CBL Group N - Goodbye GI/GU/Endo, Hello Summer!

Dr. Joan of Arc is eating apples while reading her students’ weekly questions. However, after reading this weeks’ questions, she becomes incredibly stressed and considers moving states, but she passes out instead. She has fruity breath and is taking long, deep breaths. Which of the following are expected to be elevated?

(select all that apply)

• Adipose triglyceride lipase activity

• Anion gap

• Acetyl CoA Carboxylase activity

• Ketone bodies

• pH

Dr. Joan of Arc presents to the clinic due to concerns of not being able to stop eating after sustaining a major head injury. Dr. Justmovingstatesbutwestill Appreciateyou explains to the patient that the receptor that normally controls her hunger/satiety levels may have been damaged. What is the substance that is most likely being referenced, and what are the corresponding production and target organs? (Format: substance; source; target)

• Insulin; beta cells; mainly liver, muscle, adipose

• Glucagon; alpha cells; mainly liver

• Growth hormone; pituitary; liver

• Leptin; adipose cells; hypothalamus

• Thyroxine; thyroid; most tissues

A few days after dressing as a vampire for Halloween, 25 y/o Jeronimo Fang makes an appointment to see his PCP, Dr. Aaaahhhhpel. Jeronimo has a history of DM1 and takes his insulin most days. He is concerned about a tender bump with a white peak on his neck along his hairline. Which of the following is the most appropriate course of treatment?

• Warm water soaks and f/u in 3 months

• Amoxicillin clavulanate

• Terbinafine

• I&D followed by vancomycin

• Erythromycin and advise to improve local hygiene

Dr. ApplesAndBananas is conducting a study on prevention of diabetic foot ulcers. Which of the following does not contribute to the formation of ulcers?

• Retinopathy

• Glycosylation of amyloid

• Thickened blood vessel basement membranes

• Glycosylated keratin

• Sensory and motor neuropathies

Which of following statement(s) is/are true?

(More than one may apply)

• The age of onset decreases when there are affected relatives in two previous generations

• Affected individuals almost always have an affected parent.

• An individual's risk is not altered by the number of affected first-degree relatives.

• The differential risk to relatives of an affected proband increases as the disease prevalence decreases.

• Dr. Appel, you are awesome! We will miss you, and we hope you will keep in touch with us from time to time.

The average recurrence risk for a couple that has had a child with cleft lip, a multifactorial birth defect, is approximately 4%. What is the recurrence risk if the couple has two affected children?

• 2%

• 4%

• 10%

• 25%

• 50%

Which of the following are correct characteristics of Type 1 Diabetes Mellitus?

(select all that apply)

• Amyloid deposition in pancreatic islets

• Associated with HLA-DR3 and HLA-DR4

• Onset typically before the age of 20

• Ketoacidosis is common

• Insulitis is a late-stage complication

1. Dr. Jomama AppelachianMts. is teaching her CBL group about diabetic pathology, specifically amyloidosis. Everyone else gets it, but a certain lactose intolerant ADULT with an RA just doesn’t seem to understand. The student is still confused even after explaining to him that “it’s byesic soyence innit loike whot’s naught clicken bruv”? Anyways, which of the following regarding amyloidosis are INCORRECT?

(select all that apply)

• IAPP is the major constituent of islet amyloid

• Amylin is synthesized by islet α cells and is co-secreted with glucagon

• Amyloid deposition leads to α cell dysfunction/apoptosis and β cell hyperplasia/hyperfunction

• Amyloidosis is more common in Type 2 diabetics as opposed to Type 1 diabetics

Medical students Lying "Ginger" Raisin, Arising Frond, Mensess Whachugondo, and Nicklekilla Gang"banging"sonny forgot about leptin so the night before Step 1 they email Dr. Jomamma "Sippin' on Some Sizzurp" Lapel. To honor Dr. Lapel, they did well to learn that leptin acts on the ventromedial area of hypothalamus (satiety center) to decrease appetite. But after rotations, they forgot other details about how leptin works. She replies (select 2 correct answers):

• Leptin reduces obesity in most, but not all individuals with obesity

• People with obesity have higher levels of leptin (from adipose), but also appear resistant to leptin

• Sleep deprivation and starvation increase leptin levels

• Leptin promotes satiety, and it is anorexigenic

• Leptin promotes glycogenolysis, gluconeogenesis, lipolysis, FBPase-2 activity, and can be used to treat beta-blocker toxicity

Medical students Porttea Sugarbarra, CRIPSteen Slang, Barry "Yezzir" Gong, and Brains "Out of this world" Fallon are working through a case. The patient has high C peptide levels but does not take any medicines like sulfonylureas or meglitinides that would increase C peptide levels. They conclude (select two correct answers):

• that this individual will have much lower native C peptide levels in the future

• that obesity is associated with increased expression of GLUT 4

• that they are likely HLA-DR4, -DR3, and glutamic acid decarboxylase Ab positive

• that NALFD can worsen the this disease process

• that this patient is at risk for diabetic coma