Lab diagnosis 2

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runner0369
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Lab diagnosis 2
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2011-01-30 12:04:29
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Gibbon lab diagnosis sherman
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Flashcards based on lab diagnosis 2 as taught by Dr. Gibbon at Sherman College of Chiropractic
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  1. What tests are affected by hemolysis? Which is the most important? Why?
    • Potassium, LDH, Phosphorous
    • Potassium - high or low amounts will cause cardiac arrest (small range)
  2. What molecules must be maintained at critical levels in the blood? (Too much or too little will cause problems)
    Glucose, Potassium, Calcium, Sodium
  3. What molecules indicate critical problems if there is too much in the blood?
    CK - 1 and CK - 2 and Bilirubin (infants)
  4. What tests do you have to fast before?
    • Glucose
    • Lipids
    • PO4-
  5. What is a BUN test?
    Blood urea nitrogen
  6. What were the first instruments to analyze blood samples?
    SMA 6/60, SMA 12/60 and SMAC
  7. What two methods are used for most of a biochemical profile?
    Colorimetry and Enzymes
  8. How does Colorimetry work?
    Based on Beer-Lambert Law: Color is directly proportional to concentration
  9. What are the two ways enzymes can be measured?
    • Rate at which substrate is converted to product
    • Rate at which a substrate is depleted
  10. What does Electrophoresis do?
    Separate similar substances into individual components
  11. What are the 5 tests electrophoresis is used for?
    • Hemoglobin - detecting abnormal forms
    • Protein - Total protein or serum protein electrolyte (TPE or SPE) ex. multiple myeloma
    • Immunophoresis (immunofixaton electrophoresis) (IFE or IEP) - done when their is an immunoglobulin spike in SPE
    • Lipoprotein - ex. hyperlipidemia
    • Western blot - confirmatory test (3 bands)
  12. What are the immunoglobulins? Which is the most prevalant? Which arrives first? Which lasts the longest?
    • IgG - 85%, 2nd to arrive, lasts longest
    • IgA
    • IgM - largest, first to arrive
    • IgE
    • IgD
  13. What are the 5 types of antigen-antibody complex formation tests?
    • Precipitation tests
    • Agglutination tests
    • Neutralization tests
    • Fluorescent antibody tests (Immunofluorescence)
    • Complement fixation
  14. What is the RPR a screening test for? What type of test is it?
    • Syphilis
    • Precipitation
  15. What is immunoprecipitation?
    A newer version of precipitation in which there is a well in the center and arcs will form around it if a reaction occurs
  16. What is another name for agglutination tests? What is the most common type? What is a common example?
    • Agglutination Inhibition/particle inhibition
    • Latex agglutination
    • Heterophile antibody test (for mono)
  17. What are three nutralization tests and what do they test for?
    • ASO titer (anti-streptolysin O) - strep
    • Anti-DNAaseB (ADB) - strep
    • AHT (antihyaluronidase) - strep
  18. What are the 4 most common strep pathologies?
    • Rheumatic fever
    • Acute Post strep Glomerulonephritis
    • Erythems nodosum
    • Acute bacterial endocarditis
  19. What is erythema nodosum? What can cause it?
    • red nodes on legs (usually pre-tibial)
    • Strep, mono, birth control, chron's
  20. What are the two most common Fluorescent antibody tests and what do they test for?
    • FTA (Fluorescent treponemal antibody) - syphilis
    • FANA (Fluorescnet anti-nuclear antibody) - SLE
  21. What test was done for SLE before FANA?
    dsDNA antibody (ds = double stranded)
  22. What is a complement fixation test?
    • Tests for the presence of an antibody or antigen
    • Negative test --> complement binds to and lyses sheep RBCs
    • Positive test --> complement binds to antibody-antigen complex and sheep RBC's remain intact
  23. What is RIA?
    Old antigen-antibody test, replaced by EIA (faster, more sensitive)
  24. What is ELISA?
    • Enzyme-linked immunosorbent assay
    • Screening test for many antibodies (strep, HIV, hepatitis)
    • Antibody in well, immunoglobulin binds then antibody with detection marker binds
  25. What is Nephelometry?
    Measures the rate of turbity which indicates the quantity of serum proteins (highest when antigen = antibody concentration) - particles scatter light --> positive
  26. What is Western blot?
    • Confirmatory test for many antibodies
    • Electrophoresis (color reaction occurs)
  27. What tests indicate a musculoskeletal problem?
    • Calcium (#1)
    • Phosphorous
    • Uric acid
    • Alkaline phosphatase (#2)
  28. What is calcium an indicator of?
    Parathyroid function and various malignacies
  29. What are the 3 forms of calcium?
    • 50% free/ionized
    • 45% bound
  30. What does acidosis promote?
    Increased ionized/free calcium
  31. What does PTH do to calcium blood levels?
    Increase
  32. What does calcitonin do to blood levels of calcium?
    Decreases (puts it in the bone)
  33. How does estrogen affect calcium?
    Puts calcium in bone
  34. How will hyperthyroid or hyper adrenal glands affect calcium?
    hypocalcemia, bone decalcification
  35. Causes of Hypercalcemia?
    • Primary hyperparathyroid (#1)
    • Malignancy (#2)
    • Metastatic bone tumors
    • PTH producing tumors (lungs or renal)
    • Vitamin D intoxication
  36. What are the symptoms of hypercalcemia?
    • Neurological (irritability, memory loss)
    • Peptic ulcers
    • Bone lesions
    • Anorexia
    • Kidney stones
  37. Causes of hypocalcemia?
    • Malnutrition (#1)
    • Hypoalbuminemia (#1)
    • Renal disease/failure
    • Secondary hyperparathyroidism
    • Rickets
    • Osteomalacia
    • Vitamin D deficiency
  38. What is a major cause of secondary hyperparathyroidism?
    renal osteodystrophy
  39. What are the symptoms of hypocalcemia?
    • Increased neuromuscular excitability
    • Altered cardiac function
    • Tetany
  40. What are three signs of Tetany?
    • Chvostek's - tap on parotid gland near facial nerve --> face contracts if positive
    • Main d'accoucher - tetany of wrist
    • Trousseau's - blood pressure cuff causes involuntary spasm of hand
  41. What are some follow up tests for calcium?
    • Ionized calcium test
    • PTH assay
    • X-ray or protein electrophoresis - multiple myeloma
    • Chest x-ray if coughing - sarcoidosis, TB
    • Cortisol - Cushings
    • Thyroid
    • Vitamin D levels
  42. How do Calcium and phosphorus levels affect each other?
    • When one goes up, the other goes down (body tries to maintain constant product of the two)
    • Exception - vitamin D deficiency
  43. Causes of Hyperphosphatemia?
    • Hypoparathyroidism
    • Renal failure/osteodystrophy
    • Secondary hyperparathyroidism
    • Excess vitamin D intake
  44. Causes of hypophosphatemia?
    • Primary hyperparathyroidism
    • Rickets
    • Osteomalacia
    • Malabsorption syndromes
    • Alcoholism
  45. What are the two main pathologies with high uric acid levels?
    Gout (#2) and Renal Calculi (#1)
  46. Causes of Hyperuricemia?
    • Excess purine consumption
    • Excessive cell breakdown/catabolism on nucleic acids
    • Excessive cell production and destruction (ex. leukemia, multiple myeloma, P. vera)
    • Renal disease (inability to excrete urea)
  47. What drugs can cause hypouricemia?
    • Allopurinol - purine blocker
    • Asprin - purine blocker
    • Colchicine - excretes purines
  48. Primary vs. secondary gout?
    • Primary - from overproduction of uric acid or impaired renal tubular excretion
    • Secondary - excessive uric acid from increased nucleic acid turnover or acquired renal problems decreasing excretion
  49. What are the three main isoenzymes of alkaline phosphatase (ALP)?
    • Bone (osteoblasts) (highest concentration) (#1)
    • Liver (#2)
  50. Causes of increased ALP?
    • Liver infection/cancer/disease
    • Bone pathologies (including fractures)
    • Growth
    • Last tri of pregnancy
  51. What is septic arthritis?
    Infectious arthritis - bacterial invasion of a joint --> inflammation, destruction
  52. Labs for septic arthritis?
    Arthrocentesis (pus in joint fluid), increased WBC count, C-reactive protein and ESR
  53. What is gout?
    Gouty arthritis - metabolic disease where urate deposits in joints, usually feet and legs
  54. Labs for gout?
    • Arthrocentesis (monosodium urate crystals)
    • Uric acid blood levels increased
  55. What is osteoarthritis?
    • Most common arthritis
    • Deterioration of joint cartilage, formation fo reactive new bone at margins and subchondral areas
  56. Labs for OA?
    NONE!
  57. What is osteomyelitis?
    Pyogenic bone infection that can be acute or chronic, can stay local or spread
  58. Labs for osteomyelitis?
    increased WBCs, ESR, C-reactive protein, blood cultures
  59. Differential diagnosis for osteomyelitis?
    • Rheumatic fever
    • Myositis
    • Bone fracture
    • Poliomyelitis
  60. What is Paget's?
    • Osteitis deformans
    • Slow progressive metabolic bone disease
    • Initial excess resorption of bone followed by bone formation
    • Affects males > 40 years
  61. Labs for Paget's?
    • Serum alkaline phosphatase
    • Anemia
    • Urine: 24 hour hydroxyproline
    • X-ray/bone scan
  62. What is muscular dystrophy?
    A group of congenital disorders characterized by progressive symmetrical wasting of skeletal muscles without neural or sensory defects
  63. What are the two main types of muscular dystrophy?
    • Duchenne's - childhood form, deficiency in dystrophin (protein)
    • Limb girdle - affects upper arms and legs, cardiovascular problems
  64. Tests for muscular dystrophy?
    • CK-3 (CK-MM) - elevated
    • Electromyography
    • Muscle testing
    • Pre-natal testing
  65. What is osteoporosis?
    Metabolic bone disorder in which the rate of bone resorption accelerates and formation decreases
  66. Labs for osteoporosis?
    • Calcium - normal
    • Phosphorous - normal
    • Alkaline phosphatase - normal
    • PTH - possible elevation
    • Urine - collagen
    • Dexa scan
  67. What tests on the biochemical profile indicate a problem with the liver?
    • Alkaline phosphatase
    • AST (SGOT)
    • ALT (SGPT)
    • SGGT
    • LDH
    • Bilirubin
    • Albumin/total protein
  68. What follow up liver tests are there?
    • Ammonia
    • CEA
    • Bile salts/acids
    • Vitamin K/PT/PTT
    • Alpha fetoprotein
    • Alpha 1-antitrypsin
    • BSP dye
    • Hepatitis tests
  69. What is AST? What do elevated levels of AST indicate?
    • Aspartate aminotransferase or Serum Glutamin Oxaloacetic transaminase
    • Indicates Liver (hepatitis, infectious mono, hepatic metastasis, tumor, alcoholism) or heart (MI, surgery) problem
  70. What is ALT? What organ has the highest concentration of ALT? What would a greatly increased ALT indicate? What would a moderately increased ALT indicate?
    • Alanine aminotransferase or Serum Glutamic Pyruvic transaminase
    • Liver has hghest concentration of ALT
    • Significant increase: Hepatitis, hepatic necrosis, hepatic ischemia
    • Moderate: Cirrhosis, cholestasis (bile duct is blocked), hepatic tumor, obstructive jaundice
  71. What issues are indicated by AST/ALT >1?
    Alcoholic cirrhosis, liver congestion, metastasis to liver
  72. What issues are indicated by AST/ALT <1?
    Acute hepatitis, viral hepatitis, infectious mono
  73. What enzyme is most sensitive to alcohol usage?
    SGGT
  74. What does an increase in SGGT indicate?
    • Liver disease
    • Alcohol intake
    • Mono
    • obstructive jaundice
    • Meds: Dilantin and Phenobarb
  75. How would you DDX liver disease from skeletal disease?
    • Both: Increased AST, Alk Phos, LDH
    • Liver only: Increased ALT, SGGT, Bilirubin
  76. What is LAP? What does an increased LAP indicate?
    • Leucine Aminopeptidase
    • Liver disease
  77. How many LDH isoenzymes are there? What is the most abundant? What does each indicate?
    • 5
    • LDH 2 is the most abundant
    • LDH 1 indicates MI or renal
    • LDH 2 indicates reticuloendothelial
    • LDH 3 indicates lungs or lymphocytes
    • LDH 5 indicates Liver, skeletal muscle
  78. What is a flipped or reversed LDH? What does it indicate?
    LDH 1 > LDH 2 --> MI
  79. Which LDH will be elevated during strenous exercise?
    1,2 and 5
  80. What type of bilirubin is higher in the blood?
    Unconjugated
  81. What is another name for unconjugated bilirubin?
    Indirect
  82. Where is bilirubin conjugated?
    liver
  83. Where does bilirubin come from?
    RBC breakdown (porphyrin ring of heme)
  84. What is another name for prehepatic jaundice? What is its cause?
    • Hemolytic
    • Increased RBC breakdown (hemolytic anemia, sickle cell, Pernicious anemia, erythroblastosis fetalis/hemolytic anemia of the newborn, Resolution of large hematoma, hepatitis, cirrhosis, neonatal hyperbilirubinemia, Gilbert's disease/Crigler-Najjar syndrome G6PD deficiency)
  85. What is kernicterus?
    Accumulation of bilirubin in baby's brain causing mental retardation
  86. A person with bilirubinuria and elevated direct probably has?
    Post-hepatic jaundice (obstructive) (gallstones/ cholelithiasis, pancreatic carcinoma, tumors, duct obstruction/cholestasis) - failure to excrete conjugated bilirubin
  87. Neonatal jaundice gives increased?
    Unconjugated bilirubin, cause by immature liver (hepatic jaundice)
  88. Hemolytic ds of newborn gives increased?
    Unconjugated bilirubin, mom is breaking down baby's RBCs (Rh- mom and Rh+ baby)
  89. What type of bilirubin is increased in Gilbert's ds? What is it commonly misdiagnosed as?
    • Unconjugated
    • Hepatitis B
  90. What type of bilirubin can be found in the urine? Why?
    Conjugated, it is water soluble
  91. Elevated direct and indirect bilirubin can occur wit?
    Liver damage (hepatitis, alcoholism, cancer)
  92. Increased urobilinogen in the urine reflects increased _____ in the blood?
    Unconjugated bilirubin (the U's go together)
  93. What will the urine findings be in a liver problem?
    Increased urobilinogen and presence of conjugated bilirubin
  94. What fraction of bilirubin is conjugated?
    • 15 to 20%
    • 70 to 85% is unconjugated
  95. What does decreased albumin lead to?
    Edema (swelling)
  96. What can decrease albumin levels?
    Malnutrition/malabsorption (Crohn's, Whipple's), Liver disease, inflammatory diseases, 3rd degree burns, protein-losing kidney disease (nephrotic syndrome)
  97. What can increased albumin levels?
    dehydration
  98. Are PT/PTT and Vit K used for liver testing?
    No, but they will be affected by many liver pathologies
  99. What clotting factors are vit. K dependent? What clotting pathways are affected?
    • 2, 7, 9, 10
    • Intrinsic, Extrinsic and common
  100. What clotting factors are in the intrinsic pathway? extrinsic? common?
    • Intrinsic: 9,8,11,12
    • Extrinsic: 3,7
    • Common: 1,2,10
  101. What is the problem with testing for ammonia?
    Ammonia is very volatile, must be placed on ice right away
  102. What causes increased ammonia levels?
    • Advanced liver failure:
    • Primary hepatocellular disease
    • Portal hypertension
    • Severe heart failure with congestive hepatomegaly
    • Reyes syndrome
    • Hepatic encepalopathy
    • Hepatic coma
    • Genetic metabolic disorder of urea cycle
  103. What is Reyes syndrome?
    Brain and liver damage caused by asprin in young children
  104. What happens if bile acids/salts are decreased?
    • Gallstones (cholesterol precipitates)
    • Impaired fatty acid absorption
  105. What is AFP? What is it used for?
    • Alpha-fetoprotein - made by fetal liver and yolk sac
    • Pre-natal testing and detection of liver cancer
  106. What is AAT? What does it do?
    • Alpha 1-antitrypsin
    • Protein made by the liver which keeps protesases from destroying the lungs and liver
  107. What does a deficiency in AAT cause?
    • Emphysema (early onset, panacinar, more in lower 1/3rd of lung)- proteseases make holes in cells --> decreased surface area for oxygen exchange forming an air bulla/blister
    • Low serum proteins
    • Neonatal respiratory distress sydrome
  108. What is CEA? What is it an indicator for?
    • Carcinoembryonic antigen
    • Tumor marker (particularly colon and breast)
  109. What are acute phase reactants? Which is abnormal?
    • Proteins which increased in the liver during inflammation
    • C-reactive protein is not normally present
  110. What are the most common types of hepatitis?
    • Viral (IV drugs, STD)
    • Alcohol
    • Bacterial
  111. How is hepatits spread?
    • Fecal-oral (A and E)
    • Blood borne (B and C)
  112. Which immunoglobulin is the 1st to be made? Which one lasts the longest?
    • IgM is first
    • IgG is longest
  113. What are the symptoms and lab findings for hepatitis?
    • Fever, flu, possible jaundice
    • Bilirubin, LDH, SGGT, ALT, AST and ALP are elveated, neutropenia, lymphopenia followed by lymphocytosis
  114. How contagious are you when you are showing symptoms of hepatitis?
    • Decreasing contagiousness the longer you have symptoms (peak of contagiousness comes before symptoms show)
    • Contagious when have antigens not antibodies
  115. What is another name for HAV? What is another name for HBV?
    • Infectious hepatitis
    • Serum hepatitis (Dane particle)
  116. What are the parts of hepatitis B? Which one is in the gap period?
    • C (core), E, S (surface)
    • C is in the gap or window period or serological negative period
  117. What is the seroconversion period?
    Period when antibodies (HBsV) become present
  118. What tests are included on a hepatitis panel in order of production?
    HBsAg, HBeAg, HBcAb, HBeAb, HBsAb
  119. What does a positive HBsAg indicate?
    • 1st indicator of infection (acute)
    • Person is infectious
    • Chronic carrier
  120. What does a positive HBsAg indicate?
    • Immunity
    • Previous exposure
    • Vaccination
  121. What does a postive HBcAb indicate?
    • Past infection
    • 1st antibody to appear
  122. What does a positive HBeAg indicate?
    • Index of infectivity (highly contagious)
    • Early and active HBV
  123. What does a positive HBeAb indicate?
    • Low infectivity
    • Acute phase is over
  124. Which hepatitis B test will distinguish between acute infxn, vaccination and chronic?
    Core antibody (HBcAb)
  125. What tests are positive for Acute HBV?
    • HBsAg
    • Anti-HBc (IgM)
    • HBeAg
  126. What tests are positive in a vaccination?
    Anti-HBs
  127. What tests are positive after recovery from acute HBV?
    • Anti-HBs
    • Anti-HBc (IgG)
    • Possibly Anti-HBe
  128. What tests are positive for chronic HBV low infectivity?
    • HBsAg
    • Anti-HBc (IgG)
    • Anti-HBe
  129. What tests are positive for chronic HBV high infectivity?
    • HBsAg
    • Anti-HBc (IgG)
    • HBeAg
  130. What tests are used for HCV?
    • c22p
    • NS3
    • NS4
    • NS5
    • Core antigen
    • EIA
  131. What is liver cirrhosis?
    • Chronic hepatic disease, destruction and fibrotic regeneration (note: fibrotic tissue is not functional)
    • Caused by alcohol or other liver infection/damage
  132. What labs are increased in liver cirrhosis?
    • Ammonia
    • Bilirubin
    • Globulin
    • PT
    • PTT
    • AST
    • ALT
    • LDH
    • ALP
  133. What is the most common cause of portal hypertension? Other cuases?
    • Cirrhosis is most common
    • Budd Chiari syndrome
    • Schistosomiasis
    • Sarcoidosis
    • Portal vein thrombosis
  134. What is budd chiari syndrome?
    hepatic venous or inf. vena cava is obstructed --> spider web venous collaterals form on skin and on x-ray, ascites, hepatomegaly, abdominal pain, esophageal varices
  135. What are the signs of hepatocellular failure?
    • Jaundice
    • Hepatic encephalopathy
    • Ascites
    • Bleeding diathesis (susceptible to hemorrhage)
  136. What is hepatic encephalopathy?
    Chronic liver disease interfers with ammonia catabolism and ammonia enters circulation and goes to brain, causing damage
  137. What labs will be elevated for hepatic encephalopathy?
    Ammonia, bilirubin, PT
  138. What is another name for wilson's disease? Symptoms?
    • Hepatolenticular disease
    • Excess copper retention:
    • Kayser-Fleicher rings (lenticular opacities) - only present when ds has progressed beyond the liver
    • Hepatic disease
    • Neurological changes
  139. What is the most common symptom of gallbladder disease?
    nausea and vomiting
  140. What is cholelithiasis?
    Gall stones (calculi) - 90% of all gallbladder ds
  141. What is choledocholithiasis?
    Gallstones in the common bile duct causes obstruction --> jaundice, persistent itching, retention of bile salts
  142. What is cholecystitis?
    inflammation of gallbladder
  143. What is gallstone ileus?
    gallstone ulcerates through gallbladder into intestine and causes obstruction
  144. What is biliary cirrhosis?
    Ascending infection of the biliary system leads to obstructive jaundice
  145. What are gallstones made of? How are they diagnosed?
    • Cholesterol, bile pigment stones
    • HIDA scan (track flow of bile from liver to SI)
    • Echography/x-ray

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