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224 Cards in this Set

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BMP
Na, K, Cl, C02, BUN, creat, glu
TFT
TSH
T3
T4
Cholesterol panel
total cholesterol, LDL, HDL, TG
Cardiac Enzymes
CPK-MB, Trop I, LDH
Bun/Creat
Kid fx
Osmo
[serum] and [urine]--> assesses overall pt fluid status or kid fx
Therapeutic Drug Levels
dig, phenytoin, theophylline, pheobarb
Random and 24 hour urine
creatinine, protein, electrolytes, VMA
Factors that can influence K test
hemolysis
Tests that timing is a big factor of...
Cortisol
Blood Sugars
Blood Urea Nitrogen is an _____.
end product of protein metabolism
formed in the liver and excreted in the urine.
BUN NL
10-20mg/dL
Decreased BUN can be from...
liver dz, fluid overload, malnutrition, malabsorption, early pregnancy, nephrotic syndrome
Increased BUN can be from...
azotemia
Prerenal can be from
loss of volume or blood supply to the kidneys, CHF, sepsis, dehydration, high protein
BMP
Na, K, Cl, C02, BUN, creat, glu
TFT
TSH
T3
T4
Cholesterol panel
total cholesterol, LDL, HDL, TG
Cardiac Enzymes
CPK-MB, Trop I, LDH
Bun/Creat
Kid fx
Osmo
[serum] and [urine]--> assesses overall pt fluid status or kid fx
Therapeutic Drug Levels
dig, phenytoin, theophylline, pheobarb
Random and 24 hour urine
creatinine, protein, electrolytes, VMA
Factors that can influence K test
hemolysis
Tests that timing is a big factor of...
Cortisol
Blood Sugars
Blood Urea Nitrogen is an _____.
end product of protein metabolism
formed in the liver and excreted in the urine.
BUN NL
10-20mg/dL
Decreased BUN can be from...
liver dz, fluid overload, malnutrition, malabsorption, early pregnancy, nephrotic syndrome
Increased BUN can be from...
azotemia
Prerenal can be from
loss of volume or blood supply to the kidneys, CHF, sepsis, dehydration, high protein, hemorrhage, shock, trauma, increased protein metabolism
Post Renal can be from
Obstruction
Serum Creatinine NL range
0.5-1.2mg/dL
Creatinine is...
a product of creatine phosphate catabolism
more stable than BUN
Creatinine doesn't rise until...
1/2 the nephrons lose fx
Drugs that may affect Serum Creatinine
NSAIDS, Levaquin, diurectics
elevated Scre can be from
decreased renal fx and/or renal blood flow, diabetic neuropathy, urinary tract obstruction, rhabdomyolysis, increased muscle mass
decreased Scre can be from
loss of muscle mass
BUN/Cre
BUN/Cre NL
prerenal
renal dz
liver dz, low protein diets, dialysis
10:1
>15:1
10:1 but elevated both
<10:1
Na NL range
136-145mEq/L
Na is an...
extracellular cation that maintains the ECF volume
Factors that affect Na
Aldosterone
Natriuetic Hormone
ADH
Hyponatremia is the most common electrolyte imbalance in ________.
hospitalized patients
Na <125 S&S
weakness, confusion, lethargy
Na<115 S&S
stupor, coma
This is a risk if you replenish Na more than 12mEq/L/d
pontine myelinolysis
Hypovolemic Hyponatremia
N/V/d/diuretics
Hypervolemic Hyponatremia
CHF, edema, ascites, IV fluids
Euvolemic Hyponatremia
SIADH
Pseudohyponatremia is caused by
increased lipids, increased protein, severe hypoglycemia
Hypernatremia S&S
agitation, restlessness, thirst, mania, convulsions,dry mucous mbs, hyperreflexia,
Hypernatremia Causes
increased water loss, burns, diabetes inspidis, hyperaldosteronism, Cushing's syndrome
K+ NL range
3.5-5mEq/L
K+ is an...
intracellular cation
Role in pH, cellular growth nucleic acid and protein synthesis
K+ is excreted via the
kidney and colon
H and K+ trade places to...
buffer the pH in acid.base disturbances
______ exchanges K+ for Na+
Aldosterone
______ promotes K+ secretion
ADH
______ increase K+
ACEi
Acute respiratory Acidosis/
Alkalosis
decreases K+ excretion/
increases K+ excretion
Hypokalemia causes
dietary, cellular intake, renal loss, GL loss, skin loss (burns), alkalosis
if K+ <2.5=
dysrhythmias, check EKG for flat T and U waves
Clinical manifestations of Hypokalemia
NM, Cardiac, metabolic, renal
Hyperkalemia Causes
increased exogenous uptake, cell lysis, infection, acidosis, dehydration
HyperK+ affects _____-->____
skeletal and cardiac muscles--> weakness and paralysis
HyperK+ you should check the _______ for _______
EKG for peaked T waves, widened QRS, depressed ST and V fib
Pseudohyperkalemia is due to
hemolysis
Cl NL range
90-116mEq/L
CL is a major...
extracelluar anion
Cl is important in metabolic ________ when HCO3 moves ____ of the cell.
alkalosis, out
HypoCl causes
tetany, shallow breathing, metabolic alkalosis, chronic respiratory acidosis, muscle/nervous system hyperexcitability, vomitting, NG tube
HyperCl causes
lethargy, weakness, deepbreathing, metabolic acidosis, renal tubular acidosis, eclampsia
CO2 NL
23-30mEq/L
COs is an...
oxidative byproduct of CHO, fats and amino acids
CO2/HCO3 is regulated by the ______ and is ________ proportional to pH
kidneys, directly
PCO2/H2CO3 is regulated by the ______ and is ________ proportional to pH
lungs, inversely
Metabolic Acidosis is?
etiologies?
low CO2
AG>16
HCO3 loss--> diarrhea, chronic loop diuretics, renal failure
Respiratory deficiencies are?
etiologies?
increased CO2 on lytes
increased pCO2 on ABGs
metabolic alkalosis, NGT
Anion gap NL range
8-12mEq/L
AG=Na-(Cl+CO2)
represents unmeasured anions
used to classify metabolic acidosis and mixed A-B disorders
Mg NL range
1.7-2.7mg/dL
Mg is the second most common...
intracellular cation
Mg is found in
bone, muscle and extracellular
Mg is responsible for
activation of enzymes, hydrolysis of ATP, protein synthesis
Mg Homeostasis regulated through
intestines, bone and kidneys
HypoMg causes
decreased intake, decreased absorption, increased urinary loss
hypoMg is associated with
decreased K and dec Ca
Low Mg will lead to...
cardiac irriatbility and increased cardiac dysrrhythmias
30% of alcoholics are hypoMg
HyperMg causes
renal dysfunction unless pt has been overloaded with Mg- antacids, edema
HyperMg will lead to
retard in NM conduction with cardiac slowing- wide PR, QT, QRS intervals, decreased DTR, respiratory depression
PO4 NL range
3.0-4.5mg/dL
PO4 found in
bone and teeth, doft tissues, extracellular fluid
Hyperparathyroidism
Ca--> increased in serum--> hypercalcimium--> PO4 goes down
Phosphorous homeostasis is maintained by
Ca metabolism, PTH, intestine, bone and kidney, gut absorption, renal excretion
This will decrease intestinal absorption of PO4
Antacids
PO4 is important in these two cellular processes
oxidative phosphorylation and mitochondrial respiration
HypoPO4 causes
hyperparathyroidism, increased Ca, ETOH, alkalosis
HypoPO4 will lead to
multiple organ dysfunction, neuro changes, confusion, coma, hypotn, rhabdomyolysis, hypoxia, decrease in menstruation, muscle weakness, arthralgia, hematologic dyfx
HyperPO4 causes
hyperparathyroidism, renal failure, decrease Ca acidosis
Ca NL ranges
9.0-10.5mg/dL
Ca is available in
hydroxyapatite, teeth, soft tissues, plasma, and cells.
3 forms of Ca
free/ionized, bound to albumin, anions
Function of Ca
muscle and nerve contraction, enzyme activities, cardiac function, coagulation, cell growth
Role of Ca
monitor pts with renal failure, malignancies and hyperparathyroidism
Ca is absorbed in the
intestines, needs vitamin D 1,25 dihydroxycholecalciferol
These decrease/increase the absorption of Ca
Glucocorticoids/ calctrol
Alkalosis inc/dec ionized Ca?
inc
Acidosis inc/dec ionized Ca?
dec
Loop Diuretics inc/dec Ca excretion/absorption by the kidney?
increase, excretion
thiazide Diuretics inc/dec Ca excretion/absorption by the kidney?
increase, absorption
Albumin levels must be known as for each _____ gram of _____ there is a corresponding dec ____mg/dL in Ca
dec., Albumin, 0.8
HypoCa etiologies
dec PTH, dec vitD, dec GL absorption, inc renal excretion, dec Mg, pseudohypoparathyroidism
HypoCa S&S
tetany, Chvostek's sn, Trousseau's sn, cramps, seizures, cardiac dysrrhythmias, prolonged QT
HyperCa Causes
inc bone reabsorption
What is the second leading cause of HyperCa
malignancy
What are the causes of HyperCa?
hyperparathyroidism- leading cuase, kidney stones, bone pain, pagets, granulomatous diz
Glucose NL value
70-110mg/dL
Diabetic Fasting BS--
>126
impaired GT-
FBS 111-125mg/dL
factors that lead to elevated BS
increased stress, insulin def, hyperthyroidism, increased estrogen levels, acromegaly, Cushings, pheochromocytoma, pancreatitis, CRF, hyperaldosteronism, steroids, thiazide diuretics, niacin, OCP, infx, hypermetabolic states
Nonketotic hyperosmolar syndrome
glu 700-800 range ketones not increased
Hemoglobin a1c
AKA glycosylated hemoglobin
marker of glucose level over the past 3 months
Ha1c 5% corresponds to a glu of ___. For every __% increase, add ___ to glucose.
90, 1, 30
GTT abNL
persistant elevated 2 hour levels are abNL
Hypoglycemia
insulin overdose
BS<50mg/dL with sx
Fasting Hypoglycemia etiologies
tumore, liver dz, hypothyroidism, Addison's dz, chronic ETOH abuse
Postprandial hypoglycemia due to
exaggerated insulin response
dx with 5hr GTT, insulin and cortisol levels
Bilirubin NL level
0.3-1.0mg/dL
Unconjugated, Indirect Bilirubin is...
bound to albumin in plasma for transport, can pass throught blood/brain barrier therefore > 15mg/dL in newborns require tx avoid brain damage
Conjugated, Direct Bilirubin is...
excreted in bile--> urobiliogen in intestines--> excreted in feces--> urobiliogen in urine
Jaundice pts have a level of ______ and _______urine and ________stools
>2.5mg/dL, dark, light
Babies that are jaundice have elevated level of _______, and are at risk for __________.
unconjugated bilirubin, kernicterus--> MR
Increased total Bili=
hepatic damage, hepatitis, biliary obstruction, hemolysis
increased direct, conjugated bili=
biliary obstruction, cholestasis
increased indirect, unconjugated bili=
hepatitis, sickle cell, hemolytic jaundice, transfusion rxn, gilberts dz, HDN
AST(SGOT) NL range
4-40U/L
AST(SGOT) is an enzyme in the
liver, myocardium, skeletal muscle, brain, and kidney
AST(SGOT) is elevated hou many hours after injury? When does it peak/ return to NL.
8hrs after injury, peaks 24-36 hrs, returns, to NL in 3-7 days
AST(SGOT) requires ______ as a cofactor for full enzymatic activity.
vitamin B6
AST(SGOT) is elevated in these conditions...
AMI, CHF, hypotn, hypoxic episodes, liver dz, Reye's syndrome, muscle trauma, pancreatitis, intestinal injury, renal infarction, and hepatocellular damage.
AST(SGOT) is decreased in these conditions...
severe diabetes with ketoacidosis, liver dz, chronic hemodialysis
ALT(SGPT) NL range
5-35U/L
ALT(SGPT) is specific to...
hepatocellular dz, small amount in heart, muscles, kidneys
more specific to the liver than AST
ALT(SGPT) increased in
cirrhosis, hepatic ischemia/necrosis, hepatotoxic drugs, severe burn, MI, pancreatitis, mono, hypotn, CHF
ALT/AST ratio <1
ETOH cirrhosis, liver congestion, metastatic tumor
ALT/AST ratio >1
acute hepatitis
Alk Phos NL range
30-85U/L
Alk Phos used to
monitor/detect liver or bone dz, found in rapid
Alk phos can be heat fractionated to identify source of...
bone, kidney, placenta, liver
Ak Phos is a sensative marker for...
liver metastasis
Alk phos is increased in...
active bone formation, osteomalacia, pagets, rickets
Alk phos is excreted in _______ and is increased in... 4 things
bile, biliary cirrhosis, cirrhosis, intrahepatic duct, and extrahepatic duct disorders
Gamma-Glutamyl Transferase GGT is found in ________
hepatobiliary cells as well as epithelium of pancreas, kidney, spleen, heart, intestine, brain, prostate gland
GGT is an ______ enzyme
obstructive
GGT is an indicator of
ETOH use
Decreased osmotic pressure=
ascites, edema
Total Protein increased=
multiple myeloma, waldstrom's macroglobulinemia, lymphoma, chronic inflammatory dz, sarcoidosis, viral illness
Total Protein decreased=
malnutrition, inflammatory bowel dz, hodgekins, leukemias
Alk phos is excreted in _______ and is increased in... 4 things
bile, biliary cirrhosis, cirrhosis, intrahepatic duct, and extrahepatic duct disorders
Gamma-Glutamyl Transferase GGT is found in ________
hepatobiliary cells as well as epithelium of pancreas, kidney, spleen, heart, intestine, brain, prostate gland
GGT is an ______ enzyme
obstructive
GGT is an indicator of
ETOH use
Decreased osmotic pressure=
ascites, edema
Total Protein increased=
multiple myeloma, waldstrom's macroglobulinemia, lymphoma, chronic inflammatory dz, sarcoidosis, viral illness
Total Protein decreased=
malnutrition, inflammatory bowel dz, hodgekins, leukemias
Albumin half life
14-20d
PreAlbumin is more reflective of
acute process and widely used to check for malnutrition and hepatic dysfx
Globulins are
building blocks of Abs, glycoproteins, clotting factors, complement, acute phase reactant proteins
Globulins are made in the
liver and in the reticulo-endothelial system
Globulin levels will be increased in comparison to albumin in
diseases where capillary permeability is increased.
Albumin/Globulin Ratio NL
<1
Alb/Glob ratio is decreased in
cirrhosis, liver dz, nephrotic syndrom, chronic GN, cachexia, burns, myeloma, chronic infx/inflammation
Ammonia is used to dx or tx?
severe liver dz and hepatic encephalopathy
Ammonia is generated by
bacterial degeneration of protein in intestines which enters portal circulation and is narmally transformed into urea, however, in severe liver hepatocellular dysfx ammonia cannot be catabolized.
Inc in ammonia
seen in NL neonates w/i 48 hours of birth and in liver failure, portal HTN, GI bleed and Reyes Syndrome
Troponin increase
with heart injury but not specific to MI
Troponin does not cross react with...
skeletal isotopes
elevated troponins w/o elevated CKMB is consistent with...
ACS
CPK does...
catalyzes phosphate group transfer btw creatine phosphate and ADP resulting in ATP
CPKBB
brain and smooth muscle- increased in brain injurt and pulmonary infarction
CPKMM
skeletal muscle- usually accounts for 100% of circulating CPK
CKMB
primarily used to dx AMI
When is CPK ordered
q8hours x3
Increased CKMB is seen...
after cardiac surgery, pericarditis and myositis
LDH is the essential enzyme in interconversion of...
lactate and pyruvate- found mostly in heart, liver, RBCs, kidneys, skeletal muscle, brain, lungs
** Testing is greatly affected by hemolysis**
LDH1
heart
LDH2
reticuloendothelial system, most abundant
LDH3
Lungs
LDH4
kidney, placenta, pancreas
LDH5
liver, muscle
BNP
hormone produced by heart, correspons to workload of the heart
Levels directly correspond to severity of failure
BNP affected by...
diuretics, kidney failure, MI
Cardio C- reactive protein
indicative of inflammation
overnight fast preferred to avoid excessive turbidity due to lipemic serum specimens
Total cholesterol is a major biological significane b/c it is a
building block in cell mb, hormones, bole acids, metabolites
Total cHolesterol is elevated in
hypercholesterolemia, biliary obstruction, nephrosis, hypothyroidism, pancreatic dz,pregnancy, and OCP
Total Cholesterol is decreased in
liver dz, hyperthyroidism, malnutrition, chronic anemias, steroid therapy, AMI
LDL contains the majority of
plasma cholesterol
diets high in saturated fats and cholesterol ________ LDL levels
increase
HDL is approximately ____% of circulating cholesterol
25
HDL does this
takes cholesterol from tissues back to the liver
Tangiers Dz
HDL deficient state resulting in extensive cholesterol deposition in tissues
HDL can be increased w/
exercise, and moderate ETOH use
TG are stored in
adipose tissues for readily available lipids to be used in gluconeogensis
Nonfasting TG are found in ________ whereas fasting TG are found in ________
Chylomicrons, VLDL
TG are increased in
pancreatitis, alcoholism and poorly controlled DM
TSH-
most specific test for thyroid fx
TSH is produced in the _______ after stimulation by _________.
AP gland, TRH
TSH is increased in
primary hypothyroidism and thyroiditis
TSH is decreased in
hyperthyroidism, jsecondart thypothyroidism, pituitary dysfx
T4- Thyroxine
nearly all the thyroid hormone circulating in the blood
nearly all is bound to protein
Free is metabolically active
T4 id decreased in
hypothyroidism, pituitary insufficiency
T3- Triiodothronine
more active form
used to dx hyperthyroidism
Amylase
secreted from?
pancreatic acinar cells in to pancreatic duct, cholecystokinin stimulates its release from pancreas
Amylase is produced in
salivary glands and pancreas
Amylase in intestines...
aids in breakdown of CHO into simple sugars
Amylase is sensitive for
pancreatic disorders
Amylase is increased in
almost all pancreatic disorders although some salivary gland inflammations could be the culprit
Two tumors that can release amylase
Serous Ovarian tumor
Lung Carcinoma
Lipase
enzyme that cleaves TG into FA and glycerol
FOund exclusively in pancreas
excreted by kidneys
increased lipase in
acute or chronic pancreatitis, pancreatic duct obstruction, fat embolus syndrome, renal failure and dialysis
Uric Acid
endproduct of purine metabolism, synthesized primarily by liver, excreted by kidneys
Organ meats, legumes, yeasts= high in purines
elevated uric acid =
cell turnover i.e. leukemia, ca
increase uric acid
thiazide diuretics, low dose ASA, ETOH, lactic and ketoacidosis, renal failure
Fe, TIBC, Ferritin
evaluation of microcytic, hypochromatic anemia
Fe
most abundant trace element in body
needed for RBC production