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48 Cards in this Set

  • Front
  • Back
how do liver enzymes tell you whether liver dysfunction is due to cell necrosis or obstruction?
obstruction - increased ap, increased direct bilirubin, increased ggt

necrosis (hepatitis or something) - increased ast and alt

enzymes being induced vs enzymes leaking from dead cells
what are some biliary obstruciton markers?
alkaline phosphatase - production increased in response to extrahepatic obstruction of the biliary tree


ggt (synthesis is increased by cholestasis, alcohol, and drugs like phenobarbitol)
difference b/t direct and indirect bilirubin?
conjugated bilirubin can be measured directly

unconjugated bilirubin is measured indirectly
what do high levels of indirect bilirubin indicate?
hemolytic disease
what increases ggt?
drugs (phenobarbitol)
what kind of increase in ap would an extrahepatic vs intrahepatic block cause?
intrahepatic - 2-3 fold increase
extrahepatic - >3 and up to 10-11 fold worse, a greater increase!
what do incresed alt and ast tell you about the liver?
cell necrosis
how can you tell where elevated AP came from?
liver lives, bone burns

liver is heat resistant isoform

now you can do electrophoresis
what does albumin tell you about liver disease?
acute - increased albumin
chronic - decreased albumin
how would you differentiate b/t obstructive and hepatocellular liver disease just using AST and AP
AST > 3x
AP < 2x

AST <3x
AP >2x
4 Fs predisposing to gallstones
fat female fertile forty
what is wilson's disease?
copper overload
which is worse, hepatitis A or B
B is much worse

A always resolves in 6 weeks
B can be acute and self limiting, resolving in 6 months. it can also become chronic
how is hepatitis b usually diagnosed
HepB surpresence of these denotes recoveryface Ag
what test can tell you if you are going to recover from hepatitis B?
IgG to the surface antigen (vs IgM)
how does HepB kill you?
all the liver functions get screwed up

plasma protein synthesis
are AST, ALT, and LDH sensitive or specific markers for hepatocellular liver disease?
they are sensitive but not specific. good for screening. catch true positives but also give false positives
what 2 antibodies do a sandwich assay use?
capture antibody and detection antibody
how can albumin be used to follow progression of nephropathy
micro albumin in urine
when would you measure glycosylated albumin?
in a diabetic patient with an unstable form of hemoglobin where glycosylated hemoglobin cannot be measured
formula and use for sensitivity
sensitivity is used to rule out

sens = TP / (TP + FN)
formula and use for specificity
specificity is used to rule in

spec = TN / (TN + FP)
fasting glucose level for DM
OGTT level for DM
why does someone in DKA have hyponatremia?
sodium goes down 1.6 mmol/L for every 100 glucose because it is diluted by the increased plasma volume
why does someone in DKA have hyperkalemia?
acid exchanges for K
does someone in DKA have high or low intracellular potassium?
low because H+ exchanges for it!
what is Cl level of someone in DKA?
HCO3 is decreased
Cl is decreased too because it shifts into cells in exchange for HCO3 (AE)
why is BUN elevated in DM type I?
they are breaking down protein!
what is osmolar gap?
difference between measured and calculated osmolyte level
measured - (2NA + urea + glucose)
greater than 10 is abnormal
what can elevate osmolar gap
acetoacetate, acetate, and BHBA
greater than 10 is abnormal
what is anion gap
diff b/t levels of major anions and cations.

indicates presence of mystery anions
such as ketones
difference b/t isoenzymes and isoforms?
isozymes are from different loci

isoforms are with different post trans mods
3 types of CK?
CK MB - heart isoenzyme
where is CK MB
where is CK MM
what is CKMB/CK
a ratio which is better to use because there is some CKMB in muscle
what is the cutoff point for normal CKMB/CK
what is CKM+B+ CKM+B- CKM-B+ and CKM-B-
+ and - are isoforms. - has an amino acid cleaved.
what is a macro enzyme?
enzymes aggregated to circulating IGs. this keeps them from being cleared and they elevated measured nzm levels (false psitives)
what can increase myoglobin
skel muscle injury (even minor - lifting weights)
renal failure
is troponin I elevated by renal failure?
how many hours after a heart attack will troponin I be detectable?
8-48 hours after
elevated up to a week or so
which LDH isozyme is concentrated in the heart?
what is the temporal change for CKMB like? vs troponin I
up and down in 48 hours
troponin stays high for about a week
when should you order cardiac markers
on admission
2-4 hours
6-9 hours (troponin should be elevated by now even if not at admission!!!)
why does a normal cardiac marker not rule out MI?
serial measurement (temporal) must be done@!@@@@
wTf are heterophile antibodies?
they bind to all sorts of animal antibodies and can form a bridge in a sandwich assay between the detection and the capture antibody!!!