Chemistries, Deficiencies and Dx Testing Flashcards
Normal Hb Range
Female: 12-15.5
Male: 13.5 - 17
Normal Hct Range
34-44 Female
38-50 in men
High Hb and High Hct
Polycythemia Vera
Physical signs are engorged retinal veins and splenomegaly
Cheilosis is a sign of
Riboflavin (B2) deficiency
Decreased Vibratory Sense is a sign of what deficiency
Vitamin B12 (Cobalamin) This is one of the neurological manifestations
Wilson’s Disease
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.
Upper Motor Neuron Lesion
Babinski Sign in adults
Deep Tendon Hyperreflexia
Muscle Spasticity
Think MS, TBI and Cerebral Palsy
Lower Motor Neuron Lesion
Muscle Atrophy
Twitching
Bells Palsy
Paralysis
Think Polio & ALS
Normal AST and ALT ranges
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
Normal SED Rate or ESR
0-22 mm/hr for men
0-29 mm/hr for women
Normal Bilirubin ranges
0.1 to 1 mg/dL of total bilirubin
(direct plus indirect) and
0 to 0.3 mg/dL for direct.
Direct vs Indirect bilirubin
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
ALP
Alkaline Phosphatase
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
Alpha-fetoprotein is a marker for
Liver Cancer
Light’s criteria is used to determine
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.
Exudative vs Transudative as regards infiltrates
esp pleural
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.
PTT vs PT/INR
PTT measures intrinsic clotting and heparin effectiveness
PT/INR measures the Extrinsic Pathway which factors are dependent on Vitamin K
Antidote for Heparin
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?
Office Test for Herpes skin infection
Simplex
Varicella
Zoster
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
Test for Lyme
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.
Why does BUN increase in gastric bleeding?
Digestion of blood increases absorption of Hb, breakdown of which releases nitrogenous wast. BUN is, after all, Blood Urea Nitrogen.
Serum AST increases when…
Hepatocytes are damage and leak it into the blood.
Liver protein that scavenges and sequesters free Iron, especially in the event of inflammation when it’s secretion is triggered by interleukins.
Haptoglobin
this is the mechanism of Anemia of Chronic Disease. the liver sequesters iron so the bugs can’t have it.
Test for Myasthenia Gravis
Anticholinesterase Antibody test
Coombs test (direct) for
+ in Hemolysis
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
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
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.
Chest x-ray findings of “eggshell” calcification of hilar lymph nodes strongly supports the diagnosis of:
Silicosis
Mining, blasting, ground stone, clay + glass
Salmonella pets
turtles and lizards
Get a stool culture
Most common Leukemia in Kids
ALL
“All kids get it” (Katie)
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.
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
Basophilic Stippling
Lead Poisoning
Foot droop Blue Gums Altered Mental Status
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
