
Diabetic Ketoacidosis: Clinical Presentation - Palpitations or Chest/Abdominal pain occurs why?
H+ intake to cells K+ excreted from cells but cannot be brought back in as it requires insulin So increased plasma K+ causes palpatations and inhibits the ileus
179
Diabetic Ketoacidosis: Diagnosis - 3 factors
Ketonaemia High blood glucose Low Bicarbonate
180
Diabetic Ketoacidosis: Diagnosis - Ketonaemia levels
>3mmol/L or significant ketonuria >2+ on a standard stick
181
Diabetic Ketoacidosis: Diagnosis - Blood glucose levels
>11mmol/L or known DM
182
Diabetic Ketoacidosis: Diagnosis - Bicarbonate levels
<15mmol/L or venous pH <7.3
183
Diabetic Ketoacidosis: Diagnosis - Potassium
May be a low normal or >5.5 mmol/L
184
Diabetic Ketoacidosis: Diagnosis - Creatinine
Often raised
185
Diabetic Ketoacidosis: Diagnosis - Sodium
Reduced
186
Diabetic Ketoacidosis: Diagnosis - Lactate
Raised
187
Diabetic Ketoacidosis: Diagnosis - Amylase
Raised - can be salivary source or pancreatitis
188
Diabetic Ketoacidosis: Potential Complications (5)
Cardiac arrest ARDS Cerebral Oedema Gastric dilatation Sepsis
189
Diabetic Ketoacidosis: Average loss of Fluid
Up to 12L
190
Diabetic Ketoacidosis: Average loss of Sodium
500mmol
191
Diabetic Ketoacidosis: Average loss of Potassium
350-700 mmol
192
Diabetic Ketoacidosis: Average loss of Phosphate
50-100 mmol
193
Diabetic Ketoacidosis: Management - IV fluid resusicitation stages
1. 1000 mL NaCl 0.9% in the first hour 2. 2000 mL NaCl by the end of second hour 3. 3000 mL NaCl by the end of the third hour
194
Diabetic Ketoacidosis: Management -Insulin
Subcutaneous basal insulin adminstered
195
Diabetic Ketoacidosis: Management - Glucose
If glucose falls to 15 switch to Dextrose
196
Diabetic Ketoacidosis: Ketone Monitoring - Why does insulin deficiency induce this?
Switches metabolic balance in a catabolic direction to increase the levels of ketone bodies
197
Diabetic Ketoacidosis: Ketone Monitoring - Examples of Ketones (3)
Acetone Acetoacetate Beta Hydroxybutyrate
198
Diabetic Ketoacidosis: Ketone Monitoring - High urination causes losses of what? (6)
Electrolytes Sodium Potassium Chloride Phosphate Magnesium
199
Diabetic Ketoacidosis: Kussmaul Respiration function
Involuntary attempt to remove carbon dioxide from the blood that would cause a worsening of ketoacidosis
200
Diabetic Ketoacidosis: Ketone Monitoring - Optium meter measures what?
Beta Hydroxybutyrate
201
Diabetic Ketoacidosis: Ketone Monitoring - Normal level of Beta Hydroxybutyrate
<0.6mmol/L
202
Diabetic Ketoacidosis: Ketone Monitoring - Ketosis level for Beta Hydroxybutyrate
>3 mmol/L
203
Diabetic Ketoacidosis: Ketone Monitoring - Urine Ketone testing measures what?
Acetoacetate
204
Diabetic Ketoacidosis: Ketone Monitoring - Why does ketonuria persist after clinical improvement?
Mobilisation of ketones from fat tissue
205
Diabetic Ketoacidosis: Causes of death in adults (3)
Hypokalaemia Aspiration pneumonia ARDS
206
Diabetic Ketoacidosis: Main cause of death in children
Cerebral oedema
207
Hyperglycaemic Hyperosmolar Syndrome: Common in what patient groups? (3)
Older patients Young afro-carribean patients Type II diabetics - due to insulin deficiency
208
Hyperglycaemic Hyperosmolar Syndrome: Pathophysiology
Same mechanism as DKA but endogenous insulin is present so ketosis and acidosis is not prominent
209
Hyperglycaemic Hyperosmolar Syndrome: What drugs increase the risk?
Steroids Thiazide Diuretics
210
Hyperglycaemic Hyperosmolar Syndrome: Normally preceded by what?
High refined carbohydrate intake
211
Hyperglycaemic Hyperosmolar Syndrome: Diagnosis - Glucose
Hyperglycaemia - >50 mmol/L this is higher than DKA
212
Hyperglycaemic Hyperosmolar Syndrome: Diagnosis - Blood volume
Hypovolaemia
213
Hyperglycaemic Hyperosmolar Syndrome: Diagnosis - Ketonaemia
None or mild - <3 mmol
214
Hyperglycaemic Hyperosmolar Syndrome: Diagnosis - Bicarbonate
High (>15 mmol/L) or venous pH >7.3
215
Hyperglycaemic Hyperosmolar Syndrome: Diagnosis - Osmolarity
>320 mosmol
216
Hyperglycaemic Hyperosmolar Syndrome: Diagnosis - 3 characteristic features
Hypovolaemia Marked hyperglycaemia without significant ketonaemia or acidosis High osmolarity
217
Hyperglycaemic Hyperosmolar Syndrome: Diagnosis - Lactic acidosis may occur when? (2)
If sepsis is present or patient on Metformin with marked renal dysfunction
218
Hyperglycaemic Hyperosmolar Syndrome: Management - How to measure osmolarity?
2Na + Glucose + Urea
219
Hyperglycaemic Hyperosmolar Syndrome: Management - If dehydrated
0.9% saline for fluid replacement without insulin
220
Hyperglycaemic Hyperosmolar Syndrome: Management - Risk of fluid replacement
Fluid overload
221
Hyperglycaemic Hyperosmolar Syndrome: Management - Insulin if glucose is not brought down by fluids
Start low dose insulin if significant ketonaemia or ketonuria or if blood glucose falls at a rate of less than 5 mmol/hour despite fluids
222
Hyperglycaemic Hyperosmolar Syndrome: Management - Sodium must avoid what?
Fluctuations
223
Hyperglycaemic Hyperosmolar Syndrome: Management - What to give if osmolarity doesn't fall despite fluids?
0.45% Saline
224
Hyperglycaemic Hyperosmolar Syndrome: Management - What drugs are given to all patients if not contraindicated? (2)
LMWH Prophylactic fragmin
225
Alcoholic or Starvation Ketoacidosis: Starvation pathophysiology - causes what 4 things?
NAD conversion to Acetaldehyde for gluconeogenesis Decreased glycogen stores Fatty acid mobilisation - increased Beta Hydroxybutyrate Volume depletion - increased catecholeamines and cortisol
226
Alcoholic or Starvation Ketoacidosis: Impact on glucagon
Increased
227
Alcoholic or Starvation Ketoacidosis: Impact on insulin
Decreased
228
Alcoholic or Starvation Ketoacidosis: Diagnosis - 3 components
Normal glucose Ketonaemia - >3mmol/L or +2 on a urine stick Bicarbonate increased - <15 mmol/L or venous pH <7.3
229
Alcoholic or Starvation Ketoacidosis: Management (4)
IV Pabrinex IV dextrose IV Anti-emetics Insulin - if significant ketonaemia with no improvement
230
Hospital Admission of Type I DM: Characteristics of admission (6)
Unable to tolerate oral fluids Persistent vomiting Persistent hypoglycaemia Persistent positive or increasing levels of ketones Abdominal pain Breathlessness
231
Hospital Admission of Type I DM: Target blood sugar
6-10 mmol/L (or 4-12)
232
Lactate: Origin (4)
Red blood cells Skeletal muscle Brain Medulla
233
Lactate: Why is this made?
End product of anaerobic metabolism of glucose
234
Lactate: Excretion method
Requires hepatic uptake and aerobic conversion to pyruvate and thus glucose
235
Lactic Acidosis: Normal lactate range
0.6-1.2 mmol/L
236
Lactic Acidosis: Lactate is lowest when?
Fasting state
237
Lactic Acidosis: When may lactate rise?
Exercise
238
Lactic Acidosis: Normal range of ion gap
10-18 mmol/L
239
Lactic Acidosis: Type A associated with what?
Tissue hypoxaemia
240
Lactic Acidosis: Examples of states associated with Type A (3)
Infarcted tissue Cardiogenic shock Hypovolaemic shock - sepsis or haemorrhage
241
Lactic Acidosis: Type B associated with what states? (4)
Liver disease Leukaemic states Metabolic disease - inherited Diabetes - DKA may have high lactate
242
Lactic Acidosis: Clinical presentation (3)
Hyperventilation Mental confusion Stupor or coma
243
Lactic Acidosis: Diagnosis - Bicarbonate
Reduced
244
Lactic Acidosis: Diagnosis - Anion gap
Raised
245
Lactic Acidosis: Diagnosis - Ketones
No ketonaemia
246
Lactic Acidosis: Diagnosis - Phosphate
Raised
247
Thyroid Gland: Basic functional unit
Follicle
248
Thyroid Gland: Signals for TRH release are initiated where?
Paraventricular nucleus of the hypothalamus
249
Thyroid Gland: What predominantly controls the negative feedback loop?
T3 - suppresses TSH and TRH production
250
Thyroid Gland: Hormone synthesis - Initial stage
Thyroglobulin synthesis
251
Thyroid Gland: Hormone synthesis - Thyroglobulin is rich in what?
Tyrosine
252
Thyroid Gland: Hormone synthesis - Thyroglobulin is synthesised where?
Follicular cells
253
Thyroid Gland: Hormone synthesis - Iodide is uptaken to where?
Colloid
254
Thyroid Gland: Hormone synthesis - What happens to Iodide (I-) in the follicular cells?
Oxidation of two Iodide to form Iodine (I)
255
Thyroid Gland: Hormone synthesis - Iodine passes to where?
Colloid
256
Thyroid Gland: Hormone synthesis - What is the role of Iodine?
Iodination of Thyroglobulin
257
Thyroid Gland: Hormone synthesis - How does Iodination of Thyroglobulin occur?
Colloid peroxidases - link Iodine to Tyrosine amino acids to form two intermediates
258
Thyroid Gland: Hormone synthesis - Two intermediates
MIT - Monoiodotyrosine DIT - Diiodotyrosine
259
Thyroid Gland: Hormone synthesis - Iodination of Thyroglobulin is inhibited by what? (2)
Carbomisol Propthyouracil
260
Thyroid Gland: Hormone synthesis - When the intermediates are linked what is formed?
T3 - Triiodothyronine
261
Thyroid Gland: Hormone synthesis - When two DIT are linked what is formed?
T4 - Thyroxine
262
Thyroid Gland: Hormone synthesis - How does secretion of hormones occur?
Colloid is enveloped by microvilli which form colloid vesicles within the cell that fuse with lysosomes
263
Thyroid Gland: T4 - What % of hormone secreted is this?
90%
264
Thyroid Gland: T4 - Converted to T3 where? (2)
Liver Kidney
265
Thyroid Gland: What is the biologically active hormone?
T3
266
Thyroid Gland: Hormone Transport - What serum proteins may they bind to? (3)
TBG - Thyroxine Binding Globulin - 70% TBPA - Thyroxine Binding Pre-albumin - 20% Albumin - 5%
267
Thyroid Gland: Hormone Transport - Thyroid Binding Globulins have a lower affinity to what?
T3
268
Thyroid Gland: Hormone Degradation - Conducted by what?
De-Iodinases
269
Thyroid Gland: Deiodinases - Type I Found where?
Liver Kidney
270
Thyroid Gland: Deiodinases - Type I function
Breaks down 40% of T4
271
Thyroid Gland: Deiodinases - Type II found where?
Heart Skeletal Muscle CNS Fat Thyroid Pituitary
272
Thyroid Gland: Deiodinases - Type III found where?
Foetal tissue Placenta Brain - except the pituitary
273
Thyroid Gland: Deiodinases - Type III function
T4 > T3 for excretion T3 > T2
274
Thyroid Bound Globulins: Increased TBGs - Can be caused by what drugs? (4)
Oral contraceptive pill Tamoxifen Clofibrate Heroine
275
Thyroid Bound Globulins: Increased TBGs - Can be caused by what states? (6)
Pregnancy Newborns Hepatitis A Chronic active hepatitis Biliary cirrhosis Acute intermittent porphyria
276
Thyroid Bound Globulins: Decreased TBGs - Can be caused by what drugs? (3)
Glucocorticoids Phenytoin Carbamezapine
277
Thyroid Bound Globulins: Decreased TBGs - Can be caused by what states? (4)
Androgens Active acromegaly Severe systemic disease - liver or nephrotic syndrome
278
Thyroid Hormones: Impact on metabolic rate
Increased basal metabolic rate
279
Thyroid Hormones: Impact on mitochondria
Increased number and size
280
Thyroid Hormones: Impact on oxygen use
Increased
281
Thyroid Hormones: Impact on ATP hydrolysis
Increased
282
Thyroid Hormones: Impact on glycogenesis
Decreased
283
Thyroid Hormones: Impact on blood glucose
Increased - due to gluconeogenesis and glycogenolysis
284
Thyroid Hormones: Impact on glucose uptake (insulin-dependent)
Increased
285
Thyroid Hormones: Impact on fats (4)
Mobilises fats from adipose tissue Increased fatty acid oxidation Increased lipolysis Decreased lipogenesis
286
Thyroid Hormones: Impact on protein metabolism
Increased protein synthesis
287
Thyroid Hormones: Impact on thermogenesis
Increases thermogenesis
288
Thyroid Hormones: Growth - What are thyroid hormones required for? (3)
Growth hormone production, activity and secretion Glucocorticoid-induced GHRH release Somatomedins activity
289
Thyroid Hormones: Vital for development of the foetal and neonatal brain why?
For myelinogenesis and axonal growth
290
Thyroid Hormones: Hypothyroidism impact on CNS
Slow intellectual function
291
Thyroid Hormones: Hyperthyroidism impact on CNS
Nervousness Hyperkinesis Emotional lability
292
Thyroid Hormones: Sympathomimetic Action - Increase responsiveness to what and how? (2)
Adrenaline - increased number of receptors Cardiovascular responsiveness - increased force and rate of contraction
293
Thyroid Hormones: Impact on lungs
Increased RR
294
Thyroid Hormones: Impact on hearts (2)
Increase HR and force of contraction
295
Thyroid Releasing Hormone: Source
Hypothalamus
296
Thyroid Releasing Hormone: Function
Stimulates the release of TSH
297
Thyroid Stimulating Hormone: Source
Anterior Pituitary Gland
298
Thyroid Stimulating Hormone: Mechanism of action
Binds to TSH receptor on thyroid epithelial cells to activate G proteins for T3 and T4 production
299
Thyroid Hormones: Mechanism of action
Translocate the nucleus to bind to Thyroid Response Elements on target genes to stimulate transcription of genes to increase BMR
300
Cell Signalling: Autocrine Regulation
Signalling molecules are released from the cell and bind to the receptors or in the cell that are releasing them
301
Cell Signalling: Paracrine Regulation
Signalling molecules. arereleased from cells and bind to receptord on adjacent cells to induce a response
302
Cell Signalling: Endocrine Regulation
Hormones are released from secretory cells and transported via the circulatory system to distant cells
303
Hormones
Any substance secreted from one cell that regulates another cell
304
Hormones: 3 main classes
Steroid Hormones Amine-derived Hormones Peptide Hormones
305
Hormones: Example of a steroid hormone
Oestrogen
306
Hormones: Example of an amine-derived hormone
Adrenaline
307
Hormones: Example of a peptide hormone (4)
Oxytocin ADH Growth Hormone Insulin
308
Hormones: Steroid Hormones - Derived from what?
Cholesterol
309
Hormones: Steroid Hormones - Amount synthesised is dependent on what?
Synthesis rate
310
Hormones: Steroid Hormones - Water properties
Hydrophobic
311
Hormones: Steroid Hormones - Lipid properties
Lipophilic
312
Hormones: Steroid Hormones - Transport
Bound to carrier proteins
313
Hormones: Steroid Hormones - Examples (3)
Cortisol Testosterone Oestradiol
314
Hormones: Amine Hormones - Catecholamine properties
Hydrophilic - transported unbound or free
315
Hormones: Amine Hormones - Thyroid amine hormones transport
Bound to carrier proteins
316
Hormones: Amine Hormones - Synthesis
Synthesised and stored in vesicles in the cytoplasma until required
317
Hormones: Amine Hormones - Secreted from what organs? (2)
Thyroid Adrenal Medulla
318
Hormones: Peptide Hormones - Water properties
Hydrophilic
319
Hormones: Peptide Hormones - Transport
Unbound in plasma
320
Hormones: Peptide Hormones - Secreted from what organs? (6)
Pituitary gland Parathyroid glands Heart Stomach Liver Kidneys
321
Hormones: Peptide Hormones - Synthesis overview
Synthesised as a precursor molecule and then stored within secretory vesicles
322
Hormones: Peptide Hormones - What are. thetwo structure types? (2)
Ring structure - Somatostatin 2 chains bound by disulphide bonds - Insulin
323
Hormones: Diurnal Control - Follows what rhythm?
Circadian
324
Hormones: Diurnal Control - Complementary Actions on control of glucose levels (4)
Sympathetic response Adrenaline Cortisol Glucagon
325
Hormones: Transport - Steroid and Thyroid Hormones
Insoluble in plasma - transported by proteins
326
Hormones: Transport - CBG name and function
Cortisol Binding Globulin - Binds cortisol and aldosterone
327
Cortisol Binding Globulin - TBG name and function
Thyroxine-Binding Globulin - Binds T4 selectively with some T3
328
Cortisol Binding Globulin - SSBG name and function
Sex Steroid-Binding Globulin - Binds Tesoterone and Oestradiol
329
What provides the highest level of endocrine control?
Hypothalamus
330
Hypothalamic Control: Functions - Secretes what? (2)
Regulatory hormones for the activity of the anterior pituitary cells Hormones for the posterior pituitary gland
331
Hypothalamic Control: Functions - Provides direct neural control for what?
Adrenaline and Noradrenaline production from the adrenal medulla
332
Genetics: Inframe indels have what outcome?
Gain or loss of AA AA substitutions Premature stop codons Defects in splicing
333
Genetics: Out of frame indels have what outcome?
Frameshift changes that result in premature truncation of the encoded protein
334
Examples of Monocrine Endocrine Tumour Syndromes (5)
Multiple Endocrine Neoplasia Type I Multiple Endocrine Neoplasia Type II Von Hippel-Lindau Neurofibromatosis Carney Complex
335
MEN1: Abbreviation for what?
Multiple Endocrine Neoplasia Type I
336
MEN1: Inheritance pattern
Autosomal dominant inheritance
337
MEN1: Genetic mutation where?
MEN1 gene of chromosome 11q13 - this is a tumour suppressor
338
MEN1: Mutations have what impact on proteins?
Loss or reduced protein function
339
MEN1: What are the 3'Ps?
Pancreatic, Parathyroid and Pituitary Gland Tumours
340
MEN1: Why is there a high risk of premature morbidity and mortality?
Malignant Pancreatic Neuroendocrine Tumours or Thymic Carcinoids
341
MEN1: Indications for Germline MEN1 Testing (2)
1 - >2 MEN1 associated tumours or a diagnosis of familial MEN1 or suspected MEN1 based off clinical history 2 - First degree relative of a family member with a known mutation
342
MEN1: MEN1 gene function
Involved in cell response to DNA damage, chromatin remodelling and cell signalling pathway regulation
343
MEN1: What pancreatic tumours may develop?
Insulinoma
344
MEN1: When should testing be conducted in asymptomatic individuals?
Under the age of 5 years
345
Multiple Endocrine Neoplasia Type I
Endocrine cancer syndrome characterised primarily by tumours of the parathyroid glands, endocrine gastroenteropancreatic tract and anterior pituitary
346
Multiple Endocrine Neoplasia Type II
Familial cancer syndrome that is associated with medullary thyroid cancer and phaeochromocytoma
347
MEN2: Inheritance pattern
Autosomal dominant inheritance
348
MEN2: Mutations affect what gene?
RET gene of chromosome 10q
349
MEN2: Function of RET gene
Proto-oncogene
350
MEN2: Mutation pathophysiology
Specific cysteine residues result in the activation of receptor tyrosine kinases
351
MEN2: MEN2b mutations have a high risk of what?
De novo type - not familial pattern
352
MEN2: MEN2a description
Combination of medullary thyroid cancer in association with phaeochromocytoma and parathyroid tumours
353
MEN2: MEN2a - Alternate name
Sipple syndrome
354
MEN2: MEN2a - Phaechromocytoma may occur where?
Extra-adrenal sites
355
MEN2: MEN2a - Linked. towhat type of mutation?
Germline gain of function mutations
356
MEN2: MEN2b - Description
Medullary Thyroid Cancer and Phaeochromocytoma in association with Marfanoid Habitus, Mucosal neuromas, Medullated corneal fibres and intestinal autonomic ganglion dysfunction
357
MEN2: MEN2b - First manifestation
Medullary Thyroid Cancer
358
MEN2: MEN2b - Medullary Thyroid Cancer derives from what?
Parafollicular C cells
359
MEN2: MEN2b - Clinical presentation of Medullary Thyroid Cancer (5)
Neck mass Diarrhoea Vomiting Ectopic ACTH Cushing's Syndrome
360
MEN2: MEN2b - Clinical presentation of Medullary Thyroid Cancer (5)
Neck mass Diarrhoea Vomiting Ectopic ACTH Cushing's Syndrome
361
MEN2: MEN2b - How are the mutations distinguished from MEN2a mutations?
MEN2b also germline but always activating point mutation in the catalytic domain of the encoded enzyme
362
MEN2: MEN2b - Phaeochromocytoma diagnosis
Elevated urinary or plasma metanephrines
363
MEN2: MEN2b - Phaeochromocytoma Management
Surgery with pre-operative management
364
MEN2: MEN2b - Primary Hyperparathyroidism Management
Surgical removal of enlarged or overactive parathyroid glands
365
MEN2: MEN2b - MTC Diagnosis
Neck US + Fine Needle Aspiration + Basal Serume Calcitonin + Carcinoembryonic Antigen
366
MEN2: MEN2b - MTC Management (Localised and Advanced Disease)
Localised - curative surgery of thyroidectomy with extent lymph node dissection Advanced - Tyrosine Kinase Inhibitors
367
VHL
Von Hippel-Lindau
368
Von Hippel-Lindau
Inherited disorder causing multiple tumours (benign and malignant) in the CNS and viscera
369
VHL: Inheritance pattern
Autosomal dominant
370
VHL: Pathophysiology
VHL gene mutation leading to an accumulation of HIF proteins and stimulation of cellular proliferation
371
VHL: Leads to the development of what?
Vascular tumours
372
VHL: Types - I Mutation
Deletion, Nonsense, Frameshift and Missense Mutations
373
VHL: Types - I Presentation
CNS or Retinal Haemangioblastoma OR Clear Cell Renal Cell Carcinoma
374
VHL: Types - II Mutation and Example
Missense Mutation Example - Tyr112His
375
VHL: Types - II Presentation
CNS and Retinal Haemangioblastoma OR Phaeochromocytoma
376
VHL: Types - III Mutations and Example
Due to missense mutations p.Arg167Gly
377
VHL: Types - III Presentation
CNS or Retinal Haemangioblastoma OR Clear Renal Cell Carcinoma OR Phaeochromocytoma
378
VHL: Types - IV Mutations and Example
Due to Missense mutations Example - p.Leu188Val
379
VHL: Types - IV Presentation
Phaeochromocytoma
380
VHL: Diagnosis - Retinal Angioma
Opthalmic examinations annually from infancy
381
VHL: Diagnosis - CNS Haemangioblastoma
MRI scan of the head every 12-36 months beginning in adolescence
382
VHL: Diagnosis - Renal Cell Carcinoma and Pancreatic Tumours
MRI or US examination of the abdomen every 12 months from 16
383
VHL: Diagnosis - Phaeochromocytoma or Paraganglioma
Blood pressure monitoring and 24-hour urine or fractionated metanephrines annually
384
VHL: Diagnosis - Families at high risk
Measure fractionated plasma metanephrines and Adrenal imaging annually rom the age of 8
385
Neurofibromatosis Type I: Pathophysiology
Mutation of the NF1 gene causing tumours along the nervous system
386
Neurofibromatosis Type I: Diagnosis
>2 of the following diagnostic factors: - >6 cafe au lait patches - Neurofibromas of any time or one flexiform neurofibroma - Axillary or inguinal freckling - Optic glioma - >2 Lisch Nodules - Distinctive osseous lesion - sphenoid dysplasia or thinning of the long bone cortex +/- pseudoarthritis - Frist degree relative with NF1
387
Neurofibromatosis Type I: Rare clinical features (3)
Scoliosis Learning difficulties Phaeochromocytoma
388
Carney Complex
Genetic disorder characterised by multiple benign tumours most often affecting the heart, skin and endocrine system with abnormalities with skin pigmentation
389
Carney Complex: Pathophysiology
PRKAR1A Mutation causing defective regulatory subunits to cause abnormal PA signalling and uncontrolled proliferation
390
Carney Complex: Clinical Presentation - Primary presentation
Pigmented nodular adrenocortical disease - adrenal glands produce excess cortisol to cause Cushing's Syndrome
391
Carney Complex: Clinical Presentation - Impact on skin
Spotty skin pigmentations - on lips, conjunctiva, inner or outer canthi or the genital mucosa
392
Carney Complex: Clinical Presentation - Myxoma of what? (3)
Cutaneous layer Mucosa Heart
393
Carney Complex: Clinical Presentation - Impact on breast
Breast Myxomatosis
394
Carney Complex: Clinical Presentation - Impact on Adrenal Glands
Primary Pigmented Nodulra Adrenocortical Disease
395
Carney Complex: Clinical Presentation - Presentation on Liddle's Test
Paradoxical Positive Response of Urinary Glucocorticosteroids to Dexamethasone Administration
396
Carney Complex: Clinical Presentation - What happens as a result of GH-producing adenoma?
Acromegaly
397
Carney Complex: Clinical Presentation - Impact on Thyroid (2)
Thyroid carcinoma Multiple hypoechoic nodules on thyroid ultrasonography of a prepubertal child
398
McCune-Albright Syndrome: Pathophysiology
Post-zygotic somatic mutation of GNAS resulting in mosaicism resulting in constitutive adenylyl cyclase signalling and overproduction of hormones
399
McCune-Albright Syndrome
Genetic disorder affecting the bone skin and endocrine systems
400
McCune-Albright Syndrome: Clinical Presentation - Skin
Cafe Au Lait Skin Pigmentation
401
McCune-Albright Syndrome: Clinical Presentation - Bones
Polyostotic Fibrous Dysplasia
402
McCune-Albright Syndrome: Clinical Presentation - Thyroid
Nodule production
403
McCune-Albright Syndrome: Clinical Presentation - Hormone disorders (3)
Precocious Puberty in females Pituitary gland GH excess Cushing's Syndrome
404
Imaging: Pituitary Gland - Found within what?
Sella turcica - bony depression of the cranium
405
Imaging: Pituitary Gland - Connected to the brain via what?
Pituitary stalk
406
Imaging: Pituitary Gland - Closely related to what sinus?
Sphenoid Sinus
407
Imaging: Pituitary Gland - Found inferior to what? (2)
Optic chiasm Hypothalamus
408
Imaging: Pituitary Gland - What is located laterally?
Carotid arteries
409
Imaging: Pituitary Gland - Well seen on what scan?
MRI
410
Imaging: Thyroid Gland - Right and left lobes connected by what?
Isthmus
411
Imaging: Thyroid Gland - Right and left lobes connected by what?
Isthmus
412
Imaging: Thyroid Gland - Deep to what?
Strap muscles of the neck
413
Imaging: Thyroid Gland - Anterior to what? (2)
Trachea Oesophagus
414
Imaging: Thyroid Gland - Medial to what? (2)
Common carotid arteries Internal jugular veins
415
Imaging: Thyroid Gland - Superior to what? (3)
Sternum Great vessels Aortic arch
416
Imaging: Thyroid Gland - Well visualised on what?
CT US
417
Imaging: Thyroid Gland - US can be combined with what other investigation for Euthyroid patients with Goitre/palpable nodules or hyperthyroid patients?
Fine needle aspiration
418
Imaging: Thyroid Gland - Thyroid Scintigraphy process
I-123 or Tc-99m used locally and injected into patients with imaging within 20 minutes
419
Imaging: Adrenal Glands - Location
Retroperitoneal Suprarenal position
420
Imaging: Adrenal Glands - Right Adrenal Gland is posterior to what?
IVC
421
Imaging: Adrenal Glands - Left Adrenal Gland lateral to what? (2)
Aorta Diaphragmatic Crus
422
Imaging: Adrenal Glands - Well visualised on what?
CT MRI
423
Pituitary Gland: Histology - Anterior lobes consist of what?
Islands with cords of cells
424
Pituitary Gland: Histology - Posterior lobes cocnst of what?
Non-myelinated axons of neurosecretory neurones
425
Pituitary Gland: Anterior Lobe Histology - Acidophil cells (2)
Somatotrophs Mammotrophs
426
Pituitary Gland: Anterior Lobe Histology - Basophil Cells (3)
Corticotrophs Thyrotrophs Gonadotrophs
427
Pituitary Gland: Anterior Lobe Histology - Somatotrophs produce what?
Growth Hormone
428
Pituitary Gland: Anterior Lobe Histology - Somatotrophs produce what?
Growth HormonePituitary Gland: Anterior Lobe Histology - Mammotrophs produce what?
429
Pituitary Gland: Anterior Lobe Histology - Corticotrophs produce what?
ACTH
430
Pituitary Gland: Anterior Lobe Histology - Thyrotrophs produce what?
TSH
431
Pituitary Gland: Anterior Lobe Histology - Gonadotrophs produce what?
FSH LH
432
Pituitary Gland: Hyperfunction - Can occur due to what? (2)
Adenoma Carcinoma
433
Pituitary Gland: Hypofunction - Can occur due to what? (8)
Iatrogenic - Surgery or Radiation Haemorrhage - in the gland or subarachnoid haemorrhage Ischaemic Necrosis Tumours extending into the sella Granulomatous inflammatory conditions Sheehan Syndrome Apoplexy Hypothalamic lesions
434
Pituitary Gland: Hypofunction - Example of Tymours in the sella
Rathke Cleft Cysts
435
Pituitary Gland: Hypofunction - Examples of Granulomatous Inflammatory Conditions (2)
Sarcoidosis Tuberculous Meningitis
436
Pituitary Gland: Hypofunction - Presentation of Apoplexy (3)
Headache Diplopia - due to pressure on CN III Hypopituitarism
437
Pituitary Gland: Hypofunction - Complications of Apoplexy
Cardiovascular collapse and loss of consciousness
438
Pituitary Gland: Hypofunction - Benign Hypothalamic lesion
Cranipharyngioma
439
Pituitary Gland: Hypofunction - Malignant lesion
Glioma
440
Pituitary Gland: Dysfunction of the Posterior Pituitary Gland - Diabetes Insipidus
Lack of ADH secretion causes dehydration
441
Pituitary Gland: Dysfunction of the Posterior Pituitary Gland - SIADH abbreviation
Syndrome of Inappropriate ADH secretion
442
Pituitary Gland: Dysfunction of the Posterior Pituitary Gland - SIADH Pathology
Ectopic secretion of ADH by tumours
443
Adrenal Glands: Aetiologies of Disease (4)
Pituitary disease - ACTH secreted from adenoma Ectopic ACTH secretion Shock of Disseminated Intravascular Coagulation Damage to adrenal tissue
444
Adrenal Glands: Causes of hyperfunction (3)
Hyperplasia Adenoma Carcinoma
445
Adrenal Glands: Acute cause of hypofunction
Waterhouse-Friderichsen
446
Adrenal Glands: Acute cause of hypofunction
Waterhouse-Friderichsen
447
Adrenal Glands: Chronic cause of hypofunction
Addison's Disease
448
Pregnancy: Ovarian Cycle - Length
28 days
449
Pregnancy: Ovarian Cycle - Day 1 event
First day of menstruation
450
Pregnancy: Ovarian Cycle - Length of menstruation
4-5 days
451
Pregnancy: Ovarian Cycle - Follicular phase
Follicle grows so the ovum produces Oestradiol and develops the egg
452
Pregnancy: Ovarian Cycle - Day 12-14
Surge in LH and FSH
453
Pregnancy: Ovarian Cycle - Day 14
Stimulated ovulation
454
Pregnancy: Ovarian Cycle - Luteal Phase
Luteum produces progesterone and oestradiol following fertilisation
455
Pregnancy: Ovarian Cycle - Implantation stimulates production of what?
HCG
456
Pregnancy: Ovarian Cycle - Placenta produces what?
hPL Placental progesterone Placental oestrogens
457
Pregnancy: Ovarian Cycle - Following delivery what does the pituitary gland produce?
Prolactin
458
Pregnancy: Human Chorionic Gonadotropin - Produced from what?
Fertilised implanted egg
459
Pregnancy: Human Placental Lactogen - Produced by what?
Placental
460
Pregnancy: Human Placental Lactogen - Function
Stimulates breast development
461
Pregnancy: Human Placental Lactogen - Impact on endocrine system
Causes Insulin resistance
462
Pregnancy: Insulin Resistance - Hormone risk factors (2)
Placental Progesterones hPL
463
Pregnancy: Insulin Resistance - Pathophysiology
Insulin acts as a co-gonadotrophin. toLH Insulin reduces Sex-Hormone Binding Globulin to increase free testosterone > hyperandrogenism
464
Pregnancy: Diabetes - Complications of Diabetes during pregnancy (6)
Congenital malformation Prematurity Intra-uterine Growth Retardation Macrosomia Polyhydramnios Intrauterine death
465
Polyhydramnios
Excess fluid around the baby
466
Pregnancy: Diabetes - Complications of Diabetes in the Neonate (4)
Respiratory distress Hypoglycaemia Hypocalcaemia CNS defects Genital or GI abnormalities
467
Pregnancy: Diabetes - Examples of CNS defect complications in Neonates (3)
Anencephaly Spina Bifida Caudal Regression Syndrome
468
Pregnancy: Diabetes - When does the foetus produce its own insulin?
Third trimester
469
Pregnancy: Diabetes Management - Folic Acid Dose
5mg - start 3 months early
470
Normal (non-DM) Folic Acid Dose
400 micrograms
471
Pregnancy: Diabetes Management - Eye check regularity
10, 20 and 30 weeks gestation due to accelerated retinopathy
472
Pregnancy: Diabetes Management - Avoid what drugs? (2)
ACEI Statins
473
Pregnancy: Diabetes Management - Use what drugs for Blood Pressure? (3)
Labetalol Nifedipine Methyl-DOPA
474
Pregnancy: Diabetes Management - Aspirin dose
150mg at week 12 in high risk pregnancies
475
Pregnancy: Diabetes Management - Type I DM
Insulin
476
Pregnancy: Diabetes Management - Type II DM
Metformin with insulin later on in the pregnancy
477
Pregnancy: Diabetes Management - How to maintain blood glucose during labour?
IV insulin and dextrose
478
Pregnancy: Gestational Diabetes Monitoring after pregnancy
Post-natal fasting glucose, HbA1c or GTT 6 weeks after birth
479
Pregnancy: Thyroid Gland - Maternal ... is important for neonatal development
Thyroxine
480
Pregnancy: Thyroid Gland - Impact on the maternal thyroid gland (3)
Increase in size Increased T4 production Plasma protein binding increases
481
Pregnancy: Thyroid Gland Hypothyroidism - If pre-existing hypothyroidism what is the management?
Increase thyroxine dose by 25 mcg as soon as pregnancy is suspected and then increase by 50% by 20 weeks
482
Pregnancy: Thyroid Gland Hypothyroidism - Pre-existing Hypothyroidism Monitoring
Check Thyroid Function Tests for the first 20 weeks then 2 monthly until full term
483
Pregnancy: Thyroid Gland Hypothyroidism - Aim for TSH for Pre-existing Hypothyoidism
<3-4 mU/L
484
Pregnancy: Thyroid Gland Hypothyroidism - Complications (6)
Increased abortion rate Pre-eclampsia Abruption Post-partum haemorrhage Preterm labour Foetal neuropsychological development
485
Pregnancy: Thyroid Gland Hypothyroidism - What hormone stimulates the thyroid gland in pregnancy?
hCG
486
Pregnancy: Thyroid Gland Hypothyroidism - hCG suppresses what and how?
TSH by increasing thyroxine
487
Pregnancy: Thyroid Gland Hypothyroidism - What is similar about hCG and TSH?
Identical alpha chain in protein
488
Pregnancy: Thyroid Gland Hypothyroidism - High hCG can mimic what?
Hyperthyroidism - shows weight loss and nausea too
489
Pregnancy: Thyroid Gland Hypothyroidism - Hyperemesis Gravidarum
Rapid increase in hCG increases free T4 and low TSH
490
Pregnancy: How does Hyperemesis Gravidarum differ from Hyperthyroidism?
Gestational Hyperemesis has: - Increased hCG causes decreased TSH - No TRab Antibody positive - Resolves by 20 weeks gestation
491
Pregnancy: Thyroid Gland Hyperthyroidism - Aetiologies (4)
Graves' Disease Toxic Multi-nodular Goitre Toxic adenoma Thyroiditis
492
Pregnancy: Thyroid Gland Hyperthyroidism - Complications (5)
Infertility Ammenorhoea Still birth Thyroid crisis in labour Transient neonatal thyrotoxicosis
493
Pregnancy: Thyroid Gland Graves' Disease - Monitoring
Check TRAB antibodies in the third trimester
494
Pregnancy: Thyroid Gland Graves' Disease - Impact on neonate
TRAb can cross the placenta to cause neonatal transient hyperthyroidism
495
Pregnancy: Thyroid Gland Hyperthyroidism - Anti-thyroid drugs for first trimester
Propylthiouracil
496
Pregnancy: Thyroid Gland Hyperthyroidism - Anti-thyroid drugs for second or third trimester
Carbimazole
497
Pregnancy: Carbimazole - Main concern
Embyropathy in third trimester
498
Pregnancy: Carbimazole - Side effects (4)
Scalp abnormalities GI abnormalities Choanal atresia Oesophageal atresia
499
Pregnancy: Propylthiouracil - Side effect
Risk of liver toxicity
500
Pregnancy: Post-Partum Thyroiditis - Clinical Presentation (3)
Small diffuse non-tender goitre Hypothyroid phases causes post-natal depression Exacerbates all autoimmune disease
501
Thyrotropin-Releasing Hormone: What stimulates release?
Exposure to the cold
502
Thyrotropin-Releasing Hormone: Exposure to the cold starts pathway how?
Signals to the hypothalamus to stimulate the release of TRH
503
Thyrotropin-Releasing Hormone: TRH stimulates what structure and what function?
Anterior pituitary gland to releases Thyrotropin (TSH)
504
Thyrotropin-Releasing Hormone: TSH has what function?
Stimulates the thyroid to release Thyroxine
505
Thyrotropin-Releasing Hormone: Negative Feedback loop of this feedback loop
Thyroxine inhibits the anterior pituitary
506
Gonadotropin Releasing Hormone: Hypothalamus secretes what hormone?
Gonadotropin Releasing Hormone
507
Gonadotropin Releasing Hormone: Acts on What organ?
Pituitary gland
508
Gonadotropin Releasing Hormone: GnRH acts on the pituitary gland to have what action?
LH FSH
509
Gonadotropin Releasing Hormone: LH and FSH acts on testes to do what?
Produce Testosterone
510
Gonadotropin Releasing Hormone: LH and FSH act on the ovaries to do what?
Produce Oestrogen and Progesterone
511
Gonadotropin Releasing Hormone: Testosterone acts on what?
Muscle Bone Libido Penis Hair follicles
512
Gonadotropin Releasing Hormone: Oestrogen and Progesterone act on what?
Bone Fat Vagina Heart Liver
513
Corticotrophin Releasing Hormone: Where is this secreted from?
Hypothalamus
514
Corticotrophin Releasing Hormone: Acts on what organ to do what?
Pituitary gland - to secrete ACTH
515
Corticotrophin Releasing Hormone: ACTH acts on what to do what?
Adrenal glands to secrete cortisol
516
Corticotrophin Releasing Hormone: End effects of cortisol (4)
Regulates glucose levels Increase body fat Helps defend the body against infection Response to stress
517
Function of Dopamine in the HPA axis
Inhibitory effect on the Anterior Pituitary Gland to inhibit prolactin release
518
Hormones: Steroid hormone Pair
ACTH Cortisol
519
Hormones: Thyroid Hormone Pair
TSH Thyroxine
520
Hormones: Sex Hormone Pair
LH/FSH Testosterone or Oestradiol
521
Hormones: Grwoth Hormone Pair
Growth Hormone IGF--1
522
Stimulation Tests: Synacthen Test process
Synthetic ACTH is administered and cortisol is measured at 0, 30, 60 minutes
523
Stimulation Tests: Synacthen test normal result
Cortisol reaches by 150 to reach 500
524
Stimulation Tests: Insulin Stress Test or Prolonged Glucagon Test process
Cortisol and Growth Hormone to Insulin tested every 30 minutes for 2-3 hours
525
Stimulation Tests: Insulin Stress Test Normal cortisol level
>500
526
Stimulation Tests: Insulin Stress Test Normal GH
>7 ug/L
527
Calcium Metabolism: What organ is involved in this?
Parathyroid Glands
528
Calcium Metabolism: What receptor type is used to sense Calcium?
G protein coupled receptor
529
Calcium Metabolism: Increased calcium activates the receptor to have what effect?
Inhibit PTH secretion
530
Infertility
Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse in a couple who have never had a child
531
Primary Infertility
Couple have never conceived
532
Secondary Infertility
The couple have previously conceived - however the pregnancy was not successful e.g. miscarriage or ectopic pregnancy
533
Infertility: What increases the chance of conception? (8)
Woman <30 years Previous Pregnancy Less than 3 years trying to conceive Intercourse occurring around ovulation Woman BMI - 18.5-30 Both partners are non-smokers Caffeine uptake <2 cups per day No use of recreational drugs
534
Infertility: Aetiologies (5)
Tubal disease Fibroids Endometriosis or Adenomyosis Weight-related Age-related
535
Female Investigations of Infertility: Bloods to test for what?
Rubella
536
Female Investigations of Infertility: Mid-luteal progesterone level measured when?
Day 21 of 28 day cycle or 7 days prior to expected period in prolonged cycles
537
Female Investigations of Infertility: Progesterone level that is suggestive of ovulation
>30 nmol/L
538
Female Investigations of Infertility: What tests can be conducted for tubal pregnancy? (3)
Hysterosalpingiogram Hycosy Laparoscopy
539
Female Investigations of Infertility: When is laparoscopy contraindicated?
If there is no known risk factors
540
Female Investigations of Infertility: Hysteroscopy conducted when?
If there is suspected or known endometrial pathology - Uterine Septum Adhesions or Polyp
541
Female Investigations of Infertility: When is a pelvic ultrasound performed?
Abnormality on pelvic examination e.g. enlarged uterus or adnexal mass
542
Female Investigations of Infertility: What should be tested if anovulatory cycle or infrequent periods (7)
Urine hCG Prolactin TSH Testosterone and SHBG LH FSH Oestradiol
543
Female Investigations of Infertility: What should be tested if hirsuitism is present? (2)
Testosterone SHBG
544
Female Investigations of Infertility: What should be tested if amenorrhoea is present? (2)
Endocrine profile Chromosome analysis
545
Male Investigations of Infertility: Semen analysis frequency of testing
Twice over 6 weeks apart
546
Male Investigations of Infertility: Normal semen volume
>1.5 mL
547
Male Investigations of Infertility: Normal semen pH
7.2-7.8
548
Male Investigations of Infertility: If abnormal semen what should be tested? (4)
LH FSH Testosterone Prolactin Thyroid function
549
Male Investigations of Infertility: If severely abnormal semen analysis or azoospermic what should be tested? (4)
Endocrine profile Chromosome analysis and Y chromosome deletion analysis Screen for Cystic Fibrosis Testicular biopsy
550
Male Investigations of Infertility: What should be conducted if there is abnormality on genital examination?
Scrotal ultrasound
551
Infertility: Management - Folic Acid dose
400 micrograms daily before pregnancy and within first 12 weeks 5mg a day for women planning pregnancy
552
Infertility: Management - Use 5mg of folic acid if in the early stages what presents? (4)
Neural tube defect Previous baby with neural tube defect Family history of neural tube defects Diabetes
553
Infertility: Management - Vitamin D
10 micrograms per day for pregnancy and lactating women or those at risk of Vitamin D deficiency
554
Rubella
Group of physical abnormalities that have developed in an infant as a result of maternal infection and subsequent foetal infection with rubella virus
555
Rubella: Clinical Presentation (6)
Rash at birth Low birth weight Microcephaly Cataracts Patent Ductus Arteriosus Bulging Fontanelle
556
Rubella: What antibody count suggests non-immune?
<6U/L of Rubella IgG Antibodies
557
Rubella: Prevention
MMR Vaccine
558
Chlamydia Positive Management
Immediate Azithromycin 1 gram (if allergic to Macrolides - Doxycycline 100mg twice per day for 7 days
559
Sex Steroid Axis: Pituitary Gland secretes what two gonadotropic hormones? (2)
FSH - Follcile Stimulating Hormone LH - Luteinizing Hormone
560
Sex Steroid Axis: FSH Function in Men
Causes the testes to initiate spermatogenesis
561
Sex Steroid Axis: FSH Function in Women
Causes the initiation of oogenesis, stimulating the ovaries to secrete oestrogen
562
Sex Steroid Axis: LH Function in Men
Causes the testes to secrete testosterone
563
Sex Steroid Axis: LH Function in Women
Causes ovulation and progesterone production by the corpus luteum
564
Sex Steroid Axis: GnRH function
Enables the release of FSH and LH from the anterior pituitary gland
565
Sex Steroid Axis: High GnRH frequency release has what impact?
LH pulses
566
Sex Steroid Axis: Low GnRH frequency release has what impact?
FSH pulses
567
Sex Steroid Axis: Structure of GnRH
Neuropeptide hormone
568
Sex Steroid Axis: GnRH release in males
Constant frequency
569
Sex Steroid Axis: GnRH release in females
Pulses are at a frequency dependent on the stage of the menstrual cycle
570
Sex Steroid Axis: Early follicular stage GnRH pulse rate
Every 1-2 hours
571
Sex Steroid Axis: Luteal stage GnRH pulse rate
Every 4 hours
572
Sex Steroid Axis: Impact of oestrogen on GnRH release?
Oestrogen concentrations above the threshold increased HnRH pulsatility to release LH
573
Sex Steroid Axis: Impact of progesterone on GnRH release?
Reduced GnRH pulsatility
574
Sex Steroid Axis: Kisspeptin has what function?
Regulates GnRH pulsatility as has receptors for Oestrogen and Progesterone
575
Female Reproduction: Follicular/Proliferative Phase characterised by what?
Follicular growth
576
Female Reproduction: Luteal/Secretory Phase characterised by what?
Bleeding for <7 days
577
Oligomenorrhoea
Infrequent periods - cycles of >42 days or <8 periods per year
578
Amenorrhoea
Absence of menstruation
579
Female Reproduction: Hormones - FSH function
Stimulates the thickening of the endometrium and the growth of ovarian follicles to increase oestrogen
580
Female Reproduction: Hormones - Oestrogen function
Negative feedback on the hypothalamus and pituitary gland to lower FSH
581
Female Reproduction: Hormones - Oestrogen reaching the threshold has what impact?
Positive feedback to increase FSH and LH surge
582
Female Reproduction: Hormones - Function of LH surge
Ovulation and regulation of the formation of the corpus luteum and formation of progesterone
583
Female Reproduction: Hormones - Influence of increased progesterone
Decreases LH secretion
584
Female Reproduction: Hormones - What 3 messenger proteins outside of the HPO axis also influence the axis?
Activins Inhibins Follistatin
585
Female Reproduction: Spinnbarkeit
Formation of a thread by mucus from the carvix uteri when spread onto a glass slide and drawn out onto a cover glass
586
Female Reproduction: Oestrogen - Secreted from where? (3)
Ovarian follicles Adrenal cortex Placenta - during pregnancy
587
Female Reproduction: Oestrogen - function
Fertile cervical mucus production and thickening of the endometrium
588
Female Reproduction: Oestrogen - Sustained high oestrogen mid-cycle stimulates what?
Secretion of LH and FSH
589
Female Reproduction: Progesterone - Secreted from where?
Corpeus luteum Placenta - during pregnancy
590
Female Reproduction: Progesterone - Functions (4)
Inhibits LH secretion Maintains the thickness of the endometrium Thermogenic effect to increase basal body temperature Relaxes smooth muscles
591
Female Reproduction: What does the follicle structure consists of?
Oocyte surrounded by follicular cells - granulosa and theca cells
592
Female Reproduction: Endometrium thickens under the influence of what?
Oestrogen
593
Female Reproduction: Endometrium becomes a secretory tissue under the infleunce of what?
Progesterone
594
Female Reproduction: Follicular growth - Once a follicle becomes a certain size it becomes dependent on what?
Gonadotrophins
595
Female Reproduction: Follicular growth - Follicles are lost if they don't coincide with what?
Rise in FSH during the early follicular phase
596
Female Reproduction: Follicular growth - Which follicle will survive?
One with the most FSH receptors and high vascularity
597
Female Reproduction: LH Surge - Can help predict what?
Ovulation
598
Female Reproduction: LH Surge - LH surge precedes ovulation by what?
34-36 hours
599
Female Reproduction: LH Surge - Threshold of oestrogen required for LH surge
200 pg/mL
600
Female Reproduction: Corpus Luteum - Formation occurs under the influence of what?
LH
601
Female Reproduction: Corpus Luteum - Original cell types (2)
Granulosa cells Theca cells
602
Female Reproduction: Corpus Luteum - Final cell type
Luteal cells
603
Female Reproduction: Corpus Luteum - Formation increases the production of what hormone?
Progesterone
604
Female Reproduction: Corpus Luteum - LH role in the formation of the corpeus luteum (2)
Angiogenesis ensures efficient delivery of cholesterol for progesterone synthesis Stimulates enzymes involved in the conversion of cholesterol to form progesterone
605
Female Reproduction: Corpus Luteum - LH role in the formation of the corpeus luteum (2)
Angiogenesis ensures efficient delivery of cholesterol for progesterone synthesis Stimulates enzymes involved in the conversion of cholesterol to form progesterone
606
The Cervix: Stroma
Collagen matrix and fibroblasts that regulate the rigidity of the cervical wall
607
The Cervix: Structure of the Cervix epithelium
Columnar epithelial cells
608
The Cervix: Ability for sperm to penetrate the mucus is determined by what? (4)
Thickness of the mucus - hydration of cervical mucus under hormonal control Motility of sperm Interactions with ROS Interactions with mucins
609
The Cervix: Mucus is thinner where?
Cervical canal
610
The Cervix: Mucus is thicker where?
Secondary grooves
611
Male Reproductive Tract: How long is the spermatogenesis process?
70 day process
612
Male Reproductive Tract: Spermatogenesis - Occurs within the testes under the control of what?
LH FSH Testosterone
613
Male Reproductive Tract: Spermatogenesis - LH stimulates production of what and where?
Testosterone in Leydig Cells
614
Male Reproductive Tract: Spermatogenesis - What is the only cell in the testis to present FSH hormone receptor?
Sertoli Cells
615
Male Reproductive Tract: Spermatogenesis - FSH of Sertoli Cells has what function? (2)
Production of Androgen Binding Proteins Maintains the Blood-Testis Barrier
616
Male Reproductive Tract: Testes - Mammalian testes consist of what?
Seminiferous tubules surrounded by interstitial tissue
617
Male Reproductive Tract: Testes - What cells are present? (5)
Leydig cells Leukocytes Fibroblasts Sertoli cells Germ cells
618
Male Hormones: Endocrine Factors (2)
LH FSH
619
Male Hormones: Paracrine Factors (2)
Testosterone Inhibin
620
Male Hormones: Testosterone - Mostly taken up by what?
Sertoli cells
621
Male Hormones: Testosterone - Majority binds to what in circulation? (2)
Sex-Hormone Binding Globulin Albumin
622
Male Hormones: Testosterone - Converted to what highly active form?
Dihydrotestosterone
623
Male Hormones: Testosterone - Function in Spermatogenesis (2)
Maintains the integrity of the blood-testes barrier Release of mature spermatozoa from Sertoli Cells by influencing peritubular myoid cells
624
Male Hormones: Dihydrotestosterone - Acts on (5)
External genitalia Sebum production Prostate development and growth Skin Hair follicles
625
Anti-Diuretic Hormone: Function
Water balance
626
Anti-Diuretic Hormone: Source
Posterior Pituitary Gland
627
Anti-Diuretic Hormone: Increased ADH has what impact?
Small volume of concentrated urine with high osmolarity
628
Anti-Diuretic Hormone: Decreased ADH has what impact?
Large volume of dilute urine with low osmolarity
629
Anti-Diuretic Hormone: Mechanism of action
Increases water reabsorption from the renal tubules
630
Sodium balance is controlled by what?
Steroid Hormones from the adrenal glands
631
Mineralocorticoid activity refers to what?
Na+ reabsorption in renal tubules in exchange for Potassium and Hydrogen Ions
632
Steroids with Mineralocorticoid Activity? (2)
Aldosterone Cortisol
633
Excess mineralocorticoid activity has what impact on Sodium levels?
Increase
634
Anti-Diuretic Hormone: Mineralocorticoid deficiency has what impact on sodium levels?
Loss
635
Water and Sodium Balance: Reference Interval
135-145 mmol/L
636
Water and Sodium Balance: How is this measured?
mmol of Na+/1L of water
637
Water and Sodium Balance: Sodium is confined to where?
Extracellular fluid
638
Hyponatraemia: Due to what? (2)
Increased sodium loss Decreased intake of sodium
639
Hyponatraemia: Increased loss of sodium can occur where? (4)
Adrenals Kidneys Gut Skin
640
Hyponatraemia: Clinical presentation (2)
Decreased excretion of water Compulsive water drinking
641
Hyponatraemia: Management (2)
Increased sodium loss Fluid restriction
642
Hyponatraemia: Addison's Disease - How does this lead to Hyponatraemia?
Adrenal insufficiency causes causes a reduction in steroid production meaning the kidneys cannot retain sodium
643
Hyponatraemia: Addison's Disease - Symptoms (2)
Dizziness Excess pigmentation
644
Hyponatraemia: Addison's Disease - Dizziness occurs why?
Hypotension due to reduced ECF volume
645
Hyponatraemia: Addison's Disease - Excess pigmentation occurs why?
Excess ACTH from the pituitary gland contains MSH which is exposed due to protease activity
646
Hypernatraemia: When can excess Sodium intake occur? (2)
IV medications When near drowning
647
Hypernatraemia: Results in what symptoms? (2)
Water Loss - like DI Decreased water intake
648
Hypernatraemia: Management (2)
Loop diuretic - increase sodium concentration AS dextrose - not enough water
649
Oedema: Body reacts to oedema how?
Acts as if in dehydrated state - ADH and Aldosterone secreted in an attempt to restore water volume
650
Oedema: Management for an adenomatous patient with too much water and sodium?
Loop diuretics - to break the cycle
651
Ovulation: Regular cycles have a mid luteal serum progesterone of what?
>30 nmol/L

The Endocrine System (5 decks)

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