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IPAP > ClinLab Review > Flashcards

ClinLab Review Flashcards

1
Q

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

A 
RUSS
Respiratory specimens
Urine
Sputum 
Stool
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2
Q

What specimens need to be kept at room temperatures if their delivery to the lab is delayed?

A

Body fluids
Blood culture
CSF

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3
Q

What specimens need to be transported on special types of transport medias?

A

Viral- virus transport media
Stool- Carry-Blair media
Stool parasite- Formalin and Polyvinyl Alcohol

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4
Q

What are some of the reasons/criteria specimens can be rejected by the lab?

A

Improper label
Wrong container
Leakage
Unsuitable specimen
Duplicate/repeat specimen- exception= blood cultures for suspected endocarditis
Sterile body fluids not delivered STAT to lab

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5
Q

Kids and facial infections

A

Impetigo- nose and lips
Herpes- suckling infant w/ mouth sores
Herpatic whitlow

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6
Q

Infectious endocarditis

A

Inflammation of endocardium/endothelial surface of heart
Valves- if previously damaged
Congenital- affects A/P valves
Acquired- A/M valves

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7
Q

Acute ABE

A

Rapid/aggressive infective endocarditis occurring during septicemic episode on healthy cardiac valves
Skin flora- Staph A (MRSA)
IVDU- MRSA affecting tricuspid valve

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8
Q

Subacute SBE

A

Gradual infective endocarditis occurig in damaged cardiac calves (congenital, atherosclerotic, rheumatic)
Endogenous oral flora- Strep V or intestinal flora- S Bovis (GI CA)
Skin flora- Staph A

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9
Q

Culture negative HACEK Bacteria for Endocarditis

A 
Haemophilus sp
Aggregatibacter
Cardiobacerium
Eikenella
Kingella
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10
Q

What is the significance of positive blood culture results?

A

True += growth of same organism in repeated cultures

Different organism, different bottle= probable contamination w/ bowel spillage

Growth of normal skin flora= contamination (coag neg staph, coryn, bacillus, propion)

V. Strep/Enterococci- possible endocarditis

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11
Q

Considerations for choosing antibiotics for PTs

A

Antibiogram- collection of info obtained from C&S performed in an institution within a time frame (annual)
Provides % of samples for a given organism which were sensitive to a certain ABX

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12
Q

What info is not provided by an antibiogram?

A

Organism sensitivity to an ABX base on site of infection, location in hospital, average MIC, killing at dose/concentrations

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13
Q

How do we determine the ABX drug of choice for PTs?

A

Susceptibility
Cost
Availability

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14
Q

What organism is at the top of the antibiogram data sheet and what drugs is it most/least susceptible to?

A

E Coli-

Nitrofurantoin, Cephalothin

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15
Q

IgM present in immunoglobulin testing indicates?

A

Current infection

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16
Q

IgG present in immunoglobulin testing indicates?

A

Current infection- acute and convalescent

Precious exposure- vaccine or old infection

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17
Q

IgA present in immunoglobulin testing indicates?

A

Celiac Dz

Hepatitis

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18
Q

IgE present in immunoglobulin testing indicates?

A

Allergen testing

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19
Q

IgD present in immunoglobulin testing indicates?

A

Unknown function/purpose

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20
Q

Define Titer

A

Way of expressing concentration by serial dilution to obtain approximate quantitative information to compare acute vs convalescent sera
Corresponds to highest dilution factor that still yields + reading (4x inc=acute)

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21
Q

What happens if only an acute sample is submitted for a titer?

A

Cut off value is required and can vary by organism/geography

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22
Q

What is a Primary Titer response?

What is a Secondary/Re-Exposure Titer?

A

Day 5- 1:4
Day 12- 1: 4

1:256 or higher

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23
Q

What happens during each phase of a Hep A infection?

A

Incubation- 15-45 days, relative titer levels, HAAG
Early acute- 0-14 days, AST/ALT 1-2mon, Sx, anti-HAV IgM and Total anti-HAV rise parallel
Acute- 3-6mon, toal anti-HAV plateuas, anti-HAV IgM falls off
Recovery- years later, no anti-IgM, only Total anti-HAV present

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24
Q

What globulins are present in a susceptible person?

A

HBsAg neg
anti-HBc neg
anti-HBs neg

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25
Q

What globulins are present in a person immune due to natural infection?

A

HBsAg neg
anti-HBc pos
anti-HBs pos

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26
Q

What globulins are present in a person immune due to a Hep B vaccine?

A

HBsAg neg
anti-HBc neg
anti-HBs pos

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27
Q

What globulins are present in a person that is acutely infected w/ Hep B

A 
HBsAg pos
anti-HBc pos
anti-HBs neg
IgM anti-HBc pos
ALT elevated
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28
Q

What globulins are present in a person that is chronically infected w/ Hep B

A 
HBsAg pos
anti-HBc pos
anti-HBs neg
IgM anti-HBc neg
ALT elevated
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29
Q

What will CSF results look like in bacterial meningitis?

A

PMNs
Low glucose
High Protein

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30
Q

What will CSF results look like in viral meningitis?

A

Normal glucose

Moderate inc protein

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31
Q

What will CSF results look like in fungal meningitis?

A

Lymphocytes
Low glucose
High protein

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32
Q

What will CSF results look like in parasitic meningitis?

A

Eosinophils
Norm/low glucose
High protein

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33
Q

What bacteria cause the most cases of meningitis in elderly?

A 
Strep penumo
E Coli
K pneumoniae
S agalactiae
L monocytogenes
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34
Q

What bacteria cause the most cases of meningitis in Adults?

A 
Strep pneumo
N meningitidis
Staph
H influenza
G Bacilli
Strep
L monocytogenes
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35
Q

What bacteria cause the most cases of meningitis in children?

A

Strep pneumo
N meningitidis
H influenzae

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36
Q

What bacteria cause the most cases of meningitis in neonates?

A

S agalactiae
E coli
L monocytogenes
Strep

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37
Q

What is the most common cause of UTIs in females and males?

A

E Coli- most common cause
S. Saprophyticus- young, sexually active

Enterbacteriaceae

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38
Q

What is the most common cause of recurrent UTIs?

A 
Proteus
Psudomonas
Klebsiella
Enterbacter
Entercoccus
Staph
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39
Q

Define uncomplicated cystitis and how is it diagnosed?

A

+12y/o female non-pregnant, no fever, N/V or flank pain

Dx w/ dipstick UA

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40
Q

Define Complicated Cystitis and how is it diganosed?

A 
Female w/ comorbid medical condition or ALL male PTs
Indwelling foley catheter
Urosepsis
Hospitalization
Dx w/ UA  and culture
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41
Q

How is pyelonephritis diganosed?

A

UA
Culture
CBC
Chemistry

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42
Q

Which microbes cause urethritis?

A

Gonococcal- N Gonorrhea

Non-Gonococcal- Chlamydia trachomatis, Mycoplasma, Ureaplasma (Adenovirus, Trichomonas Vaginalis, HSV)

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43
Q

What is the “traditional” UTI?

Which one is sexually transmitted?

A

Cystitis

Urethritis

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44
Q

What type of sample is sent for urethritis caused by chlamydia trachomatis?

A

UA
Culture
+ pyuria, - bacteria= chlamydia

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45
Q

What type of samples are sent for urethritis caused by N. Gonorrheae

A

UA and Culture

Pelvic exam d/c for gram stain, culture and PCR

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46
Q

What specimens are sent for urethritis?

A

Urethral/cervical swab
Urethral d/c
First void urine- 3 ml or more
Possibly- rectal or pharyngeal swab

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47
Q

What type of Gram stain is positive for Sx males?

A

+ Gram Negative Diplococcie and WBCs

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48
Q

Define Gardnerella Vaginalis

A 
Bacterial vaginosis
Malordorous gray/white d/c
Possible UTI or ASx
pH>4.5
\+ amine test
Clue cells seen on saline wet prep
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49
Q

Increase in vaginal pH suggests what two things?

A

Bacterial vaginosis

Trichomoniasis

50
Q

Define Candidiasis

A

Candida albicans- pseudohyphae
Intense itch w/ cottage cheese
Dysuria
Normal pH

51
Q

Define Trichomoniasis

A 
Trichomonas vaginalis
Frothy green/yello d/c
Requires motile organism
Inc pH 5.0-6.0
Strawberry cervix
Vaginal soreness/dyspareunia
Often ASx
52
Q

How is vaginal pH measured?

A

Narrow range pH paper

53
Q

Amine test is AKA?

A

Whiff test

KOH, inc pH, fishy smell

54
Q

Function of microscopy when evaluating vulvovaginitis lab tests?

A

Saline wet prep
Jerky Trichomonoas
Clue cells- bacterial
Budding yeast- fungal

55
Q

Function of KOH prep when evaluating vulvovaginitis lab tests?

A

KOH destroys cell walls of bacteria but not fungi/yeast

56
Q

What are the two spirochete for memory?

A

Treponema pallidum- Syphilis

Borrelia burgdoferi- Lyme Dz

57
Q

Syphilis direct testing

A

Skin, placenta, unbilicus
Dark field microscopy
Definitive Dx

58
Q

Syphilis non-treponemal tests

A

Screening of serum
RPR, VDRL (CSF)- titer
+Sensitive - Specific

59
Q

Syphilis treponemal test

A

Confirmation of serum
FTA-ABS, MHA-TP, TP-PA
+ result for life

60
Q

Steps of syhpilis screening test

A
  1. RPR looks for non-specific Abs cardiolipin
  2. RPR titer
  3. F/u + w/ confirmation
    MHA-TP or FTA-ABS
61
Q

What do the results of a syphilis RPR mean?

A

Pos RPR 1:16 + Neg confirm- false pos RPR

Pos RPR 1:16 + Pos confirm= active Dz

62
Q

What is the follow-up syphilis testing?

A

Non-treponemal test

Titer of Ab/activity of Dz

63
Q

What is important part of the follow up process of syphilis?

A

Serologic monitoring

Suggested at 3 6 and 12mon intervals after Tx and must be done w/ same testing assay (RPR or VDRL) for all f/u exams

64
Q

Syphilis testing review has two paths to choose

A 
Conventional nontreponemal (VDRL/RPR) then treponemal (TP-PA/FTA-ABS)
Reverse treponemal then nontreponemal
65
Q

What did the CDC change about treating gonorrhea?

A

Cefixime is not first line for treatment

66
Q

Characteristics of Chancroid

A 
Haemophilus Ducreyi
Painful ulcer w/ tender inguinal nodes
Necrotic/purulent base w/ ragged borders
School of fish/railroad track morphology
Dx w/ culture and neg for HSV testgin
67
Q

What is the most common STD in the US?

A

HPV genital warts

68
Q

Define Condyloma Acuminatum

A

Type 6, 11 Anogenital warts in wo/men

69
Q

HPV can lead to epithelial carcinoma of the ? and what types?

A

Cervical cancer
Low risk- 6 and 11
High- 16 18 31 33 35

70
Q

What med is FDA approved for use in males and females 9-26 for HPV?

A

Gardasil for types 6 11 16 18

71
Q

How is HPV Dx

A

Visual ID- 3-5% acetic acid
Cytologic exam of cervical cells
Molecular ID- anogenital PAP smear- hybrid capture method for ID

72
Q

PAP smears can ID what types of cancer?

A

Cervical
Uterine
Ovarian

73
Q

Define PID

A

Endometriosis, salpingitis, tuboovarian abscess and pelvic peritonitis
Usually complication of cervicitis (Gonorrhea or C trachomatis)

74
Q

What are the consequences of PID?

A

Infertility
Ectopic pregnancy
Abscess formation
Chronic pelvic pain

75
Q

How isa PID diagnosis confirmed?

A

NAT

76
Q

What are the essentials of a HIV diagnosis?

A

RNA detected/quantitated by PCR of bDNA
Low CD4
Unexplained opportunistic

77
Q

How long does it take for an HIV infection to take place?

A

Average detection within 25 days
Within 3mon of + status
4th generation assays can detect withing 12 days

78
Q

What are the confirmatory tests for HIV 1 and HIV 2

A

Western blot- HIV 1
Bio-Rad Multispot- HIV 2
Qualitative RNA PCR

79
Q

What does it mean if a 3rd blood specimen is submitted for HIV confirmation and it comes back negative?

A

PT is not infected

80
Q

When is a Western Blot assay used?

A

Detect proteins as confirmatory test for + HIV EIA results

RIBA for HCV or Lyme Diz

81
Q

HIV indeterminant status positive results require Abs against ?

A

One envelope protein

One core protein or one enzyme protein

82
Q

After PT tests positive for HIV what is the next step?

A

Determine baseline viral load
CD4 levels
Screen for TB/Hep viruses

83
Q

PTs at risk for HIV should also be tested for ?

A 
Hep ABC
STIs
Herpes
TB
CXR
84
Q

HIV screening is done with ?

A

ELISA

85
Q

S/Sx of influenza

A

PTs always have fever, HA and muscle aches

Dry cough

86
Q

S/Sx of URI

A

Hacking cough
Fever in kids
Rare HA
Sneezing and sore throat

87
Q

Bacterial vs Viral pharyngitis

A

Bacterial (GAS)- younger, sudden onset, HA, vomit, fever

Viral (Coxsackie)- young adults, slow progression, cough, low fever, conjunctivitis w/ Adenovirus

88
Q

Strep pharyngitis is caused by ?

A

GAS
Abrupt sore throat, high fever, HA
Huge, swollen tonsils

89
Q

What are the 3 sequelaes of strep pharyngitis

A

Scarlet fever
Rheumatic fever
Glomerulonephritis

90
Q

Centor Criteria

A 
Tonsil exudate
Cervical adenopathy
Fever
Absent cough
3 or more Sx= swab
91
Q

S/Sx of Strep Pyogenes

A

Scarlet fever
Starts w/ fever and sore throat
Strawberry tongue

92
Q

S/Sx of Acute Glomerulnephritis

A

10-14 days post infection
Fluid retention, HTN and edema
Sx= hematuria, foamy urine, swollen face/ankles/feet/legs

93
Q

S/Sx of rheumatic fever

A

Kids 6-15y/o starting 20 days after strep/scarlet fever

Polyarthritis, carditis, nodules under skin, rapid jerky movement
Skin rash

94
Q

Pharyngitis by Mycoplasma pneumoniae

A

Young adults w/ HA, pharyngitis and lower respiratory Sx

75% have cough= distinctive from GAS infection

95
Q

Pharyngitis by Chlamydia pneumoniae

A

Pharyngitis precedes pulmonary infection by 1-3wks

96
Q

Pharyngitis by Neisseria gonorrhoea

A

Rare cause of pharyngitis

97
Q

Pharyngits by Corynbacterium diphtheriae

A

Foul smelling gray membrane that can lead to airway obstruction

98
Q

Pharyngitis by Arcanobacterium haemolyticum

A

Similar to GAS and is identical on culture

Gram stain resembles Corynebacterium

99
Q

What causes most cases of pharyngiits

A

Viruses

EBV, Adenovirus and Coxsackie A virus

100
Q

What are the S/Sx of viral pharyngitis

A

Enlarged tonsils
White exudates
Cervical lymphadenopathy
Coxsackie- also has herpetic vesicles in posterior pharynx

101
Q

S/Sx of adenovirus pharyngitis

A

Conjunctivits and pharyngitis

AKA Pharyngoconjunctival fever

102
Q

S/Sx of Herpes Simplex pharyngitis

A

Herpangina- vesicular lesions

In older PTs can be indistinguishable from GABHS infection

103
Q

S/Sx of Coxsackie virus pharyngitis

A

Like herpes w/ white nodular vesicles in oropharynx

104
Q

S/Sx of EBV pharyngitis

A

Mono, looks like a GAS infection

Exudative pharyngitis, retrocervical or adenopathy and hepatosplenomegaly

105
Q

S/Sx of Cytomegalovirus

A

Older, sexually active PTs w/ higher fever and more malaise

Pharyngitis is not the prominent complaint

106
Q

S/Sx of HIV-1 pharyngitis

A

Like mono
Edema, erythema, aphthous ulcers
Lymphadenopathy, fever, myalgia

107
Q

Characteristics of Laryngotracheobronchitis

A

Croup from Parainfluenza virus
Inspiration stridor, non-productive barking cough w/ Sx worse at night
Nasal wash submitted to lab for culture/PCR

108
Q

Characteristics of Epiglottitis

A

HIB cause the three Ds- dysphagia, drooling, distress
Hot potato voice
Tripod posture
CBC, blood and epiglottal cultures- ALERT lab for special growth media

109
Q

Characteristics of Diphtheria

A

Toxin producing strain of Corynebacterium Diphth.
Hallmarks: thick gray/black fiber-like pseudo-membrane on tonsils, uvula and palate
Sudden onset w/ fever, bull neck and low fever
Treat w/ antitoxin prior to confirmation
+ culture and toxin assay
Alert the lab, reqs special media for growth

110
Q

How is diphtheria spread?

A

Resp droplets
Fomites
Food

111
Q

Where does diphtheria first appear?

A

Skin

112
Q

The Iditarod Dog race is done in honor of what disease outbreak?

A

Diphtheria

113
Q

Characteristics of Pertussi

A

Bordatella pertussis
B Parapertussis
Sx after 7-10 day incubation, starts w/ paroxysms coughing bouts w/ final whoop noise
Adults are main carriers w/ chronic cough
Alert lab, reqs special growth media

114
Q

What are the 3 stages of Pertussis

A

Catarrhal- common cold, most infectious time
Paroxysmal- whooping, mucus production
Convalescent- parosyxms reduce and secondary complications occur

115
Q

How is a lower respiratory tract specimen collected?

A

Expectorated/Induced Sputum: PT breathes aerosolized 15% sodium chloride and 10% glycerin x 10m FIRST thing in morning

Gasric aspirate- only for acid fast bacilli isolation in PTs unable to make sputum

116
Q

What causes bronchiectasis

A

Destruction and widening of large airways
Begins in childhood after infection or foreign object inhalation
Congenital- by CF (Burkholderia, Staph A or P Aeruginosa)
Acquired through COPD

117
Q

What type of specimen is needed for a bronchiectasis Dx

A

Sputum for culture

118
Q

Characteristics of The Common Cold

A

Coronavirus, Adenovirus- pharyngitis, Rhinovirus

Most frequent human disease from contact w/ infected mucoid secretions

119
Q

Common causes of bacterial pharyngitis

A 
M pneumo
C pneumo
N gonorrhea
C diphtheria
A haemolyticum
120
Q

Common causes of viral pharyngitis

A 
Adeno
Coxsackie
EBV
HSV
Cytomegalo
HIV
121
Q

What microbes cause Traveler’s Diarrhea

A 
Shigella
Salmonella
Campylobacter
V Cholerae
EIEC, EHEC, EPEC, ETEC

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