Cardio/ pulm review Flashcards
_____________ is very sensitive and specific for liver disease
ALT
What are the most sensitive indicators of acute hepatocellular injury (increase ~1 week before serum bilirubin)?
ALT and AST
In liver cirrhosis and alcoholic hepatitis, is AST or ALT usually more elevated?
AST (Aspartate Aminotransferase)
What is used to diagnose liver and bone disorders and is the most sensitive test for cancer metastasis to the liver?
Alkaline Phosphatase (ALP)
Which is more sensitive or specific for liver disease, ALT or AST?
Aspartate Aminotransferase (AST)
Albumin is a ____________ acute phase reactant
Negative
What does a lipid profile include?
Total cholesterol (TC)
Triglycerides (TGs)
High-Density Lipoprotein Cholesterol (HDL-C)
Low-Density Lipoprotein Cholesterol (LDL-C)
1) What should total cholesterol be?
2) What should HDL be?
3) What should LDL be?
4) What abt triglycerides?
1) <200 mg/dL
2) >60 mg/ dL
3) <100 mg/ dL
4) <150 mg/dL
Severe hypertriglyceridemia (>500 mg/dL) can cause what?
acute pancreatitis
List 3 Cardiac Enzymes (Cardiac Biomarkers)
1) Creatine (phospho)kinase (CK, CPK)
2) Myoglobin
3) Troponins
1) CK-MM is where?
2) CK-BB?
3) CK-MB?
1) Skeletal muscle
2) Brain
3) Heart
[High serum CK is indicative of release from damage to CK-rich tissue]
CK-MB generally begins to rise ________ hours after onset of MI, lasts 36-48 hours (returns to normal more quickly than troponin), and is sensitive but not specific
4-6
_____________ rises within 3 hours, is gone within 6-8 hours, and is more sensitive than CK-MB but not as specific
Myoglobin
1) What is elevated in rhabdomyolysis?
2) What turns the urine red/brown?
1) Myoglobin
2) Myoglobin
[Myoglobinuria: positive urine dipstick for “blood” (contains heme) but no RBCs on urine sediment microscopy (not hematuria)]
What measurement has the following advantages?:
1) Extremely specific (more than CK-MB) for myocardial cell injury
2) More sensitive
3) Becomes elevated sooner and lasts longer
4) Increased window for diagnosis
Troponins (TnT and TnI)
Describe the duration of troponin
1) “Sensitive”/“contemporary” assays:
Rises: 2-3 hours after injury
2) “High sensitivity” (hs) TnT:
Newer test with increased sensitivity for cardiac myocyte necrosis
Detects infarct as early as 90 minutes after onset
Duration: 7-14 days
B-Type Natriuretic Peptide (BNP) does what?
Increased diuresis, natriuresis, and vascular smooth muscle relaxation (vasodilation)
What does increased BNP indicate? What is it used to evaluate?
Too much pressure in the ventricles (especially left); congestive heart failure (CHF)
Most dyspneic pt’s with HF have ΒΝΡ value >______ pg/mL
400
What are the 3 potential causes of an exudative effusion?
1) Infection (e.g., bacterial pneumonia, TB)
2) Inflammation
3) Cancer
List 4 causes of transudative effusion
CHF
Cirrhosis (liver disease)
Nephrotic syndrome (kidney disease)
Hypoalbuminemia
Differentiate between causes of transudative and exudative effusion
1) Due to increased hydrostatic or decreased oncotic pressures (with normal capillaries)
2) Due to increased capillary permeability (e.g., pneumonia, tumors) or impaired lymphatic drainage (e.g., sarcoidosis)
Which is usually unilateral, transudative or exudative effusion?
Exudative
List light’s criteria
Pleural fluid protein/serum protein ratio >0.5
Pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio >0.6
Pleural fluid LDH level >2/3 the upper limit of the laboratory’s reference range of serum LDH
Name a cytoplasmic enzyme present in tissues throughout body that can be used to eval. hemolysis (highest concentration in heart, muscle, kidney, lung, and RBCs)
LDH
1) What triggers ADH?
2) Does a neurogenic or nephrogenic cause of diabetes insipidus respond to ADH? [by increasing urine osmolarity]
3) When should you measure GH?
1) Increase in serum osmolarity or decrease in blood volume
2) Neurogenic
3) At night
1) What is the issue when a pt has diabetes insipidus?
2) What is the medical term for “drinking too much water”?
3) What is used to differentiate neurogenic (central) diabetes insipidus vs nephrogenic diabetes insipidus?
1) Not enough ADH
2) Primary (psychogenic) polydipsia
3) ADH stimulation test (aka “vasopressin challenge test”, water deprivation test)
Measuring ____________ gives a more accurate reflection of GH
IGF-1
What is the opposite of Cushing syndrome?
2) “Endogenous” Cushing syndrome refers to what?
1) Adrenal Insufficiency: Underproduction of cortisol
2) Increased cortisol production by the adrenal cortex
1) ACTH-independent/ primary endogenous Cushing syndrome [less common] is usually due to what?
2) What is the issue with secondary endogenous Cushing syndrome?
3) When are Cortisol levels lowest?
1) Adrenal adenoma or carcinoma
2) Pituitary hypersecretion of ACTH
3) At night/ evening
Overnight low-dose dexamethasone suppression test (DЅТ): What should the result be if a pt does NOT have Cushing?
Early morning cortisol level is low (suppressed)
Describe how to interpret measuring plasma ACTH (and DHEAS) to differentiate ACTH-dependent vs. ACTH-independent
1) High cortisol, low ACTH, low DHEAS = ACTH-independent (i.e., adrenal source)
2) High cortisol, high ACTH, high DHEAS = ACTH-dependent (i.e., pituitary tumor or SCLC)
I.e. if ACTH is low, ACTH is not the problem
If a pt has ACTH-dependent Cushing, you need to differentiate pituitary vs. non-pituitary (ectopic) source of ACTH. How?
High-dose (8 mg) DST:
Cortisol level low (suppressed) = pituitary source
Cortisol level high (not suppressed) = ectopic source (SCLC)
1) Primary adrenal insufficiency (Addison disease): caused by dysfunction or absence of what?
2) Central adrenal insufficiency is caused by what?
1) Adrenal cortices
2) Pituitary or hypothalamus [exogenous use of glucocorticoids or opiates usually affects these]
How do you differentiate between primary and central hypocortisolism/ adrenal insufficiency?
High ACTH (with low cortisol) = primary
Low ACTH (with low cortisol) = central
What should you do to confirm a Dx of primary adrenal insufficiency?
cosyntropin (synthetic ACTH) stimulation test
Healthy pt: cortisol rises significantly
Primary Adrenal insufficiency: cortisol does not rise significantly (adrenals unable to respond to stimulus)
1) _____ surge indicates ovulation
2) PRL is used to monitor PRL-secreting ___________ adenomas
1) LH
2) pituitary
Trauma, tumor, infarction can cause what kind of hypothyroidism?
Secondary
The best initial screening test (most sensitive) for evaluation for primary hypo- and hyperthyroidism, and
the best test for monitoring T4 replacement therapy (e.g., in treatment of hypothyroidism), is what?
TSH
1) What does PTH do?
2) Hyperparathyroidism may result from what?
3) What is HbA1C in prediabetes?
1) Increase plasma calcium.
2) The best initial screening test (most sensitive) for evaluation for primary hypo- and hyperthyroidism
the best test for monitoring T4 replacement therapy (e.g., in treatment of hypothyroidism).
3) 5.7–6.4
1) What is OGTT in prediabetes?
2) What is FPG (fasting plasma glucose) in prediabetes?
3) What is the preferred test for gestational diabetes?
4) When is gestational diabetes tested for?
1) 140–199
2) 100–125
3) OGTT
4) 24-28 wks
You do 50-g oral glucose load given (without regard to previous meals/time of day) and plasma glucose level obtained at 1 hour. The result is abnormal. What is the next step?
3 hour fasting 100-g OGTT (more specific)
