Clin lab test 1

Question 1

1998 CLIA (Clinical Laboratory improvement) did what to deficiencies? How?

Answer 1

Decreased deficiencies by 40%. Established standards related to accuracy, reliability and timeliness.

Question 2

What are the three parts of the EBM triad?

Answer 2

1. Individual clinical expertise
2. Best external evidence
3. Patient values and expectations

Question 3

Gray top tube is used for what? What type of additives are in the tube?

Answer 3

Blood alcohol, glucose. Sodium flouride (glucose preservative) and Potassium oxylate

Question 4

Green Top has an anticoagulant. True or false? What is it?

Answer 4

True, Heparin

Question 5

Lab pathology is divided into two subsections, what are they?

Answer 5

Anatomic and clinical.

Question 6

Clinical pathology is divided into what 6 sections

Answer 6

Microbiology, UA, hematology, chemistry, serology, immunohematology

Question 7

Light blue top tube has what in it?

Answer 7

Sodium citrate (9:1)

Question 8

Light blue top goes to what lab section?

Answer 8

Hemotology, coagulation

Question 9

What is the primary and secondary function of the chemical laboratory

Answer 9

Generate info and educate providers/staff.

Question 10

What is the second most common lab sample

Answer 10

capillary pull

Question 11

What is the role of medical laboratory testing?

Answer 11

Detect, diagnose, treat

Question 12

What are the 5 criteria for testing complexity under clia 98?

Answer 12

1. Risk of harm to the patient. 2. Risk of erroneous result. 3. Type of testing method used. 4. Degree of independent judgment and interpretation. 5. availability for home use.

Question 13

What are the four categories of test complexity?

Answer 13

Waived (minimal)
Moderate (includes PPM)
High

Question 14

What are the three types of unacceptable blood specimens?

Answer 14

Icteric (jaundiced)
Lipemic
Hemolyzed (processing error)

Question 15

What color tube is used for a CBC? What anticoagulant is in it?

Answer 15

Lavender, EDTA

Question 16

What determines a good screening test? What about a good confirmatory test?

Answer 16

Screen: Sensitivity and NPV high
Confirm: Specificity and PPV high

Question 17

Define PPV, Define NPV

Answer 17

TP/TP+FP positive result actually positive ratio

TN/TN+FN negative result actually neg ratio

Question 18

What is the best site for venipuncture

Answer 18

Median cubital vein

Question 19

What is the most common specimen submitted to the laboratory

Answer 19

Venous blood samples

Question 20

What is the order of draw for tubes based on color? What are the associated inversions for each?

Answer 20

1. Yellow 8-10
2. light blue 3-4
3. gold/red/grey 5, red (plastic) 5, red (glass) 0, Orange 5-6
4. Light Green, Green 8-10 (For all following as well)
5. lavender
6. white
7. gray

Question 21

A BMP (basic metabolic panel) consists of what tests?

Answer 21

Sodium, Potassium, Chloride, CO2 (Bicarb)

Blood Urea Nitrogen, Serum Creatinine, Serum Glucose, Total Calcium

Question 22

A BMP is typically collected in what vial?

Answer 22

Red (slides say Light green, gold as well)

Question 23

Hypernatremia always indicates what in relation to body water?

Answer 23

Relative total body water deficit

Question 24

(Among other things…) Hyponatremia is found in what?

Hypernatremia is found in what?

Answer 24

Addison’s

Cushings

Question 25

Hyperkalemia leads to ______?

Answer 25

Aldosterone secretion and K excretion

Question 26

Hyperkalemia is associated with

Answer 26

Prim/Sec hypoaldosteronism

Question 27

Hypokalemia is associated with

Answer 27

Diabetes mellitus, Cushings, Hyperaldosteronism.

Question 28

Hyper and hypochloremia are generally tied to what?

Answer 28

Shifts in sodium and bicarb. Cl shifts to maintain electrical neutrality

Question 29

Increased HCO3 is indicative of what disorder?

Answer 29

Metabolic alkalosis; Primary or secondary to Respiratory acidosis

Question 30

Decreased Bicarb in BMP is associated with what disorder?

Answer 30

Metabolic acidosis

Question 31

Increased blood urea nitrogen on a panel is indicitave of disorder with what organ? What could be happening?

Answer 31

Kidneys. Decreased GFR/Increased tubular reabsorption, inadequate excretion, or increased gut production from too much protein or blood.

Question 32

Serum calcium is tied to changes in what?

Answer 32

Serum albumin

Question 33

A Complete metabolic panel includes what tests?

Answer 33

All BMP plus albumin, alanine transaminase (ALT), Alkaline phosphatase (ALP), Aspartate aminotransferase (AST), Bilirubin, Total protein

Question 34

Albumin comprises _______ percent of total extracellular blood protein. It is a measure of ______ function

Answer 34

60% | Hepatic

Question 35

Increased ALT mainly signifies what? | Increased ALP signifies what?

Answer 35

Damage to the liver (though remember skeletal muscles too) liver or bone disorders

Question 36

AST is most commonly a reflection of what? | If AST is >2 x the ALT, what should you suspect?

Answer 36

Liver injury Alcohol abuse w/ cirrhosis or alcoholic hepatitis

Question 37

Total protein measures what 2 classes of protein?

Answer 37

Albumin and globulin

Question 38

CBC contains what information? | Include critical values

Answer 38

``` Total RBC Hemoglobin Hematocrit (RBC volume of total blood) Mean Corpuscular value (avg size of RBC) Mean Corpuscular Hemoglobin MCHC (proportion of cell occupied by hemoglobin --color) RBC distribution width (variation in RBC size) WBC count (crit - <2k or >30k) Platelets (crit - <20k) ```

Question 39

UA panel consists of what 10 tests?

Answer 39

``` Specific gravity pH Protein (kidneys) Glucose Ketones Blood (ketones vs. trauma) Leucocyte esterase (infection) Nitrite (bacterial metabolism product) Bilirubin Urobilinogen (formed from bilirubin in intestine) ```

Question 40

What are desirable and high levels for Total Cholesterol?

Answer 40

D: less than 200 mg/dl High: 240+

Question 41

What are desirable and high levels for fasting triglycerides?

Answer 41

D: Less than 150 mg/dl High: 200-500 VH: 500+

Question 42

What are desirable and high levels of LDL and HDL

Answer 42

LDL Desirable: less than 100mg/dl High 160-189 HDL: Desirable:60mg/dl both men and women or MORE Low: less than 40 for men and 50 for women.

Question 43

Up to 70% of lab errors occur during what phase of testing?

Answer 43

Pre-analytical

Question 44

A critical test value must be reported in what timeframe? What about a STAT test result?

Answer 44

Crit: 1 hour from completion STAT: 1 hour from receipt of order

Question 45

What is a reflex test?

Answer 45

An automatic test conducted by the lab in the event of a specific positive first test.

Question 46

Describe cortisol's diurnal variation

Answer 46

Peaks 4-6 AM Lowest @ 8PM-12AM 50% lower at 8 PM than AM

Question 47

When is insulin lowest, night or daytime?

Answer 47

Night

Question 48

Iron peaks when? How much does it decrease following its peak?

Answer 48

Early to late morning | Decrease by up to 30% during the day.

Question 49

What are 10 common errors in specimen collection?

Answer 49

``` Mis-ID of patient Mislabel specimen Bad draw/wrong ratio Mixing problems/clots wrong tubes Hemolysis/Lipemia Hemoconcentration from TQ Exposure to light and high temps improper timing Processing errors ```

Question 50

What are 10 rejection criteria of drawn samples?

Answer 50

``` Improper collection and label Prolonged transport - degraded Leakage Incomplete request Clotted/hemolysis/insuff quantity Non-fasted Improper preservation Unprot from light Acidified Non-Frozen ```