Cardio/ pulm review

Question 1

_____________ is very sensitive and specific for liver disease

Answer 1

ALT

Question 2

What are the most sensitive indicators of acute hepatocellular injury (increase ~1 week before serum bilirubin)?

Answer 2

ALT and AST

Question 3

In liver cirrhosis and alcoholic hepatitis, is AST or ALT usually more elevated?

Answer 3

AST (Aspartate Aminotransferase)

Question 4

What is used to diagnose liver and bone disorders and is the most sensitive test for cancer metastasis to the liver?

Answer 4

Alkaline Phosphatase (ALP)

Question 5

Which is more sensitive or specific for liver disease, ALT or AST?

Answer 5

Aspartate Aminotransferase (AST)

Question 6

Albumin is a ____________ acute phase reactant

Answer 6

Negative

Question 7

What does a lipid profile include?

Answer 7

Total cholesterol (TC)
Triglycerides (TGs)
High-Density Lipoprotein Cholesterol (HDL-C)
Low-Density Lipoprotein Cholesterol (LDL-C)

Question 8

1) What should total cholesterol be?
2) What should HDL be?
3) What should LDL be?
4) What abt triglycerides?

Answer 8

1) <200 mg/dL
2) >60 mg/ dL
3) <100 mg/ dL
4) <150 mg/dL

Question 9

Severe hypertriglyceridemia (>500 mg/dL) can cause what?

Answer 9

acute pancreatitis

Question 10

List 3 Cardiac Enzymes (Cardiac Biomarkers)

Answer 10

1) Creatine (phospho)kinase (CK, CPK)
2) Myoglobin
3) Troponins

Question 11

1) CK-MM is where?
2) CK-BB?
3) CK-MB?

Answer 11

1) Skeletal muscle
2) Brain
3) Heart

[High serum CK is indicative of release from damage to CK-rich tissue]

Question 12

CK-MB generally begins to rise ________ hours after onset of MI, lasts 36-48 hours (returns to normal more quickly than troponin), and is sensitive but not specific

Answer 12

4-6

Question 13

_____________ rises within 3 hours, is gone within 6-8 hours, and is more sensitive than CK-MB but not as specific

Answer 13

Myoglobin

Question 14

1) What is elevated in rhabdomyolysis?
2) What turns the urine red/brown?

Answer 14

1) Myoglobin
2) Myoglobin
[Myoglobinuria: positive urine dipstick for “blood” (contains heme) but no RBCs on urine sediment microscopy (not hematuria)]

Question 15

What measurement has the following advantages?:

1) Extremely specific (more than CK-MB) for myocardial cell injury
2) More sensitive
3) Becomes elevated sooner and lasts longer
4) Increased window for diagnosis

Answer 15

Troponins (TnT and TnI)

Question 16

Describe the duration of troponin

Answer 16

1) “Sensitive”/“contemporary” assays:
Rises: 2-3 hours after injury
2) “High sensitivity” (hs) TnT:
Newer test with increased sensitivity for cardiac myocyte necrosis
Detects infarct as early as 90 minutes after onset
Duration: 7-14 days

Question 17

B-Type Natriuretic Peptide (BNP) does what?

Answer 17

Increased diuresis, natriuresis, and vascular smooth muscle relaxation (vasodilation)

Question 18

What does increased BNP indicate? What is it used to evaluate?

Answer 18

Too much pressure in the ventricles (especially left); congestive heart failure (CHF)

Question 19

Most dyspneic pt’s with HF have ΒΝΡ value >______ pg/mL

Answer 19

400

Question 20

What are the 3 potential causes of an exudative effusion?

Answer 20

1) Infection (e.g., bacterial pneumonia, TB)
2) Inflammation
3) Cancer

Question 21

List 4 causes of transudative effusion

Answer 21

CHF
Cirrhosis (liver disease)
Nephrotic syndrome (kidney disease)
Hypoalbuminemia

Question 22

Differentiate between causes of transudative and exudative effusion

Answer 22

1) Due to increased hydrostatic or decreased oncotic pressures (with normal capillaries)
2) Due to increased capillary permeability (e.g., pneumonia, tumors) or impaired lymphatic drainage (e.g., sarcoidosis)

Question 23

Which is usually unilateral, transudative or exudative effusion?

Answer 23

Exudative

Question 24

List light’s criteria

Answer 24

Pleural fluid protein/serum protein ratio >0.5
Pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio >0.6
Pleural fluid LDH level >2/3 the upper limit of the laboratory’s reference range of serum LDH

Question 25

Name a cytoplasmic enzyme present in tissues throughout body that can be used to eval. hemolysis (highest concentration in heart, muscle, kidney, lung, and RBCs)

Answer 25

LDH

Question 26

1) What triggers ADH? 2) Does a neurogenic or nephrogenic cause of diabetes insipidus respond to ADH? [by increasing urine osmolarity] 3) When should you measure GH?

Answer 26

1) Increase in serum osmolarity or decrease in blood volume 2) Neurogenic 3) At night

Question 27

1) What is the issue when a pt has diabetes insipidus? 2) What is the medical term for "drinking too much water"? 3) What is used to differentiate neurogenic (central) diabetes insipidus vs nephrogenic diabetes insipidus?

Answer 27

1) Not enough ADH 2) Primary (psychogenic) polydipsia 3) ADH stimulation test (aka “vasopressin challenge test”, water deprivation test)

Question 28

Measuring ____________ gives a more accurate reflection of GH

Answer 28

IGF-1

Question 29

What is the opposite of Cushing syndrome? 2) “Endogenous” Cushing syndrome refers to what?

Answer 29

1) Adrenal Insufficiency: Underproduction of cortisol 2) Increased cortisol production by the adrenal cortex

Question 30

1) ACTH-independent/ primary endogenous Cushing syndrome [less common] is usually due to what? 2) What is the issue with secondary endogenous Cushing syndrome? 3) When are Cortisol levels lowest?

Answer 30

1) Adrenal adenoma or carcinoma 2) Pituitary hypersecretion of ACTH 3) At night/ evening

Question 31

Overnight low-dose dexamethasone suppression test (DЅТ): What should the result be if a pt does NOT have Cushing?

Answer 31

Early morning cortisol level is low (suppressed)

Question 32

Describe how to interpret measuring plasma ACTH (and DHEAS) to differentiate ACTH-dependent vs. ACTH-independent

Answer 32

1) High cortisol, low ACTH, low DHEAS = **ACTH-independent** (i.e., adrenal source) 2) High cortisol, high ACTH, high DHEAS = **ACTH-dependent** (i.e., pituitary tumor or SCLC) I.e. if ACTH is low, ACTH is not the problem

Question 33

If a pt has ACTH-dependent Cushing, you need to differentiate pituitary vs. non-pituitary (ectopic) source of ACTH. How?

Answer 33

High-dose (8 mg) DST: Cortisol level low (suppressed) = pituitary source Cortisol level high (not suppressed) = ectopic source (SCLC)

Question 34

1) Primary adrenal insufficiency (Addison disease): caused by dysfunction or absence of what? 2) Central adrenal insufficiency is caused by what?

Answer 34

1) Adrenal cortices 2) Pituitary or hypothalamus [exogenous use of glucocorticoids or opiates usually affects these]

Question 35

How do you differentiate between primary and central hypocortisolism/ adrenal insufficiency?

Answer 35

High ACTH (with low cortisol) = primary Low ACTH (with low cortisol) = central

Question 36

What should you do to confirm a Dx of primary adrenal insufficiency?

Answer 36

cosyntropin (synthetic ACTH) stimulation test Healthy pt: cortisol rises significantly Primary Adrenal insufficiency: cortisol does not rise significantly (adrenals unable to respond to stimulus)

Question 37

1) _____ surge indicates ovulation 2) PRL is used to monitor PRL-secreting ___________ adenomas

Answer 37

1) LH 2) pituitary

Question 38

Trauma, tumor, infarction can cause what kind of hypothyroidism?

Answer 38

Secondary

Question 39

The best initial screening test (most sensitive) for evaluation for primary hypo- and hyperthyroidism, and the best test for monitoring T4 replacement therapy (e.g., in treatment of hypothyroidism), is what?

Answer 39

TSH

Question 40

1) What does PTH do? 2) Hyperparathyroidism may result from what? 3) What is HbA1C in prediabetes?

Answer 40

1) Increase plasma calcium. 2) The best initial screening test (most sensitive) for evaluation for primary hypo- and hyperthyroidism the best test for monitoring T4 replacement therapy (e.g., in treatment of hypothyroidism). 3) 5.7–6.4

Question 41

1) What is OGTT in prediabetes? 2) What is FPG (fasting plasma glucose) in prediabetes? 3) What is the preferred test for gestational diabetes? 4) When is gestational diabetes tested for?

Answer 41

1) 140–199 2) 100–125 3) OGTT 4) 24-28 wks

Question 42

You do 50-g oral glucose load given (without regard to previous meals/time of day) and plasma glucose level obtained at 1 hour. The result is abnormal. What is the next step?

Answer 42

3 hour fasting 100-g OGTT (more specific)