Diagnostic Tests for Primary Care Flashcards
Name the three plasma proteins
1) Albumin
2) Globulin
3) Fibrinogen
When we remove the fibrinogen from plasma we get what product?
Serum (albumin 2/3 + globulin 1/3)
What is the suffix that means …“of the clotting family”?
-ogen
What conditions increase the risk of clotting?
Obesity, venous stasis, hip and pelvic surgery, immobility, age, and excessively high estrogen levels
What are some of the causes of excess estrogen?
Age and smoking
Where are clotting factors produced? When?
Liver, at night
A venous clot is referred to as a what?
An arterial clot is referred to as a what?
Red clot
White clot
Clotting factors are highest at what time of day?
Early AM
Inflammation mediators are highest at what time of day?
AM
What is the action of ASA?
Inhibits platelet aggregation
What is the action of coumadin and heparin?
Inhibit clotting factors
What test determines nutritional status or the prognosis in liver disease?
Direct albumin
What are the functions of albumin?
1) It holds water in the vascular space
2) Binds drugs
What causes hypoalbuminemia?
1) Liver disease because of decreased synthesis of albumin (liver may be diseased or old)
2) Leaky kidneys
What is SAAG?
Serum ascities/albumin gradient
Albumin in the serum/albumin in the ascites
What SAAG ratio indicates portal HTN?
Greater than 1.1 (97% predictive)
What causes ascites other than portal HTN?
Nephrotic syndrome, infection (TB, fungal, CMV), pancreatic ascites, ovarian CA, peritoneal carcinomatosis
What protein is usually found in the urine?
Albumin (macroalbuminuria) 1+-4+
What levels of proteinuria go with the following diseases?
Nephritis?
Nephrosis?
1-2 +
3-4 +
What class of drugs are “prills”?
Ace inhibitors
Afferent means?
Efferent?
Toward the organ of interest
Away from the organ of interest (exit)
If there is microalbuminuria, what two diseases are suspect?
DM and HTN
What holds the afferent arteriole to the kidney open?
Prostaglandin (vasodilation)
What closes the efferent arteriole to the kidney?
Angiotensin II (vasoconstricts)
Hyperglycemia and HTN cause an increase in?
Prostaglandins and Angiotensin II
What increases by 1% each year after age 30?
Fibrinogen
What decreases by 1% each year after age 40?
Liver function
What drug gets knocked off protein binding sites easily and often?
Coumadin
When you add a new drug, when should you check the INR if the patient takes coumadin?
Within 72 hours
What does the alpha 1 globulin help to produce?
High density lipoprotein (HDL)
What are three functions of HDLs?
1) Clear excess cholesterol from the blood
2) Prevent LDL from oxidizing
3) Act as a potent anti-inflammatory
What is a good HDL level?
> 40 mg/dL
What helps to boost HDLs?
garlic, beans, omega-3, plant stanols, decreased trans fats and saturated fats, exercise, estrogen and ethanol
What drug boosts HDL the most?
Niaspan (up to 25%)
What drugs lower LDL cholestrol?
Statins
Which statin lowers LDL but also boosts HDL by 12%?
Crestor (rosuvastatin)
Beta globulins contribute to the making of?
Low density lipoprotein (LDL)
The higher the LDL, the greater the risk for?
Atherosclerosis
Which is better: small, dense LDL or large, loose LDL?
Large, loose LDL particles cannot deposit in the vessel walls as readily
What is the suggested level of LDL?
< 100 is acceptable
What are some risk factors for increased LDL?
Diet (high in sat fat or trans fat), smoking, high iron levels, lack of activity, abdominal fat
When should you take your statin drug?
At night or before sleep
What are triglycerides elevated by?
Sugars (high fructose corn syrup, alcohol, sugar)
What is the ideal level of triglycerides?
< 150 mg/dL
What is the recommended dose of fish oil?
1000 mg/day
What two diseases should you expect to find with high triglycerides and a low HDL?
DMII or hypothyroidism
What is a normal WBC count?
5000-10,000
What ethnic groups have low WBCs?
AA and Native Americans
Neutrophils make up what percentage of the total white count?
57-63%
Neutrophils are the first line of defense in what type of invasion?
Bacterial
Bands are what?
Immature neutrophils
Lymphocytes make up what percentage of the WBC?
30%
Lymphocytes are the first line of defense in what type of invasion?
Viral
Monocytes turn into what type of cell in the tissue?
Macrophages
What type of WBC will you see with parasites and allergies?
Eosinophils
What is elevated in an allergic reaction and turn into mast cells in the tissue?
basophils
All of the -phil cells, meaning “affinity for” are called?
Granulocytes
Neutrophils are also called what?
Segs
Where are neutrophils produced?
In the bone marrow
How long do neutrophils live in the bloodstream?
5-6 hours
Where do neutrophils migrate from the bloodstream?
Into the tissue
When there are an increased number of bands, it is called a what?
Shift to the left
What are some conditions where you see this shift?
GABHS, pyelonephritis, Acute appendicitis, bacterial meningitis
What are some drugs that cause neutropenia?
Chemo, tagamet, zantac, tegretal, flagyl, gentamicin, imipenem, imuran
what does prednisone do to your white count?
Increases it
What is the mechanism for this?
Prednisone inhibits migration and degranulation. It releases neutrophils from the walls of vessels so numbers are greater
What increases the migration of segs?
Fever
CRP is a non-specific indicator for what?
Inflammation
HS-CRP indicates a high risk of what?
Vascular inflammation and cardiac arrest
What can reduce HS-CRP?
Exercise, loss of abdominal fat, statins, Actos, ASA, Omega-3, nuts, Mediterranean diet
What measures the settling of RBCs in anticoagulated blood?
Sed Rate
What are some of the names for monocytes in tissue?
Macrophage, Kuppfer, microglial, osteoclast, mesangial cells
What is the response time for macrophages?
2-4 days
What type of inflammation do monocytes work on?
Chronic
What do you call it when macrophages surround a pathogen?
Granuloma
Granulomatous diseases are chronic inflammatory diseases that often end in the suffix?
-osis
Vitamin D is really not a vitamin but a what?
Hormone
TNF alpha (a cytokine) can be helpful in what disease?
TB
TNF alpha (a cytokine) can be harmful in what disease?
RA, Crohn’s, ankylosing spondylitis
What are some of the TNF alpha inhibitors?
Remicade, Humira, Cimzia, Simponi
The macrophage not only engulfs the pathogen but also does what?
Processes and presents it to the T4 cells
What are some drugs that inhibit the immune system?
Methotrexate, plaquenil, prednisone, TNF alpha, cyclosporin A
What cytokine increases the temperature set point?
IL -1
IL-1 also causes serotonin release from the brain and duodenum causing what two symptoms?
nausea and vomiting
Cells of the immune system are?
B cells (16%), T cells (70%) and NK cells (14%)
T lymphocytes are the first responders to what?
Viral infections
How many herpes viruses are there?
8
B lymphocytes turn into what kind of cells?
Plasma cells
How many days does it take to produce antibodies with an initial response? Memory response?
7-21, minutes to hours
What do you call cancer of the plasma cell?
Multiple myeloma
What are the five gamma globulins?
IgM, IgG, IgA, IgD, IgE
What gammaglobulin is the first antibody formed to infection?
IgM
What gammaglobulin is the second antibody formed to infection and lasts forever?
IgG
What is the antibody of allergies?
IgE
Erythropoietin is produced in the?
Kidneys
Hypothyroidism causes anemia by?
A low metabolic rate
Where do we get most of our iron?
Recycled old RBCs
How much iron do we need in our diet?
1 mg daily
How do we get iron deficient?
Bleeding
Where is iron primarily absorbed?
Duodenum
What are some reasons for poor iron absorption?
celiac disease, gastric bypass, lack of gastric acid
