Average age ranges of female sexual development

menarche?

peak fertility?

menarche - average 12.5 yrs in US

range: 8-17

peak fertility: 19-24 yoa

3 day FSH

LH

Progesterone level

estrogen level

cervical mucus fem formation

body temp measurements

hysterosalpingogram

[image][image][image]ACA, ANA, AMA immune d/os that indirectly dec fertility

ASA: antisperm Abs

AOA:antiovarian Abs

APA

Antithyroglobulin Abs

Chromosome analysis

selected gene testing

lupus anticoagulant

leukocyte Ab screen

NK cell detection

LH midcycle surge

oophorectomy

tubal ligation

hysterectomy

vasectomy - reqs semen analysis for absense of sperm (needs to be repeated in a month)

orchiectomy - removal of testes

consanguineous marriage

other affected relatives

early death of a sibling

diagnosis already made in another family member

lethargy, coma, hypotonia, seizures, poor feeding

abnormal body odor

unexplained metabolic acidosis (hyperventilation)

unexplained respiratory alkalosis (neurologic do)

enlarged liver, unexplained jaundice

hypothermia

deafness

multiple congential abnormalities

28 disorders are tested for each newborn

make sure home deliveries are tested

is an autosomal recessive genetic disorder characterized by a deficiency in the autozome phenylalanine hydroxylase

phenylalanine accumulates and is converted into phenylpyruvate

if left untreated excess deposits in the brain and can cause mental retardation and seizures

microencephaly, ECG changes, ADHD, albinism, musty odor,

through diet

avoid protein rich foods

and aspartame

limit pasta, rice, bread, cookies, and even some fruits and vegetables. 

every child born should be tested 12-24 hours after they are born for the PKU disorder

it is recommended that they get tested again in 2 wks

an autosomal recessive hereditary disease that is caused by the lack of a liver enzyme required to digest galactose.

Galactose is a breakdown product of lactose

jaundice, D/V and the baby begins to lose weight

If not detected immediately, it results in liver disease, speech difficulties, cataracts, mental retardation, and even death.

E. Coli infections are common in infants with this disorder

mostly no

the cataracts have been shown to be reversible

milk products

casesin

dry milk solids

lactose

curds etc

the body absorbs too much iron

it is especially stored in the pancreas, liver and skin

85% HFE gene mutation

Types I-III are recessive

Type IV is dominant (Ferroportin)

Who gets hemochromatosis?

What is the prevalance?

caucasians of northern european descent, mainly

5 out of every 1000 in the US

1 in 8-12 are carriers

arthritis

liver problems

cardiac abnormalites

skin color changes

impotence

early menopause

damage to pancreas - DM

thyroid deficiency

damage to adrenal gland

chronic fatigue

loss of body hair

depression

hypogonadism

abd pain

amenorrhea, infertility

some cancers

phlebotomy treatments 1-2 times a week for mths to a year

ferretin testing after every 4

Remove 1 pint every 1-4 mths for maintanence

avoid Vit C, alcohol, raw sea food

troponin I and T

CKMB

Myoglobin

lactic dehydrogenase

proteins found in cardiac and skeletal mm that aids in contraction, elevates if cardiac mm gets injuried

Troponin I is found only in cardiac mm

elevation in Troponin T could also indicated kidney disease

neither of these are elevated in sk mm injury

What are the troponin levels after an AMI?

What is the normal level?

rises 4-6 hrs after cardiac injury

peaks in 24-48 hrs

stays above normal for 7-10 days

normal is < 0.07

Which biochemical marker becomes abnormal the fastest?

CKMB, since it only stays elevated for 48 hrs

if a pt reinfarcts CKMB will raise again, while troponin is still high

troponin

bc CKMB will also rise for other reasons, like crush injuries, troponin will only go up if it is actually an AMI thats the probably post-operatively

found in skeletal mm, cardiac mm and the brain

the more mm mass the higher the CKMB

CKMB is more specific to cardiac mm, but it is also found in low levels in sk mm

CKMM and CKBB are the other types of creatinine kinase and they are not as specific to the heart

rises in 4-6 hours

peaks 12-24 hrs

returns to normal in 48 hours

a protein found in mm tissue that serves as an oxygen carrier

its found in all types of mm tissue, so with any mm tissue damage it will rise

acute chest pain centers

if it is negative it tells you there is no AMI

if its positive it only tells you that mm injury occurred somewhere

rises in 1.5-3 hrs

peaks in 6-9 hrs

returns to normal in 24-30 hours

< 100

increased BNP indicates ventricular hypertrophy and Heart failure

What do these levels indicate?

troponin I = 7.8

CKMB = 26

BNP = 447

What do these levels indicate?

Troponin I = 1.5

CKMB = 1.7

What do these levels indicate?

troponin I = 1.8

CKMB = 50

not directly

LDL = HDL + (total cholesterol/5)

if trigs >400 this formula will not work, so if you want an LDL level you have to ask for it directly

Which drug will increase HDL levels?

low HDL

cigarette smoking

HTN

FHx

advanced age

LDL < 100 in a pt with no to few risk factors

LDL < 70 in pts with 3+ risk factors or HD

low risk < 1.0

average 1.0-3.0

high >3.0 (may need to refer)

when cardiac output provides inadequate blood flow meet metabolic needs

systolic inability of the heart to contract strongly enough to provide perfusion

diastolic inability of the ventricles to relax sufficiently to receive atrial blood (heart is stiffened)

decompensation due to acute injury of the heart (MI, ruptured valve etc.)

same as low output

symptoms have developed over a long period of time, generally with coexisting heart diseases

cardiomyopathy, the heart mm is not strong enough

renin

angiotensin II

1. vasoconstriction (with inc BP)

2. sodium and water retention (inc volume the heart has to pump

dyspnea

differentiating HF from COPD, pneumonia and other pulmonary diseases

if its negative is it usually not PE

but if its positive it could be a PE or any number of other things

pH < 7.35

high PaCO2 (>45)

normal HCO3

pH <7.35

high PaCO2

high HCO3

normal pH

high PaCO2

high HCO3

ASA overdose

being to tense or anxious

high fever

dec O2

severe pain

ringing in ears is a sign of low toxic levels

pH > 7.45

low PaCO2

normal HCO3

pH > 7.45

low PaCO2

low HCO3

normal pH

low PaCO2

low HCO3

diabetic ketoacidosis

alcohol

ASA

shock (lactic acidemia)

CO poisoning

renal tubular acidosis

pH < 7.35

normal PaCO2

low HCO3

pH < 7.35

low PaCO2

low HCO3

normal pH

low PaCO2

low HCO3

pH > 7.45

normal PaCO2

  high HCO3

pH > 7.45

low PaCO2

high HCO3

normal pH

low PaCO2

high HCO3

respiratory abnormalities and monitors response to treatment

also essential for measuring the respiratory system's response to metabolic acidosis and alkalosis