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1
Q

List the 1st, 2nd and 3rd generation TSH testing methods:

A

RIA
Immunodiometric
Chemiluminescence

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2
Q

__% of T3 is derived from the Thyroid gland, the rest comes from the ____of T4 from liver, kidney, and muscle:

A

20%

de-ionization

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3
Q

List the other biologically inactive forms of T4:

A

rT3
MIT
DIT

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4
Q

T/F

MIT and DIT are precursors to T3 and T4:

A

True

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5
Q

____is the main storage site of thyroid hormones, and is also the ____ precursor to the thyroid hormones:

A

Thyroglobulin

protein

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6
Q

TSH is released in a ____ nature and exhibits ___:

A

pulsating

diurnal variation

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7
Q

Why is TSH a good biomarker for hypo/hyperthyroidism:

A
  • long half life

* single measurement is adequate

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8
Q

___ serves as an antagonist to ____:

A

Calcitonin

PTH

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9
Q

~80% of thyroid hormones are bound to ___:

A

Thyroid binding hormone

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10
Q

List the 4 carrier proteins that bind thyroid hormones:

A
  • thyroid binding hormone
  • thyroid binding prealbumin
  • albumin
  • transthyretin
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11
Q

FT3 and FT4 are metabolically active and free to travel ______:

A

across cell membranes

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12
Q

Low levels of thyroid hormones in fetus in ____ trimester increase risk of mental and psychomotor deficits:

A

first

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13
Q

Upper limit of TSH under debate, ranges between:

A

3 or 5

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14
Q

FT4 is ____ in hyper, ____ in hypo:

A

increased in hyper

decreased in hypo

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15
Q

Reference ranges for FT4 are ____, and FT3 are ____:

A

FT4: 0.7 - 1.8
FT3: 0.2 - 0.5

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16
Q

____ is helpful in distinguishing between Hashimoto’s and Graves:

A

Thyroid antibody

  • Anti-TPO
  • Anti-thyroglobulin
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17
Q

_____ and ____ can serve as markers for thyroid tumors:

A

Calcitonin and Thyroglobulin

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18
Q

____ test measures available thyroid binding sites, provides an indirect measure of TBG, considered obsolete:

A

T-uptake

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19
Q

The FTI test was used to estimate ___:

A

FT4

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20
Q

___is the the site of primary defect:

A

Thyroid gland

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21
Q

___ is the site of secondary defect:

A

Pituitary

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22
Q

___ is the site of tertiary defect:

A

Hypothalamus

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23
Q

____ means the thyroid is functioning normally:

A

Euthyroid

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24
Q

Hyperthyroidism can also be called ____:

A

Thyrotoxicosis

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25
Q

Excess thyroid hormone ingestion, leakage of stored thyroid hormone, or excess gland production of hormone all can cause ___:

A

hyperthyroidism

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26
Q

____ can be caused by autoimmunity, iodine deficiency, or radioactive iodine treatment:

A

hypothyroidism

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27
Q

T/F

Goiter may be present in both hypo/hyperthyroidism

A

True

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28
Q

Is thyrotoxicosis more common in males or females:

A

females

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29
Q

This is an autoimmune condition commonly associated with permanent primary hypothyroidism:

A

Hashimoto’s Thyroiditis

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30
Q

Hashi’s results in insufficient __ to tissues due to cell and antibody mediated destruction of thyroid tissue:

A

T4

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31
Q

This is an autoimmune disorder characterized by diffuse, toxic hyperplasia, :

A

Graves

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32
Q

Grave’s disease is caused by ___ antibody to ____:

A

IgG

TSH

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33
Q

90% of Hashi’s patients will have antibodies to ___ or _____:

A

Thyroglobulin

Thyroid Peroxidase

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34
Q

Graves Disease affects females to males at this ratio:

A

5:1

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35
Q

Illness may be seen in severely ill patients, where TSH or thyroid hormones are abnormal, but thyroid gland is functioning normally:

A

Euthyroid Sick Syndrome

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36
Q

Euthyroid sick syndrome often simulates ___, the very sick will show significant decline in __ :

A

hypothyroidism

T4 and T3

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37
Q

Euthyroid sick syndrome in acute and chronic illness will show decrease in __ and ___, increase in ___, and normal ___ and ___:

A

D: T3, FT3
I: rT3
N: T4, TSH

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38
Q

___ is the most reliable indicator of thyroid function in hospitalized patients:

A

FT4

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39
Q

___ and ___ are the 2 most important hormones in calcium regulation:

A

PTH

Vit D

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40
Q

____ is synthesized and secreted by parathyroid glands, acts directly on bone and kidney to increase Ca:

A

PTH

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41
Q

___ has pharmacological effects, physio role is unknown, it is released from the thyroid gland and increases in thyroid cancer:

A

Calcitonin

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42
Q

___ is typically caused by an adenoma of the parathyroid gland, you will see increased PTH/serum and urine Ca/Vit D, and decreased phosphorous:

A

Primary hyperparathyroidism

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43
Q

If blood calcium is low, _____ will increase secretion of ____, kidneys will increase reabsorption of Ca, and decrease phosphate reabsorption:

A

parathyroid

PTH

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44
Q

If blood calcium is high, secretion of ___ is suppressed, kidneys decrease reabsorption of Ca, and mobilization of Ca from bone is decreased:

A

PTH

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45
Q

Overstimulation of the parathyroid glands can lead to ____ and overproduction of ___:

A

hyperplasia

PTH

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46
Q

Total calcium includes these 3 forms of calcium:

A
  • Calcium bond to albumin/proteins
  • Calcium
  • ‘free’ unbound calcium
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47
Q

Free calcium is biologically active and controlled by ___ and ____, is considered the best indicator of calcium status:

A
  • PTH

* Vit D

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48
Q

The only acceptable sample for calcium testing is ___, and it must be handled ____ and transported on ___:

A

Heparin
anaerobically
ice

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49
Q

T/F

You can test the same sample for calcium and potassium:

A

False.

Calcium needs to be stored on ice, but ice will increase potassium levels in sample.

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50
Q

Prolonged tourniquet use will increase ____Ca, but not ___Ca:

A

total Ca

Free Ca

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51
Q

Decrease in pH will _____ the calcium binding to proteins, which will _____ the free calcium in the sample:

A

decrease binding

increase free Ca

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52
Q

Increase in pH will ____ the calcium binding in proteins, which will ____ the free calcium in the sample:

A

increase binding

decrease free Ca

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53
Q

Calcium will change ___% for every .1 change in pH, which is why pH is reported with free calcium:
(used to verify proper handling of sample)

A

5%

54
Q

Which cardiac marker stays elevated the longest:

A

Troponin T

55
Q

Which cardiac marker rises first and falls first:

A

Myoglobin

rises 1-4 hrs, peaks 6 hrs, falls ~24 hours

56
Q

High LDH plus high 5’ nucleotidase points to bone or liver:

A

liver

bone has normal 5’

57
Q

List the 3 diseases classified as unconjugated hyperbilirubinemia:

A
  • Criggler-Najjar
  • Gilberts Disease
  • Neonatal Jaundice
58
Q

List the 2 diseases associated with conjugated hyperbilirubinemia:

A
  • Dubin-Johnson

* Rotor Syndrom

59
Q

What would be high in neonatal jaundice, conj or unconj?

A

unconjugated

60
Q

Is bilirubin affected by hemolysis and light exposure:

A

Yes

61
Q

Tetralogy of Fallot is a combo of __ defects:

A

4

62
Q

Troponin T stays elevated longer than TnI, but can also be elevated in patients with:

A

ESRD

63
Q

The LD flip peaks at ___ and is back to normal in __:

A

peaks 48 hrs

normal 10 days

64
Q

List the 3 cardiac enzymes, and the two contractile proteins:

A
  • CK, AST, LDH

* Troponin, Myoglobin

65
Q

Which stays elevated longer, TnT or TnI:

A

TnT

66
Q

CK index <3 means ___, >6 means___:

A

muscle

cardiac

67
Q

This contractile protein binds calcium and regulates muscle contraction, is considered the gold standard:

A

Troponin

68
Q

Which cardiac marker is best for catching old MI’s that didn’t come to the ER:

A

Troponin (stays elevated the longest)

69
Q

List the 3 markers of cardiac inflammation:

A
  • CRP (non-specific)
  • hsCRP (more cardiac specific,future risk)
  • homocysteine
70
Q

Natriuretic peptides are hormones that play an important role in cardiac homeostasis, and are markers for ___:

A

CHF

71
Q

Stretching caused by increased fluid volume in CHF results in release of ___ and __:

A

BNP

NT proBNP

72
Q

BNP is a marker for ___ and is also used to assess prognosis of those with ___:

A

MI

73
Q

BNP <20 probs ___ for CHF, >20 probs ___ for CHF:

A

<20 neg

>20 pos

74
Q

BNP is also used to distinguish cause of dyspnea, will be negative if ____ cause, will be positive if ___associated CHF:

A

neg: pulmonary
pos: cardiac/CHF

75
Q

Drawing for cardiac panel is done:

A

serially (timed intervals)

76
Q

List th*e two cardiac meds that need to measured since too much is ___:

A

Digoxin
Lidocaine
*toxic

77
Q

Digoxin is used to _____, while Lidocaine is given for _____:

A
  • increase contractions

* arrhythmias

78
Q

What do you treat digoxin OD with:

A

digibind

79
Q

BUN x ____= Urea

A

2.14

80
Q

Is BUN or Creatinine affected by dietary protein:

A

BUN

81
Q

Water is controlled via ___ and ___,

electrolytes are controlled via __ and ___:

A

water: osmolality, ADH
Elec: aldosterone, renin

82
Q

___ responds to changes in BV, BP, hyponatremia:

A

Renin

83
Q

___ responds to changes in blood O2:

A

EPO

84
Q

___ are cyclic fatty acids that increase renal blood flow, control renin release, and oppose renal vasoconstriction:

A

prostaglandins

85
Q

The renal threshold of glucose is typically:

A

160-180 mg/dL

86
Q

___ is up to 75% of all non-protein nitrogen:

A

Urea

87
Q

Plasma BUN will be ___ in renal disease:

A

increased

88
Q

___ is a waste product of purine metabolism:

A

Uric acid

89
Q

Crea clearance will be ___ in renal disease:

A

decreased

90
Q

Creatinine clearance/GFR exhibits ____, random fluctuations around homeostatic setpoint:

A

biological variation

91
Q

___ will decrease with age, 6.5mL/min for each decade of life:

A

Creatinine Clearance

92
Q

Ref range for crea clearance,
Males:
Females:

A

Males: 99-137
Females: 88-128

93
Q

Myoglobin presence will cause ___ colored urine:

A

tea

94
Q

Should protein/microalbumin get through the glomerulus:

A

No. It is an early sign of kidney disease and can document the progression of disease.

95
Q

___ is relatively stable and can be elevated before decrease in GFR or increase in crea, but isnt commonly used due to price:

A

Cystatin-C

96
Q

Large increase of this protein in urine can overload proximal tubules and lead to acute renal failure (rhabdo):

A

Myoglobin

97
Q

___ is a small non-glycosylated protein on the surface of most nucleated cells, an increase in this could indicate organ rejection:

A

B2 Microglobulin

98
Q

Acute glomerulonephritis is often related to this pathogen:

A

Group A beta hemolytic Strep

99
Q

Increased serum creatinine, and decreased crea clearance means ___ GFR:

A

decreased

Backing up into serum

100
Q

Renal hypertension leads to ___ perfusion:

A

decreased

101
Q

_____: several different diseases/conditions that injure and increase permeability of glomerular basement membrane:

A

Nephrotic syndrome

102
Q

Proteinuria, hematuria, edema due to loss of albumin, hyperlipidemia, oval fat bodies in urine, and increases in Alpha 2 and beta:

A

Nephrotic syndrome

103
Q

The most important manifestation of renal tubular disease is that the kidneys cannot ____:

A

regulate pH

104
Q

T/F

You may see casts on UA in renal tubular disease:

A

True

105
Q

Waxy casts are ___:

A

bad!

106
Q

With a renal __, the kidneys lose the ability to ___, and renal blood flow is ___:

A

obstruction
concentrate urine
decreased

107
Q

Acute renal failure is ___, while chronic is ___:

A

reversible

irreversible

108
Q

___ is strongly associated with kidney failure:

A

diabetes

109
Q

Renal hypertension decreases blood perfusion through kidney, the change in blood volume will stimulate the release of ___, increasing serum__, and decreasing serum ___:

A

renin
increase Na+
decrease K+

110
Q

List the hormones involved in pancreatic endocrine function:

A

Glucagon
Insulin
Somatostatin
Pancreatic polypeptide

111
Q

Glucagon breaks down____ causing ___:

A

glycogen

glycogenolysis

112
Q

List the 4 enzymes involved in the pancreatic exocrine function:

A

Secretin
CCK
Amylase
Lipase

113
Q

Pancreatic endocrine system involves ___, and the exocrine system involves ___:

A

endocrine: hormones
exocrine: enzymes

114
Q

___ breaks down starch and glycogen, ___ breaks down trigs:

A

Amylase

Lipase

115
Q

___ produces bicarbonate rich pancreatic fluid that protects intestinal lining from HCL:

A

Secretin

116
Q

___ helps stimulate further release of digestive enzymes, combines with fats and lipids in the duodenum:

A

CCK

117
Q

T/F

There are isoenzymes for both salivary and pancreatic amylase:

A

True (S1 S2 S3, P1 P2 P3)

118
Q

True increase in serum Amylase will also show increase in ___:

A

urine amylase

119
Q

Elevated trigs can cause a false decrease in ___:

A

amylase

trigs act to suppress or inhibit amylase

120
Q

No increase in amylase is seen in ___ or ___:

A

chronic pancreatitis

pancreatic tumor

121
Q

Acute pancreatitis will see an increase in _____, while chronic pancreatitis will see an increase in ___:

A

Acute: AMY and LIP
Chronic: LIP

122
Q

List three ‘other’ pancreatic function tests:

A
  • Secretin/CCK
  • Fecal Fat
  • Sweat Cl-
123
Q

> 60mmol/L of this test is dx for CF:

A

Sweat Cl-

124
Q

List the rise, peak, and return to normal of AMY and LIP in acute pancreatitis:

A

AMY (2+hrs, 24 hrs, 3+days)

LIP (8hrs, 24 hrs, 8+days)

125
Q

This disease is defined as an autodigestion of the pancreas due to reflux of bile or duodenal contents into pancreatic duct:

A

Pancreatitis

126
Q

Do peaks in lovers of pancreatic enzymes relate to the severity of pancreatitis:

A

No.

127
Q

____ genes encode instructions for ion channel that transports Cl- in and out of the cells, gene mutation causes ___:

A

CFTR

CF

128
Q

Is amylase increased in pancreatic tumors:

A

No

129
Q

In pancreatic carcinoma, is the tail or head associated with more symptoms and likelier to detect sooner:

A

Head

tail= vague symptoms

130
Q

This syndrome causes hypersecretion of gastric volume (gastric excreting tumor), detected via ____:

A

Zollinger-Ellison syndrome

Plasma Gastrin

131
Q

____ is increased in Zollinger-Ellison syndrome:

A

Plasma Gastrin

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