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Advances in Medicine > Biochemistry tests > Flashcards

Biochemistry tests Flashcards

1
Q

Define Heart failure

A

The inability of the heart to generate sufficient blood flow

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2
Q

What are the signs of HF?

A

Lung crackles
Oedema
Raised jugular venous pressure

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3
Q

What are the symptoms of HF?

A

Shortness of breath

Tiredness/weakness

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4
Q

What are the symptoms of acute coronary syndrome?

A

Asymptomatic disease
Stable angina
Unstable angina
Myocardial infarction

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5
Q

What can lead to chronic heart failure?

A 
Hypertension
COPD
Valvular Disease
Cardiomyopathy
Infection
Cardiac stress
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6
Q

Why is the 2D doppler echocardiography good for HF diagnosis?

A

Required for definitive diagnosis

Can determine type of HF

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7
Q

Why is BNP good for HF diagnosis?

A

High NPV
Used to triage patients
Cannot diagnose HF
Cannot distinguish between different types of HF

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8
Q

What are natriuretic peptides?

A

Cardiac hormones with diuretic, natriuretic and vasorelaxant properties which is secreted by the heart in response to ventricular expansion or pressure overload

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9
Q

What does Pro-BNP release when cleaved?

A

The active 32 AA BNP

An N-terminal section of 76 amino acids called NT-ProBNP

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10
Q

What are BNP and NT-ProBNP effective markers of?

A

Ventricular distension and overload

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11
Q

Why is BNP release and what is it’s function?

A

Released as a physiological response to volume expansion and pressure overload
It’s function is to reduce blood volume and peripheral resistance
It’s synthesis in bursts is directly proportional to ventricular expansion and pressure overload

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12
Q

What do the levels of BNP mean for diagnosis?

A

400ng/L = Rule in, echo and specialist review within 2 weeks

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13
Q

What must be considered before implementing an assay?

A 
Analytical considerations
Costs
Testing protocols
Interpretation
Regular audit of process
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14
Q

What are the key benefits of BNP?

A 
Quicker and more accurate diagnosis
More timely and appropriate treatment
Less time in hospital
Greater convenience
Fewer echo referrals
Fewer outpatient consultant appointments
Fewer hospital admission
Shorter hospital stays
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15
Q

What are the limitations of BNP testing?

A

Cannot define the type of HF
Levels can be reduced by obesity, ACE inhibitors, beta-blockers, ARBs and aldosterone antagonists
High levels can have causes other than HF

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16
Q

Define infertility

A

Failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology

17
Q

What are the basic tests carried out on female patients experiencing infertility?

A 
Mid luteal progesterone
Day 3 FSH, LH, Estradiol
Chlamydia screen
Pelvic ultrasound scan
Rubella Antibody titre
Cervical smear
18
Q

What is anti-mullerian hormone and what is it used for?

A

Produced by antral follices
Measures antral follicle pool
Used and measurement of ovarian reserve or ovarian response test prior to assisted conception treatment

19
Q

What are the four levels of AMH?

A

Very low/undetectable - <2pmol/L
Low - 2-14pmol/L
Satisfactory - 14-28pmol/L
Optimal fertility - 29-49pmolL

20
Q

What does Serum Protein Electrophoresis screen for?

A

B cell malignancy

Immunodeficiency

21
Q

What are the features of the FREELITE assay?

A

Specific for free light chains
Quantitative
Nephelomyeric

22
Q

What are the features of immunofixation electrophoresis?

A

Identified paraprotein type
Not quantitative
Gives prognostic information

23
Q

What are the disadvantages of urine electrophoresis in the detection of monoclonal light chains?

A

Affected by renal function
Insensitive
24 hour urine collection is difficult
Time consuming and subjective

24
Q

What are the advantages of the serum free light chain assay in the detection of monoclonal light chains?

A 
Sensitive assay
kappa/gamma ratio little affected by renal function
Easy to collect
Quick
Quantitative
25
Q

What is calcitonin and what is it used for?

A

Plays an important role in the pathway and regulation of calcium and phosphate in bone metabolism
The main medullary thyroid carcinoma tumour makrer

26
Q

What are the advantages of PCT?

A

Early and high specific increase in response to severe systemic bacterial infection and sepsis
Excellent negative predictor
PCT levels can be observed from 2 hours after bacterial challenge
Accurately reflect the progression of the disease correlating more closely to severity than any other sepsis marker
Ideal for daily measurement
Can be used as a tool to discontinue empiric antibiotic therapy by individualising a patient’s treatment

27
Q

What are the reference ranges of procalcitonin?

A

0.5-2 - Sepsis possible, antibiotics recommended reassess in under 24 hours
>2-10 - Sepsis infection likely, antibiotics recommended
>10 - Major sepsis, antibiotics recommended

Advances in Medicine (7 decks)

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