Wk 6: Cardio + pulm highlights

Question 1

Cholesterol + triglycerides = what?

Answer 1

Lipids

Question 2

True or false: HDL and LDL are lipoproteins

Answer 2

True

Question 3

List 4 things included in a lipid profile

Answer 3

1) Total cholesterol (TC)
2) Triglycerides (TGs)
3) High-Density Lipoprotein Cholesterol (HDL-C)
4) Low-Density Lipoprotein Cholesterol (LDL-C)

Question 4

What is a desirable cholesterol value?

Answer 4

<200 mg/dL

Question 5

_________removes lipids from endothelium and carries excess cholesterol to liver for elimination

Answer 5

HDL

Question 6

What is good cholesterol?

Answer 6

HDL-C

Question 7

1) Most cholesterol carried by LDL is deposited where?
2) What is this called?
3) High LDL-C levels are associated with what?

Answer 7

1) Into the lining of blood vessels
2) Atherogenic
3) Increased ASCVD risk

Question 8

What is the goal LDL for normal risk pts?

Answer 8

<100 mg/dL
-“Normal” value is <130 mg/dL; however, the lower the better to reduce ASCVD risk

Question 9

1) LDL-C is often a ___________ value based on formulas using other lipid profile values (sometimes directly measured)
2) What can make LDL calculations inaccurate?

Answer 9

1) calculated
2) High triglyceride levels

Question 10

What is the goal TG level?

Answer 10

<150 mg/dL

Question 11

Severe hypertriglyceridemia (>500 mg/dL) can cause _____________.

Answer 11

acute pancreatitis

Question 12

List the approximate desirable values for most pts (mg/dL):
1) Total cholesterol
2) Triglycerides
3) LDL-C
4) HDL-C

Answer 12

1) Total cholesterol: <200
2) Triglycerides: <150
3) LDL-C: <100
4) HDL-C: >60

Question 13

Cardiac Enzymes (Cardiac Biomarkers):
1) What are they used to assess?
2) What are some also used for?

Answer 13

1) Used to assess acute coronary syndromes (ACS)/cardiac ischemia
2) Some also used in diagnosis of skeletal muscle disease/injury

Question 14

What 3 things are included in cardiac enzymes/ biomarkers?

Answer 14

1) Creatine (phospho)kinase (CK, CPK)
2) Myoglobin
3) Troponins

Question 15

CK is most commonly used to diagnose and follow what?

Answer 15

Muscle disease/injury

Question 16

Myoglobin is an oxygen binding protein in what muscle?

Answer 16

Cardiac and skeletal

Question 17

Rhabdomyolysis can be detected by what?

Answer 17

Myoglobin

Question 18

True or false: myoglobin is also elevated in skeletal muscle injury/ disease

Answer 18

True

Question 19

Define myoglobinuria

Answer 19

Positive urine dipstick for “blood” (contains heme) but no RBCs on urine sediment microscopy (not hematuria)

Question 20

“Sensitive”/“contemporary” assays rise when?

Answer 20

2-3 hours after injury

Question 21

Troponins are:
1) Used to assess ____________ injury
2) Troponins are the preferred blood-based tests for evaluation of patients with suspected ________.

Answer 21

1) myocardial
2) AMI

Question 22

1) True or false: Troponins have several advantages over CK-MB in AMI diagnosis
2) When do “Sensitive”/“contemporary” assays work?
3) What about “High sensitivity” (hs) TnT”?

Answer 22

1) True
2) 2-3 hours after injury
3) As early as 90 minutes after onset

Question 23

1) BNP was discovered in brain tissue, but more appropriate name is ventricular natriuretic peptide. Why?
2) What are some effects of BNP?

Answer 23

1) Released primarily by ventricular myocytes when stretch receptors are triggered
2) Diuresis, natriuresis, and vascular smooth muscle relaxation (vasodilation)

Question 24

1) BNP may be measured as plasma _________ or ____________ (reference ranges/diagnostic cut-offs are different)
2) What does increased BNP indicate?

Answer 24

1) BNP or N-terminal (NT)-рrοΒΝΡ (reference ranges/diagnostic cut-offs are different)
2) too much pressure in the ventricles (especially left)

Question 25

B-Type Natriuretic Peptide (BNP) & NT-proBNP: 1) Useful as part of the evaluation of suspected_________________ when the diagnosis is uncertain 2) Can also provide ___________ information in pts with CHF/LV dysfunction

Answer 25

1) congestive heart failure (CHF) 2) prognostic

Question 26

BNP in a dyspneic (SOB) pt in whom you are trying to differentiate CHF from a respiratory cause: 1) BNP <100 pg/mL indicates what? 2) Most dyspneic pt’s with HF have ΒΝΡ value of what?

Answer 26

1) HF is very unlikely as the cause of dyspnea 2) >400 pg/mL

Question 27

Pleural effusions are categorized as ___________ or __________

Answer 27

transudative or exudative

Question 28

What are the 4 most common causes of transudative PEs?

Answer 28

1) CHF 2) Cirrhosis (liver disease) 3) Nephrotic syndrome (kidney disease) 4) Hypoalbuminemia

Question 29

What are the 3 most common causes of exudative pleural effusions?

Answer 29

1) Infection (e.g., bacterial pneumonia, TB) 2) Inflammation 3) Cancer

Question 30

Are exudative pleural effusions usually bilat or unilat?

Answer 30

Unilat (transudative bilat)

Question 31

1) Transudative effusions occur due to increased ____________ or decreased ________ pressures (with normal capillaries. 2) Exudative effusions occur due to increased _________________ (e.g., pneumonia, tumors) or impaired _______________ (e.g., sarcoidosis)

Answer 31

1) hydrostatic; oncotic 2) capillary permeability; lymphatic drainage

Question 32

For transudative pleural effusions, list the: 1) Physiology 2) Local Pleural Disease (i.e., underlying lung pathology) 3) Lung(s) affected 4) Most common causes (4) 5) Typical pleural fluid analysis results

Answer 32

1) Due to increased hydrostatic or decreased oncotic pressures (with normal capillaries) 2) Usually absent 3) Usually bilateral (both lungs) 4) CHF, Cirrhosis (liver disease), Nephrotic syndrome (kidney disease), Hypoalbuminemia 5) Low cell/protein/LDH content, low specific gravity

Question 33

For exudative pleural effusions, list the: 1) Physiology 2) Local Pleural Disease (i.e., underlying lung pathology) 3) Lung(s) affected 4) Most common causes 5) Typical pleural fluid analysis results

Answer 33

1) Due to increased capillary permeability (e.g., pneumonia, tumors) or impaired lymphatic drainage (e.g., sarcoidosis) 2) Usually present 3) Usually unilateral 4) Infection (e.g., bacterial pneumonia, TB), Inflammation, Cancer 5) High cell/protein/LDH content, high specific gravity

Question 34

Pleural Fluid Analysis: What should you note first?

Answer 34

Gross appearance and odor

Question 35

Fluid is considered exudative if at least one of the Light’s criteria is present; what are they?

Answer 35

1) Pleural fluid protein/serum protein ratio >0.5 2) Pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio >0.6 3) Pleural fluid LDH level >2/3 the upper limit of the laboratory's reference range of serum LDH

Question 36

If a pt meets Light's criteria, is it exudative or transudative?

Answer 36

Exudative