Flashcards in Exam 1 - Urine Part 2 Deck (112)
What age group is more likely to get MM?
Older population (think around 70)
What is the name of the visual indicator seen with PEP to diagnosis MM?
What are the definitive tests for immunoglobulins in urine?
Electrophoresis and immunoelectrophoresis
What is the "CRAB" mnemonic to remember signs and symptoms associated with MM?
Calcium (elevated), Renal failure/dysfunction, Anemia, Bone lesions
What is the best next step to determine if a pathological fracture is due to osteoporosis (most common)?
Look at old films
If old films are not helpful or nonexistent when evaluating whether a pathological fracture is due to osteoporosis or not, what should the next move be?
Lab work: CBC, ESR, C-RP, BCP, UA
What are the steps when suspecting lytic metastasis as a cause for a pathological fracture due to findings on X-ray?
Bone scan ---> MRI ---> Biopsy
What are the steps when suspecting MM as a cause for a pathological fracture due to findings on X-ray?
PEP ---> Skeletal Survey ---> MRI ---> Biopsy
Why don't bone scans contribute to a MM diagnosis?
Lack of osteoblastic activity
Should we run bone scans when suspected MM?
NOPE - not sensitive for MM at all!
In the 3% of MM patients where the M-spike is not noted following PEP, what other test should be done?
Serum free light chain assay
What condition is present with a serum M protein level less than 3g/dL,
Monoclonal gammopathy of undetermined significance (MGUS)
What condition is present with a serum M protein level greater than 3g/dL, >10% bone marrow plasma cells present, and no CRAB signs and symptoms?
What condition is present with a serum M protein level greater than 3g/dL, >10% bone marrow plasma cells present, AND CRAB signs and symptoms?
What is the normal glucose measurement for urine?
What is the condition where blood glucose levels are okay, but glucose is being dumped into the urine?
Renal glycosuria (probably due to kidney disease affecting renal tubules and therefore lowering renal threshold levels)
What is the classic condition that causes hyperglycemia and glucosuria?
Why would ketones be found in the urine?
Due to lack of available sugar getting to the cells due to lack of insulin, so the body metabolizes fat for energy therefore forming the ketones instead (physiological cause)
What are ketones?
Byproduct of fat metabolism (used for energy when glucose isn't present)
What are examples of possible ketones?
Acetone, beta hydroxybutric acid, acetoacetic acid
Higher levels of ketones in the body indicate that what substance is being used as the major source of energy?
What does ketonuria indicate in diabetic patients?
What does ketonuria indicate in non diabetic patients?
Reduced carbohydrate metabolism and excessive fat metabolism
Where does bilirubin come from?
Formed in the reticuloendothelial system as a breakdown product of RBC/hemoglobin
Why can't unconjugated bilirubin pass through the glomerular filter?
Not water soluble
What conjugates the released bilirubin to make it become water soluble?
Glucuronic acid in the liver
What binds to bilirubin to transport it to the liver to be conjugated?
Where does direct/conjugated bilirubin then go?
Into bile then ultimately the small intestine
What would conjugated bilirubin in the urine indicate?
Obstruction to flow of bile from liver (possible gall stones, tumor, pancreatic cancer, liver inflammation/infection)