Exam 2 Flashcards by J Reyes

Place is the correct order of synthesis of Vitamin D in the tissues.

Skin
Kidney
Liver

Skin
Liver
Kidney

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The biochemical findings of this disorder include: low blood calcium, low blood phosphate, hypocalciuria, vitamin D deficiency.

Secondary Hyperparathyroidism
Grave’s disease
Primary Hyperparathyroidism
Hypoparathyroidism

Secondary Hyperparathyroidism

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With Familial Hypocalciuric Hypercalcemia, all of the following are expected clinical features with the exception of:

PTH mildly elevated
Demonstration of possible mutant CSR
Elevation of serum calcium
Elevation of urine calcium
All of the above are expected clinical features

Elevation of urine calcium

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Bone formation is mediated by:

Osteoclasts
Osteoblasts
Calcium sensing receptors
Parafollicular cells

Osteoblasts

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The most prevalent metabolic bone disease is:

Osteomalacia
Rickets
Osteoporosis
Milk alkali syndrome

Osteoporosis

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Which of the following hormones regulates normal blood calcium levels in the peripheral circulation?

Vitamin D
Parathyroid hormone
Calcitonin
PTH related protein

Parathyroid hormone

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Which of the following is not a site of action for calcium regulation associated with parathyroid hormone?

Bone
Kidneys
Adrenal
Small intestines (gut)

Adrenal

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This is the most common cause of hypoparathyroidism.

Congenital
Autoimmune
Tumors
Neck surgery

Neck surgery

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A 72 year old male patient presents to the ER with psychotic symptoms of anger and confusion, depression, and bouts of lethargy. The patient, although forgetful, had moments of clarity and was able to answer basic questions about family health, which included information regarding high cancer prevalence in the family. His providers ordered lab tests and the results are as follows: markedly increased calcium levels, undetectable PTH levels, normal kidney function biomarkers, slightly low vitamin D levels and normal intestinal mobility. What test should be ordered next?

PTHrP
Calcitonin
Cholesterol
Liver enzyme panel

PTHrP

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This enzyme is responsible for converting 25(OH) Vitamin D in the kidney to 1,25(OH)2 Vitamin D.

25-hydroxylase
UVB radiation
2 alpha-hydroxylase
1 alpha-hydroxylase

1 alpha-hydroxylase

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All of the following are effects of PTH on the kidneys except:

Increase the reabsorption of renal tubular calcium
Increase phosphate excretion
Enhance 1 alpha-hydroxylation of 25-hydroxy vitamin D
Increased water loss

Increased water loss

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All of the following are functions of calcium except:

Blood coagulation
Nerve cell transmission
Intercellular adhesion
Muscle repolarization

Muscle repolarization

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What is the most common cause of liver disease and failure in the U.S.?

Alcoholism
Viral hepatitis B
Autoimmune hepatitis
Hereditary hemachromatosis

Alcoholism

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These cells are macrophages that line the sinusoids of the liver.

Lobules
Kupffer cells
Hepatocytes
Foam cells

Kupffer cells

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Which of the following is not a function of the liver?

Detoxification
Synthesis of serum proteins
Carbohydrate metabolism
Synthesis of hemoglobin

Synthesis of hemoglobin

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Bilirubin is bound by ______ in the plasma and transported to the liver for conjugation.

Glucoronyl transferase
Albumin
AST
Urobilinogen

Albumin

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A major function of the liver is drug detoxification.

True
False

True

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Bilirubin levels rarely exceed 5.0 mg/dL in this type of jaundice.

Pre-hepatic
Hepatic
Post-hepatic

Pre-hepatic

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If the results for serological markers include:
HBsAg +
Anti-HBs =
Anti-HBc (total) +
HBeAg =
Anti-HBe +

What would that indicate?

Chronic Hep B, active replicating
Chronic Hep B, non replicating
Chronic Hep C
Early acute infection Hep B

Chronic Hep B, non replicating

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Conjugated bilirubin is water insoluble and cannot be removed from the body.

True
False

False

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Bile is synthesized in the liver and is stored and concentrated in the _______.

Appendix
Kidney
Gallbladder
Hepatic portal vein

Gallbladder

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The liver is one of several organs that removes heme waste products from the body.

True
False

False

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What is the indirect bilirubin concentration of a patient whose total bilirubin is 10.3 mg/dL and direct bilirubin is 1.9 mg/dL?

9.3 mg/dL
8.4 mg/dL
9.1 mg/dL
8.2 mg/dL

8.4 mg/dL

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A 3 year old child presents to the ER with severe diarrhea, vomiting, and yellowing of the sclera. The parents informed the doctor that the child goes to daycare and other children from the facility have similar symptoms. Based on these clinical manifestations, what is a probable diagnosis?

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D

Hepatitis A

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This disease is a result of chronic scarring of hepatocytes. Hepatitis Cirrhosis Kernicterus Jaundice

Cirrhosis

What environmental variable affects bilirubin concentrations in-vitro? Cold exposure Matrix agitation (aggressive mixing) Oxygen exposure Light exposure

Light exposure

What percentage of people infected with Hepatitis B develop chronic hepatitis? 90% 10% 25% 60% 10%

10%

Which hepatitis virus requires another hepatitis virus in order to replicate? Hep A Hep C Hep B Hep D

Hep D

Which syndrome is epidemiologically linked to aspirin in children? Rotor's Reye's Kernicterus Crigler-Najjar

Reye's

The liver is an extremely vascular organ that's blood is drained by: The hepatic artery The portal vein The hepatic vein The common hepatic duct

The hepatic vein

Which of the following conditions is caused by a decrease ability to remove conjugated bilirubin and is associated with delta bilirubin? Dubin-Johnson Syndrome Gilbert's Syndrome Crigler-Najjar Syndrome Physiologic jaundice of the newborn

Dubin-Johnson Syndrome

This type of jaundice will typically have increased levels of total bilirubin, conjugated bilirubin, and unconjugated bilirubin. Pre-hepatic Hepatic Post-hepatic

Post-hepatic

Which is not part of the fractions of bilirubin? Conjugated Unconjugated Delta Beta

Beta

The glomeruli and proximal and distal tubules are located in the renal _____. Pelvis Medulla Cortex None of the above

Cortex

Which of the following are causes of renal obstructions? Kidney stone Prostatic hypertrophy Metastatic cancer Scar tissue in the ureters All of the above

All of the above

When damage to the renal tubules occurs, the tubules ability to reabsorb _______ proteins is compromised, losing them in the urine concentrate. Small (low molecular weight) Large (high molecular weight) Both A and B None of the above

Small (low molecular weight)

What disease state is characterized by damage to glomeruli resulting in very large amounts of urine protein excretion? Uremic syndrome Renal tubular acidosis Nephrotic Syndrome Glomerulonephritis

Nephrotic Syndrome

A 12 year old girl presented to the ER with edema of the hands and feet, fatigue, and abdominal pain. her lab tests revealed elevated serum BUN and creatinine values and large amounts of blood and protein in her urinalysis. Upon further questioning, it was revealed by her parents that she had previously had ongoing issues with a sore throat for the past 4 weeks. Hearing this, her provider added an ASO titer to her previously drawn serum sample, revealing a very high antibody titer. Given this information, what disease state would be most probable for this patient? -Glomerulonephritis caused by group A beta-hemolytic strep -Glomerulonephritis caused by bacterial endocarditis -Glomerulonephritis caused by Goodpasture disease -Glomerulonephritis caused by lupus

Glomerulonephritis caused by group A beta-hemolytic strep

What is the function of erythropoietin? Production of white cells Production of renal stones Production of hepatocytes Production of red cells

Production of red cells

All of the following statements regarding creatinine are true except: -Rate of formation per day is relatively constant -It is completely filtered by the glomeruli -It is not reabsorbed by the renal tubules -Plasma levels are highly dependent on diet

Plasma levels are highly dependent on diet

Match the type of renal tubular acidosis with its description: Proximal RTA -Decreased bicarbonate reabsorption, results in hyperchloremic acidosis -Renal tubules unable to keep up the vital pH gradient between the blood and tubular fluid

Decreased bicarbonate reabsorption, results in hyperchloremic acidosis

Match the type of renal tubular acidosis with its description: Distal RTA -Decreased bicarbonate reabsorption, results in hyperchloremic acidosis -Renal tubules unable to keep up the vital pH gradient between the blood and tubular fluid

Renal tubules unable to keep up the vital pH gradient between the blood and tubular fluid

The eGFR is calculated using all of the following except: Age Gender Serum creatinine Weight

Weight

Acute kidney failure can be caused by all of the following except: Heavy metal exposure Hemorrhagic shock Diabetes mellitus Medication toxicities

Diabetes mellitus

When a patient experiences a crush injury, the release of this protein can overload the tubules of the nephron and is often associated with acute renal failure. Microalbumin Myoglobin Beta 2 microglobulin Cystatin C

Myoglobin

Which of the following is often characteristic of pyelonephritis? White blood cell casts Proteinuria Calcium oxalate crystals Hyaline casts

White blood cell casts

Prerenal acute kidney injury is associated with: Enlarged prostate Glomerulonephritis Renal calculi Congestive heart failure

Congestive heart failure

These types of cardiac insults can result in cardiac injury and elevated cardiac biomarkers. A. Myocarditis B. Cardiomyopathies C. Wall stress D. Myocardial infarction A, B and D B, C, and D All of the above

All of the above

Which test, if elevated, would provide information about risk for developing coronary artery disease? Troponin CK-MB hs-CRP Myoglobin

hs-CRP

This is the pathological state in which the heart fails to adequately supply the metabolic needs of the body, typically due to a decrease in pumping function. Heart failure Heart attack Pulmonary embolism Angina

Heart failure

Which of the following is false about myoglobin as it relates to acute myocardial infarction? Measure serially Cardiac specific Initial increase occurs in 1-3 hours Doubling of initial value within 1-2 hours suggestive of AMI

Cardiac specific

When an AMI occurs, the cardiac marker that is the first to return to normal is: Troponin I Myoglobin CK-MB Troponin T

Myoglobin

Which of the following is false about cardiac troponin I as it relates to AMI? -Increases above the reference interval seen in 3-6 hours -Measure initially and serially in 3-6 hour intervals -Can remain elevated for more than a week -Expressed in regenerating and diseased skeletal muscle and cardiac disorders

Expressed in regenerating and diseased skeletal muscle and cardiac disorders

Which of the following is not associated with assessment of an AMI? Elevated serum cTnI level Elevated CK-MB level Abnormal serum alk phos isoenzyme pattern Blood collected upon presentation and serually in 3-6 hour intervals

Abnormal serum alk phos isoenzyme pattern

Which of the following statements regarding atherosclerotic plaque is false? It most likely begins with vascular injury Foam cells both promote lesion progression and counter lesion progression Macrophages recognize and phagocytize oxidized LDL It is not an inflammatory process

It is not an inflammatory process

Which of the following biomarkers is utilized to aid in the diagnosis of a pulmonary embolism? Troponin C D-Dimer B-type natriuretic peptide Myoglobin

D-Dimer

A 68 year old male in an unconscious state is transported to the emergency department after being involved in a one-car crash, where he drove off the road and hit a tree. because he was alone at the time and there was no apparent cause of the accident, it is assumed that he blacked out, which caused him to lose control of the car. He was not wearing a seat belt and has a broken leg, multiple contusions, and cuts. Blood samples were drawn upon arrival to the ED and in 3 hour intervals for 12 hours. The results are as follows: Initial draw: myoglobin 57, total CK 112, CK-MB 3, cTnI 0.10 3-hour draw: myoglobin 140, total CK 170, CK-MB 6, cTnI 0.12 9-hour draw: myoglobin 281 , total CK 390, CK-MB 8, cTnI 0.11 Reference ranges: Myoglobin 30-90 ng/mL, Total CK 15-160 U/L, CK-MB 0-5 ng/mL, cTnI <0.40 ng/mL What do these results suggest? -The man had a myocardial infarction which causes the accident -The elevated results are from the skeletal muscle injuries sustained in the car crash -The elevated results are a combination of the car crash injuries and a myocardial infarction -The elevated total CK and CK-MB results indicate that the man had a stroke

The elevated results are from the skeletal muscle injuries sustained in the car crash

Which troponin protein constituent is responsible for the binding of the troponin complex to tropomyosin? Troponin I Troponin C Troponin E Troponin T

Troponin T

This test is typically not used for cardiovascular risk stratification. BNP/NT-proBNP Troponin I Homocysteine hs-CRP

BNP/NT-proBNP

In general, the risks of cardiac adverse events are escalated when: -Elevated troponin, reduced hs-CRP, elevated NT-proBNP -Elevated troponin, elevated hs-CRP, reduced NT-proBNP -Elevated troponin, elevated hs-CRP, elevated NT-proBNP -Reduced troponin, elevated hs-CRP, elevated NT-proBNP

Elevated troponin, elevated hs-CRP, elevated NT-proBNP

The biomarker that is used to distinguish cardiac from noncardiac causes of dyspnea is: B-type natriuretic peptide (BNP) Myoglobin CK-MB Troponin-I

B-type natriuretic peptide (BNP)