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Flashcards in Darrow DM Deck (42):
1

What is metabolic syndrome

2 physical findings: waist circumference >40 inches men >35 in women
apple shape
3 labs:
HTN: >130/85
TG: >150
HDL-C 100

2

what does adipose tissue secrete

inflammatory and immune mediators "adipokines"

3

specific mediators secreted by adipose tissue

leptin, adiponectin, resistin, visfatin, TNF alpha, IL-6, thrombospondin, plasminogen activator 1

4

what does adipose tissue look like in obesity and insuline R

many macrophages, tissue secretes high levels adipokines and low levels adiponectin

5

why are thiazolinediones used in severe obestiy

decrease insulin R
adipocyte differentiation is modified
VEGF induced angiogenesis inhibited
leptin levels decrease
levels of certain IL (IL6) dec
antiproliferative action
adiponectin levels rise
inhibit TSP1 expression

6

role of TSP1 in adipose tissue

activates TGF-beta which activaes PAI-1 which is procoagulant

7

what is worse
SQ fat or omental

omental

8

uric acid levels in metabolic synfrome

hyper

9

LDL levels in metabolic syndrome

low

10

plasminogen activator inhibitor levels in metabolic syndrome

high

11

levels of homocysteine in metabolic syndrome

increased

12

what is the initial step of tissue damage in DM

hyperglycemia mediated mitochondrial superoxide production

13

Dx criteria DM II

Random glucose >200 with Sx!
FBS> 126 repeatable
2 hour post meal BS >200 repeatable
HbA1c>6.5% repeatable

14

what can cause low HbA1c

HbF, hemolytic anemia, acute bleed, Vit C and E

15

Causes of DM II

genetic
TCF7L2 transcription factor for WNT signlaing for beta cell
environmental: visceral obesity, insulin R

16

causes of polyuria

CDRIPPED
Cortisol escess
DM
Recovery from renal railure
Ions (hyper Ca and hypo K)
Parkinsons
Psychogenic Polydipsia
Enzyme-vasopressinase
Drugs: lithium, demeclocycline, methicillin

17

What Ab can you detect in DM I

glutamic acid decarboxylase 65
insulin
islet cell cytoplasmic Ab
insulinoma assoc 2 autoAb
zinc transporter Ab
tyrosine phosphatase Abs

18

HLA DM I

DR3 DR4

19

Patient was Dx with DM I 20 yrs ago and on insulin since
she went on vacation and forgot insulin but no adverse effects except increased polyuria
most likely?

abnormal nuclear transcription factor in beta cells

20

defect in transcription factor hepatic nuclear factor results in what

decreased apo M and so decreased clearance of HDL which is not cardioprotective

21

inheritance of MODY (maturity onset diabetes of young)

autosomal dominant

22

what drugs are effeective in MODY 3 syndrome

sulfonylurea

23

what is defective in MODY2

glucokinase

24

how do MODY syndromes lead to diabetes

impaired glucose secretion of insulin

25

most common MODY

type 3

26

what type of diabetes resemlbles type I without the Ab

mutation of mitochondrial DNA

27

what medications can lead to diabetes

cyclosporine, tacrolimus, steroids, thiazides, beta blockers, olanzopine

28

what is stiffman synrome

immune mediated, R Ab that can lead to diabetes

29

what genetic syndromes can be associated with diabetes

downs
turners
klinefelters
friedreichs ataxia

30

Reasons for insulin resistance

aging
endocrine disorders
infections
obesity
uremia and hepatic disease
hyperglycemia
acanthosis nigricans, ataxia telangiectasia
Stress
pregnancy
cortisone
disorders of insulin

31

What drugs can produce hyperglycemia

beta blockers
hormones, HAART
alcohol, antipsycotics
sympathomimetics
thiazides, ticyclics
oral contraceptives, opiates
pentamidine, phenytoin
indocin, isoniazid, imunosuppressants
niacin

32

how does obesity lead to DM II

excess calories cause lipogenesis which block FA oxidation adn stimulate TG and LP synthesis with diacylglycerol and ceramide as byproducts that activate PKC that inhibits insulin R activity
TNF alpha is produced and increases insulin R

33

patient has DM and red bympy rash what is this called and what causes it

eruptive xanthomas from hyper TG and overproduction VLDL
assoc with DM

34

complications of eruptive xanthomas caused by increased VLDL

pancreatitis

35

in type I HLD what do you have increased amounts of

chylomicrons

36

in type IV HLD what do you have increased amounts of

VLDL

37

What is cheiropathy and what causes it

patient can't bring hands together (prayer)
from glycating collagen

38

if cholesterol is high but TG is not suepr high what type of HLD is it

2B

39

what R is messed up in 2B HLD

LDL R messed up

40

type III HLD

E2/E2
chol=TG

41

what is increased in 2B HLD

APO B 100 and VLDL

42

most common type HLD with DM

2B the familial combined HLD