Flipped Classroom Activity

PHYSIOLOGY (4th Shifting) | Brodit, Banal, Solidum, Razon | 11 March 2019 (Pilot)

OUTLINE
I. Final Questions (18)
A. Synthesis and Release 12.What is the major substrate found in the 1,5’
B. Regulation deiodinase?
C. Mechanism of Action
D. Transport and Metabolism
E. Physiologic Effects
E. Physiologic Effects
F. Clinical correlation 13. As a result of increased metabolic activity with the
II. Combined Group’s Questions presence of thyroid hormones, the peripheral
A. Thyroid Gland vascular resistance will?
B. Calcium and Phosphate Homeostasis 14. What is the direct effect of the parathyroid hormone
III. Answers for the Final Questions Only on intestinal absorption of calcium?
15. What is the adrenal hormone that inhibits bone
I. FINAL QUESTIONS
(Questions are arranged (Easy, Moderate and Difficult) formation?

A. Synthesis and Release F. Clinical Correlation

1. The precursor of vitamin D found in the skin?
2. Iodide trapping involves what kind of membrane
transport?
3. What is the necessary electron acceptor in the
oxidation of iodide to iodine?
B. Regulation
4. When the plasma calcium level is high, a low amount
of 1,25-diydroxycholecalciferol is produced. What is
the relatively inactive metabolite produced by the
kidneys instead?
5. Active Vitamin D synthesis is increased by the
deficiency of what ion?
6. The mechanism by increased β-adrenergic activity
stimulates the thyroid hormone. What is the
mechanism by which there is an increased β-
adrenergic activity that will stimulate thyroid uptake?
Simplified into: What thyroid hormone activity
stimulates increased β-adrenergic activity?
C. Mechanism of Action
7. What is the more potent form of thyroid hormone?
8. What secondary messenger mechanism is responsible
for the action of PTH?
9. An increase in UCP as an effect of thyroid hormone
results in what type of thermogenesis?
D. Transport and Metabolism
10. 10-15% of T4 or T3 is bound to another specific
thyroid binding protein. This is called?
11. The inactive form of vitamin D synthesized in the
kidney is due to an increased activity of which
enzyme?
16. A condition characterized by accumulation of excess
unmineralized osteoid due to Vitamin D deficiency in
ADULT is?
17. Myxedema in patient with hypothyroidism is due to
the skin deposition of ____ and ____?
18. Due to the effect of the parathyroid hormone in the
renal tubules, hyperparathyroidism results in what
type of acid base disorder?
II. COMBINED QUESTIONS
A. THYROID GLAND
A. Synthesis and Release
19. In Iodide trapping, what is the most important transporter
that provides the gradient to actively pump iodide in the
cell interior? -Na+/K+ ATPase
20. What protein does thyroxine mainly adhere for systemic
transport? -Thyroxine binding globulin
21. Iodide is transported out of the cell across the apical
membrane -Chloride-iodine counter transporter
22. What is the necessary electron acceptor in the oxidation
of iodide to iodine? -Hydrogen peroxide
23. When thyroglobulin enters the cell via endocytosis, what
do you call the protein that is bound by thyroglobulin in
order to be taken up by the cell and released into the
capillaries? -Megalin
24. Ave: Na-iodide symporter is the transporter for iodide to
be transported to the cell. How many sodium ions per 127
iodide ions entering across the basal membrane? -254 Na
ions (1:2)
25. Diff: In the storage of thyroid hormones, give the ratio of
thyroglobulin: thyroxine? -1:30
26. Iodide is taken up into thyroid cells by _________ in the
basolateral plasma membrane. -NIS

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27. Most conversion of T4 to T3 by ___________ occurs in
tissues with high blood flow and rapid exchange with
plasma, such as the liver and kidneys. -D1
B. Regulation
28. What gland monitors the circulating level of the thyroid
hormones and increases and decreases the amount of TSH
in order to control the amount of thyroid hormone
synthesized and secreted by the thyroid gland - Pituitary
gland
29. TSH stimulates the entry of glucose into this pathway to
generate a reduced cofactor needed for the oxidation of
iodine. Determine the pathway -HMP pathway
30. TRH effects on TSH output is through this 2nd messenger
pathway? -PLC
31. What is the pathway for the stimulation of TSH by TRH? -
PLC/IP3 pathway
32. TSH also stimulates entry of glucose into the hexose
monophosphate shunt pathway, which generates _______
needed for the peroxidase reaction -Reduced NADPH
33. Autoregulatory phenomenon seen as a decrease in the
transport and iodination activity after reaching a maximal
point in both activities in the thyroid gland -Wolff -Chaikoff
effect
34. Easy: Most acute effect of TSH. -Increase in proteolysis of
thyroglobulin
35. Ave: TRH enables high TSH output by activating which
secondary messenger system? -Phospholipase secondary
messenger system
36. Diff: Sustained regulation of this leads to the long-term
effects of hypertrophy and hyperplasia of follicular cells. -
TSH
37. TSH also stimulates entry of glucose into the hexose
monophosphate shunt pathway, which generates
______________ needed for the peroxidase reaction. -
Reduced NADPH
38. The most important regulator of thyroid gland function
and growth is the hypothalamic-pituitary _________. -
Thyroid releasing hormone–thyroid stimulating hormone
axis
C. Mechanism of Action
39. This processed forms the MIT and DIT from tyrosine and
iodine -Coupling
40. The thyroid hormone receptor forms what type of dimer
with retinoid x receptor -Heterodimer
41. Through alternative splicing, different thyroid hormone
receptors are produced. They bind to DNA as monomer,
homodimers and heterodimers with retinoid x receptor.
Among these thyroid hormone receptors, which does not
bind to T3? -TRa2
42. MIT and DIT molecules, which also are released during
proteolysis of thyroglobulin, are rapidly de-iodinated
within the follicular cell by the enzyme __ -Iodotyrosine
deiodinase
43. What is the necessary step/process for T4 as it gets
transported to target tissues? -Deiodination to T3
PHYSIOLOGY Flipped Classroom Activity (Pilot)
44. Coupling occurs between iodinated Tyrosine that remain
part of the primary structure of thyroglobulin. This entire
sequence of reactions is catalyzed by _____ -Thyroid
peroxidase (TPO)
45. Easy: Propylthiouracil is used to treat hyperthyroidism. It
prevents the further production of thyroid hormone by
blocking which enzyme? -Thyroid peroxidase
46. Ave: Which thyroid hormone mimics the effects
epinephrine, norepinephrine, glucagon, and cortisol. -T3
47. Diff: This is a human thyroid hormone receptor gene
located in chromosome 3 that encode the nuclear thyroid
hormone receptor. -THRB
48. MIT and DIT molecules, which also are released during
proteolysis of thyroglobulin, are rapidly de-iodinated
within the follicular cell by the enzyme _________. -
Iodotyrosine deiodinase
49. Coupling occurs between iodinated tyrosine that remain
part of the primary structure of thyroglobulin. This entire
sequence of reactions is catalyzed by? -Thyroid peroxidase
(TPO)
D. Transport and Metabolism
50. For many years, it was thought that thyroid hormone
diffuses passively across cell membranes, but this now
known to require transport proteins. Identify the specific
transporter of T4 across the blood brain barrier? -OATPC1
51. If endocytosis is used for some thyroglobulin to enter the
cell, what is this protein significant for the step? -Megalin
52. 3. Which glial cells is responsible for producing the supply
of T3 in neurons in the brain by the presence of deiodinase
2 -Astroglia
53. True or false, T3 binds strongly to intracellular proteins
than T4 after being transported into cells. -False
54. What is the reason for the slow release of T4 to tissues? -
High affinity to thyroxine-binding proteins
55. Easy: What is the main cause why thyroxine is released
slowly to tissues? -High affinity of plasma proteins within
its circulation
56. Ave: Upon entering tissue cells, both thyroxine and
triiodothyronine again bind with intracellular proteins,
which one binds more strongly than the other? -Thyroxine
57. Diff: What transports T4 in cerebrospinal fluid and
provides thyroid hormones to the CNS? -Transthyretin
(TTR)
58. The major binding protein of thyroid hormone is _______,
which is synthesized in the liver and binds one molecule of
T4 or T3. -Thyroxine-binding globulin (TBG)
E. Physiologic Effects
59. What transporter is enhanced by T3 to increase
contractility of heart? -NCX
60. In normal individuals, large doses of iodine act directly on
the thyroid to produce a mild and transient inhibition of
organic binding of iodine and hence of hormone synthesis.
What is the term for this inhibition? -Wolff-Chaikoff effect
61. The ability of the thyroid hormones to increase the
metabolic activities of tissues is due to its ability to
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 increase the expression of what protein? -Mitochondrial
uncoupling protein
62. It reduces the calcium uptake in the kidneys in the
intestines. -Calcitonin
63. What is the overall metabolic effect of TH? -Accelerate
response to starvation
64. What is an important physiologic effect of TH that its
deficiency causes the congenital disease cretinism? -
Normal maturation of growth centers in bones in
developing fetus
65. Easy: Thyroid hormone stimulates almost all aspects of
metabolism of these macronutrients. -Carbohydrates and
fats
66. Ave: The thyroid hormone increases metabolic activity in
almost all tissues by increasing the expression of which
protein? -Mitochondrial uncoupling protein/ UCP2
67. Diff: Sarcoplasmic reticulum Ca2+-ATPase (SERCA) is __ by
T3, whereas phospholamban is ___. -Increased, decreased
68. Thyroid hormones stimulate ______ by affecting both
adenosine triphosphate (ATP) utilization and the efficiency
of ATP synthesis. -Thermogenesis
69. T3 ___ the resting respiratory rate, minute ventilation,
and the ventilatory response to hypercapnia and hypoxia. -
Increases
F. Clinical Correlation
70. What is the medical treatment given to a patient with
hyperthyroidism in preparation for surgical removal of
thyroid -Polythiouracil
71. What is the level of TSH detected in Grave’s disease? -
Normal
72. A pregnant patient with high TSH levels with normal t4
level reflects what clinical state. -Hashimoto’s disease
73. What is the prominent (geographic/agricultural) problem
on certain countries that causes the increase in
hypothyroidism? -Low iodine concentration in soil
74. In patients with hypothyroidism what clinical sign is
caused by the increase in TSH? -Myxedema
75. A 61-year old woman with hyperthyroidism is treated with
propylthiouracil. The drug reduces the synthesis of TH
because it inhibits oxidation of ___. -Iodide
76. Easy: What clinical condition as a result of a mineral
deficiency are hyperthyroid patients predispose to? -
Osteoporosis
77. Ave: This is characterized by decreased levels of both
circulating thyroid hormone and TSH caused by CNS
mediated suppression of hypothalamic-pituitary-thyroid
axis? -Non-thyroidal Illness Syndrome (NTIS)
78. Diff: A patient has a goiter associated with high plasma
levels of TRH and TSH. The heart rate is elevated. This
patient most likely has tumor in which organ? -
Hypothalamus
79. Absence of thyroid hormone causes__________,
characterized by poor brain development, short stature,
and immature skeletal development. -Congenital
hypothyroidism -
80. The abnormal protrusion of the eyeball which is a major
clinical sign in Grave’s disease. -Exophthalmos
PHYSIOLOGY Flipped Classroom Activity (Pilot)
B. CALCIUM & PHOSPHATE HOMEOSTASIS
A. Synthesis and Release
81. UV light converts this steroid to cholecalciferol. -7
dihydroxycholecalciferol
82. The initial stage in bone production is the secretion of
collagen molecules and ground substances by which type
of cell? -Osteoblasts
83. What gene is expressed for production of 1α-hydroxylase?
-CYP27B1
84. What organ is necessary for the conversion of 25-
hydroxycholecalciferol to calcitriol? -Kidney/Parathyroid
Gland
85. What organ stores cholecalciferol for several months? -
Liver
86. 25-hydroxycholecalciferol in the liver is activated by ___
to 1,25-dihydroxyvitamin D. -Renal 1 alpha hydroxylase
87. Easy: In what organ does the second hydroxylation of
Vitamin D occur? -Kidneys (proximal tubule)
88. Ave: Vitamin D is transported to the liver through the
blood, whereas dietary Vitamin D is transported indirectly
to the liver through what? -Chylomicrons
89. Diff: What two organs does parathyroid hormone have no
direct effect to? -Small intestine and parathyroid gland
90. Vitamin D is synthesized from ________ in skin in the
presence of UVB light or acquired in the diet. 7-
dehydrocholesterol
91. 25-hydroxycholecalciferol in the liver and activated by
__________ to 1,25-dihydroxyvitamin D. -Renal 1α-
hydroxylase
B. Regulation
92. When the plasma Calcium level is high, little amount of 1,
25 dihydroxycholecalciferol is produced. What is the
relatively inactive metabolite produced by the kidneys
instead? -24,25-dihydroxycholecalciferol
93. Presence of PTH is one of the two inducers of 1 alpha
hydroxylase activity that results to an increased levels of
potent and active vitamin D. What is the other inducer of
the said mechanism? -Hypophosphatemia
94. The first line of defense in Calcium regulation is the
buffering function if exchangeable calcium in bones. What
is the second line of defense in Calcium regulation? -
Hormonal control of calcium ion concentration
95. What is the effect on Ca2+ level when all 4 parathyroid
glands are removed in thyroidectomy? -Decrease in
Ca2+/Decrease in calcitriol
96. What enzyme inhibits the activity of pyrophosphate in
bone deposition? -Tissue-nonspecific alkaline phosphatase
(TNAP)
97. At higher calcium levels, when PTH is suppressed, 25-
hydroxycalciferol is converted to ___. -24,25-
dihydroxycholecalciferol
98. Easy: This is a peptide hormone produced by osteocytes
and is a regulator of Pi metabolism. -FGF23
99. Ave: 1,25-Dihydroxyvitamin D and PTH regulate the
primary processes for Ca and Pi removal from blood. These
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 processes are renal excretion and ____. -Bone
mineralization
100. Diff: What stimulates the expression of all the
components involved in absorption of Ca2+ by the small
intestine. -1,25-Dihydroxyvitamin D
101. Give 2 major physiological hormones regulating serum
[Ca++] and [Pi]. -PTH, 1,25-dihydroxyvitamin D (calcitriol)
102. PTH and 1,25-dihydroxyvitamin D are referred to as
_______ hormones. -Calciotropic hormones -
C. Mechanism of Action
103. What secondary messenger mechanism is responsible
for the action of the parathyroid hormone? -cyclic AMP
104. What happens to the reabsorption of Calcium if there is
an increase in PTH secretion? -Increased reabsorption
105. Which gene transcription is suppressed by 1,25-
dihydroxycholecalciferol in the negative feedback loop?
-PTH gene transcription
106. What type of cell does PTH directly affect? -Osteoblast
107. How does PTH decrease phosphate levels in the blood? -
Decrease in PCT reabsorption
108. Increase amount of calcium may change the electrical
gradient in the body that it may make the charge ____
inside the cell. -less negative
109. Easy: Thyroid hormone usually forms a heterodimer
with ____ at specific thyroid hormone response elements
on the DNA. -Retinoid X Receptor (RXR)
110. Ave: Stimulates bone resorption by upregulating RANKL
expression in osteoblasts. -1,25-Dihydroxyvitamin D
111. Diff: Extracellular Ca is sensed by the parathyroid chief
cell through ________ found in the plasma membrane -
Calcium-sensing receptor (CaSR)
112. PTH promotes bone resorption by upregulation of
______ in osteoblasts. -M-CSF and RANKL
113. Because the PTH receptor also binds PTH-related
peptide (PTHrP), it is usually referred to as___. -
PTH/PTHrP receptor
D. Transport and Metabolism
114. What transporter is present in the luminal side of the
intestinal epithelial cell for calcium absorption. -TRPV5
or TRPV6
115. Parathyroid hormone activates adenylyl cyclase using
the first two receptors by coupling with which monomer
of G protein? -Gs protein
116. What substrate is increased by thyroid hormones that
results to increased dissociation of O2 from hemoglobin
in RBC? -2,3-diphosphoglycerate
117. What is the normal net intake of Ca2+ per day? -100
mg/day
118. Once inside the enterocyte, Ca++ ions bind to______,
preserving the favorable transluminal membrane Ca2+
gradient -Calbindin-D9K
119. Proteolytic enzymes released by the osteoclast act
specifically on? -Hyaluronic acid and Chondroitin sulfate
120. Easy: The percentage of Ca2+ in the glomerular filtrate is
reabsorbed in the proximal tubule, loop of henle, and
early distal tubule. -90% Ca2+
PHYSIOLOGY Flipped Classroom Activity (Pilot)
121. Ave: What is the proportion of Vitamin D bound to
Vitamin D binding protein? -More than 85%
122. Diff: In vegetarian diets, the major portion of the
phosphorous exists as phytate. In humans, what is
responsible for the metabolism of phytate to release
phosphate? -Intestinal bacteria
123. Once inside the enterocyte, Ca++ ions bind
to_________, preserving the favorable transluminal
membrane Ca++ gradient. -Calbindin-D9K
124. The ______ exchanger also contributes to the transport
of Ca2+ out of enterocyte. -Na+/Ca++ exchanger (NCX)
E. Physiologic Effects
125. What protein is secreted by osteoblasts to inhibit
differentiation of monocytes by competing with RANK
for binding of RANKL? -Osteoprotegerin
126. Vitamin D promotes calcium reabsorption by the
intestines. About 35% of the ingested Calcium is usually
absorbed. Where will the remaining Ca in the intestine
be excreted? -Feces
127. Calcitonin’s main goal in the plasma is to reduce Calcium
concentration. If there is a sudden increase in calcium
concentration calcitonin release significantly increases.
In relation to this, what is the effect of calcitonin in the
kidney and intestine. -Decreased deposition and
reabsorption of calcium
128. As the osteoblasts become surrounded by and
entrapped within bone, they become ___________ that
sit within small spaces called lacunae -Osteocytes
129. Absorption of what ions aside from Ca2+ does Vitamin D
stimulate? -Mg2+ and Phosphate
130. 3) Osteoblast lineage cells can also produce a soluble
factor called ___, which acts as a decoy receptor for
RANKL and inhibits osteoclast differentiation and
function. --Osteoprotegerin (OPG)
131. Easy: One of the physiologic effects of phosphate is the
intracellular ionic balance of which two ions? -K+ and
Mg2+
132. Ave: Thyroid hormone increases metabolic activity in all
tissues due to its ability to increase the expression of
what proteins? -Mitochondrial uncoupling proteins
(UCP)
133. Diff: A sustained program of lifting heavy weights will
increase bone mass. What mechanism stimulates
osteoblastic deposition and calcification of bone in this
condition? -Continual mechanical stress on bones
134. Osteoblast-lineage cells can also produce a soluble
factor called ___________, which acts as a decoy
receptor for RANKL and inhibits osteoclast
differentiation and function. -Osteoprotegerin (OPG)
135. As the osteoblasts become surrounded by and
entrapped within bone, they become _______ that sit
within small spaces called lacunae. -Osteocytes
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F. Clinical Correlation III. ANSWERS
136. Increased resorption of bone with increase in bone
formation are symptoms of this disease. -Paget’s disease FINAL ANSWERS
137. What condition in children causes defective calcification
due to Vit D deficiency? -Rickets A. Synthesis and Release
138. In hypocalcemia, the nervous system becomes 1. 7-dehydrocholesterol
progressively more excitable allowing easy initiation of 2. Secondary active transport
action potentials resulting to tetany. What is the term 3. Hydrogen peroxide
for tetany in the hand which usually occurs before
tetany develops in most parts of the body? -Carpopedal B. Regulation
spasm 4. 24,25-dihydroxycholecalciferol
139. Deposition of Ca++ and Pi in the heart may cause? - 5. Phosphate
Myocardial infarction 6. Peripheral mono-iodination or increased synthesis of TG?
140. During prolonged cases of rickets, what hormone is
increased due to compensation and leads to extreme C. Mechanism of Action
osteoclastic resorption of the bone? -PTH 7. T3
141. What is the major problem of patients with Paget’s 8. Adenylyl cyclase
disease? -Excessive bone resorption 9. Facultative thermogenesis
142. Easy: A condition characterized by poor mineralization
of newly formed osteoid. -Osteomalacia D. Transport and Metabolism
143. Ave: The proper balance of calcium maintains muscle
10. Transthyretin (TTR)
tone and controls nerve irritability. In line with this, a
11. 24-hydroxylase
decrease in serum calcium level results in? -Tetany
12. rT3
144. Diff: A 41-yr-old woman has hypocalcemia,
hyperphosphatemia, and decreased urinary phosphate
E. Physiologic Effects
excretion. Injection of parathyroid hormone (PTH)
13. Decrease
causes an increase in urinary cyclic adenosine
14. No effect
monophosphate (cAMP). The most likely diagnosis is? -
15. Glucocorticoid
Hypoparathyroidism after thyroid surgery
145. Children with hypophosphatemia (bone mineralization
F. Clinical Correlation
is impaired) can lead to _______, in which the
growth of long bones is abnormal and 16. Hyaluronic acid and chondroitin sulfate
impaired -Rickets 17. Osteomalacia
146. Institutionalized elderly patients who stay indoors and 18. Metabolic acidosis (Hyperchloremic)
avoid dairy products are particularly at risk for
development of ________. -Vitamin D deficiency REFERENCES
Doc Solidum and Friendships
Groups 1-3 of Batch 2022 1A
Bern & Levy 2016 (7th ed.)
Guyton & Hall 2016 (13th ed.)

PHYSIOLOGY Flipped Classroom Activity (Pilot) 5 of 5