MET EOYS7 Flashcards
Which vertebral layers does the thyroid cartilage sit between
C3-T2
C4-T2
C5-T2
C4-T1
C5-T1
Which vertebral layers does the thyroid cartilage sit between
C3-T2
C4-T2
C5-T2
C4-T1
C5-T1
Which two structures are closely related anatomically
External larnyngeal nerve and inferior thyroid artery
External larnyngeal nerve and superior thyroid artery
Internal larnyngeal nerve and inferior thyroid artery
Internal larnyngeal nerve and superior thyroid artery
Which two structures are closely related anatomically
External larnyngeal nerve and inferior thyroid artery
External larnyngeal nerve and superior thyroid artery
Internal larnyngeal nerve and inferior thyroid artery
Internal larnyngeal nerve and superior thyroid artery
Inferior vein drainage from the thyroid goes into which of the folloiwng
External jugular vein
Internal jugular vein
Brachiocephalic vein
Subclavian vein
Thyrocervical trunk
Inferior vein drainage from the thyroid goes into which of the folloiwng
External jugular vein
Internal jugular vein
Brachiocephalic vein
Subclavian vein
Thyrocervical trunk
Which vert. levels does the thryoid gland lie between? [1]
Which cartilage does the thymus sit on? [1]
C5-T1
Sits on Cricoid cartilage
Which two structures are closely related in the thryoid area? [2]
Superior thryoid artery is close to the external laryngeal nerve at its origin: have to ligate superior thyroid artery near superior pole of thyroid
How can triglycerides be used to produce ATP?
Triglycerides broken down by lipase in fatty acids and glycerol
Fatty acids can make acetyl coA via beta oxidation and therefore ATP
How does body create fuel source at:
a) post absorb. state?
b) when glucose stores are used up?
c) continued fasting
d) further fasting
Post absorbative state:
- Muscle and adipose tissue reduce their glucose utilisation
If glucose stores are used up (24hr store) moves:
- triglyceride stores: fatty acids are used to make ATP via beta oxidation in cartinine shuffle.
- glucose made at the liver via gluconeogensis (using lactate, amino acids or glycerol) to continue a glucose supply
If continued fasting: ketogenesis occurs:
- Brain and RBC use glucose from hepatic and renal gluconeogenesis
- Other tissues use keto molecules as an additional fuel source
Prolonged fasting:
- Brain reduces glucose use; uses some ketone bodies (but glucose is still required)
- RBC use glucose from renal and hepatic GNG
What is refeeding syndrome?
Which deficiences are like to get? [3]
What can it lead to? [2]
Upon refeeding, synthesis of glycogen, triglycerides, proteins
This requires intracellular ions, however these have been depleted throughout starvation. Get transport of ions (particularly K) intracellularly.
Causes a depletion of serum ion levels: can get Hypophosphataemia, hypokalamia, thiamine deficiencies
Leading to congestive heart failure and peripheral oedema
During the fasting state which processes are occurring in
a) muscle
b) liver
c) adipose
Muscle
* Glycogen is broken down (GLYCOGENOLYSIS) to provide ATP
Liver:
* GLYCOGENOLYSIS in liver releases glucose into bloodstream (reserve depleted in 24 h)
* GLYCOLYSIS is inhibited in the liver.
* Liver synthesises new glucose (GLUCONEOGENESIS) from amino acids, lactate, glycerol
Adipose tissue:
* Triglycerides are broken down in adipose tissues (LIPOLYSIS) – to provide glycerol (used in gluconeogenesis) and fatty acids
Explain how insulin works to allow glucose into cell in healthy cells? [5]
- Insulin binds to insulin receptor
- Autophosphorylation of the receptor occurs
- IRS is phosphorylated by the receptor on Tyrosine residues
- Phosphorylated IRS can now bind to PI3K which moves from the cytoplasm
- Causes PIP2 to PIP3
- Causes activation of AKT pathwayand GLUT 4 to move to membrane
GLUT4 transporters are now inserted into the membrane
Glucose can cross the membrane & it can be stored
What physiological responses occur in response to insuline resistance in obesity or pregnancy? [3]
What does this mean physiologically? [1]
New β cells can be generated in response to insulin resistance associated with obesity or pregnancy
Islets increase in both size and number due to Beta cell increase in size and number
Increased β function
THEREFORE Glucose tolerance can be maintained by increased insulin secretion
In which situitations may hypoglycaemia occur in diabetic ptx? [4]
Medications:
* Common complication when using insulin or other insulin secretagogues
* Skipped/postponed meals when taking medications
* Increasing physical activity without adjusting food ingestion/medications
Alcohol excess:
Inhibition of gluconeogenesis
Which pathways are activated during hyperglycaemia that can cause damage [3]
- Oxidative stress: get increased expression and activity of vascular NADH oxidase. Leads to ROS accumulation
- Increase in polyol pathway: increased AGE production
- Converted to PKC pathway: creates more ROS
What are AGE products?
Advanced Glycation End products (AGEs) are proteins or lipids that become glycated
Causes:
Structural modificaiton of proteins: basement membrane thickness, reduced vascular elasticity etc
Interaction with AGE receptors: activation of signalling, gene expression, secretion of pro-inflammatory molecules, increased production of free radicals etc)
Pancreatic arterial supply?
pancreatic branches of the splenic artery
superior and inferior pancreaticoduodenal arteries which are branches of the gastroduodenal (from coeliac trunk) and superior mesenteric arteries, respectively.
Describe the arterial supply to the thyroid [2]
And their sources [2]
- The superior thyroid artery (STA) arising from the external carotid artery (ECA)
- The inferior thyroid artery (ITA) branching from the thyrocervical trunk
An increase in which hormone causings this syndrome? [1]
Cortisol (Cushings syndrome)
Label 14, 19, 20, 21, 22 & 23
14 Superior suprarenal artery
19 Right inferior phrenic artery
20 Left inferior phrenic artery
21 Middle suprarenal artery
22 Inferior suprarenal artery
Label 5-10
5 Splenic artery
6 Upper pole of kidney
7 Anterior branch of renal artery
8 Interlobular arteries
9 Left renal artery
10 Lower pole of kidney
Label 1-4
1 Celiac trunk
2 Superior mesenteric artery
3 Middle colic artery
4 Abdominal aorta (with catheter)
Label A-E
A: Internal branch of superior
laryngeal nerve
B: Inferior thyroid artery
C: Superior laryngeal nerve
D: Glossopharyngeal nerve
E: Inferior laryngeal branch of recurrent
laryngeal nerve
Label 40-45
40 Internal carotid artery
41 External carotid artery
42 Superior laryngeal artery
43 Superior thyroid artery
44 Common carotid artery
45 Thyroid ansa of sympathetic
trunk and inferior thyroid artery
A 35 year old male presents with a left cervical mass, that had grown within about 8 weeks. His MRI is shown below.
Based on this, what signs would you expect his to present with?
Hoarse voice
Dysphagia
Dyspnea
A 35 year old male presents with a left cervical mass, that had grown within about 8 weeks. His MRI is shown below.
Based on this, what signs would you expect his to present with?
Hoarse voice
Dysphagia
Dyspnea
The liver has an anterior/superior surface and an inferior/visceral surface. It is divided into 4 lobes. Remind yourself of the lobes on the flashcards below.
Brian has right sided heart failure. Into which vessels will blood back up?
Pulmonary trunk
Pulonary veins
IVC
SVC
Brian has right sided heart failure. Into which vessels will blood back up?
Pulmonary trunk
Pulonary veins
IVC
SVC
Through which mechanism does liquorice induce hypertension?
Activation of 11 beta HSD2
Inhibition of 11 beta HSD2
Activation of 12 beta HSD2
Inhibition of 12 beta HSD2
Activation of 11 beta HSB2
Through which mechanism does liquorice induce hypertension?
Activation of 11 beta HSD2
(11β-HSD2), an enzyme located in renal tissue that converts active cortisol to inactive cortisone
