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Diagnostic Laboratory Medicine > Diagnostic Lab Medicine 3 > Flashcards

Diagnostic Lab Medicine 3 Flashcards

1
Q

What does BMP stand for?

A

Basic Metabolic Panel, or B-8

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2
Q

Give the abbreviations for “sequential multiple analysis 7”

A

CHEM-7 and/or SMA-7

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3
Q

What does a CMP/CCMP mean? How many tests?

A

Comprehensive/Complete Metabolic Panel, about 20 tests

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4
Q

What is the very least panel?

A

Electrolytes

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5
Q

What kind of information will you get from the chemistry panel tests?

A

-Patient’s volume status
-Acid base status
-Baseline renal function
-Glucose

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6
Q

Both the BMP and CMP should be recommended ______ blood specimens

A

FASTING

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7
Q

Both the BMP and CMP should be recommended fasting blood specimens because of which test?

A

Glucose level!

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8
Q

Determinations of plasma sodium detect changes in _____ balance rather than sodium balance

A

WATER

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9
Q

Blood level measurements are used to determine ?

A

Electrolyte balance
Acid-base balance
Water balance

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10
Q

Low Sodium = ____ = _____ Overload = ____Volemia

A

Low Sodium = Hyponatremia = Fluid Overload = HyperVolemia

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11
Q

Hyponatremia is almost always due to the oral or IV intake of ____ that cannot be completed excreted

A

water

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12
Q

Which patients is it most common to see hyponatremia in?

A

Elderly/hospitalized pts

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13
Q

In healthy patients, low sodium doesn’t develop unless _____ intake is greater than normal renal water ______

A

water intake > water excretion

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14
Q

Name the most common medical conditions for low sodium:

A

Congestive heart failure
Liver failure/Cirrhosis
Renal failure
Hyperglycemia
Too much IV fluids

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15
Q

T/F - In slow drops of sodium, the patient might not have any symptoms

A

True

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16
Q

Give symptoms for fast drops in sodium

A

CNS dysfunction due to cerebral edema = headache, nausea, vomiting, weakness, lethargy, seizure, confusion, coma

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17
Q

What are low sodium symptoms determined by?

A

-Degree of sodium loss
-Speed of sodium loss

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18
Q

What are some causes of hypernatremia?

A

Fluid depletion due to excessive sweating, vomiting, diarrhea, or hypodipsia (no feelings of thirst)
*Lack of water
*More water has to be lost than sodium

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19
Q

Which patients are hypernatremia commonly seen in?

A

Pts who cannot treat their own thirst (critically ill, dementia, pediatric, psychiatric, hospitalized)

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20
Q

Give the 6 D’s of hypernatremia

A

Diuretics, Dehydration, Diarrhea, Diseases, Docs (Iatrogenic), Diabetes Insipidus

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21
Q

Give symptoms for hypernatremia

A

Orthostatic hypotension, tachycardia, dehydration, AMS, seizures, hyperreflexia, oliguria (not urinating a lot)

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22
Q

What does potassium do for the cells? Is it high or low in hypovolemic patients?

A

Cell metabolism + neuromuscular and cardiac electrical transmission. Can be high or low in hypovolemic pts

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23
Q

_________ are the main regulator of potassium homeostasis

A

KIDNEYS

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24
Q

Give the main reasons for K+ imbalances

A

Renal dysfunction, medications, diet

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25
Q

Hypokalemic pts often have normal amounts of ___ in body, but they are losing it. How?

A

K+, losing through diarrhea, vomiting, GI losses, DIURETIC OR INSULIN medication, increased urination

+ Hypomagnesium
+Renal insufficiency
+ Combo of Hi Bicarb with low K = vomiting

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26
Q

Symptoms of hypokalemia?

A

Muscle weakness, constipation, fatigue, cardiac sx of palpitations, EKG changes

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27
Q

Symptoms of hyperkalemia?

A

Muscle weakness, cramps, paresthesias (pins and needles), EKG changes > cardiac arrest

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28
Q

Give the most common reasons for hyperkalemia

A

Hemolysis of specimen
Renal insufficiency
Meds: ACE, ARBs

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29
Q

Hypo and hyperchloremia rarely occur alone and are usually apart of parallel shifts in _____ or _____ levels

A

sodium or bicarbonate levels

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30
Q

Reasons for low and high blood chloride?

A

Low:
-Vomiting or GI output
-CHF

High
-Dehydration
-Metabolic acidosis

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31
Q

Blood carries gaseous waste product ____ to ___ where it is exhaled

A

CO2 to lungs

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32
Q

90% of carbon dioxide is found in the blood in the form of ______. Therefore, CO2 blood test is really a measure of your blood _____ level

A

Bicarbonate (HCO3)

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33
Q

CO2 levels in the blood are affected by ______ and ______ function

A

KIDNEY and LUNG

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34
Q

CO2 in a chemistry/metabolic panel is a preliminary test that may need further investigation with ____ _____ to look at ____ and _____

A

ARTERIAL BLOOD to look at OXYGENATION and PH

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35
Q

T/F - Changes in CO2 level may suggest losing or retaining fluid

A

True

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36
Q

Hypercapnia/hypercarbia is most commonly due to

A

-Respiratory failure or other breathing disorders
-Vomiting

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37
Q

Hypocapnia/Hypocarbia is most commonly due to ?

A

Hyperventilation, overdoses, kidney disease, diarrhea, metabolic lactic or ketoacidosis

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38
Q

What is the anion gap? Used for what?

A

Calculated using formula of several electrolytes
“Gap” is the difference between positive and negatively charged ions
Magnitude of the “gap” can be used when diagnosing acid-base disorders like metabolic acidosis

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39
Q

Glucose is intended to be done ___ and screens for what?

A

Fasting, screening for insulin and sugar metabolism

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40
Q

What is the first test done to check for diabetes? How long to fast?

A

Fasting Blood Sugar (FBS), fast for at least 8 hours

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41
Q

A FBS is done how?
What do the numbers mean?

A

Glucometer or venipuncture test
Fasting glucose >125 TWICE = diabetes
>110 but <125 = PRE-diabetes
<110 = normal

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42
Q

T/F - elevated fasting glucose can be found on screening BMP or CMP

A

YES! Ask if patient was truly fasting for at least 8 hours. If not, retest when patient fasts

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43
Q

If a patient did fast for 8 hours and they have elevated FBS levels, what do you do next?

A

2nd order FBS plus HBA1C to rule out pre-diabetes or impaired glucose metabolism. Follow up with lifestyle and family hx

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44
Q

If FBS _____ twice = diabetes

A

> 125 2x

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45
Q

HBA1C looks at glucose levels for the past ___ months. If it is over ____ with elevated FBS, treatment is needed

A

3 months, >6.5

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46
Q

What is osmolality?

A

Number of dissolved particles per unit of fluid

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47
Q

High blood osmolality can be increased by ? conditions

A

Dehydration, hyperglycemia, hypernatremia, uremia (+++ toxins in blood)

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48
Q

Low blood osmolality can be caused by ? conditions

A

Overhydration, hyponatremia, paraneoplastic syndromes (lung cancer), syndrome of inappropriate ADH secretions (SIADH)

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49
Q

T/F - All calcium is stored in bones and teeth

A

False, MOST is, but Ca2++ can be measured in small quantities in blood

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50
Q

Total and ionized calcium levels in the blood reflect ?

A

Parathyroid function
Calcium metabolism
Malignancy activity

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51
Q

If chemistry/metabolic panel result indicates abnormal calcium level, we follow up with further studies including ?

A

-an ionized calcium test
-parathyroid hormone levels
-Renal function testing

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52
Q

Hypercalcemia presents with symptoms of ?

A

Stones, bones, moans, psychic groans, and fatigue overtones”….
=kidney stones, bone pain, abdominal pain, muscle aching and weakness, depression, fatigue and lethargy

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53
Q

Hypercalcemia can indicate which types of cancer?

A

Bacon Lettuce Tomato Kosher pickles and Mayonnaise
Breast, Lung, Thyroid, Kidney, Prostate, and Myeloma

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54
Q

Hyperparathyroidism but patient has low albumin levels. Next step?

A

False alarm, recheck and correct albumin levels. 24 hour urine collection will be needed

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55
Q

Reasons for hypocalcemia? Symptoms?

A

Thyroid and parathyroid disease, vitamin D deficiency, malnutrition, renal failure
Symptoms: cramps, spasms, hyperreflexia, and even seizures
+ Chvostek, Trousseau

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56
Q

Hypocalcemia could be accompanied by ?

A

Hypoalbuminemia. Serum Ca measures both bound and unbound Ca, so if low protein the total Ca is low but ionized may be normal

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57
Q

_____ sign is facial spasm with percussion of ____ nerve. This is seen in hypo_____

A

Chvostek sign = facial nerve

HYPOCALCEMIA

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58
Q

____ sign is carpopedal spasms of hand with BP cuff inflated

A

Trousseau

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59
Q

Test result used in conjunction with other metabolic results to screen for body system disorders primarily of liver, kidney, GI, and chronic inflammation

A

Total Protein

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60
Q

Low blood protein levels indicate ? High?

A

Low:
-Liver dz
-Kidney dz
-Malnutrition or Malabsorption

High:
-Chronic inflammation such as Hep. HIV, or Bone marrow disorders

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61
Q

Two major types of proteins found in blood

A

Albumin and Globulin

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62
Q

Albumin is produced ONLY in the _____ and keeps our blood from _____ _____ out of the blood vessels

A

LIVER, keeps blood from seeping out of blood vessels

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63
Q

Globulin is created where ? What does it do?

A

Various areas, role in immune system

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64
Q

When it is necessary to evaluate how well our liver is functioning, a test that can determine the _______ ratio is done.

A

Globulin-albumin

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65
Q

Main function of albumin test?
Low/High?

A

indicate acute albumin loss in acute illness, renal disease, chronic illness, and nutrition status

Low in chronic illness, liver disease, renal disease, acute inflammatory processes like infections and burns

Never high in a normal situation

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66
Q

If there is a decrease of immunoglobulin being created then a high A/G ratio is what will determine this. Elevated ? Low ?

A

Elevated A/G ratios:
High protein/High carbohydrate diets, leukemia, and a few genetic disorders

Low A/G ratios:
chronic illness, liver disease, renal disease

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67
Q

What are LFT’s? What is included?

A

Liver Function Tests = liver enzymes

ALT
AST
ALP
Total Bilirubin

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68
Q

GGT, Indirect and Direct Bilirubin, or other GI tests – often needs to be ordered _______ from the above LFTs in order to further diagnose and manage conditions

A

separately

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69
Q

What is ALP?
Enzyme in the cells lining the ___ ___ of the ___, but also present in ___ and ____ tissue

A

Alkaline Phosphotase
Biliary ducts of the liver, but also present in bone and placental tissue

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70
Q

T/F - Normal to have ALP elevations in healthy, growing children with growth plates active

A

True

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71
Q

Liver-related elevations of ALP come from ?

Bone-related elevations of ALP come from ?

A

Liver-related elevations of ALP come from large bile duct obstruction, liver diseases including liver cancer

Bone-related elevations of ALP come from bone cancers, hyperparathyroidism, Paget’s disease of bone, osteomalacia, rickets

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72
Q

AST is what? What is the other name for it?
What is it associated with?

A

AST = Aspartate Transaminase
SGOT = Serum Glutamic Oxaloacetic Transaminase

Associated with liver parenchymal cells

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73
Q

AST/SGOT elevates with ?

Where else is it found?

A

Acute liver damage, but not specific to the liver

Also found in red blood cells and cardiac and skeletal muscle tissue

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74
Q

ALT = ? Other name?
Reasons for elevation?

A

ALT = Alanine Transaminase
SGPT = Serum Glutamic Pyruvic Transaminase

Elevated levels: : viral hepatitis, CHF, Liver damage, biliary duct problems, infectious mono, or myopathy

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75
Q

ALT/AST are commonly ordered together. What does elevated levels mean?
AST>ALT?

A

3x ULN = early detection
5X ULN = MUST REFER TO GI

AST>ALT = pt at risk for alcoholic liver disease

Equally elevated, investigate for meds FIRST followed by investigation of hemomchromatosis, autoimmune liver dz, Wilsons disease, alpha-1 antitrypsin deficiency

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76
Q

What meds should get periodic liver lab testing? What tests are involved?

A

Cholesterol meds
Chronic Tylenol

ALT/AST

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77
Q

What organ is responsible for clearing the blood of bilirubin? How does it work?
*Includes both conjugated (post-liver product) + unconjugated

A

LIVER

Bilirubin is taken into hepatocytes and conjugated (= liver modifies to make it water-soluble) and secretes it into the bile = excreted into the intestine

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78
Q

Bilirubin is product of ___breakdown from ____

A

Heme breakdown from RBCs

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79
Q

What to do for abnormal LFTs?

A

Analyze patient’s H&P for risks of differential diagnosis for abnormal liver tests:
Test for acute and/or chronic hepatitis after analyzing patient’s risk factors for hepatitis
Look at medication list for liver risks
NASH (non alcoholic fatty liver disease) if high BMI, metabolic syndrome, hyperlipidemia
Alcoholic liver disease
Hereditary hemochromatosis
Autoimmune liver disease
Alpha-1 anti trypsin deficiency

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80
Q

T/F - CBC Diff and CMP are both typical tests recommended for adult health screenings in preventive medicine!

A

True

81
Q

If direct bilirubin is elevated, then the liver is conjugating bilirubin normally, but is not able to excrete it.
Cause?

A

Bile duct obstruction by gallstones or cancer should be suspected.

82
Q

IF direct (i.e. conjugated) bilirubin is normal, then the problem is an excess of unconjugated bilirubin, and the location of the problem is upstream of bilirubin excretion.
Cause?

A

Hemolysis, viral hepatitis, or cirrhosis can be suspected.

83
Q

GGT = ?
T/F - Although reasonably specific to the liver and a more sensitive marker for cholestatic damage than ALP, GGT may be decreased with even minor, sub-clinical levels of liver dysfunction.

A

Gamma glutamyl transpepidase
FALSE - ELEVATED w/ minor things

84
Q

Isolated elevation of ALP. Next step?

A

Order GGT!
If GGT normal = bone-related problems of elevated ALP test

If both high = liver-related problem
RAISED IN ALCOHOL TOXICITY

85
Q

What are the common tests for biochemical markers for acute pancreatitis?

A

Serum amylase and lipase

86
Q

Lipase tests are often ordered for investigation of pancreatic inflammation. Lipase conc. rise within _____ hours of acute pancreatic attack and may remain elevated for about ____ to ___ days, ___x or more ULN

A

24-48 hours, 5-7 days, 3x or more ULN

87
Q

Amylase is (more/less) sensitive than lipase, but (more/less) specific for dx of acute pancreatitis

A

Amylase is MORE sensitive and LESS specific than lipase

88
Q

Amylase rises to more than 3x ULN within __-__ hours of onset and will stay elevated for __-__ days

A

6-12 hours and will be elevated 3-5 days

89
Q

What does magnesium do?

A

Neuromuscular transmission and many cell processes

90
Q

Reasons for Hypo/Hyper magnesium levels?

A

Hypomagnesium
-Chronic alcoholism due to poor dietary intake or excessive GI losses (V/D)
-Medications (PPIs)
-Sx lethargy, confusion, hyperreflexia, paresthesias

Hypermagnesium
-Rare to see unless pt. has renal failure or antacid abuse

91
Q

Calcium and phosphorus have an (inverse/direct) relationship

A

Inverse

92
Q

______ is a separate test when evaluating intracellular functions related to bones and teeth

A

Phosphorus

93
Q

Reasons for low phosphorus/high phosphorus?

A

Low phosphorus
Hyperparathyroidism, vit D deficiency
GI reasons such as diarrhea or malnutrition/not eating
Cardiotoxic if not corrected

High phosphorus
Chronic renal failure, some hemopoietic malignancies

94
Q

T/F - Ionized calcium level is part of the normal blood test

A

False, separate test from the total calcium found in the B8

95
Q

Ionized calcium level is physiologically ____ form of calcium in the blood. Pt should probably ____ and have test in (AM/PM)

A

active
fast, AM

96
Q

high/low calcium level meanings

A

High: bone cancer or bone disease, hyperparathyroidism, chronic renal failure

Low: chronic renal failure or other serious illnesses

97
Q

What is recommended ADA A1C goal for HBA1C?
AA of Endocrinologists goal?

A

ADA = <7.0%
AA of Endocrinologists = <6.5%

98
Q

What is RBS? Is it fasting/nonfasting? Number to indicate diabetes?

A

Random Blood Sugar , NONFASTING
Random glucose >200 with additional symptoms is diagnostic for diabetes

99
Q

All pregnant women should have an ____ ____ ____ ___ between ___-___ weeks gestation or sooner if at risk

A

ORAL GLUCOSE TOLERANCE TEST between 24-48 weeks gestation

100
Q

Gestational diabetes most often starts (at the beginning, middle, or end) of pregnancy

A

Halfway through (middle)

101
Q

Prenatal tests include:

A

2Hr GTT/ 3Hr GTT

102
Q

Fasting BGL is high but not high enough to meet dx of diabetes. What test to use?

A

OGTT/2hGTT

103
Q

A 2 hour value between ___-___ is called impaired glucose tolerance, or pre-diabetes

A

140-200 mg/dL

104
Q

Serious stress like trauma/stroke/heart attack/surgery can (raise/lower) BGL

Exercise can (raise/lower) BGL

Some meds can (raise/lower) your BGL

A

raise

lower

raise or lower

105
Q

What is assessed for in a lipid panel?

A

LDL, HDL, triglycerides, total cholesterol

106
Q

What is the most common indication for cholesterol test?

A

Aiding in the process of determining cardiovascular disease event risk

107
Q

What other reasons would you do a lipid panel for?

A

Identifying pts who are at a high risk for lipid abnormality due to FAMILY HISTORY, FAMILIAL HYPERCHOLESTEROLEMIA
-Identifying PANCREATITIS
-Managing pts with established ATHEROSCLEROTIC CARDIOVASCULAR DISEASE
-Evaluating the efficacy of and/or adherence with LIPID LOWERING THERAPY AND LIFESTYLE MODIFICATIONS

108
Q

How is a lipid panel drawn?

A

Venipuncture

109
Q

Does a lipid profile need to be fasted? Why or why not?

A

YES, should be done fasting due to Triglycerides and calculated LDL-C accuracy

110
Q

T/F - HDL varies with fasting

A

False, due to triglycerides and LDL

111
Q

Sources of cholesterol?
____ and other cells make about _______ % of blood cholesterol

A

Body and food
Liver and other cells make about 75% of blood cholesterol
25% from the food we eat

112
Q

Where is cholesterol found in the diet?

A

Found in animal products. Eat less animal products and more fruits and vegetables

113
Q

HDL = ?
What does it do?
It should be (low/high) because it is the (good/bad) cholesterol

A

High Density Lipoprotein
It plays a role in the metabolism of other lipoproteins and cholesterol transport from the TISSUE to the LIVER
GOOD CHOLESTEROL = SHOULD BE HIGH

114
Q

T/F - Strong relationship between HDL and CAD
Healthy levels ? Low ?

A

True
Healthy = protect against heart attack and stroke
Low HDL = increased risk of heart disease

115
Q

Normal/desirable range is over ____, which ironically will be the lowest number on most patient’s results

A

59

116
Q

T/F - HDL has an anti-inflammatory ability
How to increase?

A

True
-Healthy diet (monounsaturated and polyunsaturated fats improve HDL (olive, peanut, canola)
-Regular physical activity and maintain healthy weight
-Stop smoking, smoking cessation can raise HDL by up to 10%
-Add medication

117
Q

For every ____ lbs weight lost, HDL may increase by ____

A

6 lbs = increase 1

118
Q

____-____% of total serum cholesterol is present in the LDL

A

60-70%

119
Q

LDL stands for? VLDL stands for? Which one is the major carrier of triglycerides?

A

Low Density Lipoprotein
Very Low Density Lipoprotein = major carrier

120
Q

Degradation of ____ is a major source of LDL

A

VLDL

121
Q

LDL is (good/bad) cholesterol, which has (increased/decreased) risk of atherosclerosis and CAD

A

bad, increased.
WANT THE LOW TO STAY LOW

122
Q

Measuring (LDL/VLDL) is a test of choice because it has a longer half life and is easier to measure

A

LDL

123
Q

T/F - People can inherit genes that cause them to make too much LDL

A

True, lifestyle mod. might not be enough, medication may be recommended

124
Q

T/F - LDL cholesterol is produced naturally by the body
How is it obtained?

A

True
Also obtained through saturated fat, trans fat, and dietary cholesterol also increases LDL

125
Q

TRIGLYCERIDES account for _____ of dietary fat intake and comprise ____ of fat stored in tissue

A

> 90%, comprise 95%

126
Q

What do elevated levels of triglycerides indicate?

A

Increase risk factor of atherosclerotic disease + diabetes, steatosis/NASH, and pancreatitis

127
Q

Most common type of fat in the body?

A

Triglycerides

128
Q

Give some lifestyle modifications to decrease CVA risk

A

smoking, diabetes, psychosocial factors, daily consumption of fruits and vegetables, decrease regular alcohol consumption, increase regular physical activity, hypertension, abdominal obesity, dyslipidemia

129
Q

A high _______ level combined with _____ HDL cholesterol or _____ LDL cholesterol increases atherosclerosis so most primary care providers screen for the full lipid profile to include this test.

A

triglyceride, low HDL, high LDL

130
Q

Calculating 10 year risk assessment
CAC = ?
MESA = ?

A

Coronary artery calcification
Multi Ethnic Study of Atherosclerosis

131
Q

What does the annual adult check up include ?

A

CBC diff, BMP or CMP, Lipid panel, TSH

132
Q

Generally speaking, primary care providers typically agree to screen all adults starting age ___ regardless of risk factors

A

40+

133
Q

Start testing high risk pts ____ yrs old

A

~20-30 years old

134
Q

We consider patients to be at higher cardiovascular risk if they have one of the following risk factors: ?

A

hypertension, smoking, family history of premature cardiovascular disease.
+ overweight, diabetes, steroids

135
Q

Controversial rechecks of NORMAL screening results
should be repeated every ___-___ yrs according to UTD, however common practice is yearly testing for annual physical exams
If results repeatedly normal, stop screenings at __ yrs old, Others say there is not age to stop screenings because atherosclerotic cardiovascular disease (CVD) affects majority of adults over 60 according to UTD

A

3-5 years
65 years

136
Q

If you find abnormal lipid tests, you should follow up with ??

A

TSH (thyroid testing) because hypothyroidism is a potential cause of hyperlipidemia

Baseline BUN/creatinine and LFT (liver function tests) because certain lips meds are used with caution if abnormal liver or renal function

137
Q

If monitoring medication efficacy and lifestyle modifications, the recommendations are to repeat lipid panel at least annually (sometimes even ____ months initially for striving to target optimal hyperlipidemia management

A

3-6 months
*Don’t wait longer than a year to keep monitoring

138
Q

Lipoproteins = ?
consider testing in KNOWN CVD risk pts only

A

Apolipoproteins

139
Q

Lp(a) is a modified form of ?

A

LDL

140
Q

How does Lp(a) work?

A

Binds to macrophages via high-affinity receptor that promotes foam cell formation and the deposition of cholesterol in atherosclerotic plaques

141
Q

At present, screening and treatment for Lp(a) excess levels should only be considered for:

A

Patients with known coronary heart disease and no other identifiable dyslipidemia > Isolated high LDL!!

Patients with a strong family history of CHD and no other dyslipidemia > Isolated high LDL!!

Patients with hypercholesterolemia refractory to therapy with LDL cholesterol lowering therapies

142
Q

Name the 5 biomarkers for CVD prevention

A
  • Lipid panel
  • HBA1C
    -Hs CRP
    -Lp (a)
    -BNP
143
Q

_______ belongs to a family of HORMONES that are released in periods of ?

A

BNP, myocardial wall stress

144
Q

The most common clinical use of BNP is in the setting of ?

A

Acute (diagnosis) or Chronic Heart Failure (prognosis)

145
Q

Elevated BNP = Think ?

A

CHF = ELEVATED BNP

146
Q

In primary prevention, there have been consistent associations with elevated BNP or Cardiovascular risk. BNP (Or its precursor, NT-proBNP) has been shown to have (dependent/independent) prognostic values

A

independent.
Must have suspicion of cardiac disease

147
Q

What does BNP stand for?

A

B-type natriuretic peptide

148
Q

T/F - Cardiac enzymes are regular screening tests

A

FALSE, DONE IN SUSPICION OF ACTIVE HEART ATTACK, NOT EVER a screening test

148
Q

Cardiac biomarkers are ordered to evaluate patients with a ??

A

suspected MI

149
Q

Name the most frequently used cardiac biomarkers

A

The cardiac troponins I and T
MB Isoenzyme of creatine kinase (CK-MB)

150
Q

Troponin is unique to and high concentrated in ??

A

Unique to heart muscle and highly concentrated in cardiomyocytes

151
Q

When are troponin enzymes released? IMPORTANT

A

1-3 hours after injury. Therefore, if pain started 20 mins ago, probably would not show

152
Q

Preferred initial test to diagnose MI?

A

Cardiac Troponin

153
Q

Serial sampling (___-___ hour intervals) after chest pain ordered to rule out MI

A

6-8 hours. May see (“troponin Q6h x 2)

154
Q

Troponin returns to normal within ? days
It remains increased (longer/shorter) than CK-MB and is (more/less) cardiac specific

A

5-7 days
Increase LONGER and is MORE cardiac specific

155
Q

Three points should be kept in mind when using troponin to diagnose AMI:

With contemporary troponin assays, most patients can be diagnosed within __-__ hours of presentation.

A negative test at the time of presentation, especially if the patient presents early after the onset of symptoms, (does/does not) exclude myocardial injury.

A

2-3 hours of presentation
DOES NOT EXCLUDE

156
Q

AMI can be excluded in most patients by ___ hours, but the guidelines suggest that, if there is a high degree of suspicion of an ACS, a ___-hour sample be obtained.
Serial sampling (6-8 hour intervals) after chest pain ordered to rule out MI.

A

6 hours
12 hours

157
Q

Where are CK and CPK found?

A

HIGH concentration in the HEART and SKELETAL m

158
Q

What does CPK and CK stand for?

A

Creatine Phosphokinase
Creatine Kinase and Isoenzymes

159
Q

___ is used as specific index of injury to myocardium and muscle, other than troponin

A

CK

160
Q

With MI, elevations of CK/CPK start about ____-____ hours, reaches peak within ____ hours, and returns to normal in 48-72 hours

A

4-6 hours, 24 hours

161
Q

Skeletal muscle contains isoenzyme ____
Cardiac muscle contains ____ and ____.

A

MM = skeletal m.
MM and MB = cardiac m.

162
Q

T/F - If there is a negative MB >48 hours, there is still a possibility of MI

A

False

163
Q

Finding of ___ in patient with chest pain is diagnostic for __, but is becoming outdated and not typically added as a secondary test to troponin

A

MB, MI

164
Q

CK MB and total CK (decrease/increase) with acute MI

A

Increase

165
Q

If CK MB and CK are elevated but troponin is normal, MB is likely due to release from ?

A

non-cardiac tissue

166
Q

Describe the blood vessel coagulation cascade

A

Endothelium of blood vessel is damaged→ plts form plug at site of injury (1° hemostasis)→ releases chemicals that activate coag factor cascade (2° hemostasis) to form fibrin strands that strengthen plt plug→ clot dissolves (fibrinolysis) after damaged vessel is repaired.

167
Q

Baseline ____ level should be obtained before administering anticoagulant prescriptions

A

PT
Examples: Coumadin, Warfarin

168
Q

What to order when screening for coagulation disorders?

A

PTT (Partial Thromboplastin Time) and APTT (Activated Partial Thromboplastin Time) = TEST FOR SAME FUNCTION

169
Q

Which tests are sensitive and are used to monitor heparin Rx therapy?

A

PTT and APTT

170
Q

APTT > ____ seconds signifies spontaneous bleeding.

A

APTT > 70 seconds

171
Q

Which tests when together will detect approx. 95% of coagulation defects?

A

PT and PTT

172
Q

coagulation

A

process by which blood clots form

172
Q

T/F - an elevated d-Dimer + symptoms is diagnostic for a coagulation disorder or blood clot

A

False, it helps give presumptive evidence, but need more diagnostic tests. D-dimers can be increased for other reasons

173
Q

T/F - D/Os of coagulation can increase risk of hemorrhage or thrombosis

A

True

174
Q

Coagulation involves ? (pits) and ? (coag factors) components

A

Cellular (pits) and protein (Coagulation factors)

175
Q

What are the lab tests that evaluate clotting?

A

Platelet counts/MPV
PT/INR
PTT

176
Q

What does Prothrombin time/International normalized ratio (PT/INR) do?

A

Monitors Coumadin (Warfarin) therapy
Extrinsic Coagulation pathway

177
Q

What does Partial Thromboplastin time (PTT) test for ?

A

Monitors heparin therapy
Intrinsic coagulation pathway

178
Q

Increased d-dimers are associated with ?

A

DIC, arterial or venous thrombosis, renal or liver failure, pulmonary embolism, late pregnancy, preeclampsia, MI, malignancy, inflammation, severe infection, all pts after surgery or trauma

179
Q

What is d-Dimer used for?

A

Venous Thrombosis (blood clots) = VTE, DVT (Deep Vein Thrombosis)

180
Q

a serious disorder in which the proteins that control blood clotting become overactive

A

Disseminated intravascular coagulation (DIC)

181
Q

Elevated bun and creatinine = __________

A

Azotemia

182
Q

BUN/Creatinine = think _____
Normal ratio?
Are they electrolytes? Ordered together?

A

RENAL
BOTH ordered together
NOT true electrolytes
Normal ratio is 10:1 for BUN:creatinine

183
Q

Urea is formed by the ?
It is the final product of _____ metabolism

A

Liver
protein

184
Q

There is (decreased/increased) excretion of BUN in fever, diabetes, and increased adrenal activity

A

Increased

185
Q

The _____ portion of urea is an index of _______ based on production and ____ (excretion/absorption) of urea

A

Nitrogen
Kidneys’ glomerular function
kidney’s EXCRETION

186
Q

Rate at which BUN rises is influenced by degree of
tissue ______
protein _______
and rate at which kidneys excrete the urea _____

A

necrosis
catabolism
nitrogen

187
Q

Markedly elevated BUN is conclusive evidence of severe glomerular kidney function ______

A

abnormality

188
Q

If both BUN and CREAT elevated, look for _____ as a possibility

A

dehydration

189
Q

Byproduct of breakdown of _____ creatinine phosphate from energy metabolism

A

muscle

190
Q

Production of creatinine is dependent on muscle _____
The higher the body’s muscle mass, the (higher/lower) the creatinine

A

mass
higher

191
Q

Elderly pts with muscle wasting need careful attention with slight (increases/decreases) to their creatinine

A

increases

192
Q

Disorders of kidney function (increases/reduces) excretion of creatinine, resulting in (increased/decreased) blood creatinine levels

A

reduces excretion, resulting in increased blood creatinine levels

193
Q

Creatinine is a (direct/indirect) measure of glomerular function

A

Indirect

194
Q

BUN/CREAT RATIO >20:1
BUN/CREAT RATIO <10
BUN/CREAT RATIO IS 10:1-20:1

A

Prerenal - dehydration, cardiac failure or shock, sepsis, meds, before kidneys
Postrenal - excretion after kidney, stones, benign prostate enlargement, cancers
Intrarenal (Normal) - causes considered intrinsic renal such as glomerulonephritis, interstitial nephritis, acute tubular necrosis, vascular renal problems, obstruction within kidney

195
Q

GFR - glomerular filtration rate - normal levels?
Does it increase or decrease with age?

A

90 or higher
decreases with age

196
Q

T/F - Lower the GFR the worse the kidney function, but it does not dx kidney disease without further studies

A

True

197
Q

Best way to tell how much the kidney is functioning?

A

GFR

Diagnostic Laboratory Medicine (4 decks)

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