Lab Work

What is the screening tool for thyroid?

TSH

What do you do if a TSH comes back abnormal?

Order a T3 and T4 level

A low TSH and high T3/T4 indicates…

Hyperthyroidism

A high TSH and low T3/T4 indicates…

Hypothyroidism

How often are we rechecking TSH level after beginning treatment for hypothyroidism?

Every 6 weeks

What labs are we looking at to assess kidney function?

Creatinine - second most accurate

GFR - most accurate

BUN - third most accurate

At what GFR level must dialysis be initiated?

Less than 15; indicative of end stage renal failure (S5)

With which first line BP medication do we want to closely monitor BUN and creatinine?

ACE inhibitors; drastic changes cause for discontinuation of medication

What finding on a urinalysis is indicative of true kidney damage?

red or white blood cell casts

When do we screen for microalbumin in the urine? Why?

When either hypertension or diabetes is first diagnosed; allows us to hopefully catch kidney damage early since patients are normally asymptomatic until stage 3

Should be checked yearly

A low MCV is indicative of…

Microcytic anemia such as iron deficiency anemia or lead intoxication

A high MCV is indicative of…

A macrocytic anemia such as B12 or folate deficiency anemia

How often should we order a standard lipid profile?

Every 5 years unless indicated

Triglyceride levels give good insight into…

Insulin resistance and true dietary intake

If triglyceride levels exceed 500, the patient is at high risk for…

Pancreatitis

What does a creatine kinase measure?

Indication of rhabdomyolysis; CK level will be 5x the normal limit

What labs should he checked prior to starting statin therapy?

Liver function tests (ALT; AST)

Should be checked at least 12 weeks after initiation of therapy

What labs are used to monitor the pancreas?

Amylase and lipase

What does a BNP tell us?

Indication of heart failure if elevated

What labs are inflammatory markers?

ESR and CRP

In what case do we use a d-dimer test?

In the evaluation of a possible clot

At what HbA1c is a patient diagnosed with diabetes?

6.5%

At what random plasma glucose level is a patient diagnosed with diabetes?

Greater than 200 WITH symptoms

At what 2- hour GTT level is a patient diagnosed with diabetes?

Greater than 200