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B1 > Laboratory Medicine > Flashcards

Laboratory Medicine Flashcards

1
Q

What are the 5 main electrolytes in body fluid?

A

Na+, Cl-, Mg2+, Ca2+, K+

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2
Q

What are the 5 functions of hepatocytes?

A

1) Drug and toxin metabolism
2) Aid digestion via biliary system
3) Protein synthesis and secretion
4) Energy storage (glycogen)
5) Transformation and clearance

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3
Q

How can acetaminophen cause liver necrosis?

A

Liver produces a toxic metabolite of APAP –> too much leads to necrosis

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4
Q

What is the main job of the liver?

A

Take insoluble compounds and make soluble for excretion

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5
Q

Pyridoxal phosphate (AKA Vitamin B6) plays a role in what types of reaction in the liver?

A

It is a coenzyme of all transamination reactions

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6
Q

What is the function of transaminases?

A

Transfer amine groups to allow for excretion

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7
Q

Is ALT or AST more specific for liver injury and why?

A

ALT is more specific because found in cytosol of liver - AST is found in both cytosol and mitochondria of liver along with many other organs

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8
Q

What four things cause elevated AST/ALT?

A

Viral hepatitis, fatty liver (sometimes), toxins (including medications), strenuous exercise

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9
Q

Alk phos tells you about the integrity of what?

A

Biliary tree

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10
Q

What are the components of total protein?

A

Albumin and globulin

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11
Q

Bilirubin is a ____________ of older blood cells

A

Degradation product

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12
Q

Bilirubin buildup can be toxic to which organ?

A

Brain

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13
Q

What are old red blood cells a source of?

A

Hemeproteins

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14
Q

What cell breaks down heme to bilirubin?

A

Macrophages

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15
Q

How is unconjugated bilirubin transported via blood to liver?

A

It is complexed with albumin

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16
Q

Once bilirubin is uptaken by the liver, what is it conjugated with?

A

Glucaronic acid

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17
Q

Where is conjugated bilirubin secreted into following the liver?

A

Into bile then into intestine

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18
Q

What happens to conjugated bilirubin in the intestine? (two steps)

A

Bacteria remove glnucaronic acid, then bilirubin is converted to urobilinogen

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19
Q

What are the three pathways urobilinogen may take from intestine?

A

1) Some reabsorbed from gut and enters portal blood where transported to kidney –> excreted in urine as yellow “urobilin”
2) participates in enterohepatic urobilinogen cycle
3) Oxidized by intestinal bacteria to brown stercoblin

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20
Q

In the kidney, urobilinogen is converted to what yellow substance?

A

Urobilin

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21
Q

If there is elevation in indirect bilirubin, would there be a defect in
a) pre hepatic
b) post hepatic
pathway?

A

a) pre hepatic

indirect = unconjugated

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22
Q

If there is elevation in direct bilirubin, would there be a defect in
a) pre hepatic
b) post hepatic
pathway?

A

b) post hepatic

direct = conjugated

23
Q

Elevations in indirect bilirubin would NOT result from which of the following?

a) Increased production of non-conjugated bilirubin
b) Impaired conjugation of bilirubin
c) Increased hepatic uptake of bilirubin

A 
c) is wrong
results from these 3:
1) increased production
2) impaired conjugation
3) impaired hepatic uptake
24
Q

Would hemolysis result in

a) elevated indirect bilirubin
b) elevated direct bilirubin

A

a) elevated indirect

- more unconjugated bilirubin present

25
Q

What is Kernicterus?

A

Elevation in indirect bilirubin in neonate and infants which leads to severe CNS deficiencies

26
Q

Crippler/Najjar Syndrome and Gilbert’s Dz both have what in common?

A

They are caused by problems with enzymatic action that lead to elevation of indirect bilirubin

27
Q

What would cause accumulation of direct bilirubin?

a) Biliary obstruction
b) Biliary dysregulation
c) Increased secretion of conjugated bilirubin into bile

A

a) biliary obstruction

28
Q

Which of the following diseases would NOT be indicated by elevated conjugated bilirubin?

a) Crigler/Najjar Syndrome
b) Gilbert’s Disease
c) Hepatitis
d) Dubin-Johnson Syndrome
e) two of the above

A

E - A and B

29
Q

Jaundice is the result of high amounts of ________ being deposited

A

Bilirubin

30
Q

True or false: lack of albumin can cause jaundice

A

True, albumin does not bind bilirubin –> bilirubin not excreted –> jaundice

31
Q

What is the main agent of intravascular osmotic pressure?

A

Albumin

32
Q

How many mg / kg of albumin are produced by a normal adult daily?

A

150-250 mg / kg

33
Q

What leads to pitting edema and why?

a) increased albumin
b) decreased albumin

A

b) decreased albumin

lack of albumin causes water to spill out from interstitial components

34
Q

How does albumin loss result from severe burns?

A

Skin is the most important extra storage for albumin

35
Q

Nephrotic syndrome results in ______uria

A

Proteinuria

36
Q

Which of the following would be NOT indicated by decreased albumin?

a) end stage liver disease
b) Celiac disease
c) protein malnutrition
d) acute dehydration

A

acute dehydration - only clinical thing indicated by increased albumin

37
Q

Why does Celiac disease contribute to decreased albumin?

A

If you cannot absorb protein, you cannot make it

38
Q

What is Kwashiorkor and why does it result in abdominal edema?

A

This is a disease that happens in a rice-only diet. There is protein malnutrition –> no albumin synthesis –> weak osmotic pressure –> fluid from tissue diffuses into abdomen

39
Q

What test should be used to evaluate increase or decrease in globulin?

A

Serum electrophoresis

40
Q

How many liters of blood does the kidney process daily?

A

200L

41
Q

What percentage of daily blood that kidney filters is removed as waste or excess H2O?

A

1% (2L out of 200)

42
Q

______ is produced by the kidneys and stimulates RBC production in bone marrow

A

Erythropoietin

43
Q

______ is produced by the kidneys and used in regulation of blood pressure?

A

Renin

44
Q

The active form of which vitamin is produced by the kidneys?

A

Vitamin D

45
Q

Which kidney function test measures GFR (glomerular filtration rate)?

A

Creatinine

46
Q

Elevated BUN or creatinine signals what?

A

Body not excreting efficiently

47
Q

Blood in urine may signal what in adults? What if they are older?

A

Adults - kidney infection

Older - bladder ca

48
Q

Where is brain natriuretic peptide secreted from?

A

Heart ventricles

49
Q

Brain natriuretic peptide is secreted in response to what?

A

Excess stretching of heart ventricles

50
Q

What does brain natriuretic peptide signal the body to do? (2 pathways)

A

1) Vasodilation to lower blood pressure –> assist heart

2) Signals kidneys to produce urine –> decrease volume

51
Q

What is traumatic tap in lumbar punctures?

A

Blood in CSF due to trauma from actual lumbar puncture not from traumatic brain bleed

52
Q

Why would estrogen levels be an inappropriate test for menopause?

A

Estrogen levels fluctuate quite a bit pre and post menopause

53
Q

What brown substance is produced from urobilinogen in the intestines?

A

stercoblin

54
Q

The kidneys produce which vitamin? Is this a protein or hormone?

A

Vitamin D aka Calcitrol, hormone

B1 (18 decks)

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