Met PBLs

Question 1

Main energy fuels used during starvation

Answer 1

Amino acids from muscle
TAGs from adipose tissue
Ketones from the liver

Question 2

Main substrates for gluconeogenesis

Answer 2

Lactate
Glycerol
Amino acids
Oxaloacetate

Question 3

Features of Kwashiorkor

Answer 3

Ascites and pitting oedema
Hepatosplenomegaly
Dermatitis

Question 4

How does starvation lead to ketosis?

Answer 4

Decreased glucose available for the brain
Brain can only use glucose and ketones for energy production
Large amounts of lipolysis releasing FFAs to the liver for metabolism produced large amounts of acetyl CoA
Excess acetyl CoA cannot be put into the Krebs cycle as oxaloacetate supplies are depleted due to it being used in gluconeogenesis
Therefore acetyl CoA is used to make ketone bodies

Question 5

Ketone body examples

Answer 5

Acetoacetate

b-hydroyxbutarate

Question 6

Why does feeding syndrome occur?

Answer 6

Insulin release in referring stimulates glycogen, fat and protein synthesis. These processes require vitamins and minerals such as phosphate, magnesium thiamine. Therefore large amounts of these substances enter cells upon feeding to deplete the plasma levels.
Leads to features associated with refeeding syndrome.

Question 7

How is referring syndrome avoided?

Answer 7

Vitamin and mineral replacements

Slow increases in caloric intake

Question 8

Causes of oedema

Answer 8

Increased capillary hydrostatic pressure
Reduced capillary oncotic pressure
Increased capillary permeability
Lymphatic blockage

Question 9

AST

Answer 9

Aspartate + a-ketoglutarate –> oxaloacetate + glutamate
Uses vitamin B6 as cofactor
Found in the liver, muscles, bone, heart, pancreas

Question 10

ALT

Answer 10

Alanine + a-ketoglutarate –> a-pyruvate + glutamate
Vitamin B6 cofactor
Found mostly in the liver
Raised to a greater extent in liver disease

Question 11

AST/ALT ratio

Answer 11

Usually below 1

>1/2 = alcoholic causes or muscle disease

Question 12

ALP

Answer 12

Raised in liver disease

Also in biliary obstruction and bone disease

Question 13

GGT

Answer 13

Raised in liver disease
Also in biliary obstruction but not in bone disease
Large increases in excessive alcohol consumption

Question 14

INR

Answer 14

Modified PT

Intrinsic pathway

Question 15

What is in pabrinex?

Answer 15

Thiamine, riboflavin, pyridoxine, nicotinamide, vitamin C, glucose

Question 16

Why is terlipressin used?

Answer 16

Reduces bleeding from oesophageal varices

Question 17

Actions of Lactulose

Answer 17

Increases water excretion due to osmotic effect

Acidifies gut contents so reduces ammonia absorption to prevent hepatic encephalopathy

Question 18

Metabolic diseases causing cirrhosis

Answer 18

Haemochromatosis
Wilson’s disease
Alpha-1-antitrypsin deficiency

Question 19

Why does he have high urea?

Answer 19

Increased protein intake due to bleeding from varices

Question 20

Treatments of ascites

Answer 20

Diuretics
Paracentesis
TIPS
Albumin supplements

Question 21

Humalog

Answer 21

Fast acting insulin analogue

Must eat immediately after

Question 22

Glargine insulin

Answer 22

Long acting insulin with a peak less profile that mimics the tonic release from beta cells

Question 23

DKA treatment

Answer 23

Fluid and electrolyte replacement

Short acting insulin

Question 24

How does alcohol lead to ketoacidosis?

Answer 24

Ethanol metabolism leads to increased NADH/NAD ratio
Inhibits Krebs cycle, glyconeogenesis and fatty acid oxidation
Causes fatty acid synthesis and ketogenesis

Question 25

Actions of GKRP

Answer 25

Controls location of GK | GK involved in glycolysis and glycogen synthesis as well as sensing of glucose levels

Question 26

Actions of PPARG

Answer 26

Transcription factor for lipid metabolism --> increased lipid uptake and lipogenesis Decreases circulating lipid levels

Question 27

How does metformin work?

Answer 27

Activation of AMPK Inhibits hepatic gluconeogenesis Increases GLP-1 secretion Increases GLUT4 translocation

Question 28

How does sitagliptin work?

Answer 28

Inhibits breakdown of GLP-1 | Enhances insulin secretion

Question 29

How does pioglitazone work?

Answer 29

Increases PPARG transcription | Increases lipid uptake to decrease circulating FFA levels

Question 30

Define microalbuminaemia

Answer 30

Albumin excretion 30-300mg/day | ACR>3mg/mmol

Question 31

Define proteinuria

Answer 31

Albumin excretion >300mg/day | ACR>30mg/mmol

Question 32

How does the glomerular filtration barrier normally prevent passage of albumin into the urine?

Answer 32

Negative charge of endothelial cells repeals anions like albumin Large diameter too large to pass through the pores of the filtration barrier Prevents passage of molecules with molecular weight >60,000Daltons

Question 33

Pathological changes seen in the glomerular filtration barrier in diabetes?

Answer 33

BM thickening Glomerulosclerosis Mesangial cell hypertrophy and increased matrix secretion

Question 34

How does kidney disease lead to hypertension?

Answer 34

Reduced GFR --> increased RAAS activation Increased water and electrolyte retention Increases SNS activity

Question 35

BP aim for diabetics

Answer 35

135/85

Question 36

First line BP lowering drug in diabetics

Answer 36

ACEI or ARB

Question 37

Causes of goitre

Answer 37

Follicular cell hypertrophy and hyperplasia due to increased TSH levels Increased colloid accumulation in follicles Inflammatory processes Neoplastic processes

Question 38

Main cell type in Hashimoto's

Answer 38

Lymphocytes

Question 39

Effects of thyroid hormones sytsemically

Answer 39

Increased BMR and non-shivering thermogenesis Increased mitochondria number Increased cardiac myocyte activity

Question 40

Effects of thyroid hormones on the liver

Answer 40

Antagonise insulin | Increase gluconeogenesis and glycogen breakdown

Question 41

Effects of thyroid hormones on muscle

Answer 41

Act alongside insulin | Increase uptake by increasing GLUT4 translocation

Question 42

Effects of thyroid hormones on adipose tissue?

Answer 42

Activate LPL | Increased removal of TAGs from lipoproteins

Question 43

When is ACTH released?

Answer 43

Begins at 3am Peaks upon waking Decreases throughout the day

Question 44

When is GH released?

Answer 44

In pulses | Mostly at night

Question 45

What inhibits PRL secretion?

Answer 45

Dopamine

Question 46

What are high PRL levels seen?

Answer 46

Pregnancy Exercise Stress Antipsychotic drugs

Question 47

What does high PRL inhibit?

Answer 47

Kisspeptin | --> low oestrogen

Question 48

Symptoms of low ACTH

Answer 48

``` Fatigue Weakness Vomiting Abdominal pain Low blood sugar Low BP Weight loss Hyper pigmentation ```

Question 49

Symptoms of low TSH

Answer 49

``` Tiredness Cold intolerance Dry skin Brittle hair Paleness Mental slowness ```

Question 50

Symptoms of low GH

Answer 50

Reduced strength and stamina Reduced ability to exercise Impaired lipid profile

Question 51

Symptoms of low FSH/LH

Answer 51

Loss of periods

Question 52

Symptoms of low oestrogen

Answer 52

Low libido

Question 53

Symptoms of tumour mass

Answer 53

Headaches | Visual disturbance

Question 54

Metabolic actions of GH

Answer 54

Stimulates protein synthesis Increases gluconeognesis Increases lipolysis Increases ketogenesis

Question 55

IGFs

Answer 55

Types 1 and 2 Produced mainly by the liver Some auto/paracrine release in peripheral tissues Resemble proinsulin in structure Counteract the diabetogenic effects of GH Responsible for non-suppressible insulin like activity

Question 56

Metabolic actions of cortisol

Answer 56

Stimulate gluconeogensis Stimulate muscle proteolysis Stimulate lipolysis Inhibition of glucose uptake by muscle and adipose tissue

Question 57

Insulin stress test

Answer 57

Measures functioning of HPA axis and GH axis Blood taken Fast acting insulin given Blood taken again at 30 minute intervals

Question 58

Treatment

Answer 58

``` TSS Hydrocortisone Thyroxine Sex hormone replacement GH replacement ```

Question 59

Sympathetic detrusor innervation

Answer 59

Hypogastric nerve Inhibitory Beta 3 receptors

Question 60

Parasympathetic detrusor innervation

Answer 60

Pelvic nerves Excitatory M3 receptors

Question 61

Internal urethral sphincter innervation

Answer 61

Sympathetic Hypogastric nevre Alpha 1 receptor

Question 62

External urethral sphincter innervation

Answer 62

Somatic Pudendal nerve S2-4

Question 63

Tamsulosin

Answer 63

Alpha 1 blocker Relaxes bladder neck and IUS Eases urination

Question 64

Finasteride

Answer 64

5a reductase inhibitor Reduces testosterone --> DHT Reduces prostate size

Question 65

Surgical options for BPH

Answer 65

TURP TUIP Urolift

Question 66

Indications for prostate biopsy

Answer 66

High PSA | Abnormal digital rectal exam --> uneven texture