Midsem Polishing

Question 1

Which GI plexus(es) does the vagus nerve innervate?

Answer 1

Only myenteric (X = better = muscular plexus)

Question 2

Name two blood tests that we can run to differentiate between type 1 and type 2 diabetes, and expecting

Answer 2

1. C-peptide (connects alpha/beta chains of proinsulin; expected low in T1DM)
2. Diabetes autoantibody panel (expected high in T1DM)

Question 3

HHS vs DKA: common type of associated diabetes, blood sugar level, and level of insulin

Answer 3

• DKA is associated with type 1. No insulin, therefore ketones produced. Lower blood sugar level than HHS.
• HHS is associated with type 2. Some insulin, therefore no ketones produced. Higher blood sugar level than DKA.

Question 4

DKA Symptoms

Answer 4

• Polyuria/polydipsia (high blood glucose levels)
• Abdominal pain
• Nausea/vomiting (in response to acidosis)
• Fruity-smelling breath (on ketones)
• Kussmaul breathing

Question 5

HHS Signs/Symptoms

Answer 5

• Extreme hyperglycaemia
• Loss of consciousness
• Polydipsia/polyuria (due to high BGL)
• Hallucinations

Question 6

What are 3 effects of chronic stress on the Gastrointestinal system?

Answer 6

• Decreased regenerative capacity of mucosa
• Increase in permeability (?pathobiont -> gut inflammation)
• Harmful effects on microbiota

Question 7

What are the five diagnostic characteristics that can be measured to diagnose metabolic syndrome? How many are required for diagnosis?

Answer 7

• Criteria: high waist circ., low HDL, high BP, high fasting glucose, high TAG
• Three must be present (there are specific ref. ranges)

Question 8

Describe the pattern of oestrogen secretion during the menstrual cycle

Answer 8

• Rise during mid-follicular phase, and drop sharply after ovulation
• Rise during mid-luteal phase, and fade as endometrial lining is shed

Question 9

Diabetes cutoff for OGTT, fasting glucose test, HbA1c

Answer 9

OGTT: >11.1mmol/L (TT = repeat = 11.1)
Fasting: 7.0mmol/L
HbA1c: 6.5%

Question 10

Describe levels of oestrogen, progesterone, and gonadotrophs during perimenopause/menopause

Answer 10

Perimenopause
- Oestrogen: fluctuating
- Progesterone: lowered
- FSH: fluctuating
- LH: lowered

Menopause:
- Oestrogen/progesterone: decreased
- FSH/LH: increased (no negative feedback)

Question 11

Innervation of pituitary gland (incl. type of fibre)

Answer 11

Sympathetic fibres of superior cervical ganglia

Question 12

Normal range of vital signs?

Answer 12

BP: 90/60 to 120/80mmHg
HR: 60-100
O2: >95%
RR: 12-20
Temp: 36.1-37.9°C

Question 13

Strategies for communicating with patients with disability/illness

Answer 13

• Make appropriate adjustments
• Ask shorter questions/speak slower/wait for them to finish
• Book a longer appointment
• Avoid jargon
• Establish a baseline
• Involve the patient as much as possible in the decision making process

Question 14

Ethical issues with genetics and stem cells.

Answer 14

• Will only the wealthy have access to it?
• How do we gauge the side effects to determine risk/benefit?
• A newborn child cannot consent to genetic engineering that will last for the rest of their life. How do we regulate it to minimise the probability of undesirable outcomes?

Question 15

Why is it significant that some steroid hormones are produced/modified in peripheral tissues, rather than just in the adrenals, gonads, and placenta?

Answer 15

• Localised modulation (so the hormone might not act everywhere)
• Adaptation in response to local changes (injury, inflammation, stress etc.)
• Tissue-specific inactivation/metabolism of steroids