Lab med Daleo

Cardiac specific troponins

I and T

Skeletal and Cardiac troponin

C

most sensative & specific cardiac marker

troponins

Cardiospecific CK

CK-MB

Can CK-MB r/o MI

no

DDX of increased myoglobin

Rhabdomyolysis with possible renal failure

What LDH enzymes concern the heart

LDH-1 and LDH-2

Is LDH-1 or LDH-2 usually higher

2 is higher

When do you need to be concerned about LDHs

When LDH-1 is higher than LDH-2

First cardiac marker to rise

Myoglobin

Acute phase reactant that indicates inflammatory illness

CRP (C Reactive Protein)

"crap" --> can be elevated in alot

Homcysteine can promote

Atherosclerosis and blood clots

When is homocysteine more useful?

IF strong FHx of CAD

Good predictor of heart disease and used to screen for coronary disease

Lipoproteins

Low HDL increases risk for

Atherosclerotic heart disease

Total cholesterol/HDL ratio should be*

4.5-5.2

Total cholesterol/HDL ratio -- when its high it means

bad

Total cholesterol/HDL ratio --- when its low it means

good

Total cholesterol/HDL ratio -- CAD starts at

>4 (especially when accompanied by high TAGs)

What is better than total cholesterol at determining your risk for CAD and CVD??***

LDL

LDL for risk/high risk patients

< 70 risk

< 100 high risk (cant expect them to go to low with FHx)

What particle size of LDL is associated with higher risk?

SMALL LDL

Main carrier of TAGs

VLDL

Why do DM patients have an increase in TAGs?**

They have elevated production of VLDL and decreased breakdown of VLDL

Serum iron reflects

the amount of iron bound to transferrin

Decreased iron.. what should always be concerened about

malignancy (can find cancers this way)

MCC of high transferrin*

iron def

MCC of low transferrin

iron overload

Serum Ferratin measures

the amount of iron in the body

What is the most sensative test of the iron studies?*

Seum Ferratin**

Only thing that has low ferratin (on his list)

IDA

TIBC reflects

serum transferrin

Only thing that has increased TIBC (on his list)

Anemias

The most important controller of TSH secretion*

TRH

TRH increased in _____, decreased in _____

HYPOthyroidism

HYPERthyroidism

Inital test in thryroid studies

TSH**

_____ meds to bring down TSH

increase

_____ meds to bring up TSH

decrease

TSH increased in ______, decreased in _____

HYPOthyroidism

HYPERthyrodism

Majority of thyroid hormone

T4

T3 can be decreased in

Hepatic disease

2 thyroid antibodies

Thyroglobulin antibody

Thyroid peroxidase antibody (TPO -ab)

Which aB is closely linked to Hashimotos?

TPO ab

What do you order to determine HOT vs COLD of thyroid

Thyroid scan (scinitigraphy)

Thyroid scan uses

Technetium-99

Functioning thyroid would be _____, Non functioning would be _____

HOT

COLD

If its HOT think...

NOT anything bad (HOT = NOT)

-Benign Adenoma

-Toxic Goiter

If its COLD think

More worrysome

Cyst

cancer

lymphoma

adenoma

thyroditisi

If a pt has high Ca, what is the first test u order

PTH

Primary Hyperparathyroidism

High PTH, High Ca

(PT adenoma or cancer)

Secondary Hyperparathyroidism

High PTH, Low Ca

(Seen with Chronic Renal Failure - look for CK in vingette)

Tertiary Hyperparathyroidism

High PTH, High Ca

(Seen with Chronic Renal failure that overcompensates with PTH)