CA diagnostics Flashcards
what are the 8 components of a BMP?
1) calcium
2) carbon dioxide
3) chloride
4) creatinine
5) glucose
6) potassium
7) sodium
8) urea nitrogen (BUN)
what is the only difference between the chem 7 and the chem 8?
calcium
in what circumstances would you order a BMP? (5)
1) renal status
2) blood glucose
3) respiratory distress
4) abnormal cardiac rhythms
5) rule in/out electrolyte imbalance
high calcium should make you think what?
hyperparathyroidism, bone cancer, breast cancer, multiple myeloma
90 percent of elevations caused by malignancy or hyperparathyroidism
low CO2 should make you think what?
acidosis and possibly ketoacidosis (especially with low K and high glucose)
low glucose should make you think what? (2)
diabetic insulin overdose, sepsis
elevated BUN with a normal creatinine should make you think what?
patient is diuresed
elevated BUN with an elevated creatinine should make you think what?
renal failure
what is added to a BMP to make up the CMP? (6 things)
1) albumin
2) alkaline phosphatase
3) AST
4) ALT
5) total bilirubin
6) total protein
low albumin should make you think what?
malnutrition, liver disease, thyrotoxicosis, chemotherapy
increased alkaline phosphatase should make you think what?
GALLSTONES!
also hyperparathyroidism, neoplasms, hepatobiliary disease, sepsis, IBD
an elevated AST or ALT should make you think what?
hepatitis or any condition involving death of hepatocytes, myocardial cells, erythrocytes, or skeletal muscle
if you want to check liver function and/or nutritional status, what is your test of choice?
CMP
what are the 5 components of a CBC?
1) RBC count
2) hemoglobin
3) hematocrit
4) WBC count
5) platelet count
if you see low RBC, hemoglobin, hematocrit what should you think?
blood loss vs. anemia
if you see high RBC, hemoglobin, hematocrit, what should you think?
hemoconcentration due to DEHYDRATION vs. polycythemia
what should low platelets make you think of?
acute infection, bleeding, DIC, HELLP syndrome or pre-eclampsia during pregnancy
when you add a differential to the CBC, what do you get?
breaks down the WBC into types
high neutrophil counts should make you think of what? low neutrophils should make you think what?
high = acute bacterial infection
low = severe widespread bacterial or viral infection (shift to left)
high lymphocytes should make you think of what?
a viral infection such as mononucleosis, mumps, or measles
high eosoinophils should make you think of what? what about VERY high eosinophils?
high = acute allergic reaction
very high = parasitic reaction
increased total bilirubin (direct or indirect) are increased in which 2 conditions? a disproportionate elevation of DIRECT bilirubin is seen in which 2 conditions?
increased total = liver damage, neonatal jaundice
disproportionately high direct = cholestasis and late in liver disease
what does a D-dimer measure?
fibrin component – there are many positive D-dimers that are not indicative of PE or DVT
if you see a urine glucose over 130 with ketones, what should you think?
poorly controlled diabetes or possible DKA
if you see positive nitrites and/or leukocyte esterase on urinalysis, what should you think?
UTI
if you see UTI symptoms with negative nitrites and/or leukocyte esterase, what should you think?
interstitial cystitis; chronic condition
a moderate frequency beta-HcG is useful under which circumstances?
measures HcG in blood therefore allows for dating of pregnancy
it is a predictive pattern: can be used to evaluate threatened pregnancy, ectopic pregnancy, or miscarriage
if you want to test for mono, what test do you order? when do we see false positive? when do we see false negatives?
order heterophile antibody test
false positives: hepatitis, leukemia, lymphoma, rubella, SLE
false negatives: testing too early!
what do you order to test for syphilis?
RPR using BLOOD sample
what do you order to test for gonorrhea and chlamydia?
nucleic acid amplification URINE test
what do you order to test for HSV?
blood sample; searches for antibodies to differentiate between HSV1 (oral) and HSV2 (genital)
what do you order to test for HIV?
RNA based HIV early detection kit
which imaging modality is very rarely used in emergent settings?
MRI
if you want to look at the uterus, fallopian tubes, ovaries what should you order?
ultrasound
to evaluate the appendix, gallbladder, biliary tree, and large intestine for diverticula what should you order?
ultrasound
when you suspect a kidney stone, what two imaging modalities are available?
ultrasound and CT
if you want to get a blood culture, how many samples should you get, from how many sites?
2-3 blood samples from at least 2 different veins so you don’t miss bacteria or fungus
what test is the marker for cellular hypoxia? who is it indicated for?
lactate!
in patients with suspected sepsis or septic shock – tells us who needs attention and aggressive managemetn
routine urine testing for ketones is no longer necessary to diagnose DKA, what has replaced it?
capillary beta hydroxybutyrate has distinct advantage
what
how do we measure response to DKA treatment?
capillary blood ketones
what will you see on ABG of diabetic ketoacidosis?
metabolic acidosis
what will you see on ABG when patient has been vomiting?
metabolic alkalosis
what conditions will produce a respiratory acidosis?
hyPOventilation due to pulmonary edema, pneumonia, COPD, respiratory depression from drugs (opioids, sedatives)
what conditions will produce a respiratory alkalosis?
hypERventilation (PE, anxiety, pain, febrile illness)
what is the most specific lab test for pancreatic function?
lipase
approximately how many visits are made to the ED annually for chest pain? how about abdominal pain?
chest pain = 6 million
abdominal pain = 129 million
which lab test do we order to assess for CHF?
BNP
when is BNP secreted by the heart?
in response to volume overload and resulting myocardial stretch
____ are proteins that are essential to cardiac muscle contraction, myocardial injury results in a leak of these proteins
troponins
troponin has replaced _____ as the biomarker of choice for the detection of _______
troponin has replaced CKMB in the detection of myocardial injury
when is a troponin level not very helpful?
within 6 hours of symptom onset because troponin doesn’t peak right away
also those with intermittent symptoms
monitor every 2-6 hours!
the PT/INR measures the _____ pathway of coagulation
extrinsic
which clotting factors are involved in the extrinsic pathway of coagulation?
2, 7, 9, 10
what test do we order to monitor the effect of coumadin/warfarin? why?
order PT/INR
coumadin inhibits production of vitamin K dependent factors produced in the liver (2, 7, 9, 10)
PTT evaluates the _____ pathway and plays a relatively minor role in coagulation in the body (more involved with coagulation related to inflammation and innate immunity)
intrinsic pathway
a normal PTT requires the presence of which factors?
1, 2, 5, 8, 9, 10, 11, 12
notice 7 is not on the list, but 2, 9, and 10 are
the effect of which drug is measured using PTT? why?
heparin
heparin potentiates the action of antithrombin-3, which binds with activated factor 10 to stop the procoagulant process at the beginning of the pathway
a rapid strep test tests for which group of strep pharyngitis?
group A strep
the influenza swab tests for influenza A, B, or both?
influenza A and B
