Quiz 2: Inflammatory

Question 1

What are the four autoimmune lab tests?

Answer 1

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

Question 2

What is ESR used for?

Answer 2

non-specific test used as a marker for inflammation, infection, neoplasm, and tissue necrosis or infarction

Question 3

Is ESR constant?

Answer 3

No, frequent false elevations

Question 4

Normally, erythrocytes are (x) charged and therefore (x) eachother

Answer 4

• negatively charged

- repel

Question 5

In cases of inflammation or infection, the body releases X, including x and x.

Answer 5

the body releases acute phase reactants, including fibrinogen and immunoglobulins (antibodies)

Question 6

Acute phase reactants are x charged

Answer 6

positively charged

Question 7

When acute phase reactants are released, the environment around RBC becomes more x which leads to x

Answer 7

neutral which leads to “stacking of RBCs”

Question 8

Stacking of RBCs is called

Answer 8

Rouleaux formation

Question 9

How is ESR performed?

Answer 9

blood is aspirated into a sedimentation tube (westergren tube), blood separates into plasma and RBCs over 60 minutes, the amount of “settling” is measured

Question 10

Normal ESR value

Answer 10

0-20 mm/h

Question 11

A higher ESR level corresponds to:

Answer 11

more stacking of RBCs = more antibodies or inflammation

Question 12

Factors that can increase ESR (RBC)

Answer 12

microcytosis or anemia (fewer or smaller RBCs present–falls farther)

Question 13

Factors that decrease ESR (RBC)

Answer 13

More RBCs (polycythemia), abnormally shaped RBCs such as sickle cell (don’t “fall” well)

Question 14

ESR is elevated in:

Answer 14

inflammatory states, autoimmune disease, obesity, malignancy, age, infection (serious)

Question 15

C-reactive protein is an

Answer 15

acute phase reactant

Question 16

Function of c-reactive protein

Answer 16

recognize and respond to inflammatory mediators and target damaged tissue for clearance and also activate complement system

Question 17

A CRP level above x is likely to be significant

Answer 17

10 mg/dL

Question 18

A CRP level above x is a fairly sensitive and specific indicator that there is an overwhelming bacterial infection present

Answer 18

50 mg/dL

Question 19

C-reactive protein >10 (mild)

Answer 19

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

Question 20

Moderate C-reactive protein level

Answer 20

MI, malignancy, autoimmune disease, RA

Question 21

Marked C-reactive protein level >50

Answer 21

overwhelming bacterial infection, severe trauma

Question 22

ANA =

Answer 22

antinuclear antibody

Question 23

ANA test measures

Answer 23

the presence of autoantibodies towards proteins that are specific to the nucleic acids or complexes infolved with DNA or RNA

Question 24

ANA is important in the diagnosis of

Answer 24

systemic lupus erythematosus (SLE)

Question 25

What is SLE?

Answer 25

a chronic inflammatory disease that affects multiple joints and organs and is caused by an autoimmune process

Question 26

What is not impacted in the butterfly rash?

Answer 26

Nasolabial folds

Question 27

What is impacted in progressive systemic sclerosis (scleroderma)?

Answer 27

skin thickening and hardening, digital ulcers

Question 28

Sjogren Syndrome manifests with:

Answer 28

diminished lacrimal and salivary gland function, dry eyes, dry mouth, vaginal dryness, rhinitis and sinusitis, lymphoma

Question 29

Antinuclear antibodies are identified through:

Answer 29

indirect immunofluorescence

Question 30

How is the ANA test performed?

Answer 30

the sample is diluted through a set of serial dilutions and the highest dilution at which the antinuclear antibodies are detected is reported as the result

Question 31

Negative ANA test:

Answer 31

1:40 dilution

Question 32

Positive ANA test:

Answer 32

1:160

Question 33

What are the four patterns of the ANA test?

Answer 33

peripheral, diffuse, speckled, nucleolar

Question 34

Diffuse (homogenous) ANA test

Answer 34

SLE

Question 35

Peripheral or rim ANA test

Answer 35

SLE

Question 36

Nucleolar ANA test

Answer 36

SLE or scleroderma

Question 37

Speckled ANA test

Answer 37

SLE, scleroderma, others

Question 38

What is rheumatoid arthritis?

Answer 38

autoimmune disease that manifests with joint stiffness, pain, swelling, and eventual deformity of MCP and PIP joints of hands

Question 39

What is the primary lab to diagnose rhematoid arthritis?

Answer 39

rheumatoid factor

Question 40

Rheumatoid arthritis impacts the synovial joints x and x

Answer 40

symmetrically and bilaterally

Question 41

TSH normal value

Answer 41

0.5-5.0 uIU/mL

Question 42

Where is the thyroid gland located?

Answer 42

anteriorly int he neck from the fifth cervical vertebrae to the first thoracic vertebrae

Question 43

The two lateral lobes of the thyroid gland are connected by the

Answer 43

medial isthmus

Question 44

Control of the thyroid gland is regulated by the

Answer 44

hypothalamus and pituitary gland

Question 45

What is TRH?

Answer 45

Thyrotropin--releasing hormone

Question 46

Where is TRH synthesized?

Answer 46

hypothalamus

Question 47

Where is TRH transported to?

Answer 47

pituitary gland

Question 48

What does TRH stimulate?

Answer 48

secretion of TSH

Question 49

What does TSH bind to?

Answer 49

receptors on the thyroid gland

Question 50

What does TSH stimulate the release of?

Answer 50

Thyroid hormones (T3 and T4)

Question 51

T3 stands for

Answer 51

triiodothyronine

Question 52

T4 stands for

Answer 52

thyroxine

Question 53

Big place you see thyroid affect:

Answer 53

cardiovascular and metabolism

Question 54

Which is more metabolically active: T3, T4

Answer 54

T3

Question 55

T3 and T4 increase

Answer 55

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

Question 56

TSH stands for

Answer 56

thyroid stimulating hormone

Question 57

What is the most frequent cause of hypothyroidism?

Answer 57

primary hypothyroidism (defect in thyroid gland)

Question 58

What is secondary hypothyroidism?

Answer 58

decreased secretion of TSH from pituitary or decreased TRH from hypothalamus

Question 59

What deficiency can cause hypothyroidism?

Answer 59

iodine

Question 60

What disorders cause hypothyroidism?

Answer 60

autoimmune thyroiditis (Hashimoto's thyroiditis), iodine deficiency, thyroidectomy, radiation to neck, treatment for hyperthyroidism

Question 61

What is the most common cause of primary hypothyroidism?

Answer 61

Autoimmune thyroiditis (Hashimoto's thyroiditis)

Question 62

Causes of secondary hypothyroidism?

Answer 62

pituitary tumor, post-partum pituitary necrosis

Question 63

Tertiary hypothyroidism:

Answer 63

hypothalamus source

Question 64

Symptoms of hypothyroidism:

Answer 64

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

Question 65

In hypothyroidism would you expect a high or low TSH value?

Answer 65

High

Question 66

How do we differentiate thyroid disease?

Answer 66

Measure TSH and Free T4

Question 67

What percent of thyroid production is T4?

Answer 67

90%

Question 68

What percent of thyroid production is T3?

Answer 68

10%

Question 69

Is T3 or T4 more metabolically active?

Answer 69

T3

Question 70

Is T4 bound or un-bound?

Answer 70

Nearly all T4 is bound to protein

Question 71

What is free T4?

Answer 71

unbound, free metabolically active form of T4

Question 72

Is T4 or free T4 a better reflection of thyroid function?

Answer 72

Free T4

Question 73

What percent of T3 is bound to proteins?

Answer 73

70%

Question 74

In hypothyroid states, the serum TSH is elevated and in those conditions, the thyroid prefers and "chooses" to release

Answer 74

T3 so the T3 level remains constant, even in the face of disease

Question 75

So as hypothyroidism progesses: TSH increases...

Answer 75

then free T4 decreases...and the last to holdout is T3

Question 76

What will test results look like in hypothyroidism resultant from disorder of hypothalamus or pituitary gland

Answer 76

TSH is decreased and Free T4 is decreased

Question 77

Test results for subclinical hypothyroidism?

Answer 77

high normal or mildly elevated TSH with a normal free T4

Question 78

Test results for primary hypothyroidism:

Answer 78

High TSH, low Free T4

Question 79

Hypothyroidism AKA

Answer 79

thyrotoxicosis

Question 80

Most common form of hyperthyroidism is called

Answer 80

Grave's Disease

Question 81

What is Grave's disease caused by:

Answer 81

autoantibodies (TSH receptor antibody or TRAb) that bind and activate TSH receptors of the thyroid gland

Question 82

Are TSH levels high or low in hyperthyroidism?

Answer 82

low

Question 83

What is unusual about someone with Grave's Disease' eyes?

Answer 83

Exophthalmos

Question 84

Aside from Grave's disease what are other causes of hyperthyroidism?

Answer 84

hyperplasia of thyroid cells whose function is not regulated by TSH (toxic adenoma, toxic multinodular goiter), iodine rich medications

Question 85

Symptoms of hyperthyroidism:

Answer 85

anxiety, tremors, palpitations, weight loss, hyperdefacation

Question 86

All patients with primary hyperthyroidism have a suppressed:

Answer 86

TSH

Question 87

Overt hyerthyroidism levels:

Answer 87

low TSH, high free T4 and T3

Question 88

Sublclinical hyperthyroidism:

Answer 88

TSH is low, but serum T3, Free T3, and Free T4 are all normal