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Systems Screening III > Medical Record > Flashcards

Medical Record Flashcards

1
Q

What can a basic metabolic panel detect?

A
  1. Kidney failure
  2. Diabetes related problems
  3. Respiratory distress
  4. Electrolyte imbalances
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2
Q

What are the main symptoms of electrolyte imbalances?

A
  • Alter excitability of neurons, cardiac muscle, skeletal m
    1. Weakness
    2. Spasticity
    3. Altered sensations
    4. Cardiac arrhythmias
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3
Q

What causes hyponatremia?

A
  1. Excessive ingestion or infusion of water
  2. Excessive ADH
  3. Diseases that cause water retention: CHF, Cirrhosis, nephrotic syndrome, SIADH
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4
Q

What are causes of hypernatremia?

A
  1. Excessive water loss from body – sweating, diabetes insipidous, vomiting, diarrhea
  2. decreased ADH
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5
Q

Why would you look at potassium levels?

A
  1. Renal function
  2. Adrenal function
  3. Water balance
  4. Acid-base imbalances
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6
Q

What causes mental status changes, dizziness, weakness, myalgia, muscle twitches, nausea, vomiting, clammy skin, potential respiratory failure?

A

Hypokalemia

  • loop diuretics can lead to this
  • Any abnormalities in potassium levels should lead to consultation before treatment
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7
Q

What causes Numbness, tingling, flaccid paralysis, nausea, vomiting, diarrhea, anorexia?

A

Hyperkalemia

- Any abnormalities in potassium levels should lead to consultation before treatment

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8
Q

Bicarbonate and chloride move in [same/ opposite] directions into RBC. [Hyper-/ Hypo-] chloremia associated with hyperventilation.

A

opposite; Hyper

  • chloride is involved with acid/base balance
  • levels change with sodium and water
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9
Q

Evaluate kidney function in patients with renal failure; Differential diagnosis if kidney disease is suspected; Monitor kidney function secondary to certain drug

A

BUN (together with nitrogen)

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10
Q

What happens to BUN levels when there is decreased renal function, particularly renal blood flow?

A

BUN increases

- Other factors that can increase BUN: Increased protein catabolism, Increased protein dietary intake, GI bleeding

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11
Q

What can decrease BUN?

A

severe liver disease

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12
Q

Breakdown product of heme – yellow color in jaundice

A

Bilirubin

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13
Q

What can increase bilirubin levels?

A
  1. liver disease
  2. Bile duct occlusion
  3. Hemolytic anemia – excessive destruction of RBCs
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14
Q

Located in liver, heart, kidney and skeletal muscles; Increased in Liver disease and Myopathy

A

AST

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15
Q

Sensitive indicator of damage to liver cells; Primary means of detecting hepatitis

A

ALT

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16
Q

Mostly in heart and skeletal muscles - Used in differential diagnosis of chest pain; Elevated in injury to cancer cells

A

LDH

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17
Q

What is GGT elevated by?

A

Elevated by injury to liver cells

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18
Q 
Related to bile ducts (Increased when they are blocked)
Levels increased by:
- Gall bladder disease
- Liver disease
- Bile duct disease
- Chronic renal failure – secondary to increased bone turnover
- Paget’s disease of bone
- Hyperparathyroidism
- Rheumatoid arthritis
- Hepatocystic carcinoma
A

ALP

Alkaline phosphatase

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19
Q

What can decrease RBC count?

A
  1. Anemia
  2. Blood loss** most common
  3. Dietary deficiency of iron and specific vitamins
  4. Chemotherapy
  5. Other disorders
20
Q

What can increase RBC count?

A
  1. Polycythemia
  2. Dehydration
  3. Pulmonary fibrosis
  4. High altitude
  5. Chronic heart disease
21
Q

What lab results can you find for RBCs? other than count

A
  1. hematocrit- volume of whole blood is RBCs
  2. Hb levels- per volume of blood or per erythrocyte
  3. RBC shape - sickle cell, spherocytosis
  4. Reticulocytes - immature RBC
22
Q

What WBCs are looked at during lab tests?

A
  1. Neutrophils – major WBC - phagocytotic (Neutropenia= Risk factor for infection, Neutrophilia = Usually indicates infection)
  2. Basophils – immune responses, particularly allergies
  3. Eosinophils – worm infections, allergies, and certain diseases
  4. Macrophages - phagocytotic
  5. Lymphocytes - B cells (antibodies), T cells, NK cells, decr. in AIDs
23
Q

What are the measurements for hemostasis?

A
  1. PT - prothrombin time
  2. aPPT - activated partial thromboplastin time (used for low-molecular weight heparin)
  3. INR - PT results that do not vary between labs
24
Q

What does a higher INR indicate?

A

increase risk of bleeding during surgery or after trauma

  • Higher number INR = clotting time increases
  • People on anticoagulants should have INR between 2 and 3
25
Q

What can increase creatine kinase brain (CK-BB)?

A
  1. CNS surgery
  2. cardiac arrest
  3. Reye syndrome
  4. Cerebral contusion
  5. CVA
  6. renal failure
26
Q

What can increase creatine kinase myocardium (CK-MB)?

A
  1. MI
  2. cardiac contusion
  3. CHF without MI
  4. cardiac surgery
  5. myocarditis
27
Q

What can increase creatine kinase skeletal muscle (CK-MM)?

A
  1. IM injections
  2. Skeletal muscle trauma
  3. extreme muscle exertion
  4. tonic clonic seizures
  5. excessive alcohol use
  6. alcohol withdrawal
  7. muscular dystrophy
  8. severe hypokalemia
28
Q

Produced by liver in response to inflammation; Associated with atherosclerosis; Increased risk of MI and Stroke

  • can be an indicator of stroke regardless of lipid levels
  • associated with diabetes, poor diet and sedentary lifestyle
A

C-reactive protein (CRP)

29
Q

Most common hormone disorder in adults; symptoms include:

  • Cold sensitivity
  • Brittle coarse skin and nails
  • Constipation
  • Slower cognitive processing
  • Linked to muscle injury, depression and anxiety
A

Hypothyroidism

30
Q

What is in a medical record?

A
  1. Medical History
  2. Laboratory Test Results
  3. Diagnostic test results
  4. Problem list
  5. Clinical notes
  6. Treatment notes
31
Q

Performed during part of a routine physical examination or when a physician suspects an abnormality that may be detected by one or more parts of the BMP; Sample is procured through venipuncture, preferably after 10-12 hours of fasting

A

Basic Metabolic Panel

  • 8 tests measuring electrolyte levels, blood sugar, and kidney function
  • venous blood (not arterial)
32
Q

Why are potassium levels important?

A

Important for regulation of excitable cells (nerves, muscles, heart)
- Levels are usually tightly controlled – small range of normal values

33
Q

What effects can an imbalance of potassium levels result in?

A

Heart: arrhythmias, cardiac arrest
Muscle: Weakness

34
Q

What is the purpose for testing calcium levels?

A
  1. Rule in/rule out renal or bone disease

2. Rule out changes in calcium levels as a potential cause for neuromuscular problems

35
Q

What other tests may accompany a calcium level test?

A
  1. Vitamin D
  2. Phosphorus
  3. Parathyroid hormone
36
Q

What effect does decreased renal function have on creatinine levels in the blood?

A

Increases creatinine levels

  • creatine is a normal waste product of sk. m.
  • clearance occurs in the kidneys
37
Q

What kidney diseases can result in increased creatinine levels?

A
  1. Glomerulonephritis
  2. Pyelonephritis
  3. Acute tubular necrosis
  4. Obstruction by prostatitis or kidney stones
  5. Decreased renal blood flow
    - Can also be elevated by skeletal muscle injury
38
Q

What effect on creatinine results from aging?

A

Decreases creatinine

  • with age, the amount of sk. m. decreases
  • in older adults with decreases in renal fxn, creatinine levels may stay in the ‘normal’ range
39
Q

By-product of aerobic metabolism; Involved in acid/base balance

A

Carbon dioxide

- Renal disease can impair the ability to regulate pH, most often leading to acidosis

40
Q

In addition to the tests included in a BMP, what tests are also done with a comprehensive metabolic panel?

A

Tests for liver function:

  • Bilirubin
  • Total protein
  • Albumin
  • Serum enzymes – all can be elevated by injury to liver cells:
    • Aspartate aminotransferase (AST, formerly SGOT)
    • Alanine aminotransferase (ALT, formerly SGPT)
    • Lactate dehydrogenase (LDH)
    • γ-glutamyltransferase (GGT)
    • Alkaline phosphatase (ALP)
41
Q

What does liver failure increase the risk of?

A

multiorgan dysfunction syndrome

- bacteria and toxins can reach the heart and lungs if liver doesn’t filter them out

42
Q

Index of the ability of the liver to synthesize proteins; Also may be decreased in kidney disease – loss of protein in urine; Decreased in malnutrition

A

Protein and albumin levels

testing for liver function

43
Q

What are the effects of decreased albumin serum concentration of drugs?

A
  1. Edema – due to decreased oncotic pressure
  2. Can alter serum concentration of drugs which bind to albumin - If take a certain amt of a drug that binds to albumin, half of it may circulate in blood (and have and effect), while the other half may bind to albumin (therefore becoming inactive)
44
Q

What are the CV lab tests?

A
  1. Enzymes: Creatine kinase, Myoglobin, Troponin
  2. Lipids
  3. C-reactive protein
45
Q

What causes troponin I and T levels to rise?

A

MI

46
Q

What causes myoglobin levels to rise?

A

Cardiac or sk. m. injury

47
Q

What is included in a lab test for lipids? why would this test be ordered?

A
  1. Total cholesterol
  2. LDL – risk factor
  3. HDL – negative risk factor
  4. Triglycerides
  • Assess risk of atherosclerotic disease

Systems Screening III (9 decks)

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