Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
45 Cards in this Set
- Front
- Back
|
What is the most common cause of acute pancreatitis associated with normal serum amylase levels?
A. hypertriglyceridemia B. Trinidad scorpion venom C. smoking D. alcohol E. estrogen |
A. hypertriglyceridemia.
Interestingly enough and depending on the assay, triglycerides competitively interfere with the amylase assay. |
|
|
What's the best explanation for the elevated serum amylase with low urine amylase seen in macroamylasemia?
A. increased production in the pancreas of proenzyme forms of amylase B. decreased cleavage of pro-amylase to make amylase C. antibody bound to amylase, leading to decreased renal clearance D. toxic injury to renal glomeruli E. pancreatic ductal adenocarcinoma |
C. antibody bound to amylase, leading to decreased renal clearance.
Ig-amylase is referred to as macroamylase. Macroamylase cannot be cleared by the kidney due to its large size (like a bowling ball trying to pass through a sieve), which leads to increased serum amylase and decreased urinary amylase. |
|
|
Which of the following is one of the many advantages of lipase over amylase for the diagnosis of acute pancreatitis?
A. lipase is more pancreas-specific B. lipase is less reliant on renal clearance C. lipase rises in parallel to amylase, but remains elevated for longer. D. all of the above are advantages of lipase E. none of the above are advantages of lipase |
D. All of the above are advantages of lipase.
All are true, which is why lipase is a better test for acute pancreatitis - “Lipase Lasts Longer and Lies Less.” |
|
|
Which of the following is NOT considered one of the Ranson criteria for the assessment of acute pancreatitis at hospital admission?
A. age B. hematocrit C. serum glucose D. AST E. LDH |
B. hematocrit.
In addition to the criteria presented in the question choices, WBC count, rather than hematocrit, is used at admission to calculate the prognosis of a patient presenting with acute pancreatitis. The hematocrit is assessed at 48 hours post-admission. |
|
|
How long does it take to assign a Ranson score to a patient presenting with acute pancreatitis?
A. one can assign a score based on the initial evaluation at admission B. at least 1 hour C. at least 24 hours D. at least 48 hours E. at least one week |
D. at least 48 hours.
5 criteria are assessed at admission. 5 more are assessed 48 hours later. |
|
|
Which of the following genes has NOT been implicated as a cause of recurrent pancreatitis?
A. TSC1 B. PRSS-1 C. PSTI D. CFTR E. all of the above genes are associated with recurrent pancreatitis |
A. TSC1.
Cationic trypsinogen (PRSS-1), pancreatic secretory trypsin inhibitor (PSTI), and cystic fibrosis transmembrane conductance regulator (CFTR) have all been implicated as causes of recurrent pancreatitis. |
|
|
Of the following tests, which is the most sensitive and specific test of pancreatic exocrine function?
A. fecal fat B. chymotryspin C. elastase-1 D. D-xylose E. trypsinogen |
C. elastase-1.
Fecal fat, chymotrypsin, and elastase-1 are all sensitive and specific, with elastase being the most so. D-xylose is a measure of small bowel mucosal absorptive capacity, not pancreatic exocrine function. |
|
|
Match the cyst fluid associated with each of the following pancreatic cysts:
1. pseudocyst 2. serous cystadenoma 3. mucinous cystadenoma 4. intraductal papillary mucinous neoplasm 5. solid-pseudopapillary tumor A. A. low amylase, low CEA, low CA 19-9 B. high amylase, high CEA, normal to high CA 19-9 C. low amylase, high CEA, normal to high CA 19-9 D. low amylase, low CEA, low CA 19-9 E. high amylase, low CEA, high CA 19-9 |
E. 1-E, 2-D, 3-C, 4-B, 5-A.
CEA is elevated in the mucinous neoplasms, while serous cystadenoma and solid-pseudopapillary tumors have decreased levels of all three. |
|
|
Which of the creatinine kinase isozymes is most widely distributed?
A. CK-MM B. CK-MB C. CK-BB D. CK-BM E. CK-DB |
C. CK-BB.
BB is the fastest migrating and is present in nearly all tissues of the body, though found primarily in the brain. (A BB would migrate faster than an M&M, with a MB in between). |
|
|
What creatinine kinase isozyme composes nearly 100% of normal serum CK?
A. CK-BB B. CK-MB C. CK-MM D. CK-BM E. CK-DB |
C. CK-MM.
MM is present in the serum, due mostly to contributions from skeletal muscle (which is the source of most MB). |
|
|
Which creatinine kinase isozyme migrates slightly slower than MM and whose appearance is associated with disseminated malignancies and poor prognosis?
A. CK-MB B. CK-BB C. macro-CK D. mitochondrial CK E. CK-MB3 |
D. mitochondrial CK.
Mitochondrial CK, if seen on electrophoresis, appears as a faint band migrating slightly slower than CK-MM. Macro-CK is another abnormal CK that is composed of a complex of antibody-bound CK. |
|
|
Which of the following troponins has both a cardiac and skeletal muscle isoform?
A. TnT B. TnI C. TnC D. A & B E. A, B, C |
D. A & B.
The gene that encodes TnC is expressed in both cardiac and skeletal muscle, whereas TnI and TnT have separate cardiac and skeletal muscle genes. These two immunoassays can distinguish between the skeletal and cardiac forms. |
|
|
Which of the following is the most cardiac-sensitive enzyme isoform with a commercially-available assay?
A. cTnT B. cTnI C. cTnC D. CK-MB E. myoglobin |
B. cTnI.
cTnI is marginally more cardiac-specific than cTnT, while there is no cardiac-specific TnC isoform. Troponins for the most part are much more specific than either CK-MB or myoglobin, both of which are often elevated following vigorous exercise or skeletal muscle injury. |
|
|
Which of the following descriptions best fits myoglobin?
A. most sensitive, least specific marker of acute myocardial infarction B. most specific, least sensitive C. earliest marker of acute myocardial infarction D. A & C E. B & C |
D. A & C.
Usually within moments of an acute MI, there is an elevation of the myoglobin. Unfortunately, very sensitive myoglobin is very nonspecific and can be elevated due to a number of causes. |
|
|
Ischemia-modified albumin reflects myocardial ischemia, rising within minutes of ischemic damage and returning to baseline within a few hours. The assay is based on
the altered binding of albumin to which of the following elements? A. calcium B. cobalt C. phosphorus D. oxygen E. iron |
B. cobalt.
The amino terminus of albumin is modified with exposure to a number of conditions, such as acidosis, hypoxemia, and free radicals. The modification decreased the ability of albumin to bind cobalt. The amount of unbound cobalt reflects the level of ischemia-modified albumin. |
|
|
Which of the following natriuretic peptides provides the most longitudinal information about congestive heart failure?
A. atrial (A-type) natriuretic peptide (ANP) B. brain (B-type) natriuretic peptide (BNP) C. pro-BNP D. N-terminal pro-BNP E. C-type natriuretic peptide |
D. N-term-pro-BNP
A-type natriuretic peptide is released in response to increased ventricular as well as increased atrial filling pressures. For that reason, it's not as specific as BNP, which is only released in response to increased ventricular filling pressure (stretch). It is released as an inactive pro-BNP peptide which when cleaved releases an active BNP as well as the regulatory N-term-pro-BNP, a very stable molecule. Little is known about C-type natriuretic peptide. |
|
|
All of the following are included in the definition of acute coronary syndrome (ACS), except:
A. stable angina B. unstable angina C. congestive heart failure D. acute myocardial infarction E. sudden cardiac death |
C. congestive heart failure.
All are considered to be in a spectrum of disease. Stable angina is reproducible and most likely due to progressive stenosis of coronary arteries. Unstable angina may represent further stenosis, but with a little less predictable event as well, such as a transient clot or vasospasm, causing transient ischemia. Acute MI is the best characterized and is the condition that we can most readily identify. |
|
|
What is the purpose of serial measurements of elevated troponins in suspected acute myocardial infarction?
A. increased sensitivity B. increase negative predictive value C. increased specificity D. A & B E. A, B, C |
A. increased sensitivity.
The specificity of a single elevated troponin is very high; serial measurements don't change that. However, a mildly elevated troponin many not be sensitive enough to detect AMI. Serial measurements of troponin increase the sensitivity, but don't change the ability of the test to change its negative predictive value. |
|
|
What is the purpose of measuring CK-MB in the presence of elevated troponin in a patient with a suspected acute myocardial infarction (AMI)?
A. troponin is less sensitive than CK-MB for AMI B. troponin is less specific than CK-MB for AMI C. troponin is not helpful in determining the time course of AMI D. CK-MB is more stable than troponin and stays elevated longer E. CK-MB can provide additional information about congestive heart failure |
C. troponin is not helpful in determining the time course of AMI.
Troponin rises more slowly and stays elevated longer than CK-MB. If CK-MB continues to rise, it may indicate an acute event or an extension of an existing infarction, while a downward trend of CK-MB may indicate resolution of an infarction. |
|
|
In the quantitation of protein by the Kjedahl technique, what is actually measured?
A. spectrophotometry B. colorimetric assay C. refractometry D. ammonium nitrogen released by acid digestion |
D. ammonium nitrogen released by acid digestion.
All of the techniques presented are used to measure protein. The Kjedahl technique is cumbersome and makes assumptions about average nitrogen content. Colorimetric assays are preferred for the measurement of protein, and all involve formation of a colored precipitate under alkaline or acidic conditions and then measuring the absorbance at the appropriate wavelength. Refractometry is used but has many interferences. Dye-binding is limited by uneven dye uptake by proteins. |
|
|
What is the usual net charge on proteins and toward which pole do they migrate?
A. negative, anode B. negative, cathode C. positive, anode D. positive, cathode E. no charge, it depends |
A. negative, anode.
Most proteins bear a net negative charge at physiologic pH and as such migrate toward the anode or positive pole when subject to an electromotive force. Remember, anions have negative charges and are attracted to the positive pole or anode. Cations bear positive charges and are attracted to the negative pole or cathode. |
|
|
Which represents the fastest migrating band on standard serum protein electrophoresis performed at pH 8.6?
A. albumin B. alpha-1 C. alpha-2 D. beta E. gamma |
A. albumin.
Albumin accounts for the majority of normal serum protein and is the fastest migrating major protein followed by the alpha, beta, then gamma region proteins. |
|
|
All of the following techniques are used to characterize a suspected monoclonal band, except:
A. immunofixation electrophoresis B. immunotyping C. immunoelectophoresis D. immunoprecipitation E. all of the above are routinely used |
D. immunoprecipitation.
While immunoprecipitation can be used to characterize proteins, it is not commonly used to characterize monoclonal proteins. All the other techniques, especially immunofixation, are commonly used to identify and classify monoclonal proteins identified by serum electrophoresis. |
|
|
Which of the following condition(s) account for the most significant changes in serum albumin levels?
A. protein-losing enteropathy B. nephrotic syndrome C. liver disease D. A & B E. A, B, C |
D. A & B.
Protein-losing conditions are responsible for the greatest decrements in serum albumin. The ability of the liver to synthesize albumin is preserved with decreases only being apparent with severe end-stage liver disease. |
|
|
All of the following are functions of pre-albumin, except:
A. binding thyroid hormones, T3 & T4 B. bind and carry retinol-binding protein:vitamin A complex C. amyloid precursor in senile cardiac amyloidosis D. maintenance of serum osmotic pressure E. all of the above are functions of pre-albumin |
D. maintenance of serum osmotic pressure.
Pre-albumin does function in the capacity to bind thyroid hormone, vitamin A, and is the precursor in cardiac amyloidosis and familial amyloid polyneuropathy. Albumin, rather than pre-albumin, is responsible for maintenance of serum osmotic pressure. Pre-albumin is prominent in the CSF. |
|
|
Transferrin may be elevated with iron deficiency and resemble an M-spike on serum protein electrophoresis. Where does the transferrin band migrate?
A. pre-albumin B. albumin C. alpha-1 D. alpha-2 E. beta-1 |
E. beta-1.
Transferrin is the predominant beta-1 protein. On standard serum electrophoresis, beta does not resolve into beta-1 and beta-2, but can on high-resolution electrophoresis. (In the beta-2 region migrates IgA, C-reactive protein can be in beta-2 or gamma-2). The predominant alpha-1 band is alpha-1-antitrypsin; alpha-2 has haptoglobin and ceruloplasmin. |
|
|
This protein is elevated in serum with renal or hepatic disease:
A. ceruloplasmin B. alpha-2-macroglobulin C. haptoglobin D. transferrin E. fibrinogen |
B. alpha-2-macroglobulin.
Due to its large size, alpha-2-macroglobulin is typically not lost with nephrotic syndrome. As a result of the loss of other smaller proteins and fluid, the alpha-2- macroglobulin concentration increases. |
|
|
The asialated form of this protein is also known as tau protein and can be found in cerebrospinal fluid:
A. pre-albumin B. albumin C. transferrin D. alpha-1-antitrypsin E. ceruloplasmin |
C. transferrin.
Both the unmodified and asialated forms of transferrin can cross the blood-brain barrier through active transport. This accounts for the double transferrin peak typically seen in CSF electrophoresis. |
|
|
This protein should not normally be found in serum, but when it is, it runs with the beta-globins:
A. C-reactive protein B. fibrinogen C. haptoglobin D. ceruloplasmin E. alpha-2-macroglobulin |
B. fibrinogen.
Normally blood clots to make serum, and fibrinogen is consumed. In the event of incomplete clotting (such as in heparinized patients), fibrinogen may appear at the beta-gamma interface. |
|
|
What is the clinical significance of a twin albumin band?
A. M-spike B. normal variant C. acute inflammation D. starvation E. high cholesterol |
B. normal variant.
Bisalbuminemia is a normal variant seen in heterozygotes for different albumin allotypes. There is no clinical significance. |
|
|
Transferrin may be elevated with iron deficiency and resemble an M-spike on serum protein electrophoresis. Where does the transferrin band migrate?
A. pre-albumin B. albumin C. alpha-1 D. alpha-2 E. beta-1 |
E. beta-1.
Transferrin is the predominant beta-1 protein. On standard serum electrophoresis, beta does not resolve into beta-1 and beta-2, but can on high-resolution electrophoresis. (In the beta-2 region migrates IgA, C-reactive protein can be in beta-2 or gamma-2). The predominant alpha-1 band is alpha-1-antitrypsin; alpha-2 has haptoglobin and ceruloplasmin. |
|
|
This protein is elevated in serum with renal or hepatic disease:
A. ceruloplasmin B. alpha-2-macroglobulin C. haptoglobin D. transferrin E. fibrinogen |
B. alpha-2-macroglobulin.
Due to its large size, alpha-2-macroglobulin is typically not lost with nephrotic syndrome. As a result of the loss of other smaller proteins and fluid, the alpha-2- macroglobulin concentration increases. |
|
|
The asialated form of this protein is also known as tau protein and can be found in cerebrospinal fluid:
A. pre-albumin B. albumin C. transferrin D. alpha-1-antitrypsin E. ceruloplasmin |
C. transferrin.
Both the unmodified and asialated forms of transferrin can cross the blood-brain barrier through active transport. This accounts for the double transferrin peak typically seen in CSF electrophoresis. |
|
|
This protein should not normally be found in serum, but when it is, it runs with the beta-globins:
A. C-reactive protein B. fibrinogen C. haptoglobin D. ceruloplasmin E. alpha-2-macroglobulin |
B. fibrinogen.
Normally blood clots to make serum, and fibrinogen is consumed. In the event of incomplete clotting (such as in heparinized patients), fibrinogen may appear at the beta-gamma interface. |
|
|
What is the clinical significance of a twin albumin band?
A. M-spike B. normal variant C. acute inflammation D. starvation E. high cholesterol |
B. normal variant.
Bisalbuminemia is a normal variant seen in heterozygotes for different albumin allotypes. There is no clinical significance. |
|
|
In non-selective proteinuria, all of the bands on serum protein electrophoresis are decreased, except:
A. albumin B. alpha-1 C. alpha-2 D. beta E. gamma |
C. alpha-2.
Albumin is usually the most commonly affected protein. Due to its small size, it is lost in both selective and non-selective proteinuria. Other proteins also start to decrease in the serum in non-selective proteinuria, except alpha-2-macroglobulin, due to its large size. |
|
|
Beta-gamma bridging is most commonly seen in which of the following situations?
A. monoclonal gammopathy B. cirrhosis C. starvation D. non-selective proteinuria E. selective proteinuria |
B. cirrhosis.
Predominantly due to increased IgA, beta-gamma bridging is seen with cirrhosis. Cirrhosis can also show hypoalbuminemia with blunted alpha-1 and alpha-2 peaks. |
|
|
All of the following are potential causes of apparent hypogammaglobulinemia, except:
A. congenital hypogammaglobulinemia B. lymphoma C. nephrotic syndrome D. myeloma E. all of the above are potential causes of hypogammaglobulinemia |
E. all of the above are potential causes of hypogammaglobulinemia.
It may be counter-intuitive, but a significant portion of cases of myeloma can exhibit hypogammaglobulinemia, especially when there is a concomitant Bence-Jones protein seen on urine protein electrophoresis. |
|
|
All of the following are characteristic features of normal CSF protein electrophoresis relative to serum protein electrophoresis, except:
A. oligoclonal gamma bands B. prominent pre-albumin band C. dim albumin band D. double beta-transferrin band E. dim alpha-2 band |
A. oligoclonal gamma bands.
Oligoclonal bands, though they can be present in CSF protein electrophoresis, are distinctly NOT normal. Oligoclonal bands in CSF but not in a concurrent SPEP support a diagnosis of multiple sclerosis. |
|
|
In non-selective proteinuria, all of the bands on serum protein electrophoresis are decreased, except:
A. albumin B. alpha-1 C. alpha-2 D. beta E. gamma |
C. alpha-2.
Albumin is usually the most commonly affected protein. Due to its small size, it is lost in both selective and non-selective proteinuria. Other proteins also start to decrease in the serum in non-selective proteinuria, except alpha-2-macroglobulin, due to its large size. |
|
|
Which of the following types of proteinuria presents with a strong albumin band on urine protein electrophoresis?
A. tubular proteinuria B. glomerular proteinuria C. tubulointerstitial proteinuria D. overflow proteinuria E. none of the above patterns exhibit a strong albumin band |
B. glomerular proteinuria.
Glomerular proteinuria occurs due to a loss of the selective filtration of the glomerulus - large proteins, such as alpha-2 macroglobulin are retained while very small proteins are resorbed in the tubules, leaving medium-sized proteins, such as albumin in the urine. Tubular proteinuria is due to the loss of small protein resorption, while overflow proteinuria is due to very high serum levels of a protein overwhelming the kidney's filtration and resorption capacity. |
|
|
Beta-gamma bridging is most commonly seen in which of the following situations?
A. monoclonal gammopathy B. cirrhosis C. starvation D. non-selective proteinuria E. selective proteinuria |
B. cirrhosis.
Predominantly due to increased IgA, beta-gamma bridging is seen with cirrhosis. Cirrhosis can also show hypoalbuminemia with blunted alpha-1 and alpha-2 peaks. |
|
|
All of the following are potential causes of apparent hypogammaglobulinemia, except:
A. congenital hypogammaglobulinemia B. lymphoma C. nephrotic syndrome D. myeloma E. all of the above are potential causes of hypogammaglobulinemia |
E. all of the above are potential causes of hypogammaglobulinemia.
It may be counter-intuitive, but a significant portion of cases of myeloma can exhibit hypogammaglobulinemia, especially when there is a concomitant Bence-Jones protein seen on urine protein electrophoresis. |
|
|
All of the following are characteristic features of normal CSF protein electrophoresis relative to serum protein electrophoresis, except:
A. oligoclonal gamma bands B. prominent pre-albumin band C. dim albumin band D. double beta-transferrin band E. dim alpha-2 band |
A. oligoclonal gamma bands.
Oligoclonal bands, though they can be present in CSF protein electrophoresis, are distinctly NOT normal. Oligoclonal bands in CSF but not in a concurrent SPEP support a diagnosis of multiple sclerosis. |
|
|
Which of the following types of proteinuria presents with a strong albumin band on urine protein electrophoresis?
A. tubular proteinuria B. glomerular proteinuria C. tubulointerstitial proteinuria D. overflow proteinuria E. none of the above patterns exhibit a strong albumin band |
B. glomerular proteinuria.
Glomerular proteinuria occurs due to a loss of the selective filtration of the glomerulus - large proteins, such as alpha-2 macroglobulin are retained while very small proteins are resorbed in the tubules, leaving medium-sized proteins, such as albumin in the urine. Tubular proteinuria is due to the loss of small protein resorption, while overflow proteinuria is due to very high serum levels of a protein overwhelming the kidney's filtration and resorption capacity. |
