EASY Flashcards
Single-cell prokaryotic microorganisms
BACTERIA
Single-cell or multicellular eukaryotic organisms
FUNGI, PARASITES
Unicellular eukaryotic organisms
YEASTS
Dependent on host cells for survival and therefore are not considered cellular organisms but rather INFECTIOUS AGENTS
VIRUSES
Most common method of treating infectious waste; SAFEST METHOD to ensure that no infective materials remain in samples or containers when disposed
INCINERATION
MOST IMPORTANT PART OF HAND WASHING:
Mechanical action of rubbing the hands together and soaping under the fingernails
bacteria that is sensitive to temperature changes
N. meningitidis
bacteria that is sensitive to changes in pH
Shigella spp.
Determination of inducible-clindamycin resistance in staphylococci and streptococci
D-ZONE TEST
Gray, translucent, smooth, glistening; may have dry, CLAYLIKE CONSISTENCY
Neisseria elongata
Friable “hockey puck” consistency
Moraxella catarrhalis
NORMAL FLORA of the human conjunctiva, skin and nasopharynx
Corynebacterium amycolatum
0.5% sodium deoxycholate lyses Vibrio cells; used to differentiate Vibrio spp. (positive) from Aeromonas spp. and P. shigelloides (negative)
STRING TEST
Chancroid, soft chancre, School of fish arrangement, railroad track appearance
Haemophilus ducreyi
Large; boxcar shape
C. perfringens
TRUE GERM TUBE:
C. albicans, C. dubliniensis
Subacute sclerosing panencephalitis (SSPE) caused by
MEASLES VIRUS
LOEFFLER’S SYNDROME (transient pulmonary infiltration; day-to-day clearing in 3 to 14 days; associated with marked peripheral eosinophilia) caused by
Ascaris lumbricoides
Swollen belly syndrome
Strongyloides fuelleborni
abdominal angiostrongyliasis: Patient may experience lower right quadrant; ABDOMINAL PAIN SIMILAR TO THAT MANIFESTED IN APPENDICITIS
It’s causative agent is
Parastrongylus costaricensis
is an INTEGRAL PART of the transmission of nerve impulses.
Potassium
is the major intracellular cation in the body. Functions in the body include regulation of neuromuscular excitability, contraction of the heart, ICF volume, and H+ concentration.
POTASSIUM (K+)
is the most abundant cation in the ECF, representing 90% of all extracellular cations, and largely determines the osmolality of the plasma.
SODIUM (Na+)
is the major extracellular anion. It is involved in maintaining osmolality, blood volume, and electric neutrality. In most processes, Cl− shifts secondarily to a movement of Na+ or HCO3−
CHLORIDE (Cl-)
is involved in blood coagulation, enzyme activity, excitability of skeletal and cardiac muscle and maintenance of blood pressure. It is essential for myocardial contraction
CALCIUM (Ca2+)
Three hormones regulate serum CALCIUM:
PARATHYROID HORMONE, VITAMIN D, AND CALCITONIN
is inversely related to calcium. Phosphate is essential for the insulin mediated entry of glucose into cells by a process involving phosphorylation and co-entry of potassium
PHOSPHORUS
is the fourth most abundant cation in the body and second most abundant intracellular ion. It is an essential cofactor of more than 300 enzymes, including those important in glycolysis; transcellular ion transport; neuromuscular transmission; synthesis of carbohydrates, proteins, lipids, and nucleic acids; and the release of and response to certain hormones
MAGNESIUM (Mg2+)
Fever will decrease pO2 by
7%
Fever will increase pCO2 by
3 %
Forward reaction for CK (creatine to creatine phosphate):
Tanzer-Gilvarg
Reverse reaction for CK (creatine phosphate to creatine):
Oliver-Rosalki
Forward reaction for LD (lactate to pyruvate):
Wacker
Reverse reaction for LD (pyruvate to lactate):
Wroblewski LaDue
Most potent of the estrogens:
Estradiol (E2)
Confirmatory test for acromegaly:
Glucose suppression test - OGTT
Cholesterol and triglycerides in hypothyroidism:
Increased
Cholesterol and triglycerides in hyperthyroidism:
Decreased
Metabolite of cocaine:
Benzoylecgonine
BMI of obese:
≥ 30 kg/m2
Relies on piston for suction to draw sample into disposable tip; the piston does not come in contact with the liquid
Air displacement pipette
Operates by moving the piston in the pipet tip or barrel, much like a hypodermic syringe; it does not require a different tip for each use
Positive displacement pipette
Horizontal position in the centrifuge when spinning and a vertical position when the head is not moving
Horizontal centrifuge/swinging bucket centrifuge
Control that continue to either increase or decrease over a period of 6 consecutive days:
Trend
Six or more consecutive daily values that distribute themselves on one side or either side of mean:
Shift
The smaller the CV: ___ is the precision
Greater
Measurement of the diameters of all circles at a set time after initiation of the diffusion process, measurements are made 24 hours (or 18 hours) after addition of samples to the plate, preferable since results are available much sooner
Fahey RID technique
Measurements of the diameters after diffusion has ceased, often requires 2 to 3 days before results are available; provide a more reliable estimation of low levels of antigen
Mancini RID technique
stain for demonstration of spores
Shaeffer-Fulton stain
stain for demonstration of nucleic acids
Acridine orange
Fungal elements with acridine orange:
fluoresce green (APOLLON)
Thioglycollate broth boiled for 10 minutes:
To drive off oxygen
Selection and enrichment for Streptococcus agalactiae in female genital specimens
Todd-Hewitt broth
Culture media sterilization:
Autoclave sterilization, membrane filtration
Grade __ milk: Bacterial count 75,000 per mL when raw; not to exceed 15,000 bacteria per mL once pasteurized
Grade A milk
Positive malonate test:
Blue
Negative malonate test:
Green, yellow
Most common pathogen in throat cultures:
Group A Streptococcus
Storage of viral specimens:
4C
Transport of viral specimens:
-70C
Difference of enterovirus from rhinovirus: based on acid sensitivity
Enterovirus is acid resistant; Rhinovirus is acid sensitive
Non-operculated egg with small lateral spine:
S. japonicum
Non-operculated egg with lateral spine:
S. mansoni
Non-operculated egg with terminal spine:
S. haematobium
Schistosomal egg recovered in rectal biopsy:
S. mansoni, S. japonicum
Schsitosomule:
Cercaria minus tail
Gay bowel syndrome:
G. lamblia
Unholy 3 (triad of infection):
Hookworm, Ascaris, Trichuris
Nematode parasite with ❤️ to lung migration:
Ascaris, Strongyloides, Hookworms
First intermediate host of D. latum:
Copepods
Second intermediate host of D. latum:
Fresh water fish
15 to 20 tree-like, dichotomous uterine branches:
Taenia saginata
7 to 12 finger-like or dendritic branches:
Taenia solium
Iodine destroys:
troph, cysts or both
trophozoites
Granulomatous encephalitis (GAE):
Acanthamoeba
Synchronized rupture of RBCs every 72 hours:
Plasmodium malariae
Time from ordering a test through analysis in the laboratory to the charting of the report.
Turnaround time (TAT)
Step by step documentation of handling and testing of legal specimens. It begins with patient identification and continues until testing is completed and results reported.
Chain of custody (chain of evidence)
Impermeable to water: loop of Henle
Ascending loop of Henle
Highly permeable to water but poorly permeable to solutes: loop of Henle
Descending loop of Henle
11th pad in the reagent strip:
Vitamin C (ascorbic acid)
Differentiates hemoglobin from myoglobin:
Blondheim’s test (ammonium sulfate ppt. hemoglobin)
Cabbage odor urine:
Methionine malabsorption
Bence Jones protein precipitates/coagulates at
40 to 60C
Bence Jones protein dissolved at
100C
Significant value of albumin excretion rate (AER):
20 to 200 µg/min
RBCs in hypotonic urine:
ghost cells
WBCs in hypotonic urine:
glitter cells
Lipid-containing RTE cells:
oval fat bodies (in lipiduria – nephrotic syndrome)
RTE cells with nonlipid-containing vacuoles:
bubble cells (in acute tubular necrosis)
Lemon-shaped crystal:
Uric acid
crystals in Ethylene glycol poisoning:
Monohydrate calcium oxalate (oval or dumbbell)
Apatite:
Calcium phosphate
Weddelite:
Dihydrate calcium oxalate, envelope or pyramidal
Whewellite:
Monohydrate calcium oxalate, oval, dumbbell
Struvite :
Triple phosphate (magnesium ammonium phosphate)
Renal calculi may form in the
calyces and pelvis of the kidney, ureters and bladder
Size of acrosomal cap:
1/2 of the head and covers 2/3 of the nucleus
Most common cause of male infertility:
Varicocele (hardening of the veins that drain the testes)
Undiluted seminal fluid, sperms immobilized by heat:
Makler counting chamber
(for choline) - Iodine, potassium iodide (+) Dark brown rhombic crystals
Florence test
(for spermine) - Picric acid, trichloroacetic acid (+) Yellow leaf-shaped crystals
Barbiero’s test
Tuberculous pleuritic:
Adenosine deaminase (ADA) 40 U/L or greater
Dark green amniotic fluid:
Meconium
Dark red brown amniotic fluid:
Fetal death
Inserted through the nose:
Levin tube
Inserted through the mouth:
Rehfuss tube
Normal stool pH:
pH 7 to 8
Stool pH in carbohydrate disorders:
pH to below 5.5
Calibration of centrifuge:
Every 3 months
Disinfection of centrifuge:
Weekly basis
In vivo and in vitro anticoagulant (natural anticoagulant)-
Heparin
marker for hematopoietic stem cells
CD 34
Hemoglobin synthesis:
Polychromatophilic normoblast to reticulocyte
Generates ATP:
Embden-Meyerhof pathway
Generates 2,3-DPG:
Rapoport-Leubering pathway
Study of antibody structure:
Gerald Edelman, Rodney Porter
Antibody diversity:
Susumu Tonegawa
Papain fragmentation (3 fragments) =
2Fab + Fc
Pepsin fragmentation (2 fragments) =
F(ab)2 + Fc’
Natural killer cells:
CD 16 and CD56 (NK cells are part of the innate immunity)
Cook carrier of typhoid:
Mary Mallon
Most common congenital immunodeficiency:
selective IgA deficiency
Diluted household bleach prepared daily inactivates HBV:
10 minutes
Diluted household bleach prepared daily inactivates HIV:
2 minutes
Anti-A1 lectin:
Dolichos biflorus
Anti-H lectin:
Ulex europaeus
Lewis antigens are adsorbed from
plasma onto the RBC membrane
Kidd system antibody reactivity is enhanced with
enzymes, LISS, and PEG
Used to dilute blood components:
Isotonic (0.9%) saline or 5% albumin
Preparation of leukopoor RBCs:
Centrifugation, filtration, saline-washing
Primary advantage of gel technology:
Standardization
Removal of nicks:
Honing (heel to toe direction)
Removal of burrs:
Stropping (toe to heel direction)
Newcomer’s fixative:
Nuclear and histochemical fixative
Fixative for tissue photography:
Mercurial fixatives
Fixative for small tissue fragments:
Picric acid (yellow color to locate tissues easier)
Air-filled lungs may float on fixative:
Organ may be covered with several gauze to maintain it under surface
Fixation of hollow organs (stomach, intestines):
Packed with cotton soaked in fixative or completely opened before being immersed in adequate fixing solution
Decalcification:
Done after fixation and before impregnation
Optimum temp for decalcification:
Room temperature range 18 to 30C
Decalcifying agent that contains HCl:
von Ebner’s (HCl, NaCl, distilled water)
Embedding medium for electron microscopy:
Plastic medium
Double embedding (ICEP):
Infiltrated with celloidin then embedded with paraffin
Barr bodies, XX chromosomes:
Most of the nuclei of females exhibit conglomeration of chromatin, demonstrated in the smears from buccal or vaginal mucosa
Administrative investigation:
Done by at least 2 members of the board and 1 legal officer
Revocation:
Unanimous vote (3 of 3)
Suspension:
Majority vote (2 of 3)
STAT, STATIM:
Immediately
ASAP:
As soon as possible (Henry)
HEMATOMA:
NEVER PERFORM VENIPUNCTURE through a hematoma. If there is no alternative site, PERFORM THE VENIPUNCTURE DISTAL TO THE HEMATOMA to ensure the collection of free-flowing blood.
Calibrated to deliver accurately a fixed volume of a DILUTE AQUEOUS SOLUTION, bulb near the center of the pipette
VOLUMETRIC PIPETTE
Used for accurate measurement of VISCOUS FLUIDS, such as blood or serum; similar to volumetric pipettes but have the bulb closer to the delivery tip
OSTWALD-FOLIN PIPETTES
Calibrated between two marks on the stem
MOHR PIPETTE
Graduated marks down to the tip
SEROLOGIC PIPETTE
When a solute is dissolved in a solvent, these COLLIGATIVE PROPERTIES change in a predictable manner for each osmole of substance present:
- FREEZING POINT IS LOWERED by −1.86°C
- VAPOR PRESSURE IS LOWERED by 0.3 mm Hg or torr
- OSMOTIC PRESSURE IS INCREASED by a factor of 1.7 × 104 mm Hg or torr
- BOILING POINT IS RAISED by 0.52°C
SIX SIGMA STEPS (DMAIC)
DEFINE project goal or other deliverable that is critical to quality.
MEASURE baseline performance and related variables.
ANALYZE data using statistics and graphs to identify and quantify root cause.
IMPROVE performance by developing and implementing a solution.
CONTROL factors related to the improvement, verify impact, validate benefits, and monitor over time.
Best indication of overall glucose homeostasis
FASTING BLOOD GLUCOSE LEVEL
Over activity of the thyroid gland: Hyperthyroidism causing
THYROTOXICOSIS
Underactivity of the thyroid gland: Hypothyroidism causing
MYXEDEMA
Highest elevations of ALP:
Paget disease
Increased production of cortisol:
Cushing’s syndrome
Increased production of aldosterone:
Conn’s syndrome
Diagnostic tool for HEART FAILURE
B-type natriuretic peptide (BNP)
PUMPING FIST DURING VENIPUNCTURE:
↑ K+, lactic acid, Ca2+, phosphorus; ↓ pH
TOURNIQUET > 1 MINUTE:
↑ K+, total protein, lactic acid
HEMOLYSIS:
↑ K+, Mg2+, phosphorus, LD, AST, iron, ammonia
Of all the urine sediment elements, RBCs are the most difficult for students to recognize: Reasons for this include
RBCs’ lack of characteristic structures, variations in size, and close resemblance to other urine sediment constituents. RBCs are frequently confused with yeast cells, oil droplets, and air bubbles
RBC CASTS ARE EASILY DETECTED:
UNDER LPO BY THEIR ORANGE-RED COLOR
Crystals are formed by the PRECIPITATION OF URINE SOLUTES, including inorganic salts, organic compounds, and medications (iatrogenic compounds):
Precipitation is subject to changes in temperature (solutes precipitate more readily at low temperatures), solute concentration, and pH, which affect solubility
SYNOVIAL FLUID NORMAL CELL COUNT:
Red blood cell count <2,000 μL;
white blood cell count <200 μL
Most frequently used in the identification of Gardnerella vaginalis, Streptococcus agalactiae, Campylobacter jejuni, and Listeria monocytogenes
HIPPURATE HYDROLYSIS TEST
Detects the presence of this CLINDAMYCIN-INDUCIBLE RESISTANCE
D-ZONE TEST
M PROTEIN BINDS ______, a regulatory protein of the alternate complement pathway involved in the degradation of C3b; it also binds to fibrinogen blocking complement alternate pathway activation
BETA GLOBULIN FACTOR H
Produces a toxin similar to Shiga toxin produced by Shigella dysenteriae; SHIGA-LIKE TOXIN
EHEC/VTEC/STEC
Differentiates Alcaligenes faecalis from Bordetella bronchiseptica
UREASE (RAPID)
Alcaligenes faecalis (urease negative) Bordetella bronchiseptica (urease positive)
CLOSTRIDIAL ENDOSPORES may be resistant to ethanol, and after ethyl alcohol treatment, the spores will germinate upon inoculation and proper incubation on anaerobic blood agar in anaerobic conditions
ETHANOL SHOCK TECHNIQUE
Diagnostic for an infection with ACTINOMYCES
SULFUR GRANULES
SUBACUTE SCLEROSING PANENCEPHALITIS:
MEASLES
Tapeworm specialized structure for attachment:
Region for growth, regenerative region
SCOLEX; NECK
LIFESPAN OF TAPEWORMS
H. NANA:
H. DIMINUTA, D. CANINUM:
D. LATUM, T. SAGINATA, T. SOLIUM:
H. NANA: Perhaps many years as a result of autoinfection
H. DIMINUTA, D. CANINUM: Usually less than 1 year
D. LATUM, T. SAGINATA, T. SOLIUM: UP TO 25 YEARS
Organism is found most commonly in the crypts in the duodenum; associated with steatorrhea and malabsorption syndrome
G. LAMBLIA
MODIFIED AFB:
WEAKER DECOLORIZER, DECOLORIZER in modified acid-fast stains is usually 1% sulfuric acid (weak acid) rather than the stronger acid alcohol used in the routine AFB stains.
MICROFILARIA
Sheathed, nuclei absent in tail:
Sheathed, tail with 2 separate nuclei:
Sheathed, nuclei continuous up to the tip of the tail:
Unsheathed, nuclei absent in tail:
Unsheathed, nuclei continuous up to the tip of the tail:
Unsheathed, nuclei absent in tail:
Wuchereria bancrofti: Sheathed, nuclei absent in tail
Brugia malayi: Sheathed, tail with 2 separate nuclei
Loa loa: Sheathed, nuclei continuous up to the tip of the tail
Onchocerca volvulus: Unsheathed, nuclei absent in tail
Dipetalonema perstans: Unsheathed, nuclei continuous up to the tip of the tail
Mansonella ozzardi: Unsheathed, nuclei absent in tail
SITUATION AND APPROPRIATE COURSE OF ACTION
- Intravenous (IV) fluid:
- FISTULA:
- INDWELLING LINES AND CATHETERS, HEPARIN LOCKS:
- SCLEROSED VEINS:
- HEMATOMA:
- EDEMA:
- SCARS, BURNS, TATTOOS:
- MASTECTOMY:
- UNIDENTIFIED PATIENT:
Intravenous (IV) fluid: Use opposite arm or perform fingerstick, if possible; otherwise, have nurse turn off IV for 2 minutes, apply tourniquet below IV, use different vein (if possible). Document location of IV and venipuncture, type of fluid.
- FISTULA: Draw from opposite arm.
- INDWELLING LINES AND CATHETERS, HEPARIN LOCKS:Usually not drawn by lab. FIRST 5 mL DRAWN SHOULD BE DISCARDED. Lab may draw below heparin lock if nothing is being infused.
- SCLEROSED VEINS: Select another site.
- HEMATOMA: Draw below.
- EDEMA: Select another site.
- SCARS, BURNS, TATTOOS: Select another site.
- MASTECTOMY: Draw from opposite arm.
- UNIDENTIFIED PATIENT: Ask nurse to ID before drawing.
Includes enumeration of cellular elements, quantitation of hemoglobin, and statistical analyses that provide a snapshot of cell appearances
COMPELETE BLOOD COUNT (CBC) or HEMOGRAM
Hormone produced by hepatocytes to REGULATE BODY IRON LEVELS, particularly absorption of iron in the intestine and release of iron from macrophages
HEPCIDIN
Detects myelocytic cells by staining cytoplasmic granular contents
MYELOPEROXIDASE (MPO)
Detects myelocytic cells by staining cytoplasmic granular contents
SUDAN BLACK B (SBB)
Detects lymphocytic cells and certain abnormal erythrocytic cells by staining of cytoplasmic glycogen
PERIODIC ACID–SCHIFF (PAS)
Distinguish myelocytic from monocytic maturation stages (several esterase substrates)
ESTERASES
Detects tartrate-resistant acid phosphatase granules in hairy cell leukemia
TARTRATE-RESISTANT ACID PHOSPHATASE
Most potent phagocytic cell, most effective at antigen presentation
DENDRITIC CELLS
DEATH resulting from disease
MORTALITY
State of disease and its associated effects on the host
MORBIDITY
ENDOGENOUS PIGMENTS: Produced within the tissue
- HEMATOGENOUS (blood-derived): Hemosiderin, hemoglobin, bile pigment and porphyrin
- NON-HEMATOGENOUS: melanin, lipofuscin and chromaffin
- ENDOGENOUS MINERALS: calcium, iron and copper
EXOGENOUS PIGMENTS
- Tattoos, asbestos, carbon, silica, iron and silver
- CARBON is the most common exogenous pigment (chronic smokers)
ARTEFACT PIGMENTS
- dark brown or black crystal-like precipitates especially in postmortem and blood-containing tissues; removed by saturated alcoholic picric acid
- black, brown or grayish black granules or clumps in tissue; removed with alcoholic iodine solution
- black deposits on tissues which have not been properly washed out; removed by bleaching
- fine brown or black granules; removed with the use of acid alcohol
- FORMALIN: dark brown or black crystal-like precipitates especially in postmortem and blood-containing tissues; removed by saturated alcoholic picric acid
- MERCURY: black, brown or grayish black granules or clumps in tissue; removed with alcoholic iodine solution
- OSMIC ACID: black deposits on tissues which have not been properly washed out; removed by bleaching
- CHROME DEPOSITS: fine brown or black granules; removed with the use of acid alcohol
FIRST CLINICAL LABORATORY IN THE PHILIPPINES:
MANILA PUBLIC HEALTH LABORATORY at Quiricada Street, Sta. Cruz, Manila
Formally organized the Manila Public Health Laboratory:
Dr, Pio de Roda, Dr. Mariano Icasiano
Total cholesterol (mg/dL)
<200 Desirable
200–239 Borderline high
≥240 High
Triglyceride (mg/dL)
<150 Normal
150–199 Borderline high
200–499 High
≥500 Very high
HDL (mg/dL)
<40 Low; MAJOR RISK FOR HEART DISEASE
≥60 High; PROTECTION AGAINST HEART DISEASE
LDL (mg/dL)
<100 Optimal
100–129 Near optimal/above optimal
130–159 Borderline high
160–189 High
≥190 Very high
CELL DEATH
1st manifestation is shrinkage, inflammatory response NOT elicited:
1st manifestation is swelling, inflammatory response accompanies necrosis:
- APOPTOSIS (PHYSIOLOGIC) 1st manifestation is shrinkage, inflammatory response NOT elicited
- NECROSIS (PATHOLOGIC) 1st manifestation is swelling, inflammatory response accompanies necrosis
is a self-inflicted cell death originating from the activation signals within the cell itself.
- The morphologic manifestation is shrinkage of the cell.
- The nucleus condenses and undergoes systematic fragmentation due to cleavage of the DNA between nucleosome subunits (multiples of 180 to 200 base pairs).
- Cellular products are not released into the extracellular space and an inflammatory response is not elicited
APOPTOSIS
is a PATHOLOGIC process caused by direct external injury to cells—for example, from burns, radiation, or toxins
- The first morphologic manifestation is a swelling of the cell.
- More severe damage, however, disrupts organelles and membranes; enzymes leak out of lysosomes that denature and digest DNA, RNA, and intracellular proteins; and ultimately the cell lyses.
- Usually accompanied by an inflammatory response due to the release of cell contents into the extracellular space.
NECROSIS
Family Coronaviridae includes the genera:
Torovirus and Coronavirus (CoV) and contains many species of both human and animal origin
Coronaviruses are pleomorphic, roughly spherical, medium-sized, enveloped RNA viruses.
- Prefix corona- results from the viral structure and the crown-like surface projections on the external surface of the virus that can be seen with electron microscopy.
- Human respiratory coronaviruses cause colds and occasionally pneumonia in adults.
- Together the rhinoviruses and coronaviruses cause more than 55% of the “common colds” in the human populations.
- Viral transmission is person to person via contaminated respiratory secretions or aerosols.
- Virus is present in the highest concentration in the nasal passages, where it infects the nasal epithelial cells.
In November, 2002, SARS (SARS CoV-1) was identified as the cause of a worldwide outbreak. It first emerged in the Guangdong province in China.
- Because of its sensitivity and specificity, molecular testing by RT-PCR remains the recommended method for laboratory diagnosis.
- Although nucleic acid testing by RT-PCR is the most useful diagnostic test available, the virus is capable of growth in cell culture using the Vero-E6 cell line.
- The characteristic viral CPE appears as a rapid cell rounding, refractivity and detachment.
- BSL 3 or higher is required for propagation and manipulation of cell cultures containing this virus. (Bailey)
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of the current rapidly growing outbreak of coronavirus disease (COVID-19), originating from the city of Wuhan, Hubei Province, China.
- Coronavirus disease 2019 (COVID-19) is caused by a new coronavirus first identified in Wuhan, China, in December 2019.
- Although most people who have COVID-19 have mild symptoms, COVID-19 can also cause severe illness and even death.
- Some groups, including older adults and people who have certain underlying medical conditions, are at increased risk of severe illness.
- On February 11, 2020, the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. In COVID-19, ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. Formerly, this disease was referred to as “2019 novel coronavirus” or “2019-nCoV.”
- Microbiology and pathology laboratories performing diagnostic tests on stool or respiratory specimens should handle potential SARS-CoV specimens using standard Biosafety Level (BSL)-2 work practices in a Class II biological safety cabinet.
- CDC recommends virus isolation in cell culture, and initial characterization of viral agents recovered in cultures of novel SARS-CoV-2 should be conducted in a Biosafety Level 3 (BSL-3) laboratory using BSL-3 practices.
SYMPTOMS OF COVID-19 (WHO)
The most common symptoms of COVID-19 are
- Fever
- Dry cough
- Fatigue
Other symptoms that are less common and may affect some patients include:
- Loss of taste or smell
- Nasal congestion
- Conjunctivitis (also known as red eyes)
- Sore throat
- Headache
- Muscle or joint pain
- Different types of skin rash
- Nausea or vomiting
- Diarrhea
- Chills or dizziness
Symptoms of severe COVID‐19 disease include:
- Shortness of breath
- Loss of appetite
- Confusion
- Persistent pain or pressure in the chest
- High temperature (above 38 °C)
- Other less common symptoms are:
- Irritability
- Confusion
- Reduced consciousness (sometimes associated with seizures)
- Anxiety
- Depression
- Sleep disorders
- More severe and rare neurological complications such as strokes, brain inflammation, delirium and nerve damage.
The time from exposure to COVID-19 to the moment when symptoms begin is,
on average, 5-6 days and can range from 1-14 days. This is why people who have been exposed to the virus are advised to remain at home and stay away from others, for 14 days, in order to prevent the spread of the virus, especially where testing is not easily available.
Both isolation and quarantine are methods of preventing the spread of COVID-19.
- Quarantine is used for anyone who is a contact of someone infected with the SARS-CoV-2 virus, which causes COVID-19, whether the infected person has symptoms or not. Quarantine means that you remain separated from others because you have been exposed to the virus and you may be infected and can take place in a designated facility or at home. For COVID-19, this means staying in the facility or at home for 14 days.
- Isolation is used for people with COVID-19 symptoms or who have tested positive for the virus. Being in isolation means being separated from other people, ideally in a medically facility where you can receive clinical care. If isolation in a medical facility is not possible and you are not in a high risk group of developing severe disease, isolation can take place at home. If you have symptoms, you should remain in isolation for at least 10 days plus an additional 3 days without symptoms. If you are infected and do not develop symptoms, you should remain in isolation for 10 days from the time you test positive.
MASTER GLAND
PITUITARY GLAND
DRIVING FORCE of the bicarbonate-carbonic acid buffer system
CARBON DIOXIDE
Measured by potentiometry
pH, pCO2
Measured by amperometry
pO2
integral part of nerve impulse transmission; movement across the nerve tissue membrane permits the neural signal to move down the nerve fiber
POTASSIUM
YELLOW FLAME
sodium
VIOLET FLAME
potassium
RED FLAME
lithium and rubidium
BLUE FLAME
magnesium
Beer’s law states that the concentration of a substance is directly proportional to the amount of radiant energy absorbed: A = abc or ebc; where
a (or e) is molar absorptivity (a constant for a given molecule);
b is the length of the path traveled by the light;
c is the concentration of absorbing molecules
Majority of cases of laboratory-related infections
INFECTIOUS AEROSOLS
Lean Six sigma
DMAIC (Define, Measure, Analyze, Improve, and Control) methodology
CODEINE
Antitussive drug
most common abused drug
Ethanol (grain alcohol)
substance associated with blindness
Methanol (wood alcohol)
“Odor of bitter almonds”
CYANIDE
“Odor of garlic”; “metallic taste”; affinity to keratin
ARSENIC
SPECIMEN REQUIREMENTS FOR BLOOD GAS ANALYSIS
- Arterial blood is collected in a glass or plastic syringe. Capillary specimens can also be used (blood must be “arterialized”).
- Lyophilized or liquid heparin is the preferred anticoagulant.
- No air bubbles should exist in the sample because they lower the pCO2 value.
- The specimen must be placed on ice and transported to the laboratory in 15 minutes at 4◦C and tested immediately. Otherwise, pH values decrease, and pCO2 values increase.
- Blood clots are unacceptable.
Floating B lipoprotein:
Β-VLDL
Sinking pre-beta lipoprotein:
Lp (a)
Drug associated with rhabdomyolysis: side effect in certain patients taking the
cholesterol-lowering STATIN medications; example: Flavostatins
Rotting fish odor of urine:
TRIMETHYLAMINURIA
Renal stones may form in:
RENAL PELVIS AND CALYCES, URETER and BLADDER
RENAL CALCULI
- yellow to brown-red and are moderately hard
- pale and friable
- very hard and have a rough surface
- Yellow-brown, resembling an old soap and feel somewhat greasy
Uric acid and urate stones - yellow to brown-red and are moderately hard
Phosphate stones - pale and friable
Calcium oxalate stones - very hard and have a rough surface
Cystine stones - Yellow-brown, resembling an old soap and feel somewhat greasy
Person submitting urine for drug test:
DONOR /CLIENT
Anti-neutrophilic cytoplasmic antibody (ANCA):
WEGENER’S GRANULOMATOSIS
Anti-glomerular basement membrane antibody:
GOODPASTURE’S SYNDROME
Compare results with those of its peers:
BENCHMARKING
Hepatocellular damage:
ALT and AST
Hepatobiliary damage:
ALP and GGT
Abnormality of bile duct epithelium:
SERUM ALP
Cholesterol and triglyceride in hypothyroidism:
INCREASED
Cholesterol and triglyceride in hyperthyroidism:
DECREASED
Long term glucose monitoring:
GLYCOSYLATED HEMOGLOBIN (HBA1C)
Short-term glucose monitoring:
FRUCTOSAMINE
caused by reduced blood flow, poor perfusion of the kidneys resulting to decrease GFR
Pre-renal azotemia
produced by kidney failure, damage to the filtering structures of the kidneys
Renal azotemia
caused by an obstruction anywhere in the renal system
Post-renal azotemia
detects for cell-bound coagulase or clumping factor
SLIDE COAGULASE
detects for free coagulase
TUBE COAGULASE
binds to chitin in the walls of fungal cells and fluoresces white or apple green
Calcoflour white
Molar tooth colonies:
ACTINOMYCES ISRAELII
Autofluorescence:
CYCLOSPORA CAYATENENSIS
Presence of Philadelphia chromosome in CML:
BETTER PROGNOSIS
Absence of Philadelphia chromosome in CML:
POOR PROGNOSIS
Darkly staining mass of sex chromosome attached to the end of the nucleus of somatic cells:
BARR BODIES
Manual WBC count: routine dilution of
Above 30 x 10 9th/L WBCs: dilution of
WBCs 100 to 300 x 10 9th/L: dilution of
WBCs below 3 x 10 9th/L: dilution of
Manual WBC count: routine dilution of 1:20
Above 30 x 10 9th/L WBCs: dilution of 1:100
WBCs 100 to 300 x 10 9th/L: dilution of 1:200
WBCs below 3 x 10 9th/L: dilution of 1:10
Marker for hematopoeitic stem cells:
CD34
Corrected WBC count
Adult ≥5 NRBCs/100 WBC differential
Neonate ≥10 NRBCs/100 WBC differential
Poor man’s platelet aggregation:
EXAMINATION OF FILM OF FRESH CAPILLARY BLOOD
SPUN HEMATOCRIT
First layer of spun hematocrit:
Second layer:
Third layer:
Bottom layer:
First layer of spun hematocrit: FATTY LAYER (barely visible unless lipemic)
Second layer: PLASMA
Third layer: BUFFY COAT (1 mm = 10,000 WBCs/cu.mm)
Bottom layer: PACKED CELLS
Differentiates acute myelogenous and MONOCYTIC leukemias from acute lymphocytic leukemia:
PEROXIDASE
Differentiates acute myelogenous and MYELOMONOCYTIC leukemias from acute lymphocytic leukemia:
SUDAN BLACK B
BASOPHILIC STIPPLING/PUNCTATE BASOPHILIA:
Precipitation of RIBOSOMES and RNA
remnant of microtubules of mitotic spindle
CABOT RINGS
arterial blood, bright red color
OXYHEMOGLOBIN (HbO2)
venous blood, purplish red color
DEOXYHEMOGLOBIN (HbCO2)
cherry red color, formation is reversible
CARBOXYHEMOGLOBIN (HbCO)
chocolate brown color, formation is reversible
METHEMOGLOBIN/HEMIGLOBIN (Hi)
mauve lavender, formation is IRREVERSIBLE
SULFHEMOGLOBIN
Major advantage of gel technology:
STANDARDIZATION
Connection between two blood vessels:
ANASTOMOSIS
hallmark rash of measles infection; bluish white spots with a red halo located on the buccal or labial mucosa
KOPLIK’S SPOTS (IN MEASLES)
Anti-smooth muscle antibodies (ASMA):
CHRONIC ACTIVE HEPATITIS
Anti-mitochondrial antibodies (AMA):
PRIMARY BILIARY CIRRHOSIS
Antigenic determinant:
EPITOPE
Part of the antibody that binds to the antigen:
PARATOPE
RADIOIMMUNOSORBENT TEST (RIST):
measures total IgE
RADIOALLERGOSORBENT TEST (RAST):
measures allergen-specific IgE
most common congenital immunodeficiency
SELECTIVE IgA DEFICIENCY
Removal of gross nicks:
HONING (heel to toe direction)
Removal of burrs, final polishing:
STROPPING (toe to heel direction)
Fastest embedding method:
VACUUM EMBEDDING
appear in compensation for thrombocytopenia.
RETICULATED PLATELETS, sometimes known as STRESS PLATELETS
Reticulated platelets are markedly larger than ordinary mature circulating platelets; their diameter in peripheral blood films exceeds 6 mm, and their MPV reaches 12 to 14 fL.
The PERIPHERAL FILM EVALUATION IS THE CAPSTONE of a panel of tests called the
COMPLETE BLOOD COUNT (CBC) or HEMOGRAM
HEPATITIS B VIRUS VACCINATION:
Laboratory employees should receive the HBV vaccination series at no cost before or within 10 days after beginning work in the laboratory.
Heel punctures are used for infants less than 1 year old;
the puncture must be less than 2 mm deep to avoid injury to the bone.
The rule of three specifies that the value of the hematocrit should be three times the value of the hemoglobin plus or minus 3 (%) or 0.03 (L/L).
A value discrepant with this rule may indicate abnormal red blood cells or it may be the first indication of error.
which is used to assess the ERYTHROPOIETIC ACTIVITY OF THE BONE MARROW, is accomplished through the use of supravital stains (e.g., new methylene blue) or by flow cytometric methods.
RETICULOCYTE COUNT
is defined conventionally as a DECREASE IN RBCS, HEMOGLOBIN, and HEMATOCRIT below the reference interval for healthy individuals of the same age, sex, and race, under similar environmental conditions.
ANEMIA
Diagnosis of anemia is based on
history, physical examination, symptoms, and laboratory test results
Laboratory procedures helpful in the INITIAL DIAGNOSIS OF ANEMIA include the
complete blood count (CBC) with RBC indices and the red blood cell distribution width (RDW), reticulocyte count, and examination of the peripheral blood film with emphasis on RBC morphology
is a manifestation of the mucopolysaccharidosis characterized by metachromatic granules in leukocytes, which can be confused with toxic granulation.
ALDER-REILLY ANOMALY
is an inherited lethal disorder characterized by giant lysosomes in granular cells and dysfunctional leukocytes.
CHEDIAK-HIGASHI SYNDROME
is characterized by thrombocytopenia, giant platelets, and Döhle body–like inclusions in leukocytes.
MAY-HEGGLIN ANOMALY
is an inherited disorder of the NADPH oxidase system resulting in neutrophils that are incapable of killing many microorganisms due to a failure in the respiratory burst, which is necessary to produce antibacterial agents.
CHRONIC GRANULOMATOUS DISEASE
stains primary granules and is useful in differentiating granulocytic from lymphoid cells.
MYELOPEROXIDASE (MPO)
stains lipids and results PARALLEL those with the MPO stain.
SUDAN BLACK B (SBB)
help differentiate granulocytes and their precursors from cells of monocytic origin.
Butyrate esterase testing gives positive results in monocytes but not in granulocyte precursors
Naphthol AS-D chloroacetate esterase stains granulocyte precursors.
ESTERASES
is caused by the lack of expression of GP Ib/IX/V complexes on the platelet surface. This receptor complex is responsible for platelet adhesion and its absence results in a severe bleeding disorder.
BERNARD-SOULIER SYNDROME
is caused by the lack of expression of GP IIb/IIIa complexes on the platelet surface. This complex is known as the platelet aggregation receptor, and its absence is associated with a severe bleeding disorder.
GLANZMANN THROMBASTHENIA
Evacuated tube storage temp relationship to blood draw volume:
If evacuated tubes are stored at low temperature, the pressure of the gas inside the tube will decrease. This would lead to an increase in draw volume for the evacuated tube. Conversely, higher temperatures could cause reductions in draw volume.
Low temperature – increase in draw volume
High temperature – decrease in draw volume
Shelf life of an evacuated tube is defined by the
STABILITY OF THE ADDITIVE, as well as VACUUM RETENTION. Most evacuated tubes on the market have AT LEAST A 12-MONTH SHELF LIFE.
A collection of clinical findings indicating adverse glomerular changes.
It is characterized by proteinuria, hypoalbuminemia, hyperlipidemia, lipiduria, and generalized edema.
A nonspecific disorder associated with renal as well as systemic diseases.
NEPHROTIC SYNDROME
A group of clinical findings indicative of glomerular damage that include hematuria, proteinuria, azotemia, edema, hypertension, and oliguria.
Severity and combinations of features vary with the glomerular disease
NEPHRITIC SYNDROME
FACTORS THAT INTERFERE WITH THE VALIDITY OF CLOT-BASED TEST RESULTS
BLOOD COLLECTION VOLUME LESS THAN SPECIFIED MINIMUM
PT falsely prolonged; recollect specimen.
HEMATOCRIT ≥55%
Adjust anticoagulant volume using formula and recollect specimen using new anticoagulant volume.
CLOT IN SPECIMEN
All results are affected unpredictably; recollect specimen.
VISIBLE HEMOLYSIS
PT falsely shortened; recollect specimen.
ICTERUS OR LIPEMIA
Measure PT using a mechanical coagulometer.
HEPARIN THERAPY
Use reagent known to be insensitive to heparin or one that includes a heparin neutralizer such as polybrene.
LUPUS ANTICOAGULANT
PT result is invalid; use chromogenic factor X assay instead of PT.
INCORRECT CALIBRATION, INCORRECT DILUTION OF REAGENTS
Correct analytical error and repeat test.
- Chickenpox and shingles
- Vaccine important in controlling outbreaks
- Tzanck stain: Giant cells
Varicella-Zoster Virus
- Isolated from blood, urine, throat
- In adults: Syndrome similar to mononucleosis, may infect kidney (shed in urine)
- In immunocompromised: Kidney, eye, lung, often fatal
Cytomegalovirus
- Heterophile-positive infectious mononucleosis (85%)
- Can produce tumors
- Not isolated in culture
Serologic diagnosis
* Early antigen
* Viral capsid antigen: IgM and IgG
* Nuclear antigen
Epstein-Barr Virus
- Human parvovirus B-19 - erythema infectiosum (fifth disease)
- Infects bone marrow cells (erythrocyte) - Causes aplastic crisis
Parvoviruses
- Oocysts in stool are diagnostic, modified acid-fast stain
- Linked to water-borne and food-borne illness
- Mild GI symptoms
Cyclospora cayetanensis - AUTOFLUORESCENCE
Lice
- Lice occur worldwide and in all socioeconomic classes
- Vector for typhus (Rickettsia prowazekii), trench fever (Bartonella quintana), and relapsing fever (Borrelia recurrentis)
- Spread from human to human
- Body lice usually on the body and head
- Crab lice usually in pubic region, spread to the armpits, facial hair, eyebrows, and eyelashes
Mites
- Sarcoptes scabei is the cause of scabies worldwide
- Transmitted by contact
- Organisms burrow into the skin on the webbing side of fingers, later spreading to the wrists, elbows and beyond
Bedbugs
- Cimex lectularius
- Preferential feeding host is human
- Nocturnal blood meals
- Symptoms occur days after bite
- Rare acquired disorder resulting from stem cell mutation in the PIGA gene
- Cells lack glycoslyphosphatidlyinositol-anchored proteins, including CD55 and CD59
- RBCs are susceptible to complement lysis, because CD55 and CD59 inhibit complement and are absent, cells may lyse spontaneously
Paroxysmal Nocturnal Hemoglobinuria
- Characterized by increased platelets and megakaryopoiesis; however, platelets may not function normally
Essential Thrombocythemia
- Mature B-cell disorder with an indolent course
- CBC shows elevated WBC counts with a predominance of small lymphoid cells, usually with dense, hypermature nuclei and little cytoplasm, and smudge cell are frequently seen
Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma
- Chronic B-cell neoplasm with lymphocytes showing threadlike or “hairy” projections
- Flow cytometry is positive for CD19, CD20, CD22, CD11c, CD25, CD103
- Positive for tartrate-resistant acid phosphatase (TRAP) stain ○ Hairy lymphocytes may be seen
- Annexin A1 is the most specific marker for HCL, in addition to being positive for DBA-44
Hairy Cell Leukemia (HCL)
ACUTE CORONARY SYNDROME (ACS) with frank necrosis of any amount of myocardium is known as
MYOCARDIAL INFARCTION (MI)
The major clinical use of SERUM AND URINE PROTEIN ELECTROPHORESIS is to screen for
MONOCLONAL GAMMOPATHIES
ENZYMES LOWER THE ACTIVATION ENERGIES of the chemical reactions that they catalyze, so as to cause greatly enhanced rates of reaction.
Skin at a pH of approximately 5.6:
this acid pH keeps most microorganisms from growing.
B lymphocytes are stimulated to produce antibodies to HIV, which can usually be detected in the host’s serum by
SIX (6) WEEKS after primary infection.
The most commonly used disinfectant is a 1:10 dilution of SODIUM HYPOCHLORITE (HOUSEHOLD BLEACH) prepared weekly and stored in a plastic, not a glass, bottle.
should be considered a cause of diarrhea in patients on antibiotic therapy or hospitalized for more than 3 days.
CLOSTRIDIUM DIFFICILE
cause GRANULOMATOUS DISEASE IN ANIMALS and have been associated with soft tissue infection in humans following animal bites.
ACTINOBACILLUS SPP.
are short to very short gram-negative bacilli. They occur singly, in pairs, and in chains, and they tend to exhibit bipolar staining. This staining morphology gives the overall appearance of the DOTS AND DASHES OF MORSE CODE.
ACTINOBACILLUS SPP
Oocysts survive in the environment for several months to more than 1 year and are resistant to disinfectants, freezing, and drying. However, they are killed by heating to 70° C for 10 minutes.
TOXOPLASMA GONDII
Disease caused by Naegleria fowleri can be severe and life-threatening (PRIMARY AMEBIC MENINGOENCEPHALITIS[PAM])
can be caused by Acanthamoeba spp. and Balamuthia mandrillaris; keratitis is also caused by these organisms, and infection can be linked to blindness or severe corneal damage
Chronic GRANULOMATOUS AMEBIC ENCEPHALITIS(GAE)
BASKET NUCLEUS:
Iodamoeba bütschlii
is the comparison of an instrument measurement or reading to a known physical constant.
CALIBRATION
BLOOD ALCOHOL (% w/v)
no obvious impairment, some changes observable on performance testing
0.01 to 0.05
mild euphoria, decreased inhibitions, some impairment of motor skills
0.03 to 0.12
decreased inhibitions, loss of critical judgment, memory impairment, diminished reaction time
0.09 to 0.25
mental confusion, dizziness, strongly impaired motor skills (staggering, slurred speech)
0.18 to 0.30
unable to stand or walk, vomiting, impaired consciousness
0.27 to 0.40
coma and possible death
0.35 to 0.50
Gastric juice is obtained by insertion of gastric tube into the stomach. What insertion is through the mouth?
REHFUSS TUBE
Gastric juice is obtained by insertion of gastric tube into the stomach. What insertion is through the nose?
LEVIN TUBE
anti-TSH receptor antibodies (anti-TSHR)
GRAVES’ DISEASE (HYPER)
anti-thyroid peroxidase (TPO, microsomal), anti-thyroglobulin
HASHIMOTO’S THYROIDITIS (HYPO)
Most laboratory errors occur in the:
preanalytic and postanalytic stages
are tools that can be used to reduce laboratory errors and increase productivity.
Six Sigma and Lean
Effective laboratory management requires leaders to provide direction and managers to get things done. Strategic planning, marketing, human resource management, and quality management are all key elements of a laboratory organization.
describes how close a test result is to the true value.
ACCURACY
describes how close the test results are to one another when repeated analyses of the same material are performed.
PRECISION
are highly purified substances of a known composition.
STANDARDS
represents a specimen with a known value that is similar in composition, for example, to the patient’s blood.
CONTROL (noun)
is a process that monitors the accuracy and reproducibility of results through the use of control specimens.
QUALITY CONTROL
is the comparison of an instrument measure or reading to a known physical constant
CALIBRATION
Any brightfield microscope may be CONVERTED TO A DARKFIELD MICROSCOPE by use of a SPECIAL DARKFIELD CONDENSER in place of the usual condenser.
The PHASE-CONTRAST MICROSCOPE is basically a brightfield microscope with changes in the
OBJECTIVE and the CONDENSER.
To convert a brightfield microscope to a POLARIZING one requires
TWO FILTERS.
The most sensitive method for detecting C. TRACHOMATIS is
NUCLEIC ACID AMPLIFICATION.
which involves separation and identification of compounds in the gas phase from their mass/charge ratios and fragmentation patterns, is the “gold standard” for detection and quantitation of drugs in body fluids.
GAS CHROMATOGRAPHY–MASS SPECTROSCOPY
TOXEMIA OF PREGNANCY, OR PREECLAMPSIA, is characterized by HYPERTENSION and PROTEINURIA, and consequently can be monitored by urine protein measurements.
SPECIFIC GRAVITY AND OSMOLALITY MEASUREMENTS REFLECT THE CONCENTRATING ABILITY OF THE KIDNEYS. After a period of dehydration, the osmolality should be three to four times that of plasma.
is the CENTRAL CONVERGENCE POINT for all complement activation pathways.
COMPLEMENT COMPONENT C3
HBV may be stable in dried blood and blood products at 25°C for up to 7 days.
HIV retains infectivity for more than 3 days in dried specimens at room temperature and for more than 1 week in an aqueous environment at room temperature.
Two main functions of the serologic crossmatch test can be cited:
- It is a final check of ABO compatibility between donor and patient.
- It may detect the presence of an antibody in the patient’s serum that will react with antigens on the donor RBCs but that was not detected in antibody screening because the corresponding antigen was lacking from the screening cells.
are designed to stop the spread of microorganisms via direct contact, such as skin-to-skin contact and indirect contact, which is usually the result of a person making contact with a contaminated inanimate object.
CONTACT PRECAUTIONS
are designed to provide protection from extremely tiny airborne bacteria or dust particles, which may be suspended in the air for an extended period.
AIRBORNE PRECAUTIONS
protect health care workers, visitors, and other patients from droplets, which may be expelled during coughing, sneezing, or talking
DROPLET PRECAUTIONS
DEGREE OF HAZARD:
4: extreme hazard
3: serious hazard
2: moderate hazard
1: slight hazard
0: no or minimal hazard
When a solute is dissolved in a solvent, these COLLIGATIVE PROPERTIES change in a predictable manner for each osmole of substance present:
- FREEZING POINT IS LOWERED by −1.86°C
- VAPOR PRESSURE IS LOWERED by 0.3 mm Hg or torr
- OSMOTIC PRESSURE IS INCREASED by a factor of 1.7 × 104 mm Hg or torr
- BOILING POINT IS RAISED by 0.52°C
error that is INCONSISTENT and whose source cannot be definitely identified
RANDOM ERROR
error that is introduced into a test system and is not a random occurrence
SYSTEMATIC ERROR
Increased production of cortisol:
CUSHING’S SYNDROME
Increased production of aldosterone:
CONN’S SYNDROME
Diagnostic tool for HEART FAILURE:
B-TYPE NATRIURETIC PEPTIDE (BNP)
UROBILINOGEN (COLORLESS):
less than 1 mg/dL or Ehrlich unit is normally found in the urine
most frequently used in the identification of Gardnerella vaginalis, Streptococcus agalactiae, Campylobacter jejuni, and Listeria monocytogenes:
HIPPURATE HYDROLYSIS TEST
Detects the presence of this CLINDAMYCIN-INDUCIBLE RESISTANCE
D-ZONE TEST
Organism is found most commonly in the crypts in the duodenum; associated with steatorrhea and malabsorption syndrome
GIARDIA LAMBLIA
Hormone produced by hepatocytes to REGULATE BODY IRON LEVELS, particularly absorption of iron in the intestine and release of iron from macrophages
HEPCIDIN
UNIQUE AMINO ACID SEQUENCE that is common to all immunoglobulin molecules of a given class in a given species
ISOTYPE
minor variation of sequences that are present in some individuals but not others
ALLOTYPE
variable portions of each chain unique to a specific antibody molecule
IDIOTYPE
only blood group system that affects clinical transplantation
ABO
BLOOD BANK STANDARD OPERATING PROCEDURES (SOP) REVIEWED AT LEAST ANNUALLY and updated on a regular basis to reflect changes in operations and implementation of new regulations.
DEATH resulting from disease
MORTALITY
State of disease and its associated effects on the host
MORBIDITY
best taken from the UPPER LATERAL THIRD OF THE VAGINAL WALL
VAGINAL SMEAR
Some evidence of a disease that is experienced or perceived by the patient - something that is subjective. Examples are ache or pain, ringing in the ears (tinnitus), blurred vision, nausea, dizziness, itching, and chills.
SYMPTOM
Some type of objective evidence of a disease. For example, while palpating a patient, a physician might discover a lump or an enlarged liver (hepatomegaly) or spleen (splenomegaly). Other signs of disease include abnormal heart or breath sounds, blood pressure, pulse rate, and laboratory results as well as abnormalities that appear on radiographs, ultrasound studies, or computed tomography scans.
SIGN
JAUNDICE OR ICTERUS IS A PHYSICAL SIGN characterized by a yellow appearance of the skin, mucous membranes, and sclera caused by bilirubin deposition
Usually apparent clinically when the plasma bilirubin concentration reaches 2 to 3 mg/dL
indication of RELATIVE CONCENTRATION
Dilution
amount of something in proportion to an amount of something else; always describes a relative amount
Ratio
amount of solute in a given volume of solution
Concentration
number of osmoles of solute per liter of solution
Osmolarity
gram-molecular mass or weight of a compound per liter of solution
Molarity
number of equivalent weights per liter of solution
Normality
MOST BASIC PIPET:
GLASS PIPETTE
Most routinely used pipette:
AUTOMATIC PIPETTE
Cleaning of glassware:
SULFURIC ACID-DICHROMATE MIXTURE
CRITERIA FOR A GOOD STANDARD CURVE
Line is straight
Line connects all points
Line goes through the origin, or intersect, of the two axes
to determine whether the ulnar artery can provide collateral circulation to the hand after the radial artery puncture.
MODIFIED ALLEN TEST
MOST COMMON CONGENITAL FORM OF GLYCOGEN STORAGE DISEASE; associated with hyperlipidemia
VON GIERKE DISEASE or Glucose-6-phosphatase deficiency type 1 (1a)
Circulating C-peptide provides reliable indicators for pancreatic and insulin secretions (β-cell function).
TYPE 1 DM: very low, undetectable C-peptide
TYPE 2 DM: detectable, measurable C-peptide
chronic process involving damage to the endothelium and the buildup of CHOLESTEROL-RICH lesions that threaten to occlude the vasculature
ATHEROSCLEROSIS
Cholesterol: 60-70% is transported by LDL, 20-35% by HDL and 5-12% by VLDL
Triglycerides: transported in plasma mostly in the form of CHYLOMICRONS AND VLDL
Phospholipids: constitute about 25% of LDL mass and 30% of HDL mass
transport of exogenous/dietary triglyceride
CHYLOMICRONS
transport of endogenous/liver synthesized triglyceride
VLDL
cholesterol transport
LDL
reverse cholesterol transport
HDL
is the FIRST metabolite to elevate in kidney diseases.
UREA
UREA is only a rough estimate of renal function and will not show any significant level of increased concentration until the GLOMERULAR FILTRATION RATE IS DECREASED BY AT LEAST 50%.
chief extracellular anions are chloride and bicarbonate, and there is a RECIPROCAL relationship between them: a decrease in the amount of one produces an increase in the amount of the other.
CHLORIDE AND BICARBONATE
DERANGEMENTS OF BILIRUBIN METABOLISM
HEMOLYSIS: Hemolytic anemias
TRANSPORT DEFICIT: Gilbert’s syndrome
CONJUGATION DEFICIT: Crigler-Najjar syndrome
EXCRETION DEFICIT: Dubin-Johnson (IEM), Rotor syndrome (viral origin), biliary obstruction
Reference method for ALP, substrate is p-nitrophenylphosphate
Bowers-McComb
CONTRIBUTOR TO SERUM OSMOLALITY:
92% sodium, chloride and bicarbonate
8% other ECF electrolytes, serum proteins, glucose and urea
INCREASED ADH:
Fluid retention, low serum sodium
DECREASED ADH:
Fluid loss, high serum sodium
INCREASED ALDOSTERONE:
Hypertension, low serum potassium
DECREASED ALDOSTERONE:
Low serum sodium, high serum potassium
INCREASED RENIN:
Hypertension
Thyroid status is best assessed biochemically by measurement of plasma TSH and free T4, with free T3 being measured in addition if hyperthyroidism is suspected
KEY PROCESSES INVOLVED IN DRUG DISPOSITION
LIBERATION: Release of the dug
ABSORPTION: Transport of the drug from the site of administration to the blood
DISTRIBUTION: Delivery of the drug to the tissues
METABOLISM: Chemical modification of the drug by cells
EXCRETION: Drugs and its metabolites are excreted from the body
Route of drug administration is associated with 100% bioavailability:
INTRAVENOUS
Establishing a reference interval: require from 120 to as many as ≈700 study
Verifying a reference interval: require as few as 20 study individuals
RANDOM ERROR: Error that does not recur in regular pattern; no trend or means of predicting it
-Mislabeling a sample
-Pipetting errors
-Improper mixing of sample and reagent
-Voltage fluctuations not compensated for by instrument circuitry, and temperature fluctuations
SYSTEMATIC ERROR: Recurring error inherent in test procedure; seen as a trend in the data
-Improper calibration
-Deterioration of reagents
-Sample instability
-Instrument drift
-Changes in standard materials
THE ACCEPTED “BIOHAZARD” LABEL:
FLUORESCENT ORANGE
ELECTRICAL EQUIPMENT MUST BE GROUNDED WITH THREE-PRONGED PLUGS.
NOT VISIBLY SOILED HANDS: hand antisepsis with an alcohol-based hand rub
VISIBLY SOILED HANDS: hands should be washed with soap and water, dry with paper towel
ORGANIC COMPONENTS OF URINE:
urea, creatinine, uric acid
INORGANIC COMPONENTS OF URINE:
chloride, sodium, potassium
GESTATIONAL DIABETES: hormones secreted by the placenta block the action of insulin, resulting in insulin resistance and hyperglycemia.
DYSMORPHIC RED BLOOD CELLS: indicative of
GLOMERULAR BLEEDING
VALUES OF pH CAN BE ASSOCIATED WITH CALCULI FORMATION
-pH < 5.5: uric acid, cystine, or xanthine calculi
-pH 5.5 to 6: calcium oxalate and apatite calculi
-pH > 7: magnesium ammonium phosphate or calcium phosphate calculi
DIMORPHIC ANEMIA:
-The presence of hypochromic cells and normochromic cells in the same film is called anisochromia or, sometimes, a dimorphic anemia
-This is characteristic of SIDEROBLASTIC ANEMIAS but also is found some weeks after IRON THERAPY FOR IRON DEFICIENCY ANEMIA, or in a hypochromic anemia AFTER TRANSFUSION with normal cells
MACROANGIOPATHIC HEMOLYTIC ANEMIA:
-Caused by traumatic cardiac hemolysis (RBC fragmentation from damaged or prosthetic cardiac valves) or exercise-induced hemolysis (mechanical trauma from forceful impact on feet or hands or strenuous exercise)
MICROANGIOPATHIC HEMOLYTIC ANEMIA:
-Characterized by the shearing of RBCs as they pass through small blood vessels partially blocked by microthrombi
-Fragmented RBCs (called schistocytes) are formed, and the premature RBC destruction results in hemolytic anemia. Ischemic injury to the brain, kidney, and other organs also occurs.
distinctive lesions occur in the heart, RHEUMATIC FEVER
ASCHOFF BODIES
Decrease in ionized calcium: MAY RESULT IN TETANY
WILSON’S DISEASE (HEPATOLENTICULAR DEGENERATION)
-Deficiency of ceruloplasmin
-Disordered copper metabolism, in which hepatic excretion of copper into the bile is impaired, leading to toxic deposition of copper in tissues.
CHOLINESTERASE: DECREASED VALUE IS SIGNIFICANT
GAMMA-GLUTAMYLTRANSFERASE (GGT)
-SZASZ assay
-Detection of alcoholism and monitoring of alcohol consumption by these patients during treatment
ETHOSUXIMIDE
-Drug of choice for absence (petit mal) seizures unaccompanied by other types of seizures
-It is preferred over valproic acid, at least initially, because hepatotoxicity is a rare but serious side effect of valproic acid (HENRY)
Normal blood pH:
pH 7.35 to 7.45 (pH 7.40; H+ 40 nmol/L)
ACIDEMIA:
pH < 7.35; H+ >45 nmoles/L
ALKALEMIA:
pH > 7.45; H+ <35 nmoles/L
VINEGAR:
natural disinfectant; bleach alternative for some applications
Oxygen labile (destroyed by oxygen)
Antigenic
Subsurface hemolysis
STREPTOLYSIN O
Oxygen stable
Non-antigenic
Surface hemolysis
STREPTOLYSIN S
Urine volume for drug testing (COC):
30 to 45 mL urine; 60-mL container capacity
Urine volume for routine urinalysis:
10 to 15 mL urine; 50-mL container capacity
Afternoon specimen (2 pm to 4 pm):
urobilinogen determination
Renal threshold for glucose:
160 to 180 mg/dL
Squamous epithelial cell:
Largest cell in the urine sediment
Renal tubular epithelial (RTE) cell:
most significant epithelial cell, originate from the nephron
Yellow to brownish red, moderately hard:
URIC ACID AND URATE STONES
Pale and friable:
PHOSPHATE STONES
Very hard, dark color, rough surface:
CALCIUM OXALATE STONES
Yellow-brown resembling an old soap, somewhat greasy:
CYSTINE STONES
formed from the granules of disintegrating EOSINOPHILS; found in sputum in asthma patients and feces in dysentery patients
CHARCOT-LEYDEN CRYSTALS
Calibration of the centrifuge:
EVERY THREE (3) MONTHS
Disinfection of the centrifuge:
WEEKLY
Time from ordering a test through analysis in the laboratory to the charting of the report
TURNAROUND TIME (TAT)
Marker for hematopoietic stem cells:
CD 34
Most serious of the complement deficiencies
Associated with sever and recurrent infections, glomerulonephritis
C3 DEFICIENCY
Most common of the complement deficiencies
Associated with autoimmune diseases (LE-like), atherosclerosis
C2 DEFICIENCY
Anaphylaxis, hay fever, asthma, food allergy
TYPE I HYPERSENSITIVITY (ANAPHYLACTIC)
Transfusion reactions, HDN, thrombocytopenia
TYPE II HYPERSENSITIVITY (CYTOTOXIC)
Arthus reaction, serum sickness
TYPE III HYPERSENSITIVITY (IMMUNE COMPLEX)
Contact dermatitis, tuberculin test ex. Mantoux
TYPE IV HYPERSENSITIVITY (DELAYED OR CELL-MEDIATED)
predominantly polymorphonuclear leukocytes (neutrophils)
ACUTE INFLAMMATION
predominantly mononuclear cell infiltration (macrophages, lymphocytes and plasma cells)
CHRONIC INFLAMMATION
Recommended fixative for nervous tissue (CNS) preservation:
FORMALDEHYDE (FORMALIN)
Fix sputum since it coagulates mucus:
ALCOHOLIC FORMALIN (GENDRE’S) FIXATIVE
Fixative for electron microscopy:
GLUTARALDEHYDE FOLLOWED BY SECONDARY FIXATION IN OSMIUM TETROXIDE
Most common metallic fixative:
MERCURIC CHLORIDE
Fixative of choice for tissue photography:
MERCURIC CHLORIDE
Removal of black mercurial deposits:
SATURATED IODINE SOLUTION IN 96% ALCOHOL
Recommended mainly for tumor biopsies especially of the skin:
HEIDENHAIN’S SUSA SOLUTION
Recommended for study of early degenerative processes and tissue necrosis:
ORTH’S FLUID
Demonstrates Rickettsiae and other bacteria:
ORTH’S FLUID
Excellent fixative for glycogen demonstration:
PICRIC ACID
Yellow stain taken in by tissues prevents small fragments from being overlooked:
PICRIC ACID
Glacial acetic acid solidifies at what temperature:
17C
Effect of glacial acetic acid:
CAUSES THE TISSUES TO SWELL
Considered to be as the most rapid fixative; fixes and dehydrates at the same time:
CARNOY’S FLUID
Decalcification should be done:
AFTER FIXATION AND BEFORE IMPREGNATION
Most common and fastest decalcifying agent used:
NITRIC ACID
Decalcified and softens tissue at the same time:
PERENYI’S FLUID
Decalcifying agent that contains hydrochloric acid:
VON EBNER’S FLUID
Most commonly used clearing agent in histology laboratories:
XYLENE (XYLOL)
Fastest embedding:
VACUUM EMBEDDING
Highly purified paraffin and synthetic plastic polymers:
PARAPLAST
Semisynthetic wax recommended for embedding eyes:
BIOLOID
Product of paraffin containing rubber:
TISSUE MAT
Tissue is soft when block is trimmed:
INCOMPLETE FIXATION
Clearing agent turns milky:
INCOMPLETE DEHYDRATION
Air holes found on tissue during trimming:
INCOMPLETE IMPREGNATION
Serves as a link between the tissue and the dye:
MORDANT
Accelerates or hastens the speed of the staining reaction:
ACCENTUATOR
Probably the best vital dye:
NEUTRAL RED
Vital dye recommended for mitochondria:
JANUS GREEN
Ripening of hematoxylin:
OXIDATION
recommended for progressive staining but can also be used for regressive staining
ALUM HEMATOXYLIN
used only for differential or regressive staining
IRON HEMATOXYLIN
study of spermatogenesis
COPPER HEMATOXYLIN
Stain for reticulin fibers:
GOMORI’S SILVER IMPREGNATION STAIN
Stain for basement membrane:
PAS, AZOCARMINE
Stain for muscle striations:
MALLORY’S PHOSPHOTUNGSTIC ACID HEMATOXYLIN (PTAH)
Stain for melanin and argentaffin granules:
MASSON-FONTANA
Stain for calcium:
VON KOSSA
To avoid distortion of the image, the REFRACTIVE INDEX OF THE MOUNTANT should be as near as possible to that of the glass which is 1.518
Staining method of choice for exfoliative cytology:
STILL THE ORIGINAL PAPANICOLAU (PAP’S)
benign tumors arising from glands
ADENOMAS
benign tumors from epithelial surfaces
POLYPS OR PAPILLOMAS
malignant tumor of EPITHELIAL ORIGIN
CARCINOMA
malignant tumor of CONNECTIVE TISSUE (MESENCHYMAL) ORIGIN
SARCOMA
REPORTING FOR DIAGNOSIS OF CANCER (PAP’S)
CLASS I: Absence atypical or abnormal cells
CLASS II: Atypical cytological picture but no evidence of malignancy
CLASS III: Cytologic picture suggestive but not conclusive of malignancy
CLASS IV: Cytologic picture strongly suggestive of malignancy
CLASS V: Cytologic picture conclusive of malignancy
incomplete or defective development of a tissue or organ, represented only by a mass of fatty or fibrous tissue
APLASIA
failure of an organ to reach or achieve its full mature or adult side due to incomplete development
HYPOPLASIA
complete non-appearance of an organ
AGENESIA
failure of an organ to form an opening
ATRESIA
acquired decrease in size of a normally developed or mature tissue or organ resulting from reduction in cell size or decrease in total number of cells or both
ATROPHY
It is most commonly encountered when the arterial supply is cut off producing ANEMIC or ISCHEMIC INFARCTION
COAGULATION NECROSIS
Rapid total enzymatic dissolution of cells with complete destruction of the entire cell; most commonly encountered in the brain; also in all tissues in bacterial infections which lead to the formation of pus
LIQUEFACTION NECROSIS (COLLIQUATIVE)
Peculiar destruction of adipose tissue, particularly found in pancreatic degenerations
FAT NECROSIS
Special form of cell death by the Tubercle Bacillus, the destroyed cells are converted into a granular, friable mass made up of a mixture of coagulated protein and fat, with total loss of cell detail. Caseous necrosis because in the gross state, the necrotic tissue has the appearance of soft, friable CHEESE.
CASEOUS NECROSIS
Massive death or necrosis of tissue, caused by combination of ischemia and superimposed bacterial infection (necrosis plus putrefaction).
GANGRENOUS NECROSIS
PRIMARY CHANGES OR SIGNS OF DEATH
CIRCULATORY FAILURE
RESPIRATORY FAILURE
NERVOUS FAILURE
SECONDARY SIGNS OF DEATH:
-ALGOR MORTIS – first demonstrable change, cooling of the body, occurring at definite rate of about 7F per hour
-RIGOR MORTIS – rigidity or stiffening of the muscles occurring about 6 to 12 hours after death and persisting for 3 to 4 days
-LIVOR MORTIS – purplish discoloration of the body
-POSTMORTEM CLOTTING – immediately after death, rubbery consistency (must differentiate from antemortem clot – before death, friable)
-DESICCATION – drying and wrinkling of the cornea and anterior chamber of eye due to absorption of the aqueous humor
-PUTREFACTION – production of foul-smelling gases due to invasion of the tissue by saprophytic organism
-AUTOLYSIS – self-digestion of cells
Conversion factor, thyroxine (µg/dL to nmol/L):
12.9
Conversion factor, immunoglobulin (mg/dL to g/L):
0.01
Conversion factor, immunoglobulin (mg/dL to mg/L):
10
Without error, closeness to the true value:
ACCURACY
The closeness of repeated results; quantitatively expressed as standard deviation or coefficient of variation:
PRECISION
Point where most values lie:
MODE
Figure for which 50% of the values are higher and 50% of the values are lower:
MEDIAN
Ability of an analytical method to measure the smallest concentration of the analyte of interest:
ANALYTICAL SENSITIVITY
Ability of an analytical method to measure only the analyte of interest:
ANALYTICAL SPECIFICITY
Values for the control that continue to either increase or decrease over a period of six consecutive days:
TREND
Six or more consecutive daily values that distribute themselves on one side of the mean value line, but maintain a constant level:
SHIFT
System or process that encompasses (in the laboratory) PRE-ANALYTIC, ANALYTIC, AND POST-ANALYTIC FACTORS. Quality control is part of a quality-assurance system:
QUALITY ASSURANCE (QUALITY ASSESSMENT)
System for recognizing and minimizing (analytic) errors. The purpose of the quality-control system is to monitor analytic processes, detect analytic errors during analysis, and prevent the reporting of incorrect patient values. Quality control is one component of the quality-assurance system:
QUALITY CONTROL
PATTERNS OF COMMON LABORATORY TESTS FOR HEPATITIS
SUSCEPTIBLE
HBsAg negative
Anti-HBc negative
Anti-HBs negative
PATTERNS OF COMMON LABORATORY TESTS FOR HEPATITIS
IMMUNE DUE TO NATURAL INFECTION
HBsAg negative
Anti-HBc positive*
Anti-HBs positive*
PATTERNS OF COMMON LABORATORY TESTS FOR HEPATITIS
IMMUNE DUE TO HEPATITIS B VACCINE
HBsAg negative
Anti-HBc negative
Anti-HBs positive*
PATTERNS OF COMMON LABORATORY TESTS FOR HEPATITIS
ACUTELY INFECTED
HBsAg positive*
Anti-HBc positive*
Anti-HBc IgM positive*
Anti-HBs negative
PATTERNS OF COMMON LABORATORY TESTS FOR HEPATITIS
CHRONICALLY INFECTED (Larson)
Anti-HBs is not produced during chronic HBV infection, in which immunity fails to develop.
HBsAg positive*
Anti-HBc positive*
Anti-HBc IgM negative
Anti-HBs negative
PATTERNS OF COMMON LABORATORY TESTS FOR HEPATITIS
Four possibilities: (1) resolved infection (most common), (2) false positive anti-HBc thus susceptible, (3) low-level chronic infection, and (4) resolving acute infection:
HBsAg negative
Anti-HBc positive*
Anti-HBs negative
