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Quarter 3 > Clin Lab Med > Flashcards

Clin Lab Med Flashcards

1
Q

Hgb normal range

A

13.5-17.5

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2
Q

Hematocrit normal range

A

38.8-50%

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3
Q

WBC normal range

A

4.2-10.2

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4
Q

Platelet normal range

A

150-355

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5
Q

UFH

Given IV

A

Good if someone just had surgery

Only one approved for Pregnancy

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6
Q

UFH

Labs to order

A

Baseline: aPTT, PT/INR, CBC

Monitor: aPTT or Factor 10a

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7
Q

Intrinsic pathway

A

PTT

Heparin monitoring

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8
Q

Extrinsic pathway

A

PT

Warfarin monitoring

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9
Q

LMWH/Lovenox

Given SubQ

A

Does not work as well in obese pt bc it will not distribute through fat

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10
Q

LMWH/Lovenox

Labs to order

A

Baseline: aPTT, PT/INR, CBC, Creatinine

do not need monitoring labs, if anything: 10a activity

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11
Q

Warfarin/Coumadin

SubQ

A

Takes time to build up, need bridging medication

Cheap

Approved with kidney dysfunction!

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12
Q

If you have kidney dysfx, which anticoag do you use?

A

Warfarin/Coumadin

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13
Q

If you have DVT or PT and an underlying CA, which anticoag is recommended?

A

LMWH/Lovenox

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14
Q

If you have DVT or PE and NO underlying CA, which anticoag do you use?

A

any of the DOAC

Direct thrombin inh OR
Direct 10a Inhib (Xarelto and Eliquis)

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15
Q

Warfarin/Coumadin

Labs to order

A

Baseline: aPTT, PT/INR, CBC, Creatinine, LFTs (the most labs)

monitor: PT/INR

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16
Q

Which drug requires the most lab testing?

A

Warfarin/Coumadin

Baseline (5): aPTT, PT/INR, CBC, Creatinine, LFTs

Monitor: PT/INR

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17
Q

Labs to order with DOACs

A

only Baseline: PT/INR, CBC, Creatinine

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18
Q

Need 5-10 d of IV anticoag before starting Pradaxa or Edoxoban, but can do these other two without any pre-med

A

Xarelto and Eliquis

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19
Q

What do you use as a bridge when starting Warfarin (Coumadin)?

A

UFH or LMWH must be given in overlap for at least 5 d or until INR is good for 24 hr or 2 consec days

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20
Q

Reversal agent for UFH and LMWH

A

Protamine

PER977*

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21
Q

Reversal agent for Warfarin/Coumadin

A

Vitamin K

4Factor-PCC (new and expensive)

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22
Q

Reversal agent for Pradaxa

A

Idarucizumab (praxbind)

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23
Q

Reversal agent for Xarelto

A

supportive care

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24
Q

Reversal agent for Eliquis and Edoxoban

A

Andexanet (new and expensive)

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25
Q

Left side of wishbone

A

WBC

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26
Q

Top of wishbone

A

Hgb

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27
Q

Bottom of wishbone

A

Hct

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28
Q

Right side of wishbone

A

Platelets

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29
Q

Leukopenia

A

<5k

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30
Q

Leukocytosis

A

> 10k

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31
Q

Eisinophiils

A

allergic rxn and Parasites

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32
Q

Basophils

A

least common granulocyte

allergic rxn

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33
Q

Eisonophils do NOT respond to

A

Viral or Bacterial infection

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34
Q

Eisinophilia (high)

A

Fungal infection
Allergic rxn
Parasites

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35
Q

Basopenia (low)

A

Acute allergic rxn

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36
Q

Lymphocytes

A

T and B cells

fight acute Viral infection

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37
Q

Lymphocytosis

A

Viral infection

Mono or Hepatitis

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38
Q

Monocytosis

A

Severe infections

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39
Q

Normal platelet count

A

150-355

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40
Q

Polycythemia Vera

A

chronic myeloproliferative neoplasm

prolif of myeloid cells and elevated RBC mass

JAK2 mutation in setting of thrombocytosis: more at risk of developing clots or underlying CA

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41
Q

Platelet disorders (4)

A

Platelet dysfx
Splenic sequestration
Increased destruction
Impaired production

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42
Q

Splenic sequestration

A

spleen eating up platelets

vascular congestion- liver cirrhosis

43
Q

Increased Destruction

A

Immune thrombocytopenia
Disseminated Intravasc Coag
Heparin ind thrombocytopenia
Thrombotic microangiopathy

44
Q

Disseminated Intravascular Coagulation

A

clotting and bleeding at same time
hard to treat
seen in pts who are very sick (septic)

45
Q

Hepatin induced thrombocytopenia (low)

A

platelet activation -> increased risk thrombosis -> leading to thrombocytopenia and prothrombic state

46
Q

Thrombotic microangiopathy (TTP or HUS)

A

both types: condition d/t incorporation of platelets into microvasc

Result: mechanical shearing of RBC as they pass thru platelet rich microthrombi

47
Q

Thrombotic microangiopathy

easy definition

A

fragmentation of RBC bc they are passing through small vessels with a bunch of little thrombi in the way

48
Q

TTP (T.T.Purpura)

A

Medical emergency!
Auto antibodies against ADAMST-13
acquired or inherited messed up gene

Result: microthrombi form thru-out body

49
Q

5 characteristics of TTP

A

Purpura Pentad

  • Mircoangio hemolytic anemia
  • Thrombocytopenia
  • Acute Kidney Injury
  • Neuro deficits
  • Fever
50
Q

sx of TTPurpura

A

petechaie, pallor, jaundice

51
Q

HUS- Hemolytic Uremic Syndrome

A

AKA Shiga-toxin mediated HUS

52
Q

HUS hemolytic uremic syndrome

A

predominant in children

53
Q

HUS hemolytic uremic syndrome

A

Etio: shigatoxin producing E.Coli 0157

CHILD w/recent diarrhea and thrombocytopenia (RED FLAG)

54
Q

Triad of HUS-hemolytic uremic syndrome

A
  • Mircoangio hemolytic anemia
  • Thrombocytopenia
  • Acute Kidney Injury
55
Q

Tx for both types of thrombotic microangiopathy (TTP and HUS)

A

Plasma Exchange and

Supportive care

56
Q

Lab findings for Microangio Hemolytic Anemia

A

Schistocytes

Thrombocytopenia

57
Q

MTHFR gene

A

part of hypercoag panel

associated with miscarriages and clots

58
Q

Eliquis brand name

A

Apixiban

59
Q

Xarelto brand name

A

Rivaroxaban

60
Q

Hyperglycemia

high glucose

A 
IV Dextrose infusion
Stress
Endocrine disorders 
-Cushings
-Acromegaly
61
Q

Hypoglycemia

A

Addison’s Dz (diminished cortisol)

62
Q

Urea is made in the

A

Liver

BUT, excreted by kidneys

63
Q

Creatinine tells us only about the

A

KIDNEYS bc it is excreted by kidneys

64
Q

Creatinine relationship with GFR

A

INVERSE

so Cr goes up, GFR goes down

65
Q

What makes BUN/Cr Ratio so special?

A

determine CAUSE of Acute Kidney Injury

66
Q

BUN of a PRE-Renal cause of AKI

A

> 20:1 BUN/Cr

67
Q

Pre-renal cause of AKI

A

Perfusion issue

Hypovolemia- dehydration or hemorrhage
CHF
Change in vascular resistance (Renal artery stenosis)

68
Q

Intrinsic cause of AKI

A

Filtration issue

Acute tubular necrosis (IV contrast!!)

69
Q

Post-renal cause of AKI

A

Excretion issue

Stone, Bladder outlet obstruction, BPH, Urethral stricture

70
Q

Changes in Cl generally accompany

A

change in Na and Bicarb

71
Q

Bicarb is regulated by

A

Kidneys

72
Q

Total protein=

A

Albumin + Globulin

73
Q

Total protein used to tell us about:

A

Liver dz, edematous state, protein losing conditions, nutrition, immune dz, and CA!!

74
Q

Labs to measure Synthetic function of the liver (what it can make)

A

Albumin
Platelet count
PT/INR

75
Q

Albumin function:

A

Maintain Osmotic Pressure (among many others)

76
Q

Elevated Total Protein with increased GLOBULIN

A

Consider Multiple Myeloma

M spike and Bence Jones Proteins

77
Q

Liver tests

A

AST
ALT
ALP
BILI

78
Q

Transaminases of Liver tests

A

AST ans ALT

ending in T

79
Q

Liver tests reflect injury/dz to the Hepatobiliary system, which includes:

A

Liver
Gallbladder
Bile Ducts

80
Q

AST is found in

A

liver, kidney, brain, cardiac and skeletal muscle

injury to these tissues= release of AST into bloodstream

81
Q

Which is more specific to the liver, AST or ALT

A

ALT

82
Q

ALP is found in

A

Liver
Biliary Tract
BONE

83
Q

Rltnshp b/w Ca and Phosphorus

A

INVERSE

Ca goes up, Phosphorus goes down

84
Q

Cause of HypoCa2+

not enough Ca

A

Hypo-albumin
Hypo-Mg
Hypo-Parathyroid
Renal failure

85
Q

Causes of HyperCa2+

too much Ca2+

A

Hyperparathyroid

Malignancy

86
Q

decrease in excitability

muscle weakness

A

HYPER ca2+

87
Q

increase in excitability

tetany

A

HYPO ca2+

88
Q

Signs of HYPERca2+

A

kidney stone

constipation

89
Q

Signs of HYPOca2+

A

Chvosek’s sign

Trousseau’s sign

90
Q

EKG of HYPERca2+

A

short QT interval

91
Q

EKG of HYPOca2+

A

long QT interval

92
Q

Free (ionized) Ca

A

physiologically active

93
Q

Citrate is added to blood why

A

to chelate with Calcium and prevent clotting

94
Q

In pts with decreased Albumin

A

must correct the total serum Calcium

95
Q

Calcitonin

A

stimulates Ca deposit in bone (lowers serum levels)

96
Q

PTH

A

stimulates Ca release from bone (increases serum levels)

97
Q

90% of increase in Calcium is d/t:

A 
Primary Hyperparathyroid (PTH)
Malignancy
98
Q

presentation of TOO MUCH Calcium

A

muscle weakness, loss of tone, stupor, coma

SHORT QT interval on EKG

99
Q

presentation of NOT ENOUGH Calcium

A

hyperexcitable, tetany, Chvostek’s sign, Trousseau’s sign

LONG QT interval on EKG

100
Q

Cellular shift with Insulin or Refeeding syndrome can cause:

A

Hypophosphorus levels

101
Q

Magnesium is tied to what:

A

Calcium (Ca) and Potassium (K)

102
Q

Low Mg

A

inhibits PTH action (decreases Ca)

impairs kidney’s ability to conserve potassium (decreases K)

103
Q

Low Mg sx will be similar to:

A

Low Ca sx

104
Q

Torsades de pointes

A

Cardiac arrhythmia associated with Hypomagnesia

Quarter 3 (17 decks)

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