Term
| Total Protein includes which serum proteins |
|
Definition
| alpha1, alpha2, beta, gamma globulins + albumin |
|
|
Term
| polyclonal gammopathies are seen in: |
|
Definition
|
|
Term
| monoclonal gammopathies are seen in |
|
Definition
1. old age (could lead to CA tho)
2. Multiple myeloma
3. Waldenstrom's (IgM)
4. amyloidosis |
|
|
Term
|
Definition
| macroglobulinemia (IgM) from monoclonal B cells: avg age = 60-65 w increased bleeds (hypofibrinogen, fatigue, weakness, wt loss, HSM |
|
|
Term
| 7 causes for hypoalbuminemia |
|
Definition
| 1. nephrotic syndrome 2. poor diet 3. malabsorption 4. cirrhosis 5. chronic dz 6. protein losing enteropathies (chron's) 7. third degree burns |
|
|
Term
| the only condition that increases albumin concentrations |
|
Definition
|
|
Term
| 4 causes of decreased globulins |
|
Definition
| 1. burton's agammaglobulinemia 2. common variable immunodef 3. chemotherapy 4. nephrotic syndrome |
|
|
Term
| what % of calcium is bound (measurable) in plasma? |
|
Definition
| 40% bound to albumin, 13% bound to phosphate which leaves 47% free and active Ca++ |
|
|
Term
| Most common cause of increased calcium |
|
Definition
| primary hyerparathyroidism - parathyroid adenoma |
|
|
Term
| most common presenting sx of someone with primary hyperparathyroidism |
|
Definition
|
|
Term
| poshpate concentration in >PTH |
|
Definition
|
|
Term
| bicarb concentration in >PTH |
|
Definition
|
|
Term
| Chloride concentration in >PTH |
|
Definition
|
|
Term
| what is the chloride:phosphate ratio for someone with primary hyperparathyroidism? |
|
Definition
|
|
Term
| MC cause for high calcium concentrations for people in the hospital: |
|
Definition
|
|
Term
| what are the 2 cancers most associated with PTH-like peptide? |
|
Definition
| renal adenocarcinoma and squamous cell cancer of the lung |
|
|
Term
| if a CA is causing the hyperparathyroid hormone picture what will the PTH be |
|
Definition
| low; CA produce PTH-like peptide not measured as PTH in the lab |
|
|
Term
| what malignancies would Ca++ be elevated in? |
|
Definition
| multiple myeloma d/t lytic leasions in bone as well as bone mets, PTH secreting Lung/renal CAs, and sarcoidosis d/t increased Vit D synthesis. |
|
|
Term
| what mechanism of sarcoidosis causes increased Ca++? |
|
Definition
| sarcoidosis can increase synthesis of vitamin D |
|
|
Term
| drugs that cause hypercalcemia |
|
Definition
| 1. hypervitaminosis A (synergy c PTH) 2. hypervitaminosis D 3. Calcium containing antacids 4. thiazide diuretics |
|
|
Term
| how does hyperthyroid cause >Ca++? |
|
Definition
| increased turnover of bone |
|
|
Term
| genetic condition that causes hypercalcemia |
|
Definition
| familial hypocalciuric hypercalcemia - renal stones at early age |
|
|
Term
| how does Addison's cause hypercalcemia? |
|
Definition
| lack of cortisol leaves PTH and VitD uncheckd |
|
|
Term
| formula for corrected Ca++ |
|
Definition
| Serum Ca++ - Serum Alb + 4 = corrected Ca++ |
|
|
Term
| low calcium, high phosphorus, low PTH |
|
Definition
|
|
Term
| MC cause of hypoparathyroidism |
|
Definition
|
|
Term
| how does hypomagnesemia cause hypocalcemia? |
|
Definition
decreased Mg+ for the cAMP p-way in the kidney that PTH causes when absorbing Ca++ and excreting Phos
Mg+ also Coenzyme that is required in PTH synthesis |
|
|
Term
| 4 causes of hypomagnesemia |
|
Definition
| 1. EtOH 2. Diarrhea 3. aminoglycosides 4. cisplatin |
|
|
Term
| mental retardation, short stature, knuckle, knuckle, dimple, dimple, low Ca++, high phos, hiigh PTH |
|
Definition
| pseudohypoparathyroidism; hereditary insensitivity to PTH |
|
|
Term
| How does DiGeorge cause hypocalcemia |
|
Definition
|
|
Term
| how does alkalosis cause hypocalcemia? |
|
Definition
| alkalemia cause more neg charge on albumin = more free Ca++ bound = decreased free (active) calcium |
|
|
Term
| most common cause of increased phosphorous |
|
Definition
|
|
Term
| 5 causes of hyperphosphatemia |
|
Definition
|
|
Term
| what happens to phos when insulin is released? |
|
Definition
| intracellular shift - danger of ATP depletion and resp failure |
|
|
Term
| what population of patients are most likely to have |
|
Definition
| alcoholics - u can kill them if you give fructose with low phos levels |
|
|
Term
| how does alkalosis cause hypophos |
|
Definition
| alkalosis enhances phophofructokinase in glycolysis = phos is used up |
|
|
Term
| 4 causes of increased uric acid |
|
Definition
1. kidney dysfxn
2. diruetics (reabsorption)
3. tumor lysis (>purine)
4. metabolic acidosis (competes for excr in the kidney) |
|
|
Term
| what is the diurnal variation in serum iron levels |
|
Definition
|
|
Term
| increased Iron, normal TIBC, increased %sat, increased ferritin |
|
Definition
|
|
Term
| low iron, increased TIBC, low %sat, low serum ferritin |
|
Definition
|
|
Term
| how does iron leave the body |
|
Definition
| through bleeding, sloughing of GI cells and minimaly through sweat |
|
|
Term
| MCC of iron def anemia in male <50 |
|
Definition
|
|
Term
| MCC of fe def anemia in males and females >50 |
|
Definition
|
|
Term
| low serum fe, low TIBC, low %sat, normal to high serum ferritin, normal RDW |
|
Definition
| anemia of chronis diseaes - Fe is sequestered @ site of inflammation |
|
|
Term
| 5 conditions that cause hyperglycemia |
|
Definition
1. DM
2. cushings
3. pheo
4. acromegaly
5. myocardial infarction |
|
|
Term
| most common cause of hypoglycemia |
|
Definition
|
|
Term
| 6 causes of hypoglycemia in adults |
|
Definition
| 1. addison's 2. insulinoma 3. alcoholism 4. reactive hypoglycemia 5. insulin Ab's 6. post gastric bypass hypoglycemia |
|
|
Term
| mechanism in addison's that causes hypoglycemia: |
|
Definition
|
|
Term
| define reactive hypoglycemia: |
|
Definition
| 2-3hr postprandial adrenergic sx; most = functional hyperinsulinism - test bg > load. |
|
|
Term
| how does pre DM cause post-prandial hypoglycemic sx |
|
Definition
| pancrease producing increased amnt of insulin d/t presence of high glucose load eventually saturating receptors... |
|
|
Term
| how do insulin ab's cause hypoglycemia? |
|
Definition
| Ab attached to insulin cause acute increased release of insulin to compensate. Also there is a component of antibodies to insulin receptors that activiate cells to take up insulin. |
|
|
Term
| 5 conditions for increased BUN |
|
Definition
1. prerenal
2. intrarenal
3. postrenal dz
4. increased protein intake (weight-lifters)
5. GI bleed |
|
|
Term
|
Definition
1. SIADH
2. Advanced Cirrhosis
3. fluid overhydration
4. Renal tubular acidosis
5. pregnancy (increased GFR) |
|
|
Term
| Creatinine is falsely increased in which condition? |
|
Definition
| ketosis d/t analytical problem |
|
|
Term
| normal creatinine cannot rule out kidney dysfunction in patietns with |
|
Definition
|
|
Term
| fluids that lose more water than salt causing hypernatremia |
|
Definition
1. sweat
2. INFANT diarrhea
3. diabetes insipidus urine
4. insensible loss (fever/respiration) |
|
|
Term
| causes peaked T waves on EKG |
|
Definition
|
|
Term
| what is the mechanism that digitalis causes hyperkalemia |
|
Definition
| digitalis block Na/K ATPase pump |
|
|
Term
| most common cause of hyperkalemia |
|
Definition
|
|
Term
| Most common drug to cause hyperkalemia |
|
Definition
|
|
Term
| pH and K+ conversion formula |
|
Definition
| for every 0.1 drop in pH from normal (7.4) your K+ falsely elevates 0.6 |
|
|
Term
| Na+ and hyperglycemia conversion |
|
Definition
| for every 100mg/dl Glu over normal the Na+ is falsey decreased 1.6 |
|
|
Term
| 2nd most common cause of death in DKA |
|
Definition
| hypokalemic arrhythmia iatrogenic |
|
|
Term
|
Definition
| causes hypokalemia; drives K+ into cells |
|
|
Term
| which causes hypokalemia vomiting or diarrhea? |
|
Definition
|
|
Term
| Most common cause of hypokalemia |
|
Definition
|
|
Term
| chloride level in non-gap metabolic acidosis |
|
Definition
| elevated; Cl- is taken up more in the absence of bicarb |
|
|
Term
| chloride response to respiratory alkalosis: |
|
Definition
| increases d/t bicarb influx into cells |
|
|
Term
| 3 causes of decreased chloride |
|
Definition
1. vomiting
2. hyponatremia
3. compensation in resp acidosis; trades places w intracellular bicarb |
|
|
Term
| Effect of Cortisol on PTH and Vit D |
|
Definition
| Cortisol inhibits PTH VItD |
|
|
