Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/136

Click to flip

136 Cards in this Set

  • Front
  • Back
See Jaimee's graph on "Plama Lipids and Lab Dx"
Awesome Chart-Thank You!!!
Lab Dx Book
pp.386-7, 394-401, 405-7, 413-14, 421-36
ALT-enzyme
Alanine Aminotransferase
High [ ]'s in liver
Low [ ]'s in heart, muscle and kidney
What is this test used for?
To Dx liver dz and to monitor Tx for hepatitis, cirrhosis and the effecs of later drug therapy
ALT is more sensitive in the detection of liver dz than in biliary obstruction
ALT differentiates btwn hemolytic jaundice and jaundice d/t liver dz
What are the NL ALT values?
Males 10-40 U/L
Females 7-35 U/L
Newborns 13-45 U/L
(Adult levels are reached by 6 months old)
What do you use to test for ALT?
Venous Blood Sample - Serum
An increase in ALT is found in what conditions?
Hepatocelluar Dz, alcoholic cirrhosis, metastatic liver tumor, obstructive jaundice(biliary), mono, pancreatitis, MI, polymyositis (inflammation of skeletal m.), severe burns, trauma to striated m., severe shock
Which one is always increased in MI? AST or ALT?
AST
When does ALT increase with an MI?
When there is associated liver damage.
Which one is increased more w/acute extrahepatic biliary obstruction?
ALT
Why is the AST/ALT ratio high in alcoholic liver dz?
ALT is more specific for liver dz whereas AST is more sensitive to alcoholic liver dz.
So, since this is a blood test...
we can't perform it. They have to be sent out to a lab.
Alcohol-acetaminophen syndrome
Extremely High ALT/AST values =>9000 U/L
(I'm not sure if they are saying ALT and AST or ALT/AST ratio...)
Remember that certain things can cause increased or decreased ALT values.
Increased-drugs, salicylates, heparin, hemolysed blood, obesity.
Decreased-drugs, salicylates.
What should a person with elevated ALT levels and Ab's to hep B and hep C antigens NOT do?
Donate blood
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
Where is troponin highly concentrated?
Cardiomyocytes
When is troponin released?
With very small areas of myocardial damage
When?
1-3 hours after tissue injury
How long does it stay elevated?
5-7 days
Troponin I
More cardiac specific
(It remains elevated longer than CK-MB)
Troponin T
More sensitive but less specific...it is + w/angina when at rest.
When is this test used?
In the early diagnosis of small MI's that are undetectable by other approaches.
When is the test taken?
Multiple times...0, 4h, 8h and 12h after chest pain
How is it taken?
Venous blood w/a red-topped tube
What are NL troponin values?
NL = - test for MI
Troponin I <.35 ng/mL
Troponin T <.2 ng/mL
What will you also see for a -MI test?
Total CK 1-120ng/mL
CK-MB 0-3 ng/mL
CK index 0-3
LDH 140-280 U/L
Myoglobin <55 ng/mL
Troponin <.4 ng/mL
What do + or elevated Troponin I levels indicate?
Small infarts, myocardial injury during surgery.
What do + or elevated Troponin T levels indicate?
Acute MI, perisurgical MI, unstable angina, myocarditis
When can Troponin T levels also be increased?
Renal dz, chronic m. dz, trauma
What is a Troponin I critical value?
>1.5 ng/mL
Creatine Phosphokinase (CPK)
Creatine Kinase (CK)
(Same thing)
CPK/CK, CK or CPK(creatine kinase) is an enzyme found in high [ ]'s in the heart and skeletal m. and low [ ]'s in brain tissue.
I will use CK for simplicity.
So, what is this a test for?
Injury to myocardium and muscle.
What can CK be divided into what isoenzymes?
CK-MM...muscle & circ enzymes
CK-BB...brain,GIT&GUT enzymes
CK-MB...heart
NL CK levels are 100% composed of what?
CK-MM
Elevated CK levels show an increase in one or more of the isoenzymes.
MM,BB,MB depending on where the injury occurred.
A SLIGHT increase in total CK show what?
An eleveated BB from CNS injury.
What does CK mostly test for?
MI, skeletal and inflammatory m. dz
What else can elevated CK stand for?
MD, CNS disorders(ie: Reye's).
What are the NL values of CK?
Men 38-174 U/L
Women 26-140 U/L
Infants 2-3 times adult values
What are the NL value percentages of the isoenzymes?
MM 96-100%
MB 0-6%
BB 0%
Test comes from where?
Venous blood-Serum
What causes elevated CK levels?
Acute MI, myocarditis, after open heart surgery, cardiac defib
What cause decreased CK levels?
Low m. mass, bed rest
What causes elevated CK-MB levels?
MI, myocardial ischemia, angina, MD, subarachnoid hem, Reye's, M. trauma/surgery, circ failure/shock, chronic renal failure, CO poisoning
What causes elevated CK-BB levels?
Reye's, some cancers, SSS, brain injury, hypothermia, after coronary bypass, newborns
When is CK-MM elevated?
In most conditions where total CK is elevated.
What else can cause elevated CK levels?
Strenuous exercise, weight lifting, surgical procedures that damage skeletal m., alcohol, drugs, childbirth.
What other tests would be done if CK-MB is high?
Total leukos and diff
Troponin T
Myoglobin
(this would support MI Dx)
LDH (or LD)
Lactate Dehydrogenase
What is it?
Intracelluar enzyme that is widely distributed in the tissues of the body esp. kidney, heart, skeletal m., brain, liver, lungs
What do increases in LDH usually mean?
Cellular death and leakage of the enzyme from the cell
What is this test useful for then?
Confirming MI's or pulmonary infarcts in combo w/other tests
For example...
LDH remains elevated longer than CK in MI's
What else is this test good for?
CHF, liver dzes, malignancies, hypothyroidism, lung dzes, skeletal m. dzes (MD), certain anemias, seizures, etc
What can LDH be broken down into?
its 5 isoenzymes
What are the NL values?
Adults 140-280 U/L
Children 60-170 U/L
Newborns 160-450 U/L
How is this test obtained?
Venous Blood-serum
With regards to MI's, when are the LDH levels elevated?
36-55 hours after MI
How long do the elevated levels last?
past 3-10 days
With regards to pulm. infarcts, when are the levels elevated?
within 24 hours of onset
How long do they stay elevated?
24 hours
What do decreased levels of LDH show?
a good response to cancer therapy
Why is this test limited in its diagnostic value?
B/c LDH is found in almost every tissue of the body so hard to figure out which part of body cellular death is occuring. The isoenzyme testing helps here
Electrophoresis(or separation) of LDH reveals 5 isoenzymes
LDH1 & LDH2 = cardiac tissue and erythrocytes
LDH3 = lung, spleen, pancreas and placenta
LDH4 & LDH5 = skeletal m. and liver
Abnormalities in values of these isoenzymes show different patterns in various dzes
The differing patterns suggest which tissues have benn damaged
Useful for DDx of?
Acute MI, megaloblastic anemia, hemolytic anemia and renal infarct
What is megaloblastic anemia?
folate def or pericious anemia
What is pernicious anemia?
Type of autoimmune anemia. Antibodies are directed against intrinsic factor or parietal cells which produce intrinsic factor. Intrinsic factor is required for vitamin B12 absorption, so impaired absorption of vitamin B12 can result. An anemia is a deficiency of the blood cells, but in addition to blood cells, many other cells in the body need vitamin B12, including nerve cells.

The term pernicious anemia is sometimes used more loosely to include non-autoimmune causes of vitamin B12 deficiency.
The above mentioned disorders would show what?
LDH1 increases, therefore the LDH1:LDH2 ratio is inverted
What are the NL values for these isoenzymes?
LDH1...17-27%
LDH2...29-39%
LDH3...19-27%
LDH4...5-16%
LDH5...6-16%
See table 6.12 in book page 407 for ABNL LDH Isoenzyme patterns
Just a couple worth mentioning...
MI
LDH1:LDH2 flip
confirms MI when added to the detection of CK-MB
Anemias
Same flip but the time that the LDH1 levels are elevated is longer w/MI's
Cancer-malignant
LDH3 (but will decrease with Tx)
Pulmonary Infarcts/pneumonia
LDH3
Liver Dz, CHF, pulm edema, striated m. trauma, burns
LDH5
Cancers
LDH2,3,4
Systemic Dzes
All
LDh Isoenzyme testing...
used in more complex cases and always in light of clinical findings
Homocysteine Testing
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
Plasm Lipids...again, refer to Jamie's chart.
Here are some cards for extra info on this topic.
What are lipids made up of?
cholesterol, cholesterol esters, TGs, nonesterized f.a., and phospholipids
What are lipoproteins?
BUSES-plasma proteins that transport insoluble lipids
How are they categorized?
chylomicrons
LDL's (beta lipoproteins)
VLDL's (pre-beta)
HDL's (alpha lipoproteins)
What is Apolipoprotein A?
HDL
chylomicrons
VLDL
What is Apolipoprotein B?
LDL
What is the function of lipoproteins?
Energy for metabolism
Precursors to steroid hh-adrenals, ovaries, testes
Bile acids
Cell membrane dev.
S1 occurs when?
near the beg of systole (ventricular contration)
What is it?
Closing of the tricuspid and mitral valves
Is splitting NL or ABNL here?
ABNL-pathological
S2 occurs when?
near the end of systole
What is it?
Closing of the pulm and aortic valves
Is splitting NL or ABNL?
a slight gap is NL
S3?
occurs at the end of the rapid filling period of the ventricle-during the beginning of ventricular diastole
What is it?
Ventricular wall tensing
S4?
coincides w/atrial contraction
at the end of ventricular diastole
Palpation of the radial pulse should correspond with what heart sound?
S2
S1 occurs when?
near the beg of systole (ventricular contration)
What is it?
Closing of the tricuspid and mitral valves
Is splitting NL or ABNL here?
ABNL-pathological
S2 occurs when?
near the end of systole
What is it?
Closing of the pulm and aortic valves
Is splitting NL or ABNL?
a slight gap is NL
S3?
occurs at the end of the rapid filling period of the ventricle-during the beginning of ventricular diastole
What is it?
Ventricular wall tensing
S4?
coincides w/atrial contraction
at the end of ventricular diastole
Palpation of the radial pulse should correspond with what heart sound?
S2