Biochemical Profile Flashcards
Biochemical profile shows high bilirubin. What test would you do to determine if the bilirubin was conjugated or unconjugated?
Do a UA
- If high on UA = conjugated bilirubin
- If absent on UA = unconjugated bilirubin
Biochemical profile shows a reverse albumin to globulin ratio.
What is the classic Dx?
-What follow up studies does the patient need?
Multiple myeloma
-Patient needs PEP of blood and urine to look for M-spike
Primary energy source for the body
Glucose
Disorders in glucose metabolism result in hypoglycemia and ___________
Hyperglycemia
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
Insulin
Fasting blood glucose normal range is _____ mg/dL
70-99 mg/dL
MC cause of hyperglycemia
Diabetes mellitus
-other = acute stress, Cushing’s syndrome, pheochromocytoma, renal failure, acromegaly, or pancreatitis
Other causes of hypoglycemia
Insulin overdose, pancreatic islet cell tumor, starvation, liver disease, Addison’s disease, hypothyroidism
Symptoms of diabetes
- Polydipsia
- Polyuria
- Polyphagia
- Fatigue
- Weight loss
- Blurred vision
- Slow healing
- Dizziness
- Nausea
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
Fasting Blood Glucose Test
T/F A Fasting Blood Glucose test may be ordered if a patient has signs and symptoms of hyperglycemia or even hypoglycemia
True
Hypoglycemia = sweating, hunger, trembling, anxiety, confusion, blurred vision
FBG levels that indicate pre-diabetes
70-99 = Normal
100-125 = Pre-diabetes
>126 = Diabetes
If diabetes mellitus is suspected (borderline cases) glucose tolerance tests should be performed and/or _____ testing.
A1c
What is the most common OGTT used?
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)
What are the ranges for the glucose tolerance test?
< 140 = Normal
140-199 = Pre-diabetes
>200 = Diabetes
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?
Adjust him, do a FBS, and a UA
What test is best used to assess how the patient is controlling his diabetes long term?
Hemoglobin A1c
-provides an average of patient blood sugar over a 6-12 week period
Normal hemoglobin A1c
- A1c in pre-diapetic patients.
- A1c in patients with diabetes
Normal = <5.7
Pre-diabetes = 5.7-6.4
Diabetes = >6.5
Diabetes mellitus lab values
- FBS ______ mg/dL
- FBS _______ mg/dL with classic signs and conditions on 2 different occasions
- OGTT _____
- A1c ____
- FBS >200
- FBS >126 on 2 occassions
- OGTT >200
- A1c >6.5
Type 1 diabetics are dependant on exogenous _______ to sustain life
Insulin
T/F Type 2 Diabetes is the MC type of diabetes
True
Extra blood glucose is sent to the baby and is stored as ___ leading to macrosomia
Fat
X-ray joints that may indicate a person has diabetes
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)
Other name for a diabetic coma
Diabetic ketoacidosis
Hypoglycemia occurs when a persons blood glucose measures below _______
< 70 mg/dL
T/F Hypoglycemia is more common in non-diabetic patients than diabetic patients.
FALSE
-MC in diabetic patients
Non-diabetic patients =is it fasting glycemia or a postprandial
A.k.a. postprandial hypoglycemia, occurs within 4 hours after meals. Labs shows ____ mg/dL
Reactive hypoglycemia
- <70 mg/dL
A.k.a. postabsorptive hypoglycemia is often related to an underlying disease or various medication. Labs show ___ mg/dL.
Fasting Hypoglycemia (without eating)
- <50 mg/dL
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
Whipple’s Triad
Measures the amount of urea nitrogen in the blood.
BUN
T/F BUN is related to metabolic function of the kidneys and exretory function of the liver
FALSE
-BUN is related to metabolic function of the liver and excretory function of the kidneys
Represents elevated blood levels of BUN
Azotemia
Nearly all renal disease will ______ BUN
Elevate
What are the renal function studies utilized?
BUN
Creatinine
T/F Creatinine is a better indicator for renal disease than BUN
True
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?
Uric acid
-Hyperuricemia = Gout
X-ray shows nonmarginal erosions with an overhang sign at the 1st MTP joint.
-What is the Dx?
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)
Chondrocalcinosis of the triangular cartilage in the ulna is associated with what condition?
CPPD
______ in protein is seen with multiple myeloma, dehydration, chronic infections, and malignancies
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
T/F Albumin is a measure of kidney function
FALSE.
Test of liver function
T/F There should always be more albumin than globulin. An inversion of this may indicate multiple myeloma (classically)
True
A collapse fracture is seen on an X-ray, what is the DDx?
- Osteoporosis (MC)
- Lytic mets (MC malignancy)
- Multiple myeloma (MC primary malignancy)
What is the process if a collapse fracture is multple myeloma and lytic mets (assuming osteoporosis is ruled out)?
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
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
True
Common Tetrad of Multiple Myeloma
CRAB
- C = Calcium elevated
- R = Renal disease
- A = Anemia
- B = Bone lesions
T/F Metastasis and myeloma are both purely lytic
FALSE
- Mets can be osteolytic, osteoblastic or mixed
- Myeloma is purely lytic
ALP is ________ with blastic metastasis
Increased
Measures excretory function of the liver.
Bilirubin
-Total serum bilirubin is sum of conjugated and unconjugated bilirubin
Serum shows elevated bilirubin. UA shows no bilirubin. Is the problem pre-liver or post-liver?
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)
T/F For a UA, increased urobilinogen and positive bilirubin indicate a liver/biliary disease
True.
Health/Normal = < 1 urobilinogen and negative bilirubin
Bilary obstruction = absent urobilinogen and positive bilirubin
Hemolytic anemia = increased urobilinogen and no bilirubin
T/F An increase in conjugated bilirubin is highly specific for disease of the liver or bile ducts
True
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.
Alkaline Phosphatase (ALP)
New bone growth is associated with elevated ALP (osteoblastic activity). Common in conditions like adolescents, blastic mets, Pagets, bone disease, healing fractures, and ___________
Hyperparathyroidism
X-ray of the femur shows accentuated trabeculations consistent with both Pagets and Osteoporosis. What lab value could help DDx?
ALP
- Increased with Pagets
- Normal with Osteoporosis
T/F If a patient has already been diagnosed with Pagets, ALP is no longer needed
FALSE.
-Still need the ALP to form a base line and monitor it as Pagets may transistion into Osteosarcoma
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?
ALP
- Increased with blastic mets
- Normal with a bone island
Condition where a patient has multiple bone islands but normal ALP
Osteopoikliosis
Ivory Vertebrae DDx
- Pagets
- Lymphoma
- Blastic mets
Chondrocalcinosis etiologies (3 C’s)
- Cartilage degeneration (DJD)
- Crystal depostion (MC CPPD by far, maybe gout)
- Cation disease (Hemochromatosis, Hyperparathyroidism, Wilsons Disease)
X-rays shows bilateral chondrocalcinosis in the knee joints. What is the MC cause?
CPPD
Highest levels are found in the prostate gland. Used to diagnose, stage, and monitor treatment of metastatic cancer of the prostate.
Acid Phosphatase
-a.k.a. Prostatic acid phosphatase (PAP)
Tumor with enlargement although confined within capsule will show PAP as __________
Normal
-Elevated = blastic mets, especially to bone. May also be seen in multiple myeloma or BPH
Glycoprotein found in the cytoplasm of prostate epithelial cell. Detected in all males. Elevated with prostate cancer.
Prostate Specific Antigen
Change in PSA level over time. A sharp rise raises suspicion of cancer.
PSA Veolicty
What would elevated PAP, PSA, and ALP all indicate collectively?
Blastic mets to bone from prostate cancer
Non-specific lab test. Found in many tissues. Like ESR, says something is going on, but doesn’t say what or where.
Lactate Dehydrogenase
-Affected cells from diseases lyse when damaged and cause a release of lactate dehydrogenase
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)
Gamma-glutamyl Transpeptidase
(GTTP)
-Test is used to detect liver cell dysfunction (Liver Function Test)
T/F Lab shos elevated GGTP and ALP indicating skeletal disease
FALSE
- Normal GGTP with high ALP = Skeletal disease
- High GGTP and ALP = Liver/biliary disease
(GTTP is VERY SENSITIVE to hepatobiliary disease)
What is the most sensitive test for alcohol induced liver disease?
GGTP
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
Aspartate Aminotransferase (AST)
-Checks for heart primarily and liver some what
T/F AST is one of the cardiac enzymes. It rises quickly and returns to normal in 3-4 days
True
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.
Alanine Aminotransferase (ALT)
-Checks liver mostly, heart somewhat
What makes up the Liver Panel?
- AST/SGOT = Heart more than liver
- ALT/SGPT = Liver more than heart)
- ALP
- LDH
- GGTP
- Protein (albumin)
- Bilirubin
May also need a UA
Substances whose molecules dissociate into ions when in solution
-Total _____ equal total ______ to maintain this
Electrolytes
Total cations equal total anions to maintain electroneutrality
Cations = Na, K, Ca, Mg
Anions = Cl, P, Su, proteins, organic acids, bicarbonate
Major intracellular cation. Important to cellular metabolism and normal neuromuscular function, particularly of the heart
Potassium
Major extracellular anion and is important in maintaining cellular integrity thru water balance and osmotic pressure
Chloride
Major component of carbon dioxide in plasma. Helps regulate acid base balance
Bicarbonate
3 most abundant minerals in bone
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 **
Calcium levels can elevate _______ function. Hypercalcemia typically associated with muscle weakness and disorientation seen with skeletal metastasis, _______, multiple myeloma, hyperthyroidism, renal transplant.
Parathyroid function
-Hyperparathyroidism
What causes of hypercalcemia account for over 90% of cases of hypercalcemia?
Primary hyperparathyroidism is MC cause
-Malignancy is the 2nd MC cause
Subperiosteal reabsorption of the radial side of the middle and proximal phalanx with acro-osteolysis are seen in what condition?
Hyperparathyroidism
What conditions cause acro-osteolysis?
- Leprosy
- HPT
- Fire trauma
- Scleroderma
- Psoriatic
- Congenital
- PVC exposure
T/F Parathyroid hormone has a strong osteoblastic influence
FALSE
-Osteoclastic activity occurs from PTH
What are the 3 main types of hyperparathyroidism?
1) Primary = caused by parathyroid gland adenoma
Renal Osteodystrophies
2) Secondary (chronic renal disease)
3) Teriary (chronic renal disease)
What is the phrase to help remember possible symtpoms of someone with hyperparathyroidism?
“Stones, bones, abdominal groans, and psychiatric moans”
(renal stones, peptic ulcers, pancreatitis, confusion, lethargy, weakness)
What hyperparathyroidism type has normal BUN, creatine, and elevated calcium, and decreased phosphorus?
Primary Hyperparathyroidism
Secondary = low/normal caclium, high phosphorus, BUN and creatinine elevated
Tertiary = high calcium, phosphorus, BUN, and creatinine
Soft tissue calcification of small arteries and veins visible on X-rays should indicate what 2 conditions?
Hyperparathyroidism
Diabetes
(Charcot joints + vascular calcifications = Diabetes)
(Normal joints + vascular calcifications = HPT)
Most definitive radiographic sign of hyperparathyroidism
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
Sub-endplate sclerosis seen in the spine on X-ray. Usually indicates secondary HPT over primary HPT
Rugger-Jersey Spine
T/F 4 radiographic signs of HPT in the spine are picture frame vertebrae, Rugger-Jersey Spine, Salt and pepper skull, and Sandwich vertebrae
FALSE
- Picture frame vertebrae = Pagets
- Rugger-Jersey Spine and Salt and Pepper Skull = HPT (secondary > primary)
- Sandwich vertebrae = Osteopetrosis
T/F Phosphorus has a inverse relationship with calcium
True
Hyperphosphatemia = renal failure, hypoparathyroidism, excess Vit D, bone mets, myeloma, cell destruction
Hypophosphatemia = decreased intestinal absorption, increased renal excretion, HPT
Enthesopathic changes occur from either _________ condtions or ________ disease
Degenerative
Inflammatory (think Reiter’s/Reactive)
Cotton wool skull with enlargement of the inner table of the skull indicates what Dx seen on X-ray
Pagets
With Pagets of the skull, bone softening can occur and lead to ________ which is best evaluated using what Roetgenometrics?
Basilar Invagination
-Use Chamberlains or McGregors lines
What makes up the bone panel?
- Calcium
- Phosphorus
- ALP
- PAP (males)
- PSA (males)
- Uric acid
- Total protein
- A/G ratio
- Serology (HLA B27, RF, ANA)
- CBC/ESR.CRP
Most specific lab for pancreatitis (upper quadrant, epigastric severe pain, mid back pain)
Amylase
Enzyme secreted by the pancreas into the duodenum to break down triglycerides. Increased levels (with increase in Amylase) indicate damage to pancreatic cells
Lipase
(elevates a little later and lasts a little longer than amylase)
Pancreatic stones is seen in 90% of patients with what condition?
Alcoholics
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 _____________
Creatine Phosphokinase
-a.k.a. creatine kinase (CPK, CK)
Specific for Cardiac muscle injury
Form of fat that exists in the blood stream. Part of the lipid profile used to assess the risk of coronary and vascular disease
Triglycerides (TG)
- Transported by VLDL and LDL
- Produced in the liver by using glycerol and other fatty acids
Normal cholesterol levels
-Cholesterol is the _______ associated with arteriosclerotic vascular disease
< 200 mg/dL
-Main lipid
T/F High cholesterol is associated with hyperlipidemia
True
Lipoproteins are a good indicator of ______________
Coronary heart disease
Lipid profile consists of:
- Triglycerides
- Total cholesterol
- HDL
- LDL
- VLDL
Good cholesterol. Produced in the liver. Prevent cellular uptake of cholesterol and lipids.
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
Predominate carrier of triglyceries. Carry a small amount of cholesterol.
VLDL’s
Cardiac Enzymes/Panel
- Creatine kinase (muscle breakdown)
- AST/SGOT (more heart)
- LDH (liver, heart, etc.)
- ALT/SGPT (more liver)
- Cardiac troponin
Most sensitive and specific test for myocardial damage
Cardiac troponin
Risk factors for heart attack
- Previous heart attack
- Smoking
- Diabetes
- Family history
- Hypertension
- Male
- Overweight
- Increased cholesterol
- Increased LDL’s
Thyroid is an endocrine gland producing ___ and ___ which is regulated by ______
Produces T3 (triiodithyronine) and T4 (thyroxine or tetraiodothyronine)
Regulated by TSH (from pituitary gland)
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
Hyperthyroidism
Caused by an inadequate production of thyroid hormones. Dry skin, coarse features, subcutaneous swelling (myxedema), lethargy, tiredness, cold interolerance, and weight gain.
Hypothyroidism
What lab values are seen with hyperthyroidism?
- Increased T3, T4 levels
- Decreased TSH
Primary hypothyroidism has decreased _________ and increased_______ lab values
Decreased T3 and T4
Increased TSH
T/F Secondary hypothyroidism has increased T3, T4, and TSH
FALSE
-Has decreased T3, T4, and TSH
