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Clinical Pathology > 3. Core Clinical Biochemistry > Flashcards

3. Core Clinical Biochemistry Flashcards

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1
Q

Secrete hormones directly into the blood stream and act systematically.

  1. Autocrine secretion
  2. Paracrine system
  3. Endocrine glands
  4. Thyroid glands
A
  1. Endocrine glands
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2
Q

Secrete hormones that act locally.

  1. Autocrine secretion
  2. Paracrine system
  3. Endocrine glands
  4. Thyroid glands
A
  1. Paracrine system
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3
Q

Secrete hormones which affect the cell releasing the hormone/protein.

  1. Autocrine secretion
  2. Paracrine system
  3. Endocrine glands
  4. Thyroid glands
A
  1. Autocrine secretion
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4
Q

What type of adenomas can occur in the anterior pituitary gland?

(hint: think of the hormones produced in the pituitary gland)

A
  1. Prolactinoma (most common) - results in galactorrhoea (unwanted flow of milk from the breast) + menstrual disturbances
  2. Growth hormone secreting adenoma - results in gigantism in children, acromegaly in adults
  3. ACTH secreting adenoma - can result in Cushing’s syndrome
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5
Q

Why can a thyroid gland enlargement lead to a hoarse voice?

A

The recurrent laryngeal nerve is situated just posteriorly to the thyroid gland.
Thyroid gland pressing on this can cause a hoarse voice.

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6
Q

What is chronic lymphocytic thyroiditis?

A

Hashimoto’s
Autoimmune chronic inflammation of the thyroid gland due to autoantibodies attacking the thyroid gland.

Enlarged gland, more common in women.

Many patients become hypothyroid.

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7
Q

Hashimoto’s gives an increase risk of what?

A

Papillary thyroid carcinoma

most common thyroid malignancy

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8
Q

What is diffuse hyperplasia?

A

Grave’s disease
Autoimmune process resulting in hyperthyroidism and diffuse hyperplasia of the follicular epithelium (responsible for 80% of hyperthyroidism).

More common in females.
Diffuse enlargement of thyroid gland.

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9
Q

What happens to T3, T4, TSH levels in Grave’s disease?

A

T3 + T4 = ↑

TSH = ↓

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10
Q

Enlargement of the thyroid with varying degrees of nodularity, where patients are mostly euthyroid (normal hormone level, not hypo/hyper).

A

Multinodular Goitre

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11
Q

Benign tumour of follicular epithelium of thyroid.

Solitary nodule on one lobe, usually a cold nodule on radioactive imaging.

A

Follicular adenoma

cold nodule = non-functioning so show up as defects in the scan since there is little activity

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12
Q

What is the most common malignant tumour of the thyroid?

What mutation leads to the most aggressive type of this tumour?

A

Papillary carcinoma

BRAF V600E mutation

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13
Q

What is the difference between Follicular carcinomas and Hurthle Cell carcinomas?

A

Hurthle cell carcinoma =
significant incidence of cervical lymph node metastases
Spread via lymph + blood
Worse prognosis

Follicular carcinoma =
only spread via blood

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14
Q

Hyperplasia of the glands with elevated PTH in response to hypocalcemia.

  1. Primary hyperparathyroidism
  2. Secondary hyperparathyroidism
  3. Tertiary hyperparathyroidism
  4. Primary hypoparathyroidism
A
  1. Secondary hyperparathyroidism

Seen in renal insufficiency, malabsorption, vitamin D deficiency

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15
Q

Excessive secretion of parathyroid hormone from one or more glands.

  1. Primary hyperparathyroidism
  2. Secondary hyperparathyroidism
  3. Tertiary hyperparathyroidism
  4. Primary hypoparathyroidism
A
  1. Primary hyperparathyroidism

gland itself is abnormal

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16
Q

Adenoma in association with longstanding secondary hyperparathyroidism

  1. Primary hyperparathyroidism
  2. Secondary hyperparathyroidism
  3. Tertiary hyperparathyroidism
  4. Secondary hypoparathyroidism
A
  1. Tertiary hyperparathyroidism
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17
Q

Malignant tumour derived from parathyroid parenchymal cells.

A

Parathyroid carcinoma

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18
Q

What is Cushing’s syndrome caused by?

A

Prolonged exposure to cortisol

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19
Q

An exogenous cause of Cushing’s syndrome is excessive glucocorticoid medication.
Give 2 endogenous causes.

A
  1. Tumour in adrenal gland
  2. Ectopic ACTH releasing tumour
  3. ACTH secreting pituitary adenoma
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20
Q

Give 8 signs and symptoms of Cushing’s syndrome.

A
  1. Hypertension
  2. Moon face
  3. Central obesity
  4. Buffalo hump
  5. Weak muscles
  6. Osteoporosis
  7. Insomnia
  8. Excess sweating
  9. Mood swings
  10. Headaches
  11. Chronic fatigue
  12. Increased hair growth (women)
  13. Irregular menstruation (women)
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21
Q

What is Conn’s syndrome?

A

Hyperaldosteronism

excess aldosterone production, resulting in low renin levels.

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22
Q

What is Addison’s Disease?

A

Hypoadrenalism

Primary adrenal cortical insufficiency = lack of adrenal gland formation, adrenal destruction

Secondary = failure of ACTH secretion

Treated with long term steroid replacement

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23
Q

What is the triad in Addison’s Disease?

A
  1. Hyperpigmentation
  2. Postural hypotension
  3. Hyponatraemia (low sodium)
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24
Q

Adrenal cortical adenomas can cause what 2 conditions?

A
  1. Conn’s syndrome - aldosterone producing tumours

2. Cushing’s syndrome - cortisol producing tumours

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25
Catecholamine secreting tumour arising from adrenal medulla.
Phaeochromocytoma | catecholamines are dopamine, epinephrine, norepinephrine
26
Low PTH levels and low calcium levels are commonly seen in what condition?
Hypoparathyroidism
27
A T-score of less than -2.5 on a DEXA scan indicates which disease condition?
Osteoporosis
28
Low thyroxine, Low TSH = ?
Pituitary failure Secondary hypothyroidism
29
Low thyroxine, High TSH = ?
Unresponsive thyroid Primary hypothyroidism
30
High thyroxine, Low TSH = ?
Thyroid gland overproduction Primary hyperthyroidism
31
High thyroxine, High TSH = ?
Pituitary gland overproduction / feedback fail Secondary hyperthyroidism
32
What can be missed by using TSH as a front line test?
Secondary hypothyroidism since they have normal TSH levels, but low T4.
33
How often should Thyroid function tests (TFTs) be repeated in healthy patients?
Every 3 years
34
Why should TFTs not be measured in hospitalised patients unless a thyroid problem is suspected?
Sick euthyroid disease Patients will have abnormalities in their thyroid function tests tests suggesting they have a thyroid problem despite being euthyroid. The abnormalities are due to their other illnesses. Therefore you will incorrectly diagnose someone of a thyroid problem.
35
Disease which presents with excessive and often episodic release of catecholamines.
Phaeochromocytoma
36
What do you measure to diagnose phaeochromocytomas?
Plasmametanephrines
37
What is Whipple's triad?
Diagnosis of hypoglycemia 1. Signs + symptoms of hypoglycemia 2. Low blood glucose level 3. Resolution of symptoms once glucose level rises
38
Most common tumours arising from the islets of Langerhans. How is it diagnosed?
Insulinoma | Simple fasting blood test. low blood sugar with high insulin = insulinoma
39
Diabetes is characterized by hyperglycaemia. | True or False?
TRUE
40
Which of these is NOT a pancreatic islet cell? 1. Alpha cells 2. Beta cells 3. Chief cells 4. Delta cells 5. F cells
3. Chief cells alpha cell = glucagon beta cells = insulin delta cells = somatostatin F cells = pancreatic polypeptide
41
What fasting glucose value is diagnostic of diabetes? ≥ 7 mmol/litre ≥ 11.1 mmol/litre ≥ 5 mmol/litre ≥ 9.1 mmol/litre
≥ 7 mmol/litre | ≥ 11.1 mmol/litre = random glucose diabetes diagnosis
42
What is the oral glucose tolerance test (OGTT)?
1. Fasting glucose is measured. 2. 75g of glucose is ingested 3. Blood glucose levels are measured 2 hours later ≥ 11.1 mmol/litre = diabetic
43
HbA1c (glycated haemoglobin) reflects average plasma glucose over the previous 8 to 12 weeks. What HbA1c value is diagnostic of diabetes? ≥ 11.1 mmol/mol ≥ 20 mmol/mol ≥ 41 mmol/mol ≥ 48 mmol/mol
≥ 48 mmol/mol = diabetes ≥ 41 and <48 = pre-diabetes
44
Where is insulin produced?
Beta cells in Islet of Langerhans (pancreas)
45
What antibodies measure are used to measure/diagnose type 1 diabetes?
1. IAA - Insulin autoantibodies 2. GAD 65 (and 67) - Glutamic acid decarboxylase autoantibodies 3. IA-2 - Islet antigen-2 autoantibodies 4. ZnT8 transporter autoantibodies (having or not having antibodies does NOT diagnose diabetes if they do not come with symptoms)
46
Type of diabetes that has a rapid onset and presents with wight loss and ketoacidosis.
Type 1 Diabetes Mellitus | no insulin production
47
Type of diabetes which presents over a few months with minimal weight loss and can present with vision loss/foot ulcers/fungal infection.
Type 2 Diabetes Mellitus | some insulin production, but cells are not responsive to it
48
How is gestational diabetes diagnosed?
Symptoms: 1. Hyperglycemia and diabetes first detected in pregnancy Diagnosis: 1. Oral glucose tolerance test (OGTT) (HbA1c is NOT used, isn't very reliable in pregnancy)
49
What are 3 actions that glucagon has?
1. Increases secretion of insulin + growth hormone 2. Reduces intestinal motility and gastric acid secretion 3. Increases glucose levels (glycogenolysis, gluconeogenesis, lipolysis)
50
Which of these stimulate glucagon release and which inhibit it? 1. Amino acids 2. Beta adrenergic stimulation 3. Insulin 4. Gastrin 5. CCK 6. Cortisol 7. Somatostatin 8. Glucose 9. Ketones 10. Amino acids 11. Free fatty acids 12. Fasting, hypoglycaemia 13. Exercise
Stimulate glucagon: 1. Amino acids 2. Beta adrenergic stimulation 3. Gastrin 4. CCK 5. Cortisol 6. Fasting, hypoglycaemia 7. Exercise Inhibit glucagon: 1. Insulin 2. Free fatty acids 3. Ketones 4. Glucose 5. Somatostatin
51
Which of these hormones raise blood glucose levels? 1. Glucagon 2. Insulin 3. Epinephrine 4. Cortisol 5. Growth hormone
ALL except insulin | hypothalamus is the homeostasis centre for all of these hormones
52
What is commonly measured to assess the degree of long term glycaemic control?
Glycated haemoglobin
53
Hereditary iron overload storage disorder that can result in diabetes?
Haemochromatosis
54
Class of drugs used in the management of osteoporosis that can sometimes result in osteonecrosis of the jaw?
Bisphosphonates | primary therapy used
55
Cells that are responsible for the breakdown of bone and are critical for its repair and maintenance?
Osteoclasts
56
What is the main carrier of protein bound calcium in the blood?
Albumin
57
FSH releasing factor is secreted by?
Hypothalamus
58
The spongy inner layer of bone is called?
Trabecular bone
59
The hard outer layer of bone is called?
Cortical bone
60
What is an osteon?
Microscopic columns of osteoblasts + osteocytes that make up cortical bone. Blood vessels + nerves travel through the central canals (Haversian canals) of these osteons.
61
An inorganic component of bone which gives rigidity.
Hydroxyapatite
62
Osteoid is an unmineralised organic support tissue in bone made by osteoblasts. What material does it mainly consist of?
Type 1 Collagen
63
What is the name of osteoblasts that become buried/trapped within the matrix?
Osteocytes
64
Cells which create and repair new bone.
Osteoblasts
65
Cells which break down bone and increase blood calcium levels - critical for repair and maintenance of bone.
Osteoclasts
66
What enzymes do osteoclasts produce? 1. Tartrate resistant acid phosphatase (TRAP) 2. Alkaline phosphatase 3. RANK 4. Cathepsin K 5. Procollagen type 1 propeptides (P1NP)
1. Tartrate resistant acid phosphatase (TRAP) 4. Cathepsin K (alkaline phosphatases + P1NP are made by osteoblasts) (RANK ligands are not enzymes, they are signalling molecules that regulate osteoclast activity)
67
Name the 4 main stages of the bone cycle?
1. Resting 2. Resorption 3. Osteoid formation 4. Mineralisation (cycle restarts)
68
With increasing age, bone formation increases and bone resorption decreases. True or False?
FALSE bone formation ↓ bone resorption ↑ (even greater bone loss in women after menopause)
69
What cell releases alkaline phosphatase?
Osteoblasts | involved in mineralisation
70
The concentration of what molecule released by osteoblasts, can be used to measure osteoblast activity?
Procollagen type 1N propeptide (P1NP) | ↑ levels with ↑ osteoblast activity vice versa
71
A T-score of -1.0 and above on a DEXA scan indicates what?
Normal bone density
72
A T-score between -1.0 and -2.5 on a DEXA scan indicates which disease condition?
Osteopenia | thinning of the bones - not quite osteoporosis
73
A systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue, with consequent increase in bone fragility and susceptibility to fracture.
Osteoporosis
74
``` Alendronate, Risendronate, Ibandronate, IV Zoledronic acid. These are all what class of drug used in osteoporosis management? ```
Bisphophonates
75
What bone marker is used to monitor compliance/response to anti-resorptive therapy
CTX | collagen cross-linking molecule, released with bone resorption
76
What are 5 presenting symptoms of bone metastases?
1. Pain - usually worse at night + gets better with movement 2. Broken bones - fractures with minimal/no trauma 3. Numbness, paralysis, trouble urinated - metastatic spinal cord compression 4. Loss of appetite, nausea, thirst, confusion, fatigue - symptoms of hypercalcaemia 5. Anaemia - disruption of bone marrow
77
What are the 2 types of bone metastases?
1. Osteolytic - destruction of normal bone (high calcium levels) 2. Osteoblastic - deposition of new bone
78
What blood test would you do in anyone with a high calcium level?
Parathyroid hormone (PTH) blood test. When calcium levels are low, PTH is released to increases blood calcium levels. If calcium is high and PTH is high, there is a problem with the feedback mechanism or the parathyroid glands have an issue. In lytic bone metastases, there would be high calcium with low PTH.
79
What happens to calcium and PTH levels in Primary hyperparathyroidism?
Calcium ↑ | PTH ↑
80
What is Paget's Disease?
Rapid bone turnover and formation leading to abnormal bone remodelling. (elevated alkaline phosphatase reflecting increased bone turnover)
81
What would be the best treatment for Paget's disease and how would it be monitored?
Bisphosphonates - they reduce osteoclastic activity, which also reduces osteoblastic activity. Alkaline phosphatase (easiest to measure) / P1NP
82
What is Osteomalacia?
Lack of mineralisation of bone. Due to: 1. Insufficient calcium absorption from intestine - poor diet or Vit D deficiency/resistance 2. Excessive renal phosphate excretion
83
What is the purpose of 'adjusted calcium' in blood tests?
1. Calcium binds strongly to albumin, therefore if albumin levels are low, the total calcium level will appear to be low in a blood test. 2. The adjusted calcium value is an equation which compensates for the change in serum albumin.
84
Low calcium and magnesium levels trigger PTH release from the parathyroid glands. What effect does PTH have?
1. PTH acts on bone to increase resorption of Ca + PO4 2. PTH acts on kidneys to increase reabsorption of Ca from filtrate + increase excretion of PO4 3. PTH also acts on kidneys to increase the conversion of vitamin D to its active form - which increases Ca + PO4 absorption in the gut The net effect of PTH is to increase serum calcium and decrease serum phosphate.
85
Which of these is NOT a regulator of calcium and phosphate homeostasis? 1. Calcitonin 2. Oestrogen 3. MGD23 4. FGF23 5. PTH 6. Vitamin A 7. Vitamin D
MGD23 (made up) + vitamin A
86
What is Chvostek's sign?
Sign for hypocalcaemia - tapping over the facial nerve causes twitching of facial muscles (tetany). (Trousseau's sign - spasm of wrist + hand after compressing forearm)
87
What are the signs and symptoms of hypercalcaemia?
STONES - renal stones BONES - bone pain + osteoporosis MOANS - lethargy, fatigue, depression GROANS - abdo pain, constipation, nausea, vomiting
88
What ion deficiency can present with severe muscle weakness, respiratory muscle failure and rhabdomyolysis?
Phosphate deficiency
89
What effect will severe hypomagnesaemia have on PTH and calcium levels?
PTH release inhibited, causing hypocalcaemia. ↓ magnesium = ↑ PTH release ↑ magnesium = ↓ PTH HOWEVER, PTH release is magnesium dependent
90
What are the primary regulators of calcium and phosphate homeostasis?
PTH | Vitamin D
91
2.2 - 2.6 mmol/L is the normal range for what ion?
Total plasma calcium Calcium > 3.5 mmol/L or < 1.6 mmol/L is a medical emergency requiring immediate treatment

Clinical Pathology (11 decks)

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