Trastornos endocrinos y metabólicos

Question 1

First two autoantibodies that appear in patient with T1DM

Answer 1

antiinsulin and antiGAD65

Question 2

Autoantibody in T1DM that usually disppears by age 5

Answer 2

antiinsulin

Question 3

Most common age for T1DM

Answer 3

<15 years old

Question 4

What factor influences the risk of a faster progresion to the symptomatic phase in T1DM

Answer 4

The number of autoantibodies and the age of seroconversion of the first antibody

Question 5

Theory of production of autoantibodies in T1DM

Answer 5

By a continuous exposition to beta-cell autoantigens

Question 6

What autoantibody is associated with the haplotype HLA-DR3-DQ2

Answer 6

anti-GAD65

Question 7

What autoantibody is associated with the haplotype HLA-DR4-DQ4

Answer 7

antiinsulin

Question 8

The appearance of which autoantibody increases the risk of reaching the symptomatic phase

Answer 8

anti-IA2

Question 9

How do polymorphisms affect the development of immune tolerance in the fetal thymus

Answer 9

They lead to inadequate deletion of autorreactive T cells or insufficient generation of T reg cells

Question 10

What characterizes the progression from phase 1 to phase 2 in T1DM

Answer 10

dysglucemia

Question 11

How is dysglucemia detected when T1DM progresses from phase 1 to phase 2

Answer 11

Oral glucose tolerance test or intravenous glucose tolerance test

Question 12

How does the intravenous glucose tolerance test work

Answer 12

It detects the preformed insulin granules before they are secreted

Question 13

Common age, ethnicity and BMI for patients with type 1b diabetes

Answer 13

<20 years, of african or asian origin, and greated BMI

Question 14

Drugs that can cause diabetic ketoacidosis

Answer 14

antipsychotic agents, illicit drugs, alcohol, thiazide diuretics, corticosteroids, etc

Question 15

How does insulin deficiency lead to ketoacidosis

Answer 15

Glucose usage will decrease, therefore increasing lipolysis and free fatty acids. This will cause an increase of ketone body production and lead to hyperketonemia, until reaching ketoacidosis

Question 16

How does insulin deficiency lead to hyperosmolarity

Answer 16

Gluconeogenesis will be increased, causing hyperglycemia which will also cause glycosuria, electrolyte loss, and volume depletion, causing hyperosmolarity

Question 17

Diagnostic criteria in diabetic ketoacidosis for ketosis

Answer 17

concentration of b-hydroxybutyrate > 3 mmol/L or urine ketone strip >2+

Question 18

Diagnostic criteria in DKA for metabolic acidosis

Answer 18

pH <7.3 or HCO3- <18 mmol

Question 19

Diagnostic criteria in hyperglycemic hyperosmolar state for hyperglycemia

Answer 19

plasma glucose >600 mg/dL

Question 20

Diagnostic criteria in hyperglycemic hyperosmolar state for hyperosmolarity

Answer 20

Calculated effective serum osmolality >300 m0sm/kg or total serum osmolality >320 m0sm/kg

Question 21

What defines the severity of DKA

Answer 21

Whether the mental status is alert, drowsy or coma

Question 22

What is usually given as treatment for DKA

Answer 22

Fluids

Question 23

Causes of hypoglycemia in adults

Answer 23

Insulin secretagogue, alcohol, hepatic/renal/cardiac failure, hypocortisolism, etc

Question 24

Sympathoadrenal response in the presence of hypoglycemia

Answer 24

increase of oxygen consumption, which increases heart work load and causes heart rate variability and ECG changes

Question 25

Effects of hypoglycemia in the eye

Answer 25

Diplopia, decrease of retinal sensitivity and response, loss of vision

Question 26

Effects of hypoglycemia in the brain

Answer 26

Neurocognitive dysfunction, increase of seizures, brain injury

Question 27

Pathways that cause oxidative stress and loss of insulin actions

Answer 27

Polyol, hexosamine, protein C kinase, AGE

Question 28

Main sensory tests for diabetic neuropathy

Answer 28

Vibration, pain, pressure, light touch, temperature

Question 29

Events that occur at earliest stage of diabetic retinopathy

Answer 29

Microaneurysms

Question 30

What causes changes to the appearance of the retina in moderate diabetic retiniopathy

Answer 30

Distortion of blood vessels in retina

Question 31

What could cause retinal detachment in diabetic retinopathy

Answer 31

Angiogenesis inside retinal surface increases risk of their leakage, in that case it could peel the retina from the underlying tissue

Question 32

Normal value of glomerular filtration rate

Answer 32

>90

Question 33

Normal value of albuminuria

Answer 33

<30 mg/g

Question 34

Value of GFR that is considered kidney failure

Answer 34

<15

Question 35

Value of albuminuria considered severely increased

Answer 35

>300 mg/g

Question 36

Cotransporter in proximal tubules responsible for reabsorption of glucose and sodium

Answer 36

SGLT1 (proximal) and SGLT2 (distal)

Question 37

How are SGLT1 and SGLT2 upregulated under hyperglycemic conditions

Answer 37

hypatocyte nuclear factor 1 (HNF1a) and glucocorticoid-induced kinase-1 (SGK1) stimulate them

Question 38

How does hyperglycemia lead to glomerular hyperfiltration

Answer 38

Reabsorption of glucose in the proximal tubule will cause a decrease of hydraulic pressure in Bowman's capsule and concentration of NaCI in macula densa, leading to a decreased vasoconstrictor tone and a efferent arterial dilation

Question 39

How does hyperglycemia lead to podocyte death

Answer 39

Promotion of ROS can react with NO (produced by podocytes to prodtect glomerulus), creating oxidative stress and inducing apoptosis

Question 40

How does insulin regulate protein synthesis and cell growth in the glomerulus

Answer 40

It activates PI3K and mTOR pathways

Question 41

What are the effects of angiotensin II, endothelin 1, ROS, and thromboxane A2 on the efferent arteriole of the glomerulus

Answer 41

Vasoconstriction

Question 42

What are the effects of insulin resistance, COX2, prostanoids on the afferent arteriole of the glomerulus

Answer 42

Vasodilation

Question 43

Therapies that could slow the progression of DKD

Answer 43

SGLT2 inhibitors, RAS blockers, GLP-1RAs

Question 44

How does the polyol pathway promote hyperglycemia

Answer 44

Increases intracellular oxidative stress

Question 45

How does the hexosamine pathways promote hyperglycemia

Answer 45

Activation of serine and threonine residues of transcription factors cause pathologic gene expression

Question 46

How does the PKC activation promote hyperglycemia

Answer 46

Increased expression of NFKB, PAI1, and TGFb

Question 47

Most common type of diabetic neuropathy

Answer 47

Chronic distal symmetric sensory poly-neuropathy

Question 48

Criteria for confirmed neuropathy

Answer 48

Abnormal nerve conduction and symptoms or signs of neuropathy

Question 49

How are NE and 5HT involved in pain

Answer 49

Modulate descending inhibitory pain pathways

Question 50

What are some symptoms of cardiac autonomic neuropathy

Answer 50

Resting tachycardia, exercise intolerance, orthostatic hypotension, QT prolongation

Question 51

Symptoms of a GI autonomic neuropathy

Answer 51

Gastroparesis, diarrhea, constipation

Question 52

How does hyperglycemia lead to the collapse of arch (Charcot Arthropathy)

Answer 52

Oxidative stress and ischemia cause a progressive localized inflammatory response and impaired vascular smooth muscle

Question 53

How does hyperglycemia lead to an ulcer formation on the foot

Answer 53

Decreased blood supply will cause impaired healing, so when the skin degrades it won't be healed properly

Question 54

The simultaneous or sequential appearance of diverse metabolic and inflammatory conditions associated with insulin resistance and accumulation of fat tissue, refers to:

Answer 54

Metabolic syndrome

Question 54

How does the Semmes-Weinstein Monofilament test work to detect diabetic foot

Answer 54

Apply pressure to several spots of the foot with a monofilament

Question 55

Diagnostic criteria for abdminal obesity

Answer 55

Waist circumference >102cm in men and >88cm in women