Week 6 Review Q's Flashcards
Pharma of GH (1-35) Physio of GH (36-55) GH and Growth factors biochem (56-88) behavioral science 1 (89-107) behavioral science 2 (108-118) patho lab assessment of growth disorders (119-132)
1
Q
Growth hormone is made up of how many amino acids?
A
191 (2 disulfide bonds connecting them)
2
Q
How does GH mediate its effects?
A
via IGF-1
3
Q
Which of the following does NOT increase GH production? a. exercise b. low fatty acids c. high protein meal d. high sugar in blood e. ghrelin
A
d. high sugar in blood (low blood sugar stimulates GH, it has an anti-insulin effect)
4
Q
During sleep, when is GH the highest?
A
after 60-90 minutes of sleep (stage 3 of 4 of sleep)
5
Q
Dopamine acts to increase GH release by acting on which receptor? a. alpha 1 b. alpha 2 c. beta 1 d. beta 2
A
d. beta 2
6
Q
serotonin and adrenergic agonists (ex/clonidine) act to increase GH release by acting on which receptor? a. alpha 1 b. alpha 2 c. beta 1 d. beta 2
A
b. alpha 2 (adrenergic receptors)
7
Q
Where is somatostatin found? What does it inhibit?
A
found in hypothalamus and pancreas; decreases insulin, glucagon, and growth hormone
8
Q
Which inhibits the release of GH? a. IGF-1 b. somatostatin c. both d. neither
A
c. both
9
Q
Which inhibits the synthesis of GH? a. IGF-1 b. somatostatin c. both d. neither
A
a. IGF-1
10
Q
Which two of the following stages is GH likely to increase in? a. neonate b. childhood c. adolescence d. adults e. elderly
A
a. neonate & c. adolescence (around puberty)
11
Q
Whats the half-life of GH? What metabolizes it?
A
20 minutes liver and kidney
12
Q
short term GH uptake VERSUS long term GH uptake (how does each affect carb uptake?)
A
short term causes increase of glucose uptake, but long term causes decrease of glucose uptake
13
Q
What mediates the actions of growth hormone?
A
IGF-1
14
Q
How can you determine if a kid has insufficient GH?
A
- growth less than 4cm per year
- no response to agents that usually increase GH secretion (low response= less than 7 microliters)
- delayed bone age
15
Q
Which of the following is an analog of Growth hormone-releasing hormone (GHRH)? a. Mecasermin b. Somatrem c. Somatropin d. Sermorelin
A
d. Sermorelin
16
Q
Which of the following is made by adding methionine amino acid? a. Somatropin b. Somatrem c. both d. neither
A
b. Somatrem
17
Q
Which of the following can be taken orally? a. Somatropin b. Somatrem c. both d. neither
A
d. neither
18
Q
What is used to treat Laron Dwarfism? explain.
A
Mecasermin is used because it’s an IGF-1 analog. In Laron Dwarfism, the GH receptor is insensitive or not functioning, so we bypass it and directly give IGF-1.
19
Q
Hexarelin is an analog of … made up of … amino acids
A
Hexarelin is an analog of ghrelin made up of 6 aa’s (can be given intranasally)
20
Q
How do androgen and estrogens interfere with GH action?
A
they enhance epiphysis closure
21
Q
How do glucocorticoids interfere with GH action?
A
because they’re catabolic hormones (increase protein degradation) and that goes against GH
22
Q
Which of the following has the exact AA sequence as GH? a. Somatropin b. Somatrem c. both d. neither
A
a. Somatropin (GH aka Somatropin)
23
Q
How does GH affect drug concentrations?
A
it increases Cytochrome P-450 activity, and this metabolizes the drugs and decreases their serum level
24
Q
Octreotide is an analog of what? What does it inhibit?
A
its an analog of somatostatin, so it decreases insulin, glucagon, and GH
25
Cabergoline & Bromocriptin are analogs of
dopamine (used to treat acromegaly)
26
What drug blocks GH receptors?
Pegvisomant
27
T/F: Octreotide is given orally
false, it can be given subcutaneously
28
When (time of day) should you give GH or GH analogs? Why?
in the evening, to mimic body rhythms
29
What's the relationship between dopamine analogs and GH?
dopamine stimulates GH secretion in normal people, but in patients with acromegaly, Cabergoline & Bromocriptin, (dopamine analogs) it decreases GH secretion
30
Which is used to treat Pancreatic cell tumors (VIPomas)? a. Somatropin b. Octreotide c. Cabergoline d. Hexarelin e. Pegvisomant
b. Octreotide (also to treat carcinoid tumor and GH excess)
31
What two drugs normalize IGF-I levels in 35% of patients?
Cabergoline & Bromocriptin
32
Which has a side effect of vomiting? explain the mechanism. a. Somatropin b. Octreotide c. Cabergoline d. Hexarelin e. Pegvisomant
c. Cabergoline (vomiting due to the activation of the chemoreceptor trigger zone)
33
Which has a side effect of H. pylori infections? a. Somatropin b. Octreotide c. Cabergoline d. Hexarelin e. Pegvisomant
b. Octreotide
34
Which drug is given once or twice a month via intramuscular methods?
Somatrem
35
Which drug has a side effect of gall bladder contractility?
Octreotide
36
T/F: GH mainly targets the liver
true, it does have receptors in many places in the body but the liver is where IGF-1 is secreted which mediates GH activities (GH receptor is enriched in the liver)
37
What is more, GH in free form or GH bound to its binding protein (GHBP)?
they're equal
38
What stabilized IGF-1? For how long can it do this?
IGF-1/IGFBP/ALS complex works to stabilize IGF-1 for up to 12 hours
39
What do you measure when you want to evaluate GH in the body?
GH's half-life is very short, so we measure IGF-1, which has a longer half-life and is stimulated by GH (IGF-1 is a good indicator of GH levels)
40
Explain how GH can lead to the burn out of pancreatic beta cells?
GH has an anti-insulin effect, so it reduces glucose uptake and it increases glucose output. This results in high glucose in the blood, and that triggers insulin release. Insulin is getting released more and more (GH acting against it) that the body becomes insulin INsensitive. So now more insulin is needed to make the same progress. beta cells work more and more until they burn out. Just like us in medical school.
41
What occurs to insulin if no GH is present?
lower insulin secretion
42
GH is anabolic for which of the following? a. carbs b. fats c. proteins
c. proteins
43
How can you remove the lipolytic effects of GH?
if you give insulin along with it (long term GH effect becomes ketogenic)
44
What type of energy do we use when we sleep? why?
GH is released during sleep and it shifts the metabolism towards lipolysis conserve carbs and proteins.
45
How does GH effect urea production?
it increases amino acid uptake and helps the body retain nitrogen, thus decreasing urea production
46
What is the Protein sparing effect?
(aka amino acid sparing) is the process by which the body derives energy from sources other than protein. Such sources can include fatty tissues, dietary fats and carbs.
47
How do high amounts of free fatty acids and hyperglycemia effect GH release?
decrease it
48
Explain how sex hormones affect GH release.
sex hormones increase GH release, however, very high levels of sex sterioids- like in pregnancy- inhibit GH stimulation and release
49
Why are those with pituitary dwarfism likely obese?
GH-induced lipolysis lost
50
What condition is characterized by high GH but no IGF-I production?
Laron syndrome (remember: Laron Dwarfism is treated with IGF-I analogs)
51
What is Simmonds disease?
form of hypopituitarism due to pituitary destruction.
52
give me at least 3 symptoms of Simmonds disease
* Hypoglycemia
* Increase percentage of fat
* Decrease percentage of protein
* Muscle weakness and exhaustion
* Increased risk of heart disease
53
Which results in increased brain weight? a. acromegaly b. giantism
a. acromegaly
54
Which results in higher susceptibility to infections? a. acromegaly b. giantism
b. giantism
55
T/F: ketoacidosis is common among patients with giantism
false, diabetes can occur, but ketoacidosis is rare
56
What chromosome encodes GH?
chromosome 17
57
Using what mechanism does GHRH activate somatotrophs to release GH?
via cAMP
58
Using what mechanism does Ghrelin activate the release of GH?
Ca
59
Using what mechanism does somatostatin inhibit GH release?
by inhibiting cAMP
60
What type of receptors are receptors of the hypothalamus?
heptahelical transmembrane receptors that are bound to G proteins
61
Which of the following G proteins activates phosphodiesterase? What occurs after this activation? a. Gs b. Gi c. Gq
b. Gi Gi activates phosphodiesterase, which converts cAMP to 5'-AMP inactivating it to stop the GH expression
62
Which activates somatostatin release (negative feedback)? a. GH b. IGF-1
b. IGF-1
63
What is one of the reasons that older people lose muscle mass?
reduction of GH
64
GH receptor is made up of how many aa's?
620
65
How many binding sites does GH have?
two
66
GHBP is made up of which part of the GH receptor?
the extracellular domain
67
What does GHBP do and how does it work?
it inhibits GH by attaching to the GH ligand (non-productivity binding) it increases GH half-life by binding to it and delaying its elimination
68
how many aa's make up IGF-I & IGF-II?
IGF-I = 70 aa's IGF-II = 67 aa's
69
Which of the following mainly comes from the liver? a. IGF-I b. IGF-II
a. IGF-I
70
Which of the following is implicates in cancer development? a. IGF-I b. IGF-II
a. IGF-I
71
What is des(1-3)IGF-1? What is it made of? How is its activity special? why?
It's made up of IGF-I that has been converted. It's more potent than IGF-I because of reduced affinity to IGFBP (growth factor binding protein)
72
IGF-I half-life is prolonged by ... when .... is administered
IGF-I half-life is prolonged by 12 hours when IGFBP is administered (binding protein)
73
What type of IGFBP is the major one found in the serum?
IGFBP-3
74
Which of the following effects fetal development? a. IGF-I b. IGF-II
b. IGF-II
75
IGFBP-3 concentration is dependent on what?
GH dependent
76
Which of the following effects skeletal and cartilage growth? a. IGF-I b. IGF-II
a. IGF-I
77
The receptors of which two of the following are similar? What does this mean? a. IGF-I b. IGF-II c. insulin
a. IGF-I & c. insulin (parts of each of them can merge and create a receptor)
78
What is more likely to bind to a IGF-I receptor?
IGF-I, then IGF-II, then with least affinity it can bind with insulin
79
How is the IGF-II receptor different from IGF-I receptor?
no tyrosine kinase domain (the IGF-II receptor is just there to trap and remove the IGF-II)
80
What are the two kinds of receptor tyrosine kinases?
monomeric dimeric
81
What activates MAPK (mitogen-activated protein kinase)?
SHC (src homologous and collagen)
82
Which of the following controls glucose homeostasis within the cell? a. src homologous and collagen (SHC) b. Phosphoinositide 3-kinase (PI3K) c. mitogen-activated protein kinase (MAPK)
b. Phosphoinositide 3-kinase (PI3K) (activated by Insulin receptor substrate 1 (IRS-1))
83
How do intracellular proteins know when to bind to receptor tyrosine kinases?
SH2 and/or SH3 domains of proteins recognize the activated phosphotyrosine residues
84
Which two of the following are off switches? (inhibitors of GH intracellular activity) a. SHP-2 b. Shc c. SOCS d. Grb2
a. SHP-2 (src homology 2 domain-containing protein tyrosine phosphatase 2) & c. SOCS (suppressor of cytokine signaling)
85
How does SHP-2 & SOCS act?
SHP-2 -\> dephosphorylates the GH receptor and/or JAK2 SOCS -\> inhibits JAK2
86
Which decreases JAK2 activity and which increases JAK2 activity? a. SH2-B b. Shc c. SOCS d. Grb2
a. SH2-B -\> increases JAK2 c. SOCS -\> decreases JAK2
87
African pigmy is characterized by a. GH resistance b. GH deficiency c. IGF-I resistance d. IGF-I deficiency
c. IGF-I resistance (due to partial defect in GH receptor. Bad receptor-\> delayed rise in IGF)
88
Laron Dwarfism is characterized by a. GH resistance b. GH deficiency c. IGF-I resistance d. IGF-I deficiency
a. GH resistance
89
What is the allostatic load?
the wear and tear on the body which accumulates as an individual is exposed to repeated or chronic stress
90
Which (one or two) of the following has adrenaline and noradrenaline receptors? a. T cells b. B cells c. Lymphocytes d. Macrophages
c. Lymphocytes
91
Which (one or two) of the following glucocorticoid receptors? a. T cells b. B cells c. Lymphocytes d. Macrophages
a. T cells & b. B cells
92
How does stress indirectly affect immunity?
by encouraging maladaptive behaviors
93
How do stressors affect the immune system?
acute stressors stimulate the immune system but chronic ones suppress it
94
T/F: cortisol and epinephrine can promote nerve cell damage in chronic stress
true (also encourage deposition of fat, insulin resistance, and hypertension- in chronic stress)
95
How does chronic stress affect cortisol levels?
chronic stress makes the body less sensitive to glucocorticoids (ex/cortisol) and when its less sensitive, it takes more glucocorticoid to negatively inhibit the secretion (negative feedback loop). thats why the levels increase. (higher levels lead to inflammation)
96
How does chronic stress lead to reduced cardiovascular health?
chronic stress releases cholesterol into the blood, it builds up on arterial walls and restricts blood flow to the heart
97
T/F: cardiac patient outcomes are associated with anger levels
true (anger has 20% increased risk for coronary artery disease)
98
Which personality type is associated with anger? a. type A b. type B c. type C d. type D
a. type A (main compnents= hostility and anger)
99
Which personality type has an increased risk of adverse cardiac outcomes? a. type A b. type B c. type C d. type D
d. type D
100
Which of the following is more likely to have IBS or a gastrointestinal disease? a. stay at home mom b. gym teacher c. soldier d. a high school dropout
c. soldier found twice as often in more stressful occupations
101
What bacteria causes ulcers?
H. pylori
102
What type of stress is associated with enhanced memory storage and greater concentration on immediate events?
short term
103
How does chronic stress affect the brain?
shrinking of the hippocampus (due to high long term cortisol exposure)
104
What does antonovsky salutogenic model emphasize?
concerned with the relationship between health, stress, and coping. What people do to maintain health? (underlying origin of health)
105
Whats the function of generalized resistance resources (GRRs)?
they're used to adapt and to resist the forces that push towards disease (used in the salutogenic model)
106
What are the three factors of the salutogenic model? explain them. Whats the most important factor?
comprehensibility - makes cognitive sense manageability - can use resources to cope with them meaningfulness - makes emotional sense (most important is meaningfulness)
107
What does a weak sense of coherence (SOC) present as? how about a strong SOC?
Weak SOC - no hope, everything will go wrong strong SOC - life is complicated and it will work out
108
Why is pain in cancer patients the least reported and treated pain?
Patients believe that if they report the pain the physician will focus on the pain rather than the cancer treatment and they will get worst
109
What is an independent risk factor for predicting cancer survival?
pain
110
Where does pain perception occur?
in the brain not the pain receptors
111
T/F: the more severe the pain is the more likely the patient is expressing it (yelling, crying, etc.
false, many factors go into the expression of pain (ex/ culture, believes, mental status, etc
112
Which kind of somatic pain is more intense? a. surface somatic pain b. deep somatic pain
b. deep somatic pain
113
Which kind of somatic pain in neoplasms? a. surface somatic pain b. deep somatic pain
b. deep somatic pain
114
describe of liver and pancreatic pain
sharp and penetrating
115
What's malingering pain?
an exasperated response to pain for secondary gains
116
What is Anorexia-cachexia syndrome?
progressive weight loss associated with malignancy and is characterized by loss of appetite (anorexia), skeletal muscle wasting, and reduced adipose tissue
117
T/F: children exposed to repeated painful procedures often experience less anxiety and pain due to acclimatization
false, anxiety and pain increases with more procedures
118
Which chemotherapy symptoms does acupuncture help relieve?
nausea and vomiting
119
What three organs does GH have a direct effect on?
liver, muscle, adipose
120
A patient has spade hand, what is a possible explanation?
he has acromegaly (spade hands is when the patient can put his fingers close together due to excess growth)
121
What are two chromosomal abnormalities that cause short stature?
turner's syndrome down's syndrome
122
Which is more helpful in diagnosis of GH disorders? why? a. baseline GH levels b. dynamic GH levels
b. dynamic GH levels (GH is pulsatile, so based on the time you measure it, the basal GH levels may appear normal or abnormal. Dynamic GH levels are measured after a stimulatory agent is given to enhance GH secretion)
123
How do you assess bone age?
X-ray of nondominant hand and wrist
124
What does a GH stimulation test indicate?
GH deficiency or pituitary tumor
125
What are four things that can stimulate GH secretion?
insulin arginine clonidine L-dopa
126
How do you diagnose/confirm GH deficiency?
failure of at least 2 stimulation tests and/or IGF-1 levels (this can also confirm GH deficiency)
127
What are two chromosomal abnormalities that cause tall stature?
Klinefelter syndrome Marfan syndrome
128
What suppresses GH secretion?
glucose (OGTT) (many more ex/ high free fatty acids)
129
Besides GH, what hormone is increased in acromegaly?
prolactin (high in 25% of the patients)
130
IGF-1 levels can confirm which of the following? a. GH deficiency b. acromegaly c. both d. neither
a. GH deficiency (it can screen for acromegaly, but not confirm it)
131
GH excess in children vs GH excess in adults
in children= giantism in adults= acromegaly
132
GH deficiency in children vs GH deficiency in adults
in children= pituitary dwarfism in adults= more fat mass (especially in omentum), less lean body mass, cardiovascular risk factors, and social isolation
133
What is the mechanism of somatorem in a child with growth hormone
deficiency?
A. Decrease collagen synthesis
B. Increases proliferation of chondroblasts and osteoblasts
B. Increases proliferation of chondroblasts and osteoblasts
134
What is a characteristic of IGF-1 receptor? (Ask Dr.)
A. Exhibits intrinsic tyrosine kinase activity
B. Heterodimerizes with GH receptor
C. Couples with Gi protein
D. Couples with Ras
no answer provided
135
Which of the following stimulates growth hormone release?
A. Exercise
B. Glucagon
C. Carbergoline
D. Oral glucose tolerance test
A. Exercise
