Biochemical Profile 3

Question 1

where is most alkaline phosphatase found?

Answer 1

liver
bone
biliary tract epithelium
placenta
interstital mucosa

Question 2

ALP is importnat for what?

Answer 2

detecting liver and bone disorders

Question 3

alkaline phosphatase is increased in?

Answer 3

intrahepatic and extrahepatic obstructions
biliary disease
cirrhosis
tumors
hepatitis
liver mets

Question 4

elevated ALP in the bone is associated with?

Answer 4

new bone growth (increased osteoblastic activity)

Question 5

alkaline phosphatase is high in?

Answer 5

adolescents
pathological new bone growth (metastasis, paget’s, bone disease, healing fracutres)
HPT

Question 6

alkaline phosphatase is decreased in

Answer 6

hypothyroidism

pernicious anemia

Question 7

if you have anxray with accentuated trabeculation, what tests might you need to run?

Answer 7

baseline alkaline phosphatase test
bone scan
xray hot spots

Question 8

what do people with paget’s need?

Answer 8

an MRI to see if the basilar invagination is affecting them

Question 9

if you saw one large blob on an xray, what are the ddx?

Answer 9

bone island
blastic mets
fibrous dysplasia

Question 10

chondrocalcinosis etiologies

Answer 10

3 Cs
cartilage degeneration
crystal deposition (primary CPPD, gout)
cation disease (hemochromatosis, hyperparathyroidism, Wilson’s disease)

Question 11

if you had an 11 year old girl with a circular density near the epiphyseal part of the bone, what are the ddx? what labs would you want to perform?

Answer 11

osteosarcoma, bone island

alkaline phosphatase

Question 12

acid phosphatase is normally found in?

Answer 12

liver
RBCs
platelets
bone marrow

Question 13

highest levels of acid phosphatase are in?

Answer 13

prostate gland

Question 14

elevated levels of acid phosphatase from the prostate indicate?

Answer 14

prostate cancer that has metastasized beyond the prostate capsule to toehr part of the body (bone)
can also be seen in multiple myeloma, benign prostatic hypertrophy, recent prostate examination

Question 15

describe prostate specific antigen

Answer 15

glycoprotein
detected in all males
elevated levels are seen in prostate cancer

Question 16

PSA levels are elevated in?

Answer 16

benign prostatic hypertorphy
prostatitis
between 4 and 10 ng/mL is suspicious
a high jump in PSA is a good indicator of PSA

Question 17

PSA velocity

Answer 17

change in PSA level over time

Question 18

PAP and PSA

Answer 18

markedly elevated with elevated alkaline phosphatase indicates prostate cancer with metastasis to bone

Question 19

LDH

Answer 19

total not specific indicator for any one disease

disease affects cells that contain LDH, the cell lyse and release LDH

Question 20

GGTP

Answer 20

highest concentrations in liver and biliary tract
lesser concentration in kidneys, spleen, heart
detects liver cell dysfunction

Question 21

GGTP is not elevated in?

Answer 21

bone disease

Question 22

elevated GGTP and ALP indicates

Answer 22

hepatobiliary disease

Question 23

GGTP is sensitivie for?

Answer 23

chronic alcohol ingestion and is the most sensitivie for alcohol induced liver disease

Question 24

AST/SGOT

Answer 24

used for suspected coconary occlusive heart disease or

suspected hepatocellular disease

Question 25

which is more sensitivie for heart? liver?

Answer 25

heart: AST/SGOT liver: ALT/SGPT

Question 26

liver panel

Answer 26

``` ADT/SGOT (heart) ALT/SGPT (liver) Alkaline phosphatase (liver and bone) GGTP (liver) protein (liver) bilirubin BUN elevated (kidney) BUN decreased (liver) UA would also be helpful ```

Question 27

calcium

Answer 27

99% in bone and involved with neurotransmission an dmuscular contraction

Question 28

phosphorous

Answer 28

80-85% in bone

Question 29

magnesium

Answer 29

50-60% in bone cofactor for enzymes activator for some enzymes neurotransmission and muscular contraction

Question 30

hypercalcemia

Answer 30

``` muscle weakness disorientation seen with skeletal metastasis HPT multiple myeloma hyperthyroidism renal transplant ```

Question 31

hypocalcemia

Answer 31

``` tetany hypoalbuminemia (alcoholics) renal failure vitamin D deficiency hypoparathyroidism ```

Question 32

most common cause of hypercalcemia, second?

Answer 32

MC: primary hyperparathyroidism | 2nd MC malignancy

Question 33

S/S of hypercalcemia

Answer 33

``` constipation nausea loss of appetite extreme thirst dehydration tired weak sleepy confused coma ```

Question 34

xray finding for HPT?

Answer 34

aco-osteolysis

Question 35

primary HPT

Answer 35

``` most common type parathyroid adenoma in 90% carcinoma, hyperplasia, ectopic PTH producing tumors elevated parathormone levels hypercalcemia hypophosphatemia ```

Question 36

secondary HPT

Answer 36

complication of chronic renal disease persistent loss of calcium and phosphorous stimulates PTH release (calcium low to normal) hyperphosphatemia (kidneys can't extrete it as well)

Question 37

tertiary HPT

Answer 37

dialysis patients parathyroid gland acts independent of serum calcium levels high PTH and calcium

Question 38

s/s of HPT

Answer 38

``` 30-50 women bone pain fractures weakenss lethargy polydipsia polyuria muscle weakness hypotonia renal stones pancreatitis elevated alkaline phosphatatse elevated PTH hypercalcemia in primary normal to low calcium in secondary ```

Question 39

parathormone

Answer 39

stimulates osteoclasts, which reabsorb bone and release calcium and phosphorous ion into the blood stream increases calcium absorption through small intestine

Question 40

radiologic findings associated with HPT

Answer 40

``` osteopenia subperiosteal resorption distal tuft resorption accentuated trabeculation brown tumors loss of cortical definition soft tissue calcification dystrophic, physiological calcification ```

Question 41

what is the most definitive radiographic sign of HPT?

Answer 41

subperiosteal resorption

Question 42

where might you see subperiosteal resorption

Answer 42

radial margins of middle and proximal phalanges of the 2nd and 3rd digits widened joint spaces and osteolysis AC and SI joints symphysis pubis

Question 43

what spinal radiographic changes do you see in people with HPT?

Answer 43

rugger jersey spine | salt and pepper skull

Question 44

you see wide, irregular pubic symphysis. DDX? labs?

Answer 44

HPT, infection | CBC, biochemical profile

Question 45

if you see soft tissue calcification, what is the DDX?

Answer 45

diabetes | HPT (secondary>primary)

Question 46

hyperphosphatemia

Answer 46

``` renal failure hypoparathyroidism excess vit. D bone mets myeloma cell destruction ```

Question 47

hypophosphatemia

Answer 47

decreased intestinal absorption increased renal extretion HPT

Question 48

bone panel

Answer 48

``` calcium phosphorus alkaline phosphatase uric acid total proteins A/G ratio serology CBC/ESR/CRP (men only) acid phosphatase, PSA ```

Question 49

hypermagnesemia

Answer 49

dehydration renal insufficiency uncontrolled diabetes

Question 50

hypomagnesemia

Answer 50

``` malabsorption malnutrition alcoholism cirrhosis tetany muscle weakness cardiac arrhythemias ```