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Clinical Science > Quiz 2: Inflammatory > Flashcards

Quiz 2: Inflammatory Flashcards

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1
Q

What are the four autoimmune lab tests?

A

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

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2
Q

What is ESR used for?

A

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

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3
Q

Is ESR constant?

A

No, frequent false elevations

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4
Q

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

A
  • negatively charged

- repel

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5
Q

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

A

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

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6
Q

Acute phase reactants are x charged

A

positively charged

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7
Q

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

A

neutral which leads to “stacking of RBCs”

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8
Q

Stacking of RBCs is called

A

Rouleaux formation

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9
Q

How is ESR performed?

A

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

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10
Q

Normal ESR value

A

0-20 mm/h

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11
Q

A higher ESR level corresponds to:

A

more stacking of RBCs = more antibodies or inflammation

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12
Q

Factors that can increase ESR (RBC)

A

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

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13
Q

Factors that decrease ESR (RBC)

A

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

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14
Q

ESR is elevated in:

A

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

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15
Q

C-reactive protein is an

A

acute phase reactant

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16
Q

Function of c-reactive protein

A

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

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17
Q

A CRP level above x is likely to be significant

A

10 mg/dL

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18
Q

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

A

50 mg/dL

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19
Q

C-reactive protein >10 (mild)

A

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

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20
Q

Moderate C-reactive protein level

A

MI, malignancy, autoimmune disease, RA

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21
Q

Marked C-reactive protein level >50

A

overwhelming bacterial infection, severe trauma

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22
Q

ANA =

A

antinuclear antibody

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23
Q

ANA test measures

A

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

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24
Q

ANA is important in the diagnosis of

A

systemic lupus erythematosus (SLE)

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25
Q

What is SLE?

A

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

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26
Q

What is not impacted in the butterfly rash?

A

Nasolabial folds

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27
Q

What is impacted in progressive systemic sclerosis (scleroderma)?

A

skin thickening and hardening, digital ulcers

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28
Q

Sjogren Syndrome manifests with:

A

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

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29
Q

Antinuclear antibodies are identified through:

A

indirect immunofluorescence

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30
Q

How is the ANA test performed?

A

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

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31
Q

Negative ANA test:

A

1:40 dilution

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32
Q

Positive ANA test:

A

1:160

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33
Q

What are the four patterns of the ANA test?

A

peripheral, diffuse, speckled, nucleolar

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34
Q

Diffuse (homogenous) ANA test

A

SLE

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35
Q

Peripheral or rim ANA test

A

SLE

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36
Q

Nucleolar ANA test

A

SLE or scleroderma

37
Q

Speckled ANA test

A

SLE, scleroderma, others

38
Q

What is rheumatoid arthritis?

A

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

39
Q

What is the primary lab to diagnose rhematoid arthritis?

A

rheumatoid factor

40
Q

Rheumatoid arthritis impacts the synovial joints x and x

A

symmetrically and bilaterally

41
Q

TSH normal value

A

0.5-5.0 uIU/mL

42
Q

Where is the thyroid gland located?

A

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

43
Q

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

A

medial isthmus

44
Q

Control of the thyroid gland is regulated by the

A

hypothalamus and pituitary gland

45
Q

What is TRH?

A

Thyrotropin–releasing hormone

46
Q

Where is TRH synthesized?

A

hypothalamus

47
Q

Where is TRH transported to?

A

pituitary gland

48
Q

What does TRH stimulate?

A

secretion of TSH

49
Q

What does TSH bind to?

A

receptors on the thyroid gland

50
Q

What does TSH stimulate the release of?

A

Thyroid hormones (T3 and T4)

51
Q

T3 stands for

A

triiodothyronine

52
Q

T4 stands for

A

thyroxine

53
Q

Big place you see thyroid affect:

A

cardiovascular and metabolism

54
Q

Which is more metabolically active: T3, T4

A

T3

55
Q

T3 and T4 increase

A

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

56
Q

TSH stands for

A

thyroid stimulating hormone

57
Q

What is the most frequent cause of hypothyroidism?

A

primary hypothyroidism (defect in thyroid gland)

58
Q

What is secondary hypothyroidism?

A

decreased secretion of TSH from pituitary or decreased TRH from hypothalamus

59
Q

What deficiency can cause hypothyroidism?

A

iodine

60
Q

What disorders cause hypothyroidism?

A

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

61
Q

What is the most common cause of primary hypothyroidism?

A

Autoimmune thyroiditis (Hashimoto’s thyroiditis)

62
Q

Causes of secondary hypothyroidism?

A

pituitary tumor, post-partum pituitary necrosis

63
Q

Tertiary hypothyroidism:

A

hypothalamus source

64
Q

Symptoms of hypothyroidism:

A

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

65
Q

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

A

High

66
Q

How do we differentiate thyroid disease?

A

Measure TSH and Free T4

67
Q

What percent of thyroid production is T4?

A

90%

68
Q

What percent of thyroid production is T3?

A

10%

69
Q

Is T3 or T4 more metabolically active?

A

T3

70
Q

Is T4 bound or un-bound?

A

Nearly all T4 is bound to protein

71
Q

What is free T4?

A

unbound, free metabolically active form of T4

72
Q

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

A

Free T4

73
Q

What percent of T3 is bound to proteins?

A

70%

74
Q

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

A

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

75
Q

So as hypothyroidism progesses: TSH increases…

A

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

76
Q

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

A

TSH is decreased and Free T4 is decreased

77
Q

Test results for subclinical hypothyroidism?

A

high normal or mildly elevated TSH with a normal free T4

78
Q

Test results for primary hypothyroidism:

A

High TSH, low Free T4

79
Q

Hypothyroidism AKA

A

thyrotoxicosis

80
Q

Most common form of hyperthyroidism is called

A

Grave’s Disease

81
Q

What is Grave’s disease caused by:

A

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

82
Q

Are TSH levels high or low in hyperthyroidism?

A

low

83
Q

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

A

Exophthalmos

84
Q

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

A

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

85
Q

Symptoms of hyperthyroidism:

A

anxiety, tremors, palpitations, weight loss, hyperdefacation

86
Q

All patients with primary hyperthyroidism have a suppressed:

A

TSH

87
Q

Overt hyerthyroidism levels:

A

low TSH, high free T4 and T3

88
Q

Sublclinical hyperthyroidism:

A

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

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