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IPAP > ClinLab 3: Final Final Review > Flashcards

ClinLab 3: Final Final Review Flashcards

1
Q

What samples need to be refrigerated if their delivery to the lab is delayed?

A

Respiratory
Urine
Sputum
Stool

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2
Q

What samples need to be maintained at room temps if their delivery to the lab is delayed?

A

CSF
Body fluids
Blood cultures

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3
Q

What criteria will get samples rejected by the lab?

What is the exception?

A 
Improper label or container
Leakage
Unsuitable specimen
Duplicates- unless blood culture for endocarditis
Body fluids need to be delivered stat
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4
Q

What infections can kids get from sucking/oral route

A 
Roseola- droplet transmission
Herpes- herpetic whitlow
Giardia
Hep A
Otitis Media
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5
Q

Define acute endocarditis

A

Serious/aggressive septicemic episodes on healthy cardiac valves (catheter) from skin flora, Staph A/MRSA
IVDU- affects tricuspid valves

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6
Q

Define subacute/gradual endocarditis

A

Occurs in damaged cardiac valves from congenital defects, atherosclerosis, rheumatic fever

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7
Q

What microbes can cause subacute/gradual endocarditis

A 
Endogenous oral flora:
Strep Viridians (S mutans/mitis/snaguis/milleri) 
Intestinal flora (S bovis – suggestive of gastric cancer)  
Skin flora: Staph aureus
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8
Q

What are the HACEK microbes that commonly cause endocarditis

A 
Haemophilus species
Aggregatibater
Cardiobacterium
Eikenella
Kingella
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9
Q

S/Sx of bacteremia, endocarditis and sepsis?

These samples need to be taken prior to ?

A

Sx: fever, leukocytosis, N/C

Collect before antibiotic therapy

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10
Q

Define a Blood Culture Set

A

1 “set” = 1 aerobic and 1 anaerobic bottle
Different sites/times
No more than 4 total sets w/I 24 hours
Pediatric patients 1 bottle

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11
Q

What is the significance of a positive blood culture?

A

Growth of the same organism in repeated culture: True positive
Growth of different organism in different culture bottles: Contamination, bowel spillage
Growth of normal skin flora – likely contamination w/ Coagulase negative Staph, Coryn, Bacillus, or Propion
Organisms like Viridians Streptococci or Enterococci= possible endocarditis – associated w/ low grade symptoms

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12
Q

What must be done after the receipt of blood culture results?

A

Always match culture results with S/Sx

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13
Q

Define Antibiogram

A

Info obtained from C&S performed in the institution in given time– antibiogram is annual.
Provides % of samples for organism which were sensitive to certain antibiotics

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14
Q

What info do Antibiograms not provide?

A

Organism sensitivity to an Abx based on the site of infection
Organism sensitivity based on location in hospital (ICU vs non-ICU)
Average MIC
Abx killing at various doses/concentrations – trend data

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15
Q

What pitfalls come with Antibiograms?

A

Concentration differences between site of infection and in vitro
Penetration to the site of infection Inactivation of drug at site of infection Declining levels in vivo vs continuous levels in vitro
Rapid development of resistance in vivo vs in vitro
FQ and MRSA
Erythromycin induced clindamycin resistance Inaccurate due to small isolate number

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16
Q

What is encompassed in Antibiogram data?

A

DOC- susceptibility, cost and availability

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17
Q

Define Passive Immunity

A

Resistance based on Abs preformed in another host
Administration of Ab against toxins makes large amounts of antitoxin immediately available to neutralize the toxins or limits viral multiplication
Other forms of passive immunity= IgG passed in pregnancy and IgA passed during breast feeding

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18
Q

What is the main advantage of passive immunity?

What are the disadvantages?

A

Prompt availability of large amounts of Ab;

Disadvantages= short life span of these Abs and possible hypersensitivity reactions if globulins from another species are used

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19
Q

What are the immunoglobulin classes and what’s their meanings?

A

IgM: Current infection
IgG: Current infection, Acute and convalescent, Previous exposure (Vaccinated or old infection)
IgA : (secretory) Celiac disease, hepatitis
IgE: Allergen testing

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20
Q

Define Primary and Secondary Immunity?

A

Primary: IgM binds first, specific IgG binds later, makes more IgG specific for that Ag

Secondary: IgM and IgG (memory) react simultaneously

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21
Q

Define Titer

A

Method of expressing concentration
Employs serial dilution to obtain approximate quantitative information
Corresponds to the highest dilution factor that still yields a positive reading.
Often compares acute vs convalescent

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22
Q

What does a 4x increase of a titer mean?

A

Acute infection

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23
Q

What happens if only an acute sample is submitted to the lab?

A

Cut off value is required

Varies by organism and geography

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24
Q

Define Primary Response Titer

Define Secondary Response Titer

A

Day 5 1:4 titer
Day 12 1:64 titer

Re-exposure Titier: 1:256 titer or even higher

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25
Q

S/Sx of Hep A-E infection include ?

A 
Abd pain/distension
Breast development (males)
Dark urine
Clay stool 
Fatigue
Low fever 
Generalized itching
Jaundice 
N/V, weight loss
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26
Q

What labs are drawn to test for acute hepatitis?

A 
IgM 
anti-HAV
IgM anti-HBc
HBsAg  
anti-HCV
LFTs- based on screening
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27
Q

What will PE of PT with acute hepatitis show?

A

Large/tender liver
Fluid in abdomen
Yellow skin/eyes

28
Q

What is included in a lab work up for acute hepatitis?

A 
U/S
Autoimmune blood markers
Serologies
LFT
Biopsy,
Paracentesis (if fluid present)
29
Q

Characteristics of Hep A

A

Fecal-oral, high incidence in developing countries with low hygiene standards
Self-limited, no chronic liver dz
At risk: MSM, IVDU, Pts w/ clotting factor disorders
Labs: acute hepatitis A: anti-HAV IgM (+), anti-HAV IgG (+)
Resolved hepatitis A: anti-HAV IgG (+)

30
Q

Characteristics of Hep B

A

Spread by contact w/ blood, semen, vaginal fluids. Vaccine available
Shared needles, toothbrushes, razors, nail clippers
Acute or chronic. Chronic can be active or inactive “carrier”

31
Q

Characteristics of Chronic Hep B

A

 Clinical evidence: no Sx required. Chronic infection covers a spectrum from no Sx to cirrhosis
Labs: IgM Anti HBc (-) AND HBsAg (+) or HBV DNA (+) or HBeAg (+) OR HBsAg (+) or HBV DNA (+) or HBeAg (+) twice at least 6 months apart (any combination is acceptable)
Confirmed case: meets lab criteria alone
Presumed: Pt w/ single HBsAg (+) or HBV DNA (+) or HBeAg (+) and does not meet acute case definition

32
Q

Characteristics of Hep C

A

Blood/Vertical spread (mom to baby)
Most develop chronic disease
Active infection: Anti-HCV EIA: screening (+), Anti-HCV RIBA: confirmatory (+), qualitative HCV RNA (+)
EIA assay (screening) to detect HC-Ab, confirmed by RIBA or HCV RNA
Hep C RNA assays measure virus levels (viral load) to measure response to therapy
Hep C genotype: 6 of them. Most Americans have genotype 1. 2 and 3 respond to therapy

33
Q

Immunoglobulins in PTs that are susceptible

A

HBsAG neg
anti HBc neg
anti HBs neg

34
Q

Immunoglobulins in PTs that are immune from natural infection

A

HBsAG neg
anti HBc pos
anti HBs pos

35
Q

Immunoglobulins in PTs that are immune from Hep B vaccination

A

HBsAG neg
anti HBc neg
anti HBs pos

36
Q

Immunoglobulins in PTs that are acutely infected

A

HBsAG pos
anti HBc pos
anti HBs pos
IgM anti-HBc neg

37
Q

Immunoglobulins in PTs that are chronically infected?

A

HBsAG pos
anti HBc pos
anti HBs neg
IgM anti-HBc neg

38
Q

Characteristics of HBsAg

A

HBV is in the body of the patient
Acute: serology turns negative with development of anti-HBs
Chronic: HBsAg is persistently positive

39
Q

Characteristics of anti-HBs

A

Produced in response to HBsAg
Presence indicates either an infection or vaccination Vaccine is essentially HBsAg
Anti-HBs hangs around for a long time, decreasing gradually with age

40
Q

Characteristics of HBeAg

A

Comes from the core of the HBV
When the core degrade in the serum, Ag is created and can be detected, although not all Pts will have a detectable HBeAg
If HBeAg is (+), it is equivalent to a positive HBcAg marker and shows that the BPV is replicating actively and the patient is infectious

41
Q

Characteristics of Anti-HBe

A

Body’s immune reaction to HBeAg

Presence indicates HBV replication activities have decreased and the Pt is less infections/not infectious at all

42
Q

Characteristics of HBcAg

A

Totally degraded in the serum and is not detectable, but a portion survives as HBeAg

43
Q

Characteristics of IgM anti-HBC

A

FIRST immune response against infection, indicates active infection or flare against natural exposure
Immune response matures, this is replaced by IgG anti-HBc
Anti-HBc is absent in those who have been vaccinated

44
Q

Define Total Anti-HBc

A

Made in response to HBcAg, refers to presence of either IgG or IgM and does not discriminate
Presence indicates prior or current Hep B infection

45
Q

Characteristics of HBV DNA

A

Indicates active infection (acute or chronic)
Used as a quantitative test to monitor response to therapy, mainly in chronically infected patients
“Viral load”

46
Q

What test results show active syphilis

A

+ non-treponemal test (screening)

+ treponemal test (confirmatory)

47
Q

What test results show a false positive RPR

A

+ non-treponemal test (screening)

- treponemal test (confirmatory)

48
Q

What test result show Spirochete or previous syphilis

A
  • non-treponemal test (screening)

+ treponemal test (confirmatory)

49
Q

What can cause bacterial traveler’s diarrhea

A

Salmonella
Campylobacter
Shigella

50
Q

What can cause viral Traveler’s Diarrhea

A

Rota
Noro
Enteric adeno
Astro

51
Q

What can cause parasitic traveler’s diarrhea

A 
Giardia
Cryptosporidium
Cyclospora
Isospora
Balantidium
Entamoeba histolytica
52
Q

What causes microbes can cause Traveler’s Diarrhea

A 
Shigella
EIEC, EHEC, EPEC, ETEC
Salmonella
Campylobacter
V Cholera
53
Q

What microbe specifically causes Traveler’s Diarrhea

A

ETEC from contaminated food/water

Cramps and watery diarrhea

54
Q

What are the Traveler Infections

A 
Typhoid fever
Leishmaniasis
Yellow fever
Dengue fecer
Leptospirosis
Meningitis
55
Q

Upper UTIs include ?

Lower UTI is called ?

A

Pyelonephritis

Cystitis (“traditional” UTI)
Urethritis (often STI)
Prostatitis

56
Q

What causes Cystitis and what are the two types?

A

E coli, staph saprophyticus, proteus mirabilis, klebsiella, enterococcus
Uncomplicated- Healthy adult women (>12), non-pregnant, no fever/N/G/flank pain dx w/ dipstick UA

Complicated- Females w/ comorbidities, ALL males, indwelling foley catheters, urosepsis/hospitalization
Dx w/ UA and culture

57
Q

Define Pylonephritis and the S/Sx

How is it diagnosed?

A

Infection of kidney presenting w/ Fever, N/V, HA and flank pain
Dx w/ UA, culture, CBC and chemistry

58
Q

What are some complications that can arise from untreated pyelonephritis?

A

Perinephric/renal abscess- suspected in PTs not improving on ABX
Dx- CT w/ contrast, renal US

59
Q

Characteristics of nephrolithiasis w/ UTI

A

PTs w/ severe flank pain

Consult w/ urology

60
Q

S/Sx of Protatitis

How is it diagnosed

A

Sx: pain in perineum, lower abdomen, testicles, penis, and with ejaculation, bladder irritation, bladder outlet obstruction, sometimes blood in semen
Dx w/ Hx (fevers/chills/dysuria/malaise/myalgias/pain/cloud urine) Tender prostate on PE. Increased PSA. UA and urine culture
Risk factors: Trauma, sexual abstinence, dehydration

61
Q

What causes urethritis?

A

Chlamydia trachomatis

Neisseria gonorrhea

62
Q

S/Sx of Chlamydia trachomatis urethritis

A

Frequently asymptomatic in females, but can present w/ dysuria, discharge, or PID
Send UA, urine culture (if pyuria seen, but no bacteria, suspect chlamydia)
Pelvic exam – send discharge from cervical or urethral site for chlamydia PCR
Chlamydia screening is now recommended for all females 25 or under

63
Q

S/Sx of Gonorrhea urethritis

A

May present w/ dysuria, discharge, PID
Send UA, urine culture. Pelvic exam – send discharge samples for gram stain culture, culture, PCR
You should always also treat for chlamydia when treating for gonorrhea!

64
Q

How is Gonorrhea urethritis diagnosed and with what specimens?

A

Specimens: urethral/cervical swab, urethral discharge, urine (first void).
Dx urethritis/cervicitis: gram stain. Culture (100% specificity), serology (useful for diagnosis of LGV caused by C. Trichomatis), nucleic acid amplification (can test both GC and Ct simultaneously, very sensitive and specific)

65
Q

What is the most common cause of urethritis in females?

What are the S/Sx and causes of recurring infections?

A

E coli
S saprophyticus in young sexually active females.
Cystitis, pyelonephritis.
Recurring infections – reinfection pathogens: proteus, pseudomonas, klebsiella, Enterobacter, enterococcus, staphylococcus

66
Q

What is the most common cause of urethritis in males?

What S/Sx are seen on PE for Dx?

A

Enterobacteriaceae. Very low prevalence. S/Sx: urethritis (sterile culture: discharge, dysuria, frequency), prostatitis (obstructed urine flow: “complicated UTI”)
PE: CVA tenderness (pyelonephritis). Urethral discharge (urethritis) Tender prostate (prostatitis)

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