Biochemical Profile Flashcards
Does insulin increase or decrease blood glucose concentrations?
Decrease
Do glucagon, epinephrine, growth hormone, ACTH, and cortisol increase or decrease glucose blood levels?
Increase
What is the function of insulin?
Drives glucose into cells to be metabolized into glycogen, amino acids, and fatty acids
What is the “classic” hyperglycemic disorder?
Diabetes mellitus
What is the normal fasting blood glucose range?
70-99 mg/dL
What is the range for FBG in a pre-diabetic?
100-125 mg/dL
What is the FBG measurement for a diabetic?
126 or greater mg/dL
What is the FBG measurement when considered “low”?
Below 70 mg/dL
Does an insulin overdose lead to hyper- or hypoglycemia?
Hypoglycemia (glucose goes into cells to be stored and glucose is decreased in the blood)
Which is associated with hyperglycemia: Cushing’s syndrome or Addison’s disease?
Cushing’s syndrome
Which is associated with hypoglycemia: Cushing’s syndrome or Addison’s disease?
Addison’s
What type of respiratory symptom is seen with Type I diabetes?
Kussmaul breathing (hyperventilation)
What are the common symptoms associated with diabetes?
Increased thirst (polydipsia), frequent urination (polyuria), fatigue, blurred vision
If diabetes mellitus is suspected, what testing should be done?
Glucose tolerance test (OGTT) and/or HgbA1c
How does a glucose tolerance test show a person has diabetes?
Glucose load isn’t tolerated, and serum levels will be greatly elevated along with glucose spilling into the urine
At what time and serum level is a glucose tolerance test usually stopped?
2 hours with serum levels at less than 140 mg/dL (normal)
What are the serum levels with OGTT in a pre-diabetic at 2 hours?
140-199 mg/dL
What are the serum levels with OGTT in a diabetic at 2 hours?
Greater than 200 mg/dL
If your patient comes in with diabetic symptoms, what should be your next move?
Adjust subluxations, FBG test, UA
What is the HgbA1c test for?
Determines how well a patient’s diabetes/blood sugar levels are being controlled
What is the normal range for the hemoglobin A1c test in a patient without diabetes?
4-6% (blood sugar average) but overall less than 5.7%
What should be the goal for a Hgb A1c test in a patient with diabetes?
Less than 7% (means lower likelihood of developing complications)
What is the range for the hemoglobin A1c test in a pre-diabetic patient?
5.7-6.4%
What is the range for the hemoglobin A1c test in a diabetic patient?
Greater than 6.5%
Are all diabetic patients aware of their disorder?
No; only about half
What confirms glycosuria?
Levels exceed the renal threshold values of 180mg
What type of diabetes is dependent on exogenous insulin to sustain life?
Type 1
Type 1 Diabetes involves the autoimmune destruction of which cells?
Pancreatic islet beta cells
What is the most common type of diabetes?
Type 2
Does gestational diabetes remain?
No; it goes away after delivery (but increased chance of developing DM later in the next 10-20 years)
What is the leading cause of Charcot joints in the US?
Diabetes
What is the unique breath feature associated with diabetic ketoacidosis?
Fruity breath odor
What is the difference between reactive and fasting hypoglycemia?
Reactive aka postprandial = occurs within 4 hours after meals (<70 mg/dL); Fasting = related to underlying disease (<50 mg/dl)
What type of hypoglycemia can occur immediately after a meal?
Postprandial/reactive
What is Whipple’s Triad?
Hypoglycemic symptoms, low plasma glucose measure at the time of symptoms, and relief of symptoms when glucose is raised to normal
What can relieve reactive hypoglycemia?
Eat small meals and snacks about every 3 hours (also exercise regularly)
What measures the amount of urea nitrogen in the blood?
Blood Urea Nitrogen (BUN)
Where is urea formed and how?
Formed in the liver as an end product of protein metabolism
In functional terms, what does BUN measure?
Metabolic function of the liver and excretory function of the kidneys
Elevated BUN levels are associated with the disease of which organ?
Kidneys (could also be a high protein diet, however)
Decreased BUN levels are associated with the disease of which organ?
Liver
What are the renal function studies?
BUN an creatinine levels
What is creatinine?
Catabolic product of creatine phosphate which is used in muscle contraction
Why do creatinine and BUN levels help identify kidney problems?
Both are excreted by the kidneys and therefore show kidney function
Which is a better indicator for renal disease: BUN or creatinine?
Creatinine
What is uric acid?
Nitrogenous compound that is a product of purine catabolism
Hyperuricemia is associated with what condition?
Gout
What is the term for gout of the big toe?
Podagra
Bilateral sacroilitis is most likely due to what condition?
Seronegative spondyloarthropathy like AS
Which substances constitute most of the protein in the body?
Albumin and globulin
What conditions exhibit increased protein levels?
MM, dehydration, chronic infections, malignancies
What conditions exhibit decreased protein levels?
Liver disease, kidney disease, malabsorption
Where is albumin formed?
Liver (60% of total protein)
What is the function of albumin?
Regulates colloidal osmotic pressure and transports important blood constituents
Albumin is a measure of the function of which organ?
Liver
What is the function of globulins?
Building block of antibodies and some transport proteins
What condition is associated with a low/reversed albumin/globulin ratio?
Multiple Myeloma (overproduction of globulins)
What condition would possibly be present with a high albumin/globulin ratio?
Some leukemias (underproduction of immunoglobulins)
What type of anemia is associated with MM?
Normocytic normochormic anemia
What type of RBC formation is associated with MM?
Rouleaux
What function does bilirubin measure?
Excretory function of the liver
What type of issue results in elevated UNconjugated bilirubin?
Hepatocellular dysfunction and/or increased RBC hemolysis
What type of issue results in elevated conjugated bilirubin?
Liver disease and extrahepatic obstruction like gallstones or a tumor
What is the order in which bilirubin is formed?
RBC breaks into heme and globin, heme is transformed into unconjugated bilirubin, and the liver converts it to conjugated
What location has the highest concentrations of alkaline phosphatase (ALP)?
Liver, bone***, biliary tract epithelium, placenta, intestinal mucosa
What is the most important extra hepatic site for ALP?
BONE
What type of bone change is associated with elevated ALP?
Osteoblastic activity (bone growth)
In what osseous conditions can we see elevated ALP?
Blastic mets, Paget’s, bone disease, healing fractures, HPT
In what conditions can we see decreased ALP levels?
Hypothyroidism, pernicious macrocytic anemia
What is the term for multiple bone island formation?
Osteopoikliosis
What feature helps distinguish possible Paget’s disease from other bone conditions?
Bone enlargement
Which cation disease is associated with iron buildup? Calcium? Copper?
Iron = hemochromatosis; Calcium = hyperparathyroidism; Copper = Wilson’s
Where are the highest levels of acid phosphatase found?
Prostate gland
Acid phosphatase levels are primarily used to diagnose what condition?
Prostate metastasis (could also be myeloma or benign prostatic hypertrophy)
What is the PAP level associated with a tumor that has enlargement although confined within a capsule?
NORMAL
What is prostate specific antigen (PSA)?
Glycoprotein found in the cytoplasm of prostate epithelial cells
Elevated PSA is associated with what condition?
Prostate cancer (could also be BPH or prostatitis)
Which is more sensitive and specific: PAP or PSA?
PSA
What is PSA velocity used for?
Sharp rise in PSA levels raises suspicion of cancer
What does elevated PSA, PAP, and ALP indicated?
Prostate cancer with metastasis to bone
Which lab tests are used when an inflammatory process is involved?
ESR and CRP
What test is a marker of adenocarcinomas such as colonic, rectal, pancreatic, gastric, and breast?
CEA (carcinoembryonic antigen)
What test is important to run with a differential for any suspected malignancy?
CBC
What levels are measured to evaluate for liver cancer?
Alpha fetal protein (AFP)
What is the indicator for bone collagen breakdown?
Urinary N-telopeptices
What does lactate dehydrogenase do?
Catalyzes lactate to pyruvate
Where is lactate dehydrogenase found?
Heart, liver, RBCs, kidneys, skeletal muscles, brain, lungs
What is gamma-glutamyl transpeptidase (GGTP)?
Enzyme that participates in transfer of amino acids and peptides across cell membranes
Where do we find the highest concentrations of GGTP?
Liver and biliary tract
GGTP is used to detect dysfunction of which cells?
Liver cells
If ALP is elevated without GGTP, what is the problem?
Skeletal disease (GGTP detects liver problems)
Elevated GGTP and ALP implied what problem?
Hepatobiliary disease
What is the most sensitive test for alcohol induced liver disease?
GGTP
What is aspartate aminotransferase (AST)?
Enzyme that removes the amino group from aspartate
What is the former name for AST?
Serum glutamic-oxaloacetic transaminase (SGOT)
Where is AST found?
Heart, liver, skeletal muscles
AST is used for the suspicion of which conditions?
Coronary occlusive heart disease or hepatocellular disease
Which is most sensitive for the heart: AST or ALT? The liver?
Heart = AST; Liver = ALT
What is the former name for ALT?
Serum glutamic-pyruvic transaminase (SGPT)
Where is ALT primary found?
Liver
What makes up a liver panel?
AST, ALT, ALP, LDH, GGTP, protein (esp. albumin), bilirubin, possibly UA
What makes up the electrolyte profile?
Sodium, potassium, chloride, biocarbonate
What is the major extracellular cation that is important for water distribution and osmotic pressure in plasma?
Sodium
What is the major intracellular cation that is important for cellular metabolism and normal neuromuscular function, particularly of the heart?
Potassium
Calcium levels evaluate the function of what organ?
Parathyroid
Is HPT associated with hyper or hypocalcemia?
Hyper
What are the 2 most common causes of hypercalcemia?
1 primary hyperparathyroidism; 2 malignancy
Is parathyroid hormone osteoblastic or osteoclastic in nature?
Osteoclastic (breaks down bone)
What is another name for secondary hyperparathyroidism from renal disease?
Renal osteodystrophy (secondary or teriary HPT)
What usually causes primary HPT?
Parathyroid adenoma (90%)
Secondary HPT is a complication of what organic disease?
Renal disease
Tertiary HPT is seen in what kind of patients?
Those on dialysis
Why does parathormone stimulate osteoclasts in HPT?
Bone is reabsorbs and destroyed to release calcium and phosphorus into the blood stream to fix the levels
What are radiographic signs of HPT?
Osteopenia, subperioseal resorption, acro-osteolysis, brown tumors
What is the most definitive radiographic sign of HPT?
Subperiosteal resorption especially at radial margins of middle and proximal phalanges of 2nd and 3rd digits
What sign is associated with HPT when radiodensities are seen on the superior and inferior endplates?
Rugger jersey spine
What skull radiographic sign is seen with HPT?
Salt and pepper skull
Is there a direct or indirect relationship between calcium and phosphorus?
INDIRECT (think back to nutrition!)
Are decreased or increased levels of phosphorus seen with HPT?
Decreased: hypophosphatemia
How does a decrease in magnesium affect the aorta and kidney?
Results in calcium being released from bone and increased deposition in the aorta and kidney
What makes up a bone panel?
Calcium, phosphorus, ALP, acid phosphatase, PSA, uric acid, total proteins, A/G ratio, serology, CBC/ESR/CRP
Amylase analysis is most specific for what condition?
Pancreatitis
What is the function of amylase?
Secreted by pancreas to aid in catabolism of carbohydrates
What is the most common cause of elevated lipase?
Acute pancreatitis
What is the function of lipase?
Secreted by pancreas into duodenum to break down triglycerides into fatty acids
Which elevates a little later and lasts a little longer: amylase or lipase?
Lipase
When is serum creatine phosphokinase elevated?
When there has been damage to muscle or nerve cells
Which test was specifically designed for cardiac muscle injury?
Creatine phosphokinase (aka creatine kinase)
What are triglycerides?
Form of fat that exists in the blood stream
What transports triglycerides?
VLDLs and LDLs
What is the purpose of measuring triglycerides?
Asses risk of coronary and vascular disease
What is the good cholesterol?
HDL
What should be the normal range for cholesterol levels?
<200 mg/dL
What is the main lipid associated with arteriosclerotic vascular disease?
Cholesterol
Where is cholesterol produced?
Liver
Cholesterol is the main component in which: LDLs or HDLs?
LDLs (minimally in HDLs)
Which type of cholesterol is most associated with CHD?
LDLs
High cholesterol is associated with what condition?
Hyperlipidemia
Lipoproteins are a good predictor for what condition?
Coronary heart disease
What makes up the lipid profile?
Triglycerides, total cholesterol, HDL, LDL, VLDL
What is the most sensitive and specific test for myocardial damage?
Cardiac troponin
Is cardiac troponin a part of the biochemical profile?
Technically no…
What hormones does the thyroid produce primarily?
Calcitonin, T3, and T4
What regulates the production of T3 and T4?
TSH (from the pituitary gland)
Is graves disease associated with hyper or hypothyroidism?
HYPER
What is the relation shit between T3/T4 levels and TSH?
INVERSE
What are the levels like with secondary hypothyroidism?
Decreased T3, T4, and TSH
Are lab results interpreted the same among the elderly?
NO; lab values are based on ages 20-40
