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