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Residency Boards > Chemistry > Flashcards

Chemistry Flashcards

1
Q

What is the function of cystatin C

A

Measure GFR

*Endogenous substances used to determine GFR are urea nitrogen, creatinine and cystatin C

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2
Q

Pt has low serum cholinesterase level–what is next step in workup?

A

Test if cholinesterase can be inhibited by dubicaine

**In hereditary hypocholinesterasemia, cholinesterase will not be inhibited by dubicaine

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3
Q

Most common drug to cause drug-induced lupus?

A

procainamide

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4
Q

Which lipid tests are invalid if patient is not fasting?

A

triglycerides and calculated LDL

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5
Q

Where is DHEA-S produced?

A

adrenals

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6
Q

What type of bilirubin is water insoluble and bound to albumin in blood?

A

Unconjugated (indirect)

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7
Q

What type of bilirubin is water soluble?

A

conjugated (direct)

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8
Q

4 diagnostic criteria for DM

A

HbA1c >6.5%
FPG >126
OGTT 2 hr >= 200 (75g ora glucose load)
Random plasma glucose >=200

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9
Q

Which patients have macro CK type 1?

A

healthy elderly women

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10
Q

Which patients have mitochondrial CK (macro-ck type 2)?

A

advanced malignancy

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11
Q

What does prealbumin bind in the serum?

A

thyroxine (aka transthyretin)

retinol binding protein: vitamin A complex

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12
Q

Causes of pseudo M-spike on SPEP?

A 
Fibrinogen (incompletely clotted sample
hemoglobin (hemolyzed sample)
elevated CRP
elevated transferrin (beta area)
Medicaitons (antibiotics, radiocontrast agents)
Serum tumor markers (e.g. CA 19-9)
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13
Q

Define type 1 cryoglobulin

A

monoclonal immune globulin associated with MM or waldenstrom

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14
Q

Define type 2 cryoglobulin

A

mixture of monoclonal IgM and polyclonal IgG; IgM has rheumatoid factor activity (anti-IgG)
-most common type

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15
Q

Define type 3 cyroglobulin

A

mix of two polyclonal Ig’s, typically IgG and IgM; IgM has rheumatoid factor activity

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16
Q

What is the most common cause of mixed cryoglobulinemia (type 2+3)

A

HCV
Sx include leukocytoclastic vasculitis, arthralgia, LAD hepatosplenomegaly, anemia, sensorineural hearing deficits, MPGN type II

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17
Q

what medical conditions can cause pseudohyponatremia?

A

hypertriglyceridemia
hypercholesterolemia
hyperproteinemia
(due to decreased water content of plasma)

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18
Q

What cancers can secrete PTHrp?

A

SCC lung, head and neck, skin ,cervix and esophagus
breast ca
T cell lymphoma

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19
Q

What forms of PTH are biologically active?

A

intact PTH
N-terminal PTH
-rapidly cleared from blood T1/2=5 mins

20
Q

What is cause of increased BUN/creatinine ratio?

A

normal 10:1, if greater than 20:1 prerenal azotemia (due to hypoperfusion)

21
Q

Most common cause of false pos b-hCG

A

heterophile antibodies

22
Q

Quad screen showing low AFP, low uE, raised hCG and raised DIA

A

Trisomy 21 (Downs)

23
Q

Quad screen showing low AFP, hCG and uE

A

Trisomy 18 (edwards)

24
Q

Quad screen showing elevated AFP, normal hCG and low uE

A

NTD

25
Q

What is metabolite of serotonin (5-HT) that is produced by carcinoids?

A

5 hydroxyindoleacetic acid (5-HIAA)

excreted in urine

26
Q

What do foregut carcinoids produce?

A

histamine, catecholamines, 5 hydroxytryptophan (5-HTP)

27
Q

What do midgut carcinoids produce?

A

serotonin only

28
Q

What do hindgut carcinoids produce?

A

usually nothing! non-secretory

29
Q

VMA is a metabolite of what

A

norepi–>normetanephrine–>vanillylmandelic acid (VMA)

epi–>metanephrine–>VMA

30
Q

What two metabolites are elevated in neuroblastoma?

A

VMA and HVA (homovanillic acid; final breakdown product of dopamine)

31
Q

At what time points does cortisol trough and peak?

A

Trough midnight

Peak 8am

32
Q

TWO MOST COMMON CAUSE CONGENITAL ADRENAL HYPERPLASIA

A
  1. 21-HYDROXYLASE DEFICIENCY

2. 11-HYDROXYLASE DEFICIENCY

33
Q

What is responsible for the majority (70%) of kidney stones?

A

Calcium oxalate

34
Q

What metabolite is elevated in CAH

A

17 hydroxyprogesterone

35
Q

Increased osmolar gap but normal anion gap. What ingested?

A

isopropanol

36
Q

osmolar gap calcuation

A

osmolal gap=osmolarity measured-osmolarity calculated
=osmolarity measured-(2[Na]+glucose/18+BUN/2.8)
*normal=10

37
Q

Anion gap calculation

A

anion gap=Na-(Cl+HCO3)

38
Q

Causes if metabolic acidosis with increased anion gap?

A

MUDPILES

methanol, uremia, DKA, paraldehyde, lactic acidosis, ethylene glycol, salicylate

39
Q

Causes if metabolic acidosis with normal anion gap?

A

diarrhea, ureterosigmoidoscopy, NH4Cl, carbonic anhydrase inhibitors, TPN, RTA

40
Q

2 potential causes of increased osmolar gap and increased anion gap?

A

Methanol or ethylene glycol

41
Q

What inhibits prolactin secretion?

A

Dopamine

42
Q

Patient with elevated serum osmolarity, elevated serum sodium, and low urine osmolarity. When they are given a dose of ADH, their urine becomes concentrated (osmolarity increases from ~100 to ~700 mOsm/kg). What do they have?

A

Central diabetes insipidus

43
Q

Patient with lung disease with decreased serum osmolarity, decreased serum sodium, and elevated urine osmolarity. What do they have?

A

SIADH

44
Q

Which drug has benzoylecgonine as a metabolite

A

cocaine

45
Q

Which HLA types are associated with T1DM

A

HLA-DR3

HLA-DR4

46
Q

Which HLA types are associated with celiac

A

HLA-DQ2 95%

HLA-DQ8 5%

Residency Boards (9 decks)

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