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M&R > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

Why are infants of diabetic mothers with high levels of BG often larger than average and at risk for neonatal hypoglycemia?

A

Elevated maternal glucose stimulates fetal beta cell hypertrophy and hyperplasia (insulin is potent anabolic growth hormone)

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2
Q

What are the major susceptibility genes for T1DM?

A

HLA DR4 and DR3

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3
Q

What type of receptor does ADH target at low concentrations? Where are these receptors found?

A
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4
Q

What type of receptor does ADH target at high concentrations? Where are these receptors found?

A
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5
Q

In Sheehan syndrome, why is the anterior pituitary subject to ischemic damage (due to hypovolemic shock), but the posterior pituitary is rarely affected?

A

The anterior pituitary receives blood supply from the low-pressure hypophyseal portal system, making it more vulnerable to hypervolemic episodes

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6
Q

Define an endocrine gland:

A

A gland that secretes products directly into the blood

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7
Q

Define an exocrine gland:

A

A gland that secretes products into a duct to be distributed onto an epithelial surface (i.e. sebaceous & sweat glands, pancreatic islet cells, goblet cells, and liver secretion of bile)

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8
Q

What other fluid can hormones travel in besides blood?

A

Lymph

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9
Q

What are peptide hormones synthesized from? Where in the target cell are their receptors found?

A

Amino-acids (amines, peptides, and proteins)

Receptors on the cell membrane

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10
Q

What are the two classes of Tyrosine derived amine hormones?

A

Catecholamines- NE, EPI, and DA
Thyroid hormones- T3 and T4

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11
Q

What makes thyroid hormones unique to other peptide hormones?

A

They behave like steroids (i.e. binding a nuclear hormone receptor and traveling in the blood bound to TBG)

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12
Q

How do peptide hormones exert an effect on target tissues?

A
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13
Q

How do steroid hormones exert an effect on target tissues?

A
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14
Q

In what cranieal stricture does the pituitary gland sit?

A

The sella turcica

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15
Q

What embryological structure does the anterior pituitary gland develop out of? What structure does the posterior pituitary gland, infundibulum and hypothalamus develop out of?

A
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16
Q

Which arteriole feeds into the hypophyseal portal system? Which sinus does the hypophyseal portal system drain into?

A
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17
Q

What are three common names for the anterior pituitary gland?

A

Pars distalis
Pars anterior
Adenohypophysis

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18
Q

What are the 6 hormones released by the anterior pituitary gland?

A

FSH
LH
ACTH
TSH

Prolactin
GH

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19
Q

ACTH has the largest effect on which of the adrenal hormones?

A

Cortisol

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20
Q

In a pathology involving high secretion of ACTH (i.e. Addison’s disease), what hormone is responsible for the often-seen hyperpimentation of the skin?

A

The prohormone to ACTH, POMC, is also a precursor to several other hormones, such as MSH (melanocyte stimulating hormone), which is responsible for increased melanin production by epithelial basal cells

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21
Q

Prolactin is tonically inhibited by DA (Prolactin inhibiting hormone/PIH), but existence of prolactin releasing hormone (PRH) is only hypothetical at this point. What factors exist that can stimulate prolactin release?

A

TRH
Oxytocin
Vasoactive intestinal peptide
Estrogen

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22
Q

Oxytocin release during childbirth is involved in what type of feedback loop?

A
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23
Q

What types of cells surround colloid in the thyroid? What structure do these two cell types form?

A
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24
Q

What other major cell type forms aggregates in between thyroid follicles?

A
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25
Q

What are the 8 steps of thyroid hormone synthesis? Where do steps 1-3 occur? Steps 4-6? Step 7 and 8?

A
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26
Q

What are the two major functions of calcitonin?

A
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27
Q

What are the two main cell types that compose the parathyroid gland? Which cell is responsible for making parathyroid hormone?

A
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28
Q

Parathyroid hormone directly and indirectly has an effect on calcium through what three mechanisms?

A
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29
Q

What is the main mechanism through which parathyroid hormone exerts an effect on bone?

A
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30
Q

What are the three main effects that parathyroid hormone has on renal tubular cells?

A
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31
Q

What is the main effect that vitamin D has on the intestines?

A
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32
Q

Parathyroid hormone has what overall effect on serum calcium and phosphate levels?

A
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33
Q

The adrenal gland receives blood from which three arteries?

A
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34
Q

What are the three parts of the adrenal cortex?

A

Zona glomerulosa
Zona fasciculata
Zona reticularis

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35
Q

What organ is responsible for creation of angiotensinogen?

A
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36
Q

What catalyzes the conversion of angiotensinogen to angiotensin I?

A
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37
Q

What catalyzes the conversion of angiotensin I to angiotensin II? Where is it found?

A

Angiotensin converting enzyme (ACE)

It is found mainly in pulmonary capillaries, but also in the kidneys as well to a smaller degree

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38
Q

What is the most important function of angiotensin II? What are two other functions?

A

Stimulating aldosterone secretion from the adrenal cortex

-Vasoconstriction
-Na+ reabsorption from Na/H antiporter in PCT

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39
Q

What are the 7 main effects of cortisol on the body?

A
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40
Q

What type of receptor does glucagon bind to? What second messenger cascade is used?

A
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41
Q

Recurrent episodes of hyperglycemia can lead to what pathology involving the autonomic nervous system?

A

Hypoglycemia Associated Autonomic Failure (HAAF)

*It is also known to contribute to dementia later in life

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42
Q

What are the 2 most common forms of ketones found in the human body?

A

B-hydroxybutyrate Acetoacetate

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43
Q

What acronym is used to help describe common causes of anion gap acidosis?

A

Methanol
Uremia
DKA
Propylene glycol
Isoniazid, Iron
Lactic acid
Ethylene glycol
Salicylates

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44
Q

What acronym is used to help describe common causes of normal gap acidsosis?

A

Hyperalimentation
Addison’s disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion

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45
Q

What is a common presentation of DKA?

A
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46
Q

What are the two main aspects of the pathophysiology of DKA?

A

Acidosis
Osmotic diuresis

47
Q

What are three major causes of DKA? Which is most common?

A
48
Q

What lab results are used to define DKA?

A

Also a lack of insulin and elevation of counter regulatory hormones

49
Q

What are the two normal ranges for anion gap?

A
50
Q

How is DKA treated?

A

Note it is important to give potassium if levels are low/normal before adminstering insulin

*IV bicarbonate is indicated in pH <7.0

51
Q

T/F: DKA patients may present with hyperkalemia upon arrival to clinic

A

True

Acidic environment/lack of insulin is thought to affect H/K ATPase and Na/K ATPase respectively

52
Q

In what type of diabetes does a hyperosmolar hyperglycemic state occur? Why?

A
53
Q

Does DKA or HHS present with higher average plasma glucose? Which presents with higher pH (less acidic)?

A
54
Q

What does the ADA recommend for screening for diabetes?

A
55
Q

What should be included in routine care for diabetic patients?

A
56
Q

What are the three main microvascular complications for diabetes?

A

Nephropathy
Neuropathy
Retinopathy

57
Q

What role is sorbitol thought to play in microvascular complications of diabetes?

A
58
Q

What is the significant of advanced glycosylation end products (AGE) in microvascular complications of diabetes?

A
59
Q

How does protein kinase C activation in microvascular complications of diabetes lead to neuropathy symptoms?

A
60
Q

What two characteristics of diabetic neuropathy are most common?

A

It is most likely to be distal and symmetrical

61
Q

What is the lifetime risk of a foot ulcer for all patienst with diabetes?

A

25%

62
Q

What are the most common treatments for diabetic foot ulcers?

A

Debridement
Antibiotics if infected
Revascularization
Mechnical offloading (shoes, casts, knee walker, etc.)

63
Q

What are common GI complications for diabetics?

A
64
Q

What kind of fungal infections are diabetics especially at risk for?

A
65
Q

What is the number one killer of diabetics?

A

Heart attack, stroke, PVD

66
Q

What is the pathogenesis of diabetic nephropathy?

A
67
Q

Will a glucagon response be activated in diabetics if there is no decrease in insulin (T1DM or advanced T2DM)

A

No, glucagon response is dependent on a decrease in insulin release

68
Q

What two other notable hormones besides aldosterone can bind the mineralocorticoid receptor?

A

Cortisol
Deoxycorticosterone

69
Q

What types of steroid-like hormones utilize a type I nuclear hormone receptor? What are the 3 steps in gene activation involving a T1 NHR?

A
70
Q

What types of steroid-like hormones utilize a type II nuclear hormone receptor? What are the 2 steps in gene activation involving a T2 NHR?

A
71
Q

What type of receptor is used for nearly all peptide/protein hormones, as well as some small molecule hormones?

A
72
Q

A GPCR is in its active state when it is bound to what molecule?

A

GTP

73
Q

Increased GTPase activity of a GPCR would lead to it spending more time in the active or inactive state?

A

Inactive state

74
Q

What are four pathologies of hormone excess found in patients?

A
75
Q

What are four pathologies of hormone deficiency found in patients?

A
76
Q

What are iodothyronine transporters? Is there tissue specific expression (i.e. brain, muscles)?

A
77
Q

T4 activity and feedback to the hypothalamus and pituitary glands is determined by what type of T4?

A

Free T4 (unbound by TBG)

78
Q

In a patient with clinically low T4 but no symptoms of hypothyroidism, what is the most likely adaptation the body has induced?

A

Reduced levels of thyroxine-binding globulin (TBG)

79
Q

What significant enzyme is inhibited by glycyrrhetinic acid? How can this lead to metabolic derangements? What food is known to be high in glycyrrhetinic acid?

A

11B-hydroxysteroid dehydrogenase 2

Cortisol cannot be converted to cortisone (metabolically inactive), so excess cortisol is formed, which can bind the MRC receptor

Licorice

80
Q

What kind of testing should be done if hormone excess is suspected? If hormone deficiency is suspected?

A
81
Q

What abnormality is visible on the CT image indicated by the arrow?

A

An adrenal tumor

Note the right adrenal gland has an upside “Y” shape

82
Q

What lab testing could be done to confirm a suspected pheochromocytoma or paraganglioma?

A
83
Q

What lab testing could be done to confirm a suspected case of Cushing’s syndrome?

A
84
Q

What lab testing could be done to confirm primary aldonsteronism?

A
85
Q

What lab testing could be done to confirm primary adrenal insufficiency?

A

ACTH, cortisol

86
Q

How should a hormone-producing adrenal nodule be treated? What if it is not producing excess hormones?

A
87
Q

What treatments are available for primary aldosteronsim?

A
88
Q

Why could a midnight salivary cortisol be used as an additional screening test for Cushing’s disease?

A

Cortisol should normally be minimal at midnight, so abnormally high levels may indicate CS

89
Q

Why would a patient presenting with dark gums be an indication for elevated ACTH in primary adrenal insufficiency?

A

Elevated ACTH would indicate probable increase in POMC, which can also be used to make MSH, which can cause hyperpigmentation (resulting in darkened gums)

90
Q

Though muscle weakness, unintentional weight loss and loss of appetite can be seen in severeal pathologies, what additional 3 symptoms would make adrenal insufficiency more likely?

A

Hypotension
Salt cravings
Darkened gums

91
Q

What are 3 common gluccocorticoids used to treat adrenal insufficiency or CAH?

A
92
Q

What is the most common mineralocorticoid used to treat adrenal insufficiency?

A
93
Q

What are three important points of patient education to be given to patients diagnosed with adrenal insufficiency?

A
94
Q

Which organ is reponsible for producing DHEA-S? Will exogenous testosterone use cause in increase in DHEA-S?

A

The adrenal gland

No

95
Q

What further diagnostic evaluation should be done in a case of suspected pheochromocytoma-paraganglioma with elevated metanephrines?

A

CT scan or MRI

96
Q

What further diagnostic tests should be done in a case of suspected primary aldonsteronism with elevated aldosterone and low renin?

A

24 hour urine aldosterone and a saline suppression test

97
Q

What further diagnostic tests should be done in a case of suspected Cushing’s syndrome with elevated 24 hour uriine cortisol and elevated MN salivary cortisol?

A

High dose dexamethasone suppression test

98
Q

What further diagnostic tests should be done in a case of suspected primary adrenal insufficiency with elevated ACTH and low cortisol?

A

ACTH stimulation test

99
Q

What criteria are necessary for a diagnosis of diabetes?

A
100
Q

Screening for T2DM is indicated in children/adolescents who meet what criteria?

A
101
Q

What screening should be done for T2DM in adults? What populations should be screened? How often?

A
102
Q

Approximately what percentage of US children and adolescents are clinically overweight or obese?

A

40%

103
Q

If IGF-1 screening is done and is found to be high, what will be the next step in testing? Why?

A

OGTT with GH levels afterwords; in normal physiology glucose would suppress GH levels

104
Q

What imaging should be done if an OGTT with GH levels shows inadequate suppression?

A
105
Q

What is the Jod Basedow effect?

A

Exposure to iodine results in hyperthyroidism

-usually in iodine deficient areas
-usually someone with pre-disposition for thyroid hormone overproduction

106
Q

Is T4 or T3 more strongly bound to TBG?

A

T4 (its in the name; thyroxine binding globulin)

107
Q

What would be the expected TSH and T4 for subclinical hypothyroidism?

A
108
Q

Why do pregnant women or patients using OCP need more T4 replacement than an average patient with hypothyroidism?

A

Estrogen raises TBG levels

109
Q

What is the most likely cause of Low TSH, high T4 with undetectable levels of thyroglobulin?

A

Exogenous thyroid hormone use (thyroglobulin is T4 precursor)

110
Q

If microcalcifications are noted in a thyroid nodule ulstrasound, what next step is indicated?

A

Fine needle aspiration (FNA)

111
Q

What effect does PTH have on kidney resorption of phosphate?

A

Decreased tubular resorption of phosphate

112
Q

Vitamin D increases absorption of both calcium and what other mineral?

A

Phosphorous

113
Q
A

M&R (8 decks)

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