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Flashcards in Week 2 Deck (90)
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1
Q

Toxicology screening platfrom

A

Immunoassay

2
Q

Toxicology confirmatory platform

A

Chromatography
gas= gold standard
Can also do liquid

3
Q

Antidotes for ethylene glycol poisoning?

A

Fomepizole

4
Q

Antidote for acetaminophen poisoning?

A

Acetylcysteine (to replenish glutathione stores)

5
Q

How long after ingestion should you wait to get an acetaminophen level?

A

4 hours…. need to wait for drug to get fully distributed

6
Q

Elimination of drug is independent of drug concentration

A

0 order kinetics

7
Q

Elimination is dependent on drug concentration

A

first order kinetics

8
Q

Most common cause of acute liver failure in UK and US?

A

Acetaminophen poisoning

9
Q

Nomogram used to monitor acetaminophen poisoning?

A

Rumack and Matthew nomogram

10
Q

Hepatotoxicity is rare if the antidote to acetaminophen poisoning is administered with in what time frame?

A

8 hours

11
Q
Anhydrosis
Mydriasis
Flushing
Fever
Delirium
A

Anticholinergic Toxidrome

Agent blocks Ach

Common agents: antihistamines, atropine, TCA, parkinson’s drugs, Jimson weed

12
Q
Diarrhea
Urination
Miosis
Bradycardia
Bronchoconstriction
Emesis
Lacrimation
Sweating/salvation
A

Cholinergic Toxidrome
(ACh inhibitor)

Common agents: organophosphate, insecticides

13
Q
CNS depression
Miosis
Respiratory depression
Bradycardia
Hypotension
Decreased bowel sounds
Decreased reflexes
A

Opioid Toxidrome

14
Q

Treatment for opioid overdose?

A

Naloxone

15
Q

CNS depression
Ataxia
Slurred speech
Normal VS

A

Sedative Hypnotic Toxidrome

Common agents: Barbs and benzos

16
Q
Agitation
Anxiety
Tremors
Delusions
Paranois
Tachycardia
Seizures
HTN
Mydriasis
Hyperpyrexia
DIAPHORESIS
A

Sympathomimetic Toxidrome

Common agents: Amphetamines, cocaine, ephedrine

*** TO distinguish from Anti-cholinergic toxidrome….. sympathomimetic has sweating!

Anticholinergic = “Dry as a bone”

17
Q

What antibiotic can cause false positives on the opiod urine screen?

A

Levofloxacin

18
Q

Most common cause for UA test cancellation

A

Sitting at room temp for > 2 hours

19
Q

When would you use a Clinitest?

A

To look for reducing sugars

20
Q

When would you use Ictotest?

A

Used to confirm presence of bilirubin

21
Q

What ketones does chemistry pick up in urine?

A

Acetoacetic acid, and acetone but NOT B-hydroxybutyric acid

22
Q

Normal urine specific gravilty?

A

Decreased = more dilute
Normal 1.003- 1.03
Increased = more concentrated

23
Q

Typical urine pH

A

4.5 -8

If low pH could be high protein diet, acidosis

If high pH could be after meals, UTI, or bacterial contamination

24
Q

Can chemistry distinguish between hemoglobinuria and myoglobinuria?

A

Nope!

25
Q

Levels of proteinuria

A

Minimal ~ 50 mg/day
Moderate 50-400 mg/day
Marked > 400 mg/day

26
Q

Urine strip is more sensitive to which protein?

A

Albumin

27
Q

What do urine nitrites indicate?

A

GRAM NEG bacterial infection

28
Q

RBCs casts indicate?

A

Intrinsic renal disease

29
Q

Fatty casts indicate?

A

Diagnostic of Nephrotic syndrome

30
Q

Broad Casts indicate?

A

Diagnostic of renal failure

31
Q

Total protein ratio < 0.5

LDH ratio < 0.6

A

Transudate

32
Q

Total protein ratio > 0.5

LDH ratio > 0.6

A

Exudate

33
Q

At what pH does an effusion need to be drained?

A

pH < 7.2

Acid can cause more damage, and that pH indicates a definite pathology

34
Q

SAAG > 1.1 (1.2)

A

> 1.1 suggests portal HTN

> 1.2 suggests transudate

35
Q

SAAG < 1.1 (1.2)

A

< 1.1 suggests malignancy

< 1.2 suggests exudate

36
Q

Leukocyte levels for joint aspiration

A

0- 2,000 WBC= Non inflammatory

2,000- 10,000 WBC = inflammatory

> 10,000 WBC = septic joint

37
Q

Normal opening pressure for CSF

A

50-180 mmH20

38
Q

CSF with high predominance of PMN

A

Bacterial meningitis

39
Q

CSF with high predominance of lymphocytes

A

VIRAL but could be fungal or TB

40
Q

Stool analysis:

Low osmotic gap < 50 mOsm/kg with high fecal sodium

A

Secretory diarrhea

41
Q

Stool analysis:

High osmotic gap > 100 mOsm/kg with low sodium

A

Osmotic diarrhea

42
Q

Define transudate

A

fluid accumulation caused by hydrostatic and osmotic pressure across a HEALTHY membrane (CHF, low serum albumin, constrictive pericarditis)

43
Q

Define exudate

A

Fluid accumulation caused by MEMBRANE DAMAGE (malignancy, PE, pneumonia, TB, rheum, chylothroax)

44
Q

What things are evaluated in Light’s Criteria?

A

Protein
LDH

Can also look at:
Albumin gradient

45
Q

What are the components of the Framingham Risk Score?

A

Gives 10 year risk for CVD event

Components: 
Age
Gender
smoking
Total cholesterol
HDL
Systolic BP
HTN Rx
46
Q

Friedewald Calculation of LDL-C?

A

cLDL = [Total Chol] - [HDL Chol] - TG/5

47
Q

B-48

A

Chylomicron

Structural

48
Q

Chylomicrons have all the apolipoproteins except for?

A

B100 (binds LDL receptor)

49
Q

B-100

A
*binds LDL receptor
Found on:
VLDL
IDL
LDL
50
Q

An increase/decrease in Troponin by what percent is clinical significant?

A

20% (or 1 standard deviation)

51
Q

What lab should you always get on an acutely decompensated HF patient?

A

Troponin

52
Q

Which of the troponins is not cardiac specific?

A

TnC

Tnl, and Tnt are cardiac specific

53
Q

Which lab is NOT recommended as part of routine MI work-up, but is continually ordered by physicians?

A

CK-MB

54
Q

What process can cause falsely elevated Troponin I, and falsely low Troponin T?

A

Hemolysis

55
Q

What part of the Pro-BNP molecule is active with a short half life?

A

BNP

56
Q

What part of the Pro-BNP molecule is inactive with a longer half life, and more stable for analytical measurement?

A

NT-proBNP

57
Q

When might you see falsely elevated BNP?

A

In CKD patients, both BNP and NT-proBNP are renally cleared

58
Q

HBsAg Neg
Anti-HBc Neg
Anti- HBs Neg

A

Not infected

Not immunized

59
Q

HBsAg Neg
Anti-HBc Neg
Anti- HBs Pos

A

Vaccinated

60
Q

HBsAg Neg
Anti-HBc Pos
Anti-HBs Pos

A

Infected but cleared now

has seroconverted (no antigen detected)

61
Q

HBsAg Neg
Anti-HBc Pos
Anti- HBs Neg

A

Window Period

** Only Anti-HBc will be positive during window period! **

62
Q

HBsAg Pos
Anti-HBc (IgM) Pos
Anti-HBs Neg

A

ACUTE infection

(because IgM, and because positive surface antigen without antibody)

**Don’t know if they will seroconvert or not at this point **

63
Q

HBsAg Pos
Anti HBc (IgM) Neg
Anti HBC (total) Pos
Anti-HBs Neg

A

Chronic Infection

**virus on board, past acute period, has not yet seroconverted cuz no Anti-HBs **

64
Q

ALT, AST > AP

A

Hepatocellular injury, necrosis

65
Q

AP > ALT or AST

A

Cholestatic injury

66
Q

Elevated AP with normal AST/ALT

OR

AP > ALT, AST

A

Infiltrative (neoplasm, amyloid)

67
Q

What test is more specific for liver disease? and has a longer half life?

A

ALT (AST is found in muscle and red cells)

68
Q

What should you order to see if the elevated Alk Phos is from the liver?

A

GGT

69
Q

AST: ALT > 2

AST < 400

A

Alcoholic hepatitis

70
Q

What defines chronic hepatits?

A

> 3 months duration (transaminases around 300)

71
Q

Benign defect in UDPGT activity

Jaundice when stressed

A

Gilbert Syndrome

72
Q

Bronze diabetes

Ferritin > 200

A

Hereditary Hemochromatosis

73
Q

Defect in ATP7B
LOW serum ceruloplasmin
Kayser Fleischer Rings

A

Wilson Disease

74
Q

Absent UDPGT activity

A

Crigler-Najjar Type 1

75
Q

deficient UDPGT

A

Crigler-Najjar Type 2

76
Q

What liver diseases should you expect if elevated direct bilirubin?

A

Dubin Johnson

Rotor’s Syndrome

77
Q

If ALT is > 5,000 what should you be thinking about?

A

Acetaminophen, ischemia, or unusual viruses

78
Q

What is the best test to order for a patient with a history of
gastric bypass who has had vomiting/diarrhea for the past
week and presents to the ED?
A. Plasma thiamine
B. Urinary thiamine
C. Erythrocyte transketolase activity
D. Whole blood thiamine

A

D

Plasma and urinary thiamine would show recent intake

Limited storage of thiamine, deficiency can occur in 10-21 days with poor intake

79
Q

45 year old known alcoholic with burning eyes, sore tongue, reduced appetite, ab pain, dull hair, oily skin

Vit Def?

A

Riboflavin

80
Q

10 yr old girl with skin eruptions, ataxia, mental changes, diarrhea, hx of hartnup disease

Vit Def?

A

B3 = Niacin!

Dermatitis, dementia, diarrhea

Found in foods high in tryptan

81
Q

Burning feet syndrome

Prisoners

A

B-Pantothenic Acid

82
Q

Select the best answer to the question. Why do alcoholics
have an increased AST/ALT ratio?
A. The cofactor, PLP, is needed for both AST and ALT enzymes
and usually deficient in alcoholics
B. In alcoholic hepatitis, there is damage to mitochondria which
releases an isoform of AST to increase the concentration
C. Alcoholics have a reduction in ALT due to liver damage
D. All of the above

A

Answer D

B does contribute the most, but all are true

83
Q

What vitmain can cause interference with the T4 and TSH assays?

A

Biotin

Falsely high T4
Falsely low TSH

84
Q
Folic acid deficiency can lead to....
 A. microcytic anemia
 B. Pellagra
 C. Neural tube defects in fetuses of pregnant women
 D. Wernicke-Korsakoff syndrome
A

Answer C

85
Q

Megaloblastic anemia
Neuropathy
Neuropsychiatric damage

A

B12 deficiency

86
Q

What vitamin can causes labs to find no cholesterol?

A

High dose vit C

Called the Trinder Reaction, causes falsely low cholesterol in lab assay

87
Q

Swollen, bruised, bleeding joints, spongy gums, loose teeth, increased risk of CHD and CVA

Vit Deficiency?

A

Vitamin C

88
Q

Which fat soluble vitamin is a radical scavenger in
membranes that protects against lipid peroxidation?
A. Vitamin C
B. Vitamin B12
C. Vitamin K
D. Vitamin E

A

Answer D

89
Q

When should you test Vit K levels?

A

If pt has abnormal INR and does NOT respond to Vit K therapy

90
Q

An 88-year-old woman with a history of chronic
lymphocytic leukemia presented for routine
ophthalmologic examination. She complained of ‘itchy,
burning eyes’ and general visual decline. Her past ocular
history included uneventful bilateral cataract surgery. The
suspected vitamin deficiency is….
A. Vitamin A
B. Vitamin D
C. Vitamin B12
D. folic acid

A

Answer: A