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Pod Med II > Lab Medicine (Part 2) > Flashcards

Lab Medicine (Part 2) Flashcards

1
Q

Lymphocytes reference values

A
  • ~ 10 μm in diameter
  • ~ 30% leukocytes
  • T-lymphocytes: 75-80%
  • B-lymphocytes: 10-15%
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2
Q

Lymphocytes role

A
  • Host response against viral infection: humoral immunity, cell mediated immunity
  • Produce cytokines (lymphokines): interferon, interleukins
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3
Q

B lymphocytes mechanism

A
  • Possess antigen-specific receptors
  • B cell binds to antigen
  • Binds with matching receptor on T helper cell
  • T cell releases cytokines
  • Activation of B cell > plasma cell > antibody production
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4
Q

T lymphocytes (60-80%)

A
  • T4 helper cells (CD4)

- T8 cells (CD8)

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5
Q

T4 helper cells (CD4)

A
  • Require antigen Class II protein for activation

- Possess antigen specific receptors

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6
Q

T8 cells (CD8)

A
  • “true” suppressors CD8+ and CD11+

- Cytotoxic killers – CD8- and CD11-

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7
Q

CD4 counts reference values

A
  • Immunocompetent: 500 – 1500 cells/mm3
  • “threshold” for management: < 500 cells/mm3
  • Complications: <350 cells/mm3
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8
Q

CD4 viral load

A
  • Quantity of HIV-RNA in the plasm
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9
Q

CD4 “ideal” reference values

A
  • “ideal”: 4500-5000 copies/ml
  • Initiation of therapy: 30,000 copies/ml
  • “undetectable”: < 400 copies/ml
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10
Q

Monocytes reference values

A
  • ~4% total leukocytes

- 14 to 20 μm in diameter

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11
Q

Monocyte role

A
  • Become macrophage
  • Activate T cells
  • Produce leukotrienes (interleukin 1, tumor necrosis factor)
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12
Q

Platelet reference values

A
  • 150,000 – 400,000/μl

- Can be acute phase reactant

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13
Q

Platelet aggregation test

A
  • Measures rate platelets clump when in contact with known aggregator (e.g. ADP, ristocetin)
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14
Q

Thrombocythemia

A
  • Unregulated production with abnormal platelet function
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15
Q

Platelet Function Assay – PFA-100

A
  • Collect citrated specimen
  • Flows through capillary tube through a membrane with an aperture
  • Membrane saturated with platelet activators
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16
Q

Membrane saturated with platelet activators in PFA

A
  • Collagen/epinephrine

- Collagen/ADP

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17
Q

In PFA, platelet function is determined by

A
  • The time is takes to occlude the membrane
  • Collagen/epinephrine (CEPI): 79-170 seconds
  • Collagen/ADP (CADP): 55-112 seconds
  • Also utilized to evaluate anti-aggregation effects of certain drugs
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18
Q

Mean platelet volume

A
  • Average volume of platelet

- Reference range 7.5-11.5

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19
Q

Elevated mean platelet volume

A
  • Increased risk of myocardial infarction
  • Increased risk of stroke
  • Thrombocytopenia with sepsis
  • ITP
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20
Q

Thrombocytopenia inflammatory disorders

A
  • Infection

- Neoplasm

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21
Q

Thrombocytopenia systemic disease

A
  • Uremia
  • Abnormal serum proteins
  • Myeloproliferative disorders
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22
Q

Thrombocytopenia drugs

A
  • Aspirin and NSAID’s

- Alcohol inhibits ADP-related aggregation

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23
Q

Thrombocytopenia < 20,000 RBC

A
  • Spontaneous bleeding
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24
Q

Thrombocytopenia etiologies

A
  • ITP
  • Viral, bacterial, rickettsial infection
  • CHF, congenital heart disease
  • HIV
  • Alcohol toxicity
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25
Q

Heparin induced thrombocytopenia type 1

A
  • 1 – 2 days after exposure

- Transient

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26
Q

Heparin induced thrombocytopenia type 2

A
  • 5-14 days after exposure
  • Auto-immune
  • Heparin-PF4 complex
  • Decreased 50% platelet baseline
  • Platelet disruption > clot formation
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27
Q

Plasma collection tubule

A
  • Heparin tube
  • Green/gray top
  • Separates plasma from whole blood
  • Inhibits action of thrombin
  • Serum: does not posses clotting factors
  • Plasma: contains clotting factor
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28
Q

Platelet rich plasma

A
  • α-granule degranulation
  • Macrophage signalling proteins
  • Anti-microbial activity
  • Minimum of 1,000,000 platelets/mL
  • Activated by thrombin or calcium
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29
Q

α-granule degranulation

A
  • PDGF
  • TGF-β
  • PF4
  • IL-1
  • VEGF
  • Numerous other growth factors
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30
Q

PF4

A
  • Immune system that is targeted for an autoimmune response
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31
Q

Liver function

A
  • Intrahepatic

- Extrahepatic

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32
Q

Intrahepatic function

A
  • Catabolic = Ability to breakdown or metabolize substances

- Anabolic = Ability to synthesize proteins

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33
Q

Extrahepatic function

A
  • Biliary
  • Ability to conjugate with bile acids
  • Ability to excrete conjugated acids
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34
Q

Lactate dehydrogenase reference values

A
  • Reference value: 38-62 U/L

- Tetrameric molecule - ubiquitous

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35
Q

Lactate dehydrogenase in intrahepatic liver function

A
  • LDH5 is almost exclusive to liver
  • LDH1 and LDH2 are plentiful in heart and RBC’s
  • LDH2 more prevalent than LDH1
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36
Q

Lactate dehydrogenase with MI

A
  • With MI, a “flip” occurs
  • LDH1/LDH2 ratio > 1.0
  • Rises 24 to 48 hours after injury
  • Peaks in 3 to 6 days
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37
Q

LDH highest elevations

A
  • 4 to 40 fold
  • Megaloblastic anemia
  • Lymphomas
  • Neoplastic conditions
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38
Q

LDH moderate elevations

A
  • 2 to 4 fold
  • Myocardial infarction
  • Pulmonary infarction
  • Leukemia
  • Muscular dystrophy
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39
Q

LDH slight elevations

A
  • ~ 2 fold
  • Hepatitis
  • Obstructive jaundice
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40
Q

LDH in congestive heart failure

A
  • LDH1 and LDH5 may be elevated
  • Elevation of brain natriuretic peptide is also highly consistent with CHF
  • BNP levels elevate as the ventricular myocytes are stretched
  • Levels correlate with disease severity
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41
Q

LDH in congestive heart failure reference values

A
  • Normal < 50 pg/ml
  • “Gray Area” 100 – 500 pg/ml
  • Positive CHF > 500 pg.ml
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42
Q

Serum glutamate oxaloacetate transaminase (SGOT)and aspartate aminotransferase (AST)

A
  • Reference values: 11-32 U/L

- Primarily in mitochondria of liver and heart

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43
Q

SGOT and AST: mitochondria of liver and heart

A
  • Transaminiation reaction between aspartate and alpha-ketoglutamic acid
  • Amino acid catabolism
  • Requires pyridoxine (Vitamin B6)
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44
Q

Hepatic SGOT/AST elevation

A
  • Marked elevation: hepatitis, chronic liver disease

- Moderate elevation: cirrhosis, AST:ALT ratio 2:1, alcoholic liver damage

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45
Q

Cardiac SGOT/AST elevation

A
  • Elevates with MI
  • Begins to rise at 12 hours
  • Peaks at 36 hours
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46
Q

SGOT/ALT (alanine aminotransferase) reference values

A
  • 3-30 U/L
  • Catalyzes the amino group between alanine and alpha-ketoglutamic acid
    In cytosol of hepatocytes
  • Catalyzes the amino group between alanine and alpha-ketoglutamic acid
    In cytosol of hepatocytes
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47
Q

SGOT/ALT highest elevations

A
  • 20 fold or greater
  • Viral hepatitis
  • Toxic hepatitis
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48
Q

SGOT/ALT moderate elevations

A
  • 3 – 10 fold elevation
  • Mononucleosis
  • Chronic active hepatitis
  • Bile duct obstruction
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49
Q

SGOT/ALT mild elevations

A
  • Inflammatory damage
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50
Q

Anabolic proteins (intrahepatic function)

A
  • Vitamin K dependent clotting factors

- Serum proteins (Albumin, Fibrinogen, Globulins, antibodies)

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51
Q

Hepatic alkaline phosphatase reference value

A
  • 25-165 U/L
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52
Q

Hepatic alkaline phosphatase

A
  • Most common measure for biliary obstruction

- High levels present in cells that are metabolically active

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53
Q

Hepatic alkaline phosphatase two enzymes

A
  • Hepatic – heat stabile

- Bone – heat labile

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54
Q

Hepatic alkaline phosphatase high elevations

A
  • 10 fold or greater
  • Biliary cirrhosis
  • Extrahepatic bile duct obstruction
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55
Q

Hepatic alkaline phosphatase moderate elevations

A
  • 3 – 10 fold normal value

- Obstruction by stones

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56
Q

Hepatic alkaline phosphatase mild elevations

A
  • 1-3 fold normal values
  • Alcoholic liver disease
  • Chronic active hepatitis
  • Viral hepatitis
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57
Q

Bilirubin reference values

A
  • Total: 0.3-1.9 mg/dl

- Direct: 0 to 0.3 mg/dl

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58
Q

Bilirubin (extrahepatic liver function)

A
  • Breakdown product of hemoglobin catabolism
  • Occurs within Kupffer cells via cytochrome P-450
  • Transported in its inactive state on albumin
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59
Q

Free or indirect bilirubin elevates with

A
  • Lack of serum albumin
  • Red cell hemolysis
  • Hepatitis
  • Gilbert’s syndrome
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60
Q

Free or indirect bilirubin

A
  • Diffuses freely through BBB

- Jaundice

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61
Q

Conjugated or direct bilirubin

A
  • Conjugated in the hepatocytes with glucuronic acid
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62
Q

Conjugated or direct bilirubin elevates with

A
  • Biliary obstruction
  • Pancreatitis
  • Lymphoma
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63
Q

Tiglycerides (extrahepatic liver function)

A
  • Reference values:
    10-190 mg/dl
  • Wiggin1 correlated elevated triglycerides levels with DPN (this loss was independent of glycemic control and duration of disease)
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64
Q

Blood urea nitrogen (BUN) reference value

A
  • 9-27 mg/dl
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65
Q

BUN (renal functionP)

A
  • End product of amino group removal in degradation of amino acids
  • Urea is freely filtered by the glomerulus
  • Moves through renal tubules via passive diffusion intra renal cycling (60% is reabsorbed, 40% is secreted)
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66
Q

BUN clinical significance

A
  • Elevates with severe glomerular injury

- Decreases with severe liver damage (severe poisoning, hepatitis)

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67
Q

Elevated BUN at higher limits

A
  • Quite sensitive

- >25 mg/100 ml suggests ~25% nephrons damages

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68
Q

Creatinine (renal function) reference value

A
  • 0.5-1.5 mg/dl
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69
Q

Creatinine (renal function)

A
  • Most sensitive indicator of glomerular filtration
  • End product of creatine catabolism (Creatine-PO3 + muscle contraction -> creatinine)
  • Nearly filtered completely by the kidney
  • Ideal to measure glomerular filtration rate
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70
Q

Sodium (serum electrolyte)

A
  • Major cation in extracellular fluid

- Principal osmotic particle outside cell

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71
Q

Hyponatremia

A
  • Overhydration
  • Loop diuretics
  • Increased secretion of antidiuretic hormone
  • Adrenal failure
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72
Q

Hypernatremia

A
  • Excessive water loss – dehydration
  • Renal losses
  • Diabetes insipidus
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73
Q

Hypo/hypernatremia reference range

A
  • 135 – 145 mEq/l
  • Symptomatic hyponatremia: < 120 mEq/l
  • Symptomatic hypernatremia: 150 – 170 mEq/l
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74
Q

Potassium (serum electrolyte)

A
  • Major intracellular cation

- Abnormal values profoundly affect neuromuscular system

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75
Q

Hypokalemia

A
  • Serum depletion of potassium
  • Renal losses
  • Presence of EKG U-wave
76
Q

Hyperkalemia

A
  • Acute and chronic renal failure
  • High concentration in RBC’s
  • Presence of peaked T-waves
77
Q

Potassium reference range

A
  • 3.5-5.5 mEq/l
78
Q

Hypochloridemia

A
  • GI losses
  • Diabetic ketoacidosis
  • Mineral corticoid excess
  • Respiratory acidosis
  • Metabolic alkalosis
79
Q

Hyperchloridemia

A
  • GI loss from diarrhea
  • Mineral corticoid deficiency
  • Hyperparathyroidism
80
Q

Chloride reference range

A
  • 98-106 mEq/l
81
Q

Serum bicarbonate elevates with

A
  • Metabolic alkalosis
  • Comp. respiratory acidosis
  • Diuretics
  • Corticosteroids
82
Q

Serum bicarbonate decreases with

A
  • Metabolic acidosis
  • Comp. respiratory alkalosis
  • Salicylate poisoning
83
Q

Serum bicarbonate reference range

A
  • Arterial: 19-25 mEq/l

- Venous: 23-30 mEq/l

84
Q

Anion gap equation

A
  • Anion Gap = [Na+ + (*K+)] – [Cl- + HCO3-]
85
Q

Anion gap elevated with

A
  • Uremia
  • Diabetic ketoacidosis
  • Starvation states
  • Ingestions of toxins (Methanol, Salycilates, Ethylene glycol)
86
Q

Anion gap decreased with

A
  • Dilutional states
  • Hyperviscosity syndromes
  • Lithium intoxication
87
Q

Anion gap reference range

A
  • Reference range: 8 - 12 mEq/l

- May be calculated without serum potassium

88
Q

Uric acid

A
  • End product of purine catabolism

- Renal excretion

89
Q

Uric acid reference values

A
  • Male: 4.0 – 8.5 mg/dl

- Females: 2.7-7.3 mg/dl

90
Q

Uric acid accumulation is predominantly a male disease

A
  • Estrogens are protective
  • Solubility of crystals decrease with body temperature
  • 37 C – solubility 6.8 mg%
  • 30 C – solubility 4.5 mg%
91
Q

Gout

A
  • Ingestion of crystal by neutrophil

- Negatively birefringent

92
Q

Gouty arthritis and draining tophi

A
  • Patient with endstage renal disease
  • Unable to tolerate allopurinal
  • Currently started Uloric - febuxostat
93
Q

Globular proteins (total serum proteins)

A
  • Albumin (55-60%)
  • Globulins
  • Synthesized in liver
  • Source of stored protein
94
Q

Globulins

A
  • Immunoglobulins
  • Lipoproteins
  • Fibrinogen
  • Hemoglobin
  • Cytochromes
95
Q

Total serum protein

A
  • Insight to nutritional status

- Reference range: 6.0-8.5 g/dL

96
Q

Low serum protein

A
  • Starvation states
  • Inability of liver to synthesize proteins
  • “Leaky” glomerular filtration
97
Q

Albumin role

A
  • Maintenance of plasma oncotic pressure
  • “Transport” protein
  • Substances are inactive when bound to albumin
98
Q

Decreased albumin levels

A
  • Inability of liver to synthesize

- Poor nutritional status

99
Q

Albumin level clinical significance

A
  • Large body pool with a T1/2 of ~20 days

- Affected by hydration and renal status (chronic liver disease, malnutrition)

100
Q

Albumin reference value

A
  • 3.5-5.5 g/dL
101
Q

Prealbumin

A
  • Preferred marker for protein malnutrition
  • Less affected by liver disease
  • Distinct marker for protein synthesis
  • Not affected by hydration status
  • Very high ration of essential to non-essential amino acids
102
Q

Prealbumin clinical interpretation

A
  • Normal range: 10.5-35.0 mg/dl
  • Increased risk for morbidity: 5.0-15.0 mg/dl
  • Poor prognosis: < 5.0 mg/dl
  • Increased 2.0 mg/dl/day with supplementation
103
Q

Serum transferrin

A
  • Half life of one week
  • Responds more quickly to nutritional status changes
  • Serum transferrin is determined two site enzyme immuno-assay
  • Measuring total iron binding capacity is roughly equivalent to transferrin
104
Q

Total iron binding capacity (TIBC) is determined by

A
  • Saturating transferrin with iron
  • Removing the unbound iron
  • Measuring the iron in the infiltrate
105
Q

TIBC increases in

A
  • Iron deficiency anemia
  • Pregnancy
  • Oral contraceptives
  • Possibly hepatitis
106
Q

TBIC decreases in

A
  • Reduced protein synthesis, nephrosis or other direct loss

- Increased catabolism (secondary to malignancy or starvation)

107
Q

Alkaline phosphatase

A
  • Released by osteoblasts actively secreting bone matrix
108
Q

Pronounced elevation of alkaline phosphatase

A
  • 5 fold or greater
  • Osteitis deformans
  • Osteogenic sarcoma
  • Hyperparathyroidism
109
Q

Moderate elevation of alkaline phosphatase

A
  • 3 – 5 fold greater
  • Metastatic bone tumors
  • Metabolic bone diseases
110
Q

Slight elevation of alkaline phosphatase

A
  • Healing fractures
  • Growth spurts
  • Pregnancy
111
Q

Calcium

A
  • Most abundant cation in body

- Reference values: 9.2-11 mg/dl

112
Q

Calcium levels are regulated by

A
  • Kidney

- Parathyroid hormones

113
Q

Hypocalcemia

A
  • Renal failure (increased phosphorus)

- Hypoparathyroidism

114
Q

Hypercalcemia (CHIMPS)

A
  • Cancer
  • Hyperthyroidism
  • Iatrogenic
  • Multiple myeloma
  • Parathyroidism
  • Sarcoidosis
115
Q

Phosphorous levels are controlled by

A
  • PTH
  • 1, 25- dihydroxycholicalciferol
  • Calcitonin
116
Q

Decreased levels of phosphorous

A
  • Diabetic ketoacidosis
  • Hyperinsulinism
  • Hyperparathyroidism
  • Inadequate diet
117
Q

Increased levels of phosphorus

A
  • Bone metastasis
  • Hypoparathyroidism
  • Liver disease
  • Renal failure
  • Sarcoidosis
118
Q

Three isoenzymes of creatinine kinase (cardiac)

A
  • MB – myocardial injury
  • MM – skeletal muscle
  • BB – brain
119
Q

Cardiac elevations of creatinine kinase

A
  • CK-MB band elevates during first 48 hours
  • Along with LDH “flip” quite reliable (LDH1 >LDH2)
  • Myoglobin will be elevated before CK-MB band
  • Cardiac troponins (I elevates 5 – 9 days, T elevated up to 2 weeks)
120
Q

Skeletal muscle damage

A
  • CK-MM band elevation

- Elevation of aldolase

121
Q

Elevation of aldolase

A
  • Glycolytic enzyme

- Most useful for inflammatory muscle disease

122
Q

Elevations of aldolase also secondary to

A
  • Metastatic carcinoma
  • Granulocytic leukemia
  • Megaloblastic anemia
  • Hemolytic anemia
123
Q

Pancreatic (P form) amylase

A
  • Levels rise within 6-24 hours and return to normal within 48-72 hours
  • Does not correlate with severity of disease
124
Q

Pronounced amylase elevations

A
  • > 5 times normal values
  • Acute pancreatitis
  • Administration of morphine
125
Q

Moderate amylase elevations

A
  • 3-5 times normal values
  • Pancreataic carcinoma
  • Salivary gland disease
126
Q

Pancreatic amylase reference values

A
  • 30-220 u/l
127
Q

Pancreatic lipase

A
  • Diagnostic for acute pancreatitis
  • Cleaves triglycerides into free fatty acids
  • Nearly exclusive to pancreas
  • Will elevate with heparin administration
128
Q

Pancreatic lipase reference value

129
Q

Fasting glucose values

A
  • Diabetes: > 126 mg/dl
  • Glucose impaired: 100-126 mg/dl
  • Normal: <100 mg/dl
130
Q

Glucose tolerance values

A
  • Diabetes: >200 mg/dl

- Glucose impaired: 140-200 mg/dl

131
Q

Casual glucose values > 200 mg/dl on two occasions

A
  • Increased thirst
  • Increased hunger
  • Unexplained weight loss
132
Q

Glycosylated hemoglobin

A
  • Glycosylation of β-chain of Hb
  • Window into past three months
  • Reference values: < 6%
133
Q

Glycosylated albumin

A
  • Glycosylation of serum proteins
  • Window into past 2-3 weeks
  • Reference values: Albumin < 8%, total serum proteins < 3%
134
Q

C-peptide measurements

A
  • Indicator of endogenous insulin production

- Assesses integrity of islet cells

135
Q

C-peptide serum ratios

A
  • Normal = 15:1
  • Normal to high = Type 2
  • Absent to low = Type 1
136
Q

A1C levels

A
  • Diagnostic indicator of diabetes Type II
  • ≥ 6.5% = diabetes
  • 5.7 - 6.4% = prediabetes
  • < 5% = normal non-diabetic
137
Q

Glycosylated albumin properties

A
  • Serum half-life 17-20 days
  • Reflects hyperglycemic periods within the previous few weeks
  • Up to 8% may be normally glycosylated
138
Q

New studies on A1C to glycated albumin

A
  • Suggest that an A1C to glycated albumin ratio may provide a better insite into glucose control
139
Q

C-reactive protein (CRP) acute phase reactant is an indicator for

A
  • Inflammatory process (rapid rise with acute disease, rapid clearance with resolution of process)
  • Future coronary events
140
Q

CRP future coronary event indicators

A
  • < 1 mg/L = low risk
  • 1-3 mg/L = average risk
  • > 3 mg/L = high risk
141
Q

Homocysteine

A
  • Variant of cysteine
142
Q

Elevated homocysteine levels result in

A
  • Oxidation of low density lipoproteins
  • Increased clot formation
  • Endothelial damage
143
Q

Causes of homocysteine high levels

A
  • Nutritional deficit of folate, pyridoxine and B12
  • Hereditary homocysteinuria
  • Methyl-tetrahydrofolate reductase deficiency
144
Q

Complement measurements

A
  • Circulate until cascade is initiated

- C1, C3 and C4 are most plentiful

145
Q

Low levels of complement

A
  • Indicative of antibody-antigen mediated process
  • Collagen vascular diseases
  • Connective tissue disease
146
Q

High levels of complement

A
  • Cancer

- Ulcerative colitis

147
Q

Synovial fluid analysis

A
  • Sterile preparation of joint

- Transport in heparin or EDTA tube

148
Q

Synovial fluid analysis evaluated on

A
  • Color/clarity
  • Viscosity
  • Total WBC and % PMN’s
  • Presence of formed elements
  • Mucin clot retraction
149
Q

Synovial fluid elements

A
  • Normal = none
  • OA = collagen fibrils
  • Traumatic DJD = many RBCs
  • SLE = LE cells
  • RA = cholesterol crystals
  • Pseudogout = Calcium pyrophosphate crystals
  • Gout = monosodium urate crystals
150
Q

Synovial fluid infection

A
  • WBC: >50,000 cells/μl
  • Normal: PMN < 25%
  • Infection: PMN > 90%
  • Glucose: 25 mg/dl lower than serum levels
151
Q

Urinalysis specific gravity

A
  • Ion concentration of urine
  • Reflects concentrating ability of kidneys
  • Reference: 1.010-1.030
152
Q

Urinalysis color and appearance

A
  • Normal color – yellow

- Normal appearance - clear

153
Q

Urinalysis pH

A
  • Reflects renal acid excretion
  • Dependent on dietary intake
    acidic – high protein diets, -DM, tubular acidosis
  • Alkaline – UTI’s
  • Reference: 4.8-7.5
154
Q

Urinalysis protein

A
  • No protein in urine

- No reference to trace

155
Q

Urinalysis protein 2+

A
  • Glomerular disease

- Urinary tract disorder

156
Q

Urinalysis protein 2-4 g/day

A
  • Collagen vascular disease
  • Congestive heart failure
  • Nephrotic syndrome
157
Q

Urinalysis glucose

A
  • A significant index of hyperglycemia
  • No reference to trace
  • Not sensitive to glucose
158
Q

Urinalysis not sensitive to glucose due to

A
  • Incomplete bladder empyting
  • Concomitant renal disease
  • Serum glucose levels are > 200-250 before detected
159
Q

Urinalysis ketones

A
  • Reflect the use of fatty acid metabolism
  • Presence important in starvation states and diabetes mellitus
  • Reference: 0-160 mg/dl
160
Q

Urinalysis hemoglobin and red cells

A
  • Trauma, infection, glomerular damage

- Reference: 0-3 cells/hpf

161
Q

Urinalysis bilirubin

A
  • Only conjugated bilirubin appears in urine

- Reflects biliary obstruction

162
Q

Urinalysis urobilinogen

A
  • Elevated with hemolysis and most liver diseases

- Decreased with antibiotics and bile duct obstruction

163
Q

Urinalysis leukocyte esterase

A
  • Released by WBC’s responding to infection
164
Q

Urinalysis nitrates

A
  • Byproduct of vegetable ingestion

- Some bacteria convert nitrate to nitrite

165
Q

Casts in microscopic examination of urinalysis

A
  • Suggest renal tubular damage

- Debris collects in tubules

166
Q

Granular debris in tubules

A
  • Plasma protein aggregates that escape through damaged tubules
167
Q

Fatty debris in tubules

A
  • Significant proteinurea
168
Q

Waxy debris in tubules

A
  • Oliguria

- Nephron obstruction

169
Q

Hyaline debris in tubules

A
  • Glomerular capillary damage
170
Q

White blood cells in urinalysis microscopic examination

A
  • Suggests inflammation or infection
171
Q

Epithelial cells in urinalysis microscopic examination

A
  • Represent desquamation of urinary tract epithelial cells
  • May represent poorly collected specimen
  • Renal tubular cells abnormal
172
Q

Microalbuminuria collection techniques

A
  • Albumin to creatinine ratio from random sample
  • 24 hour collection with creatinine
  • Timed collection (min. 4 hrs)
173
Q

Elevation in microalbuminuria

A
  • Early sign of renal disease
174
Q

Microalbuminuria reference values

A
  • < 30 – normal
  • 30 – 299 – microalbuminuria
  • > 300 – albuminuria
175
Q

Microalbuminuria hypertensive patients

A
  • Should be placed on ACE or ARB meds
176
Q

Urinary 24 hour calcium

A
  • Reflects intestinal absorption of calcium or renal leakage
177
Q

Low levels of urinary 24 hour calcium

A
  • Underactivity of parathyroid gland
  • Check parathyroid – if normal…evaluate 25 hydroxy Vitamin D
  • Inadequate intake of vitamin D
178
Q

Urinary 24 hour calcium reference values

A
  • Low - < 150 mg
  • Average – 150-250 mg
  • High – 250-300 mg
179
Q

Systemic inflammatory response syndrome (SIRS) criteria

A
  • Evaluation of the physiologic response to inflammation
  • Temperature < 36° C or > 38° C
  • Heart Rate > 90 bpm
  • Respiratory Rate > 20 breaths/minor PaCO2 < 32 mm/Hg
  • White Blood Cell Count > 12,000 or < 4,000 cells/mm3 or > 10% bands
  • Minimum of 2 of above for SIRS diagnosis
180
Q

Septic shock criteria

A
  • Trauma = SIRS
  • Sepsis = SIRS, infection
  • Severe sepsis = sepsis, organ failure, hyoptension, hypoperfusion
  • Septic shock = sepsis with hypotension, 2+ organ failure
181
Q

Procalcitonin (PCT)

A
  • Helps identify SIRS from sepsis
  • More specific than CRP, IL-6 and LBP
  • May help guide antibiotic therapy
182
Q

Procalcitonin (PCT) levels

A
  • < 2 ng/ml – can exclude sepsis (NPV – 97%)

- > 10 ng/ml – bacterial infection likely (PPV – 88%)

183
Q

Laboratory risk indicator for necrotizing fasciitis (LRINEC score)

A
  • Help discriminate between necrotizing and non-necrotizing infections
  • Six independent variables with an applied point system
184
Q

LINREC score

A
  • Range from 0 – 13
  • Intermediate to high risk if the score was >6
  • Utilized when there is a high index of suspicion
185
Q

Necrotizing fasciitis risk category

A
  • Low = ≤ 5 total score, < 50% probability of NF
  • Intermediate = 6 – 7 total score, 50 – 75% probability of NF
  • High = ≥ 8 total score, > 75% probability of NF

Pod Med II (3 decks)

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