Week 3: Common Lab Tests

Question 1

high C reactive protein (CRP) levels in the blood are a non-specific marker for…

Answer 1

inflammation

Question 2

Electrolytes are minerals dissolved in the blood as …

Answer 2

salts

Question 3

T or F
Electrolytes can only be found in blood

Answer 3

F
They can also be found in the tissues of the body.

Question 4

What functions do electrolytes serve in the body?

Answer 4

moving nutrients and waste products into and out of cells, maintaining the body’s acid/base (pH) balance, and maintaining the body’s fluid balance.

Question 5

high creatine kinase (CK) levels in the blood usually indicate…

Answer 5

muscle damage

Question 6

Enzymes found in the blood can be markers of … damage or disease.

Answer 6

tissue

Question 7

T or F
An individual’s pathology result may be outside the reference range without necessarily being indicative of a health issue requiring treatment.

Answer 7

T

Question 8

When we are measuring kidney function, we are measuring the ability of the kidney to filter blood through the … A key measurement of kidney function therefore is the ….

Answer 8

glomerulus
GFR (Glomerular Filtration Rate)

Question 9

T or F
Reduced kidney function is always considered chronic

Answer 9

F
Reduced kidney function can be an acute problem (Acute Kidney Injury – AKI) or a chronic problem (Chronic Kidney Disease – CKD) and this needs to be interpreted from the blood tests.

Question 10

To estimate the rate of glomerular filtration (eGFR), blood is tested for the presence of a waste product from muscle tissue called …

Answer 10

creatinine.

Question 11

Why is creatinine used to measure glomerular filtration rate?

Answer 11

• because it is produced as a breakdown product from muscle at a reliably consistent rate.
• The kidneys generally filter out between 90-95% of creatinine from the body.

Question 12

T or F
Each method of estimating renal function uses the serum concentration of creatinine as a variable.

Answer 12

T

Question 13

T or F
Tests to estimate renal function are interchangeable as they all use creatinine as a variable.

Answer 13

F

Question 14

Acute Kidney Injury (AKI) is defined as an abrupt decrease in kidney function which encompasses both … and …

Answer 14

injury (structural damage) and impairment (loss of function).

Question 15

ACE inhibitors are more likely to precipitate an AKI if a person is …

Answer 15

dehydrated

Question 16

When it comes to drug causes of AKI, of significant concern is the so-called TRIPLE WHAMMY, which includes what drug classes?

Answer 16

The term triple whammy refers to the concurrent use of an ACE inhibitor or ARB, with a loop diuretic such as furosemide, and an NSAID (ACEi/ARB + Diuretic + NSAID)

Question 17

Cardiac biomarkers used to diagnose a heart attack or heart failure can include:

Answer 17

Cardiac Troponin (Troponin I or Troponin T)
Creatine Kinase (CK)
Creatine Kinase-MB (CK-MB)
B-Type Natriuretic Peptide (BNP) and N-terminal-proBNP (NT-proBNP)

Question 18

T or F
Cardiac biomarkers can not only be used to diagnose an MI but also indicate the level of damage.

Answer 18

T

Question 19

Heart attack symptoms in males can include:

• sudden cold sweat
• chest pain or pressure
• shortness of breath
• nausea
• discomfort or tingling in the back, shoulder, arms, neck or jaw

What additional symptoms are more common in females?

Answer 19

• lightheadedness, dizziness
• chest pressure without pain
• vomiting
• a feeling of heartburn/indigestion
• extreme fatigue
• discomfort or tingling in one or both arms

*Note crossover symptoms between genders do occur

Question 20

Creatine kinase is an enzyme that is found in many tissues of the body. The three isoenzyme forms include:

Answer 20

CK-MM (found in the heart and skeletal muscle, which makes up most of the CK in the blood)
CK-MB (found mostly in heart muscle)
CK-BB (found mostly in the brain)

Question 21

antipsychotic medications have been associated with a life-threatening condition called …., which can also lead to raised CK levels.

Answer 21

neuroleptic malignant syndrome (NMS)

Question 22

T or F
CK elevations are likely to occur following absence seizures or simple and complex partial seifibrates, antiretrovirals, ARBs, immunosuppressants and hydroxychloroquine. zures.

Answer 22

F
unlikely

Question 23

Elevations in CK levels are common after generalised …-… seizures.

Answer 23

tonic-clonic

Question 24

List some medication categories that have the potential to impact CK levels.

Answer 24

Statins, fibrates, antiretrovirals, ARBs, immunosuppressants and hydroxychloroquine.

Question 25

T or F elevated CK levels are common in patients experiencing alcohol withdrawal syndrome and the more severe the withdrawal the higher the CK levels.

Answer 25

T

Question 26

Cardiac troponin (cTn) is a complex of what three proteins?

Answer 26

troponin C (TnC), troponin I (TnI), and troponin T (TnT)

Question 27

T or F Cardiac troponins are normally found in high concentrations in the blood.

Answer 27

F These proteins are ordinarily found in cardiac muscle, but not normally found in high concentrations in the blood.

Question 28

T or F cardiac ischaemia is always caused by myocardial infarction.

Answer 28

F often but not always

Question 29

The major use of troponin assays is to either diagnose or exclude what?

Answer 29

acute myocardial infarction.

Question 30

T or F Chest pain is a non-specific symptom

Answer 30

T

Question 31

What am I? This biomarker is an enzyme that indicates non-specific muscle damage. It can more than double in people who have had a heart attack but can also be elevated due to other conditions that cause muscle damage.

Answer 31

CK

Question 32

What am I? This peptide biomarker is not diagnostic for a heart attack. Rather, it is released as the body’s natural response to heart failure, such as stretching of the heart muscle wall. Increased levels of this biomarker indicate an increased risk of cardiac problems in a person experiencing symptoms of chest pain.

Answer 32

BNP and NTproBNP

Question 33

What am I? The most useful cardiac biomarker for diagnosing myocardial infarctions (heart attacks), as it is very specific for the heart.. This biomarker is three different types of proteins joined together, which become cleaved when released from heart muscle. These proteins are useful measures of myocardial damage. These biomarkers stay in the bloodstream days after other biomarkers return to normal levels.

Answer 33

Cardiac troponin

Question 34

What am I? cardiac specific subtype of a generalised enzyme biomarker for muscle damage. This marker tends to rise 4 to 6 hours after a heart attack but returns to normal after a day or two, which limits its utility.

Answer 34

CK-MBA

Question 35

T or F A biomarker alone is enough to diagnose an MI

Answer 35

F

Question 36

B-type Natriuretic Peptide (BNP) and N-terminal-proBNP (NT-proBNP) belong to a family of protein hormones called ....

Answer 36

natriuretic peptides.

Question 37

Natriuretic peptides are released when the heart muscle (ventricular wall of the heart) is ...

Answer 37

stretched.

Question 38

Stretching of the ventricular wall of the heart often occurs in patients who are ... overloaded and who have reduced ....

Answer 38

fluid cardiac output.

Question 39

T or F BNP reduces the production of adrenaline and testosterone

Answer 39

F adrenaline and aldosterone

Question 40

T or F The actions of BNP on the kidneys leads to the excretion of more potassium

Answer 40

F salt and water

Question 41

T or F BNP acts on blood vessels causing them to dilate

Answer 41

T

Question 42

Angiotensin promotes ... and ... retention, vasoconstriction/vasodilation, ... outflow, cardiac hypotrophy/hypertrophy and fibrosis.

Answer 42

fluid and sodium vasoconstriction sympathetic hypertrophy

Question 43

What drug class does valsartan belong to?

Answer 43

Angiotensin II receptor blocker (ARB)

Question 44

What drug class does sacubitril belong to?

Answer 44

neprilysin inhibitor

Question 45

Natriuretic peptides are metabolised by the enzyme ...

Answer 45

neprilysin.

Question 46

T or F Most of the body’s potassium is found intracellularly

Answer 46

T

Question 47

T or F Minor changes in serum potassium concentration can have significant consequences.

Answer 47

T

Question 48

T or F Both hypokalaemia (low K+) and hyperkalaemia (high K+) are serious conditions but can't be fatal.

Answer 48

F They can be fatal

Question 49

What am I? (hypokalaemia or hyperkalaemia) I can cause peaked T waves, wider QRS complex (ECG changes) and may result in bradycardia, asystole, and sudden cardiac death?

Answer 49

Hyperkalaemia

Question 50

What am I? (hypokalaemia or hyperkalaemia) I can cause significant QT prolongation (ECG changes) with a subsequent risk or torsades des pointes, ventricular fibrillation, and sudden cardiac death.

Answer 50

Hypokalaemia

Question 51

Why is decreased dietary intake NOT the major cause of hypokalaemia?

Answer 51

the kidney can lower potassium excretion in the presence of potassium depletion, hence decreased intake alone rarely causes significant hypokalaemia.

Question 52

T or F Thiazide diuretics cause hypokalaemia more frequently than loop diuretics

Answer 52

T

Question 53

What two overarching mechanisms can cause a rise in serum potassium (hyperkalaemia)?

Answer 53

- Increased potassium release from cells - Reduced urinary potassium excretion

Question 54

Aside from certain medications other factors that may contribute to the risk of a person developing hyperkalaemia include:

Answer 54

Increasing age, metabolic acidosis, poorly controlled diabetes mellitus, increased potassium intake via supplements, dehydration, chronic kidney disease, hyperaldosteronism

Question 55

What causes hyperkalaemia or pseudohyperkalamia?

Answer 55

where the appearance of hyperkalaemia based on high serum concentrations is due to the movement of potassium out of the cells during or after a drug specimen has been drawn.

Question 56

The ... is the largest and heaviest solid organ of the body

Answer 56

liver

Question 57

The ... contains the body’s largest reservoir of phagocytotic (macrophages) cells.

Answer 57

liver

Question 58

Vitamin ... is absorbed and synthesised through the action of bile salts

Answer 58

K

Question 59

... is a toxic waste product derived from the breakdown of proteins.

Answer 59

Ammonia

Question 60

T or F transaminase levels directly correlate to the degree of liver damage.

Answer 60

F

Question 61

T or F Fibrate drugs such as fenofibrate are more effective than Statins in treating hypertriglyceridaemia where lifestyle alone has failed ​​​​​​​

Answer 61

T

Question 62

Hypertriglyceridaemia is associated with an increased risk of which diseases?

Answer 62

Coronary heart disease and pancreatitis

Question 63

What is the difference between primary and secondary prevention of LDL-c?

Answer 63

Primary prevention = patient has not had a previous cardiovascular event. Secondary prevention = patient has experienced a cardiovascular event, and is thus at a greater risk of a subsequent event.

Question 64

T or F cholesterol levels are generally higher in the morning and lower in the evening (when cholesterol synthesis peaks)

Answer 64

F vice versa

Question 65

T or F The effect of statins on lowering LDL cholesterol levels is linear as the dose is increased.

Answer 65

F not linear

Question 66

Which statins would you recommend to be dosed at night?

Answer 66

Fluvastatin, pravastatin and simvastatin

Question 67

Fibrates are associated with an increased risk of myopathy and rhabdomyolysis when combined with ...

Answer 67

statins.

Question 68

Which fibrate is most likely to increase the risk of myopathy and rhabdomyolysis, and increase statin serum concentrations when combined with statins?

Answer 68

Gemfibrozil

Question 69

Which medication am I? I am an add on treatment in patients who have high cholesterol despite the use of a maximum tolerated statin dose.

Answer 69

Ezetimibe

Question 70

What is the name of the only bile acid binding resin available in Australia?

Answer 70

Colestyramine

Question 71

Bile acid binding resins should be taken ... hour after taking other medications, or ... to ... hours before taking other medications.

Answer 71

one 4 to 6

Question 72

T or F Fish oil is a coagulant

Answer 72

F It is an anticoagulant

Question 73

What is the first-line medication for the treatment of raised LDL-c?

Answer 73

statins

Question 74

What is the first-line medication for the treatment of severely raised TGs.

Answer 74

fibrates

Question 75

What parts of the kidney in isolation, are capable of performing all functions of the kidney?

Answer 75

The nephron and collecting ducts

Question 76

T or F The heart does not exercise influence on arterioles, but the kidneys do.

Answer 76

T

Question 77

Which parts of the nephron play a role in tubular reabsorption and secretion?

Answer 77

Loop of Henle, distal convoluted duct, proximal convoluted duct and the collecting duct.

Question 78

T or F As the age advances, the number of nephrons decreases.

Answer 78

T

Question 79

What does micturate mean?

Answer 79

to urinate

Question 80

Most of the bladder lumen is thrown into folds and these folds give inside of the bladder a wrinkled appearance. These folds are known as ...

Answer 80

rugae.

Question 81

Only a small part of the bladder, called the ..., is smooth.

Answer 81

trigone

Question 82

When the bladder fills up, the ... will flatten.

Answer 82

rugae

Question 83

T or F The body is not capable of measuring blood volume.

Answer 83

T

Question 84

The body can determine blood pressure through the baroreceptors in the ... and ....

Answer 84

aorta carotid sinuses.

Question 85

The body can determine blood pressure through the ... in the aorta and carotid sinuses.

Answer 85

baroreceptors

Question 86

T or F Increased pressure leads to widespread vasocontriction.

Answer 86

F vasodilation

Question 87

The cardiomyocytes in the atria respond to changes in blood pressure by secreting ...

Answer 87

ANP

Question 88

T or F When blood passes through the glomerulus, it produces a filtrate. This filtrate does not contain protein.

Answer 88

T

Question 89

Filtrate produced by the glomerulus is is captured by what?

Answer 89

The Bowman's capsule

Question 90

(referring to the kidneys) Where does tubular secretion mostly occur?

Answer 90

in the proximal and distal convoluted tubules

Question 91

What factors determine the generation of filtrate in the Bowman's space?

Answer 91

Blood hydrostatic pressure, blood colloid osmotic pressure, and the capillary hydrostatic pressure

Question 92

What is nocturia?

Answer 92

A desire to urinate at night-time. The individual might have to wake up 1-2 times to void.

Question 93

Sodium is reabsorbed in all parts of the nephron except...

Answer 93

the thin descending segment

Question 94

Why does increasing salt in your diet increase you BP?

Answer 94

sodium results in retention of water, leading to expansion of vascular volume. The larger the volume of blood the higher the pressure it exerts. Think about Frank Starling's law!

Question 95

T or F The total peripheral resistance helps define the function of the heart, whereas cardiac output helps understand the properties of the vasculature.

Answer 95

F vice versa

Question 96

T or F Hypokalemia is more prevalent than hyperkalemia

Answer 96

T

Question 97

A significant rise in the extracellular potassium concentration causes a sustained ...

Answer 97

depolarisation.

Question 98

T or F Unless the kidney is grossly damaged proteins and fat do not appear in the urine

Answer 98

T