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Clinical Laboratory Sciences
Lab and diagnostics lecture 5 notecards
Terms in this set (305)
liver disease, hepatic encephalopathy, protein catabolism, bacteria, proteins, liver, portal vein, urea, kidneys, liver disease, increase
¨Assist in the diagnosis of severe ______ _______.
¨Also used to diagnose and follow up ______ _______.
it is a byproduct of _______ ________, most of which is made by _______ acting on ______ in the gut.
it goes to the _______ via the ______ _____ where it is converted to _____ and excreted by the _______. it cannot be catabolized with severe _____ ____ so levels (increase/decrease?)
ton of protein, problem w portal circulation, liver disease, enzymatic defects (congenital), impaired renal function
what things can cause ammonia to increase in general?
encephalopathy and coma.
what can high blood levels of ammonia cause
false. the levels do not correlate well.
T/F: levels of ammonia correlate with the degree of encephalopathy
liver disease (not enough functioning liver cells to metabolize it)
portal HTN, heart failure (altered portal blood flow from gut to liver-- ammonia cant get to liver)
Gi bleeding/obstruction, esophageal varices (more protein)
genetic metabolic disorder of urea cycle (ammonia cannt be catabolyzed like normal by urea cycle)
what sort of things can cause increased ammonia?
ammonia acts as false neurotransmitters -- brain cannot function properly. leads to altered level of consciousness
what is hepatic encephalopathy (d/t ammonia)?
Celiac Sprue, gliadin, gluten, monitor, negative, successful
used to diagnose _____ ____.
identifies the Ab ____ and ______
can be used to ________ disease status and dietary compliance.
Antibodies become ________ on a gluten free diet, so the test will identify __________ treatment
t/f: if a person with celiac disease eats a gluten free diet, they will not have gliadin or gluten Ab
proteins in wheat
what are gliadin and gluten?
proteins, wheat, gliadin, gluten, intestinal mucosa, IgA
in celiac disease, cannot tolerate _______ in ______, which causes buildup of _____ and _______. this can cause ________ _______ damage. ____ Ab are also made and can be found in the mucosa and serum.
small bowel biopsy
once gliadin and gluten Ab are identified, pt can then have a ____ _____ ____ via endoscopy. also must improve with gluten free diet
nonspecific, acute phase, inflammatory, vascular, cardiovascular
¨CRP is a (specific/nonspecific?) ______ _____ reactant protein used to indicate an ________ illness
¨CRP may also be used to assess _________ inflammation and __________ risk stratification
false. not always.
T/F: CRP always rises with viral infections
false. its non-specific. tells us that something is causing inflammation but doesnt indicate a particular cause
T/F: CRP can tell you the cause of the disease if positive
bacterial infections, inflammatory, rheumatoid arthritis, tissue necrosis
CRP is elevated with _______ ________ and _______ disorders such as ___________ _________.
is also elevated with tissue _________
sensitive, faster, earlier, bigger, before
CRP is more ________ and response (faster/slower?) than ESR. it shows up (earlier/later?) than ESR and has (bigger, smaller?) increase than ESR. it returns to normal (before/after?) ESR.
false, NSAIDS suppress inflammatory process
T/F: NSAIDs will not decrease CRP
T/F: CRP may be a better predictor for cardiovascular events than LDL
T/F: elevated levels of CRP are associated with CV morbidity and mortality in pts with CAD
FALSE. it increases within 4-6 hours after surgery, decreases after 3rd postoperative day.
T/F: CRP can be used postoperatively to detect wound infections and normally increases within 12-16 hours after surgery and decreases after 5th postoperative day
false. if they DONT Fall, can indicate complications like infection, PE
t/f: if CRP levels fall, it can indicate surgical complications
acute noninfectious inflammatory reactions (arthritis, rheumatic fever, crohns)
collagen vascular diseases (vasculitis, lupus)
tissue infarction or damage (MI, pulmonary infarction, kidney or bone marrow transplant rejection)
what type of things can increase CRP?
T/F: increased risk for CV ischemic events d/t inflammation of the intimal lining of blood vessels is associated with an elevated CRP
intravascular clotting, fibrin degradation, fibrin, plasmin, activated, fibronolysis
used to identify ________ _______.
it is a _________ _______ fragment and indicates that a _____ clot was formed and then degraded by ________.
it is elevated whenever coagulation system has been _______ followed by ________
T/F: normal plasma will have detectable amounts of D-Dimer
T/F: D Dimer test is highly specific measurement of the amount of fibrin degradation that occurs
T/F: thrombolytic therapy can increase D-Dimer
false, half life is 8 hours, stays elevated for 3 days
T/F: the half life of D dimer is 10 hours and stays elevated for 24 hours
T/F: Deep vein thrombosis, pulmonary embolism, sickle cell anemia, and thrombosis of malignancy all can have a high D-dimer.
T/F: patients with abnormal D-Dimer 1 month after stopping anticoagulant therapy have an increased risk of recurrent DVT. This risk can be reduced with anticoagulant therapy
DVT, PE, low,
D dimer is used as a screening test for ____ and ____ only useful in (low/high?) risk patients.
false. if it is a LOW risk pt, they probably do not have it.
T/F: if D-Dimer test in a low risk pt is negative, the pt may still have a DVT so we should go ahead and move on to the next level of testing
false, it doesnt mean they have it, we then have to move onto a definitive test
T/F: if a low risk pt has a positive D-Dimer, they definitely have a clot and we should start anticoagulants right away
pregnant, post-op, cancer, elderly.
who should you not perform a D-dimer on because they are "high risk?
DIC (causes rapid coagulation and fibrinolysis)
thrombolytic therapy - D dimer produced by action of plasmin on the clot
DVT, PE, arterial thromboemolism, sickle cell anemia
Old age, pregnant, malignancy, surgery, inflammatory conditions
what things can cause an increased D-dimer?
Nonspecific, infection, inflammation, neoplasm, necrosis, RBCs
___________ test used to detect illnesses associated with acute and chronic ________, ________ (collagen-vascular diseases), advanced _________, and tissue _________ or infarction.
It measures the rate _____ settle in saline solution or plasma over a specified time period.
false- it is NONspecific
T/F: ESR is a specific test that can detect illnesses associated with acute and chronic infection
T/F: ESR can indicate the course of the disease and can monitor disease therapy
T/F: ESR does not always increase with active disease and may remain elevated longer than other indicators.
false, creates falsely LOW results
T/F: An interfering factor for ESR is if you let the specimen stand for > 3 hours, which creates falsely high results
false, they have INCREASED ESR
T/F: diseases with increased proteins have decreased ESR
T/F: severe anemias can cause an increased ESR
CNS, .08, Depression, CNS, fatalities
levels greater than ___ g/dL can cause flushing, slowing of reflexes, and impaired visual acuity.
_________ of ______ occurs with levels over 0.1 g/dL and ________ are reported at levels over 0.4g/dL
true. this deems them clinically sober.
T/F: you can discharge someone who can pass clinical sobriety tool (walk w/o staggering, talk, answer certain number of questions right) even if their BAC is above the legal limit
hemoglobin that can strongly bind glucose by glycosylation (not easily reversible). HbA1C most strongly combines with glucose and is the most accurate measurment.
what is glycosylated hemoglobin?
HbA1, glucose, HbA1C, glucose, 120, average, higher
As RBC's circulate, they combine their ______ with some of the ______ in the bloodstream to form ______ - how much depends on the amount of _______ available in the blood stream over the RBC's _____ day life span.
¨HbA1C reflects the ______ blood sugar for the 100-120 days (the lifespan of the RBC) prior to the test.
¨The more glucose the RBC is exposed to, the ________ the percentage
true. it is not affected by short term variations
T/F: A1C can be drawn at any time
false, it is good because brittle diabetics' glucose levels change significantly day to day and A1C is the average
T/F: A1C is not a good indicator for brittle diabetics
true. stress and MI can cause an increase in glucose, but A1C will not be elevated.
T/F: A1C can differentiate between short term hyperglycemia in nondiabetics and diabetics
daily mean plasma glucose (MPG), glucose goals
HbA1C can be correlated with ____ _____ _______ _____ level which is helpful in determining and evaluating daily ________ ________
True, this is because RBC survival is prolonged
T/F: pt with postspenectomy will have elevated A1C
false, these things decrease A1C because they decreased RBC lifespan
T/F: hemolytic anemia, sickle cell disease, chronic blood loss can cause increased A1C
T/F: chronic renal failure pts will have reduced hemoglobin levels d/t lack of EPO
false, it is a measurement of the iron bound to transferrin
T/F: serum iron is a measurement of iron bound to hgb
small intestine, globulin, transferrin, bone marrow, hemoglobin, iron, transferrin
¨Iron is supplied by the diet with about 10% of ingested iron being absorbed in the______ ______ and transported to the plasma => bound to a _______ protein called _______ and carried to ______ ______ => into _______.
¨Serum iron is a measurement of the ____ bound to ________
increase, decrease, need, iron.
if iron stores are low, transferrin will _________.
if iron is high, transferrin will _________.
this is because transferrin is related to the _____ for _______
UIBC (unsaturated iron binding capacity), serum iron
TIBC is the ______ + _______ _______
about 1/3 of _________ is used for transport of iron, so there is always ___________ iron binding capcity
Transferrin, iron, 1/3, iron, empty seats, iron binding capacity, empty seats
__________ is a school bus and each seat can be occupied by _______
Only about _____ of the transferrin is used for ____ so there are always _______ _____ on the bus
So there is always _____ _______ _____, which refers to how many seats can be filled with iron
The capacity at any moment of time to bind iron depends on how many _____ _____ there are
TIBC and UIBC are basically the same.
serum iron, dietary intake, absorption, requirements, blood
iron deficiency anemia is due to reduced _______ _______.
causes include: insufficient _______ ________, inadequate ________, increased __________ (children, late pregnancy), loss of _______ (menstraution, bleeding, peptic ulcer, colon neoplams)
RBC production, microcytic hypochromic, serum iron, TIBC, transferrin saturation
iron deficiency causes decreases ________ ________ which leads to _________ ________ RBCs. the _______ ______ level is decreased, the ______ is elevated and _________ _______ is low
increased, more, TIBC, more, transferrin saturation
When iron is decreased, transferrin is ________ because we want _____ buses to transport it so ________ increases because we have ______ seats available.
Within a school bus, there are a lot more open seats, so the _______ ________ is low
hemochromatosis or hemosiderosis
chronic iron overload. excess iron is deposited in the brain, liver, and heart to cause organ dysfunction
false, it should be drawn in the Am, because eating certain foods may artificially elevate iron measurements.
T/F: iron levels should be drawn in the afternoon because eating certain foods can decrease iron
iron poisoning d/t overdose: iron level _______ ________
false, it is not included because it only binds to stored iron
T/F: ferritin is included in TIBC
available, mobile iron, iron binding, transferrin, indirect measurement
¨TIBC is a measurement of all proteins _________ for binding______ ______. It looks at the potential for ______ _______.
¨________ is the largest quantity of iron binding proteins.
¨TIBC is an ______ _______ of transferrin
false: transferrin levels stay the same or decrease while other proteins increase => TIBC is less reflective of true transferrin levels with iron overload.
During iron overload, transferrin levels will increase while less common iron carrying proteins decrease
T/F: with iron deficiency, TIBC usually increases
true, it is a negative acute phase reactant. it also decreases with chronic illnesses and liver diseases
T/F: transferrin levels will decrease with inflammatory reactions
iron intake, liver function, iron metabolism, hyperalimentation (TPN)
¨TIBC varies minimally with _____ _______ - is a reflection of _____ _______ (transferrin is made by the liver) and nutrition and not so much of ____ _______
¨TIBC is used to monitor patients during __________
transferrin, saturated, abnormal iron, TIBC, iron deficiency anemia, increased
the percentage of __________ and other iron binding proteins ____________ with iron.
Helpful in determining the cause of _________ _______ and ________ levels.
the transferrin saturation is decreased to <15% in _______ ______ _______.
it is ________ in hemolytic or megaloblastic anemia, with iron overload or iron poisoning, and with liver disease
false, transferrin saturation will INCREASE in liver disease because there is less transferrin. the second part of the statement is true
T/F: transferrin saturation decreases in liver disease and transferrin also decreases in liver disease
iron levels, TIBC, transferrin saturation.
increased intake or absorption of iron leads to elevated ____ _____ but the ______ is unchanged (other proteins increase to compensate for the increased iron, so the percentage of _____ __________ is high)
low, decreased, less transferrin
chronic illnesses (infections, neoplasm) have _____ serum iron and _______ TIBC because there is _____ ___________ with chronic inflammation
hemosiderosis, iron poisoning, hemolytic anemia, massive blood transfusions
what things can cause an increased serum iron level
true, so if you are losing your RBcs, you will have low iron.
T/F: chronic blood loss depletes iron because most of the iron exists in hemoglobin in RBCS
Estrogen therapy (causes increased transferrin to be made)
Iron deficiency anemia (if there are more buses, so also increased empty seats)
what things can increase TIBC and transferrin levels?
malnutrition, hypoproteinemia (transferrin is a protein), inflammatory diseases, cirrhosis (transferrin is a negative acute phase reactant, will decrease w acute inflammatory reactions)
what things can decrease transferrin levels?
hemolytic anemia, pernicious anemia, sickle cell anemia (have elevated iron levels and decreased TIBC -- tying up more of the seats, lower capacity to bind iron
what things can cause decreased TIBC levels?
¨Hemochromatosis or hemosiderosis, increased iron intake - increased iron saturates transferrin
¨Hemolytic anemias - iron is increased and saturates transferrin
what can increase transferrin saturation?
¨Iron deficiency anemia, chronic illnesses (malignancy, other chronic illnesses) - iron levels are low, so transferrin levels are increased.
what can decrease transferrin saturation
what most sensitive test to determine iron deficiency anemia?
Fe, Tin, stored iron
Ferritin - __ in a ____, it is what?
T/F: the amount of iron in serum is directly related to iron storage
decrease, iron storage, before, iron levels, count, indices
Decreases in ferritin levels indicate a _______ in ______ _______ (iron deficiency anemia).
Decrease in ferritin may occur _______ other signs such as decreased _____ ______ or change in RBC ______ or ________.
true, because ferritin is a protein.
T/F: ferritin can be decrease in malnutrition only when protein depletion is severe
iron excess, hemochromatosis, iron poisoning, recent transfusions, megaloblastic anemia, hemolytic anemia, chronic hepatitis
increased ferritin levels are a sign of _____ ______ .
increases are seen in what?
acute phase reactant,
Ferritin acts as an _____ ______ _______ protein, and may be elevated in non-iron related conditions (acute inflammatory diseases, infections, metastatic cancer, lymphomas)
false, it INCREASES with inflammation and INCREASES occur 1-2 days after onset
T/F: Ferritin decreases with inflammatory processes and decreases occur 3-4 days after onset and peaks 3-5 days
true, because ferritin is an acute phase reactant, so it will appear elevated even though they do not have enough iron
T/F: if pts with acute inflammatory diseases have iron deficiency, it may not be recognized
T/F: ferritin combined with serum iron level and TIBC is helpful in differentiating and classifying anemias
¨Hemochromatosis, hemosiderosis - increased iron stores
¨Megaloblastic anemia, hemolytic anemia - RBC's lyse to release iron
¨Alcoholic/inflammatory hepatocellular disease, inflammatory disease, advanced cancers - ferritin is an acute phase reactant protein
¨Chronic illnesses like leukemia, cirrhosis, chronic hepatitis, or collagen vascular diseases
what things can cause increased ferritin levels?
¨Iron deficiency anemia - iron stores are decreased so less ferritin is required
¨Severe protein deficiency - ferritin synthesis is reduced
¨Hemodialysis - iron stores are reduced by dialysis => less ferritin needed
what things can cause decreased ferritin levels?
diagnosis, monitoring, protein electrophoresis, immunoglobulin, immunodeficiency
¨Used to assist in _______ and _______ of therapeutic response in many diseases (hypersensitivity, immune deficiencies, autoimmune diseases, chronic infections, malignancies) - ordered if serum _________ ____________ indicates a spike at the __________ level or if concerned for ______________
albumin, globulin, globulin, gamma globulins
proteins in the blood are made of ______ and _______. one type of ______is ________ ______ which makes up antibodies
a class of immunoglobulin: ¨75-85% of serum immunoglobulins. Maternal ____ can cross the placenta and is effective for immune protection of the newborn the first few months of life
a class of immunoglobulin that is responsible for ABO blood grouping and rheumatoid factor. Also involved in immunologic reactions to many infections (hepatitis, gram negative sepsis). Does not cross placenta, so an elevation of _____ in the newborn indicates an intrauterine infection such as rubella, cytomegalovirus, or an STD
false, IgG can but IgM CANNOT cross
T/F: IgG and IgM can cross the placenta
false, its IgM
T/F: the immunoglobulin responsible for ABO blood grouping is IgG
T/F: IgM is involved in immunological reactions to many infection
T/F: An elevated IgM in a newborn can indicate an intraueterine infection such as rubella, cytomegalovirus or an STD
a class of immunoglobulin. about 15% of the immunoglobulins. Mainly present in secretions of respiratory and GI tract, in saliva, in colostrum and in tears and is also in small quantities in the blood
A class of immunoglobulins that mediates an allergic response and is measured to detect allergic diseases
A class of immunoglobulin that smallest portion of the immunoglobulins and is rarely evaluated or detected
chronic liver diseases, chronic infections, IBD
what can cause increased IgA levels?
Hereditary telangiectasia, hypoproteinemia (nephrotic syndrome, protein losing enteropathies) , Drug immunosuppression
what can cause decreased IgA levels?
chronic granulomatous infections, hyperimmunizations reactions, chronic liver disease, MM, autoimmune diseases -- stimulate IgG synthesis
What can cause increased IgG levels?
Agammaglobinemia - genetic deficiency that results in decreased synthesis
Acquired immunodeficiency syndrome
non-IgG MM, leukemia
what can cause decreased IgG levels?
Acute infections: first to respond.
waldenstrom macroglobulinemia (secreted at high levels by malignant cells)
what can cause increased IgM levels?
what is the first immunoglobulin to respond to infection?
Agammaglobulinemia - genetic deficiency with inadequate synthesis
IgG or IgA MM, leukemia (production is diminished as marrow is taken over by tumor cells)
what can cause decreased IgM levels?
allergic reactions (hay fever, asthma, eczema, anaphylaxis) allergic infections (aspergillosis, parasites)
what can cause increased IgE levels?
agammaglobulinemia- deficient production of one or all immunoglobulins
what can decrease IgE levels?
synthesized by the liver from fatty acids when a lack of glucose causes the body to use fat for energy.
¨In low insulin states (diabetes), fat and fatty acids are metabolized less efficiently than normal, resulting in a buildup .
consist of acetone, acetoacetic acid, and beta-hydroxybutyric acid
liver, fatty acids, glucose, fat, less, buildup, acetone, acetoacetic, beta-hydroxybutyric
ketone bodies are
synthesized by the ______ from _____ _____ when a lack of _______ causes the body to use ____ for energy.
¨In low insulin states (diabetes), fat and fatty acids are metabolized (more/less?) efficiently than normal, resulting in _________ .
consist of _________, __________ acid, and _____________ acid
what is the main ketone body in diabetic ketoacidosis?
false, it only measures acetone and acetoacetic acid, so may need beta-hyroxybutyrate blood test to determine cause of coma
T/F: Ketone bodies measure hydroxybutyrate
fruity breath, acidosis, ketonuria, depressed level of consciousness
what are symptoms of elevated ketones?
false, theyre NOT useful -- because acetoacetate levels tend to remain stable, even with treatment.
T/F: Ketone bodies are useful for monitoring response to DKA
false, ketones appear in urine before there is a significant increase in the amount in the blood
T/F: ketones apear in blood before urine
rubbing alcohol ingestion
what would an elevated acetone with a normal anion gap, bicarbonate and glucose suggest?
think of things that force you to breakdown more fats
-carbohydrate deficiency, DM, eclampsia, fasting, high fat diet, hyperglycemia, isopropyl alcohol ingestion, alcoholism, pregnant diabetic women, prolonged exercise, starvation
what conditions have positive ketones?
This is how we measure tissue perfusion
If someone is in shock or has a blockage in a blood vessel, anything distal to that blockage, there will be poor perfusion and lack of oxygen
This causes an increase in ______ ________
anaerobic metabolism, glucose
when oxygen is diminished, ______ ______ of ________ occurs and lactate is formed
liver, does not, accumulates, lactic acidosis,
when the _______ is hypoxic, it (does/does not?) clear lactic acid, so it ___________ leading to _______ _______
true -- local tissue hypoxia = mesenteric ischemia, extremity ischemia or generalized tissue hypoxia (shock)
T/F: lactate is a sensitive and reliable indicator for tissue hypoxia which can be caused by local tissue hypoxia
FALSE. thats type A. Type B LA is caused by diseaes that increase lactate not related to hypoxia.
T/F: Type B LA is caused by hypoxia. Ex. shock, convulsions, or extremity ischemia
tissue hypoxia, degree, hypoxia, diseases, hypoxia.
¨Documents the presence of ______ ________ , determine the ________ of hypoxia, and monitor the effect of therapy.
Type A LA is caused by __________
Type B LA is caused by _________ that increase lactate, not related to ________
shock, tissue ischemia (anaerobic metabolism), carbon monoxide poisoning, severe liver disease, genetic errors of metabolism
what things can cause an elevated LA?
¨Intracellular enzyme - evaluates injury or disease of the heart, liver, RBC's, kidneys, skeletal muscle, brain, and lungs
many tissues, not specific, disease, injury
found in cell of many _____ ______.
widely distributed through the body - total LDH is _____ ______ to any one disease or injury to any one organ.
_________ or ______ cause cells to lyse and release LDH into the bloodstream
LDH 1-5, as a percent of the total
what are the different LDH isoenzymes? how are each measured?
T/F: if a pt has two diseases that coexist and cause an increase in LDH, the elevation of one could be overshadowed by the elevation of others
neoplasm or injury to the urologic system
what does elevated LDH in urine indicate?
false, it is AN EXUDATE NOT a transudate.
T/F: if the LDH in an effusion (pleural, cardiac, peritoneal) is > 60% of the serum total LDH, the effusion is a transudate not an exudate
spirochete borrelia burgdorferi, deer tick
Lyme disease is caused by the _____ ________ ________ transmitted by ______ _______
enzyme linked immunosorbet assay, titers, IgM, IgG
what is the best test for lyme disease Ab? it determines _____ of specific ____ and _____Ab to the spirochete
first ab: IgM. Peaks during 3rd-6th week after disease onset then gradually decreases.
Second Ab: IgG. Titers are low for several weeks, max at 4-6 months and remain elevated for years
in Lyme disease, which is the first Ab to peak? when does it peak?
what is the second Ab to peak? when does it peak?
true. if the samples are positivve or equivocal you do this.
T/F: in a lyme disease titer, if you have a positive EIA, you should then complete a western blot
erythema chronicum migrans rash, known exposure to endemic area
how do you diagnose lyme disease w/o labs?
previous infection, other spirochete diseases can cause FP
what are interfering factors for lyme disease titer?
Mononucleosis spot (heterophil Ab)
¨Rapid test to assist in diagnosis of infectious mononucleosis (IM), caused by the Epstein-Barr virus (EBV)
¨usually affects young adults - fever, pharyngitis, lymphadenopathy, and splenomegaly.
¨6-10 days after onset of disease, many patients have antibodies in their serum that react against warm RBC's.
¨Levels increase through 2nd and 3rd weeks and persist but decline over 1 year.
young adults, fever, pharyngitis, LAD, splenomegaly
who is effected by mono, what are symptoms?
6-10, RBCs, 2nd, 3rd weeks, 1 year
______ days after onset of disease, many pts have IM heterophil Ab in their serum that react agains _______. Levels increase through ___and ___ _____ and persist but decline over ________
clinical presentation, lymphocytosis, and positive serologic test
to diagnose mono, must have ________ _________, __________ and ____________ _______ ______
leukemia, burkitt lymphoma, GI cancers, hepatitis, CMV
false positive results of mononucleosis spot test can be caused by?
heterophil Ab negative, EBV serology
about 30% of cases of mono are ______ ______ _______, so if mono is still suspected, a repeat test or ____ ________is done
¨Used to diagnose systemic lupus erythematosus (SLE) and other autoimmune diseases
¨Used to screen for SLE - almost all patients with SLE develop autoantibodies, so a negative _____ excludes the disease.
¨If ______ is positive, then other antibody studies must be done to confirm the diagnosis
¨Normal: negative at 1:40 dilution
true, almost all pts with SLE develop autoantibodies
T/F: if ANA is negative, lupus can be ruled out
false. it is positive in other autoimmune disease processes, so other Ab studies must be done to confirm.
T/F: if ANA is positive, this confirms a dx of lupus
group of protein Ab that react against cellular nuclear material
false, other rheumatic diseases are also associated with ANA, so it is NOT a specific test for SLE
T/F: ANA is specific for SLE
pattern, positive, homogeneous (diffuse), outline (peripheral), speckled, nucleolar, negative, increased, more active, less active, fall
¨Results are reported as a titer with a type of immunofluorescence _________ if ________
¨include _______, _________, _________, and __________ - different diseases associated with each
¨Low level titers are considered _________, while ________ titers are positive => indicate an elevated concentration of antinuclear antibodies.
¨The higher the titer of a certain ANA antibody associated with a certain autoimmune disease, the more likely that disease exists and the _______ _________ the disease is
¨As the disease becomes ____ _____ because of the therapy, the ANA titers will _______
Human Chorionic gonadotropin (HCG)
used to diagnose pregnancy. ¨Also used to monitor high risk pregnancies and can be used as a tumor marker for certain cancers.
normal findings include qualitative, and quantitative findings
accurate, high risk, secreting tumors, blood
more ______, used to monitor _____ _____ patients also monitors pt with _____ ___ -- uses _______
placental trophoblast, ovum, fertilized, 10 days, rises rapidly, higher, similar, double, 2-3 days, 6 weeks
HCG is secreted by _______ ________ after the _____ is _____.
it appears in the blood and urine as early as ___ _____ after conception.
the first few weeks ofr pregnancy, HCG ____ _____ with serum levels _____ than urine.
After a month, the levels are ________.
levels usually _______ every ______ for the first __ _________
1000-2000, ectopic pregnancy
at an HCG level of _____-______, the embryo should be visible on transvaginal ultrasound. if the HCG is high and nothing is seen in uterus, what should you worry about???
false, HCG is produced by germ cell tumors of the testes, also formed by hepatic, breast, ovarian, pancreatic and cervical cancers.
t/f: men cannot have a positive HCG because they cant be pregnant
true. can be used for identification and monitoring .
t/f: the humor used in pregnancy tests can be used as a tumor marker
false. Ectopic pregnancy, hydatidiform mole of uterus, recent abortion and choriocarcinoma of the uterus can produce hCG
T/F: the presence of HCG indicates normal pregnancy
false, the first voided morning specimen has the greatest concentration and is best for urine pregnancy test
T/F: the best specimen for a hCG is right before bed
T/F: hematuria and proteinuria may cause false positive pregnancy tests
serial monitoring, initial test
_______ _________ of hCG in tumors is probably more important than the ______ _______ result
threatened abortion, incomplete abortion, dead fetus - diminished viability of the placenta, which produces hCG in pregnancy
what things can cause decreased HCG?
¨Used to gain information about fluid status and electrolyte imbalance
¨Also assists in evaluating diseases involving ADH
concentration, dissolved particles, increases, decreases, decreases, increases, increases, decreases
¨Measures the ___________ of ______ ______ in the blood.
¨As free water in blood _______ or the amount of particles ___________, osmolality decreases
¨As free water in blood __________ or the amount of particles __________, osmolality increases.
¨Osmolality _________ with dehydration and _________ with overhydration
ADH, more, les
Feedback mechanisms control osmolality:
Increased osmolality stimulates secretion of ______ which increases water reabsorption in the kidneys to make ______ concentrated urine and ______ concentrated serum
ADH, decrease, large amounts, concentrated
Feedback mechanisms control osmolality:
Decreased osmolality suppresses _____ secretion => _______ water reabsorption and cause _____ _______ of dilute urine and make more ________ serum
T/f: Urine osmolarity along with serum helps in interpreting and evaluating problems with osmolality
stupor in pts with hyperglycemia
Osmolality >385 is associated with what?
osmolality 400-420 can cause ? and >420 can cause ?
evaluating ¨seizures, ascites, hydration status, acid base balance, and ADH abnormalities
¨Also helpful in identifying presence of organic acids, sugars, or ethanol which will cause an osmolar gap
what is measurement of osmolality helpful for?
false, theyll increase it
T/F: organic acids, sugars or ethanol will decrease an osmolar gap
¨Hypernatremia, hyperglycemia - all cause increased number of particles dissolved in the blood
¨Ingestion of ethanol, methanol, or ethylene glycol - stimulate free water loss from kidneys and excretion in the urine. Also, their metabolites cause an increase in the number of solutes in the blood
¨Uremia, diabetes insipidus (decreased ADH), renal tubular necrosis, severe pyelonephritis - poor urine concentration leading to free water loss
what things can increase osmolality?
¨Syndrome of inappropriate ADH (SIADH) secretion - can be caused by several illnesses. ADH is inappropriately secreted despite factors that normally inhibit its secretion => large quantities of water reabsorbed by the kidneys and serum becoming dilute
¨Paraneoplastic syndromes associated with carcinoma (lung, breast, colon) - act as an ectopic source for secretion of ADH and is not impacted by feedback mechanism
what things can decrease osmolality?
represents the difference between what the osmolality should be based on calculations of serum sodium, glucose, and BUN (the 3 most important solutes in the blood) and the osmolality as truly measured
should be, serum sodium, glucose, BUN, truly measured
represents the difference between what the osmolality _______ ____ based on calculations of _______ ______ and ______ (the 3 most important solutes in the blood) and the osmolality as ____ _________
10, organic acids, ketones, glucose, ethanol
if the gap is large (>____) solutes such as ____ _____ (______) or unusually high levels of _____ or ________ byproducts are suspected to be present
2xsodium + glucose/20 + bun/3
how do you calculate osmolality
lab serum osmolality - calculated osmolality
how do you calculate osmolar gap?
Hemolysis, decrease, 1.6, 100, increase, osmotic, water, pseudohyponatremia
osmolar gap interfering factors:
¨________ invalidates sodium, glucose, and BUN values
¨Sodium concentration may _______ by _____ mEq/L for every ______ mg/dL ________ in plasma glucose concentration because of an _________ shift of ________ into the bloodstream causing a _________________
figure out how much glucose has increased over normal (normal is 100, is if 1000, it is 10x normal), then we know that sodium concentration decreases by 1.6 per each 100 increase in glucose, so multiply 1.6 by how many 100 increases their are in glucose and add that value to the lab value of sodium to see if there is pseudohyponatremia.
how would you calculate pseudohyponatremia?
¨Decrease in serum water content (severe hyperlipidemia)
¨Hyperproteinemia - macroglobulinemia and multiple myeloma
¨Presence of low molecular weight solutes such as ethanol, methanol, ethylene glycol, isopropanol, or mannitol in the blood
¨Diabetics with hyperglycemia
¨Chronic renal failure when dialysis is needed
what things can increase osmolar gap?
¨Acute phase reactant - increases with inflammation, especially bacterial pathogens
¨May be helpful in determining need for antibacterial therapy, especially with pneumonia, sepsis, septic arthritis, meningitis
Not used on its own but in conjunction with other findings (history, exam, labs, x-rays) to determine appropriate management of seriously ill patients with possible infection
true, because it is an acute phase reactant that increases w bacterial pathogens
t/f: procalcitonin may be helpful in deteremining need fo rnatibacterial therapy
false: used with other findings (hx, exam, labs, xrays)
t/f: procalcitonin can be used on its own to determine appropriate management of serious ill pts with infections
¨Used as a screening method for early detection of prostate cancer.
¨When combined with a rectal exam, nearly 90% of clinically significant cancers can be detected.
Also used to monitor disease after treatment
A glycoprotein found in high concentrations in the prostatic lumen.
what is PSA
Prostate gland, vascular, lumen, barriers, penetrated, PSA
¨______ _______ tissue and _______ structure are between the _______ and the bloodstream, so when cancer, infection, and benign hypertrophy occur the _______ can be __________, and______ is released into the blood stream
true. levels more than 4ng/mL have been found in more than 80% of men with prostate cancer
t/f: elevated PSA is associated with prostate cancer
t/f: the higher the levels of PSA, the greater the mass of the tumor
t/f: subsequent elevation of PSA indicates recurrence of prostate cancer
false, all of those things REDUCE PSA level.. the part about using to monitor response to treatment is true though.
t/f: PSA is used to monitor response to treatment, as surgery, radiation, or hormone therapy all increase PSA level
false, this is why there is controversy using PSA in asymptomatic men.
t/f: mortality is significantly reduced by annual PSA screenings
false, the cancer identified by PSA is not aggressive and not associated with increased mortality, so there is controversy with use of PSA in asymptomatic men
t/f: prostate cancer identified by screening PSA is aggressive and associated with increased mortality
false, most of PSA screens are FALSE POSITIVES. this may trigger biopsy and invasive surgery with little beenfit
t/f: most of PSA screens are false negatives
true, there are a lot of false positivies.
t/f: PSA is a sensitive test
false, it should still be offered in high risk men
t/f: given the controversy over PSA screens, it should not really be offered in any men
t/f: if you do a PSA, you should also complete a digital rectal exam because the combination of the two tests is more sensitive than either alone
false, do not complete in men greater than 70 or those with 10-15 year life expectancy, and should not be completed in asymptomatic men
t/f: PSAs should be completed in men >70 YO or those asymptomatic
false, some pts will not have elevated PSA and levels above four are not always associated with cancer
t/f: some pts with early prostate cancer will have elevated PSA and levels above four are associated with cancer
Age adjusted PSA
Free vs. bound PSA
what PSA labs are more accurate than general PSA?
change in PSA levels over time
what is PSA velocity
suspicion of cancer and may indicate a fast growing cancer
what does a sharp rise in PSA velocity indicate
t/f: PSA velocity >0.35 ng/mL/year have higher risk of dying from prostate cancer
50, 6.5, 70
age adjusted PSA:
men < ____ should have PSA < 2.4, whereas ____ is normal in a _______ year old
false, other way around, BPH has more FREE, cancer has more BOUND.
T/F: in BPH there is more bound PSA and in cancer there is more free PSA
true. also If free PSA is < 10% there is an increased risk of cancer
t/f: if attached PSA is high but free is not, then there is a greater chance of cancer
stage, localized, local therapy, metastatic staging, localized, treatment, treatment
¨PSA is used to ______ known prostate cancer
¨Levels < 10 are most likely to have _______ disease and respond to _________ ________
¨Levels < 20 usually do not need routine ______ _________ tests if cancer appears _________
¨Periodic PSA testing should follow any form of ________ since PSA levels can indicate a further need for _________
rectal exams, TURP, ejaculation win 24 hours, recent UTI or prostatitis
what things can falsely elevate PSA?
IgG, antibodies, synovial, antigens, IgG, IgM, antibodies , antigenic IgG, complement , joint damage, rheumatoid factor
¨In RA, abnormal ____ ___________ produced by lymphocytes in the _______ membranes act as _______, so other _____ and ___ ________- in the serum react with the _________ _____ to produce immune complexes
¨These complexes activate the __________ system and other inflammatory systems to cause _____ _________
¨The reactive IgM and sometimes IgG and IgA make up ________ _________
false, can also be positive d/t sjogren syndrome, lupus, scleroderma and other autoimmune conditions.
t/f: RF is specific for RA
false, it is positive in 80% of pts, so there is a chance that a person with it will not have positive RF
t/f: a negative RF excludes RA
T/F: RF is not a useful disease marker as it does not disappear in patients in remission - not helpful in screening for reoccurrences.
t/f: a pt with mono can have a positive RF
t/f: a pt with TB can have a positive RF
¨Used to determine the extent of disease and prognosis in patients with cancer
¨Also used to monitor disease and treatment and recurrence
¨Carcinoembryonic Antigen (CEA), Cancer Antigen-125 (CA-125), Cancer Antigen 19-9 (CA 19-9), Breast Cancer Tumor Analysis (HER 2 /neu protein), Alpha-Fetoprotein (AFP)
what tumor marker is useful in colorectal cancer but also found in breast, pancreatic, gastric, hepatobilliary and sarcomas?
t/f: a pt with ulcerative colitis, diverticulutis, cirrhosis may have positive CEA
true, it can be positive in chronic smokers
t/f: pt is a 65 YOM with a 40 year pack history. his CEA may be positive
FALSE: Not a sensitive or specific test. Also not always produced in colorectal cancer, so not a reliable screening test
t/f: CEA is a sensitive and specific test and is always produced in colon cancer so we can use it for screening.
t/f: CEA is helpful in evaluating prognosis and monitoring response to treatment in cancer patient, especially those w breast and GI cancers
false, ¨Pretreatment level indicates tumor burden and prognosis - low or normal level has better prognosis
t/f: a low or normal level of CEA does not necessarily mean better prognosis
t/f: Significant reduction of CEA level after surgery/treatment indicates tumor eradication
rising CEA level
What could be the first sign of recurrence in monitoring those with colon cancer
¨Presence of CEA in other body fluids may indicate metastasis (peritoneal fluid, chest effusion, CSF)
what could indicate metastasis when drawing CEA level?
what tumor marker is useful in ovarian cancer?
false, it is not specific (IT IS SENSITIVE) and it cannot be used to diagnose! -- it only helps support the Dx .
t/f: CA-125 has a high specificity and can be used to diagnose ovarian cancer
true. should not be used in for screening in asymptomatic women
t/f: CA-125 is not specific and is better for high risk women
what tumor marker is used for pancreatic or hepatobiliary cancer
false, it is neither sensitive nor specific. not used as a screening tool.
t/f: CA-19-9 is sensitive and specific so it is used as a screening tool
concern for pancreatic or hepatic biliary cancer, draw CA 19-9 because this elevated level along with other things noted in their history could support this dx.
You are reviewing records on your pt. you see that they had an abdominal ultrasound showing a pancreatic mass and you note scleral icterus on PE. what should you be concerned for and what lab would you draw to support the dx of your concern?
¨Breast cancer tissue is tested for many markers
¨Used to predict relapse after curative surgery
¨______ = human epidermal growth factor receptor 2 - associated with aggressive breast cancers
¨If +, may need more aggressive chemotherapy - certain meds only effective if this is present
relapse, aggressive , aggressive , present
¨Breast cancer tissue is tested for many markers
¨Used to predict _______ after curative surgery
¨HER-2 = human epidermal growth factor receptor 2 - associated with ________ breast cancers
¨If + may need more __________ chemotherapy - certain meds only effective if this is (present/absent?)
¨Screens for increased risk for birth defects - maternal and amniotic fluid levels can be checked
Also used as a tumor marker to identify certain cancers - hepatomas, certain testicular and ovarian cancers, Hodgkin disease, lymphoma, renal cell carcinoma
risk, birth defects, amniotic, hepatomas, testicular, ovarian, Hodgkin , lymphoma, renal
¨Screens for increased _____ for _____ ________ - maternal and _______ fluid levels can be checked
Also used as a tumor marker to identify certain cancers - _________, certain _______ and _______ cancers, _______ disease, ________ , _______ cell carcinoma
¨Used in the evaluation of gout or recurrent urinary calculus
critical >12mg/dL. made in the liver. blood level is determined by the rate of synthesis in the liver and the rate of excretion by the kidney.
liver, synthesis, liver, excretion, kidney
uric acid is made in the ________. the blood level is determined by the rate of _____ in the ____ and the rate of _______ by the ________
uric acid is a ________ compound that is the final breakdown product of _______ catabolism
gout, does not, gout, gout, elevated
when uric acid is elevated, the pt may have _______- elevated serum uric acid (does/does not?) diagnose _______. roughly 2/3 of cases of ______ have ______ uric acid level
false, not necessarily. because the uric acid is measured from the serum, but gout is uric acid in the joint! So 1/3 of gout is not detectable in serum uric acid levels
t/f: an elevated uric acid level means the pt has gout
arthritis, deposition, uric acid crystals, tophi, urine, crystallize, kidney stones
gout is a form of ______ cause by _____ of _____ _____ ____ in the periarticular tissue. soft tissue deposits of uric acid are called _______. uric acid can also become supersaturated in the ____ and _____to form _____ _____
overproduction, decreased excretion (renal failure)
causes of hyperuricemia can be ____________ or ______ __________ of uric acid
enzyme deficiency that stimulates purine metabolism or in cancer patients where purine and DNA turnover is great. Also seen in alcoholism, DM, dehydration due to diuretic therapy.
¨Increased ingestion of purines - liver, sweetbreads (thymus gland), kidney, anchovies
¨Genetic inborn error in purine metabolism
¨Metastatic cancer, multiple myeloma, leukemias, cancer chemotherapy - rapid cell destruction with rapidly growing cancers that have high cell turnover, and especially after chemotherapy for rapidly growing tumors => cells lyse and spill nucleic acids into the bloodstream
what can cause overproduction of uric acid?
¨Idiopathic - most common cause of hyperuricemia. Reduced uric acid clearance in the kidneys. Gout patients excrete less than half the uric acid in their urine as normal persons. Unknown cause
¨Chronic renal disease
¨Alcoholism - accelerated breakdown of ATP in the liver increases uric acid production
what can cause decreased excretion of uric acid?
¡Venereal Disease Research Laboratory (VDRL)
¡Rapid Plasma Reagin (RPR)
¡Fluorescent Treponemal Antibody (FTA)
¡Treponema Pallidum Antibody (TP-PA)
what are the tests for syphilis?
treponema, pallidum, primary, secondary, latent, tertiary, antibodies, bacteria, two
syphilis is caused by the spirochete _____ ______ and has four stages: ____,______,_____ and _______. immunologic tests detect ________ to the _______. there are _____ groups of antibodies
ab, reagin, phospholipids, ab, directly
tests for syphilis:
the first group of tests detects the presence of nontreponemial ____ called _______, which reacts to __________ in the body.
the second group of tests detects _____ directed ________- against the treponemia organism itself
false, RPR more sensitive
t/f: VDRL is more sensitive than RPR
t/f: nontreponemal Ab tests are nonspecific screening tests
what are the two nontreponemal ab tests for syphilis
false, they have high false positive rate because they test for a nonspecific ab
t/f: RPR and VDRL have high false negative rate
2 weeks, treatment, primary, secondary, 2/3
VDRL becomes positive ____ ______ after inoculation with bacteria and returns to normal after _________. it is positive in almost all _____ and _______ stages and in ____ of tertiary stages
t/f: if VDRL or RPR is positive, the diagnosis must be confirmed with a more specific FTA or TP-PA test
false, FTA is more specific and more accurate
t/f: RPR is more specific than FTA
t/f: FTA and TP-PA are more specific than RPR and VDRL and test for treponemal ab
false, 4-6 weeks
t/f: FTA becomes positive 1-2 weeks after inoculation
false, is required before the diagnosis of syphilis can be made with certainty
t/f: the FTA or TP-PA test is not required to diagnose syphilis
true, they could have other diseases
t/f: VDRL or RPR positive and FTA negative means pt does not have syphilis
malaria, typhus, cat scratch fever, hepatitis, mono, lupus, bacterial infections,
what other diseases could cause a positive RPR or VDRL
false, usually screened with VDRL or RPR
T/F: ¨Syphilis screening usually is done at the first prenatal checkup of pregnant women with the FTA or TP-PA test
t/f: if syphilis is untreated can cause abortion, stillbirth, or premature labor as well as CNS damage, hearing loss, or death to the fetus
true.. it returns to normal after successful treatment, but in tertiary stage it may never convert to normal
t/f: tests for syphilis may remain elevated even after treatment
2-4 months, a year, negative
in primary stage of syphilis, the tests may become negative in ___ _______ after treatment, in later stages it may take longer than ______, in tertiary stage it may never convert to ________
DKA, because we are only concerned about the pH not concerned about O2 or CO2
in what disease could you consider drawing a venous pH
west nile virus testing
¨is indicated when flu-like symptoms occur in an area where the virus exists
¨is an RNA virus of the Flavivirus family whose vector is the mosquito.
¨It is not transmitted from human to human
¨Most common during peak mosquito season (July - October)
t/f: WNV is transmitted from human to human
false, ¨Most common during peak mosquito season (July - October)
t/f: most common WNV is may to april
false, does not exclude
t/f: if WNV testing is negative, it excludes the infection
IgM, antibodies, is not, 10 days, IgM, symptoms,
¨Initial testing measures ______ _________ to Flaviviruses and (is/ is not?) specific to WNV.
¨Antibodies are detectable about __ _______ after symptoms onset.
¨If ____ is positive and ________ meet CDC criteria, the diagnosis of WNV can be made, especially if the person lives in or has traveled to an area than has WNV.
false, it is true that confirmatory testing can be done, but it is more important in area where WNV is not known to exist.
t/f: confirmatory testing for WNV can be done especially if it occurs in an endemic area
false, other way around
t/f: WNV confirmatory testing is more important for clinicians than public health officials and researchers
second IgM, 3-4 weeks, four, RNA, CSF
confirmatory testing for WNV:
¡A ____ ____ test on convalescing serum _____ ________ later - should see a _____-fold increase in level
¡Direct detection of WNV _____
¡Detection of IgM WNV antibodies in _____
t/f: patient age and size, extent and rate of drug absorption and excretion, and metabolic rate can all affect levels of drug monitoring
t/f: drug monitoring is important in patients who are outside the normal range variables or who have other diseases that can affect drug levels.
false, it is helpful in these pts
t/f: drug monitoring is not helpful in patients who take other medications that may affect drug levels or act in a synergistic or antagonistic manner with the drug being tested
t/f: drug monitoring can be used to identify noncompliant pts
Used to monitor drug levels to determine effective drug dosages and prevent toxicity
narrow therapeutic, therapeutic effects, higher, toxic effects , standard, Blood, one moment
Some medications have a very ____ ________ margin antiarrhythmics, anticonvulsants.....
Helpful if desired _______ _______ are not being seen - may need dosages ________ than usual.
Also, if ______ ______ are seen in ________ doses, may need a lower dose.
______ level reflects what is happening with the drug at ___ _______ in time
cardiac meds, psych meds, seizure meds
what are some common drug types that are monitored for?
when would you monitor for acetaminophen, slicylates?
false, they can be measured at peak or trough.
t/f: drug monitoring levels can only be taking at the peak level
false, thats trough. peak is useful for testing toxicity
t/f: peak levels of drug monitoring are useful for demonstrating an adequate therapeutic level
¨Time after last dose to draw the sample depends on whether a peak or trough level is requested and the ______ ____ of the medication.
toxicity, below, inadequate
if peak levels are higher than the therapuetic range, ______ may occur, if trough levels are ____the therapeutic range, therapy may be ________
Preoperative evaluation of lungs and pulmonary reserve
Evaluation of response to bronchodilator therapy
Differentiate between restrictive and obstructive forms of lung disease
Determine diffusing capacity of lungs
¨Inhalation tests with inhalation allergies
pulmonary reserve, bronchodilator, restrictive, obstructive, diffusing capacity , inhalation allergies
¨Preoperative evaluation of lungs and _______ _____
¨Evaluation of response to _____________ therapy
¨Differentiate between _________ and ________ forms of lung disease
¨Determine ______ ______ of lungs
¨Inhalation tests with _______ ________
¨pulmonary fibrosis, tumors, chest wall trauma. Ventilation is abnormal due to limitation of chest expansion => affects inspiration
¨emphysema, bronchitis, asthma. Ventilation is abnormal due to increased airway resistance => affects expiration
Tube diameters are smaller
t/f: spirometry is measured first in a PFT and measures air volumes, airflow rates and provides information about obstruction or restriction
obstruction, time, flow, volume, obstruction, improvement
measurement of airflow rates:
¨Provides information about airflow ___________
¨Adds _____ element to spirometry
¨Plot _____ vs. ______ - shape of curve can be interpreted to identify and quantify airway _________
¨Can repeat after bronchodilator to document ________
calculation of lung volumes and capacities
¨Uses nitrogen or helium washout techniques
¨Provides further information about air trapping in lungs
Forced vital capacity
¨amount of air forcefully expelled from maximally inflated lungs - lower values in obstructive and restrictive pulmonary diseases
forced expiratory volume in 1 second (FEV1)
volume of air expelled during first second of FVC. Decreased in obstructive pulmonary disease. Decreased in restrictive lung disease because air originally inhaled is decreased.
false, its decreased in both
t/f: FEV1 is increased in obstructive and restrictive lung diseases
false, tis lower
t/f: FVC is higher in obstructive lung diseases
maximal midexpiratory flow
¨maximal rate of airflow through pulmonary tree during forced expiration. Decreased in obstructive pulmonary diseases and normal in restrictive
Maximal volume ventilation
¨maximal volume of air that patient can breathe in and out during 1 minute. Decreased in both restrictive and obstructive lung disease.
false, its decreased in both
t/f: MVV is decreased in restrictive lung disease but not obstructive
false, its decreased in obstructive, normal in restrictive.. obstructive diesease cant get air out
t/f: MMEF is decreased in both obstructive and restrictive diseases
carbon monoxide poisoning, arterial, venous
Carboxyhemoglobin is used to detect _____ ______ _____ . can be measured from _____ or ____ sample
C: when CO occupies the oxygen binding sites, the Hgb molecule is changed so it binds the remaining oxygen more tightly
all of the following are true about carboxyhemoglobin except:
a: measures the amount of COHb which is formed by a combination of CO and Hgb
b: CO combines with HgB 200x more readily than O2, which means fewer Hgb bonds are avilable for O2
C: when CO occupies o2 binding sites, the Hgb molecule is chnged so it binds O2 less tightly
d: conformational changes in HgB from binding CO do not allow O2 to pass from RBCs to tissue
give high concentrations of oxygen to displace the COHb
how do you treat CO toxicity?
T/F: Oxygen saturation studies and oximetry are inaccurate in CO-exposed patients because they measure all forms of oxygen saturated Hgb, including COHb.
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