Hormones, Arthritis, Misc. Flashcards
(99 cards)
1
Q
What is an initial test to order at a regular adult checkup?
A
TSH
along with CBC, CMP, Lipid screenings
2
Q
What is the single most sensitive test for primary hypothyroidism?
A
TSH
3
Q
Does thyroid dysfunction risk increase or decrease with age? Does it affect women or men more?
A
Increases, women>men
4
Q
Why would you test patients for thyroid dysfunction outside of the annual check up?
A
Goiter on exam
Fam. hx of thyroid dx
Pts taking drugs that impair thyroid function
Substantial hyperlipidemia or a change in lipid pattern, which occurs in hypothyroidism
Hyponatremia, SIADH, can cause hypothyroidism
Previous thyroid injury
Pituitary or hypothalamic disorders
Hx of autoimmune dx
5
Q
(Hyper/hypo)thyroidism can cause (hyper/hypo)lipidemia
A
Hypothyroidism can cause hyperlipidemia
6
Q
initial screening test for thyroid disorders?
A
TSH
7
Q
Where is TSH produced? What does it stimulate the release of, and where is that found?
A
TSH = anterior pituitary gland, which stimulates secretion of T3 and T4
8
Q
What stimulates TSH? Where is it secreted from?
A
Thyrotropin, released from the hypothalamus, stimulates TSH
9
Q
What does T3 stand for? What does this test diagnose?
A
Triiodothyronine
used when dx Hyperthyroidism
T3 thyrotoxicosis = Graves disease
10
Q
“Total” T3 = bound by a _____ vs “____ T3” is not
A
protein
Free T3 is not
11
Q
What is a good index of thyroid function under treatment?
A
Total T4 levels
11
Q
Increased T3 = ?
Decreased T3 = ?
A
Increased = Hyperthyroidism, early thyroid failure, acute thyroiditis, T3 toxicosis (Graves disease)
Decreased = hypothyroidism, third trimester of pregnancy
12
Q
In non-thyroidal illness, a low ___ is a nonspecific, insignificant finding
A
FT3
13
Q
increased levels of T4, or _____, means ?
decreased levels?
A
Thyroxine = T4
Increased >20 = thyroid storm possible
Decreased <2.0 = myxedema coma possible
14
Q
T4 and T3 upon initial diagnose will follow the (direct/inverse) relationship with TSH test, but T4 level will be altered once medications have been added.
A
inverse
15
Q
TSH is high in ____thyroidism, or ____
A
Primary HYPOthyroidism (Hashimoto’s)
Subclinical Hypothyroidism
Or in Pts noncompliant to their thyroid medication
16
Q
“Underactive thyroid” = ____ TSH level
A
HIGH TSH
17
Q
_____ hypothyroidism is in 95% of pts. (Low/high) TSH and a (low/high/normal) free T4 level
A
Primary
High TSH and LOW T4
18
Q
_____ hypothyroidism is in 5% of pts. (Low/high) TSH and a (low/high/normal) free T4 level
A
Subclinical hypothyroidism
High TSH and a NORMAL free T4
19
Q
Chronic autoimmune thyroiditis = ?
A
Hashimoto’s Thyroiditis
20
Q
Hashimoto’s is a gradual thyroid failure, with or without goiter, due to an _____ mediated destruction of the thyroid gland involving _____ of thyroid epithelial cells
A
autoimmune
apoptosis
21
Q
Nearly all patients with Hashimoto’s have
TSH level
serum concentrations of antibodies against one or more thyroid antigens
serum T4 level
diffuse lymphocytic infiltration of the thyroid, which includes predominantly thyroid-specific B and T cells
destruction, which is the characteristic hallmark of thyroiditis.
A
High TSH level
High antibodies
Low T4
High TSH level
Follicular destruction
22
Q
Most common cause of hypothyroidism in US?
A
Hashimoto’s Thyroiditis = Autoimmune Thyroiditis
23
Q
If TSH is high or you find a new goiter on exam, what do you do?
A
For new or uncontrolled hypothyroidism, repeat TSH and order anti-Tg Ab and anti-TPO Ab
24
What does Anti-Tg Ab stand for?
Anti-TPO Ab?
Anti-Tg Ab = antithyroglobulin antibodies
Antithyroid peroxidase antibodies
They will be high in Hashimoto's
25
If pt is on meds for hypothyroidism and their TSH is high again, you should ask for ?
and also see if there is an (under/over) dose
Are they skipping or running out?
Could be an under-dose
26
TSH is low in primary _____thyroidism, or ____ dx
Hyperthyroidism, or Grave's disease
27
"Overactive thyroid" or an OVERDOSE or daily thyroid medication
Graves' disease = LOW TSH LEVELS
or an overdose or daily thyroid meds
28
Signs and Sx of Graves' disease?
Exophtalmos (eyes bulge), tremors, pretibial myxedema, palpitations, wt loss, menstrual irreg.
29
Low TSH, what next?
Repeat TSh + free T4 and T3 levels.
Low TSH, high T4 and T3 = Graves' disease
No Ab testing needed
30
If LOW TSH in known hypothyroid pt, what should you ask about?
Over/under dose?
Pt could be taking too much thyroid replacement meds
Could be an overdose and need to lower strength
31
In pts with HYPERthyroidism, need to stabilize thyroid before going down rabbit holes. Which tests will this affect?
Will result In low serum total, LDL, and HDL
normocytic anemia
serum alkaline phosphatase may be high
32
Secondary (Central) Hypothyroidism means there is a (high/low/normal) TSH and a (high/low/normal) T4
Normal TSH
Low T4
*Need to distinguish if cause if pituitary or hypothalamic
32
if a pt has very low cholesterol levels, what should you do next?
Make sure thyroid is okay
33
Which hormone binds thyroid hormone and is a major thyroid hormone protein carrier?
Thyroxine binding globulin (TBG)
34
T/F - TBG is significant in dx hyperthyroidism
False
TBG doesn't have any clinical usefulness in hyper or hypothyroid diagnosis
35
Used in evaluation of unexplained abnormal T4 or T3 that does not correlate with hyperthyroid or hypothyroid pictures
TBG (Thyroxine Binding Globulin)
36
TRH means? It is produced by the ____ which sends TRH to the _____ to produce ____
Thyroid-releasing Hormone
hypothalamus which sends TRH to pituitary to produce TSH
37
TRH can also stimulate ____ in addition to TSH
Is it typically ordered in thyroid evals?
prolactin (PRL) production
No
38
If you have a high or low serum calcium level, what tests to order next?
Ionized calcium and parathyroid hormone and vitamin D
39
What does PTH stand for? What secretes it?
Parathyroid hormone
Parathyroid gland
40
High PTH?
Low?
High PTH = Primary Hyperparathyroidism, some neoplasms with high calcium, renal failure
Low PTH = hypoparathyroidism, severely impaired bone mineralization
41
Vitamin D level test = 25??
22-OH-Cholecalciferol
42
25-OH Cholecalciferol is a pre hormone that is eventually ruled into ____
Vitamin D
43
Deficiency of Vitamin D can be related to low ____ and low ____
calcium and phosphate
also plays a role in bone metabolism
44
Most important biological action of vitamin D?
intestinal absorption of calcium and phosphorus in the GI tract
45
Vitamin D deficiency can occur as a result of decreased intake or absorption, reduced ___ exposure, increased hepatic (anabolism/catabolism), or decreased endogenous synthesis (via the liver or in the kidney), secondary hyperparathyroidism in CKD
reduced sun exposure, hepatic catabolism
46
What are the gonadal stimulatory hormones? Produced and stored where?
Follicle Stimulating Hormone, Lutenizing hormone
Produced in the anterior pituitary
47
In males, FSH and LH are necessary for ____ development and maturation
spermatozoa
48
_____ stimulate the production of testosterone
LH
49
Elevated ____ level is diagnostic for menopause when associated signs and symptoms are present.
FSH
50
In females, ____ stimulates follicular formation in the early stages of the menstrual cycle and at midcycle, LH surge causes _____ of the FSH ripened ovarian follicle.
FSH
Ovulation
51
Female sex hormone primarily involved in the preparation of the uterus for pregnancy and its maintenance during pregnancy.
Progesterone
52
Placenta begins producing progesterone at ____ weeks gestation.
12
53
Single best test to determine if ovulation has occurred
Levels rise for 4-5 days, then fall
Progesterone = testing for ovulation
54
_______ levels peak at the midluteal phase of the menstrual cycle?
progesterone
55
Responsible for the development of male secondary sexual characteristics
Secreted by ? and ?
Testosterone
Secreted by adrenals and testes/ovaries
56
Excessive production of testosterone
Men = ?
Women = ?
Both sexes: ?
Excessive production
Men = premature puberty
Women = Hirsutism, Polycystic ovaries
Both sexes: Adrenal tumors
57
Low levels of testosterone?
Low levels:
Hypogonadism, Testosterone deficiency affects peripheral mechanisms that are responsible for penile erections.
58
T/F - males should have no to trace amounts of PSA
False, normal amounts are in every adult male
59
PSA = ?
PSA is a glyco____ produced by _____ epithelial cells.
Prostate Specific Antigen
Glycoprotein produced by prostate epithelial cells
60
T/F - Digital examinations detected significantly more of the cancers than PSA
False, PSA (82%) vs digital exams (55%)
61
PSA levels may be elevated in men with ? but can be elevated even in benign conditions such as ? and ?
Prostate cancer, or benign prostatic hyperplasia (BPH) and prostatitis.
62
Two types of PSA levels?
Screening PSA
Diagnostic PSA - follow up to make sure levels are coming down with tx
63
For HIV:
The “opt-___” method is preferred over the “opt-___” method as the new standard of care.
CDC recommendations is to screen
ALL patients ages ____-_____ for HIV
And
ALL _____ women
Opt-out is better than opt-in
CDC recs. to screen 15-65 year olds and
all pregnant women
64
Serologic tests for HIV infection are based upon detection of ____ antibodies against HIV-____ antigens in serum.
IgG against HIV-1
65
HIV-specific IgG antibodies appear ___ to ____ weeks following HIV infection in the majority of patients and by six months in 95 percent of patients.
6-12 weeks
66
The standard screening assay LAB TEST for detecting antibodies to HIV is an enzyme _____ = “HIV _____"
A confirmatory “___________” is performed automatically without you needing to order anything if the screening test is positive.
Test results are then reported as positive, negative, or indeterminate.
Immunoassay (EIA) = HIV EIA
HIV Western blot, DO NOT NEED TO ORDER ANYTHING, AUTOMATIC
67
T/F - False positive tests are very rare and usually represent labeling errors.
The most common cause of a false negative HIV antibody test in a high-risk patient is that the assay is being conducted during the "window period" of acute HIV infection prior to seroconversion
(Improvements in testing methodology with third generation testing have reduced this "window period" to approximately three to six weeks.).
True
68
Later generation (4th gen HIV ____ antigen and HIV antibody test) combination HIV assays are NOW PREFERRED TESTING during AHI window period.
The advantage of these combination assays is their ability to detect HIV ____ antigen and HIV antibodies during acute infection when antibody formation may not yet be detected (eg, "window period of acute HIV infection").
NEWER TEST DETECTS HIV APPROX ____ DAYS AFTER INITIAL INFECTION.
p24
Now approx. 15 days after initial infection
69
Where do you swab for HIV?
In the outer gums with flat pad
69
Rapid HIV
Rapid serologic tests offer high diagnostic accuracy with the advantage of providing test results at the point of care.
Result available in ---- to ---- minutes, depending on type of test used
specimen testing can include ___, _____, _____.
The sensitivity of whole blood and oral specimens was very high (99.7 and 99.1 percent)
The specificity for whole blood and oral specimens was also high (99.9 and 99.6 percent).
5-40 mins
blood, plasma, saliva
70
This count is used to stage disease and guide clinical management for HIV care
CD4 T-cell laboratory testing
71
Although other viruses can chronically infect ____ cells, HIV is unique in that it selectively targets and infects activated, expanding ____ cells
CD4 T
72
In the untreated HIV-infected patient, CD4 T cells subsequently (increase/decline) over several years.
Significant depletion of CD4 T cells can lead to opportunistic infections and mortality in the untreated patient.
decline
73
T/F - Patients must receive HIV education and counseling by a medical provider
HIV consent forms are often mandatory by medical facilities that require patient’s signature and medical provider signature stating you had discussed HIV with them and how to inform pt of results confidentially.
True
74
A CD4 count of <____ cells/mm3 indicates the clinical stage of ____, which implies a high susceptibility to opportunistic infections, such as Pneumocystis pneumonia.
<200, AIDS
Normal is 800-1050
74
ENZYME released during cellular death
Where is it found
Lactate Dehydrogenase
Found in tissues of body, specifically kidney, heart, skeletal m., brain, liver, and lungs
75
High LDH = ?
Acute MI
Pulmonary infarction or other lung dx
CHF
Liver dx (end stage liver, hepatitis)
Skeletal m. dx (muscular dystrophy or other m. damage)
Shock
Renal infarction
76
Identifies the 5 isoenzymes of fractions of LDH
Sharpens diagnostic value of testing
Used as follow up test when high LDH found and indeterminate diagnosis remains
LDH Isoenzyme (Electrophoresis)
NEVER SCREENING TEST
77
Test results are used to assess the adequacy of oxygenation and ventilation of your patient
Used to evaluate acid-base status of your patient
Arterial Blood Gases (ABGs)
78
An ___ is a test that measures
the oxygen tension (PaO2),
carbon dioxide tension (PaCO2),
acidity (pH),
oxyhemoglobin saturation (SaO2),
and bicarbonate (HCO3) concentration in arterial blood.
Some blood gas analyzers also measure the methemoglobin, carboxyhemoglobin, and hemoglobin levels.
Such information is vital when caring for patients with critical illness or respiratory disease.
As a result, the ABG is one of the most common tests performed on patients in intensive care units (ICUs).
ABG
79
What is ordered to mark nonspecific inflammatory conditions for acute and chronic inflammation.
Erythrocyte Sedimentation Rate (ESR)
C-reactive protein (CRP)
80
Elevated CPR + ESR = ?
Lupus
Osteoarthritis or Rheumatoid Arthritis
Inflammatory Bowel disease
Osteomyelitis
81
indirect measurement of serum acute phase protein concentrations, particularly ______.
It is also influenced greatly by the size, shape, and number of red blood cells (RBC), as well as by other constituents in the blood such as immunoglobulins.
fibrinogen
ESR levels
82
It has long been known that anemia increases the sedimentation rate
As a patient’s condition worsens or improves, the ____ changes relatively slowly; by comparison, ____ concentrations change rapidly.
ESR = slowly, CRP = rapidly
83
Markedly elevated levels of CRP are strongly associated with ______.
infection
84
T/F - very important to note that there is no uniformity in the units that are used to report CRP levels, some labs use mg/dL and others mg/L.
Studies inconclusive on role in heart disease at this time
True
85
_____ is a biomarker whose characteristics (ie, its constant half-life) make it ideal as an indicator of acute ongoing inflammation.
Hs-CRP
High sensitivity C-reactive protein
86
A meta-analysis from the USPSTF demonstrated that hs-CRP >3 mg/dL was associated with 60% increased risk of ________.
The ACC/AHA have given hs-CRP screening in the decision to use a statin a Class IIa indication and a Class IIb recommendation for men >50 years and women >60 years.
Cardiovascular disease
87
____ is also an acute-phase reactant, it is often elevated in the course of disease.
A normal C-reactive protein can be used to exclude elevated _____ caused by acute phase reactions.
Ferritin
88
Elevated ferritin could be due to many chronic _____ diseases, but is nonspecific.
Low ferritin, as you recall, is typically diagnostic for ____.
Inflammation
IDA (Anemia)
89
Ddx is narrowed down to rheumatoid arthritis or lupus. What will you order?
RF (Rheumatoid factor)
90
Rheumatoid factor is elevated, and anti-CCP (Cyclic citrullinated peptides) is elevated = ?
Rheumatoid arthritis
MOST SPECIFIC FOR RHEUMATOID ARTHRITIS (98%) = Anti-CCP
91
Rheumatoid factor is elevated, and anti-CCP (Cyclic citrullinated peptides) is normal = ?
lupus
92
_____ are serologic hallmarks of patients with systemic autoimmune disease
Nonspecific marker
A positive _____ can be seen with systemic autoimmune diseases, organ-specific autoimmune diseases, and a variety of infections. Their presence does not mandate the presence of illness, since they can also be found in otherwise normal individuals.
ANA (Antinuclear antibodies)
93
Positive ANA shows a high sensitivity to inflammatory conditions like ?
systemic lupus erythematosus (SLE)
Scleroderma
Rheumatoid Arthritis
Mixed connective tissue disease
juvenile chronic arthritis
Autoimmune hepatitis
Primary biliary cirrhosis
94
Low levels are rare
High levels = decreased efficiency or renal ____ ____ excretion is responsible for about 85%
Uric Acid
95
High levels of uric acid are related to which conditions?
GOUT***
medications (diuretics)
kidney diseases
hypothyroidism
