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7 UA > EXAM 2 > Flashcards

EXAM 2 Flashcards

1
Q

Bense Jones protein test aka

A

Immunoglobulin light chain urine test

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2
Q

What are BJ (bence jones proteins)?

A

Small light chains of immunoglobulin produced by Neoplastic plasma cells

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3
Q

Are BJ proteins detected with routine urinalysis?

A

NO

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4
Q

What can detect BJ proteins?

A

Immunoelectrophoresis of urine

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5
Q

What does the presence of BJ proteins mean?

A

Presence of abnormal growth of plasma cells in the body (serious disorders)

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6
Q

What 4 big diseases are associated with Bence Jones Proteins?

A

1) Multiple Myeloma
2) Chronic lymphocytic leukemia (CLL)
3) Lymphoma
4) Metastatic lytic bone lesions

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7
Q

What are the 3 (unbolded) diseases associated with Bence Jones proteins?

A
  • Waldenstrom’s
  • End stage of renal failure
  • Amyloidosis
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8
Q

What is Multiple Myeloma?

A

A cancer of plasma cells, a type of white blood cell normally responsible for producing antibodies

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9
Q

Where do abnormal plasma cells accumulate in Multiple Myeloma?

A

In the bone marrow, where they interfere with the production of normal blood cells

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10
Q

Most cases of multiple Myeloma also feature ______

A

The production of BJ protein which causes kidney problems

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11
Q

Common symptoms of multiple Myeloma:

A

CRAB

C = Calcium
R = Renal failure
A = Anemia
B = Bone lesions
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12
Q

What are 3 clinical manifestations of Multiple Myeloma?

A

1) Bone pain
2) Fractures of bones due to lytic processes
3) Low counts of RBC, WBC, and platelets

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13
Q

What happens to the kidneys during Multiple Myeloma?

A

They can be damaged by the tubulopathic effects of proteins or BJ light chains

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14
Q

What are the nervous system symptoms of Multiple Myeloma?

A

Stroke like manifestations, numbness, and weakness

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15
Q

What does HCG stand for?

A

Human Chorionic Gonadotropin

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16
Q

What is (HCG) Human Chorionic Gonadotropin?

A

It is a hormone produced by placenta or malignant tumors

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17
Q

When will HCG be NORMALLY present in the urine?

A

Only during the pregnancy

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18
Q

HCG is found in the urine of males or non-pregnant females in what disorders?

A
  • Testicullar (seminoma) and ovarian cancers
  • Teratoma **
  • Choriocarcinoma (malignant trophoblastic cancer, usually of the placenta)
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19
Q

What types of cancers will you see when HCG is present in urine?

A

Stomach, pancreas, lungs, and liver

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20
Q

What would LOW levels of HCG in women represent?

A

Miscarriage, death of baby or embryo, or ectopic pregnancy

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21
Q

What disease can HIGH BLOOD level HCG be used as a screening for?

A

Screening of Down’s syndrome between 15-20 weeks of pregnancy

(It does NOT indicate 100% presence of disease *** )

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22
Q

What test is used to determine B12 deficiency?

A

Schilling’s

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23
Q

What 3 diseases will Schilling’s test be a great indicator of?

A

1) Megaloblastic anemia (pernicious anemia)
2) Nervous system pathology due to Vitamin B12 deficiency
3) General malabsorption syndrome whether the body adequately absorbs Vitamin B12

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24
Q

How can Schilling’s Test be performed?

A

May be performed in 4 different stages to find the cause of low absorption of Vitamin B12

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25
Q

Stage I of Schilling’s Test:

A

Low vitamin B12 level in food or diet

Megaloblastic Anemia

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26
Q

Stage II of Schilling’s Test:

A

Low intrinsic factor (problems with the stomach) causing low vitamin B12 level

(chronic atrophic gastritis, gastrectomy pernicious anemia)

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27
Q

Stage III of Schilling’s Test:

A

Abnormal bacterial growth causing the low Vitamin B12 absorption in ILEUM

(Tropical sprue, Celiac disease, Chron’s disease)

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28
Q

Stage IV of Schilling’s Test:

A

Low Vitamin B12 absorption caused by problems with the pancreas

(malabsorption syndrome, pancreatitis)

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29
Q

Who is a toxicology screen ordered by?

A

1) Hospital emergency
2) Sports
3) Workplace

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30
Q

When does a hospital order a toxicology report?

A
  • appears to be unconscious
  • demonstrates change in mental status
  • in dementia
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31
Q

What does a toxicology report check?

A

blood, urine, saliva, breath air, sweat, hair for presence of specified parent drugs or their metabolites

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32
Q

What tests are easier to do than blood tests and many drugs show up in the area?

A

Urine and Saliva

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33
Q

Traces of a drug may remain in urine _________ than in blood

A

Longer

within the last 5 days

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34
Q

What type of test is used to identify if mood altering drugs were taken several hours or days before the urine sample was collected?

A

Urine toxicology test

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35
Q

What 3 drugs are screened for in a urine toxicology test?

A

Marijuana, Cocaine, and Amphetamines

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36
Q

How long is Marijuana in the urine for?

A

1 hour after use up to 7-10 days; and in heavy users up to 30 days

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37
Q

How long is cocaine in your system for?

A

1-4 hours after use for 2 to 5 days; and in heavy users up to 7-10 days

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38
Q

How long are amphetamines in your system for?

A

About 3 hours after use for 1-2 days

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39
Q

What are 3 other common drugs found in urine?

A
  • Narcotic alkaloids: Morphine, Heroine, and Codeine
  • Alcohol
  • Steroids
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40
Q

How long are narcotic alkaloids in the urine for?

A

2 hours after use for 2-3 days

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41
Q

How long is alcohol present in urine?

A

6-24 hours

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42
Q

How long are steroids present in urine?

A

3-30 days

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43
Q

What do most toxicology tests determine?

A

Only the presence of drugs in the body (so called QUALITATIVE testing) and NOT the QUANTITY

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44
Q

What do EIA’s (enzymatic immunoassay tests) determine? **

A

They are antibody based. Useful in detection of classes of drugs but cannot determine a SPECIFIC drug

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45
Q

What detects EXACTLY what types of drugs are present?

A

Gas chromatography and mass spectroscopy

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46
Q

What is the Gold Standard of drug testing?

A

Urine Toxicology

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47
Q

What is performed on every specimen to ensure the urine has not been altered?

A

Urine specific gravity, constant urine temperature, and creatinine concentration

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48
Q

What is a product of the metabolic breakdown of purine nucleotides?

A

uric acid

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49
Q

What percentages of uric acid are excreted, and where?

A

75% of this uric acid is excreted by the kidneys and 25% is excreted in the intestinal tract

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50
Q

Uric acid concentrations in urine above and below normal are known as:

A

Hyperuricosuria and Hypouricosuria

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51
Q

Uric acid level can also be checked by:

A

Using blood test

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52
Q

What are the normal values of uric acid?

A

250-750 mg per 24 hours

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53
Q

What is hyperuricosuria associated with?

A
  • Gout
  • Metastatic Cancer
  • Multiple Myeloma
  • Cancer Chemotherapy
  • High purine diet
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54
Q

What are uricosuric drugs?

A

Ascorbic acid, calcitonin, estrogens, steroids, and salicylates

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55
Q

What is Hypouricosuria?

A

Kidney diseases

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56
Q

What are the kidney diseases?

A
  • Chronic glomerulonephritis
  • Eclampsia
  • Chronic alcohol ingestion with kidney pathology
  • lead toxicity with kidney pathology
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57
Q

Creatinine is a product of _____

A

Muscle Metabolism

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58
Q

What does a creatinine clearance test measure?

A

How well creatinine is removed from blood by the kidneys, how well kidneys are working

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59
Q

What does a creatinine clearance test require?

A

Urine and Blood sample

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60
Q

What gives better information, Blood creatinine test or Creatinine clearance ?

A

A creatinine clearance

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61
Q

What is an indicator of the kidney’s filtering unit function?

A

creatinine level in urine

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62
Q

What are normal urine values of urine creatinine?

A

(24 hour sample)

500-2000 mg/day

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63
Q

What is the average MALE urine creatinine per minute?

A

107-139 mL/min per minute

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64
Q

What is the average FEMALE urine creatinine per minute?

A

87-107 mL/min

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65
Q

What happens to creatinine clearance values as you get older?

A

Normally go down

normal values go down by 6.5 mL/min for every 10 years past the age of 20

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66
Q

What would HIGH creatine clearance test be the result of?

A
  • strenuous exercise
  • pregnancy
  • muscle injury (crushing)
  • burns
  • hypothyroidism
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67
Q

What would LOW creatine clearance test be the result of?

A
  • serious kidney damage (infection, shock, low blood flow to kidneys, and cancer)
  • urinary tract blockage
  • heart failure
  • dehydration
  • liver disease (cirrhosis)
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68
Q

What is BUN?

A

Blood Urea Nitrogen

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69
Q

What is BUN (blood urea nitrogen)?

A

A substance formed in the liver through an enzymatic protein breakdown process

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70
Q

What is Urea?

A

The waste product of protein metabolism and normally removed from the blood by the kidneys

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71
Q

What is BUN (blood urea nitrogen) a measurement of?

A

Kidney’s excretory function and liver metabolic function

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72
Q

What is the normal result of BUN?

A

6-20 mg/dL in the blood

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73
Q

Why would blood urea nitrogen be physiologically increased?

A

High dietary protein intake and athletes with a lot of muscle mass

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74
Q

Abnormally high blood levels of BUN and creatine is known as _____ *****

A

Azotemia **

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75
Q

What are the 3 types of Azotemia?

A

1) Prerenal
2) Renal
3) Postrenal

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76
Q

What is prerenal azotemia?

A

Without primary involvement of the urinary system

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77
Q

Prerenal Azotemia is associated with:

A
  • Hypovolemia due to GI bleeding, dehydration, shock
  • Excessive protein ingestion (alimentary tube feeding)
  • Starvation
  • Excessive protein catabolism (burns, sepsis)
  • Congestive heart failure
  • Myocardial infarction
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78
Q

What is Renal Azotemia due to ?

A

Primary kidney diseases

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79
Q

What is Renal Azotemia associated with?

A

Renal Failure and Nephrotoxic drugs

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80
Q

What is post renal azotemia due to?

A

Primary lower urinary tract involvement

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81
Q

What is post renal azotemia associated with?

A

Lower urinary tract obstruction with abnormal or inadequate excretion of urine

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82
Q

Decreased BUN level develops in what pathologies?

A
  • Liver failure (cirrhosis)
  • Overhydration
  • Negative Nitrogen balance (a diet low in protein, malabsorption)
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83
Q

What is Acid Phosphatase ?

A

An enzyme found throughout the body

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84
Q

Where is Acid Phosphatase found?

A

Different organs: Prostate gland, spleen, pancreas, liver, heart, muscle, kidneys, bones, red blood cells, platelets

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85
Q

What has 100 x’s more Acid Phosphatase than any other body tissue (pAP)?

A

Prostate Gland

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86
Q

Increased serum levels of Acid Phosphatase is useful in the diagnosis of what diseases?

A
  • Prostate cancer Mets to the bone*
  • Systemic Infection
  • Anemia
  • Multiple Myeloma
  • Thrombophlebitis
  • Paget’s Disease
  • Hepatitis
  • Kidney Diseases
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87
Q

What can determine from which tissue the enzyme is coming, from prostate or RBC?

A

Blood test on Acid Phosphatase

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88
Q

Short-term increase of Acid Phosphatase is possible after:

A
  • Digital rectal exam
  • Catheterization
  • Biopsy of prostate gland
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89
Q

What is a Prostate Specific Antigen?

A

A protein that is produced by the prostate gland

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90
Q

What blood level is often elevated in men with prostate problems (benign path or cancer)?

A

Blood level of PsA

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91
Q

What must the PsA be analyzed in conjunction with?

A

PsA test must be analyzed in conjunction with digital rectal exam

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92
Q

High level of PsA and enlargement of the prostate during digital rectal exam may indicate:

A

Benign prostate hyperplasia, prostatitis (mostly due to venereal disease)

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93
Q

High level of PsA and Normal or Small size of prostate on the digital exam may indicate:

A

Prostate Cancer

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94
Q

What is the only thing that can be used for diagnosis of prostate cancer?

A

Prostate Biopsy

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95
Q

< 50 y/o PsA level =

A

Less than 2.5 ng/ml

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96
Q

50-59 y/o PsA level =

A

Less than 3.5 ng/ml

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97
Q

60-69 y/o PsA level =

A

Less than 4.5 ng/ml

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98
Q

> 70 y/o PsA level =

A

Less than 6.5 ng/ml

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99
Q

When is PsA test NOT recommended?

A

Screening men over 75 y/o because with age PsA is normally increased

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100
Q

Aspartate aminotransferase aka

A

Serum Glutamic Oxalacetic Transaminase SGOT

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101
Q

What is Aspartate Aminotransferase ?

A

Intracellular enzyme found in:

liver, cardiac muscle, skeletal muscle, kidney, pancreas, brain, RBC

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102
Q

Low levels of AST are normally found ______

A

in the blood

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103
Q

When do AST (aspartate aminotransferase levels rise)?

A

In 6-10 hours after severe damage of afore-mentioned tissue, and remain high for about 4 days

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104
Q

When will blood level of AST increase?

A
  • Liver parenchymal cell damage
  • myocardial infarction
  • skeletal muscle trauma
  • acute renal disease
  • acute pancreatitis
  • severe burns
  • hemolytic anemias
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105
Q

Alanin Aminotransferase (ALT) aka

A

Serum glutamic pyruvic transaminase (SGPT)

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106
Q

What is Alanin Aminotransferase (aka serum glutamic pyruvic transaminase SGPT)?

A

An intracellular enzyme found predominantly in the liver, less in the kidneys, pancreas and heart

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107
Q

Low levels of ALT are normally found ____

A

In the blood

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108
Q

Most increases in ALT are caused by _____

A

Liver damage:

  • hepatitis
  • cirrhosis
  • liver toxins
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109
Q

Where can ALT elevate in?

A

Congestive heart failure and infectious mononucleosis

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110
Q

ALT can naturally elevate when?

A

Physiological blood level increase - after strenuous physical exercise

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111
Q

What is Gamma Glutamyl Transpeptidase (GGTP)?

A

An enzyme found in many tissues, most prevalent in the cell membranes of hepatobiliary system (liver, billiary system), pancreas, kidney, heart

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112
Q

What 2 important times would you see GGTP elevated?

A
  • Biliary system disorder (provided Alkaline Phosphatase blood level is increased)
  • Pancreatitis (provided lipase and amylase blood levels are increased)
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113
Q

What is Alkaline Phosphatase (ALP)?

A

An enzyme found predominantly in liver, bile ducts, bones, and less present in kidneys, placenta, and intestines

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114
Q

What does Alkaline Phosphatase (ALP) do?

A

Helps breakdown proteins in the body

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115
Q

When will ALP NORMALLY be found (no pathology)?

A
  • Rapidly growing children
  • Pregnant women
  • Bone healing after fracture
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116
Q

Abnormally high alkaline phosphatase ALP level is found in what MAJOR disorders?

A

1) Biliary tract obstruction (along with increased blood level of GGTP)
2) Osteoblastic Bone tumors (Paget’s where GGTP blood level is NOT increased)
3) Hepatitis (in conjunction with increased blood levels of ALT, AST, GGTP)

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117
Q

Abnormally high ALP blood levels are in what children’s disease?

A

Osteomalacia (Rickets)

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118
Q

Biliary tract obstruction has what 2 levels high ?

A

ALP and GGTP

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119
Q

Osteoblastic bone tumors have (pagets) have what blood levels high?

A

ALP

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120
Q

Hepatitis has what blood levels increased?

A

ALP, ALT, AST, GGTP

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121
Q

When is abnormally low ALP blood level found?

A
  • Protein malnutrition (e.g. Celiac disease)

- Deficiency in vitamins and minerals (osteoporosis and Vit D)

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122
Q

Lactic Acid Dehydrogenase aka

A

Lactate Dehydrogenase (LDH)

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123
Q

What is an enzyme that helps produce energy?

A

Lactic Acid Dehydrogenase aka Lactate Dehydrogenase (LDH)

124
Q

Lactic Acid Dehydrogenase is present in many tissues, what are they?

A

heart muscles, blood cells, skeletal muscles, liver, pancreas, brain, and lungs

125
Q

When does Lactic Acid Dehydrogenase become elevated?

A

In response to cell damage

126
Q

Lactate Dehydrogenase exists in ______

A

FIVE isoenzyme forms

127
Q

What is the Lactate Dehydrogenase test usually screened for?

A

Tissue damage

acute vs chronic

128
Q

LDH levels can raise when?

A

In cancers, so LDH may be used as a tumor marker, but at the same time, it is NOT useful in a specific cancer

129
Q

In the event of myocardial injury the serum ______

A

LDH levels will rise within 24-48 hours after myocardial infarction onset, peak in 2-3 days and return to normal in 5-10 days

130
Q

What is LDH (lactate dehydrogenase) extremely useful for?

A

DELAYED diagnosis of myocardial infarction

131
Q

The use of LDH to diagnose infarction has been largely superseded by the use of ______

A

Troponin I or T measurement

132
Q

What does the “Troponin Test” measure?

A

The levels of certain proteins called Troponin T and Troponin I in the blood

133
Q

When does Troponin T and I get released?

A

When the heart muscle has been damaged, such as (Heart Attack)

134
Q

The more damage of the heart, the greater the amount of ______ in the blood

A

Troponin T and I

135
Q

Can cardiac Troponin levels normally be detected?

A

No, they are normally very low

136
Q

What levels will be increased within 6 hours from the beginning of a heart attack?

A

Troponin (after 12 hours almost everyone who has had a heart attack will have raised levels)

137
Q

What may remain high for 1-2 weeks after a heart attack onset?

A

Troponin levels

138
Q

What is Creatine Phosphokinase (CPK)? Where is it found?

A

An ENZYME found mainly in the brain, lungs, heart, and skeletal muscles

139
Q

What is CPK Creatine Phosphokinase made of?

A

1) CPK-1
2) CPK-2
3) CPK-3

140
Q

CPK-1 aka

A

CPK-BB

141
Q

CPK-2 aka

A

CPK-MB

142
Q

CPK-3 aka

A

CPK-MM

143
Q

Where is CPK-1 (CPK-BB) found?

A

Brain and lungs

144
Q

Where is CPK-2 (CPK-MB) found?

A

Mostly in heart

145
Q

Where is CPK-3 (CPK-MM) found?

A

Mostly in skeletal muscle

146
Q

Increased CPK-1 (BB) levels may be due to?

A
  • Brain cancer
  • Brain injury
  • electroconvulsive therapy
  • pulmonary infarction
  • seizure
147
Q

CPK-2 (MB) levels rise 3-6 hours after _______

A

A heart attack onset

148
Q

When would CPK-2 levels NOT usually rise?

A
  • Chest pain caused by angina
  • Pulmonary embolism (blood clot in the lung)
  • Congestive heart failure
149
Q

What is increased CPK-3 (MM) levels usually a sign of?

A

Muscle injury or muscle stress

150
Q

Increased CPK-3 (MM) may be due to:

A
  • crush injuries
  • muscle damage due to drugs or being immobile (rhabdomyolysis)
  • muscular dystrophy
  • myositis (skel muscle inflamed)
  • recent seizures
  • recent surgery
  • strenuous exercise
151
Q

What is a test that measures the myoglobin in the blood?

A

Blood (serum) myoglobin

152
Q

What can myoglobin affect? When is it released?

A

When muscle is damaged, myoglobin is released into the bloodstream. The kidneys help remove myoglobin from the body into urine. In large amounts myoglobin can damage kidneys

153
Q

Serum myoglobin levels may be obtained to confirm ______

A

Suspected muscle damage, including heart and skeletal muscle damage

154
Q

What is a normal (negative) result of myoglobin?

A

0-85 ng/mL

155
Q

What can be the result of a positive myoglobin result?

A
  • heart attack (3 hours)
  • muscular dystrophy
  • rhabdomyolysis
  • myositis
  • skeletal muscle ischemia
  • skeletal muscle trauma
156
Q

All blood proteins are synthesized ______

A

In the liver

157
Q

All blood proteins are synthesized in the liver, but what is the only exception?

A

Gamma-globulins (IG) which are synthesized in lymph nodes

158
Q

High protein diet causes a high blood protein level t/f?

A

FALSE

159
Q

What do Albumins do in the blood?

A

Maintain colloid osmotic (oncotic) pressure within the plasma, preventing plasma loss from the blood vessels, and transport the insoluble molecules

160
Q

What is a normal level of Albumin in the blood?

A

3.5-5 g/dl

161
Q

What part of the blood participate in immune reactions?

A

Globulins, and normal level is 2-2.5 g/dl

162
Q

What is the normal albumin to globulin ratio?

A

Greater than 1 ( ~ 1.4)

163
Q

What is the normal range of fibrinogen in the blood?

A

.2 - .45 g/dl

164
Q

Increased serum albumin levels can be found in:

A

Dehydration

165
Q

Decreased serum albumin levels are found in:

A
  • advanced malignancy
  • liver disease
  • crohn’s
  • starvation
  • nephrotic syndrome
  • kwashiorkor
  • hypertensive disorders of pregnancy
166
Q

Increased globulin levels are found in:

A
  • liver diseases (acute or chronic hep BCD)
  • amyloidosis
  • multiple myeloma
  • leukemias
  • lymphomas
167
Q

Decreased fibrinogen can be found in?

A

Liver cirrhosis

168
Q

The total protein test measures the total amount of 2 proteins:

A

albumin and globulin

169
Q

Normal range of Total Protein is:

A

6 - 8.3 gm/dL

170
Q

What is the total protein test usually done to diagnose?

A

Nutrient problems, kidney disease and liver disease

171
Q

If total protein is abnormal, what will you need?

A

More tests to be done to look for the exact cause of problem

172
Q

When can total protein be increased?

A

During pregnancy

173
Q

Higher than normal levels may be due to:

A
  • chronic inflammation of infection (hep B,C,D, AIDS)
  • multiple myeloma
  • Waldenstrom macroglobulinemia
174
Q

Lower than normal blood protein levels may be due to:

A
  • Agammaglobulinemia
  • bleeding (hemorrhage)
  • burns (extensive)
  • glomerulonephritis (nephrotic syndrome)
  • liver diseases (cirrhosis)
  • protein malnutrition
  • malabsorption syndrome
175
Q

What 2 ways is blood glucose measured?

A

Fasting: After not eating for at least 8 hours

Random: At any time of the day

176
Q

What is normal Fasting blood glucose level?

A

70-100 mg/dL

177
Q

What is random blood glucose test numbers?

A

Most of the time blood glucose levels will be below 125 mg/dL

178
Q

What is Hypoglycemia?

A

Means blood glucose level < 70 mg/dl

179
Q

What is Hyperglycemia means?

A

Blood glucose level is > 125 mg/dl

180
Q

What does Fasting blood glucose level of 100-125 mg/dL mean?

A

A type of prediabetes. This increases risk of type 2 diabetes

181
Q

A level of fasted glucose test (126 mg/dL) and higher indicates?

A

Diabetes Mellitus

182
Q

Higher than normal random blood glucose levels may be a sign of:

A

Diabetes, or that the diabetes is not well controlled

183
Q

What are the 2 types of hyperglycemia?

A

persistent and transient

184
Q

Persistent Hyperglycemia is present with what diseases?

A
  • diabetes mellitus
  • pancreatitis
  • pancreatic tumor
  • pheochromocytoma
  • cushing’s syndrome
185
Q

What diseases would be associated with Transient Hyperglycemia (stress hyperglycemia)?

A
  • stroke
  • heart attack
  • after surgery
  • shock
  • severe liver damage
186
Q

What are the 2 types of HYPOglycemia?

A

persistent and transient

187
Q

What diseases would be found with Persistenhypglycemia?

A
  • insomula
  • addison’s disease
  • ectopic insulin production

(eg: ovarian carcinoid, mesotheliomas, liver, kidney, lung cancer)

188
Q

What diseases are associated with Transient hypoglycemia?

A
  • acute alcohol intoxication
  • severe glycogen storage disease
  • strenuous exercises
  • overdosage of insulin or other diabetic medicines
189
Q

What does the glucose screening tolerance test measure?

A

Body’s ability to break down glucose, that is the body’s main source of energy

190
Q

Glucose tolerance tests are one of the tools used to screen:

A

Prediabetes vs Type 2 diabetes, or gestational diabetes

high blood glucose between 24-28 weeks of pregnancy

191
Q

What is a patient not supposed to do before a glucose tolerance test?

A

Not eat or drink anything at least 8 hours before the test, and not eat during the test

192
Q

What does the patient do DURING a glucose tolerance test?

A

Patient drinks a liquid containing glucose (75 grams)

193
Q

During a glucose tolerance test, when will a patients blood test be taken?

A

Every 60 minutes after drinking the solution

test takes 4 hours

194
Q

Normal blood values for a 75 gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant, fasting:

A

70-100 mg/dL

195
Q

Normal blood values for a 75 gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant, 1 hour:

A

less than 200 mg/dL

196
Q

Normal blood values for a 75 gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant, 2 hours:

A

less than 140 mg/dL

197
Q

Normal blood values for a 75 gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant, 3 hours:

A

less than 125 mg/dL

198
Q

Normal blood values for a 75 gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant, 4 hours:

A

less than 115 mg/dL

199
Q

During the glucose tolerance test, a glucose level that is higher than normal could mean:

A

prediabetes, diabetes type 2, gestational diabetes

200
Q

2 hours after beginning the glucose tolerance test, if glucose level is 140-199 mg/dL, what is it called?

A

Impaired glucose tolerance, could also be called prediabetes

201
Q

2 hours after beginning glucose tolerance test, if glucose level is 200 mg/dL or higher it’s a sign of ______

A

Diabetes (type 2 or gestational)

202
Q

A high glucose level may be related to another medical problem _____

A

Cushing Syndrome

203
Q

Where are Ketones produced?

A

In the liver when fat cells break down

204
Q

What is a serum ketone test?

A

A measurement of how many ketones are in the blood, and to diagnose ketoacidosis

205
Q

Are there normally ketones in the blood?

A

NO

206
Q

What would a positive ketone blood test indicate?

A
  • alcoholic ketoacidosis
  • diabetic ketoacidosis
  • starvation
  • uncontrolled blood glucose in diabetics
207
Q

When could Transient ketoacidosis be present?

A

In children at age < 16 after they ate a lot of meat, chocolate, fast food, or soft beverages

208
Q

What is Amylase?

A

An enzyme which is produced by Pancreas and Salivary glands, may be found in blood and urine

209
Q

Blood amylase test is sensitive but usually requires _____

A

Confirmation by urine amylase test

210
Q

Decreased amylase levels may occur due to:

A

Cancer of pancreas or damage to pancreas (pancreonecrosis)

211
Q

Increased blood and urine amylase levels may occur due to:

A
  • acute pancreatitis
  • chronic pancreatitis
  • cancer of the pancreas (mets to ovaries or lungs)
  • infection or blockage of the salivary glands (mumps)
212
Q

What is Lipase?

A

A protein (enzyme) released by the Pancreas into the small intestine. It helps the body absorb fat

213
Q

What is lipase test usually used for?

A

Disease of pancreas, most often acute pancreatitis

214
Q

Higher than normal lipase levels may be due to:

A
  • Acute or chronic pancreatitis
  • bowel obstruction
  • celiac disease
  • penetration of peptic ulcer to pancreas
  • cancer of the pancreas
  • infection or swelling of the pancreas
215
Q

What is cholesterol?

A

A waxy, fat-like substance that’s found in all cells of the body

216
Q

What is cholesterol required for?

A

Production of steroids, sex hormones, bile acids, cellular membranes, and Vitamin D

217
Q

What are the 3 types of lipoproteins?

A

LDL
HDL
VLDL

218
Q

What does low density lipoprotein (LDL) contain?

A

A higher ratio of cholesterol to protein and are thought of as “bad” cholesterol

219
Q

What does high density lipoprotein (HDL) contain?

A

Made up of a higher level of protein and lower level of cholesterol

220
Q

What is a lipid profile?

A

It is a panel of blood tests that serves as an initial broad medical screening tool for abnormalities in lipids, (cholesterol and triglycerides)

221
Q

The lipid profile typically includes:

A
  • LDL
  • HDL
  • triglycerides
  • total cholesterol
222
Q

Why is LDL called bad cholesterol?

A

Because it picks up cholesterol from liver, takes it to an artery wall creating plaques

223
Q

A high LDL level is related to HIGHER risk of heart disease t/f

A

TRUE

224
Q

HDL is called “good” why?

A

Because it removes excess cholesterol from the tissue and takes it back to the liver

225
Q

What does VLDL transport?

A

Endogenous triglycerides, phospholipids and cholesterol to adipose tissue

226
Q

What are the normal levels of LDL

A

lower than 130 mg/dL

227
Q

What is normal HDL?

A

greater than 40-60 mg/dL

228
Q

What is total cholesterol?

A

160-200 mg/dL

229
Q

What are triglycerides numbers?

A

10-150 mg/dL

230
Q

What is normal VLDL numbers?

A

2-30 mg/dL

231
Q

What is the best ratio of total cholesterol/HDL?

A

below 5:1

232
Q

Optimal LDL/HDL ratio is less than?

A

3.5 : 1

233
Q

What is associated with total cholesterol < 160 mg/dL?

A
  • hemorrhagic stroke
  • depression
  • reduced synthesis of hormones
  • could indicate liver cancer
234
Q

When are triglycerides elevated ?

A

In obese or diabetic patients. Level increases from eating simple sugars or drinking alcohol, associated with heart and blood vessel diseases

235
Q

What is Alpha fetoprotein (AFP)?

A

A protein normally produced by the liver and yolk sac of a developing baby during pregnancy

236
Q

What is the normal levels of Alpha Fetoprotein (AFP)?

A

generally 0-40 mg/liter

237
Q

What is the normal levels of Alpha Fetoprotein (AFP) in pregnant women?

A

with 14-22 weeks of pregnancy 10-130 micrograms/liter

238
Q

During pregnancy, The AFP test can be done with _____ ?

A

Amniocentesis to help detect spina bifida or other birth defects in the developing baby

239
Q

If the fetus has an open neural tube defect, what would you think happened?

A

AFP is thought to leak directly into the amniotic fluid causing unexpectedly high concentrations of AFP

240
Q

What are the environmental risk factors for neural tube defect NTD?

A
  • folic acid deficiency
  • anti-seizure medication (vampiric acid)
  • uncontrolled diabetes
  • alcohol
  • obesity
  • increased body temperature
241
Q

Higher than normal levels ( >40) of AFP in men and non-pregnant women may be due to:

A
  • cancer of testes, ovaries, biliary tract, liver, stomach, pancreas
  • liver cirrhosis
  • malignant teratoma
  • recovery from hepatitis
242
Q

High level of AFP ( > 130) in the mother’s blood between 14th and 22nd weeks of pregnancy may be due to:

A
  • birth defects, anencephaly, spina bifida, abdominal wall defect, tetralogy of Fallot
  • gene disorder (Turner Syndrome aka 45 XO)
  • intrauterine death (usually results in a miscarriage)
  • multiple pregnancy (twins, triplets, etc.)
243
Q

LOW level of AFP in pregnant woman could indicate:

A

Down’s syndrome, or Edward’s syndrome (Trisomy 18)

244
Q

What are antinuclear antibodies?

A

Substances produced by the immune system that attack the body’s own tissues

245
Q

Is ANA (antinuclear antibodies) normally in blood?

A

No (normally negative test)

246
Q

ANA is reported as a ____

A

“Titer”

1:40 to 1:60

247
Q

ANA (antinuclear antibodies) does not confirm ______

A

A diagnosis of systemic lupus erythematosus (SLE) without the double stranded form of DNA (anti-dsDNA)

248
Q

A positive ANA can also be a sign of other autoimmune diseases:

A
  • chronic liver disease
  • vasculitis
  • dermatomyositis
  • rheumatoid arthritis
  • Sjogren syndrome
  • scleroderma
249
Q

What are Anti-dsDNA antibodies?

A

A group of anti-nuclear antibodies and their target antigen is double stranded DNA

250
Q

What are Anti-dsDNA antibodies highly diagnostic of?

A

Systemic Lupus Erythematosus (SLE) and are implicated in the pathogenesis of lupus nephritis

251
Q

What blood tests are routinely performed to detect anti-dsDNA in diagnostic labs?

A
  • enzyme linked immunosorbent assay (ELISA)

- Immunofluorescence

252
Q

Anti-dsDNA antibodies can also be found:

A
  • rheumatoid arthritis
  • viral infection (e.g. HIV, Epstein-Barr virus)
  • autoimmune hepatitis
253
Q

What is Antistreptolysin O (ASO) titer?

A

A blood test to measure antibodies against streptomycin O, a substance produced by group A Streptococcus

254
Q

What are the acceptable values, where there is no clinical suspicion of Streptococcus infection?

A

Adults: less than 200 units

Children: less than 400 units

255
Q

The presence of Antistreptolysin O ASO indicates:

A

Exposure to the bacteria, and it does NOT indicate disease

256
Q

If Antistreptolysin O ASO is greatly elevated, (>200), what happens?

A

Antibody levels rise after 1-3 weeks of streptococcal infection and peaks in 3-5 weeks then falls back to insignificant levels in 6 months

257
Q

What is the main thing you need to look for when identifying antistreptolysin O ASO?

A

Lab values need to be correlated with clinical manifestations

258
Q

If Antistreptolysin O ASO test is positive, with symptoms of a previous infection by group A Streptococcus it indicates:

A
  • rheumatic fever
  • scarlet fever
  • bacterial endocarditis
  • acute glomerulonephritis
  • strep throat
259
Q

C-reactive protein CRP is produced by the ____

A

liver

260
Q

CRP test is a general test to check for _____

A

inflammation and destruction in the tissue

NOT SPECIFIC

261
Q

Generally there is/isn’t CRP detectable in the blood?

A

IS NOT

262
Q

What might a CRP test indicate:

A
  • cancer
  • connective tissue damage (rheumatoid arthritis, rheumatic fever, SLE)
  • heart attack (positive CRP test after 18-72 hours of MI)
  • infection (pneumonia, TB)
  • inflammatory bowel disease (IBD)
263
Q

What is a sensitive test that is used to determine a person’s risk for heart disease?

A

A more sensitive CRP test, called:

High-Sensitivity C Reactive Protein (hs-CRP)

264
Q

According to the AHA (american heart ass.) CRP levels are:

A
  • low risk = CRP level lower than 1.0mg/L
  • average risk = CRP levels are 1-3 mg/L
  • high risk = CRP levels HIGHER than 3.0 mg/L
265
Q

What may HIV (human immunodeficiency Virus) tests use and detect?

A

HIV tests may use serum, saliva, or urine and may detect antibodies, antigens or viral RNA

266
Q

What is the initial HIV test based on?

A

Based on the enzyme like immune assay (ELISA) method, detects presence of antibodies

267
Q

What is the Second HIV test based on?

A

Wester Blot, determines the antibodies: method more complicated. ELISA results are not reported as positive unless confirmed by a Western Blot

268
Q

The combo of what 2 HIV test is highly accurate?

A

Initial and Second test

if it is negative the test must be repeated 3-6 months

269
Q

What detects the genetic material of HIV itself?

A

PCR (polymerase chain reaction) test

  • Identifies HIV in blood within 2-3 weeks of infection
270
Q

What is PCR (polymerase chain reaction test) also used for?

A

Babies born to HIV positive mothers, because their blood contains their mother’s HIV antibodies for several months

271
Q

What is HLA-B27?

A

A blood test to look for a protein that is found on the surface of white blood cells

272
Q

What is the protein that is found on the surface of white blood cells?

A

Human Leukocyte Antigen B27 (HLA-B27)

273
Q

What are HLA’s?

A

Proteins that help the body’s immune system tell the difference between its own cells and foreign, harmful substances

274
Q

Why would you order a HLA-B27 test?

A

A patient complains of joint stiffness, pain, swelling

275
Q

What else is HLA antigen testing used to do?

A

HLA antigen testing is also used to match donated tissue in a person who is getting organ transplant

276
Q

What is the positive/negative testing with HLA-B27?

A

Normal (negative) result means HLA-B27 is absent, a positive test means HLA-B27 is present

277
Q

What does a positive test for HLA-B27 mean?

A

A greater than average risk for developing or having certain autoimmune disorders

278
Q

What are the autoimmune disorders associated with positive HLA-B27?

A
  • psoriatic arthritis
  • AS
  • IBD
  • Reiter’s Syndrome
  • Uveitis (iritis)
279
Q

What is Rheumatoid Factor defined as?

A

An autoantibody against the Fc portion of IgG

280
Q

Where is Rheumatoid factor (RF) found?

A

It was first found in rheumatoid arthritis in 80% of cases

281
Q

Where is positive RF found in?

A
  • Sjogren’s syndrome
  • SLE
  • dermatomyositis
  • sarcoidosis
  • scleroderma
  • chronic hepatitis
282
Q

What does Prothrombin Time (PT) measure?

A

A blood test that measures how long it takes blood to clot

283
Q

What can prothrombin Time PT test check?

A
  • bleeding problems
  • whether medicine to prevent blood clots is working
  • presence of clotting factors I, II, V, VII, and X
  • Liver damage
  • Vit K
284
Q

What are normal values of Prothrombin Time (PT) test?

A

11-13.5 seconds

285
Q

Most ammonia in the body forms when protein is broken down by ______

A

bacteria in intestines

286
Q

What does the liver do in regard to ammonia?

A

The liver normally converts ammonia into urea, which is then eliminated in urine

287
Q

Normal values of Ammonia test are:

A

15-60 micrograms/dl

288
Q

High levels of ammonia in body =

A
  • liver disease (cirrhosis, hep)
  • kidney failure
  • heart failure
  • Reye’s Syndrome
289
Q

AFP (alpha fetoprotein) tumor marker:

A

Cancer of ovaries and testes. Some primary liver cancers (hepatocellular)

290
Q

Bence Jones Proteins Tumor Markers

A

Multiple Myeloma, Waldenstrom’s macroglobulinemia, chronic lymphocytic leukemia

291
Q

CA 15-3 (Cancer Antigen) tumor marker

A

BREAST, (also lung, ovarian, endometrial, bladder, and gastrointestinal)

292
Q

CA 19-9 (Cancer Antigen) tumor marker:

A

Pancreas**, colorectal, liver, biliary tree, and stomach

293
Q

CA 125 (Cancer Antigen) tumor marker:

A

Ovarian cancer*** , breast, colorectal, uterine, cervical, pancreatic, liver, lung

294
Q

CA 27.29 tumor marker:

A

Breast*** (best used to detect recurrence or metastatic), colorectal, stomach, liver, lung, pancreatic, ovarian, and prostate cancers

295
Q

CEA (Carcinoembryonic Antigen) marker:

A

Colorectal cancer***

296
Q

HCG (Human Chorionic Gonadotrophin) marker:

A

Ovarian and testicular cancer** , gestational trophoblastic neoplasia

297
Q

LDH (Lactic Dehydrogenase) marker:

A

Lymphoma, melanoma, and acute leukemia

298
Q

PAP (Prostatic Acid Phosphatase) marker:

A

Metastatic prostate cancer*** , myeloma, lung cancer, osteogenic sarcoma

299
Q

PSA (Prostate Specific Antigen) marker:

A

Prostate carcinoma ***

300
Q

Thyroglobulin Tg marker:

A

Thyroid Cancer

301
Q

Urine Catecholamines: VMA (Vanillylmandelic Acid) marker:

A

24 hour collection of urine.

Neuroblastoma***, pheochromocytoma, ganglioneuroma, rhabddomyosarcoma

302
Q

HVA (Homovanillic Acid/ 24 hour collection of urine) marker:

A

Neuroblastoma **

303
Q

NSE (Neuron Specific Enolase) marker:

A

Small cell lung carcinoma ***, neuroblastoma

304
Q

NMP 22 (urine test) marker:

A

Bladder Cancer**

305
Q

BTA (Bladder Tumor Antigen, urine test) marker:

A

Bladder Cancer**, cancer of kidney or ureters

7 UA (4 decks)

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