Exam 2 Flashcards
What is the correct order of synthesis of Vitamin D in the tissues?
Skin, liver, kidney
The biochemical findings of this disorder include: low blood calcium, low blood phosphate, hypocalciuria, vitamin D deficiency.
Secondary Hyperparathyroidism
With Familial Hypocalciuric Hypercalcemia, all of the following are expected clinical features with the exception of:
Elevation of urine calcium
Bone formation is mediated by:
Osteoblasts
The most prevalent metabolic bone disease is:
Osteoporosis
Which of the following hormones regulates normal blood calcium levels in the peripheral circulation?
Parathyroid hormone
Which of the following is not a site of action for calcium regulation associated with parathyroid hormone?
Small intestines (gut)
This is the most common cause of hypoparathyroidism.
Neck surgery
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?
PTHtP
This enzyme is responsible for converting 25(OH) Vitamin D in the kidney to 1,25(OH)2 Vitamin D.
1 alpha-hydroxylase
All of the following are effects of PTH on the kidneys except:
Increased water loss
All of the following are functions of calcium except:
Muscle repolarization
What is the most common cause of liver disease and failure in the U.S.?
Alcoholism
These cells are macrophages that line the sinusoids of the liver.
Kupffer cells
Which of the following is not a function of the liver?
Synthesis of hemoglobin
Bilirubin is bound by ______ in the plasma and transported to the liver for conjugation.
Albumin
(T/F) A major function of the liver is drug detoxification.
True
Bilirubin levels rarely exceed 5.0 mg/dL in this type of jaundice.
Pre-hepatic
If the results for serological markers include:
HBsAg +
Anti-HBs =
Anti-HBc (total) +
HBeAg =
Anti-HBe +
What would that indicate?
Chronic Hep B, non replicating
(T/F) Conjugated bilirubin is water insoluble and cannot be removed from the body.
False
Bile is synthesized in the liver and is stored and concentrated in the _______.
Gallbladder
(T/F) The liver is one of several organs that removes heme waste products from the body.
False
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?
8.4 mg/dL
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
This disease is a result of chronic scarring of hepatocytes.
Cirrhosis
What environmental variable affects bilirubin concentrations in-vitro?
Light exposure
What percentage of people infected with Hepatitis B develop chronic hepatitis?
10%
Which hepatitis virus requires another hepatitis virus in order to replicate?
Hep D
Which syndrome is epidemiologically linked to aspirin in children?
Reye’s
The liver is an extremely vascular organ that’s blood is drained by:
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
This type of jaundice will typically have increased levels of total bilirubin, conjugated bilirubin, and unconjugated bilirubin.
Post-hepatic
Which is not part of the fractions of bilirubin?
Beta
The glomeruli and proximal and distal tubules are located in the renal _____.
Cortex
What are causes of renal obstructions?
Kidney stones
Prostatic hypertrophy
Metastatic cancer
Scar tissue in the ureters
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)
What disease state is characterized by damage to glomeruli resulting in very large amounts of urine protein excretion?
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
What is the function of erythropoietin?
Production of red cells
What is not true about creatinine levels?
Plasma levels are highly dependent on diet
Describe Proximal RTA
Decreased bicarbonate reabsorption, results in hyperchloremic acidosis
Describe Distal RTA
Renal tubules unable to keep up the vital pH gradient between the blood and tubular fluid
The eGFR does not use ____ in its calculation
Weight
Acute kidney failure can be caused by all of the following except:
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.
Myoglobin
Which of the following is often characteristic of pyelonephritis?
White blood cell casts
Pre-renal acute kidney injury is associated with:
Congestive heart failure
Which test, if elevated, would provide information about risk for developing coronary artery disease?
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
Which of the following is false about myoglobin as it relates to acute myocardial infarction?
Cardiac specific
When an AMI occurs, the cardiac marker that is the first to return to normal is:
Myoglobin
Which of the following is false about cardiac troponin I as it relates to AMI?
Expressed in regenerating and diseased skeletal muscle and cardiac disorders
Which of the following is not associated with assessment of an AMI?
Abnormal serum alk phos isoenzyme pattern
Which of the following statements regarding atherosclerotic plaque is false?
It is not an inflammatory process
Which of the following biomarkers is utilized to aid in the diagnosis of a pulmonary embolism?
D-Dimer
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 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 T
This test is typically not used for cardiovascular risk stratification.
BNP/NT-proBNP
In general, the risks of cardiac adverse events are escalated when:
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)
