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[h] Endocrinology Flashcards

[i] Master this session in just 5 minutes.

[q] ………. constitute about 20% of the islet cells and secrete glucagon and tend to be located near the periphery of the islet.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFscGhhIGNlbGxzLg==

Cg==

Cg==[Qq]

[q] ………….. constitute 60-75% of the islet cells and tend to be located near the center of the islet. It synthesize preproinsulin, which is cleaved to form proinsulin, which, in turn, splits into insulin and C peptide both of which are secreted in equimolar quantities.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEJldGEgY2VsbHMu

Cg==

Cg==[Qq]

[q] ……………….. constitute about 5% of the islet cells, are interspersed between the alpha and beta cells and secrete somatostatin.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERlbHRhIGNlbGxzLg==

Cg==

Cg==[Qq]

[q]The K-lowering action of insulin is used to treat acute, life-threatening hyperkalemia because insulin increases the activity of ………….. in most body tissues?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE5hL0stQVRQYXNlLg==[Qq]

[q] Transport of glucose across the cell membrane facilitated by transmembrane proteins without the expenditure of energy is called ………………….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGZhY2lsaXRhdGVkIGRpZmZ1c2lvbiAoY2Fycmllci1tZWRpYXRlZCB0cmFuc3BvcnQpLg==[Qq]

[q] ………… is the insulin-sensitive transporter found in skeletal muscle cells and adipocytes?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEdMVVQ0Lg==[Qq]

[q] The most important controller of insulin secretion is ……..?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHBsYXNtYSBnbHVjb3NlLg==

Cg==

Cg==[Qq]

[q] For glucose to promote insulin secretion, it must not only enter the β-cell but also be metabolized, so as to increase intracellular ……….. concentration. This causes the ATP-gated potassium channels in the cellular membrane to …………..?. The ensuing rise in positive charge inside the cell, due to the increased concentration of potassium ions, leads to ……. of the cell. The net effect is the activation of ………………, which transport calcium ions into the cell.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFUUCwgY2xvc2UgdXAsIGRlcG9sYXJpemF0aW9uLCB2b2x0YWdlLWdhdGVkIGNhbGNpdW0gY2hhbm5lbHMu

Cg==

Cg==[Qq]

[q] Oral glucose leads to an increase in insulin secretion more than when glucose in administered intravenously, this is due to ………….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEdsdWNhZ29uIGxpa2UgUGVwdGlkZS0xIChHTFAtMSkgYW5kIGdhc3RyaWMgaW5oaWJpdG9yeSBwZXB0aWRlIChhbHNvIGtub3duIGFzIGdsdWNvc2UgZGVwZW5kZW50IGluc3VsaW5vdHJvcGljIHBvbHlwZXB0aWRlIG9yIEdJUCkuIEJvdGggb2YgdGhlbSBhcmUgY2FsbGVkIGluY3JldGlucy4=

Cg==

Cg==[Qq]

[q] …………….. stimulate a decrease in blood glucose level by causing an increase in the amount of insulin released from pancreatic beta cells after eating, before blood glucose level become elevated. They also inhibit the release of glucagon from alpha cells, delay gastric emptying, and decrease appetite.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGluY3JldGlucy4=

Cg==

Cg==[Qq]

[q] Glucagon (stimulates or inhibits) insulin release.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHN0aW11bGF0ZXMu[Qq]

[q] Insulin (stimulates or inhibits) Glucagon release.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGluaGliaXRzLg==[Qq]

[q] Somatostatin (stimulates or inhibits) insulin release.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGluaGliaXRzLg==[Qq]

[q] Parasympathetic stimulation of muscarinic M3 receptors (stimulates or inhibits) insulin secretion and is induced by the smell and/or sight of food.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHN0aW11bGF0ZXMu[Qq]

[q] Stimulation of beta-2 receptors (stimulates or inhibits)

insulin secretion while stimulation of alpha-2 receptors (stimulates or inhibits) insulin release. However, ………..  is predominant, causing sympathetic stimulation to lead to overall (stimulates or inhibits) of insulin secretion.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHN0aW11bGF0ZXMsIGluaGliaXRzLCB0aGUgYWxwaGEtMi1tZWRpYXRlZCBpbmhpYml0b3J5IGVmZmVjdCwgaW5oaWJ0aW9uLg==[Qq]

[q] ………. is made by α cells of pancreas and elevates blood sugar levels to maintain homeostasis when bloodstream glucose levels fall too low (fasting state).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEdsdWNhZ29uLg==[Qq]

[q] The primary target for glucagon action is ……….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHRoZSBsaXZlciBoZXBhdG9jeXRlLg==[Qq]

[q] ………. accounts for 5-10% of diabetes worldwide. The age of onset is usually age <30 (Onset in childhood). There is an increased prevalence of autoantibodies to islet cells. Not related to obesity. Patients usually have a lean body build and are prone to ketosis owing to absent insulin production.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFR5cGUgMSBETSAoaW5zdWxpbi1kZXBlbmRlbnQgb3IganV2ZW5pbGUgb25zZXQpLg==[Qq]

[q] ………….. is the most common type of diabetes, accounting for 90% of cases. Age of onset is usually ˃ 40 (Onset in adulthood). Directly related to obesity. Defined as insulin resistance.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFR5cGUgMiBETSAobm9uLWluc3VsaW4tZGVwZW5kZW50IG9yIG1hdHVyaXR5IG9uc2V0KS4=[Qq]

[q] In the United States, fasting blood sugar is the most preferred way to screen patients for diabetes mellitus. Two fasting blood glucose measurements ≥ ………. after Fasting for > 8 hours.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IDEyNiBtZy9kTC4=[Qq]

[q] Hemoglobin A1c ≥ …….. is a diagnostic criterion and is the best test to follow response to therapy over the last several months. HbA1c levels are affected by alterations in red blood cell survival; conditions that ………. can cause falsely low HbA1c levels.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IDYuNSUsIGluY3JlYXNlIHJlZCBibG9vZCBjZWxsIHR1cm5vdmVyIChoZW1vbHl0aWMgYW5lbWlhKS4=[Qq]

[q] ………. play a causative role in beta cell apoptosis and defective insulin secretion in patients with type 1 DM.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IElzbGV0IGxldWtvY3l0aWMgaW5maWx0cmF0ZS4=

Cg==

Cg==[Qq]

[q] ………. play a causative role in beta cell apoptosis and defective insulin secretion in patients with type 2 DM.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IElzbGV0IGFteWxvaWQgcG9seXBlcHRpZGUgKElBUFApIGRlcG9zaXRzLg==

Cg==

Jm5ic3A7

Cg==

[Qq]

[q] Measuring of the waist-to-hip ratio (WHR) indirectly measures the visceral fat to subcutaneous fat as the abdomen contains mainly viscera and hips have only subcutaneous fat. A high waist hip ratio is associated with ………..?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IG1ldGFib2xpYyBzeW5kcm9tZSwgaW5zdWxpbiByZXNpc3RhbmNlLCBhbmQgdHlwZSAyIGRpYWJldGVzIG1lbGxpdHVzLg==[Qq]

[q] ………… is a known mechanism of insulin resistance induced by TNF-alpha, glucagon, and glucocorticoids because it interferes with down-stream signaling.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFNlcmluZSBwaG9zcGhvcnlsYXRpb24u

Cg==

Cg==[Qq]

[q] Non-enzymatic glycosylation (NEG) of large- and medium-sized vessels leads to atherosclerosis and its resultant complications. ……….. is the leading cause of death among diabetics.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENvcm9uYXJ5IGFydGVyeSBkaXNlYXNlcy4=[Qq]

[q] PoIyoI pathway impairment cause accumulation of sorbitol and fructose leading to ………. of Schwan cells and lens.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IG9zbW90aWMgY2VsbHVsYXIgaW5qdXJ5Lg==[Qq]

[q] ……….. is the most common cause of adult kidney failure in the developed world.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERpYWJldGVzIG1lbGxpdHVzLg==[Qq]

[q] ………. presents with symptoms of anorexia, nausea, vomiting, early satiety, postprandial fullness, and impaired glycemic control. Hypoglycemic episodes can occur with insulin administration prior to meals.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERpYWJldGljIGdhc3Ryb3BhcmVzaXMgKGRlbGF5ZWQgZ2FzdHJpYyBlbXB0eWluZyku[Qq]

[q] What is the most likely diagnosis?

35 years old female with history of type 1 DM presenting with nausea and vomiting, severe abdominal pain, dry mucous membranes and lethargy, polyuria, fruity odor on her breath, and deep and rapid breath + Lab values shows hyperglycemia, high anion gap metabolic acidosis, and hyperkalemia?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERpYWJldGljIEtldG9hY2lkb3Npcy4=

Cg==

Cg==[Qq]

[q] The main 2 causes of paradoxical hyperkalemia in patients with diabetic acidosis are ……………… and ………….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]

Cg==

byBFeHRyYWNlbGx1bGFyIHNoaWZ0IG9mIHBvdGFzc2l1bSBpbiBleGNoYW5nZSB0byBoeWRyb2dlbiBpb24sIHdpdGggcmVzdWx0YW50IGludHJhY2VsbHVsYXIgcG90YXNzaXVtIGRlZmljaXQu

Cg==

[Qq]

o Impaired insulin-dependent cell entry of the potassium ion.

[q] Hyperkalemia in diabetic ketoacidosis is sometimes called paradoxical because ………………….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHRoZSBib2R5IHBvdGFzc2l1bSByZXNlcnZlcyBhcmUgYWN0dWFsbHkgZGVwbGV0ZWQgZHVlIHRvIGluY3JlYXNlZCBnYXN0cm9pbnRlc3RpbmFsIGxvc3NlcyBhbmQgb3Ntb3RpYyBkaXVyZXNpcy4=[Qq]

[q] ………….. is characterized by severe hyperglycemia (frequently >1000 mg/dL) and increased serum osmolality (>320 mOsm/kg). There is little or no ketonemia or acidosis present, and most patients have pH >7.3 and serum bicarbonate >20 mEq/L. It frequently develop neurologic symptoms (focal signs, lethargy, blurry vision, and obtundation) due to severe hyperglycemia and elevated serum osmolality.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEh5cGVyb3Ntb2xhciBoeXBlcmdseWNlbWljIHN0YXRlIChISFMpLg==

Cg==

Cg==[Qq]

[q] There are two important causes of hypoglycemia in non-diabetic patients with elevated insulin level:
1. Insulinoma (beta cell tumor).
2. Surreptitious use of insulin or sulfonylurea.

How to differentiate between them?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFmdGVyIG1lYXN1cmluZyBDLXBlcHRpZGU6

Cg==

JiM4MjExOyBJZiB0aGVyZSBpcyBsb3cgQy1wZXB0aWRlIHRoaXMgbWVhbnMgaXQmIzgyMTc7cyBkdWUgdG8gaGlnaCBleG9nZW5vdXMgaW5zdWxpbi4=

Cg==

[Qq]

– If there is high C-peptide ask for urine drug assay, if it’s positive —-> it’s due to sulfonylurea, if negative —> sulfonylurea.

[q] If IV access cannot be established in a patient with hypoglycemia, the patient can be given ………?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGludHJhbXVzY3VsYXIgZ2x1Y2Fnb24gaW5qZWN0aW9uLg==[Qq]

[q] Infants of diabetic mothers at risk of macrosomia due to …………?. They also at risk of transient hypoglycemia that persist for several days after delivery due to ………….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGJldGEgY2VsbCBoeXBlcnBsYXNpYSwgdHJhbnNpZW50IGh5cGVyaW5zdWxpbmVtaWMgc3RhdGUu[Qq]

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