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Elaina: Emergency 2 > CA diagnostics > Flashcards

CA diagnostics Flashcards

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1
Q

what are the 8 components of a BMP?

A

1) calcium
2) carbon dioxide
3) chloride
4) creatinine
5) glucose
6) potassium
7) sodium
8) urea nitrogen (BUN)

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2
Q

what is the only difference between the chem 7 and the chem 8?

A

calcium

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3
Q

in what circumstances would you order a BMP? (5)

A

1) renal status
2) blood glucose
3) respiratory distress
4) abnormal cardiac rhythms
5) rule in/out electrolyte imbalance

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4
Q

high calcium should make you think what?

A

hyperparathyroidism, bone cancer, breast cancer, multiple myeloma

90 percent of elevations caused by malignancy or hyperparathyroidism

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5
Q

low CO2 should make you think what?

A

acidosis and possibly ketoacidosis (especially with low K and high glucose)

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6
Q

low glucose should make you think what? (2)

A

diabetic insulin overdose, sepsis

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7
Q

elevated BUN with a normal creatinine should make you think what?

A

patient is diuresed

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8
Q

elevated BUN with an elevated creatinine should make you think what?

A

renal failure

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9
Q

what is added to a BMP to make up the CMP? (6 things)

A

1) albumin
2) alkaline phosphatase
3) AST
4) ALT
5) total bilirubin
6) total protein

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10
Q

low albumin should make you think what?

A

malnutrition, liver disease, thyrotoxicosis, chemotherapy

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11
Q

increased alkaline phosphatase should make you think what?

A

GALLSTONES!

also hyperparathyroidism, neoplasms, hepatobiliary disease, sepsis, IBD

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12
Q

an elevated AST or ALT should make you think what?

A

hepatitis or any condition involving death of hepatocytes, myocardial cells, erythrocytes, or skeletal muscle

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13
Q

if you want to check liver function and/or nutritional status, what is your test of choice?

A

CMP

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14
Q

what are the 5 components of a CBC?

A

1) RBC count
2) hemoglobin
3) hematocrit
4) WBC count
5) platelet count

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15
Q

if you see low RBC, hemoglobin, hematocrit what should you think?

A

blood loss vs. anemia

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16
Q

if you see high RBC, hemoglobin, hematocrit, what should you think?

A

hemoconcentration due to DEHYDRATION vs. polycythemia

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17
Q

what should low platelets make you think of?

A

acute infection, bleeding, DIC, HELLP syndrome or pre-eclampsia during pregnancy

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18
Q

when you add a differential to the CBC, what do you get?

A

breaks down the WBC into types

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19
Q

high neutrophil counts should make you think of what? low neutrophils should make you think what?

A

high = acute bacterial infection

low = severe widespread bacterial or viral infection (shift to left)

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20
Q

high lymphocytes should make you think of what?

A

a viral infection such as mononucleosis, mumps, or measles

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21
Q

high eosoinophils should make you think of what? what about VERY high eosinophils?

A

high = acute allergic reaction

very high = parasitic reaction

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22
Q

increased total bilirubin (direct or indirect) are increased in which 2 conditions? a disproportionate elevation of DIRECT bilirubin is seen in which 2 conditions?

A

increased total = liver damage, neonatal jaundice

disproportionately high direct = cholestasis and late in liver disease

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23
Q

what does a D-dimer measure?

A

fibrin component – there are many positive D-dimers that are not indicative of PE or DVT

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24
Q

if you see a urine glucose over 130 with ketones, what should you think?

A

poorly controlled diabetes or possible DKA

25
Q

if you see positive nitrites and/or leukocyte esterase on urinalysis, what should you think?

A

UTI

26
Q

if you see UTI symptoms with negative nitrites and/or leukocyte esterase, what should you think?

A

interstitial cystitis; chronic condition

27
Q

a moderate frequency beta-HcG is useful under which circumstances?

A

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

28
Q

if you want to test for mono, what test do you order? when do we see false positive? when do we see false negatives?

A

order heterophile antibody test

false positives: hepatitis, leukemia, lymphoma, rubella, SLE

false negatives: testing too early!

29
Q

what do you order to test for syphilis?

A

RPR using BLOOD sample

30
Q

what do you order to test for gonorrhea and chlamydia?

A

nucleic acid amplification URINE test

31
Q

what do you order to test for HSV?

A

blood sample; searches for antibodies to differentiate between HSV1 (oral) and HSV2 (genital)

32
Q

what do you order to test for HIV?

A

RNA based HIV early detection kit

33
Q

which imaging modality is very rarely used in emergent settings?

A

MRI

34
Q

if you want to look at the uterus, fallopian tubes, ovaries what should you order?

A

ultrasound

35
Q

to evaluate the appendix, gallbladder, biliary tree, and large intestine for diverticula what should you order?

A

ultrasound

36
Q

when you suspect a kidney stone, what two imaging modalities are available?

A

ultrasound and CT

37
Q

if you want to get a blood culture, how many samples should you get, from how many sites?

A

2-3 blood samples from at least 2 different veins so you don’t miss bacteria or fungus

38
Q

what test is the marker for cellular hypoxia? who is it indicated for?

A

lactate!

in patients with suspected sepsis or septic shock – tells us who needs attention and aggressive managemetn

39
Q

routine urine testing for ketones is no longer necessary to diagnose DKA, what has replaced it?

A

capillary beta hydroxybutyrate has distinct advantage

what

40
Q

how do we measure response to DKA treatment?

A

capillary blood ketones

41
Q

what will you see on ABG of diabetic ketoacidosis?

A

metabolic acidosis

42
Q

what will you see on ABG when patient has been vomiting?

A

metabolic alkalosis

43
Q

what conditions will produce a respiratory acidosis?

A

hyPOventilation due to pulmonary edema, pneumonia, COPD, respiratory depression from drugs (opioids, sedatives)

44
Q

what conditions will produce a respiratory alkalosis?

A

hypERventilation (PE, anxiety, pain, febrile illness)

45
Q

what is the most specific lab test for pancreatic function?

A

lipase

46
Q

approximately how many visits are made to the ED annually for chest pain? how about abdominal pain?

A

chest pain = 6 million

abdominal pain = 129 million

47
Q

which lab test do we order to assess for CHF?

A

BNP

48
Q

when is BNP secreted by the heart?

A

in response to volume overload and resulting myocardial stretch

49
Q

____ are proteins that are essential to cardiac muscle contraction, myocardial injury results in a leak of these proteins

A

troponins

50
Q

troponin has replaced _____ as the biomarker of choice for the detection of _______

A

troponin has replaced CKMB in the detection of myocardial injury

51
Q

when is a troponin level not very helpful?

A

within 6 hours of symptom onset because troponin doesn’t peak right away

also those with intermittent symptoms

monitor every 2-6 hours!

52
Q

the PT/INR measures the _____ pathway of coagulation

A

extrinsic

53
Q

which clotting factors are involved in the extrinsic pathway of coagulation?

A

2, 7, 9, 10

54
Q

what test do we order to monitor the effect of coumadin/warfarin? why?

A

order PT/INR

coumadin inhibits production of vitamin K dependent factors produced in the liver (2, 7, 9, 10)

55
Q

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)

A

intrinsic pathway

56
Q

a normal PTT requires the presence of which factors?

A

1, 2, 5, 8, 9, 10, 11, 12

notice 7 is not on the list, but 2, 9, and 10 are

57
Q

the effect of which drug is measured using PTT? why?

A

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

58
Q

a rapid strep test tests for which group of strep pharyngitis?

A

group A strep

59
Q

the influenza swab tests for influenza A, B, or both?

A

influenza A and B

Elaina: Emergency 2 (11 decks)

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