Notes in 01 Pancreatitis and Diabetes

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Published	02/27/2024	The {{c2::alpha}} cells of the islets of Langerhans compose 20% of the islet and secrete {{c1::glucagon}}
Published	02/27/2024	The {{c2::β}} cells of the islets of Langerhans compose 65% of the islet and secrete {{c1::insulin}}
Published	02/27/2024	The {{c2::delta}} cells of the islets of Langerhans compose 10% of the islet and secrete {{c1::somatostatin}}
Published	02/27/2024	The remaining cells (non-alpha, beta, delta) of the islets of Langerhans secrete {{c1::pancreatic polypeptide}} or other peptides
Published	02/27/2024	{{c1::Glucose}} is the major regulator of insulin release
Published	02/27/2024	When insulin binds to its receptor, {{c1::tyrosine kinase}} is activated and autophosphorylates the β-subunits
Published	02/27/2024	Insulin decreases blood glucose concentration by promoting synthesis and storage of {{c1::glycogen}} in the {{c2::muscle}} and {{c2::liver}}, while si…
Published	02/27/2024	In adipose tissue, insulin stimulates {{c1::fat deposition (increased triglyceride synthesis)}} and inhibits {{c1::lipolysis}}
Published	02/27/2024	Insulin stimulates amino acid uptake into cells and {{c1::increases}} protein synthesis in muscles
Published	02/27/2024	What is the effect of insulin on blood K+ and amino acid concentration?{{c1::Decreased (due to increased uptake into cells)}}
Published	02/27/2024	The major factor that stimulates glucagon secretion is {{c1::hypoglycemia}}
Published	02/27/2024	What is the effect of insulin on glucagon secretion?{{c1::Decreased}}
Published	02/27/2024	Glucagon increases blood glucose concentration by increasing {{c1::glycogenolysis}}, while simultaneously inhibiting {{c1::glycogen}} formation from g…
Published	02/27/2024	Glucagon increases blood glucose concentration by increasing {{c1::gluconeogenesis}} via decreased production of fructose-2,6-bisphosphate
Published	02/27/2024	Glucagon causes {{c1::decreased}} fatty acid synthesis and {{c1::increased}} lipolysis, which shunts substrates towards gluconeogenesis
Published	02/27/2024	What is the effect of somatostatin on insulin and glucagon secretion?{{c1::Decreased}}
Published	02/27/2024	Type {{c1::1}} diabetes mellitus is characterized by insulin deficiency
Published	02/27/2024	Type {{c1::2}} diabetes mellitus is characterized by insulin resistance
Published	02/27/2024	Type 1 diabetes mellitus is due to {{c1::autoimmune destruction}} of pancreatic {{c2::β}} cells by {{c3::anti-glutamic acid decarboxylase}} antibodies…
Published	02/27/2024	What is the diagnostic cutoff for the 2-hour oral glucose tolerance test for a diagnosis of diabetes mellitus?{{c1::≥ 200 mg/dL}}
Published	02/27/2024	One of the most feared complications of type 1 diabetes is {{c1::diabetic ketoacidosis}}
Published	02/27/2024	In type 1 diabetics, increased {{c2::lipolysis}} leads to an increase in free fatty acids which are converted to {{c1::ketone bodies}} in the liver
Published	02/27/2024	What is the serum potassium level in a type 1 diabetic patient? {{c1::Increased::increased or decreased}}
Published	02/27/2024	What is the intracellular potassium level in a type 1 diabetic patient?{{c1::Decreased::increased or decreased}}
Published	02/27/2024	One of the most feared complications of type 2 diabetes is {{c1::hyperosmolar hyperglycemia non-ketotic syndrome}}
Published	02/27/2024	Hyperosmolar hyperglycemic non-ketotic syndrome often presents with glucose levels > {{c1::600}} mg/dL and increased serum osmolarity (> 320 mOs…
Published	02/27/2024	What is the treatment for hyperosmolar hyperglycemic non-ketotic syndrome? {{c1::Intense IV fluids and insulin therapy}}
Published	02/27/2024	The Whipple's triad help confirm symptomatic {{c2::hypoglycemia}} - low blood {{c1::glucose}}- {{c1::symptoms}} of hypoglycemia- resolution of sy…
Published	02/27/2024	Symptomatic patients with insulinoma have {{c1::low::high/low}} blood glucose and {{c1::high::high/low}} C-peptide levels
Published	02/27/2024	Overall, the effects of insulin are {{c1::anabolic::anabolic, catabolic}}
Published	02/27/2024	Overall, the effects of glucagon are {{c1::catabolic::anabolic, catabolic}}
Published	02/27/2024	The most common complication of insulin therapy is {{c1::hypoglycemia}}; may also experience lipodystrophy and hypersensitivity reaction (rare)
Published	02/27/2024	Alcoholics commonly have fasting {{c1::hypoglycemia::blood sugar}}
Published	02/27/2024	Vagal stimulation increases H+ secretion directly via binding of {{c2::acetylcholine}} to {{c1::M3}} receptors on parietal cells
Published	02/27/2024	The {{c1::enzymatic}} component of pancreatic secretion is secreted by acinar cells
Published	02/27/2024	The ductal cells modify the initial pancreatic secretion via {{c1::secretion}} of HCO3-
Published	02/27/2024	Pancreatic {{c1::lipases}} are responsible for fat digestion in the small intestine
Published	02/27/2024	What test is used to indirectly assess pancreatic function?{{c1::Fecal elastase}}
Published	02/27/2024	Pancreatic insufficiency is associated with {{c1::decreased}} excretion of fecal elastase
Published	02/27/2024	What stain is used to screen for fecal fat? {{c1::Sudan stain}}
Published	02/27/2024	{{c1::Acute pancreatitis}} is due to {{c2::autodigestion}} of pancreatic parenchyma by pancreatic enzymes
Published	02/27/2024	Acute pancreatitis results in {{c1::liquefactive}} necrosis of the pancreas
Published	02/27/2024	Acute pancreatitis results in {{c1::fat}} necrosis of the peripancreatic fat
Published	02/27/2024	The causes of {{c14::acute pancreatitis}} may be remembered with the mnemonic "I GET PP SMASHED":I: {{c1::Idiopathic}} G: {{c2::Gallstones}} E: {{c3::…
Published	02/27/2024	Which pancreatic enzyme is more specific for acute pancreatitis?{{c1::Lipase::amylase or lipase}}
Published	02/27/2024	Acute pancreatitis may be complicated by {{c1::pancreatic pseudocysts}}, which are formed by fibrous tissue surrounding liquefactive necrosis and panc…
Published	02/27/2024	Pancreatic pseudocyst presents as an abdominal mass with persistently elevated serum {{c1::amylase}}
Published	02/27/2024	Pancreatic pseudocysts may {{c1::rupture}}, causing hemorrhage and release of enzymes into the abdominal cavity
Published	02/27/2024	{{c1::Chronic}} pancreatitis is characterized by fibrosis of pancreatic parenchyma
Published	02/27/2024	Chronic pancreatitis is most often secondary to recurrent acute {{c1::pancreatitis}}
Published	02/27/2024	What are the major causes of chronic pancreatitis in adults? {{c1::Alcohol}} and {{c2::genetic predisposition (ex. Cystic Fibrosis)}}
Published	02/27/2024	Pancreatitis (acute and chronic) may present with {{c1::epigastric}} abdominal pain that radiates to the {{c2::back}}
Published	02/27/2024	Chronic pancreatitis may present with {{c1::pancreatic insufficiency}}, which results in malabsorption with steatorrhea and fat-soluble vitamin defici…
Published	02/27/2024	Are serum amylase and lipase useful serum markers for chronic pancreatitis? {{c1::No (may or may not be elevated)}}
Published	02/27/2024	{{c2::Chronic}} pancreatitis is characterized by atrophy and dystrophic {{c1::calcification}} of pancreatic parenchyma on imaging
Published	02/27/2024	Contrast studies of chronic pancreatitis reveal a "{{c1::chain of lakes}}" pattern due to dilatation of pancreatic ducts
Published	02/27/2024	What endocrine pathology may arise secondary to chronic pancreatitis? {{c1::Diabetes mellitus}}
Published	02/27/2024	The major risk factors for pancreatic adenocarcinoma are - {{c2::smoking}} - {{c1::chronic pancreatitis (especially > 20 years)}}
Published	02/27/2024	Gallstones that reach the confluence of the common bile and pancreatic ducts at the {{c1::ampulla of Vater::name of hole}} can block both ducts (…
Published	02/27/2024	What is the preferred initial management for symptomatic patients with a pancreatic pseudocyst (e.g. abdominal pain, vomiting)?{{c1::Endoscopic draina…
Published	02/27/2024	What is the likely diagnosis in a patient with a history of alcohol use and chronic, intermittent epigastric abdominal pain that is relieved by leanin…
Published	02/27/2024	What is the treatment for acute pancreatitis from uncorrectable causes (e.g. ischemia, atheroemboli)?{{c1::Analgesics and IV fluids (supportive care)}…
Published	02/27/2024	What complication may result from correcting hypernatremia too quickly?{{c1::Cerebral edema}}
Published	02/27/2024	In the treatment of Diabetic Ketoacidosis and Hyperosmolar Hyperglycemia State, aggressive {{c1::iso}}tonic saline fluids are indicated
Published	02/27/2024	How do total K+ levels typically change in patients with diabetic ketoacidosis or hyperosmolar hyperglycemic state?{{c1::Decreased}}
Published	02/27/2024	What is dx of acute pancreatitis with poor Ranson's criteria or needs pressors?{{c1::Necrotizing pancreatitis}}
Published	02/27/2024	What do you do if pt. presents with severe acute pancreatits with poor Ransons criteria and ?{{c1::ICU and monitor w/ CT scans}}
Published	02/27/2024	How do you dx a pancreatic pseudocyst?{{c1::CT}}
Published	02/27/2024	How do you decide to treat pancreatic pseudocyst?{{c1::<6cm AND <6 wks old -> watch and wait>6cm OR >6 wks -> drain (risk of hemorr…
Published	02/27/2024	The osmotic diuresis in diabetic ketoacidosis may lead to fatal arrhythmias by causing {{c1::total body K+}} depletion
Published	02/27/2024	Hereditary pancreatitis may be caused by mutations in the {{c2::cleavage}} site of trypsinogen or the {{c1::SPINK1}} protein
Published	02/27/2024	Which glucose test is preferred for general use?{{c1::Fasting glucose}}
Published	02/27/2024	Which glucose test is the preferred screening method for gestational diabetes / CF-diabetes?{{c1::2 hour oral glucose test}}
Published	02/27/2024	The neurogenic symptoms of hypoglycemia are caused by {{c2::sympathoadrenal}} activation and are mediated via neurotransmitters from {{c1::sympathetic…
Published	02/27/2024	The neuroglycopenic symptoms of hypoglycemia include behavioral changes, confusion, visual disturbances, stupor, and {{c1::seizures}}
Published	02/27/2024	Physical activity / exercise, inadequate food intake, excessive insulin dose can precipitate {{c1::hypo}}glycemia in patients with insulin treated dia…
Published	02/27/2024	In a nonmedical setting, severe hypoglycemia is ideally treated with intramuscular {{c1::glucagon}}
Published	02/27/2024	In a medical setting, severe hypoglycemia is treated with IV {{c1::glucose}}
Published	02/27/2024	{{c1::Chronic pancreatitis::condition}} is characterized by steatorrhea, epigastric pain, alcohol abuse, fat-soluble vitamin deficiency and diabetes
Published	02/27/2024	Acute pancreatitis typical imaging = {{c1::ultrasound}}Acute pancreatitis imaging (if unclear labs) = {{c1::CT}}
Published	02/27/2024	Acute pancreatitis and persistent fever/leukocytosis = pancreatic {{c1::abscess::abscess/pseudocyst}}Acute pancreatitis + mass symptoms (feel a mass/e…
Published	02/27/2024	What is the first test/imaging study that should be ordered to diagnose pancreatitis in a patient with acute epigastric abdominal pain that radiates t…
Published	02/27/2024	Hypoglycemia can be precipitated by exercise in patients with insulin-treated diabetes -- why?{{c1::Exogenous insulin continues to suck glucose into c…
Published	02/27/2024	What is the treatment regimen for diabetic ketoacidosis?- Prophylactic {{c1::potassium}}, IV {{c1::insulin}}, and IV {{c1::fluids}}- Once anion gap cl…
Published	02/27/2024	Fasting Glucose:Normal: {{c1::< 100}}Impaired fasting glucose (pre-diabetes): {{c1::100-125}}Diabetes: {{c1::> 126}}
Published	02/27/2024	HbA1c ≥ {{c1::6.5%::%}} = diabetesHbA1c < {{c1::5.7%::%}} = normal
Published	02/27/2024	Acute pancreatitis is usually caused by:{{c1::gallstones (50%)::condition}}{{c2::alcoholism (30%)::condition}}
Published	02/27/2024	Most common cause of chronic pancreatitis is {{c1::alcoholism (95%)::condition}}
Published	02/27/2024	Acute pancreatitis may present with absent bowel sounds due to {{c1::ileus::GI complication}}
Published	02/27/2024	Acute pancreatitis and ↑ AST/ALT/ALP = {{c1::gallstones::source}}
Published	02/27/2024	Rapid lowering of glucose in DKA can lead to {{c1::cerebral edema::neurological problem}}
Published	02/27/2024	In gallstone pancreatitis ALT {{c1::>}} AST, whereas in alcohol-induced pancreatitis ALT {{c1::<}} AST
Published	02/27/2024	What level of random serum glucose is diagnostic for type 2 diabetes mellitus?{{c1::> 200 mg/dL on 2 separate occasions/1 symptomati…
Published	02/27/2024	In normal pancreatic histology, {{c2::Islets of Langerhans}} (contains endocrine cells) appear {{c1::pale}} compared to {{c2::acinar cells}}…
Published	02/27/2024	In Diabetic Ketoacidosis, {{c1::ketone bodies}} accumulate in the serum and are used as fuel in peripheral tissues
Published	02/27/2024	Hyperosmolar Hyperglycemic State (HHS) may present with what symptoms?{{c1::Hypovolemic shock, Hypotension, Seizures (HHS)::3}}
Published	02/27/2024	What are the effects of adrenal Insufficiency on serum glucose levels?{{c1::Decreased (hypoglycemia)}}
Published	02/27/2024	In the pancreas, the acinar cells secrete an initial fluid that is high in {{c1::Na+}} and {{c1::Cl-}}, similar to plasma. The ductal cells then …
Published	02/27/2024	In the pancreas, {{c3::secretin}} acts mainly on the {{c1::ductal (and centroacinar)}} cells to secrete more {{c2::bicarb}} and {{c3::CCK}} …
Published	02/27/2024	In the image of the pancreas below, the lighter-staining areas are the {{c1::islets of Langerhans}} and the darker-staining areas are the {{…
Published	02/27/2024	Pancreatic secretions will digest {{c1::all of them (proteases, nuclease, lipase, amylase)::macronutrient categories}}
Published	02/27/2024	The early symptoms of hypoglycemia are indicative of {{c1::SANS activation (tremors, palp, hunger)}}, while the late symptoms are indicative of&n…
Published	02/27/2024	Type {{c1::2}} diabetes can be treated with many drugs, but type {{c1::1}} diabetes can only be treated with {{c2::insulin}}
Published	02/27/2024	Which pancreatic enzyme is more sensitive for acute pancreatitis in a patient that presents > 24 hrs after onset of sympto…
Published	02/27/2024	Which pancreatic enzyme is more sensitive for acute pancreatitis in a patient that presents < 24 hrs after onset of symptoms?{{…
Published	02/27/2024	Patients with heavy alcohol use are more likely to develop pancreatitis if they also have heterozygous mutation in the {{c1::CFTR}} gene
Published	02/27/2024	Mild acute pancreatitis = {{c1::no}} organ failure and no complicationsModerate acute pancreatitis = organ failure that {{c1::resolves}} within 4…
Published	02/27/2024	Which scoring system for acute pancreatitis requires 48 hours before predicting mortality?{{c1::Ranson's}}
Published	02/27/2024	Which scoring system for acute pancreatitis determines severity solely based on imaging?{{c1::CT scoring index}}
Published	02/27/2024	Which scoring system for acute pancreatitis is most used clinically to predict mortality and guide therapy?{{c1::BISAP}}
Published	02/27/2024	Should patients with acute pancreatitis be made NPO?{{c1::No}}
Published	02/27/2024	Pancreatic pseudocysts present {{c1::more::more or less}} than 4 weeks after the initial pancreatitis
Published	02/27/2024	In chronic pancreatitis, steatorrhea is managed with {{c1::pancreatic enzyme supplementation}}
Published	02/27/2024	The {{c1::neurogenic}} symptoms of hypolgycemia are due to sympathetic activation (e.g. sweating, anxiety)The {{c1::neuroglycopenic}} s…
Published	02/27/2024	{{c1::Epsilon}} Pancreatic cells secrete Ghrelin
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