Archive for the ‘MCQ’ Category

Biochemistry

Posted: May 6, 2012 in MCQ

a-1 FETOPROTEIN (ALPHA-I-FETOPROTEIN )

 

Elevated in:

Hepatocellular carcinoma (usually values >1000 ng/ml), germinal neoplasms (testis, ovary, mediastinum, retroperitoneum), liver disease (alcoholic cirrhosis, acute hepatitis, chronic active hepatitis), fetal anencephaly, spina bifida

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ACETONE (serum or plasma)

 

Elevated in:

DKA, starvation, isopropanol Ingestion

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ACID PHOSPHATASE (serum)

 

Elevated in:

Carcinoma of prostate, other neoplasms (breast, bone), Paget’s disease, osteogenesis imperfecta, malignant invasion of bone, Gaucher’s disease, multiple myeloma, myeloproliferative disorders, benign prostatic hypertrophy, prostatic palpation or surgery, hyperparathyroidism, liver disease, chronic renal failure

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ALANINE AMINOTRANSFERASE (ALT, SGPT)

 

Elevated in:

Liver disease (hepatitis, cirrhosis, Reye’s syndrome), hepatic congestion, infectious mononucleosis, Ml, myocarditis, severe muscle trauma, dermatomyositis/polymyositis, muscular dystrophy, drugs (antibiotics, narcotics, antihypertensive agents, heparin, labetalol, lovastatin, NSAIDs, amiodarone, chlorpromazine, phenytoin), malignancy, renal and pulmonary infarction, convulsions, eclampsia, shock liver

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ALBUMIN (serum)

 

Elevated in:

Dehydration

 

Decreased in:

Liver disease, nephrotic syndrome, poor nutritional status, rapid IV hydration, protein-losing enteropathies (inflammatory bowel disease), severe bums, neoplasia, chronic inflammatory diseases, pregnancy, oral contraceptives, prolonged immobilization

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ALDOLASE (serum)

 

Elevated in:

Muscular dystrophy, rhabdomyolysis, dermatomyositis/polymyositis, trichinosis, acute hepatitis and other liver diseases, Ml, prostatic carcinoma, hemorrhagic pancreatitis, gangrene, delirium tremens

 

Decreased in:

Loss of muscle mass, late stages of muscular dystrophy

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ALKALINE PHOSPHATASE (serum)

 

Elevated in:

Biliary obstruction, cirrhosis (particularly primary biliary cirrhosis), liver disease (hepatitis, infiltrative liver diseases, fatty metamorphosis), Paget’s disease of bone, osteitis deformans, rickets, osteomalacia, hypervitaminosis D, hyperparathyroidism, hyperthyroidism, ulcerative colitis, bowel perforation, bone metastases, healing fractures, bone neoplasms, acromegaly, infectious mononucleosis, CMV infections, sepsis, pulmonary infarction, CHF, hypernephroma, leukemia, myelofibrosis, multiple myeloma, drugs (estrogens, albumin, erythromycin and other antibiotics, cholestasis-producing drugs [phenothiazines])

 

Decreased in:

Hypothyroidism, pernicious anemia, hypophosphatemia, hypervitaminosis D, malnutrition

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AMMONIA (serum)

 

Elevated in:

Hepatic failure, hepatic encephalopathy, Reye’s syndrome, portacaval shunt, drugs (diuretics, polymyxin B. methicillin)

 

Decreased in:

Drugs (neomycin, lactulose, tetracycline), renal failure

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AMYLASE (serum)

 

Elevated in:

Acute pancreatitis, pancreatic neoplasm, abscess, pseudocyst, ascites, macroamylasemia, perforated peptic ulcer, intestinal obstraction, intestinal infarction, acute cholecyshtis, appendicitis, ruptured ectopic pregnancy, salivary gland inflammation, peritonitis, burns, diabetic ketoacidosis, renal insufficiency, drugs (morphine), carcinomatosis of lung, esophagus, ovary, acute ethanol ingestion

 

Decreased in:

Advanced chronic pancreatitis, hepatic necrosis

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ANGIOTENSIN CONVERTING ENZYME (ACE level)

 

Elevated in:

Sarcoidosis, primary biliary cirrhosis, alcoholic liver disease, hyperthyroidism, hyperparathyroidism, diabetes mellitus, amyloidosis, multiple myeloma, lung disease (asbestosis, silicosis, berylliosis, allergic alveolitis, coccidioidomycosis), Gaucher’s disease, leprosy

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ANION GAP

 

Elevated in:

Lactic acidosis

Ketoacidosis (DKA, alcoholic starvation)

Uremia (chronic renal failure)

Ingestion of toxins (paraldehyde, methanol, salicylates, ethylene glycol)

 

Decreased in:

Hypoalbum nemia, severe hypermagnesem a, IgG myeloma, littaum toxicity, lab error (falsely

Decreased sodium or overestimation of bicarbonate or chloride)

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ANTI-DNA

 

Present in:

SLE, chronic active hepatitis, infectious mononucleosis, biliary cirrhosis

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ANTI-STREPTOLYSIN O TITER (STREPTOZYME, ASLO titer)

 

Elevated in:

Streptococcal upper airway infection, acute rheumatic fever, acute glomerulonephritis, increased levels of B-lipoprotein

 

NOTE: A fourfold increase in titer between acute and convalescent specimens is diagnostic of streptococcal upper airway infection regardless of the initial titer.

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ANTIMITOCHONDRIAL ANTIBODY

 

Elevated in:

Primary biliary cirrhosis (85-95%), chronic active hepatitis (25%-30%) cryptogenic cirrhosis (25-30%)

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ANTINUCLEAR ANTIBODY (ANA)

 

Positive test:

SLE (more significant if titer >1: 160), drugs (phenytoin, ethosuximide, pnmudone, methyldopa, hydralazine, carbamazepine, penicillin, procainamide, chlorpromazine, griseofulvin, thiazides), chronic active hepatltis, age over 60 yr (particularly age over 80), rheumatoid arthritls, scleroderma, mixed connective tissue disease, necrotizing vasculitis, Sjogren’s syndrome (SS), tuberculosis, pulmonary interstitial fibrosis

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ANTITHROMBIN III

 

Decreased in:

Hereditary deficiency of antithrombin III, DIC, pulmonary embolism, cirrhosis, thrombolytic therapy, chronic liver failure, post-surgery, third trimester of pregnancy, oral contraceptives, nephrotic syndrome, IV heparin >3 days, sepsis

 

Elevated in:

Warfarin drugs, post-MI

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ASPARTATE AMINOTRANSFERASE (AST, SGOT)

 

Elevated in:

Liver disease (hepatitis, cirrhosis, Reye’s syndrome), hepatic congestion, infectious mononucleosis, MI, myocarditis, severe muscle trauma, dermatomyositis/polymyositis, muscular dystrophy, drugs (antibiotics, narcotics, antihypertensive agents, heparin, labetalol, lovastatin, NSAIDs, phenytoin, amiodarone, chlorpromazine), malignancy, renal and pulmonary infarction, convulsions, eclampsia

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BASOPHIL COUNT

 

Elevated in:

Leukemia, inflammatory processes, polycythemia vera, Hodgkin’s Iymphoma, hemolytic anemia, after splenectomy, myeloid metaplasia

 

Decreased in:

Stress, hypersensitivity reaction, steroids, pregnancy, hyperthyroidism

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BILIRUBIN, DIRECT (conjugated bilirubin)

 

Elevated in:

Hepatocellular disease, biliary obstruction, drug-induced cholestasis, hereditary disorders (Dubin-Johnson syndrome, Rotor’s syndrome)

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BILIRUBIN, INDIRECT (unconjugated bilirubin)

 

Elevated in:

Hemolysis, liver disease (hepatitis cirrhosis, neoplasm), hepatic congestion secondary to congestive heart failure, heredltary dlsorders (Gilbert’s disease, Crigler-Najjar syndrome)

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BILIRUBIN, TOTAL

 

Elevated in:

Liver disease (hepatitis, cirrhosis, cholangitis, neoplasm, biliary obstruction, infectious mononucleosis), hereditary disorders (Gilbert’s dsease, Dubin-Johnson syndrome), drugs (steroids, diphenylhydanton, phenothiazines, penicillin, erythromycin, clindamycin, captopril, amphotericin B. sulfonamides, azathioprine, isoniazid, 5-aminosalicylic acid, allopurinol, methyldopa, indomethacin, halothane, oral contracepuves, procainamide, tolbutamide, labetalol), hemolysis, pulmonary embolism or infarct, hepatic congestion secondary to CHF

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BLEEDING TIME (modified Ivy method)

 

Elevated in:

Thrombocytopenia, capillary wall abnormalities, platelet abnormalities (Bernard-Soulier, Glamzmann’s), drugs (aspirin, warfarin, antinflammatory medications, streptokinase, urokinase, dextran, B lactam antibiotics, moxalactam), DIC, cirrhosis, uremia, myeloproliferative dlsorders, Von Willebrand’s

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C-REACTIVE PROTEIN

 

Elevated in:

Rheumatoid arthritis, rheumatic fever, inflammatory bowel disease, bacterial infections, Ml, oral contraceptives, third trimester of pregnancy (acute phase reactant), inflammatory and neoplastic diseases

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CALCITONIN (serum)

 

Elevated in:

Medullary carcinoma of the thyroid (particularly if level >1500 pg/ml), carcinoma of the breast, APUDomas, carcinolds, renal failure, thyroiditis

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CALCIUM (serum)

 

Increased in:

-Hyperparathyroidism, primary (due to hyperplasia or adenoma of parathyroids) or secondary

-Hyperparathyroidism due to parathormone-secreting cancer -Hematologic malignancies (e.g., myeloma, lymphoma, leukemia)

-Excess vitamin D intake

-Bone tumor (Metastatic carcinoma (10% of patients))

-Acute osteoporosis (e.g., immobilization of young patients or in Paget’s disease)

-Milk-alkali (Burnett’s) syndrome

-Idiopathic hypercalcemia of infants

-Infantile hypophosphatasia

-Berylliosis

-Hyperthyroidism (some patients)

-Cushing’s syndrome (some patients)

-Addison’s disease (some patients)

-Myxedema (some patients)

-Hyperproteinemia (Sarcoidosis, -Multiple myeloma (some patients))

-Thiazide drugs

-Artifactual (e.g., venous stasis during blood collection, use of cork-stoppered test tubes)

 

Decreased in:

-Hypoparathyroidism (Surgical; Idiopathic; Pseudohypoparathyroidism)

-Malabsorption of calcium and vitamin D (Obstructive jaundice)

-Hypoalbuminemia (Cachexia, Nephrotic syndrome, Sprue, Celiac disease, Cystic fibrosis of pancreas)

-Chronic renal disease with uremia and phosphate retention

-Acute pancreatitis with extensive fat necrosis

-Insufficient calcium, phosphorus, and vitamin D ingestion (Bone disease (osteomalacia, rickets); Starvation; Late pregnancy)

 

Total serum protein should always be known for proper interpretation of serum calcium levels.

 

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CARBOXYHEMOGLOBIN (CARBON MONOXIDE; CO)

 

Elevated in:

Smoking, exposure to smoking, exposure to automobile exhaust fumes malfunctioning gas-burning appliances

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CARCINOEMBRYONIC ANTIGEN (CEA)

 

Elevated in:

Colorectal carcinomas, pancreatic carcmomas, and metastatic disease usually produce higher elevations (>20 ng/ml)

 

Carcinomas of the esophagus, stomach, small intestine, liver, breast ovary, lung and thyroid usually produce lesser elevations

 

Benign conditions (smoking, inflammatory bowel disease hypothyroidism, cirrhosis, pancreatitis, infections) usually produce ievels <10 ng/ml

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CAROTENE (serum)

 

Elevated in:

Carotenemia, chronic nephritis, diabetes mellitus, hypothyroidism, nephrotic syndrome

 

Decreased in:

Fat malabsorption, steatorrhea, pancreatic insufficiency, lack of carotenoids in diet

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CEREBROSPINAL FLUID (CSF)

 

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CERULOPLASMIN (serum)

 

Elevated in:

Pregnancy, estrogens, oral contraceptives, neoplastic diseases (leukemias, Hodgkin’s Iymphoma, carcinomas), inflammatory states, SLE, prirnary biliary cirrhosis, rheumatoid arthritis

 

Decreased in:

Wilson’s disease (values often <10 mg/dl), nephrotic syndrome, advanced liver disease, malabsorption, total parenteral nutrition, Menkes’ syndrome

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CHLORIDE (serum)

 

Elevated in:

-Dehydration, excessive infusion of normal saline

-Hyperparathyroidism, renal tubular disease, metabolic acidosis, prolonged diarrhea

-Drugs (ammonium chloride administration, acetazolamide, boric acid, triamterene)

 

Decreased in:

CHF, SIADH, Addison’s disease, vomiting, gastric suction, salt-losing nephritis, continuous infusion of D5W, thiazide diuretic administration, diaphoresis, diarrhea, burns

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CHOLESTEROL, TOTAL

 

Elevated in:

Primary hypercholesterolemia, biliary obstruction, diabetes melhtus, nephrotic syndrome, hypothyroidism, primary biliary cirrhosis, high cholesterol diet, third trimester of pregnancy, Ml, drugs (steroids, phenothiazines, oral contraceptives)

 

Decreased in:

Starvation, malabsorption, sideroblastic anemia, thalassemia, abetalipoproteinemia, hyperthyroidism, Cushing’s syndrome, hepatic failure, multiple myeloma, polycythemia vera, chronic myelocytic leukemia, myeloid metaplasia, Waldenstrom’s macroglobulinemia, myelofibrosis

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CIRCULATING ANTICOAGULANT (lupus anticoagulant)

 

Detected in:

SLE, drug-induced lupus, long-term phenothiazine therapy, multiple myeloma, ulcerative colhis, rheumatoid arthritis, postpartum, hemophilia, neoplasms, chronic inflammatory states

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COLD AGGLUTININS TITER

 

Elevated in:

Primary atypical pneumonia (mycoplasma pneumonia), infectious mononucleosis, CMV infection

 

Other: hepatic cirrhosis, acquired hemolytic anemia, frostbite, multiple myeloma, Iymphoma, malaria

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COMPLEMENT (C3, C4)

 

C3 is increased in:

Acute and chronic inflammation (slightly), obstructive jaundice

 

C3 is decreased in:

Acute glomerulonephritis, systemic lupus erythromatosis

 

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COOMBS, DIRECT

 

Positive:

Autoimmune hemolytic anemia, erythroblastosis fetalis, transfusion reactions, drugs (a-methyldopa, peniecllins, tetraeyeline, sulfonamides, levodopa, cephalosporins, quinidine, insulin)

 

False positive:

May be seen with cold agglutinins

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COOMBS, INDIRECT

 

Positive:

Acquired hemolytic anemia, incompatible cross-matched blood, anti-Rh antibodies, drugs (methyldopa, mefenamic acid, levodopa)

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COPPER (serum)

 

Increased in:

-Anemias (Pernicious anemia, Megaloblastic anemia of pregnancy, Iron deficiency anemia, Aplastic anemia, Leukemia, acute and chronic, Infection, acute and chronic, Malignant lymphoma, Hemochromatosis)

-Collagen diseases (including SLE, rheumatoid arthritis, acute rheumatic fever, glomerulonephritis)

-Hypothyroidism

-Hyperthyroidism

-Frequently associated with increased C-reactive protein

 

Decreased in:

-Nephrosis (ceruloplasmin lost in urine)

-Wilson’s disease

-Acute leukemia in remission

-Some iron deficiency anemias of childhood (that require copper as well as iron therapy)

-Kwashiorkor

 

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CORTISOL (plasma)

 

Elevated in:

-Ectopic ACTH production (i.e., oat cell carcinoma of lung), loss of normal diurnal variation, pregnancy, chronic renal failure

-Iatrogenic, stress, adrenal or pituitary hyperplasia or adenomas

 

Decreased in:

Primary adrenocortical insufficiency, anterior pituitary hypofunction, secondary adrenocortical insufficiency, adrenogenital syndromes

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CREATINE KINASE (CK, CPK)

 

Elevated in:

MI, myocarditis, rhabdomyolysis, myositis, crush injury/trauma, polymyositis, dermatomyositis, vigorous exercise, muscular dystrophy, myxedema, seizures, malignant hyperthermia syndrome, IM injections, CVA, pulmonary embolism and infarction, acute dissection of aorta

 

Decreased in:

Steroids, decreased muscle mass, connective tissue disorders, alcoholic liver disease, metastatic neoplasms

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CREATINE KINASE ISOENZYMES

 

CK-MB

Elevated in: Mi, myocarditis, pericarditis, muscular dystrophy, cardiac defibrillation, cardiac surgery, extensive rhabdomyolysis, strenuous exercise (marathon runners), mixed conmective tissue disease, cardiomyopathy, hypothermia

 

CK-MM

Elevated in: crush injury, seizures, malignant hyperthermia syndrome, rhabdomyolysis, myositis, polymyositis, dermatomyositis, vigorous exercise, muscular dystrophy, IM injections, acute dissection of aorta

 

CK-BB

Elevated in: CVA, subarachnoid hemorrhage, neoplasms (prostate, Gl tract, brain, ovary, breast, lung), severe shock, bowel infarction, hypothermia

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CREATININE (serum)

 

Elevated in:

Renal insufficiency (acute and chronic),

Decreased renal perfusion (hypotension, dehydration, CHF), urinary tract infection, rhabdomyolysis, ketonemia

Drugs (antibiotics [aminoglycosides, cephalosporins], hydantoin, diuretics, methyldopa)

 

Falsely elevated in:

DKA, administration of some cephalosporins (e.g., cefoxitin, cephalothin)

 

Decreased in:

Decreased muscle mass (including amputees and older persons), pregnancy, prolonged debilitation

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CREATININE CLEARANCE

 

Elevated in:

Pregnancy, exercise

 

Decreased in:

Renal insufficiency, drugs (cimetidine, procainanude, antibiotics, quinidine)

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CRYOGLOBULINS (serum)

 

Present in:

Collagen-vascular diseases, CLL, hemolytic anemias, multiple myeloma, Waldenstrom’s macroglobulinemia, chronic active hepatitis, Hodgkin’s disease

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D-XYLOSE ABSORPTION

 

Decreased in:

Malabsorption syndrome

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EOSINOPHIL COUNT

 

Elevated in:

Allergy, parasitic infestations (trichinosis, aspergillosis, hydatidosis), angmneurotic edema, drug reactions, warfarin sensitivity, collagen-vascular diseases, acute hypereosinophilic syndrome, eosinophilic nonallergic rhinitis, myeloproliferative disorders, Hodgkin’s Iymphoma, radiation therapy, NHL, L-tryptophan ingestion

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ERYTHROCYTE SEDIMENTATION RATE (Westergren)

 

Elevated in:

Collagen-vascular diseases, infections, MI, neoplasms, inflammatory states (acute phase reactant)

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EXTRACTABLE NUCLEAR ANTIGEN (ENA complex, anti-RNP antibody, anti-Sm, anti-Smith)

 

Present in:

SLE, rheumatoid arthritis, Sjogren’s syndrome, MCTD

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FECAL FAT, QUANTITATIVE (72 hr collection)

 

Elevated in:

Malabsorption syndrome

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FERRITIN (serum)

 

Elevated in:

Hyperthyroidism, inflammatory states, liver disease (ferritin elevated from necrotic hepatocytes), neoplasms (neuroblastomas, Iymphomas, leukemia, breast carcinoma), iron replacement therapy, hemochromatosis

 

Decreased in:

Iron deficiency anemia

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FIBRIN DEGRADATION PRODUCT (FDP)

 

Elevated in:

DIC, primary fibrinolysis, pulmonary embolism, severe liver disease

 

NOTE: The presence of rheumatoid factor may cause falsely elevated FDP

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FIBRINOGEN

 

Elevated in:

Tissue inflammation/damage (acute-phase protein reactant), oral contraceptives, pregnancy, acute infection, MI

 

Decreased in:

DIC, hereditary afibrinogenemia, liver disease, primary or secondary fibrinolysis, cachexia

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FOLATE (FOLIC ACID)

 

Decreased in:

Folic acid deficiency (inadequate intake, malabsorption), alcoholism, drugs (methotrexate, trimethoprim, phenytoin, oral contraceptives, azulfadine), vitamin B12 deficiency (defective red cell folate absorption)

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FTA-ABS (serum)(FLUORESCENT TREPONEMAL ANTIBODY)

 

Reactive in:

Syphilis, other treponemal diseases (yaws, pinta, bejel)

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GASTRIN (serum)

 

Elevated in:

Zollinger-Ellison syndrome (gastrinoma), pernicious anemia, hyperparathyroidism, retained gastric antrum, chronic renal failure, gastric ulcer, chronic atrophic gastritis, pyloric obstruction, malignant neoplasms of the stomach, H2 blockers, omeprazole

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GLOMERULAR BASEMENT MEMBRANE ANTIBODY (ANTIGLOMERULAR BASEMENT ANTIBODY)

 

Present in:

Goodpasture’s syndrome

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GLUCOSE-6-PHOSPHATE DEHYDROGENASE SCREEN (blood)

 

Abnormal:

If a deficiency is detected, quantitation of G6PD is necessary; a G6PD screen may be falsely interpreted as abnormal

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GLUCOSE TOLERANCE TEST

 

Elevated in:

Glucose intolerance, diabetes mellitus, Cushing’s syndrome, acromegaly, pheochromocytoma

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GLUCOSE, FASTING

 

Elevated in:

Diabetes mellitus, stress, infections, MI, CVA, Cushing’s syndrome, acromegaly, acute pancreatitis, glucagonoma, hemocbromatosis, drugs (glucocorticoids, diuretics [thiazides, loop diuretics]), glucose intolerance

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GLUCOSE, POSTPRANDIAL

 

Elevated in:

Diabetes mellitus, glucose intolerance

 

Decreased in:

Post-gastrointestinal resection, reactive hypoglycemia, hereditary fructose intolerance, galactosemia, leucine sensitivity

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GLYCATED (GLYCOSYLATED) HEMOGLOBIN (HbA1c)

 

Elevated in:

Uncontrolled diabetes mellitus (glycated hemoglobin levels reflect the level of glucose control over the preceding 120 days)

 

Decreased in:

Hemolytic anemias,

Decreased RBC survival, pregnancy, chronic blood loss, chronic renal failure, insulinoma

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HAM TEST (acid serum test)

 

Positive in:

Paroxysmal nocturnal hemoglobinuria (PNH)

 

False positive in:

Hereditary or acquired spherocytosis, recent transfusion with aged RBC, aplastic anemia, myeloproliferative syndromes, leukemia, hereditary dyserythropoietic anemia type II (HEMPAS)

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HAPTOGLOBIN (serum)

 

Elevated in:

Inflammation (acute phase reactant), collagen-vascular diseases, infections (acute phase reactant), drugs (androgens)

 

Decreased in:

Hemolysis (intravascular > extravascular), megaloblastic anemia, severe liver disease, large tissue hematomas, infectious mononucleosis, drugs (oral contraceptives)

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HEMATOCRIT

 

Elevated in:

Polycythemia vera, smoking, COPD, high altitudes, dehydration, hypovolemia

 

Decreased in:

Blood loss (GI, GU), anemia, pregnancy

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HEMOGLOBIN

 

Elevated in:

Hemoconcentration, dehydration, polycythemia vera, COPD, high altitudes, false elevations (hyperlipemic plasma, WBC >50,000 mm3), stress

 

Decreased in:

Hemorrhage (GI, GU), anemia

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HEPATITIS A ANTIBODY

 

Present in:

Viral hepatitis A, can be IgM or IgG (if IgM, acute hepatitis A; if IgG, previous infection with hepatitis A)

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HEPATITIS B SURFACE ANTIGEN (HBsAg)

 

Detected in:

Acute viral hepatitis Type B. Chronic hepatitis B

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HIGH DENSITY LIPOPROTEIN (HDL) CHOLESTEROL

 

Increased:

Use of gemfibrozil, nicotinic acid, estrogens, regular aerobic exercise, small (1 oz) daily alcohol intake

 

Decreased:

Deficiency of apoproteins, liver disease, probucol ingestion, Tangier disease

NOTE: A cholesterol/HDL ratio >4.5 is associated with increased risk of coronary artery disease.

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IMMUNE COMPLEX ASSAY

 

Detected in:

Collagen-vascular disorders, glomerulonephritis, neoplastic diseases, malaria, primary biliary cirrhosis, chronic acute hepatitis, bacterial endocarditis, vasculitis

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IMMUNOGLOBULINS

 

Elevated in:

-IgA: Iymphoproliferative disorders, Berger’s nephropathy, chronic infections, autoimmune disorders, liver disease

-IgE: allergic disorders, parasitic infections, immunological disorders IgE myeloma

-IgG: chronic granulomatous infections, infectious diseases, inflammation, myeloma, liver disease

-IgM: primary biliary cirrhosis, infectious diseases (brucellosis, malaria), Waldenstrom’s macroglobulinemia, liver disease

 

Decreased in:

-IgA: nephrotic syndrome, protein-losing enteropathy, congenital deficiency, Iymphocytic leukemia, ataxia-telengiectasia, chronic eosinopulmonary disease

-IgE: hypogammaglobulinemia, neoplasm (breast, bronchial, cervical) ataxia, telengiectasia

-IgG: congenital or acquired deficiency, Iymphocytic leukemia, phenytoin, methylprednisolone, nephrotic syndrome, protein-losing enteropathy

-IgM: congenital deficiency, Iymphocytic leukemia, nephrotic syndrome

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IRON-BINDING CAPACITY (TIBC)

 

Elevated in:

Iron deficiency anemia, pregnancy, polycythemia

 

Decreased in:

Anemia of chronic disease, hemochromatosis, chronic liver disease, hemolytic anemias, malnutrition (protein depletion)

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LACTATE (blood)

 

Increased in:

(Without signifigant acidosis): Muscular exercise, hyperbentilation, glucaon, glycogen storage disease, severe anemia, pyruvate infusion, HCO3 infusion, glucose and insulin infusion.

 

(With hypoxia and acidosis): Acute hemorrage, circulatory collapse, cyanotic heart disease, severe acute CHF, acute anoxemia, extracorpeal circulation, epinephrine

 

(Idiopathic): Mild uremia, infections (esp. pyelonephritis), septicemia, cirrhosis, acute pancreatitis (+/-), third trimester of pregnancy, severe vascular disease, leukemia, anemia, chronic alcoholism, subacute bacterial endocarditis, poliomyelitis

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LACTATE DEHYDROGENASE (LDH)

 

Elevated in:

Infarction of myocardium, lung, kidney

 

Diseases of cardiopulmonary system, liver, collagen, CNS

 

Hemolytic anemias, megaloblastic anemias, transfusions, seizures, muscle trauma, muscular dystrophy, acute pancreatitis hypotension shock, infectious mononucleosis, inflammation, neoplasia, intestinai obstruction, hypothyroidism

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LACTATE DEHYDROGENASE ISOENZYMES

 

Abnormal values:

LDH1 > LDH2: MI (can also be seen with hemolytic anemias, pernicious anemia, folate deficiency, renal infarct)

 

LDH5 > LDH4: liver disease (cirrhosis, hepatitis, hepatic congestion)

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LEGIONELLA TITER

 

Positive in:

Legionnaire’s disease (presumptive: > 1:256 titer; definitive: fourfold titer increase to >1: 128)

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LEUKOCYTE ALKALINE PHOSPHATASE (LAP SCORE)

 

Elevated in:

Leukemoid reactions, neutrophilia secondary to infections (except in sickle cell crisisƒ€no significant increase in LAP score), Hodgkin’s disease, polycythemia vera, hairy cell leukemia, aplastic anemia, Down’s syndrome, myelofibrosis

 

Decreased in:

Acute and chronic granulocytic leukemia, thrombocytopenic purpura, paroxysmal nocturnal hemoglobinuria (PNH), hypophosphatemia, collagen disorders

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LIPASE

 

Elevated in:

Acute pancreatitis, perforated peptic ulcer, carcinoma of pancreas (early stage), pancreatic duct obstruction

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LOW DENSITY LIPOPROTEIN (LDL) CHOLESTEROL

 

Elevated in:

Primary hyperlipoproteinemia, diet high in saturated fats, acute MI, hypothyroidism, primary biliary cirrhosis, nephrosis, driabetes mellitus

 

Decreased in:

Abetalipoproteinemia, advanced liver disease, malabsorption, malnutrition

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LYMPHOCYTES

 

Elevated in:

Chronic infections, infectious mononucleosis and other viral infections, CLL, Hodgkin’s disease, ulcerative colitis, hypoadrenalism, ITP

 

Decreased in:

AIDS, ARC, bone marrow suppression from chemotherapeutic agents or chemotherapy, aplastic anemia, neoplasms, steroids, adrenocortical hyperfunction, neurologic disorders (multiple sclerosis, myasthenia gravis, Guillain-Barre syndrome)

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MAGNESIUM (serum)

 

Increased in:

-Renal failure

-Diabetic coma before treatment

-Hypothyroidism

-Addison’s disease and after adrenalectomy

-Controlled diabetes mellitus in older patients

-Administration of antacids containing magnesium

 

Decreased in:

-GI disease showing malabsorption and abnormal loss of GI fluids (e.g., nontropical sprue, small bowel resection, biliary and intestinal fistulas, abdominal irradiation, prolonged aspiration of intestinal contents, celiac disease and other causes of steatorrhea)

-Acute alcoholism and alcoholic cirrhosis

-Insulin treatment oof diabetic coma

-Hyperthyroidism

-Aldosteronism

-Hyperparathyroidism

-Lytic tumors of bone

-Diuretic drug therapy (e.g., ethacrynic acid, furosemide)

-Some cases of renal disease (e.g., glomerulonephritis, pyeloneI phritis, renal tubular acidosis)

-Acute pancreatitis

-Excessive lactation

-Idiopathic disorders

 

Magnesium deficiency may cause apparently unexplained hypocalcemia and hypokalemia; the patients may have neurologic and GI symptoms

 

—————————————————————————————————-

MEAN CORPUSCULAR VOLUME (MCV)

 

Elevated in:

Vitamin B12 deficiency, folic acid deficiency, liver disease, alcohol abuse, reticulocytosis, hypothyroidism, marrow aplasia, myelofibrosis

 

Decreased in:

Iron deficiency, thalassemia syndrome and other hemoglobinopathies, anemia of chronic disease, sideroblastic anemia, chronic renal failure, lead poisoning

—————————————————————————————————-

MONOCYTE COUNT

 

Elevated in:

Viral diseases, parasites, infections, neoplasms, inflammatory bowel disease, monocytic leukemia, Iymphomas, myeloma, sarcoidosis

 

Decreased in:

Aplastic anemia, Iymphocytic leukemia, glucocorticoid administration

—————————————————————————————————-

NEUTROPHIL COUNT

 

Elevated in:

Acute bacterial infections, acute MI, stress, neoplasms, myelocytic leukemia

 

Decreased in:

Viral infections, aplastic anemias, immunosuppressive drugs, radiation therapy to bone marrow, agranulocytosis, drugs (antibiotics, antithyroidals), Iymphocytic and monocytic leukemias

—————————————————————————————————-

OSMOLALITY, SERUM

 

It can be estimated by the following formula:

 

2([Na] + [K]) + Glucose/18 + BUN/2.8

 

Elevated in:

Dehydration, hypernatremia, diabetes insipidus, uremia, hyperglycemia, mannitol therapy, ingestlon of toxins (ethylene glycol, methanol ethanol)

 

Decreased in:

SIADH, hyponatremia, overhydration

—————————————————————————————————-

pH, BLOOD

 

Increased in:

Metabolic alkalosis, respiratory alkalosis

 

Decreased in:

Metabolic acidosis, repiratory acidosis

—————————————————————————————————-

PARTIAL THROMBOPLASTIN TIME (PTT), ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)

 

Elevated in:

Heparin therapy, coagulation factor deficiency (I, II, V, VIII, IX, X, XI XII), liver disease, vitamin K deficiency, DIC, circulating anticoagulant, warfarin therapy, specific factor inhibition (PCN reaction, rheumatoid arthritis), thrombolytic therapy

 

NOTE: Useful to evaluate the intrinsic coagulaion system.

—————————————————————————————————-

PHOSPHATASE, ALKALINE; see ALKALINE PHOSPHATASE PHOSPHORUS (serum)

 

Elevated in:

Renal failure, dehydration, Addison’s disease, myelogenous leukemia, hypervitaminosis D, hypoparathyroidism, pseudohypoparathyroidism, bone metastases, sarcoidosis, milk-alkali syndrome, immobilization, magnesium deficiency, transfusions, hemolysis

 

Decreased in:

Starvation (e.g., alcoholics), DKA, TPN, continuous IV dextrose administration, vitamin D deficiency, hyperparathyroidism, pseudohyperparathyroidism, antacids containing aluminum hydroxide, insulin administration, nasogastric suctioning, vomiting, diuretics, steroids, gram-negative septicemia

—————————————————————————————————-

PHOSPHORUS (serum)

 

Increased in:

-Hypoparathyroidism (Idiopathic, Surgical, Pseudohypoparathyroidism)

-Excess vitamin D intake

-Secondary hyperparathyroidism (renal rickets)

-Bone disease (Healing fractures, Multiple myeloma (some patients), Paget’s disease (some patients), Osteolytic metastatic tumor in bone (some patients))

-Addison’s disease

-Acromegaly

-Childhood

-Myelogenous leukemia

-Acute yellow atrophy

-High intestinal obstruction

-Sarcoidosis (some patients)

-Milk-alkali (Burnett’s) syndrome (some patients)

-Artifactual increase by hemolysis of blood

 

Decreased in

-Alcoholism*

-Diabetes mellitus*

-Hyperalimentation*

-Nutritional recovery syndrome* (rapid refeeding after prolonged starvation)

-Alkalosis, respiratory (e.g., gram-negative bacteremia) or metabolic

-Acute gout

-Salicylate poisoning

-Administration of glucose intravenously (e.g., recovery after severe burns, hyperalimentation)

-Administration of anabolic steroids, androgens, epinephrine, glucagon, insulin

-Acidosis (especially ketoacidosis)

-Hyperparathyroidism

-Renal tubular defects (e.g., Fanconi syndrome)

-Hypokalemia

-Hypomagnesemia

-Administration of diuretics

-Prolonged hypothermia (e.g., open heart surgery)

-Malabsorption

-Vitamin D deficiency and/or resistance, osteomalacia

-Malnutrition, vomiting, diarrhea

-Administration of phosphate-binding antacids*

-Primary hypophosphatemia

 

*Indicates conditions associated with severe hypophosphatemia.

 

Mechanisms of hypophosphatemia are intracellular shift of phosphate, increased loss (via kidney or intestine), or decreased intestinal absorption; usually associated with prior phosphorus depletion.  Often, more than one mechanism is operative.

 

—————————————————————————————————-

PLATELET COUNT

 

Elevated in:

Neoplasms (GI tract), CML, polycythemia vera, myelofibrosis with myeloid metaplasia, infections, after splenectomy, postpartum, after hemorrhage, hemophilia, iron deficiency, pancreatitis, cirrhosis

—————————————————————————————————-

POTASSIUM (serum)

 

Increased in:

-Renal failure: (Acute with oliguria or anuria; Chronic end-stage with oliguria (glomerular filtration rate <3-5 ml/minute); Chronic nonoliguric associated with dehydration, obstruction, trauma, or excess potassium)

-Decreased mineralocorticoid activity: (Addison’s disease; Hypofunction of renin-angiotensin-aldosterone system; Pseudohypoaldosteronism; Aldosterone antagonist (e.g., spironolactone))

-Increased supply of potassium: (Red blood cell hemolysis (transfusion reaction, hemolytic anemia); Excess dietary intake or rapid potassium infusion; Striated muscle (status epilepticus, periodic paralysis); Potassium-retaining drugs (e.g., triamterene); Fluid-electrolyte imbalance (e.g., dehydration, acidosis))

-Laboratory artifacts (e.g., hemolysis during venipuncture, conditions associated with thrombocytosis, incomplete separation of serum and clot)

 

Decreased in:

-Renal and adrenal conditions with metabolic alkalosis: (Administration of diuretics, Primary aidosteronism, Pseudoaldosteronism, Salt-losing nephropathy, Cushing’s syndrome)

-Renal conditions associated with metabolic acidosis: (Renal tubular acidosis, Diuretic phase of acute tubular necrosis, Chronic pyelonephritis, Diuresis following relief of urinary tract obstruction)

-Gastrointestinal conditions: (Vomiting, gastric auctioning; Villous adenoma; Cancer of colon; Chronic laxative abuse; Zollinger-Ellison syndrome; Chronic diarrhea; Ureterosigmoidostomy)

 

—————————————————————————————————-

PROLACTIN

 

Elevated in:

Prolactinomas (level >200 highly suggestive), drugs (phenothiazines, cimetidine, tricyclic antidepressants, metoclopramide, estrogens, antihypertensives [methyldopa], verapamil, haloperidol), postpartum, stress, hypoglycemia, hypothyroidism

—————————————————————————————————-

PROTEIN (serum)

 

Elevated in:

Dehydration, multiple myeloma, Waldenstrom’s macroglobulinemia, sarcoidosis, collagen-vascular diseases

 

Decreased in:

Malnutrition, low-protein diet, overhydration, malabsorption, pregnancy, severe bums, neoplasms, chronic diseases, cirrhosis, nephrosis

—————————————————————————————————-

PROTEIN ELECTROPHORESIS (serum)

 

Elevated:

-Albumin: dehydration

-a-l: neoplastic diseases, inflammation

-a-2: neoplasms, inflammation, infection, nephrotic syndrome

-b: hypothyroidism, biliary cirrhosis, diabetes mellitus

-y: see IMMUNOGLOBULINS

 

Decreased:

-Albumin: malnutrition, chronic liver disease, malabsorption, nephrotic syndrome, burns, SLE

-a-I: emphysema (a-l antitrypsin deficiency), nephrosis

-a-2: hemolytic anemias (

Decreased haptoglobin), severe hepatocellular damage

-b: hypocholesterolemia, nephrosis

-y: see IMMUNOGLOBULINS

—————————————————————————————————-

PROTHROMBIN TIME (PT)

 

Elevated in:

Liver disease, oral anticoagulants (Warfarin), heparin, factor deficiency (I, II, V, VII, X), DIC, vitamin K deficiency, afibrinogenemia, dysfibrinogenemia, drugs (salicylae, chloral hydrate, diphenylhydantoin, estrogens, antacids, phenylbutazone, quinidine, antibiotics, allopurinol, anabolic steroids)

 

Decreased in:

Vitamin K supplementation, thrombophlebitis, drugs (gluthetimide, estrogens, griseofulvin, diphenhydramine)

—————————————————————————————————-

PROTOPORPHYRIN (free erythrocyte)

 

Elevated in:

Iron deficiency, lead poisoning, sideroblastic anemias, anemia of chronic disease, hemolytic anemias, erythropoietic protoporphyria

—————————————————————————————————-

RED BLOOD CELL COUNT

 

Elevated in:

Polycythemia vera, smokers, high altitude, cardiovascular disease, renal cell carcinoma and other erythropoietin-producing neoplasms, stress, hemoconcentration/dehydration

 

Decreased in:

Anemias, hemolysis, chronic renal failure, hemorrhage, failure of marrow production

—————————————————————————————————-

RED BLOOD CELL DISTRIBUTION WIDTH (RDW)

 

Normal RDW and…

Elevated MCV: aplastic anemia, preleukemiaNormal MCV: normal, anemia of chronic disease, acute blood loss or hemolysis, CLL, CML, nonanemic enzymopathy or hemoglobinopathy

 

Decreased MCV: anemia of chronic disease, heterozygous thalassemia

 

 

Elevated RDW and…

Elevated MCV: vitamin Bl2 deficiency, folate deficiency, immune hemolytic anemia, cold agglutinins, CLL with high count, liver disease

 

Normal MCV: early iron deficiency, early vitamin Bl2 deficiency, early folate deficiency, anemic globinopathy

 

Decreased MCV: iron deficiency, RBC fragmentation, Hb H. thalassemia intermedia

—————————————————————————————————-

RED BLOOD CELL MASS (VOLUME)

 

Elevated in:

Polycythemia vera, hypoxia (smokers, high altitude, cardiovascular disease), hemoglobinopathies with high 2B affinity, erythropoietin-producmg tumors (renal cell carcinoma)

 

Decreased in:

Hemorrhage, chronic disease, failure of marrow production anemias, hemolysis

—————————————————————————————————-

RETICULOCYTE COUNT

 

Elevated in:

Hemolytic anemia (sickle cell crisis, thalassemia major, autoimmune hemolysls, hemorrhage, postanemia therapy (folic acid, ferrous sulfate, vitamin B12)

 

Decreased in:

Aplastic anemia, marrow suppression (sepsis, chemotherapeutic agents radlation), hepatic cirrhosis, blood transfusion, anemias of disordered maturation (iron deficiency anemia, megaloblastic anemia, sideroblastlc anemua, anemna of chronic disease)

—————————————————————————————————-

RHEUMATOID FACTOR

 

Present in titer >1:20:

Rheumatoid arthritis, SLE, chronic inflammatory processes, old age, infection, liver disease

—————————————————————————————————-

SMOOTH MUSCLE ANTIBODY (ANTI- SMOOTH MUSCLE ANTIBODY)

 

Present in:

Chronic active hepatitis (>1:80), primary biliary cirrhosis (<1:80), infectious mononucleosis

—————————————————————————————————-

SODIUM (serum)

 

Increased in:

 

Excess loss of water…

-Conditions that cause loss via gastrointestinal tract (e.g., in vomiting), lung (hyperpnea), or skin (e.g., in excessive sweating)

-Conditions that cause diuresis (Diabetes insipidus, Nephrogenic diabetes insipidus, Diabetes mellitus, Diuretic drugs, Diuretic phase of acute tubular necrosis, Diuresis following relief of urinary tract obstruction, Hypercalcemic nephropathy, Hypokalemic nephropathy)

 

Excess administration of sodium (iatrogenic), e.g., incorrect replacement following fluid loss.

“”Essential”” hypernatremia due to hypothalamic lesions

 

Decreased in (serum osmolality is decreased):

 

-Dilutional: (e.g., congestive heart failure, nephrosis, cirrhosis with ascites)

-Sodium depletion: (Loss of body fluids (e.g., vomiting, diarrhea, excessive sweating) with incorrect or no therapeutic replacement, diuretic drugs (e.g., thiazides); Adrenocortical insufficiency; Salt-losing nephropathy; Inappropriate secretion of antidiuretic hormone)

-Spurious (serum osmolality is normal or increased): (Hyperlipidemia; Hyperglycemia (serum sodium decreases 3 mEq/L for every increase of serum glucose of 100 mg/100 ml))

 

 

—————————————————————————————————-

SUCROSE HEMOLYSIS TEST (sugar water test)

 

Positive in:

Paroxysmal nocturnal hemoglobinuria (PNH)

 

False positive: autoimmune hemolytic anemia, megaloblastic anemnas

False negative: may occur with use of heparin or EDTA

—————————————————————————————————-

T3 (TRIIODOTHYRONINE)

 

Decreased in:

Starvation, trauma, surgery, may be an adaptive response to illness, drugs (PTU)

—————————————————————————————————-

T3 RESIN UPTAKE (T3RU)

 

This test should be used only with a simultaneous measurement of serum T4 to exclude the possibility that an increased T4 is due to an increase in T4-binding globulin.  Measurement of serum T-3 concentration should be done by radioimmunoassay for diagnosis of hyperthyroidism

 

Increased in:

-Hyperthyroidism

-Certain drugs (e.g., testosterone, androgens, anabolic steroids, prednisone, heparin, Dicumarol, salicylates, Butazolidin, penicillin, Dilantin)

-Threatened abortion

-Infants (up to about age 2 months)

-Severe nephrosis

-Metastatic neoplasms

 

Decreased in_

-Hypothyroidism

-Pregnancy (from about tenth week of pregnancy until up to 12th week postpartum)

-Certain drugs (e.g., estrogens alone or in birth control pills, large amounts of iodine, propylthiouracil in hyperthyroidism)

 

Normal in:

-Pregnancy with hyperthyroidism

-Nontoxic goiter

-Carcinoma of thyroid

-Diabetes mellitus

-Addison’s disease

-Anxiety

-Certain drugs (mercurials, iodine)

 

Variable in:

Liver disease

 

—————————————————————————————————-

T4, FREE (free thyroxine)

 

This determination gives corrected values in patients in whom the total thyroxine (T-4) is altered on account of changes in serum proteins or in binding sites. (Pregnancy; Drugs (e.g., androgens, estrogens, birth control pills, Dilantin); Altered levels of serum proteins (e.g., nephrosis))

 

This is the best single screening test for thyroid dysfunction. It is paralleled by the free thyroxine factor.

 

Increased in:

-Hyperthyroidism

-Hypothyroidism treated with thyroxine -Very ill euthyroid patients (frequently)

 

Decreased in:

-Hypothyroidism

-Hypothyroidism treated with triiodothyronine

 

—————————————————————————————————-

THROMBIN TIME (TT)

 

Elevated in:

Thrombolytic and heparin therapy, DIC, hypofibrinogenemia, dysfibrinogenemia

—————————————————————————————————-

THYROID STIMULATING HORMONE (TSH)

 

Elevated in:

Hypothyroidism, drugs (haloperidol, chlorpromazme, metoclopramide, domperidone), TSH antibodies, pituitary resistance to thyroid hormone

 

Decreased in:

Hyperthyroidism, acute medical illness, drugs (dopamine, corticosteroids, bromocriptine, levodopa, pyridoxine), hyponatremia, malnutrition

 

Normal in:

Cushing’s syndrome

Acromegaly

Pregnancy at term

 

—————————————————————————————————-

THYROXINE-BINDING GLOBULIN (TBG)

 

Increased in:

-Pregnancy

-Excess TBG, genetic or idiopathic -Hypothyroidism (sorr-te patients)

-Certain drugs (estrogens, birth control pills)

-Gross iodine contamination

-Acute intermittent porphyria

 

Decreased in:

-Nephrosis and other causes of marked hypoproteinemia Deficiency of TBG, genetic or idiopathic

-Certain drugs (androgenic and anabolic steroids)

 

An increase of TBG is associated with an increase in PBI, BEI, and T-4 by column and a decrease in T-3; converse association for decrease of TBG.

—————————————————————————————————-

THYROXINE (T4)

 

Increased in:

-Hyperthyroidism

-Pregnancy

-Certain drugs (estrogens, birth control pills, d-thyroxine, thyroid extract, TSH)

 

Decreased in:

-Hypothyroidism

-Hypoproteinemia

-Certain drugs (phenytoin sodium [Dilantin], triiodothyronine, testosterone, ACTH, corticosteroids)

 

Not affected by:

-Radiopaque substances for x-ray studies -Mercurial diuretics

-Nonthyroidal iodine

 

—————————————————————————————————-

TRANSFERRIN

 

Elevated in:

Iron deficiency anemia, oral contraceptive administration, viral hepatitis

 

Decreased in:

Nephrotic syndrome, liver disease, hereditary deficiency, protein malnutrition, neoplasms, chronic inflammatory states, chronic illness thalassemia

—————————————————————————————————-

TRIGLYCERIDES

 

Elevated in:

Hyperlipoproteinemias (Types I, IIb, III, IV, V), hypothyroidism, pregnancy, estrogens, acute MI, pancreatitis, alcohol intake, nephrotic syndrome, diabetes mellitus, glycogen storage disease

 

Decreased in:

Malnutrition, congenital abetalipoproteinemias, drugs (e.g., gemfibrozil, nicotinic acid, clofibrate)

—————————————————————————————————-

UREA NITROGEN (BUN)

 

Elevated in:

-Drugs (aminoglycosides and other antibiotics, diuretics, lithium, corticosteroids), dehydration, gastrointestinal bleeding,

-Decreased renal blood flow (shock, CHF, MI), renal disease (glomerulonephritis pyelonephritis, diabetic nephropathy), urinary tract obstruction (prostatic hypertrophy)

 

Decreased in:

Liver disease, malnutrition, third trimester of pregnancy, overhydration

—————————————————————————————————-

URIC ACID (serum)

 

Elevated in:

Renal failure, gout, excessive cell Iysis (chemotherapeutic agents, radiation therapy, leukemia, Iymphoma, hemolytic anemia), hereditary enzyme deficiency (hypoxanthine-guanine-phosphoribosyl transferase) acidosis, myeloproliferative disorders, diet high in purines or protein drugs (diuretics, low doses of ASA, ethambutol, nicotinic acid), lead poisoning, hypothyroidism, Addison’s disease, nephrogenic diabetes insipidus, active psoriasis, polycystic kidneys

 

Decreased in:

Drugs (allopurinol, high doses of ASA, probenecid, warfarin, corticosteroid), deficiency of xanthine oxidase, SIADH, renal tubular deficits (Fanconi’s syndrome), alcoholism, liver disease, diet deficient in protein or purines, Wilson’s disease, hemochromatosis

—————————————————————————————————-

URINE 5-HYDROXYINDOLE-ACETIC ACID (URINE 5-HIAA)

 

Elevated in:

Carcinoid tumors, after ingestion of certain foods (bananas, plums, tomatoes, avocados, pineapples, eggplant, walnuts), drugs (MAO inhibitors, phenacetin, methyldopa, glycerol guaiacolate, acetaminophen,salicylates, phenothiazines, imipramine, methocarbamol, reserpine, metamphetamine)

—————————————————————————————————-

URINE AMYLASE

 

Elevated in:

Pancreatitis, carcinoma of the pancreas

—————————————————————————————————-

URINE BILE (BILIRUBIN, URINE)

 

Abnormal:

Urine bilirubin: Hepatitis (viral, toxic, drug-induced), biliary obstruction

Urine urobilinogen: Hepatitis (viral, toxic, drug-induced), hemolytic jaundice, liver cell dysfunction (cirrhosis, infection, metastases)

—————————————————————————————————-

URINE CALCIUM

 

Elevated in:

Primary hyperparathyroidism, hypervitaminosis D, bone metastases multlple myeloma, increased calcium intake, steroids, prolonged immobilization, sarcoidosis, Paget’s disease, idiopathic hypercalciuria renal tubular acidosis

 

Decreased in:

Hypoparathyroidism, pseudohypoparathyroidism, vitamin D deficiency vitanun D-resistant rickets, diet low in calcium, drugs (thiazide diuretics, oral contraceptives), familial hypocalciuric hypercalcemia, renal osteodystrophy

—————————————————————————————————-

URINE CATECHOLAMINES

 

Elevated in:

Pheochromocytoma, neuroblastoma, severe stress

—————————————————————————————————-

URINE CHLORIDE

 

Elevated in:

Corticosteroids, Bartter’s syndrome

 

Decreased in:

Chloride depletion (vomiting, diuretics), colonic villous adenoma

—————————————————————————————————-

URINE COPPER

 

Increased in:

Wilson’s disease

—————————————————————————————————-

URINE CORTISOL, FREE

 

Elevated:

Refer to CORTISOL (serum)

—————————————————————————————————-

URINE CREATININE (24 hr)

 

NOTE: Useful test as an indicator of completeness of 24 hr urine collection.

—————————————————————————————————-

URINE GLUCOSE (qualitative)

 

Present in:

Diabetes mellitus, renal glycosuria (decreased renal threshold for glucose), glucose intolerance

—————————————————————————————————-

URINE HEMOGLOBIN, FREE

 

Present in:

Hemolysis (with saturation of serum haptoglobin binding capacity and renal threshold for tubular absorption of hemoglobin)

—————————————————————————————————-

URINE HEMOSIDERIN

 

Present in:

Paroxysmal noctumal hemoglobinuria (PNH), chronic hemolytic anemia, hemochromatosis

—————————————————————————————————-

URINE INDICAN

 

Present in:

Malabsorption secondary to intestinal bacterial overgrowth

—————————————————————————————————-

URINE KETONES (semiquantitative)

 

Present in:

DKA, alcoholic ketoacidosis, starvation, isopropanol ingestion

—————————————————————————————————-

URINE METANEPHRINES

 

Elevated in:

Pheochromocytoma, neuroblastoma, drugs (caffeine, phenothiazines, MAO inhibitors), stress

—————————————————————————————————-

URINE MYOGLOBIN

 

Present in:

Severe trauma, hyperthermia, polymyositis/demmatomyositis, carbon monoxide poisoning

—————————————————————————————————-

URINE NITRITE

 

Present in:

Urinary tract infections

—————————————————————————————————-

URINE OCCULT BLOOD

 

Positive in:

Trauma to urinary tract, renal disease (glomerulonephritis, pyelonephritis), renal or ureteral calculi, bladder lesions (carcinoma, cystitis), prostatitis, prostatic carcinoma, menstrual contamination, hematopoietic disorders (hemophilia, thrombocytopenia), anticoagulants, ASA

—————————————————————————————————-

URINE OSMOLALITY

 

Elevated in:

SIADH, dehydration, glycosuria, adrenal insufficiency, high-protein diet

 

Decreased in:

Diabetes insipidus, excessive water intake, IV hydration with D5W acute renal insufficiency, glomerulonephritis

—————————————————————————————————-

URINE pH

 

Elevated in:

Bacteriuria, vegetarian diet, renal failure with inability to form ammonia, drugs (antibiotics, sodium bicarbonate, acetazolamide)

 

Decreased in:

Acidosis (metabolic, respiratory), drugs (ammonium chloride, methenamine mandelate), diabetes mellitus, starvation, diarrhea

—————————————————————————————————-

URINE POTASSIUM

 

Elevated in:

Aldosteronism (primary, secondary), glucocorticoids, alkalosis, renal tubular acidosis, excessive dietary potassium intake

 

Decreased in:

Acute renal failure, potassium-sparing diuretics, diarrhea, hypokalemia

—————————————————————————————————-

URINE PROTEIN (quantitative)

 

Elevated in:

Renal disease (glomerular, tubular, interstitial), CHF, hypertension, neoplasms of renal pelvis and bladder, multiple myeloma, Waldenstrom’s macroglobulinemia

—————————————————————————————————-

URINE SODIUM (quantitative)

 

Elevated in:

Diuretic administration, high sodium intake, salt-losing nephritis, acutetubular necrosis, vomiting, CHF, hepatic failure. Addison’s disease, SIADH, hypothyroidism

—————————————————————————————————-

URINE SPECIFIC GRAVITY

 

Elevated in:

Dehydration, excessive fluid losses (vomiting, diarrhea, fever) x-ray contrast media, diabetes mellitus, CHF, SIADH, adrenal insufficiency,

Decreased fluid intake

 

Decreased in:

Diabetes insipidus, renal disease (glomerulonephritis, pyelonephritis), excessive fluid intake or IV hydration

—————————————————————————————————-

URINE VANILLYLMANDELIC ACID (VMA)

 

Elevated in:

Pheochromocytoma, neuroblastoma, ganglioblastoma, drugs (isoproterenol, methocarbamol, levodopa, sulfonamides, chlorpromazine), severe stress, after ingestion of bananas, chocolate, vanilla, tea, coffee

 

Decreased in:

Drugs (MAO inhibitors, reserpine, guanethidine, methyldopa)

—————————————————————————————————-

VDRL

 

Positive test:

Syphilis, other treponemal diseases (yaws, pinta, bejel)

 

NOTE: A false-positive test may be seen in patients with SLE and other autoimmune diseases, infectious mononucleosis, atypical pneumonia, malaria, leprosy.

—————————————————————————————————-

VISCOSITY

 

Elevated in:

Monoclonal gammopathies (Waldenstrom’s macroglobulinemia, multiple myeloma), hyperfibrinogenemia, SLE, rheumatoid arthritis, polycythemia, leukemia

—————————————————————————————————-

y-GLUTAMYL TRANSFERASE (GGT; GAMMA-GLUTAMYL TRANSFERASE )

 

Elevated in:

Chronic alcoholic liver disease, neoplasms (hepatoma, metastatic disease to the liver, carcinoma of the pancreas), SLE, CHF, trauma, nephrotic syndrome, sepsis, cholestasis. drugs (phenytoin, barbiturates)

 

 

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Physiology

Posted: May 6, 2012 in MCQ

PHYSIOLOGY

 

1-Urination: autonomic control

“When you pee, it’s PISs”:

Parasympathetic Inhibits Sympathetic.

 

2-Adrenal cortex layers and products

“Great Attire And Fast Cars Are Really Sexy Attributes”:

Granulosa secretes Aldosterone in response to Angiotensin II. Fasiculata secretes Cortisol in response to ACTH. Reticularis secretes Sex steroids in response to ACTH.

 

3-Adrenal gland: functions ACTH:

Adrenergic functions

Catabolism of proteins/ Carbohydrate metabolism

T cell immunomodulation

Hyper/ Hypotension (blood pressure control)

 

4-Adrenal cortex layers and products

“Go Find Rex, Make Good Sex”:

• Layers: Glomerulosa Fasiculata Reticulata

• Respective products: Mineralcorticoids Glucocorticoids Sex hormones

• Alternatively for layers: GFR (Glomerular Filtration Rate, convenient since adrenal glands are atop kidney).

 

5-Carotid sinus vs. carotid body function

carotid SinuS: measures preSSure.

carotid bO2dy measures O2.

 

6-Einthoven’s Triangle: organization

Corners are at RA (right arm), LA (left arm), LL (left leg).

Number of L’s at a corner tell how many + signs are at that corner [eg LL is ++].

Sum of number of L’s of any 2 corners tells the name of the lead [eg LL-LA is lead III].

For reference axes, the negative angle hemisphere is on the half of the triangle drawing that has all the negative signs; positive angle hemisphere contains only positive signs.

 

7-Pituitary: anterior hypophysis hormones

FLATPiG:

FSH

LH

ACTH

TSH

Prolactin ignore GH

 

8-Hb-oxygen dissociation curve shifts: effect, location

Left shift: causes Loading of O2 in Lungs.

Right shift: causes Release of O2 from Hb.

 

 

9-Diabetes Insipidous: diagnosing subtypes :

After a desmopression injection:

Concentrated urine = Cranial.

No effect = Nephrogenic.

 

10-Hyperthyroidism: signs and symptoms THYROIDISM:

Tremor

Heart rate up

Yawning [fatigability]

Restlessness

Oligomenorrhea & amenorrhea

Intolerance to heat

Diarrhea

Irritability

Sweating

Musle wasting & weight loss

 

11-Oxytocin-producing nucleus of hypothalamus

Paraventricular nucleus–> Parturition (childbirth is oxytocin’s most important role).

 

12-PGI2 vs. TxA2 coagulation function

TxA2 Aggregates platelets.

PGI2 Inhibits aggregation.

• Note: full name of PGI2 is prostaglandin I2 or prostacyclin, full name of TxA2 is thromboxane A2.

 

13-Alkalosis vs. acidosis:

directions of pH and HCO3 ROME:

Respiratory= Opposite:

• pH is high, PCO2 is down (Alkalosis). • pH is low, PCO2 is up (Acidosis).

Metabolic= Equal:

• pH is high, HCO3 is high (Alkalosis). • pH is low, HCO3 is low (Acidosis).

 

14-Temperature control: cerebral regions

“High Power Air Conditioner”:

Heating = Posterior hipothalamo [hypothalamus].

Anterior hipothalamo [hypothalamus] = Cooling.

 

15-VO2 normal value is 250 mL/min

“V02” is the numbers, just need to rearrange the order. V is roman numeral for 5, so rearrange to 2V0, or 250 mL/min.

 

16-Nervous stimulus: the 4 ways to classify

“A MILD stimulus”: Modality Intensity Location Duration

 

17-Compliance of lungs factors COMPLIANCE:

Collagen deposition (fibrosis)

Ossification of costal cartilages

Major obesity

Pulmonary venous congestion

Lung size

Increased expanding pressure

Age

No surfactant

Chest wall scarring

Emphysema

• All but L/A/E decrease compliance.

 

18-Intrinsic vs. extrinsic pathway tests

“PeT PiTTbull”:

PeT: PT is for extrinsic pathway.

PiTTbull: PTT is for intrinsic pathway.

 

19-Heart: -tropic definitions

Lusitropic: loose is relaxed. Definition: relax heart.

Inotropic: when heart wall contracts, moves inward. Definition: contract heart.

Chronotropic: ‘chrono-‘ means ‘time’. Defintion: heart rate (of SA node impulses).

Dromotropic: only one left, it must be conduction speed by default.

 

20-Pituitary hormones FLAGTOP:

Follicle stimulating hormone

Lutinizing hormone

Adrenocorticotropin hormone

Growth hormone

Thyroid stimulating hormone

Oxytocin

Prolactin

Alternatively: GOAT FLAP with the second ‘A’ for Anti-diruetic homone/vasopressin

• Note: there is also melanocyte secreting homone and Lipotropin, but they are not well understood.

 

21-Heart valves: sequence of flow

TRIPS BIAS:

TRIcuspid Pulmonary Semilunar

BIcuspid Aortic Semilunar

 

22-V/Q gradient in lung

Infinity, a lung and a zero stack nicely.

V/Q is lowest at bottom, highest at top.

 

23-Balance organs

Utricle and Saccule keep US balanced.

 

 

24-Adrenal cortex layers and products

“Get your Facts Right, Men are Glued to their Gonads”:

Glomerulosa

Fasciculata

Reticularis

Mineralocorticoids

Glucocorticoids

Gonadocorticoids [androgens]

 

 

25-Heart electrical conduction pathway

“If patient’s family are all having Heart attacks, you must SAVe HIS KIN!”

SA node —> AV node —> His (bundle of) –> PurKINje fibers

 

 

26-Gut intrinsic innervation:

myenteric plexus vs. submucosal plexus function

Myenteric: Motility.

Submucosal: Secretion and blood flow.

 

 

 

27-Progesterone: actions PROGESTE:

Produce cervical mucous

Relax uterine smooth muscle

Oxycotin sensitivity down

Gonadotropin [FSH, LH] secretions down

Endometrial spiral arteries and secretions up

Sustain pregnancy

Temperature up / Tit development

Excitability of myometrium down

 

 

28-Mechanoreceptor types

“Frustated Muscular Mechanics Rub Her Pussy”:

Free nerve endings

Meisner’s

Merkel’s disc

Ruffini’s

Hair end organ

Pacinian corpuscle

 

 

 

29-Hemoglobin and myoglobin: binding strengths, sites

“ABC” of glycosylated Hb (Hb1c):

 

• Glucose binds to Amino terminal of Beta Chain.

“HbF binds Forcefully”:

 

• HbF binds oxygen more forcefully than HbA, so Oxy-Hb dissociation curve shifts to left. Stored blood is SOS:

 

• Stored blood Hb binds to Oxygen Strongly because of decrease in 2,3 BPG. 2,3 BPG binding site is BBC:

 

• BPG binds to Beta Chain of Hb.myoglobin binding strength is MOM:

 

• Myoglobin binds Oxygen More strongly than Hb.

 

 

30-Muscle spindle: origin of primary vs. secondary endings

“1 from 1, 2 from 2”:

Primary ending is from Group Ia.

Secondary ending from Group II.

.

 

31-Osteoblast vs. osteoclast

OsteoBlast Builds bone.

OsteoClast Consumes bone.

 

 

32-Pepsin-producing cells

“Chief of Pepsi-Cola”:

• Chief cells of stomach produce Pepsin.

 

 

33-Prostaglandins: dilatation abilities

Prospectors keep mineshafts open:

Mineshaft 1: Patent ductus ateriosus.

Mineshaft 2: renal afferent arteriole dilatation.
 

34-Adrenal cortex layers and products

“Get My Freakin’ Gun Right Away”:

Glomerulosa: Mineralcorticoid (aldosterone) Fasiculata: Glucocorticoid (cortisol) Reticularis: Androgens

 

 

 

 

35-MAO isoenzyme form locations

• MAO-A in: Adrenergic peripheral structures Alimentary mucosa [intestine]

• MAO-B in: Brain Blood platelets

 

 

36-Adrenal cortex layers and products

“Get All Fat Chicks Right Away”:

• Layers: Glomerulosa Fasciculata Reticularis • Products: Aldosterone Cortisol Androgens

 

 

37-Cochlea: inner vs. outer hair cell function

“Outer cells are Out of the brain. Inner cells are Into the brain”:

Outer hair cells are motor efferents to amplify signal. Inner hair cells are sensory afferents that actually pick up the sound.

 

 

38-LH vs FSH: function in male

LH: Leydig cells stimulated to produce testosterone.

FSH: Spermatogenesis stimulated.

 

 

39-Heart valves: closure sequence

“Many Things Are Possible”:

Mitral, Tricuspid, Aortic, Pulmonic

 

 

40-Rods vs. cone function

RoD: Dim light.

Cones: Color.

Microbiology

Posted: May 6, 2012 in MCQ

Microbiology

 

1-Gram positive stain

Gram Positives Stain Purple (violet-blue) because of their thick Peptidoglycan layer

 

2-UTI-causing microorganisms

KEEPS:

Klebsiella

Enterococcus faecalis/ Enterobacter cloacae

E. coli

Pseudomonas aeroginosa/ Proteus mirabilis

Staphylococcus saprophyticcus/ Serratia marcescens

 

3-pGram+: bacterial cell wall

• Gram+ has: +hick pepidoglycan layer. +eichoic acid in wall.

 

4-Klebsiella details

You tell the patient: “Get UPS you fat alcoholic”:

UTI

Pneumonia

Sepsis

Fat capsule

Get up=nonmotile since no flagella.

Alcoholic=commonly seen in alcoholic and nosocomial patients.

 

5-Listeria: motility

Istanbulsounds like Listambul = list + tumble.

Listeria has tumbling motility.

 

6-Acute post-streptococcal glomerulonephritis: classic presentation

“Sore throat, Face bloat, Pi$$ coke”:

Sore throat: 1 week ago

Face bloat: facial edema

Pi$$ coke: coke-coloured urine

• Alternatively, short version: “Throat, bloat and coke”.

 

7-Neisseria: fermentation of N. gonorrhoeae vs. N. meningitidis

Gonorrhoeae: Glucose fermenter only.

MeninGitidis: Maltose and Glucose fermenter.

• Maltose fermentation is a useful property to know, since it’s the classic test to distinguish the Neisseria types.

 

8-Vibrio: motility

“Vibrio Vibrates”:

Vibrio is a genus of actively motile bacteria.

 

9-Gram staining: mechanism

“Murein gets the red out” [Allusion to an old eye-wash slogan]:

Peptidoglycan (aka murein) remains purple during Gram staining. The Gram negatives, devoid of murein, are red. Thus, murein prevents redness and are purple (positive).

 

10-Staphylococci: novobiocin test to distinguish coagulase negative staphylococci

Staph epidermidis stays away from the novobiocin disc like an epidemic.

• Therefore, epidermidis is sensitive to novobiocin.

Staph saprophyticus, much friendlier, comes up to the disc and says, “‘sap?'” [short for “whassup?”, ie “what’s up”].

• Therefore, saprophyticus is novobiocin resistant.

 

11-Streptococci: classification by hemolytic ability

Gamma: Garbage (no hemolytic activity).

Alpha: Almost (almost lyse, but incomplete).

Beta: Best (complete lysis).

 

12-Common cold: viral causes

“Common cold (acute infectious rhinitis, coryza) is

PRIMArily caused by”:

Paramyxoviruses

Rhinoviruses

Influenza viruses

Myxoviruses

Adenoviruses

 

13-RNA viruses: negative stranded

“Orthodox Rhabbi’s Party Around Fine Bunnies”:

Orthomyxo

Rhabdo

Paramyxo

Arena

Filo

Bunya

 

14-RNA viruses: positive stranded

“Pico Called Flavio To Return Renzo’sCorona”:

Picorna Calici Flavi Toga Retro Reo Corona

 

15-Streptococcus pyrogenes: antibodySPAM:

Streptococcus Pyogenes: Antibody to M protein.

 

16-Trypanosoma brucei: disease caused

“I went on a TRYP toAFRICA”:

TRYPanosoma brucei causes AFRICAn sleeping sickness.

 

17-DNA viruses: morphology rule of thumbDNA:

Double-stranded Nuclear replication ‘Anhedral symmetry

• Rule breakers: pox (cytoplasmic), parvo (single-stranded).

 

18-Proteus: disease caused

Firstly, “PROTeus hates PROTons”:

So what does it do to fight the protons? It has a urease that raises the pH. Urea is in urine, so Proteus causes UTIs.

 

19-E. coli: diseases caused in presence of virulence factors DUNG:

Diarrhea

UTI

Neonatal meningitis

Gram negative sepsis

• Dung, since contract E. coli from dung-contaminated water.

 

20-Kidney transplant virus

“Borrowed Kidney”:

BK virus is associated with kidney transplants.

 

21-Clostridium difficile: disease caused

“Difficult to be in a Closet with someone having explosive foul smelling diarrhea, because it would smell and there would be no air in there. Clostridium Difficile causes explosive foul smelling diarrhea and is an anaeorbe (no air).

 

22-Urease positive organisms PUNCH:

Proteus (leads to alkaline urine)

Ureaplasma (renal calculi)

Nocardia

Cryptoccocus (the fungus)

Helicobacter pylori

 

23-Pneumonia: acute pneumonia infiltrates from different causes

“Pyrogenic=PMN,

Miscellaneous=Mononuclear”:

Acute pneumonia caused by Pyogenic bacteria: PMN infiltrate.

Acute pneumonia caused by Miscellaneous microbes: Mononuclear infiltrate.

 

24-Pseudomonas details

Patient: bug commonly infects nosocomial.

Oxygen tank: oxidase positive.

IV bag: has glucose and lactose, so its OK to give because its a nonlactose fermenter.

Why giving oxygen? Because it commonly caused pneumonia.

IV in the arm: supposed to signify sepsis.

The foley: UTI.

Burn on his foot: can infect burns.

 

 

 

25-Entameoba histolytica: disease caused, action

EntAmoeba causes Amoebic dysEntery.

Action: histo (cell) lytic (burst), so it bursts cells.

 

26-Obligate anaerobes: members worth knowingABC:

Actinomyces

Bacteroides

Clostridium

 

27-Streptococci: Quellung reaction: positive sign, Strep type confirmed”Quell-lung”:

Quell: Capsules swell [+ve test].

Lung: S. pnuemonia [type confirmed].

• You get pneumonia in your lung.

 

28-Nematodes: ones spreading by egg ingestion

“ATE eggs”:

Ascaris Lumbricoides

Trichuris trichuira

Enterobius vermicularis spread by ingestion of eggs (vs skin invasion or insect bite)

 

29-Tetanus: treatment for infection

SAD RAT:

Sedation

Antitoxin

Debridement

Relaxant

Antibiotic

Tracheostomy

 

30-Mycobacterium tuberculosis: culture identification

“Rough, Tough, Buff”:

Rough: colony isn’t smooth but rough like breadcrumbs.

Tough: colony stuck to plate well, and tough to remove.

Buff: buff is a color, a cream/coffee shade.

 

31-Streptococcus pyogenes: virulence factors SMASHED:

Streptolysins

M protein

Anti-C5a peptidase

Streptokinase

Hyaluronidase

Exotoxin

DNAses

 

32-Psedomonas aeruginosa: features AERUGINOSA:

Aerobic

Exotoxin A

Rod/ Resistance

UTIs, burns, injuries

Green-blue dressings

Iron-containing lesions

Negative gram

Odor of grapes

Slime capsule sometimes (in CF pt)

Adherin pili

 

33-Influenza infection: clinical manifestations

“Having Flu Symptoms Can Make Moaning Children A Nightmare”:

Headache

Fever

Sore throat

Chills

Myalgias

Malaise

Cough

Anorexia

Nasal congestion

 

34-Meningitis: risk factors

“Can Induce Severe Attacks Of Head PAINS”:

Cancer

Immunocompromised state

Sinusitis

Age extremes

Otitis

Head trauma

Parameningeal infection

Alcoholism

Infections (systemic, esp. respiratory)

Neurosurgical procedures

Splenectomy

 

35-Endocarditis: indications for surgeryPUSRIVER:

Prosthetic valve endocarditis (most cases)

Uncontrolled infection

Supporative local complications with conduction abnormalities

Resection of mycotic aneurysm

Ineffective antimicrobial therapy (eg Vs fungi)

Valvular damage (significant)

Embolization (repeated systemic)

Refractory congestive heart failure

 

36-Endocarditis: causes of culture negative endocarditis

“With Negative Tests, Investigators Should Focus Attention Somewhere Meaningful”:

Wrong diagnosis

Noninfectious endocarditis

Timing (cultures drawn at end of chronic course)

Intracellular obligate organisms

Slow growing fastidious organisms

Fungal infection

Antibiotic used previously

Subacute right-sided endocarditis

Mural endocarditis

 

37-Endocarditis: lab results suggesting it

“High Tech Lab Results Point At Endocarditis”:

Hematuria

Thrombocytopenia

Leukocytosis, -penia

Red blood cell casta

Proteinuria

Anemia

Elevated ESR

 

38-Vaccines: types STARK:

Subunit

Toxoid

Attenuated [live]

Recombinant

Killed [inactivated]

 

39-Streptococcus pyogenes: diseases caused pages :

Necrotising fasciitis and myositis

Impetigo

Pharyngitis

Pneumonia

Lymphangitis

Erysipelas and cellulitis

Scarlet fever/ Streptococcal TSS

 

40-AIDS pathogens (T-cell suppression) worth knowing

“The Major Pathogens Concerning Complete T-Cell Collapse”:

Toxoplasma gondii

M. avium intracellulare

Pneumocystis carinii

Candida albicans Cryptococcus neoformans

Tuberculosis CMV Cryptosporidium parvum

 

41-Capsulated bacteria

“Some Bacteria Have An Effective Paste Surrounding Membrane Yielding Pseudo Fort, Bypassing Killing”:

Strep pneumonia

Bacteroides

 H. influenza

Anthrax (B. anthracis)

E. coli

Pasteurella

Salmonella

Menigitidis (N. Menigitidis)

Yersinia pestis

Pseudomonas

 Francisella

Brucella

Klebsiella

 

42-Food poisoning: bugs inducing

“Eating Contaminated Stuff Causes Very Big Smelly Vomit”:

E. coli O157-H7 [undercooked meat, esp. hamburgers]

Clostridium botulinum [canned foods]

Salmonella [poultry, meat, eggs]

Vibrio parahaemolyticus [seafood]

Bacillus cereus [reheated rice]

Staphylococcus aureus [meats, mayo, custard]

Clostridium perfringens [reheated meat]

Vibrio vulnificus [seafood]

 

43-Trichomaniasis: features•

5 F’s:

Flagella

Frothy discharge

Fishy odor (sometimes)

Fornication (STD)

Flagyl (metronidazole) Rx

 

44-Chlamydia: elementary vs. initial body location

Elementary: Extracellular

Initial: Intracellular

 

45-HIV infection:

high-risk groupsHIV:

Homosexuals/ Hemophiliacs IV drug abusers

 

46-Toxoplasma gondii: clinical features

      Cat reservoir: a cat.  Bug name is Gondii: cat has a Gandi head.

Cat fecal origin: cat is in the litter box.

Causes brain infection, diagnosed by CAT scan: a “CAT” scan of Gandi’s brain.

Toxic to eyes: Gandi has cat eyes.

      Lymph nodes enlarged: large nodes around neck.

      Affects fetus : small kitten in womb.

AIDS patient commonly: cat is very skinny, like an AIDS patient.

 

 

47-IgA protease-producing bacteria

“Nice Strip of Ham”:

Neisseria

Streptococcus pneumonia

Haemophilus influenza

 

 

48-E. coli: major subtypes, key point of each

“HIT by E. coli outbreak”:

EnteroHemorrhagic:

• HUS from Hamburgers EnteroInvasive:

• Immune-mediated Inflammation EnteroToxigenic:

• Traveller’s diarrhea

 

 

49-Teratogens: placenta-crossing organisms

ToRCHeS:

Toxoplasma

Rubella

CMV

Herpes simplex, Herpes zoster (varicella), Hepatitis B,C,E

Syphilis

• Alternatively: TORCHES: with Others (parvo, listeria), add HIV to H’s,

Enteroviruses.