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64 Cards in this Set

  • Front
  • Back
Type of Glucose Specimens
FBS, 2 hr post prandial screen, OGGTT, serum ketones, A1C, POCT, Fructosamine, Microalbuminuria
Causes of decreased Glucose
over dose of insulin, addisons disease, bacterial sepsis, starvation, insulinoma
Causes of increased glucose
DM, cushings disease, acute stress syndrome, pheochromocytoma, corticosteroid therapy
Diabetic Ketoacidosis, DKA
elevated blood glucose, positive glucose in urine. positive ketones in urine, dehydration, labored breathing
Azotemia
significant increase in plasma concentrations of urea and creatinine in kidney insufficiency
BUN is used for
index of glomerular function in production and excretion of urea. Urea wil not show significant increase until GFR is decreased by at least 50%! Directly related to the metabolic function of the liver and the excretory function of the kidney.
Causes of elevated BUN
Kidney disease, urinary obstruction, dehydration, shock, infection, DM
Creatinine measures what?
Breakdown of creatinine muscle metabolism. more reliable than BUN as single index of renal function. however with BUN it is sensitive and specific screen for renal function
CC is a measure of what?
GFR
GFR is the best overall index of what?
kidney function
Excessive Uric acid is knows as what disease?
gout
Multiple Myeloma is...
malignant proliferation of plasma cells and increase in IgGs.
What happens as a result of myeloma?
monoclonal gammopathy, protein leeches Ca++ out from bone, patients present with pathologic fractures
Characteristics of Multiple myeloma
elevated total protein, viscous blood, abnormal serum portion electrophoreses (SPEP) liver problems, abnormal LFT's. Bence-Jones Protein, RBC rouleaux
Presence of what during multiple myeloma is a good sign?
alk phos because in means new bone is being laid down.
What is Bence-Jones Protein?
24 hr urine measure tests for low weight molecular proteins
All cardia tests should be examined how?
Cardiac enzymes plus context of the pt history, PE, risk factors, and standards of care
CK=CPK is found?
predominantely in the heart, skeletal muscle, and brain. CPK levels elevated when injury occurs to these muscle or nerve cells
What is the most specific enzyme for myocardial cells?
CK-MB
A CPK-MB of 3.0 with relative index greater than or equal to 2.5 is highly suggestive of what?
MI
What are the guidelines for diagnosis of acute MI?
1. characterisit rise and gradual fall of troponin or CK-MB. 2. at least one of the following: ischemic symptoms, pathologic q waves on ecg. changes on ecg indicative of ischemia, history of coronary artery intervention.
increased bilirubin levels leads to what?
jaundice and icterus of the body tissues
Where is AST found?
Heart muscle, liver, skeletal muscle
AST level rises within how many hours after cell injury?
8 hrs
WHich is more specific to the liver? AST or ALT?
ALT
Alcoholic hep is an exception to the AST ALT rule. WHich one is higher in this case?
AST
AST/ALT ration is usually greater than 1 in patients with what?
alcoholic cirrhosis, liver congestion and metastatic tumors of the liver
AST/ALT ratio is generally greater than 2 in
alcoholic hepatitis
AST/ALT ratio is less than 1 in...
patients with acute hepatitis viral hepatitis and infectious mono.
Source of ALT?
Liver mainly, lesser amt. in heart, skeletal muscle, and kidney
ALT usually increased more than AST in what case?
acute extra hepatic biliary obstruction
AST is more sensitive to
alcoholic liver disease
LDH is found where?
heart, liver, RBC, some in skeletal muscle, kidney, brain and lung
What are the 5 isoenzymes of LDH?
LDH 1 - mostly from heart
2- mostly from reticuloendothelial system
3- from lungs and other tissues
4- kidney, placenta, and pancrease
5- mostly from liver and striated muscles
What LDH usually makes up the greatest percentage of total LDH?
LDH-2 makes up 27-37%
Which LDL is normally highest?
LDH-2 is normally greater than LDH-1 but not so in case of MI, they flip
Cause of decreased LDH
good response to cancer chemotherapy
What test is very sensitive to about of ETOH consumed by chronic drinkers?
GGT
what are some causes of elevated amylase?
acute pancreatic (alcoholism), perforated peptic ulcer, acute cholecysitits, intestinal obstruction, abdominal trauma, mumps
Where is the source of lipase?
pancrease - breaks down fat
What is the source of amylase?
saliva, salivary glands, pancrease, low levels in ovaries an skeletal muscle.
WHich of the two has normal levels during the mumps? amylase or lipase?
lipase
What is the major extracellular cation?
Na+
What are the functions of K+?
action potential in the Na/K pump
osmolality-osmotic pull
glucose metabolism
acid-base balance! can't interpret K without knowing the acid/base status of the pt.
Causes of decreased K+?
Hypokalemia is the most common cause of decreased K in GI loss. also, pyloric obstruction, diarrhea, vomitting, starvation, severe burns
Signs and symptoms of hypokalmeia:
weakness, parlysis, hyporeflexia, ileus, increased carida sensitivety to digoxin, ECG has flattened T waves, and prominent U waves, cardia arrythmias.
What is an indirect measure of bicarbonate anion in serum?
CO2
CO2 measurement tells us what?
major role in acid-base balance, HCO3 is regulated by kidneys.
Causes of increased CO2
sever vomitting, starvation, metabolic alkalosis,
causes of decreased CO2
renal failure, salicylate toxicity, DKA, metabolic acidosis, shock
How do you calculate the Anion Gap?
Na + K - (Cl+bicarbonate)
What is the AG useful for?
identifying the cause of metabolic acidosis. increased AG is most commonly from increased amounts of unmeasured anions
Cuases of increased AG gap?
DKA, poisoning by ethylene glycol, methanol, etc. drug overdose, lactic acidosis - starvation, alcoholic keotacidosis, renal failure,
What % of Ca is found in the ionized form? where is the other percent?
50%
other 50% is bound to albumin
The ionized calcium level is unaffected by changes in what?
serum albumin levels.
Causes of elevated Ca
cancer, esp. with metastatic bone disease, multiple myloma, non endocrine tumors that produce PTH like subtances, hodgkins, hyperparathyroidism, addisons disease, pagets disease , excessive vit. D
The most common cause of elevated blood phosphate levels are found in association with
kidney dysfunction and uremia
What electrolyte is most important in the clotting cascade?
Mg
What is the lipid calculation (friedwald formula)
LDL cholesterol = total cholesterol - (HDL - trig/5)
What is the best single test to diagnose and monitor hypothyroidism thyroid replacement?
TSH
TSH is ____ in secondary hypothyroidism due to malfunction of pituitary gland
low
Causes of elevated TSH
primary hypothyroidism, thyroiditis
What is the marker for hepatocellular disease or biliary obstruction?
GGT
What are the causes of elevated LDH?
acute mi, acute leukemia, hepatic disease, cancer, etc