USA Pathophysiology Exam 2

What is the condition where the blood glucose is high in a pt?

Diabetes

After a pt has been fasting for 8 hours, what levels would indicate prediabetes?

100-125mg/dL

After a pt has been fasting for 8 hours, what levels would indicate diabetes?

Greater than 125mg/dL

A glucose tolerance test has been performed, what levels indicate prediabetes?

140-199mg/dL

A glucose tolerance test has been performed, what levels indicate diabetes?

Greater than 200 mg/dL

What is the A1C value?

The blood glucose level over the past 3 months

Looking at an A1C value, what is considered normal?

Less than 5.7%

Looking at an A1C value, what is considered prediabetes?

5.7% - 6.4%

Looking at an A1C value, what is considered diabetes?

6.5% or higher

What is the role of the pancreas?

Secrete insulin and glucagon to regulate blood glucose levels

Which cells secrete Glucagon?

Alpha cells

What cells secrete Insulin?

Beta cells

Which tissues do insulin target?

Striated muscle

Adipose tissue

Liver

How does insulin affect the blood glucose level?

Decreases the plasma-glucose level

What is secreted in response to a decrease in blood glucose level?

Glucagon

What is the role of glucagon?

To increase the blood glucose concentration

Glucagon helps maintain adequate plasma glucose levels by doing what?

promoting glycogenolysis and gluconeogenesis

What dominates in a fed-state?

insulin

What dominates in a fasted-state?

glucagon

Which type of diabetes is caused by lack of insulin secretion?

Type 1 Diabetes

Which type of diabetes is caused by decreased sensitivity of target tissues to the metabolic effect of insulin and insulin deficiency?

Type 2 Diabetes

What is insulin resistance?

Reduced sensitivity to insulin

What develops in pregnant women who have never had diabetes?

Gestational diabetes

Which is the most common type of diabetes?

Type 2 Diabetes

What is type 1 diabetes mellitus (DM)?

The pancreas produce no insulin or little insulin (juvenile diabetes or insulin-dependent)

What causes Type 1 diabetes mellitus?

Autoimmunity (viruses and genetics)

What are the symptoms of type 1 diabetes mellitus?

Hyperglycemia

Osmotic diuresis and polyuria

Polydipsia

Polyphagia

Blurred vision

Sudden weight loss

Fatigue

Diabetic Ketoacidosis

What is type 2 diabetes mellitus?

adult onset diabetes

90-95% of all cases of diabetes

What does type 2 diabetes mellitus cause?

Decreased sensitivity of target tissues to the metabolic effect of insulin (insulin resistance)

What are the risk factors of type 2 diabetes mellitus?

Genetics

overweight

increased BMI

increased waist circumference

Life style

What are the symptoms of type 2 diabetes mellitus?

Same symptoms as type 1 + numbness, tingling feet or hands, wounds that don't heal

What complications can occur from Diabetes Mellitus?

Blood vessels disease

Polyneuropathy

Kidney damage

Eye damage

How do we treat Diabetes mellitus?

Exercise

Caloric restriction

Weight reduction

Hypoglycemic drugs

Insulin administration

What is the combination of type 2 diabetes, obesity, atherosclerosis, and High BP create?

Metabolic Syndrome

How do you diagnose Metabolic syndrome?

2 or more of the following:

Central obesity >40" males, >35" females

Blood pressure >130/85 mmHg

Fasting blood glucose >110mg/dL

Elevated fasting plasma triglyceride levels (>150mg/dL)

Low plasma HDL-C levels (normal=40-60mg/dL)

What hormones are secreted by the adrenal gland?

Aldosterone

Glucocorticoid (Cortisol)

Sex Hormones

Catecholamines (NE and Epi)

When is cortisol highest?

Morning

When is cortisol released?

During stress

What promotes gluconeogenesis in the liver, breaks down skeletal muscle proteins for gluconeogenesis, and enhances lipolysis for energy use?

Cortisol

What protects against hypoglycemia?

Cortisol

How does cortisol suppress the immune system?

inhibits inflammatory response

poison ivy, pollen

can prevent rejection of transplant organs

Exogenous administration can shut down ACTH production and adrenal cells (atrophy)

How does cortisol cause a negative calcium balance?

Kidneys secrete large amounts of calcium into the body which increases the risk for fracture

What happens during the negative feedback of cortisol?

Once cortisol is released, it shuts off CRH and ACTH to inhibit the production of more cortisol

Which disease is caused by excessive cortisol?

Cushing's Disease

What will you see in the clinic is a pt presents with Cushing's disease?

Moon face with red cheeks

Abdominal fat with striations from protein breakdown of skin

The symptoms of Cushing's disease include?

Hyperglycemia

Hypertension

Proximal muscle wasting

Poor wound healing

Osteoporosis

Hypokalemia (dec. potassium)

Which disease is caused by hyposecretion of all steroid hormones and usually results from a autoimmune destruction of the adrenal cortex?

Addison's Disease (adrenal insufficiency)

What symptoms are seen in Addison's disease?

Gluconeogenesis disease

Mild neurotic to severe depression

Weakens stress response

What disease is classified as Hypocortisolism?

Addison's disease

What disease is classified as Hypercortisolism?

Cushing's disease

Which part of the endocrine system receives neural signals from the brain and peripheral NS and funnels the signals to the Pituitary gland?

hypothalamus

Which part of the endocrine system ultimately controls the other endocrine glands and the body's response to the environment?

Pituitary Gland

What are the functions of the Endocrine System?

Differentiation CNS to fetus

Coordination male and female reproductive

Stimulation of sequential growth childhood-adolescence

Maintenence of homeostasis

Initiation of stress response

what is a chemical secreted by a cell or group of cells called?

Hormone

Where do hormones travel?

bloodstream

What are phermones?

Type of ectohormone secreted into the external environment (ex. armpit sweat)

A pt presents with a fruity breath odor indicating?

Ketoacidosis

Catabolism is a term that describes:

Breakdown of large biomolecules into smaller ones

The adrenal medulla produces:

catecholamines

What cells secrete thyroid horome?

follicular cells

Which type of hormone needs to bind to a membrane surface receptor to initiate signal transduction process?

Peptide or Protein hormones

Where does a steroid hormone synthesize?

Adrenal cortex and smooth ER because it needs a protein carrier

What type of hormones are Estradiol/androgens, cortisol and aldosterone?

Steroid hormones

What types of hormones are tryptophan, tyrosine, catecholamines, and thyroid hormones?

Amino-acid derived and Amine hormones

What are classified as "True Hormones"?

Thyroid hormones

Which endocrine structure secretes melatonin?

Pineal gland

What are the functions of a hormone?

Initiated by a specific stimulus

Can act directly on an endocrine gland

Activates Nervous System (Action potential)

What is the sensor in simple endocrine reflexes?

The endocrine cell

What are the 2 hormones the Posterior pituitary gland secretes?

Vasopressin (antidiuretic hormone)

Oxytocin

What type of tissue is the posterior pituitary gland?

Extension of neural tissue

What is considered the "True Endocrine Gland"?

Anterior Pituitary Gland

What are the six hormones that are secreted from the Anterior pituitary gland?

Prolactin

Thyrotropin

Adrenocorticotropin

Growth hormone

Follicle-stimulating hormone

Luteinizing hormone

What structure uses a portal system?

Anterior pituitary gland

What is a portal system?

2 sets of capillaries connected in series by a vein

What hormones control growth, metabolism and reproduction?

Prolactin

Growth Hormone

2 Gonadotropins

Thyroid-stimulating hormone

Adrenocorticotrophic hormone

Which type of pathology is due to last endocrine gland in pathway?

Primary pathology

Which type of pathology is due to pituitary gland?

Secondary pathology

Which type of pathology is due to hypothalamus?

Tertiary pathology

Examples of hypersecretion

Benign or cancerous tumors

What is down regulation?

target cell will decrease number of receptors if hormone is abnormally high

Example of hyposecretion

Gland atrophy

What is essential about the thyroid hormone?

Has long-term effects on metabolism

Needed for growth and development in children

Where does thyroid synthesis occur?

Thyroid follicles

What is made inside the follicle cells?

Glycoprotein thyroglobulin

How is T3 made?

Target cells use deiodinases to remove iodine from T4

When the thyroid gland secretes too much hormone what pathology occurs?

Hyperthyroidism

What happens in hyperthyroidism?

Inc. oxygen consumption and metabolic heat production

Inc. protein catabolism and may cause muscle weakness

Hyperexcitable reflexes and psychological disturbances

Influence B-adrenergenic receptors in the heart

What disease comes about from Hyperthyroidism?

Graves Disease- bulging eyeballs

What is the treatment for Graves disease?

surgical removal of pituitary gland

destroy with radioactive iodine

block biosynthesis of hormone

When a pt presents with a goiter, what disease could they possibly have?

Hyperparathyroidism

What disease has excessive stimulation of the thyroid gland by TSH resulting in an enlargement of the gland?

Hyperparatyroidism

What is hypothyroidism?

Slows metabolic rate and O2 consumption

Dec. protein synthesis (myxedema/puffy)

Slowed reflexes, slow speech/thought process, fatigue

Bradycardia

What is the treatment for hypothyroidism?

oral thyroid hormone

What is an upper motor neuron?

the nerves that make up the direct and indirect pathways within the central nervous system

Where is an upper motor neuron lesion located?

CNS above the ventral horn cell in the spinal cord or above the nuclei of the cranial nerve

How is muscle tone affected in an upper motor neuron lesion?

Increased (spasticity and/or clonus)

How are deep tendon reflexes affected in an upper neuron lesion?

increased

If a pt. presents with a Babinski sign in the foot, what might have happened?

Upper motor neuron lesion

What is a lower motor neuron?

nerves that connect the central nervous system to the muscle fibers from the ventral horn

Where is a lower motor neuron lesion located?

primarily the PNS, ventral horn cell, motor nerve fiber, or neuromuscular junction