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Visceral Disorder and Lab Interpretation > Biochemical Profile > Flashcards

Biochemical Profile Flashcards

1
Q

Biochemical profile shows high bilirubin. What test would you do to determine if the bilirubin was conjugated or unconjugated?

A

Do a UA

  • If high on UA = conjugated bilirubin
  • If absent on UA = unconjugated bilirubin
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2
Q

Biochemical profile shows a reverse albumin to globulin ratio.

What is the classic Dx?

-What follow up studies does the patient need?

A

Multiple myeloma

-Patient needs PEP of blood and urine to look for M-spike

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3
Q

Primary energy source for the body

A

Glucose

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4
Q

Disorders in glucose metabolism result in hypoglycemia and ___________

A

Hyperglycemia

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5
Q

After eating, glucose levels are elevated and _________ is secreted to drive glucose into the cells to be metabilized to glycogen, amino acids, and fatty acids thereby reducing glucose

A

Insulin

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6
Q

Fasting blood glucose normal range is _____ mg/dL

A

70-99 mg/dL

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7
Q

MC cause of hyperglycemia

A

Diabetes mellitus

-other = acute stress, Cushing’s syndrome, pheochromocytoma, renal failure, acromegaly, or pancreatitis

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8
Q

Other causes of hypoglycemia

A

Insulin overdose, pancreatic islet cell tumor, starvation, liver disease, Addison’s disease, hypothyroidism

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9
Q

Symptoms of diabetes

A
  • Polydipsia
  • Polyuria
  • Polyphagia
  • Fatigue
  • Weight loss
  • Blurred vision
  • Slow healing
  • Dizziness
  • Nausea
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10
Q

May also be ordered when someone has signs and symptoms of high blood glucose (hyperglycemia) such as increased thirst with frequent urination, fatigue, blurred vision, slow-healing wounds or infections

A

Fasting Blood Glucose Test

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11
Q

T/F A Fasting Blood Glucose test may be ordered if a patient has signs and symptoms of hyperglycemia or even hypoglycemia

A

True

Hypoglycemia = sweating, hunger, trembling, anxiety, confusion, blurred vision

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12
Q

FBG levels that indicate pre-diabetes

A

70-99 = Normal

100-125 = Pre-diabetes

>126 = Diabetes

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13
Q

If diabetes mellitus is suspected (borderline cases) glucose tolerance tests should be performed and/or _____ testing.

A

A1c

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14
Q

What is the most common OGTT used?

A

2 hour OGTT

-Patient fasts, then does FBS, then patient is given an oral glucose load and has levels tested at 30min, 1 hour, and 2 hour (usually stopped at 2 hour)

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15
Q

What are the ranges for the glucose tolerance test?

A

< 140 = Normal

140-199 = Pre-diabetes

>200 = Diabetes

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16
Q

45 year old patient is over weight, states he is always thirsty and says he always feels like he needs to urinate. What would be the most appropriate management?

A

Adjust him, do a FBS, and a UA

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17
Q

What test is best used to assess how the patient is controlling his diabetes long term?

A

Hemoglobin A1c

-provides an average of patient blood sugar over a 6-12 week period

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18
Q

Normal hemoglobin A1c

  • A1c in pre-diapetic patients.
  • A1c in patients with diabetes
A

Normal = <5.7

Pre-diabetes = 5.7-6.4

Diabetes = >6.5

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19
Q

Diabetes mellitus lab values

  • FBS ______ mg/dL
  • FBS _______ mg/dL with classic signs and conditions on 2 different occasions
  • OGTT _____
  • A1c ____
A
  • FBS >200
  • FBS >126 on 2 occassions
  • OGTT >200
  • A1c >6.5
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20
Q

Type 1 diabetics are dependant on exogenous _______ to sustain life

A

Insulin

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21
Q

T/F Type 2 Diabetes is the MC type of diabetes

A

True

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22
Q

Extra blood glucose is sent to the baby and is stored as ___ leading to macrosomia

A

Fat

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23
Q

X-ray joints that may indicate a person has diabetes

A

Charcot joints

a. k.a. Neurotrophic joints
- MC in the feet

may also see vasculature on the X-ray also (need to rule out hyperparathyroidism)

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24
Q

Other name for a diabetic coma

A

Diabetic ketoacidosis

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25
Q

Hypoglycemia occurs when a persons blood glucose measures below _______

A

< 70 mg/dL

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26
Q

T/F Hypoglycemia is more common in non-diabetic patients than diabetic patients.

A

FALSE

-MC in diabetic patients

Non-diabetic patients =is it fasting glycemia or a postprandial

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27
Q

A.k.a. postprandial hypoglycemia, occurs within 4 hours after meals. Labs shows ____ mg/dL

A

Reactive hypoglycemia

  • <70 mg/dL
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28
Q

A.k.a. postabsorptive hypoglycemia is often related to an underlying disease or various medication. Labs show ___ mg/dL.

A

Fasting Hypoglycemia (without eating)

  • <50 mg/dL
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29
Q

Symptoms known or likely to be caused by hypoglycemia

  • A low plasma glucose measured at the time of the symptoms
  • Relief of symptoms when the glucose is raised to normal
A

Whipple’s Triad

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30
Q

Measures the amount of urea nitrogen in the blood.

A

BUN

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31
Q

T/F BUN is related to metabolic function of the kidneys and exretory function of the liver

A

FALSE

-BUN is related to metabolic function of the liver and excretory function of the kidneys

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32
Q

Represents elevated blood levels of BUN

A

Azotemia

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33
Q

Nearly all renal disease will ______ BUN

A

Elevate

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34
Q

What are the renal function studies utilized?

A

BUN

Creatinine

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35
Q

T/F Creatinine is a better indicator for renal disease than BUN

A

True

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36
Q

Nitrogenous compound that is a product or purine catabolism. Excreted by the kidney and to a small degree intestinal tract. When elevated, what condition is it associated with?

A

Uric acid

-Hyperuricemia = Gout

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37
Q

X-ray shows nonmarginal erosions with an overhang sign at the 1st MTP joint.

-What is the Dx?

A

Gout of the 1st toe

a.k.a. Podagra

(still need to DDx DJD and infection so a CBC and uric acid levels would be appropriate)

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38
Q

Chondrocalcinosis of the triangular cartilage in the ulna is associated with what condition?

A

CPPD

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39
Q

______ in protein is seen with multiple myeloma, dehydration, chronic infections, and malignancies

A

Increased

-Albumin and globulin constitute most of the protein in the body are are measured as the total protein

***Decreased protein = liver disease, kidney disease, malabsorption

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40
Q

T/F Albumin is a measure of kidney function

A

FALSE.

Test of liver function

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41
Q

T/F There should always be more albumin than globulin. An inversion of this may indicate multiple myeloma (classically)

A

True

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42
Q

A collapse fracture is seen on an X-ray, what is the DDx?

A
  • Osteoporosis (MC)
  • Lytic mets (MC malignancy)
  • Multiple myeloma (MC primary malignancy)
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43
Q

What is the process if a collapse fracture is multple myeloma and lytic mets (assuming osteoporosis is ruled out)?

A

Lytic mets = Bone scan (look for hot spots)–> MRI hot spots –> Biopsy an abdnormal spots on MRI

Multiple Myeloma = PEP of urine and blood –> skeletal survey if M-spike is seen –> MRI any abnormal spots from survey –> Biopsy any abnormal spots from MRI

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44
Q

T/F Multiple myeloma and lytic mets must be included in the differential diagnosis of any lytic bone lesion, whether well-defined or ill-defined in someone > 40

A

True

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45
Q

Common Tetrad of Multiple Myeloma

A

CRAB

  • C = Calcium elevated
  • R = Renal disease
  • A = Anemia
  • B = Bone lesions
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46
Q

T/F Metastasis and myeloma are both purely lytic

A

FALSE

  • Mets can be osteolytic, osteoblastic or mixed
  • Myeloma is purely lytic
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47
Q

ALP is ________ with blastic metastasis

A

Increased

48
Q

Measures excretory function of the liver.

A

Bilirubin

-Total serum bilirubin is sum of conjugated and unconjugated bilirubin

49
Q

Serum shows elevated bilirubin. UA shows no bilirubin. Is the problem pre-liver or post-liver?

A

Pre-liver

  • Hemolysis, Hematoma, Gilbert’s Syndrome
  • If bilirubin is in the urine it is conjugated which occurs after processing from the liver. If bilirubin is elevated in the blood, but not in the urine it is unconjugated bilirubin and therefore occured before the liver could process it (Pre-liver)
50
Q

T/F For a UA, increased urobilinogen and positive bilirubin indicate a liver/biliary disease

A

True.

Health/Normal = < 1 urobilinogen and negative bilirubin

Bilary obstruction = absent urobilinogen and positive bilirubin

Hemolytic anemia = increased urobilinogen and no bilirubin

51
Q

T/F An increase in conjugated bilirubin is highly specific for disease of the liver or bile ducts

A

True

52
Q

Found in many tissues with highest concentrations in the liver and bone cells. Detection of this enzyme is important in detecting liver and bone disorders.

A

Alkaline Phosphatase (ALP)

53
Q

New bone growth is associated with elevated ALP (osteoblastic activity). Common in conditions like adolescents, blastic mets, Pagets, bone disease, healing fractures, and ___________

A

Hyperparathyroidism

54
Q

X-ray of the femur shows accentuated trabeculations consistent with both Pagets and Osteoporosis. What lab value could help DDx?

A

ALP

  • Increased with Pagets
  • Normal with Osteoporosis
55
Q

T/F If a patient has already been diagnosed with Pagets, ALP is no longer needed

A

FALSE.

-Still need the ALP to form a base line and monitor it as Pagets may transistion into Osteosarcoma

56
Q

A large radiodense object is seen in the ilium of a 50 year old patient. Initial DDx is blastic mets or bone island. What lab value could help narrow down the DDx?

A

ALP

  • Increased with blastic mets
  • Normal with a bone island
57
Q

Condition where a patient has multiple bone islands but normal ALP

A

Osteopoikliosis

58
Q

Ivory Vertebrae DDx

A
  • Pagets
  • Lymphoma
  • Blastic mets
59
Q

Chondrocalcinosis etiologies (3 C’s)

A
  • Cartilage degeneration (DJD)
  • Crystal depostion (MC CPPD by far, maybe gout)
  • Cation disease (Hemochromatosis, Hyperparathyroidism, Wilsons Disease)
60
Q

X-rays shows bilateral chondrocalcinosis in the knee joints. What is the MC cause?

A

CPPD

61
Q

Highest levels are found in the prostate gland. Used to diagnose, stage, and monitor treatment of metastatic cancer of the prostate.

A

Acid Phosphatase

-a.k.a. Prostatic acid phosphatase (PAP)

62
Q

Tumor with enlargement although confined within capsule will show PAP as __________

A

Normal

-Elevated = blastic mets, especially to bone. May also be seen in multiple myeloma or BPH

63
Q

Glycoprotein found in the cytoplasm of prostate epithelial cell. Detected in all males. Elevated with prostate cancer.

A

Prostate Specific Antigen

64
Q

Change in PSA level over time. A sharp rise raises suspicion of cancer.

A

PSA Veolicty

65
Q

What would elevated PAP, PSA, and ALP all indicate collectively?

A

Blastic mets to bone from prostate cancer

66
Q

Non-specific lab test. Found in many tissues. Like ESR, says something is going on, but doesn’t say what or where.

A

Lactate Dehydrogenase

-Affected cells from diseases lyse when damaged and cause a release of lactate dehydrogenase

67
Q

Enzyme that participates in transfer of amino acids and peptides across cell membranes. Highest concentration in the liver and biliary tract (lesser in kidneys, spleen, heart)

A

Gamma-glutamyl Transpeptidase

(GTTP)

-Test is used to detect liver cell dysfunction (Liver Function Test)

68
Q

T/F Lab shos elevated GGTP and ALP indicating skeletal disease

A

FALSE

  • Normal GGTP with high ALP = Skeletal disease
  • High GGTP and ALP = Liver/biliary disease

(GTTP is VERY SENSITIVE to hepatobiliary disease)

69
Q

What is the most sensitive test for alcohol induced liver disease?

A

GGTP

70
Q

Formerly called serum glutamic-oxaloacetic transaminase (SGOT). Widely used for suspected coronary occlusive heart disease or suspected hepatocellular disease. Found in heart, liver, and skeletal muscles

A

Aspartate Aminotransferase (AST)

-Checks for heart primarily and liver some what

71
Q

T/F AST is one of the cardiac enzymes. It rises quickly and returns to normal in 3-4 days

A

True

72
Q

Formerly called serum glutamic-pyruvis transaminase (SGPT). Found predominately in the liver, and lessor quantities in the heart, kidneys, and skeletal muscles. Injury or damage to the liver will release this enzymes, although it may also be elevated in heart disease.

A

Alanine Aminotransferase (ALT)

-Checks liver mostly, heart somewhat

73
Q

What makes up the Liver Panel?

A
  • AST/SGOT = Heart more than liver
  • ALT/SGPT = Liver more than heart)
  • ALP
  • LDH
  • GGTP
  • Protein (albumin)
  • Bilirubin

May also need a UA

74
Q

Substances whose molecules dissociate into ions when in solution

-Total _____ equal total ______ to maintain this

A

Electrolytes

Total cations equal total anions to maintain electroneutrality

Cations = Na, K, Ca, Mg

Anions = Cl, P, Su, proteins, organic acids, bicarbonate

75
Q

Major intracellular cation. Important to cellular metabolism and normal neuromuscular function, particularly of the heart

A

Potassium

76
Q

Major extracellular anion and is important in maintaining cellular integrity thru water balance and osmotic pressure

A

Chloride

77
Q

Major component of carbon dioxide in plasma. Helps regulate acid base balance

A

Bicarbonate

78
Q

3 most abundant minerals in bone

A

1) Calcium (99% in bone and involved with neurotransmission and muscular contraction)
2) Phosphorus (80-85% in bone)
3) Magnesium (50-60% in bone, cofactor for enzymes, activator for some enzymes, neurotransmission and muscular contraction)

** Look at these 3 minerals to evaluate the bones in the body **

79
Q

Calcium levels can elevate _______ function. Hypercalcemia typically associated with muscle weakness and disorientation seen with skeletal metastasis, _______, multiple myeloma, hyperthyroidism, renal transplant.

A

Parathyroid function

-Hyperparathyroidism

80
Q

What causes of hypercalcemia account for over 90% of cases of hypercalcemia?

A

Primary hyperparathyroidism is MC cause

-Malignancy is the 2nd MC cause

81
Q

Subperiosteal reabsorption of the radial side of the middle and proximal phalanx with acro-osteolysis are seen in what condition?

A

Hyperparathyroidism

82
Q

What conditions cause acro-osteolysis?

A
  • Leprosy
  • HPT
  • Fire trauma
  • Scleroderma
  • Psoriatic
  • Congenital
  • PVC exposure
83
Q

T/F Parathyroid hormone has a strong osteoblastic influence

A

FALSE

-Osteoclastic activity occurs from PTH

84
Q

What are the 3 main types of hyperparathyroidism?

A

1) Primary = caused by parathyroid gland adenoma

Renal Osteodystrophies

2) Secondary (chronic renal disease)
3) Teriary (chronic renal disease)

85
Q

What is the phrase to help remember possible symtpoms of someone with hyperparathyroidism?

A

“Stones, bones, abdominal groans, and psychiatric moans”

(renal stones, peptic ulcers, pancreatitis, confusion, lethargy, weakness)

86
Q

What hyperparathyroidism type has normal BUN, creatine, and elevated calcium, and decreased phosphorus?

A

Primary Hyperparathyroidism

Secondary = low/normal caclium, high phosphorus, BUN and creatinine elevated

Tertiary = high calcium, phosphorus, BUN, and creatinine

87
Q

Soft tissue calcification of small arteries and veins visible on X-rays should indicate what 2 conditions?

A

Hyperparathyroidism

Diabetes

(Charcot joints + vascular calcifications = Diabetes)

(Normal joints + vascular calcifications = HPT)

88
Q

Most definitive radiographic sign of hyperparathyroidism

A

Subperiosteal resorption

  • Widened joint spaces and osteolysis, esp. AC and SI erosions
  • Especially radial margins middle and proximal phalanges
  • May also see lace like or frayed cortical erosions
89
Q

Sub-endplate sclerosis seen in the spine on X-ray. Usually indicates secondary HPT over primary HPT

A

Rugger-Jersey Spine

90
Q

T/F 4 radiographic signs of HPT in the spine are picture frame vertebrae, Rugger-Jersey Spine, Salt and pepper skull, and Sandwich vertebrae

A

FALSE

  • Picture frame vertebrae = Pagets
  • Rugger-Jersey Spine and Salt and Pepper Skull = HPT (secondary > primary)
  • Sandwich vertebrae = Osteopetrosis
91
Q

T/F Phosphorus has a inverse relationship with calcium

A

True

Hyperphosphatemia = renal failure, hypoparathyroidism, excess Vit D, bone mets, myeloma, cell destruction

Hypophosphatemia = decreased intestinal absorption, increased renal excretion, HPT

92
Q

Enthesopathic changes occur from either _________ condtions or ________ disease

A

Degenerative

Inflammatory (think Reiter’s/Reactive)

93
Q

Cotton wool skull with enlargement of the inner table of the skull indicates what Dx seen on X-ray

A

Pagets

94
Q

With Pagets of the skull, bone softening can occur and lead to ________ which is best evaluated using what Roetgenometrics?

A

Basilar Invagination

-Use Chamberlains or McGregors lines

95
Q

What makes up the bone panel?

A
  • Calcium
  • Phosphorus
  • ALP
  • PAP (males)
  • PSA (males)
  • Uric acid
  • Total protein
  • A/G ratio
  • Serology (HLA B27, RF, ANA)
  • CBC/ESR.CRP
96
Q

Most specific lab for pancreatitis (upper quadrant, epigastric severe pain, mid back pain)

A

Amylase

97
Q

Enzyme secreted by the pancreas into the duodenum to break down triglycerides. Increased levels (with increase in Amylase) indicate damage to pancreatic cells

A

Lipase

(elevates a little later and lasts a little longer than amylase)

98
Q

Pancreatic stones is seen in 90% of patients with what condition?

A

Alcoholics

99
Q

Found predominately in the heart muscle, skeletal muscle, and brain. Serum levels elevate when there has been damage to muscle or nerve cells.

-Test is specifically designed for _____________

A

Creatine Phosphokinase

-a.k.a. creatine kinase (CPK, CK)

Specific for Cardiac muscle injury

100
Q

Form of fat that exists in the blood stream. Part of the lipid profile used to assess the risk of coronary and vascular disease

A

Triglycerides (TG)

  • Transported by VLDL and LDL
  • Produced in the liver by using glycerol and other fatty acids
101
Q

Normal cholesterol levels

-Cholesterol is the _______ associated with arteriosclerotic vascular disease

A

< 200 mg/dL

-Main lipid

102
Q

T/F High cholesterol is associated with hyperlipidemia

A

True

103
Q

Lipoproteins are a good indicator of ______________

A

Coronary heart disease

104
Q

Lipid profile consists of:

A
  • Triglycerides
  • Total cholesterol
  • HDL
  • LDL
  • VLDL
105
Q

Good cholesterol. Produced in the liver. Prevent cellular uptake of cholesterol and lipids.

A

HDL’s

-Increase in HDL’s lowers LDL’s

LDL = Bad cholesterol, rich in cholesterol deposits cholesterol into tissues and is associated with risk of arteriosclerotic heart and vascular disease

106
Q

Predominate carrier of triglyceries. Carry a small amount of cholesterol.

A

VLDL’s

107
Q

Cardiac Enzymes/Panel

A
  • Creatine kinase (muscle breakdown)
  • AST/SGOT (more heart)
  • LDH (liver, heart, etc.)
  • ALT/SGPT (more liver)
  • Cardiac troponin
108
Q

Most sensitive and specific test for myocardial damage

A

Cardiac troponin

109
Q

Risk factors for heart attack

A
  • Previous heart attack
  • Smoking
  • Diabetes
  • Family history
  • Hypertension
  • Male
  • Overweight
  • Increased cholesterol
  • Increased LDL’s
110
Q

Thyroid is an endocrine gland producing ___ and ___ which is regulated by ______

A

Produces T3 (triiodithyronine) and T4 (thyroxine or tetraiodothyronine)

Regulated by TSH (from pituitary gland)

111
Q

Excessive production of thyroid hormones. Due to Graves, toxic goiter, adenoma, pituitary tumor, exogenous iodine. Decreased weight with normal appetite, fatigue, heart palpitations, goiter, eyelid retraction, oligomenorrhea, diarrhea, sweating, heat intolerance, tremors, and muscle weakness

A

Hyperthyroidism

112
Q

Caused by an inadequate production of thyroid hormones. Dry skin, coarse features, subcutaneous swelling (myxedema), lethargy, tiredness, cold interolerance, and weight gain.

A

Hypothyroidism

113
Q

What lab values are seen with hyperthyroidism?

A
  • Increased T3, T4 levels
  • Decreased TSH
114
Q

Primary hypothyroidism has decreased _________ and increased_______ lab values

A

Decreased T3 and T4

Increased TSH

115
Q

T/F Secondary hypothyroidism has increased T3, T4, and TSH

A

FALSE

-Has decreased T3, T4, and TSH

Visceral Disorder and Lab Interpretation (7 decks)

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