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Physiology MRCEM part 1 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Alpha cells of the pancreas produce?

A

Glucagon

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2
Q

Beta cells of the pancreas produce?

A

Insulin

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3
Q

Delta cells of the pancreas produce?

A

Somatostatin

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4
Q

Epsilon cells of the pancreas produce?

A

Ghrelin

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5
Q

Gamma / F cells of the pancreas produce?

A

Pancreatic polypeptide

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6
Q

What does Ghrelin stimulate?

A

Appetite, increase food intake and promotes fat storage

Also stimulates release of growth hormone from the pituitary gland

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7
Q

Glucagon MOA

A

Acts on G-protein coupled receptor to stimulate cAMP production

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8
Q

Impact of glucagon on blood levels:

Glucose
Fatty acid
Ketoacid

A

ALL INCREASE

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9
Q

Glucagon major actions:

A

Decrease glycogenesis
Increase glycogenolysis
Increase gluconeogenesis
Decrease fatty acid synthesis
Increase lipolysis
Increase ketoacid production

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10
Q

Impact of insulin on blood levels:

Glucose
Fatty acid
Ketoacid
K+
Aminoacid

A

DECREASE

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11
Q

Insulin MOA

A

Acts on tyrosine kinase receptor to activate the intracellular pathway that results in translocation of GLUT-4 transporter to the plasma membrane

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12
Q

Insulin major actions

A

Increase glucose uptake into cells
Increase glycogenesis
Decrease gylcogenolysis
Decrease gluconeogenesis
Increase protein synthesis (decrease degradation)
Increase fat deposition (reduce lysis)
Reduce ketoacid production
Increase K+ uptake

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13
Q

What simulates insulin release?

A

During eating by the parasympathetic system

Gut hormone secretin

Rise in plasma glucose concentration after a meal (most)

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14
Q

Where is somatostatin secreted from?

A

D cells n pyloric antrum, duodenum and pancreatic islet

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15
Q

What stimulates somatostatin secretion?

Inhibits?

A

H+ in GI lumen

Vagal stimulation

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16
Q

Actions of somatostatin?

A

Inhibits gastric acid secretion (directly on parietal cells and via G-protein coupled receptors, indirectly via inhibition of gastrin and histamine secretion)

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17
Q

Which hormones does somatostatin inhibit?

and therefore mediates ….

A

Insulin
Glucagon
Cholecystokinin
Secretin
GIP

DECREASED gastric and intestinal mobility
Decreased gastric and intestinal secretions
Decreased pancreatic endocrine and exocrine function
Decreased bile production

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18
Q

Main action of pancreatic polypeptide

A

The primary role of PP is to modulate digestion of food by inhibition of gastric emptying as well as biliary secretion

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19
Q

Hormones secreted by the ANTERIOR pituitary gland ?

A

FSH
Prolactin
TSH
ACTH
LH
GH

Fresh pituitary tastes almost like guinness…

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20
Q

Hormones secreted by the POSTERIOR pituitary gland ?

A

Oxytocin
ADH

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21
Q

POSTERIOR pituitary is a direct extension of?

A

Hypothalamus

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22
Q

Control most pituitary hormones except oxytocin is by which type of feedback mechanism?

A

Negative

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23
Q

Action of ACTH

A

acts on the adrenal cortex to stimulate glutococoticoid and

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24
Q

What stimulates ACTH release?

A

CRh

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25
Q

ACTH

Deficiency ->

Excess ->

A

Secondary adrenal insufficiency

Cushing’s disease

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26
Q

ADH action

A

Acts on the KIDENYS to increase water permeability in the DISTAL NEPHRON

Allowing greater water reabsorption and concentration of urine

Also acts on vascular smooth muscle causing vasoconstriction

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27
Q

What mainly stimulates ADH release?

A

Raised plasma osmolality detected by osmoreceptors in the Ant. hypothalamus

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28
Q

What inhibits ADH release?

A

Low plasma osmolality
Alcohol
Caffeine
Glutocorticoids
ANP

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29
Q

ADH deficiency ->

Excess ->

A

Central diabetes insipidus

SIADH

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30
Q

Three zones of the adrenal cortex

A

Outer glomerulosa
Middle zona fasciculata
Inner zone reticularis

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31
Q

Outer glomerulosa releases what? + example

A

Mineralcorticoids e.g. aldosterone

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32
Q

Middle zona fasciculata releases what? + example

A

Glucocorticoids e.g cortisol

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33
Q

Inner zone reticularis release what?

A

Androgens and stress hormones

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34
Q

Mineralcorticoids e.g aldosterone regulate?

A

Salt and water homeostasis

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35
Q

Glucocorticoids e.g. cortisol regulate?

A

Carbohydrate metabolism and response to stress

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36
Q

What regulates cortisol release?

A

ACTH

37
Q

What regulates aldosterone release?

A

RAS

38
Q

what does the adrenal medulla release ?

A

Catecholamines

39
Q

Which zones of the adrenal cortex are typically affected in primary adrenal insufficiency (addisions)

A

All three

40
Q

Aldosterone release stimulated by (3)

A

Angiotensin II (secondary to fall in blood volume, BP or plasma sodium)

High K+

ACTH (least important)

41
Q

Where does aldosterone act in the kidney?

A

Distal convoluted tuble

42
Q

Action of aldosterone at the DCT?

A

Sodium retention and potassium loss (increase synthesis of transport mechanisms)

43
Q

Which part of the brain drives the stress response and what does it lead to?

A

amygdala

stimulates CRH neurons -> ACTH

stimulates sympathetic nervous system

stimulates parasympathetic nerves that cause acid secretion in the stomach

Fear

44
Q

What stimulates tyrosine breakdown by specific enzymes to create catecholamines?

A

Cortisol

45
Q

What receptors do catecholamines act on?

A

Alphas and beta G protein coupled receptors

46
Q

Alpha 1 adrenergic receptors

Main stimulator

Actions

A

Noradrenaline > adrenaline

Vasoconstriction
Increase PVR
Increased B
Mydriasis
Increased closed bladder sphincter

47
Q

Alpha 2 adrenergic receptors

Main stimulator

Actions

A

Adrenaline > Noradrenaline

Inhibits NA release
Inhibits ACh release
Inhibits insulin release

48
Q

Beta 1 adrenergic receptors

Main stimulator

Actions

A

Adrenaline = Noradrenaline

Increase HR
Increased lipolysis
Increase myocardial contractility
Increases renin

49
Q

Beta 2 adrenergic receptors

Main stimulator

Actions

A

Adrenaline&raquo_space; Noradrenaline

Vasodilation
Decrease PVR
Bronchodilation
Glycogenolysis
Glugacon release
Relaxes uterine smooth muscle e

50
Q

Common presenting sx of phaeochromocytoma?

A

Headache / sweating / pallor / palpitations

51
Q

Phaeochromocytoma aetiology?

A

Catecholamine secreting tumour

52
Q

diagnosis of Phaeochromocytoma

A

Biochemical confirmation of elevated catecholamines followed by radiological localisation of the tumour

53
Q

Cushing’s syndrome =

A

Clinical signs & symptoms related to chronic glucocorticoid excess

54
Q

Cushing’s disease =

A

Excess corticosteroids due to ACTH secreting pituitary adenoma

55
Q

Causes of Cushing’s syndrome (3)

A

Excess ACTH (pituitary or ectopic ACTH secreting tumour)

Excess cortisol (adrenal tumur)

Exogenous steroids

56
Q

Where is Ca2+ mainly absorbed?

A

Duodenum and proximal jejunum (some in S. intestine)

57
Q

How to activated Vit D act in the gut?

A

To increased Ca2+ gut absorption

58
Q

How does pH act on Ca2+ levels?

A

Increase in pH (alkalosis) promotes increased protein binding, decreasing free Ca2+ levels

(competes with H+ ions for binding sites on albumin etc)

59
Q

What mainly drives Ca2+ reabsorption in the nephron?

A

Na2+ reabsorption

60
Q

Where in the kidney is the main target for hormonal control of Ca2+?

A

Distal nephron

61
Q

How does parathyroid hormone control Ca2+?

A

Acts on the kidney to increase calcium re-absorption in the distal tubule

Activates Ca2+ entry channels in the apical membrane and Ca2+ ATPase pumps in the basolateral membranes

Also stimulates osteoclasts to release Ca2+ from bone

62
Q

How does activated Vit D control Ca2+?

A

Activates Ca2+ ATPase pumps in the basolateral membranes

63
Q

PTH action on phosphate reabsorption?

A

Decrease phosphate reabsorption in the proximal tubule

64
Q

Activated Vit D action on phosphate reabsorption?

A

Increase phosphate reabsoprtion

65
Q

How does calcitonin control Ca2+?

A

Inhibits renal reabsorption of calcium

Osteoclast activity inhibited

66
Q

What synthesises PTH?

A

Chief cells of the parathyroid gland

67
Q

PTH is released in response to…

A

Decrease plasma Ca2+

Increased blood phosphate level

68
Q

Action of PTH on the kidneys

A

Increase Ca2+ reabsorption

Increase phosphate excretion

Inhibit bicarb re-absorption -> metabolic acidosis -> favour dissociation of calcium from plasma proteins

Stimulate 1-alph-hydroxylase in the kidneys to produce MORE activated vit D

69
Q

How does PTH act on the gut?

A

Increase calcium and phosphate absorption in the small intestine (via activated vit D)

70
Q

How does PTH act on bone?

A

Increase calcium and phosphate resorption

71
Q

Pre vit D3 -> activated Vit D

A

Pre Vit D -> cholecalciferol (D3) -> Calcitrol in the liver via enzyme -> Activated Vit D in the kidneys via enzyme

72
Q

Action of activated Vit D on the gut?

A

Increase Ca2+ and phosphate absorption in the small intestine

73
Q

Action of activated Vit D on the kidneys?

A

Increase calcium reabsorption

Increase phosphate reabsorption

Negative feedback on the enzyme in the kidney creating activated vit D

74
Q

Enzyme in the kidney creating activated Vit D?

A

1-ALPHA-HYDROXYLASE

75
Q

What secretes calcitonin?

A

C cells (parafollicular) cells of the thyroid gland

76
Q

When is calcitonin secreted?

A

Rising levels of Ca2+

77
Q

Actions of calcitonin?

A

Act on kidneys to inhibit renal absorption of calcium and phosphate

& on bones to inhibit resorption by osteocytes

78
Q

ADH binds to which receptors (2)

A

V2 on renal principle cells -> increase water reabsorption via aquaporins

V1 receptor on vascular smooth muscle, causing vasoconstriction

79
Q

What activates the baroreceptor reflex

A

A fall in blood pressure detected by a fall in CVP (atrial or other cardiopulmonary stretch receptors)

80
Q

Sympathetic stimulation in baroreceptor reflex, actions:

A

Peripheral vasoconstriction, increased TPV

Renal vasoconstriction to decrease eGFR

Stimulate ADH to increase water reabsorption

Stimulate release of renin

81
Q

Where are renin producing granular cells found?

A

Juxtaglomerular apparatus

82
Q

What stimulates renin production

A

Fall in extracellular fluid volume, CVP or arterial BP

Decrease perfusion pressure in renal afferent arterioles

Decreased tubular NaCl concentration (detected by macula densa cells)

reduced eGFR

83
Q

MOA of benzodiazepines

A

GABA receptor agonists, enhance inhibitory synaptic transmission throughout the CNS

84
Q

Benzodiazepines duration of action:

Midazolam

Lorazepam / temazepam

Diazepam / chlordiazepoxide

A

<6hrs

12-18hrs

24-48hrs

85
Q

Why do patients taking antipyschotic drugs get extra pyramidal side effects?

A

Blockage of dopamine receptors in the basal ganglia

86
Q

Examples of extra pyramidal side effects

A

Parkinsonian symptoms - tremor, bradykinesia and rigidity

Dystonia

Dyskinesa

Akathsia - motor restlessness

Tardive dyskinesia - rhythmic, involuntary movements of the tongue / face / jaw

87
Q

Treatment for acute dystonia

A

Acute dystonia should be treated with IM/IV anticholinergics (e.g. procyclidine).

88
Q
A

Physiology MRCEM part 1 (7 decks)

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