9.6.2013(endocrinology) 32 Flashcards
(177 cards)
0
Q
Type 1 nuclear receptor
A
Cytoplasmic nuclear receptor
Type2: typical nuclear receptor
1
Q
First hormone to be discovered
A
Secretin
2
Q
Serine kinase
A
TGF beta
MIS
3
Q
Tyrosine kinase
A
Insulin
IGF1
EGF
4
Q
Hormones acting on type 2 receptor
A
Thyroid
VitD
Retinoic acid
5
Q
GH secretion peaks at
A
Night
6
Q
Best time for administration of single dose steroid
A
Morning
7
Q
Most important predictor of Type 1 diabetes
A
Loss of first phase insulin response
8
Q
Monogenic diabetes
A
Diabetes due to single gene mutation
9
Q
Type 1A diabetes
A
Antibodies present in serum
10
Q
Autoantibodies in type1A
A
Anti GAD65 Glutamic acid decarboxylase(most abundant)
Anti-IA2
Anti-ZnT8
Anti insulin
11
Q
Pro insulin
A
C peptide+ insulin
12
Q
C peptide cannot differentiate btw
A
SUR overdose and insulinoma
13
Q
Beta cells cosecrete
A
Amylin(Islet amyloid polypeptide)
14
Q
glucose receptor in pancreas
A
GLUT2
15
Q
ATP in beta cells act on
A
SUR sensitive K+ channels
16
Q
Phase 1 of insulin secretion
A
Glucose mediated insulin secretion
17
Q
Phase 2 insulin response
A
Basal insulin secretion
18
Q
Other name for phase 1 response
A
Prandial response
19
Q
Insulin receptors have
A
Tyrosine kinase activity
20
Q
Vitamin with protective effect on type1 DM
A
Vitamin D
21
Q
Feeding practice that predisposes to diabetes
A
Cow milk(early initiation of cow milk)
22
Q
Mech of cow milk predisposing to DM1
A
Anti casein antibody
23
Q
Time of onset of DM1
A
Unpredictable
24
Dietary substance protective against DM1
Omega3 fatty acids
25
Most common presentation of DM1
Polyuria
Polyphagia
Polydipsia
26
Most common cause of DKA
DM2
27
Two things that can rise HDL cholesterol
Exercise
| Alcohol
28
Omega 3 fatty acid improves lipid profile by
Lowering triglycerides
29
Omega 3 fatty acid effects
Decreases total cholesterol
INCREASES LDL
VLDL decreases
Low triglycerides
30
HLA in DM1
HLA DR3 and 4
31
One parent with DM2,risk in child
1/7
32
Both parents with DM2,risk in child
1/2
33
Strongest risk factor for DM2
Obesity
34
Protective factors for DM2
Coffee and other caffeinated drinks
35
Increased risk for DM2
Statins
| Cigarette smoking
36
Types of LDL
```
Small dense(atherogenic)
Large fluffy
```
37
Glucokinase deficiency leads to
MODY2
38
Monogenic diabetes is diagnosed within
6 months of birth
39
Normal fasting blood sugar
100mg%
40
Most accurate time to measure PPBS
83min
41
Normal HbA1C value
5.6 and below
42
HbA1C criteria for diabetes
>=6.5
43
Frequency of measurement of HbA1C in a diabetic who are not at goal levels of blood glucose
Every 3 months
Good control:every 6 months
44
Screening of diabetes should start at
45 yrs
45
Frequency of screening of diabetes in asymptomatic pts
Every 3 yrs
46
HbA1C levels reflect control over
6-8weeks
47
Previous day diabetes control
7 point curve
| Alpha1,5 anhydroglucitol
48
Glucose control over past 2 wks
Fructosamine
49
Duration of action and peak effect of regular insulin
Duration:8hrs
Peak:4hrs
50
Basal insulins
NPH
detemer
Glargine
51
Disadvantage of NPH
It has a peak(8hrs)
| It can cause nocturnal hypoglycaemia
52
Ultra fast acting analogues
Lispro
Aspart
Glulysine
53
Insulin pump uses
Ultrafast acting analogues
54
Premixed insulin
30% short acting
| 70% intermediate acting
55
Best premixed insulin
BiASP
30% Aspart
70% protaminated Aspart
56
First drug recommended for DM2
Metformin
57
DM2 not controlled by metformin
Add either SUR(glimepride) or basal insulin
58
Step 3 therapy in DM2
Intensive insulin therapy
59
Risk of pioglitazone
Doubles the risk of heart failure in post MI pts
60
Effects of pioglitazone
Decreases abdominal obesity
| Increased incidence of FRACTURES
61
Second most efficacious drug for DM
SUR 2-2.5% reduction in HbA1C
62
Efficacy of anti diabetic drugs
```
Insulin 3-3.5%
SUR 2-2.5%
MF 2%
Pioglitazone 0.8-1.4%
Meglitinide 1.5-2%
Acarbose 0.2-0.4%
```
63
Anti diabetic drug producing weight loss
Exenatide
64
Metformin is weight _________
Neutral
65
Anti diabetic agent with high risk of weight gain
Insulin
66
Effects of GLP-1
Stimulates insulin release
Inhibits appetite
Delays gastric emptying
Inhibits glucagon
67
GLP-1 analogues
Exenatide
| Liraglutide
68
DPP-4 inhibitor
Gliptins
69
Amylin effects
All properties of GLP-1 except insulin release
70
Amylin analogue
Pramilnatide
71
Effect of DPP-4 inhibitors on exenatide
Exenatide is naturally resistant to DPP-4
72
Exenatide has no risk of hypoglycaemia because
It produces glucose dependant insulin secretion
73
Pramilntide is useful in
DM1 and DM2
74
Insulin is degraded in
Kidney
75
Target HbA1C in diabetics
7
76
Best agents to reduce blood sugar in CKD pts
1. insulin
2. Repaglinide
3. sitagliptin
77
Bed time insulins
Glargine
| Detemer
78
Somoyogi phenomenon
Night hypoglycaemia followed by morning hyperglycaemia
79
Most acidity in serum is produced by which ketone
Beta hydroxy butyrate
80
Rothera test detects
Acetone
Acetoacetate
Not betahydroxy butyrate
81
Fluid of choice for DKA
NS
82
0.45N is
50ml NS+50ml water
83
Effective plasma osmolality
2*Na+ RBS/18
84
Ineffective osmoles
Urea
85
Most common cause of hypopitutaryism
Non functional adenoma
86
Persistent Elevated levels of prolactin in non pregnant women
Adenoma
87
Prolactinomas are detected early in
Females
88
Acidophils in pituitary gland
GH
| PROLACTIN
89
Normal pituitary size
6-8mm
| In puberty:12mm
90
Enlarged pituitary
Pole to pole length in nonpubertal people>10mm
91
MRI findings in pituitary adenoma
Posterior pituitary bright spot preserved
Upper surface convexity
Pole to pole length increased
92
Absent pituitary bright spot
Posterior pituitary lesion
93
Best dopamine agonist
Cabergoline
94
Dopamine agonist preferred when pregnancy is desired
Bromocriptine
95
Adverse effect of cabergoline
Cardiac valvular stenosis(TS,PS)
96
Anti insulin hormones
GH
glucagon
Cortisol
Epinephrine
97
MC extra pituitary cause of acromegaly
Pancreatic islet cell tumor
98
Pituitary tumor which has high association with headache
Acromegaly(macroadenoma)
99
Acromegaly pts have increased risk of
Colonic malignancy
100
IGF1 is synthesised from
Liver
101
Initial screening test for acromegaly
Serum IGF1 levels
102
Confirmatory test for acromegaly
OGTT
103
Test of choice to detect post surgery residual disease in acromegaly
OGTT
104
Mech of action of bromocriptine in acromegaly
Decreases GHRH release from pituitary
105
First hormone to be replaced in hypopitutaryism
Steroids
106
Order of replacement in hypopitutaryism
1. Cortisol
| 2. thyroxine
107
Rx of bone loss after hypopitutaryism
Testosterone
108
Pregnant pt presenting with hypopitutaryism
1. sheehan syndrome
| 2. lymphocytic hypophysitis
109
Location of vasopressin receptor
V1A - vascular
V1B- brain(ACTH or CRH release)
V2 - collecting tubules in kidney
110
First response to hyperosmolality
ADH
111
Better mechanism of maintaining osmolality
Thirst(ADH action limited by GFR)
112
Type of hyponatremia in SIADH
Euvolemic hyponatremia(due to ANP)
113
ADH release stimulated by
Nausea
| Steroid deficiency
114
Threshold for ADH release
280mosm
Thirst osmostat is 6 osm higher
115
Type 1 hyponatremia
Hypervolemic hypernatremia
116
Type 1 hyponatremia causes
Nephrotic syndrome
Cardiac failure
Cirrhosis
117
Type 2 hyponatremia causes
Hypovolemic hyponatremia
Diarrhoea
Diuretic abuse
118
Rx of type 1 hyponatremia
Water restriction+ diuretics
119
Rx of hypovolemic hyponatremia
NS
120
Rx of Euvolemic hyponatremia
Hypertonic saline
121
Rx of cerebral salt wasting syndrome
NS
122
Cerebral salt wasting syndrome,type of hyponatremia
Hypovolemic
123
Mech of Cerebral salt wasting syndrome
Impaired sympathetic input to kidneys
124
Effect of NS in SIADH and Cerebral salt wasting syndrome
Decreases Na in SIADH
| Corrects Na in Cerebral salt wasting syndrome
125
Rx of SIADH
Hypertonic saline
Demeclocycline (reduces V2 receptor sensitivity)
Fludrocortisone
Conivaptan
126
Causes of polydipsia
Dipsogenic DI
Iatrogenic polydipsia
Psychogenic polydipsia
127
Cause of Dipsogenic polyuria
MS
128
Normal urine specific gravity
1.012-1.024
129
Principle enzyme in mineralocorticoid synthesis
CYP11B2
130
Enzyme in glucocorticoid synthesis
CYP11B1
131
Anti inflammatory effects of steroids are mediated by
Heterodimerisation
132
Principle enzyme in sex steroid synthesis
17 alpha hydroxylase
133
Paraneoplastic Cushing syndrome is a feature of
```
Pancreatic islet malignancy
Prostate cancer
Bronchial carcinoid
Adenocarcinoma of lung
Thymic malignancy
```
134
Screening tests for Cushing
24hr urine free cortisol
| Overnight Dexamethasone suppression test
135
Overnight Dexamethasone suppression test
1mg at 11pm,cortisol >50 at 8am
136
Confirmatory test
Low dose Dexamethasone suppression test
137
Equivocal high dose Dexamethasone suppression test
Petrosal venous sinus sampling
138
Tests for Cushing with low ACTH
MRI pitutary
CRH test
High dose Dexamethasone suppression test
139
Rx of adrenocortical carcinoma
Mitotane
140
Defect in classic barrter
ClC-k+ defect
141
Neonatal barterr
Type 1 neonatal barterr: Na -2Cl-k
| Type 2 neonatal barterr: ROMK
142
Diff btw bartter and gitelman
Hypomagnesimia is seen in gitelman
143
Bartter syndrome
```
Hypocalcemia
Hypokalemia
Hypochloremia
Metabolic alkalosis
With normal blood pressure
```
144
Hypokalemic metabolic alkalosis syndrome
Gitelman syndrome
Bartter
Conn
145
Liddle syndrome is due to
Nedd4 mutation
It is ubiquitin ligase for ENaC channel
146
Diff btw Liddle,conn,barterr
Liddle: hypertension,decreased renin,decreased aldosterone
Barterr: normotension,increased renin,increased aldosterone
Conn: hypertension,decreased renin,increased aldosterone
147
Rx of hypertension with steroids
Glucorticoid remediable hyperaldosteronism
148
Screening test for conn syndrome
Aldosterone/renin ratio
149
Confirmatory test for conn syndrome
Failure to suppress aldosterone after NS infusion
150
Schmidt syndrome is a type of
Type 2 polyglandular syndrome
151
Whitaker syndrome
PGA-1
152
Most common PGA syndrome
Type 2
153
Type 1 APS
Mucocutaneous candidiasis
| Hypoparathyroidism
154
Type 2 APS
```
Hypo/hyperthyroidism
Premature ovarian failure
Vitiligo
DM1
Pernicious Anemia
```
155
Gold standard diagnostic test in integrity of HPA axis
Insulin tolerance test
156
Insulin tolerance test
Looks for cortisol rise following insulin induced hypoglycaemia
157
1mg of hydrocortisone equals
0.20mg prednisolone= 0.25mg prednisone=0.025mg Dexamethasone
158
Extra adrenal pheochromocytoma mainly secretes
Norepinephrine
159
Type of pheochromocytoma which secrete epinephrine
Familial pheochromocytoma
160
Features of pheochromocytoma
Tako-tsubo cardiomyopathy
Episodic hypertension
Sustained hypertension
Episodic hypotension
161
Tako-tsubo cardiomyopathy
Broken heart syndrome
| Apical ballooning syndrome
162
Cardiac troponin in taka-tsubo cardiomyopathy
Elevated
163
DD for pheochromocytoma
Autonomic epilepsy
| panic disorder
164
IOC of choice of pheochromocytoma associated with NF1
Plasma fractionated metanephrine(most sensitive test)
165
Most specific test for pheochromocytoma
urine fractionated metanephrine
166
Investigation of choice for extra adrenal pheochromocytoma
MRI
167
Below the age of 20yrs,most common cause of pheochromocytoma
VHL
168
>20yrs,most common cause of pheochromocytoma
Sporadic
169
Gene mutated in MEN1
Menin
170
Paraganglioma are due to mutations of
Succinate dehydrogenase gene(B>C>D)
171
SDH A mutation causes
Leigh syndrome
172
First drug to start in pheochromocytoma
Phenoxybenzamine
173
Rx of paroxyms of HT in pheochromocytoma
Phentolamine
| Prazocin
174
Intra operative BP control in pheochromocytoma
Nitroprusside
175
Dietary modification in pheochromocytoma
Salt repletion
176
Most symptomatic pancreatic tumor in MEN1
Insulinoma
