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List the 1st, 2nd and 3rd generation TSH testing methods:
RIA
Immunodiometric
Chemiluminescence
__% of T3 is derived from the Thyroid gland, the rest comes from the ____of T4 from liver, kidney, and muscle:
20%
de-ionization
List the other biologically inactive forms of T4:
rT3
MIT
DIT
T/F
MIT and DIT are precursors to T3 and T4:
True
____is the main storage site of thyroid hormones, and is also the ____ precursor to the thyroid hormones:
Thyroglobulin
protein
TSH is released in a ____ nature and exhibits ___:
pulsating
diurnal variation
Why is TSH a good biomarker for hypo/hyperthyroidism:
- long half life
* single measurement is adequate
___ serves as an antagonist to ____:
Calcitonin
PTH
~80% of thyroid hormones are bound to ___:
Thyroid binding hormone
List the 4 carrier proteins that bind thyroid hormones:
- thyroid binding hormone
- thyroid binding prealbumin
- albumin
- transthyretin
FT3 and FT4 are metabolically active and free to travel ______:
across cell membranes
Low levels of thyroid hormones in fetus in ____ trimester increase risk of mental and psychomotor deficits:
first
Upper limit of TSH under debate, ranges between:
3 or 5
FT4 is ____ in hyper, ____ in hypo:
increased in hyper
decreased in hypo
Reference ranges for FT4 are ____, and FT3 are ____:
FT4: 0.7 - 1.8
FT3: 0.2 - 0.5
____ is helpful in distinguishing between Hashimoto’s and Graves:
Thyroid antibody
- Anti-TPO
- Anti-thyroglobulin
_____ and ____ can serve as markers for thyroid tumors:
Calcitonin and Thyroglobulin
____ test measures available thyroid binding sites, provides an indirect measure of TBG, considered obsolete:
T-uptake
The FTI test was used to estimate ___:
FT4
___is the the site of primary defect:
Thyroid gland
___ is the site of secondary defect:
Pituitary
___ is the site of tertiary defect:
Hypothalamus
____ means the thyroid is functioning normally:
Euthyroid
Hyperthyroidism can also be called ____:
Thyrotoxicosis
Excess thyroid hormone ingestion, leakage of stored thyroid hormone, or excess gland production of hormone all can cause ___:
hyperthyroidism
____ can be caused by autoimmunity, iodine deficiency, or radioactive iodine treatment:
hypothyroidism
T/F
Goiter may be present in both hypo/hyperthyroidism
True
Is thyrotoxicosis more common in males or females:
females
This is an autoimmune condition commonly associated with permanent primary hypothyroidism:
Hashimoto’s Thyroiditis
Hashi’s results in insufficient __ to tissues due to cell and antibody mediated destruction of thyroid tissue:
T4
This is an autoimmune disorder characterized by diffuse, toxic hyperplasia, :
Graves
Grave’s disease is caused by ___ antibody to ____:
IgG
TSH
90% of Hashi’s patients will have antibodies to ___ or _____:
Thyroglobulin
Thyroid Peroxidase
Graves Disease affects females to males at this ratio:
5:1
Illness may be seen in severely ill patients, where TSH or thyroid hormones are abnormal, but thyroid gland is functioning normally:
Euthyroid Sick Syndrome
Euthyroid sick syndrome often simulates ___, the very sick will show significant decline in __ :
hypothyroidism
T4 and T3
Euthyroid sick syndrome in acute and chronic illness will show decrease in __ and ___, increase in ___, and normal ___ and ___:
D: T3, FT3
I: rT3
N: T4, TSH
___ is the most reliable indicator of thyroid function in hospitalized patients:
FT4
___ and ___ are the 2 most important hormones in calcium regulation:
PTH
Vit D
____ is synthesized and secreted by parathyroid glands, acts directly on bone and kidney to increase Ca:
PTH
___ has pharmacological effects, physio role is unknown, it is released from the thyroid gland and increases in thyroid cancer:
Calcitonin
___ is typically caused by an adenoma of the parathyroid gland, you will see increased PTH/serum and urine Ca/Vit D, and decreased phosphorous:
Primary hyperparathyroidism
If blood calcium is low, _____ will increase secretion of ____, kidneys will increase reabsorption of Ca, and decrease phosphate reabsorption:
parathyroid
PTH
If blood calcium is high, secretion of ___ is suppressed, kidneys decrease reabsorption of Ca, and mobilization of Ca from bone is decreased:
PTH
Overstimulation of the parathyroid glands can lead to ____ and overproduction of ___:
hyperplasia
PTH
Total calcium includes these 3 forms of calcium:
- Calcium bond to albumin/proteins
- Calcium
- ‘free’ unbound calcium
Free calcium is biologically active and controlled by ___ and ____, is considered the best indicator of calcium status:
- PTH
* Vit D
The only acceptable sample for calcium testing is ___, and it must be handled ____ and transported on ___:
Heparin
anaerobically
ice
T/F
You can test the same sample for calcium and potassium:
False.
Calcium needs to be stored on ice, but ice will increase potassium levels in sample.
Prolonged tourniquet use will increase ____Ca, but not ___Ca:
total Ca
Free Ca
Decrease in pH will _____ the calcium binding to proteins, which will _____ the free calcium in the sample:
decrease binding
increase free Ca
Increase in pH will ____ the calcium binding in proteins, which will ____ the free calcium in the sample:
increase binding
decrease free Ca
Calcium will change ___% for every .1 change in pH, which is why pH is reported with free calcium:
(used to verify proper handling of sample)
5%
Which cardiac marker stays elevated the longest:
Troponin T
Which cardiac marker rises first and falls first:
Myoglobin
rises 1-4 hrs, peaks 6 hrs, falls ~24 hours
High LDH plus high 5’ nucleotidase points to bone or liver:
liver
bone has normal 5’
List the 3 diseases classified as unconjugated hyperbilirubinemia:
- Criggler-Najjar
- Gilberts Disease
- Neonatal Jaundice
List the 2 diseases associated with conjugated hyperbilirubinemia:
- Dubin-Johnson
* Rotor Syndrom
What would be high in neonatal jaundice, conj or unconj?
unconjugated
Is bilirubin affected by hemolysis and light exposure:
Yes
Tetralogy of Fallot is a combo of __ defects:
4
Troponin T stays elevated longer than TnI, but can also be elevated in patients with:
ESRD
The LD flip peaks at ___ and is back to normal in __:
peaks 48 hrs
normal 10 days
List the 3 cardiac enzymes, and the two contractile proteins:
- CK, AST, LDH
* Troponin, Myoglobin
Which stays elevated longer, TnT or TnI:
TnT
CK index <3 means ___, >6 means___:
muscle
cardiac
This contractile protein binds calcium and regulates muscle contraction, is considered the gold standard:
Troponin
Which cardiac marker is best for catching old MI’s that didn’t come to the ER:
Troponin (stays elevated the longest)
List the 3 markers of cardiac inflammation:
- CRP (non-specific)
- hsCRP (more cardiac specific,future risk)
- homocysteine
Natriuretic peptides are hormones that play an important role in cardiac homeostasis, and are markers for ___:
CHF
Stretching caused by increased fluid volume in CHF results in release of ___ and __:
BNP
NT proBNP
BNP is a marker for ___ and is also used to assess prognosis of those with ___:
MI
BNP <20 probs ___ for CHF, >20 probs ___ for CHF:
<20 neg
>20 pos
BNP is also used to distinguish cause of dyspnea, will be negative if ____ cause, will be positive if ___associated CHF:
neg: pulmonary
pos: cardiac/CHF
Drawing for cardiac panel is done:
serially (timed intervals)
List th*e two cardiac meds that need to measured since too much is ___:
Digoxin
Lidocaine
*toxic
Digoxin is used to _____, while Lidocaine is given for _____:
- increase contractions
* arrhythmias
What do you treat digoxin OD with:
digibind
BUN x ____= Urea
2.14
Is BUN or Creatinine affected by dietary protein:
BUN
Water is controlled via ___ and ___,
electrolytes are controlled via __ and ___:
water: osmolality, ADH
Elec: aldosterone, renin
___ responds to changes in BV, BP, hyponatremia:
Renin
___ responds to changes in blood O2:
EPO
___ are cyclic fatty acids that increase renal blood flow, control renin release, and oppose renal vasoconstriction:
prostaglandins
The renal threshold of glucose is typically:
160-180 mg/dL
___ is up to 75% of all non-protein nitrogen:
Urea
Plasma BUN will be ___ in renal disease:
increased
___ is a waste product of purine metabolism:
Uric acid
Crea clearance will be ___ in renal disease:
decreased
Creatinine clearance/GFR exhibits ____, random fluctuations around homeostatic setpoint:
biological variation
___ will decrease with age, 6.5mL/min for each decade of life:
Creatinine Clearance
Ref range for crea clearance,
Males:
Females:
Males: 99-137
Females: 88-128
Myoglobin presence will cause ___ colored urine:
tea
Should protein/microalbumin get through the glomerulus:
No. It is an early sign of kidney disease and can document the progression of disease.
___ is relatively stable and can be elevated before decrease in GFR or increase in crea, but isnt commonly used due to price:
Cystatin-C
Large increase of this protein in urine can overload proximal tubules and lead to acute renal failure (rhabdo):
Myoglobin
___ is a small non-glycosylated protein on the surface of most nucleated cells, an increase in this could indicate organ rejection:
B2 Microglobulin
Acute glomerulonephritis is often related to this pathogen:
Group A beta hemolytic Strep
Increased serum creatinine, and decreased crea clearance means ___ GFR:
decreased
Backing up into serum
Renal hypertension leads to ___ perfusion:
decreased
_____: several different diseases/conditions that injure and increase permeability of glomerular basement membrane:
Nephrotic syndrome
Proteinuria, hematuria, edema due to loss of albumin, hyperlipidemia, oval fat bodies in urine, and increases in Alpha 2 and beta:
Nephrotic syndrome
The most important manifestation of renal tubular disease is that the kidneys cannot ____:
regulate pH
T/F
You may see casts on UA in renal tubular disease:
True
Waxy casts are ___:
bad!
With a renal __, the kidneys lose the ability to ___, and renal blood flow is ___:
obstruction
concentrate urine
decreased
Acute renal failure is ___, while chronic is ___:
reversible
irreversible
___ is strongly associated with kidney failure:
diabetes
Renal hypertension decreases blood perfusion through kidney, the change in blood volume will stimulate the release of ___, increasing serum__, and decreasing serum ___:
renin
increase Na+
decrease K+
List the hormones involved in pancreatic endocrine function:
Glucagon
Insulin
Somatostatin
Pancreatic polypeptide
Glucagon breaks down____ causing ___:
glycogen
glycogenolysis
List the 4 enzymes involved in the pancreatic exocrine function:
Secretin
CCK
Amylase
Lipase
Pancreatic endocrine system involves ___, and the exocrine system involves ___:
endocrine: hormones
exocrine: enzymes
___ breaks down starch and glycogen, ___ breaks down trigs:
Amylase
Lipase
___ produces bicarbonate rich pancreatic fluid that protects intestinal lining from HCL:
Secretin
___ helps stimulate further release of digestive enzymes, combines with fats and lipids in the duodenum:
CCK
T/F
There are isoenzymes for both salivary and pancreatic amylase:
True (S1 S2 S3, P1 P2 P3)
True increase in serum Amylase will also show increase in ___:
urine amylase
Elevated trigs can cause a false decrease in ___:
amylase
trigs act to suppress or inhibit amylase
No increase in amylase is seen in ___ or ___:
chronic pancreatitis
pancreatic tumor
Acute pancreatitis will see an increase in _____, while chronic pancreatitis will see an increase in ___:
Acute: AMY and LIP
Chronic: LIP
List three ‘other’ pancreatic function tests:
- Secretin/CCK
- Fecal Fat
- Sweat Cl-
> 60mmol/L of this test is dx for CF:
Sweat Cl-
List the rise, peak, and return to normal of AMY and LIP in acute pancreatitis:
AMY (2+hrs, 24 hrs, 3+days)
LIP (8hrs, 24 hrs, 8+days)
This disease is defined as an autodigestion of the pancreas due to reflux of bile or duodenal contents into pancreatic duct:
Pancreatitis
Do peaks in lovers of pancreatic enzymes relate to the severity of pancreatitis:
No.
____ genes encode instructions for ion channel that transports Cl- in and out of the cells, gene mutation causes ___:
CFTR
CF
Is amylase increased in pancreatic tumors:
No
In pancreatic carcinoma, is the tail or head associated with more symptoms and likelier to detect sooner:
Head
tail= vague symptoms
This syndrome causes hypersecretion of gastric volume (gastric excreting tumor), detected via ____:
Zollinger-Ellison syndrome
Plasma Gastrin
____ is increased in Zollinger-Ellison syndrome:
Plasma Gastrin
