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abdominal viscera > CS5 lecture material > Flashcards

CS5 lecture material Flashcards

1
Q

the full blood count is an invaluable tool that measures…

the clinician should always rely on the reference ranges provided by…

A

several parameters of circulating blood cells

each pathology service provider

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2
Q

3 types of cells normally found in the blood are:

A

RBCs (erythrocytes)
WBCs (leukocytes)
platelets

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3
Q

3 main classes of leukocytes are:

A

granulocytes
monocytes
lymphocytes

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4
Q

3 types of granulocytes are:

3 types of lymphocytes are:

A

neutrophils, eosinophils and basophils

T-lymphocytes, B-lymphocytes and Natural Killer Cells

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5
Q

what cell is the body’s main circulating phagocyte?
what do monocytes become?
what type of lymphocyte produces antibodies?

A

neutrophils
macrophages
B-lymphocytes

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6
Q

list 3 conditions which may be indicated by abnormally low WBC numbers

list 3 conditions which may be indicated by abnormally high WBC numbers

A 
LOW WBC:
liver or spleen disorders
bone marrow disorders
exposure to radiation
exposure to toxic substances
some viral infections

HIGH WBC:
infection-causes a ‘left shift’ which means that an increased number of immature neutrophils are being produced
leukemia
inflammatory disease

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7
Q

what is meant by the term, a shift to the left?

A

increased amount of immature circulating neutrophils as a compensatory reaction to infection

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8
Q 
define the following terms:
reticulocyte count
hemoglobin
hematocrit (packed cell volume)
mean corpuscular (cell) volume
mean corpuscular (cell) hemoglobin 
mean corpuscle hemoglobin concentration
A

reticulocyte count-the number of immature RBCs in the blood
hemoglobin-the amount of hemoglobin in the blood
hematocrit (packed cell volume)-the percentage of RBCs as a proportion of total blood volume; 40-45%
mean corpuscle volume-average volume of RBCs; dependant on size
mean corpuscle hemoglobin-average amount of hemoglobin in RBCs
mean corpuscle hemoglobin concentration-average concentration of hemoglobin in RBCs

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9
Q 
list some pathologies associated with abnormal levels of:
Red cell count
packed cell volume
mean cell hemoglobin
mean cell hemoglobin concentration
A

RED CELL COUNT:
low=anemia, bone marrow failure, malnutrition e.g. iron deficiency
high=congenital heart disease, lung diseases, kidney diseases, dehydration, polycythemia vera
large numbers of reticulocytes=anaemia

PACKED CELL VOLUME:
low haematocrit=anemia, bone marrow failure, leukemia, multiple myeloma, nutritional deficiency, over-hydration
high haematocrit= dehydration, polycythemia vera

MCH:
low=anemia where RBC abnormally small e.g. iron deficiency
high=megaloblastic anaemias where RBCs enlarged e.g. folic acid or VitB12 deficiency

MCHC:
low=iron deficiency, blood loss, pregnancy, anaemias caused by chronic diseases

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10
Q

in relation to platelet parameters, list some conditions indicative of:
thrombocytopenia (low number platelets)
thrombocytosis (high number platelets)

A 
thrombocytopenia:
drugs with a toxic effect on bone marrow
conditions affecting bone marrow e.g. leukaemia
autoimmune conditions
viral infections

thrombocytosis:
infections-tuberculosis
thrombocytothemia-neoplastic cells produce massive number of platelets

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11
Q

list 4 aspects of cells that are analysed using a blood film

A

size, shape, colour, intracellular structure

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12
Q

list 2 common misconceptions related to FBC

A
  1. an abnormal test result is a sign of a real problem

2. a normal test result means i have nothing to worry about

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13
Q

what is a cumulative report?

A

a series of follow up tests which are done over a period of time

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14
Q

list 2 WBC and platelet findings in leukaemia

list RBC indices in leukaemia

A

throbocytopenia=decreased platelet numbers
leukocytosis=increased WBCs

RBC indices:
reduced number (anaemia) due to less space
reduced hemoglobin secondary to anaemia 
reduced hematocrit
normal MCV, normal MCH, normal MCHC
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15
Q

true or false: FBC can diagnose lymphoma and multiple myeloma

A

false

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16
Q

list the FBC findings in lymphoma and multiple myloma:

A

marrow invasion evidenced by anaemia, thrombocytopenia, low WBC

*biopsy for both

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17
Q

define acute abdomen

A

the rapid onset of severe symptoms that may indicate potentially life threatening intra-abdominal or pelvic pathology requiring urgent surgical intervention.

abdominal pain is usually a feature, but pain free acute abdomen can occur, particularly in the older people, children, immunocompromised and the last trimester of pregnancy

the pain onset can be sudden, severe or constant

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18
Q

list three clinical presentations and examination findings indicative of acute abdomen

A

peritonitis
tachycardia
hypotension
involuntary guarding

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19
Q

list the common investigations for acute abdomen

A 
blood tests:
FBC/CBC
EUC (electrolytes, urea, creatinine)
LFT-liver function tests
BSL-blood sugar levels

urinalysis
pregnancy test- HCG

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20
Q

how big, in cm, is an abdominal aneurysm?

A

greater than 3cm

21
Q

what is a common clinical finding in appendicitis in relation to pain progression?

A

the pain migrates to the RLQ *recall the nerve supply to the appendix:

  1. visceral peritoneum affected=diffuse pain around T10
  2. parietal pain involved=highly sensitive
22
Q

define gastroscopy

what pathologies can be identified?

A

inspection of the interior of the stomach with an instrument that is passed through the mouth and oesophagus to the stomach
*it is the only test that confirms Barrett’s Oesophagus
tumours, varices, mucosal inflammation, hiatus hernia, polypts, ulcers, obstructions

23
Q

list 3 invasive Helicobacter Pylori studies

list 3 non-invasive Helicobacter Pylori studies

A

rapid urease tests
culture
histology

serology
urea breath test
stool antigen test

24
Q

define colonoscopy
the indications can be divided into…
identify some indications

A 
the visual inspection of the interior colon with a flexible, light tube inserted through the rectum
therapeutic and diagnostic
symptoms and signs associated with bowel cancer e.g.
history
rectal bleeding
change in bowel habit
weight loss
iron deficiency anaemia
25
Q

colonoscopy can be used therapeutically to…

complications may include…

A

remove polyps, foreign body removal, decompression of nontoxic megacolon or sigmoid vulvulus (twisting), treatment of stenosis

difficulties with bowel prepartion (needs to be cleaned out), complications with sedation or anaesthesia, perforating the colon, haemorrhage, death

26
Q

define liver function tests

A

LFTs are a group of tests performed together to detect, evaluate and monitor liver disease or damage.
LFTs assess:
synthetic capability of liver
evidence of hepatocellular disease

27
Q

list three markers measured to test the synthetic capability of the liver
list 2 markers measured to test for hepatocellular disease

A

bilirubin
albumin
total protein
*liver failure: increased unconjugated bilirubin, decreased albumin levels

Aspartate Aminotransferase (AST)
Alanine Aminotransferase (ALT)
*enzymes found in hepatocytes
*when hepatocytes are damaged, AST and ALT will enter the blood stream, incresed blood levels

28
Q

list some indications for a LFT

A

poisoning, jaundice, alcohol abuse, ascites, fam history haemochromatosis

29
Q

define cholestasis

mention the effect on bilirubin, bile salts and ALP

A

reduced bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra or extra hepatic ducts
substances normally secreted into bile by hepatocytes with build up in the cytoplasm and diffuse back into the bloodstream
increased serum concentrations of conjugated bilirubin and bile salts
high pressures in biliary pathways will damage canalicular surface of hepatocytes resulting in increased plasma levels of alkaline phosphatase ALP (enzyme found in hepatocytes) because they leak back into bloodstream

30
Q

list 2 blood tests for the pancreas

what happens to these enzymes in pancreatic damage?

A

serum lipase
serum amylase

in pancreatic damage, lipases pass into bloodstream and urine levels are absent because lipase is reabsorbed by the kidneys
a small amount of amylases pass into blood and then into urine
acute pancreatitis-serum amylase rise rapidly, then fall back to normal after 2 days
serum amylase levels >5X upper reference range=acute pancreatitis

31
Q

urinalysis is frequently used to?

A 
check renal function
diagnose UTIs
look for blood in urine
confirm pregnancy
monitor disease
monitor drug use
32
Q

specific gravity refers to?
decreased SG indicates?
increased SG indicates?

A

the concentration of solutes in the urine compared to water
increased=kidney is unable to concentrate urine effectively e.g. acute glomerulonephritis
decreased=large amounts of dissolved solutes e.g. dehydration

33
Q 
how much protein is normally in urine?
how many nitrates are usually in urine?
blood?
ketones?
glucose?
bilirubin?
crystals?
A 
proteins-tiny amount
nitrates-zero
blood-zero
ketones-zero
glucose-minimal
bilirubin-zero
urobilinogen- tiny amount
crystals-none
34
Q

associations with a RBC cast?

associations with a WBC cast>

A

pyelonephritis
glomerulonephritis
acute interstitial nephritis
lupus nephritis

glomerulonephritis

35
Q

2 advantages and 2 disadvantages of urine dipstick?

A

advantages:
convenient
cost-effective

disadvantages:
qualitative results
time sensitive

36
Q

urine pregnancy test is?

A

HCG

37
Q

STI tests is?

A

NAAT

38
Q

list 2 normal and 2 abnormal findings for a DRE for suspected prostatic pathology

A

normal:
rubbery and smooth
middle groove separated the 2 lobes

abnormal:
enlarged
hard consistency
nodules
tenderness
loss of middle groove
39
Q

what is the name of the blood test done in men with prostate symptoms and signs?

A

Prostate Specific Antigen

used to rule out prostate cancer

40
Q

if DRE and PSA tests indicate a prostatic problem other tests may be done. what are some of these?

A 
urinalysis
urodynamic studies
cytoscopy
abdominal US
imaging
TRUS-trans rectal ultra sound guided biopsy
41
Q

the Human Papilloma Virus Cervical Screening Program is done every… years for females aged between … and …
if HPV DNA is detected, … tests will be carried out

A

5 years
25-74 years old
cytology tests

42
Q

what is the golden standard for investigating endometriosis?

A

laparoscopy and biopsy

43
Q

1 lab test and 1 non-lab test for Pelvic Inflammatory Disease

A

lab test-FBC, ESR, CRP, pregnancy

non-lab test-laparoscopy, CT, MRI, US

44
Q

to investigate PCOS, many hormones are tested, many of the hormones tested will yield normal or elevated amounts in PCOS. which two hormones may be reduced in PCOS?

which hormone is tested to rule out hypothyroidism

identify 2 non-lan tests for PCOS

A

FSH-follicle stimulating hormone
SHBG-sex hormone binding globulin

TSH-normal in PCOS, tested to rule our hypothyroidism

US, laparoscopy

45
Q

identify 4 tests used to determine blood glucose levels in Diabetes Mellitus (particularly T2)

a range of other tests can be done. identify some kidney function tests and some plasma lipid monitoring test:

A
  1. fasting blood glucose
  2. random blood glucose
  3. HbA1c-Haemoglobin A1c test (glycated haemoglobin)
  4. OGTT-oral glucose tolerance test

kidney function tests:
plasma creatinine-increase with disease
creatinine clearance-decrease clearance with disease
urine albumin creatinine ratio-increasedurinary albumin
eGFR-decrease with glomerular damage

plasma lipid monitoring tests:
triglycerides and cholesterol=increased
HDL cholesterol=decreased
LDL cholesterol=increased

46
Q

test for T3?
test for T4?
2 additional thyroid tests?

A

T3=Triodothyronine test; tests HYPERthyroidism only
T4=thyroxine tests; tests hypo/hyperthyroidism
serum thyroid antibodies: thyroid peroxidase antibody (hashimoto’s or Grave’s), thyroid stimulating antibodies receptorantibodies (Grave’s)
serum thyroglobulin test: thyroid carcinomas

47
Q

MANTRELS is used for the diagnosis of appendicitis in adults.
what does it stand for?
what score indicates appendicitis?

A 
M-migration of pain to RLQ
A-anorexia
N-nausea/vomitting
T-tenderness in RLQ (2pts)
R-rebound tenderness
E-elevated temperature
L-leukocytosis (2pts)
S-shift of WBC count to left

score greater than or equal to 7=probable appendicitis

48
Q

diverticular disease usually starts at what age?

what part of the bowel is mostly affected?

A

40years

Sigmoid Colon

49
Q

PID is most commonly sexually transmitted. What are the 3 main organisms responsible?

A

gonorrhoea, chlamydia and mycoplamsa

abdominal viscera (11 decks)

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