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Terms Definitions
Antigens provoke _____________ antibodies
What causes jaundice? elevated bilirubin
Female sterilization options: oophorectomy
tubal ligation
hysterectomy
Which immunoglobulin responses first after recent antigenic exposure? IgM
Normally, unconjugated bilirubin makes up _____% of the total bilirubin. 70-85%
HCO3 HCO3 helps prevent/correct acidosis. when an increase in needed, the kidney incs reabsorption and reduced urinary bicarbonate
What percentage of patients with hypothyroidism due to Hashimoto's have elevated anti-thyroid peroxidase and anti-thyroglobulin antibody levels? 95%
Elevated aldosterone cause an increase in ____? BP
What medications can decrease TSH levels? Heparin
NSAIDS
steroids 
What can cause metabolic acidosis? diabetic ketoacidosis
alcohol
ASA
shock (lactic acidemia)
CO poisoning
renal tubular acidosis
 
Infertility is... deficient fertility usually expressed as the failure to produce a viable newborn
What do these levels indicate?
troponin I = 1.8
CKMB = 50
patient reinfarcted
pH < 7.35
normal PaCO2
low HCO3
metabolic acidosis
The exocrine pancreas produces what? amylase and lipase
Fasting glucose levels
normal?
impaired glucose tolerance?
diabetes?
normal: <100 mg/dL
impaired glucose tolerance: 100-125 mg/dL
diabetes: >125 mg/dL 
In disorders involving liver cells the PT will _____________ increase
Which regions of the body are considered endocrine? pituitary
thyroid
parathyroid
adrenal glands
pancreas 
How long does acute diarrhea last? <14 days
What is the normal amylase range? 30-220 units/L
Oxygen saturation measure the percentage of hemoglobin carrying O2
pH measures the hydrogen ions in the blood
If diarrhea persists >14 days,
is bloody,
and is negative for fecal leukocytes
what should you test for?
ova and parasites
Which of the main 2 pancreatic enzymes in predominately found in the pancreas? lipase
What is the most sensitive test for biliary damage? GGT
What will elevate levels of free T4? exogenous T4
heparin
propranolol 
Why would you order a PTH? evaluation of hypercalcemia
 
monitoring in chronic renal failure 
Serum ammonia is a byproduct of what? protein catabolism
The liver converts serum ammonia into what? urea (BUN)
Since chronic pancreatitis is most often caused by alcohol abuse what else would you expect to see? abnormal liver tests
What happens if you have too little cortisol and aldosterone? hypoglycemia
hyponatremia
hypotension
hyperkalemia
 
ADRENAL INSUFFICIENCY
 
addison's disease if the problem is the adrenal itself and not any precursors 
What is the normal range for PTH? 10-65 pg/mL
What is phenylketonuria? is an autosomal recessive genetic disorder characterized by a deficiency in the autozome phenylalanine hydroxylase
 
phenylalanine accumulates and is converted into phenylpyruvate
When would you study metabolic disorders, in terms of family history, during pregnancy? consanguineous marriage
other affected relatives
early death of a sibling
diagnosis already made in another family member
What are the symptoms of hemochromatosis? arthritis
liver problems
cardiac abnormalites
skin color changes
impotence
early menopause
damage to pancreas - DM
thyroid deficiency
damage to adrenal gland
chronic fatigue
loss of body hair
depression
hypogonadism
abd pain
amenorrhea, infertility
some cancers
What is the normal level for CKMB? < 4.0
What is the normal level of serum d-dimer? 45-500
Non-hormonal female fertility tests: cervical mucus fem formation
body temp measurements
hysterosalpingogram
 
 
Fertility is... the natural ability to produce new life
What is the most common cause of chronic pancreatitis? alcohol abuse
Which tests access esophageal and gastric function? occult blood testing
 
Helicobacter pylori testing
Which 2 tests of hepatocyte integrity are on almost all chem 20 panels? AST and ALT
If the damage to the pancreas resolves how fast will the amylase levels return to normal? 48-72 hours
What else can cause Cushing's like symptoms? long term steroids
Thyroid cancers are often associated with... normal thyroid function tests
90% of the time ____________ is the cause of hyperthyroidism. Grave's disease
What are some causes of hypercalcemia? hyperparathyroidism - most common
 
malignancy - 2nd most common
 
drugs: thiazide diuretics, antacids, vit D  
What is the main test used to detect thyroid dysfunction? TSH
What is autoimmunity? an immune response to self antigens, failure of immune tolerance
Glucagon concentration is influenced by what 2 things? blood glucose and insulin concentration
What is carrier detection? detects recessive genes in healthy people for genetic counseling/family planning purposes
normal pH
low PaCO2
high HCO3
full compensation phase of metabolic alkalosis
normal pH
low PaCO2
low HCO3
full compensation phase of metabolic acidosis
What is troponin? proteins found in cardiac and skeletal mm that aids in contraction, elevates if cardiac mm gets injuried
 
Troponin I is found only in cardiac mm
elevation in Troponin T could also indicated kidney disease
 
neither of these are elevated in sk mm injury
If ALT > AST, then... damage is caused by viral hepatitis
How long does persistent diarrhea last? btwn 14 and 30 days
Type II DM is caused by... insulin resistance of tissues, therefore concentration ranges from high (early) to low (late)
 
glucagon concentration often elevated
 
What are the major causes of hypothyroidism? hashimoto's
iatrogenic: surgery or radiation
iodine deficiency
meds: valproic acid
secondary or tertiary hypothyroidism (rare) 
What are the different tests used to access parathyroid function? total Calcium
ionized Calcium
PTH
PTH-related protein
phosphorus (if its increased Ca++ is lowered) 
How long do you have to get stool samples to the lab if you are testing for ova and parasites? 30-60 minutes
A primary disorder of the endocrine pancreas is called: Type 1 Diabetes mellitus
Which is the most non-invasive way to test for H. pylori? serum antibody test
If AM cortisol is high and
ACTH is low,
what should you suspect? 
an adrenal adenoma
What can cause respiratory alkalosis? ASA overdose
being to tense or anxious
high fever
dec O2
severe pain
 
ringing in ears is a sign of low toxic levels
Blood gas measurement helps determine the cause for... respiratory abnormalities and monitors response to treatment
 
also essential for measuring the respiratory system's response to metabolic acidosis and alkalosis
What are the risk factors for CAD other than high LDL? low HDL
cigarette smoking
HTN
FHx
advanced age
 
What the normal level for BNP? < 100
 
increased BNP indicates ventricular hypertrophy and Heart failure
HF classified as High Output means... blood doesn't have enough O2
What can cause surgical jaundice? anything that blocks bile getting from the liver to the duodenum
 
gallstones
 
pancreatic tumors
What abnormalities will you see in the tests of a patient with chronic renal failure? high BUN
high Creatinine
low Ca++
high phosphorus (this binds up the Ca++) 
Primary hypothyroidism hormone levels
(like hashimoto's) 
 
high or low TSH?
high or low free T4?
+ or - anti-thyroid peroxidase?
+ or - anti-thyroglobulin?
TSH will be high
free T4 will be low
anti-thyroid peroxidase and/or anti-thyroglobulin will be + 
What is a pheochromocytoma? a tumor of the adrenal medulla that makes NorEpi and Epi
 
it increases BP/HR
increases glycogenolysis, gluconeogenesis and lipolysis
 
very uncomfortable for the pt, puts them at risk for a stroke 
What are some reasons to order thyroid function tests? unexplained weight loss,
anxiety, tremor,
new onset of atrial fibrillation
or a mental status change 
What controls secretion of PTH from the parathyroid? ionized Ca++ in the blood
How do you measure LDLs? not directly
 
LDL = HDL + (total cholesterol/5)
 
if trigs >400 this formula will not work, so if you want an LDL level you have to ask for it directly
How do you treat hemachromatosis? phlebotomy treatments 1-2 times a week for mths to a year
 
ferretin testing after every 4
Remove 1 pint every 1-4 mths for maintanence
 
avoid Vit C, alcohol, raw sea food
What is hereditary hemochromatosis? the body absorbs too much iron
it is especially stored in the pancreas, liver and skin
 
85% HFE gene mutation
 
Types I-III are recessive
Type IV is dominant (Ferroportin)
What does a Direct Coombs (anti-humanglobulin) test identify? IgG and/or complement (C3) on red cells
H. pylori is responsible for what percentage of ulcers? 100% of duodenal
 
80% of gastric ulcers
How long can a serum antibody test for H. pylori be positive after an infection? up to one year
How does PTH increase serum Ca++ levels? 1. mobilizing Ca++ from the bone
 
2. increasing kidney reabsorption of Ca++, decreasing phosphate reabsorption
 
3. stimulates kidney to convert Vit D
 
4. increases GI absorption of Ca++
 
(step 3 is used to allow step 4) 
Which is the most frequently used class of immunoglobulins in testing? IgG
 
used to diagnose most common immunodeficiencies
If AST/ALT ratio is >1 this points towards... alcoholic liver injury or tumor
What are the tests you do to access hepatocyte function? serum albumin
prothrombin time
serum ammonia
Absent or extremely low IgA is... the most common cause of anaphylactic transfusion reactions
If the pancreas is slowly and completely destroyed what happens? amylase and lipase are not elevated
 
DM -- elevated glucose
 
malabsorption and malnutrition -- decreased serum protein
What tests do you do to access biliary excretion function? total bilirubin
conjugated and unconjugated bilirubin
 
If serum ammonia is elevated what do you need to be concerned about? liver failure
 
get a GI consultation
HF classified as Low Output means... the heart is unable to pump sufficiently with activity or at rest
Where can you find CKMB? found in skeletal mm, cardiac mm and the brain
 
the more mm mass the higher the CKMB
 
CKMB is more specific to cardiac mm, but it is also found in low levels in sk mm
 
CKMM and CKBB are the other types of creatinine kinase and they are not as specific to the heart
What are the signs and symptoms of hypothyroidism? mental slowness, fatigue, loss of interest
 
weight gain, constipation, hair falling out, cold intolerance
 
delayed deep tendon reflexes 
TRH stimulation test is used to differentiate ____________ from ________________ hypothyroidism. TRH stimulation test is used to differentiate secondary from tertiary hypothyroidism.
If the ratio of AST/ALT is <1 this points towards... viral hepatitis (B or C)
What is the definition of hypercalcemia? elevation of serum Ca++ on 3 separate occassions
Why would TSH and T4 both be abnormally high? secondary hyperthyroidism from a TSH producing tumor
What are the critical values for TSH tests? < 0.1 mU/L
and
> 20 mU/L
 
the lab will call you if you get these 
When the pancreas is injured it releases... enzymes into the blood and surrounding tissues (which digest fat in and around the pancreas)
Why do lipids require proteins? bc they are not water soluble so they need apolipoproteins to transport them in the blood
What are the CRP levels in reference to their predictive ability? low risk < 1.0
average 1.0-3.0
high >3.0 (may need to refer)
What is the problem with having galactosemia? Since galactose cannot be broken down, it builds up in the cells and becomes toxic.  The body then produces abnormal chemicals, which causes the symptoms seen in infants with untreated galactosemia.
If you have a pt with a pheochromocytoma you should consider ordering a... a 24 hour urine checking for:
 
epi and norepi
metanephrine and normetanephrine
VMA (the product catabolism of both metanephrine and normetanephrine)
 
 
hard test to do 
Why is lipase better for later diagnosis of acute pancreatitis than amylase? bc it remains elevated up to 7 days
What can cause an increase in alkaline phosphatase? blockage to the biliary tree
or bone disease
What are the 4 main functions of the liver? 1. synthesis of many plasma proteins
 
2. detoxification and excretion into bile of waste products
 
3. processing dietary elements... aas, fats, proteins and vits
 
4. clearing blood of any microbes or toxins that have been absorbed in the GI tract
What are the complement (THC, C4, C3) levels during Classic Pathway activation? THC -- 100
C4 -- 10
C3 -- 80
What happens when we lose the ability to distinguish self from non-self immunologically? suppressor T cells overcome helper T cells
 
or there is a helper T cell deficiency
If the hepatocytes are not functioning what happens to the serum ammonia levels? they increase bc they are not being converted into urea so they can be excreted
Why would you get an increase in plasma d-dimer? DIC, PE, DVT or other coagulation problems
Why are Ca++ levels decreased if the pancreas is injured? bc as lipase breaks down fats it produces fatty acids with strong negative charges
 
Ca++ has a strong positive charge and binds to these exposed fatty acids which lowers serum Ca++ levels
 
low Ca++ in pancreatitis is a bad sign, esp if it stays persistently low
When would you do a work up on a patient with acute diarrhea? melena > 48 hrs in duration
 
severe abd pain
 
immunocompromised
Where will you see myoglobin used as a screening tool? acute chest pain centers
 
if it is negative it tells you there is no AMI
if its positive it only tells you that mm injury occurred somewhere
Glucose Tolerance Test: In order to be considered normal, glucose levels should be <____ after a 1 hr,
 
AND they should be <____ after 2 hrs.
1 hr: <200 mg/dL
2 hr: < 140 mg/dL (both are normal)
 
 
if at 2 hr its 140-200 you have IGT
if its > 200 you have DM 
What should you do if your pt has chronic diarrhea? consider a GI referral, bc the longer the duration the less likely it is to be infectious
What do we want to evaluate when we do liver tests? how well the liver cells are doing their job
Heptaocyte function
 
how well the liver is excreting bile
biliary excretion function
 
if the liver cells themselves have been damaged
hepatocyte integrity
If the pituitary is the cause of low T4 then TSH will be _____________. If the pituitary is the cause of low T4 then TSH will be __depressed__.
What is one of the easiest ways to fix respiratory alkalosis? breathing in a paper bag, it will fix it in as little as 1 minute
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