Quiz 2 Flashcards
How long would you wait to see results of a allergy skin test?
20 - 30 min
What mutation exists in Dubin-Johnson Syndrome?
Multidrug Resistance Associated Protein 2 (MRP2)
What modulates Na absorption and K secretion in the colon?
Aldosterone
What protein binds copper to enter circulation?
Ceruloplasmin
What does long-chain free fatty acid Palmitate bind on adipocytes, causing inflammation?
TLR-4
Both Zollinger-Ellison Syndrome and Duodenal Ulcers are caused by beefed up parietal cells juiced up on gastrin. What distinguishes the two disorders?
Zollinger-Ellison: Caused by Pancreatic Tumor
Duodenal Ulcer: Caused by food ingestion response
Somatostatin decreases gastric H+ by stimulating Gi and inhibiting two kinds of cells. What are they?
ECL cells (histamine) G cells` (gastrin)
What does the male membranous urethra pass through?
Urogenital Diaphragm
What does NABQ1 do?
Free-Radical Peroxidizing / Damage to the Liver
How does Cholera increase Cl- Secretion?
increased cAMP secretion
What does cholesterol ester hydrolase do?
Catalyzes production of free cholesterol
Hydrolyzes TAGS into glycerol
Where is glucagon stored?
Dense Granules of a-cells
What are bile acids and bile salts synthesized from?
Hepatic Choleterol
What is the difference between a bile salt and a bile acid?
A bile acid is protonated
What is the downstream pathway of the H2 receptor?
Uses Gs to simulate cAMP to make H+
What is the significance of the North-South gradient of DMI?
It may be linked to Vitamin D deficiency (and wheat gluten, just didnt want to make another card)
Why can C Peptide be a marker for Endogenous Insulin Secretion?
Its cleaved and packaged alongside Pro-Insulin, and those two are equally released together in the blood
What supplies blood to the vascular smooth muscle of the dick?
Helicine As
Where is sperm mainly stored?
Epididymis
What two cytokines do Th1 cells release in DMI, and what do they do (leading to b-cell destruction)?
IFN-y: Activates Macrophages
IL-2: Activation of Auto-Ag specific CD8 T Cells
What are the lateral boundaries of the perineum?
Ischiopubic Rami
Sacrotuberous Ligaments
What effect does interruption of enterohepatic circulation have on bile?
Increases synthesis (up to 10x)
What do Prostaglandins act on to decrease H+ secretion in the stomach?
Inhibit ECL cells (histamine)
Stimulate Gi
What two effects do mutations in the CFTR gene have that cause Cystic Fibrosis?
Disrupts Cl- channel on the apical pancreatic duct cells
Loss of HCO3- secretion (may lead to pancreatitis)
Amylin is released with Insulin. What hormone does it inhibit?
NPY - amylin suppresses hunger
Which urethral mal-development has it running along the top vs the bottom of the dick?
Top: Hypospadias
Bottom: Epispadias
What three TH-2 Derived cytokines are associated with food allergy?
IL-4
IL-13
IL-9
What four structures do the external pudendal a. branches supply?
Dorsal: Penis / Clitoris
Perineal: Scrotum / L. Minora
Which salivary glad is exclusively serous?
Parotid
What urine lab value is elevated in rotors but normal in Dubin-Johnson?
Total Coproporphyrin
POMC releases something to initiate the Anorexigenic pathway of food intake regulation. What is it and what does it bind?
a-MSH to bind MCR-4 (mutations linked to obesity)
What ordinarily stops NABQ1 from damaging the liver?
Glutathione
Where do the ejaculatory ducts open into within the prostatic urethra?
Seminal Colliculus
What two deficiencies can make you 46XY DSD, and how does it present?
Female Phenotype with male testes
17b-Hyodroxy (androstenedione to T)
5a-Reductase (T to DHT)
What products are released in response to C3a in peanut allergies?
PAF and Histamine
From Macrophages, basophils, mast cells
What enzyme is inhibited by bile salts, resulting in negative feedback on bile synthesis?
Cholesterol 7a-hydroxylase
What two things does the liver have and what two things does the liver lack to increase access to the blood?
Has: Fenestrations, Gap Junctions
Lacks: BM, Tight Junctions
Where does Atropine act in the production of saliva?
Blocks parasympathetics post-synapse.
Decreases Saliva Production
What structural feature of ductal cells makes saliva more hypotonic as it travels down the duct?
They are H2O Impermeable
What acts on the Y4R receptor to decrease food intake?
Pancreatic Peptide (PP)
What is the acronym for the female superficial perineal space contents?
S C G B B I
What are the two main differences in the male reproductive tract from the female?
It has a continuous lumen all the way to the end
It connects to the distal urinary tract
Prostaglandin E2 is a mast cell mediator. What does it do?
Pain and Vascular Permeability
What do chief cells secrete?
Pepsinogen
What happens if theres a Defect in CTLA-4 expression on Tregs and activated T cells?
Cant down-regulate the immune response / maintain tolerance as well
Asthma is more common in DMI patients. What is their common pathway?
Dysregulation of Tregs (loss of FOXP3 expression)
What effect do Gastrinomas have on gastrin secretion?
Paradoxically, it causes secretin to INCREASE gastrin
Which transaminase level is more sensitive?
ALT (cytosolic)
What ingredients would you use to make gallstones?
Take bile and super-saturate it with cholesterol
What does MRP2 do?
Transports Bilirubin out of liver cells and into bile (see Dubin-Johnson)
What three peptides favor insulin release?
ACh, CCK, GLP-1
What three things stimulate what three receptors to make gastric H+?
ACh: M3 Receptor
Gastrin: CCKb Receptor
Histamine: H2 Receptor
NB! What is the primary tool for assessing immediate hypersensitivity reactions?
History
Primary bile salts go into the duodenum to emulsify fats, or can be deconjugated and dehydroylated into primary and secondary bile acids. What are these secondary bile acids and their derivatives?
Deoxycholic Acid (from Cholic acids) Lithocholic Acid (from chenodeoxycholic acids)
What do LPL and HSL fail to do in obesity related insulin resistance?
LPL: Adipose Tissue Uptake
HSL: Lipolysis
What would you expect Leptin levels to be like in obese humans?
High (upregulated from failure to respond to it)
What does AIRE do to protect against DMI development?
Presents insulin to developing T cells in the thymus
What releases Leptin?
Adipose Tissue
What is the mechanism behind possible Type IV hypersensitivity responses to food?
Activation of allergen-specific T Cells
What transports Glucose, Galactose, and Fructose from the cell into the blood?
Each have their own GLUT2
What would you do to get rid of HCl secretion caused by taste / smell / mastication?
Vagotomy
What oxidizes acetaminophen into NABQ1?
CYP3A4
What do the remnants of the cloacal membrane form?
Glans Plate
What effect do Insulin and Leptin have on appetite?
Inhibits NPY (therefore preventing hunger) Stimulates POMC (dont eat)
What is the downstream pathway of the M3 and CCKb receptors?
Uses Gq to stimulate IP3 / Ca++ to make H+
What is the embryonic derivative of the Seminal Vesicle?
Buds from Mesonephric Duct
What final products do taurine and glycine turn into during cholic acid conjugation, respectively?
Taurine to Taurocholic Acid (pKa 2)
Glycine to Glycocholic Acid (pKa 4)
What two muscles are cut through in an episiotomy?
Bulbospongiosus m.
Superficial Transverse Perineus m.
Somatostatin inhibits ECL and G cells, but what regulates it?
Vagal activation and H+ Inhibits it
Gastrin Stimulates it
What transplantation did we talk about that can match human islet cells’ insulin release?
HEK-B
What is the main mechanism of protein uptake by the microvilli?
Pinocytosis
What does Histamine potentiate?
ACh and Gastrin
What enzyme in the liver merits the release of free glucose?
Glucose 6 Phosphate (G6P)
What is the procedure of choice for cholelithiasis?
Ultrasonography
What brings Free Iron and Hb together to form Transferrin?
Apotransferrin
NB! What is the fate of T and B cells in Peyers Patches following activation by DCs?
Bail through efferent lymph and enter bloodstream
What is the embryonic derivative of the Prostate Gland?
Buds from Endoderm of urogenital sinus, in the pelvic urethra region
What down regulates the Insulin Receptor
Insulin itself! Auto-phosphorylation when bound
HLAII that lack what are found among DMI patients?
Beta Chain Asp57
Why is Type 1 Crigler-Najjar worse?
No UDP-GT function at all
Kernicterus: Brain damage from all that unconjugated bilirubin in the brain
Muscle Contraction stimulates insulin uptake. How?
Activates AMPK for GLUT4 translocation to the plasma membrane
Paneth cells are stimulated by MAMPS. What do they secrete?
Defensins
What does the hydrophobic vs hydrophilic surfaces of bile salts associate with for emulsification of fats?
Hydrophobic: TAG
Hydrophilic: Lipase
In SMA syndrome, what is it compressing?
3rd part of duodenum, between aorta and SMA
Sometimes Test needs to be converted to DHT in target tissues to become active. What enzyme does this?
5a-Reductase
What two muscles make up the Levator Ani?
Iliococcygeus and Pubococcygeus
What two things do Sertoli Cell Secretions do?
Secrete nutrients to the sperm
Secrete transport fluid for transport from seminiferous tubules to the epididymis
What type of immune response do short chain fatty acids support
IgA (peaceful)
What are the three parts of the vulva?
Labia Majora and Minora
Clitoris
The secondary exposure response to IgE mediated immune response to food allergy is characterized by vasoactive amines, cyto/chemokines, and lipids. What initiates their release?
Cross-linking, leading to mast cell degranulation
What potentiates cAMP in ductal cells, leading to the release of aqueous secretion in the exocrine pancreas?
ACh and CCK
Why is plasma K usually normal in DMI patients despite it all shifting out of the cells?
Polyuria and dehydration wash it out
What are the bile acids, from most abundant to least abundant?
Cholic, Chenodeoxycholic, deoxycholic, lithocholic
What does the Growth Hormone Secretagogue Receptor (GHSR) bind?
Ghrelin
Whats in pancreatic juice?
HCO3- to neutralize acid from the stomach
Digestive enzymes
What stage in development can Low T give you Eunuchoidism?
Puberty. It means you look more pre-pubescent
What does inhibin inhibit?
FSH (negative self-feedback of sertoli cells)
What is the product of the committed step of Bile Acid Synthesis?
7a - Hydroxycholesterol
Viruses can use direct cytotoxicity and molecular mimicry to destroy b-cells. What two compounds from streptomycin are toxic to these b-cells?
Streptozocin
bafilomycin A1
Where is the insulin gene located?
Chr 11 IDDM2
Which pancreatic cells can communicate with each other via gap junctions?
a-a, b-b, a-b
What does NO do that leads to vascular smooth muscle relaxation for a boner?
Activates Guanylyl Cyclase, leading to more cGMP, leading to less intracellular Ca++
Histamine is a mast cell mediator. What does it do?
Contracts Smooth Muscle
Vascular Permeability
What does hyaluronic acid do that the sperm needs to depolymerize it so badly?
Holds the ovarian granulosa cells together
Where is albumin made?
Exclusively in the liver: reduced in liver damage
Dubin-Johnson, Rotor, and Biliary tree obstructions are conjugated jaundice disorders. Where in the pathway are these dysfunctions?
D-J and Rotor Syndromes: X Secretion to Bile
Biliary Tree obstruction: Passage of bile
What two things mediate Diarrhea response to allergen exposure?
PAF
Serotonin
What is the final protein that synthesizes gastric H+, also inhibited by Omeprazole?
H+ - K+ ATPase
What physical exam finding is seen in wilson’s disease, and rarely anything else?
Kayser-Fleischer Rings
What cells produce the original isotonic, plasma-like solution that is primary saliva?
Acinar Cells
What three Islet Cell Auto-Abs appear months-years prior to DMI metabolic changes?
GAD65
IA-2
IAA
What is co-transported with each amino acid type from the gut lumen into the cell?
Na
H+ is cotransported with di/tripeptides
In saliva secretion, there is a net absorption of solute (making it hypotonic, compared to plasma). What are the three exchangers on the luminal side used to facilitate this?
Na / H
Cl / HCO3
H / K
What is release alongside macrophage activation in DMI?
IL-1
TNF-a
What mutation causes inadequate hepatic copper secretion in wilson’s disease?
ATP7B
What muscle covers the clitoris?
Ischiocavernosus
Which DM has ketosis at onset, and has less association with family history?
DMI
What antibodies are developed in Celica Sprue?
Gliadin
What results from the fusion of the paramesonephric ducts and the parts that remain unfused?
Fused parts become the uterus
Unfused become uterine tubes
What do G cells secrete?
Gastrin (to circulation)
Gluten is rich in glutamine and another amino acid residue, which is poorly digested due to lack of propyl endopeptidases. What other amino acid is this?
Proline
What Protein does Calcium and Vitamin D need to get across the small intestine?
Calbindin D - 28K
What three cytokines polarize and maintain the Th1 response in Celiac Disease?
IL-18
IFN-y
IL-21
Why is H2O important in gastric juice?
Its a medium for HCl and enzyme action
it makes ingested material soluble
What anatomical structure is formed by Sertoli cells’ tight junctions, interspersed with Germ cells?
Seminiferous Tubule
What does cholestyramine do?
Increases bile acid excretion.
This is a non-absorbable bile-acid resin
What hallmark of Cystic Fibrosis causes inability to move enzymes from ducts and chronic pancreatitis?
Loss of HCO3- secretion
What liver function can cause brain damage if it is impaired?
Clearance of ammonia
How long after exposure to cow milk would you expect to find a non-IgE reaction?
up to 48 Hours
What does Ketoacidosis and Hyperglycemia do in the kidney?
Causes Polyuria, volume depletion, and therefore polydipsia
What muscle can tear in childbirth, possibly leading to incontinence?
Pubococcygeus
What do delta cells secrete?
Somatostatin
What gives parasympathetics to the exocrine pancreas?
Vagus N (pre-ganglionic synapse in ENS)
What is the first test you should do if you suspect celiac disease in a patient?
IgA antibody to transglutaminase (tTG)
NB! no longer anti-gliadin Ab test b/c it sucks
What stage of development would cause low T to give you cryptorchidism and a micropenis?
3rd trimester of pregnancy
What is the only essential stomach secretion?
Intrinsic Factor
What is released in response to Ghrelin being secreted by stomach endocrine cells?
Neuropeptide Y
How do oyou get Atrophic Gastritis?
Chronic stomach inflammation leading to loss of parietal cells
What is the modality of choice for imagineer the bile duct and pancreatic duct?
Endoscopic Retrograde Cholangiopancreatography (ERCP)
What Na Cotransporter moves both Glucose and Galacotse from the Lumen into the cell?
SGLT1
What does coffee do to HCl secretion?
Increases it via the Gastric Phase
To initiate puberty, how would you administer a GnRH analogue so that downstream hormones are secreted?
Pulsatile (long-acting prevents putberty)
g6p gets oxidized during insulin release, promoting ATP generation. What is the significance of this?
It closes the K+ channels so that Ca++ channels can open and let it inside to mobilize the vesicles
What activates Pepsinogen to Pepsin, allowing for protein degradation?
HCl (H+, really)
What causes the symptoms of Tropical Sprue?
Reduced Microvilli Surface (Folate and B12 deficient)
What two anorectic hormones do L cells release?
PYY
Oxynomodulin
What are the two different somatic support cells?
Male: Sertoli
Female: Follicle
What is the passive feedback mechanism of HCl secretion?
Lower pH means Less Gastrin means Stop Lowering the pH!
What assimilation disorder would you find AA in the feces?
Cystinuria
What do Th2 cells release in DMI, and what does it do (leading to b-cell destruction)?
Il-4: Activates B Cells to make Islet auto-Abs and AntiGAD65 Abs
Suppressed by Th1 expression
What causes the grossly black liver in Dubin-Johnson Syndrome?
Impaired excretion of epinephrine metabolites
Peanut allergies can induce IgE activation of Mast Cells via cross linking of what receptor?
FceRI
What does CCK act on, that facilitates enzyme release from the exocrine pancreas?
IP3 and Ca++, potentiated by ACh
What final products do taurine and glycine turn into during chenodeoxycholic acid conjugation, respectively?
Taurine to Taurochenodeoxycholic Acid
Glycine to Glycochenodeoxycholic Acid
What would you expect to accumulate in response to Acetate buildup in the gut?
IL-10 (from Tregs)
What are the two final products of Bile Acid Synthesis?
Cholic Acid
Chenodeoxycholic Acid
What insulin gene alleles are at higher risk for DMI?
Class I
What lifestyle factor enhances Gilbert’s symptoms?
Fasting
The Internal pudendal a. supplies all perineal structures. What does it branch from and go through?
Internal Iliac a. through the greater and lesser sciatic foramina
What is the difference in UGT1A1 mutations between Type I and II C-N syndrome
I: totally absent or unexpressed
II: coding region defective / lessa active
What is the rate limiting step of testosterone synthesis, and what catalyzes it?
Conversion of Cholesterol to Pregenenolone
P450 Side Chain Cleavage Enzyme
What would you expect to accumulate in response to PSA buildup in the gut?
IL-10 and TGF-b (from Tregs)
What nerve plexus is implicated in male impotence?
Prostatic
What does cAMP do in acing or ductal cells?
Decreases Saliva Production
Protein metabolism in the liver is responsible for the synthesis of almost all plasma protein. In this context, what can liver failure result in?
Hypoalbuminemia, leading to edema
What is the satiety center of the brain?
Ventromedial Hypothalamic Nucleus
What is unique about gastric ulcers compared to duodenal, or Zollinger-Ellison?
Decreased H+ Secretion, its just damage to the protective layer
What liver function causes encephalopathy when it fails?
Urea cycle metabolism: ammonia the crosses BBB
What gene is expressed in the absence of SRY?
WNT-4
IL-5 is a mast cell mediator. What does it do?
Sputum Eosinophils
What is the one way out of the liver for blood?
IVC
What is Type I herpersensitivity characterized by?
Development of IgE against food allergens (measured in skin or serum)
What lies directly behind the female bladder?
Uterine Cervix and Vagina
What tonicity is the adsorbate of electrolytes in the small intestine?
Isosmotic
What does phenobarbital do?
aids in the conjugation of bilirubin in C-N type 2
What property of defensins allow them to make pores in microbes while protecting the lining of the gut?
They are Amphipathic
How is testosterone concentrated in the seminiferous tubules?
Binding Androgen-Binding Protein (ABP)
Where can you find 7a - Hydroxylase?
Hepatocyte ER
What 6 things damage the GI mucosa?
NSAIDs
H and Pepsin
H Pylori
Stress, Smoking, Alcohol
What does a colon look like in the case of ulcerative colitis?
Lead Pipe: No Haustra
What is the circular path of bile salts in the GI tract?
Ilium to liver to duodenum
Where would you find a healthy D-xylose test vs an unhealthy D-xylose test?
Healthy: in the urine
Malabsorption: in the feces
The gallbladder needs to contract and the sphincter of oddi needs to contract so that bile salts can be delivered to the liver. What induces this?
CCK
What lines the plate exposed by rupture of the cloacal membrane?
Endoderm (this is th urogenital plate)
What auto-Ab is specifically associated with Celiac Disease?
Tissue Transglutaminase 2 (TG2)
What do ductal cells do?
Modify the initial saliva into hypotonic final saliva
Which appetite hormone acts exclusively on Vagal Afferents, and which acts exclusively on the hypothalamus, as opposed to both?
Vagal Afferents: CCK
Hypothalamus: Insulin
Why does consuming citrus stuff increase plasma drug levels?
Inhibits CYP
What gene suppresses Sox9?
FOXL2
What molecules are the main genetic predisposing factor of celiac disease?
HLA-DQ2.5 and DQ8 (virtually excluded if DQ2 and 8 aren’t present)
What are the Para- and Mesonephric Ducts formed from?
Intermediate Mesoderm of urogenital ridge
Which parts of the Broad Ligament are attached to What?
Mesometrium: Uterus
Mesovarium: Ovary
Mesosalpinx: Uterine Tube
What cascade causes the Mullarian duct to recede in males?
SRY’s Sox9 gene releases Anti-Mullerian Hormone
What enzyme do you need to send H+ into the stomach and HCO3- into the blood?
Carbonic Anhyhdrase
Where does the Milky Aqueous semen fluid come from?
Prostate Gland. Rich in Citrate, Calcium, Enzymes
What is the classical skeletal muscle impairment seen in obesity induced insulin resistance?
Decreased GLUT-4 Uptake of glucose in response to insulin
What is the order of blood flow through the islets of langerhans?
Center first (for insulin) to periphery (carrying insulin to a cells, inhibiting glucagon release)
What do the dorsomedial hypothalamic nucleus and paraventricular nucleus do?
Promotes appetite
What three changes occur when a sperm comes into contact with female fluids?
Inhibitory factors are washed away
Acrosome’s cholesterol is lost
Sperm is more motile via Ca++
What are the two possible causes of cholelithiasis?
insufficient secretion of bile salts / phospholipids
excess cholesterol secretion into bile
What mediates signals between the NTS and Stomach for satiety?
Vagus N
What direction do paracrine actions go in the islets of langerhans?
Opposite to blood flow: Periphery to Center
What 3 things do the Paramesonephric (Mullarian) Duct become?
Oviduct
Uterus
Upper Vagina
What transfers cholesterol within the mito membrane for conversion to Pregnenolone?
Steroidogenic Acute Regulatory Protein
StAR
Which disease gives the liver black pigmentation?
Dubin Johnson
What three peptides (besides insulin) inhibit glucagon?
Somatostatin, fatty acids, keto-acids
Cholic acid has to be conjugated before secretion. What does it turn into after the first reaction?
Cholyl CoA (pKa 6)
What is the embryonic derivative of the bulbourethral glands?
Endodermal buds
What is the function of prostaglandins in sperm?
They make female cervical mucus more receptive
Cause reverse peristalsis in the uterus to mobilize sperm
What is the net result of the modification of initial pancreatic secretion by ductal cells?
Secretion of HCO3- into pancreatic ductal juice
Net Absorption of H+
Peanut allergies can induce plasma B cells to produce what?
IgG1
What composes the Islets of Langerhans?
a, b, d cells of endocrine pancreas
What happens to the IgE found in the primary immune response to food allergy?
Immediately bound by FcRe (CD23) on mast cells
In insulin resistance, Th1 response ramps up and Th2 responses diminish. What three cytokines are diminished with the Th2 response?
IL-4
IL-10
IL-13
What saliva ions have high concentration and which are low?
High: K+, HCO3-
Low: Na+, Cl-
F, M, W, peptides and fatty acids stimulate I cells in the pancreas. What do these cells release?
CCK
What part of testosterone synthesis can the adrenal glands do?
Conversion of cholesterol to androstenedione (the first part only)
What is the goal of Phase 1 of Xenobiotic inactivation?
Increase Polarity
What four things increase with ghrelin release?
Appetite
Gastric Motility
Gastric Acid
Adipogenesis
Why do Leydig cells need a Hormone Sensitive Lipase (HSL)?
It converts the stored Cholesterol Esters to Free Cholesterol for Androgen Production
What cytokine causes acute inflammation in adipose tissue and insulin resistance in DMII?
IL-6
What nerve would you block for child-birthing anesthesia?
Pudendal (S2 - S4)
What 4 genes are we looking at to associate with DMI?
HLA
INS
AIRE
CTLA-4
Where are pancreatic proteases converted to their active forms?
Lumen of the Duodenum
What three things do DCs use to stimulate Treg Differentiation in oral tolerance?
Retinoic Acid
TGF-b (foxp3 up-regulation)
IDO (effector anergy)
What changes would you expect to see in saliva composition altered by ADH and Aldosterone?
Decreased Sodium
Increased Potassium
If grapefruit juice is a CYP inhibitor, what would take as a CYP inducer?
St Johns Wort
Bradykinin is a mast cell mediator. What does it do?
Vasodilator, Smooth muscle contraction
What does the vagina form from?
Lengthening of the Sinuvaginal bulb
Tryptase is a mast cell mediator. What does it do?
Trypsin-like activity: Anaphylaxis, urticaria
B12 has many functions. What happens without it?
Nerve Demyelination, No RBC synthesis
What is failure to secrete Intrinsic Factor Associated with?
Achlorhydria and lack of parietal cells
What transcription factor would you expect to find in nTregs?
FOXP3
What two things explain neonatal jaundice?
Short-life fetal RBC’s increases Bilirubin
Low UDP-GT activity
What releases the IgE found in primary immune response to food allergy?
Plasma Cells (from B cells)
What do mucous cells secrete?
Mucus, HCO3-, Pepsinogen
What 3 things does the remaining tissue become after the uterus and oviduct form?
Broad ligament
mesovarian
mesophalanx
How do Biguanide drugs (metformin) work to treat DMII?
Insulin Sensitizer: Better insulin receptor trafficking
What does the Ligament of Ovary attach to?
Medial Ovary to the Lateral Angle of Uterus
What two ways does LH work to regulate the level of Testosterone synthesis by the Leydig cells?
Conversion of cholesterol to pregenenolone via
Increase Affinity of P450SCC for cholesterol
Stimulate P450 Synthesis
If a patient has run out of glutathione stores, what would you give them as a cure to their acetaminophen overdose?
N-acetyl Cysteine
What do Leydig cells do?
Synthesize and secrete testosterone
What does secretin do?
Induces secretion of HCO3- from pancreatic cells into duodenum
What binds to circulating testosterone?
Steroid Hormone Binding Globulin (SHBG)
Albumin
What would you use to diagnose gallstones?
Ultrasound
What two structures supply blood to the liver?
Portal Vein (Enteric) (75%) Hepatic Artery (Peripheral) (25%)
What is cholangitis?
Infection of the bile duct
How do you prevent the acrosomal reaction from happening in a sperm before it reaches the egg?
Decapitation in the epidiymis
What muscles are responsible for blowing your load?
Blubospongiosus
Ischiocavernosus
What replaces dead beta cells in late stage DMII?
Hyaline cartilage
What might be missing in chronic pancreatitis vs congenital trypsin absence?
Pancreatitis: Proteases (trypsinogen)
Congenital: ALL pancreatic enzymes gone
What does the Suspensory Ligament of Ovary attach to?
Lateral Ovary to Lateral wall of pelvic cavity
Contains ovarian vessels, nerves, lymphatics
Beta cells secrete insulin, everyone knows that. But what comes with it?
C Peptide
What does Lecithin do?
Emulsifies Fat Produts into Micelles
What do the Inferior rectal Artery and Vein branch from?
Internal Pudendal A and V
What two enzymes are absent from the testes, resulting in an absence of glucocorticoid and mineralocorticoid production?
21B and 11B Hydroxylases
Sure, insulin is secreted in response to CHO- and protein ingestion. Whats the major stimulatory factor though?
Glucose
What trait of hepatic metabolism increases the ability of xenobiotics to be excreted?
It makes them more hydrophilic
What happens to the parietal component of gastric juice secretion as secretion increases?
[electrolyte] become more like those of pure parietal cell secretion
Why would you want to know transaminase levels (ALT and AST) in a metabolic panel?
They are released from damaged hepatocytes: indicates liver damage
What does bilirubin do as a function of a liver function test?
Measures livers ability to detoxify metabolites and transport organic anions into the bile
What are the four contents of the vestibule of the vagina?
External Urethral and Vaginal Orifices
Paraurethral and Greater Vestibular Glands
Where does the Broad Ligament run?
Side of uterus to the lateral pelvic wall, pelvic floor
What is the significance of Atropine exclusively blocking the direct pathway of vagal stimulation?
It doesn’t block the Vagus’s effect on gastrin secretion because that neurotransmitter is GRP, not ACh!
Where does the round ligament run?
Side of Uterus (through inguinal canal)
To Labia Majora
What do you get with a 5a-Reductase deficiency?
Ambiguous external genitalia
What is the main, specific action of DHT in development?
External male genitalia
Vagus N. Stimulation is the most important part of pepsinogen secretion. What condition must be met for this to occur?
pH must be low enough to cover it to Pepsin (which also converts more pepsinogen over)
What type of bilirubin is increased due to hemolytic anemia?
Unconjugated (more bilirubin produced as a response than the liver can handle)
What cytokine would you expect as the final product of DC interaction with local lymphocytes in Peyers Patches?
Dimeric IgA (from Plasma Cell Differentiation)
How are water-soluble vitamins absorbed?
Na-Dependent
What is the female analogue of a prostate gland?
Para-Urethral Glands
What does TAG association with a bile salt result in?
Formation of a micelle
if Hydrogen is exchanged into the Lumen of the stomach, what is pumped the opposite way into the blood?
HCO3- (exchanged for Cl- in Alkaline Tide)
ECL cells stimulate Histamine to favor gastric H+ secretion. What two things can you count on to stimulate these cells?
ACh
Gastrin
What does the sulfonylurea receptor do?
increase insulin secretion - easy membrane depolarization, Ca++ entry
What produces inhibin besides Leydig cells turning themselves off?
Sertoli Cells
How does GALT receive Ags since it doest have Afferent Lymphatics?
Dendritic Cells
M Cells
What are the three erectile bodies in the dick?
2 Corpora Cavernosa
1 corpus spongiosum
Bile salts and bile acids are strong detergents. What effect does this have on lipids?
Helps to form micelles and expose them to lipases
What does Cholyl CoA turn into during cholic acid conjugation, and which one is favored?
Taurine and Glycine (favored 3:1)
What muscle does the Pudendal Canal lie on?
Operator Internus
What decreases as PT increases?
Ability of cirrhotic liver to synthesize clotting factors
What two things do cholangiocytes control in the liver?
Controls bile flow rate and pH
In celiac disease, the adaptive immune system is linked to the innate immune system by what cytokine?
IL-15 (growth factor for T cells)
Why is there a short and blindly ending vagina in those with Androgen Insensitivity Syndrome?
Anti-Mullerian Hormone is still produced
How would you explain the fact that Benign Prostatic Hyperplasia patients have the same amount of DHT in their prostate?
They have more DHT receptors on their prostates
What is the link between alcohol and ascites?
Alcoholism causes Cirrhosis
Cirrhosis Causes Portal Hypertension
Portal Hypertension causes Ascites
What is the etiology of Hartnup disease?
cannot absorb NEUTRAL AAs
Nutcracker syndrome involves the impingement of the Left Renal V. by the SMA. What view would you use to visualize this?
Mid-Sagittal View
What HLAII haplotype confers protection to DMI?
DR2 / DQ6
What may be the earliest response of obesity-induced insulin resistance?
Insulin cant repress hepatic glucose production as well
What is the most common cause of ascites?
Portal hypertension
What is the fate of much of the testosterone in target tissues?
Conversion to DHT
What is the mechanism behind possible Type III hypersensitivity responses to food?
FcyR-dependent activation of macrophages by allergen-Ab complexes
How does atrophic gastritis cause pernicious anemia?
chronic stomach inflammation causes a loss of parietal cells
What transports Fructose from the lumen into the cell?
GLUT5 (uniporter)
What does the round ligament of the ovary vs the round ligament of the uterus come from?
Ovary: from Superior Gubernaculum
Uterus: from Inferior Gubernaculum
What stimulates Sertoli cells’ cAMP/PKA pathway of inhibin, ABP, Aromatase, and other protein synthesis?
Testosterone and FSH
What enzymes catalyzes phase 1 of xenobiotic inactivation?
Cytochrome P450 (CYP)
What does IP3 and Ca++ do in acing or ductal cells?
Increases Saliva Production
What three environmental chemicals would you identify as linked to DMI?
N-Nitroso compounds
Alloxan
Smoked meat / food chemicals
What is the major structural change found in liver disease?
Impairment of free exchange of material between hepatocytes and blood (de-fenestration, thickening, stiffening, fibrosis of blood vessels)
What ion follows Hydrogen into the stomach?
Cl-
GLP-1 and GIP are intestine-derived Incretin Hormones. What do they do?
Stimulate Insulin Secretion / Inhibit glucagon, Slow gastric emptying independent of glucose (though they themselves are stimulated by GI glucose and fat)
What does TG2 do to some glutamates in gluten peptides?
Deaminated into negatively charged glutamic acid residues
What receptor does glucose go through for Insulin Release?
GLUT2
What two drug treatments for DMII slow absorption of CHO?
a-Glucosidase Inhibitors
Amylin Analogs
PGD2, Leukotrienes (C4, D4, E4) is a mast cell mediator. What does it do?
Smooth Muscle Contraction
Vascular Permeability
What is the difference between gastric and cephalic HCl secretion?
Gastric adds local reflexes, amino acids, and small peptides to release ACh on G-Cells
What does PSA use to enhance IL-10 and TGF-b expression in Treg cells?
TLR2
What does ACh potentiate?
Histamine and Gastrin
What can ex-tregs produce?
IFN-y and IL-17 (pro-inflammatory)
What are the two transport proteins on the blood / basolateral side of salivary duct cells?
Na / K ATPase
Cl- Channels
What fluid neutralizes the acidic seminal fluids?
Prostatic Fluid (alkaline)
What structure do the Inferior Rectal A, V, N pass through?
Ischiorectal Fossae
What are the two components of Gastric Juice secretion?
Parietal and Non-Parietal
What genes are abnormally short and non-functional in Rotor Syndrome?
OATP1B1 / 3 (transport bilirubin from blood to liver)
Where would you expect to find oxyntic glands vs pyloric glands
Oxyntic is in 80% of the proximal stomach (body and fundus)
Pyloric is only in the last 20% of the stomach (antrum)
What stimulates the Leydig Cell cAMP/PKA pathway of steroidogenesis and testosterone?
LH
Why would a 5a-reductase inhibitor treat prostate hypertrophy and male pattern baldness?
These things are specific for DHT, not testosterone
What is detected in a breath test for SIBO?
Hydrogen and Methane
Insulin suppresses appetite. What does glucagon do to appetite?
Also suppresses it by increases insulin secretion
What do the liver’s Pit Cells do?
Natural killer cells, protecting against viruses and tumor cells
Which part of gastric secretion is alkaline, low volume, and mainly Na and Cl?
Non-Parietal
What CN give parasympathetics to the salivary glands?
VII
IX
What cells are resistant to Treg Suppression?
Activated Effector T Cells
What does Lipase association with a micelle result in?
Smaller Micelle that can be absorbed
What does CCK do?
Induces pancreatic enzyme release into the duodenum
The exocrine pancreas ducts is organized into acinar cells and ductal / centroacinar cells. What do these secrete?
Acinar: Major Digestive Enzymes
Ductal / Centroacinar: Aqueous Solution w/ HCO3-
What is elevated by damage to hepatocytes vs the bile duct?
Hepatocytes: ALT / AST (aminotransferases)
Bile Duct: Alkaline Phosphatase
What is lactose converted to that produces H+ in lactose intolerance?
Short Chain Fatty Acids (ferment)
Where is sodium absorbed, and HCO3- secreted in the GI tract?
Ilium
The celiac trunk branches into the splenic a. (left) and common hepatic a (right). What three branches does that right common hepatic a branch into?
Right Gastric a
Proper Hepatic a.
Gastroduodenal a.
portal hypertension causes esophageal variances and caput Medusae. Where are the systemic and portal system connections swollen in these two disorders?
Esophageal Varices: Inferior Esophagus
Caput Medusae: Around Umbilicus
What cytokine, in excess, leads to a suppression of TH1, TH2, and TH17 responses?
TGF-b (makes Tregs)
What does Omeprazole act on?
H / K Exchanger in the lumenal gastric parietal cell
What does PYY inhibit?
NPY (stimulates POMC)
What would you transfer to give oral tolerance to another animal?
CD4+ CD25+ CD4 Treg Cells
What does Cimetidine act on to make your stomach stop secreting so much acid?
Inhibits Histamine’s effect on the H2 Receptor, also inhibiting the potentiated effects of ACh and Gastrin
What do parietal cells secrete?
Intrinsic Factor
HCl
Gilbert’s doesn’t need treatment, but you should avoid certiain drugs. What is one that is contraindicated?
Irinotecan (also metabolized by UGT1A1)
How would you characterize parietal gastric juice secretion?
Kinda Hyperosmotic
Lots of H+, some K+, and Cl (the only anion)
What does the sympathetic vs parasympathetic stimulation do to saliva secretion?
Both increase Salivary Secretion
What does Urease do that makes it so damaging to the gastric mucosa in an H Pylori Infection?
Converts Urea to Ammonia, buffering the pH and allowing colonization / inflammation
What results in DKA?
Decreased utilization of Ketoacids, increased in the blood
What are the anterior and posterior boundaries of the perineum?
Pubic symphysis is the front
Coccyx is the back
What two mechanisms does the Vagus nerve use to secrete HCl in the cephalic phase of acid secretion?
Releases ACh directly to Parietal Cells (Releases HCl)
GRP stimulating Gastrin stimulating Pariteal Cells
What two things do you get with chronic disturbance in bile salt metabolism?
steatorrhea (mal-absorption)
fat-soluble vitamin deficiency
What does collapse do once its activated by trypsin?
Displaces bile salts by binding to pancreatic lipase (activates it)
TNF-a and IL-1 are mast cell mediators. What do they do?
Inflammation (target endothelial cells)
What conversion is being made by phototherapy?
Trans into Cis-Bilirubin (water soluble)
What plexuses innervate the sympathetics of the exocrine pancreas?
Celiac and Superior Mesenteric Plexuses
What are the products of Aromatase acting on Testosterone?
Estradiol-17b and Estrogen (byproduct)
What are the roof and ceiling of the perineum?
Superior: Pelvic Diaphragm
Inferior: Skin of the gooch
What is the most common cause of Female Sexual Ambiguity?
Congenital Adrenal Hyperplasia
How do amino acids get from gut cells into the blood?
Facilitated diffusion
What releases Somatostatin?
D Cells
What is directly above the female bladder?
Body and Fundus of Uterus
What two sets of HLA-II alleles on chromosome 6 are associated with DMI?
DQ2 / DQ8
DR3/ DR4 (most common in children > 5)
Which pancreatic enzyme cleaves AAs into carboxyl ends?
Carboxypeptidase
Optimal pH for pepsin is 1.8 to 3.5. When is it reversibly vs irreversibly inactivated?
Reversibly: Above 3.5 to 5.0
Irreversibly: Above 7-8
HLA-DQ-A105 and B102 encode the heterodimer HLADQ2.5 in celiac patients. What does this class II HLA bind?
Proline and Glutamic Acid on gluten Ag
Which parts of the perineum drain into which lymph nodes?
Superficial and distal portions drain to SIN
Deep and proximal regions drain to Internal Iliac Nodes
Besides testosterone, what two other androgens do the testes secrete?
Dihydrotestosterone (DHT)
Androstenedione
What hormone is co-secreted with GLP-1?
PYY
What establishes the transport gradient for protein from the gut to the blood?
Na/K Transporter (sodium is cotransported into the cell with Na)
If you are an XXY male (Kleinfelter’s), what happens to cause infertility?
Seminiferous tubules destroyed from low Androgen Production
What two peptides inhibit insulin release?
Somatostatin
Glucagon
What does the Lateral Hypothalamic Area use to stimulate hunger?
Melanin-Concentrating Hormone (MCH)
Orexin A and B
What is the goal of Phase 2 of xenobiotic inactivation?
Conjugating functional groups for safe excretion
What three cytokines look like they’re interacting between DCs and B cells in DMI?
IL-2
IL-12
IFN-y
How does mucosal remodeling and villus atrophy occur in Celiac disease?
IFN-y secreted by CD4 T cells induces MMPs by myofibroblasts
Since [Estrogen] is high in the seminiferous tubules, what cells would you expect to produce it?
Sertoli Cells
What three muscles make up the pelvic diaphragm?
Iliococcygeus and Pubococcygeus
Coccygeus
Which two appetite hormones antagonize each other?
Leptin and Ghrelin
What type of cells line the striated duct?
Columnar Epithelial Cells
What do F cells secrete?
Pancreatic Polypeptide (satiety signal)
H+ activates S Cells in the pancreas, which releases Secretin. What does this activate to release Aqueous Secretion (Na+, HCO3-)
cAMP in Ductal cells
Atropine helps you stop drooling but also makes your stomach less acidic. How does it inhibit that H+?
Blocks the Vagus Nerve’s Ach from acting on the M3 receptor, also inhibiting the potentiated effects of Histamine and Gastrin
Trypsin converts a ton of enzymes into their active forms (including itself). But what else cleaves it into its active form?
Enterokinase (brush border)
What are the three most important wheat-related allergens?
a-Amylase inhibitors
germ Agglutinin
Peroxidase
What is the gene dysfunciton in Gilbert syndrome?
UGT1A1 promoter
What penis structures lubricate the urethra?
Bulbourethral glands
What structure houses feeding / satiety centers?
Hypothalamus (mostly arcuate nucleus)
What type of hypersensitivity is Celiac Disease?
IV
What would you expect to accumulate in response to Butyrate buildup in the gut?
IL-10 (from Tregs or DC’s Treg-inducing abilities)
What does the Intestinal phase of HCl secretion use?
Digested protein directly acts on parietal cells and uses G Cells to act on them through gastrin
How does autoimmune metaplastic atrophic gastritis cause pernicious anemia?
Immune system attacks IF protein or gastric parietal cells
Where do salivary gland sympathetics originate?
Cervical ganglion
Where does the Citrate/Fructose/Pgl/Fibrinogen-rich semen fluid come from?
Seminal vesicles of the Vas Deferens
What two drug treatments for DMII would you consider Insulin Secretagogues?
Sulfonylurea Drugs
Incretin Analogs
What supplement can you give Wilson’s patients that competes with copper for absorption in the gut via the same transporter?
Zinc
If you see a narrowing of the esophagus / ring of mucosal tissue on imaging, what answer should you choose?
Shatzki Ring
What type of urinary incontinence involves a urethral blockage (maybe from an enlarged prostate, hmmm)?
Overflow
What 4 things does the Mesonephric (Wolffian) duct turn into?
Epididymis
Vas Deferens
Seminal Vesicle
Ejaculatory duct
Almost all bile formation is driven by bile acids, but some is stimulated by secretin. In this case, it stimulates HCO3- and H2O from ductile cells. What does this increase and decrease?
Increased Bile Volume, HCO3-, pH
Decreased: [Bile Salt]
If CCK makes yo feel full, what effect would you expect it to have on Ghrelin?
Decreases Ghrelin
What muscle, forming the anal sling, relaxes to allow defecation?
Puborectalis m.
What atrophies vs what hyperplasias in Celica Sprue?
Villi Atrophy
Intestinal Crypts Hyperplasia
What system of bile salt uptake into the liver is Na dependent and which is independent?
dependent: NTCP
independent: OATP
What happens when excess H+ overwhelms the buffering capacity of HCO3- in the stomach?
Creates an Ulcer, generally wreaks havoc on the gut
How does Kallman’s syndrome disrupt puberty and impair your sense of smell?
GnRH neurons fail to migrate to the hypothalamus
In insulin resistance, the Th1 response ramps up and Th2 responses diminish. What three cytokines are ramped up with the Th1 response?
TNF-a
IFN-y
IgG2c Abs
What four things protect the lining of the stomach from all that acid and pepsin?
Mucous combined with HCO3- (from epithelial cells)
Mucosal Blood Flow
prostaglandins
growth factors
What ingredients does carbonic anhydrase use to create HCO3- and H+ (really, HCl)?
H2O and CO2
A high fat diet promotes inflammation, but what three vitamins suppress inflammation?
D, A, Folate
What is the role of C Peptide in the signal peptide version of insulin?
Connects A and B chains (no disulfide bonds)
This is PreProInsulin
What is the relationship between Bile Acids and pKa?
Lower pKa = More Ionized molecule = Better Detergent Effect
What does autoimmune metaplastic atrophic gastritis target?
IF Protein or Gastric Parietal cells
What structure is the posterior fornix related to?
Recto-uterine Pouch
What two things are released to initiate the Orexigenic pathway of food intake regulation?
Neuropeptide Y (binds Y1R) Agouti-Related Peptide (AGRP): Antagonizes MCR-4
what is the rate limiting enzyme of drug metabolism?
NADPH: CYPR
Gilbert’s and Crigler-Najjar are both unconjugated jaundice disorders. Where in the pathway are their dysfunctions?
Gilberts: Disrupted uptake into liver
Crigler-Najjar / Gilberts: Conjugation
Which component of GALT develops after birth?
Isolated Lymphoid Tissue
Tregs suppress the responses of TH2, Mast Cells, and IgE. On the other hand, they may increase IgG and IgA. What two cytokines do they use to do this?
IL-10 and TGF-b
What products are secreted by the oxyntic gland vs the pyloric gland?
Oxyntic secretes Acid
Pyloric makes and secretes Gastrin
Exocrine pancreas secretions are divided up like gastric secretions. All the phases are enzymatic, but which is also aqueous?
Intestinal
Zenker’s diverticulum causes food trapping among other symptoms. Where does this occur along the esophagus?
Adjacent to the inferior pharyngeal constrictor and cricopharyngeus m.
When is the rectum lose its lateral peritoneal covering?
The Middle 1/3
What enzyme catalyzes the committed step of bile acid synthesis?
7a - Hydroxylase
What covers the genital tubercle?
Ectoderm
