Clin Lab 1 Flashcards
1
Q
What is the role of medical laboratory testing?
A
Detection, diagnosis and treatment of PT diseases
2
Q
What are the Primary and Secondary functions of the Clinical Laboratory?
A
Primary: Generate Information
Secondary: Educate providers/staff
3
Q
What are the 5 rationales for ordering tests?
A
ID changes in PT health Diagnose disease/condition Plan treatment for disease/condition Evaluate treatment response Monitor course of disease over time
4
Q
What are the 3 parts of Evidence Based Medicine?
A
Individual Clinical Expertise
Best External Evidence
PT Values/Expectations
5
Q
Define “Good Test”
A
Provides info useful in PT management decisions
Screening: High sensitivity, Negative predictive value
Diagnosis: High Specificity, Positive predictive value
6
Q
Define “Bad Test”
A
Uses resources but fails to provide info useful in PT management decisions
7
Q
Define “Ugly Test”
A
Uses resources and provides info that is misleading or irrelevant
8
Q
Define Positive and Negative Predictive Value?
A
PPV: Pos screening, Pos disease
NPV: Neg screening, Neg disease
9
Q
What are the 3 parts of Anatomic Pathology?
A
Histology
Cytology
Autopsy
10
Q
What are the 6 parts of Clinical Pathology?
A
Microbiology Hematology Urinalysis Serology Chemistry Immunohematology
11
Q
What are the 4 support services of the lab?
A
Central Process/Client Services
Phlebotomy
Clerical Services
Lab Info Services
12
Q
Cytology studies what 3 things?
A
Structure, function and chemistry of cells
13
Q
What are the most common specimens that go through the Chemistry branch of Clinical Pathology?
A
Blood
Urine
14
Q
List 6 tests that may be seen ordered that would go through the Chemistry branch of Clinical Pathology?
A
Blood Glucose Electrolytes Enzymes Hormones Lipids Proteins
15
Q
ABO Blood Group Ag, Ab and Notes
A
A= A Ag, B Ab, N/A B= B Ag, A Ab, N/A AB= AB Ag, 0 Ab, Universal Recipient O= 0 Ag, AB Ab, Universal Donor
16
Q
Immunology and Serology tests focus on what 3 things?
A
ID Abs
Investigate immune problems
Determine/measures organ compatibility
17
Q
Name 5 testing locations within the lab?
A
Central/Main lab Satellite Lab POCT Reference Lab Physician Office Lab
18
Q
What are the 3 phases of testing under CLIA?
A
1: before testing (ordering and collection)
2: during testing ( Control, Test, Interpretation)
3: after testing (Reporting, Documentation, Confirmation, BioHazard Waste disposal)
19
Q
What are the 4 categories of CLIA test complexity?
A
Minimal- AKA Waived Testing
Provider Performed- subcategory of moderate complexity
Moderate Complexity
High Complexity
20
Q
What are the 5 criteria for classification within CLIA testing?
A
1- Risk of harm to PT 2- Risk of erroneous result 3- Type of testing method used 4- Degree of independent judgement/interpretation 5- Availability of test for home use
21
Q
Define Waived Tests and give 6 examples
A
Pose no reasonable risk of harm to PT if test is performed incorrectly
Dipstick UA, Fecal Occult, Ovulation, Pregnancy, Erythrocyte Sedimentation, Hemoglobin, Bed Side tests
22
Q
Give 5 examples of Moderate Complexity Testing
A
General Chemistry Specific Proteins Drug abuse/Toxicology Therapeutic Drug Monitoring Hematology Testing
23
Q
Who can perform Provider Performed Microscopy?
What level of testing does this fall into?
A
PA, NP, RN, MidWife, DDS
Moderately Complex
24
Q
What are 6 examples of Provider Performed Microscopy tests?
A
Wet Prep Mounts KOH Preps Pinworm Exams Fern Test Urine Sediment Nasal Smears for granulocytes
25
Basic Metabolic Panel is a _____ panel that includes what two things?
Chemistry
| Electrolytes and kidney functions
26
Blood for BMP can be dran in what color tube tops?
Light Green PST
Gold SST
Red
27
What is the major ECF cation?
Na
28
What two ions combine to make the majority of the plasma osmotic pressure?
Na and Cl
29
What do in/decreased serum sodium levels mean?
```
Hyper= total body water deficit
Hypo= total body water excess
```
30
What is the major ICF cation?
K+
31
What 3 roles does K+ have within the body?
Maintains body fluid balance
| Muscle/nerve function
32
Why is plasma K+ tightly regulated?
```
Hyper= aldosterone secretion and K+ excretion
Hypo= excretion of urine completely lacking K+
```
33
Hyper and Hypo K+ levels can be indicative of what conditions?
```
Hyper= Primary/Secondary hypoaldosteronism
Hypo= Diabetes mellitus, Cushings, Hyperaldosteronism
```
34
What is the major EXF anion?
Cl-
35
What do hypo/hyperchloremia indicate?
Rarely occur, indicative of shifts between Na/BiCarb levels to maintain electrical neutrality
36
BMP CO2 content measures what 3 things?
H2CO3
Dissolved CO2
HCO3
37
What do Inc/Dec BiCarb levels indicate?
```
Inc= Metabolic alkalosis, 1*/2* to respiratory acidosis
Dec= Metabolic acidosis
```
38
What does an increased BUN level indicate?
Dec glomerular filtration
Inc tubular reabsorption
Inadequate excretion
Inc production in the gut
39
BUN levels are interpreted with what other thest?
Creatinine test
40
What two thing make up a renal function study?
BUN
| Creatinine test
41
Where does creatinine come from?
Creatine phosphate used for skeletal muscle contractions
42
What is one of the most commonly measured tests in the laboratory?
Glucose
43
Total serum Ca+ is a measurement of what two calcium levels?
Free (ionized) calcium
| Protein bound calcium
44
Changes to serum albumin can/will affect the total serum level of what other ion?
Ca+
45
What is the rule of thumb when total serum calcium levels decrease?
Total Ca+ decreases by 0.8mg per 1 gram decrease in serum albumin levels
46
Where is Ca+ absorbed within the body?
| What hormone influences this absorption?
Small Intestine
Proximal Renal Tubule
Parathyroid Hormone
47
What tests are included in a BMP?
```
Na
K
Cl
CO2
BUN
Cr
Glu
Ca+
```
48
What tests are included in a Complete Metabolic Panel?
```
BMP and
ALB
ALT
ALP
AST
TP
Bilirubin
```
49
What is the most abundant extracellular protein?
| What is the most abundant intracellular protein?
Albumin
| Hgb
50
What protein is used to measure hepatic function?
Albumin, synthesized in liver
51
Where is alanine aminotransferase found within the body?
Hepatocytes
| Smaller amounts in skeletal and heart muscles
52
Why/when is alanine aminotransferase enzyme released into circulation?
Upon cell damage/necrosis
53
What events causes increased alanine aminotransferase levels in the blood?
Liver damage
| Skeletal muscle damage
54
The two major circulating alkaline phosphatase isoenzymes are found where?
Bone
| Liver
55
Elecated serum alkaline phosphatase is most commonly a sign of what issues?
Liver or bone disorders
56
Elevated Aspartate Aminotransferases is an indication of what?
Liver injury
57
Aspartate Aminotransferase serum levels usually increases with what other enzyme level?
AST goes up with ALT
58
PT with AST levels that are more than 2.0 times the ALT levels indicates what issues?
Alcohol abuse w/ cirrhosis
| Alcoholic hepatitis
59
What kind of bilirubin makes up the majority of bilirubin in the body?
Unconjugated
60
Total protein measures what two classes of proteins?
Albumin
| Globulin
61
Where are most serum proteins synthesized?
Liver
| Mature plasma cells (immunoglobulins)
62
CBC blood draw is pulled in what color tube?
Lavender, contain anticoagulant EDTA
63
What is the "Rule of 3s" with a CBC?
```
RBC= 5 mill/microliter
Hgb= 15g/deciliter
Hct= 45% + / - 2
```
64
Define Total Red Blood Cell Count
of circulating RBCs per 1mm of blood
65
Define hematocrit?
Total blood volume made up by RBCs
66
What causes abnormal hematocrit levels?
```
Anemia
Bleeding
RBC destruction
Leukemia
Malnutrition
Over hydration
```
67
What causes critical value hematocrit levels?
Dehydration
Hypoxia
Congenital heart disease
Polycythemia
68
What does the type of MCV help with diagnostically?
Types of anemia
69
Define anisocytosis
Variation in RBC sizes
70
What causes Leukocytosis
```
Infections
Leukemia
Pregnancy
Neoplasms
Pneumonia
Inflammation
Tissue necrosis
```
71
What causes leukopenia?
```
Bone marrow failure
Radiation
Chemotherapy
HIV
Viral infections
```
72
What causes throbocytosis?
```
Bone marrow disorder
Acute bleeding
Exercise
Heart attack
Infections
Splenectomy
```
73
What causes thrombocytopenia
```
Autoimmune
Medicaitons
Alcohol
Viruses
Cancer
Anemia
```
74
What are the 5 types of leukocytes that are measured in a CBC + Differential
```
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
```
75
What is a Urinalysis Screening
Group of 10 chemical tests to detect UTIs, metabolic and kidney disorders
76
What do high triglyceride levels mean?
PT regularly eats more calories than are burned
77
Function of LDL, HDL and VLDL
LDL: Carries fat from liver to body
HDL: binds fat in blood and carries to liver
VLDL: distributes triglycerides synthesized by liver
78
When does the AAP recommend testing children/adolescents for routine lipid testing?
9 - 11 y/o
| 17 - 21 y/o
79
Critical test values must be reported to ordering provider within what time frame?
STAT results must be delivered within what time?
1 hr of completion
| W/in 1hr of receipt
80
When are cortisol level peaked and lowest?
Peak: 4-6am
Low: 8pm-12am
81
Insulin levels are usually lower during _____
| Iron levels peak during ______
Night
| Early to late morning
82
Pre-Collection variables that can alter blood chemistry
```
Time of draw
Exercise
Diet
Posture
Stress
Age
Gender
Hemolysis
```
STAGED PH
83
High protein and low carb diets will have ______ ketones and BUN
Elevated
84
Ethanol ingestion will ____ plasma lactate, urate and triglyceride concentrations
Elevate
85
Mental and physcial stresses stiulate the production of what 3 things?
ACTH
Cortisol
Catecholamines
86
Mild stress induces and increase of ____ while decreasing _____
Total cholesterol
| HDL
87
Hyperventilation elevates what 3 things
Leukocytes
Serum lactate
Free FAs
88
An upright position increases hydrostatic pressure which will _ plasma volumes and _ protein concentrations
Dec
| Inc
89
Albumin and Ca+ levels change in what direction during changing positions from supine to upright?
Inc
90
Bed rest will change a PTs Hb in which direction?
Lowers
91
After 50 y/o, men's testosterone decreases and women ____ increases
FSH
92
How does hemolysis slightly and significantly effect analytes?
Slight: haptoglobin, bilirubin
Significant: dec in Troponin T
93
Define Hemoconcentration
Increased enzymes, proteins, and protein-bound substances (cholesterol, Ca+, triglycerides)
94
Define Hemodilution
Standing to reclining causes extravascular water to transfer to vascular system and dilutes plasma constituents
95
10 common errors of specimen collection?
```
Incorrect ID of PT
Mislabeled specimen
Improper blood/additive ratio
Mixing problem/clot
Wrong tube/coagulant
Hemolysis/lipemia
Hemoconcentration from prolonged TQ time
Exposure to light/temp
Imroperly timed/delivery
Processing errors
```
96
How quickly is glucose metabolized?
Room Temp: 7mg/dl/hr
| 4*C: 2mg/dl/hr
97
Acute viral hepatitis panel is drawn in what color tube?
Marble
| Serum separator tube
98
How are stool cultures transported?
Cary Blair Transport Media
99
Define Whole Blood
Formed elements and fluid plasma combined (sample doesn't clot)
100
Define Serum
Liquid portion of clotted blood samples, lacking coagulation protein fibrinogen
101
Define Plasma
Liquid portion of anti-coagulated whole blood with all coagulated proteins
(serum with anticoagulants now becomes plasma)
102
What are the two types of blood specimens?
Whole blood
| Serum
103
What is the composition of a capillary/skin puncture sample?
Arteriole, capillary and venule blood with tissue fluid
104
What are the 3 preferred sites for venipuncture sites?
1- median cubital vein- connects cephalic and basilic
2- cephalic- empties into axillary
3- basilic- joins brachial vein
105
What is the sequence of events when processing blood tubes?
```
Collect
Invert 8-10x
Wait
Centrifuge
Analyze
```
106
Plain Red tubes yield ____ and are sent to (2) _____ testing areas of the lab
Serum
| Chemistry/Serology
107
Red and Gray/Marble tubes yield ___ and are sent to what area of the lab for testing?
Serum
| Chemistry
108
Purple top tubes yield _____ and are sent to what (2) areas of the lab for testing
Plasma
| Hematology and Blood Bank
109
How does EDTA exert its effect within purple tubes?
Chelates Ca+
| Best for preserving blood cell integrity
110
Purple top tubes are unacceptable for what type of analysis?
Ca+ or K
111
Lavender/EDTA tubes would be used for what 3 types of tests?
Chemistry- Ammonia, BNP, G6PD, lead
Hematology- CBC, Hct, Hgb, Manual differential, Sickle Cell
Microbiology- blood parasites
112
Which tube is used to preserve coagulation factors?
Light Blue Tube- Sodium Citrate
113
Light Blue tubes are unacceptable use for what two types of analysis?
Calcium
| Sodium
114
What does green top tubes yield and what type of testing are they used for?
Plasma
| Chemistry
115
What are green top tubes used for?
pH
Electolytes
Blood gas
Ionized calcium test
116
What specific type of green top tube is used for electrolyte tests?
Lithium
117
What type of additives are in gray top tubes?
Anticoagulant: potassium oxalate
| Glucose preservative: sodium flouride
118
What type of sample do gray top tubes yield and for what type of testing area?
Plasma for glycolytic inhibition
| Chemistry
119
What types of tests are gray top tubes used for?
Glucose testing
Blood alcohol
Lactate
Bicarbonate
120
What types of tests are dark blue tubes used for?
Special Chemistry: Trace metal studies
121
What are the big 3 types of unacceptable specimens?
Iceteric specimen
Lipemic specimen
Hemolyzed specimen
122
What are the SI prefixes below 10?
```
Deci -1
Centi -2
Milli -3
Micro -6
Nano -9
Pico -12
Femto -15
Atto -18
```
123
What part of the blood is being tested during a cardiac panel?
Plasma
124
What is the correct order of collection for blood obtained by skin punctures?
Serum tube
Heparin tube
EDTA
125
Examples of samples that require chilled specimen transport?
```
ACTH
Acetone
ACE
Blood Ammonia
Catecholamines
Free FAs
Lactic Acid
Pyruvate
Renin
```
126
Examples of samples that are light sensitive analytes?
Billirubin
Erythrocyte Protoporphyrin
Carotene
127
What colored tube is used for HLA/Paternity tests?
Yellow top
| Acid Citrate dextrose
128
What color tube is used for coagulation tests?
Blue top
| Sodium Citrate
129
What color tube is used for hematology tests?
Lavender top
| EDTA
130
What color tube is used for transfusion service tests?
Pink top
| EDTA
131
What color tube is used for serum testing?
Red top
132
What color tube is used for cardiac profiles?
Green top
| Heparin
133
What color tube is used for glucose tests?
Gray top
| Potassium oxalate
134
What type of anticoagulant may be found in royal/dark blue tubes?
None
EDTA
Heparin
135
What are the 5 areas that Pre-Analytical/Analytical causes of error can occur?
1: samples
2: operator
3: reagants
4: laboratory environment
5: measuring system
136
Where in the pre-analytical/analytical causes of error would instrument failure of inadequate instrument maintenance be found?
#5- measuring system
137
6 examples of pre-analytical errors?
Wrong PT, time, tube, label, processing, sequence
138
5 examples of analytical errors?
```
Failure to notice instrument flags
Disregard OOC QC results
Wrong assay
Wrong procedure
No test but results produced
```
139
6 examples of post-analytical errors
```
Incorrect verbal reporting
Incompatible instrument interface
Confused reference ranges
Wrong results reported
Transposed results from manual entry
Incorrect interpretation
```
140
What agency incorporated QA/Proficiency testing into lab procedures?
CLIA
141
Define Reliability
Consistency/reproducible
Considers random errors
"is it measuring something?
142
Define Validity
"is it measuring the correct sample? what conclusion can be obtained?"
143
What can effect validity?
Bias, a form of systematic errors
| Safety, Acceptability, Cost
144
What are the four indicators most commonly used to determine the reliability/validity of a lab test?
Precision/Accuracy- how well the test performs day to day
Sensitivity/Specificity- How well test is able to distinguish disease presence from disease absence
145
Define Sensitivity
Test ability to correctly ID those w/ a disease/condition
More sensitive a test, fewer false-negative results
146
Define False Negative
100 people with disease
90 tested positive
10 shown as normal
147
Negative test result is used by a provider in what manner?
SnOut, rules out disease/diagnosis
148
Define Specificity
Tests ability to correctly exclude those who do not have a disease
More specificity= fewer false positives
149
Define False Positive
100 healthy
90 ID'd as normal
10 shown as "positive"
150
What are the two types of microscopes and the two types of lens they have?
Simple or compound
| Ocular or objective
151
How do you get the total magnification power of a microscope?
Ocular x objective lens
152
What kind of microscope is the most commonly used in the lab?
Light/Bright Field Microscope
153
Light/bright field microscope has a _____ magnification power and a ____ resolution
High magnification
| Low resolution
154
When is phase contrast microscopes preferred?
High magnifications needed 400x, 1000x
Colorless specimen
Detailed so fine colors don't show
155
What part of microbes is phase contrast microscopy effective for observing?
Cytoplasmic streaming
Motility
Organelles
156
Define Birefringence
Objects/Crystals w/ ability to rotate or polarize light for viewing through a cross polarizing filter
157
What if Polarizing Light microscopy used to distinguish between?
Gout and pseudo gout
| Monosodium urate vs calcium pyrophosphate dihydrate
158
How does Dark-Field Microscopy work?
Enhances contrast in unstained samples
| Illuminates sample with light that won't be collected by objective lens
159
Dark Field Microscopy is used for viewing what type of microbe?
Spirochetes (syphilis)
| Unfixed, unstained specimens
160
When is fluorescence microscopy used?
Infectious diseases diagnosis
| Identify specific Abs in response to Ags
161
What are the two types of Electron Microscopes?
Transmission Electron Microscope- high resolution, e- passes through thin sample
Scanning Electron Microscope- bounces e- off of surface of specimen to form 3D image
162
What are wet mounts used to detect the presence of?
Bacteria
Fungi
Parasites
Human Cellular elements
163
What are KOH slides used to detect?
Fungal elements
164
What is Urine Sediment tests used to identify?
```
Hematuria- UTI/systemic infection
Pyuria- infection
Casts- formed elements of urine
Crystals
Microbes
```
165
What do epithelial cells in urine sediment exams mean?
Squamous type= insignificant
| Renal epithelial= significant
166
What types of conditions cause the formation of crystals?
pH
Temp
Urine concentration
167
What types of crystals are in normal acid urine?
Uric acid
| Calcium Oxalate
168
What types of crystals are in normal alkaline urine?
Calcium/Magnesium phosphate
Calcium carbonate
Ammonium biurate
169
What types of crystals are in abnormal urine?
```
Cystine
Tyrosine
Leucine
Sulfonamide
Ampicillin
```
170
What are Saline Wet Prep wet mounts used to detect?
Trichomonas baginalis- clue cells
| Yeast- vaginitis
171
What type of microscopy is often performed after a saline prep slide?
KOH Prep
172
Why is a Fern Test conducted?
Determines if rupture of fetal membrane has occurred before the onset of labor
Amniotic fluid appears "fern-like"
173
Why is a postcoital test conducted?
Evaluates infertility
174
Nasal smear eosinophilia is used to make what diagnosis?
Allergic rhinitis
175
Fecal leukocytosis is an infection of what microorganism infection?
Salmonella
| Shigella
176
Semen analysis study focuses on what 3 areas?
| It is used to determine what 3 things?
Motility
Morphology
Sperm count
Infertility
Post-Vesectomy
Vesectomy reversal
177
What is the function/use of POCTs?
Shortened turn around time for critical results to enhance convenience
178
What lab oversights are required for POCT?
Method validation
Training
Policies/procedures
Responsibilities
179
What are the limits of POCT?
```
Technology
Knowledge/training
QA
Accountability
Cost
```
180
What are 3 Hematology POCTs?
Hg
Hct
Coagulation test
181
What are 4 Chemistry POCTs?
Glucose
Urine dipstick
Creatine/cardiac markers
Pregnancy
182
What are the microbiology PPM tests available?
```
Strep
Flu
Malaria
Fecal occult
Mono
Pylori
S. pneumoniae
Lyme
HIV
Respiratory Syncitial virus
Trichomonas
Adenovirus
Bacterial vaginosis
```
183
What is the PURPOSE of TDM?
Measuring the concentration of a drug/metabolite to aid in the correct dosing and to assess PT compliance
184
What is the GOAL of TDM?
Increase likelihood of therapeutic effect and avoide adverse effects
185
What are 5 indications to start TDM?
```
Rx has low margin for safety
Eval PT compliance
Difficult to distinguish S/Sx from toxicity
Not a measured end point
Pharmacokinetic variability
```
186
Define Unpredictable Dose Response
When same dose produces therapeutic effect in one PT and toxic effects in another
187
What part of blood is tested during TDM?
Serum or Plasma
188
What are the 4 steps of pharmacokinetics?
Absorption
Distribution
Metabolism
Excretion
189
Drugs administered orally must have what two characteristics?
Withstand gastric pH
| Transportable across lipid membrane
190
When are suppositories usually used/prescribed?
Infants when oral form is not available
191
What are the 3 forms of parenteral drug administrations?
IV
IM
Sub-C
192
What do insoluble drugs require in order to enter the body's systemic system?
Protein carries
193
What are the two most common carrier proteins and where are they produced?
Albumin
A-Acid Glycoprotein
Liver
194
Presence of any liver disease will increase what in a drugs presence in the body?
Free fraction
195
Define Free Fraction
Therapeutically active fraction of a drug that is non-protein bound
196
Most laboratory assays measure the total drug concentration which is what two measurements?
Free and bound medications
197
Define Therapeutic Range
Drug concentration with the highest probability of desired response and the lowest probability of an unacceptable toxicity
198
Define Minimum Effective Concentration and Minimum Toic Concentration
MEC- below this level, therapeutic effect is not reached
| MTC- above this level cause symptoms of toxicity to occur
199
Define Trough Value and when is it present?
Lowest therapeutic concentration during dosing cycle
| Occurs before next dose and should remain above the MEC of a drug
200
Define Peak Value and when does it normally occur?
AKA Toxicity risk
| Highest therapeutic concentration level of dosing cycle but should be below minimum toxic concentration
201
When/how is Steady-State Concentration achieved?
When rate of drug entering body is equal to rate of drug elimination from body
202
Steady state occurs after how many half lives?
5 - 7
203
Drug metabolism changes non-polar lipophilic drugs how?
Into polar water soluble compounds that can be eliminated
204
What is the primary site for drug metabolism?
Liver
205
Polar, non-lipophilic drugs are primarily eliminated through the urine and is dependent on what factors?
Renal function
Renal blood flow
Urine pH
Drug molecule size
206
Define Drug Clearance
Volume of plasma that is completely cleared of a drug per unit of time
207
Drug Clearance is the sum of what 3 elimination mechanisms?
Hepatic
Renal
Biliary
208
What are the key processes involved in drug disposition?
```
Liberation
Absorption
Distribution
Metabolism
Excretion
LADME
```
209
What 4 factors influence drug distribution?
Age
Weight
Gender
Race
210
Decreased carrier protein levels result in what effect on drug distribution?
Increased free fraction
| Increased physiological effect
211
What procedural factors can effect drug distribution?
PT compliance
Wrong specimen draw time
Lab test methodology
212
What are 3 clinical benefits of TDM?
Recognizing PT non-compliance
Unusual drug disposition characteristics
Adjustments of prolonged therapeutics
213
What tube is used for TDM specimens?
Red top serum
214
Definition of chronic ingestion of analgesics/aspirin?
100 mg/kg/day x 2 days
215
What are the indications for monitoring of aspirin?
Suspected toxicity
216
What is the timing requirements for analgesic monitoring?
No less than 6hrs post-ingestion
No more than 60hrs post ingestion
Draw serial values to prove declining values
217
Estimations of toxicity are used using what type of chart?
Done nomogram for acute ingestion
218
Define Toxicology
Study of poisons, their actions/detection/treatment of conditions caused by them
219
What are the make ups of toxicology cases seen?
50% attempted suicide
30% accidental
20% occupational exposure/homicide
220
What are some of the common drugs and toxins tested for?
```
Acetaminophen
CO
Ethanol
Salicylates
Drugs of abuse
Lead
```
221
What 3 factors determine the best specimen for toxicology specimens?
When
How
Mode of exposure
222
Blood draws for toxicology reports are best for testing for ?
```
Acetaminophen
CO
Ethanol
Salicylates
Pesticides
Lead
```
223
Urine samples for toxicology are taken for testing for ?
Arsenic
Mercury
Drug abuse
224
Acetaminophen overdose is associated with ?
| Why is this?
Hepatotoxicity
| High protein binding affinity
225
What part of the blood is NOT reliable for testing for acetaminophen levels?
Serum
226
What is a Rumack-Matthew nomogram used for and what info is used when using it?
Serum acetaminophen level
Known time since ingestion
Predicts if toxic levels of meds were ingested
227
What are the 3 POCT methods for drug abuse?
Rapid ID for agent
Urine
Oral fluid
228
UA sample that tests positive for drugs has be subjected to what tests?
Screening
Re-screening
Confirmation
229
The term "serous fluid" is an encompassing term for what 3 fluids?
Pleural
Pericardial
Peritoneal
230
CSF has what 5 functions?
Transportation (nutrients/waste)
Buoyancy
Sudden change protection
BBB
231
What does healthy/normal CSF look like?
What 3 areas does it bathe?
Clear
Colorless
Sterile
Ventricles
Subarachnoid
Spinal cord
232
How much CSF is produced/replaced each day?
Produce 500ml/day
Normal volume- 90-150ml
Turned over every 5-7hrs
233
Where is CSF made and where is it reabsorbed?
Choroid plexus
| Arachnoid villi
234
What happens with CSF flow with varying pressures of CSF and blood pressure?
Inc CSF, Dec venous= CSF-> blood stream
Dec CSF, Inc venous= blood does NOT pass into ventricular system
235
3 functions of BBB
Protection from:
Foreign substances
Hormone/neurotransmitters
Environment maintenance
236
What effect does BBB have on ions and molecules?
Large- don't pass
Lipid insoluble don't cross
Lipid soluble pass
Highly charged molecules are slowed
237
4 indications that require a STAT CSF test?
Meningeal infection
Brain hemorrhage
Primary/Secondary malignancy
Neurological
238
List the S/Sx of meningitis
```
Sudden fever
Severe headache
N/V
Double vision
Stiff neck
Photophobia
```
239
List the S/Sx of encephalitis
```
Fever
Seizure
Behavior changes
Confusion
Disorientation
```
240
Majority of infectious encephalitis cases are caused by ?
Viral infections
241
Characteristics of bacterial, viral, fungal, and parasitic meningitis?
Bacterial- life threatening w/ vaccine avail
Viral- self-limiting
Fungal- AIDS
Parasitic- free living amoeba and is 99% fatal
242
What microbes cause bacterial encephalitis?
Listeria
Leptospira
Borrelia
Treponema
243
What is the most common cause of encephalitis?
```
Viral
Herpes
Enterovirus
Arbovirus
Rabies
```
244
What causes fungal encephalitis?
Histoplasma
| Cryptococcus
245
What causes parasitic encephalitis?
Toxoplasma
| Taenia
246
Define subarachnoid hemorrhage
Bleeding in subarachnoid space from aneurysms and head trauma
247
Define Intra-cerebral hemorrhage
Ruptures of small vessels in the brain from chronic high BP
248
Define Cerebral Infarct
Blockage of blood flow to brain
249
What are the 3 types of malignancy associated w/ CSF?
Leukemia
Lymphoma
Metastatic carcinoma
250
What neurological diseases are associated with CSF?
MS
Demyelinating disorders
Guillain-Barre syndrome
251
What is normal opening pressure during a LP?
5-20cm of water
252
How much CSF is collected during an LP?
10 drops per tube
| 20ml total
253
What is the sequence of collection during an LP?
1- chemical/serologic (glucose/proteins)
2: micro (gram stain/culture)
3: hematology (Cell count/differential)
4: micro w/ further exclusion of skin contaminants/better serological tests
254
What are the storage requirements for Hematology/Micro/Chemistry CSF tubes?
Hematology- refrigerated
Micro- room temp
Chem- frozen
255
Routine exam of CSF samples contain what examinations?
How quickly are results returned?
```
Gross appearance
Red/white cell counts
Morphology
Chemistry
Micro
Serology
```
All tests except micro returned w/in 1 hr
256
CSf gross appearance can include what 3 things?
```
Turbidity= WBC, bacteria, protein, lipid
Clots= protein, traumatic tap
Color= clarity should increase as collection increases
```
257
Define Xanthochromia
Pale pink/orange/yellow collor of CSF samples
258
Subarachnoid hemorrhage will have what presentation during an LP/CSF test?
Elevated opening pressure
RBCs
Xanthochromia
259
What is the normal WBC count for a CSF sample?
0-8/uL
260
Morphologic examination of CSF samples include what 3 things?
Cytocentrifugation
Smears
Differential
261
What doe protein levels in CSF tests mean?
```
Inc= meningitis, hemorrhage, MS
Dec= CNS leakage
```
262
What do glucose levels in CSF tests mean?
Dec= bacterial meningitis
263
Where is the LP performed?
Lumber L3 and L4
264
What does increased lactate in CSF tests mean?
Bacterial, fungal or tubercular meningitis
Lactate greater than 25mg is more consistent than dec glucose
265
Lactate levels in CSF that are +35= ?
| Below 25= ?
Bacterial meningitis
| Viral meningitis
266
Microbial CSF is normally sterile w/ Gram Stain completed in less than ___ and a culture in ___
GS= 1 hr
| Culture- 72hrs
267
Micro exams of CSF test for what 2 Ags?
Bacterial Ag
| Cryptococcal Ag
268
When is a serology testing of CSF useful?
When PCR is negative, typically for neurosyphyllis
269
Veneral Disease Research Lab can onbly be used for what work up?
CSF- non treponemal test (similar to RPR)
270
What are 6 pathogens that can be tested via serology tests of CSF?
```
Measles
Rubella
West Nile
Toxoplasma
Herpes
Varicella
```
271
What are the two types of effusions?
Transudate- systemic disorder disrupting the filtration/re-absorption process
Exudate- produced by conditions directly involving membrane of a particular cavity (local accumulation)
272
What are the most common causes of pleural effusions in adults and children?
Adult= Heart failure, malignancy, pneumonia, TB, PE
Children- pneumonia
273
PT S/Sx that would lead you to order an analysis of pleural fluid?
```
Chest pain that inc w/ deep breathing
Coughing
SOB
Fever/chills
Fatigue
```
274
What are the most common causes of pleural effusions?
```
CHF
Kidney failure
Malignancy
PE
Hypoalbuminemia
Cirrhosis
```
275
What are the most common causes of pericardial effusions?
```
Infection
Autoimmune
Malignancy
Kidney failure
Inflammation
Trauma
```
276
PT S/Sx that would lead you to order an analysis of pericardial fluid?
```
Chest pain relieved by bending forward
Couch
SOB
Arrythmia
Enlarged heart
Abnormal echo
```
277
What are the most common causes of peritoneal effusion?
```
Infection
Autoimmune
Malignancy
Cirrhosis
Inflammation
Pancreatitis
```
278
When/why would an analysis of peritoneal fluid be ordered?
Ascites of unknown origin
Abdominal pain
Intestinal perforation
Intra-abdominal malignancy
279
Upon gross appearance, clotting in a serous fluid samples indicates?
High protein level
280
What are the 3 chemical analysis of serous fluid exams?
Protein
Lactate dehydrogenase
Glucose
281
What is an abnormal visual appearance of seroud fluid analysis?
Turbid- high WBCs
Viscous- clotting/hydrolyzed
Colored- red/pink= blood
282
Transudate fluid summary info
Low Protein
Low Spec Gravity
Non-inflammatory
283
Exudate fluid summary info
```
High protein
High Spec Gravity
Hyperprotein
Inflammatory
Decreased glucose
```
284
What chemical finding in synovial fluid differentiates it from all other bodily fluids?
Mucopolysaccharide hyaluronic acid
285
What are the 4 classifications of synovial fluid joint disease?
1- Non-Inflammatory- degenerative (OA)
2- Inflammatory- immunologic disease
3- Infectious- bacterial infection
4- crystal induced- gout
286
What does abnormal synovial fluid that is yellow, green cloudy or red mean?
Dark yellow- inflammation
Green- bacteria
Cloud- WBCs, crystals
Red- RBCs
287
What type of microscopy is used for synovial fluids?
Bright field/Phase Contrast
| Polarized- gout
288
Why do all synovial fluids have a culture and gram stain performed?
Acute bacterial arthritis is the most rapid destructive disease to joints
