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IPAP > Clin Lab 1 > Flashcards

Clin Lab 1 Flashcards

1
Q

What is the role of medical laboratory testing?

A

Detection, diagnosis and treatment of PT diseases

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2
Q

What are the Primary and Secondary functions of the Clinical Laboratory?

A

Primary: Generate Information
Secondary: Educate providers/staff

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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
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4
Q

What are the 3 parts of Evidence Based Medicine?

A

Individual Clinical Expertise
Best External Evidence
PT Values/Expectations

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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

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6
Q

Define “Bad Test”

A

Uses resources but fails to provide info useful in PT management decisions

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7
Q

Define “Ugly Test”

A

Uses resources and provides info that is misleading or irrelevant

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8
Q

Define Positive and Negative Predictive Value?

A

PPV: Pos screening, Pos disease
NPV: Neg screening, Neg disease

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9
Q

What are the 3 parts of Anatomic Pathology?

A

Histology
Cytology
Autopsy

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10
Q

What are the 6 parts of Clinical Pathology?

A 
Microbiology
Hematology
Urinalysis
Serology
Chemistry
Immunohematology
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11
Q

What are the 4 support services of the lab?

A

Central Process/Client Services
Phlebotomy
Clerical Services
Lab Info Services

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12
Q

Cytology studies what 3 things?

A

Structure, function and chemistry of cells

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13
Q

What are the most common specimens that go through the Chemistry branch of Clinical Pathology?

A

Blood

Urine

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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
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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
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16
Q

Immunology and Serology tests focus on what 3 things?

A

ID Abs
Investigate immune problems
Determine/measures organ compatibility

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17
Q

Name 5 testing locations within the lab?

A 
Central/Main lab
Satellite Lab
POCT
Reference Lab
Physician Office Lab
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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)

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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

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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
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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

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22
Q

Give 5 examples of Moderate Complexity Testing

A 
General Chemistry
Specific Proteins
Drug abuse/Toxicology
Therapeutic Drug Monitoring
Hematology Testing
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23
Q

Who can perform Provider Performed Microscopy?

What level of testing does this fall into?

A

PA, NP, RN, MidWife, DDS

Moderately Complex

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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
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25
Q

Basic Metabolic Panel is a _____ panel that includes what two things?

A

Chemistry

Electrolytes and kidney functions

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26
Q

Blood for BMP can be dran in what color tube tops?

A

Light Green PST
Gold SST
Red

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27
Q

What is the major ECF cation?

A

Na

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28
Q

What two ions combine to make the majority of the plasma osmotic pressure?

A

Na and Cl

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29
Q

What do in/decreased serum sodium levels mean?

A 
Hyper= total body water deficit
Hypo= total body water excess
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30
Q

What is the major ICF cation?

A

K+

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31
Q

What 3 roles does K+ have within the body?

A

Maintains body fluid balance

Muscle/nerve function

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32
Q

Why is plasma K+ tightly regulated?

A 
Hyper= aldosterone secretion and K+ excretion
Hypo= excretion of urine completely lacking K+
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33
Q

Hyper and Hypo K+ levels can be indicative of what conditions?

A 
Hyper= Primary/Secondary hypoaldosteronism
Hypo= Diabetes mellitus, Cushings, Hyperaldosteronism
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34
Q

What is the major EXF anion?

A

Cl-

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35
Q

What do hypo/hyperchloremia indicate?

A

Rarely occur, indicative of shifts between Na/BiCarb levels to maintain electrical neutrality

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36
Q

BMP CO2 content measures what 3 things?

A

H2CO3
Dissolved CO2
HCO3

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37
Q

What do Inc/Dec BiCarb levels indicate?

A 
Inc= Metabolic alkalosis, 1*/2* to respiratory acidosis
Dec= Metabolic acidosis
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38
Q

What does an increased BUN level indicate?

A

Dec glomerular filtration
Inc tubular reabsorption
Inadequate excretion
Inc production in the gut

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39
Q

BUN levels are interpreted with what other thest?

A

Creatinine test

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40
Q

What two thing make up a renal function study?

A

BUN

Creatinine test

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41
Q

Where does creatinine come from?

A

Creatine phosphate used for skeletal muscle contractions

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42
Q

What is one of the most commonly measured tests in the laboratory?

A

Glucose

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43
Q

Total serum Ca+ is a measurement of what two calcium levels?

A

Free (ionized) calcium

Protein bound calcium

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44
Q

Changes to serum albumin can/will affect the total serum level of what other ion?

A

Ca+

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45
Q

What is the rule of thumb when total serum calcium levels decrease?

A

Total Ca+ decreases by 0.8mg per 1 gram decrease in serum albumin levels

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46
Q

Where is Ca+ absorbed within the body?

What hormone influences this absorption?

A

Small Intestine
Proximal Renal Tubule
Parathyroid Hormone

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47
Q

What tests are included in a BMP?

A 
Na
K
Cl
CO2
BUN
Cr
Glu
Ca+
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48
Q

What tests are included in a Complete Metabolic Panel?

A 
BMP and 
ALB
ALT
ALP
AST
TP
Bilirubin
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49
Q

What is the most abundant extracellular protein?

What is the most abundant intracellular protein?

A

Albumin

Hgb

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50
Q

What protein is used to measure hepatic function?

A

Albumin, synthesized in liver

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51
Q

Where is alanine aminotransferase found within the body?

A

Hepatocytes

Smaller amounts in skeletal and heart muscles

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52
Q

Why/when is alanine aminotransferase enzyme released into circulation?

A

Upon cell damage/necrosis

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53
Q

What events causes increased alanine aminotransferase levels in the blood?

A

Liver damage

Skeletal muscle damage

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54
Q

The two major circulating alkaline phosphatase isoenzymes are found where?

A

Bone

Liver

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55
Q

Elecated serum alkaline phosphatase is most commonly a sign of what issues?

A

Liver or bone disorders

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56
Q

Elevated Aspartate Aminotransferases is an indication of what?

A

Liver injury

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57
Q

Aspartate Aminotransferase serum levels usually increases with what other enzyme level?

A

AST goes up with ALT

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58
Q

PT with AST levels that are more than 2.0 times the ALT levels indicates what issues?

A

Alcohol abuse w/ cirrhosis

Alcoholic hepatitis

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59
Q

What kind of bilirubin makes up the majority of bilirubin in the body?

A

Unconjugated

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60
Q

Total protein measures what two classes of proteins?

A

Albumin

Globulin

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61
Q

Where are most serum proteins synthesized?

A

Liver

Mature plasma cells (immunoglobulins)

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62
Q

CBC blood draw is pulled in what color tube?

A

Lavender, contain anticoagulant EDTA

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63
Q

What is the “Rule of 3s” with a CBC?

A 
RBC= 5 mill/microliter
Hgb= 15g/deciliter
Hct= 45% + / - 2
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64
Q

Define Total Red Blood Cell Count

A

of circulating RBCs per 1mm of blood

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65
Q

Define hematocrit?

A

Total blood volume made up by RBCs

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66
Q

What causes abnormal hematocrit levels?

A 
Anemia
Bleeding
RBC destruction
Leukemia
Malnutrition
Over hydration
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67
Q

What causes critical value hematocrit levels?

A

Dehydration
Hypoxia
Congenital heart disease
Polycythemia

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68
Q

What does the type of MCV help with diagnostically?

A

Types of anemia

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69
Q

Define anisocytosis

A

Variation in RBC sizes

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70
Q

What causes Leukocytosis

A 
Infections
Leukemia
Pregnancy
Neoplasms
Pneumonia
Inflammation
Tissue necrosis
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71
Q

What causes leukopenia?

A 
Bone marrow failure
Radiation
Chemotherapy
HIV
Viral infections
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72
Q

What causes throbocytosis?

A 
Bone marrow disorder
Acute bleeding
Exercise
Heart attack
Infections
Splenectomy
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73
Q

What causes thrombocytopenia

A 
Autoimmune
Medicaitons
Alcohol
Viruses
Cancer
Anemia
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74
Q

What are the 5 types of leukocytes that are measured in a CBC + Differential

A 
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
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75
Q

What is a Urinalysis Screening

A

Group of 10 chemical tests to detect UTIs, metabolic and kidney disorders

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76
Q

What do high triglyceride levels mean?

A

PT regularly eats more calories than are burned

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77
Q

Function of LDL, HDL and VLDL

A

LDL: Carries fat from liver to body
HDL: binds fat in blood and carries to liver
VLDL: distributes triglycerides synthesized by liver

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78
Q

When does the AAP recommend testing children/adolescents for routine lipid testing?

A

9 - 11 y/o

17 - 21 y/o

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79
Q

Critical test values must be reported to ordering provider within what time frame?

STAT results must be delivered within what time?

A

1 hr of completion

W/in 1hr of receipt

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80
Q

When are cortisol level peaked and lowest?

A

Peak: 4-6am
Low: 8pm-12am

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81
Q

Insulin levels are usually lower during _____

Iron levels peak during ______

A

Night

Early to late morning

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82
Q

Pre-Collection variables that can alter blood chemistry

A 
Time of draw
Exercise
Diet
Posture
Stress
Age
Gender
Hemolysis

STAGED PH

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83
Q

High protein and low carb diets will have ______ ketones and BUN

A

Elevated

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84
Q

Ethanol ingestion will ____ plasma lactate, urate and triglyceride concentrations

A

Elevate

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85
Q

Mental and physcial stresses stiulate the production of what 3 things?

A

ACTH
Cortisol
Catecholamines

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86
Q

Mild stress induces and increase of ____ while decreasing _____

A

Total cholesterol

HDL

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87
Q

Hyperventilation elevates what 3 things

A

Leukocytes
Serum lactate
Free FAs

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88
Q

An upright position increases hydrostatic pressure which will _ plasma volumes and _ protein concentrations

A

Dec

Inc

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89
Q

Albumin and Ca+ levels change in what direction during changing positions from supine to upright?

A

Inc

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90
Q

Bed rest will change a PTs Hb in which direction?

A

Lowers

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91
Q

After 50 y/o, men’s testosterone decreases and women ____ increases

A

FSH

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92
Q

How does hemolysis slightly and significantly effect analytes?

A

Slight: haptoglobin, bilirubin
Significant: dec in Troponin T

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93
Q

Define Hemoconcentration

A

Increased enzymes, proteins, and protein-bound substances (cholesterol, Ca+, triglycerides)

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94
Q

Define Hemodilution

A

Standing to reclining causes extravascular water to transfer to vascular system and dilutes plasma constituents

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95
Q

10 common errors of specimen collection?

A 
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
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96
Q

How quickly is glucose metabolized?

A

Room Temp: 7mg/dl/hr

4*C: 2mg/dl/hr

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97
Q

Acute viral hepatitis panel is drawn in what color tube?

A

Marble

Serum separator tube

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98
Q

How are stool cultures transported?

A

Cary Blair Transport Media

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99
Q

Define Whole Blood

A

Formed elements and fluid plasma combined (sample doesn’t clot)

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100
Q

Define Serum

A

Liquid portion of clotted blood samples, lacking coagulation protein fibrinogen

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101
Q

Define Plasma

A

Liquid portion of anti-coagulated whole blood with all coagulated proteins
(serum with anticoagulants now becomes plasma)

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102
Q

What are the two types of blood specimens?

A

Whole blood

Serum

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103
Q

What is the composition of a capillary/skin puncture sample?

A

Arteriole, capillary and venule blood with tissue fluid

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104
Q

What are the 3 preferred sites for venipuncture sites?

A

1- median cubital vein- connects cephalic and basilic
2- cephalic- empties into axillary
3- basilic- joins brachial vein

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105
Q

What is the sequence of events when processing blood tubes?

A 
Collect
Invert 8-10x
Wait
Centrifuge
Analyze
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106
Q

Plain Red tubes yield ____ and are sent to (2) _____ testing areas of the lab

A

Serum

Chemistry/Serology

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107
Q

Red and Gray/Marble tubes yield ___ and are sent to what area of the lab for testing?

A

Serum

Chemistry

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108
Q

Purple top tubes yield _____ and are sent to what (2) areas of the lab for testing

A

Plasma

Hematology and Blood Bank

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109
Q

How does EDTA exert its effect within purple tubes?

A

Chelates Ca+

Best for preserving blood cell integrity

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110
Q

Purple top tubes are unacceptable for what type of analysis?

A

Ca+ or K

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111
Q

Lavender/EDTA tubes would be used for what 3 types of tests?

A

Chemistry- Ammonia, BNP, G6PD, lead
Hematology- CBC, Hct, Hgb, Manual differential, Sickle Cell
Microbiology- blood parasites

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112
Q

Which tube is used to preserve coagulation factors?

A

Light Blue Tube- Sodium Citrate

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113
Q

Light Blue tubes are unacceptable use for what two types of analysis?

A

Calcium

Sodium

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114
Q

What does green top tubes yield and what type of testing are they used for?

A

Plasma

Chemistry

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115
Q

What are green top tubes used for?

A

pH
Electolytes
Blood gas
Ionized calcium test

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116
Q

What specific type of green top tube is used for electrolyte tests?

117
Q

What type of additives are in gray top tubes?

A

Anticoagulant: potassium oxalate

Glucose preservative: sodium flouride

118
Q

What type of sample do gray top tubes yield and for what type of testing area?

A

Plasma for glycolytic inhibition

Chemistry

119
Q

What types of tests are gray top tubes used for?

A

Glucose testing
Blood alcohol
Lactate
Bicarbonate

120
Q

What types of tests are dark blue tubes used for?

A

Special Chemistry: Trace metal studies

121
Q

What are the big 3 types of unacceptable specimens?

A

Iceteric specimen
Lipemic specimen
Hemolyzed specimen

122
Q

What are the SI prefixes below 10?

A 
Deci -1
Centi -2
Milli -3
Micro -6
Nano -9
Pico -12
Femto -15
Atto -18
123
Q

What part of the blood is being tested during a cardiac panel?

124
Q

What is the correct order of collection for blood obtained by skin punctures?

A

Serum tube
Heparin tube
EDTA

125
Q

Examples of samples that require chilled specimen transport?

A 
ACTH
Acetone
ACE
Blood Ammonia
Catecholamines
Free FAs
Lactic Acid
Pyruvate
Renin
126
Q

Examples of samples that are light sensitive analytes?

A

Billirubin
Erythrocyte Protoporphyrin
Carotene

127
Q

What colored tube is used for HLA/Paternity tests?

A

Yellow top

Acid Citrate dextrose

128
Q

What color tube is used for coagulation tests?

A

Blue top

Sodium Citrate

129
Q

What color tube is used for hematology tests?

A

Lavender top

EDTA

130
Q

What color tube is used for transfusion service tests?

A

Pink top

EDTA

131
Q

What color tube is used for serum testing?

132
Q

What color tube is used for cardiac profiles?

A

Green top

Heparin

133
Q

What color tube is used for glucose tests?

A

Gray top

Potassium oxalate

134
Q

What type of anticoagulant may be found in royal/dark blue tubes?

A

None
EDTA
Heparin

135
Q

What are the 5 areas that Pre-Analytical/Analytical causes of error can occur?

A

1: samples
2: operator
3: reagants
4: laboratory environment
5: measuring system

136
Q

Where in the pre-analytical/analytical causes of error would instrument failure of inadequate instrument maintenance be found?

A

5- measuring system

137
Q

6 examples of pre-analytical errors?

A

Wrong PT, time, tube, label, processing, sequence

138
Q

5 examples of analytical errors?

A 
Failure to notice instrument flags
Disregard OOC QC results
Wrong assay
Wrong procedure
No test but results produced
139
Q

6 examples of post-analytical errors

A 
Incorrect verbal reporting
Incompatible instrument interface
Confused reference ranges
Wrong results reported
Transposed results from manual entry
Incorrect interpretation
140
Q

What agency incorporated QA/Proficiency testing into lab procedures?

141
Q

Define Reliability

A

Consistency/reproducible
Considers random errors
“is it measuring something?

142
Q

Define Validity

A

“is it measuring the correct sample? what conclusion can be obtained?”

143
Q

What can effect validity?

A

Bias, a form of systematic errors

Safety, Acceptability, Cost

144
Q

What are the four indicators most commonly used to determine the reliability/validity of a lab test?

A

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
Q

Define Sensitivity

A

Test ability to correctly ID those w/ a disease/condition

More sensitive a test, fewer false-negative results

146
Q

Define False Negative

A

100 people with disease
90 tested positive
10 shown as normal

147
Q

Negative test result is used by a provider in what manner?

A

SnOut, rules out disease/diagnosis

148
Q

Define Specificity

A

Tests ability to correctly exclude those who do not have a disease

More specificity= fewer false positives

149
Q

Define False Positive

A

100 healthy
90 ID’d as normal
10 shown as “positive”

150
Q

What are the two types of microscopes and the two types of lens they have?

A

Simple or compound

Ocular or objective

151
Q

How do you get the total magnification power of a microscope?

A

Ocular x objective lens

152
Q

What kind of microscope is the most commonly used in the lab?

A

Light/Bright Field Microscope

153
Q

Light/bright field microscope has a _____ magnification power and a ____ resolution

A

High magnification

Low resolution

154
Q

When is phase contrast microscopes preferred?

A

High magnifications needed 400x, 1000x
Colorless specimen
Detailed so fine colors don’t show

155
Q

What part of microbes is phase contrast microscopy effective for observing?

A

Cytoplasmic streaming
Motility
Organelles

156
Q

Define Birefringence

A

Objects/Crystals w/ ability to rotate or polarize light for viewing through a cross polarizing filter

157
Q

What if Polarizing Light microscopy used to distinguish between?

A

Gout and pseudo gout

Monosodium urate vs calcium pyrophosphate dihydrate

158
Q

How does Dark-Field Microscopy work?

A

Enhances contrast in unstained samples

Illuminates sample with light that won’t be collected by objective lens

159
Q

Dark Field Microscopy is used for viewing what type of microbe?

A

Spirochetes (syphilis)

Unfixed, unstained specimens

160
Q

When is fluorescence microscopy used?

A

Infectious diseases diagnosis

Identify specific Abs in response to Ags

161
Q

What are the two types of Electron Microscopes?

A

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
Q

What are wet mounts used to detect the presence of?

A

Bacteria
Fungi
Parasites
Human Cellular elements

163
Q

What are KOH slides used to detect?

A

Fungal elements

164
Q

What is Urine Sediment tests used to identify?

A 
Hematuria- UTI/systemic infection
Pyuria- infection
Casts- formed elements of urine
Crystals
Microbes
165
Q

What do epithelial cells in urine sediment exams mean?

A

Squamous type= insignificant

Renal epithelial= significant

166
Q

What types of conditions cause the formation of crystals?

A

pH
Temp
Urine concentration

167
Q

What types of crystals are in normal acid urine?

A

Uric acid

Calcium Oxalate

168
Q

What types of crystals are in normal alkaline urine?

A

Calcium/Magnesium phosphate
Calcium carbonate
Ammonium biurate

169
Q

What types of crystals are in abnormal urine?

A 
Cystine
Tyrosine
Leucine
Sulfonamide
Ampicillin
170
Q

What are Saline Wet Prep wet mounts used to detect?

A

Trichomonas baginalis- clue cells

Yeast- vaginitis

171
Q

What type of microscopy is often performed after a saline prep slide?

172
Q

Why is a Fern Test conducted?

A

Determines if rupture of fetal membrane has occurred before the onset of labor
Amniotic fluid appears “fern-like”

173
Q

Why is a postcoital test conducted?

A

Evaluates infertility

174
Q

Nasal smear eosinophilia is used to make what diagnosis?

A

Allergic rhinitis

175
Q

Fecal leukocytosis is an infection of what microorganism infection?

A

Salmonella

Shigella

176
Q

Semen analysis study focuses on what 3 areas?

It is used to determine what 3 things?

A

Motility
Morphology
Sperm count

Infertility
Post-Vesectomy
Vesectomy reversal

177
Q

What is the function/use of POCTs?

A

Shortened turn around time for critical results to enhance convenience

178
Q

What lab oversights are required for POCT?

A

Method validation
Training
Policies/procedures
Responsibilities

179
Q

What are the limits of POCT?

A 
Technology
Knowledge/training
QA
Accountability
Cost
180
Q

What are 3 Hematology POCTs?

A

Hg
Hct
Coagulation test

181
Q

What are 4 Chemistry POCTs?

A

Glucose
Urine dipstick
Creatine/cardiac markers
Pregnancy

182
Q

What are the microbiology PPM tests available?

A 
Strep
Flu
Malaria
Fecal occult
Mono
Pylori
S. pneumoniae
Lyme 
HIV
Respiratory Syncitial virus
Trichomonas
Adenovirus
Bacterial vaginosis
183
Q

What is the PURPOSE of TDM?

A

Measuring the concentration of a drug/metabolite to aid in the correct dosing and to assess PT compliance

184
Q

What is the GOAL of TDM?

A

Increase likelihood of therapeutic effect and avoide adverse effects

185
Q

What are 5 indications to start TDM?

A 
Rx has low margin for safety
Eval PT compliance
Difficult to distinguish S/Sx from  toxicity
Not a measured end point
Pharmacokinetic variability
186
Q

Define Unpredictable Dose Response

A

When same dose produces therapeutic effect in one PT and toxic effects in another

187
Q

What part of blood is tested during TDM?

A

Serum or Plasma

188
Q

What are the 4 steps of pharmacokinetics?

A

Absorption
Distribution
Metabolism
Excretion

189
Q

Drugs administered orally must have what two characteristics?

A

Withstand gastric pH

Transportable across lipid membrane

190
Q

When are suppositories usually used/prescribed?

A

Infants when oral form is not available

191
Q

What are the 3 forms of parenteral drug administrations?

A

IV
IM
Sub-C

192
Q

What do insoluble drugs require in order to enter the body’s systemic system?

A

Protein carries

193
Q

What are the two most common carrier proteins and where are they produced?

A

Albumin
A-Acid Glycoprotein

Liver

194
Q

Presence of any liver disease will increase what in a drugs presence in the body?

A

Free fraction

195
Q

Define Free Fraction

A

Therapeutically active fraction of a drug that is non-protein bound

196
Q

Most laboratory assays measure the total drug concentration which is what two measurements?

A

Free and bound medications

197
Q

Define Therapeutic Range

A

Drug concentration with the highest probability of desired response and the lowest probability of an unacceptable toxicity

198
Q

Define Minimum Effective Concentration and Minimum Toic Concentration

A

MEC- below this level, therapeutic effect is not reached

MTC- above this level cause symptoms of toxicity to occur

199
Q

Define Trough Value and when is it present?

A

Lowest therapeutic concentration during dosing cycle

Occurs before next dose and should remain above the MEC of a drug

200
Q

Define Peak Value and when does it normally occur?

A

AKA Toxicity risk

Highest therapeutic concentration level of dosing cycle but should be below minimum toxic concentration

201
Q

When/how is Steady-State Concentration achieved?

A

When rate of drug entering body is equal to rate of drug elimination from body

202
Q

Steady state occurs after how many half lives?

203
Q

Drug metabolism changes non-polar lipophilic drugs how?

A

Into polar water soluble compounds that can be eliminated

204
Q

What is the primary site for drug metabolism?

205
Q

Polar, non-lipophilic drugs are primarily eliminated through the urine and is dependent on what factors?

A

Renal function
Renal blood flow
Urine pH
Drug molecule size

206
Q

Define Drug Clearance

A

Volume of plasma that is completely cleared of a drug per unit of time

207
Q

Drug Clearance is the sum of what 3 elimination mechanisms?

A

Hepatic
Renal
Biliary

208
Q

What are the key processes involved in drug disposition?

A 
Liberation
Absorption
Distribution
Metabolism
Excretion
LADME
209
Q

What 4 factors influence drug distribution?

A

Age
Weight
Gender
Race

210
Q

Decreased carrier protein levels result in what effect on drug distribution?

A

Increased free fraction

Increased physiological effect

211
Q

What procedural factors can effect drug distribution?

A

PT compliance
Wrong specimen draw time
Lab test methodology

212
Q

What are 3 clinical benefits of TDM?

A

Recognizing PT non-compliance
Unusual drug disposition characteristics
Adjustments of prolonged therapeutics

213
Q

What tube is used for TDM specimens?

A

Red top serum

214
Q

Definition of chronic ingestion of analgesics/aspirin?

A

100 mg/kg/day x 2 days

215
Q

What are the indications for monitoring of aspirin?

A

Suspected toxicity

216
Q

What is the timing requirements for analgesic monitoring?

A

No less than 6hrs post-ingestion
No more than 60hrs post ingestion
Draw serial values to prove declining values

217
Q

Estimations of toxicity are used using what type of chart?

A

Done nomogram for acute ingestion

218
Q

Define Toxicology

A

Study of poisons, their actions/detection/treatment of conditions caused by them

219
Q

What are the make ups of toxicology cases seen?

A

50% attempted suicide
30% accidental
20% occupational exposure/homicide

220
Q

What are some of the common drugs and toxins tested for?

A 
Acetaminophen
CO
Ethanol
Salicylates
Drugs of abuse
Lead
221
Q

What 3 factors determine the best specimen for toxicology specimens?

A

When
How
Mode of exposure

222
Q

Blood draws for toxicology reports are best for testing for ?

A 
Acetaminophen
CO
Ethanol
Salicylates
Pesticides
Lead
223
Q

Urine samples for toxicology are taken for testing for ?

A

Arsenic
Mercury
Drug abuse

224
Q

Acetaminophen overdose is associated with ?

Why is this?

A

Hepatotoxicity

High protein binding affinity

225
Q

What part of the blood is NOT reliable for testing for acetaminophen levels?

226
Q

What is a Rumack-Matthew nomogram used for and what info is used when using it?

A

Serum acetaminophen level
Known time since ingestion
Predicts if toxic levels of meds were ingested

227
Q

What are the 3 POCT methods for drug abuse?

A

Rapid ID for agent
Urine
Oral fluid

228
Q

UA sample that tests positive for drugs has be subjected to what tests?

A

Screening
Re-screening
Confirmation

229
Q

The term “serous fluid” is an encompassing term for what 3 fluids?

A

Pleural
Pericardial
Peritoneal

230
Q

CSF has what 5 functions?

A

Transportation (nutrients/waste)
Buoyancy
Sudden change protection
BBB

231
Q

What does healthy/normal CSF look like?

What 3 areas does it bathe?

A

Clear
Colorless
Sterile

Ventricles
Subarachnoid
Spinal cord

232
Q

How much CSF is produced/replaced each day?

A

Produce 500ml/day
Normal volume- 90-150ml
Turned over every 5-7hrs

233
Q

Where is CSF made and where is it reabsorbed?

A

Choroid plexus

Arachnoid villi

234
Q

What happens with CSF flow with varying pressures of CSF and blood pressure?

A

Inc CSF, Dec venous= CSF-> blood stream

Dec CSF, Inc venous= blood does NOT pass into ventricular system

235
Q

3 functions of BBB

A

Protection from:
Foreign substances
Hormone/neurotransmitters
Environment maintenance

236
Q

What effect does BBB have on ions and molecules?

A

Large- don’t pass
Lipid insoluble don’t cross
Lipid soluble pass
Highly charged molecules are slowed

237
Q

4 indications that require a STAT CSF test?

A

Meningeal infection
Brain hemorrhage
Primary/Secondary malignancy
Neurological

238
Q

List the S/Sx of meningitis

A 
Sudden fever
Severe headache
N/V
Double vision
Stiff neck
Photophobia
239
Q

List the S/Sx of encephalitis

A 
Fever
Seizure
Behavior changes
Confusion
Disorientation
240
Q

Majority of infectious encephalitis cases are caused by ?

A

Viral infections

241
Q

Characteristics of bacterial, viral, fungal, and parasitic meningitis?

A

Bacterial- life threatening w/ vaccine avail
Viral- self-limiting
Fungal- AIDS
Parasitic- free living amoeba and is 99% fatal

242
Q

What microbes cause bacterial encephalitis?

A

Listeria
Leptospira
Borrelia
Treponema

243
Q

What is the most common cause of encephalitis?

A 
Viral
Herpes
Enterovirus
Arbovirus
Rabies
244
Q

What causes fungal encephalitis?

A

Histoplasma

Cryptococcus

245
Q

What causes parasitic encephalitis?

A

Toxoplasma

Taenia

246
Q

Define subarachnoid hemorrhage

A

Bleeding in subarachnoid space from aneurysms and head trauma

247
Q

Define Intra-cerebral hemorrhage

A

Ruptures of small vessels in the brain from chronic high BP

248
Q

Define Cerebral Infarct

A

Blockage of blood flow to brain

249
Q

What are the 3 types of malignancy associated w/ CSF?

A

Leukemia
Lymphoma
Metastatic carcinoma

250
Q

What neurological diseases are associated with CSF?

A

MS
Demyelinating disorders
Guillain-Barre syndrome

251
Q

What is normal opening pressure during a LP?

A

5-20cm of water

252
Q

How much CSF is collected during an LP?

A

10 drops per tube

20ml total

253
Q

What is the sequence of collection during an LP?

A

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
Q

What are the storage requirements for Hematology/Micro/Chemistry CSF tubes?

A

Hematology- refrigerated
Micro- room temp
Chem- frozen

255
Q

Routine exam of CSF samples contain what examinations?

How quickly are results returned?

A 
Gross appearance
Red/white cell counts
Morphology
Chemistry
Micro
Serology

All tests except micro returned w/in 1 hr

256
Q

CSf gross appearance can include what 3 things?

A 
Turbidity= WBC, bacteria, protein, lipid
Clots= protein, traumatic tap
Color= clarity should increase as collection increases
257
Q

Define Xanthochromia

A

Pale pink/orange/yellow collor of CSF samples

258
Q

Subarachnoid hemorrhage will have what presentation during an LP/CSF test?

A

Elevated opening pressure
RBCs
Xanthochromia

259
Q

What is the normal WBC count for a CSF sample?

260
Q

Morphologic examination of CSF samples include what 3 things?

A

Cytocentrifugation
Smears
Differential

261
Q

What doe protein levels in CSF tests mean?

A 
Inc= meningitis, hemorrhage, MS
Dec= CNS leakage
262
Q

What do glucose levels in CSF tests mean?

A

Dec= bacterial meningitis

263
Q

Where is the LP performed?

A

Lumber L3 and L4

264
Q

What does increased lactate in CSF tests mean?

A

Bacterial, fungal or tubercular meningitis

Lactate greater than 25mg is more consistent than dec glucose

265
Q

Lactate levels in CSF that are +35= ?

Below 25= ?

A

Bacterial meningitis

Viral meningitis

266
Q

Microbial CSF is normally sterile w/ Gram Stain completed in less than ___ and a culture in ___

A

GS= 1 hr

Culture- 72hrs

267
Q

Micro exams of CSF test for what 2 Ags?

A

Bacterial Ag

Cryptococcal Ag

268
Q

When is a serology testing of CSF useful?

A

When PCR is negative, typically for neurosyphyllis

269
Q

Veneral Disease Research Lab can onbly be used for what work up?

A

CSF- non treponemal test (similar to RPR)

270
Q

What are 6 pathogens that can be tested via serology tests of CSF?

A 
Measles
Rubella
West Nile
Toxoplasma
Herpes
Varicella
271
Q

What are the two types of effusions?

A

Transudate- systemic disorder disrupting the filtration/re-absorption process

Exudate- produced by conditions directly involving membrane of a particular cavity (local accumulation)

272
Q

What are the most common causes of pleural effusions in adults and children?

A

Adult= Heart failure, malignancy, pneumonia, TB, PE

Children- pneumonia

273
Q

PT S/Sx that would lead you to order an analysis of pleural fluid?

A 
Chest pain that inc w/ deep breathing
Coughing
SOB
Fever/chills
Fatigue
274
Q

What are the most common causes of pleural effusions?

A 
CHF
Kidney failure
Malignancy
PE
Hypoalbuminemia
Cirrhosis
275
Q

What are the most common causes of pericardial effusions?

A 
Infection
Autoimmune
Malignancy
Kidney failure
Inflammation
Trauma
276
Q

PT S/Sx that would lead you to order an analysis of pericardial fluid?

A 
Chest pain relieved by bending forward
Couch
SOB
Arrythmia
Enlarged heart
Abnormal echo
277
Q

What are the most common causes of peritoneal effusion?

A 
Infection
Autoimmune
Malignancy
Cirrhosis
Inflammation
Pancreatitis
278
Q

When/why would an analysis of peritoneal fluid be ordered?

A

Ascites of unknown origin
Abdominal pain
Intestinal perforation
Intra-abdominal malignancy

279
Q

Upon gross appearance, clotting in a serous fluid samples indicates?

A

High protein level

280
Q

What are the 3 chemical analysis of serous fluid exams?

A

Protein
Lactate dehydrogenase
Glucose

281
Q

What is an abnormal visual appearance of seroud fluid analysis?

A

Turbid- high WBCs
Viscous- clotting/hydrolyzed
Colored- red/pink= blood

282
Q

Transudate fluid summary info

A

Low Protein
Low Spec Gravity
Non-inflammatory

283
Q

Exudate fluid summary info

A 
High protein
High Spec Gravity
Hyperprotein
Inflammatory
Decreased glucose
284
Q

What chemical finding in synovial fluid differentiates it from all other bodily fluids?

A

Mucopolysaccharide hyaluronic acid

285
Q

What are the 4 classifications of synovial fluid joint disease?

A

1- Non-Inflammatory- degenerative (OA)
2- Inflammatory- immunologic disease
3- Infectious- bacterial infection
4- crystal induced- gout

286
Q

What does abnormal synovial fluid that is yellow, green cloudy or red mean?

A

Dark yellow- inflammation
Green- bacteria
Cloud- WBCs, crystals
Red- RBCs

287
Q

What type of microscopy is used for synovial fluids?

A

Bright field/Phase Contrast

Polarized- gout

288
Q

Why do all synovial fluids have a culture and gram stain performed?

A

Acute bacterial arthritis is the most rapid destructive disease to joints

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