Term
|
Definition
found predominantly in the liver; lesser values in the kidneys, heart and skel.muscle
-released into bloodstream upon injury to liver parencyma |
|
|
Term
|
Definition
normal: 4-36 U/L
-may be twice as high in infant vs. adult
-most elevations due to liver disease
-sensitive but not very specific unless significantly elevated |
|
|
Term
| When is the ALT:AST ratio greater than 1? |
|
Definition
|
|
Term
| What are some interfering factors when measuring ALT? |
|
Definition
|
|
Term
| What are some abnormal findings with ALT measurements? |
|
Definition
Hepatitis
Cirrhosis
Cholestasis
Hepatotoxic drugs
Trauma
Pancreatitis
MI
Infectious mono |
|
|
Term
|
Definition
When disease affects hepatic cells, they lyse... AST is released into blood during this lysis.
-amt of AST elevation is directly related to the number of cells affected by disease or injury
-also reflects time after injury that blood is drawn. |
|
|
Term
|
Definition
normal: 0-35 U/L
-higher in newborn and child
-elevated 8 hrs post injury (peak 24-36H)
-20X normal in acute hepatitis
-10x normal in acute extrahepatic obstruction |
|
|
Term
| The normal AST:ALT ratio is <1. When is it >1? Whenis this ratio less accurate? |
|
Definition
>1: alcoholic cirrhosis, liver congestion, metastatic tumor
...less accurate if AST greater than 10x normal level |
|
|
Term
| What are some interfering factors when measuring AST? |
|
Definition
Exercise
B6 deficiency
Drugs such as Anti HTN med, oral contraceptives, antibiotics (erythromycin), salicylates, statins. |
|
|
Term
| What may be abnormal findings associated with AST? |
|
Definition
Similar to ALT
In addition to Musculoskeletal disease and injury
Acute hemolytic anemia
DKA
Pregnancy
Renal dialysis |
|
|
Term
| What are normal levels of LDH? |
|
Definition
|
|
Term
| There are 5 different types of LDH isoenzymes, from where does each one come? |
|
Definition
LD1: Heart, RBC, Renal cortex
LD2: Heart, RBC, Renal cortex
LD3: Pancreas, lung, lymphocyte, platelet
LD4: No specific distribution
LD5: Hepatocyte, skeletal muscle, prostate |
|
|
Term
| Where is ALP found and when is it increased? |
|
Definition
normal: 30-120 U/L
Found in:
Osteoblasts
Membrane of hepatocytes
Ileum
Placenta
Greater increases in biliary dz than AST, ALT
-not a great deal of specificity bc can also be found in osteoblasts |
|
|
Term
| When is ALP elevated? decreased? |
|
Definition
Elevated :
Children 2-3 fold due to skeletal growth
Bone disease such as metastatic cancer
Ileal disease
3rd trimester of pregnancy
Decreased:
Hypothyroidism
Malnutrition
Pernicious anemia
Celiac disease
Excess vitamin B ingestion |
|
|
Term
| What is GGTP and what is it the most sensitive liver NZ for? |
|
Definition
- highest concentrations in liver and biliary tract, involved in transferring aas and peptides across membrane
-Parallels ALP but GGTP is more sensitive
-Most sensitive liver enzyme in detecting biliary obstruction, cholangitis or cholecystitis* |
|
|
Term
| What is the range of GGTP in pts <45? >45? |
|
Definition
5-27 U/L <45 yrs
8-48 U/L >45 yrs |
|
|
Term
| Where else is GGTP found? |
|
Definition
| kidney, spleen, hear, intestine, brain and prostate. |
|
|
Term
|
Definition
-in about 75% of chronic alcohol users
Hepatitis
Cirrhosis
Hepatic necrosis
Hepatic or post-hepatic tumor or metastasis
Jaundice
MI
ETOH ingestion
CA of pancreas (anatomically close to liver)
Epstein-Barr (Infectious mono)
CMV
Reye’s syndrome (why we don't give young adults aspirin during a viral infection)
#last 3 are infectious agents |
|
|
Term
| What is 5’-Nucleotidase (5’-NT)? |
|
Definition
normal: 0-1.6 units.
-Enzyme specific to liver
-Elevated in liver disease esp. cholestasis
-When used w/ ALP and both are elevated the problem is certainly liver
-If ALP is elevated and 5’-nucleotidase is negative, problem is not liver indicating possible bone, kidney, spleen relationship |
|
|
Term
| What are normal total bilirubin levels? direct? indirect? |
|
Definition
Total 0.3-1.0 mg/dL
Direct 0.1-0.3 mg/dL
Indirect 0.2-0.8 mg/dL
TB-DB=ID |
|
|
Term
| Direct bilirubin is _______ bilirubin that has already been processed by the _______. Indirect bilirubin _____ been to the liver yet. So, these levels are indicative of the problem being pre-hepatic, hepatic or post-hepatic. |
|
Definition
|
|
Term
| Bilirubin can cross the ___ and cause __________. |
|
Definition
|
|
Term
| When are is conjugated bilirubin elevated? |
|
Definition
Gallstones
Extrahepatic duct obstruction
Cholestasis 2ndry to drugs |
|
|
Term
| When is unconjugated bilirubin elevated? |
|
Definition
PREHEPATIC:
HDN
Hemolytic jaundice (lysing RBCs from whatever cause, overwhelming the liver’s ability to process them)
Resolution of large hematoma
Hepatitis
Sepsis
Neonatal hyperbilirubinemia
Pernicious anemia
Transfusion reaction |
|
|
Term
| What is the hepatitis panel when it is viral and not due to anything else? |
|
Definition
Hepatitis A IgM antibodies
Hepatitis B Surface antigen
Hepatitis B IgM core antibody
Hepatitis C antibody |
|
|
Term
| Antigen is around when infection is occurring, antibodies will then be around during and _____ infection. So, just bc antibody levels are high does not mean pt is having an ______ _______. |
|
Definition
|
|
Term
| IgM is the first Ig to appear, so if positive is pretty indicative of what? |
|
Definition
-a new infection
-will then taper off quickly and IgG is the second to appear and linger longer |
|
|
Term
| Which heps are chronic? which are technically not chronic? |
|
Definition
|
|
Term
| What does the HAV IgM antibody indicate? What does HAV total antibody (all classes) indicate? |
|
Definition
-Positively indicates acute infection with HAV
-Indicates past/present infection with HAV or immunization against HAV
So can’t tell what you’re dealing with (IgM-acutely, IgG-chronically) |
|
|
Term
| What is crowder's example of an acute Hep A infection? |
|
Definition
| Burger joint guy doesn't wash his hand good enough. |
|
|
Term
| Look at HAV infection graph in ppt. |
|
Definition
|
|
Term
| What does HBV surface Ag indicate? |
|
Definition
| acute or chronic w/HBV infection |
|
|
Term
| What does HBV e Ag indicate? |
|
Definition
| acute or chronic HBV infection and increased infectivity |
|
|
Term
| What does HBV core IgM Ab indicate? |
|
Definition
Indicates acute infection w/HBV
* |
|
|
Term
| What does HBV core total Ab indicate? |
|
Definition
| past or present infection w/ HBV |
|
|
Term
| What does HBV e Ab indicate? |
|
Definition
Indicates chronic or past infection w/HBV
-indicates that an acute infection is over, and that infectivity is greatly decreased. |
|
|
Term
| What does HBV surface Ab* indicate? |
|
Definition
chronic or past infection w/HBV or immunization against HBV if persists
-good measure of inefectivity level |
|
|
Term
|
Definition
never alone, always with B
-B capsid, but a D genome in the capsid… so if you see D you will see it with B |
|
|
Term
| What does HCV indicate? HDV IgM Ab? HDV Ab? |
|
Definition
-Indicates present or past infection w/HCV
-Indicates acute infection w/HDV-Indicates past or present infection w/HDV |
|
|
Term
| Hep C is what, no matter what the book says? |
|
Definition
chronic
-anytime you test a pt looking for the viral genome, you will always find C… it is always hanging around in your genetic genome
-mostly infected by blood transfusion
-slowly progressive |
|
|
Term
| Hep B is a biggie world wide bc of what? |
|
Definition
VERTICAL TRANSMISSION!!!!!!!
-check out the Hep chart in ppt. |
|
|
Term
| What are some other tests that might ne used to evaluate Hepatitis? (these are used when Hep is not viral) |
|
Definition
ANA
Can be postitive in autoimmune hepatitis
Antismooth muscle autoantibodies
Can be postitive in autoimmune hepatitis
Antimitochondiral autoantibodies
Can be positive in biliary cirrhosis
Alpha-fetoprotein
Marker of hepatocellular carcinoma
Ammonia
Can be elevated in cases of end stage liver dz
Converted to urea and excreted by kidney
Hyperammonemia leads to encephalopathy |
|
|
Term
|
Definition
normally secreted from pancreatic acinar cells to pancreatic duct to duodenum.. aids in metabolism of carbohydrates.. destruction of pancreatic cells causes an outflow of amylase into pancreatic lymph system and peritoneum
-sensitive but not specific for pancreatic disorders
-NORMAL: 30-220 U/L |
|
|
Term
| Why is amylase sensitive but not specific for pancreatic disorders? |
|
Definition
| Salivary glands contain amylase, elevations can be expected in patients with parotiditis (mumps) |
|
|
Term
| When urine/creatinine clearance in >5% what can be diagnosed with certainty? what about when urine/ creatinine clearance is <5%? |
|
Definition
-pancreatitis
-nonpancreatic pathologic conditions such as perforated bowel |
|
|
Term
| What is the number 1 reason for pancratitis? |
|
Definition
|
|
Term
| What is lipase and what does it parallel? |
|
Definition
normal: 0-160 U/L
-Secreted from pancreas to duodenum to breakdown triglycerides
-Parallels amylase in pancreatitis:
Rises after amylase 24-48 hr – pancreatitis
Remains elevated longer than amylase |
|
|
Term
|
Definition
Acute pancreatitis
Pancreatic cancer or pseudocyst
Acute cholecystitis
Cholangitis
Extrahepatic duct obstruction
Renal failure
Bowel obstruction/infarction
Salivary gland inflammation or tumor
PUD |
|
|
Term
| What are normal glucose levels? When is it increased? decreased? |
|
Definition
70-110 mg/dL
Increased
Acute pancreatitis
DM
Corticosteroid therapy (salt, sugar, sex)
Cushings
Decreased
Insulinoma
Addison’s dz
Extensive liver dz
Insulin overdose
hypopituitarism |
|
|
Term
| What is required to get glucose from the circulatory system to the tissues? |
|
Definition
insulin
-glucose levels can help to detect DM sooner.
-insulin release goes from the pituitary to adrenal cortex to the islet cells. |
|
|
Term
Glucose levels are controlled by insulin and glucagon.
In the fasting state, glucose levels are ___. In response, ______ is secreted causing glucose levels to rise.
After eating, glucose levels are _______. Insulin is then released to drive glucose into the cells to be metabolized to ____, ______, and ________-. |
|
Definition
low
glucagon
high
glycogen, amino acids and fatty acids. |
|
|
Term
| What does glycosylated hemoglobin (Hb A (IC)) monitor? |
|
Definition
-diabetic tx
-Provides accurate long-term index of patient’s average blood glucose level
-HbA1 is a type of Hgb that can combine strongly with glucose in a process called glycosylation; the amt of glycosylated Hgb depends on the amount of glucose available in the bloodstream over an RBC's 120-day life-span.
--follows glucose levels over time (chronically), instead of just the moment in time of when they came to your office. |
|
|
Term
| What should glycosylated hemoglobin levels be in various stages of diabetes? |
|
Definition
Nondiabetic 4-5.9%
Good diabetic control <7%
Fair diabetic control 7-9%
Poor diabetic control >9% |
|
|
Term
| We don't produce insulin, we produce pro-insulin... What are insulin and c-peptide good indicators of? |
|
Definition
| how well insulin is being produced. |
|
|
Term
| What is C-peptide and normal levels? |
|
Definition
Coproduct with insulin from proinsulin
Correlate 1:1 w/insulin levels in blood
Longer half-life than insulin
-ability to measure whether the pt has the ability to make insulin on their own.
Fasting 0.78-1.89 ng/ml
1 hr post glucose load 5-12 ng/ml |
|
|
Term
| What does C-peptide accurately reflect and in what 4 ways is this helpful in assessing diabetics? |
|
Definition
Accurately reflects islet cell function:
Patients w/diabetes treated w/exogenous insulin and who have anti-insulin antibodies
Factitious hypoglycemia
Diabetics taking insulin to see if the diabetic is in remission and may not need exogenous insulin
Distinguishing type I from type II as type I has a low level of insulin and C-peptide whereas the type II has a normal or high level of C-peptide |
|
|
Term
| What are normal insulin levels and what do they help to diagnose? What do they evaluate? |
|
Definition
6-26 uU/ml
Diagnosis of insulinoma
Evaluation of patient with fasting hypoglycemia |
|
|
Term
| When insulin levels are combined with Glucose Tolerance Test (GTT), how can a juvenile diabetic be determined? a mild diabetic? |
|
Definition
Juvenile diabetic = low fasting insulin levels + flat GTT insulin curves
Mild diabetic = normal fasting insulin + GTT curves w/delayed rise |
|
|
Term
| When insulin levels are combined with fasting glucose tests what can be accurately detected? |
|
Definition
| insulinoma (a benign neoplasm of our islet cells. |
|
|
Term
|
Definition
Diagnosis, response to treatment, and surveillance for MRD with h/o pancreatic or hepatobiliary cancer
Elevated in 70% w/pancreatic cancer
Elevated in 65% w/hepatobiliary cancer
Confirmed response to surgery, chemo, radiation therapy |
|
|
Term
| What is CA19-9 not effective in? |
|
Definition
| screening for pancreaticobiliary tumors |
|
|
Term
| CA19-9 is helpful in diagnosing pancreatic, biliary, stomach and gall bladder cancer. But, why is this not going to be the only thing on which we base a cancer diagnosis? |
|
Definition
| -more useful in following CA once identified… a larger mass=larger CA19-9, if mass goes down due to tx or chemo CA19-9 will go down. |
|
|
Term
| What is the Ranson criteria on admission? (likelihood of survival) #If pt has only 1-2, mortality is minimal; 3-5, 10-20% chance of mortality; 5+ 50% mortality rate. |
|
Definition
Blood Glucose greater than 200 mg/dl
Age greater than 55 years
Serum LDH greater than 350 I.U./L
SGOT (AST) greater than 250 I.U./L
WBC greater than 16,000/ul |
|
|
Term
What is the Ranson criteria developing during the first 48 hours? (likelihood of survival)
#If pt has only 1-2, mortality is minimal; 3-5, 10-20% chance of mortality; 5+ 50% mortality rate. |
|
Definition
Serum Calcium less than 8 mg/dl
Hematocrit fall greater than 10%
Arterial Oxygen saturation less than 60 mm Hg
BUN increase greater than 8 mg/dl
Base deficit greater than 4 meq/L
Estimated fluid Sequestration greater than 600 ml |
|
|
Term
| What is aldosterone tests used to dx? What two types of aldosteronism cause this? |
|
Definition
Hyperaldosteronism
-primary aldosteronism: adenoma or benign nodular hyperplasia increases production of aldosterone
-secondary aldosteronism: aldosterone increased due to non-adrenal conditions |
|
|
Term
| Where is aldosterone produced and regulates it? |
|
Definition
Adrenal cortex
Renin angiotensin system
Stimulated by ACTH, Low Na+ and High K+
Stimulates renal tubules to absorb H2O and to secrete K+ |
|
|
Term
| What does the adrenal gland control? (3) |
|
Definition
|
|
Term
| What is the 'sugar' component of the adrenal gland? |
|
Definition
Glucocorticoids
-Cortisol: Primary glucocorticoid produced and secreted by the adrenal cortex |
|
|
Term
| What are some of the fxns of glucocorticoids? |
|
Definition
CHO, lipid and protein metabolism
Suppression of inflammation
Stimulates gluconeogensis
Increases urine production
Stimulates erythropoiesis
Diurinal variation, highest in morning, lowest in evening |
|
|
Term
| What is the 'salt' component of the adrenal gland? |
|
Definition
Mineralocorticoids
-Aldosterone: Primary mineralocorticoid and produced by adrenal cortex |
|
|
Term
| What are some of the fxns of mineralcorticoids? |
|
Definition
Stimulates Na resorption in the DCT in exchange for K+ and H+
Regulated primarily by renin angiotensin system………..
Regulates extracellular fluid volume
Stimulates renal tubules to absorb H2O and to secrete K+
Targets distal renal tubules and large intestine |
|
|
Term
| The 3rd thing the adrenal gland produces is Catecholamines. Not sure if this is the "sex portion" of the adrenal glands, but what is it the product of and what are some of it's fxns? |
|
Definition
-product of hydroxylation of tyrosine
-mobilize energy stores by increasing BP, HR and glycoganolysis
-Neurotransmitter actions
Released in response to pain and stress to mobilize organs
20% excreted into the urine as
-Metanephrine and Normetanephrine
-Vanillylmandelic acid (VMA) |
|
|
Term
| Why does the adrenal gland produce catcholamines? |
|
Definition
| The adrenal glands make large amounts of catecholamines as a reaction to stress. The main catecholamines are epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine. They break down into vanillylmandelic acid (VMA) and metanephrine, which are passed in the urine |
|
|
Term
| What are four ways by which there can be a renal disorder |
|
Definition
excretion
reabsorption
acid-base homeostasis
water and sodium metabolism |
|
|
Term
| When there is an excretion disorder of the kidney, what is occurring? |
|
Definition
| not properly removing waste products of metabolism |
|
|
Term
| When there is an reabsorption disorder of the kidney, what is occurring? |
|
Definition
| not properly retaining certain electrolytes and solutes |
|
|
Term
| When there is anacid-base homeostasis disorder of the kidney, what is occurring? |
|
Definition
| kidney is no longer controlling the synthesis and excretion of bicarbonate and hydrogen ions |
|
|
Term
| When there is an water and sodium excretion disorder of the kidney, what is occurring? |
|
Definition
-water is not being controlled via concentrating and diluting urine
-sodium is not being reabsorbed in the proximal and distal/ collecting tubules. |
|
|
Term
| What 2 things maintain vascular tone and how? |
|
Definition
Angiotensin II
Derivative of the renin-angiotensin-aldosterone system
Vasoconstricts peripheral resistance arterioles and efferent arterials
Stimulates the synthesis and release of aldosterone
Renal-derived prostaglandin
Vasodilates the afferent arterioles |
|
|
Term
| Where does erythropoiesis occur? |
|
Definition
| Erythropoietin is synthesized in the endothelial cells in the peritubular capillaries |
|
|
Term
| What are the 2 components of calcium homeostasis? |
|
Definition
1-alpha-hydroxylase and Vitamin D
1-alpha-hydroxylase
Synthesized in the proximal renal tubule cells
Converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol, the active form of Vitamin D
Vitamin D
Increases GI reabsorption of calcium and phosphorus
Regulates serum calcium
Promotes bone mineralization
Increases the production of osteoclasts |
|
|
Term
| What are some indicators of renal dz? (what you might look for in the blood grossly and chemically) |
|
Definition
Increased serum blood urea nitrogen and serum creatinine
Decreased creatinine clearance
Loss of urine concentration and dilution
Proteinuria (their should be minimal proteins in the urine, easily detected by foamy urine)
Hematuria
Pyuria (detecting inflammatory cells in the urine)
Presence of renal tubular casts |
|
|
Term
| How can you further analyze renal tubular casts? |
|
Definition
| if processed time in the nephron is slowed for some reason, there are many things that can sediment out in the tubules.. As they sediment out, they can be observed once spun down to see what settles in the bottom |
|
|
Term
| What is blood urea nitrogen> (BUN) |
|
Definition
|
|
Term
| What is creatinine? What are the precursors involved in energy production? What might too much creatinine be indicative of? |
|
Definition
Cretinine- normal product in muscle mass. Creatine phosphate are the precursors, involved in energy production
-too much of this could be ndicative of renal pathology, good measure of GFR… almost 1:1; GFR almost equals creatinine |
|
|
Term
| What are normal serum BUN levels? (renal fxn test) What is BUN and where can it be found? |
|
Definition
Normal 7-18 mg/dL
End product: amino acid & pyrimidine metabolism
-Produced by the liver via urea cycle
-Filtered in the kidneys and partly reabsorbed in the proximal tubule
-Extrarenal sites of excretion |
|
|
Term
| What are serum BUN levels dependent on? |
|
Definition
Glomerular filtration rate (GFR)
Protein content in the diet
Tissue metabolism
Proximal tubule reabsorption which is dependent on GFR
Functional status of the hepatic urea cycle |
|
|
Term
| What are some causes of increased serum BUN? |
|
Definition
CHF, Shock (hemorrhage), volume depletion (diuretics)
-Renal insufficiency
-Starving catabolic state (dependent on the degree of starvation, chronic)
-Dehydration, hypovolemia
High protein diet, TPN, blood in GI tract
3rd degree burns, Post-op states, wasting disease (HIV)
-Losing proteins like crazy
Poststreptococcal glomerulonephritis
Acute tubular necrosis, diabetic glomerulopathy
Urinary tract obstruction |
|
|
Term
| What are some causes of decreased serum BUN? |
|
Definition
Normal pregnancy, SIADH
-May see a 30% decrease in 1st trimester, 40 % at half, 20% at term
-Normal for an infants to be by 20%
Cirrhosis, fulminant liver failure
Starvation (depends on the degree of starvation, acute) |
|
|
Term
| What is the normal range of serum creatinine? What is it the end product of? |
|
Definition
Serum Creatinine
Normal range 0.6 – 1.2 mg/dL
End product: amino acid & pyrimidine metabolism
-Metabolic end product of creatine in muscle
--Filtered in the kidney and not reabsorbed or secreted |
|
|
Term
| *What does serum concentration vary with? |
|
Definition
| age, gender, muscle mass. |
|
|
Term
When is serum creatinine increased?
*Is this a good indicator of renal dz? |
|
Definition
renal dz, hypovolemia & tissue necrosis
*Poor indicator of early renal disease
-So use it with BUN, togethet are good.. Separated just ok.
-Approx. 50-70% of functioning renal tissue must be -destroyed before creatinine is increased |
|
|
Term
| There can be drug or chemical interference in certain assays... when is serum creatinine falsely increased (2)? falsely decreased (1)? |
|
Definition
Falsely increased with certain cephalosporins
Falsely increased in diabetic ketoacidosis
Falsely decreased in hyperbilirubinemia |
|
|
Term
| When causes an increase in serum creatinine levels? |
|
Definition
CHF, Shock, volume depletion
Body builder
3rd degree burn, rhabdomyolysis
Post-streptococcal glomerulonephritis
Acute tubal necrosis, diabetic glumerulopathy
Urinary tract obstruction
Creatine supplements in body builder |
|
|
Term
| What causes a decrease of serum creatinine? |
|
Definition
Normal pregnancy, SIADH
Wasting disease, marasmus
Hyperbilirubinemia |
|
|
Term
| What is Azotemia? What is the normal ratio? |
|
Definition
elevated BUN and Cr
BUN: Cr 6-20:1 (15.5 being optimal) |
|
|
Term
| What is occurring when the azotemia is prerenal? |
|
Definition
Prerenal
Reduced blood flow to kidney
Reduced GFR
Retention waste
Volume depletion, CHF, Hemorrhage, pancreatitis |
|
|
Term
| What is occurring when the azotemia is renal? |
|
Definition
Kidney is dysfunctional or damaged
Glomerulonephritis or Acute tubular necrosis
acute or chronic renal failure |
|
|
Term
| What is occurring when the azotemia is postrenal? |
|
Definition
Due to urinary tract obstruction
Prostate hyperplasia obstructing the urethra
Bladder/cervical CA obstructing ureters
Blockage of ureters by stone (renal lithiasis |
|
|
Term
| What are BUN:Cr ratios when azotemia is caued by a prerenal issue? renal? postrenal? |
|
Definition
|
|
Term
| What doe the creatinine clearance test correlate with? |
|
Definition
Correlates with GFR
Annual decrease in CCr of 1mL/min beyond age 50 |
|
|
Term
| When is performing a creatinine clearance (CCr) test useful? |
|
Definition
Detecting renal dysfunction
-A change in >22 mL/min from previous in either direction is medically significant
Calculating dose intervals for nephrotoxic drugs
Evaluating the effectiveness of therapy on progressive renal diseases
-Use of angiotensin-converting enzyme inhibitors in the treatment of diabetic glomerulopathy |
|
|
Term
Which of the following is a cause of acute kidney failure due to prerenal azotemia?
A. Excessive diuresis
B. Urinary tract obstruction (this one is postrenal)
C. Radiologic contract media (administered these drugs, and they had their nephrotoxic on the kidney… so considered renal)
D. Aminoglycosides (administered these drugs, and they had their nephrotoxic on the kidney… so considered renal) |
|
Definition
|
|
Term
| What does urine osmolality test? What is the first laboratory sign of tubular dysfxn? |
|
Definition
Evaluates the concentrating ability of kidney
Loss of urine urine concentration is the first laboratory sign of tubular dysfunction |
|
|
Term
| When is Uosm >500 mOsm/kg |
|
Definition
| Maximally concentrating your urine…. Getting everything you can in your urine. |
|
|
Term
| When is Uosm <350 mOsm/kg? |
|
Definition
Very dilute urine.
Can be physiologic due to drinking a lot of water
Can also be pathologic- not able to concentrate like you normally would. |
|
|
Term
| When is urine osmolality increased? |
|
Definition
Anything that is osmotically active is going to pull water back in to the tubules causing concentrated urine.
Syndrome Inappropriate ADH Secretion (SIADH)
-ADH, maximally conserving water… so maxumally concentrating urine
Dehydration
Glycosuria
Adrenal Insufficiency
High protein diet |
|
|
Term
| When is urine osmolality decreased? |
|
Definition
Diabetes Insipidus
-Can be nephrogenic- kidney is unresponsive to the ADH
Excessive hydration (oral or intravenous)
Acute or chronic renal insufficiency
Glomerulonephritis |
|
|
Term
| Look at case studies throughout. |
|
Definition
|
|
Term
| Is glucose osmolality active? |
|
Definition
|
|
Term
| What are CA 15-3 and CA 27.29 used for? |
|
Definition
Staging breast cancer
Monitoring treatment
<50% with localized breast CA have increased levels
Metastatic breast dz
80% elevated CA 15-3
65% elevated CA 27.29
Not to be used for screening |
|
|
Term
|
Definition
Extremely accurate marker for nonmucinous epithelial tumor
Elevated in >80% of woman w/ovarian cancer
High degree of sensitivity and specificity
Used to determine response to therapy
Used in post-treatment surveillance
Not effective for screening, but close |
|
|
Term
| Unfortunately, what other tissues render CA-125? |
|
Definition
|
|
Term
| In what other cancers is CA-125 increased? |
|
Definition
Increased in other cancers
Ovary *
Pancreas
Nonovarian female genital tract
Breast
Colon
Lung
Lymphoma
Peritoneal carcinoma |
|
|
Term
| What is beta-hCG a marker for? |
|
Definition
| Excellent for germ cell tumors.. Be they from the ovary or the testes. |
|
|
Term
| What is carcinoembryonic antigen (CEA) a marker for? |
|
Definition
| Lung potentially, GI tract primarily |
|
|
Term
| What is CA 19-9 a marker for? |
|
Definition
| Pancreatic tumors, however may see it elevated in stomach and hepatobiliary |
|
|
Term
| What is alpha-fetoprotein (AFP) a marker for? |
|
Definition
|
|
Term
| What is PSA a marker for? |
|
Definition
If elevated not necessarly indicative if a cancer, could also be BPH or prostatitis.
-10 % of prostate cancers can be detected by DRE |
|
|
Term
| What is included in the thyroid panel? |
|
Definition
TSH
T4
Free T4 (when not bound to protein (albumin and thyroid binding globulin)
Free T3 (when not bound to protein (albumin and thyroid binding globulin) |
|
|
Term
| What is the most common cause of endocrine hypofxn? |
|
Definition
autoimmune dz
-body is inappropriately attacking itself. |
|
|
Term
| What is the most common cause of endocrine hyperfxn? |
|
Definition
| adenoma, hyperplasia, benign proliferation of the cells |
|
|
Term
| What type of feedback does the thyroid system (from hypothalamus to excretion in kidney (urine) and liver (feces)) display? |
|
Definition
positive and negative
-look at diagram |
|
|
Term
| What are normal levels of TSH? |
|
Definition
2-10 uU/ml
Pituitary TSH proportional to thyroid releasing hormone (TRH from hypothal) |
|
|
Term
| What do low levels of T3 and T4 in the tissues stimulate? |
|
Definition
TRH and TSH
-compensation can then occur both ways. |
|
|
Term
| Classically, when are TRH and TSH elevated? |
|
Definition
|
|
Term
| *What is TSH useful in monitoring? |
|
Definition
| exogenous thyroid replacement |
|
|
Term
|
Definition
| affects almost every physiological process in the body, including growth, development, metabolism, body temperature, and heart rate, and more….. |
|
|
Term
How many times more potent is T3 than T4?
What is the total thyroid hormone ratio? |
|
Definition
4
Total thyroid hormone:
about 10% is T3
about 90% is T4. |
|
|
Term
|
Definition
Similar effects as T3 but less potent
Thyroxine is a prohormone and a reservoir for the active thyroid hormone (T3) |
|
|
Term
| Total T4 includes bound and unbound fractions... what is free T4 ? |
|
Definition
| The unbound portion and is metabolically active. |
|
|
Term
| What is thyroxine binding globulin? What do elevated levels correspond to? Is this an indicator of hyperthyroid? |
|
Definition
-major thryroid hormone protein carrier
-elevated T3 and T4
-not necessarily |
|
|
Term
| When is TBG elevated? decreased? |
|
Definition
Elevated in pregnancy, HRT, porphyria, infectious hepatitis, certain drugs
Decreased in certain drugs, GI malabsorption, neprhotic syndrome, malnutrion |
|
|
Term
|
Definition
| any dysfxn in heme production |
|
|
Term
| What 2 are the 2 uses of toxicology? |
|
Definition
Monitor drugs of abuse and environmental toxins
Monitor concentration of therapeutic drugs to limit toxicity |
|
|
Term
| What are some commonly monitored drugs by toxicology (drug screening)? What are some specific tests? |
|
Definition
Amphetamine
Barbituate
Benzodiazepine
Cannabinoid
Cocaine
Opiates/Opioids
Oxycodone
Fentanyl
Suboxone
PCP
Specific tests:
Acetaminophen
Aspirin
ETOH |
|
|
Term
| What are some environmental toxins? |
|
Definition
Carbon Monoxide
Based on carboxyhemoglobin
May cause ischemic damage to skeletal and cardiac muscle
Lead
Primarily children
Levels >10 ug/dL consider lead poisoning treatment |
|
|
Term
| What are some diseases associated in a positive ANA? |
|
Definition
SLE (active) 95-98%
--Remission 90%
Sjorgren’s syndrome 48%
Scleroderma/CREST 85%
Rheumatoid Arthritis 41%
Mixed connective tissue disease 93%
Drug induced Lupus 100%
Graves disease 50%
Hashimoto thyroiditis 46%
Autoimmune hepatitis 63-91%
Primary biliary cirrhosis 10-40% |
|
|
Term
| What is Anti-ds DNA used for in testing SLE? |
|
Definition
Titers are useful to monitor disease activity*
Hallmark: generation of antibodies to ds DNA* |
|
|
Term
| What are the major S/S of SLE? |
|
Definition
Malar rash
Discoid rash
Photosensitivity
Arthritis
Oral ulcers
Serositis
Renal diseases (protein >0.5 g/d)
Neurologic (seizure or psychosis)
Hematologic ( any cytopenia)
Immunologic ( positive anti-ds DNA antibody, positive antiphospholipid antibody, positive anti-Sm antibody and false –positive serologic test for syphilis
Antinuclear antibody (abnormal ANA titer) |
|
|
Term
| What is cryoglobin? There are 3 types, which is indicative of multiple myeloma? |
|
Definition
abnormal globulin protein complexes that exist in the blood of patients with various diseases
-Type 1 (monoclonal) |
|
|
Term
| What are the 4 clostridium exotoxins? |
|
Definition
C. diphtheriae
Gram positive rod (bacillus) “Chinese letters”
Causes diphtheria
Toxin is very potent
C. botulinum
Gram positive spore forming rods – obligate anaerobe
Foodborne 1-2 days incubation. Infants –honey ingestion
C. perfringes
Gram positive spore forming anaerobic rods
C. difficile
Antibiotic associated diarrhea |
|
|
Term
| Why don't you by the dented can in the store? |
|
Definition
C. botulinum
Don’t buy the dented can in the store.. Bc bacteria could have gotten in.
-when the veggies went into the can they were heated to kill the bacteria remained, but the spores stayed… if can dented, could be from the gases that spores are producing. |
|
|
Term
| C. diff is in normal flora.. but what can happen in hospitals and after antibiotic tx? |
|
Definition
pseduomembranous colitis.
-diarrhea |
|
|
Term
| Do gram positives stain? what about gram negatives? |
|
Definition
|
|
Term
| Can you gram stain all organisms? |
|
Definition
| no- this is just one weapon in our armory |
|
|
Term
| why are Staph and Strep capitalized? |
|
Definition
are genera.
FYI: are gram positive cocci |
|
|
Term
What will a beta hemolytic strep look like in agar?
-what about with alpha? gamma? |
|
Definition
a clear zone around the colony.. So in your red agar, will have what looks ike clear jello
will be a green zone in the blood around the colony (represents partial lysis)
no evidence of lysis |
|
|
Term
| What are some examples of some gram negative bacteria? |
|
Definition
coccobacilli= H. flu, B. pertussis
cocci= neisseria
bacilli= either lactose positive or lactose negative |
|
|
Term
| Salmonella is a gram negative bacilli that does not respond to oxidase and what else? |
|
Definition
| very readily picked out due to movement. |
|
|
Term
| What are some mechanisms of protection against bacteria? |
|
Definition
Normal flora
Tears
Saliva
Mucus; cilia
pH in GI tract
Vaginal pH and normal flora
Flushing of urinary tract |
|
|
Term
| How does innate immunity handle invaders? |
|
Definition
| non-specifically (macrophages) |
|
|
Term
| How do you appropriately take a urine sample? |
|
Definition
-wait a few seconds, bc last few mm of urethra is contaminated with bacteria.
--so in a healthy and appropriate individual, nothing should be growing here. |
|
|
Term
| What do normal microbial flora do? |
|
Definition
Role in maintaining health/normal function
May prevent colonization of pathogens
May be opportunistic becoming pathogens |
|
|
Term
| What is 80% of the mass of feces? |
|
Definition
microbes
->symbiotic relationship bw us and them |
|
|
Term
| When are normal microbial flora harmful? |
|
Definition
may be if have an accident or surgery, and they are able to get in where they should not be
maybe on an antibiotic, and abx is knocking out one guy, whie another one is being permitted to fluorish |
|
|
Term
| What does the normal skin flora consist of? |
|
Definition
Staphylococcus epidermis
Staphylococcus aureus (small amount)
Micrococcus species
Nonpathogenic neisseria species
Alpha-hemolytic and nonhemolytic streptococci
Diphtheroids
Propionibacterium species
Peptostreptococcus species |
|
|
Term
| What is the normal nasopharynx flora? |
|
Definition
Any amount of the following:
Cornybacterium
Staph aureus
Diphtheroids
Alpha hemolytic streptococcus
Staph. Epidermidis
Nonhemolytic strep
Lesser amounts of the following when accompanied by organisms listed above:
Yeast, haemophilus species, pneumococci, gram-negative rods, Neisseria meningitidis, strep pneumoniae |
|
|
Term
| What is the normal flora of the GI and rectum? |
|
Definition
Enterococci
Alpha hemolytic and nonhemolytic strep
Diphtheroids
Staph aureus in small numbers
Yeast in small numbers
Many anaerobes
Various Enterobacteriaceae except salmonella, shigella, yersinia, vibrio and campylobacter |
|
|
Term
| What does yersinia cause and what are the S/S? what is his example of a scenario? |
|
Definition
Yersinia causes bubonic plague fever lethargy and bubous/swollen LNs.
vector is the flea from the praire dog, usually when visiting an indian plantation. |
|
|
Term
| What are the characteristics of vibrio including crowder's scenario? |
|
Definition
have to visit from somewhere else
mission trip in guatemala with sewers.
can lose a tremendous amount of fluids in a day… can get over fast if you are hydrated.
described as rice-water stool (very liquid, clear, runny diarrhea in a TREMENDOUS VOLUME) |
|
|
Term
| What is the normal flora of the genitalia? |
|
Definition
Any amount of the following:
Cornybacterium
Lactobacillus
Alpha hemolytic and nonhemolytic strep
Nonpathogenic neisseria species
Many anaerobes
The following when mixed and not predominant:
Enterococci, Enterobacteriaceae and other GNRs, S. epidermidis, Candida albicans |
|
|
Term
| What are 3 important properties of the immune system? |
|
Definition
It is specific
It remembers a previous exposure to an antigen
It tolerates the presence of its own macromolecular components |
|
|
Term
|
Definition
most abundant circulating antibody, making up 80% of the total antibodies and 75% of that found in serum. It contains a single antibody protein complex, with two heavy chains and two light chains
second type of antibody synthesized in response to an infection and is the only antibody that can pass through the wall of small blood vessels to access antigens present in the extracellular spaces |
|
|
Term
| What is complement activated by and what are the results? |
|
Definition
Activated by antibodies or certain microbial secretion and causes a cascade of enzymatic reactions.
The results of these reactions is induction of inflammation, recruitment of phagocytes and the formation of a pore in the membrane of the microbial cell. |
|
|
Term
| One of the end results of complement is MAC, what is the fxn of MAC? |
|
Definition
| MAC (C5b,6,7,8,9) MAC literally pokes holes in invaders |
|
|
Term
|
Definition
an opsonin
-binds to an invader and acts like a handhold
C5a is a chemotactic agent…immune cells coming after complement can follow C5a’s “bread trail” |
|
|
Term
| Inflammation occurs in response to tissue damage through what 2 occurences? |
|
Definition
|
|
Term
| In the case of an infection, what does inflammation cause? |
|
Definition
| the activation of the immune response recruiting neutrophils, macrophages and leukocytes that destroy the invading particles and help to induce a specific immune response |
|
|
Term
| What are the clinical manifestations of inflammation? |
|
Definition
|
|
Term
-CD_ positive cells are T helper cells and go w/ MHC class 2
-CD_ positive cells go with cytotoxic cells and MHC class 1 |
|
Definition
|
|
Term
|
Definition
| Destroy cell walls, or prevent cell wall synthesis, affect protein synthesis, enzyme pathways, affect RNA synthesis (ability of microbe to reproduce) |
|
|
Term
| How do microorganisms build up antimicrobial resistance? |
|
Definition
Produce enzymes (new, that he didn’t previously produce)
Change their permeability
Develop an altered structural target
Develop an altered metabolic pathway
Develop an altered enzyme
get this resistance via mutations. |
|
|
Term
| In gram positive and negative cell walls there is peptidoglycan, what does this peptidoglycan consist of? |
|
Definition
-protein and sugar components
-Nag and Nam- chains of aas that link the peptidoglycans together. |
|
|
Term
What can be used to target gram positive organisms bc it is only found in gram positive organisms?
What about in gram negative? |
|
Definition
LTA- liptycoic acid… antigenicdeterrant that can be used to target gram-positive organisms… find it ONLY in gram-positive organisms.
LPS- lipopolysaccharide… ONLY in gram negatives… 2 componants: nasty part is lipid A and then Ag O. |
|
|
Term
| Do bacteria have a nucleus? What are the means by which a bacteria can give resistance? |
|
Definition
NO
-DON’T have a nucleus, have a nuceoid in which they have their ONE double stranded circular chromosome.
-outside of nucleoid may have plasmids… are the means by which one can give resistance on the recipient of the plasmid. |
|
|
Term
| What is the pili on bacteria used for? |
|
Definition
use for adherence, NOT LOCOMOTION and for “bacterial sex”
-through this hollow tube that 2 dudes can spread genetic material. |
|
|
Term
| How do bacteria get through hard times until environment gets better? |
|
Definition
Endospores (cyst produced)
-Survival mechanism
-Survive for years
-Right conditions |
|
|
Term
| What is the pathogenesis of bacterial infection? |
|
Definition
Transmission of Infection:
-Asymptomatic or mild disease
-Manifestations of disease
The infectious process:
-Bacteria attach or adhere to host
-Spread via lymphatic system |
|
|
Term
| What is the difference bw endotoxins and exotoxins? |
|
Definition
Endotoxins- (produced by the microbe but not released)
Exotoxins- (producing and releasing this toxin into our systems) |
|
|
Term
| What is an endotoxin an integral part of? |
|
Definition
cell wall of GN bacteria
-lippopolysaccharides of GN bacteria |
|
|
Term
| When are endotoxins released? Where are they only found? How toxic are they? How do they usually produce fever? What is activated upon their release? |
|
Definition
Released on bacterial death and in part during growth
Only found in GN bacteria
Moderately toxic and fatal
Usually produce fever by release of interleukin- and mediators
Complement and coagulation cascades are activated |
|
|
Term
| How does the LPS (lipopolysaccharide) cause fever? |
|
Definition
| Bacteria lysed -> LPS-> Interleukin-1-> Fever |
|
|
Term
| What is bacteriodes fragilis? |
|
Definition
Gram-negative anaerobic bacilli
Commensal bacteria that normally lives in the human gastrointestinal tract this organism can become pathogenic under circumstances involving disruption of the normal intestinal mucosa such as trauma, or surgery |
|
|
Term
When are exotoxins released?
Where are they present?
Are they antigenic?
What do they usually bind to?
Do they produce fever?
Give 2 examples? |
|
Definition
Excreted by living cell
Many GN and GP bacteria
Highly antigenic
Usually bind to specific receptors on the cell
Usually do not produce fever
C. tetani
C. diptheria |
|
|
Term
| C. tetani and C. diptheria produce what? (2) |
|
Definition
|
|
Term
|
Definition
anaerobic gram-positive rod
Spores live in soil
50K killed in WWII
Subunits A & B
Results to Rx of C. tetani not satisfactory
-Active immunization w/toxoids
-Proper care of wounds contaminated with soil
-Prophylactic use of antitoxin
-Administer penicillin. |
|
|
Term
| The tetanus shot is a toxoid, what does this allow? |
|
Definition
| building up of immune system against c. tetani without being attacked |
|
|
Term
| What are exotoxins associated with diarrheal dzs frequently called? |
|
Definition
|
|
Term
| What are 2 types of enterotoxins? |
|
Definition
Vibrio cholerae
-Gram-negative curved rods with singular polar flagella ---Life threatening loss of 20 L/day
-Fluid loss
-Acid-base imbalance
Staphylococcus aureus
Most common type of food poisoning |
|
|
Term
| What do some staph aureus strains release? |
|
Definition
toxins such as that in TSST-1
-Toxin accumulates in tampon-->shock syndrome
Group A beta-hemolytic strep produce pyrogenic exotoxin A resulting in scarlet fever |
|
|
Term
| What are the 3 baterial modes of locomotion? |
|
Definition
flagella
slime (glycochelates).. allows organisms to adhere to medical hardware (can contaminate IV lines and get into the pt)
rotate |
|
|
Term
| When gram staining, what are you staining? |
|
Definition
peptidoglycan
-colorize and then you counter stain
+blue due to counter stain
-pink due to counter stain |
|
|
Term
| When culturing, how can you separate organisms? |
|
Definition
by what pathways they utilize
by what NZs they utilize
what nutrients required
what byproducts they produced of their various pathways
*metioned beta hemolytic strep based on how they grew on a culture of blood agar |
|
|
Term
Which of the following clean catch urine culture colony counts indicates the patient likely has a Urinary tract infection?
A. 101 CFU/mL
B. 103 CFU/mL
C. 105 CFU/mL
CFU- colony forming unit... |
|
Definition
Typically tx at about 100,000
-should be 0 in a clean catch
-anything above 0
-so A. |
|
|
Term
| What are kirby-bauer minimum inhibitory concentration used to evaluate? |
|
Definition
antibiotics
-concentration
effectiveness
-lot of bacteria on plate (yellow) with varied concentrations of antibiotics or different abx, have a zone where bugs have been killed.. so are evaluating the size of that zone at a minimum inhibitory concentration for effectiveness if it were utilized |
|
|
Term
|
Definition
Produced by bacteria
Breaks beta lactam ring of PCN
Resistance
Ex: N. gonorrhoeae
penicilln has a beta lactam ring.. and is disrupted by this NZ |
|
|
Term
|
Definition
Smallest infectious agent
-prions are smaller (causative agent of mad cow (encephalitis))
--we have prions in us now
Contain either RNA or DNA (not both)
Replicate only in living cells
Known to infect unicellular organisms such as mycoplasmas, bacteria and algae |
|
|
Term
| What are some parts of a viruse used for? |
|
Definition
capsid contains the nuclear material
tail is where the receptor by which the virus will recognize the host cell |
|
|
Term
| What is a virus of bacteria? |
|
Definition
|
|
Term
| What are some examples of DNA viruses? |
|
Definition
Parvovirus
-Aplastic crisis, 5ths disease, fetal death
Papillomavirus
-Genital cancers
-HPV
Adenovirus
-acute respiratory diseases, conjunctivitis and gastroenteritis
-like rotavirus.. associate it with daycare centers
Herpesvirus
-HSV1, HSV2, Cytomegalovirus, Varicella-zoster,
-Epstein-Barr
Poxvirus
-Molluscum contagiosum, cowpox, small pox |
|
|
Term
| What are some RNA viruses? |
|
Definition
Picornavirus
-common cold, poliomyelitis
Astrovirus
-gastroenteritis
Reovirus
-colorado tick fever
Calcivirus
-Norwalk virus
Arbovirus
-Meningitis, encephalitis
*reo and arbo require a vector
Coronavirus
-severe acute respiratory syndrome (SARS)
Retrovirus
-AIDS
Rhabdovirus
-Rabies
Paramyxovirus
-Mumps, measles, parainfluenza, RSV |
|
|
Term
| RNA viruses... genetic material is RNA... virus wants to replicate inside the host cell in order to make little viruses... what does this require (bc host cell is DNA)? |
|
Definition
reversetranscriptase
-NZ to go back from RNA to DNA
-they must carry this NZ with them
-this makes the perfect target to get rid of this NZ. |
|
|
Term
| How infectious is varicella? DNA or RNA? |
|
Definition
Before vaccinations, chicken pox infected 3-4 million annually (10%) adults.
Highly infectious, spreads person to person by air
Double stranded DNA virus enters respiratory tract than disseminates
*for some individuals who are already sick can have fatality |
|
|
Term
| What does varicella primarily affect? Who is death higher in? |
|
Definition
-skin
-Death 15x greater in adults
Virus is preceded by a mild prodrome
Lesions have a centripetal distribution beginning on the trunk and later spreading to the extremities
Lesions at all stages are present at the same time (macropapules, vesicles and scabs)
Lesions are pruritic |
|
|
Term
| How does small pox differ from varicella? |
|
Definition
varicella in various maculopustule stages
small pox all in same stage |
|
|
Term
What is varicella zoster?
reemergence of varicella virus from single dermatome later in adulthood when adult is stressed. |
|
Definition
Double stranded DNA herpesvirus
Zoster
-Reactivation of nerve ganglion
-Usually involves single dermatome
-Pain precedes rash
-Ramsey Hunt
-Zoster opthalmicus |
|
|
Term
What are some other complications (bad outcomes) in varicella?
When is pneumonia increased in severity and what does severity directly correlate with here? |
|
Definition
Pneumonia in adults can be fatal
-Severity increased in pregnancy and smokers
-Severity often correlates with extent of skin lesions
Encephalitis
Complications
-Postherpetic neuralgia
-Guillain-Barre
-Ophthalmic-branch keratitis
Dissemination in immunosuppressed patients is often fatal |
|
|
Term
| What kind of neuropathy is Guillan Berret? |
|
Definition
|
|
Term
What is the tx of varicella?
-antiviral armory is not very big
--want to target a particular protein or NZ |
|
Definition
Chickenpox
-Acyclovir
Zoster
-Acyclovir, famcyclovir or valcyclovir
-Reduces acute neuritis and accelerates healing
-Prevents dissemination in the immune compromised
-May reduce post herpetic neuralgia
-Varicella zoster immune globulin is effective at preventing active disease (passive immunity so dont develop a response bc are already given the weapons to deal with it) |
|
|
Term
| Why is our generation dealing with the highest population of immunosuppressed pts? |
|
Definition
| bc now have drugs to deal, 200 yrs ago these people would just be dead. |
|
|
Term
How is Epstein-Barr spread and how many adults carry this virus?
What does it infect?
What is the clinical triad of symptoms? |
|
Definition
Spread by oral secretions with 95% of adults carrying the virus
Infects B cells and illness manifestations are result of vigorous T cell and natural killer (NK) inflammatory response
Fever, sore throat, lymphadenopathy – classic triad
Acute complications
Complications of chronic infection |
|
|
Term
| When would you want to admit an elderly pt with herpes zoster? |
|
Definition
Depends on how many dermatomes are covered… typically covers 3 dermatomes admit them.. Potential respiratory disorders
-if elderly patient has some co-morbidities may not even need three to admit. |
|
|
Term
What test is positive in Epstein Barr infection? What other anti-antibody test is offered ?
* in both, detecting antibodies to epstein barr via anti-antibodies. |
|
Definition
Heterophil antibody agglutination test is positive in 90% of primary disease
Monospot may be negative especially in early course of disease
-Monospost is less sensitive in children and often needs to be repeated |
|
|
Term
| For epstein barr, which test is the most sensitive and specific? |
|
Definition
Titer of immunoglobulin M (IgM) antibody to viral capsid antigen (VCA) is the most sensitive and specific test
--- igM in acute infections. |
|
|
Term
| In epstein barr, Nuclear antigen begins to rise after 4 weeks indicating _____________ |
|
Definition
|
|
Term
| Are antibodies to early epstein-barr viral antigens helpful? |
|
Definition
|
|
Term
| What does the differential for epstein-barr include? |
|
Definition
|
|
Term
| What may be helpful for predicting the risk of subsequent lymphoproliferative dz in transplant pts with epstein-barr? |
|
Definition
Quantitative PCR
-not fast
-24-48 hr turn around
-monospot is a rapid test. |
|
|
Term
| what is the tx for epstein-barr? |
|
Definition
Supportive
Avoid antibiotics
Ampicillin almost always causes rash
Prednisone for airway obstruction, thrombocytopenia or hemolytic anemia
Acyclovir or gancyclovir may be helpful in severe case
Chronic active infection w/EBV may produce severe end organ involvement and may benefit from antiviral therapy |
|
|
Term
| What are some neoplastic B cells that Epstein Barr can affect? |
|
Definition
B-cell lymphoma
-Burket's lymphoma (doesn't necessarily require the virus to develop the neoplasm bc are also genetic causes) |
|
|
Term
What is hantavirus?
his story is with illegal alien who is sick
-Can occur here. |
|
Definition
Spread by rodents
Found in the Four Corners area (UT, AZ, CO, NM)
Begins as mild febrile illness w/abdominal pain proceeding to fulminant respiratory failure
-Virus causes pulmonary capillary lead syndrome w/ARDS
-Severe hypoxia, hemoconcentration and increased APTT & LDH
Serologies, PCR and immunohistochemical staining
Supportive car and cautious fluid administration assist the patient to survive the ARDS, full recovery is possible |
|
|
Term
|
Definition
Single stranded RNS coronavirus
-Virus has characteristics similar to influenza and measles
Spread by aerosol droplets and spread by stool
Most cases 25 – 70 yrs
Incubation: 2-7 days
Dx based on clinical criteria
Only current Rx – meticulous supportive care
Mortality 11% overall; 43% >60 yrs
Strict respiratory isolation
VECTOR-civet cat (jungle cat) |
|
|
Term
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Definition
Enveloped RNA virus
A &B cause epidemics; Influenza A - pandemic
Epidemics Q1-3 yrs generally during winter
Antigenic drift (minor, subtle small change over a decade or 2)
Antigenic shift (dramatic)
-Influenza A
-Produces pandemic-causing viral strains
Spread by aerosolized respiratory secretions
Avian influenza – H5N1 |
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Term
| What does influenza infect? What are the S/S? What are the complications? |
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Definition
Infects respiratory epithelium
High fever, chills, HA, myalgia, pharyngitis, rhinorrhea
Complications: pneumonia or VIRAL infection can set you up for a bacterial infection
-Viral pneumonia can lead to ARDS, pulmonary hemorrhage
-Superinfection w/Staph aureus, H. influenza, Strep pneumoniae
-Reyes syndrome |
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Term
| Describe avian influenza attacks in children. |
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Definition
-Severe dz occurs in children >12 yrs
-Diarrhea, severe cough, fever
-Lymphopenia w/prominent infiltrates on CXR
-Acute onset of ARDS that develops 6-29 days after onset of fever leads to 78% mortality |
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Term
| What is the tx of influenza? |
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Definition
Neuramindase inhibitors zanamivir and oseltamavir are effective for types A & B
-Start agent early
-Resistance to oseltamavir has been reported for H5N1 strain
-Oseltamavir associated w/neurologic & behavioral side affects, especially children |
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Term
| What are the only txs tha will cover influenza a or b? |
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Definition
tamaflu and rulenza
-TAKE if someone in family has it.. want it before you develop symptoms, as early as you can get it. |
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Term
| What are the types of HSV? How is it transmitted? |
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Definition
HSV-1: cause of herpes labialis (90% worldwide)
-Resides in trigeminal ganglion
HSV-2: cause of genital herpes
-Resides in sacral ganglion
Contact w/infected surface or mucosa
Viral replication occurs in nerve ganglia |
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Term
| How does HSV present? What about in healthcare workers or wrestlers? |
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Definition
Vesiculopustular & moderately painful
Less common
-Herpatic whitlow in healthcare workers
-Herpes gladiatorum in wrestlers |
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Term
| What are some complications of HSV? |
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Definition
Herpes encephalitis (HSV-1) can manifest w/personality changes, obtundation, seizures; mortality 15%
Herpes keratitis – leading cause of blindness
Cutaneous dissemination can occur in eczema patient and bronchopneumonia is a possibility in debilitated patients |
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Term
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Definition
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Term
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Definition
| Acyclovir, famciclovir, valacyclovir |
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Term
Young children – primary source
Transmission ______________
Many infections are subclinical
Causes a mononucleosis-like syndrome
Immune compromised: retinitis, hepatitis, pneumonitis, GI disease, polyradiculopathy
Dx: ____________
Self limiting disease in normal host
Immune compromise - ganciclovir |
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Definition
BODILY FLUIDS- saliva, blood, urine, milk, feces..
Rapid, serologic tests, looking at immunoglobulins |
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Term
What are some infections of the immune compromised?
-anything that can set pt up for infection |
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Definition
Neutropenia – neutrophil count < 500/mm3
-Risk of infection increases as the cell number decreases below this threshold
-Reduced count is typically caused by cancer chemotherapy that depresses the bone marrow
Cell-medicated deficiencies
-Corticosteroids (suppressing inflamm response)
-Immunosuppression for organ transplant
Mixed defects are seen chiefly in bone marrow transplant patients |
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Term
| Neutrophils are ubiquitous, if are neutropenic what is this setting you up for? |
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Definition
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Term
| What are infections associated with neurtopenia? |
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Definition
Risk is inversely related to the number of neutrophils below 500/mm3
Primary organisms from skin, oral cavity, GI
Multiple organisms
Fungal infections develop after antibiotic therapy has had time to reduce the bacterial flora (usually after 7 days or more); Candida and Aspergillus spp. are the most common |
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Term
| What are some sources of bactera infectin neutropenic patients? |
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Definition
SKIN
-Coagulase negative staphyloccoci
-Staph aureus
ORAL CAVITY
-Strep viridans & oral anaerobes
GUT
-Escherichia coli
-Klebsiella spp.
-Enteroccoci
-P. aeruginosa
-Other enteric bacteria and gut anaerobes |
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Term
| What are some infections associated with defective cell-mediated immunity |
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Definition
Can contract same community-acquired pathogens as normal host
Increased risk of bacterial infections w/Mycobacterium spp., Listeria monocytogenes, Norcardia and Salmonella spp.Fungal infections are often life threatening and difficult to diagnose
-Cryptococcus- cryptosporidium, izospera (all these are protists)
-Aspergillus spp
-Histoplasmosis and coccidiomycosis should be considered depending on geography
-Reports of dematiaceous fungi (black mold) are increasing |
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