Lab diagnosis 2 test 2

  1. What tests are used for the diagnosis of a myocardial infarction?
    • CK (total)
    • CK-MB/CK-II
    • Troponin
    • Myoglobin (sometimes)
  2. What happens to CK after a heart attack?
    Increases at about 4 hours after beginning of MI, reaches max. at about 24 hours, returns to normal after 3 days
  3. What happens to troponin after an MI?
    Increases about 3 hours after beginning of MI, reaches max. at about 14 hours, remains elevated for 4 to 9 days
  4. What cardiac enzyme increases the most post-MI?
  5. What will cause an increase in CK-MM (CK-I)?
    Muscular dystrophy, myositis, large muscle mass, strenous exercise
  6. What will increase CK-MB (CK-II)?
    Acute MI or other serious heart condition (cardiac defibrillation, cardiac ischemia, myocarditis, ventricular arrhythmias)
  7. What will increase CK-BB (CK-III)?
    CNS diseases (brain injury, CVA/stroke, seizure)
  8. What will increase total CK?
    anything that increases CK-I, II, or III (MI, skeletal muscle diesease, neurological disease)
  9. What is troponin used for?
    estimation of the size of an MI (amount of damage)
  10. What is the most sensitive of the cardiac tests?
    Myoglobin, but it is the least specific
  11. What will increase myoglobin?
    • Myocardial infarction
    • Skeletal muscle inflammation
    • Trauma
    • Muscular dystrophy
    • Rhabdomyolysis
  12. What is included on a lipid panel/profile?
    Cholesterol, triglyceride, HDL, LDL, VLDL, Lipid ratio
  13. How does high levels of thyroxine (T4) impact cholesterol?
    decreases cholesterol
  14. How does estrogen affect cholesterol?
    estrogen lowers cholestrol except in pregnancy (lipids are needed for fetus)
  15. How can diabetes impact cholesterol?
    If glucose levels are not controlled, cholesterol will increase
  16. What results from burning fat?
  17. How does a fatty liver influence cholesterol?
    hepatic synthesis of lipoproteins is limited
  18. What happens to cholesterol levels in people with Neiman pick?
    increases (Neiman pick is a lipid storage disease)
  19. When taking cholesterol levels what can effect the results?
    Diet (must fast before test) and position (seated vs. lying down)
  20. What can increase cholesterol levels?
    Genetics, hyperlipidemia, hypothyroidism, diabetes (uncontrolled), nephrotic syndrome, MI, stress, atherosclerosis, biliary cirrhosis
  21. What will decrease cholesterol levels?
    Malabsorption, malnutrition, hyperthyroidism, advanced cancer, liver disease
  22. What is a better indicator of heart health triglycerides or cholesterol?
  23. What will cholesterol < 160 mg/dL do?
    Increase mortality risk in compromised individuals
  24. What will increase triglycerides?
    Hyperlipidemias, genetics, high carb diet, hypothyroidism, nephrotic syndrome, diabetes, chronic renal disease, glycogen storage disease
  25. What will decrease triglyceride levels?
    malabsorption, malnutrition, abetalipoproteinemia, hyperthyroidism
  26. Which lipids are beta lipoproteins? alpha lipoproteins? Which do you want higher amounts of?
    • LDL = beta - want lower (B is bad)
    • HDL = alpha - want higher
  27. What will increase HDL?
    Genetic HDL lipoproteinemia, excessive exercise, moderate alcohol consumption, estrogen supplements
  28. What will decrease HDL?
    Genetics, hepatitis/cirrhosis, nephrotic syndrome, malnutrition
  29. What will decrease LDL and VLDL?
    Genetic hypolipoporteinemia, malabsorption, malnutrition, hyperthryroidism
  30. What will increase LDL and VLDL?
    Genetics, nephrotic syndrome, hypothyroidism, glycogen storage disease, chronic liver disease, excessive alchol consumption, multiple myeloma, cushing's, systemic illness
  31. What are the two most commonly used ratios to predict coronary artery disease (CAD)?
    • LDL:HDL
    • Apo A:Apo B (B=bad) - one of the best indicators, low ratio (more Apo B) indicates increased risk of CHD (coronary heart disease)
  32. Which lipoproteins are electrophoresis done on?
    LDL and HDL
  33. What does post prandiol mean?
    after eating
  34. What does apoprotein A1 indicate?
    low levels indicate CAD
  35. What do apoprotein B indicate?
    high levels indicate CAD
  36. What is homocysteine?
    a metabolic byproduct of methionine metabolism, high levels indicate CAD
  37. What is fibrinogen?
    plasma protein which can be transformed by thrombin into a fibrin clot, in excess indicate CAD and higher mortality risk
  38. What does insulin indicate?
    Elevated levels indicate atherosclerosis
  39. What is chlamydia pneumoniae?
    obligate intracellular pathogen asssociated with atherosclerosis
  40. What is C-reactive protein?
    nonspecific indicator of inflammation (ONLY abnormal protein made by the liver during inflammation, acute phase reactant protein), high levels indicate higher risk of cardiovascular events
  41. What is lipo-PLA2?
    indicator of vascular inflammation, high levels indicate CAD or stroke
  42. What phenotype of lipoprotein is the most common? What is the best indicator?
    type IV (caused by diet, lack of exercise and diabetes), increased triglycerides
  43. What is PLAC?
    Another name for lipoprotein-phospholipase A2 (lipo-PLA2)
  44. What is the BNP assay for?
    differentiate dyspnea of congestive heart failure (CHF) from other respiratory conditions, elevated in cardiac diseases (triggered by ventricular stretch)
  45. What is VMA?
    vanillymandelic acid (catecholamines), indicates hypertesion secondary to pheochromocytoma, tested with a 24 hour urine sample
  46. What is a pheochromocytoma?
    benign tumor of the chromaffin cells of the adrenal medulla which secretes high levels of epinephrine and norepinephrine causing episodic (paroxysmal) or persistent severe hypertension
  47. What order are the catecholamines produced? What do they become?
    • dopamine --> norepinephrine --> normetanephrine --> VMA
    • dopamine --> epinephrine --> metanephrine --> VMA (DEMV - alphabetical order)
  48. What are the symptoms of a pheochromocytoma?
    hypertension, tachycardia, flushing, hyperglycemia, cold/clammy skin, excess sweat, angina/palpitations, attacks can be episodic or continuous
  49. What is the D-dimer test for?
    • evaluation of disseminated intravascular coagulation (DIC), deep vein thrombosis (DVT), polycythemia vera
    • Indicates fibrin split or degradation products (FSP)
  50. What are the risk factors for an arterial thrombosis?
    Smoking, hypertension, atheromas, myeloproliferative diseases (leukemia, multiple myeloma, polycythemia vera)
  51. What are the risk factors for a venous thrombosis?
    Immobility, trauma, surgery, malignancies, obesity, oral contraceptives
  52. What is the most common type of hypertension?
    essential or idiopathic
  53. Is malignant hypertension essential or secondary?
    Can be either, it is a severe form of hypertension
  54. What are most secondary causes of hypertension?
    endocrine issues
  55. What is myocarditis caused by?
    usually a virus
  56. What is endocarditis caused by? What does it present with?
    • IV drug use (used to be rheumatic heart disease)
    • vegetative friable verrucous growths on heart valves
    • friable = crumbly
    • verrucous = wart-like
  57. What is pericarditis? What is it caused by?
    Inflammation of the fibroserous sac around the heart, can be caused by anything (bacteria, virus, fungi, tumor, etc.)
  58. What is a classic sign of pericarditis?
    pericardial friction rub (grating sound as heart moves)
  59. What causes rheumatic fever?
    unresolved group A, beta hemolytic strep infextion
  60. How does strep present in the renal system?
    acute post strep glomerulonephritis
  61. What are the symptoms of rheumatic fever?
    • SPECS: Subcutaneous nodules, Polyarthritis, Erythema marginatum, Carditis, Syndenham's chorea
    • JONES: Joints, Ocarditis, Nodules, Erythema marginatum, Syndenhams chorea
    • SPECS and JONES are two ways to remember the same thing, learn whichever is easiest for you to remember
    • Arthralgias is the most common symptom
    • Erythema marginatum is pink rings on the trunk and inner surfaces of the arms and legs
    • Syndenhams chorea (st. vitus dance) is sudden movements of the arms, legs and face
  62. What urine tests are done for renal?
    urinalysis, specific gravity and osmolality, 24 hour collection for protein and creatinine, clearance tests
  63. What blood tests are done for renal?
    creatinine, BUN (blood urea nitrogen), uric acid, total protein, albumin
  64. What are other miscellaneous tests for renal?
    urine culture and sensitivity, electolytes
  65. What lab tests are used to differentially diagnosis prostate from kidney when patient presents with back pain?
    • PSA (prostate specific antigen) - better, present even if membrane of prostate is intact
    • Acid phosphatase (AcP)
  66. What is the best lab test to determine if prostate cancer has spread to the spine?
    Alkaline phosphatase (NOT acid phosphatase - only tells you they have prostate cancer not that it has spread)
  67. What does a sodium/potassium imbalance suggest?
    aldosterone problem
  68. What is an IVP?
    Intravenous pyelogram (die is injected, x-ray is taken)
  69. What is a renal ultrasound (US) good for?
    Wilm's tumor (children) because they don't have to hold still but not as specific as an MRI or CT
  70. What roles does the kidney have in urine production?
    filtration, reabsorption, active secretion
  71. What does the kidney do with creatinine?
    Filter only
  72. What does the kidney do with BUN?
    Filter and reabsorb
  73. What does the kidney do with uric acid?
    filter and reabsorb
  74. What does the kidney do with albumin?
    Nothing (it is not filtered, body retains all of it)
  75. What is the best blood test for kidney function?
    Creatinine (NOTE: not the same as creatine)
  76. What increases creatinine?
    Renal issues (glomerulonephritis, pyelonephritis and UTI's, tubular necrosis) and post-renal issues (blockage) and pre-renal issues (reduced blood flow from shock, dehydration, CHF, atherosclerosis)
  77. What decreases creatinine?
    decrased muscle mass, ex. muscular dystrophy
  78. Labs for muscular dystrophy?
    decreased creatinine, increased creatine, increased CK-MM
  79. What happens to phosphorylcreatine?
    During exercise it becomes creatine, during rest it becomes creatinine
  80. What test has replaced the creatinine tests?
    eGFR (estimated glomerular filtration rate)
  81. What increases creatine?
    muscular dystrophy, severe muscle damage
  82. What is BUN?
    main nonprotein nitrogen end product of protein catabolism and most common
  83. What is azotemia?
    high levels of BUN in the blood, leads to disorientation and convulsions
  84. What can increase BUN levels?
    kidney or liver issues
  85. What does low albumin cause?
  86. What are the three major proteins in our blood?
    albumin (most), globulin, fibrinogen
  87. What can decrease albumin levels?
    hepatic disease, malnutrition, malabsorption, nephrosis/nephrotic syndrome, CHF, eclampsia, burns
  88. What can increase albumin levels?
  89. What three hormones affect sodium levels?
    • Aldosterone - stimulates kidneys to reabsorb sodium
    • Natriuretic hormone - increases renal excretion of sodium
    • ADH - increases reabsorption of water by kidney
  90. What does the specific gravity/osmolality test represent?
    the concentrating and diluting ability of the kidney, specific gravity = screening, osmolality = confirmatory
  91. What tests indicate a UTI?
    nitrite, leukocyte esterase, presence of WBCs (all in urinalysis)
  92. Where are proteins made?
    Most in the liver (albumin, fibrinogen, alpha and beta globulins), some in the reticuloendothelial system (RES) or plasma cells (gamma globulins/immunoglobulins)
  93. What is the main function of proteins?
    contribute to osmotic pressure
  94. Abnormal protein levels indicate a problem with what?
    liver, kidney or immune
  95. What is more common hypo or hyperproteinemia?
  96. What causes decreased proteins?
    nephrotic syndrome, severe liver disease, malabsorption
  97. What causes increased proteins?
    multiple myeloma, dehydration
  98. What are the three types of globulin?
    alpha and beta and gammaglobulins (immunoglobulins - G (85%), A, M, E, D)
  99. What increases gamma globulins?
    chronic infections, multiple myeloma
  100. What decreases gamma globulins?
    hypo or agmmaglobulinemia (genetic)
  101. What test should you run next if protein levels are increased in the blood?
    protein electrophoresis (TPE or SPE)
  102. What pathologies cause a decreased A/G ratio?
    RA, SLE, chronic infections, sarcoidosis, malignant tumors
  103. What pathologies cause an increased or inverse A/G ratio?
    Multiple myeloma
  104. What is a monoclonal gammopathy?
    one protein is increased, gamma globulin spike, occurs in myeloma and macroglobulinemia
  105. What is a polyclonal gammopathy?
    more than one gamma globulin is increased
  106. What is hypogammaglobulinemia?
    gamma globulins are decreased
  107. What happens to proteins in an acute reaction (APR)?
    Albumin decreases and alpha-2-globulins increase, occurs in acute infections, MI, burns, tissue necrosis and stress
  108. What happens in nephrotic syndrome to proteins?
    albumin moderately decreases and alpha-2-globulins moderately increase
  109. What happens to protein levels in chronic inflammation?
    albumin slightly decreases, gamma globulins slightly increase
  110. What is pre-albumin used for?
    assessment of nutritional status
  111. What does transferrin do?
    transports iron, increased levels indicate low iron stores, part of beta 1 globulin
  112. What does haptoglobulin do?
    binds free hemoglobin preventing loss thru kidney, part of alpha-2-globulin
  113. What is alpha-1-antitrypsin?
    main part of alpha-1-globulin, inhibits proteases, genetic deficiency is common, deficiency leads to premature emphysema
  114. What does ceruloplasmin do?
    transport copper, it is absent in Wilson's disease
  115. What does antithrombin III do?
    prevents clotting by enhancing antithrombin
  116. What occurs if fibrinogen is not present?
    hemorrhage (may use up in child delivery causing mother to hemorrhage), part of beta-2-globulins
  117. What are complement C3 and C4?
    help in immune and inflammation response, helps in the destruction of foreign cells, C3 is 70%, C4 is the 2nd most common complement
  118. What decreases C3?
    acute post-strep glomerulonephritis, active SLE, severe recurrent bacterial infections, nephritis, RA, Immune complex disorders (type 3 hypersensitivity)
  119. What can low C3 lead to?
    shock and death
  120. What decreases C4?
    active SLE, early glomerulonephritis, immune complex diseases
  121. What increases C4?
    many malignancies
  122. What is alpha-fetoprotein used for?
    tumor marker for cancer, detection of neural tube defects in fetus (highest levels with hepatomas)
  123. Where is c-reactive protein found?
    blood, CSF, bullous fluid
  124. What are the lab findings for a UTI?
    leukocytosis, nitrite, leukocyte esterase, hematuria, WBC casts with pyelonephritis, culture and sensitivity
  125. What is vesicouretheral reflex?
    When the urethra is too small causing urine to go back up ureters when voiding (cause of frequent UTIs in little bodys)
  126. What is nephrotic syndrome?
    condition resulting from specific glomerular defects and indicates renal damage from severe, prolonged increase in glomerular permeability for protein, more prevelent in children
  127. What lab tests are used to diagnose nephrotic syndrome?
    Proteinuria, hyaline/granular/waxy casts in urine, decreased albumin in the blood
  128. What are the lab findings with chronic glomerulonephritis?
    proteinuria, granular casts, hematuria, RBC casts, elevated BUN and creatinine levels in blood
  129. What causes acute glomerulonephritis?
    type III hypersensitivity reaction - follows a URI (upper respiratory infection) or skin infection (impetigo- usually staph, very contagious, pus-filled), most common in young boys but can occur in anyone
  130. What are the lab findings with acute glomerulonephritis?
    proteinuria, RBC casts, WBC casts, low C3 and low C4 in blood, throat culture may be positive for strep (if caused by a strep infection)
  131. What is one of the most common renal diseases caused by bacteria?
    pyelonephritis, note: acute glomerulonephritis and UTIs are also common
  132. What causes pyelonephritis?
    bacteria from bladder spreads to ureters due to vesicoureteral reflux or benign prostatic hypertrophy
  133. What are the lab diagnosis associated with pyelonephritis?
    Leukocytes and pyuria, WBC casts, some hematuria, low specific gravity
  134. What lab tests are done for renal infarction?
    renal angiogram, other labs are not unique to infarction
  135. What are the symptoms of a renal infarction?
    severe upper abdominal pain, deep gnawing flank pain, costovertebral tenderness, fever, anorexia/vomiting/nausea
  136. What are renal calculi?
    kidney stones, made mostly of calcium
  137. What are the signs and symptoms of renal calculi?
    pain anywhere from costovertebral angle to suprapubic region, fever, chills, frequent urination or anuria, nausea/vomiting/abdominal discomfort, hematuria
  138. Lab tests for renal calculi?
    hematuria, urate or calcium crystals, casts, pyuria
  139. Who are renal calculi most common in?
    men 30 to 50, especially in southeastern US
  140. What is polycystic kidney disease?
    genetic disease characterized by multiple, bilateral, grapelike clusters of fluid-filled cysts that grossly enlarge the kidney, compressing and replacing the functional tissue
  141. How does polycystic kidney disease differ in infants vs. adults?
    • infants - deadly, kidney does not function
    • adult - insiduous onset, benign
  142. What is fanconi syndrome?
    malfunctioning proximal renal tubules (lose everything to urine), aplastic anemia, growth hormones --> electolyte and hematological abnormalities
  143. What tests would you do to diagnose fanconi syndrome?
    24hr protein, clearance tests, 24 hour urine electrolyte
  144. What is alport's syndrome?
    hereditary nephritis characterized by recurrent gross or microscopic hematuria, deafness, albuminuria, progressive azotemia, x-linked disorder
  145. What is Goodpasture's syndrome?
    autoimmune, anti-glomerular basement antibodies, first manifests in lungs (hemoptysis - cough blood) then in kidney (hematuria, proteinuria, glomerulonephritis)
  146. What are the functions of the thyroid?
    • maintain metabolism
    • stimulate oxygen consumption by cells
    • growth and maturation
    • lipid and carbohydrate metabolism
  147. What controls the thyroid?
    TRH from hypothalamus and TSH from the anterior pituitary
  148. What is required for thyroid hormone synthesis?
    iodine, tyrosine (amino acid)
  149. How many iodine molecules does T3 and T4 have?
    T3 has 3, T4 has 4
  150. Is thyroid testing included on a biochemical profile?
    No, ordered separately
  151. What is included on a thyroid panel?
    T3, T4 and TSH
  152. What additional tests can be done for throid? (be able to recognize, don't need to memorize)
    Free T4, FTI (T7), T3 RU (THBR), TBG, TRH, BMR, LATS, TSI, TGI, anti-microsomal antibodies, anti-thyroglobulin antibodies
  153. What diagnostic imaging can be done on thyroid?
    thyroid scan, RAI, US, fine needle aspiration
  154. Which is the major hormone used to screen for thyroid function? Why?
    T4, long half life (1 week)
  155. What % of T4 and T3 are bound to protein (TBG)?
    99% of T4, 70% of T3
  156. What T4 is metabolically active?
  157. What increases T4 and T3?
    Grave's disease, plummer's disease, acute thyroiditis (hashimotos - causes release of stored T4 and T3), pregnancy, estrogen, oral contraceptives, hyperproteinemia
  158. What decreases T3 and T4?
    Chronic thyroiditis (after gland has been destroyed), myxedema, cretinism, renal failure (T3 only), liver disease (T3 only), hypoproteinemia, nephrotic syndrome, serious illness
  159. What % of circulating thyroid hormone is T3?
  160. Where is T3 made?
    In the liver (converts T4 to T3)
  161. What is TBG?
    Thyroid binding globulin, major thyroid hormone protein carrier
  162. What happens when TBG levels increase?
    more T3 and T4 is bound, the pituitary thinks that thyroid is low so it makes more TSH, increasing T3 and T4
  163. What is THBR?
    Thyroid hormone binding ratio (used to be T3 resin uptake) - represents the amount of free thyroid hormone
  164. What is the major test used to distinguish between primary and secondary hypothyroidism?
  165. What will increase TSH?
    Primary hypothyroidism (Hashimoto's), severe and chronic illness
  166. What will decrease TSH?
    Secondary hypothyroidism, hyperthyroidism
  167. What two tests can be done as a suppression or stimulation test?
    TSH and TRH
  168. What is TRH test?
    injection of TRH is given to patient, in normal person TSH will increase in response, in person with hyperthyroid there will be little to no increase in TSH (one of the most reliable tests for hyperthyroid)
  169. What antibodies are present in hyperthyroid?
    LATS (long acting thyroid stimulator), TSI (thyroid stimulating immunoglobulin), TBII, TBI
  170. What antibodies are present in hypothyroid?
    anti-thyroglobulin antibodies and anti-microsomal antibodies (note: both of these are also present in most hyperthyroid as well)
  171. What antibody involved with the thyroid crosses the placenta?
  172. What is a hot spot on a thyroid? What does it indicate?
    area of activity which is seen on a radioactive uptake scintiscan of the thyroid, it is normal to have a few small hot spots but large hot spots indicate hyperthyroid
  173. What can an ultrasound of a thyroid differentiate?
    solid tumor (more likely to be malignant) from fluid filled cyst (usually benign)
  174. What is the preferred diagnosis method for thyroid masses?
    fine needle aspiration
  175. What is required for a thyroiditis diagnosis?
    swelling of the thyroid (painless but may cause pressure), antithyroglobulin antibodies are usually positive, thyroid function tests may vary but decreased T4, T3 and Thyroid uptake is expected, TSH and lipids are elevated
  176. What is the major type of thyroiditis?
  177. What is myxedema?
    syndrome of decreased thyroid function (includes symptoms of hypothyroid)
  178. What are the two most common types of thyrotoxicosis?
    Grave's (most common) and Plummer's disease (2nd most common - it is a multi-nodular goiter)
  179. What are the common lab findings with thyrotoxicosis?
    Increased blood sugar (absorb more), T4, T3, Thyroid uptake, presence of LATS, TSI and TGI, decreased lipids and TSH
  180. What is a goiter? What are the types?
    most common cause of thyroid enlargement, usually seen at puberty, pregnancy or menopause, non-toxic or simple
  181. What is euthyroid sick syndrome?
    acute or chronic illness causes secondary hypothyroidism, often decreased pre-albumin is present
  182. What are the symptoms of hashimoto's?
    Female 30-50, genetic, enopthalmia, edema (puffy face), cold and yellow, speech difficulties (thick tongue), hair loss/coarse, thick/dry skin, hypersensitive to cold, constipated, personality changes, mental apathy
  183. What are the symptoms of grave's?
    "Basedow's disease", females 20-40, genetic, exopthalmia/stares, goiter, tachycardia, nervous/restless/tremors, velvet/moist skin, heat intolerance, loose stools, irritable/fatigue/weakness, menstrual irregularity
  184. Which thyroid disease is auto immune? Which tends to occur with autoimmune diseases?
    Both, both
Card Set
Lab diagnosis 2 test 2
flashcards based on Lab diagnosis as taught at sherman by Dr. Gibbon