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Block Exams > Clin Lab > Flashcards

Clin Lab Flashcards

1
Q

Which of the following values would be consistent with hyponatremia?

A

Na+ <135

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2
Q

A patient has a potassium of 6.5. This would be consistent with which of the following?

A

Hyperkalemia, risk of fatal cardiac arrythmia.

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3
Q

Which of the following represents the normal range of hemoglobin in a male?

A

14-18

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4
Q

Which of the following is an example of a threshold value?

A

There will only be one value

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5
Q

Which of the following describes prevalence?

A

The # of people w/ the disease at a specific time.

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6
Q

A cutoff for a lab test is set so that all people with the disease are identified, therefore a negative test does help rule out the disease. Therefore, this lab would have high____

A

sensitivity

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7
Q

Which of the following tests measures the % of RBCs in the total volume of blood tested?

A

hematocrit

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8
Q

Which of the following accurately describes diascopy

A

using a glass slide to assess any red lesions for blanchability

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9
Q
  1. Which diagnostic imaging modality utilizes a series of rapid x-rays taken from one angle that form a video?
A

Fluoroscopy

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10
Q
  1. Which of the following tests are commonly used in microbiology diagnostics?
A

Stain, Culture& ID, Antimicrobial sensitivity testing

(other test that uses microbes: chem testsantigen/antibody test)
(Molecular/Genetic tests RNA/DNA testing)

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11
Q

A test involves the detection of antigens for a bacteria in which the binding of specific antibodies to the antigens causes a color change. This is an example of what type of test?

A

ELISA

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12
Q

Which of the following tests is used in the diagnosis of sickle cell anemia?

A

electrophoresis

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13
Q
  1. Which of the following best describes the indication for using a Wood’s lamp?
A

When a fungal infection is suspected (can tell us about pseudomonas infections)

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14
Q

Which of the following should be considered before ordering a diagnostic test?

A

Purpose, result in timely fashion, harm of false (+) & (-), cost effective, risk, invasive?, special prep for test, FU?

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15
Q

Which of the following labs is part of a BMP (basic metabolic panel)?

A

Ca++, Na+, K+, Cl-, CO2, BUN, Cr, Glucose, (Anion Gap), (GFR)

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16
Q

A patient presents with a pruritic rash under her abdominal pannus and under her breasts. She recently completed a course of ciprofloxacin for a urinary tract infection. Which of the following tests would be most likely to help confirm the diagnosis?

A

KOH prep test

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17
Q

A patient comes to the clinic with complaints of muscle weakness. On examination, you note significantly increased reflexes. Which of the following would be expected on a BMP (basic metabolic panel)?

A

Decreased Calcium/hypocalcemia

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18
Q

A patient comes to the clinic with a macular rash. On physical exam, you note a negative diascopy exam. Which of the following is the most likely underlying cause of the rash?

A

Hemorrhagic issue

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19
Q

A new strain of the MERS virus has emerged and is making people very sick with severe respiratory symptoms. A new diagnostic test is under development to try and identify anyone who potentially has the virus, so that people who test negative can continue to come to school / work. Which of the following would be correct about this test?

A

a sensitive test

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20
Q

Gram stain is used for?

A

Used to differentiate Gram (+) and Gram (-) bacteria

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21
Q

Acid fast stain is used for?

A
  • Used on things that have atypical cell walls
  • Mycobacteria and Nocardia
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22
Q

India ink stain is used for?

A
  • “negative” stain
  • Used on organisms that have capsule
  • Cryptococcus
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23
Q

Calcofluor white stain is used for?

A
  • Fluorescent stain used for fungi
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24
Q

List some examples of microorganisms that show up well with India ink stain

A
  • Cryptococcus
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25
Q

List examples of bacteria stained with acid fast stain.

A
  • Mycobacteria
  • Nocardia
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26
Q

Explain the difference in cell membrane structure in Gram negative versus Gram positive bacteria

A
  • Gram (+) have a thick peptidoglycan wall  purple
  • Gram (-) have a thin peptidoglycan wall and have an outer membrane  pink
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27
Q

What sites in the body should be sterile?

A
  • LRT (bronchoscopy or bronchioalveolar lavage)
  • Blood (tend to be septic)
  • CSF (meningitis/encephalitis)
  • Pericardial fluid
  • Pleural fluid
  • Peritoneal fluid
  • Synovial fluid (considered medical emergency b/c it can degrade joint)
  • Bone
  • Urine (bladder/kidney) (true sterile–> used catheter)
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28
Q

Explain how MacConkey agar and EMB agar distinguish between bacteria

A
  • MacConkey will turn Lactose fermenters(pink) & non lactase fermenters (yellow)
  • EMB will turn Lactose fermenters (dark green) (E. coli–>metallic green) Enterobacter (purple)& non lactase fermenter (yellow)
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29
Q

List Lactose-fermenting Gram-negative bacteria that would turn MacConkey agar pink and would have green colonies on EMB agar.

A
  • E. coli, Klebsiella, Enterobacter
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30
Q

List Lactose non-fermenting Gram negative bacteria that would turn MacConkey agar yellow and would have yellow colonies on EMB agar.

A
  • Pseudomonas, Proteus, Salmonella
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31
Q

Explain how sheep blood agar distinguishes between types of Streptococcus.

A
  • Alpha
  • Beta
  • Gamma
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32
Q

Explain how catalase is used to differentiate Streptococcus from Staphylococcus

A
  • Staph–> gram (+) catalase (+)
  • Strep–> gram (+) catalase (-)
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33
Q

Explain how serology testing is done, and what indicates a result that supports diagnosis of an infection

A

Take a blood sample from the patient and you want to test the presence of antibodies. You can see a 4-fold increase in two samples that are two weeks apart

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34
Q

Describe the differences in primary versus secondary antibody response to infections

A

The primary response is smaller reactions of IgM and with the secondary antibody response you have a higher and quicker IgG response because of memory.

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35
Q

Describe what acute phase reactants are, and list examples

A
  • The PROs whose concentration will either increase or decrease due to inflammatory response or process of inflammation.
  • Increased: CRP, ESR, Fibrinogen, Alpha-1-antitrypinsin, hepcidin, Procalcitonin
  • Described: Albumin and transferrin
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35
Q

Explain what a titer is and how it is reported

A
  • Do serial dilutions of the patient’s blood.
  • Add antigens of the organism you are testing for to the dilutions.
  • If the patient has the antibodies, it will change colors once it attaches to the antigen.
  • You keep doing this until there is a well with no color change.
  • The patient’s titer is the well right before the clear well.
  • The will always be reported in a ratio. Example: 1:256.
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36
Q

Describe what CRP is and how it is used in clinical practice

A
  • Non-specific inflammatory marker
  • PROs bind w/ phosphocholine on pathogenic & damaged cells to activate complement & phagocytic cells. Used to monitor effectiveness of Tx
  • Men–> and Women–> 1.6
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37
Q

Describe what ESR is and how it is used in clinical practice

A
  • Non-specific inflammatory marker
  • When inflammation occurs–> ^^ PROs (fibrinogen: acute phase reactant)–> causes rouleaux which settles faster than blood w/less rouleaux
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38
Q

Describe changes in CBC seen in the following:

A
  • bacterial infections–> increased neutrophils; more banded neutrophils; increased WBC, vacuoles & granulations
  • viral infections–> decreased WBC & increased lymphocytes
  • parasite infections–> increased eosinophils
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39
Q

Gram positive cocci

A
  • Strep,
  • Staph
  • Enterococcus
  • Peptostreptococcus
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40
Q

Gram positive rods

A
  • Bacillus
  • Clostridium
  • Clostridioides
  • Corynebacterium, Listeria
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41
Q

Gram negative cocci

A
  • Neisseria
  • Moraxella
  • Hemophilus
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42
Q

Gram negative rods

A
  • Bacteroides, Bartonella, Bordetella, Brucella
  • Campylobacter
  • Enterobacter, Escherichia
  • Francisella
  • Klebsiella
  • Legionella
  • Pasteurella, Proteus, Pseudomonas
  • Salmonella, Serratia, Shigella
  • Vibrio
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43
Q

Gram variable bacteria

A
  • Bacillus
  • Clostridium
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44
Q

Anaerobic bacteria: gram (+)

A
  • Clostridium
  • Actinomyces
  • Propionibacterium
  • Peptostreptococcus
    (Mouth bacteria)
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45
Q

Anaerobic bacteria: gram (-)

A
  • Bacteroides
  • Fusobacterium
  • Campylobacter
  • From hotdogs
  • Prevotella
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46
Q

List two bacteria that are usually diagnosed with serology.

A

Brucella & Rickettsia

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47
Q

Sheep Blood Agar: strep pneumo

A

alpha–> green

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48
Q

Sheep Blood Agar: strep viridans

A

alpha–> green

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49
Q

Sheep Blood Agar: strep pyogenes

A

Group A Beta–> green w/ hemolysis

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50
Q

Sheep Blood Agar: strep agalactiae

A

Group B Beta–> green w/ hemolysis

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51
Q

Explain the appearance of a Clostridium perfringens infection on imaging

A
  • Imaging may show gas in the tissues as dark circles
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52
Q

Explain the testing for C. diff?

A
  • varies depending on toxin
  • Glutamate dehydrogenase (GDH) antigen test
  • PCR, Culture (GS)
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53
Q

Explain the testing for Legionella pneumo

A
  • Urine Ag test
  • PCR
  • Culture (GS)
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54
Q

Explain the testing for Bartonella henselae?

A
  • most times Clin Dx
  • Culture or Serology
  • PCR
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55
Q

Explain the testing for mycobacterium tuberculosis

A

Active
- Culture (GS)
- NAAT & acid-fast bacilli stain
Latent
- IGRA
- PPD aka TST

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56
Q

Explain the testing for Bordetella pertussis

A
  • mostly Clin Dx,
  • Culture or PCR (0-4 weeks)
  • Serology (>4weeks)
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56
Q

Explain the testing for Borrelia burgdorferi

A

Serology (titers) & PCR (must do two separate tests) then
- Western Blot or ELISA

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57
Q

Explain the testing for Influenza

A
  • Rapid antigen test (flu swab), HIGH specificity & low sensitivity
  • PCR – HIGH specificity & sensitivity
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58
Q

Explain the testing for SARS-CoV 2

A

o NAAT/Rapid PCR HIGH specificity, low sensitivity
o Antigen test LOW specificity & sensitivity

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59
Q

Explain the testing for Human Herpes Virus 1 & 2 (HHV)

A

o Tzanck smear, culture, fluorescent Ab stain, PCR (from CSF), serology (rule out)

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60
Q

Explain the testing for * Epstein-Barr virus (HHV 4) – mononucleosis

A

o Heterophile antibodies (“monospot”)

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61
Q

Explain the testing for * Cytomegalovirus (HHV 5)

A

o Quantitative PCR
o CMV pp65 Antigen Test

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62
Q

Explain the testing for * Rabies testing

A

o Suspected infx multiple samples like blood, skin (posterior neck), saliva, CSF
o Screening RFFIT test

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63
Q

Explain the testing for * HIV testing

A

o Screening: 3rd gen or 4th gen (Ag & Ab)
o Acute: 4th gen (Ag & Ab) and HIV-1 RNA test
o HIV+ patients:
 CD4 T- Lymphocyte Count
 HIV-RNA quantification (viral load)
 Phenotypic and Genotypic Assays for Antiretroviral Drug Resistance

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64
Q

Explain the criteria for a definitive diagnosis of a fungal infection

A
  • ID the fungus Culture, DNA sequencing, or mass spectrometry
  • Evidence of inflammation CRP, ESR, Elevated WBC count
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65
Q

Explain the role of beta-d-glucan testing for fungal infections

A
  • Non-specific marker for fungal infections that detects Ag that is present in the cell wall of fungus.
  • Sepsis can show up has elevated Beta-D-glucan
66
Q
  1. Explain how dermatophyte test media is used
A
  • Normal is yellow, negative test is yellow, positive is magenta
67
Q

Explain the testing for Sporothrix

A
  • biopsy
  • fluid sample
68
Q

Explain the testing for Aspergillus

A
  • culture
  • histopathology
  • serology (IgG Ab)
  • Direct Ag (Beta-D-glucan or Galactomannan)
  • Maldi-Tof
  • Imaging is supportive
69
Q

Explain the testing for Cryptococcus

A
  • India ink stain
  • Imaging (solid nodules)
  • Culture (Biospy/blood/ CSF)
  • Direct Antigen (Crypto Ag {specific, less sensitive (+) rules it in}),
  • Image of lungs will show nodules
70
Q

Explain the testing for Pneumocystis

A
  • Imaging (bilateral lungs, near hilum)
  • Antigen testing (Beta-D-glucan), - PCR
  • Imaging “ground class” opacity (CT)
71
Q

What does dimorphic fungi look like on imaging?

A

more nodular

72
Q

What does a serology look for in dimorphic fungi?

A

antibodies

73
Q

Which dimorphic fungi can have antibody testing?

A
  • Paracoccidioidomycosis
  • Coccidioidomycosis
  • Histoplasmosis
74
Q

Which dimorphic fungi can have antigen testing?

A
  • Blastomycosis (serum)
  • Histoplasmosis (serum/urine/BAL)
75
Q

Describe which parasitic infections tend to cause ring-enhancing lesions on CT scans of the brain

A

Toxoplasmosis–> cat litter

75
Q

Describe the manifestations of and testing for nematode infections

A
  • 90% are asymptomatic, S/S: diarrhea, fever, blood stools
  • Stool microscopy, Stool Ag testing, PCR, Supportive–> heme+ stool (hemoccult test)
75
Q

What are the basic densities of tissues on x-rays and CTs, and what do they look like on imaging?

A
  • Air–> darkest
  • Fat–> a little gray
  • Soft tissue–> bright gray
  • Calcium–> bright
  • Metal–> brightest
76
Q

Describe which parasite infections tend to have associated eosinophilia.

A
  • Toxocara
  • Ascaris
  • Strongyloides,
  • Schistosomes
  • Filaria
  • Trichinella
  • Necator
76
Q

What are the types of contrast used with x-rays? What are the major possible adverse effects?

A
  • Oral
  • Barium (GI tract)
  • Water Soluble (iodinated): X shellfish or iodine allergy
77
Q

Describe the testing for Cryptosporidium

A
  • Acid fast–> Stool staining (3 samples) or PCR
77
Q

What are the risks, benefits, and limitations of x-rays?

A
  • Risks: Radiation exposure (lifetime exposure)
  • Benefits: Easy, Fast, Widely available, Cheap
  • Limitations: Hard to see soft tissue, Need multiple view for 3-
78
Q

Describe what a Hounsfield unit is, and give typical Hounsfield units (HU) for the following:

A
  • Each image = thousands of pixels
  • Bright white or dark black
  • Each pixel is assigned a Hounsfield unit based on attenuation
  • air: -1000 HU
  • water: 0 HU
  • bone: +400 - +1000
  • organs and fat: +20 - +10
78
Q

What are the three windows for a CT chest?

A
  • Mediastinal or soft tissue
  • lung
  • bone
79
Q

Describe the types of contrast used with CT scans and give indications to use or not use contrast

A
  • Water soluble (iodinated)
  • To use: enhance soft tissue, GI tract, & BVs
  • Not to use: Active bleeding, stones, acute kidney failure, don’t used for fracture
80
Q

Describe the differences between T1 and T2 images

A
  • T1 is shorter interval; Fat shows bright
  • T2 is longer interval; Fat & water are bright
  • T2 – T1 to show just water and this will be indicative of inflammation & damaged cells
81
Q

What view do you use for a broken nose on x-ray?

A

nasal bone series

81
Q

C spine x- ray: AP view shows

A

C4 - C7

81
Q

C spine x- ray: Oblique view shows

A

can see more space b/t the vertebrae (facet) where nerves come out

81
Q

Describe the risks, benefits, and limitations of MRI scans

A
  • Risks: nephrogenic systemic fibrosis (body turns to rock) w/ contrast
  • Benefits: no radiation, good visualization of NS & tendons/ligaments
  • Limitation: take long time, costly, size, less readily available-
81
Q

What view do you use for maxillary sinuses on x-ray?

A

water’s view (PA view)

81
Q

What view do you use for frontal sinuses on x-ray?

A

Caldwell view (PA view)

82
Q

Describe the level of echogenicity seen with different types of tissues, and describe the appearance on the ultrasound image

A
  • Fluids – dark area on screen – ANECHOIC
  • Bone – bright area on screen w/ shadow beyond – HYPERCHOIC
  • Soft tissue – gray area – ISOCHOIC
  • B/t the isochoic and anechoic is HYPOCHOIC
83
Q

CT maxillofacial w/o contract is good for?

A

trauma

83
Q

What view do you use for metal fragments or orbital floor fracture on x-ray?

A

orbital view

83
Q

C spine x- ray: lateral view shows

A

C1 - C7

83
Q

Which x-ray imaging view is good for abscess?

A

lateral soft tissue neck

84
Q

CT maxillofacial w/ contrast is good for?

A

sinuses, chronic sinusitis

84
Q

C spine x- ray: odontoid view shows

A

atlas & axis (C1 & C2)

85
Q

CT neck w/o contrast is good for?

A

masses/swelling, hoarseness, dysphagia, stridor

85
Q

Describe the differences on ultrasound between cellulitis and abscess

A
  • Cellulitis–> cobblestoning
  • Abscess–> dark area w/ pus (will be darker)
85
Q

CTA neck is good for?

A

BVs

86
Q

Describe the indications for nasal and sinus endoscopy

A

Indications:
- Chronic illness
- Chronic difficulty w/ air flow
- chronic epistaxis
- chronic HA

86
Q

Describe the contraindications for nasal and sinus endoscopy

A
  • Contraindications: Trauma, Intracranial infection, bleeding disorder or on blood thinners
87
Q

Normal pressure of the eye?

A

10 to 20 mmHg

87
Q

Which is worse an alkalotic chemical or acidic chemical & what is the target pH for the eye

A
  • Alkalotic
  • 7.0 to 7.3
88
Q

Abnormal pressure of the eye?

A

> 20 mmHg

88
Q

Neutrophils Relative Normal

A

54 - 62%

89
Q

Total RBC Count

A

4.7 - 6.1 x 10^6 (males)

4.2 - 5.4 x 10^6 (females)

90
Q

Causes of polycythemia.

A
  • high altitudes or chronic hypoxia (smokers)
90
Q

Causes of anemia.

A
  • iron deficiency, vitamin d deficiency, sickle cell
90
Q

Causes of Leukocytosis.

A
  • > /= 11
  • sometimes bacterial infx (#s high & have symptoms) or Myeloproliferative disorder
91
Q

Hematocrit

A

42 - 52% (males)

37 - 47% (females)

91
Q

Hemoglobin

A

14 - 18 (males)

12 - 16 (females)

92
Q

Causes of leukopenia.

A
  • Viral infx
  • Severe bacterial infx
  • Autoimmune disorders, drugs, aplastic anemia
92
Q

Total WBC Count

A

4.5 - 11 x 10^3

93
Q

Lymphocytes Relative Normal

A

25 - 33%

93
Q

Monocytes Relative Normal

A

3 - 7%

94
Q

Eosinophils Relative Normal

A

1 - 3%

94
Q

Lymphocytes Absolute Normal

A

1000 - 4000

94
Q

Monocytes Absolute Normal

A

200 - 800

94
Q

Basophils Relative Normal

A

0 -1%

94
Q

Neutrophils Absolute Normal

A

2000 - 8000

95
Q

Basophils Absolute Normal

A

0 - 400

95
Q

Platelet Count Normal

A

150,000 - 450,000

95
Q

Eosinophil Absolute Normal

A

100 -400

96
Q

Is thrombocytosis concerning in most cases?

A

No

> 450,000

97
Q

Causes for thrombocytopenia.

A

< 150,000

  • Autoimmune or liver issues
  • can mess w/ clotting & bleeding problems
  • surgeons like it above 150,000
98
Q

What platelet level can cause spontaneous bleeds?

A

< 20,000

98
Q

Sodium Normal Range

A

135 - 145

99
Q

What does hyponatremia cause?

A
  • muscle weakness & seizures
  • we worry about neurons not working
100
Q

Causes of hyponatremia

A
  • dehydration
101
Q

Causes of hypernatremia.

A
  • dehydration
102
Q

Hypernatremia can cause?

A
  • obtunded
103
Q

Which hypokalemia value is considered toxic?

A

< 2.5

103
Q

Potassium Normal Range

A

3.5 - 5.0

103
Q

Which hyperkalemia value is considered toxic?

A

> 6

104
Q

Chloride Normal Range

A

95 - 110

104
Q

Which two values are similar?

A

Na+ & Cl-

  • pay attention when one is abnormal & the other isn’t
104
Q

Causes of hypocapnia.

A

ketoacidosis

104
Q

Carbon Dioxide Normal Range

A

22 - 30

104
Q

Causes of hypercapnia

A

COPD

105
Q

Calcium Normal Range

A

8.4 - 10.2

106
Q

Hypocalcemia causes…

A
  • hyperexcitability (twitching, tetany)
107
Q

Hypercalcemia causes…

A
  • neuromuscular depression (hypoflexia)
108
Q

What controls Ca++ levels in the blood?

A

Parathyroid Hormone

109
Q

Magnesium Normal Range

A

1.6 - 2.6

109
Q

Hypomagnesemia causes…

A
  • incr excitability (twitching)
110
Q

Hypermagnesemia causes…

A
  • depress muscle excitability (hypoflexia)
111
Q

___ & ____ imbalances have similar presentations.

A

Ca++ & Mg++

112
Q

What is given to pregnant women to induce labor?

A
  • Mg++
113
Q

Which adult levels are similar in pediatric normal values?

A
  • Na+
  • Cl-
  • Mg++
114
Q

Which peds normal levels have a slightly wider range than adults and why?

A
  • Ca++ & Phosphorus
  • increased bone deposition
115
Q

Describe peds potassium levels.

A
  • K+ levels are normal in children < 1yo due to decreased urinary K+ excretion
  • newborns may have incr turnover of RBCs
116
Q

BUN Normal Range

A

5 - 20

116
Q

Azotemia (> 20 BUN) symptoms

A
  • no symptoms
116
Q

Uremia symptoms

A
  • azotemia + symptoms
  • itching, flaky deposits on skin, confusion, fatigue
117
Q

Are low BUN levels clinically significant?

A

No

117
Q

Creatinine Normal Range

A

0.5 - 1.5

117
Q

^ BUN & Cr ^ is likely due to?

A
  • renal causes
118
Q

^ BUN & normal Cr is likely due to?

A
  • GI bleed (nonrenal)
119
Q

What pediatric normals are similar to adult normals?

A
  • Na++
  • Cl-
  • Mg+
120
Q

Which pediatric normals have a slightly wider range than adults due to increase bone desposition?

A

Ca+
P

121
Q

Describe K+ levels for pediatrics

A

higher K+ is normal in children less than 1yo due to decreased urinary K+ excretion

  • newborns also may have increase turnover of RBCs
122
Q

Electrolytes that may require separate orders?

A
  • phosphorus
  • magnesium
  • serum osmolality

Block Exams (3 decks)

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