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1

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

RIA
Immunodiometric
Chemiluminescence

2

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

20%
de-ionization

3

List the other biologically inactive forms of T4:

rT3
MIT
DIT

4

T/F
MIT and DIT are precursors to T3 and T4:

True

5

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

Thyroglobulin
protein

6

TSH is released in a ____ nature and exhibits ___:

pulsating
diurnal variation

7

Why is TSH a good biomarker for hypo/hyperthyroidism:

*long half life
*single measurement is adequate

8

___ serves as an antagonist to ____:

Calcitonin
PTH

9

~80% of thyroid hormones are bound to ___:

Thyroid binding hormone

10

List the 4 carrier proteins that bind thyroid hormones:

*thyroid binding hormone
*thyroid binding prealbumin
*albumin
*transthyretin

11

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

across cell membranes

12

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

first

13

Upper limit of TSH under debate, ranges between:

3 or 5

14

FT4 is ____ in hyper, ____ in hypo:

increased in hyper
decreased in hypo

15

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

FT4: 0.7 - 1.8
FT3: 0.2 - 0.5

16

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

Thyroid antibody
*Anti-TPO
*Anti-thyroglobulin

17

_____ and ____ can serve as markers for thyroid tumors:

Calcitonin and Thyroglobulin

18

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

T-uptake

19

The FTI test was used to estimate ___:

FT4

20

___is the the site of primary defect:

Thyroid gland

21

___ is the site of secondary defect:

Pituitary

22

___ is the site of tertiary defect:

Hypothalamus

23

____ means the thyroid is functioning normally:

Euthyroid

24

Hyperthyroidism can also be called ____:

Thyrotoxicosis

25

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

hyperthyroidism

26

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

hypothyroidism

27

T/F
Goiter may be present in both hypo/hyperthyroidism

True

28

Is thyrotoxicosis more common in males or females:

females

29

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

Hashimoto's Thyroiditis

30

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

T4

31

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

Graves

32

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

IgG
TSH

33

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

Thyroglobulin
Thyroid Peroxidase

34

Graves Disease affects females to males at this ratio:

5:1

35

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

Euthyroid Sick Syndrome

36

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

hypothyroidism
T4 and T3

37

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

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

38

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

FT4

39

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

PTH
Vit D

40

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

PTH

41

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

Calcitonin

42

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

Primary hyperparathyroidism

43

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

parathyroid
PTH

44

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

PTH

45

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

hyperplasia
PTH

46

Total calcium includes these 3 forms of calcium:

*Calcium bond to albumin/proteins
*Calcium
*'free' unbound calcium

47

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

*PTH
*Vit D

48

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

Heparin
anaerobically
ice

49

T/F
You can test the same sample for calcium and potassium:

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

50

Prolonged tourniquet use will increase ____Ca, but not ___Ca:

total Ca
Free Ca

51

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

decrease binding
increase free Ca

52

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

increase binding
decrease free Ca

53

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)

5%

54

Which cardiac marker stays elevated the longest:

Troponin T

55

Which cardiac marker rises first and falls first:

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

56

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

liver
(bone has normal 5')

57

List the 3 diseases classified as unconjugated hyperbilirubinemia:

*Criggler-Najjar
*Gilberts Disease
*Neonatal Jaundice

58

List the 2 diseases associated with conjugated hyperbilirubinemia:

*Dubin-Johnson
*Rotor Syndrom

59

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

unconjugated

60

Is bilirubin affected by hemolysis and light exposure:

Yes

61

Tetralogy of Fallot is a combo of __ defects:

4

62

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

ESRD

63

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

peaks 48 hrs
normal 10 days

64

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

*CK, AST, LDH
*Troponin, Myoglobin

65

Which stays elevated longer, TnT or TnI:

TnT

66

CK index <3 means ___, >6 means___:

muscle
cardiac

67

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

Troponin

68

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

Troponin (stays elevated the longest)

69

List the 3 markers of cardiac inflammation:

*CRP (non-specific)
*hsCRP (more cardiac specific,future risk)
*homocysteine

70

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

CHF

71

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

BNP
NT proBNP

72

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

MI

73

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

<20 neg
>20 pos

74

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

neg: pulmonary
pos: cardiac/CHF

75

Drawing for cardiac panel is done:

serially (timed intervals)

76

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

Digoxin
Lidocaine
*toxic

77

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

*increase contractions
*arrhythmias

78

What do you treat digoxin OD with:

digibind

79

BUN x ____= Urea

2.14

80

Is BUN or Creatinine affected by dietary protein:

BUN

81

Water is controlled via ___ and ___,
electrolytes are controlled via __ and ___:

water: osmolality, ADH
Elec: aldosterone, renin

82

___ responds to changes in BV, BP, hyponatremia:

Renin

83

___ responds to changes in blood O2:

EPO

84

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

prostaglandins

85

The renal threshold of glucose is typically:

160-180 mg/dL

86

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

Urea

87

Plasma BUN will be ___ in renal disease:

increased

88

___ is a waste product of purine metabolism:

Uric acid

89

Crea clearance will be ___ in renal disease:

decreased

90

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

biological variation

91

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

Creatinine Clearance

92

Ref range for crea clearance,
Males:
Females:

Males: 99-137
Females: 88-128

93

Myoglobin presence will cause ___ colored urine:

tea

94

Should protein/microalbumin get through the glomerulus:

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

95

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

Cystatin-C

96

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

Myoglobin

97

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

B2 Microglobulin

98

Acute glomerulonephritis is often related to this pathogen:

Group A beta hemolytic Strep

99

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

decreased
(Backing up into serum)

100

Renal hypertension leads to ___ perfusion:

decreased

101

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

Nephrotic syndrome

102

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

Nephrotic syndrome

103

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

regulate pH

104

T/F
You may see casts on UA in renal tubular disease:

True

105

Waxy casts are ___:

bad!

106

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

obstruction
concentrate urine
decreased

107

Acute renal failure is ___, while chronic is ___:

reversible
irreversible

108

___ is strongly associated with kidney failure:

diabetes

109

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

renin
increase Na+
decrease K+

110

List the hormones involved in pancreatic endocrine function:

Glucagon
Insulin
Somatostatin
Pancreatic polypeptide

111

Glucagon breaks down____ causing ___:

glycogen
glycogenolysis

112

List the 4 enzymes involved in the pancreatic exocrine function:

Secretin
CCK
Amylase
Lipase

113

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

endocrine: hormones
exocrine: enzymes

114

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

Amylase
Lipase

115

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

Secretin

116

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

CCK

117

T/F
There are isoenzymes for both salivary and pancreatic amylase:

True (S1 S2 S3, P1 P2 P3)

118

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

urine amylase

119

Elevated trigs can cause a false decrease in ___:

amylase
(trigs act to suppress or inhibit amylase)

120

No increase in amylase is seen in ___ or ___:

chronic pancreatitis
pancreatic tumor

121

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

Acute: AMY and LIP
Chronic: LIP

122

List three 'other' pancreatic function tests:

*Secretin/CCK
*Fecal Fat
*Sweat Cl-

123

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

Sweat Cl-

124

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

AMY (2+hrs, 24 hrs, 3+days)
LIP (8hrs, 24 hrs, 8+days)

125

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

Pancreatitis

126

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

No.

127

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

CFTR
CF

128

Is amylase increased in pancreatic tumors:

No

129

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

Head
(tail= vague symptoms)

130

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

Zollinger-Ellison syndrome
Plasma Gastrin

131

____ is increased in Zollinger-Ellison syndrome:

Plasma Gastrin