this is the second lecture on blood chemistry in lab diagnosis II. we covered glucose levels, various glucose testing, BUN, creatinine, calcium, albumin, and globulin.
questions
glucose and fasting glucose tests...
1. blood glucose levels are controlled primarily by which two hormones?
2. blood glucose levels are influenced secondarily by...
3. what is the normal range for fasting glucose levels?
4. what is the critical high value for FG?
5. after age 50, how do fasting glucose levels generally change?
6. what are some interfering factors for the fasting glucose test?
7. what are some factors that can cause increased glucose levels?
8. what are some factors that can cause decreased glucose levels?
9. what is the glucose level that is used to diagnose diabetes mellitus?
10. what is the glucose level that is used to diagnose "pre-diabetes"?
two hour post prandial...
11. what is the 2hrgpp?
12. what level on the 2hrgpp corresponds to the dx of pre-diabetes?
13. what level on the 2hrgpp corresponds to the dx of diabetes?
14. what factors will cause falsely elevated levels on the 2hrgpp?
15. what factors will cause falsely ∂ecreased levels on the 2hrgpp?
16. what are the advantages of a 2hrgpp over a fasting blood glucose test?
GTT and HbA1c...
17. what is the glucose tolerance test?
18. GTT sometimes used in conjunction with insulin levels to diagnose...
19. what is the HbA1c test?
20. 8% on the HbA1c test corresponds to what level of blood glucose?
BUN...
21. blood urea nitrogen is an indirect measure of the function of which two organs?
22. urea is an end product of metabolism of what substance?
23. what is the most common etiology of increased BUN?
24. what is renal azotemia?
25. what is post-renal azotemia?
26. what are some general factors that could lead to a decreased BUN?
27. what are some factors that could interfere with BUN level testing?
28. what is the normal range for BUN levels?
29. what is the critical high level for BUN levels?
creatinine...
30. creatinine is produced from metabolism of...
31. describe the variability of creatinine throughout the day.
32. relationship of creatinine and kidney function?
33. relationship of creatinine and liver function?
34. in renal disease, which level rises first, creatinine or BUN?
35. what are some factors that could increase creatinine levels?
36. what are some factors that could decrease creatinine levels?
37. what are some factors that interfere in the testing of creatinine levels?
38. what are the normal values for creatinine levels in males and females?
39. what is the critical high level for creatinine?
40. what do BUN/creatinine ratios of 10:1, 20:1 correspond to?
bound calcium...
41. calcium tests are useful in determining...
42. what form is calcium found in the blood?
43. what are 3 mechanisms in the body used to maintain calcium homeostasis?
44. what is the general relationship between calcium and phosphorous in the blood?
45. what are the most common causes of hypercalcemia?
46. what are some causes of hypocalcemia?
47. what is the normal and critical range for calcium in the blood?
ionized calcium...
48. what is the relationship between ionized calcium and serum albumin?
49. ionized calcium might be a better indicator for what disorder?
50. ionized calcium levels is used as a monitor for what procedures?
51. what are some factors that could cause decreased ionized calcium levels?
52. what are some factors that could lead to increased ionized calcium levels?
53. how do the normal and critical ranges of ionized calcium compare to bound calcium?
54. what are some factors that might interfere with calcium measurements in general?
55. what time during the day is calcium generally highest?
total protein...
56. what percentage of protein in the serum does albumin account for?
57. where are globulins synthesized?
58. increase in total proteins are either from...
59. what is total protein used to measure?
60. what is the normal range for total protein?
61. what are some factors that could interfere with the measurement of total protein?
62. what are some drugs that could falsely increase the measurement of total protein?
63. what are some drugs that could falsely decrease the measurements of total protein?
serum albumin...
64. where is serum albumin synthesized?
65. describe the importance of serum albumin in the vascular system.
66. what is the normal range for serum albumin?
67. what are some factors that could increase serum albumin levels?
68. what are some factors that could decrease serum albumin levels?
globulins...
69. globulins form the building blocks of which molecules?
70. serum globulin reflects the damage of which system?
71. where are alpha, beta, and gamma globulins synthesized?
72. what is the normal range of globulins?
73. what are some factors that cause increased globulin levels?
74. what are some factors that cause decreased globulin levels?
75. what is the ratio of albumin to globulin generally?
76. decreased A/G ratio can be caused by...
answers
1. glucagon and insulin.
2. ACTH, corticosteroids, EP, thyroxine.
3. 70-100 mg/dl.
4. 400 mg/dl.
5. increases 1 mg/dl per year.
6. stress, caffiene, pregnancy, delayed testing time, drugs.
7. DM, stress/fever, hyperthyroid, cushing's, chronic renal failure, pancreatitis, pheochromocytoma. [damn that stress- try crushing your liver with your pancreas and some chromosomes]
8. insulinoma, hypothyroid, hypopituitarism, addison's, severe liver disease, glucagon deficiency, reactive hypoglycemia. [low insults adds leverage to the reactivity of glucagon]
9. 126 mg/dl, two samples.
10. 100-125 mg/dl, two samples.
11. glucose levels taken 2 hours after eating.
12. 140-199 mg/dl.
13. >200 mg/dl.
14. smoking, stress, eating.
15. vomiting, a small meal.
16. less expensive and less patient discomfort.
17. a series of blood glucose measurements before glucose ingestion and at set intervals afterwards.
18. delayed onset hypoglycemia and impaired glucose tolerance.
19. a test that measures the percentage of glucose attached to hemoglobin A1c.
20. glucose above 200mg/dl.
21. liver and kidney.
22. proteins.
23. pre-renal azotemia such as CHF.
24. any kidney damage that leads to decreased excretory capabilities leads to increased BUN in the blood.
25. obstruction after the kidneys: kidney stones in the ureters, bladder neck, decreased urine excretion.
26. liver failure, overhydration, negative nitrogen balance, early pregnancy, nephrotic syndrome (loss of BUN through kidneys). [buns filled with water and nitrous never failed the overly-negative pregnant woman]
27. abnormal water or protein consumption, late pregnancy, increased muscle mass.
28. 6-20 mg/dl.
29. >50 mg/dl.
30. creatine phosphate in muscle.
31. slightly low at 7AM, slightly high at 7PM.
32. completely excreted by kidneys and thus a useful measure of GFR.
33. generally is not affected.
34. BUN rises first.
35. renal disease, acromegaly, rhabdomylosis, muscular dystrophy, myasthenia gravis, urinary obstruction, high protein diet. [creatine kid- like a tall rabbit with muscles, pees protein against gravity]
36. decreased muscle mass, inadequate protein, pregnancy, small stature. [short, skinny, pregnant]
37. high meat diets, ketoacidosis, some drugs.
38. 0.8-1.3 mg/dl for males, 0.6-1.1 mg/dl for females.
39. >4 mg/dl.
40. 10:1 can be normal or renal azotemia. 20:1 can be pre or post renal azotemia.
41. calcium metabolism and parathyroid function.
42. 50% bound to albumin, 50% ionized.
43. PTH controls calcium resorption from bone, reabsorption from kidney, and vitamin D increases Ca2+ absorption in intestines.
44. they have a roughly inversely proportional relationship.
45. hyperparathyroid, malignancies.
46. decreased serum albumin, hypoparathyroidism, vitamin D deficiency, some others.
47. 8.8-10.4 mg/dl normal, less than 7.0 critical.
48. no relationship to serum albumin.
49. hyperparathyroidism.
50. open heart surgery and organ transplants.
51. acute pancreatitis, hypoparathyroidism, vitamin D deficiency, magnesium deficiency, multiple organ failure, toxic shock. [acute, PTH, D, mg, organ failure, toxic shock] [IC: to damp]
52. hyperparathyroidism, PTH producing tumors, excess vitamin D. [PTH, PTH, D]
53. roughly half the levels.
54. vitamin D intoxication, decreased pH (increases levels), increased pH (decreases levels).
55. around 9pm.
56. about 60%.
57. the reticuloendothelial system, the liver.
58. increase in globulins or dehydration (albumin generally not affected)
59. liver dysfunction, nutritional status, chronic edema, immune system disorders, SLE, protein wasting, cancer. [liver, nutrition, edema, immune, SLE, cancer]
60. 6.4-8.3 mg/dl.
61. prolonged tourniquet application, drugs, dehydration/overhydration.
62. anabolic steroids, growth hormone, insulin, progesterone.
63. OCP's, estrogen, hepatoxic drugs, nephrotoxic drugs.
64. in the liver.
65. maintains oncotic pressure. important transport protein for drugs, hormones, enzymes, calcium.
66. 3.5-5.0 g/dl.
67. dehydration.
68. liver disease, nephrotic syndrome, ascites, severe burns, increased capillary permeability (SLE), overhydration, inflammation, malnutrition.
69. antibodies, glycoprotein, lipoproteins, clotting factors, acute phase reactants.
70. the RE system in the liver.
71. alpha and beta by the liver, gamma by WBC's.
72. 2.3-3.4 mg/dl.
73. MM, waldenstrom's macroglobulinemia, acute inflammation, chronic inflammation, cirrhosis, infectious disease, dehydration, autoimmune hepatitis.
74. genetic disorders that limit antibody production, secondary immune deficiencies, over-hydration.
75. generally much more albumin than globulin.
76. conditions that cause loss of albumin such as SLE, in which increased capillary permeability causes loss of albumin but not globulin.
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