next Flashcards
1
Q
List the 1st, 2nd and 3rd generation TSH testing methods:
A
RIA
Immunodiometric
Chemiluminescence
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
3
Q
List the other biologically inactive forms of T4:
A
rT3
MIT
DIT
4
Q
T/F
MIT and DIT are precursors to T3 and T4:
A
True
5
Q
____is the main storage site of thyroid hormones, and is also the ____ precursor to the thyroid hormones:
A
Thyroglobulin
protein
6
Q
TSH is released in a ____ nature and exhibits ___:
A
pulsating
diurnal variation
7
Q
Why is TSH a good biomarker for hypo/hyperthyroidism:
A
- long half life
* single measurement is adequate
8
Q
___ serves as an antagonist to ____:
A
Calcitonin
PTH
9
Q
~80% of thyroid hormones are bound to ___:
A
Thyroid binding hormone
10
Q
List the 4 carrier proteins that bind thyroid hormones:
A
- thyroid binding hormone
- thyroid binding prealbumin
- albumin
- transthyretin
11
Q
FT3 and FT4 are metabolically active and free to travel ______:
A
across cell membranes
12
Q
Low levels of thyroid hormones in fetus in ____ trimester increase risk of mental and psychomotor deficits:
A
first
13
Q
Upper limit of TSH under debate, ranges between:
A
3 or 5
14
Q
FT4 is ____ in hyper, ____ in hypo:
A
increased in hyper
decreased in hypo
15
Q
Reference ranges for FT4 are ____, and FT3 are ____:
A
FT4: 0.7 - 1.8
FT3: 0.2 - 0.5
16
Q
____ is helpful in distinguishing between Hashimoto’s and Graves:
A
Thyroid antibody
- Anti-TPO
- Anti-thyroglobulin
17
Q
_____ and ____ can serve as markers for thyroid tumors:
A
Calcitonin and Thyroglobulin
18
Q
____ test measures available thyroid binding sites, provides an indirect measure of TBG, considered obsolete:
A
T-uptake
19
Q
The FTI test was used to estimate ___:
A
FT4
20
Q
___is the the site of primary defect:
A
Thyroid gland
21
Q
___ is the site of secondary defect:
A
Pituitary
22
Q
___ is the site of tertiary defect:
A
Hypothalamus
23
Q
____ means the thyroid is functioning normally:
A
Euthyroid
24
Q
Hyperthyroidism can also be called ____:
A
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
