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ENR Biweekly 3 > Schuler- Pancreatic Pathology > Flashcards

Schuler- Pancreatic Pathology Flashcards

1
Q

in the _____ state there is Low insulin / high glucagon

A

fasting

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2
Q

in the ____ state there is high insulin/low glucagon

A

fed state

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3
Q

either not enough insulin produced or end up with tissues insensitive with insulin secretion

A

diabetes

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4
Q

GLUT receptor on beta cell

A

GLUT2

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5
Q

what happens when glucose comes into beta cell

A

lots of ATP produced
K+ channel closes (no efflux)
Ca2+ influx
insulin secretion

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6
Q

____ phase of insulin secretion: insulin secretion in abundance in response to high blood glucose
fed state

A

1st

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7
Q

____ phase of insulin secretion: prolonged phase, largely independent of blood glucose

A

2nd

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8
Q

_____need glucose to survive to perform metabolic processes

A

tissues

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9
Q

DM - low insulin/ low C-peptide

A

type I DM

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10
Q

normal or high insulin and C-peptide

A

type 2 DM

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11
Q

low C-peptide / high insulin

A

Excessive exogenous insulin

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12
Q

high C-peptide / high insulin

A

Insulinoma

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13
Q

drug that increases tissue specific insulin sensitivity; and one of the mechanisms by which they do this is increasing the translocation of GLUT4 transporters to cell membrane

A

Metformin

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14
Q

glucose transporter found in kidneys

A

SGLT2

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15
Q

glucose transporter found in intestines

A

SGLT1

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16
Q

pancreatic beta cells have what 2 glucose transporters

A

GLUT1 and GLUT2

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17
Q

hepatocytes have what 2 glucose transporters

A

GLUT1 and GLUT2

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18
Q

CNS haas what glucose transporter

A

GLUT3

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19
Q

skeletal muscle, cardiac muscle, adipose tissue has what glucose transporter that is insulin-dependent

A

GLUT4

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20
Q

lipogenesis at adipose tissue and liver
glycogen synthesis at liver and muscle
(by what)

A

insulin

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21
Q

Secreted by GI tract due to a meal
Slows down gastric emptying, and gives body more time to use substrates (pt stays full longer)
why pts lose weight
And increases insulin sensitivity in target cells

A

GLP-1 (incretin) agonists

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22
Q

incretin effect is significantly blunted in type 2 DM, so administering exogenous _____ is incredibly helpful

A

GLP-1

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23
Q

abnormal glucose metabolism resulting in hyperglycemia and dyslipidemia

A

diabetes mellitus

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24
Q

million Americans age 18 and older had prediabetes & are at high risk for developing frank diabetes

A

96

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25
Q

older patients
low socioeconomic status
ethnic minorities

A

susceptible to diabetes

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26
Q

Renal threshold b/t 180-200; if surpasses _____, kidneys unable to keep glucose from spilling over into the urine; sequellae: glucose in urine and fluid follows; dehydrated patients

A

200

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27
Q

fasting plasma glucose > _____ for diagnosing diabetes

A

126

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28
Q

2 hour plasma glucose from oral glucose test > ______ to diagnose diabetes

A

200

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29
Q

A1C > _____% for diabetes

A

6.5

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30
Q

A1C of 5.7-6.5%

A

prediabetes

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31
Q

In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥ _____mg/dL to diagnose diabetes

A

200

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32
Q

prediabetes oral glucose tolerance test

A

140-199 mg/dL

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33
Q

Formed by covalent binding of glucose moieties to hemoglobin in red blood cells.
_____is an indirect measure of BG levels and can be impacted by factors that impact hemoglobin
provides measure of glycemic control over the past 3-4 months

A

A1C

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34
Q

beta cell destruction, usually leading to absolute insulin deficiency

A

type 1 diabetes

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35
Q

Absolute deficiency of insulin
Autoimmune beta cell destruction

A

type 1diabetes

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36
Q

Most common subtype of diabetes diagnosed in patients < 20 y.o.

A

type 1 DM

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37
Q

Autoimmune attack begins many years before disease becomes evident

A

type 1 DM

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38
Q

lots of cellular infiltrate in beta cells

A

type 1 DM

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39
Q

Autoimmune, genetic, environmental

A

causes of type 1 DM

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40
Q

suspected cause of type 1 DM in _______ is recent viral infection

A

children

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41
Q

Rare form of Type 1 DM:
Absolute deficiency of insulin
No evidence of autoimmune beta cell destruction

A

Idiopathic type 1 DM

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42
Q

small, atrophic, distorted islet cells

A

idiopathic type 1 diabetes

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43
Q

classic triad of polyuria, polydipsia, polyphagia

A

type 1 DM

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44
Q

pt who is 10 yrs old w/ no bed wetting is now peeing in his bed at night

A

type 1 DM

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45
Q

unknown etiology
90% of diabetic patients are this
combination of insulin secretory defect w/ insulin resistance (with insulin resistance happening first)

A

type 2 DM

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46
Q

Overweight kids and/or familial history of diabetes screen them at age 10 for what

A

type 2 DM

47
Q

genetics
environmental
metabolic defects

A

causes of type 2 DM

48
Q

_____ causes muscle tissue to upregulate GLUT4 transporters; first line treatment for diabetes

A

exercise

49
Q

Over-eating, obesity, inactivity, smoking

A

major causes of type 2 DM

50
Q

how does obesity cause type 2 DM

A

central adipocity
fat cells release adipokines, FFAs, inflammatory cytokines
oxidative stress
insulin resistance in target tissues

51
Q

rare form of diabetes, But these are single gene defects either in beta cell function or insulin action; something that they are born with; usually identified fairly early

A

monogenic diabetes

52
Q

number 1 drug cause of iatrogenic diabetes; these patients will get central adiposity

A

glucocorticoids

53
Q

these drugs can also result in hyperglycemia

A

atypical antipsychotics (mental health drugs)

54
Q

state of increased insulin resistance superimposed on an already existing state of beta cell dysfunction or loss

A

gestational diabetes

55
Q

risk factors for

A

gestational diabetes

56
Q

If ______ is untreated: babies will have higher birth weight, mother can have preeclampsia, and low blood sugar

A

gestational diabetes

57
Q

glucose tolerance test to check for gestational diabetes b/t what weeks

A

20-28

58
Q

intermediate stages in the disease processes but not quite disease

A

prediabetes

59
Q

_____ is major risk factor for CV events, dyslipidemias, and diabetes

A

obesity

60
Q

Fasting plasma glucose between 100 and 125 mg/dL (not diagnostic)

A

prediabetes

61
Q

2-hour plasma glucose between 140 – 199 mg/dL following a 75 –gm glucose OGTT

A

prediabetes

62
Q

(HbA1C) level between 5.7% & 6.4%

A

prediabetes

63
Q

basically, screen every _____ patient for diabetes

A

overweight or obese

64
Q

most important contributor to insulin resistance

A

obesity

65
Q

failure of target tissues to respond to insulin

A

insulin resistance

66
Q

state of obesity results in _______ leading to insulin resistance

A

oxidative stress

67
Q

Severe acute metabolic complication of DM (more common and severe in type 1 DM)

A

Diabetic Ketoacidosis (DKA)

68
Q

Precipitating factors: failure to take insulin (most common); stressors – intercurrent infections, illness, trauma

A

DKA

69
Q

stressors associated with release of epinephrine (blocks insulin release) cause this

A

DKA

70
Q

Insulin deficiency + glucagon excess exacerbates hyperglycemia (blood glucose levels in 250 – 600 mg/dL range)

A

DKA

71
Q

comes into ED w/ altered mental state, dehydrated
kids been wetting bed
Kussmahl breathing
”fruit-loopy” kind of smell to their breath

A

DKA

72
Q

in DKA, ______oxidized in liver to ketone bodies (acetoacetic acid & beta-hydroxybutyric acid) which build up in blood (ketonemia) and urine (ketonuria)

A

free fatty acids

73
Q

Dehydration compromises urinary excretion of ketone bodies, resulting in systemic metabolic _____

A

ketoacidosis

74
Q

Absence of _____; unable to use glucose; brain needs fuel
ketogenic machinery kicks in and goes int overdrive
pt gets dehydrated due to excretion of ketone bodies and glucose

A

insulin

75
Q

Can result in coma and death
Trying to blow out the acid (CO2) —-Kussmaul breathing

A

DKA

76
Q

Seen in type 2 DM
Due to severe dehydration resulting in sustained osmotic diuresis associated with hyperglycemia

A

hyperosmolar hyperosmotic syndrome (HHS)

77
Q

Typically an older disabled diabetic unable to maintain adequate water intake; dehydration w/ impaired mental status

A

hyperosmolar hyperosmotic syndrome (HHS)

78
Q

Most common acute metabolic complication in either type of diabetes

A

hypoglycemia

79
Q

treat hypoglycemia by

A

giving glucose

80
Q

Develop 15 – 20 years after onset of hyperglycemia
Responsible for majority of morbidity/mortality associated with type 1 and type 2 DM

A

late complications of DM

81
Q

PERSISTENT HYPERGLYCEMIA “GLUCOTOXICITY”

A

oxidative stress causing high glucose state

82
Q

At the end of the day, trying to maintain blood glucose at a good range and increase insulin____ at target tissues

A

sensitivity

83
Q

chronic complication of DM with accelerated atherosclerosis of large and medium-sized muscular arteries

A

macrovascular disease (MI, stroke, gangrene)

84
Q

chronic complication of DM resulting in capillary dysfunction in target organs due to deposition of excess basement membrane material and synthesis of extracellular matrix

A

microvascular disease

85
Q

diabetic retinopathy (retina)
diabetic nephropathy (kidneys)
diabetic neuropathy (peripheral nerve)

A

examples of microvascular disease as chronic complication of DM

86
Q

_______involving the aorta, large- and medium-sized arteries
Coronary artery atherosclerosis and myocardial infarction
Most common cause of death in diabetics
Type 2 DM often accompanied by HTN and dyslipidemia

A

accelerated atherosclerosis

87
Q
A

atherosclerosis

88
Q
A

atherosclerosis

89
Q

which vessel occluded

A

left anterior descending

90
Q

Vascular lesion also associated with HTN; not specific for DM
More prevalent and severe in DM
Amorphous, hyaline thickening of the walls of arterioles causing luminal narrowing

A

hyaline arteriolosclerosis

91
Q
A

hyaline arteriolosclerosis

92
Q

vision changes and foamy urine

A

diabetic microangiopathy

93
Q
A

diabetic microangiopathy

94
Q

_____lesions seen in diabetic nephropathy

A

glomerular

95
Q
A

glomerular lesions seen in diabetic nephropathy

96
Q

Renal artery atherosclerosis & hyaline
arteriolosclerosis seen in diabetic_____

A

nephropathy

97
Q

_____ is also seen in diabetic nephropathy that deals with infection from bladder up to kidneys

A

pyelonephritis

98
Q

cellular infiltrare in kidney

A

acute pyelonephritis

99
Q

Leading cause of end-stage renal disease in the U.S.

A

diabetic nephropathy

100
Q

acquired opacification of the lens

A

cataracts

101
Q

Most common cause of blindness in the U.S. in adults aged 20 – 74

A

diabetic retinopathy

102
Q

increased intraocular pressure resulting in damage to the optic nerve

A

glaucoma

103
Q
A

cataract

104
Q

retinal blood vessel walls weaken; deals with HTN

A

nonproliferative diabetic retinopathy

105
Q

new blood vessels growing into retina where they shouldn’t be

A

proliferative retinopathy

106
Q
A

neurovascular glaucoma

107
Q

Distal, ascending, symmetric sensorimotor polyneuropathy “stocking and glove” distribution involving hands and feet

A

diabetic neuropathy

108
Q

Abnormal feeling in hands and feet (due to peripheral nerves not getting blood flow they need from capillary beds); getting enough that the tissue is not becoming gangrenous

A

diabetic neuropathy

109
Q

Loss of pain sensation, numbness, difficulty with balance; Alternatively may have burning, prickling pain, tingling, aching in extremities

A

diabetic neuropathy

110
Q

footdrop is diagnostic for what

A

untreated diabetes

111
Q

Bowel, bladder, sexual dysfunction, footdrop

A

diabetic neuropathy

112
Q

long term diabetes changes _____ function increasing susceptibility to infections

A

neutrophil

113
Q

______ renal infection

A

candida

114
Q

can be seen in pt in DKA; unconscious

A

Mucormycosis

ENR Biweekly 3 (14 decks)

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