Lab Values

Question 1

Alkaline Phosphatase - Increased

Answer 1

Highest with biliary obstruction and infiltrative liver disease

Liver disease

Increased calcium deposition in bone (hyperparathyroidism)

Osteoblastic bone tumors/osteomalacia

Hyperthyroidism

Question 2

Alkaline Phosphatase - Decreased

Answer 2

Malnutrition

Excess Vitamin D Ingestion

Pernicious anemia

Wilson’s Disease

Hypothyroidism

Question 3

ALT (Alanine Aminotransferase) - Increased

Answer 3

Liver disease or metastasis

Biliary obstruction

Pancreatitis

Liver congestion - ALT > AST with viral hepatitis

Question 4

Amylase - Increased

Answer 4

Acute pancreatitis or duct obstruction

Pancreatic pseudocyst or abscess

Mumps

Renal disease

Cholecystitis

Peptic ulcer disease

Intestinal obstruction

Question 5

Amylase - Decreased

Answer 5

Pancreatic destruction

Liver damage - hepatitis, cirrhosis

Normally decreased in healthy infant during 1st year

Question 6

AST (Aspartate Aminotransferase) - Increased

Answer 6

Acute MI

Liver disease

Muscle trauma & injection

Pancreatitis

Intestinal injury or surgery

Burns

Cardiac catheterization

Brain damage

Renal infarction

Question 7

AST (Aspartate Aminotransferase) - Decreased

Answer 7

Beriberi - Vitamin B6 deficiency

DKA

Liver disease

Chronic hemodialysis

Question 8

Albumin - Decreased

Answer 8

Malnutrition

Nephrotic syndrome

Multiple Myeloma

Hodgkin disease

Leukemia or Metastatic cancer

Chronic glomerulonepthritis

Alcoholic cirrhosis

IBD

Hyperthyroidism

Question 9

Bilirubin - Increased Total

Answer 9

Hepatic damage

Biliary obstruction

Hemolysis

Fasting

Question 10

Bilirubin - Increased Direct (conjugated)

Answer 10

Only have to determine w/ total levels <1.2 mg/dL

Biliary obstruction

Cholestasis

Question 11

Bilirubin - Increased Indirect (Unconjugated)

Answer 11

Hemolytic jaundice from any hemolytic anemia

Gilbert Syndrome - liver doesn’t process bilirubin

Physiologic jaundice of the newborn

Question 12

Bilirubin - Increased in the neonate

Answer 12

Erythroblastosis fetalis

Physiologic jaundice of the newborn

Hematoma/hemorrhage reabsorption

Obstructive jaundice

Question 13

BUN (Blood Urea Nitrogen) - Increased

Answer 13

Renal failure

Prerenal azotemia - Decreased perfusion secondary to CHF, shock, or volume depletion

Postrenal obstruction

GI bleeding

Stress

Drugs

Question 14

BUN - Decreased

Answer 14

Starvation

Liver failure

Infancy

Nephrotic syndrome

Overhydration

Question 15

Increased BUN/Creatinine Ratio

Answer 15

Prerenal azotemia

GI Bleed

High protein diet

Sepsis/hypermetabolic state

ileal conduit

Drugs

Question 16

Decreased BUN/Creatinine Ratio

Answer 16

Malnutrition

Low-protein diet

Ketoacidosis

Hemodialysis

SIADH

Drugs

Question 17

Increased Serum Calcium

Answer 17

Primary hyperparathyroidism

PTH-secreting tumors

Vitamin D excess

Paget’s Disease

Osteoporosis

Question 18

Decreased Serum Calcium

Answer 18

Hypoparathyroidism

Insufficient vitamin D

Calcium and phosphorus ingestion

Hypomagnesemia

Chronic renal failure

Acute pancreatitis

Question 19

Increased Creatine Kinase

Answer 19

Muscle damage/trauma

Troponin is marker of choice for AMI

Pericarditis with myocarditis

Rhabdomyolysis

Crush injury

Malignant hyperthermia

Question 20

Increased Serum Creatinine

Answer 20

Renal failure

Gigantism

Acromegaly

Red meat ingestions

False positive in DKA

Question 21

Increased D-Dimer

Answer 21

DVT

PE

MI

CVA

Sickle cell crisis

Cancer

Renal failure

CHF

Question 22

Increased Ferritin

Answer 22

Iron excess

Porphyria

Sideroblastic anemia

Type 2 diabetes

Hyperthyroidism

Question 23

Decreased Ferritin

Answer 23

Iron deficiency - earliest and most sensitive test before rbc morphologic change

Question 24

Increased Glucose

Answer 24

Diabetes mellitus - 1&2

Cushings syndrome

Acromegaly

Pancreatitis - acute and chronic

Question 25

Decreased Glucose

Answer 25

Pancreatic disorders Hepatic disease Endocrine disease Malnutrition Sepsis

Question 26

Increased Iron

Answer 26

Hemochromatosis Hemosiderosis with excessive iron intake Excess destruction/decreased production erythrocytes Liver necrosis

Question 27

Decreased Iron

Answer 27

Iron deficiency anemia Nephrosis Normochromic anemia of chronic disease and infections

Question 28

Increased Lactate Dehydrogenase

Answer 28

AMI Prosthetic valve Hepatitis/Liver disease Pernicious/Megaloblastic anemia PE Hemodialysis Renal infarction

Question 29

Increased Lactic Acid

Answer 29

Lactic acidosis due to hypoxia Hemorrhage Shock Sepsis Cirrhosis Ethanol DKA

Question 30

Increased Lipase

Answer 30

Acute/chronic pancreatitis Pancreatic duct obstruction Renal failure/Dialysis Intestinal perforation Diabetes (DKA)

Question 31

Increased Magnesium

Answer 31

Renal failure Hypothyroidism Addison's disease Diabetic coma Severe dehydration Lithium intoxication

Question 32

Decreased Magnesium

Answer 32

Malabsorption Steatorrhea Alcoholism/cirrhosis Hyperthyroidism Acute pancreatitis

Question 33

Increased B-Natriuretic Peptide (BNP)

Answer 33

CHF/Left ventricular dysfunction

Question 34

Increased Serum Osmolality

Answer 34

Hyperglycemia Ethanol/Methanol/Ethylene glycol Mannitol Increased sodium due to water loss

Question 35

Decreased Serum Osmolality

Answer 35

Low serum sodium diuretics Addison's disease SIADH Iatrogenic

Question 36

Increased Phosphorus

Answer 36

Hypoparathyroidism Excess vitamin D Renal failure Bone disease Addison's disease

Question 37

Decreased Phosphorus

Answer 37

Hyperparathyroidism Alcoholism Diabetes Acidosis/Alkalosis Salicylate poisoning Diuretics

Question 38

Increased Potassium

Answer 38

Factitious increase Renal failure Addison's disease acidosis ACEI

Question 39

Decreased Potassium

Answer 39

Diuretics Vomiting NG Suctioning Diarrhea Zollinger-Ellison syndrome

Question 40

Increased Serum Protein

Answer 40

Multiple myeloma Waldenstrom macroglobulinemia Lymphoma Chronic inflammatory disease Sarcoidosis

Question 41

Decreased Serum Protein

Answer 41

Malnutrition IBD Hodgkin disease Leukemia

Question 42

Increased Uric Acid

Answer 42

Gout Renal failure Diuretics Lactic acidosis Hypothyroidism Parathyroid disease

Question 43

Decreased Uric Acid

Answer 43

Uricosuric drugs Wilson disease Fanconi syndrome

Question 44

Increased Vitamin B12

Answer 44

Excessive intake Myeloproliferative disorders

Question 45

Decreased Vitamin B12

Answer 45

Inadequate intake - strict vegetarianism Malabsorption Hyperthyroidism Pregnancy