11 - Labs Flashcards
RLQ pain, what labs will you order? (depending on ROS)
UA CBC-infection, H/H FOB--for melana BMP-electrolytes for v/d coags--for melana, or prep for surgical HCG
RLQ pain, what additional studies will you order? (depending on ROS)
pelvic exam–adnexa vs appendix, guides you for GI or GU work up.
GI = CT
GU = US
We know CBC is not specific for any specific infection. What other lab in combination with a CBC is emerging as a more sensitive test for appendicitis?
CRP
Epi and RUQ pain post prandially with n/v. What’s you Ddx?
choleycystitis gastritis/PUD pancreatitis gallstone pancreatitis MI gastroenteritis hepatitis
What labs will you order for this RUQ pain pt?
1) CBC–infection, H/H
2) BMP +/- LFT (rather than CMP) to include direct and total bili
3) Lipase
4) coags (liver dz will have elevated)
5) UA–pyelo/UTI
When an attending asks why you didn’t order an amylase, what do you say?
It is completely non-specific, and doesn’t lend any weight to a diagnosis
What imaging will you order first if your DDx is as follows: choleycystitis gastritis/PUD pancreatitis gallstone pancreatitis MI gastroenteritis hepatitis
1) US first
also consider EKG if patient has risk factors
You see a gallstone on US and the lipase is elevated. What leads your DDx?
gallstone pancreatitis
clutching chest in pain is what sign?
Levign
chest pain guy having classic MI symptoms and edema. DDx?
ACS
PE
New CHF
CAP
What labs will you order for the following DDx: ACS PE New CHF CAP
1) CBC–r/o pna
2) BMP–electrolytes, fluid imbalance for CHF
3) cardiac enzymes
4) D-Dimer–r/o PE
5) coags–blood thinners, pre-op
6) Blood cx–r/o PNA
7) BNP???
When do you order D-Dimer?
Low to Moderate risk of PE: patients can be safely excluded via negative D-Dimer (if elevated, order CTA)
EKG shows inferior MI, CXR shows basal congestion, hilum is fuzzy. What is the conclusion?
Inferior MI is causing new onset CHF
