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Visceral Disorders > Biochemical Profile > Flashcards

Biochemical Profile Flashcards

1
Q

Does insulin increase or decrease blood glucose concentrations?

A

Decrease

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2
Q

Do glucagon, epinephrine, growth hormone, ACTH, and cortisol increase or decrease glucose blood levels?

A

Increase

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3
Q

What is the function of insulin?

A

Drives glucose into cells to be metabolized into glycogen, amino acids, and fatty acids

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4
Q

What is the “classic” hyperglycemic disorder?

A

Diabetes mellitus

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5
Q

What is the normal fasting blood glucose range?

A

70-99 mg/dL

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6
Q

What is the range for FBG in a pre-diabetic?

A

100-125 mg/dL

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7
Q

What is the FBG measurement for a diabetic?

A

126 or greater mg/dL

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8
Q

What is the FBG measurement when considered “low”?

A

Below 70 mg/dL

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9
Q

Does an insulin overdose lead to hyper- or hypoglycemia?

A

Hypoglycemia (glucose goes into cells to be stored and glucose is decreased in the blood)

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10
Q

Which is associated with hyperglycemia: Cushing’s syndrome or Addison’s disease?

A

Cushing’s syndrome

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11
Q

Which is associated with hypoglycemia: Cushing’s syndrome or Addison’s disease?

A

Addison’s

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12
Q

What type of respiratory symptom is seen with Type I diabetes?

A

Kussmaul breathing (hyperventilation)

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13
Q

What are the common symptoms associated with diabetes?

A

Increased thirst (polydipsia), frequent urination (polyuria), fatigue, blurred vision

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14
Q

If diabetes mellitus is suspected, what testing should be done?

A

Glucose tolerance test (OGTT) and/or HgbA1c

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15
Q

How does a glucose tolerance test show a person has diabetes?

A

Glucose load isn’t tolerated, and serum levels will be greatly elevated along with glucose spilling into the urine

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16
Q

At what time and serum level is a glucose tolerance test usually stopped?

A

2 hours with serum levels at less than 140 mg/dL (normal)

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17
Q

What are the serum levels with OGTT in a pre-diabetic at 2 hours?

A

140-199 mg/dL

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18
Q

What are the serum levels with OGTT in a diabetic at 2 hours?

A

Greater than 200 mg/dL

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19
Q

If your patient comes in with diabetic symptoms, what should be your next move?

A

Adjust subluxations, FBG test, UA

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20
Q

What is the HgbA1c test for?

A

Determines how well a patient’s diabetes/blood sugar levels are being controlled

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21
Q

What is the normal range for the hemoglobin A1c test in a patient without diabetes?

A

4-6% (blood sugar average) but overall less than 5.7%

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22
Q

What should be the goal for a Hgb A1c test in a patient with diabetes?

A

Less than 7% (means lower likelihood of developing complications)

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23
Q

What is the range for the hemoglobin A1c test in a pre-diabetic patient?

A

5.7-6.4%

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24
Q

What is the range for the hemoglobin A1c test in a diabetic patient?

A

Greater than 6.5%

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25
Q

Are all diabetic patients aware of their disorder?

A

No; only about half

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26
Q

What confirms glycosuria?

A

Levels exceed the renal threshold values of 180mg

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27
Q

What type of diabetes is dependent on exogenous insulin to sustain life?

A

Type 1

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28
Q

Type 1 Diabetes involves the autoimmune destruction of which cells?

A

Pancreatic islet beta cells

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29
Q

What is the most common type of diabetes?

A

Type 2

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30
Q

Does gestational diabetes remain?

A

No; it goes away after delivery (but increased chance of developing DM later in the next 10-20 years)

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31
Q

What is the leading cause of Charcot joints in the US?

A

Diabetes

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32
Q

What is the unique breath feature associated with diabetic ketoacidosis?

A

Fruity breath odor

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33
Q

What is the difference between reactive and fasting hypoglycemia?

A

Reactive aka postprandial = occurs within 4 hours after meals (<70 mg/dL); Fasting = related to underlying disease (<50 mg/dl)

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34
Q

What type of hypoglycemia can occur immediately after a meal?

A

Postprandial/reactive

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35
Q

What is Whipple’s Triad?

A

Hypoglycemic symptoms, low plasma glucose measure at the time of symptoms, and relief of symptoms when glucose is raised to normal

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36
Q

What can relieve reactive hypoglycemia?

A

Eat small meals and snacks about every 3 hours (also exercise regularly)

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37
Q

What measures the amount of urea nitrogen in the blood?

A

Blood Urea Nitrogen (BUN)

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38
Q

Where is urea formed and how?

A

Formed in the liver as an end product of protein metabolism

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39
Q

In functional terms, what does BUN measure?

A

Metabolic function of the liver and excretory function of the kidneys

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40
Q

Elevated BUN levels are associated with the disease of which organ?

A

Kidneys (could also be a high protein diet, however)

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41
Q

Decreased BUN levels are associated with the disease of which organ?

A

Liver

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42
Q

What are the renal function studies?

A

BUN an creatinine levels

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43
Q

What is creatinine?

A

Catabolic product of creatine phosphate which is used in muscle contraction

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44
Q

Why do creatinine and BUN levels help identify kidney problems?

A

Both are excreted by the kidneys and therefore show kidney function

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45
Q

Which is a better indicator for renal disease: BUN or creatinine?

A

Creatinine

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46
Q

What is uric acid?

A

Nitrogenous compound that is a product of purine catabolism

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47
Q

Hyperuricemia is associated with what condition?

A

Gout

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48
Q

What is the term for gout of the big toe?

A

Podagra

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49
Q

Bilateral sacroilitis is most likely due to what condition?

A

Seronegative spondyloarthropathy like AS

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50
Q

Which substances constitute most of the protein in the body?

A

Albumin and globulin

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51
Q

What conditions exhibit increased protein levels?

A

MM, dehydration, chronic infections, malignancies

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52
Q

What conditions exhibit decreased protein levels?

A

Liver disease, kidney disease, malabsorption

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53
Q

Where is albumin formed?

A

Liver (60% of total protein)

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54
Q

What is the function of albumin?

A

Regulates colloidal osmotic pressure and transports important blood constituents

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55
Q

Albumin is a measure of the function of which organ?

A

Liver

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56
Q

What is the function of globulins?

A

Building block of antibodies and some transport proteins

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57
Q

What condition is associated with a low/reversed albumin/globulin ratio?

A

Multiple Myeloma (overproduction of globulins)

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58
Q

What condition would possibly be present with a high albumin/globulin ratio?

A

Some leukemias (underproduction of immunoglobulins)

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59
Q

What type of anemia is associated with MM?

A

Normocytic normochormic anemia

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60
Q

What type of RBC formation is associated with MM?

A

Rouleaux

61
Q

What function does bilirubin measure?

A

Excretory function of the liver

62
Q

What type of issue results in elevated UNconjugated bilirubin?

A

Hepatocellular dysfunction and/or increased RBC hemolysis

63
Q

What type of issue results in elevated conjugated bilirubin?

A

Liver disease and extrahepatic obstruction like gallstones or a tumor

64
Q

What is the order in which bilirubin is formed?

A

RBC breaks into heme and globin, heme is transformed into unconjugated bilirubin, and the liver converts it to conjugated

65
Q

What location has the highest concentrations of alkaline phosphatase (ALP)?

A

Liver, bone***, biliary tract epithelium, placenta, intestinal mucosa

66
Q

What is the most important extra hepatic site for ALP?

A

BONE

67
Q

What type of bone change is associated with elevated ALP?

A

Osteoblastic activity (bone growth)

68
Q

In what osseous conditions can we see elevated ALP?

A

Blastic mets, Paget’s, bone disease, healing fractures, HPT

69
Q

In what conditions can we see decreased ALP levels?

A

Hypothyroidism, pernicious macrocytic anemia

70
Q

What is the term for multiple bone island formation?

A

Osteopoikliosis

71
Q

What feature helps distinguish possible Paget’s disease from other bone conditions?

A

Bone enlargement

72
Q

Which cation disease is associated with iron buildup? Calcium? Copper?

A

Iron = hemochromatosis; Calcium = hyperparathyroidism; Copper = Wilson’s

73
Q

Where are the highest levels of acid phosphatase found?

A

Prostate gland

74
Q

Acid phosphatase levels are primarily used to diagnose what condition?

A

Prostate metastasis (could also be myeloma or benign prostatic hypertrophy)

75
Q

What is the PAP level associated with a tumor that has enlargement although confined within a capsule?

A

NORMAL

76
Q

What is prostate specific antigen (PSA)?

A

Glycoprotein found in the cytoplasm of prostate epithelial cells

77
Q

Elevated PSA is associated with what condition?

A

Prostate cancer (could also be BPH or prostatitis)

78
Q

Which is more sensitive and specific: PAP or PSA?

A

PSA

79
Q

What is PSA velocity used for?

A

Sharp rise in PSA levels raises suspicion of cancer

80
Q

What does elevated PSA, PAP, and ALP indicated?

A

Prostate cancer with metastasis to bone

81
Q

Which lab tests are used when an inflammatory process is involved?

A

ESR and CRP

82
Q

What test is a marker of adenocarcinomas such as colonic, rectal, pancreatic, gastric, and breast?

A

CEA (carcinoembryonic antigen)

83
Q

What test is important to run with a differential for any suspected malignancy?

A

CBC

84
Q

What levels are measured to evaluate for liver cancer?

A

Alpha fetal protein (AFP)

85
Q

What is the indicator for bone collagen breakdown?

A

Urinary N-telopeptices

86
Q

What does lactate dehydrogenase do?

A

Catalyzes lactate to pyruvate

87
Q

Where is lactate dehydrogenase found?

A

Heart, liver, RBCs, kidneys, skeletal muscles, brain, lungs

88
Q

What is gamma-glutamyl transpeptidase (GGTP)?

A

Enzyme that participates in transfer of amino acids and peptides across cell membranes

89
Q

Where do we find the highest concentrations of GGTP?

A

Liver and biliary tract

90
Q

GGTP is used to detect dysfunction of which cells?

A

Liver cells

91
Q

If ALP is elevated without GGTP, what is the problem?

A

Skeletal disease (GGTP detects liver problems)

92
Q

Elevated GGTP and ALP implied what problem?

A

Hepatobiliary disease

93
Q

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

A

GGTP

94
Q

What is aspartate aminotransferase (AST)?

A

Enzyme that removes the amino group from aspartate

95
Q

What is the former name for AST?

A

Serum glutamic-oxaloacetic transaminase (SGOT)

96
Q

Where is AST found?

A

Heart, liver, skeletal muscles

97
Q

AST is used for the suspicion of which conditions?

A

Coronary occlusive heart disease or hepatocellular disease

98
Q

Which is most sensitive for the heart: AST or ALT? The liver?

A

Heart = AST; Liver = ALT

99
Q

What is the former name for ALT?

A

Serum glutamic-pyruvic transaminase (SGPT)

100
Q

Where is ALT primary found?

A

Liver

101
Q

What makes up a liver panel?

A

AST, ALT, ALP, LDH, GGTP, protein (esp. albumin), bilirubin, possibly UA

102
Q

What makes up the electrolyte profile?

A

Sodium, potassium, chloride, biocarbonate

103
Q

What is the major extracellular cation that is important for water distribution and osmotic pressure in plasma?

A

Sodium

104
Q

What is the major intracellular cation that is important for cellular metabolism and normal neuromuscular function, particularly of the heart?

A

Potassium

105
Q

Calcium levels evaluate the function of what organ?

A

Parathyroid

106
Q

Is HPT associated with hyper or hypocalcemia?

A

Hyper

107
Q

What are the 2 most common causes of hypercalcemia?

A

1 primary hyperparathyroidism; 2 malignancy

108
Q

Is parathyroid hormone osteoblastic or osteoclastic in nature?

A

Osteoclastic (breaks down bone)

109
Q

What is another name for secondary hyperparathyroidism from renal disease?

A

Renal osteodystrophy (secondary or teriary HPT)

110
Q

What usually causes primary HPT?

A

Parathyroid adenoma (90%)

111
Q

Secondary HPT is a complication of what organic disease?

A

Renal disease

112
Q

Tertiary HPT is seen in what kind of patients?

A

Those on dialysis

113
Q

Why does parathormone stimulate osteoclasts in HPT?

A

Bone is reabsorbs and destroyed to release calcium and phosphorus into the blood stream to fix the levels

114
Q

What are radiographic signs of HPT?

A

Osteopenia, subperioseal resorption, acro-osteolysis, brown tumors

115
Q

What is the most definitive radiographic sign of HPT?

A

Subperiosteal resorption especially at radial margins of middle and proximal phalanges of 2nd and 3rd digits

116
Q

What sign is associated with HPT when radiodensities are seen on the superior and inferior endplates?

A

Rugger jersey spine

117
Q

What skull radiographic sign is seen with HPT?

A

Salt and pepper skull

118
Q

Is there a direct or indirect relationship between calcium and phosphorus?

A

INDIRECT (think back to nutrition!)

119
Q

Are decreased or increased levels of phosphorus seen with HPT?

A

Decreased: hypophosphatemia

120
Q

How does a decrease in magnesium affect the aorta and kidney?

A

Results in calcium being released from bone and increased deposition in the aorta and kidney

121
Q

What makes up a bone panel?

A

Calcium, phosphorus, ALP, acid phosphatase, PSA, uric acid, total proteins, A/G ratio, serology, CBC/ESR/CRP

122
Q

Amylase analysis is most specific for what condition?

A

Pancreatitis

123
Q

What is the function of amylase?

A

Secreted by pancreas to aid in catabolism of carbohydrates

124
Q

What is the most common cause of elevated lipase?

A

Acute pancreatitis

125
Q

What is the function of lipase?

A

Secreted by pancreas into duodenum to break down triglycerides into fatty acids

126
Q

Which elevates a little later and lasts a little longer: amylase or lipase?

A

Lipase

127
Q

When is serum creatine phosphokinase elevated?

A

When there has been damage to muscle or nerve cells

128
Q

Which test was specifically designed for cardiac muscle injury?

A

Creatine phosphokinase (aka creatine kinase)

129
Q

What are triglycerides?

A

Form of fat that exists in the blood stream

130
Q

What transports triglycerides?

A

VLDLs and LDLs

131
Q

What is the purpose of measuring triglycerides?

A

Asses risk of coronary and vascular disease

132
Q

What is the good cholesterol?

A

HDL

133
Q

What should be the normal range for cholesterol levels?

A

<200 mg/dL

134
Q

What is the main lipid associated with arteriosclerotic vascular disease?

A

Cholesterol

135
Q

Where is cholesterol produced?

A

Liver

136
Q

Cholesterol is the main component in which: LDLs or HDLs?

A

LDLs (minimally in HDLs)

137
Q

Which type of cholesterol is most associated with CHD?

A

LDLs

138
Q

High cholesterol is associated with what condition?

A

Hyperlipidemia

139
Q

Lipoproteins are a good predictor for what condition?

A

Coronary heart disease

140
Q

What makes up the lipid profile?

A

Triglycerides, total cholesterol, HDL, LDL, VLDL

141
Q

What is the most sensitive and specific test for myocardial damage?

A

Cardiac troponin

142
Q

Is cardiac troponin a part of the biochemical profile?

A

Technically no…

143
Q

What hormones does the thyroid produce primarily?

A

Calcitonin, T3, and T4

144
Q

What regulates the production of T3 and T4?

A

TSH (from the pituitary gland)

145
Q

Is graves disease associated with hyper or hypothyroidism?

A

HYPER

146
Q

What is the relation shit between T3/T4 levels and TSH?

A

INVERSE

147
Q

What are the levels like with secondary hypothyroidism?

A

Decreased T3, T4, and TSH

148
Q

Are lab results interpreted the same among the elderly?

A

NO; lab values are based on ages 20-40

Visceral Disorders (7 decks)

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