Term
| The leading cause of end-stage renal disease, amputation of the lower extremities (non-trauma) and adult-onset blindness in the US |
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Definition
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Term
| Diabetes mellitus has a wide variety of underlying causes, list the broad classes |
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Definition
| Type 1, Drug-induced, Gestational, genetic conditions assocaited with DMII (Down Syndrome, Kleinfelter, Turner), Genetic defects of B-cell function, Genetic defects in insulin action, exocrine pancreatic disease (pancreatitis, neoplasia), Endocrinopathies (acromegaly, hyperthyroidism), Infections (Coxsackie B, CMV, Congenital rubella), type 2 diabetes mellitus (insulin-resistance and insulin dysfunction) |
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Term
| True or false: low levels of circulating insulin and high levels of circulating glucagon stimulate glycogen synthesis and suppress glycogenolysis and gluconeogenesis |
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Definition
| False, glucagon stimulates hepatocytes to break down glycogen (glycogenolysis) and make more glucose (gluconeogenesis) to prevent hypoglycemia |
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Term
| This biomolecule, produced from the conversion of pre-proinsulin in the golgi appartus, is secreted in equimolar concentrations with insulin from B-cells in the pancreas, making it a useful marker for B-cell function |
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Definition
| C-peptide, produced from proteolytic cleavage of pre-proinsulin in the golgi appartus of B-cells in the pancreatic islet cells |
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Term
| True or false: the most important stimulus of insulin production and secretion is glucose |
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Definition
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Term
| This transporter on B-cell membranes takes glucose into the pancreatic B-cells independent of insulin |
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Definition
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Term
| True or false: ATP generated from glucose in B-cells activates potassium channels that increase membrane potential to release glucose |
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Definition
| False, ATP inhibits the inward-rectifying K channel, which increases membrane depolarization, causing an influx of Ca-ions which triggers glucose secretion from the cell |
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Term
| This compound is complexed to the inward rectifying K-channel on B-cells, also a target for some pharmacologic agents used in the tx of DMII |
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Definition
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Term
| These two cells make up the majority of cells involved in insulin-mediated glucose uptake |
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Definition
| Skeletal muscle cells and adipocytes |
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Term
| True or false: Glucose taken up by adipocytes is stored as a lipid, and inhibits lipid degradation |
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Definition
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Term
| True or false: In addition to glucose transport and anabolic stimulation, insulin has mitogenic properties in some tissues |
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Definition
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Term
| Through phosphorylation of the tyrosine kinase portion of the B-subunit of the insulin receptor, proceeding through the PI-3K and MAP kinase pathways, Insulin triggers the expression and insertion of this transporter in the cell membrane |
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Definition
| GLUT-4, the insulin-dependent glucose transporter |
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Term
| These genes, also linked with Hashimoto's thyroiditis, are implicated in susceptibility to DMI |
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Definition
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Term
| True or false: The two metabolic defects that characterize DMII are a decreased response of peripheral tissues to insulin (insulin resistance) and B-cell dysfunction leading to inadequate insulin secretion compounding hyperglycemia and insulin resistance |
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Definition
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Term
| This event in the pathogenesis of DM II is likely to be the largest contributor |
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Definition
| Loss of insulin sensitivity in hepatocytes, leading to increased gluconeogenesis and glycogenolysis |
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Term
| True or false: Obesity often results in insulin resistance with or without hyperglycemia |
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Definition
| True, ie part of the metabolic syndrome |
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Term
| True or false: Central adiposity is a bigger contributor to insulin resistance than peripheral adiposity |
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Definition
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Term
| These four factors contribute to increased DMII risk in obese individuals |
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Definition
| Elevated non-esterified fatty acids in liver and skeletal muscle cells, adipokines (lectin) that affect fatty acid metabolism throughout the body, inflammation from pro-inflammatory cytokines (TNFa, IL2, IL6) secreted by adipose tissue, and peroxisome proliferation-activated receptor gamma (PPARy) an important transcription factor in adipose tissue that promotes secretion of anti-hyperglycemic adipokines (lectin, adiponectin) and the target of the anti-DM2 meds thiazolidinediones, which are PPARy agonists |
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Term
| The key mediator in pathogenesis of type 2 diabetes mellitus. |
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Definition
| glucotoxiciy from chronic hyperglycemia |
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Term
| The four pathophysiologic consequences of advanced glycation end-products are: |
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Definition
| AGE bound to RAGE on macrophages causing inflammatory cytokine release, especially in the intima of blood vessels, generation of ROS in endothelial cells, increased procoagulant activity on endothelial cells and macrophages, and enhanced proliferation of vascular smooth muscle |
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Term
| True or false: de novo synthesis of diacyl glycerol in response to intracellular hyper glycemia results in increased nitric oxide synthesis and decreased endothelin-1 synthesis |
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Definition
| False, nitric oxide, a vasodilator, is lowered by decreased expression of the nitric oxide synthase enzyme. Endothelin-1 is increased |
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Term
| Increased production of profibrogenic factors, TGF-B for instance, from increased intracellular glucose concentrations is a result of increased activation of this enzyme |
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Definition
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Term
| True or false: Nerve tissue is damaged by hyperglycemia in spite of lacking insulin-dependent glucose transport systems |
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Definition
| True, chronic hyperglycemia increases intracellular glucose concentration, which is reduced to fructose by aldose reductase and NADPH, which reduces the amount of NADP+ available for antioxidant synthesis (glutathione), increaseing oxidative stress in the cell |
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Term
| List the three types of endogenous Cushing's syndrome |
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Definition
| an ACTH secreting tumor/hyperplastic mass in the pituitary, hypersecretion of cortisol by an adrenal adenoma, carcinoma or hyperplastic gland, and secretion of ectopic ACTH by a nonendocrine neoplasm |
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Term
| T or F: Primary hypersecretion of ACTH accounts for 10-20% of cases of endogenous hypercortisolism |
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Definition
| False, 70-80%, remainder come from nonendocrine neoplasms or adrenal hypersecretion |
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Term
| T or F: Cushing's disease affects men about five times more frequently than women. |
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Definition
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Term
| What can be said of serum ACTH levels in the case of Cushing's disease due to an adrenal neoplasm versus a pituitary neoplasm? |
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Definition
| In adrenal neoplasms the serum ACTH is low due to inhibition from elevated cortisol, wherein pituitary neoplasm the ACTH is high as well as the cortisol since the tumor is secreting ACTH |
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Term
| Which ectopic ACTH-secreting tumor is usually responsible for Cushing's disease |
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Definition
| small cell carcinoma of the lung |
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Term
| The most common alteration of pituitary tissue in Cushing's syndrome, resulting in replacement of granular basophilic cyoplasm of ACTH cells with a homogenous lightly basophilic material due to keratin filament accumulation, is called () |
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Definition
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Term
| Describe the dexamethasone suppression tests |
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Definition
| Low dose should inhibit ACTH secretion if there is NO pituitary abnormality at all, points to either an exogenous Cushing's syndrome (drugs usually) or not Cushing's at all, High dose rules out pituitary tumor vs. ectopic source of ACTH since ectopic sources are less sensitive to neg. feedback than pituitary tumors |
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Term
| Which enzyme deficiency accounts for more than 90% of CAH? |
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Definition
| 21 hydroxylase or CYP21B deficiency, results from pseudogene (CYP21A) replacement of functional gene |
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Term
| When massive adrenal hemorrhage complicates a bacteremic infection it is called () |
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Definition
| Waterhouse-Friderichsen syndrome |
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Term
| What 3 classifications exist for adrenal insufficiency? |
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Definition
| Primary acute insufficiency or adrenal crisis, primary chronic adrenocortical insufficiency (Addison disease) and secondary adrenocortical insufficiency |
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Term
| What organisms are usually implicated in the Waterhouse-Friderichsen syndrome? |
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Definition
| Neisseria meningitidis, pneumcocci, pseudomonas, HiB, and staphylococci |
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Term
| 90% of primary adrenal insufficiency are caused by what 4 conditions? |
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Definition
| Autoimmune adrenalitis, TB, AIDS, and metastatic cancers |
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Term
| List some signs and symptoms of adrenal insufficiency |
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Definition
| Easy fatigability and weakness, GI disturbances, hyperpigmentation in sun exposed areas and pressure points, hyperkalemia hyponatremia volume depletion and hypotension |
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Term
| T or F: In secondary adrenal insufficiency, hyperpigmentation is lacking b/c melanotropic hormone levels are low |
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Definition
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