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Metabolism, Endocrinology & Haematology > Revision > Flashcards

Revision Flashcards

1
Q

What are the two main stores of glycogen?

A

Muscle

Liver

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2
Q

Give an example of a cell type that can only use glucose as an energy source

A

RBCs

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3
Q

Which glucose transporter is found in the BBB?

A

GLUT3

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4
Q

The GLUT3 transporter is ________ dependent

A

concentration

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5
Q

What is the potential risk associated with using protein as an energy source?

How does the body deal with this?

A

Production of ammonia

Urea cycle- excretes as urea

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6
Q

Where does the bulk of ATP production occur?

A

The electron transport chain

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7
Q

How does the electron transport chain work to produce ATP?

A

Using the proton gradient to drive ATP synthase

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8
Q

Glycolysis can be split into which two phases?

A

Investment (uses glucose)

Payback (2ATP per glucose)

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9
Q

In which situations would we use glycolysis as an energy source?

A

As a quick energy source (e.g. sprinting)

Anaerobic conditions

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10
Q

Which is the regulator enzyme of glycolysis?

What does it do?

A

Phosphofructokinase

Catalyses the reaction of fructose-6-phosphate to fructose 1,6 bisphosphate

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11
Q

How does PFK regulate glycolysis at the muscles and in the liver?

A

Muscles- allosteric (ATP,AMP)

Liver- hormonal (Insulin, glucagon)

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12
Q

The main function of the citric acid cycle is the production of what?

A

NADH

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13
Q

What drives the electron transport down the ETC?

A

Reduction of NADH and FADH2

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14
Q

How would a protonophore act on the ETC?

Give an example of such.

A

Proton gradient dissipated through the protonophore

Energy is released as heat

Dinitrophenoyl

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15
Q

What is the function of the brown adipose tissue in new born babies?

How does it achieve this?

A

Heat production:

Thermogenin

Uncoupling protein- harnesses the energy in the proton gradient

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16
Q

What is the important enzyme used in fatty acid activation?

A

Fatty acyl CoA synthase

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17
Q

How are fatty acids tansported into mitochondria?

A

Carnitine shuttle

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18
Q

How can the transport of FA into mitochondria be inhibited?

What is the function of this inhibition?

A

Malonyl CoA

Prevents newly synthesised FA from being immediately transported into mitochondira and oxidised

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19
Q

What are the useful products produced by FA oxidation?

A

NADH and FADH2 (for ETC)

Acetyl CoA (for citric acid cyle)

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20
Q

High levels of ketones in the blood can cause what condition?

A

Ketoacidosis

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21
Q

What are the two main upstream effects of alcohol oxidation seen in chronic alcohol consumption?

A

Decrease in NAD+/NADH ratio

Increased Acetyl-CoA

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22
Q

What cellular defences are present to protect against ROS?

A

Superoxide Dismutase (SOD)

Catalase

Glutathione

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23
Q

In RBCs the only source of NADPH is what?

A

Pentose phosphate pathway

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24
Q

Ferrous iron is Fe___

Ferric iron is Fe___

A

Ferrous Fe2+

Ferric Fe3+

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25
Q

Where does iron absorption occur?

A

Duodenum

Upper jejunum

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26
Q

Which form of iron can we absorb?

Via which transporter?

A

Fe2+ (ferrous)

DMT1

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27
Q

Conversion of Fe3+ to Fe2+ is aided by what?

A

Vitamin C

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28
Q

How is iron stored in the body once it has been absorbed?

A

Ferritin (Fe3+)

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29
Q

How do we transport iron out of the enterocyte?

What protein inhbits this?

A

Ferroportin

Hepcidin

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30
Q

Via what mechanism relating to iron transport can chronic inflammarion cause anaemia?

A

Production of Hepcidin which inhibits ferroportin and prevents iron from being released from enterocytes

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31
Q

A 60 year old presents with gradual onset lethargy. His GP arranges for some blood tests.

Hb 83, wcc 3.5, plt 156, MCV 112, retics 10

Signs and symptoms?

Possible causes?

A

Lethargy, SOB, headache

Palor, tachycardia, tachypnoea, hypotension

B12 deficiency, folate deficiency

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32
Q

Give some specific signs of anaemia

A

Koilonychia

Glossitis (B12 def.)

Angular stomatitis

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33
Q

What are the three locations of RBCs in which a problem ight occur that may cause anaemia?

A

Bone marrow

Peripheral RBCs

Removal

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34
Q

In which cases of anaemia are reticulocyte levels more likely to be high?

A

Problems with: Peripheral RBCs and removal of RBCs

35
Q

In what conditions might a patient have anaemia with a LOW reticulocyte count?

A

Macrocytic anaemia (high MCV)

Normocytic anaemia (normal MCV)

Secondary bone marrow failure

36
Q

In what conditions might a patient have anaemia with a HIGH reticulocyte count?

A

Microcytic anaemia (Low MCV)

37
Q

List some causes of microcytic anaemia

A

Thalassaemia trait
Anaemia of chronic

disease (may be

normocytic)
Iron deficiency
Lead poisoning
Sideroblastic anaemia

“TAILS”

38
Q

A 40 year old woman presents to A+E with a one week history of shortness of breath and yellow sclera.

She has a FBC taken: Hb 59, wcc 4.1, plt 378, retics 215

What are the possible causes of this presentation?

A

Bleeding

Increased destruction of RBCs

39
Q

A 40 year old woman presents to A+E with a one week history of shortness of breath and yellow sclera.

She has a FBC taken: Hb 59, wcc 4.1, plt 378, retics 215

What would you want to ask in the history?

A

History of trauma

Post-partum haemorrhage

Bleeding history/Past medical history/Family history/Drug history

40
Q

What is Disseminated Intravascular Coagulation?

A

Abnormal activation nof coagulation

Small clots form in the small blood vessels and deposit fibrin leading to damage of the RBCs as they pass through = microangiopathies

41
Q

What is autoimmune haemolytic anaemia?

A

Autoantibodies bind to RBC membrane proteins

RES cells recognise part of the Ab, attach to it and remove it from the RBC circulation

42
Q

How can autoimmune haemolytic anaemia be broadly classified?

What differentiates them?

A

Warm autoimmune haemolytic anaemia (IgG, maximally active at 37◦ C)

Cold autoimmune haemolytic anaemia (IgM, maximally active at 4◦ C)

43
Q
A
44
Q

A 40 year old woman presents to A+E with a one week history of shortness of breath and yellow sclera.

She has a FBC taken: Hb 59, wcc 4.1, plt 378, retics 215

How would you further investigate this patient?

A

Examination inc palpating for splenomegaly

Check ferritin/look for bleeding (OGD/colonoscopy etc..)

Haemolysis screen – check LDH, bilirubin, blood film, also direct antiglobulin test (you will learn more about this later)

45
Q

A 65 year old man has a routine FBC as part of a well man check. His past medical history includes COPD.

Hb 194, wcc 6.7, plt 228, haematocrit 0.597

He asks you to explain his blood results…

A

Haematocrit/Packed cell volume(PCV) = Proportion of blood that is made up of RBC

Haemoglobin = concentration in the blood i.e. amount of Hb mass/plasma volume

Red cell count = Number of RBC in given volume of blood

46
Q

What is mean cell volume (MCV)?

A

Mean size of RBC, measured using the amount of light scattered as they pass in a single file past a laser

47
Q

What is red cell distribution width (RDW)?

A

Variation in the size of the RBC

48
Q

What is mean cell haemoglobin (MCH)?

A

Average measure of the amount of Hb in each RBC (e.g. Hb/RCC)

49
Q

What is the reticulocyte count?

What units is it measured in?

A

Measurement of the number of young erythrocytes

Identified using size and RNA content.

x10^9/L

50
Q

How is vitamin B12 acquired?

What is required in order to absorb B12?

A

Diet

Intrinsic factor (IF)

51
Q

Which cells are responsible for the production of intrinsic factor?

Where are they found?

A

Parietal cells

Stomach

52
Q

Where in the GI tract is B12 absorbed?

A

Terminal ileum

53
Q

List some causes of low vitamin B12

A

Dietary deficiency

Lack of IF= pericious anaemia

Disease of the ileum (Crohn’s, ileal resection)

Lack of transcobalamin

54
Q

How might folate deficiency occur?

A

Dietary deficiency

Increased use (pregnancy, heamolytic anaemia)

Disease of duodenum & jejunum

Lack of methylTHF

55
Q

Where is folate absorbed?

A

Duodenum & jejunum

56
Q

Why do we try and avoid blood transfusion in patients with B12 deficiency?

A

Can cause fluid overload leading to cardiac failure

57
Q

Which precursor moleculre is used to synthesise the hormones aldosterone, testosterone and progesterone?

A

Cholesterol

58
Q

What effect does insulin have on hormone sensitive lipase?

A

Decrease in activity

59
Q

Define the term anaemia?

A

A Hb concentration below the normal range for that patient dependent on age, sex and ethinicity

60
Q

How does 2,3 Bisphosphate production aid with anaemia?

A

Shifts the oxygen dissociation curve to the right so that oxygen is more readily given up at tissues

61
Q

Under normal conditions, what is the approximate lofiespan of RBCs in the circulatory system?

A

120 days

62
Q

What is a sign of intravascular haemolysis?

A

Haemoglobinaemia (excess Hb in the blood)

Raised MCV (reticulocytes larger than RBCs)

63
Q

Briefly describe the pathophysiology of heriditary spherocytosis?

A

Increased RBC rigidity resulting in loss of function

64
Q

In a pyruvate kinase deficiency what is the net gain of ATP from glycolysis?

A

0 ATPs

65
Q

What is measured by a direct Coombs test?

A

Antibodies bound directly to RBC membrane

66
Q

Which cellular process is most affected by folic acid deficiency?

A

DNA synthesis

67
Q

What are megakaryocytes?

A

Precursors of platelets

68
Q

Which neurotransmitter is relased from the primary neurones in the arcuate nucleus of the hypothalamus to stimulate appetite?

A

Neuropeptide Y

Agouti-related peptide (AgRP)

69
Q
A
70
Q

Which cell plays an imporant fole in recycling iron from old RBCs?

A

Macrophages

71
Q

Which biochemical finding would you expect in a patient with acromegaly?

A

Raised IGF-1 production

72
Q

Does parathyroid hormone has direct actions on the GI tract to increase the rate of calcium and phosphate absorption from food?

A

No, acts via the active form of vitamin D (calcitrol)

(outdated- there is some evidence that it does act directly)

73
Q

What effect would glucagon have on the enzyme glycogen synthase in the liver?

A

Decrease in activity- don’t want to replenish glycogen stores as we need glucose

74
Q

What happens to the serum TSH level in hyperthyroidism?

A

TSH decreases below the normal range

(loss of negative feedback)

75
Q

At approx. what age does the switch of fetal to adult haemoglobin occur ?

A

3-6 months

76
Q

Where is the hormone oxytocin synthesised?

Where is this stored and released from?

A

Hypothalamus

Posterior pituitary

77
Q

What term describes abnormally shaped RBCs?

A

Poikilocytosis

78
Q

What is the normal range for fasting blood glucose?

A

3.3-6.0mmol/L

79
Q

TSH is released from where?

A

Anterior pituitary

80
Q

What is the approximate net weight gain in pregnancy?

A

8kg

81
Q

The units of MCV are usually stated in femtolitres (fL), how many femtolitres in a litre?

A

10^15

82
Q

What is the half life of T4?

What is the half life of T3?

A

About 5-7 days

About 1 day

83
Q

Which glucose transporter is the primary of glucose in pancreatic beta cells?

A

GLUT2

Metabolism, Endocrinology & Haematology (13 decks)

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