Biochemical Profile 2

Question 1

BUN

Answer 1

measures the amount of urea nitrogen in the blood

Question 2

when is urea formed?

Answer 2

in the liver as an end product of protein metabolism

transported to the kidneys for excretion

Question 3

BUN is related to?

Answer 3

metabolic function of the liver and extratory function of the kidneys

Question 4

azotemia

Answer 4

elevated blood levels of BUN

Question 5

creatinine

Answer 5

only renal disorders such as glomerulonephritis, tubular necrosis, reduced renal blood flow and obstruction can elevate serum levels

Question 6

creatinine is a better indicator for?

Answer 6

renal disease

better than BUN

Question 7

when do creatinine levels rise?

Answer 7

they tend to rise later and indicate chronicity

Question 8

what are the kidney function tests?

Answer 8

BUN and creatinine

Question 9

uric acid

Answer 9

a nitrogenous compound that is a product of puine catabolism

extreted by kidney and intestinal tract(to a smaller degree)

Question 10

hyperuricemia is associated with?

Answer 10

gout

Question 11

uric acid levels may be elevated in?

Answer 11

gout
renal disease
metastasis
multiple myeloma
alcoholism
leukemia

Question 12

gout of the big toe

Answer 12

podagra

Question 13

xray signs of gout

Answer 13

overhanging edge sign

swelling of soft tissues

Question 14

proteins

Answer 14

most significant factor for osmotic pressure

keeps fluids within the vascular space

Question 15

what are the proteins that make up most of the protein in the body?

Answer 15

albumin

globulin

Question 16

protein in the blood is increased in

Answer 16

multiple myeloma
dehydreation
chronic infection
malignancies

Question 17

protein in the blood is decreased in

Answer 17

liver disease
kidney disease
malabsorption

Question 18

albumin

Answer 18

formed in the liver and makes up 60% of the total protein

Question 19

what does albumin do?

Answer 19

helps regulate colloidal osmotic pressure and transports important blood constituents

Question 20

albumin is a measure of?

Answer 20

liver function

Question 21

albumin levels are decreased in?

Answer 21

liver disease
malnutrition
overhydration
inflammatory disease

Question 22

albumin levels are increased in?

Answer 22

dehydration

Question 23

how can proteins seem normal, but not?

Answer 23

if the albumin is low and globulins are high, then protein total can appear normal

Question 24

changes in the protein ratio can be detected by?

Answer 24

albumin/globulin ratio

Question 25

what is the normal A/G ratio?

Answer 25

1.0

Question 26

diseases that increase total proteins (particularly globulins), thus reversing the ratio

Answer 26

multiple myeloma malignancy inflammatory disease

Question 27

a reversed A/G ratio reflects?

Answer 27

overproduction of globulins

Question 28

if someone has multiple lytic destructive changes associated with lytic mets or multple myeloma, what tests do you need to order?

Answer 28

``` CBC ESR C-RP BCP UA serum protein electrophoresis radiographs specialized imaging bone marrow biopsy ```

Question 29

if labs suggest lytic mets, what happens next?

Answer 29

bone scan MRI biopsy

Question 30

if labs suggest multiple myeloma, what happens next?

Answer 30

PEP of urine and blood skeletal survey MRI biopsy

Question 31

common tetrad of multiple myeloma

Answer 31

``` CRAB Calcium elevated Renal disease Anemia Bone lesions ```

Question 32

lab findings for multiple myeloma

Answer 32

``` hypercalcemia hypercalciuria elevated ESR elevated protein in blood and urine M spike Rouleaux formation normocytic normochromic anemia reversed A/G ratio phosphorous normal alkaline phosphatase usually normal or low increased BUN and creatinine (kidney dysfunction) uric acid may be increased ```

Question 33

what malignancy is purely lytic?

Answer 33

multiple myeloma

Question 34

lytic lab results include

Answer 34

urine calcium levels increased serum calcium and phosphate normal or increased serum ALP normal or increased normocytic normochromic anemia

Question 35

blastic lab results include

Answer 35

``` serum calcium usually norma urine calcium low ALP increased acid phosphatase increased serum phosphorus variable normocytic normochromic anemia ```

Question 36

bilirubin

Answer 36

mesures excretory function of the liver

Question 37

describe bilirubin metabolism

Answer 37

breakdown of RBCs in RES hemoglobin released from RBCs is broken down into heme and globin heme-->bilirubin (unconjugated) liver converts it to conjugated bilirubin

Question 38

jaundice

Answer 38

yellow discoloration f tissue due to high levels of bilirubin

Question 39

what dysfunction is it if the unconjugated bilirubin is elevated?

Answer 39

hepatocellular dysfunction

Question 40

what dysfunction is it if the conjugated bilirubin is elevated?

Answer 40

liver disease | extrahepatic dysfunction

Question 41

bilirubin concentrations are elevated in the blood by?

Answer 41

increased production, decreased conjugation decreased secretion by the liver blockage of bile duct

Question 42

what do you do when you find elevated total bilirubin

Answer 42

check urine if it is positive for bilirubin, it is direct bilirubin need liver function tests if bilirubin is negative, it is indirect bilirubin means hemolysis, hematoma or Gilbert's syndrome

Question 43

bilirubin and urobilinogen in the urine for a healthy person

Answer 43

bilirubin- normal | urobilinogen- negative

Question 44

bilirubin and urobilinogen in the urine for liver/biliary disease

Answer 44

biliruin- increased | urobilinogen- positive

Question 45

bilirubin and urobilinogen in the urine for biliary obstruction

Answer 45

bilirubin- absent | urobilinogen- positive

Question 46

bilirubin and urobilinogen in the urine for hemolytic anemia

Answer 46

bilirubin- increased | urobilinogen- negative

Question 47

if there is primarily unconjugated hyperbilirubinemia, increased production could mean

Answer 47

hemolysis (intravascular or extravascular) ineffective erythropoiesis hematomas, pulmonary embolus

Question 48

if there is primarily unconjugated bilirubin, decreased hepetic uptake could mean

Answer 48

hereditary diseases | drugs

Question 49

if there is primarily unconjugated bilirubin, decreased glucouronidation coudl mean

Answer 49

hereditary disease (gilbert's syndrome) physiologic jaundice of a newborn breast milk jaundice severe liver disease

Question 50

if there is primarily conjugated hyperbiliruinemia, and there is decreased liver excretion, it could mean

Answer 50

``` acquired disorders (hepatitis, cirrhosis, drugs and toxins) or hepatic malignancy, primary or metastatic CHF shock sepsis toxemia of pregnancy hepatic trauma intrahepatic obstruction ```

Question 51

if there is primarily conjugated bhyperbilirubinemia, what extrahepatic biliary obstruction could this be?

Answer 51

``` congenital acquired cholecystitis choledocholithiasis tumors infection or external compression (structures, pancreatitis/tumor, parasites (ascaris) ```