Week One

Front 1

Types of cardiovascular disease

Back 1

coronary heart disease, cerebrovascular disease, peripheral arterial disease, aortic atherosclerotic disease

Front 2

CHD risk factors

Back 2

Age (>45 males, >55 or premature menopause females); family history, hypertension, cigarette smoking, diabetes, obesity/inactivity

Front 3

Ischemia

Back 3

lack of adequate blood supply to heart; can lead to activity related chest pain (stable angina)

Front 4

Cardiac biomarkers

Back 4

normal in unstable angina; elevated in MI; includes enzymes (CK/CK-MB, AST, LD) and proteins (myoglobin and troponin)

Front 5

Atherosclerosis

Back 5

Progressive accumulation of lipids, smooth muscle cells, macrophages, and connective tissue within large and medium sized arteries

Front 6

________ is the first to be elevated post AMI. Raises for __________ hours after AMI. Peaks at about __________ hours (10x normal)

Back 6

CK; 6-8 hours; 24 hours

Front 7

Isoenzymes

Back 7

CK-MM (striated muscle), CK-MB (cardiac tissue), CK-BB (brain)

Front 8

Total CK/CPK can be elevated in:

Back 8

diseases of muscle, heart and brain; chronic alcoholism, stroke and strenuous exercise

Front 9

LD

Back 9

NOT specific to cardiac tissue; in healthy person, LD2 is highest isoenzyme, but in MI, LD1 exceeds LD2.

Front 10

Ideal cardiac marker

Back 10

-Spikes/rises quickly in serum or plasma, stays elevated several days post AMI, is specific to cardiac tissue, is sensitive (detected at low levels)

Front 11

Troponins

Back 11

-TnT: binds to tropomyosin

-TnI: binds actin and myosin

TnC: binds to calcium to reverse TnI; NOT used as cardiac marker

Front 12

Troponins are measured using _______________ techniques.

Back 12

immunoassay; utilize monoclonal antibodies specific to protein epitopes

Front 13

Myoglobin

Back 13

Iron/oxygen binding protein in muscle - muscle hemoglobin

Front 14

Heart failure

Back 14

due to decrease in pumping function; congestive most common

Front 15

Most common laboratory assay for detection of and monitoring severity of Congestive Heart Failure

Back 15

BNP; the higher the result, the most severe the CHF

Front 16

Markers of CHD risk

Back 16

CRP and homocysteine

Front 17

CRP

Back 17

hs-CRP highly sensitive to cardiac tissue, but nonspecific; elevated in all inflammatory responses

Front 18

Homocysteine

Back 18

common in patients with artherosclerosis and thromboembolisms; derived from methionine; possible marker for CVD as it promotes artherosclerotic lesions and plaque formation

Front 19

Markers of pulmonary embolism

Back 19

Embolus lodged in pulmonary arteries, impairing blood flow; diagnosis can be challenging due to similarities with other conditions, such as AC; BNP and D-dimer

Front 20

D-dimer test

Back 20

measures fibrinolysis; coag test (lt blue tube); abnormal in 90% PE patients;

Front 21

LDL

Back 21

bad; can be oxidized & taken up by endothelial cells and macrophages in arterial walls, leading to first stages of atherosclerosis

Front 22

HDL

Back 22

good; thought to be involved in transport of excess cholesterol from membranes to the liver for removal from the body.

Front 23

Total cholesterol reference range

Back 23

<200 = desirable

200-239 = borderline high risk

>240 = high risk

Front 24

HDL reference range

Back 24

<40 = low

>60 = high; negates one risk factor

Front 25

LDL reference range

Back 25

<100 = desirable

100-129 = above optimal

130-159 = borderline high

>160 = high risk

Front 26

Triglycerides

Back 26

> 200 = high

Front 27

Cardiac troponin

Back 27

above reference limit at 3 to 12 hours, peak at 12 to 24 hours, and remain increased 4 to 14 days post AMI

Front 28

B-type Natriuretic Peptide

Back 28

used in diagnosis of CHF; cutoff of 100 ng/L BNP 90% sensitivity/75% specificity; for NT-proBNP: >150 ng/L for <50y.o., >900 ng/L for >50y.o

Front 29

CK-MB

Back 29

takes 4-6 hours to rise above reference limit, peak at 24 hours, return to normal 48 – 72 hours post AMI

Front 30

myoglobin

Back 30

non-specific, but rises 1 hour after AMI, peaks at 2-12 hours, rapidly cleared after 12 hours

Front 31

Kidney regions

Back 31

cortex (outer) & medulla (inner)

Front 32

Nephrons

Back 32

functional units of kidneys; approximately 1 million are found in each kidney

Front 33

Glomerulus

Back 33

capillary tuft surrounded by expanded end of renal tubule called Bowman’s capsule.

Afferent arteriole – brings blood in

Efferent arteriole – carries blood out

Front 34

Renal processes

Back 34

Glomerular filtration

Tubular reabsorption

Tubular secretion

Front 35

Glomerular filtration

Back 35

-Semipermeable glomerular basement membrane.

-Molecular cutoff value 66,000 Dalton (about size of albumin).

-Negative charge of basement membrane.Negatively charged particles like protein are repelled.

- filters out 125–130 mL of protein-free, cell-free fluid (glomerular filtrate)

Front 36

GFR

Back 36

volume of blood filtered per minute

Front 37

Proximal convoluted tubule

Back 37

-receives filtrate

-75% of water, sodium, and chloride

-100% of glucose (up to renal threshold)

-Almost all amino acids, vitamins, and proteins

-98 to 100% of Uric Acid is reabsorbed here, but re-secreted in the DCT

Front 38

Distal convoluted tubule

Back 38

-adjusts for electrolyte & acid–base homeostasis through hormonal control of ADH & aldosterone

-most active region for homeostatic regulation of plasma electrolytes.

Front 39

Collecting duct

Back 39

-Final site for concentrating or diluting urine-ADH and aldosterone act on CD

Front 40

ADH

Back 40

-secreted in response to Increased blood osmolality

-when blood volume is decreased by more that 5 to 10%

Front 41

Aldosterone

Back 41

-Stimulates sodium reabsorption

-Stimulates excretion of potassium and H ions

Front 42

Urea

Back 42

-Protein metabolism in the liver (Proteins -> amino acids –> ammonia –> urea)

Front 43

Creatinine

Back 43

Muscle contains creatine phosphate for rapid ATP formation.Catalized by creatine kinase. Creatinine levels are a function of muscle mass.Creatinine levels remain same in individual unless muscle mass or renal function change. Not reabsorbed by tubules. Jaffe reaction (picric acid -> orange/yellow)

Front 44

Uric acid

Back 44

-waste product of purine

-renal calculi and gout

Front 45

Water balance

Back 45

Increased plasma osmolality or decreased intervascular volume stimulates (thirst) secretion of ADH from posterior pituitary.ADH increases permeability of distal convoluted tubules & collecting ducts to water, causing increased water absorption.ADH (Vasopressin)

Front 46

__________ promotes sodium retention.

Back 46

Aldosterone

Front 47

Acid-base balance

Back 47

-Regeneration of bicarbonate ions (HCO3-)

-Excretion of metabolic acids

Front 48

Normal blood pH

Back 48

7.35-7.45

Front 49

Kidneys synthesize:

Back 49

renin, erythropoietin, 1, 25-hihydroxy vitamin D3, prostaglandins

Front 50

Renin

Back 50

catalyzes synthesis of angiotensin (vasoconstrictor that increases blood pressure and stimulates release of aldosterone).

Front 51

Erythropoietin

Back 51

acts on erythroid progenitor cells in bone marrow, increasing number of red blood cells.Hypoxia promotes increase within 2 hours

Front 52

1,25-Dihydroxy vitamin D3

Back 52

determines phosphate & calcium balance & bone calcification

Front 53

Prostaglandins

Back 53

Increase renal blood flow

Front 54

Estimated GFR

Back 54

no urine collection required; calculations w/factors

Front 55

Cystatin C

Back 55

Used in conjunction with creatinine to detect early kidney function loss.Rises faster than creatinine clearance.

Front 56

B2 microglobulin

Back 56

Used to assess renal tubular function in renal transplant patients.

Front 57

Microalbumin

Back 57

Urine microalbumin measurement is important in management of patients with diabetes mellitus, who are at risk for nephropathy. Urinary albumin concentrations of 30-300 mg/24 hours are predictive of diabetic nephropathy.

Front 58

Neutrophil Gelatinase-Associated Lipocalin

Back 58

Elevated 2-6 hours of AKI

Front 59

Acute glomerulonephritis

Back 59

Rapid onset of hematuria & proteinuria

Front 60

Nephrotic syndrome

Back 60

Associated with massive proteinuria, hypoalbuminemia, edema, & lipiduria (oval fat bodies)

Front 61

UTI

Back 61

+ nitrates and leukocyte esterase

Front 62

Renal calculi

Back 62

calcium oxalate crystals

Front 63

Chronic kidney failure

Back 63

-Kidney damage for > 3months, as defined by structural or fxnalabnormalities, with or without decreased GFR

-GFR < 60 mL/min/1.73m2 for > 3 months, with or without renal damage

-diabetes, glomerular disease, vascular disease, cystic disease, transplant related

Front 64

Kidney failure

Back 64

GFR < 15 or dialysis

Front 65

Acute glomerulonephritis

Back 65

often related to a recent infection of Group A Strep (S. pyogenes)

Front 66

Acute pyelonephritis

Back 66

WBC casts

Front 67

Broad casts

Back 67

renal failure

Front 68

Glucose

Back 68

glucose oxidase

Front 69

Ketones

Back 69

-acetoacetic acid

-sodium nitroprusside

Front 70

Protein

Back 70

-protein error of indicators

Front 71

pH

Back 71

double indicator (methyl red and bromthymol blue)

Front 72

Bilirubin

Back 72

diazo rxn

Front 73

Which analyte is most useful in the detection of congestive heart failure?

Back 73

BNP (brain natriuretic peptide)

Front 74

The troponin complex consists of:

Back 74

troponin C, troponin I, and troponin T.

Front 75

When myocardial infarction occurs, the first enzyme to become elevated is

Back 75

CK (creatine kinase)

Front 76

Chest pain that is associated with a decrease in oxygen supply to the heart muscle but that exhibits no cellular necrosis based on cardiac troponin value is referred to as

Back 76

angina.

Front 77

An oxygen-binding protein in muscle that is a nonspecific protein assessed in predicting AMI is

Back 77

myoglobin.

Front 78

Heart tissue contains which of the following CK isoenzyme fractions?

Back 78

MB

Front 79

Elevation of cardiac enzymes in serum may be used to detect

Back 79

cardiac cell necrosis.

Front 80

What is the function of Troponin I in the heart muscle?

Back 80

Inhibits the binding of actin and myosin

Front 81

How does hyper-homocysteinemia contribute to CVD-cardiovascular disease?

Back 81

Promotes atherosclerotic lesions

Front 82

Distinction between a pulmonary embolism and acute coronary syndrome is often difficult due to similar onset presentations. Which test is used to aid in the diagnosis?

Back 82

D-Dimer

Front 83

What is stable angina?

Back 83

Chest pain that occurs after activity

Front 84

Which lipoproteins have an affinity for the arterial wall and contributes to plague build up?

Back 84

LDL and VLDL

Front 85

A normal myoglobin concentration 8 hours after the onset of symptoms of a suspected MI will

Back 85

be interpreted with careful consideration to TnT.

Front 86

A 4-year-old girl has edema that is most obvious around her ankles and face, and a rash. Her laboratory findings reveal (normal values are in parentheses): serum protein 4.8 g/dL (6.5 to 8.3 g/dL), serum cholesterol 450 mg/dL (< 200 mg/dL), serum urea 20 mg/dL (7 to 18 mg/dL), heavy urine protein (normal is negative), and negative urine blood (normal is negative). All other values were normal. These findings are most consistent with a diagnosis of

Back 86

nephrotic syndrome.

Front 87

If a physician orders a creatinine clearance on an individual, what is he or she attempting to determine?

Back 87

Glomerular filtration rate

Front 88

Which mechanism influences the production of aldosterone?

Back 88

Renin-angiotensin

Front 89

Erythropoietin increases the number of RBCs by acting on

Back 89

the bone marrow RBC precursor cells.

Front 90

In terms of GFR, kidney failure is best described as a GFR of

Back 90

< 15 mL/min

Front 91

most dilute specimen of the day and therefore any chemical compounds present will not exceed the detectability limits of the reagent strips.

Back 91

most concentrated specimen of the day and therefore it is more likely that abnormalities will be detected.

Front 92

The diluting and concentrating ability of the kidney may be measured by determining the urine's

Back 92

specific gravity.

Front 93

The major non-protein nitrogen degradation product of endogenous purines and is increased in gout is

Back 93

uric acid.

Front 94

An increase in ADH will cause which of the following?

Back 94

Water reabsorption increased in body