Exam 1

Question 1

What makes up a CBC

Answer 1

WBC, RBc, Platelets

Question 2

What does elevated neutrophils indicate

Answer 2

probably bacterial infection, possibly viral
chronic illness (malignancies, inflammation)
Medication effect

Question 3

What does elevated lymphocytes indicate

Answer 3

Malignancies (leukemias, lymphomas)

Viral illnesses

Question 4

What do elevated monocytes indicate

Answer 4

hematological disorders (50%) - splenectomy, ITP, polycythemia, hemolytic anemia)

Malignancies (8%) - leukemia, Hodgkins

Chronic illness (10%) - connective tissue disorders, SLE, RA
Misc - sarcoidosis, liver disease, trauma, marathon running

Question 5

What does elevated eosinophils indicate

Answer 5

Worldwide - parasitic infection
industrialized countries - allergies
hospitalized - new drug?
asthmatics - aspergillosis or Churg-Strauss syndrome?

Question 6

What does increased basophils indicate

Answer 6

Reactive - occurs when patient has a non neoplastic condition
Neoplastic - cancer in bone

Question 7

Hemoglobin

Answer 7

part of the cell that carries oxygen

Question 8

Hematocrit

Answer 8

% of RBC’s to whole blood

Question 9

normal H&H ratio

Answer 9

1:3; false normal with dehydration

Question 10

what is Mean corpuscular Volume (MCV)

Answer 10

size of the red blood cell

Question 11

Macrocytic anemia

Answer 11

MCV>96
B12 or Folate deficiency***
Hypothyroidism, alcohol abuse
other causes

Question 12

Microcytic anemia

Answer 12

MCV<80
Iron deficiency **
thalassemia
anemia of chronic disease
lead poisoning
sideroblastic anemia

Question 13

Normocytic anemia

Answer 13

MCV normal 80-96 with low H&H

trauma, acute blood loss, hemolytic anemia, metastasis, iron, B12, or folate def

Question 14

Work up for macrocytic anemia

Answer 14

B12, folate level

TSH if those are normal

Question 15

Work up for microcytic anemia

Answer 15

serum iron
ferritin (protein that stores iron)
transferrin (protein that carries iron to sites)
Total Iron Binding Capacity (how many open sites - high is worse)

Question 16

Work up for normocytic anemia

Answer 16

Look for blood loss - check stool for occult bleeding

Consider IDA, anemia of chronic disease, mixed anemia

Question 17

Polycythemia (increased RBC)

Answer 17

• smoker, CPOD
• high altitude
• sleep apnea, CO2 intoxication
• renal disease
  cancer
  medication

Question 18

What condition must you r/o with Polycythemia

Answer 18

Polycythemia Vera - JAK2 genetic testing
Serum erythropoietin (if normal retest)
if above tests are normal - consider erythropoietin secreting tumor

Question 19

Thrombocytopenia (decreased platelets) - causes

Answer 19

ITP, DIC, Neonates, Medications (chemo, thiazides, estrogens, heparin), infections (CMV, HIV, parovirus), bone marrow problems
- order manual reading

Question 20

Thrombocytosis causes

Answer 20

Reactive - acute blood loss, infection, IDA, post-op, hypersplenism or post splenectomy, trauma
Clonal - leukemia

Question 21

Thrombocytosis - what to do next

Answer 21

check manual count/peripheral smear
retest if no initial cause found
if not a reactive cause refer to hematologist for clonal

Question 22

What is included in a CMP (excluding BMP) - 6

Answer 22

Total Protein
Albumin
Total Bilirubin
ALT
AST
ALK Phos

Question 23

Low Total Protein

Answer 23

liver, renal disease, or severe malnutrition

Question 24

High Total Protein

Answer 24

Chronic Inflammation (Hepatitis, HIV)

Question 25

Albumin

Answer 25

``` nutritional status (if low will cause third spacing) If low affects medications slow to change (1/2 life is 20 days, can take up to 14 days to return to normal) ```

Question 26

Pre - Albumin

Answer 26

half life is 2 days so it is better evaluates response to treatment. Not on CMP Can be decreased due to diet, alcoholism, steroid, zinc deficiency Hydration does not affect

Question 27

Total Bilirubin - Indirect

Answer 27

Unconjugated, if elevated probable live problem

Question 28

Bilirubin - direct

Answer 28

Conjugated - problem past the liver (GB or pancreas)

Question 29

ALK (Alkaline Phosphatase) - increases with:

Answer 29

ductal cell problems GB, Pancreas, Liver problems Pregnancy (normal) Bone problems (growth in children, cancer fractures)

Question 30

Hypernatremia (cause and how to correct)

Answer 30

due to loss of water (GI, diuretics, renal disease, lungs) | Correct with fluid PO or IV 1/2 NS

Question 31

Hyponatremia - what causes false lows

Answer 31

hyperlipidemia, hyperglycemia, hyperproteinemia

Question 32

How to correct hyponatremia

Answer 32

IV - NS; use 3%NS with neuro symptoms

Question 33

What to do if hyponatremia is not correcting with IVF

Answer 33

urine and serum levels of osmolarity and sodium

Question 34

Hyperkalemia S &S

Answer 34

tented T waves, v-fib, agonal rhythm

Question 35

Hypokalemia S &S

Answer 35

muscle cramping, heart irregularities

Question 36

Hyperkalemia - causes

Answer 36

renal failure, trauma, DKA, ACEI, Adrenal Insufficiency

Question 37

Hypokalemia - causes

Answer 37

volume depletion, diuretics, N/V

Question 38

BUN - Low causes

Answer 38

over-hydration or liver disease, nutritional deficiency

Question 39

BUN - High causes

Answer 39

renal disease, dehydration, GI bleed, post renal obstruction

Question 40

Chloride

Answer 40

follows Sodium, if changed independently of sodium then you have a metabolic acid - base problem

Question 41

What is renal dosing of meds based on

Answer 41

Creatinine Clearance, not GFR

Question 42

Serum Creatinine - low reasons

Answer 42

secondary to decreased muscle mass

Question 43

Serum Creatinine - high reasons

Answer 43

secondary to volume depletion or renal insufficiency