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Foundations of Medicine PA S1 > Common Lab Tests > Flashcards

Common Lab Tests Flashcards

1
Q

Basic Urinalysis (dipstick)

A

basic urinalysis can give/tell you info about:
- color
- specific gravity
- pH
- heme/blood
- albumin/protein
- urinary glucose
- ketones
- nitrite
- leukocyte esterase
- bilirubin
- urobilinogen

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2
Q

Urine Color: Normal

A

pale yellow (straw) to amber (in between)

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3
Q

Urine Color: Straw

A

normal but low specific gravity (ex: hydrated)

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4
Q

Urine Color: Amber

A

normal but high specific gravity (ex: dehydrated)

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5
Q

Urine Color: Colorless

A

common meaning:
- large fluid intake
- untreated DM
- diabetes insipidus
- alcohol
other:
- reduction of perspiration
- chronic interstitial nephritis
- nervousness

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6
Q

Urine Color: Orange

A

common meaning:
- dehydration/restricted fluid intake
- concentrated urine
- fever
-medications (Pyridium/AZO)
other:
- excess sweating
- small quantity of bile
- medications (sulfasalazine (GI))

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7
Q

Urine Color: Bright Yellow (neon)

A

result of B vitamin intake

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8
Q

Urine Color: Brownish/Greenish Yellow

A

result of bilirubin increase in urine

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9
Q

Urine Color: Reddish/Dark Brown

A

due to:
- blood
- hemoglobin
- myoglobin
- porphyria (metabolic dz)
- meds: cascara/Senna (laxative)
- foods: beets, blackberries, rhubarb

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10
Q

Urine Color: Milky

A

due to fat, pus, or WBC

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11
Q

Urine Color: Purple

A

due to:
- porphyria
- Purple Urine Bag Syndrome (Cath + infection)

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12
Q

Urine Color: Green

A

due to:
-medications
-food dye

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13
Q

Urine Color: Brown-Black

A

due to:
- hemoglobin
-Lysol poisoning
-Melanin

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14
Q

Urine Color: Black

A

due to:
- Alkaptonuria (metabolic disease)

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15
Q

Normal Urine Specific Gravity (SG)

A

1.0003-1.035

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16
Q

Concentrated Urine SG

A

1.025-1.030+

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17
Q

Diluted Urine SG

A

1.001-1.010

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18
Q

Infants (<2) Urine SG

A

1.001-1.018

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19
Q

High Specific Gravity

A

clinical implications:
- dehydration**
- DM
- fever
- vomiting
- diarrhea
- increase in ADH (antidiuretic hormone)

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20
Q

Low Specific Gravity

A

clinical implications:
- diabetes insipidus**
- decrease in antidiuretic hormone (ADH)
- glomerulonephritis
- severe renal damage

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21
Q

Urine pH

A

Average Range: 4.6-8 (6.0)
- low pH: acidic
- high pH: basic/alkaline

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22
Q

Acidic Urine Implications

A
  • uncontrolled DM (ketoacidosis)
  • some kidney stones
  • emphysema
  • diarrhea
  • starvation
  • dehydration
  • diet high in protein
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23
Q

Alkaline Urine Implications

A
  • UTI (some bacterial strains)**
  • aspirin intoxication
  • kidney problems
  • diet high in fruits and veggies
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24
Q

Fruity Urine Odor

A

DM (ketosis)

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25
Q

Foul Urine Odor

A

bacteria

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26
Q

Other Urine Odors

A

can indicate metabolic diseases
- ex: maple syrup urine disease

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27
Q

Hematuria

A

blood in urine
- normal value in urine is NONE
- can be found through UA (dipstick) and microscope testing

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28
Q

False Positive for Hematuria

A
  • menstrual blood
  • concentrated urine
  • vigorous exercise
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29
Q

False Negative for Hematuria

A

vitamin C

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30
Q

Clinical Implications of + Blood in UA

A

COMMON:
- lower UTI**
- nephrolithiasis**
- urinary tract cancers**
- renal cancers**
- urinary catheter (trauma)**
- anticoagulants**
- strenuous exercise**
Other:
- Hemophilia
- Lupus
- Glomerulonephritis
- Heavy Smokers

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31
Q

Proteinuria

A

increased protein in urine
**the presence of protein in urine is the single most important indication of renal (kidney) disease, even in a very healthy person, if persistent
- can be mild, moderate, or severe

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32
Q

Clinical Implications of Proteinuria

A
  • various kidney diseases (DM)**
  • chronic urinary tract obstruction
  • malignant hypertension
  • fever
    -trauma
  • Lupus (can affect kidneys)
  • poisoning
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33
Q

False Positive for Proteinuria

A

numerous WBCs/epithelial cells in sample

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34
Q

Glucosuria/Glycosuria

A

increased urinary glucose
- normal value of glucose in urine is NONE

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35
Q

Clinical Implications of Glucosuria

A
  • DM** (+ glucose urine test = evaluation for DM)
  • pituitary diseases/brain injury
  • various kidney diseases
    **+ glucose is NOT always abnormal:
  • could be due to a large meal OR emotional stress
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36
Q

False Negatives with Glucosuria

A
  • increased Vitamin C in diet
  • high presence of ketones
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37
Q

Ketonuria

A

increased presence of urinary ketones in urine
- normal value us NONE

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38
Q

Clinical Implications of Ketonuria

A
  • DM (ketoacidosis)**
  • starvation/fasting**
  • high fat diets (keto)
  • low carb diet
  • prolonged vomiting
  • fever
    -anorexia
  • pregnancy/lactation
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39
Q

False Positives of Ketonuria

A
  • dehydration**
  • medications
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40
Q

Nitrites in Urine

A

some bacteria convert nitrate into nitrite, so nitrites in urine often indicate infection
- normal value of nitrite is NONE

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41
Q

Nitrite Accuracy in Infection

A

nitrites in the urine can come back negative during an infection if:
- patient is urinating frequently
- infection w/organisms that do not change nitrate to nitrite
- diet low in nitrates

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42
Q

False Positives with Nitrites in urine

A
  • Pyridium/AZO**
  • contamination
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43
Q

False Negatives with Nitrites in Urine

A

vitamin C

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44
Q

Leukocyte Esterase (LE) in Urine

A

LE is an enzyme in WBC’s
- normal amount in urine should be negative

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45
Q

Clinical Implications of LE in urine

A
  • UTI**
  • sterile pyuria
    **+ reading indicates pyuria and should be evaluated microscopically
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46
Q

False Positives w/LE in Urine

A
  • vaginal discharge**
  • trichomonas
  • parasites
  • contamination of sample**
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47
Q

False Negative w/LE in Urine

A
  • pyridium/AZO**
  • vitamin C
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48
Q

Urinary Bilirubin

A

Normal range for bilirubin in urine is: 0-0.02 mg/dL

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49
Q

Clinical Implications of Increased Bilirubin in Urine

A

THINK LIVER
- hepatitis
- infection or toxic agents
- obstructive biliary tract diseases
always investigate increase in this protein

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50
Q

Interfering Factors w/Bilirubin in Urine

A
  • false positive: Pyridium/AZO
  • false negative: Vitamin C
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51
Q

Urobilinogen in Urine

A

normal range: 0.1-1.0 mg/dL

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52
Q

Increased Urobilinogen in Urine

A

indicates:
- liver disease**
- hemolysis

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53
Q

Decreased Urobilinogen in Urine

A

indicates:
- biliary obstruction (ex: gallstones, pancreatic cancer)
- antibiotic therapy

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54
Q

Urine Test Specimen Handling

A

test within ONE HOUR or refrigerate specimen otherwise:
- glucose levels may drop
- ketones may dissipate
- color will deepen
- urinary sediment will deteriorate
- bacteria will multiple
- pH will become more alkaline/basic
- bilirubin and urobilinogen may be oxidized

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55
Q

Urine Microscopic Analysis Can…

A

Test for:
- bacteria
- WBCs
- RBCs
- crystals
- Casts (CASTS=KIDNEYS)**
-> red cell
-> white cell
-> others: fatty, hyaline, granular, renal tubular epithelial cell

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56
Q

Urine Microscopy: Bacteria

A
  • 20 or more bacteria/HPF may indicate UTI
  • if nitrite positive too, reliable indicator of infection
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57
Q

Urine Microscopy: WBCs

A
  • usually indicates UTI or injury (5 or more per HPF)
    causes:
  • UTI**
  • stones**
  • cancer**
  • inflammation**
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58
Q

HPF

A

high power field (microscopy)

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59
Q

Interfering Factors w/WBCs in Urine

A

-vaginal discharge
-trichomonas
-parasites
-heavy mucous discharge

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60
Q

Urine Microscopy: RBCs

A

significant if 2 or more RBCs/HPF
indicates:
- UTI**
- renal cancer**
- bladder cancer**
- kidney stones**

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61
Q

Urine Microscopy: Epithelial Cells

A

presence of squamous epithelial cells indicates contamination of sample

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62
Q

Urine Microscopy: Red Blood Cell Casts

A

indicates hemorrhage and always pathologic
- Glomerulonephritis**
- Renal infarction
- Lupus
- Others

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63
Q

Urine Microscopy: White Bood Cell Casts

A

come from kidney tubules and indicate renal parenchymal disease…
…may indicate:
- pyelonephritis
- glomerulonephritis
- other kidney disease

64
Q

Urine Microscopy: Crystals

A

crystals are microscopic and can indicate many things based on the type; stones are visible to the eye in comparison to crystals

65
Q

Uric Acid

A

acidic urine, normal or indication of kidney stones

66
Q

Oxalate

A

acidic urine, normal or indication of kidney stones

67
Q

Phosphate

A

alkaline urine, normal or indication of kidney stones

68
Q

Cystine

A

acidic urine, PATHOLOGIC!!

69
Q

Complete Blood Count (CBC) Test

A

performed on whole blood in a lavender/purple tube, which contains EDTA (prevents blood from clotting)
can quantify:
- WBCs
- RBCs
- platelets
- hemoglobin
- hematocrit

70
Q

Interfering Factors w/CBC Test

A
  • physiologic stress can alter/influence results
  • natural body rhythms can cause fluctuation
  • dehydration/overhydration can alter values
  • fasting is not necessary but fat-laden meals may alter some results
71
Q

WBC Normal Range in Blood

A

4,000-11,000 per microliter

72
Q

Leukocytes

A

term for WBCs as a whole

73
Q

Leukocytosis

A

increased WBCs
- WBC count above 11,000 per microliter
- usually a result of increase in just one type of WBC
- often a result of acute infection (or inflammation)**
-> but can also be indication of hemorrhage, leukemia, trauma, etc.

74
Q

Leukopenia

A

decreased WBCs
- WBC count below 4,000 per microliter
causes include:
- viral infections **
- some bacterial infections
- BAD infections (sepsis)**
- meds that suppress bone marrow
- bone marrow disorders (leukemia)

75
Q

5 Different WBCs

A
  1. Neutrophils
  2. Lymphocytes
  3. Eosinophils
  4. Monocytes
  5. Basophils
76
Q

How High WBC Count Depends On:

A
  • severity of infection
  • patient’s age
  • bone marrow efficiency/immune system
77
Q

Neutrophils

A

most numerous WBC** and primary defense against microbial invasion
- are PMNs (polymorphonuclear neutrophils)

78
Q

Neutrophilia

A

increased neutrophils in blood
pathologic causes:
- bacterial infection**
- inflammation**
- hemorrhage
- tissue damage
- leukemia
- heart attack (MI)
non-pathologic causes:
- stress/exercise
- steroids (prednisone)**
- exposure to temperature extremes

79
Q

Neutropenia

A

decreased neutrophils in blood
causes:
- overwhelming bacterial infection (sepsis)**
- viral infection**
- drugs (ex: chemo)
- blood diseases (ex: leukemia)
also know: some elderly patients can have lower neutrophil counts in general

80
Q

Lymphocytes

A

type of WBC that is a part of immune system
- made in bone marrow and plays role in immune response
- migrates to areas of inflammation
3 Types:
1. B Cells
2. T Cells
3. Natural Killer (NK) Cells

81
Q

Lymphocytosis

A

increase in lymphocytes in blood
causes:
- infections
- mononucleosis (viral infection)**
- measles
- mumps
-varicella
- types of leukemia
- lymphoma

82
Q

Lymphopenia

A

decrease in lymphocytes
causes:
- chemo and radiation**
- AIDS**
- bone marrow disorders
- heart failure
- renal failure

83
Q

Eosinophils

A

type of WBC that fights disease and contains granules
- bilobed nuclei (also a PMN)
- chemicals in granules are toxic to invaders AND host cells

84
Q

What can affect eosinophil count?

A
  • time of day (low in morning, rises after noon)
  • burns
  • post-surgery
85
Q

Eosinophilia

A

increased eosinophils in blood
causes:
- allergies
- asthma
- parasitic/tapeworm diseases
- medications
- some skin problems (eczema)
“Wheezes, sneezes, and weird diseases”

86
Q

Eosinopenia

A

decreased eosinophils in blood
causes:
- medications
- early bacterial infection

87
Q

Basophils

A

type of WBC that works w/immune system to defend body from allergens, pathogens, and parasites
- have granules that obscure the nucleus
- granules produce histamine and other substances
- are PMNs
- usually not seen in blood at all

88
Q

Basophilia

A

increased basophils in blood
causes:
- inflammation like: allergies**, bowel diseases
- bone marrow problems: leukemia/lymphoma
- some infections (ex: varicella/chicken pox)

89
Q

Basopenia

A

decreased basophil levels detectable
causes:
- acute phase of infection
- following prolonged steroid therapy

90
Q

Monocytes

A

type of WBC that resides in blood to find and destroy germs and eliminate infected cells
- big cells w/big nuclei
- second line of defense against infection

91
Q

Monocytosis

A

increased monocytes in blood
causes:
- infections (TB, parasites, ticks, etc.) and recovery**
- bone marrow/blood cancers
- some GI disorders (w/inflammation in intestines)

92
Q

Monocytopenia

A

decreased monocytes in blood
causes:
- prednisone treatment
- HIV infection

93
Q

Red Blood Cells (RBCs)

A

the most abundant blood cell in the bloodstream
- do not have nuclei
- carry oxygen to tissue and bring back CO2 to lungs (uses hemoglobin to do this)
- lifespan: ~120 days

94
Q

Normal Range for Red Blood Cells

A

Men: 4.6-6 x 10^6/mL
Women: 4.0-5.0 x 10^6/mL

95
Q

Erythrocytosis

A

Increased RBC count
causes:
- polycythemia vera**
- renal disease
- high altitude
- pulmonary disease
- cardiovascular disease
- tobacco use
- dehydration

96
Q

Erythrocytopenia

A

decreased RBC count
causes:
- anemia**
- bone marrow/blood cancers
- Lupus

97
Q

Hemoglobin (Hgb)

A

part of RBC that carries oxygen and CO2
- the initial test to check for anemia

98
Q

Normal Range for Hemoglobin

A

Female: 12.0-15.5 g/dL
Male: 13.6-17.5 g/dL
Panic values: <7

99
Q

Hematocrit (Hct)

A

the % of RBCs within the entire blood
- depends on number and size of RBCs

100
Q

Normal Range for Hct

A

Female: 35-45%
Male: 40-50%

101
Q

Hematocrit & Hemoglobin Calculation

A

Hct is approx 3x the Hgb
Hct = Hgb x 3

102
Q

Platelets

A

smallest of the formed cellular elements and mostly formed in bone marrow (some in spleen)
- play important role in blood clotting**, vasoconstriction, etc.

103
Q

Normal Range for Platelets

A

approx 150,000-450,000/mL

104
Q

Thrombocytosis

A

increased platelets in the blood
causes:
- cancer (leukemia)**
- trauma and exercise
- acute infections**
- iron deficiency anemia

105
Q

Thrombocytopenia

A

decreased platelets in blood
causes:
- some infections (viruses, bacteria, ticks)**
- ITP (idiopathic thrombocytopenia)
- other anemias
- liver disease (cirrhosis)**

106
Q

Basic Metabolic Panel (BMP)

A

gets levels for:
- Na+
- K+
- Cl-
- HCO3-
- BUN (Blood urea nitrogen)
- Creatinine
- Serum Glucose (“blood sugar”)
- Ca2+
BMP is performed on serum or plasma
- serum: gold tube that has gel that helps serum separate from other blood components
- plasma: light green tube w/heparin (anticoagulant) in it

107
Q

BMP Sodium (Na+)

A

sodium is the primary cation in extracellular fluid (outside cell)**
- normal range: 134-145 mEq/L

108
Q

Hypernatremia

A

increased serum Na+
- indicates a total water deficit in the body

109
Q

Hyponatremia

A

decreased serum Na+
- indicates a total water excess in the body

110
Q

BMP Potassium (K+)

A

potassium is the primary cation of intracellular fluid (inside cell)**
- changes in K+ can affect nerves, muscles, and the heart**
- if blood sample gets hemolyzed during collection, K+ leaves the cells and leads to a. falsely elevated K+ level

111
Q

Hyperkalemia

A

increased K+ in blood serum

112
Q

Hypokalemia

A

decreased K+ in blood serum

113
Q

BMP Chloride (Cl-)

A

chloride is the primary anion of the extracellular fluid
- typically goes hand-in-hand w/Na+

114
Q

Hypercholeremia

A

increased chloride in blood serum

115
Q

Hypocholeremia

A

decreased chloride in blood serum
- ex: increased sweating

116
Q

BMP Bicarbonate (HCO3-)

A

ion formed in kidneys that acts as a buffer when H+ is produced by metabolism of acids
- normal range: 22-26 mEq/L
- holds CO2 content

117
Q

Alkalosis

A

increased bicarbonate in blood serum

118
Q

Acidosis

A

decreased bicarbonate in blood serum

119
Q

BMP Blood Urea Nitrogen (BUN)

A

protein metabolism leads to ammonia production and then urea is synthesized in the liver
- normal range: 10-20 mg/dL

120
Q

Increased BUN Levels Indicates

A
  • kidney insufficiency**
  • urinary tract obstruction**
  • dehydration
  • increased protein ingestion
121
Q

Decreased BUN Levels Indicates

A
  • low protein diet**
  • starvation
  • cirrhosis
122
Q

BMP Creatinine

A

muscles metabolize creatine, which leads to creatinine production
- more muscle mass = more creatinine production
- normal range: <1.5 mg/dL but with some difference in range between men and women**

123
Q

Elevated Creatinine Indicates

A

decreased renal function**

124
Q

Decreased Creatinine Indicates

A

decreased muscle mass/cachexia

125
Q

Interfering Factors w/Creatinine Readings

A
  • Vit C/Cephalosporin can cause falsely elevated levels
  • A diet high in meat can cause an increased level
  • May be falsely decreased by bilirubin or high levels of glucoseBMP
126
Q

BMP Report - GFR

A

BMP results typically include a calculation of the GFR (glomerular filtration rate)
- indicates how well kidneys are working
- indicates how much blood is passing through glomeruli each minute
- calculation of GFR involves Scr, age, and sex

127
Q

Glomerular Filtration Rate (GFR)

A

rate at which blood is filtered each minute

128
Q

BMP Report - Anion Gap (AG)

A

BMP results typically include an anion gap (AG)
- formula: Anion Gap = Na - (Cl+HCO3)
- increased anion gap indicates type of acidosis
- decreased anion gap is very rare

129
Q

Anion Gap (AG)

A

difference between serum cations and anions
formula: Anion Gap = Na - (Cl + HCO3)

130
Q

BMP - Serum Glucose

A

glucose is a primary energy source for metabolism
- liver converts carbs to glucose
- excess glucose converted to glycogen in liver/muscle
- process needs insulin
- normal range of glucose in blood: 75-110 micrograms/dL

131
Q

Hyperglycemia

A

increased serum glucose
causes:
- diabetes**
- endocrine disorders
- severe infection**
- steroids**

132
Q

Hypoglycemia

A

decreased serum glucose
causes:
- endocrine disorders
- metabolic disorders
- meds (too much insulin)
- liver disease

133
Q

BMP Calcium (Ca2+)

A

normal range: 9.0-10.5 mg/dL

134
Q

Hypercalcemia

A

increased blood serum calcium
causes:
- heart problems**
- hyperparathyroidism (bone breakdown)**
- too much vitamin D**
- kidneys aren’t excreting Ca

135
Q

Hypocalcemia

A

decreased blood serum calcium
causes:
- muscle contractions**
- seizure**
- hypoparathyroidism**
- vitamin D deficiency**
- renal insufficiency**

136
Q

Hemoglobin A1c (Hgb A1c) Test

A

test that tells us the average blood sugar level of the past 6-12 weeks (avg lifespan of RBC)
- normal range: 3.8-6.4%
- elevated A1c of 6.5+ or more is diagnostic of DM**
- not accurate during pregnancy**, renal failure, or blood loss
- Hgb related diseases can increase or decrease Hgb A1c

137
Q

Serum Amylase Test

A

tests for a pancreatic enzyme
- enzyme normalizes faster than lipase

138
Q

Increased Serum Amylase Indicates

A
  • pancreatitis**
  • pancreatic obstruction
  • gallbladder inflammation
139
Q

Decreased Serum Amylase Indicates

A
  • pancreatic insufficiency**
  • liver disease
140
Q

Serum Lipase Test

A

tests for pancreatic enzyme Lipase
- Lipase stays elevated longer in pancreatitis than amylase

141
Q

Increased Lipase in Serum Indicates

A
  • pancreatitis**
  • pancreatic cancer
  • gallbladder inflammation
142
Q

Serum Aspartate Aminotransferase (AST) Test

A

tests for a liver enzyme
- although enzyme is also located in heart, muscle, kidney and a few other organs
- gets released when tissues are injured
- normal range: 9-40 U/L

143
Q

Increased AST Indicates:

A
  • liver problems**
  • heart attack (MI)
144
Q

Serum Alanine Aminotransferase (ALT) Test

A

tests for a liver enzyme that is primarily in lover but has small amounts in. muscles and heart
- also gets released when tissues are injured
- normal range: 0-35 U/L

145
Q

Increased ALT Indicates…

A

liver damage** (infections, meds, alcohol, cancer, etc)

146
Q

Serum Alkaline Phosphatase

A

looks for liver enzyme alkaline phosphatase
- present in many types of cells not just liver (includes bone, biliary tract, intestines, placenta, kidney)
- gets released when cells are destroyed OR during growth periods
- normal range: 30-120 U/L

147
Q

Increased Alkaline Phosphatase Indicates…

A
  • liver problems**
  • bone disorders
  • biliary tract disorders
148
Q

Decreased Alkaline Phosphatase Indicates…

A
  • osteoporosis**
  • some vitamin deficiencies
149
Q

Serum Bilirubin

A

bilirubin is conjugated in the liver and excreted in bile
- can also come from breakdown of RBCs

150
Q

Increased Bilirubin in Blood Indicates…

A
  • increased breakdown of RBCs (hemolysis)
  • certain liver and bile duct problems
151
Q

Decreased Bilirubin in Blood Indicates…

A

some types of anemia

152
Q

What is a CMP?

A

CMP = Comprehensive Metabolic Panel
tests for everyone on BMP plus:
- AST
- ALT
- Alk phos
- Bilirubin
- Total protein
- Albumin

153
Q

Serum Gamma-Glutamyl Transferase (GGT) Test

A

tests for liver enzyme GGT
- also found in kidney, prostate, and spleen
- levels are higher in male patients

154
Q

Increased GGT Indicates…

A

liver problems** (including alcoholism)

155
Q

Point of Care Testing (POCT)

A
  • relatively inexpensive tests
  • performed at “Point of Care (at/near bedside)
  • can be performed by non-lab personnel
  • gets results faster than non-POCT (less delay in treatment)
  • speed at the expense of accuracy
  • may need to do further confirmatory testing later
156
Q

Types of POC Tests

A
  • fingerstick glucose test
  • urine pregnancy test
  • rapid strep test
  • Hgb A1c
  • POC troponin (for diagnosis of MI)

Foundations of Medicine PA S1 (13 decks)

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