Chemistries, Deficiencies and Dx Testing

Question 1

Normal Hb Range

Answer 1

Female: 12-15.5

Male: 13.5 - 17

Question 2

Normal Hct Range

Answer 2

34-44 Female

38-50 in men

Question 3

High Hb and High Hct

Answer 3

Polycythemia Vera

Physical signs are engorged retinal veins and splenomegaly

Question 4

Cheilosis is a sign of

Answer 4

Riboflavin (B2) deficiency

Question 5

Decreased Vibratory Sense is a sign of what deficiency

Answer 5

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

Question 6

Wilson’s Disease

Answer 6

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.

Question 7

Upper Motor Neuron Lesion

Answer 7

Babinski Sign in adults
Deep Tendon Hyperreflexia
Muscle Spasticity

Think MS, TBI and Cerebral Palsy

Question 8

Lower Motor Neuron Lesion

Answer 8

Muscle Atrophy
Twitching
Bells Palsy
Paralysis

Think Polio & ALS

Question 9

Normal AST and ALT ranges

Answer 9

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

Question 10

Normal SED Rate or ESR

Answer 10

0-22 mm/hr for men

0-29 mm/hr for women

Question 11

Normal Bilirubin ranges

Answer 11

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

0 to 0.3 mg/dL for direct.

Question 12

Direct vs Indirect bilirubin

Answer 12

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

Question 13

ALP

Alkaline Phosphatase

Answer 13

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

Question 14

Alpha-fetoprotein is a marker for

Answer 14

Liver Cancer

Question 15

Light’s criteria is used to determine

Answer 15

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.

Question 16

Exudative vs Transudative as regards infiltrates

esp pleural

Answer 16

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.

Question 17

PTT vs PT/INR

Answer 17

PTT measures intrinsic clotting and heparin effectiveness

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

Question 18

Antidote for Heparin

Answer 18

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?

Question 19

Office Test for Herpes skin infection

Simplex
Varicella
Zoster

Answer 19

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

Question 20

Test for Lyme

Answer 20

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.

Question 21

Why does BUN increase in gastric bleeding?

Answer 21

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

Question 22

Serum AST increases when…

Answer 22

Hepatocytes are damage and leak it into the blood.

Question 23

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

Answer 23

Haptoglobin

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

Question 24

Test for Myasthenia Gravis

Answer 24

Anticholinesterase Antibody test

Question 25

Coombs test (direct) for

Answer 25

+ in Hemolysis

Question 26

Lab ranges that will be out of whack in alcoholics

Answer 26

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

Question 27

Cystic Fibrosis Test

Answer 27

Sweat Chloride TEst

Classic presentation is recurrent respiratory infection d/t thick mucus

Neonatal CF testing looks at trypsinogen as a marker

Question 28

Ship Builders respiratory ailment

Answer 28

Asbestosis

Chest x-ray findings include interstitial fibrosis, pleural thickening and calcified pleural plaques on the diaphragm or lateral chest wall.

Question 29

Chest x-ray findings of “eggshell” calcification of hilar lymph nodes strongly supports the diagnosis of:

Answer 29

Silicosis

Mining, blasting, ground stone, clay + glass

Question 30

Salmonella pets

Answer 30

turtles and lizards

Get a stool culture

Question 31

Most common Leukemia in Kids

Answer 31

ALL

“All kids get it” (Katie)

Question 32

Roleaux and Bence Jones Urine Proteins indicate

Answer 32

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.

Question 33

Sideroblasts

Answer 33

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

Question 34

Basophilic Stippling

Answer 34

Lead Poisoning

Foot droop Blue Gums Altered Mental Status

Question 35

Sort Viral Pneumonia from Mycoplasma Pneumonia

Answer 35

Cold Agglutinin Titer

Will be elevated in bacterial pneumonia, esp Mycoplasma not in viral pneumo

WILL also be elevated in Mono Nucleosis