1
Q
What is the purpose of the life insurance laboratory test profile?
A
It is used to evaluate medical risk and provides explanations of laboratory tests encountered by underwriters.
2
Q
What are blood samples used for in laboratory testing?
A
Blood samples serve as risk markers for disease or abnormal health conditions.
3
Q
What is serum?
A
Serum is the liquid portion of the blood, separated from the cellular components after clotting and centrifugation.
4
Q
What can affect the quality of insurance laboratory test results from serum samples?
A
The serum must be centrifuged within two hours of collection to ensure quality.
5
Q
What does urine contain that can indicate health status?
A
Urine contains waste products, drugs, metabolites, and substances found in blood that can serve as risk markers.
6
Q
How is urine collected for laboratory testing?
A
Urine is collected using a simple plastic container.
7
Q
What are some potential issues with urine sample collection?
A
There is a risk of adulteration, dilution, or substitution of the urine sample.
8
Q
What health conditions can urine testing reveal?
A
Urine testing can indicate kidney function, urinary infections, diabetes, and smoking or drug use.
9
Q
What do laboratory tests identify and quantify?
A
They identify and quantify risk markers for disease and other abnormal health conditions.
10
Q
What are cut-offs in laboratory testing?
A
Cut-offs are test values that indicate whether an individual is considered healthy/normal.
11
Q
What are laboratory test cut-offs?
A
Laboratory test cut-offs are values that distinguish between healthy/normal and unhealthy/abnormal test results.
12
Q
What does it mean if an individual is ‘positive’ for a laboratory test?
A
An individual who is ‘positive’ for a laboratory test has a test result on the unhealthy/abnormal side of the cut-off, indicating a higher mortality risk.
13
Q
What does it mean if an individual is ‘negative’ for a laboratory test?
A
An individual who is ‘negative’ for a laboratory test has a test result on the healthy/normal side of the cut-off, indicating an average or better than average mortality risk.
14
Q
What are false positives?
A
False positives are results where a positive test does not reflect a true state of disease or abnormal health, often due to transient conditions.
15
Q
What are false negatives?
A
False negatives are results that fail to detect the proposed insured’s true condition of disease or abnormal health.
16
Q
What are the two options for questioning test results?
A
The underwriter can either have another sample taken and repeat the test or look at other information about the individual to assess consistency.
17
Q
What is sensitivity in laboratory testing?
A
Sensitivity measures a test’s ability to detect persons who have a disease or abnormal health condition (true positives).
18
Q
What is specificity in laboratory testing?
A
Specificity measures how well a test excludes the possibility of a particular disease or abnormal health condition (true negatives).
19
Q
How can sensitivity be increased?
A
Sensitivity can be increased by lowering the cut-off value that defines a positive test, which may decrease specificity.
20
Q
What are proteins composed of?
A
Proteins are composed of amino acids and have highly-defined molecular structures that determine their function.
21
Q
What are enzymes?
A
Enzymes are a special class of proteins that build or break down other proteins, sugars, lipids, or genetic molecules.
22
Q
What role do carbohydrates and fats play in the body?
A
Carbohydrates and fats serve as sources of energy and building blocks for cells to produce larger structures.
23
Q
What is cholesterol’s function?
A
Cholesterol is a special fat present in all cell membranes and serves as a precursor for various hormones.
24
Q
What does abnormally high glucose indicate?
A
Abnormally high glucose levels in blood or urine may indicate impaired glucose tolerance and/or diabetes.
25
What is hemolysis?
Hemolysis is the rupture of red blood cells, releasing hemoglobin and other contents into the serum, often due to delays in handling samples.
26
How is hemolysis classified?
Hemolysis is classified as slight, moderate, or severe based on the amount of hemoglobin present in the serum sample.
27
What is lipemia?
Lipemia is the presence of high concentrations of lipids in serum, which can affect test results.
28
What causes postprandial lipemia?
Postprandial lipemia is usually caused by high-fat meals leading to increased triglycerides and glucose levels.
29
What is glycolysis in the context of blood samples?
Glycolysis is the loss of glucose due to red and white blood cells metabolizing it if centrifugation is delayed.
30
What tests provide reliable estimates of average glucose levels?
Fructosamine and hemoglobin A1c tests provide more reliable estimates of average glucose levels.
31
What are laboratory test cut-offs?
Laboratory test cut-offs are values that distinguish between healthy/normal and unhealthy/abnormal test results.
32
What does it mean if an individual is 'positive' for a laboratory test?
An individual who is 'positive' for a laboratory test has a test result on the unhealthy/abnormal side of the cut-off, indicating a higher mortality risk.
33
What does it mean if an individual is 'negative' for a laboratory test?
An individual who is 'negative' for a laboratory test has a test result on the healthy/normal side of the cut-off, indicating an average or better than average mortality risk.
34
What are false positives?
False positives are results where a positive test does not reflect a true state of disease or abnormal health, often due to transient conditions.
35
What are false negatives?
False negatives are results that fail to detect the proposed insured's true condition of disease or abnormal health.
36
What are the two options for questioning test results?
The underwriter can either have another sample taken and repeat the test or look at other information about the individual to assess consistency.
37
What is sensitivity in laboratory testing?
Sensitivity measures a test's ability to detect persons who have a disease or abnormal health condition (true positives).
38
What is specificity in laboratory testing?
Specificity measures how well a test excludes the possibility of a particular disease or abnormal health condition (true negatives).
39
How can sensitivity be increased?
Sensitivity can be increased by lowering the cut-off value that defines a positive test, which may decrease specificity.
40
What are proteins composed of?
Proteins are composed of amino acids and have highly-defined molecular structures that determine their function.
41
What are enzymes?
Enzymes are a special class of proteins that build or break down other proteins, sugars, lipids, or genetic molecules.
42
What role do carbohydrates and fats play in the body?
Carbohydrates and fats serve as sources of energy and building blocks for cells to produce larger structures.
43
What is cholesterol's function?
Cholesterol is a special fat present in all cell membranes and serves as a precursor for various hormones.
44
What does abnormally high glucose indicate?
Abnormally high glucose levels in blood or urine may indicate impaired glucose tolerance and/or diabetes.
45
What is hemolysis?
Hemolysis is the rupture of red blood cells, releasing hemoglobin and other contents into the serum, often due to delays in handling samples.
46
How is hemolysis classified?
Hemolysis is classified as slight, moderate, or severe based on the amount of hemoglobin present in the serum sample.
47
What is lipemia?
Lipemia is the presence of high concentrations of lipids in serum, which can affect test results.
48
What causes postprandial lipemia?
Postprandial lipemia is usually caused by high-fat meals leading to increased triglycerides and glucose levels.
49
What is glycolysis in the context of blood samples?
Glycolysis is the loss of glucose due to red and white blood cells metabolizing it if centrifugation is delayed.
50
What tests provide reliable estimates of average glucose levels?
Fructosamine and hemoglobin A1c tests provide more reliable estimates of average glucose levels.
51
What are common units of measure for test results?
Common units include:
1. gram/liter (gL)
2. milligram per 100 ml of sample (mg/dL)
3. microgram/milliliter (ug/ml)
4. nanogram/ml (ng/ml)
5. International Units per liter (IU/L)
## Footnote
The prefix milli- indicates 1 thousandth, micro- is 1 millionth, and nano- is 1 billionth.
52
What are SI units?
SI units (International System of Units) are increasingly used in laboratory reports, such as U/L or mmol/L.
## Footnote
These may require conversion to U.S. units for some test values.
53
Why can reference ranges vary among laboratories?
Reference ranges can vary due to differences in methods or equipment.
## Footnote
What is normal in one laboratory can be abnormal in another.
54
How are abnormal results flagged in laboratory reports?
Abnormal results are typically flagged as H (high) or L (low) in laboratory reports.
55
What is venipuncture?
Venipuncture is the method of collecting blood samples by drawing blood from a vein, typically when the policy amount exceeds a predetermined level.
56
What is the difference between serum and plasma?
Serum is the liquid portion of blood without clotting factors, while plasma contains clotting factors.
57
What is required before a blood sample is drawn?
The proposed insured is generally told to fast for at least eight hours prior to the blood draw.
58
What is a dried blood spot (Ds)?
Dried blood spot (Ds) is a method where blood droplets are collected on blotting paper and allowed to air dry for laboratory testing.
59
What samples can be collected for lower policy amounts?
For lower policy amounts, oral fluid and/or urine samples can be collected for risk assessment.
60
What is the ideal temperature for urine samples?
The temperature of the urine sample should ideally be 90-100 degrees Fahrenheit to reduce the chance of substitution.
61
What processing is required for serum samples?
Serum samples must be allowed to clot for one to two hours and then separated from the clot by centrifugation.
62
What is the typical transport time for samples to the laboratory?
The typical transport time for samples is two days.
63
How are cut-off test values determined?
Cut-off test values can be determined by statistical calculations or clinical practice recommendations by expert consensus.
64
Why is understanding statistics important for underwriters?
Understanding statistics helps underwriters determine which results are normal/healthy and which are abnormal/unhealthy.
65
What are common units of measure for test results?
Common units include:
1. gram/liter (gL)
2. milligram per 100 ml of sample (mg/dL)
3. microgram/milliliter (ug/ml)
4. nanogram/ml (ng/ml)
5. International Units per liter (IU/L)
## Footnote
The prefix milli- indicates 1 thousandth, micro- is 1 millionth, and nano- is 1 billionth.
66
What are SI units?
SI units (International System of Units) are increasingly used in laboratory reports, such as U/L or mmol/L.
## Footnote
These may require conversion to U.S. units for some test values.
67
Why can reference ranges vary among laboratories?
Reference ranges can vary due to differences in methods or equipment.
## Footnote
What is normal in one laboratory can be abnormal in another.
68
How are abnormal results flagged in laboratory reports?
Abnormal results are typically flagged as H (high) or L (low) in laboratory reports.
69
What is venipuncture?
Venipuncture is the method of collecting blood samples by drawing blood from a vein, typically when the policy amount exceeds a predetermined level.
70
What is the difference between serum and plasma?
Serum is the liquid portion of blood without clotting factors, while plasma contains clotting factors.
71
What is required before a blood sample is drawn?
The proposed insured is generally told to fast for at least eight hours prior to the blood draw.
72
What is a dried blood spot (Ds)?
Dried blood spot (Ds) is a method where blood droplets are collected on blotting paper and allowed to air dry for laboratory testing.
73
What samples can be collected for lower policy amounts?
For lower policy amounts, oral fluid and/or urine samples can be collected for risk assessment.
74
What is the ideal temperature for urine samples?
The temperature of the urine sample should ideally be 90-100 degrees Fahrenheit to reduce the chance of substitution.
75
What processing is required for serum samples?
Serum samples must be allowed to clot for one to two hours and then separated from the clot by centrifugation.
76
What is the typical transport time for samples to the laboratory?
The typical transport time for samples is two days.
77
How are cut-off test values determined?
Cut-off test values can be determined by statistical calculations or clinical practice recommendations by expert consensus.
78
Why is understanding statistics important for underwriters?
Understanding statistics helps underwriters determine which results are normal/healthy and which are abnormal/unhealthy.
79
What is a typical laboratory profile in the life insurance industry?
A typical laboratory profile consists of about 20 blood tests to evaluate mortality risks.
80
How are laboratory tests used by underwriters?
Underwriters use laboratory tests as markers for risk, not for diagnosis.
81
What substances are evaluated in urine samples?
Urine samples are evaluated for drugs of abuse, nicotine, creatinine, protein, glucose, and blood cells.
82
Can urine be tested for HIV?
Yes, in some cases, urine can also be tested for antibodies to human immunodeficiency virus (HIV).
83
What is routinely tested in oral fluid?
Oral fluid is routinely tested for HIV, cotinine, and cocaine.
84
Why are fewer tests available for oral fluid?
Fewer tests are available for oral fluid due to limited sample volume.
85
What happens if a screening test is abnormal?
Other testing can be ordered in an automated fashion if a screening test is abnormal.
86
Can hepatitis testing be authorized automatically?
Yes, there can be preset authorization for hepatitis testing when a screening test is abnormal.
87
What is a typical laboratory profile in the life insurance industry?
A typical laboratory profile consists of about 20 blood tests to evaluate mortality risks.
88
How do underwriters use laboratory tests?
Underwriters use laboratory tests as markers for risk, not for diagnosis.
89
What substances are evaluated in urine samples?
Urine samples are evaluated for drugs of abuse, nicotine, creatinine, protein, glucose, and blood cells.
90
Can urine samples be tested for HIV?
Yes, urine samples can also be tested for antibodies to human immunodeficiency virus (HIV).
91
What is routinely tested in oral fluid?
Oral fluid is routinely tested for HIV, cotinine, and cocaine.
92
Why are fewer tests available for oral fluid?
Fewer tests are available for oral fluid due to limited sample volume.
93
What happens if a screening test is abnormal?
If a screening test is abnormal, other testing can be ordered in an automated fashion.
94
What is an example of automated testing after an abnormal screening?
An example is preset authorization for hepatitis testing when an abnormal screening test occurs.
95
What is the average daily production of creatinine?
The average production of creatinine is 1 gram per day.
96
What does the glomerular filtration rate (GFR) measure?
The GFR measures renal filtration and can be assessed by the rate of excretion of an injected dye or radioactive molecule.
97
What is the significance of urine creatinine concentration?
Urine creatinine concentration helps adjust other urine test results for variations in daily urine volume.
98
What is considered proteinuria?
The presence of protein in urine greater than 150 mg/day is associated with excess mortality due to likely kidney impairment.
99
What is the relationship between urine dilution and creatinine concentration?
More fluid intake leads to more dilute urine, resulting in lower concentrations of creatinine and other tested substances.
100
What are the common substances examined in urine testing?
Urine samples are routinely examined for levels of cocaine, cotinine, creatinine, glucose, protein, hemoglobin, and leukocyte esterase.
101
What adjustments are made for total protein and albumin in urine tests?
Adjustments are made by calculating protein/creatinine or albumin/creatinine ratios.
102
What does extremely low urine creatinine indicate?
Extremely low urine creatinine values can indicate very high fluid intake or addition of fluid to the urine.
103
What is the importance of first-morning urine?
First-morning urine is more concentrated than urine from later in the day.
104
What is a reflex test in the context of urine testing?
A reflex test is performed in response to an initial laboratory test result or an applicant-reported health condition.
105
What can a positive urine sample for protein indicate?
A positive urine sample for protein can indicate proteinuria, which may be benign or associated with disease.
106
What is albuminuria?
Albuminuria is the excess loss of albumin into the urine, indicating damage to the kidney's filtering unit, the glomerulus.
107
What are possible causes of benign proteinuria?
Possible causes of benign proteinuria include recent strenuous exertion, orthostatic proteinuria, viral infections, and post-collection contamination.
108
What is the significance of urine albumin levels between 30-300 mg/day?
Urine albumin levels between 30-300 mg/day are clinically considered as microalbuminuria, indicating potential kidney damage.
109
What should be done if urine glucose is positive?
If urine glucose is positive, a blood test should be requested to check the hemoglobin A1c level.
110
What is the clinical diagnosis of diabetes based on?
The clinical diagnosis of diabetes is based on a fasting blood glucose concentration greater than 124 mg/dL or a hemoglobin A1c level greater than 6.4%.
111
What does the presence of leukocyte esterase in urine indicate?
The presence of leukocyte esterase indicates the presence of white blood cells, which may suggest infection or inflammation.
112
What is hematuria?
Hematuria is the presence of red blood cells in the urine, which can indicate various medical conditions.
113
What are casts in urine analysis?
Casts are tiny aggregates of proteins or blood cells shaped like tubes, indicating kidney issues.
114
What is the primary method for testing drugs of abuse in urine?
The primary method for testing drugs of abuse in urine is a simple and rapid antibody test, followed by confirmation with GCMS or LC-MS/MS.
115
Why is cotinine used instead of nicotine for tobacco detection?
Cotinine is used for tobacco detection because it has a longer half-life and remains in the body longer than nicotine.
116
What percentage of proposed insured samples detect cotinine?
Cotinine is detected in 9-29% of proposed insured samples.
117
What proportion of cotinine-positive samples come from non-tobacco users?
Approximately one-third to one-half of cotinine-positive samples are from individuals applying as non-tobacco users.
118
What can be done to confirm positive cotinine test results?
The original sample can be tested with GC-MS or LC-MS/MS to confirm the presence of cotinine.
119
How long are smokers typically positive for cotinine after last use?
Smokers are typically positive for cotinine for one to three days after last use.
120
What are common explanations for cotinine-positive results in non-tobacco users?
Common explanations include exposure to side-stream smoke, nicotine substitutes, and cigar use.
121
Can herbal teas or betel nut cause a positive cotinine test?
Yes, ingestion of mixtures containing tobacco will cause a positive test in the absence or presence of smoking.
122
Does second-hand smoke cause positive cotinine test results?
No, second-hand or environmental smoke will not cause positive test results for the range of cut-off values used by insurers.
123
What is the normal result for a urine culture?
A normal result for a urine culture is to have no growth of any bacteria or fungi.
124
What tests are routinely run on oral fluid samples?
The three tests are for HIV antibodies, cotinine, and cocaine.
125
What is the typical use of blood testing in insurance?
Blood testing is usually performed for larger risk amounts almost always in conjunction with a urine sample.
126
What is the virus that causes AIDS?
Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS).
127
How are positive HIV samples confirmed?
Repeat positive samples are tested with a recombinant protein dot blot to confirm reactivity against HIV proteins.
128
What is hepatitis?
Hepatitis is inflammation of the liver, and it can be acute or chronic.
129
What are some causes of acute hepatitis?
Acute hepatitis can be caused by infections with hepatitis viruses or by drugs, alcohol abuse, and environmental toxins.
130
What is a marker of acute hepatitis?
A marker of acute hepatitis is liver enzymes elevated from 3 to 10 times the upper limit of the normal reference range.
131
What are abnormal liver enzyme levels in acute hepatitis?
Abnormal liver enzyme levels can be in the thousands and will return to normal in less than six months.
132
How is chronic hepatitis defined?
Chronic hepatitis is defined as liver enzyme elevations lasting longer than six months.
133
What are typical liver enzyme levels in chronic hepatitis?
Typical liver enzyme levels can vary from normal to three times the upper limit of the reference range.
134
What are common causes of chronic hepatitis?
Common causes include non-alcoholic fatty liver, over-the-counter anti-inflammatory drugs (e.g., acetaminophen), hepatitis B or C, and alcohol abuse.
135
What risks are associated with chronic inflammation of the liver?
Chronic inflammation increases the risk for fibrosis, cirrhosis, and hepatocellular carcinoma.
136
What tests should individuals with chronic hepatitis or abnormal ALT/AST levels undergo?
They should be tested for the presence of antibodies to hepatitis C virus (HCV) and/or surface protein from hepatitis B virus (HBV).
137
How is hepatitis normally detected?
Hepatitis is normally detected by an increase in liver enzyme levels.
138
What can advanced fibrosis/cirrhosis cause in terms of liver enzyme levels?
Advanced fibrosis/cirrhosis can cause low enzyme levels due to few functioning liver cells remaining.
139
What percentage of adult-infected individuals develop chronic hepatitis B?
Hepatitis B becomes chronic in about 0.5 to 2.0% of adult-infected individuals.
140
What is the detection method for HBV?
HBV is detected by the presence of surface antigen, a protein on the virus's exterior.
141
What additional tests can be requested if HBV surface antigen is positive?
Tests for 'e' antigen, antibody to surface antigen, and antibody to core antigen can be requested.
142
What does the presence of HBV surface antigen indicate?
If confirmed positive, it indicates an active infection.
143
What is the leading cause of liver failure?
Hepatitis C is the leading cause of liver failure and transplantation.
144
What percentage of individuals infected with hepatitis C develop chronic infection?
Hepatitis C becomes chronic in 70-85% of infected individuals.
145
When does the antibody against HCV become detectable?
The antibody becomes detectable in 6 to 12 weeks following infection.
146
What is the definitive test for HCV?
The definitive test for HCV is a molecular test for hepatitis C RNA (HCV-RNA).
147
What drug was approved in 2013 for HCV treatment?
Sofosbuvir was approved by the FDA in 2013.
148
What are the cure rates for HCV with new drug combinations?
Cure rates approach 95%-99% even for difficult-to-treat HCV genotypes.
149
What is the only energy source used by the brain?
Glucose is the only energy source used by the brain.
150
What do high fasting glucose values indicate?
High fasting glucose values indicate impaired glucose tolerance or diabetes.
151
What happens to glucose levels after blood sample collection?
Glucose continues to be metabolized by red and white blood cells until the blood sample is centrifuged.
152
What is the gold standard test for evaluating diabetic risk?
Hemoglobin A1c (HbA1c) is the gold standard test for evaluating diabetic risk.
153
What is considered an abnormal hemoglobin A1c level?
Hemoglobin A1c is clinically considered abnormal if 6.0% or higher.
154
What is the half-life of red blood cells?
Red blood cells have a half-life of about 120 days.
155
What is the liver's role in the body?
The liver is a biosynthesis, storage, and detoxification center, and the largest internal organ.
156
What substances are synthesized by the liver?
Cholesterol, albumin, glucose, transferrin, and clotting factors are synthesized by the liver.
157
What are the five liver enzymes used as measures of liver well-being?
The five liver enzymes are AST, ALT, GGT, LDH, and alkaline phosphatase.
158
What are ALT and AST?
ALT and AST are transaminases elevated in most cases of hepatic disease.
159
What is the correlation between ALT levels and hepatitis C infection?
In hepatitis C infection, there is poor correlation between ALT levels and degree of organ damage.
160
What does AST elevation indicate?
AST elevation can be associated with alcohol damage to the liver and is more predictive of increased mortality risk compared to ALT elevation.
161
What are normal levels for aminotransferases?
Both aminotransferases are normally less than 45 International Units per liter (IU/L).
162
What can cause elevations greater than 1000 IU/L in aminotransferases?
Elevations greater than 1000 IU/L can occur with drug toxicity or acute viral hepatitis.
163
What are common causes of minor elevation of ALT?
Minor elevation of ALT is commonly caused by fatty liver and non-alcoholic steatohepatitis (NASH), both associated with obesity.
164
What do elevations of GGT and alkaline phosphatase indicate?
Elevations of GGT and alkaline phosphatase are associated with biliary obstruction or inflammation.
165
What does isolated elevation of alkaline phosphatase indicate?
Elevation of alkaline phosphatase in the absence of other liver enzyme elevations can indicate an extrahepatic origin, usually a bone disorder.
166
What can cause elevations in lactate dehydrogenase (LDH)?
Elevations in LDH can be associated with hemolytic or megaloblastic anemia, kidney disease, liver disease, or heart disease.
167
What are indirect markers of excess alcohol use?
Indirect markers include high HDL levels, liver enzyme elevations (especially GGT), smoking, and low blood urea nitrogen.
168
What are direct markers of alcohol use?
Direct markers include self-reported alcohol use and blood alcohol levels.
169
What is carbohydrate-deficient transferrin (CDT)?
CDT is a secondary confirmation method used to evaluate high liver enzyme results and high HDL.
170
What can cause false positive results for CDT?
Conditions causing false positives include primary biliary cirrhosis, a rare genetic variant of transferrin, and some types of anemia.
171
What lipoproteins are cholesterol present in?
Cholesterol is present in high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL).
172
What is the formula to calculate LDL?
LDL is calculated using the formula: LDL = total cholesterol - HDL - (triglycerides/5).
173
What does low HDL indicate?
Low HDL is a risk factor for the development of coronary disease.
174
What is the significance of apolipoprotein E (ApoE4)?
ApoE4 is a potential marker for the risk of Alzheimer's disease.
175
What characterizes insulin resistance syndrome (metabolic syndrome)?
It is characterized by high normal to minor elevations of cholesterol, triglycerides, glucose, high blood pressure, and low HDL in the presence of obesity.
176
What is Brain Type Natriuretic Protein (BNP)?
BNP is produced in response to increased stress on the heart muscle and/or heart failure.
177
What is the primary site of synthesis for proBNP hormone?
The heart is the primary site of synthesis for proBNP hormone.
178
What is NT-proBNP?
NT-proBNP is an independent predictor of mortality risk and can be abnormal when other cardiovascular disease markers are normal.
## Footnote
It helps differentiate risk in proposed Insureds who self-report heart disease.
179
What is the function of the kidneys?
The kidneys remove waste products, excess water, salts, and toxins from the blood.
180
How do the kidneys filter blood?
The glomeruli of the kidneys act as a selective mechanical filter, allowing small proteins and water-soluble substances into the urine.
181
What reflects kidney function?
Blood levels of creatinine and blood urea nitrogen (BUN) reflect the balance between their rates of production and removal by the kidneys.
182
What is creatinine?
Creatinine is the breakdown product of muscle creatine phosphate and serves as a measure of renal filtration and urine formation.
183
What factors affect serum creatinine levels?
Serum creatinine levels are impacted by muscle mass, age, and diet, particularly high meat intake.
184
What is BUN?
Blood urea nitrogen (BUN) is a by-product from the breakdown of protein and reflects its rate of production minus the rate of renal removal.
185
What can cause decreased BUN levels?
Decreased BUN levels can occur due to a low protein diet, pregnancy, or severe liver disease.
186
What is Cystatin C?
Cystatin C is a low molecular weight protein present in all nucleated cells, freely filtered by the kidneys, and increases with age-related decline in renal function.
187
What is the estimated Glomerular Filtration Rate (eGFR)?
eGFR estimates the volume of blood that the kidney filters per minute, commonly calculated using serum creatinine, age, and gender.
188
What is the normal lower limit of eGFR?
The lower limit of normal eGFR is generally considered to be 60 ml/min/1.73 m².
189
What happens if eGFR is lower than 60 ml/min?
If eGFR is lower than 60 ml/min, the individual is considered to have impaired renal function.
190
What are the common formulas for calculating eGFR?
The Rule (or Mayo) formula and the CKD-EPI formula are commonly used to calculate eGFR.
191
What is Albumin?
Albumin, produced in the liver, is the most abundant protein in blood and is decreased in conditions like starvation and cirrhosis.
192
What does low albumin indicate?
Low levels of albumin indicate that the individual requires additional evaluation.
193
What is Bilirubin?
Bilirubin is a breakdown product of heme in hemoglobin, excreted in bile, and can increase due to liver disease or biliary obstruction.
194
What can cause increased serum bilirubin?
Increased serum bilirubin can be due to liver disease, biliary obstruction, hemolytic anemia, or genetic variations like Gilbert's syndrome.
195
What is the mortality risk associated with isolated abnormal bilirubin levels?
The mortality risk associated with isolated, abnormal levels of bilirubin among insurance applicants is generally low.
196
What is globulin?
Globulin is comprised of proteins such as immunoglobulins (i.e., antibodies). It is calculated by subtracting albumin from total protein.
197
What do high levels of immunoglobulin indicate?
High levels of immunoglobulin can indicate an acute or chronic infection or inflammation, myeloma, or other malignancy, or a recently cleared infection.
198
What is myeloma?
Myeloma is a cancer of certain white blood cells characterized by high levels of a single specific antibody.
199
What is the significance of total protein?
Total protein is a measure of all the protein present in the serum minus the clotting factors, allowing for the calculation of the globulin fraction.
200
What is uric acid?
Uric acid is a metabolic product from the building blocks of DNA and RNA, with high values associated with renal disease, hypertension, gout, and use of thiazide diuretics.
201
What does a complete blood count (CBC) include?
A CBC includes red blood cell count, white blood cell count, hemoglobin, platelet count, and hematocrit.
202
What are tumor markers?
Tumor markers are substances produced by cancer cells or by the body in response to cancer.
203
What is Prostate-Specific Antigen (PSA)?
PSA is a protein produced in the prostate, with levels increasing in cancer, benign prostatic hypertrophy (BPH), and inflammation.
204
What does a total PSA level exceeding 10 ng/ml indicate?
A total PSA level exceeding 10 ng/ml usually leads to referral for additional testing as it suggests potential cancer spread.
205
What does a free PSA percentage of 25% or higher indicate?
A free PSA percentage of 25% or higher indicates a lower cancer risk.
206
What is Carcinoembryonic Antigen (CEA)?
CEA is produced in excess amounts by many solid tumors and is used to follow patients after treatment if their tumor was initially associated with a CEA elevation.
207
What is the significance of high CEA levels in tumor testing?
High CEA levels generally indicate that no cure for any tumor found is possible, increasing the test's value for insurers.
208
What is the use of tumor markers in insurance?
Tumor markers are used by some insurers for screening proposed insureds over age 50, utilizing higher reference cut-off values to limit false positives.
209
What are some common tests used for cancer screening?
Common tests include chest x-rays, genetic markers (e.g., BRCA1 and BRCA2), and mammography.
210
What does the BRCA genetic marker indicate?
BRCA is associated with an increased risk for breast and ovarian cancer, helping identify individuals at risk based on family history.
211
What are CA-19-9 and AFP used for?
CA-19-9 is a marker for gastrointestinal cancer, while alpha-fetoprotein (AFP) is used for liver and germ cell cancer.
212
What is genetic testing?
Genetic testing determines the risk of future diseases, including Alzheimer's, Huntington's, various cancers, and cardiovascular disease.
213
How can genetic tests reveal disease risk?
They can show diseases with a 100% chance of occurrence if positive (e.g., Huntington's disease) or diseases with some probability based on gene presence.
214
What is the role of genetic testing in cancer treatment?
Genetic testing of tumor cells helps determine treatment courses and predict outcomes for various cancers.
215
What is epigenetics?
Epigenetics studies chemical modifications of DNA and RNA that do not alter the base sequence but can be inherited.
216
How can epigenetic modifications be used in health assessments?
They can predict smoking behavior or determine if free-floating DNA in the bloodstream is from a malignant tumor.
217
What are mortality risk scores in laboratory reports?
Mortality risk scores reflect overall and individual risk based on laboratory tests and physical measurements.
218
Why are expected or reference range values rarely specified?
Different insurance companies and laboratories may have varying cut-off values, which can change over time.
ALU 101 12th Ed.
flashcards
Decks in class (15)
# Cards
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Diagnostic Tests368
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Build & Blood Pressure153
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Diabetes126
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Cancer153
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Coronary Artery Disease122
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Basic Lab Testing218
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Motor Vehicle Risk88
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Intro To Financial Underwriting106
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Life Insurance Products, Marketing, And Distribution152
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Contract Law And Legal Factors Affecting Underwriting143
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Aviation154
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Avocations, Professional Sports, And Occupations152
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International Risk78
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Insurance Regulation, Basic Compliance, And MIB113
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Underwriting Alcohol And Substance Use Disorders172
