Exam 2 Study Questions

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What is the primary dietary source of glucose for humans?
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Starch
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What is the primary storage form of glucose for humans?
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Glycogen
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What salivary and pancreatic enzyme is responsible for initial digestion of carbohydrates?
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AMS
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lipolysis
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Breakdown of fats with the production of ketones through the TCA cycle
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aerobic oxidation
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Acetyl CoA enters the TCA cycle and ATP, CO2 and water are made
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HMP shunt
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Endproduct is NADPH; important energy source in RBCs
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glycogenesis
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Conversion of glucose into the storage form
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glycolysis
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Production of pyruvate / lactate during oxygen depletion
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glycogenolysis
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Breakdown of glycogen back into glucose
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What is the only hormone that will lower blood glucose levels, and where is it produced?
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Insulin, made in the pancreas
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What primary hormone raises glucose levels, and where is it produced?
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Glucagon, made in the pancreas
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Which hormone is capable of raising glucose levels most rapidly, and where is it produced?
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Adrenaline (epinephrine), adrenal gland
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The ingestion of excess carbohydrate will lead to the production and storage of what type of compound?
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Fat
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List the reference range for fasting serum glucose.
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Approx 70-110 mg/dL
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How will ranges be affected if whole blood is tested?
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10% lower
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What is the preferred anticoagulant for testing whole blood and color of collection tube?
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NaFl, gray top
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What is the preferred anticoagulant for plasma testing and color of collection tube?
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Heparin, green top
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What happens to glucose levels after one hour if unpreserved whole blood is left to sit?
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Levels may decrease 10-12% per hour
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Gestational
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May be transient
Interference from lactogen
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Type 2
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Obesity and sedentary lifestyle
Adult onset
Strongest genetic connection
Includes most cases of diabetes
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Type 1
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Autoimmune
Insulin dependent
Acute onset of polydipsia and polyuria
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What causes excess ketone production in diabetes?
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Increased fat metabolism
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List several metabolic complications seen in diabetes
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Renal and heart dz, vascular dz, blindness
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What constitutes “hypoglycemia”?
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glucose <50 mg/dL
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List the primary causes of hypoglycemia.
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Insulin shock due to overdose or insulin-producing tumor
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According to the ADA, what criteria is diagnostic for diabetes when testing:
A fasting serum or plasma
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>126
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According to the ADA, what criteria is diagnostic for diabetes when testing:
A random serum or plasma
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>200 with symptoms
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According to the ADA, what criteria is diagnostic for diabetes when testing:
A 2-hour postprandial sample
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>200
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HbA1C is an indicator of glucose control for what preceding time period?
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2-3 months
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What is the specimen requirement for HbA1C testing?
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EDTA
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What conditions can cause a falsely decreased HbA1C?
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hemolytic anemias, blood loss, alcohol, lead and some drugs
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What is microalbumin and what is the purpose of performing this test?
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Small levels of albumin not detected by urine dipstick; may indicate early renal dz
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List the two primary methodologies used to measure serum glucose.
Include those substances known to cause interference.
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Glucose oxidase; BUN, uric acid and bilirubin interfere
Hexokinase; bilirubin
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Exogenous fats are those derived from what source?
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Diet
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Endogenous fats are those derived from what source?
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Liver
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A fatty acid that contains NO double bonds is classified as saturated or unsaturated?
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Saturated
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Which type of fat is more easily excreted?
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Unsaturated
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What class of fats has a steroid alcohol base?
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Cholesterol
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What class of fats is composed of fatty acids plus glycerol?
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Triglyceride
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What type of fats are products of man-made manipulation of oils to solids?
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Trans fats
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Lung surfactants
Principle component of most cell membranes
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phospholipids
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Cell membranes of brain and CNS
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glycolipids
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Steroid hormone and vitamin D precursor
Component of bile acids
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cholesterol
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Regulates renin secretion
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prostaglandins
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Primary storage form of fat
Broken down under the influence of lipase enzyme
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triglycerides
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No good function that we know of
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trans fatty acids
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Building blocks that contribute to production of acetyl CoA
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fatty acids
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What is the protein portion of the lipoprotein molecule called?
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apoprotein
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What abnormal lipoprotein is associated with CHD at an early age?
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Lp(a)
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Made in the intestines in response to food ingestion
Causes a milky layer on serum after meals
Carries exogenous Tg to tissues
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Chylomicrons
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Excess leads to plaques and clogged arteries
“Bad” cholesterol
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LDL
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Contains the highest percentage of protein
Transports cholesterol to liver for excretion
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HDL
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Transports Tg from liver to tissues
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VLDL
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Foam cells–>fatty streaks–>plaques
Leading cause of death in U.S.
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Arteriosclerosis
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Major cause of pancreatitis
Increase of glycerol-based lipids
GGT and beta-gamma bridging
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Alcoholism
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Inc TG, chol, and LDL
Microalbuminuria
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Diabetes
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Inc. TG and chol,
Dec. albumin
Massive proteinuria and oval fat bodies
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Nephrotic syndrome
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Supersaturated bile
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Gallstones
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LDL receptor problem
Cause of early onset heart disease
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Familial hypercholesterolemia
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Name the enzyme needed to break cholesterol esters into free cholesterol particles.
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cholesteryl esterase
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List the most common interfering factors in the cholesterol test.
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Bilirubin, ascorbic acid
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List specimen requirements for TG and chol.
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Fasting preferred
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Name the enzyme needed to break TG into fatty acids and glycerol.
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Lipase
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Describe the homogeneous method of HDL quantitation.
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Selective enzymes block non-HDL lipids; reagent reacts with free HDL
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Which of the NPNs is the best indicator of liver dysfunction?
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Ammonia
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What test is commonly used as an indicator of GFR?
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Creatinine clearance
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List the 3 most common causes of an elevated uric acid.
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Gout, chemo/irradiation, renal dz
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Which NPN is elevated in Reye’s syndrome?
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Ammonia
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Define azotemia.
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Increased BUN
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Define uremia.
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Increased BUN with renal failure
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For each of the following, identify it as a prerenal, renal, or postrenal cause of an elevated BUN:
Kidney stone
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post
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For each of the following, identify it as a prerenal, renal, or postrenal cause of an elevated BUN:
Glomerular disease
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renal
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For each of the following, identify it as a prerenal, renal, or postrenal cause of an elevated BUN:
Congestive heart failure
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pre
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For each of the following, identify it as a prerenal, renal, or postrenal cause of an elevated BUN:
Bladder tumor
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post
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For each of the following, identify it as a prerenal, renal, or postrenal cause of an elevated BUN:
High protein diet
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pre
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Match the NPN with the source:
Muscle metabolism
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Creatinine
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Match the NPN with the source:
Purine metabolism
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Uric acid
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Match the NPN with the source:
Protein metabolism
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BUN
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Which NPN is adversely affected by fluoride and citrate in the sample?
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BUN
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Picric acid in an alkaline environment. Name the reaction and the analyte being measured.
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Jaffe reaction for creatinine
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List special handling requirements for ammonia analysis.
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Put tube on ice immediately after collecting; spin @ 4 C, test ASAP or keep on ice.
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Match the function with its primary site or action:
Initial filtration of blood
Blood retention of proteins and cells
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Glomerulus
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Match the function with its primary site or action:
Reabsorption of most water, glucose and amino acids
Secretion of non-filterable wastes
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Proximal tubule
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Match the function with its primary site or action:
Na reabsorbed under the influence of aldosterone
Water reabsorption under the influence of ADH
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Distal tubule
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Na reabsorbed under the influence of?
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aldosterone
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Water reabsorption under the influence of?
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ADH
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In order to maintain electrical neutrality, what 2 analytes will be excreted when Na is reabsorbed?
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K and H
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What two analytes are excreted or reabsorbed to help maintain blood pH?
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H & HCO3
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In response to a decrease in blood pressure or volume, the kidneys secrete the hormone ____, which stimulates the production of angiotensin.
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Renin
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Angiotensin stimulates the adrenal gland to secrete the hormone
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aldosterone.
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Aldosterone then causes the renal tubules to reabsorb the analyte
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sodium
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An increase in sodium causes the plasma osmolality to:
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Rise
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In response to an increased osmolality, the pituitary gland secretes
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ADH (vasopressin).
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ADH in turn causes the tubules to reabsorb
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water.
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After ADH causes reabsorption of water, the blood volume/pressure will then
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Fall
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U Cr = 105mg/dL
U vol = 950 mL
S Cr = 1.5mg/dL
Time = 24 hours
BSA = 1.95 m2
What is the Creatinine Clearance?
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46 mL/min
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U Cr = 105mg/dL
U vol = 950 mL
S Cr = 1.5mg/dL
Time = 24 hours
BSA = 1.95 m2
What is the Corrected Creatinine Clearance?
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41 mL/min
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What is a normal average GFR for adults?
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120 ml/min
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What are advantages of the eGFR and cystatin C as compared to a traditional creatinine clearance?
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No urine needed
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What urine dipstick result is considered the best indicator of renal disease?
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Protein
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What cell and cast type is consistent with:
Renal failure
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waxy/broad casts
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What cell and cast type is consistent with:
Acute glomerulonephritis
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red cells and RBC casts
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What cell and cast type is consistent with:
Pyelonephritis
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WBC and WBC casts
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What cell and cast type is consistent with:
Nephrotic syndrome
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RTE, oval fat bodies, fatty casts and cholesterol crystals
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What substance in plasma contributes the most to osmolality?
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sodium
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Would the urine of someone with diabetes mellitus have a dipstick SG that is increased, decreased or normal?
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Normal
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Would the urine of someone with diabetes mellitus have a refractometer SG that is increased, decreased or normal?
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Increased
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What test is used as an early indicator of renal disease in diabetics?
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microalbumin
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In someone who is deficient in ADH (diabetes insipidus), would the SG of the urine be increased, decreased or normal?
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Decreased
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In someone who is deficient in ADH (diabetes insipidus), would the Urine Volume be increased, decreased or normal?
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Increased

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