Western Diagnosis 2

chantalinha's version from 2017-12-20 14:14


Question Answer
Name 3 methods of assessing Kidney Function:Creatinine, BUN, Cystatine C
What is Creatinine and how can we test for it?A catabolic product of creatinine phosphate, used in skeletal muscle contraction. We can test via blood sample in 2 ways: 1) Blood Urea Nitrogen (BUN); 2) Serum Creatinine.
Why is Creatinine such a consistent marker in the urine?because it depends on muscle mass, which fluctuates very little
Name 2 conditions that give rise to a raised Creatinine1) high meat diets; 2) some drugs
What is the eGFR and which factors are used in its calculation?Estimated Glomerular Filtration Rate - used to detect KID damage - it’s a mathematical estimation involving blood and urine samples, incorporating age, gender, ethnicity
In Pregnancy would we expect an increased or decreased eGFR?an increased GFR
Name 2 reasons for a decreased Creatinine Clearance (or eGFR)1) impaired KID function; 2) decrease blood flow to KID (dehydration, congestive HT failure…)
What other serum protein might be a better marker for kidney function than Creatinine and why?Cystatin C - because it has a more constant rate of production, its level is determined only by glomerular filtration, not influenced by those factors that affect serum creatinine and BUN
Give 3 indications for Urinalysis1) urinary tract diseases; 2) dysuria; 3) hematuria
List 7 parameters assessed in a urinalysis:1) appearance and color; 2) odor; 3) glucose and ketones; 4) pH; 5) leukocyte esterase and nitrites; 6) protein; 7) specific gravity
What does an acetone smell in urine indicate?diabetes (diabetic ketoacidosis)
Name one pathology and one KD stone associated with acid urine pHgout / uric acid
Name 1 renal and 2 non-renal causes (and thus findings) of proteinuriarenal: 1) renal diseases; non-renal: 1) Severe Muscle Exertion; 2) congestive Heart Failure
What is Specific Gravity?a measure of concentration of particles in the urine, also a measurement of hydration status.
What might a high specific gravity imply?concentrated urine (maybe dehydration?)
Name three positive urinalysis findings that are likely in a bacterial UTI1) increased WBC levels; 2) increased protein levels; 3) granular casts; 4) crystals


Question Answer
Name 2 “bony” and one “non-bony” indications for an X-Ray1) Bony: Fracture, bone spurs/age, cancers/tumors; 2) Non-Bony: infection (Lungs, bones)
Name (Why) 2 reasons why serial X-Rays might be useful1) to evaluate bones for fracture; 2) to evaluate bones for tumors;
Why might bone densitometry be indicated in a bed-bound patient?A: Because these people might develop osteopenia/osteoporosis
How often should a post-menopausal woman be given a bone density scan? A: Every 2 years
What tests comprise the Rheumatoid Panel?1) RF - Rheumatoid Factor, 2) ESR - Erythrocyte Sedimentation Rate , 3) Anti-CCP; 4) CRP - C-reactive protein; 5) HLA B27 - Human Leukocyte Antigen B27
Describe the individual components of the Rheumatoid Panel1) RF: testing of IgM antibodies; 2) ESR: a measurement of the rate of sedimentation of RBCs during a time period - indicates presence of inflammation; 3) Anti-CCP: an antibody that appears early in the course of RA, present in the blood of most patients with RA; 4) C-Reactive Proteine - a non-specific, reactant protein used to indicate inflammatory illness, appears in acute-phase; 5) HLA B27-Human Leukocyte Antigen B27, assess the likelyhood of the presence of an autoimmune disorder (RA, ankylosing spondylitis…)
Describe 1 benefit and 1 drawback for both CRP and ESRCRP benefit: believed to be of value in predicting coronary events. CRP drawback: its levels do not consistently rise with viral infections; ESR benefit: is a fairly reliable indicator of the course of disease and monitoring of disease therapy; ESR drawback: may remain elevated longer than other disease indicators
Compare Rf and Anti-CCP testing for RA in terms of sensitivity and specificityAnti-CCP is more sensitive (by not much) and more specific than RF
What are the three common methods used to test for Gout?1) serological studies (serum uric acid levels); 2) urinalysis; 3) x-rays / MRI
What is the benefit of testing for urine pH in Gout?If urine is acidic, we want to alkalize the urine by ingestion of a strong base to prevent stone formation. “Uric acid is less well saturated in alkaline urine. As the urine pH rises, more uric acid can exist without crystallization and stone formation” Slide 10, file 10.
What do each of the following shades indicate on an X-Ray in terms of tissues or materials? White, Light Grey, Mid Grey, Dark Gray, Black?White: metal; Light Grey: bone; Mid grey: soft tissue; Dark grey: gas/air; black: no material (tissue)


Thyroid Testing
Question Answer
Give 3 indications for a thyroid scan1) neck mass; 2) evaluation of thyroid nodule; 3) hyperthyroidism
Describe 1 difference between “functioning” and “non-functioning” nodules found on a thyroid scanfunctioning: hot/warm (functioning, busy - benign adenoma); non-functioning: cold (non-functioning, full of fluids - cysts)
Name 2 pathologies that a cold nodule might reveal1) cyst, 2) carcinoma
Why might a Whole Body Thyroid Scan be indicated?to evaluate if there is metastasis of a thyroid cancer
Which thyroid imaging technique is favoured in pregnancy?Ultrasound
Name 2 findings possible via Thyroid Ultrasound1) cyst; 2) thyroid carcinoma; 3) thyroid adenoma
Which 3 tests would you recommend for an initial look at someone with suspected Hypothyroidism?1) TSH; 2) FT4; 3) FT3
Which 3 further tests would you recommend if Hashimoto’s was suspected?1) TPO Ig; 2) TB Ig; 3) rT3
Name 2 possible results indicated by a raised TSH1) Primary hypothyroidism; 2) Thyroiditis (Hashimoto)
What is the difference between Total T3 and FT3?T3 is the total amount of T3 hormones, FT3 is the amount of the free T3.
Give 2 reasons for a raised T31) primary hyperthyroidism (grave’s disease); 2) acute thyroiditis (hashimoto)
Which 2 antibody tests are commonly tested for together in Hashimoto’s?1) Anti-Tg; 2) Anti-TPO
Which antibodies are commonly tested for in the diagnosis of Grave’s Disease?TSI
What does a high TSH and low FT4 & FT3 indicate?Primary hypothyroidism
What does a normal TSH, normal FT4 and low FT3 indicate?T4 conversion to T3 problems (LIV or KID)


Diabetes Testing
Question Answer
Name 3 blood testing methods and one other type of testing for diabetes1) blood glucose; 2) glycosylated hemoglobin; 3) glucagon; 4) urinalysis
Name one advantage of testing for Glycosylated Hb over Blood Glucoseit exposes patient blood sugar levels over the last 120 days. Also, it is not affected by stress or food.
Describe the Glucose Tolerance Test and the two methods via which it can be performedglucose is administered (orally or IV) and sugar levels are monitored by obtaining blood and urine specimens. It should decrease in up to 3hrs in normal patients. Diabetics will have it decreased in up to 5 hours.- 1) orally; 2) Intra-Venously
How would a diabetic respond to a Glucose Tolerance Test?Serum glucose levels will take up to 5hrs to decrease.
What would a persistently high glycosuria indicate in pregnancy?it may indicate gestational diabetes or other obstetric illness
Name 2 other findings related to glycosuria, this time unrelated to pregnancy1) diabetes mellitus; 2) KID-diseases


Liver Testing
Question Answer
Name 5 liver tests1) albumin; 2) bilirubin; 3) GGT; 4) ALT (alanine aminotransferase); 5) AST (aspartate aminotransferase);
Why are significantly raised ALT levels almost certainly due to liver pathology? because this enzyme is found predominantly in the liver, and most ALT elevations are caused by liver dysfunction.
List 3 liver, 1 skeletal muscle and 1 other (non-liver, non-muscule) reason for a raised AST liver: 1) hepatitis; 2) cirrhosis; 3) drug-induced liver injury; skeletal muscle: skeletal muscle trauma; other: acute pancreatitis.
Which Liver test is the most useful for detecting/monitoring alcoholism? GGT/GGTP test
Which liver test is more sensitive: GGT or ALP? GGT
If GGT is not raised but ALP is, what is the implication? Skeletal Disease
Which liver enzyme tends to be significantly raised in Alcoholic Hepatitis? GGT
What is the difference between Conjugated and Unconjugated Bilirubin? Conjugated bilirubin is aka Directed, is water soluble, whilst Unconjugated (Undirected) is not water soluble.
Give 2 reasons for a raised Conjugated (Direct) Bilirubin in the serum1) Gallstones; 2) extrahepatic duct obstruction (cancer in pancreatic duct….)
Give 2 reasons for a raised Unconjugated Bilirubin - one relating to the liver and one to events in the blood1) Hepatitis; 2) Sickle cell anemia;
What are the 2 components of a Total protein level? 1) albumin; 2) globulins.
Why does Total Protein tend to remain normal in early liver disease even though Albumin tends to fall? Because LIV increases globulin levels in compensation as albumin falls
In chronic liver disease why is Albumin a better measure of liver function than Globulin?Because in these diseases the LIV cannot produce albumin, but globulins are normally produced
Give one non-hepatic reason for a decreased Albumin level Malnutrition
Give one reason for an increased Gamma Globulin Inflammatory Diseases
Why is PT/INR raised in liver disease?because the factors might not be readily available, or the impaired LIV might take longer to synthesize the factors, therefore increasing Prothrombin Time.
Name a dietary factor that would cause a raised PT/INR level and explain whydecreased Vitamin K intake/absorption (leafy greens). Vitamin K is needed to form clotting factors in LIV. When not present, clots will take longer to form or might not form at all, therefore increasing PT (Prothrombin Time)