Laboratory Medicine Flashcards
(530 cards)
1
Q
Blood constitutes ___ of total body weight
A
6-8%
2
Q
Plasma comprises ___ of blood volume
A
45-60%
3
Q
___ ml of blood in a 70 K male (about 154 lbs)
A
5600ml
4
Q
normal blood pH
A
7.35-7.45
5
Q
sources of collection of blood
A
skin puncture
venous puncture
arterial puncture
6
Q
skin puncture specimen is composed of
A
mixed venous and arterial blood
7
Q
skin puncture blood is the same thing as
A
capillary blood
8
Q
what can be contained in the skin puncture specimen
A
interstitial and intracellular fluid
9
Q
what is the blood collection method of choice in pediatrics
A
skin puncture
10
Q
which blood collection method is useful for glucose monitoring
A
skin puncture
11
Q
in the skin puncture, capillary tube is utilized for
A
hematocrit
12
Q
site selection of skin puncture in infants
A
lateral or medial aspect of the heel
13
Q
site selection of skin puncture in adults
A
lateral to digital pulps
14
Q
warming the area for skin puncture will do what
A
increase blood flow about 42 degrees celsius
15
Q
ways to do a skin puncture
A
warm the area, prep with alcohol, discard first drop, do not milk the area.
16
Q
composition of venous puncture dependent upon
A
metabolic activity of the perfused organs
17
Q
sites of venous puncture
A
anticubital fossa (median cubital vein, cephalic vein)
wrist, hand, ankle,
or femoral vein
18
Q
when taking a venous puncture, the tourniquet is applied
A
proximal to the selected site
19
Q
techniques for venous puncture
A
- tournique proximal to site
- flexing the hand helps facilitate distention
- anchor vein distal and proximal
- deliver needle bevel up and enter at 15 degree angle
- direct along path of vein
20
Q
when do you release the tourniquet in a venous puncture
A
when the blood begins to flow
21
Q
___ blood is uniform throughout the body
A
arterial
22
Q
site selection for arterial puncture in pediatric
A
scalp artery
23
Q
site selection for arterial puncture in adult
A
Radial, Femoral, Brachial
24
Q
what is the most common artery used in an adult arterial puncture
A
radial artery
25
the Allen test is a tested on what artery
radial
26
modified Allen test verifies
ulnar artery can supply the hand
27
when preforming a modified Allen test, you release pressure from which artery
the ulnar artery
28
which arteries are compressed in the Allen test
radial and ulnar arteries, palm of hand will become blanched
29
what should happen when you release the compression of the ulnar artery in a modified Allen test
the hand should become flushed
30
technique of arterial puncture
- infiltration of a local anesthetic may help
- collect blood gases in heparin tube
- prep skin with alcohol
- deliver distal to where the pulse is felt
- gently mix specimen
- apply firm compression for a minimum of 5 min
- transport on ice for blood gases
31
how to interpret lab values
look for trends in value,
| all abnormal labs would be repeated
32
ostlers rule
- used on patient younger than 60
| - seek to attribute all abnormal values to a SINGLE pathology
33
serum collection tube
with coagulants - red or SST (tiger top)
34
plasma - anti coagulant present tubes
citrate, EDTA, Heparin, fluoride
35
citrate tube top
blue
36
EDTA top
lavender
37
heparin top
green
38
fluoride top
gray
39
serum has __ while plasma doesn't
coagulation factors
40
what was the original anticoagulant (1914)
citrate
41
coagulation studies, acts via ___ to calcium blocking coagulation cascade
chelation
42
__ increases red cell viability
adenine
43
what measures coagulation
PT, PTT, thrombin clotting time
44
enoxyporin
Xa inhibitor
45
prothrombin time (PT) evaluates
extrinsic clotting pathway
46
Vitamin K dependent factors
II, VII, IX, X (2,7,9,10)
| Protein C and Protein S- synthesized in LIVER
47
conditions with prolonged PT
Vitamin K deficiency
impaired fat absorption
liver disease
Coumadin therapy
48
reference values for PT
11-13 seconds
49
PT is standardized by
international normalized ratio
| INR=[observed PT/ control PT] xISI
50
(PT) prophylaxis values for pulmonary embolism
2.0-3.0
51
(PT) prophylaxis values for mechanical heart valve
2.5-3.5
52
best singular test for coagulation
Partial Thromboplastin Time (PTT)
53
PTT evaluates
the intrinsic and final common pathway
54
PTT is used for screening of
disorders of fibrin formation and heparin therapy
55
reference values PTT:
60-85 seconds
56
reference values for aPTT
30-40 seconds
57
PTT Analyzes factors
II, V, VIII, IX, X, XI, XII
58
Thrombin clotting time assesses
the terminal steps of coagulation pathway
59
thrombin clotting time evaluates
fibrin-fibrinogen interaction by introducing thrombin
60
how fast is thrombin induced clotting
very rapid
61
TCT elevated when
- fibrinogen levels are below 100 mg/dl
- heparin interferes with thrombin action
- fibrin degradation products are present
62
reference values for TCT
10-15 seconds
63
antifactor Xa assay monitors
low-molecular weight heparins and danaparoid
64
low-molecular weight heparins and danaparoid, renal disease may result in
higher than desirable levels (anti factor Xa Assay)
65
antifactor Xa assay may be ordered
factor deficiencies or in patients with lupus anticoagulants
66
antifactor xa assay reference values - not on anticoagulants
0 units/mL
67
antifactor xa assay reference values - heparin
0.3-0.7 units/mL
68
antifactor xa assay reference values LMWH 30 mg BID
0.4-1.1 units/ml
69
antifactor xa assay reference values LMWH 40 mg once daily
1-2 units/mL
70
antifactor xa assay reference values danaparoid (orgaran)
0.5-0.8 units/mL
71
bleeding time clotting tests are good for screening
platelet disorders
72
ivy method clotting test
forearm with cuff @ 40 mm/Hg- <5 minutes
73
duke method clotting test
ear lobe- <3 minutes
74
lee white clotting time
oldest but least accurate test
| time required for clot to form in test tube (4-8 min is normal)
75
do not perform clotting test if platelet count is less than
4000/ml
76
D- Dimer Assay
protein released during fibrin clot break down
77
the D-dimer assay is an area of
cross-linked fibrin degradation product
78
the D-Dimer assay is detected with an
ELISA assay
79
D-Dimer Assay is elevated with
DVT
PE
DIC
80
complete blood count includes data on
red and white cells
81
when test is excellent for cell morphology
complete blood count
82
a complete blood count is done in what tube
lavender top tube- EDTA
83
__ prevents platelet aggregation in an complete blood count
EDTA
84
red blood cell count is expressed as
cells per unit of volume
85
Red blood cells are
biconcave disc 6-8 μm in diameters.
86
red blood cells have deeper staining on
periphery
87
the pale central portion of a RBC should be what size
1/3 of the size of the cell
88
what is the lifespan of a RBC
120 days
89
reference values of RBC in men
4.6-6.2 x 10^6
90
reference values of RBC in women
4.2-5.4 x 10^6
91
reticulocytes are
immature red blood cells
92
reticulocytes circulate for
approximately 24 hours
93
reticulocytes may be referred to
polychromatophilia
94
reticulocyte counts ___ with anemia when bone marrow is competent
increase
95
reference values for reticulocytes
~1% (range 0.5 to 1.8%)
96
main component of RBC
hemoglobin
97
hemoglobin is the vehicle for
oxygen and carbon dioxide transport
98
hemoglobin concentration obtained by assessing
specific gravity of whole blood
99
reference values of hemoglobin in men
13.5-18 g/dl
100
reference values for hemoglobin in women
12-16 g/dl
101
fully saturated hemoglobin has __ of oxygen
12.34 ml
102
hematocrit is the measure of
packed red cell volume
103
____ is expressed as a percentage or decimal fraction
hematocrit
104
reference values of hematocrit in men
40-54%
105
reference values of hematocrit in women
38-47%
106
red blood cell indices calculations based on=
RBC total, Hb, and Hct
107
red blood cell indices help determine the
size, content and HB concentration of the RBC
108
what is useful in the characterization of anemia
red blood cell indices
109
mean cell volume reflect the volume of
the average cell
110
MCV (mean cell volume) is calculated from the
hematocrit and red cell count
111
MCV=
(Hctx1000)/RBC
112
reference values of MCV in men
80-98 fl
113
reference values of MCV in women
81-99 fl
114
mean cell hemoglobin
hemoglobin content or "weight" of average red blood cell
115
calculated from Hb concentration and red cell count
mean cell hemoglobin
116
MCH=
Hb/RBC
117
reference values fro MCH in men
26-32 pg
118
reference values for MCH in women
26-32 pg
119
Mean cell hemoglobin concentration
ratio of the average amount of hemoglobin divided by the average hematocrit
120
represents the average amount of hemoglobin in a set amount of packed cells.
mean cell hemoglobin concentration
121
MCHC=
Hb/Hct
122
reference voles for MCHC
32-36%
123
Red Cell distribution width
an estimate of anisocytosis
124
the first indicator to change in iron def anemia secondary to chronic blood loss or dialysis
red cell distribution width
125
reference values for red cell distribution width
11.6-14.6 %
| average is 13.1%
126
erythrocyte morphology- color is reflection of
hemoglobin concentration
127
normochromic
center of biconcave disc is 1/3 the diameter of the RBC
128
hypochromic
center of biconcave disc is enlarged and paler (seen in MCH and MCHC)- iron deficient anemia
129
hyperchromic
center of biconcave disc is smaller and stain more deeply - mesoblastic anemia
130
ansiochrmia
reflective of a dimorphic anemia
131
polyhromatophilia
reflects the presence of residual RNA within the RBC
| cells are larger and may lack the central pallor
132
polychromatophilia represents
a reticulocyte or immature RBC
133
may be referred to as shift cells
polychromatophilia
134
erythrocyte morphology - size
microcytes, macrocytes, anisocytosis
135
microcytes
abnormally small erythrocytes
136
macrocytes
abnormally large erythrocytes
137
anisocytosis
variation in size of erythrocyte- a feature of most anemias
138
These become reflective of actual cell volume rather than diameter will result in changes in the MCV
erythrocyte size morphology
139
Poikilocytosis
variation in shape. Tear drop, helment shaped, oval, pear shaped
140
Elliptocytes
iron deficiency anemia myelofibrosis, megablastic anemia, and sicle cell anemia
141
spherocytes
hereditary
hemolytic disease
splenic condition- hallmark
142
target cells
liver disease
| any hypochromia
143
shistocytes
mesoblastic anemia
| microangiopathic hemolytic anemia
144
acanthocytes
crenated cells
| echinocytes
145
normocytic anemias are secondary too
increased blood loss
decreased red cell production
anemia of chronic disease
146
nomocytic anemias are identified by
reticulocyte count
147
acute blood loss
trauma
| "third" spacing- retroperitoneal pooling
148
hemolytic disorders
hereditary spherocytosis or elliptocytosis
sickle cell anemia
G6PD deficiencies
149
G6PD deficiencies
moth ball cells
burr cells
vulnerable to oxidation
150
decreased red cell production, reticulocyte count is ____
NOT elevated
151
decreased red cell production is a
primary marrow disease
152
other causes of decreased red cell production
human Parvo virus B19- "fifth" disease
decreased erythropoietin production
hypothyroidism
liver disease
153
anemia of chronic disease is associated with
chronic inflammatory process
- defective RBC production
- faulty incorporation of iron
154
anemia of chronic disease is usually
normocytic or normochromic
- may border hypo chromic
Hb: 9-11g/dl
MCHC ~32
155
Macrocytic anemia
form disorders of DNA synthesis in erythrocyte precursors.
156
Macrocytic anemia - folate deficiency
absorbed in upper intestine, stores last only a few months,
| result of drug therapy (methotrexate, phytonin, bantrim)
157
mesoblastic anemia [a macrocytic anemia]
B12 deficiency or "pernicious anemia"
158
B12
absorbed in the ileum
| b12 binds with intrinsic factor
159
mesoblastic, b12 deficiency/pernicious anemia due to
[neurological disease. ]
gastric mucosal atrophy
autoimmune reaction to gastric cells or intrinsic factor
160
symptoms of mesoblastic anemia
neurological
psychologic
cardiac
161
schilling test
used in megablastic anemia
162
in pt with mesoblastic anemia: do an antibody assay for
Abs against parental cells
| Abs against intrinsic factor
163
microcytic anemia Hb:
< 7.5 g/dl
164
microcytic anemia, decrease in availability or synthesis of
iron
porphyrin
globin
165
common causes of microcytic anemia
iron deficiency
thalassemia
sideroblasts
166
iron deficient anemia physical findings
pallor
tachycardia
wide pulse pressure
vertigo and headache
167
iron deficient anemia laboratory findings
low serum iron and ferritin
| elevated TIBC
168
__ of iron is recycled
~80%
169
Erythropoiesis will not increase if
transferrin saturation is maintained between 20-60%.
170
iron absorption occurs in the
proximal small intestine
171
daily iron needs for men
1mg/day
172
daily iron needs for women
1.4 mg/day
173
transferrin has __ binding sites
2
174
clearance of Fe2+ is
60-90 minutes
175
erythrocyte sedimentation rate
rate at which RBC precipitate to bottom of vertical tube
176
the erythrocyte sedimentation rate is influenced by
rouleaux formation
red cell factors
plasma factors- presence of globulins
177
erythrocyte sedimentation rate reference values men
8 mm/hr
178
erythrocyte sedimentation rate reference values women
15 mm/hr
179
erythrocyte sedimentation rate ___ with age
increases
180
erythrocyte sedimentation rate red cell factors
anemia (Hct ~ 30-40%)
red cell surface area
rouleaux formtion
181
Three main uses for erythrocyte sedimentation rate
detecting inflammatory processes
monitoring disease course
screen for occult neoplastic processes
182
granulocytes
neutrophils, eosinophils, basophils
183
lymphocytes
t-lymphocytes
| b-lymphocytes
184
white blood cells
granulocytes
lymphocytes
monocytes
185
ideally albumin should be __. less than that is considered as pre albumin
4
186
absolute neutrophil count will tell you if
you should do a procedure or not
187
absolute cell count calculation
total # of WBC x % cell type
188
ANC (neutrophils)
1800-7000
189
ANC (neutrophils) below 1000
no elective procedures
190
ACC eosinophils
100-300
191
ACC basophils
10-100
192
ACC lymphocytes
1700-3500
193
ACC monocytes
200-600
194
reference values for neutrophils
12-15 μm
PMNs: 56%
Band Cell 3%
195
role of neutrophils
first line against bacterial invaders
interact with lymphocytes
activation of complement
phagocytosis
196
left shit in neutrophils
increase in band cells
| PMNs >75%
197
left shift –
pt has an infection and its "winning" because you are using your immature PMNs and have pump out more PMNs
198
Neutrophilia
actual influx of band cells from marrow
| increase in total number of PMNs
199
causes of neutrophilia
infections, tissue inflammation, surgery within 12-36 hours
| tissue trauma and injury
200
neutrophilia infection cell counts
elevation of band cells
decrease eosinophils
elevated monocytes
201
drugs and chemicals associated with neutrophilia
cortisone and heavy metals
202
tissue trauma associated with neutrophilia
surgery and crush injuries
203
neutropenia
```
increased risk of bacterial infection
congenital
chronic infection
nutritional
acquired.
```
204
acquired neutropenia
drugs and heavy metals
205
nutritional neutropenia
B12 and folate
| Copper
206
eosinophil reference values
~13 μ in diameter
| 3% of leukocytes
207
role of eosinophils
```
to modulate the inflammatory response
inactivate mast cells
decrease PMN migration
poor phagocytosis
not bactericidal
```
208
Eosinophilia
absolute count > 450/ μl (% Eos x WBC count)
209
Eosinophilia CHINA
Collagen vascular diseases
Helminthic disease (can directly injure larvae)
Idiopathic hyper-eosinophic syndrome
Neoplasm (lymphomas, gastric and lung carcinoma)
Allergic
210
Basophils Reference values
10-12 μ diameter, 1% leukocytes
211
role of basophils
possess IgE receptors
Tissue Mast cells
granules posses: histamine, slow reaction substance anaphylaxis
212
basophilia
absolute value > 50/μl
myeloproliferative disorders
chronic hypersensitivity states
213
reference values for lymphocytes
~10 μ in diameters
~30% leukocytes
T- lymphocytes: 75-80%
B-lymphocytes: 10-15%
214
lymphocyte role
```
host response against viral infection (humoral immunity, cell mediated immunity)
produce cytokines (lymphokines)- interferon, interleukins
```
215
B lymphocytes possess __ receptors
antigen specific
216
B cell binds to
antigen
217
B cell with antigen binds to
matching receptor on T Helper cell
218
__ cell releases cytokines
T cell
219
activation of b cell -->
plasma cell --> antibody production
220
T4 " helper cells"
CD4
221
T4 helper cells require __ for activation
antigen class II protein
222
T4 helper cells posses __ receptors
antigen specific
223
T8 cells
CD8
224
"true" suppressors
CD8+ and CD11+
225
cytotoxic killers
CD8- and CD11-
226
CD4 count reference values in immunocompetent
500-1500 cells/mm3
227
CD4 count reference values "threshold" for management
<500 cells/mm3
228
CD4 count reference values complications
<350 cells/mm3
229
Viral load
quantity of HIV-RNA in the plasma
230
viral load reference value: Ideal
4500-5000 copies/ml
231
reference value for viral load: initiation of therapy
30,000 copies/ml
232
viral load reference value "undetectable"
<400 copies/ml
233
monocyte reference values
4% total leukocytes
| 14-20 μ in diameter
234
role of monocytes
quite versatile
become macrophages
activate T cells
produce leukotrienes (interleukin 1, tumor necrosis factor)
235
Platelet reference values
150,000-4000,000/μl
| an be acute phase reactant
236
platelet aggregation test
measures rate platelets clump when in contact with known aggregator (e.g ADP, ristocetin)
237
thrombocythemia
unregulated production with abnormal platelet function
238
platelet function assay (PFA-100)
collect citrate specimen
| flows through capillary tube through membrane with an aperture
239
PFA-100: membrane saturated with platelet activators
collagen/epinephrine
| collagen/ADP
240
platelet function determined by the time it takes to
occlude membrane
241
collagen/epinephrine (CEPI)
79-170 sec to occlude membrane
242
collagen/ADP (CADP)
55-112 sec to occlude membrane
243
PFA-100 is also utilized to evaluate
aggregation effects of certain drugs
244
Affect of NSAIDS on platelet aggregation
affects the Thromboxane A2 pathway responsible for vasoconstriction and aggregation
245
Mean platelet volume
average volume of platelet
246
reference range of mean platelet volume
7.5-11.5
247
elevated MPV (mean platelet volume)
increased risk od myocardial infraction
increased risk of stroke
thrombocytopenia with sepsis
ITP
248
thromobocythemia
inflammatory disorders, systemic disease, drugs
249
thromobocythemia from inflammatory disorders
infection, neoplasm
250
thromobocythemia from systemic disease
uremia
abnormal serum proteins
myeloproliferative disorders
251
thromobocythemia from drugs
aspirin and NSAIDs
| alcohol inhibits ADP- related aggregation
252
thrombocytopenia
<20,000- spontaneous bleeding
253
Etiologies of thrombocytopenia
```
ITP
Viral, bacterial, rickettsial infection
CHF, congenital heart disease
HIV
alcohol toxicity
```
254
thromobocytopenia- HIT
heparin induced (type 1 and type 2)
255
type 1 HIT
1-2 days after exposure, transient
256
type 2 HIT
```
5-14 days after exposure
autoimmune
heparin-Pf4 complex
decreased 50% platelets baseline
platelet disruption leads to clot formation
```
257
plasma collection tube
```
heparin tube
green/grey top
separates plasma from whole blood
inhibits action of thrombin
(serum- no clotting factors, plasma- contain clotting factors)
```
258
alpha-granule degranulation
```
PDGF
TGF-BETA
PF4
IL-1
VEGF
Numerous other growth factors
```
259
platelet rich plasma
alpha-granule degranulation
macrophage signalling proteins
anti-microbial activity
260
platelet rich plasma minimum of ___ platelets/mL
1,000,000
261
platelet rich plasma activated by
thrombin or calcium
262
__ is the immune system that is targeted for a autoimmune response
PF4
263
intrahepatic function- catabolic
ability to breakdown or metabolize substances
264
intrahepatic function- anabolic
ability to synthesize proteins
265
extra hepatic function: biliary
ability to conjugate with bile acids
| ability to excrete conjugated acids
266
intrahepatic liver function, lactate dehydrogenase reference values
38-62U/L
267
LDH, lactate dehydrogenase is a __ molecule
tetrameric molecule - ubiquitous
268
LDH1, HHHH
17-27%
| myocardium, red blood cells
269
LDH2, HHHM
27-37%
| myocardium, red blood cells, brain
270
LDH3, HHMM
18-25%
| brain kidney lung
271
LDH4, HMMM
3-8%
| liver, skeletal muscle, brain, kidney
272
LDH5, MMMM
0-5%
| liver, skeletal muscle
273
LDH5 is almost exclusive to
the liver
274
LDH1 and LDH2 are plentiful in
heart and RBCs
275
LDH2 is __ than LDH1
more prevalent
276
with an MI, a "flip" occurs
LDH1/LDH2 ratio >1.0
rises 24-48 hours after injury
peaks in 3-6 days
277
highest elevation LDH: 4-40 fold
megaloblastic anemia
lymphomas
neoplastic conditions
278
moderate elevations LDH (2-4 fold)
myocardial infarction
pulmonary infarction
leukemia
muscular dystrophy
279
slight elevation of LDH (~2fold)
hepatitis
| obstructive jaundice
280
LDH and Congestive heart failure, __ may be elevated
LDH1 and LDH5
281
elevation of ___ is also highly consistent with CHF
brain natriuretic peptide
282
BNP levels elevate as the ___ are stretched
ventricular myocytes
283
BNP levels correlate with disease ___
severity
284
reference values in congestive heart failure
normal <50 pg/ml
"gray area" 100-500 pg/ml
positive CHF >500 pg/ml
285
intrahepatic liver function SGOT/AST reference values
11-32 U/L
286
SGOT and AST are found primarily in
mitochondria of the liver and the heart
287
in mitochondria of the liver and heart, Transamination reaction between ___ and ___
aspartate and alpha-ketoglutamic acid
288
amino acid catabolism takes place in __ and requires ___
```
mitochondria of the liver and heart
requires pyridoxine (vitamin B6)
```
289
SGOT and AST are marked elevated in the liver with
hepatitis and chronic liver disease
290
SGOT and AST are elevated the liver with
cirrhosis and AST:ALT ration 2:1 (alcoholic liver damage)
291
in cardiac tissue, SGOT/AST are elevated with
myocardial infarction
| begins to rise at 12 hours and peaks at 36 hours
292
SGPT and ALT reference values
3-30 U/L
293
SGPT and ALT catalyzes the amino group between
alanine and alpha keto glutamic acid
294
AGPT and ALT are in the
cytosol of hepatocytes
295
highest elations of ALT/SGPT (20 fold or greater)
viral hepatitis
| toxins hepatitis
296
moderate elevating of ALT/AGPT (3-10 fold)
mononucleosis
chronic active hepatitis
bile duct obstruction
297
mild elevations of ALT/SGPT
inflammatory damage
298
ALT
alanine aminotransferase
299
SGPT
serum glutamate pyruvate transaminase
300
SGOT
serum glutamate oxaloacetate transaminase
301
AST
aspartate aminotransferase
302
serum proteins
albumin
fibrinogen
globulins
antibodies
303
anabolic proteins have __ dependent clotting factors
vitamin K
304
hepatic alkaline phosphatase reference values
25-165 U/L
305
what is the most common measure for biliary obstruction
hepatic alkaline phosphatase
306
__ levels of hepatic alkaline phosphatase present in cells that are metabolical active
high
307
two isoenzymes of hepatic alkaline phosphatase
hepatic and bone
308
heat stable isoenzyme
hepatic
309
heal labile isoenzyme
bone
310
high elevations of hepatic alkaline phosphatase 10 fold or greater
biliary cirrhosis
| extra hepatic bile duct obstruction
311
moderate elevations 3-10 fold normal value of hepatic alkaline phosphatase
obstruction by stones
312
mild elevation of hepatic alkaline phosphatase, 1-3 fold normal levels
alcoholic liver disease
chronic active hepatitis
viral hepatitis
313
bilirubin reference values
total: 0.3-1.9 mg/dl
direct: 0-0.3mg/dl
314
breakdown product of hemoglobin catabolism
bilirubin
315
where does the breakdown of hemoglobin to bilirubin occur
within kupffer cells via cytochrome p450
316
bilirubin is transported how
in inactive state on albumin
317
free or indirect bilirubin elevates with
lack of serum albumin
red cell hemolysis
hepatitis
gilberts syndrome
318
if free/indirect bilirubin diffuses freely through the blood brain barrier what occurs
jaundice
319
conducted to direct bilirubin is conjugated in
hepatocytes with glucuronic acid
320
conjugated or direct bilirubin elevates with
biliary obstruction
pancreatitis
lymphoma
321
triglycerides reference values
10-190 mg/dl
322
wigging correlated elevated triglycerides levels with __.
| this loss was __ of glycemic control and duration of disease
DPN
| independant
323
blood urea nitrogen -BUN reference values
9-27 mg/dl
324
end product of amino group removal in degradation of amino acids
blood urea nitrogen
325
urea is freely filtered by
the glomerulus
326
BUN moves through renal tubules via passive diffusion intra renal cycling __ is reabsorbed while __ is secreted.
60% reabsorbed.
| 40% secreted
327
BUN elevates with
severe glomerular injury
| at higher limits quite sensitive (>25mg/100mol suggests 25% nephron damages)
328
BUN __ with severe liver damage
decreases. (severe poisoning and hepatitis)
329
creatinine reference value
0.5-1.5 mg/dl
330
most sensitive indicator of glomerular filtration
creatinine
331
end product of creatine catabolism
creatinine
| creatine-PO3 + muscle contraction =creatinine
332
creatinine is nearly filtered completely by the __
kidney
333
what is ideal to measure GFR (glomerular filtration rate)
creatinine
334
BUN: creatinine ratio
10:1
335
BUN:creatinine ration elevates with
```
pre renal pathology
reduced muscle mass
high protein diet
tissue destruction
myopathies associated with cushings syndrome
```
336
renal dosing in the elderly and patients with renal failure
Cockcroft/gault equation
| creatinine clearance
337
what may be more sensitive than creatinine for GFR?
cystatin-C
338
non glycosylated, low molecular mass protein- 120 amino acid residue
-freely filtered by glomeruli
reabsorbed and catabolized by proximal tubular cells
uninfluenced by body mass, diet, sex, acute inflammatory states. or drugs
339
normal adult value of cystatin-C
<0.86mg/L
340
major cation in extracellular fluid
sodium
341
what is the principal osmotic particle outside cell
sodium
342
hyponatremia
overhydration
loop diaretics
increased secretion of antidiuretic hormone
adrenal failure
343
hypernatremia
excessive water loss/dehydration
renal losses
diabetes insipidus
344
references ranges for sodium
135-145 mEq/l
345
symptomatic hyponatremia reference range
<120mEq/l
346
symptomatic hypernatremia reference range
150-170mEq/l
347
abnormal values of this major intracellular cation profoundly affect neuromuscular system
potassium
348
hypokalemia
serum depletion
renal losses
presence of EKG U wave
349
hyperkalemia
acute and chronic renal failure
high concentration in RBCs
presence of peaked T waves
350
reference range for potassium
3.5-5.5 mEq/l
351
Major extracellular anion
Chloride
352
Hypochloridemia (GDMexRMalk)
```
GI losses
Diabetic ketoacidosis
Mineral corticoid excess
Respiratory acidosis
Metabolic alkalosis
```
353
Hyperchloridemia (GMlossH)
GI loss from diarrhea
Mineral corticoid deficiency
Hyperparathyroidism
354
chloride reference range
98-106 mEg/l
355
Serum bicarbonate is used to evaluate
acid base disorders
356
Serum bicarbonate is elevated with
Metabolic alkalosis
Comp. respiratory acidosis
Diuretics
Corticosteroids
357
Serum bicarbonate is decreased with
Metabolic acidosis
Comp. respirtor alkalosis
Salicylate poisoning
358
sodium bicarbonate reference range: arterial
19-25 mEq/l
359
sodium bicarbonate reference range: venous
23-30 mEq/l
360
Anion gap =
[Na+ + (*K+)] – [Cl- + HCO3-]
361
anion gap elevated with
Uremia
Diabetic ketoacidosis
Starvation states
Ingestions of toxins (Methanol, Salycilates,Ethylene glycol)
362
anion gap decreased with
Dilutional states
Hyperviscosity syndromes
Lithium intoxication
363
anion gap reference range
8-12 mEq/l (may be calculated without serum potassium)
364
End product of purine catabolism
uric acid
365
uric acid is excreted how
renal
366
reference values in men for uric acid
4.0-8.5 mg/dl
367
reference values in women for uric acid
2.7-7.3 mg/dl
368
uric acid are predominantly male diseases because
estrogens are protective
| solubility of crystals decreases with body temperature
369
urate at 37 degrees C solubility
6.8 mg%
370
urate at 30 degrees C solubility
4.5 mg%
371
a patient with end stage renal disease is unable to tolerate
allopurinol (for gout treatment)
| start uloric-febuxostat
372
albumin %
55-60%
373
Globulins
```
Immunoglobulins
Lipoproteins
Fibrinogen
Hemoglobin
Cytochromes
```
374
globulins are synthesized in
liver
375
source of stored protein
globular protein
376
low serum protein
Starvation states
Inability of liver to synthesize proteins
“leaky” glomerular filtration
377
globular protein reference range
6.0-8.5 g/dl
378
role of albumin
maintenance of plasma oncotic pressure
| transport protein-substances are inactive when bound to plasma
379
causes of decreased levels of albumin
inability of liver to synthesize
| poor nutritional status
380
albumin has a large body pool with a T1/2 of how many days
20 days
381
albumin is effected by hydration and renal status
chronic liver disease
| malnutrition
382
albumin reference value
3.5-5.5 g/dl
383
what is the preferred marker for protein malnutrition
prealbumin
384
normal range of prealbumin
10.5-35.0 mg/dl
385
increased risk for morbidity prealbumin range
5.0-15.0 mg/dl
386
poor prognosis range for prealbumin
<5.0 mg/dl
387
prealbumin can be increased __ with supplementation
2.0 mg/dl/day
388
why is prealbumin the preferred marker for protein malnutrition
Less affected by liver disease
Distinct marker for protein synthesis
Not affected by hydration status
Very high ration of essential to non-essential amino acids
389
serum transferrin half life
1 week
390
__ responds more quickly to nutritional status changes
serum transferrin
391
Serum transferrin is determined
two site enzyme immuno-assay
392
Measuring ___ is roughly equivalent to transferrin
total iron binding capacity
393
total iron binding capacity determined by
saturating transferrin with iron, removing the unbound iron and then measuring the iron in the infiltrate
394
TIBC increases in:
iron deficiency anemia, pregnancy, oral contraceptives and possibly hepatitis
395
TIBC decreases in:
```
reduced protein synthesis, nephrosis or other direct loss
increased catabolism (secondary to malignancy or starvation)
```
396
Released by osteoblasts actively secreting bone matrix
Alkaline Phosphatase
397
Pronounced elevation of Alkaline Phosphatase 5 fold or greater
Osteitis deformans
Osteogenic sarcoma
hyperparathyroidism
398
moderate elevation of Alkaline Phosphatase 3-5 fold
Metastatic bone tumors
| Metabolic bone diseases
399
slight elevation of Alkaline Phosphatase
Healing fractures
Growth spurts
Pregnancy
400
Most abundant cation in body
calcium
401
calcium reference values
9.2-11 mg/dl
402
Iaterogenic
illness that can be caused by an examination of medical treatment
403
calcium Levels regulated by:
kidney
| parathyroid hormones
404
Hypocalcemia
```
Renal failure (↑phosphorus)
Hypoparathyroidism
```
405
Hypercalcemia (hint: CHIMPS)
```
Cancer
Hyperthyroidism
Iatrogenic
Multiple myeloma
Parathyroidism
Sarcoidosis
```
406
phosphorus levels controlled by
PTH
1, 25- dihydroxycholicalciferol
Calcitonin
407
Phosphorus decreased levels caused by
Diabetic ketoacidosis
Hyperinsulinism
Hyperparathyroidism
Inadequate diet
408
Phosphorus increased levels caused by
```
Bone metastasis
Hypoparathyroidism
Liver disease
Renal failure
Sarcoidosis
```
409
three isoenzymes of creatine kinase
MB- myocardial injury
MM- skeletal muscle
BB- brain
410
cardiac evaluation for cardiac muscle damage
CK-MB band elevations during first 48 hours
| LDH flip LDH1>LDH2
411
which elevates first myoglobin or CK-MB band
myoglobin
412
cardiac troponin I elevates
5-9 days
413
cardiac troponin T elevated
2 weeks
414
what is elevated with skeletal muscle damage
CK-MB
| Aldolase
415
aldolase elevation most useful for
inflammatory muscle disease
416
aldolase is a
glycolytic enzyme
417
aldolase elevations also secondary to
Metastatic carcinoma
Granulocytic leukemia
Megaloblastic anemia
Hemolytic anemia
418
amylase
pancreatic enzyme- P-form
419
amylase levels rise
within 6-24 hours and return to normal within 48-72 hours
420
amylase does not correlate with
severity of pancreatic disease
421
amylase pronounced elevations >5 times normal values
Acute pancreatitis
| Administration of morphine
422
amylase moderate elevations 3-5 times normal values
Pancreatic carcinoma
| Salivary gland disease
423
amylase reference values
30-220 u/l
424
lipase is diagnostic for
acute pancreatitis
425
lipase
cleaves triglycerides into free fatty acids
426
lipase is nearly exclusive to what organ
pancreas
427
lipase will elevate with
heparin administration
428
lipase reference values
0-417 u/l
429
fasting glucose in diabetic
>126 mg/dl
430
fasting glucose in glucose impaired
100-126 mg/dl
431
normal fasting glucose
<100 mg/dl
432
glucose tolerance in diabetic
>200 mg/dl
433
glucose tolerance in glucose impaired
140-200 mg/dl
434
casual glucose >200mg/dl on two occasions symptoms
Increased thirst
Increased hunger
Unexplained weight loss
435
glycosylated hemoglobin reference values
<6%
436
glycosylated hemoglobin
Glycosylation of β-chain of Hb
| Window into past three months
437
glycosylated albumin reference values
Albumin: < 8%
| Total serum proteins: < 3%
438
glycosylated albumin
Glycosylation of serum proteins
| Window into past 2-3 weeks
439
C-Peptide measurements
Indicator of endogenous insulin production
| Assesses integrity of islet cells
440
normal c-peptide serum ratio
15:1
normal to high levels- type 2
absent to low levels- Type 1
441
A1C in diabetes
≥6.5%
442
A1C in prediabetes
5.7-6.4%
443
A1C in normal non diabetic
<5%
444
why is A1C a good diagnostic for diabetes
No need to fast for testing
| Increased patient compliance
445
glycosylated albumin serum half life in the circulation
17-20 days
446
glycosylated albumin reflects hyperglycemic periods within
the previous few weeks
447
up to __ of glycosylated albumin may be normally glycosylated
8%
448
new studies suggest that an A1C to glycated albumin ratio may provide a better insite into
glucose control
449
C- reactive Protein (CRP) is __ phase reactant
acute
450
CRP (C Reactive Protein) is indicator for
Inflammatory process:
- Rapid rise with acute disease
- Rapid clearance with resolution of process
451
CRP <1 mg/L __ for future coronary events
low risk
452
CRP 1-3 mg/L __ for future coronary events
average risk
453
CRP >3 mg/L __ for future coronary events
high risk
454
homocysteine is a variant of
cysteine
455
elevated levels of homocysteine result in
Oxidation of low density lipoproteins
Increased clot formation
Endothelial damage
456
causes of high levels of homocysteine
Nutritional deficit of folate, pyridoxine and B12
Hereditary homocysteinuria
Methyl-tetrahydrofolate reductase deficiency
457
most plentiful compliment measures
C1,C3,C4
458
complement measure circulate
until cascade initiated
459
low levels of complement measures
Indicative of antibody-antigen mediated process
Collagen vascular diseases
Connective tissue disease
460
high levels of complement measurements
cancer
| ulcerative colitis
461
what happens to glucose with physiological stress
increases
462
synovial fluid analysis __ prep of joint
sterile
463
synovial fluid analysis is transport in __ tube
heparin or EDTA
464
synovial fluid analysis evaluated on
```
color/clarity
viscosity
total WBC and % PMN’s
presence of formed elements
mucin clot retraction
```
465
normal synovial fluid elements
no elements present
466
osteoarthritis synovial fluid elements
collagen fibrils
467
Traumatic DJD synovial fluid elements
many RBCs
468
SLE synovial fluid elements
LE Cells
469
RA synovial fluid elements
cholesterol crystals
470
pseudogout synovial fluid elements
calcium pyrophosphate crystals
471
gout synovial fluid elements
monosodium urate crystals
472
synovial fluid elements present in infection
WBC >50,000 cells/μl
PMNs >90% (compared to normal <25%)
glucose 25mg/dl lower than serum levels
473
specific gravity- urinalysis reference
1.010-1.030
474
pH Urinalysis reference
4.8-7.5
475
specific gravity is the
ion concentration of urine and reflects the concentrating abilities of the kidneys
476
color and appearance of normal urine
yellow color and clear appearance
477
pH of urine reflects
renal acid excretion and is dependent on dietary intake
478
acidic urine points to
high protein diets, diabetes (DM), tubular acidosis
479
alkaline urine points to
UTIs
480
reference of protein in urine
NONE to trace
481
2+ levels of protein in urine
Glomerular disease
| Urinary tract disorder
482
3-4 grams/day protein in urine
Collagen vascular disease
Congestive heart failure
Nephrotic syndrome
483
glucose in urine
is a significant index of hyperglycemia
484
glucose in urinalysis is not sensitive due to
Incomplete bladder emptying
| Concomitant renal disease
485
serum glucose levels are ___ before detected in urinalysis
>200-250
486
reference of glucose in the urine
none to trace
487
ketones in urine
Reflect the use of fatty acid metabolism
| Presence important in starvation states and diabetes mellitus
488
reference range of ketones in urine
0-160 mg/dl
489
urinalysis: hemoglobin and red cells
Trauma, infection, glomerular damage
490
hemoglobin and red cells in urinalysis reference
0-3 cells/hpf
491
bilirubin in urine
Only conjugated bilirubin appears in urine
| Reflects biliary obstruction
492
Urobilinogen in urinalysis
Elevated with hemolysis and most liver diseases
| Decreased with antibiotics and bile duct obstruction
493
Leukocyte esterase in urinalysis
Released by WBC’s responding to infection
494
nitrates in urinalysis
Byproduct of vegetable ingestion
| Some bacteria convert nitrate to nitrite
495
casts in urinalysis
suggest renal tubular damage
496
debris collects in urinalysis tube
granular
fatty
waxy
hyaline
497
granular debris in urinalysis
plasma protein aggregates that escape through damaged tubules
498
fatty debris in urinalysis
significant proteinuria
499
waxy debris in urinalysis
oliguria and nephron obstruction
500
hyaline debris in urinalysis
glomerular capillary damage
501
White blood cells in urinalysis
suggests inflammation or infection
502
epithelial cells in urinalysis
Represent desquamation of urinary tract epithelial cells
May represent poorly collected specimen
Renal tubular cells abnormal
503
Microalbuminuria collection techniques
```
Albumin to creatinine ratio from random sample
24 hour collection with creatinine
Timed collection (min. 4 hrs)
```
504
Normal reference values for microalbuminuria
< 30
505
reference values for microalbuminuria
30-299
506
Normal reference values for albuminuria
>300
507
Microalbuminuria, Hypertensive patients should be placed on
ACE or ARB meds
508
Urinary 24 Hour Calcium
Reflects intestinal absorption of calcium or renal leakage
509
low levels of urinary 24 hour calcium
Underactivity of parathyroid gland
(Check parathyroid – if normal…
Evalate 25 hydroxy Vitamin D)
Inadequate intake of vitamin D
510
low reference values for 24 hour calcium
<150 mg
511
average 24 hour calcium reference values
150-250 mg
512
high reference values for 24 hours calcium
250-300 mg
513
SIRS Criteria
Systemic Inflammatory Response Syndrome
514
SIRS evaluation, Temp, HR, Resp rate, WBCC
Temperature < 36° C or > 38° C
Heart Rate > 90 bpm
Respiratory Rate > 20 breaths/minor PaCO2 < 32 mm/Hg
White Blood Cell Count > 12,000 or < 4,000 cells/mm3 or > 10% bands
515
Minimum of __ for SIRS diagnosis
2 or above (temp, HR, RR, WBCC)
516
Septic Shock Criteria: Trauma
SIRS
517
Septic Shock Criteria: Sepsis
SIRS, Infection
518
Septic Shock Criteria: severe sepsis
Sepsis, organ failure, hypotension, hypoperfusion.
519
Septic Shock Criteria: Septic Shock
Sepsis with hypotension, ≥2 organ failure
520
Procalcitonin Helps identify
SIRS from sepsis
521
More specific than CRP, IL-6 and LBP
Procalcitonin
522
Procalcitonin levels <2 ng/ml
can exclude sepsis (NPV – 97%)*
523
Procalcitonin levels >10 ng/ml
bacterial infection likely (PPV – 88%)*
| May help guide antibiotic therapy
524
Laboratory Risk Indicator for Necrotizing Fasciitis, to help discriminate between necrotizing and non-necrotizing infections
(LRINEC score)1
525
(LRINEC score)1
six independent variables with an applied point system
| Score has a range from 0-13
526
(LRINEC score)1 intermediate to high risk score
>6
527
(LRINEC score)1 utilized when
there is a high index of suspicion
528
low risk category for necrotizing fasciitis
≤ 5 total score
| < 50% probability of NF
529
intermediate category for necrotizing fasciitis
6 – 7 total score
| 50 – 75% probability of NF
530
high risk category for necrotizing fasciitis
≥ 8 total score
| > 75% probability of NF
