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104 Cards in this Set
- Front
- Back
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What percent of the body is water?
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60%
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What percent of water is intercellular?
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40%
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What percent of water is extracellular?
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20%
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What is the difference between plasma and serum?
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Serum has no fibrinogen and will not clot. Plasma will.
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What is the normal value for fasting blood sugar?
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70 to 105
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What are the critical ranges for fasting blood sugars?
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<50 and >400
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What is indicative of diabetes in terms of fasting glucose?
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>126
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What is the glucose load given for glucose tolerance tests?
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75 grams
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When do ketones increase in serum?
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Increase catabolism of fat
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What is the critical value of HA1C?
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> 8%
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H1AC provides an average of blood glucose over what time frame?
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Previous 4 to 8 weeks
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When will H1AC be inaccurate? What test can be used as an alternative?
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When red blood cells are not normal. Fructosamine.
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What is the leading cause of hypoglycemia?
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Overdose of insulin
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What is a normal value for Blood Urea Nitrogen?
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10 - 20
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What is a critical value for Blood Urea Nitrogen?
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>100
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What is the underlying physiology of Blood Urea Nitrogen?
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Waste product of protein (amino acid) metabolism (mainly in liver) and the kidney's ability to excrete it. Rise in blood means kidney is not excreting efficiently.
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At what point will the Blood Urea Nitrogen start to show a significant increase?
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When GFR has already decreased by 50%
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What is uremia?
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Condition of abnormally high urea nitrogen
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What is azotemia?
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Increase in plasma concentration of urea and creatinine due to kidney malfunction
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What are the three "types" of azotemia?
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Prerenal azotemia, renal azotemia, postrenal azotemia
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What are causes of prerenal azotemia?
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It is a system issue - poor perfusion of kidneys, low GFT, CFH, low blood volume
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What are causes of renal azotemia?
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Diminished GFR from acute or chronic renal failure, glomerular nephritis, polycystic kidneys - * kidney disease *
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What are causes of postrenal azotemia?
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Result of obstruction like stones
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What is the main cause of elevated Blood Urea Nitrogen?
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Renal disease (renal failure, nephritis, tubular necrosis.)
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What is the normal creatinine value?
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0.6 to 1.2
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What is the critical value of creatinine?
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>4
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What is the most sensitive and specific screen for renal function?
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BUN and creatinine?
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What is the normal value of creatinine clearance in men?
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107 to 139
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What is the normal value of creatinine clearance in women?
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87 to 107
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What does creatinine clearance measure?
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GFR
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What is the best overall index of kidney function?
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GFR
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What substance is used to measure GFR?
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Inulin
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What is the normal ratio between urine and serum osmolality?
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3:1
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What disease is associated with high uric acid?
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Gout
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What is the normal value for total proteins?
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6.4 to 8.3 GRAM/dl
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What is the normal value for albumin?
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3.5 to 5.0 GRAM/dl
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What is the normal value for globulin?
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2.3 - 3.4 GRAM/dl
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What is the normal ratio of albumin to globulin?
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Greater than 1
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What are three major classes of proteins found in the body?
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Organ (tissue) proteins, plasma proteins, and hemoglobin
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In conditions of deprivation, what is the greatest source of protein?
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Muscle
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Decrease in both albumin and globulin could be a sign of what two things?
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Liver disease / malabsorption
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What would be seen in polyclonal gammopathy?
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Increase in GAMMA globulins
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What is monoclonal gammopathy? What is it also known by?
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Proliferation of PLASMA cells. IgG INCREASES and other Ig's DECREASE. Multiple myeloma.
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What two things would likely be noteable in a patient with multiple myeloma?
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Pathological fractures and osteoporosis due to Ca++ being leached out of the bones (this is more noteable in skull and long bones)
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What two tests would be performed on a patient suspected of having multiple myeloma? If the patient had the disorder, what would the results of the tests be?
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1) Serum Protein Electrophoresis (SPEP) - increase in IgG ONLY.
2) Bence Jones protein test - increase in low molecular weight proteins |
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Patients with multiple myeloma may have secondary conditions as well. What would we be the main cause? Provide an example.
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Diseases associated with bone marrow disruption. Pancytopenia (decrease in all cellular elements)
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What is one way to treat multiple myeloma? What does it do?
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Alk Phos - lays down new bone.
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How often should cardiac testing be completed? What is this method of testing called?
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Serial testing - once every 6 to 9 hours for 12 to 24 hours.
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What are the three major cardiac markers?
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Troponin
Creatine Kinase - MB Myoglobin |
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Can a cardiac marker test be conclusive by itself for cardiac conditions? Why or why not?
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No - results must be evaluated in the context of patient history, physical exam, and risk factors.
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What are normal values for CK (aka CPK) in men?
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55 to 170
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What are normal values for CK (aka CPK) in women?
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30 to 135
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Where can CK (CPK) be found in the body? (3 areas)
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Brain, skeletal muscle, cardiac muscle
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What is CK-MB in relation to CK (CPK)?
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Creatine Kinase-MB is an isoenzyme of Creatine PhosphoKinase (CK or CPK)
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What CPK-MB measurement would be indicative of myocardial injury?
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3.0 with relative index > 2.5
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What CPK-MB measurement would NOT be indicative of myocardial injury?
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>3.0 with relative index <2.5
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Why is CPK-MB a better measurement than CPK?
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CPK-MB is specific for cardiac tissue - but it can still pick up brain or skeletal muscle so be careful.
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What is CPK-MM?
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Marker for skeletal muscle
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What is CPK-BB
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Marker for brain tissue
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What is the normal value of myoglobin for men?
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30 to 90
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What is the normal value of myoglobin for women?
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<50
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What is important about myoglobin in the context of cardiac testing?
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It is the first to rise in the event of myocardial injury
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What are the two cardiac-specific troponins?
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Troponin-T and Troponin-I
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What is the normal value for troponin T
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<0.2
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What is the normal value for troponin I?
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<0.03
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In what ways is troponin better than CPK-MB?
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It is not impacted by other tissue types (skeletal or brain) and it lasts in circulation much longer.
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To diagnosis an acute MI, what needs to be true?
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Abnormal results troponin OR cpk-MB AND atleast one of ischemia, pathologic q wave, ecg results for ischemia, patient history
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What is c-reactive protein? (CRP) What are two important things to understand when interpreting results of the test?
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It is a protein release during inflammation processes. It is not specific for cardiac muscle. It is a sign that something is inflamed, but not indicative of WHAT is inflamed. Prolonged elevated CRP may indicate ongoing damage to heart tissue.
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What is homocysteine? Why does its increase in circulation matter clinically?
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It is an amino acid in the blood that may damage inner linings or arteries and promote blood clots.
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For CK-MB, how much elapses before it starts to rise? Peaks? Returns to normal?
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4-8 hours
12 - 24 hours 72 - 96 hours |
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For Myoglobin, how much elapses before it starts to rise? Peaks? Returns to normal?
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2-4 hours
8-10 hours 24 hours |
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For Troponin-I and Troponin-T, how much elapses before it starts to rise? Peaks? Returns to normal?
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4-6 hours
12 hours 3 - 10 DAYS |
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For lactic dehydronase, how much elapses before it starts to rise? Returns to normal?
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2-5 days
10 days |
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What are the three different kinds of bilirubin? What are their normal values?
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Total bilirubin: 0.3 to 1.0
Direct (conjugated): 0.1 to 0.3 Indirect (unconjugated): 0.2 to 0.8 (MG / dl) |
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What two conditions result from increased bilirubin?
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Jaundice and icterus
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At what point in bilirubin elevation does jaundice appear?
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Above 2.5 mg/dl
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What is unconjugated (indirect) bilirubin?
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bilirubin that is bound to albumin. It is water insoluable Elevated levels precipitate out in tissue.
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What is conjugated (direct) bilirubin?
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Conjugated with glucuronic acid in the liver. Water soluble. Used to make bile, which is excreted into the small intestine.
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What are the two final destinations (forms) of direct bilirubin?
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fecobilinogen - excreted in feces
urobilinogen - excreted in urine by kidneys |
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What is unconjugated hyperbilirubinemia?
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Less than 15% of bilirubin in blood is conjugated
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What is conjugated hyperbilirubinemia? When is that seen clinically?
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More than 50% of bilirubin is conjugated. Gallstones, tumor, obstruction of ducts.
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What are the three types of jaundice?
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pre-hepatic, hepatocellular, post-hepatic
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What is the cause of pre-hepatic jaundice?
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Breakdown (hemolysis) of red blood cells, thus increasing the amount of UNCONJUGATED bilirubin in circulation.
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What is clinically important about a sharp rise in indirect bilirubin?
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It can crystalize. This is particulary bad in the brain (called 'kernicterus'). Happens in newborns when
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What are some causes of hepatocellular jaundice?
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Liver disease such as hepatitis, cirrhosis
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What are some causes of post-hepatic jaundice?
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Gall stones - obstruction in liver ducts
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What is AST test? Where does it come from?
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Asparate Transaminase. Heart, liver, skeletal muscle
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Why would there be elevated AST in the blood?
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Injury to liver OR cardiac cells
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When do AST levels rise? Peak? Return to normal?
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8 hours
24 to 36 hours 3 to 7 days |
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What is ALT? Where in the body is it found?
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Liver with lesser amounts in heart, skeletal muscle, and kidney
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Which is more specific to the liver - ALT or AST? What is the exception?
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ALT... but in alcoholic hepatitis, AST will be higher than ALT.
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What is the DeRitis ratio?
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AST/ALT
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In what conditions will the DeRitis ration be greater than 1?
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alcoholic cirrhosis, liver congestion, and metastatic tumors
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In what conditions will the DeRitis ration be less than 1?
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acute hepatitis, viral hepatitis, infectious mono
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Where is alkaline phosphatase found?
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Bone, liver, placenta. (Some in kidney, intestinal wall, and lactating mammary glands)
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What are the two sub-types of alk phos?
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ALP-1: from liver
ALP-2 from bone |
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What does a rise in alk phos (ALP) indicate?
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bone disease or liver disease (must have isoenzyme to know which.)
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What are the five isoenzymes of lactate dehydrogenase and where do they came from?
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LDH-1: heart
LDH-2: reticuloendithelial system LDH-3: lungs LDH-4: kidney, placenta, pancreas LDH-5: liver and striated muscle |
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Which isoenzyme of LDH makes up the highest concentration of LDH under normal conditions? In cardiac conditions which is greater?
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LDH-2, LDH-1
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What is high total LDH indicative of?
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That there is a disease process happening but it does not provide any information as to WHICH disease
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What is the GGT/GGTP test? What is highly sensitive to?
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Gamma-Glutamyl Transferase / Transpeptidase. Alcohol (ETOH)
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Elevated ALP with no rise in GGT is indicative of what?
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Bone disease
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Elevated ALP and GGT is indicative of what?
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Liver disease
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GGT is the most sensitive for what three liver related conditions?
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biliary obstruction, cholangitis, cholecystitis
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