exam 2 old qs Flashcards
place in the correct order of vitamin D synthesis in tissue
- liver
- skin
- kidney
in order
- skin
- liver
- kidney
the biochemical findings of this disorder include: low blood calcium, low blood phosphate, hypocalciuria, vitamin D deficiency.
- secondary hyperparathyroidism
- grave’s disease
- primary hyperparathyroidism
- hyperparathyroidism
secondary hyperparathyroidism
with familial hypocalciuruic 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
elevation of urine calcium
- calcium sensors working at a higher concentration but still bodily normal
bone formation is mediated by:
- osteocalsts
- osteoblasts
- calcium sensing receptors
- parafolicular cells
osteoblasts
the most prevalent metabolic bone disease is:
- osteomalacia
- rickets
- osteoporosis
- milk alkali syndrome
osteoporosis
which of the following hormones regulates normal blood caliucm levels in the peripheral circulation
- vitamin D
- parathyroid hormone
- calcitonin
- PTH related protein
parathyroid hormone
which of the following is not a site of action for calcium regulation associated with parathyroid hormone
- bone
- kidneys
- adrenal
- small intestines (gut)
adrenal
the most common cause of hypoparathyroidism
- congenital
- autoimmune
- tumors
- neck surgery
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
- calcitonin
- cholesterol
- liver enzyme panel
PTHtP
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
all of the following are effects of PTH on the kidneys except
- increase the reabsoprtion of renal tubular calcium
- increase phosphate excretion
- enhance 1 alpha-hydroxylation of 25-hydroxy vitamin D
- increased water loss
increased water loss
all of the following are functions of calcium except
- blood coagulation
- verve cell transmission
- intercellular adhesion
- muscle repolarization
muscle repolarization
what is the most common cause of liver disease and failure in the US
- alcoholism
- viral hep B
- autoimmune hep
- hereditary hemochromatosis
alcoholism
these cells are macrophages that line the sinusoids of the liver
- lobules
- kupffer cells
- hepatocytes
- foam cells
kupffer cells
which of the following is not a function of the liver
- detoxification
- synthesis of serum proteins
- carbohydrate metabolism
- synthesis of hemoglobin
synthesis of hemoglobin
Bilirubin is bound by ______ in the plasma and transported to the liver for conjugation.
- Glucoronyl transferase
- albumin
- AST
- urobilinogen
albumin
true or false
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
- hepatic
- post hepatic
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 active replicating
- chronic hep B non replicating
- chronic hep C
- early acute infection hep B
chronic hep B non replicating
-> envelope antigen based
true or false
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 _______.
- appendix
- kidney
- gallbladder
- hepatic portal vein
gallbladder
true or false
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
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?
- hep A
- hep B
- hep C
- hep D
hep A
- fecal oral route common in kids
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 agglutination
- oxygen exposure
- light exposure
light exposure
what pecentage of people infected wiht Hep B develop chronic hepatitis
- 90
- 25
- 60
- 10
10
-> 90% of people recover
which hepatitis virus requires another hepatitis virus in order to replicate
- hep A
- hep C
- hep B
- hep D
hep D
- delta hep requires superinfeciton with hep B
which syndrome is epidemiologically linked to aspirin in children
- rotor’s
- reye’s
- kernicterus
- crigler-najjar
reye’s
the liver is a vascular organ that’s blood is drained by:
- hepatic artery
- portal vein
- hepatic vein
- common hepatic duct
hepatic vein
Which of the following conditions is caused by a decrease ability to remove conjugated bilirubin and is associated with delta bilirubin?
- Dublin Johnson
- Gilbert’s
- Crigler-Najjar
- Physiologic jaundice of the newborn
Dublin Johnson
- Johnson is a poor mover of packages
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 occure, the tubules ability to reabsorb _____ proteins is compromised, losing them in the urine concentrate
- small
- large
- A and B
- none of the above
small
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 strep
- GN caused by bacterial endocarditis
- GN caused by Goodpasture disease
- glomerulonephritis by lupus
GN by group A strep (ASO titer)
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 filters 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
based on the description is this proximal renal tubular acidosis or distal tubule acidosis
- Decreased bicarbonate reabsorption, results in hyperchloremic acidosis
proximal RTA
based on the description is this proximal renal tubular acidosis or distal tubule acidosis
- Renal tubules unable to keep up the vital pH gradient between the blood and tubular fluid
distal RTA
The eGFR is calculated using all of the following except
- age
- gender
- serum creatinine
- weight
weight
acte 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 expreiences 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
myoglobulin
which of the following is often cahracteristic of pyelonephritis
- white blood cell casts
- proteinuria
- calcium oxalate crystals
- hyaline casts
white blood cell casts
pre renal acute kidney injury is assocaited with:
- enlarged prostate
- glomerulonephritis
- renal calculi
- congestive heart failure
CHF
These types of cardiac insults can result in cardiac injury and elevated cardiac biomarkers
A. myocarditis
B. cardiomyopathies
C. wall stress
D. myocardial infarction
E. all of the above
all of the above
Which test, if elevated, would provide information about risk for developing coronary artery disease?
- troponin
- CKMB
- 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
- CKMB
- troponin T
myoglobin
Which of the following is false about cardiac troponin I as it relates to AMI?
- increases above the reference interval 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 CKMB level
- abnormal serum alk phos isoenzyme pattern
- blood collected upon presentation and serially for 3-6 hours
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 prompt lesion progression and counter lesion progression
- macrophages recognize and phagocytize OX LDL
- it is not an inflammatory process
it not not an inflammatory process
Which of the following biomarkers is utilized to aid in the diagnosis of a pulmonary embolism?
- troponinC
- D Dimer
- BNP
- 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?
- MI causing accident
- skeletal muscle injury from crash
- combo of crash injury and MI
- total CK and CKMB elevation indicate stroke
skeletal injry from 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:
- BNP
- myoglobin
- CKMB
- troponin I
BNP
