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Clinical laboratory Medicine > Exam I > Flashcards

Exam I Flashcards

1
Q

What is a common normal finding of a vaginal wet prep

A

lactobacilli

considered normal vaginal flora, believed to create acidic environment

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2
Q

[] are part of normal vaginal flora and are believed to create an acidic environment

A

lactobacilli

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3
Q

an acidic vaginal pH is protective against what?

A

infection

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4
Q
  1. fishy vaginal d/c
  2. milky, homogenous d/c

these are common findings with what d/o

A

Bacterial Vaginosis

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5
Q

What does Vaginosis mean?

A

it means that there is NO inflammation, i.e. abnormal pathology WITHOUT inflammation

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6
Q

Is there mucosal inflammation in BV?

A

NO! Vaginosis means pathology with NO inflammation

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7
Q

Describe Amsel’s Criteria

What can it be helpful in diagnosing?

A
  1. Homogenous vaginal d/c
  2. amine odor when d/c mixed with KOA
    - i.e. positive whiff test
  3. Clue cell presence in >/= 20% epithelial cells
  4. vaginal pH > 4.5

Amsel’s can provide an accurate dx of BV 90% of the time

3/4 criteria must be met for dx

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8
Q

Clue cells are assoc. with what d/o?

A

BV

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9
Q

a stippled or granulated epithelial cell is also called what?

A

clue cells

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10
Q

a vaginal pH of what can be diagnostic for BV

A

pH > 4.5

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11
Q

describe the whiff test

A

KOH added to vaginal secretion

positive: amine, fishy odor
negative: no odor

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12
Q

[] % clue cells can be diagnostic BV

A

20%

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13
Q

clue cells are described as []

A

stippled, granulated epithelial cells

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14
Q
  1. vulvar pruritis
  2. vulvovaginal erythema
  3. thick white d/c

can be diagnostic of what?

A

candidiasis

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15
Q

Hyphae or buds on wet prep can be indicative of what

A

candidiasis

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16
Q

[] is a unicellular protozoan

A

trichomonas vaginalis

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17
Q

[] causes trichomonal vaginitis

A

trichomonas vaginalis

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18
Q

Describe the size of trichomonas vaginalis

A

leukocytes < t. vaginalis < epithelial cells

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19
Q
  1. profuse frothy, green, foul smelling discharge, pruritis
  2. significant erythema of vaginal mucosa
  3. petechia on cervix

these are indicative of what?

A

Trichomonas

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20
Q

Strawberry Cervix is assoc with what d/o

A

trichomonas, AKA petechia on cervix

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21
Q

how is trichomonas diagnosed

A

Wet prep, with unicellular protozoa spotting

DNA probe

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22
Q

Tx trichomonas

A

2g metronidazole PO x1 dose

partner needs treated

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23
Q

Is trichomonas reportable

A

no

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24
Q

[] is a chromatographic assay for qualitative detection of strep A Ag from throat swab specimen

A

Moorebrand Strep A rapid test-dipstick

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25
Q

Moorebrand Strep A Rapid Test-Dipstick is a

a. qualitative
b. quantitative test

A

a. qualitative

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26
Q

describe the MOA of more brand Strep A Rapid Test

A

chromatographic immunoassay for qualitative detection of strep A Ag from specimens

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27
Q

Benefit of using strep A rapid test

A

it does not require growth of microorganisms like cultures, rapid

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28
Q

Moorebrand Strep A is a [] immunoassay to detect strep a

A

lateral flow

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29
Q

[] is coated on the test line region of the moorebrand dipstick

A

Ab specific to Strep A carbohydrate Ag

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30
Q

Strep A has a [] Ag

A

carbohydrate

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31
Q

[] indicates positive strep test result, what is happening on the strip?

A

red line = positive

throat swab specimen interacts with strep A antibody and will generate red line

*every test has one red “c” (control) line to ensure the test was done properly

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32
Q

Important findings on strep test package insert

A
  1. what it is used for
  2. how it works
  3. precautions while using test
  4. storage directions
  5. specimen collection and prep
  6. directions
  7. interpretation of results
  8. limitations of test
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33
Q

Where would you swab a patient for a strep test?

A
  1. posterior pharynx
  2. tonsils
  3. other inflamed areas
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34
Q

Where should you avoid swabbing during the strep test?

A

tongue, cheeks, teeth

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35
Q

swab specimen can be stored up to [] hours room temp.

A

8 hours

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36
Q

swab specimen must be stored [] hours 2-8 degrees celsius

A

72 hours

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37
Q

[] is the larges endocrine gland

A

thyroid

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38
Q

the thyroid is enclosed by []

A

CT capsule

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39
Q

TRH full name, what secretes this hormone?

A

Thyroid Releasing Hormone

Hypothalamus

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40
Q

TSH full name and secreting organ

A

Thyroid Stimulating Hormone

Pituitary (stimulated to release by TRH)

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41
Q

T4 full name and secreting organ

A

Thyroxine

secreted by thyroid gland (stimulated by TSH)

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42
Q

T3 full name and secreting organ

A

Triiodothyronine

secreted by thyroid (stimulated by TSH)

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43
Q

Describe T3 and its role

A

ACTIVE hormone, stimulates metabolism

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44
Q

Describe reverse T3

A

inactive hormone

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45
Q

[] is secreted from the thyroid and is converted to [] for activation

A
  1. T4

2. T3

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46
Q

[] is converted into T3

A

T4

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47
Q

low concentration of [] in blood regulates release of TSH

A

T4, T3

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48
Q

T3, T4 are high

what does this mean for TSH?

A

low

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49
Q

T4 and T3 are low

what does this mean for TSH?

A

high

unless secondary (pituitary) thyroid d/o, then it would be low as well

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50
Q

Describe TBG and its role

A

Thyroxine Binding Globulin

Carrier protein for T4

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51
Q

[] forms of thyroid hormones are biologically active

A

free, i.e. not bound to carrier protein

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52
Q

[] thyroid hormone is transported more easily

A

T3

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53
Q

T4 and T3 circulate in [] and [] forms

A
  1. free

2. bound

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54
Q

[] thyroid hormone has more metabolic activity

A

T3

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55
Q

80% T4-T3 conversion occurs in the []

A

liver and other organs

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56
Q

20% T4-T3 conversion occurs in the []

A

thyroid

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57
Q

only [] thyroid hormones have metabolic activity

A

free

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58
Q

Thyroid dysfunction usually occur as [] disorders of the []

A
  1. primary

2. thyroid gland

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59
Q

[] is the most sensitive thyroid screening for thyroid abnormalities?

why?

A

TSH

because most problems arise from thyroid gland itself (primary [increase or decrease T4, T3]) both of which will have a direct impact on the secretion of TSH

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60
Q

what is the first-line thyroid abnormality test?

A

TSH

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61
Q

Free T4 measures what?

A

unbound T4 in serum

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62
Q

what is the most accurate reflection of functional state of thyroid?

A

serum free T4

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63
Q

What does total serum T4 measure

A

BOTH bound and free T4

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64
Q

most T3 is []

A

bound

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65
Q

[] is primarily used as an indicator of hyperthyroidism and its severity

A

T3

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66
Q

What thyroid test is generally not a reliable indicator of thyroid function on its own?

A

T3

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67
Q

[] is the last test to become abnormal

A

T3

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68
Q

Free T3 measures what

A

the fraction of T3 that is not bound and is circulating in blood stream

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69
Q

Free T3 is usually done to r/o what?

A

T3 thyrotoxicosis

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70
Q

What combination most accurately determines how the thyroid is functioning

A

TSH + T4

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71
Q

Elevates TSH, Low T4 is indicative of what?

A

primary hypothyroidism

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72
Q

Low TSH with Low T4 is indicative of what

A

secondary hypothyroidism, problem at level of pituitary

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73
Q

name some thyroid Ab

A
  1. Thyroid Peroxidase AB

2. Thyroglobulin Ab

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74
Q

What diseases are thyroid Ab commonly found in?

A
  1. Grave’s

2. Hashimoto’s

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75
Q

[] detects the ability of thyroid to trap iodine and produce thryroid hormone

A

RAIU I123

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76
Q

Describe RAIU I123

A

it detects the ability of thyroid to trap iodine and produce thyroid hormone

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77
Q

RAIU I123 tests for what?

A

intrinsic function of thyroid gland

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78
Q

Describe RAIU I123 test

A
  1. patient swallows RAIU I123 in the form of capsule or fluid
  2. absorption of thyroid is studied after 4-6 hours and after 24 hour with aid of scintillation counter
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79
Q

A scintillation counter is used in what test?

A

RAIU I123

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80
Q

What is a normal RAIU I!123 rest result

A

15-25%

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81
Q

a patients RAIU I123 test shows 15-25% uptake

what can you conclude about this patient

A

they are euthyroid, showing normal results

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82
Q

a low RAIU uptake suggests what

A

hypothyroidism, thyroiditis

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83
Q

high RAIU uptake suggests what

A

Grave’s disease, thyrotoxicosis

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84
Q

[] secretes calcitonin

A

thyroid gland

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85
Q

What is the role of calcitonin

A
  1. regulate osteoblast activity
  2. lower serum calcium (trap in bone)
  3. increase serum phospate
  4. oppose PTH
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86
Q

[] is secreted when serum calcium is high

A

calcitonin

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87
Q

[] helps regulate water balance in the body by controlling the amount of water the kidneys reabsorb while filtering waste out of blood

A

ADH

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88
Q

ADH regulates water balance by what mechanism?

A

controlling the amount of water the kidneys reabsorb while filtering waste out of blood

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89
Q

low ADH is assoc with what disease

A

DI

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90
Q

High ADH is assoc with what diease

A

SIADH

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91
Q

[] works with GH to promote normal bone and tissue growth

A

IGF-1

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92
Q

[] is primarily produces in liver, skeletal muscle, and tissues in response to GH secretion

A

IGF-1

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93
Q

Where is IGF-1 produced?

A

liver, skeletal muscle, tissues

in response to GH

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94
Q

[] mediates the action of GH and stimulates growth of bones and other tissues, promotes production of muscle mass

A

IGF-1

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95
Q

Describe the role of IGF-1

A

Mediate the action of GH

stimulate growth of bones and other tissues, promote production of muscle mass

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96
Q

[] plays a role in non growth and lipid metabolism

A

IGF-1

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97
Q

[] has been implicated in metabolic syndrome

A

IGF-1

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98
Q

What can cause IGF-1 and GH deficiency

A
  1. dysfunctional pituitary gland with decreased pituitary hormones
  2. non-Gh producing pituitary adenoma due to damage or GH producing cells
  3. lack of responsiveness to GH
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99
Q

IGF and GH excess is often due to []

A

pituitary adenoma, slow growing, benign tumor

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100
Q

[] can lead to enlarged organs, heart, liver, kidney, spleen, thyroid, parathyroid, pancrease

A

Gigantism/acromegaly

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101
Q

[] has an increased rx DM2, CVD, HTN, arthritis, cancer

A

giantism/acro

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102
Q

[] helps regulate blood levels of calcium, phosphorus, and magnesium

A

vitamin D

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103
Q

What is the role of vitamin D

A

regulate blood levels calcium, phosphorus, magnesium

influence growth and differentiation of many other tissues to help regulate immune system

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104
Q

rickets occurs in []

A

children, due to lack of vit D

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105
Q

osteomalacia occurs in []

A

adults due to lack vit dD

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106
Q

without [] bones will be soft, malformed, and unable to repair themselves normally

107
Q

rickets and osteomalacia is caused from what?

A

lack vitamin D
rickets= children
osteomalacia=adults

108
Q

[] influences growth and differentiation of many other tissues to help regulate immune system

109
Q

What 2 body systems van be influenced by Vit D levels?

A
  1. immune

2. musculoskeletal

110
Q

Who is at risk for lack of vit d?

A
  1. older adults
    - institutionalized
    - home-bound
    - limited sun exposure
  2. obese
  3. s/p gastric bypass sx
  4. fat malabsorption
  5. darker skin
  6. breast fed
111
Q

25(OH)D is what

A

25- hydroxyvitamin D

major circulating form vitamin D

112
Q

[] is the major form circulating vitamin D

A

25-hydroxyvitamin D

113
Q

[] is the best indicator of vitamin D supply to body from cutaneous synthesis and nutritional intake

A

total serum 25(OH)D

114
Q

what are two ways for patients to get vitamin D

A
  1. cutaneous synthesis

2. nutritional intake

115
Q

What is the reference range 25(0H)D

A

25-80 ng/mL

116
Q

What hormones does the adrenal medulla secrete?

what are they for?

A

Catecholamines, epinephrine, norepinephrine

fight or flight

117
Q

What three hormones does the adrenal cortex secrete

A
  1. Glucocorticoids (cortisol)
  2. Mineral corticoids (aldosterone)
  3. Sex hormones (testosterone)
118
Q

What are the most common causes Addison’s

A
  1. Autoimmune
    most common in western world
  2. infectious TB
    more common world wide
119
Q

what labs would you draw on a patient you suspect to have addison’s

A
  1. AM cortisol

2. ACTH stimulation test

120
Q

< 10 mg/dL in an AM cortisol test suggests what?

A

cortisol deficiency

121
Q

<3 mg/dL in an AM cortisol test suggests what

A

is DIAGNOSTIC of addison’s

122
Q

Decreased AM cortisol points to []

A

adrenal insufficiency

123
Q

Describe an ACTH stimulation test

A

250 mg of ACTH is administered IV or IM

serum cortisol measured 30-60 minutes later

124
Q

What is a normal ACTH stimulation test result

A

peak of 18-20mg/dL or more

125
Q

after an ACTH stimulation test, the patients cortisol is

18-20 mg/dL

what does this indicate?

A

cortisol adequacy, normal

126
Q

after an ACTH stimulation test, the patient’s cortisol is < 18 mg/dL

what does this indicate

A

diagnostic of addisons, cortisol insufficiency

127
Q

Hypersecretion of cortisol leads to []

A

high glucose

128
Q

Cushing’s is usually caused by

A

ACTH-secreting pituitary adenoma

129
Q

What labs would you draw if you suspect your patient has cushing’s

A
  1. late-night salivary cortisol

2. Dextromathason suppression test or 24 hour urinary free cortisol (to confirm salivary cortisol)

130
Q

Describe the late-night salivary cortisol test

A
  1. patient collects saliva with swab or drools into collection tube between 11-12am
131
Q

What is a positive late-night salivary cortisol test?

A

value greater than upper limit of normal

normal results vary depending on assay and clinical lab used

132
Q

A positive late-night salivary test needs to be confirmed with []

A

dexamethasone suppression test or 24 hours urinary free cortisol

133
Q

[] is the easiest screening for Cushing’s

A

Dexamethasone suppression test

134
Q

Describe dexamethasone suppression tes

A

dexa. 1 mg given orally at 11 pm, serum collected for cortisol determination at 8 am next morning

135
Q

[] regulates mineral balance of K and Na

How?

A

aldosterone

  1. Na reabsorbtion
  2. K excretion

by adding Na/K pumps in kidney (solon, sweat, and salivary glands)

136
Q

[] plays a central role in regulating BP

A

aldosterone (ADH too)

137
Q

What are some functions aldosterone

A
  1. regulate mineral balance between K and Na
  2. BP regulation
  3. reduce loss Na when sweating
  4. Increase sensitivity of tastebuds to Na
138
Q
  1. HTN
  2. Hypokalemia

signs of what?

A

hyperaldosteronism

139
Q
  1. facial flushing
  2. visual impairment
  3. weakness

these are signs of what?

140
Q
  1. contipation
  2. polyuria
  3. polydipsia
  4. weakness

these are signs of what?

A

Hypokalemia

141
Q
  1. facial flushing
  2. visual impairment
  3. weakness
  4. polyuria
  5. polydipsia
  6. constipation

these are signs of what?

A

patient suffering from HTN and hypokalemia due to hyperaldosteronism

HTN: facial flushing, visual impairment, weakness

Hypokalemia: polyuria, polydipsia, weakness, constipation

142
Q

How would you obtain accurate labs on a patient you suspect to have hyperaldosteronism

A

have patient consume diet high in NaCl (>6 g per day)
and hold certain medications

then test aldosterone levels in blood

143
Q

high aldosterone to renin suggests []

A

primary hyperaldosteronism

144
Q

if a patients blood work is showing high aldosterone to renin, what is the next step?

A

confirm diagnosis with 24-hour urine, aldosterone, cortisol, creatinine

145
Q

In a patient you suspect hyperaldosteronism, what should you check for in their urine?

A
  1. aldosterone
  2. cortisol
  3. creatinine
146
Q

aldosterone > 20 mcg/24 h is indicative of what

A

it confirms hyperaldosteronism

147
Q

Urine with 55nmol/24 h concentration of aldosterone suggests what

A

hyperaldosteronism

148
Q

[] is the main function cortisol

A

controlling glucose homeostasis

149
Q

cortisol does what in the liver

A

increase glucose production

150
Q

cortisol does what in the muscle

A

break down

151
Q

cortisol does what in the bone

A

inhibit bone formation and collagen synthesis

152
Q

cortisol does what in the immune system

A

provide anti-inflammatory response

153
Q

cortisol does what to the vasculature

A

modulate reactivity to vasoactive substances, like angiotensin II and norephinephrine

154
Q

when are cortisol levels the highest

A

4-5 am, vial circadian rhythm from diurnal variation

155
Q

[] is an effective way to measure glucose over long periods of time

156
Q

A1c measures what

A

the amount of Hb that attached to blood glucose (glycosylated Hb)

157
Q

[] measures the amount of glycosylated Hb (Hb attached to blood glucose)

158
Q

[] is high when you blood sugar is high

159
Q

How often do you check a HbA1c

A

3-4 months

160
Q

What pathological states can cause glucose to rise?

A
  1. diabetes (most common)
  2. disease
    - cushing’s
    - pancreatitis
  3. severe illness
  4. steroids/medication
161
Q

[] is the most common cause of an increase in blood glucose

A

diabetes I and II

162
Q

[] is the most common endocrine d/o

163
Q

[] is an endocrine d/o in which insulin does not appropriately regulate blood glucose levels

164
Q

[]% americans have DM, []% unaware

165
Q

DM [] is where the body doesn’t produce inulin

A

DM I

less common, more severe

166
Q

DM [] is where the body becomes insensitive to insulin

167
Q

[] diabetes appears after childbirth

A

gestational

168
Q

describe oral glucose tolerance test

A
  1. patient fasts 8-12 hours
  2. blood drawn to establish fasting glucose
  3. patient drinks 75g carb sugary drink
  4. blood drawn at various intervals to measure glucose levels
    - usually 1-2 hours after beverage is consumed
169
Q

for 75 grams of glucose, normal values at 1 hr are (during OGTT)

A

less than 200 mg/dL

170
Q

for 75 grams glucose, normal values after 2 hrs of OGTT are

171
Q

for 75 grams glucose in OGTT

140-200 mg/dL indicates what

A

impaired glucose tolerance, pre-diabetes

172
Q

for 75 grams glucose

> 200 mg/dL indicates what

173
Q

pregnancy alters a women’s ability to []

A

metabolize blood sugar

174
Q

what is recommended for all expectant mothers?

A

oral glucose tolerance test

check for gestational diabetes, recommended by american diabetes assoc

175
Q

When is the OGTT done during pregnancy

A

24th- 28th week

176
Q

for a 50g OGTT, [] is a normal value after 1 hr

A

1 hour < 140 mg/dL

pregnant mothers start with 50 g

177
Q

what happens if a pregnant patient fails the 50g OGTT

A

she will take a 100g OGTT

178
Q

[] is a normal value of fasting before OGTT

A

< 95 mg/dL

*anything above indicated gestational diabetes

179
Q

[] is a normal value after 1 hr of 100 g OGTT

A

< 180 mg/dL

*anything above indicates GD

180
Q

[] is a normal value after 2 hours of 100g OGTT

A

< 155 mg/dL

*anything above indicates GD

181
Q

[] is a normal value after 2 h of 100g OGTT

A

< 140 mg/dL

*anything above indicated GD

182
Q

[] is used to describe patients who do not meet the criteria for diabetes but have a fasting plasma glucose levels in excess of normal

A

prediabetic patients

183
Q

pre diabetic patients have one of 2 things

A
  1. impaired fasting glucose

2. impaired glucose tolerance

184
Q

what is IFG

A

impaired fasting glucose

185
Q

what is IGT

A

impaired glucose tolerance

186
Q

FPG [] is normooglycemic

A

< 100 mg/dL

187
Q

2hr GTT [] is normoglycemic

A

< 140 mg/dL

188
Q

< 100 mg/dl FPG indicates what

A

normoglycemia

189
Q

< 140 mg/dL in 2 hr GTT indicates what

A

normoglycemia

190
Q

[] used for intermediated stage between normoglycemia and DM, included IFG and IGT

A

prediabetes

191
Q

100 < FPG < 126 indicates

A

prediabetes

192
Q

140 < GTT < 200 indicates

A

prediabetes

193
Q

[] represents any level of glucose intolerance initially recognized during pregnancy

A

gestational diabetes

194
Q

what are some complications of GD

A
  1. Macrosomia
  2. intrauterine fetal demise
  3. pulmonary immaturity
195
Q

macrosomia means what? What d/o is this assoc with this

A

birth weight > 9 lbs ( 4,000 g)

assoc. with GD

196
Q

[] weeks after the end of a pregnancy complicated with GD, the provider should do what?

A
  1. 6 weeks

2. bring patient back to be re-tested

197
Q

[]% chance of a mother with GD developing diabetes in []yrs

A
  1. 50%

2. 7-10 years

198
Q

What is diagnostic criteria for DM2

A
  1. Fasting plasma glucose >/= 126
  2. 2 hr PP >/= 200
  3. HbA1C >/= 6.5%
  4. symptoms and random glucose level >/= 200
199
Q

a FPG >/= 126 indicates what

200
Q

a 2 hr PP >/=200 indicates what

201
Q

a HB1AC >=/ 6.5% indicates what

202
Q

symptoms + RGL >/= 200 indicates

203
Q

2 hr pp after glucose load < 140 indicates what

A

euglycemia, normal

204
Q

Hb1ac < 5.7 indicates

A

euglycemia, normal

205
Q

HB1AC 5.7-6.4%

A

pre diabetes

206
Q

FPG < 100 indicates

A

euglycemia, normal

207
Q

2 h PP after glucose load >/= 140-199 indicates

A

impaired glucose tolerance, prediabetes

208
Q

FPG 100-125 is indicative of

A

prediabetes

209
Q

What produces insulin

A

beta cells of islets of langerhands in pancreas

210
Q

what prompts insulin to be produces

A

presence of glucose in blood

211
Q

[] is a gateway transporter of glucose from blood into cells

212
Q

What can insulin levels be used to dx

A
  1. insulinoma
  2. undiagnosed/untreated DM2
  3. other endocrine disease with high glucose content
213
Q

[] is produced with proinsulin senses glucose and breaks down

A

c peptide

proinsulin breaks down into c peptide and insulin

214
Q

what does proinsulin breakdown into?

A

C peptide and insulin

215
Q

describe c peptide

A

it is a byproduct of the breakdown on endogenous proinsulin into

insulin
and c peptide

216
Q

when proinsulin senses [] it breaks down into [] and []

A
  1. glucose
  2. insulin
  3. c peptide
217
Q

What is the main use of C peptide

A

evaluate hypoglycemia

218
Q

in [] there is minimal c peptide

A

DM1, may not be any at all because almost no endogenous insulin/proinsulin is being made

219
Q

in [] c peptide may be high

220
Q

a blood sugar of 70-140 indicates what?

A

normal range

221
Q

BG =/< 70 indicates

A

hypoglycemia alert (level 1)

low for treatment with fast acting carb. and dose adjustment for glucose lowering therapy

222
Q

BG < 54 indicates

A

clinically significant hypoglycemia (level 2)

hypoglycemia, sufficiently low to indicate serious, clinically important hypoglycemia

223
Q

[] assoc with severe cognitive impairment requiring external assistance for recovery

A

severe hypoglycemia level 3

224
Q

Describe level 1 hypoglycemia

A

=/< 70

low for treatment with fast acting carb. and dose adjustment for glucose lowering therapy

225
Q

Describe level 2 hypoglycemia

A

/=< 54
hypoglycemia, sufficiently low to indicate serious, clinically important hypoglycemia

clinically significant

226
Q

Describe level 3 hypoglycemia

A

NOS glucose threshold

severe cognitive impairment requiring external assistance for recovery

227
Q

[] is the main cause of hypoglycemia

A

diabetic treatment

228
Q
  1. intermittent episodes of sweating
  2. tachycardia
  3. anxiety
  4. dizziness
  5. slurred speech
  6. double vision
  7. confusion
A

signs hypoglycemia

229
Q

name some signs hypoglycemia

A
  1. intermittent episodes of sweating
  2. tachycardia
  3. anxiety
  4. dizziness
  5. slurred speech
  6. double vision
  7. confusion
230
Q

transient rise in blood glucose during acute illness is called

A

stress hyperglycemia

231
Q

name 2 reasons why hyperglycemia is commonly seen in hospitalized patients

A
  1. stress hyperglycemia

2. undiagnosed diabetes

232
Q

increase in blood glucose in hospitalized patients is assoc with [] and []

A
  1. increased morbidities

2. poorer prognosis

233
Q

all hospitals now have policies to monitor [] in all patient population

A

blood glucose i.e. tight glycemic control

234
Q

How do hospitals maintain tight glycemic control?

A
  1. check BG upon admission
  2. inpatient hyperglycemia = RBG >200 and fasting >126
  3. manage with IV or SQ insulin algorithm
  4. have diabetic patients (type II) d/c oral anti diabetic drugs
235
Q

what is considered hyperglycemic in a hospital patient?

A

x> 200 RBG

x > 126 FBG

236
Q

in a patient who is critically ill and a surgical patient, what is the BG goal

237
Q

in a patient who is critically ill non surgical what is the BG goal

238
Q

in a patient who is non critally ill in the hospital, what is the BG goal (fasting and random)

A

fasting < 126

random < 180-200

239
Q

[] is a syndrome where insulin deficiency and glucagon excess combine to yield dehydration, acidosis, elevated blood glucose and electrolyte abnormalities

240
Q

What is assoc with DKA

A
  1. dehydration
  2. acidosis
  3. elevated blood glucose electrolyte abnormalities
241
Q

What is a DKA triad?

A
  1. Hyperglycemia > 250
  2. ketosis
  3. metabolic acidosis pH<7.3
242
Q

a patient presents with BG > 250, what should be on your radar?

243
Q

What pH is assoc with DKA

244
Q

What bicarb would you expect to see in a DKA patient

245
Q

What would be present in a DKA patient’s urine

A

glucose, ketones

246
Q

What is the elctorlye situation with a DKA patient

A

Na LOW
K High
(follows sugar and sugar is in blood)

247
Q

why is serum K high in a DKA patient

A

because K follows sugar and sugar is in blood

248
Q

how is a DKA patient treated

A
  1. ICU admission
  2. Hourly: blood glucose, K, EKG, urine output, ABG
  3. fluid! NS then change to D5 to prevent hypoglycemia once K is normal
  4. INSULIN
249
Q

What needs checked hourly in a DKA patient

A
  1. blood glucose
  2. K
  3. EKG
  4. urine output
  5. ABG
250
Q

describe Hyperosmolar/Hyperglycemic syndrome

A

severe dehydration form sustained hyperglycemic diuresis

251
Q

[] severe dehydration from sustained hyperglycemic diuresis

A

hyperosmolar/hyperglycemic syndrome (HHS)

252
Q

What usually causes HHS

A

diabetic patients who are not able to drink enough

253
Q

BUN and serum creatinine are markedly increased in what?

254
Q

a glucose of 600+ indicates what?

255
Q

High serum osmolality indicates what?

A

HHS (hyperosmolar hyperglycemic syndrome)

256
Q

what labs would you expect to see in a HHS patient

A
  1. increased BUN and creatinine
  2. Glucose 600+
  3. high serum osmolality
257
Q

how is serum osmolality calculated

A

(2Na + glucose)/18

258
Q

what are some other names for HHS

A
  1. HONC
    hyperosmolar non-ketonic syndrome
  2. HHNS
    hyperglycemic hyperosmolar nonketotic syndrome
  3. HHNC
    hyperglycemic hyperosmolar non ketotic coma
259
Q

random plasma glucose is commonly measured from

A

venipuncture

260
Q

[] a measure of glucose in blood at any given time, usually from fingerstick

what is a normal range

A

RBG/BG/BD

72-140 mg/dL

261
Q

[] is a measure of glucose in the blood in a patient who has not eaten in the last 8 hours, commonly from fingersitck

what is a normal range

A

FBG

70-100

262
Q

[] is a measure of glucose in the plasma at any given time, commonly from venupuncture

what is a normal range?

A

random plasma glucose

72-140

263
Q

[] is the measure of glucose in the plasma in a patient who has been fasting in the last 8 hours, commonly from a venipuncture

what is a normal range?

A

FPG

70-100

264
Q

[] is the average glucose levels in a patient for the last 90 days
what is a normal range?

A

Hb1AC

=/<5.7%

Clinical laboratory Medicine (1 decks)

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