CS5 lecture material Flashcards
the full blood count is an invaluable tool that measures…
the clinician should always rely on the reference ranges provided by…
several parameters of circulating blood cells
each pathology service provider
3 types of cells normally found in the blood are:
RBCs (erythrocytes)
WBCs (leukocytes)
platelets
3 main classes of leukocytes are:
granulocytes
monocytes
lymphocytes
3 types of granulocytes are:
3 types of lymphocytes are:
neutrophils, eosinophils and basophils
T-lymphocytes, B-lymphocytes and Natural Killer Cells
what cell is the body’s main circulating phagocyte?
what do monocytes become?
what type of lymphocyte produces antibodies?
neutrophils
macrophages
B-lymphocytes
list 3 conditions which may be indicated by abnormally low WBC numbers
list 3 conditions which may be indicated by abnormally high WBC numbers
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
what is meant by the term, a shift to the left?
increased amount of immature circulating neutrophils as a compensatory reaction to infection
define the following terms: reticulocyte count hemoglobin hematocrit (packed cell volume) mean corpuscular (cell) volume mean corpuscular (cell) hemoglobin mean corpuscle hemoglobin concentration
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
list some pathologies associated with abnormal levels of: Red cell count packed cell volume mean cell hemoglobin mean cell hemoglobin concentration
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
in relation to platelet parameters, list some conditions indicative of:
thrombocytopenia (low number platelets)
thrombocytosis (high number platelets)
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
list 4 aspects of cells that are analysed using a blood film
size, shape, colour, intracellular structure
list 2 common misconceptions related to FBC
- an abnormal test result is a sign of a real problem
2. a normal test result means i have nothing to worry about
what is a cumulative report?
a series of follow up tests which are done over a period of time
list 2 WBC and platelet findings in leukaemia
list RBC indices in leukaemia
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
true or false: FBC can diagnose lymphoma and multiple myeloma
false
list the FBC findings in lymphoma and multiple myloma:
marrow invasion evidenced by anaemia, thrombocytopenia, low WBC
*biopsy for both
define acute abdomen
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
list three clinical presentations and examination findings indicative of acute abdomen
peritonitis
tachycardia
hypotension
involuntary guarding
list the common investigations for acute abdomen
blood tests: FBC/CBC EUC (electrolytes, urea, creatinine) LFT-liver function tests BSL-blood sugar levels
urinalysis
pregnancy test- HCG
how big, in cm, is an abdominal aneurysm?
greater than 3cm
what is a common clinical finding in appendicitis in relation to pain progression?
the pain migrates to the RLQ *recall the nerve supply to the appendix:
- visceral peritoneum affected=diffuse pain around T10
- parietal pain involved=highly sensitive
define gastroscopy
what pathologies can be identified?
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
list 3 invasive Helicobacter Pylori studies
list 3 non-invasive Helicobacter Pylori studies
rapid urease tests
culture
histology
serology
urea breath test
stool antigen test
define colonoscopy
the indications can be divided into…
identify some indications
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
colonoscopy can be used therapeutically to…
complications may include…
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
define liver function tests
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
list three markers measured to test the synthetic capability of the liver
list 2 markers measured to test for hepatocellular disease
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
list some indications for a LFT
poisoning, jaundice, alcohol abuse, ascites, fam history haemochromatosis
define cholestasis
mention the effect on bilirubin, bile salts and ALP
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
list 2 blood tests for the pancreas
what happens to these enzymes in pancreatic damage?
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
urinalysis is frequently used to?
check renal function diagnose UTIs look for blood in urine confirm pregnancy monitor disease monitor drug use
specific gravity refers to?
decreased SG indicates?
increased SG indicates?
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
how much protein is normally in urine? how many nitrates are usually in urine? blood? ketones? glucose? bilirubin? crystals?
proteins-tiny amount nitrates-zero blood-zero ketones-zero glucose-minimal bilirubin-zero urobilinogen- tiny amount crystals-none
associations with a RBC cast?
associations with a WBC cast>
pyelonephritis
glomerulonephritis
acute interstitial nephritis
lupus nephritis
glomerulonephritis
2 advantages and 2 disadvantages of urine dipstick?
advantages:
convenient
cost-effective
disadvantages:
qualitative results
time sensitive
urine pregnancy test is?
HCG
STI tests is?
NAAT
list 2 normal and 2 abnormal findings for a DRE for suspected prostatic pathology
normal:
rubbery and smooth
middle groove separated the 2 lobes
abnormal: enlarged hard consistency nodules tenderness loss of middle groove
what is the name of the blood test done in men with prostate symptoms and signs?
Prostate Specific Antigen
used to rule out prostate cancer
if DRE and PSA tests indicate a prostatic problem other tests may be done. what are some of these?
urinalysis urodynamic studies cytoscopy abdominal US imaging TRUS-trans rectal ultra sound guided biopsy
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
5 years
25-74 years old
cytology tests
what is the golden standard for investigating endometriosis?
laparoscopy and biopsy
1 lab test and 1 non-lab test for Pelvic Inflammatory Disease
lab test-FBC, ESR, CRP, pregnancy
non-lab test-laparoscopy, CT, MRI, US
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
FSH-follicle stimulating hormone
SHBG-sex hormone binding globulin
TSH-normal in PCOS, tested to rule our hypothyroidism
US, laparoscopy
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:
- fasting blood glucose
- random blood glucose
- HbA1c-Haemoglobin A1c test (glycated haemoglobin)
- 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
test for T3?
test for T4?
2 additional thyroid tests?
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
MANTRELS is used for the diagnosis of appendicitis in adults.
what does it stand for?
what score indicates appendicitis?
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
diverticular disease usually starts at what age?
what part of the bowel is mostly affected?
40years
Sigmoid Colon
PID is most commonly sexually transmitted. What are the 3 main organisms responsible?
gonorrhoea, chlamydia and mycoplamsa
