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What is the gut microflora? - ✅✅A diverse bacterial community in the gut. What are the major functions of the gut microflora? - ✅✅Metabolic activities, trophic effects, and protection against pathogens. Why do the stomach and small intestine contain only a few species of bacteria? - ✅✅Due to acidic and propulsive luminal contents. What factors influence the colonization of the GI tract? - ✅✅Passage through birth canal, diet, neonatal care, stress, pH, and immunologic status. What is the major metabolic function of colonic microflora? - ✅✅Fermentation of undigestible dietary residue and endogenous mucus. What is the role of colonic microorganisms in vitamin synthesis? - ✅✅They synthesize vitamin K.
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What is the source of energy in the colon? - ✅✅Fermentation of nondigestible carbohydrates. What nutrients are absorbed by colonic microorganisms? - ✅✅Calcium, magnesium, and iron. What is resident gut flora? - ✅✅Endogenous microbes in gut What is colonization resistance? - ✅✅Protection against exogenous microbes What does gut flora restrict? - ✅✅Opportunistic bacteria growth What is the primary treatment for celiac disease? - ✅✅Removal of gluten from the diet. What is gluten? - ✅✅The primary protein in wheat, barley, and rye.
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What is bilirubin? - ✅✅Final product of heme breakdown in RBCs What gives bile its color? - ✅✅Bilirubin What is free bilirubin? - ✅✅Insoluble bilirubin attached to plasma albumin What is conjugated bilirubin? - ✅✅Soluble bilirubin in bile Where is free bilirubin converted to conjugated bilirubin? - ✅✅Inside hepatocytes What happens to conjugated bilirubin? - ✅✅Secreted as a constituent of bile What happens to bilirubin in the small intestine? - ✅✅Half is converted to urobilinogen by intestinal flora
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What happens to urobilinogen produced in the intestine? - ✅✅Half is absorbed into portal circulation, remaining excreted in feces What happens to absorbed urobilinogen? - ✅✅Returned to liver to be reexcreted into bile What is the role of hepatocytes in bilirubin metabolism? - ✅✅Convert free bilirubin to conjugated bilirubin What is the fate of bilirubin after it is secreted as a constituent of bile? - ✅✅Passes through bile ducts into small intestine What is the function of bile? - ✅✅Digestion of dietary fats and absorption of fats and fat-soluble vitamins from the intestine. What are the components of bile? - ✅✅Water, bile salts, bilirubin, cholesterol, and certain by-products of metabolism. What is the importance of bile salts in digestion? - ✅✅They aid in emulsifying dietary fats and are necessary for the formation of micelles
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Who is at special risk for hepatitis A? - ✅✅People traveling abroad who have not been exposed. Why do young children play an important role in the spread of hepatitis A? - ✅✅They are often asymptomatic. What promotes viral infection among children attending preschool day care centers? - ✅✅Oral behavior and lack of toilet training. How is hepatitis B usually transmitted? - ✅✅Inoculation with infected blood/serum. Where can the viral antigen for hepatitis B be found? - ✅✅Most body secretions. Who is at high risk for hepatitis B in the United States? - ✅✅Injecting drug users, heterosexuals with multiple sex partners, men who have sex with men. Why are health care workers at risk for hepatitis B? - ✅✅Blood exposure and accidental needle injuries.
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What is the second most common risk factor for HCV transmission in the United States? - ✅✅High-risk sexual behavior. How can HCV be spread in the health care setting? - ✅✅Needlestick injuries. What activities may facilitate the transmission of HCV? - ✅✅Tattooing, acupuncture, body piercing. What is the incubation period for hepatitis B? - ✅✅Longer than hepatitis A. Which hepatitis virus represents a more serious health problem? - ✅✅Hepatitis B. What is the most common risk factor for HCV transmission in the United States? - ✅✅Recreational injecting drug use. What is the most common cause of chronic hepatitis, cirrhosis, and hepatocellular cancer in the world? - ✅✅HCV.
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What is the role of leptin in glucose metabolism? - ✅✅Involved in glucose metabolism What are the interactions of leptin with other hormones? - ✅✅Hypothalamic-pituitary-adrenal, thyroid, and growth hormones axes What are the functions of leptin receptors in the hypothalamus? - ✅✅Appetite, food intake, sympathetic nervous system activity, temperature regulation, and insulin release When do leptin levels tend to rise and fall? - ✅✅Rise after food intake and fall during fasting What does adipose tissue signal the brain via leptin? - ✅✅Sufficient storage of calories has been achieved and increased food intake is not necessary What are the hormones produced by the anterior pituitary? (6) - ✅✅FLAT PiG
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FSH, LH, ACTH, TSH, Prolactin and GH What is the function of GH? - ✅✅Stimulates growth of bone and muscle, promotes protein synthesis and fat metabolism, decreases carbohydrate metabolism. What is the function of ACTH? - ✅✅Stimulates synthesis and secretion of adrenal cortical hormones. What is the function of TSH? - ✅✅Stimulates synthesis and secretion of thyroid hormone. What is the function of FSH? - ✅✅Female: stimulates growth of ovarian follicle, ovulation Male: stimulates sperm production. What is the function of LH? - ✅✅Female: stimulates development of corpus luteum, release of oocyte, production of estrogen and progesterone. Where are ADH and oxytocin released? - ✅✅Posterior pituitary.
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What is the dilutional effect referred to as in DKA? - ✅✅Pseudohyponatremia. What is the cause of metabolic acidosis in DKA? - ✅✅Excess ketoacids that require buffering by bicarbonate ions. What is the effect of hyperglycemia in DKA? - ✅✅Osmotic diuresis, dehydration, and electrolyte loss. What is the effect of stress on DKA? - ✅✅Increases release of gluconeogenic hormones and predisposes to ketoacidosis. What are some examples of physical or emotional stress that can precede DKA? - ✅✅Infection, pregnancy, extreme anxiety. What is the effect of insulin omission or inadequate use on DKA? - ✅✅Can lead to ketoacidosis. What is the effect of hyperosmolality of extracellular fluids in DKA? - ✅✅Leads to a shift of water and potassium from the intracellular to the extracellular compartment.
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What is the effect of enteric water losses in DKA? - ✅✅Frequently results in low or normal extracellular sodium concentration despite losses. What is the effect of protracted polyuria and vomiting in DKA? - ✅✅May result in normal or elevated serum potassium levels despite total potassium depletion. What is the most common type of diabetes associated with DKA? - ✅✅Type 1 diabetes. When can DKA occur in relation to the onset of diabetes? - ✅✅It can occur at the onset of the disease, often before the disease has been diagnosed. What are the major metabolic derangements in DKA? - ✅✅Hyperglycemia, ketosis, and metabolic acidosis. What is the cause of ketone production in DKA? - ✅✅Increase in fatty acid levels due to mobilization from adipose tissue.
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What are the effects of cortisol on inflammatory and immune responses? - ✅✅Inhibition of inflammatory and immune responses, leading to increased susceptibility to infection. What are the effects of cortisol on gastric acid secretion? - ✅✅Increased gastric acid secretion, which may cause gastric ulceration and bleeding. What are the effects of excess glucocorticoids on androgen levels in women? - ✅✅Hirsutism, mild acne, and menstrual irregularities. What are the emotional effects of excess glucocorticoids? - ✅✅Extreme emotional lability, ranging from mild euphoria to grossly psychotic behavior. What is HHS? - ✅✅Hyperosmolar Hyperglycemic State characterized by hyperglycemia, hyperosmolarity (>320 mOsm/L) and dehydration. What are the symptoms of HHS? - ✅✅Depression of the sensorium and absence of ketoacidosis.
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What are the causes of HHS? - ✅✅Type 2 diabetes, acute pancreatitis, severe infection, myocardial infarction, and treatment with oral or parenteral nutrition solutions. Who is most likely to get HHS? - ✅✅People with type 2 diabetes. What is hyperosmolar state? - ✅✅A condition where increased serum osmolarity pulls water out of body cells. What causes hyperosmolar state? - ✅✅Partial or relative insulin deficiency, hyperglucagonemia, and increased hepatic glucose output. What is the effect of hyperosmolar state on blood glucose levels? - ✅✅It leads to increasingly higher blood glucose levels. What is the effect of hyperosmolar state on plasma volume? - ✅✅It contracts, leading to dehydration and renal insufficiency. What is the effect of hyperosmolar state on brain cells? - ✅✅It pulls water out of brain cells.
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What type of diabetes can cause erectile dysfunction? - ✅✅Both type 1 and type 2 diabetes What is the current availability of treatment for erectile dysfunction? - ✅✅Pharmacologic treatment What should be done before prescribing pharmacologic treatment for erectile dysfunction? - ✅✅Individuals must be appropriately screened due to cardiac implications and other conditions associated with diabetes What is the risk associated with loss of position sense? - ✅✅Increased risk of falling, serious burns, and injuries to the feet What is the treatment for autonomic neuropathy? - ✅✅Depends on the specific symptoms and may include medications and lifestyle changes What is the effect of autonomic neuropathy on bladder function? - ✅✅Inability to empty the bladder
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What is the effect of autonomic neuropathy on sexual function in males? - ✅✅Sexual dysfunction What is somatic neuropathy? - ✅✅Loss of sensory/motor function, bilateral and symmetric. What are the symptoms of somatic neuropathy? - ✅✅Diminished perception of vibration, pain, and temperature. What are the complications of peripheral neuropathy? - ✅✅Insensate foot, increased risk of falling, burns, and injuries. What is diabetic nephropathy? - ✅✅Leading cause of chronic kidney disease in diabetes, Lesions in glomerular capillaries causing renal failure. What percentage of new chronic kidney disease cases does diabetic nephropathy account for? - ✅✅40%
