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Course 5: Lab Studies Flashcards

1
Q

Complete Blood Count (CBC):

4 components

A

WBC (white blood cells)
Hgb (hemoglobin)
Hct (hematocrit)
Plt (platelets)

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2
Q

Complete Blood Count (CBC):

4 components, abnormal level (assoc dx)

A

WBC (white blood cells), high (leukocytosis)
Hgb (hemoglobin), low
Hct (hematocrit), low
Plt (platelets), low (thrombocytopenia)

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3
Q

Complete Blood Count (CBC):

4 components, abnormal level (assoc dx), significance

A

WBC (white blood cells), high (leukocytosis), infection
Hgb (hemoglobin), low, anemia
Hct (hematocrit), low, anemia
Plt (platelets), low (thrombocytopenia), prone to bleeding

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4
Q

Differential - CBC with Diff:

5 components + CBC

A 
Bands (band cells)
Segs (segmented neutrophils)
Lymphs (lymphocytes)
Monos (monocytes)
Eos (eosinophils)
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5
Q

Differential - CBC with Diff:

5 components + CBC, abnormal level (assoc dx)

A 
Bands (band cells), high (bandemia)
Segs (segmented neutrophils), high (left shift)
Lymphs (lymphocytes), high
Monos (monocytes), high
Eos (eosinophils), high
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6
Q

Differential - CBC with Diff:

5 components + CBC, abnormal level (assoc dx), significance

A

Bands (band cells), high (bandemia), serious infection
Segs (segmented neutrophils), high (left shift), acute infection
Lymphs (lymphocytes), high, viral infection
Monos (monocytes), high, bacterial infection
Eos (eosinophils), high, parasitic infection

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7
Q

Basic Metabolic Panel (BMP):

7 components

A 
Na (sodium)
K (potassium)
BUN (blood urea nitrogen)
Creat (creatinine)
Gluc (glucose)
HCO3 (bicarbonate)
Cl- (chloride)
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8
Q

Basic Metabolic Panel (BMP):

7 components, abnormal level (assoc dx)

A

Na (sodium), high (hypernatremia)/low (hyponatremia)
K (potassium), high (hyperkalemia)/low (hypokalemia)
BUN (blood urea nitrogen), high
Creat (creatinine), high
Gluc (glucose), high (hyperglycemia)/ low (hypoglycemia)
HCO3 (bicarbonate), high (hypercarbia)/low (hypocarbia)
Cl- (chloride), high (hyperchloremia)

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9
Q

Basic Metabolic Panel (BMP):

7 components, abnormal level (assoc dx), significance

A

Na (sodium), high (hypernatremia)/low (hyponatremia), dehydration
K (potassium), high (hyperkalemia)/low (hypokalemia), high (poor kidney function) / low (may cause arrhythmias)
BUN (blood urea nitrogen), high, renal insufficiency or failure
Creat (creatinine), high, renal insufficiency or failure
Gluc (glucose), high (hyperglycemia)/ low (hypoglycemia), high blood sugar/ low blood sugar
HCO3 (bicarbonate), high (hypercarbia)/low (hypocarbia), high (possible respiratory disease)/low (hyperventilation, pos DKA)
Cl- (chloride), high (hyperchloremia), possible dehydration

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10
Q

Comprehensive Metabolic Panel (CMP):

5 components + BMP

A 
T Prot/Alb (total protein/albumin)
T bili (total bilirubin)
AST (SGOT) (aspartate transaminase) -LFT
ALT (SGPT) (alanine transaminase) -LFT
Alk Phos (alkaline phosphatase) -LFT
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11
Q

Comprehensive Metabolic Panel (CMP):

5 components + BMP, abnormal level,

A 
T Prot/Alb (total protein/albumin), low
T bili (total bilirubin), high 
AST (SGOT) (aspartate transaminase), high 
ALT (SGPT) (alanine transaminase), high
Alk Phos (alkaline phosphatase), high
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12
Q

Comprehensive Metabolic Panel (CMP):

5 components + BMP, abnormal level, significance

A

T Prot/Alb (total protein/albumin), low, poor nutrition
T bili (total bilirubin), high, jaundice/liver failure
AST (SGOT) (aspartate transaminase), high, liver damage
ALT (SGPT) (alanine transaminase), high, liver damage
Alk Phos (alkaline phosphatase), high, liver damage

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13
Q

Cardiac Enzyme Panel (CEP):

5 components

A 
Trop (troponin)
CK (creatine kinase)
CK-MB (creatine kinase- muscle breakdown)
CK-RI (creatine kinase relative index)
Myo (myoglobin)
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14
Q

Cardiac Enzyme Panel (CEP):

5 components, abnormal level

A

Trop (troponin), high
CK (creatine kinase), high
CK-MB (creatine kinase- muscle breakdown), high
CK-RI (creatine kinase relative index), high
Myo (myoglobin), high

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15
Q

Cardiac Enzyme Panel (CEP):

5 components, abnormal level, significance

A

Trop (troponin), high, specific to heart damage
CK (creatine kinase), high, heart damage or rhabdomyolysis
CK-MB (creatine kinase- muscle breakdown), high, heart damage
CK-RI (creatine kinase relative index), high, heart damage
Myo (myoglobin), high, heart damage

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16
Q

D-Dimer

A

negative (rule out PE)

positive or high (must receive CTA chest, VQ scan to rule out)

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17
Q

BNP (B-type natriuretic peptide)

A

abnormal high, CHF

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18
Q

ABG (arterial blood gas)

A

low pH, acidosis
high/low bicarb, metabolic problem
high/low pCO2, respiratory problem
low pO2, hypoxia

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19
Q

VBG (venous blood gas)

A

low pH, acidosis

high pH, alkalosis

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20
Q

The Cardiac Order Set:

7 components

A

CBC, BMP, CK, CK-MB, Trop, EKG, CXR

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21
Q

CSF Analysis:

5 components, abnormal level, significance

A

CSF Gluc, low, possible bacterial meningitis
CSF Prot, high, possible meningitis
CSF RBC, >0 in Tube 4, subarachnoid hemorrhage (brain bleed)
CSF WBC, >3 in Tube 4, possible meningitis
CSF Gram Stain, positive bacteria, likely bacterial meningitis

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22
Q

CSF Analysis Details:

How many tubes are obtained? Why?

A

4 tubes of CSF during a LP; because if abnormal results only seen in two tubes (contamination), if in all four tubes, then results are valid.

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23
Q

COAGS - Coagulation Studies and Coumadin Levels

3 components

A

PT (prothrombin time)
INR (international normalized ratio)
PTT (partial thromboplastin time)

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24
Q

COAGS - Coagulation Studies and Coumadin Levels

3 components, abnormal level (assoc dx)

A

PT (prothrombin time), high

INR (international normalized ratio), >3.0 (supertherapeutic)/

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25
COAGS - Coagulation Studies and Coumadin Levels | 3 components, abnormal level (assoc dx), significance
PT (prothrombin time), high, blood too thin | INR (international normalized ratio), >3.0 (supertherapeutic)/
26
COAGS Details: PT v INR? What is the INR?
PT and INR are the same test; just two different representations of the results. They're ordered as "PT/INR". The INR is an adjusted PT value accounting for differences between patients. It is normalized so that the INR=1.0 for every pt that is not on Coumadin. NORMAL INR= 1.0
27
Strep
- Rapid Strep Test | if positive, step throat
28
Monospot
- Mononucleosis Test | if positive, mononucleosis
29
Influenza A + B
if positive, "the flu"
30
RSV
- respiratory syncytial virus | if positive, likely bronchiolitis
31
Lip
- lipase high, specific to pancreatitis (the more common test)
32
Amy
- amylase | high, possible pancreatitis
33
Thyroid Labs: | 3 components
TSH (thyroid stimulating hormone), high/low, pos hypothyroidism/hyperthyroidism T3 (triiodothyronine), low, hypothyroidism T4 (thyroxine), low, hypothyroidism
34
TSH Lab - why opposite result for abnml levels?
high - pos hypothyroidism low - pos hyperthyroidism Because it is a negative feedback system. Increased levels shut down the precursor.
35
Inflammation Labs: | 2 components, abnormal level, significance
CRP (C-Reactive Protein), high, active inflammation | ESR or Sed Rate (Erythrocyte sedimentation rate), high, active inflammation
36
OB/GYN Labs (5)
HCG, Serum HCG Qual, Serum HCG Quant, T+S/ABORh, T+X
37
HCG
Urine beta-HCG positive, pregnant negative, not pregnant
38
Serum HCG Qual
Serum beta-HCG Qualitative positive, pregnant negative, not pregnant
39
Serum HCG Quant
Serum beta-HCG Quantitative higher, further along in pregnancy unchanged/lower, failed pregnancy
40
T+S/ABORh
Type and Screen/Blood Type | Rh Neg, needs RhoGAM shot if pregnant
41
T+X
Type and Cross | possible blood transfusion
42
Wet Prep
Vaginal Wet Mount abnormal: many clue cells, bacterial vaginosis (BV) many trichomonas, trichomonas (STD) many yeast, vaginal yeast infection
43
GC
Gonococcus | positive, gonorrhea, will call pt with results
44
CT
Chlamydia Trachomatis | positive, chlamydia, will call pt with results
45
Genital Cx
Genital Culture | positive growth, pending results: ED will call if Cx is pos.
46
Urine Dip: | 4 components
Leuks (leukocyte esterase) Nit (nitrite Gluc Blo (blood) Done at bedside. If dip is abnormal, will get sent for UA and UCx
47
Urine Dip: | 4 components, abnormal level (assoc dx), significance
Leuks (leukocyte esterase), positive, likely UTI Nit (nitrite), positive, UTI Gluc, positive (glycosuria), high blood sugar (DM) Blo (blood), positive (hematuria), kidney stone v UTI (further analysis) Done at bedside. If dip is abnormal, will get sent for UA and UCx
48
UA: | 4 components
WBC RBC Back Epi (epithelial cells)
49
UA: | 4 components, abnormal level (assoc dx), significance
WBC, >6 (pyruia), UTI RBC, >6 (hematuria), UTI v kidney stone Bact, many, UTI Epi (epithelial cells), many, contaminated sample
50
Sepsis Labs (3) with abnormal results
CBC, high WBC (leukocytosis) or high bands (bandemia), possible sepsis Lactate (Lactic Acid), high, sepsis or cell death in the body Blood Cx, pos growth, definitive sepsis
51
Sepsis Next Steps
Physician needs to know source of infection. Will order CXR (r/o PNA), UA (r/o UTI), LP (r/o meningitis). Box ordered to diagnose type of sepsis and what abx bact sensitive to.
52
BCx
Blood culture | pos growth, sepsis
53
UCx
pos growth, UTI
54
Wound Cx
results pending
55
Stool Cx
results pending
56
Toxicology Labs (4)
ASA (serum, acetylsalicylic acid), APAP (serum, acetaminophen), EtOH (serum ethanol, alcohol), UTox (urine drug screen)
57
ASA
ASA (serum, acetylsalicylic acid) | high, toxic ASA level
58
APAP
APAP (serum, acetaminophen) | high, toxic Tylenol level
59
EtOH
EtOH (serum ethanol, alcohol) | high, alcohol intoxication
60
UTox
UTox (urine drug screen) | pos for opiates, cannabinoids, cocaine, methamphetamines, PCP, drug abuse
61
Ketones
Serum Ketones, large, likely DKA
62
Accu-chek
Finger stick blood glucose (FSBG), less than 80mg/more than 110 mg, low or high blood sugar
63
Medication Levels: Dilantin
Serum phenytoin, low, sub therapeutic; at risk for sz
64
Medication Levels: INR
Coumadin level, low/high, sub therapeutic/at risk for clots, super therapeutic/risk for bleed
65
Medication Levels: Dig
Digoxin, low, sub therapeutic, at risk for Afib
66
Medication Levels: Tegretol
Serum carbamazepine, low, sub therapeutic/at risk for sz
67
Medication Levels: Keppra
Serum Keppra, low, sub therapeutic, at risk for sz
68
Medication Levels: Depakote
Serum valproic acid, low, sub therapeutic/at risk for sz
69
Medication Levels: Neurontin
serum gabapentin, low, sub therapeutic/at risk for sz
70
3 Labs for Efficiency
D-Dimer, Trop, Creat (Creatinine - from BMP) **rate timing steps** Carefully track and frequently check!
71
3 Labs for Efficiency and RESULTS
D-Dimer, high, must order CTA or VQ scan (but first Creat before CTA) Trop, high, acute MI: give ASA, NTG, beta blocker, heparin Creat, >1.4, assesses kidney function. Creatinine must be obtained prior to order CT with IV contrast due to IV contrast stressing kidneys. Any pt with >1.4 cannot receive IV contrast.
72
Hemolyzed Samples
If something is done incorrectly, the blood may hemolyze (blood cells have broken down which may skew results). Nurse must re-draw blood and send another sample. ALERT PHYS ASAP if results as hemolyzed.
73
CBC with Diff: What is it used to assess?
infection (WBC) or anemia (Hgb and Hct = H&H)
74
BMP: What is it used to assess?
electrolytes (Na + K), renal function (BUN + Creat), glucose
75
CMP: What is it used to assess?
BMP + LFTs (liver function)
76
Trop: What is it used to assess?
acute MI (if high)
77
uDip + UA: What is it used to assess?
UTI or blood (possible kidney stone)
78
BNP: What is it used to assess?
acute CHF (if high)
79
Coags (PT/INR/PTT): What is it used to assess?
risk for bleeding (if high)
80
ABG: What is it used to assess?
respiratory function (hypoxia?)
81
D-Dimer: What is it used to assess?
possible blood clot (if high, need Creat for CTA chest)
82
CXR: Potential Findings?
PNA, PTX, Dissection, Pleural effusion, CHF
83
AAS/KUB : Potential Findings? | acute abdominal series/ kidneys ureters bladder
Free air (rupture), SBO, constipation, large kidney stones
84
Xray v CT readings?
XR can be interpreted by ED physician. | CT and US must be interpreted separately by a specialized radiologist.
85
CT Scans
CT w/o CT without IV Contrast "Dry CT" CTA, CT w/ CT Angiogram CT with IV Contrast CT A/P w/ PO CT Abd/Pelvis with PO Contrast
86
CT w/o CT without IV Contrast "Dry CT"
CT Head: Large Hemorrhagic or ischemic CVA CT C-Spine/ T-Spine/L-Spine: Cervical/ Thoracic/Lumbar spine fx or subluxation (partial dissolution) CT Chest: PNA, PTX, Pleural effusion, rib fracture CT Abd/Pel: Kidney Stones. Pyelonephritis.
87
CTA, CT w/ CT Angiogram CT with IV Contrast
CTA Chest: PE, Aortic Dissection CTA Head: Hemorrhagic CVA. Ischemic CVA CTA Neck: Cartoid dissection. Carotid occlusion.
88
CT A/P w/ PO | CT Abd/Pelvis with PO Contrast
APPY, SBO, Diverticulitis, Ischemic Gut
89
US Doppler LE
DVT
90
US RUQ
Cholelithiasis, Cholecystitis, Bile sludge, Gallbladder wall thickening, Bile duct obstruction.
91
US OB/Transvag/Pelvis
Intrauterine Pregnancy (IUP), Ectopic pregnancy. Ovarian cyst, ovarian torsion.
92
US Scrotum
testicular torsion, testicular mass
93
How US Works
High freq sound waves to generate real-time images. | Investigate "flow" over time. Take longer to complete.
94
ED Procedures Documentation
"Discussed risks, benefits, alternatives. Consent obtained. Time-out performed."

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