Unit 12 Flashcards
(211 cards)
1
Q
hormone mechanisms can be amplified and spread throughout the cell by
A
second messengers
2
Q
diverse structure of hormones
A
amines and amino acids
peptides
proteins
steroids
fatty acid
3
Q
different hormones have different
A
half lives
4
Q
what are the different ways a hormone can be destroyed
A
enzymes, by the cell, by the liver
5
Q
2 types of hormone receptor interactions
A
surface (second messenger) and intracellular interactions
6
Q
examples of surface hormone receptor interactions
A
cAMP, glucagon, insulin, epinephrine, pth, TSH, ACTH, FSH, LH, ADH
7
Q
up regulation
A
cells make more receptors
8
Q
down regulation
A
cells make fewer receptors
9
Q
response of a hormone depends on the receptor number and
A
affinity
10
Q
your patient has low levels of circulating thyroid hormone. how will the cells of the thyroid gland respond
A
up regulation
11
Q
aniterior pituitary
A
gland
12
Q
posterior pituitary
A
neural
13
Q
hypothalamus detects the state of the bodys
A
temp
blood osmolarity
blood nutrients
blood hormones
inflammatory mediatiors
emotions
pain
14
Q
T/F: the pituitary gland controls the release of thyroid hormone
A
T
15
Q
the pituitary gland tells other organs/glands to produce and secrete or inhibit the appropriate hormones. Where does the pituitary glad receive the cue to act from
A
hypothalamus
16
Q
hypofunction
A
underproduction
17
Q
causes of hypofunction
A
decline with aging
atrophy
congenital defects
disruption in blood flow
infection
inflammation
autoimmune responses
neoplastic growth
receptor defects
18
Q
hyperfunction
A
excessive hormone production
19
Q
causes of hyperfunction
A
excessive stimulation and hyperplasia of the endocrine gland
hormone producing tumor of the gland (PARENOPLASTIC)
20
Q
primary disorders
A
originate in the target gland
21
Q
secondary disorders
A
target gland is normal but its function is altered by defective levels of stimulating hormones or releasing factors from the pituitary system
22
Q
tertiary disorders
A
result from hypothalamic dysfunction
both pituitary and target organ are under stimulated
23
Q
T4 is inactive until converted into __ in tissues
A
T3
24
Q
both thyroid hormones exert a
A
negative feedback
25
thyroid hormone increases metabolism and ________ synthesis
protein
26
if there is thyroid deficit in infancy this may cause
mental retardation
27
thyroid has strong interactions with
SNS and ANS
28
if you suspect you might have a thyroid issue what is the first test that would be done
blood sample
29
HYPOthyroid BMR is
decreased
30
HYPOthyroid will have ___________ sensitivity to catecholamines
decreased
31
HYPOthyroid will have ______________ features
myxedematous
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HYPOthyroid will make people feel
sluggish
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HYPOthyroid ____________ CO
decrease
34
HYPOthyroid _______cardia
brady
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HYPOthyroid will have ________ with their bowel movements
constipation
36
HYPOthyroid will have ______ventilation
hypo
37
HYPOthyroid will be _____ intolerant
cold
38
HYPOthyroid will have weight
gain
39
HYPOthyroid will have coarse ____ skin and hair
dry
40
HYPOthyroid will have ________ muscle tone
decreased
41
HYPERthyroid will have BMR
increased
42
HYPERthyroid will have ________ sensitivity to catecholamines
increased
43
HYPERthyroid will appear with exophthalmus which is what
bulging eyes that look like a pug
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HYPERthyroid will make the patient feel
restlessness, irritability, anxiety
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HYPERthyroid will have _________ CO
increased
46
HYPERthyroid will have _______cardia
tachy
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HYPERthyroid will have what kind of bowel movements
diarrhea
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HYPERthyroid will have what kind of breathing
dyspena
49
HYPERthyroid will be _______ intolerant
heat
50
HYPERthyroid will have weight ________
loss
51
HYPERthyroid will have thin and ______ hair and skin
silky
52
HYPERthyroid will also have the patient
tremor and twitching
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if there is a lack of iodine the T3 and T4 will
not be made
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the lack of iodine will cause no negative feedback there for
TRH and TSH will continue to be made
55
when there is a lack of iodine the patient may present with a
goiter
56
you need what to make T3 and T4
iodine
57
hypothyroidism can be
congenital or acquired
58
an example of acquired hypothyroidism besides the thyroidectomy is
Hashimoto thyroiditis
59
Hashimoto thyroiditis is
autoimmune
60
2 types of hyperthyroidism
graves and thyroid tumors
61
graves is
hyperthyroidism
62
a person with graves disease may physically present how?
with wasting, goiter, opthalmopathy (esothalamus)
63
graves disease is most common in
women
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graves is an
autoimmune disorder
65
graves disease will have an abnormal stimulation of thyroid gland by
thyroid stimulating antibodies
66
in graves disease exophthalmos results when
antibodies interact with antigens found in fibroblasts in orbital tissue behind the eyeball
67
thyroid storm is a life threating form of
thyrotoxicosis
68
thyroid storm can be causes by
stress, infection, DKA, trauma
69
thyroid storm is manifested by
very high fever, tachycardia, CHF, angina and exaggeration CNS symptoms
70
can you treat thyroid storms with out urgency
NO must treat with urgency, life threatening
71
T/F: goiters are always associated with increased production of thyroid hormone
F, can occur with hypo, hyper and euthyroid
72
euthyroid is
when the thyroid is functioning normally
73
adrenal medulla secretes
epi and norepi
74
the adrenal cortex is responsible for
life essential hormones
75
cortex secretes
glucocorticoids, mineralocoricoids, adrenal sex hormones
76
mineralocoricoid example
aldosterone
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mineralocoricoid function in balance of what 3 things
sodium, potassium, water
78
adrenal sex hormones example
androgens
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glucocorticoids example
cortisol
80
glucocorticoids are essential for survival in
stress
81
glucocorticoids regulates metabolic functions of body and controlling
inflammatory resposne
82
actions of cortisol
plasma proteins increased, immune/inflammatory systems suppressed, muscle breakdown, free fatty acids increased, SNS response increased, blood glucose increased
83
cortisol release can be impacted when
there is a disease, stress or use of pretinzones
84
glucocorticoids diurnal variation peak in
early morning
85
glucose metabolism stimulates __________ and __________ glucose use which causes ________ in glucose
gluconeogenesis, decreased, increase
86
many people do not like to take glucocorticoids because of
psychological effect
87
long term therapy with pharmacolgoic preparations of the adrenal cortical hormone may casue
adrenal insufficiency on withdrawl
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when on glucocorticoids for extended periods of time the adrenals
atrophy
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if you have been talking glucocorticoids for extended periods of time and stop abruptly will you or will you not have any adrenal function
you will not, recovery might take 12 months
90
a primary diease of adrenal insufficiency is
Addisons disease
91
Addisons disease is caused by
destruction of gland
92
Addisons disease is
rare autoimmune
93
Addisons disease does not manifest until ___% is destroyed
90
94
adrenal insufficiency secondary results from a disorder of
HPA system
95
glucocorticoid hormone excess
cushings syndrome
96
cushings syndrome can be caused by
parenoplastic tumor, long term therapy
97
cushings syndrome apperances
buffalo hump, moon face, protruding abdomen, purple striae, muscle wasting, osteoporosis, 20% become DM, hypokalemia, hypertension, inhibited immune response
98
HPA system is the
target of steriods
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Addisons disease will present with
bronzy tan hyperpigmentation, hypoglycemia, loss of weight, hypotension, adrenal atrophy, urinary losses, retention of potassium
100
types of cushings syndrome
Cushing diease, ectopic cushings syndrome, iatrogenic Cushing syndrome
101
Diabetes Mellitus is a disorder of ______, ______, and _____ metabolism resulting from a lack of insulin availability or a reduction in the biological effects of insulin
carb, protein, fat
102
what is the new tool to diagnose DM earlier
A1C
103
normal A1C is
4-6%
104
type 2 diabetes mainly affects
white people non hispanic
105
why would someone have a higher risk for type 2 diabetes
overweight/obesity, 45 and older, first gen relative with type 2 diabetes, physically active less than 3 times a week, had gestational diabetes, gave birth to a big baby, or certain race
106
alpha cells released
glucagon
107
beta cells release
insulin and amylin
108
glucagon
causes cells to release stored food into the blood
109
insulin
allows cells to take up glucose from the blood
110
ways to test for DM
fasting plasma glucose test
random glucose test
oral glucose tolerance test
capillary whole blood glucose monitoring
hemoglobin A1C
111
increased blood glucose causes
insulin secretion
112
insulin stimulates uptake, use, and storage of
glucose
113
glucose to glycogen
glycogenesis
114
glucose to fat
lipogenesis
115
insulin inhibits
glycogen breakdown
fat breakdown
protein breakdown
116
glycogen breakdown
glycogenolysis
117
fat breakdown
lipolysis
118
protein breakdown into glucose
gluconeogenesis
119
if someone lacks insulin what happens to their blood glucose levels
increase
120
if someone lacks insulin what happens to their blood pH
decreases, become acidosis
121
liver regulates blood glucose through 3 processes
glycogenesis, glycogenolysis, gluconeogenesis
122
synthesis of glucose from non carb souces
gluconeogenesis
123
glucose levels rise
removed form blood and converted to glycogen
124
glucose levels fall
liver glycogen stores broken down and release into circulation
125
liver only uses a small amount of fatty acids for its own energy needs; converts the retainer into
ketones and is released into the blood
126
ketones
organic acids that cause ketoacidosis when they are present in excessive ammounts
127
when someone has severe metabolic acidosis you will have an increase in __ ____ into the cell which causes __ to leave the cell
H ion, K+
128
K+ is the main ____________ ion
INTRACELLULAR
129
ketoacidosis causes an increase in K+ how do you fix this
fix the acidosis and the K+ will fix it self
130
insulin lowers glucose by
facilitating movement of glucose into body tissues
131
actions of insulin include
promotes glucose uptake by target cells, glucose breakdown, inhibits gluconeogenesis, increases protein synthesis
132
decreased blood glucose leads to
glucagon secretion
133
glucagon stimulates release of glucose into
blood
134
glycogen into glucose
glycogenolysis
135
fat into fatty acids for energy
lipolysis
136
amino acids into glucose
gluconeogenesis
137
glucagon maintains blood glucose by increasing the release of
glucose from the liver into the blood
138
glucocorticoids stimulate ______________ 6-10 fold increase
gluconeogenesis
139
type 1A
autoimmune destruction of pancreatic beta cells
140
type 1B
idiopathic diabetes
141
type 2
beta cell dysfunction and insulin resistance, increased hepatic production of glucose
142
T/F: DM 2 is more common than DM 1
true
143
in type 1 diabetes with the absence of insulin
free fatty acids are released from fat cells and converted to ketoacids in the liver
144
what type is more prone to DKA
type 1
145
all type 1A are
insulin dependent
146
if there is better A1C there will be
less complications
147
type 2 metabolic abnormalities leading to
peripheral insulin resistance, deranged beta cell secretion of insulin, increased hepatic glucose production
148
metabolic syndrome is ______ resistant
insulin
149
metabolic syndrome includes ________ obesity
central
150
metabolic syndrome people have ____________ which is increased triglycerides, low HDL
dyslipidemia
151
metabolic syndrome have hyper ot hypo tension
hyper
152
metabolic syndrome do or do not have atherloslcerosis
do
153
metabolic syndrome has acanthuses nigricans which are
dark skin folds
154
metabolic syndrome have what kind of inflammation
systemic chronic inflammation
155
is gestational diabetes a small or large percent
small 5-10%
156
how can we diagnose gestational diabetes
fasting plasma glucose >126 or random >200
157
up to 60% of women with GDM will develop
type 2 diabetes after delivery
158
a child that was born from a mom with GDM will
have an increase risk of developing type 2
159
manifestations of type 1 are slow or rapid
rapid
160
are manifestations of type 1 specific or nonspecific
very specific
161
manifestations of type 2 are slow or rapid
slow
162
manifestations of type 2 specific or nonspecific
nonspecific
163
three polys that present with DM
polyuria, polydipsia, polyphagia
164
glucose is a _______, osmotically active molecule
small
165
high blood glucose levels exceeds amount that can be reabsorbs by _______ (aka renal threshold)
kidney
166
the glucose exceeds renal threshold this causes
glycosuria and large water losses in urine
167
intracellular dehydration causes
thirst
168
cellular depletion of carbs, fats and proteins causes
hunger
169
type 2 may present with
blurred vision, fatigue, paresthesias, skin infections
170
polyuria is caused in DM because
glucose levels exceeds renal threshold
171
polydipsia is caused in DM because
because urinating so much
172
polyphagia is caused in DM because
glucose is not in the cell where it should be
173
why can we not give insulin via mouth
it is destroyed in the GI tract
174
DKA causes include
infection, inadequate use of insulin, pregnancy, stress
175
DKA is a
metabolic acidosis
176
DKA will present with deep breathing because of
compensation to the metabolic acidosis
177
when a patient with DKA is breathing deep and hard what is this called
kussmaul breathing
178
when blood pH decreases this causes decreased nerve firing which can lead to
confusion and coma
179
when a patient has large amounts of ketones in their blood some patients are able to tell because of
acetone/fruity smell on breath
180
if a patient is in DKA why would they be breathing heavy
R ALK
181
if a patient is in DKA why would they be urinating so much
glucose has exceeded renal threshold
182
if a patient is in DKA why would they be dehydrated
because they are losing fluid because of increased amounts of urination
183
you find a man collapsed on the sidewalk and he is wearing a diabetic alert bracelet and has an insulin syringe in his brief case.
What happened?
Does he need insulin?
Why?
Hyper/hypo?
it happened suddenly so it is hypoglycemia. He does not need insulin he needs glucose/glucagon
184
is DKA a slow or fast onset
slow
185
DKA will have _________ tenderness
abdominal
186
in DKA can or cannot patients tell if they are going through DKA
they can with an odor on their breath
187
how will patients in DKA present BP and respiration wise?
hypotension and kussmaul breathing
188
does hypoglycemia have slow or rapid onset
rapid
189
when in hypoglycemia they will have altered _______ function and could lead to _____ and ________
cerebral, coma, seizures
190
hypoglycemia will first have PNS which will present as
hunger
191
in hypoglycemia after PNS is active then SNS will become active and present as
anxiety, tachycardia, sweating, skin cool/clammy
192
in an elderly patient in hypoglycemia they may only present with ____ changes
CNS
193
does a patient with HHS have a pH change
no
194
HHS is characterized by hyperglycemia of
>600
195
HHS may mimic a
stroke
196
HHS presents with (besides glucose count)
hyperosmolarity, dehydration, absence of ketoacidosis, depression of DNS
197
DKA is normally in type
1
198
HHS is normally in type
2
199
somogyi effect
insulin induced hypoglycemia caused by a compensatory increase in catecholamines, glucagon, cortisol, and growth hormone which lead to hyperglycemia
200
dawn phenomenom
hyperglycemia between 5A-9A with out following hypoglycemia
201
if a patient who has known DM (don't know what type) and their pH is 7.1
DKA or HHS
DKA
202
if a patient who has known DM (don't know what type) and their pH is 7.4
DKA or HHS
HHS
203
if a patient who has known DM and their pH is 6.9, what type do they have
type 1 (DKA)
204
if a patient who has known DM and their pH is 7.39 what type do they have
type 2 (HHS)
205
nerve cells produce _________ ______ to keep their osmolarity balanced with the blood
intracellular osmoles
206
DM can lead to chronic complications
diabetic neuropathies, nephropathies, retinopathies
207
nephropathies can lead to
end stage renal diease
208
retinopathies are the leading cause of acquired
blindness
209
diabetic foot ulcers
impaired pain sensation contributes, risk of amputation if ulcers are not treated
210
somatic neuropathies
diminished perception of vibration, pain and temp
211
autonomic neuropathy
impaired motility of the gastrointestinal tract- gastroparesis
