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57 Cards in this Set
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Creatine kinase
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Associated w/ ATP regeneration
Biggest fxn is in muscle cells where it stores high energy creatine phosphate Considered a sensitive indicator for AMI CK-MB usually <6% of total CK. Values greater is dx for AMI Following AMI, CK-MB levels rise w/in 4-8hrs, peak at 12-24hrs, then return to normal w/in 48-72hrs |
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Lactate dehydrogenase
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Very high concentrations in heart, liver, skeletal muscle, kidney, and RBCs
Highest LD: viral hepatitis, cirrhosis, AMI, pulmonary infarct, skeletal muscle disorders, leukemias High levels: pernicious anemia In AMI, levels rise w/in 12-24hrs, peak at 48-72hrs, then remain elevated for 10 days |
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Troponin
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Three proteins that bind to thin filaments of striated muscle and regulate muscle contraction
TnT is used as AMI indicator b/c conc. starts to rise w/in 4hrs Remains elevated for 10-14 days Essentially absent from most normal serum |
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B-type natriuretic peptides (BNP)
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Response to abnormal heart wall stress
Elevated in majority of pts w/ acute congestive heart failure |
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Kupffer cells
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Phagocytic macrophages that line sinusoids
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Lobule
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Cord of hepatocytes from central vein
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Sinusoid
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Vascular space b/t lobules
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Prehepatic jaundice
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Occurs when large amt of bilirubin is brought to liver for metabolism
Unconjugated hyperbilirubinemia is characterstic of this condition Occurs when there is hemolysis (hemolytic anemia), increased RBC turnover, or neonatal physiologic jaundice |
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Hepatic jaundice
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Occurs when liver cells cannot take up or conjugate bilirubin or secrete too much bilirubin
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Gilbert syndrome
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Cells cannot take up bilirubin
Pts have mild icterus and bilirubin <3mg/dL, which is unconjugated |
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Crigler-Najjar
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Complete absence (Type I) or decreased (Type II) uridyldiphosphate glycuronyl transferase
No or little conjugated bilirubin is formed |
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Dublin-Johnson’s and Rotor’s syndrome
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Characterized by conjugated hyperbilirubinemia d/t defective liver cell excretion of bilirubin
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Posthepatic jaundice
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Occurs when obstruction blocks flow of bile into intestines
Serum conjugated bilirubin increases, conjugated bili is found in urine, and stool is clay-colored |
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Jaundice
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Yellow discoloration of skin and sclera d/t excess bili (>2-3 mg/dL)
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Kernicterus
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Elevated bili levels that affect CNS in infants, resulting in mental retardation
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Hypercarotenemia
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Skin discoloration d/t elevated vit A levels
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Cirrhosis
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Result of chronic scarring of hepatocytes, turning them into nodules
Alcoholism causes micronodular cirrhosis Other causes include hemochromatosis A cirrhotic liver causes portal hypertension, resulting in splenomegaly, esophageal varices, reduced synthesis of proteins and clotting factors, and accumulation of ascites in abdomen Esophageal varices can rupture, resulting in life-threatening hemorrhage |
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Reye’s syndrome
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Symptoms: encephalopathy, seizures or coma, and abnormal liver fxn tests d/t hepatic destruction
Usually occurs after a viral infection (varicella or influenzae) and aspirin therapy (mainly in children) |
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Hepatitis A
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RNA virus. Fecal-oral
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Hepatitis B
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DNA virus. Transmitted by body fluids, especially serum
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Hepatitis C
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RNA virus. Infection by serum; injection drug use and transfuion are common means of infection
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Hepatitis E
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RNA virus w/ clinical course similar to hep A. Fecal-oral route.
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Growth hormone
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Controlled by hypothalamus, GHRH, and stomatosomatostatin. Secreted by anterior pituitary.
Increased levels: Children: giant Adults: acromegaly Decreased levels: Children: pituitary dwarfism Adults: decreased muscle mass, increased body fat, and decreased bone density |
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Prolactin
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Secreted by anterior pituitary. Initiation and maintenance of lactation
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Posterior pituitary
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Hormones released are synthesized in hypothalamus, then secreted by posterior pituitary
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Antidiuretic hormone (ADH, vasopressin)
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Makes DCT and CT of kidney permeable to water.
Increases plasma osmolality and decreases blood volume and blood pressure Decreased levels: diabetes insipidus resulting in severe polyuria and polydipsia |
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Oxytocin
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Stimulates contractions during delivery and causes ejection of milk
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Parathyroid hormone
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Increases serum calcium level by increasing calcium resorption from bone, stimulating calcium retention in renal tubules, and increasing Vit D production in kidney
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Hyperparathyroidism
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Primary: Increased PTH released from pituitary adenoma
• Kidney stones; increased calcium resorption from bone Secondary: increased PTH secretion d/t decreased serum Ca and hyperplasia of parathyroid glands • Causes vit D deficiency and chronic renal failure and can lead to severe osteoporosis Tertiary: Pts w/ secondary develop parathyroid adenoma |
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Hypoparathyroidism
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Severe hypocalcemia and altered neuromuscular activity (tetany).
D/t injury to the glands during surgery or removal of glands |
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Pseudohypoparathyroidism
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Hereditary. End organs are resistant to PTH. Patients have round faces and deformities of hand bones
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Hyperthyroidism
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Symptoms: heat interolerance, tachycardia, weight loss, weakness, emotional lability, and tremor
Decreased TSH Increased T4, free (unbound) T4 (FT4), and T3 |
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Graves’ disease
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Hyperthyroidism caused by circulating antibodies to TSH receptor
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Hypothyroidism
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Cold sensitivity, dry skin, and muscle weakness
Increased TSH Decreased T4 and FT4 |
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Zona glomerulosa
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Outermost layer of adrenal cortex. Secretes mineralcorticoids w/ aldosterone the major hormone. Controlled by renin-angiotensin axis
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Renin-angiotensin axis
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Low sodium levels or low renal pressure:
Renin produced by kidney, acts on angiotensin to produce angiotensin I, which is converted to angiotensin II, which stimulates secretion of aldosterone (potent vasoconstrictor) |
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Aldosterone
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↑ renal tubular retention of Na+ and ↑ excretion of K+
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Zona fasciculate
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Second layer of adrenal cortex. Secretes glucocorticoids w/ cortisol as major hormone
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Hypercortisolism
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Cushing’s syndrome. Weight gain in face, neck, shoulders, and abdomen (including “buffalo hump” at base of neck), muscle wasting, and hyperglycemia
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Hypocortisolism
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Addison’s disease. Primary adrenal disease or secondary to pituitary hypofunction.
Primary adrenal disease: atrophy of the gland o Symptoms include weight loss, weakness, and GI problems o Adrenal insufficiency: low sodium, bicarbonate, glucose; high potassium, BUN |
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Zona reticularis
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Third layer of adrenal cortex. Secretes sex steroids.
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Adrenal medulla
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Produces catecholamines: dopamine, norepinephrine, and epinephrine
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Function of epinephrine and norepinephrine
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Mobilize energy stores and increase heart rate, blood sugar, and blood pressure. Also inhibit insulin.
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Hormone changes in female reproductive cycle
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FSH promotes growth of follicles and increase in estrogen in first part of cycle
Rising estrogen levels decrease FSH, but cause LH to be released LH trigger ovulation causing estrogen and LH levels to decrease rapidly The follicle becomes the corpus luteum to degenerate, and decreases estrogen and progesterone lvls Menstruation results, then cycle repeats |
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Progesterone
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Prepares uterus for pregnancy and breast for lactation
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Turner’s syndrome
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A genetic defect when ovaries do not develop properly; patients are sterile
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β-hCG
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Secretion maintains progesterone synthesis by corpus luteum in early pregnancy
The placenta takes over to maintain pregnancy Levels are useful in detecting ectopic pregnancy, spontaneous abortion, multiple fetuses, and dx/monitoring of hCG-producing tumors |
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Testes
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FSH stimulates spermatogenesis
LH stimulates production of testosterone from Leydig’s cells |
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Klinefelter’s syndrome
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Patient possesses an extra X chromosome (XXY)
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Zollinger-Ellison syndrome
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Elevated gastrin level accompanied by gastric hyperacidity
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Serotonin
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Secreted by argentaffin cells in GI tract
Function: binds platelets and is released during coagulation |
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Cystic fibrosis
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Dysfunction of mucus and exocrine glands of the body
Blocks pancreatic secretions from entering duodenum |
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Islet cell tumor
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In beta cells, result is hyperinsulinemia
In alpha cells, result is gastrinoma or Zollinger-Ellison syndrome |
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Chronic pancreatitis
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Excessive alcohol consumption
Increased amylase, lipase, and trigs, hypercalcemia, and hypoproteinemia |
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Fecal fat
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Mix small amt of stool w/ fat-soluble stain (ie. Sudan III) and look for orange-red colored oil droplets
Indicates there is undigested fat (neutral fats, triglyceride) in stool |
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Amylase
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Values rise w/in a few hours of onset of symptoms, peak in 24hrs, then return to normal in 3-5 days
Elevated in mumps, cholecystitis, hepatitis, cirrhosis, and ruptured ectopic pregnancy |
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Lactose tolerance test
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Lactase cleaves lactose into glucose and galactose
Patient ingests 50g lactose, then blood specimens obtained at 0, 30, 60, and 120 minutes Blood glucoses are done, and increase in blood glucose level of 30mg/dL or more is positive for lactase |