Pbd 2 Exam 4 - Week 3 Autoimmune/adrenal

Front 1

True/False
Cold, stress, exercise, fasting, hypoglycemia and anxiety will result in a similar release of norepinephrine and epinephrine by the adrenal medulla.

Back 1

False. opposite release

Front 2

True/False
Release of catecholamines from the adrenal medulla can result in hyperglycemia by increasing both glycogenolysis and gluconeogenesis.

Back 2

True

Front 3

T/F?
LE cells are PMN’s that contain LE bodies. These bodies are composites of nuclear parts of a cell (DNA, etc) attached to an immunoglobulin.

Back 3

True

note:
(PMN contain LE bodies)
[nuclear material coated with antibodies-AgAb]
-basis for ANA test

Front 4

Which of the following statements is FALSE:
a. Mineralocorticoids and glucocorticoids are bound to albumin and/or CBG (transcortin) in
order to be transported in the blood.
b. The major hormone regulator of the Zona Glomerulosa is ACTH and the major hormone
regulator of the Zona Fasiculata is angiotensin II,
c. Angiotensin II can increase the activity of the side chain cleavage enzyme.
d. The enzyme that is confined to the Zona Glomerulosa of the adrenal gland is 18 hydroxylase.

Back 4

b. The major hormone regulator of the Zona Glomerulosa is ACTH and the major hormone
regulator of the Zona Fasiculata is angiotensin II,

Front 5

Which of the following is a FALSE statement for the actions of glucocorticoids:
a. Can increase bone resorbtion, directly and by indirect actions on calcium excretion.
b. Permissive for maintaining vascular reactivity to catecholamines.
c. Inhibit the action of insulin at the muscle and fat cell.
d. Decrease gastrointestinal activity.

Back 5

a. Can increase bone resorbtion, directly and by indirect actions on calcium excretion.

Front 6

Which of the following signs and symptoms is NOT usually manifested in Addison's disease:
a. Pigmentation of the skin.
b. Hypotension.
c. Muscle weakness.
d. Hypokalemic alkalosis.

Back 6

d. Hypokalemic alkalosis.

Front 7

Which of the following is a TRUE statement about PRIMARY hypofunction of the adrenal cortex.
a. Long-term glucocorticoid therapy can result in adrenal atrophy.
b. Most prevalent cause is autoimmunity.
c. Usually there is a near normal secretion of aldosterone.
d. Pigmentation of the skin would not be a common manifestation.

Back 7

b. Most prevalent cause is autoimmunity.

Front 8

Of the following, which symptom is ~ frequently manifested in Conn's syndrome:
a. Increased susceptibility for infections.
b. Hypertension.
c. Weight gain, buffalo hump, & moon face.
d. Glucose intolerance.

Back 8

b. Hypertension.

Front 9

____________ may induce both tyrosine hydroxylase and dopamine B hydroxylase in the adrenal medulla.

Back 9

ACTH

Front 10

The activity of PNMT (phenylethanolamine N methyl transferase) can be stimulated by __________.

Back 10

cortisol

Front 11

T/F? Type 2 immune damage is the more common mode of tissue injury for non-organ specific diseases such as SLE and Rheumatoid arthritis whereas, Type 3 immune injury is a common finding in organ specific autoimmune diseases such as Grave’s Disease, Hashimoto’s thyroiditis, Addison’s or Diabetes.

Back 11

False

Type 3 is for non-organ specific (aka immune complexes)
--all diseases listed at Type 2

Front 12

True/False
Raynaud's phenomena is paroxysmal vasospastic disorder that is a clinical feature found in some patients with SLE.

Back 12

True

Front 13

True/False
Polyarthritis is evident in about 90% of the patients with SLE.

Back 13

True

Front 14

True/False
Myasthenia Gravis is a chronic disease that is characterized by neuromuscular dysfunction in which there is an autoimmune process that reduces the nicotinic acetylcholine receptors.

Back 14

True

Front 15

True/False
In Grave's disease, the autoantibody, sometimes called LATS or TSA binds to the TSH receptor on the thyroid gland.

Back 15

True

Front 16

True/False
Type 3 immune damage is the more common mode of tissue injury for non-organ specific diseases such as SLE and Rheumatoid arthritis whereas, Type 1 immune damage is a common finding in organ specific autoimmune diseases such as Grave's disease, Hashimoto's thyroiditis, Addison's or Diabetes.

Back 16

False. Type 2 immune damage is a

Front 17

True/False
Catecholamines are derived from a single amino acid, tyrosine.

Back 17

True

Front 18

Autoimmune reactions may originate through all of the following mechanisms except:
a. Invading viruses produce changes in host tissue, which the body then recognizes as foreign.
b. Invading antigen is recognized as dissimilar and attacked as foreign
c. Invading antigen and host have antigen similarities and thus host tissue is recognized as foreign.
d. Mutant clones of T cells are programmed to recognize host cells as foreign.

Back 18

b. Invading antigen is recognized as dissimilar and attacked as foreign

Front 19

Mr. Iknoweverything is a 50 year old undergraduate who has been diagnosed with Lupus. Which of the following signs/symptoms would best be considered as part of the diagnostic criteria for LUPUS?
a. A positive Anti-nuclear Antibody test, symmetrical joint swelling, photosensitivity, subcutaneous nodules.
b. A positive Anti-nuclear Antibody test, anemia, photosensitivity, nephritis
c. Photosensitivity, oral ulcerations, pleuritis, a positive Anti-nuclear Antibody test, positive rheumatoid factor
d. Morning stiffness, pain on motion, photosensitivity, elevated uric acid concentrations

Back 19

b. A positive Anti-nuclear Antibody test, anemia, photosensitivity, nephritis

Front 20

Which of the following statements is/are TRUE in Myasthenia Gravis?
a. There is a close relationship with the thyroid gland.
b. There is a production of autoantibodies against muscle acetylcholine receptors
c. Some destruction of the acetylcholine receptor may occur via the activation of complement as a result of antibodies binding at sites near the acetylcholine receptor.
d. Symptoms of myasthenia gravis could be aggravated in pregnancy.
e. Only b, c and d are true

Back 20

e. Only b, c and d are true

Front 21

Which of the following is a TRUE statement?
a. In Hashimoto's Thyroiditis TSH levels are elevated and the individual is hyperthyroid
b. Estrogens are thought to enhance the immune response
c. In chronic lymphocytic thyroiditis the patient develops a goiter and a hyperthyroid state
d. In Myasthenia Gravis there is a strong association with the thyroid gland

Back 21

b. Estrogens are thought to enhance the immune response

Front 22

The serial or simultaneous presence of which of the criteria listed below would best be considered diagnostic of SLE:
a. Photosensitivity, a positive ANA (anti-nuclear antibody) test, ulcers
b. A butterfly-like rash, pain on motion, morning stiffness of less than 30 minutes duration, ulcers
c. Photosensitivity, a positive rheumatoid factor, stomach ulcers, pleuritis
d. Photosensitivity, a butterfly-like rash, a positive ANA test, anemia, arthritis

Back 22

d. Photosensitivity, a butterfly-like rash, a positive ANA test, anemia, arthritis

Front 23

Which of the following signs/symptoms would be considered ABNORMAL in a patient?
a. A platelet count of 298,000/mm3
b. A urinary protein of 2.4 mg/24 hours
c. An ESR of 48 mm/hr
d. A BUN of 16 mg%

Back 23

c. An ESR of 48 mm/hr

Front 24

Which of the following would be the least likely mechanism for the breakdown of tolerance and resulting development of autoimmunity?
a. Invading viruses produce changes in host and render host as foreign
b. Invading antigen is recognized as dissimilar and is attacked as foreign
c. Epitopes on an exogenous antigen are similar to those expressed in host cells and thus host cells may be recognized as foreign (cross reactivity)
d. A dysfunction of T-cell suppressor function could lead to the development of unwanted antibodies

Back 24

b. Invading antigen is recognized as dissimilar and is attacked as foreign

Front 25

Which of the following is/are TRUE statement(s) with regard to autoimmunity?
a. The incidence of autoimmunity increases with age. One possible mechanism for this is the decrease in T cell suppressor cells that occurs with aging.
b. Injury could result in the release of previously sequestered antigens and the subsequent development of an autoimmune response.
c. One possible reason that women are more susceptible to autoimmune disorders is estrogens have been associated with depressing the immune response such that the immune system acts inappropriately and can destroy self antigens.
d. all of the above are true
e. only a and b are true

Back 25

e. only a and b are true

Front 26

The adrenal medulla is stimulated to secrete by:
a. a tropic hormone
b. acetylcholine
c. dopamine
d. cortisol
e. tyrosine

Back 26

a. a tropic hormone

Front 27

T/F?
Hormones secreted from the adrenal cortex have to bind to receptors on the surface of the target cells in order to mediate any physiological effect.

Back 27

False. do not have to bind

Front 28

The normal value for hemoglobin in an adult female is ______________.

Back 28

12-16 gm% or 120-160 g/l or 7-10 mmol/l

Front 29

Removal of the __________ gland has been used as a treatment for myasthenia gravis

Back 29

thymus

Front 30

The activity of tyrosine hydroxylase enzyme can be stimulated by (b) ___________ (a hormone),
and the autonomic nervous system, and (a) _________ is a hormone that can induce PMNT.

Back 30

a. ACTH (not cortisol)
b. cortisol

Front 31

Lupus would be characterized as a Type ____ mode of tissue injury (hypersensitivity).

Back 31

type III

Front 32

____________can induce tyrosine hydroxylase in the adrenal medulla.

Back 32

4. ACTH or SNS stimulation

Front 33

______________ can induce the side chain cleavage enzyme (CYP 11A1) in the adrenal cortex to convert cholesterol to pregnenolone.

Back 33

ACTH or ANG II

Front 34

LE cells are ______________, which contain LE bodies (antigen-antibody complexes) and are found in patients with Lupus.

Back 34

neutrophils (PMNs)

Front 35

The activity of PMNT (phenyethanolamine-N-methyl transferase) can be stimulated by _____________.

Back 35

cortisol or glucorticoids

Front 36

True/False
An example of a type of autoimmune state is the development of rheumatic heart disease when the immune system's response to the streptococci in rheumatic fever ends up destroying self tissue (valves of the heart).

Back 36

True

Front 37

True/False
One type of autoimmunity is when there is T-helper cell dysfunction.

Back 37

False. T-suppressor cell

Front 38

_____________ exhibits negative feedback on ACTH and CRH.

Back 38

cortisol

Front 39

The normal range for glucose is ______________.

Back 39

80-100 mg%

Front 40

The aspect of immunity that is altered in an autoimmune disease is _____________.

Back 40

self-tolerance

Front 41

In preacclampsia, there is a development of antibodies to the _____________.

Back 41

self

Front 42

True/False
Graves' disease is more common in women and is the most common autoimmune disease.

Back 42

False. Hashimoto's thyroiditis

Front 43

Which enzyme is responsible for converted NE to Epinephrine? ____________

Back 43

PNMT

Front 44

What is the rate-limiting step for the production of catecholamines? _________________

Back 44

Tyrosine hydroxylase

Front 45

Which enzyme is located in the Zona Glomerulosa and responsible for the conversion of corticosterone to aldosterone? ________________

Back 45

18-hydroxylase

Front 46

True/False
Denervation of the adrenal gland will significantly reduce the function of this entire endocrine gland.

Back 46

False. will not