Chemistries, Deficiencies and Dx Testing Flashcards

1
Q

Normal Hb Range

A

Female: 12-15.5

Male: 13.5 - 17

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2
Q

Normal Hct Range

A

34-44 Female

38-50 in men

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3
Q

High Hb and High Hct

A

Polycythemia Vera

Physical signs are engorged retinal veins and splenomegaly

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4
Q

Cheilosis is a sign of

A

Riboflavin (B2) deficiency

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5
Q

Decreased Vibratory Sense is a sign of what deficiency

A
Vitamin B12 (Cobalamin)  
This is one of the neurological manifestations
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6
Q

Wilson’s Disease

A

Copper excretion defect

Copper accumulates in the tissues - particularly kidneys, eyes + brain. Also causes Hemolysis.

Kayser-Fleischer Rings - copper colored Cu++ deposits form a ring around the iris. First at the top then continuing 360 degrees
This is pathopneumonic for Wilson’s Dz but is not always present.

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7
Q

Upper Motor Neuron Lesion

A

Babinski Sign in adults
Deep Tendon Hyperreflexia
Muscle Spasticity

Think MS, TBI and Cerebral Palsy

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8
Q

Lower Motor Neuron Lesion

A

Muscle Atrophy
Twitching
Bells Palsy
Paralysis

Think Polio & ALS

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9
Q

Normal AST and ALT ranges

A

AST 10 to 40 units per liter

ALT 7 to 56 units per liter.
ALT is THE MOST LIVER SPECIFIC of the Liver Enzymes ALT, ALP and AST

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10
Q

Normal SED Rate or ESR

A

0-22 mm/hr for men

0-29 mm/hr for women

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11
Q

Normal Bilirubin ranges

A

0.1 to 1 mg/dL of total bilirubin
(direct plus indirect) and

0 to 0.3 mg/dL for direct.

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12
Q

Direct vs Indirect bilirubin

A

Unconjugated = Indirect
Spleen to Liver

Conjugated=Direct
Liver to Bile/Urine/Feces

When liver function is poor, Conjugated bilirubin decreases
if Total Bilirubin is predominantly UNconjugated, there is liver trouble.

If it’s predominantly CONjugated, there may be spleen trouble

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13
Q

ALP

Alkaline Phosphatase

A

High in Liver, Bile Duct, Kidney & Bone

Normal Range is 20-140 IU/L
High usually means LIVER cells or BONE Cells are being lysed and leaking ALP

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14
Q

Alpha-fetoprotein is a marker for

A

Liver Cancer

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15
Q

Light’s criteria is used to determine

A

Whether fluid aspirated from a pleural effusion is exudative or transudative

Exudative= Inflammation dilates vessels
making them leaky. Fluid leaves the vessel
and PROTIEN leaves with it. Exudative
effusions have fluid AND protein and other
things: triglycerides or other large particles.

Transudative= A change in pressure caused
this fluid to be in the pleural space
This would be mainly controlled by serum
protein. This is third spacing and when it
third spaces into the pleural space it is calle
a pleural effusion. PROTEINS do NOT slip
through these vessels as they are not
dilated, just under higher pressure.

CHF also causes transudative pleural effusions by blood backing up to the lungs increasing pressure in the alveoli pushing fluid out of the vessels into the pleural space.

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16
Q

Exudative vs Transudative as regards infiltrates

esp pleural

A

High LDH - as compared with serum.
LDH ratio over 0.6 is EXUDATIVE
meaning its from Inflammation
i.e. from INFECTION

             LDH ratio under 0.6 is 
                    TRANSUDATIVE i.e. from low
                    serum protein and 3rd spacing
                    NO Infection

Transudative infiltrate is 3rd spaced d/t low albumin, look for holes in the kidneys, vessel and for liver dz.

Exudative infiltrate is secreted in response to infection. Get CBC and blood cultures.

17
Q

PTT vs PT/INR

A

PTT measures intrinsic clotting and heparin effectiveness

PT/INR measures the Extrinsic Pathway which factors are dependent on Vitamin K

18
Q

Antidote for Heparin

A

Protamine Sulfate
1-1.5 mg per 100 units Heparin
Max 50 mg

Also mixed with insulin to slow it’s action

Also may inhibit lipase and thereby inhibit dietary fat metabolism and enhance weight loss.

Consider choosing the insulin with protamine in it for enhancing weight control in obese DM?

19
Q

Office Test for Herpes skin infection

Simplex
Varicella
Zoster

A

Tzanck Test

Unroof vescicle
Scrape base
Smear on slide
Add Methanol to fix (MeOH)
Stain w/Giemsa, Methylene Blue        
     or Wrights

Microscopic exam under oil shows Giant Multi-Nucleated Cells

20
Q

Test for Lyme

A

After a few weeks, most will have a (+) Serum Antibody Test for Borrelia Borgdorfi

This positive result wanes and then disappears as the spirochete attacks and then kills off the B-Cells that generate the antibodies so late stage may very well be negative for Ab.

21
Q

Why does BUN increase in gastric bleeding?

A

Digestion of blood increases absorption of Hb, breakdown of which releases nitrogenous wast. BUN is, after all, Blood Urea Nitrogen.

22
Q

Serum AST increases when…

A

Hepatocytes are damage and leak it into the blood.

23
Q

Liver protein that scavenges and sequesters free Iron, especially in the event of inflammation when it’s secretion is triggered by interleukins.

A

Haptoglobin

this is the mechanism of Anemia of Chronic Disease. the liver sequesters iron so the bugs can’t have it.

24
Q

Test for Myasthenia Gravis

A

Anticholinesterase Antibody test

25
Coombs test (direct) for
+ in Hemolysis
26
Lab ranges that will be out of whack in alcoholics
MCV - ETOH is hard on bone marrow cells It makes it difficult for Fe++ to be absorbed into Hb and they form RINGS of iron laden mitochondria around the nucleus (Sideroblastic Anemia) This iron is inaccessible for O2 carrying. Also contributing to RBC volume are the development of vacuoles inside developing RBCs It is not known if they are pathogenic but they are thought to indicate alcoholism Regular old Iron Deficiency Anemia Folic acid will be low Hyperlipidemia- Spur Cells RBCs grow spikes to use up their extra cholesterol
27
Cystic Fibrosis Test
Sweat Chloride TEst Classic presentation is recurrent respiratory infection d/t thick mucus Neonatal CF testing looks at trypsinogen as a marker
28
Ship Builders respiratory ailment
Asbestosis Chest x-ray findings include interstitial fibrosis, pleural thickening and calcified pleural plaques on the diaphragm or lateral chest wall.
29
Chest x-ray findings of “eggshell” calcification of hilar lymph nodes strongly supports the diagnosis of:
Silicosis Mining, blasting, ground stone, clay + glass
30
Salmonella pets
turtles and lizards Get a stool culture
31
Most common Leukemia in Kids
ALL "All kids get it" (Katie)
32
Roleaux and Bence Jones Urine Proteins indicate
Multiple Myeloma You will also see lots of calcium about and likely find compression fractures at tumor cites and High Serum IgG - as its Plasma Cells gone wild.
33
Sideroblasts
Sideroblastic Anemia is found in alcoholics who suffer a porphyrin change and cannot utilize dietary iron, which fills up their mitochondria that end up circling the nucleus of the immature RBC like a RING
34
Basophilic Stippling
Lead Poisoning Foot droop Blue Gums Altered Mental Status
35
Sort Viral Pneumonia from Mycoplasma Pneumonia
Cold Agglutinin Titer Will be elevated in bacterial pneumonia, esp Mycoplasma not in viral pneumo WILL also be elevated in Mono Nucleosis