1 Quiz 07 Results Name Quiz 07a Attempt Score 1.33121 Attempts 157 (Total of 157 attempts for this assessment) Question 1: Multiple Choice Average Score 0.46815 points Which one of the following stimulates both insulin and glucagon secretion? Correct Percent Answered hyperglycemia 1.911% somatostatin 1.911% cortisol 1.911% hypoglycemia 0.637% a high protein meal 93.631% Unanswered 0% Question 2: Multiple Choice Average Score 0.42675 points Which one of the following statements is true? Correct Percent Answered Because it strongly stimulates glycogen synthesis in the liver, cortisol lowers plasma glucose. 4.459% One would expect insulin secretion to be high during prolonged fasting. 3.185% Plasma concentrations of keto acids would be low in a person with anorexia nervosa. 7.006% A patient with central (= neurogenic) diabetes insipidus would likely have decreased ACTH release compared to a healthy person. 85.35% Unanswered 0% Question 3: Multiple Choice Average Score 0.43631 points A woman suffers from hyperglycemia, abdominal obesity, and skeletal muscle wasting. Lab tests reveal high circulating levels of ACTH. Which one of the following is the most likely cause of her symptoms? Correct Percent Answered a hormone-secreting tumor of the adrenal medulla 1.274% long-term treatment with exogenous glucocorticoids 3.185% hypercortisolism due to an adrenal tumor that oversecretes cortisol 4.459% hypocortisolism due to autoimmune destruction of the adrenal cortex 3.822% hypercortisolism due to an ACTH-secreting tumor of the anterior pituitary 87.261% Unanswered 0%2 Question 4: Essay A resting, unstressed person has elevated plasma levels of free fatty acids, glycerol, amino acids, and ketones. Give two possible explanations for these findings, and describe what further lab tests might be used to distinguish between these two conditions. Given Answers Explanation 1: Diabetes Mellitus I. Elevated free fatty acids, amino acids, glycerol all come from increased catabolism probobly indicative of gluconeogenesis. Check glycated hemoglobin (a1c), which would indicate the average blood sugar level for the past 2-3 months bymeasuring the percentage of blood sugar attached to hemoglobin, and perform a blood sugar test during a fasting period. Explanation 2: Anorexia Nervosa. It would cause a catabolic breakdown and certainly an increase in ketones. Check cortisol to confirm. Two possible conditions are starvation and untreated diabetes mellitus. During starvation, plasma glucose levels drop and stimulate glucagon to generate new forms of energy such as ketogenesis (which explains the elevated ketone levels) as a fuel source for the brain. Additionally, well cells are deprived of glucose they switch to fatty acid and/or amino acid metabolism as an energy source so the demonstrated high levels of free fatty acids and amino acids are a result of triglyceride and protein catabolism. In untreated type 1 diabetes, nutrients cannot be absorbed and the glucose remains the blood because the individual is insulin defecient so there is not stimulus to intiate glucose metabolism. Therefore, the body turns to protein ad fat metabolism which explain the high levels of FFA, amino acids and ketones. The liver also metabolizes glucose bc it is unaware of its presence through gluconeogenesis and glycogenolysis which produce additional glucose, amino acids and glycerol. Lab tests to distinguish the two conditions could be a blood test for insulin and glucose, a person with diabetes will be nearly insulin deficient but have elevated plasma glucose. One possible explanation may be that the person has ketosis, which is a condition in which the individual receives most of their bodies energy supply from ketones in the blood rather than glucose. Another explanation may be that the individual is a trained athlete who eats plenty of protein, resulting in high metabolism with elevated levels of free fatty acids, glycerol, and amino acids. Besides a blood test, a urine test could be done to distinguish between these two conditions since ketosis should also result in ketones found in the urine. One possible explanation for these findings would be that the individual is diabetic. Due to issues with the insulin receptors, cells are unable to uptake glucose, causing lipolysis and protein breakdown to be stimulated, leading to higher levels of free fatty acids, glycerol, amino acids, and ketones. Another explanation would be that the individual is a trained athlete. At rest, trained atheletes have a lower RER than normal individuals. The lower the RER, the less the body relies on carbohydrate metabolism and the more it relies on fat metabolism. Since these trained athletes rely more heavily on fat metabolism, plasma levels of free fatty acids, glycerol, amino acids, and ketons would be elevated. In order to distinguish between these two conditions, an oral glucose tolerance test could be conducted. Trained athletes would show a decrease in plasma glucose two hours into the OGTT, while the diabeteic patients would show elevated levels of plasma glucose. The patient is either fasting/starving or has diabetes melitus. In both conditions the body starts to break down aidpose tissue for energy instead of carbohydrates, catablalizezing the fat to glycerol and fatty acids. The excess ketones and amino acids in the blood is due to the inefficient filtering of the kidneys, due to the high levels of ketones in the blood, which are porcessed when fats are used for energy. A simple oral glucose tolerance test, where the patient ingests glucose and then whose glucose levels are checked hours later to detrmine if their body repsonsd to it corectly.3 Two possible explanations of this occurence is decrease in plasma glucose (fasting state), and when someone has prologned hypoglycemia this can cause an increase in ketones, etc. The other explanation is Diabetes Mellitus Type 1 and Typ2. A person with diabetes doesn't have the ability for their cells to take in glucose, essentially causing the cells to starve. This causes an increase in all of the above mentioned because the body is trying to compensate. Some further lab tests that could be useful for determining the difference between the two is observe the activity of insulin. A person at rest that is "fasting" can have all of these things elevated in the plasma but still have funtioning insulin. A person with