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Scribe Training > Course 5: Lab Studies > Flashcards

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
Q

COAGS - Coagulation Studies and Coumadin Levels

3 components, abnormal level (assoc dx), significance

A

PT (prothrombin time), high, blood too thin

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

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26
Q

COAGS Details:
PT v INR?
What is the INR?

A

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

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27
Q

Strep

A
  • Rapid Strep Test

if positive, step throat

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28
Q

Monospot

A
  • Mononucleosis Test

if positive, mononucleosis

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29
Q

Influenza A + B

A

if positive, “the flu”

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30
Q

RSV

A
  • respiratory syncytial virus

if positive, likely bronchiolitis

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31
Q

Lip

A
  • lipase
    high, specific to pancreatitis
    (the more common test)
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32
Q

Amy

A
  • amylase

high, possible pancreatitis

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33
Q

Thyroid Labs:

3 components

A

TSH (thyroid stimulating hormone), high/low, pos hypothyroidism/hyperthyroidism
T3 (triiodothyronine), low, hypothyroidism
T4 (thyroxine), low, hypothyroidism

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34
Q

TSH Lab - why opposite result for abnml levels?

A

high - pos hypothyroidism
low - pos hyperthyroidism

Because it is a negative feedback system. Increased levels shut down the precursor.

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35
Q

Inflammation Labs:

2 components, abnormal level, significance

A

CRP (C-Reactive Protein), high, active inflammation

ESR or Sed Rate (Erythrocyte sedimentation rate), high, active inflammation

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36
Q

OB/GYN Labs (5)

A

HCG, Serum HCG Qual, Serum HCG Quant, T+S/ABORh, T+X

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37
Q

HCG

A

Urine beta-HCG
positive, pregnant
negative, not pregnant

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38
Q

Serum HCG Qual

A

Serum beta-HCG Qualitative
positive, pregnant
negative, not pregnant

39
Q

Serum HCG Quant

A

Serum beta-HCG Quantitative
higher, further along in pregnancy
unchanged/lower, failed pregnancy

40
Q

T+S/ABORh

A

Type and Screen/Blood Type

Rh Neg, needs RhoGAM shot if pregnant

41
Q

T+X

A

Type and Cross

possible blood transfusion

42
Q

Wet Prep

A

Vaginal Wet Mount

abnormal:
many clue cells, bacterial vaginosis (BV)
many trichomonas, trichomonas (STD)
many yeast, vaginal yeast infection

43
Q

GC

A

Gonococcus

positive, gonorrhea, will call pt with results

44
Q

CT

A

Chlamydia Trachomatis

positive, chlamydia, will call pt with results

45
Q

Genital Cx

A

Genital Culture

positive growth, pending results: ED will call if Cx is pos.

46
Q

Urine Dip:

4 components

A

Leuks (leukocyte esterase)
Nit (nitrite
Gluc
Blo (blood)

Done at bedside. If dip is abnormal, will get sent for UA and UCx

47
Q

Urine Dip:

4 components, abnormal level (assoc dx), significance

A

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
Q

UA:

4 components

A

WBC
RBC
Back
Epi (epithelial cells)

49
Q

UA:

4 components, abnormal level (assoc dx), significance

A

WBC, >6 (pyruia), UTI
RBC, >6 (hematuria), UTI v kidney stone
Bact, many, UTI
Epi (epithelial cells), many, contaminated sample

50
Q

Sepsis Labs (3) with abnormal results

A

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
Q

Sepsis Next Steps

A

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
Q

BCx

A

Blood culture

pos growth, sepsis

53
Q

UCx

A

pos growth, UTI

54
Q

Wound Cx

A

results pending

55
Q

Stool Cx

A

results pending

56
Q

Toxicology Labs (4)

A

ASA (serum, acetylsalicylic acid), APAP (serum, acetaminophen), EtOH (serum ethanol, alcohol), UTox (urine drug screen)

57
Q

ASA

A

ASA (serum, acetylsalicylic acid)

high, toxic ASA level

58
Q

APAP

A

APAP (serum, acetaminophen)

high, toxic Tylenol level

59
Q

EtOH

A

EtOH (serum ethanol, alcohol)

high, alcohol intoxication

60
Q

UTox

A

UTox (urine drug screen)

pos for opiates, cannabinoids, cocaine, methamphetamines, PCP, drug abuse

61
Q

Ketones

A

Serum Ketones, large, likely DKA

62
Q

Accu-chek

A

Finger stick blood glucose (FSBG), less than 80mg/more than 110 mg, low or high blood sugar

63
Q

Medication Levels: Dilantin

A

Serum phenytoin, low, sub therapeutic; at risk for sz

64
Q

Medication Levels: INR

A

Coumadin level, low/high, sub therapeutic/at risk for clots, super therapeutic/risk for bleed

65
Q

Medication Levels: Dig

A

Digoxin, low, sub therapeutic, at risk for Afib

66
Q

Medication Levels: Tegretol

A

Serum carbamazepine, low, sub therapeutic/at risk for sz

67
Q

Medication Levels: Keppra

A

Serum Keppra, low, sub therapeutic, at risk for sz

68
Q

Medication Levels: Depakote

A

Serum valproic acid, low, sub therapeutic/at risk for sz

69
Q

Medication Levels: Neurontin

A

serum gabapentin, low, sub therapeutic/at risk for sz

70
Q

3 Labs for Efficiency

A

D-Dimer, Trop, Creat (Creatinine - from BMP)

rate timing steps
Carefully track and frequently check!

71
Q

3 Labs for Efficiency and RESULTS

A

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
Q

Hemolyzed Samples

A

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
Q

CBC with Diff: What is it used to assess?

A

infection (WBC) or anemia (Hgb and Hct = H&H)

74
Q

BMP: What is it used to assess?

A

electrolytes (Na + K), renal function (BUN + Creat), glucose

75
Q

CMP: What is it used to assess?

A

BMP + LFTs (liver function)

76
Q

Trop: What is it used to assess?

A

acute MI (if high)

77
Q

uDip + UA: What is it used to assess?

A

UTI or blood (possible kidney stone)

78
Q

BNP: What is it used to assess?

A

acute CHF (if high)

79
Q

Coags (PT/INR/PTT): What is it used to assess?

A

risk for bleeding (if high)

80
Q

ABG: What is it used to assess?

A

respiratory function (hypoxia?)

81
Q

D-Dimer: What is it used to assess?

A

possible blood clot (if high, need Creat for CTA chest)

82
Q

CXR: Potential Findings?

A

PNA, PTX, Dissection, Pleural effusion, CHF

83
Q

AAS/KUB : Potential Findings?

acute abdominal series/ kidneys ureters bladder

A

Free air (rupture), SBO, constipation, large kidney stones

84
Q

Xray v CT readings?

A

XR can be interpreted by ED physician.

CT and US must be interpreted separately by a specialized radiologist.

85
Q

CT Scans

A

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
Q

CT w/o
CT without IV Contrast
“Dry CT”

A

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
Q

CTA, CT w/
CT Angiogram
CT with IV Contrast

A

CTA Chest: PE, Aortic Dissection
CTA Head: Hemorrhagic CVA. Ischemic CVA
CTA Neck: Cartoid dissection. Carotid occlusion.

88
Q

CT A/P w/ PO

CT Abd/Pelvis with PO Contrast

A

APPY, SBO, Diverticulitis, Ischemic Gut

89
Q

US Doppler LE

A

DVT

90
Q

US RUQ

A

Cholelithiasis, Cholecystitis, Bile sludge, Gallbladder wall thickening, Bile duct obstruction.

91
Q

US OB/Transvag/Pelvis

A

Intrauterine Pregnancy (IUP), Ectopic pregnancy. Ovarian cyst, ovarian torsion.

92
Q

US Scrotum

A

testicular torsion, testicular mass

93
Q

How US Works

A

High freq sound waves to generate real-time images.

Investigate “flow” over time. Take longer to complete.

94
Q

ED Procedures Documentation

A

“Discussed risks, benefits, alternatives. Consent obtained. Time-out performed.”

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