Lab diagnosis 2 test 2

• CK (total)
• CK-MB/CK-II
• Troponin
• Myoglobin (sometimes)

Increases at about 4 hours after beginning of MI, reaches max. at about 24 hours, returns to normal after 3 days

Increases about 3 hours after beginning of MI, reaches max. at about 14 hours, remains elevated for 4 to 9 days

CK-MB

Muscular dystrophy, myositis, large muscle mass, strenous exercise

Acute MI or other serious heart condition (cardiac defibrillation, cardiac ischemia, myocarditis, ventricular arrhythmias)

CNS diseases (brain injury, CVA/stroke, seizure)

anything that increases CK-I, II, or III (MI, skeletal muscle diesease, neurological disease)

estimation of the size of an MI (amount of damage)

Myoglobin, but it is the least specific

• Myocardial infarction
• Skeletal muscle inflammation
• Trauma
• Muscular dystrophy
• Rhabdomyolysis

Cholesterol, triglyceride, HDL, LDL, VLDL, Lipid ratio

decreases cholesterol

estrogen lowers cholestrol except in pregnancy (lipids are needed for fetus)

If glucose levels are not controlled, cholesterol will increase

ketosis

hepatic synthesis of lipoproteins is limited

increases (Neiman pick is a lipid storage disease)

Diet (must fast before test) and position (seated vs. lying down)

Genetics, hyperlipidemia, hypothyroidism, diabetes (uncontrolled), nephrotic syndrome, MI, stress, atherosclerosis, biliary cirrhosis

Malabsorption, malnutrition, hyperthyroidism, advanced cancer, liver disease

triglycerides

Increase mortality risk in compromised individuals

Hyperlipidemias, genetics, high carb diet, hypothyroidism, nephrotic syndrome, diabetes, chronic renal disease, glycogen storage disease

malabsorption, malnutrition, abetalipoproteinemia, hyperthyroidism

• LDL = beta - want lower (B is bad)
• HDL = alpha - want higher

Genetic HDL lipoproteinemia, excessive exercise, moderate alcohol consumption, estrogen supplements

Genetics, hepatitis/cirrhosis, nephrotic syndrome, malnutrition

Genetic hypolipoporteinemia, malabsorption, malnutrition, hyperthryroidism

Genetics, nephrotic syndrome, hypothyroidism, glycogen storage disease, chronic liver disease, excessive alchol consumption, multiple myeloma, cushing's, systemic illness

• 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)

LDL and HDL

after eating

low levels indicate CAD

high levels indicate CAD

a metabolic byproduct of methionine metabolism, high levels indicate CAD

plasma protein which can be transformed by thrombin into a fibrin clot, in excess indicate CAD and higher mortality risk

Elevated levels indicate atherosclerosis

obligate intracellular pathogen asssociated with atherosclerosis

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

indicator of vascular inflammation, high levels indicate CAD or stroke

type IV (caused by diet, lack of exercise and diabetes), increased triglycerides

Another name for lipoprotein-phospholipase A2 (lipo-PLA2)

differentiate dyspnea of congestive heart failure (CHF) from other respiratory conditions, elevated in cardiac diseases (triggered by ventricular stretch)

vanillymandelic acid (catecholamines), indicates hypertesion secondary to pheochromocytoma, tested with a 24 hour urine sample

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

• dopamine --> norepinephrine --> normetanephrine --> VMA
• dopamine --> epinephrine --> metanephrine --> VMA (DEMV - alphabetical order)

hypertension, tachycardia, flushing, hyperglycemia, cold/clammy skin, excess sweat, angina/palpitations, attacks can be episodic or continuous

• evaluation of disseminated intravascular coagulation (DIC), deep vein thrombosis (DVT), polycythemia vera
• Indicates fibrin split or degradation products (FSP)

Smoking, hypertension, atheromas, myeloproliferative diseases (leukemia, multiple myeloma, polycythemia vera)

Immobility, trauma, surgery, malignancies, obesity, oral contraceptives

essential or idiopathic

Can be either, it is a severe form of hypertension

endocrine issues

usually a virus

• IV drug use (used to be rheumatic heart disease)
• vegetative friable verrucous growths on heart valves
• friable = crumbly
• verrucous = wart-like

Inflammation of the fibroserous sac around the heart, can be caused by anything (bacteria, virus, fungi, tumor, etc.)

pericardial friction rub (grating sound as heart moves)

unresolved group A, beta hemolytic strep infextion

acute post strep glomerulonephritis

• 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

urinalysis, specific gravity and osmolality, 24 hour collection for protein and creatinine, clearance tests

creatinine, BUN (blood urea nitrogen), uric acid, total protein, albumin

urine culture and sensitivity, electolytes

• PSA (prostate specific antigen) - better, present even if membrane of prostate is intact
• Acid phosphatase (AcP)

Alkaline phosphatase (NOT acid phosphatase - only tells you they have prostate cancer not that it has spread)

aldosterone problem

Intravenous pyelogram (die is injected, x-ray is taken)

Wilm's tumor (children) because they don't have to hold still but not as specific as an MRI or CT

filtration, reabsorption, active secretion

Filter only

Filter and reabsorb

filter and reabsorb

Nothing (it is not filtered, body retains all of it)

Creatinine (NOTE: not the same as creatine)

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)

decrased muscle mass, ex. muscular dystrophy

decreased creatinine, increased creatine, increased CK-MM

During exercise it becomes creatine, during rest it becomes creatinine

eGFR (estimated glomerular filtration rate)

muscular dystrophy, severe muscle damage

main nonprotein nitrogen end product of protein catabolism and most common

high levels of BUN in the blood, leads to disorientation and convulsions

kidney or liver issues

edema

albumin (most), globulin, fibrinogen

hepatic disease, malnutrition, malabsorption, nephrosis/nephrotic syndrome, CHF, eclampsia, burns

dehydration

• Aldosterone - stimulates kidneys to reabsorb sodium
• Natriuretic hormone - increases renal excretion of sodium
• ADH - increases reabsorption of water by kidney

the concentrating and diluting ability of the kidney, specific gravity = screening, osmolality = confirmatory

nitrite, leukocyte esterase, presence of WBCs (all in urinalysis)

Most in the liver (albumin, fibrinogen, alpha and beta globulins), some in the reticuloendothelial system (RES) or plasma cells (gamma globulins/immunoglobulins)

contribute to osmotic pressure

liver, kidney or immune

hypo

nephrotic syndrome, severe liver disease, malabsorption

multiple myeloma, dehydration

alpha and beta and gammaglobulins (immunoglobulins - G (85%), A, M, E, D)

chronic infections, multiple myeloma

hypo or agmmaglobulinemia (genetic)

protein electrophoresis (TPE or SPE)

RA, SLE, chronic infections, sarcoidosis, malignant tumors

Multiple myeloma

one protein is increased, gamma globulin spike, occurs in myeloma and macroglobulinemia

more than one gamma globulin is increased

gamma globulins are decreased

Albumin decreases and alpha-2-globulins increase, occurs in acute infections, MI, burns, tissue necrosis and stress

albumin moderately decreases and alpha-2-globulins moderately increase

albumin slightly decreases, gamma globulins slightly increase

assessment of nutritional status

transports iron, increased levels indicate low iron stores, part of beta 1 globulin

binds free hemoglobin preventing loss thru kidney, part of alpha-2-globulin

main part of alpha-1-globulin, inhibits proteases, genetic deficiency is common, deficiency leads to premature emphysema

transport copper, it is absent in Wilson's disease

prevents clotting by enhancing antithrombin

hemorrhage (may use up in child delivery causing mother to hemorrhage), part of beta-2-globulins

help in immune and inflammation response, helps in the destruction of foreign cells, C3 is 70%, C4 is the 2nd most common complement

acute post-strep glomerulonephritis, active SLE, severe recurrent bacterial infections, nephritis, RA, Immune complex disorders (type 3 hypersensitivity)

shock and death

active SLE, early glomerulonephritis, immune complex diseases

many malignancies

tumor marker for cancer, detection of neural tube defects in fetus (highest levels with hepatomas)

blood, CSF, bullous fluid

leukocytosis, nitrite, leukocyte esterase, hematuria, WBC casts with pyelonephritis, culture and sensitivity

When the urethra is too small causing urine to go back up ureters when voiding (cause of frequent UTIs in little bodys)

condition resulting from specific glomerular defects and indicates renal damage from severe, prolonged increase in glomerular permeability for protein, more prevelent in children

Proteinuria, hyaline/granular/waxy casts in urine, decreased albumin in the blood

proteinuria, granular casts, hematuria, RBC casts, elevated BUN and creatinine levels in blood

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

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)

pyelonephritis, note: acute glomerulonephritis and UTIs are also common

bacteria from bladder spreads to ureters due to vesicoureteral reflux or benign prostatic hypertrophy

Leukocytes and pyuria, WBC casts, some hematuria, low specific gravity

renal angiogram, other labs are not unique to infarction

severe upper abdominal pain, deep gnawing flank pain, costovertebral tenderness, fever, anorexia/vomiting/nausea

kidney stones, made mostly of calcium

pain anywhere from costovertebral angle to suprapubic region, fever, chills, frequent urination or anuria, nausea/vomiting/abdominal discomfort, hematuria

hematuria, urate or calcium crystals, casts, pyuria

men 30 to 50, especially in southeastern US

genetic disease characterized by multiple, bilateral, grapelike clusters of fluid-filled cysts that grossly enlarge the kidney, compressing and replacing the functional tissue

• infants - deadly, kidney does not function
• adult - insiduous onset, benign

malfunctioning proximal renal tubules (lose everything to urine), aplastic anemia, growth hormones --> electolyte and hematological abnormalities

24hr protein, clearance tests, 24 hour urine electrolyte

hereditary nephritis characterized by recurrent gross or microscopic hematuria, deafness, albuminuria, progressive azotemia, x-linked disorder

autoimmune, anti-glomerular basement antibodies, first manifests in lungs (hemoptysis - cough blood) then in kidney (hematuria, proteinuria, glomerulonephritis)

• maintain metabolism
• stimulate oxygen consumption by cells
• growth and maturation
• lipid and carbohydrate metabolism

TRH from hypothalamus and TSH from the anterior pituitary

iodine, tyrosine (amino acid)

T3 has 3, T4 has 4

No, ordered separately

T3, T4 and TSH

Free T4, FTI (T7), T3 RU (THBR), TBG, TRH, BMR, LATS, TSI, TGI, anti-microsomal antibodies, anti-thyroglobulin antibodies

thyroid scan, RAI, US, fine needle aspiration

T4, long half life (1 week)

99% of T4, 70% of T3

Free/unbound

Grave's disease, plummer's disease, acute thyroiditis (hashimotos - causes release of stored T4 and T3), pregnancy, estrogen, oral contraceptives, hyperproteinemia

Chronic thyroiditis (after gland has been destroyed), myxedema, cretinism, renal failure (T3 only), liver disease (T3 only), hypoproteinemia, nephrotic syndrome, serious illness

90%

In the liver (converts T4 to T3)

Thyroid binding globulin, major thyroid hormone protein carrier

more T3 and T4 is bound, the pituitary thinks that thyroid is low so it makes more TSH, increasing T3 and T4

Thyroid hormone binding ratio (used to be T3 resin uptake) - represents the amount of free thyroid hormone

TSH

Primary hypothyroidism (Hashimoto's), severe and chronic illness

Secondary hypothyroidism, hyperthyroidism

TSH and TRH

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)

LATS (long acting thyroid stimulator), TSI (thyroid stimulating immunoglobulin), TBII, TBI

anti-thyroglobulin antibodies and anti-microsomal antibodies (note: both of these are also present in most hyperthyroid as well)

LATS

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

solid tumor (more likely to be malignant) from fluid filled cyst (usually benign)

fine needle aspiration

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

Hashimoto's

syndrome of decreased thyroid function (includes symptoms of hypothyroid)

Grave's (most common) and Plummer's disease (2nd most common - it is a multi-nodular goiter)

Increased blood sugar (absorb more), T4, T3, Thyroid uptake, presence of LATS, TSI and TGI, decreased lipids and TSH

most common cause of thyroid enlargement, usually seen at puberty, pregnancy or menopause, non-toxic or simple

acute or chronic illness causes secondary hypothyroidism, often decreased pre-albumin is present

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

"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

Both, both