Lecture 12 Hormones Flashcards

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1
Q

What are the four autoimmune laboratory tests?

A

erythrocyte sedimentation rate, c-reactive protein, antinuclear antibody, rheumatoid factor

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2
Q

What are the four autoimmune laboratory tests?

A

erythrocyte sedimentation rate, c-reactive protein, antinuclear antibody, rheumatoid factor

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3
Q

What are the indications for an ESR?

A

erythrocyte sedimentation rate; sed rate; does not tell you a diagnosis just tells you that something is wrong; marker for inflammation, infection, neoplasm, and tissue necrosis

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4
Q

What is the pathophysiology behind ESR test?

A

erythrocytes are negatively charged and therefore repel eachother; inflammation and infection can increase release of acute phase reactants therefor increasing the positive charge; the RBCs start to stack in the test tube making the ESR higher

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5
Q

In the case of inflammation and infection what are the two acute phase reactants that the body releases?

A

fibrinogen and immunoglobulin’s

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6
Q

What is the normal value for an ESR?

A

0-20 mm/h

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7
Q

What is the normal value for C-reactive protein?

A

0-10 mg/dL

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8
Q

What is the function of C-reactive protein?

A

recognizes and responds to inflammatory mediators and target damages tissue for clearance

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9
Q

What is the purpose of CRP-HS?

A

can detect small enough amounts of CRP to stratify risk for cardiac disease or future cardiovascular events

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10
Q

What is the ANA test important for diagnosing?

A

systemic lupus erythematosus (SLE)

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11
Q

What are the manifestations of SLE?

A

butterfly rash!, fatigue, weight loss, arthralgia. myalgias, lymphadenopathy, multiple organ involvement

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12
Q

What are the negative and positive values for ANA?

A

less than 1:40 dilution is negative…

greater than 1:160 is positive

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13
Q

What are some of the other diseases one could have with a positive ANA test?

A

SLE, progressive systemic sclerosis, rheumatoid arthritis, siogren syndrome, dermatomyoaitia, polyarteritis

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14
Q

What are the manifestations of scleroderma?

A

fatigue, arthralgia, myalgia, skin thickening and hardening, digital ulcers

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15
Q

What percent of people with a positive ANA will actually have lupus?

A

11-13%; shows that people with other disease can present with a positive ANA test

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16
Q

What are the systemic manifestations of rheumatoid arthritis?

A

fatigue, cardiovascular, renal, and others…

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17
Q

What is the normal value for rheumatoid factor?

A
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18
Q

How does rheumatoid arthritis differ from osteoarthritis?

A

it is caused by autoantibody destruction of joint tissue and has systemic manifestations

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19
Q

What is the rheumatoid factor predominantly composed of?

A

IgM antibodies that are directed against the portion of IgG antibody known as the Fc fragment

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20
Q

What disease is the rheumatoid factor increased with?

A

rheumatoid arthritis, other autoimmune disease, chronic infections, such as hepatitis, malignancy

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21
Q

What are the lab tests ordered for the thyroid gland?

A

TSH, T4, Free T4, T3, Free T3

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22
Q

What are the normal values for the thyroid stimulating hormone?

A

0.5-5.0 uIU/ mL

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23
Q

What is control of the thyroid gland controlled by?

A

hypothalamus and pituitary gland

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24
Q

What are the indications for an ESR?

A

erythrocyte sedimentation rate; sed rate; does not tell you a diagnosis just tells you that something is wrong; marker for inflammation, infection, neoplasm, and tissue necrosis

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25
Q

What is the pathophysiology behind ESR test?

A

erythrocytes are negatively charged and therefore repel eachother; inflammation and infection can increase release of acute phase reactants therefor increasing the positive charge; the RBCs start to stack in the test tube making the ESR higher

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26
Q

In the case of inflammation and infection what are the two acute phase reactants that the body releases?

A

fibrinogen and immunoglobulin’s

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27
Q

What is the normal value for an ESR?

A

0-20 mm/h

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28
Q

What is the normal value for C-reactive protein?

A

0-10 mg/dL

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29
Q

What is the function of C-reactive protein?

A

recognizes and responds to inflammatory mediators and target damages tissue for clearance

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30
Q

What is the purpose of CRP-HS?

A

can detect small enough amounts of CRP to stratify risk for cardiac disease or future cardiovascular events

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31
Q

What is the ANA test important for diagnosing?

A

systemic lupus erythematosus (SLE)

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32
Q

What are the manifestations of SLE?

A

butterfly rash!, fatigue, weight loss, arthralgia. myalgias, lymphadenopathy, multiple organ involvement

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33
Q

What are the negative and positive values for ANA?

A

less than 1:40 dilution is negative…

greater than 1:160 is positive

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34
Q

What are some of the other diseases one could have with a positive ANA test?

A

SLE, progressive systemic sclerosis, rheumatoid arthritis, siogren syndrome, dermatomyoaitia, polyarteritis

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35
Q

What are the manifestations of scleroderma?

A

fatigue, arthralgia, myalgia, skin thickening and hardening, digital ulcers

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36
Q

What percent of people with a positive ANA will actually have lupus?

A

11-13%; shows that people with other disease can present with a positive ANA test

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37
Q

What are the systemic manifestations of rheumatoid arthritis?

A

fatigue, cardiovascular, renal, and others…

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38
Q

What is the normal value for rheumatoid factor?

A

less than 30

39
Q

How does rheumatoid arthritis differ from osteoarthritis?

A

it is caused by autoantibody destruction of joint tissue and has systemic manifestations

40
Q

What is the rheumatoid factor predominantly composed of?

A

IgM antibodies that are directed against the portion of IgG antibody known as the Fc fragment

41
Q

What disease is the rheumatoid factor increased with?

A

rheumatoid arthritis, other autoimmune disease, chronic infections, such as hepatitis, malignancy

42
Q

What are the lab tests ordered for the thyroid gland?

A

TSH, T4, Free T4, T3, Free T3

43
Q

What are the normal values for the thyroid stimulating hormone?

A

0.5-5.0 uIU/ mL

44
Q

What is control of the thyroid gland controlled by?

A

hypothalamus and pituitary gland

45
Q

What is the thyrotropin- releasing hormone?

A

it is synthesized in the hypothalamus and transported to the pituitary where is stimulates the secretion of TSH

46
Q

What can T3 and T4 increase?

A

myocardial contractility and heart rate, mental alertness, ventilator drive, bone turnover, GI motility

47
Q

Why would you use the TSH test in conjunction with T3 and T4?

A

can identify origin of thyroid dysfunction, thyroid gland dysfunction or central

48
Q

What is primary hypothyroidism and what are the causes?

A

defect in the thyroid gland; autoimmune thyroiditis (Hashimoto’s thyroiditis) is most common cause

49
Q

What is secondary hypothyroidism and what are the causes?

A

less common than primary; decreases the secretion of TSH from pituitary or decrease TRH from hypothalamus; pituitary tumor, post-partum pituitary necrosis

50
Q

What are the symptoms of hypothyroidism?

A

fatigue, dull mentation, dry skin, weight gain, bradycardia, constipation, cold intolerance

51
Q

In hypothyroidism what happens to your TSH levels?

A

TSH level goes up

52
Q

What does the thyroid gland produce?

A

T3 and T4; produced 90% T4 and 10% T3

53
Q

Which thyroid hormone is more metabolically active?

A

T3

54
Q

How can T3 be formed in the tissues?

A

by conversion of T4 to T3

55
Q

What are the genetic and environmental causes of hashimoto’s thyroiditis?

A

hypothyroidism, thyroid failure, +/- goiter, follicular destruction

56
Q

What are the genetic and environmental causes of Grave’s disease?

A

hyperthyroidism, goiter, orbitopathy, pretibial myxedema

57
Q

What is the primary method for identifying autoimmune conditions?

A

identifying specific autoantibodies to each disease; also can evaluate acute phase reactants such as c-reactive protein and erythrocyte sedimentation rate

58
Q

What is Roulaeux?

A

stacking of RBCs

59
Q

What is a Westergren tube?

A

a sedimentation tube used in sed rate test

60
Q

What are some factors that can interfere with ESR results?

A

microcytosis or anemia can increase ESR; polycythemia can decrease ESR; abnormally shaped RBCs can decrease ESR

61
Q

What is the ESR that indicates infections?

A

if over 100 mm/hr

62
Q

What is mild C-reactive protein?

A

mild respiratory infection, pregnancy, post-exercise, obesity, depression

63
Q

What is moderate C-reactive protein?

A

myocardial infarction, malignancy, autoimmune disease, rheumatoid arthritis

64
Q

What is marked C-reactive protein?

A

overwhelming bacterial infection, severe trauma

65
Q

What is the pathophysiology behind ANA test?

A

antinuclear antibodies are identified through the use of indirect immunofluorescence; sample is diluted and the highest dilution at which the antinuclear antibodies are detected is reported as a result; the end point occurs when fewer than half the cells show antibody fluorescence

66
Q

What are the different patterns in an ANA test?

A

peripheral, diffuse, speckled, nucleolar

67
Q

What are the manifestations of polymyositis/ dermatomyositis?

A

proximal skeletal muscle weakness, pulmonary disease, dysphagia, polyarthritis, dermatologic manifestations

68
Q

What are other autoantibodies that can be measured and are more specific for SLE?

A

anti-phospholipid antibodies, anti-double-stranded DNA, anti-smith antibody

69
Q

What are other autoantibodies that can be measured and are more specific for Sjogren’s Syndrome?

A

anti-RO/ SSA, and Anti-LA/ SSB

70
Q

What antibodies is Rheumatoid factor predominantly composed of?

A

IgM antibodies directed against the portion of an IgG antibody known as the Fc fragment; can be caused by other antibodies against the IgG Fc fragment

71
Q

What percent of people with rheumatoid arthritis have rheumatoid factor?

A

60-80%

72
Q

What is the rheumatoid factor that is measured in lab tests?

A

IgM RF

73
Q

In predicting hypothyroidism or hyperthyroidism what should you measure?

A

TSH and more specifically serum free T4

74
Q

How can you differentiate between primary and secondary hypothyroidism?

A

if both TSH and free T4 is decreased then there may be a disorder of hypothalamus or pituitary gland which is secondary hypothyroidism

75
Q

What may a patient present with if they have subclinical hypothyroidism?

A

may have high normal or mildly elevated TSH with a normal free T4; there are nonspecific symptoms

76
Q

What is hyperthyroidism caused by?

A

increased secretion of thyroid hormones from thyroid gland

77
Q

What is the most common form of hyperthyroidism?

A

Grave’s Disease

78
Q

What is Grave’s Disease caused by?

A

autoantibodies (TRAb) that bind and activate TSH receptors of the thyroid gland -> leads to an inhibitory effect on the hypothalamic-pituitary axis and TSH level decreases

79
Q

What are some causes of hyperthyroidism?

A

Grave’s Disease, Hyperplasia of thyroid cells caused by toxic adenoma or toxic multinodular goiter, iodine rich medication such as amiodarone

80
Q

What are some symptoms of hyperthyroidism?

A

anxiety, tremors, palpitations, perspiration, heat intolerance, weight loss, hyperdefacation

81
Q

What are the antibodies that have been found to be associated with autoimmune thyroid conditions such as Hashimoto’s thyroiditis and Grave’s Disease?

A

thyroglobulin antibodies, thyroid peroxidase antibodies, thyrotropin (TSH) receptor antibodies

82
Q

Who is recommended for thyroid screening by the American thyroid association?

A

beginning at age 35 start screening every 5 years

83
Q

What is parathyroid hormone?

A

secreted in parathyroid gland in response to hypocalcemia; when serum calcium levels are low PTH increases

84
Q

What increases PTH?

A

hyperparathyroidism secondary to parathyroid cancer, hypocalcemia, chronic renal failure, malabsorption syndrome, vitamin D deficiency

85
Q

What decreases PTH?

A

surgical ablation or parathyroid gland, Hypercalcemia, metastatic bone tumor, Hypercalcemia of malignancy, Vitamin D intoxication

86
Q

What are the acute phase reactants helpful in evaluating autoimmune disease?

A

C-reactive protein and ESR

87
Q

What are the factors that can interfere with ESR?

A

microcytosis or anemia increase, polycythemia decrease, abnormally shaped RBCs decrease

88
Q

CRP

A

C-reactive protein

89
Q

What give a mild C-reactive protein?

A

mild respiratory infection, pregnancy, post-exercise, obesity, depression

90
Q

What can give a moderate C-reactive protein?

A

myocardial infarction, malignancy, autoimmune disease, rheumatoid arthritis

91
Q

What can give a marked C-reactive protein?

A

overwhelming bacterial infection, severe trauma

92
Q

autoimmune thyroiditis

A

hashimoto’s thyroiditis

93
Q

What are the antibodies that have been found to be associated with autoimmune thyroid diseases?

A

thyroglobulin antibodies, thyroid peroxidase antibodies, thyrotropin TSH receptor antibodies