Overview 2 Flashcards
1
Q
Major risk factors for atherosclerosis? x4
A
Hypercholestrolaemia
Hypertension
Smoking
Diabetes
2
Q
Outcome of the Framingham study? x2
A
Obesity is a risk for heart failure
Hypertension is a risk for CVD
3
Q
Diabetes increases the risk of CVD by what amount?
A
Causes x3 increased risk of CVD
4
Q
Metabolic syndrome is?
A
Syndrome including increased risk of CVD consisting of four particular factors
5
Q
Four factors included in metabolic syndrome?
A
Insulin resistance/DM2
Abdominal obesity
Dyslipidaemia
Hypertension
6
Q
Ethnicity most sensitive to the effects of obesity are?
A
South Asians
7
Q
Major factor increasing insulin resistance/DM2 is?
A
Hypertriglyceridaemia/increased intracellular fatty acids
8
Q
Rectors associated with increased transport of fatty acids is?
A
CD36
9
Q
Effect of flavonoids on CVD?
A
Beneficial effect on MI and stroke
10
Q
Flavonoids are found in what food groups? x3
A
Fruit
Veg
Tea
11
Q
Two beneficial effects of flavonoids?
A
Reduces ROS
Reduces CVD
12
Q
Effect of folate/B12 on CVD? x2
A
Reduces methionine and homocystokine - these are toxic and damage endothelial cells
SO reduces CVD
13
Q
Effect of low birthweight on CVD?
A
Increased rate of CHD
Increased LDL
Increased fibrinogen
Increased BP
14
Q
BMI of underweight?
A
<18.5
15
Q
BMI of normal weight?
A
18.5-24.9
16
Q
BMI of overweight?
A
25-29.9
17
Q
BMI of obese?
A
> 30
18
Q
BMI of morbidly obese?
A
> 40
19
Q
Way to measure BMI?
A
Weight (kg) / height (m) squared
20
Q
Healthy BMI of individuals may differ according to what factor?
A
Ethnicity
21
Q
Alternative measurement for healthy weight x2 and why is this necessary?
A
Waist circumference
Waist/hip ratio
Can distinguish muscular people
22
Q
Prevalence of obesity in Tower Hamlets when starting primary school?
A
One in eight
23
Q
Prevalence of obesity in Tower Hamlets when leaving school (age 11)?
A
One in four
24
Q
What percentage of weight issues are related to medications?
A
10-15%
25
Drugs causing weight issues x6
```
Mood stabilisers
DM
Corticosteroids
Beta blocker
Allergy relievers
Drugs preventing seizures and migraines
```
26
The thrifty gene is?
Genes that predispose to obesity have a selective advantage in populations that previously experienced starvation
27
Two ethnicities mainly effected by the thrifty gene?
Asian
| African
28
Gene associated with thrifty gene hypothesis?
CREBRF
29
Four features of syndromic monogenic obesity?
Mental retardation
Dysmorphic features
Organ specific abnormalities
OBESITY
30
Main site of adaptive thermogenesis?
Brown adipose tissue
31
Effect of brown adipose tissue on obesity?
Protection against obesity
32
Effect of white adipose tissue on obesity?
Increased rates
33
Apple/pear shape - which has greater risk of weight-related health problems and why?
Apple shape - more visceral fat
34
Obesity related diseases could cut the lifespan by how many years?
11
35
Main drug used to treat obesity?
Orlistat
36
Action of orlistat?
Lipase inhibitor - reduces the amount of fat absorbed from food that is eaten
37
What must first be undertaken prior to surgery for weight loss?
Weight management course - diet and nutrition, fitness and exercise
38
Indications for surgery in those that are obese? x2
```
Morbid obesity (BMI >40)
Or BMI > 35 and obesity related complications once conventional medical treatments have failed
```
39
Three surgery types for the treatment of obesity?
Restrictive procedures - gastric band
Malabsorptive procedures
Restriction plus malabsorption
40
Problems associated with malabsorptive procedures to cause weight loss? x3
Cause nutrient deficits and malnutrition and also dumping syndrome
41
Functions of the hypothalamus x7
```
Pituitary function
Feeding - appetite and satiety
Stress response
Water balance
Sleep-wake cycle
Thermoregulation
Emotions
```
42
Six hormones released by the anterior pituitary
```
Growth hormone
TSH
LH
FSH
PRL
ACTH
```
43
Two hormones released by the posterior pituitary
Oxytocin
| AVP/ADH
44
Blood comes to the anterior pituitary via which artery?
Superior hypophyseal
45
What travels from the hypothalamus to the anterior pituitary via the superior hypophyseal artery?
Hormones
46
Pituitary gland sits in?
Sella turcica
47
Enlargement of pituitary gland causes which deficit most commonly?
Bitemporal hemianopia
48
Bitemporal hemianopia is?
Loss of vision in the lateral half of each eye
49
Cause of bitemporal hemianopia is?
Compression of the optic chiasm
50
Hypothalamic hormone causing release of growth hormone?
GHRH - growth hormone releasing hormone
51
Hypothalamic hormone causing release of thyroid stimulating hormone TSH?
Thyroid releasing hormone
52
Hypothalamic hormone causing release of prolactin?
Thyroid releasing hormone
53
Hypothalamic hormone causing release of ACTH? x2
AVP and CRH
54
Hypothalamic hormone causing release of FSH? x2
Kisspeptin
| Gonadotrophin releasing hormone GnRH
55
Hypothalamic hormone causing release of LH? x2
Kisspeptin
| Gonadotrophin releasing hormone GnRH
56
Thyroid releasing hormone is secreted from where?
Hypothalamus
57
Thyroid releasing hormone causes the release of which two hormones from the pituitary gland?
TSH
| Prolactin
58
Hypothalamic hormone somatostain inhibits the release of which pituitary hormones? x2
Growth hormone
| TSH
59
Hypothalamic dopamine hormone inhibits the release of which pituitary hormone? x1
Prolactin
60
Growth hormone causes the release of what from where?
IGF-1 from the liver
61
TSH causes the release of what from where?
T3 and T4 from the thyroid gland
62
Prolactin has an effect where? x2
Mammary glands
| Immune system
63
ACTH releases what from where
Glucocorticoid cortisol from the adrenal gland
64
Cortisol is released fro which part of the adrenal gland?
zona fasciculata
65
FSH and LH release what from where?
Ovaries - oestrogen and progesterone
| Testes - testosterone
66
Negative feedback of thyroid hormone works via which two pathways?
Thyroxine on TSH - pituitary gland
| Thyroxine on TRH - hypothalamus
67
Thyroxine is T4 or T3?
T4
68
Primary underactivity is?
Damage to the target organ so lack of production of the target hormone
69
Secondary underactivity is?
Damage to the pituitary gland - lack of production of the pituitary hormone AND the target hormone
70
Primary underactivity of thyroid - lack of which hormone?
T4/T3
71
Secondary underactivity of thyroid - lack of which hormone?
TSH AND T4/T3
72
Hormone that can also stimulate the release of GHRH and GH?
Ghrelin
73
Pituitary hormone that has circadian rhythm is?
Growth hormone GH
74
GH relation to puberty?
Increased release during puberty
75
Inheritance of McCune-Albright syndrome?
Mosaic mutation
| NOT inherited
76
Mutation associated with McCune-Albright syndrome?
R201
77
Diagnostic criteria for McCune-Albright syndrome?
Fibrous dysplasia
Cafe au lait spots
Endocrine dysfunction
78
Four examples of endocrine dysfunction in McCune-Albright syndrome?
Precocious puberty
Hyperthyroid goitre
Adrenal hyperplasia
Somatotroph hyperplasia
79
What is the main pathology of McCune-Albright syndrome?
Excess release of growth hormone
80
Excess levels of cortisol results in what condition?
Cushing's syndrome
81
Persistently low levels of cortisol results in what condition?
Addison's disease
82
What are the two types of Cushing's syndrome?
ACTH independent
| ACTH dependent
83
Causes of ACTH independent Cushing's syndrome? x2
Adrenal hyperplasia
Adrenal tumour
Essentially increased adrenal release of cortisol
84
Cortisol is released from which part of the adrenal gland?
Zona fasciculata of the adrenal cortex
85
Cause of ACHT-dependent Cushing's syndrome?
Pituitary adenoma causing excess release of ACTH
86
Kisspeptin stimulates the release of?
GnRH
87
GnRH stimulates the release of?
Oestrogen/progesterone
| Testosterone
88
Oestrogen has a negative feedback effect on what?
On kisspeptin
89
Breast/prostate cancer - why treat with long acting GnRH analogue?
To activate receptor desensitisation
90
Which receptor type do you want to desensitise with long acting GnRh analogues?
G-protein coupled receptors
91
Oxytocin released during which two physiological actions?
Giving birth
| Milk ejection
92
Vasopressin is otherwise known as?
ADH
93
Lack of ADH causes which condition?
Diabetes insipidus
94
Three features of diabetes insipidus
Massive thirst
Polyuria
Nocturia
95
Nocturia is?
Waking at night to void urine
96
Two groups of micronutrients are?
Organic - vitamins
| Inorganic - trace elements
97
Four fat soluble vitamins?
A
D
E
K
98
Four water soluble vitamins?
B
Folate
Biotin
C
99
Fat/water soluble vitamins - which can be stored?
Fat soluble
100
Fat/water soluble vitamins - which is excreted in urine?
Water soluble
101
Presentation of lack of calcium? x3
Osteoporosis
Parastehesis
Muscle spasms
102
Presentation of lack of phosphorus?
```
Bone pain
Pseudofractures
Proximal muscle weakess
Rickets/short stature
Neurological complications
```
103
Presentation of lack of Iron?
Anaemia
104
Presentation of lack of Selenium?
Cardiomyopathy
105
Presentation of lack of Zinc?
```
Growth retardation
Alopecia
Dermatitis
Diarrhoea
Congenital malformations
```
106
Presentation of lack of Copper?
Growth retardation
107
Source of calcium?
Dairy products
108
Source of phosphorus?
Seeds and nuts
Lentils
Soya
109
Source of iron?
Red meat
Dark vegetables
Watermelon
110
Source of selenium?
Seafood
Red meat
Cereal
111
Source of zinc?
Meat
Shellfish
Nuts
Legumes
112
Source of copper?
```
Shellfish
Liver
Nuts
Legumes
Bran
Offal
```
113
Malnutrition contributes to what proportion of child deaths worldwide?
1/3
114
Kwashiorkor is due to?
Lack of protein and sufficient carbs
115
Masasmus is due to?
Lack of all nutrient groups
116
Number of adults in UK that are malnourished?
2 milllion
117
Presentation of vitamin A deficiency?
Xeropthalmia
118
Presentation of vitamin D deficiency?
Rickets
| Osteomalacia
119
Presentation of vitamin E deficiency?
Peripheral neuropathy
120
Presentation of vitamin K deficiency?
Coagulopathy
121
Presentation of vitamin C deficiency?
Scurvy
122
Presentation of vitamin B1 deficiency?
Beri beri
123
Presentation of vitamin B2 deficiency?
Angular stomatitis
124
Presentation of vitamin B3 deficiency?
Pellagra
125
Presentation of vitamin B6 deficiency?
Neuropathy
| Anaemia
126
Presentation of vitamin B12 deficiency?
Anaemia
127
Presentation of vitamin folate deficiency?
Anaemia
128
Vitamin B1 also known as?
Thiamine
129
Vitamin B3 also known as?
Niacin
130
Vitamin D2 known as and source?
Ergocalciferol - plant sources
131
Vitamin D3 known as and source?
Cholecalciferol - synthesised in the skin
132
Four lifestyle factors causing reduced levels of vitamin D?
Obesity
Smoking
Alcohol
Exercise
133
Target level of vitamin D in patients is?
>75nmol/l
134
What is osteomalacia?
Reduced bone strength
135
What is rickets?
Osteomalacia in children- expansion of the growth plate
136
Gait of someone with osteomalacia described as?
Waddling gait
137
Two types of thiamine deficiency?
Wernicke's encephalopathy
| Korsakoff's psychosis
138
Where is B1/thiamine absorbed?
Jejunum
139
Commonly see B1/thiamine deficiency in? x2
Malignancy
| Alcohol deficiency
140
Three other conditions B1/thiamine deficiency si seen in?
Anorexia/weight loss
Cognitive impairment
Muscle weakness - proximal
141
Proximal muscle weakness means that what movement is often difficult?
E.g. getting up from a chair
142
What is thiamine specifically required for, biochemically?
For the removal of pyruvate from the Kreb's cycle
143
Lack of thiamine results in what biochemically?
Build up of pyruvate and hence, build up of lactic acid - death of neurones
144
Function of thiamine
Conversion of pyruvic acid to acetyl-coA
145
Beri-beri is caused by?
Thiamine B1 deficiency
146
The two types of beri-beri are?
Wet
| Dry
147
Dry beri-beri causes?
Sympathetic peripheral neuropathy
148
Wet beri-beri causes?
Cardiac complications - enlarged heart, tachycardia, peripheral oedema
Neurological conditions
149
Triad of signs in Wernicke's/Korsakoff's are?
Horizontal nystagmus
Opthalmoplegia
Cerebellar ataxia
Mental impairment also
150
Vitamin B3/Niacin deficiency causes?
Pellagra
151
Three causes of vitamin B3 deficiency?
Vegetarianism
Alcoholism
Other vitamin deficiency states
152
Early symptoms of pellagra are? x6
```
Loss of appetite
Generalised weakness
Irritability
Abdominal pain
Vomiting
Bright red glossitis
```
153
Late signs of pellagra? x6
```
Casal's necklace
Vaginitis
Oesophagitis
Diarrhoea
Depression
Seizures
```
154
The four D's of late pellagra are?
Dermatitis
Diarrhoea
Dementia
Death
155
Why does Casal's necklace occur around the neck?
Area typically exposed to sunlight
156
Vitamin B12 also known as?
Cobalamin
157
What percentage of B12 is absorbed?
50%
158
How is vitamin B12 excreted?
In the urine or the bile
159
Four conditions B12 deficiency may be seen in?
Inadequate intake - vegans
Disorders of the terminal ileum
Inadequate production of IF
Defective release of cobalamin from food c
160
Common treatment for the prevention of refeeding syndrome is?
Pabrinex
161
Three types of transplant rejection are?
Hyperacute
Acute
Chronic
162
Hyperacute rejection occurs how soon after transplant?
Minutes to hours
163
Acute rejection occurs how soon after transplant?
One week to six months after
164
Chronic rejection occurs how soon after transplant?
Months to years after
165
Acute rejection is mediated through what?
Immune-mediated damage
166
Acute cellularly mediated rejection involves which cell types? x3
CD4+ T-lymphocyte
CD8+ T-lymphocyte
Macrophage
167
Acute antibody mediated rejection involves which cell type?
B-lymphocyte - antibodies
168
Two types of acute rejection are?
Cellularly mediated
| Antibody mediated
169
Primary target in acute antibody mediated rejection is?
Endothelium of arteries and capillaries
170
Three criteria for acute AMR is?
Evidence of acute renal injury on histology
Evidence of antibody activity e.g. CD4 staining
Circulating anti-donor antibodies
171
What is the cause of hyperacute rejection?
Preformed antibodies due to prior pregnancy, transplant or transfusion
172
Ig commonly associated with hyperacute rejection is?
IgM
173
Other than immunology/rejection - three other reasons a graft may fail are?
Damaged prior to transplantation
Surgical complications
Recurrence of the original disease
174
How can you prevent hyperacute rejection?
Screen for the presence of pre-formed antibodies
175
Four consequences of ischaemia in transplant rejection?
Upregulates adhesion molecules
Increases adhesion of leucocytes
Increases non-specific damage
Increases acute rejection
176
Four factors to prevent chronic rejection?
Choose best possible organ
Minimise surgical damage
Minimise acute rejection
Minimise drug toxicity
177
Just anterior to the infundibulum is?
Optic chiasm
178
Just posterior to the infundibulum is?
Pituitary gland in sella turcica
179
Pituitary tumour pressing on central part of the optic chiasm causes which visual field defect?
Bitemporal hemianopia
180
Anterior and posterior clinoid processes are located where?
Laterally - anterior and posterior to the sella turcica
181
Clivus of the sphenoid bone is?
Between the sella turcica and the foramen magnum
182
V1 opthalmic exits through which foramina?
Superior orbital fissure
183
V2 maxillary exits through which foramina?
Foramen rotundum
184
V3 mandibular exits through which foramina?
Foramen ovale
185
Flashcards of foramina of the skull!!
Flashcards of foramina of the skull!!
186
Embryology of the kidney - the mesonephric duct is also known as?
Wolffian duct
187
Paramesonephric duct is also known as?
Mullerian duct
188
Mesonephric (wolffian)/paramesonephric (mullerian) - which is male and which is female?
Mesonephric - male
Paramesonephric - female
189
Paramesonephric duct goes on to form?
Oviduct
190
Mesonephric duct does on to form?
Uretic duct
191
How many embryonic kidneys are there?
Three
192
What are the three stages of kidney development?
Pronephric
Mesonephric
Metanephric
193
So the metanephric kidney develops from what?
The mesonephric kidney
194
Which of these three embryonic kidneys goes on to be the functional kidney?
Metanephric kidney
195
Metanephric kidney is developed from which two structures?
```
Uteric bud (mesonephric duct)
Metanephric bud
```
196
Metanephric bud is derived from where?
The mesenchyme
197
The uteric bud develops into which part of the kidney?
The collecting system - pelvis, calyces, collecting ducts, ureters
198
The metanephric bud develops into which part of the kidney
Excretory system of the kidney i.e. the nephron - glomerulus, capsule, convoluted tubules, loop of Henle
199
Development of the kidney starts at which vertebral level?
S1
200
Final location of the kidney is at which vertebral level?
T12
201
Failure of the kidney to ascend to position is known as?
Ectopic kidney
202
What happens to the renal arteries as the kidney ascends to position?
Renal arteries continually degenerate and regenerate
203
What is kidney agenesis?
Failure of the kidney to form - unilaterally OR bilaterally
204
Kidney agenesis is associated with which mutation?
Defect in uteric bud formation
205
Uteric bud develops from what?
Mesonephric duct
206
Will the baby survive in bilateral agenesis?
No
207
Effect of bilateral agenesis on the amniotic fluid?
Reduced amniotic fluid
208
Reduced amniotic fluid is known as?
Oligohydramnios
209
Two birth defects developing from bilateral agenesis are?
Failure of lung development
| Club foot
210
Bifid ureter is?
Ureter splits into two OR duplicate ureter
211
What is an ectopic kidney?
When the kidney remains in the pelvic region - does not asence
212
What is a pancake kidney?
When the kidneys come together and fuse as one - does not then ascend
Type of ectopic kidney
213
Is a pancake kidney functional?
Yes
214
What is a horseshoe kidney?
Kidneys fuse in pelvic region and form singe U shape
Type of ectopic kidney
215
Is a horseshoe kidney functional?
Yes
216
What is a polycystic kidney?
Kidneys develop fluid filled cysts
217
Inheritance of polycystic kidney is?
Autosmal dominant OR autosomal recessive
218
Prevalence of kidney failure in those with polycystic kidneys is?
50% kidney failure by the age of 60
219
Two histological changes in kidney cysts?
Change in epithelium to secretory
| Increased proliferation of the cyst epithelium
220
Arcuate blood vessels are between what?
Between the cortex and the medulla
221
Stages of the renal arteries
Renal artery - segental artery - interlobar arteries - arcuate arteries - interlobular arteries
222
Which of the renal arteries bend around the medullary pyramids?
The arcuate arteries
223
Renal corpuscle is what?
Bowman's capsule and glomerular capillaries
224
Vascular pole of the renal corpuscle is?
Site of afferent and efferent arterioles
225
Urinary pole of the renal corpuscle is?
Where the proximal convoluted tubule begins
226
Podocytes are which layer of the Bowman's?
Visceral layer of Bowman's capsule
227
Channel protein located in the proximal convoluted tubule is?
Na+/K+ ATPase
228
What is reabsorbed in the proximal convoluted tubule and how much? x6
```
Water - 70-80%
Na+ - 70-80%
Cl- - 70-80%
Amino acids - 100%
Glucose - 100%
Bicarbonate - small amount
```
229
How can you differentiate between proximal and distal convoluted tubules histologically?
The PCT will have many microvilli sticking out into the lumen whereas the DCT will have a much clearer lumen
230
Epithelium of thin limb of loop of Henle?
Simple squamous epithelium
231
Epithelium of thick limb of loop of Henle?
Simple cuboidal epithelium
232
Functions of the distal convoluted tubule x2
Reabsorotion of water via ADH
| Electrolyte and acid base balance - Na+, K+, H+
233
Juxtaglomerulosar cells are located where?
Afferent arterial
234
Juxtagomerulosa senses what? secretes what?
Changes in BP
| Secretion of renin
235
Macula densa sense what?
Decreased Na+ content of distal tubule
236
Function of collecting duct? x2
(Similar to DCT)
Final concentration of urine - ADH
Electrolyte and acid-base balance - aldosterone
237
Muscle of internal sphincter of bladder is?
Smooth muscle
238
Renal corpuscles are located in which part of the kidney?
Renal cortex
239
What are the only arteries that go into the renal cortex?
Arcuate arteries
240
The colon is what?
Large intestine
241
What is Hirschsprung's disease?
Dilation of the large intestine (megacolon) causing obstruction in infant
242
Three symptoms of Hirschsprung's disease?
Failing to pass meconium within 48 hours
Swollen belly
Vomiting green fluid i.e. bile
243
Four muscles of the pelvic floor?
Levator ani - pubococcygeus, iliococcygeus, ischiococcygeus
| Puborectalis
244
Internal/external anal sphincters - which is voluntary and which is involuntary?
Internal - involuntary
| External - voluntary
245
Internal/external anal sphincters - which is stimulated first?
External - voluntary and then the involuntary opens
246
Which pelvic floor muscle forms a U shaped loop?
Puborectalis
247
Where does the puborectalis form a loop from and to?
Loop that slings around the rectum TO the pelvis
248
Puborectalise supports which anal sphincter?
External - closure
249
Function of puborectalis?
Maintain angle between anal canal adn rectum
250
Nervous innervation of continence is via (and nerve roots)?
S2, S3, S4 (keeps the 3 P's off of the flood - penis, poo, pee)
Pudendal nerve
251
Innervation of external anal sphincter is via?
Inferior rectal nerves from pudendal nerve
252
Innervation of internal anal sphincter is via? x2
Hypogastric nerves L1, L2 - sympathetic
| Pelvic nerves S2-S4 - parasympathetic
253
Three components essential for foecal continence
Internal anal sphincter
External anal sphincter
Puborectalis muscle
254
Which two structures make up the anorectal angle?
Puborectalis muscle
| External anal sphincter
255
What is meant by reservoir continence?
The ability of the rectum to retain stool
256
What is meant by rectal compliance?
The elastic component of the rectum that allows it to stretch/expand
257
Function of the IAS?
Responsible for closure of the rectum and the maintenance of the resting pressure
258
Function of the EAS?
Squeezing and the pressure during contraction
259
What is the rectoanal inhibitory reflex (RAIR)?
Reflex enabling you to relax your IA sphincter and empty the rectum
260
What initiates RAIR?
Progressive rectal filling
261
What is the valsalva manouvre?
Person holds breath and forcibly tries to exhale a closed glottis - pushing down to excrete foecal matter
262
What does the valsalva manouvre result in?
Increases the abdominal pressure
263
Closing reflex of the rectum involves which sphincter?
EAS
264
Two groups constipation effects the most?
Females
| Elderly
265
What is foecal incontinence?
Involuntary passage of rectal content - gas or stool
266
What is passive incontinence?
When the IAS is not working - you have no idea that you are passing stools until you feel it
267
What is urge incontinence?
When the EAS is not working - feel immediate urgency to pass stool but do not make it to the toilet in time
268
When are cortisol levels the highest?
Morning
269
When are cortisol levels the lowest?
Evening
270
Normal plasma cortisol levels are in the range of?
30-100ug/100ml
271
What can cause cortisol levels to increase?
Stress
272
What is Hans Selye's general adaptation syndrome?
Following acute stress there is chronic stress and then there is exhaustion and pathogenic stress
273
Drug given to patients to increase cortisol levels is?
Cortizone
274
Name some side effects of long term cortisol treatment
```
Oedema
Weight gain
Glaucoma
Hypertension
Insomnia
Depression
Thrombosis
```
275
Two forms of glucocorticoid receptor is? How do these differ?
Alpha - binds steroid
| Beta - does not bind steroid
276
Two ways in which glucocorticoid receptors can work are?
Genomic - slow - acting on the DNA
| Non-genomic - fast - not acting on the DNA but on the receptors
277
Three types of stress causing a release of glucocorticoids x5
```
Metabolic disturbance
Tissue damage
Infection
Fluid loss
Neural disturbance
```
278
Why can steroid treatment not be suddenly stopped?
Patient stops producing steroid when on treatment - must slowly lower the dose
279
Most of the calcium in the blood is in what form?
Bound to albumin
280
Calcium is bound to albumin at the expense of?
H+
281
Changes to albumin bound calcium in acidosis?
Acidosis - less calcium bound to albumin so more H+ can be bound
SO more ionise calcium in teh blood
282
Changes to albumin bound calcium in alkalosis?
More calcium bound to albumin for increased release of H+ SO less ionised calcium in the blood
283
Main role of calcium in cells?
Cell signalling
284
Majority of phosphate in the body is where?
85% body phosphate mineralised in bone
285
Calcium levels are controlled by which hormone?
Parathyroid hormone
286
Parathyroid glands develop from where embryologically?
Pharyngeal pouches
287
What are the cells responsible for the secretion of PTH?
Chief cells
288
Two cells of the parathyroid glands are?
Chief cells
| Oxyphilic cells
289
What are the three types of hormone?
Peptide hormone
Steroid hormone
Amine hormone
290
What hormone type is thyroid hormone?
Peptide hormone
291
Pathway of thyroid hormone production?
Same way as insulin - pre, pro...
292
Major stimulus for the release of PTH is?
Low levels of ionised calcium
293
Low levels of ionised calcium causes what change to chief cells?
Hyperplasia of chief cells
294
Normal serum calcium levels are?
2.2-2.6
295
Three functions of the calcium sensing receptor?
Reduces PTH secretion
Increases the breakdown of stored PTH
Suppresses the transcription of the PTH gene
296
What type of receptor is the calcium sensing receptor?
G-protein coupled receptor
297
PTH has a role at which part of the kidney?
Distal tubule
298
What is the role of PTH at the distal convoluted tubule?
Increased reabsorption of calcium
299
Calcium reabsorption at the proximal convoluted tubule is dependent/independent of PTH?
Independent
300
What stimulates calcium reabsorption at the proximal convoluted tubule?
Voltage gradient
301
What stimulates calcium reabsorption at the loop of Henle?
Voltage dependent
302
What stimulates calcium reabsorption at the distal convoluted tubule?
PTH
303
What is Barter's syndrome?
Mutation in the calcium channel of the loop of Henle
304
What is Gitelman syndrome?
Mutation in the Na+/Ca2+ channel of the kidney
305
Effect of vitamin D on the parathyroid gland is?
Reduces PTH transcription
306
Effect of vitamin D on bone is? x2
Reduces expression of type I collagen
| Increases RANKL levels
307
What is FGF23?
Phosphatonin - hormone that reduces serum phosphate levels
308
Where is calcitonin produced?
Chief cells of the thyroid
309
Where are vitamin D2/D3 obtained from?
D2 - from vegetables
| D3 - from meat
310
What is familial hypocalciuric hypercalcemia? FHH?
A mutation that inacivates CaSR
311
What happens in FHH?
Parathyroid cannot sense high calcium so PTH is not supressed by high calcium
CaSR in kidney not activated
312
Change in ion levels due to FHH is? x3
High serum Ca2+
Low urine Ca2+
High serum Mg
313
Pituitary adenoma is of the anterior or the posterior pituitary?
Anterior pituitary
314
Goitre of thyroid involves infiltration of what cell type?
Lymphocyte
315
Hashimoto's thyroditis - what structure is formed histologically?
Lymphoid follicle
316
Hashimoto's thyroditis - is this hyper or hypothyroidism?
Hypothyroidism
317
Grave's disease - is this hyper or hypothyroidism?
Hypothyroidism
318
Hyperthyroidism has what effect n the sympathetic nervous system?
Overactivity of the sympathetic nervous system
319
Adrenal gland - cortex/medulla is brown or yellow?
Cortex - pale yellow
| Medulla - brown
320
Two cell types in the parathyroid gland are?
Chief cells
| Oxyphill cells
321
Most abundant cell type in the parathyroid gland is?
Chief cells
322
Cells of the thyroid gland are?
Follicular cells
323
Chief cells produce what hormone?
Parathyroid hormone
324
Parafollicular/C cells are in which gland?
Thyroid gland
325
Parafollicular/C cells produce what hormone?
Calcitonin
326
Which endocrine structure has a tricornate/three horned appearance?
Adrenal gland
327
Portal triad of the liver - which structure is teh largest?
Portal vein
328
Portal triad of the liver - which structure is the smallest?
Hepatic artery proper
329
Renal cell carcinoma tend to invade which renal structure?
Renal vein
330
What type of carcinoma is commonly found in teh kidney?
Transitional cell carcinoma
331
Renal corpuscles are only found in the cortex or in the medulla?
In the cortex
