Worksheetsderm finale
Total questions: 212
Worksheet time: 2hrs 8mins
what is xerosis characterized by
roughness, scaling
gain of flexibility
inflammation and/or fissures
pruritis
redness
what are risk factors for xerosis?
physical damage such as shaving or scrubbing
lack of natural skin oils
hyperthyroidism
cholinergic drugs
exposure to additional environmental elements and chemicals
when do we refer patients with xerosis and self-care is not effective?
if large areas are affected
if it is in any interiginous areas
if there are infection
if there is intense itching
if they are younger than 2
which is best in lesions without thickening of the skin
ointments
creams
lotions
do soap-free skin cleansers work the same way as emollients
yes
no
patient education for emollients
3-4 applications daily for most benefit
can be greasy and stain clothing
avoid wounds, infections, or lacerations
avoid eyes, mucous membranes, and acne prone areas
over-application can lead to tissue becoming too soft and wearing away
true or false: the atopic march theory explains the natural history of atopic manifestations. It is characterized by some antibody responses to immunoglobulin E and clinical symptoms that may appear in childhood, and continue for years or decades and often changing with age.
true
false
in what atopic dermatitis phase does a patient have "weepy lesions"
infantile (up to 2 years old)
childhood (2 years old to puberty)
adult
in what atopic dermatitis phase does a patient start to not have "weepy lesions" and they become more thickened?
infantile (up to 2 years old)
childhood (2 years old to puberty)
adult
in what atopic dermatitis phase do we start seeing thickened lesions and potentially chronic hand/foot lesions that may indicate a chronic course
infantile (up to 2 years old)
childhood (2 years old to puberty)
adult
two types of contact dermatitis
irritant
allergic
atopic
poison ivy is an example of what
atopic dermatitis
irritant contact dermatitis
allergic contact dermatitis
in _____ do we see a quicker reaction to exposure, often being only minutes to hours
allergic contact dermatitis
irritant contact dermatitis
atopic dermatitis
what type of dermatitis can we see anywhere
irritant dermatitis
allergic dermatitis
what is first line in atopic dermatitis?
emollients
topical corticosteroids
PDE-4 inhibitors
systemic corticosteroids
what is flare treatment for atopic dermatitis
topical or oral corticosteroids first, emollients second, then PDE-4 inhibitors or calcineurin inhibitors or dupixent
emollients first, PDE-4 inhibitors or calcineurin inhibitors or dupixent second, topical or oral corticosteroids last
PDE-4 inhibitors or calcineurin inhibitors or dupixent, topical or oral corticosteroids second, emollients last
emollients first, topical or oral corticosteroids second, then PDE-4 inhibitors or calcineurin inhibitors or dupixent
true or false: you can use topical benadryl for dermatitis
true
false
what is first line in contact dermatitis?
emollients
topical corticosteroids
PDE-4 inhibitors
systemic corticosteroids
what are the MOAs of corticosteroids
anti-inflammatory
immunosuppressive properties
antiproliferative actions to help decrease skin turnover
vasoconstrictive properties to help decrease histamine production and less immune fighters to that area
why do we taper steroids?
exogenous steroids can lead to negative feedback in the HPA axis causing a decrease in endogenous cortisol production over time
natural production of hormones decreases if abruptly stopped
not a big issue for topical corticosteroids because there's not enough systemic absorption UNLESS USING HIGH POTENCY TOPICAL CORTICOSTEROIDS
in derm, tapers are preferred to help reduce flares
safe for infants, children, longer duration, and interiginous areas
low potency
medium potency
high potency
ultra high potency
safe for short durations in infants and children; face, axillae, genitals ok in adults
low potency
medium potency
high potency
ultra high potency
may be used with close supervision in children for less than two weeks
low potency
medium potency
high potency
ultra high potency
no occlusion, maximum duration of 2-4 weeks. do not use in infants, children, on face, axillae, or groin
low potency
medium potency
high potency
ultra high potency
for palms, soles, scalp
higher potency steroids
medium potency steroid
low potency steroid
for arms, legs, abdomen
higher potency steroids
medium potency steroid
low potency steroid
for thinner skin like eyelids, face, anogenital region
higher potency steroids
medium potency steroid
low potency steroid
topical steroid side effects include
skin atrophy
acne-like lesions
striae
folliculitis (pore clogging)
periorbital dermatitis
systemic steroid side effects/counseling points include
take with food
insomnia
tapering if necessary
when we we use systemic corticosteroids in contact dermatitis
when the affected area is 5% BSA or more
when affected area is 10% BSA or more
when affected area is 20% BSA or more
when affected area is 35% BSA or more
which class of drugs has the black box warning: risk of serious infections, mortality, malignancy, major adverse cardiovascular events, and thrombosis (blood clots)
JAK inhibitors
interleukin antagonists
PDE-4 inhibitors
calcineurin inhibitors
adverse effects: conjunctivitis, herpes simplex virus flares
dupixent
eucrisa
tacrolimus
rinvoq
adverse effects: itching, hypersensitivity reactions
dupixent
eucrisa
tacrolimus
rinvoq
adverse effects: burning, stinging, and immunosuppression
dupixent
eucrisa
tacrolimus
rinvoq
which class of drugs has the black box warning: long term use has been linked to basal cell and squamous cell carcinomas as well as lymphomas
JAK inhibitors
interleukin antagonists
PDE-4 inhibitors
calcineurin inhibitors
IL4 and IL13 inhibitor via inhibition of the IL4aR subunit. decreases the release of proinflammatory cytokines. 600mg once and then 300mg every other week. can be used with or without topical corticosteroids
dupixent
eucrisa
tacrolimus
rinvoq
specifically blocks degradation of cAMP. suppresses production of pro-inflammatory cytokines. increases production of anti-inflammatory mediators.
dupixent
eucrisa
tacrolimus
rinvoq
inhibits calcineurin from initiating T cell activation and release of inflammatory mediators, thereby decreasing itching and inflammation
dupixent
eucrisa
tacrolimus
rinvoq
an alternative to long-term use of corticosteroids. no skin atrophy/striae or metabolic abnormalities. can be applied to the face and used on children older than 2. much more expensive than topical corticosteroids.
JAK inhibitors
interleukin antagonists
PDE-4 inhibitors
calcineurin inhibitors
exclusions for self-treatment of poison ivy
less than 2 years old
dermatitis present for more than 2 weeks
involvement of more than 20% BSA (need systemic corticosteroids)
swelling of eyes, eyelids shut, body, or extremities
failure of self-management after 7 days
true or false: breastfed infants do not have lower rates of diaper dermatitis compared to bottle-fed infants
true
false
diaper rash fungal infections are usually caused by
candida albicans
tinea capitis
tinea manum
candidal intertrigo
non-pharmacologic recommendations for diaper rash
keep patient dry
change diaper 6 or more times a day
disposable diaper decrease the rate of severe diaper dermatitis compared to cloth
make sure skin is dry before re-diapering
clean area with plain water or a bland soft cloth or wipe
first-line diaper rash treatment
(a)
when to refer for diaper rash treatment
after 7 days
after 30 days
if improvement is seen in 7 days can continue for another 3 days
after 14 days
contraindications for diaper rash self-treatment
secondary infections: bacterial, fungal, or viral
presence of rash outside diaper region
presence of broken skin: ulcers, blisters, peeling slin
oozing, blood, vesicles, or pus at lesion site
lesions present for more than 7 days
treatment goals for seborrheic dermatitis
reduce inflammation and epidermal turnover rate of scalp or affected skin
reduce malassezia levels
minimize or eliminate erythema and scaling
minimize itch
first line for seborrheic dermatitis
topical corticosteroids
medicated shampoos
salicylic acid and sulfur
for OTC medicated shampoos
daily for 1-2 weeks then 2-3 times a week for the next 4 weeks then apply once weekly
2 times a week for 4 weeks then apply once weekly
once weekly for 1-2 weeks then daily for 4 weeks
once weekly for 4 weeks and then 2 times a week
second line treatment for seborrheic dermatitis is topical corticosteroids. what is the requirements for said recommendation?
can be used to manage greater levels of inflammation
hydrocortisone ointment no more than BID
treat up to 7 days then need to be seen by a PCP
causes for rosacea
immune dysregulation
neurovascular dysregulation causing more blood flow to the skin
genetic predisposition
overgrowth of demodex (a parasite like organism)
overgrowth of malassezia (a parasite like organism)
rosacea triggers include
UV radiation
heat exposure
alcohol
spicy food
stress
what are the non-prescription therapies for rosacea
gentle cleansers
moisturizers
sunscreen
green tinted makeup
treatments for rosacea include
metronidazole
oxymetazoline
terbinafine
salicylic acid
brimonidine
reduces oxidative stress and has been proven to reduce redness and inflammation. often start with the lotion and then go to the gel but the gel is more irritating
metronidazole
oxymetazoline
azelaic acid
brimonidine
ivermectin
A1 agonist, causing vasoconstriction to decrease redness. can cause rebound redness so requires regular application to be effective
metronidazole
oxymetazoline
azelaic acid
brimonidine
ivermectin
suspect some antimicrobial activity. inhibits production of ROS which decreases redness and inflammation. typically used as an adjunct therapy 1-2 times a week
metronidazole
oxymetazoline
azelaic acid
brimonidine
ivermectin
decreases inflammation and redness. has antiparasitic effects.
metronidazole
oxymetazoline
azelaic acid
brimonidine
ivermectin
alpha adrenergic agonist to cause vasoconstriction. little rebound redness is seen with this medication
metronidazole
oxymetazoline
azelaic acid
brimonidine
ivermectin
which of these has a side effect of phototoxicity
sodium sulfacetamide sulfur
azelaic acid
metronidazole
oxymetazoline
what medications are recommended for severe rosacea
fluconazole
doxycycline
isotretinoin
minocycline
imiquimod
what treatment options can be used for warts
cryotherapy
salicylic acid
azelaic acid
imiquimod
cimetidine
activates immune cells through toll-like receptor 7. side effects include phototoxicity and influenza-like symptoms.
metronidazole
oxymetazoline
imiquimod
brimonidine
ivermectin
treatments for molluscum contagiosum
retinoids
imiquimod
cryotherapy
salicylic acid
melasma
must treat continuously or it will come back
due to hormonal changes
treatment is triple therapy fluocinolone, hydroquinone, and retinoid. or just hydroquinone or retinoids on their own
no treatment during pregnancy. best to wait until post partum to begin treatment.
vitiligo
immune mediated skin condition resulting in a loss of pigmentation
treatment includes high potency steroids (class II and III)
treatment include topical calcineurin inhibitors
treatment includes UVA or UVB exposure
treatment includes systemic corticosteroids
a (a) % improvement in PASI score means the therapy is effective
for psoriasis, a BSA of __% or more is mild, up to __% is moderate, and __ or more is severe
(a)
for mild to moderate psoriasis categorize treatment by order phototherapy, topical agents, and systemic agents in order
(a)
true or false: we do not use higher potency steroids first in psoriasis
false
true
in corticosteroid dosing for psoriasis
we can occlude with saran wrap to increase effects
can have them do TID instead of BID
potency can be increased by using an ointment versus a cream
location of plaques dictates the vehicle
vitamin D analogs
also first line therapy in psoriasis
calcipotriene is available in combination with betamethasone
use a thin layer BID for 8 weeks
can exacerbate psoriasis and can rarely cause hypercalcemia
what is third line for psoriasis treatmetn
topical retinoids such as tazarotene
coal tar
systemic corticosteroids
phototherapy
which third line treatment could we use in combination with phototherapy
coal tar
tazarotene
systemic corticosteroids
what systemic drugs can we use for psoriasis
otezla
acitretin
methotrexate
humira
cosentyx
what medication requires LFTs and CBCs done regularly and has many drug interactions. it is a treatment for psoriasis.
methotrexate
metronidazole
remicade
cimetidine
a topical retinoid that has an incredibly long half life, should avoid alcohol when taking, and has it's own REMS program? a treatment for psoriasis
otezla
acitretin
methotrexate
isotretinoin
metronidazole
treatment success is shown with a (a) % and above reduction in PASI score
adverse effects of methotrexate
GI toxicity - anorexia, nausea
liver toxicity - fibrosis and/or cirrhosis
neutropenia, thrombocytopenia, anemia
many drug interactions
psuedotumor cerebri
adverse effects of acitretin
hyperlipidemia
liver toxicity
bone/muscle pain
pseudotumor cerebri
eye irritation
adverse effects of otezla
GI upset in diarrhea and nausea
headache
weightloss
depression and suicidal behavior
dosing for otezla
daily titration from 10mg daily to 30mg BID
max dose is 60mg
enbrel (etanercept) is
TNF inhibitor
T-cell activation inhibitor
interleukin antagonist
PDE-4 inhibitor
remicade (infliximab) is
TNF inhibitor
T-cell activation inhibitor
interleukin antagonist
PDE-4 inhibitor
humira (adalimumab)
TNF inhibitor
T-cell activation inhibitor
interleukin antagonist
PDE-4 inhibitor
amevive (alefacept)
TNF inhibitor
T-cell activation inhibitor
interleukin antagonist
PDE-4 inhibitor
which drug do you have to get a CD4 count done for
enbrel (etanercept)
remicade (infliximab)
humira (adalimumab)
amevive (alefacept)
stelara (ustekinumab)
non-blanchable redness with warmth or hardness. no skin breakdown
stage I
stage II
stage III
stage IV
superficial lesion with partial thickness skin loss. looks like a popped blister.
stage I
stage II
stage III
stage IV
full thickness skin loss. can see fat within the wound
stage I
stage II
stage III
stage IV
extensive tissue necrosis and damage to muscle, tendon, joint, or bone
stage I
stage II
stage III
stage IV
which type of ulcer is due to obesity, heart failure, and anything causing fluid retention
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
which type of ulcer is associated with peripheral vascular disease (PVD). cholesterol buildup can prevent good blood flow
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
which type of ulcer is associated with peripheral vascular disease (PVD), neuropathy, trauma, and most commonly diabetes
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
because of the large fluid buildup, these have lots of exudate. not quick to heal
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
a dry wound with little to no exudate. quite painful
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
maintain a moist wound environment - moderately wet or moderately dry
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
you can promote healing of _____ by modification of risk factors for PVD including smoking cessation and treating hyperlipidemia by putting patient on a statin.
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
most common chronic wound. treatment is minimal - rotating patients positions and use of dressings
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
we would use dressings that absorb fluid for ____
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
we would use dressings that maintain wet or dry environment for ____
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
we would use dressings that hydrate for ____
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
which of these REQUIRES a secondary dressing
calcium alginates
hydrogel sheets
amorphous hydrogels
hydrocolloids
foams
which of these CAN ACT AS a secondary dressing
calcium alginates
hydrogel sheets
amorphous hydrogels
hydrocolloids
transparent films
may over-dry the wound
calcium alginates
hydrogel sheets
amorphous hydrogels
hydrocolloids
transparent films
non-transparent so cannot visualize the wound
calcium alginates
hydrogel sheets
amorphous hydrogels
hydrocolloids
foams
which of these should you use a transparent film as a secondary dressing
calcium alginates
hydrogel sheets
amorphous hydrogels
hydrocolloids
foams
which of these provides cushioning
calcium alginates
hydrogel sheets
amorphous hydrogels
hydrocolloids
foams
which of these melts into the wound
calcium alginates
hydrogel sheets
amorphous hydrogels
hydrocolloids
foams
which of these can you go 3-4 days without changing (good for adherence)
calcium alginates
hydrogel sheets
amorphous hydrogels
hydrocolloids
foams
which of these can facilitate autolytic debridement
calcium alginates
transparent films
amorphous hydrogels
hydrocolloids
foams
which of these is ointment-like and is usually in a tube. it does not adhere to wounds and is the best agent for getting moisture into the wound
calcium alginates
transparent films
amorphous hydrogels
hydrogel sheets
foams
which of these is especially useful for burns as it has a cooling effect
calcium alginates
transparent films
amorphous hydrogels
hydrogel sheets
foams
which of these are difficult to position at some anatomical sites
calcium alginates
transparent films
amorphous hydrogels
hydrogel sheets
foams
risk factor medications for chronic wounds
sedative/hypnotics
antihistamines
diuretics
beta blockers
corticosteroids
risk factors for chronic wounds
excessive pressure can lead to immobility
immunodeficiency and infection
poor circulation and poor nutrition
age
obesity
regranex gel is used for ____
venous stasis ulcer
aterial ulcer
pressure ulcer
neuropathic ulcer
when to refer a patient to an outpatient clinic
2 degree burn on <2% of BSA and not on the hands, feet, face, genitalia, perineum, or major joints
2 or 3 degree burns on <10% BSA and not on the hands, feet, face, genitalia, perineum, or major joints
1 degree burns on <2% BSA
electrical and chemical burns
those with preexisting medical or mental disorders that would prohibit or prolong treatment
when to refer a patient to a community hospital
2 degree burn on <2% of BSA and not on the hands, feet, face, genitalia, perineum, or major joints
2 or 3 degree burns on <10% BSA and not on the hands, feet, face, genitalia, perineum, or major joints
1 degree burns on <2% BSA
electrical and chemical burns
those with preexisting medical or mental disorders that would prohibit or prolong treatment
when to refer self-treatment
2 degree burn on <2% of BSA and not on the hands, feet, face, genitalia, perineum, or major joints
2 or 3 degree burns on <10% BSA and not on the hands, feet, face, genitalia, perineum, or major joints
1 degree burns on <2% BSA
electrical and chemical burns
those with preexisting medical or mental disorders that would prohibit or prolong treatment
when to refer to a burn center
TBSA burned is >10%
2 or 3 degree burns on <10% BSA but on the hands, feet, face, genitalia, perineum, or major joints
electrical and chemical burns
those with preexisting medical or mental disorders that would prohibit or prolong treatment
inhalation injury or any burn associated with accompanying trauma such as fractures
what stage of frostbite is this: numb, central white plaque with edema
stage I
stage II
stage III
stage IV
what stage of frostbite is this: blisters form with edema and erythema
stage I
stage II
stage III
stage IV
what stage of frostbite is this: hemorrhage blisters turn into eschar in 14 days
stage I
stage II
stage III
stage IV
what stage of frostbite is this: complete necrosis and tissue loss
stage I
stage II
stage III
stage IV
get absorbed into the skin where they absorb the radiation
sunscreen
sunblock
chemical sunscreen
physical sunscreen
stay on top of the skin and reflect UV radiation
sunscreen
sunblock
chemical sunscreen
physical sunscreen
first line: OTC topical such as terbinafine, miconazole, or clotrimazole. second line: RX topicals such as ketoconazole and econazole. in resistant cases, systemic antifungals such as fluconazole or terbinafine can be used
tinea corpis
tinea capitis
onychomycosis
candida intertrigo
candida albicans (diaper rash)
first line: systemic oral agents such as terbinafine or griseofulvin then use topical OTC selenium sulfide or RX ketoconazole to help decrease transmission
tinea corpis
tinea capitis
onychomycosis
candida intertrigo
candida albicans (diaper rash)
first line: topicals do not work well (take up to 48 weeks) but include ciclopirox and efinaconazole and should be used in conjunction with systemic terbinafine
tinea corpis
tinea capitis
onychomycosis
candida intertrigo
candida albicans (diaper rash)
the two types of candida skin infection are
(a)
true or false: the most common cause of skin and nail fungal infections is trichophyton rubrum
true
false
general spectrum of action for mupirocin
gram positive and gram negative
gram positive only
gram negative only
general spectrum of action for bacitracin
gram positive and gram negative
gram positive only
gram negative only
general spectrum of action for retapamulin
gram positive and gram negative
gram positive only
gram negative only
what are the major roles of steroids in humans
main component of membranes
hormones
bile acids
vitamin D3 precursor
what is the simplest steroid
(a)
what is the common precursor to steroids
(a)
cortisol; functions include immunosuppression
glucocorticoids
mineralocorticoids
progestogens
androgens
estrogens
aldosterone; helps regulate blood pressure through water and electrolyte balance
glucocorticoids
mineralocorticoids
progestogens
androgens
estrogens
progesterone; regulates cyclical changes in the endometrium of the uterus and maintains a pregnancy
glucocorticoids
mineralocorticoids
progestogens
androgens
estrogens
testosterone; contributes to the development and maintenance of male secondary sex characteristics
glucocorticoids
mineralocorticoids
progestogens
androgens
estrogens
estradiol; contributes to the development and maintenance of female secondary sex characteristics
glucocorticoids
mineralocorticoids
progestogens
androgens
estrogens
neurosteroids
DHEA and allopregnanolone
pancuronium bromide
cholecalciferol
ergocalciferol
calcitriol
aminosteroid neuromuscular blocking agent
DHEA and allopregnanolone
pancuronium bromide
cholecalciferol
ergocalciferol
calcitriol
secosteroid
DHEA and allopregnanolone
pancuronium bromide
cholecalciferol
ergocalciferol
calcitriol
cholesterol
testosterone
progesterone
corticosterone
11-desoxycorticosterone
what is an example of a common drug that is an anti-mineralocorticoid and how does it work?
MCRA is an anti-mineralocorticoid. it is a diuretic drug which antagonizes the action of aldosterone at mineralocorticoid receptors.
spironolactone is an antimineralocorticoid (steroidal spironolactone)
finerenone is a non-steroidal antimineralocorticoid
transactivation vs transrepression
transactivation – homodimerization of the receptor, translocation of the receptor into the nucleus, and binding to specific DNA elements activating gene transcription.
transrepression – homodimerization of the receptor, translocation of the receptor into the nucleus, and binding to specific DNA elements activating gene transcription.
transrepression – when GRs are not activated, other transcription factors can transactivate the target genes. however, activated GRs can complex with these other factors and prevent them from binding their target genes and repress the expression.
transactivation – when GRs are not activated, other transcription factors can transactivate the target genes. however, activated GRs can complex with these other factors and prevent them from binding their target genes and repress the expression.
When you add something to a mineralocorticoid receptor what happens?
aldosterone fufills its major physiological function of maintaining sodium and potassium balance and blood pressure control
potassium secretion and sodium reabsorption increase
the regulation of gene transcription for development, metabolism, and immune response
When you add a steroid to a glucocorticoid receptor what happens?
aldosterone fufills its major physiological function of maintaining sodium and potassium balance and blood pressure control
potassium secretion and sodium reabsorption increase
the regulation of gene transcription for development, metabolism, and immune response
how is aldosterone produced and what does it do?
produced by the zona glomerulosa of the adrenal cortex in the adrenal gland
produced by your mom
conserves sodium
regulates BP and potassium levels
In common prescription terms what steroid is cortisol most commonly known as?
(a)
how does cortisol weaken the immune system
increases blood sugar through gluconeogenesis to suppress the immune system.
prevents proliferation of T-cells by making the interleukin 2-producer T-cells unresponsive to interleukin I.
chronic elevations can lead to the immune system becoming “resistant,” an accumulation of stress hormones, and increased production of inflammatory cytokines that further compromise the immune response
unable to produce the T-cell growth factor IL-2.
HMG-CoA reductase turns HMG-CoA into ___
mevalonate
squalene
isopentenyl diphosphate
farnesyl diphosophate
lanesterol
through a series of ATP kinases, mevalonate becomes ____
mevalonate
squalene
isopentenyl diphosphate
farnesyl diphosophate
lanesterol
through a series of steps, IPP becomes ____
mevalonate
squalene
isopentenyl diphosphate
farnesyl diphosophate
lanesterol
farnesyl diphosphate becomes ____
mevalonate
squalene
isopentenyl diphosphate
farnesyl diphosophate
lanesterol
denaturation of squalene epoxide gives ____
mevalonate
squalene
isopentenyl diphosphate
farnesyl diphosophate
lanesterol
through a series of steps, what is the precursor to cholesterol?
mevalonate
squalene
isopentenyl diphosphate
farnesyl diphosophate
lanesterol
cholesterol and NADPH becomes _____
7-dehydrocholesterol
chenocholic acid
vitamin D3
trioxo-cholanic acid
after cholesterol becomes 7-dehydrocholesterol, what is the next step in the synthesis of vitamin D3?
UV light
heat
vitamin D3
NADPH
what is the last step in the synthesis of vitamin D3 from cholesterol?
UV light
heat
H2O
NADPH
what is the first step in the conversion of cholesterol to bile acids
oxidation of the side chain from C27 becomes COOH at C24
inversion of 3b-OH to 3a-OH
reduction of a double bond to 5b-H
hydroxylation on C7 and C12 become 7a-OH and 12a-OH
further oxidation of 7a-OH and 12a-OH become ketones
which of these steps in the conversion of cholesterol to bile acids is incorrect
oxidation of the side chain from C27 becomes COOH at C24
inversion of 3a-OH to 3b-OH
reduction of a double bond to 5b-H
hydroxylation on C7 and C12 become 7a-OH and 12a-OH
further oxidation of 7a-OH and 12a-OH become ketones
at which carbon(s) does hydroxylation occur in conversion of cholesterol to bile acids
C7
C12
C19
C3
what is the rate limiting enzyme of cholesterol synthesis
HMG-CoA reductase
HMG-CoA synthase
squalene epoxidase
oxidosqualene lanesterol cyclase
17C
gonane
estrane
androstane
pregnane
cholestane
19C
gonane
estrane
androstane
pregnane
cholestane
18C
gonane
estrane
androstane
pregnane
cholestane
21C
gonane
estrane
androstane
pregnane
cholestane
27C
gonane
estrane
androstane
pregnane
cholestane
the junctions between B and C
are always transfused
are normally transfused and can be cisfused
can be cisfused or transfused
are always cisfused
the junctions between C an D
are always transfused
are normally transfused and can be cisfused
can be cisfused or transfused
are always cisfused
the junctions between A and B
are always transfused
are normally transfused and can be cisfused
can be cisfused or transfused
are always cisfused
what means below the plane
alpha
beta
what means above the plane
alpha
beta
disruption of enterohepatic circulation of bile acids will lower cholesterol
hyperlipidemia
cholestasis
gallstones
bile acid diarrhea
structural or functional abnormalities of the biliary system results in an increase in bilirubin (jaundice) and a decrease in bile acids in the blood.
hyperlipidemia
cholestasis
gallstones
bile acid diarrhea
normally treated with ursodeoxycholic acid
hyperlipidemia
cholestasis
gallstones
bile acid diarrhea
may result from increased saturation of cholesterol or bilirubin or from bile stasis
hyperlipidemia
cholestasis
gallstones
bile acid diarrhea
excessive concentration of bile acids in colon cause chronic ___ which is seen in ulcerative colitis and chron's disease
hyperlipidemia
cholestasis
gallstones
bile acid diarrhea
nuclear receptor proteins are transcription factors able to regulate the expression of genes controlling numerous processes including
reproduction
development
metabolism
bile acid synthesis
mediate biological effects of retinoids by their involvement in retinoic acid gene activation
RXR
LXR
FXR
PPARs
important regulators of cholesterol, fatty acids, glucose homeostasis
RXR
LXR
FXR
PPARs
expressed at increased levels in the lliver and intestines
RXR
LXR
FXR
PPARs
cholesterol lowering fibrates bind to and regulate PPARy
RXR
LXR
FXR
PPARs
in the inactive state, receptors for steroids reside in the ____ and then translocate to the ____ after ligand binding
cytoplasm, nucleus
nucleus, cytoplasm
true or false: some LXRs and FXRs don't reside in the cytoplasm when inactivated and instead actually reside in the nucleus. they are activated by changes in concentration of hydrophobic lipid molecules
false
true
adrenal steroids are synthesized by the (a) backbone
adrenal steroids are derived from the
adrenal glands in the kidneys
the zona reticularis layer
the adrenal cortex
the hypothalamus
the anterior pituitary
adrenocorticoids are regulated by
ACTH
CRH
cortisol
what stimulates corticosteroid synthesis
ACTH
CRH
angiotensin II
angiotensin I
the ____ secretes CRH which then signals the ____ to release ACTH. this then signals the _____ to produce cortisol
hypothalamus, anterior pituitary, adrenal cortex
adrenal cortex, hypothalamus, anterior pituitary
adrenal cortex, anterior pituitary, hypothalamus
hypothalamus, adrenal cortex, anterior pituitary
the hypothalamus secretes ____ which signals the anterior pituitary to secrete ____ when signals the adrenal cortex to produce ____
CRH, ACTH, cortisol
cortisol, CRH, ACTH
CRH, cortisol, ACTH
ACTH, CRH, cortisol
cortisol is predominantly a _____ but possesses modest _____ activity
glucocorticoid, mineralocorticoid
mineralocorticoid, glucocorticoid
when is cortisol released
in stress
in low blood glucose concentration
in high blood glucose concentration
when sodium is low
which of these is a GR agonist
dexamethasone
ketoconazole
nifepristone
which of these is a GR antagonist
dexamethasone
ketoconazole
nifepristone
which of these are functions of cortisol
increase blood sugar by stimulating gluconeogenesis
suppression of the immune system
metabolism of fat, protein, and carbs
increase in bone formation
allows for release of substances in the body the causes inflammation
what are some of cortisol's other functions
treats conditions resulting from overactivity of B-cell mediated antibody reponse
can weaken activity of immune system by prevention of proliferation of T-cells
has negative feedback effect on interleukin I
in early fasting, cortisol stimulates
gluconeogenesis
anti-inflammatory pathway activation
glycogenesis
proteolysis and muscle wasting
in late fasting, cortisol stimulates
gluconeogenesis
anti-inflammatory pathway activation
glycogenesis
proteolysis and muscle wasting
prolonged elevated cortisol stimulates
gluconeogenesis
anti-inflammatory pathway activation
glycogenesis
proteolysis and muscle wasting
what do mineralocorticoid receptors do
they are ligand-activated transcription factors
bind to hormone-responsive elements and activate transcription of discrete sets of genes in target tissues
expressed in epithelial tissues involved in electrolyte transport
cortisol causes ____ and ____ retention in the kidney
salt
water
potassium
cortisol
androgens
DHEA
DHEA sulfate
androstedione
aldosterone
cortisol
neurosteroids
DHEA
DHEA sulfate
androstedione
aldosterone
cortisol
