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CDP > Final > Flashcards

Final Flashcards

1
Q

Summarize the purpose of CLIA

A

Regulates labs/facilities that test human specimens for health assessment or to diagnose, prevent, or treat disease

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2
Q

What makes a “perfect test”?

A
  • Accurate
  • Precise
  • Discriminating
  • Risk free
  • Pain free
  • Inexpensive
  • Useful
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3
Q

Describe what makes a “waived” complexity CLIA test and name some examples

A

Simple tests, small chance of error or risk
Can be OTC
- Urine dipstick
- Influenza A/B
- Strep A
- HCG urine
- THC
- PT/INR
- COVID

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4
Q

Describe what makes a “moderate” complexity CLIA test and name some examples

A

Available on automated equipment in a facility
- CBC
- Chem/electrolyte profiles
- Urinalysis microscopic

Provider performed microscopy
- KOH scraping
- Semen analysis
- Nasal eosinophils

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5
Q

Describe what makes a “high” complexity CLIA test and name some examples

A

Requires clinical expertise beyond normal automation to perform
- Cytology
- Peripheral smears
- Viral loads
- Gel electrophoresis

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6
Q

Describe sensitivity and specificity

A

Sensitivity
- Helps rule OUT a disease when test is negative
- Few false negative results

Specificity
- Helps rule a disease IN when test is positive
- Few false positive results

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7
Q

Which phase of testing, pre-analytic, analytic, or post-analytic has the highest chance of errors?

A

Pre-analytic

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8
Q

Describe the pre-analytic phase of lab testing. What does it start and end with?

A

Specimen receiving
- Most vulnerable part of testing process
- Starts with patient assessment
- Ends with specimen received in laboratory

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9
Q

Describe the analytic phase of lab testing. What does it start and end with?

A

Testing
- Begins when patient specimen is prepared for testing
- Ends when test result is interpreted and verified

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10
Q

Describe the post-analytic phase of lab testing. What does it start and end with?

A

Result reporting
- Starts with result review and release to the clinician
- Ends with diagnostic and therapeutic decision making

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11
Q

Describe the screening guidelines for colon cancer

A

USPSTF
- Age 50 to 75 (A)
- Age 45 to 49 (B)

ACS
- Start age 45

Stool tests
- gFOBT (guaiac-based fecal occult blood test) - blood in stool most common
- FIT - blood in stool
- FIT-DNA - blood and altered DNA in stool

Camera
- Flexible sigmoidoscopy - Every 5 years, (or every 10 if annual FIT) NO sedation
- Colonoscopy - Every 10 years if no increased risk of colon cancer, requires bowel prep, sedation

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12
Q

Describe the screening guidelines for breast cancer

A

USPSTF
- Women aged 40 to 74
- Mammogram every two years (B)

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13
Q

Describe the screening guidelines for cervical cancer

A

USPSTF
- Women aged 21 to 29 - PAP every 3 years (A)
- Women aged 30 to 65 - Continue PAP every 3 years, OR HPV every 5 years, OR PAP + HPV every 5 years (A)

ACS
- Women aged 25 to 65 - HPV every 5 years

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14
Q

Describe the screening guidelines for chlamydia and gonorrhea

A

CDC
- All sexually active women under 25 and any men who have sex with men - NAAT every year

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15
Q

Describe the STI screening guidelines for pregnant women

A

CDC
- All pregnant women tested for syphilis, HIV and Hep B early in pregnancy

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16
Q

Describe the screening guidelines for HIV

A
  • Everyone aged 15 to 65 tests at least once in their lifetime - ELISA, confirmed with repeat ELISA, and then Western Blot
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17
Q

Describe the screening guidelines for syphilis

A

Indications = symptomatic or high risk patients

No chancre
- Nontreponemal -> Treponemal

Chancre
- Dark field microscopy

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18
Q

Describe the screening guidelines for osteoporosis and how to interpret results

A

USPSTF
- Women aged 65+ or postmenopausal - DEXA scan (B)

  • -1 and above = NORMAL
  • -1.1 to -2.4 = OSTEOPENIA
  • -2.5 and below = OSTEOPOROSIS
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19
Q

Name the components included in a BMP

A
  • Glucose
  • Calcium
  • Sodium
  • Potassium
  • CO2/Bicarb
  • Chloride
  • BUN
  • Creatinine
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20
Q

True or false. A patient needs to fast prior to a BMP

A

True
- Fasting 10-12 hours

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21
Q

Name the components included in a CMP

A

BMP
- Glucose
- Calcium
- Sodium
- Potassium
- CO2/Bicarb
- Chloride
- BUN
- Creatinine
PLUS LFTs
- Total protein
- Albumin
- Total bilirubin
- ALP
- AST
- ALT

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22
Q

When in doubt over differences in normal reference ranges for a lab value, which one should be used?

A

Always use the reference range supplied by the lab that performed the test

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23
Q

Normal range for blood glucose

A

60 to 100 mg/dL

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24
Q

Reasons for blood glucose to be increased/decreased

A

Increased
- Diabetes
- Acute stress response
- Corticosteroid therapy

Decreased
- Insulin overdose

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25
Q

Normal range for serum calcium

A

8.7 to 10.7 mg/dL

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26
Q

Reasons for serum calcium to be increased/decreased

A

Increased
- Hyperparathyroidism
- Nonparathyroid PTH-producing tumor (lung/renal carcinoma)
- Granulomatous infection (sarcoidosis, TB)
- Hyperthyroidism
- Thiazide diuretics

Decreased
- Hypoparathyroidism
- Vitamin D deficiency
- Hypoalbuminemia

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27
Q

Normal range for sodium

A

135 to 145 mEq/L

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28
Q

Describe the three kinds of hyponatremia

A

Hyponatremia = sodium <135 mEq/L

Hypovolemic
- Na and H2O deficit
- Diuretic excess
- Vomiting/diarrhea

Euvolemic
- Slight increase in H2O
- SIADH

Hypervolemic
- Na and H2O excess
- Cardiac failure

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29
Q

Normal range for potassium

A

3.5 to 5.3 mEq/L

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30
Q

Reasons for potassium to be increased/decreased

A

Increased
- Renal failure (acute and chronic)
- Excess K+ intake
- NSAIDs
- K+ sparing diuretics

Decreased
- Thiazide/loop diuretics
- Vomiting/diarrhea/laxatives
- Severe eating disorders

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31
Q

Reasons for chloride to be increased/decreased

A

Increased
- Dehydration
- Metabolic acidosis
- Respiratory alkalosis

Decreased
- Overhydration
- Metabolic alkalosis
- Respiratory acidosis

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32
Q

Normal range for BUN

A

8 to 18 mg/dL

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33
Q

Describe pre-renal, renal, and post-renal causes for increased/decreased BUN

A

Pre-renal increase
- Hypovolemia
- Dehydration
Pre-renal decrease
- Overhydration
- SIADH

Renal increase
- Renal disease (glomerulonephritis, pyelonephritis, ATN)

Post-renal increase
- Urethral/bladder obstruction

34
Q

Normal range for creatinine

A

Male: 0.6 to 1.2 mg/dL

Female: 0.5 to 1.1 mg/dL

35
Q

Reasons for increased creatinine

A
  • Hyperthyroidism
  • Pyelonephritis
  • Reduced renal blood flow

(decrease not significant)

36
Q

Normal BUN:Creatinine ratio range

A

12 to 16

37
Q

Describe pre-renal, renal, and post-renal azotemia causes and their corresponding BUN:Creatinine ratios

A

Pre-renal
- BUN:Cr more than 20:1
- Most common
- Reduced renal blood flow

Renal
- BUN:Cr less than 20:1
- Direct kidney injury
- Acute tubular necrosis

Post-renal
- BUN:Cr >20:1 then <20:1
- Any urinary tract obstruction

38
Q

Normal range for magnesium

A

1.3 to 2.1 mEq/L

39
Q

Reason for increased magnesium levels

A

Diuretics

40
Q

Four components of a urinalysis

A
  • Macroscopic = color, clarity, specific gravity
  • Dipstick reagent = chemical analysis
  • Microscopic
  • Culture
41
Q

Normal pH range for urine

A

4.6 to 8.0

42
Q

True or false. CBC requires fasting

A

False
- CBC does NOT require fasting

43
Q

Reasons for increased/decreased red blood cell count

A

Increased
- High altitude
- Polycythemia vera
- Severe COPD

Decreased
- Anemia
- Advanced cancer

44
Q

Normal range for hemoglobin

A

Male: 14 to 18 g/dL

Female: 12 to 16 g/dL

45
Q

Reasons for increased/decreased hemoglobin

A

Increased
- Polycythemia vera
- COPD
- High altitude

Decreased
- Anemia
- Neoplasia

46
Q

Normal hematocrit level

A

3 times Hb

47
Q

Normal range for MCV

A

80 to 100 fL

48
Q

Reasons for MCV to be increased/decreased

A

Increased (macrocytic)
- B12/folate deficient

Decreased (microcytic)
- Iron deficiency
- Thalassemia
- Anemia of chronic disease

49
Q

Normal range for platelets

A

130 to 400

50
Q

Reasons for platelets to be increased/decreased

A

Increased
- Iron deficiency anemia
- Polycythemia vera
- Malignancy

Decreased
- Autoimmune destruction
- Malignancy (yes, again)

51
Q

Name the five types of white blood cells seen on a differential and the expected proportion of each

A
  • Neutrophils (60%)
  • Lymphocytes (30%)
  • Monocytes (6%)
  • Eosinophils (3%)
  • Basophils (1%)
52
Q

Normal range for white blood cells

A

3,200 to 9,800

53
Q

What is a “left shift” and what does it indicate?

A
  • 80-90% neutrophils
  • Increased immature neutrophils (“bands” or “stabs”)
  • Acute bacterial infection
54
Q

Reasons for increased lymphocytes

A
  • Acute viral infection
  • Chronic bacterial infection
55
Q

Reasons for increased eosinophils and basophils

A
  • Allergic reactions
  • Parasites
  • Inflammatory reactions
56
Q

Describe the following blood pressure levels
- Normal
- Elevated
- Stage 1 HTN
- Stage 2 HTN

A

Normal
- <120 and <80
Elevated
- 120-129 and <80
Stage 1 HTN
- 130-139 or 80-89
Stage 2 HTN
- 140+ or 90+

57
Q

Describe screening guidelines for hypertension

A

USPSTF
- Adults ages 18+ screen at every visit (A)

58
Q

What components are included in a lipid panel?

A
  • Total cholesterol
  • LDL
  • HDL
  • VLDL
  • Triglycerides
59
Q

Normal range for total cholesterol

A

Less than 200 mg/dL

60
Q

Reasons for increased/decreased total cholesterol

A

Increased
- Hypercholesterolemia
- Hyperlipidemia
- Uncontrolled diabetes
- Hypertension

Decreased
- Liver disease

61
Q

Normal range for HDL

A

Male: >45 mg/dL

Female: >55 mg/dL

62
Q

Normal range for LDL

A

Normal adult: <130 mg/dL

Moderate risk: <100 mg/dL

High risk: <70 mg/dL

63
Q

Diagnostic criteria for acute MI

A

Requires two of three
1. Chest discomfort
2. Elevated cardiac enzymes
3. EKG findings

64
Q

Gold standard for diagnosis CAD

A

Cardiac catheterization

65
Q

Reasons for increased myoglobin

A
  • Myocardial infarction
  • Rhabdomyolysis
66
Q

Which, CK-MM, CK-MB, or CK-BB, is most specific to the heart?

A

CK-MB = heart

  • CK-MM = skeletal muscle and heart
  • CK-BB = brain
67
Q

Reasons for increased CK-MB

A
  • Acute myocardial infarction
  • Severe rhabdomyolysis
68
Q

Which cardiac troponin, T or I, is more specific to the heart?

A

Cardiac troponin I

69
Q

Reasons for increased troponins

A
  • Myocardial infarction
  • Pulmonary embolism
70
Q

Which cardiac marker is first to elevate, peak, and return to baseline in acute myocardial infarction?

A

Myoglobin

71
Q

In acute myocardial infarction, when does myoglobin:
- Initially elevate
- Peak
- Return to baseline

A
  • Initial: 1 to 4 hours
  • Peak: 4 to 12 hours
  • Return: 10 to 24 hours
72
Q

In acute myocardial infarction, when does CTnI:
- Initially elevate
- Peak
- Return to baseline

A
  • Initial: 2 to 6 hours
  • Peak: 10 to 24 hours
  • Return: 7 to 10 days
73
Q

In acute myocardial infarction, when does CKMB:
- Initially elevate
- Peak
- Return to baseline

A
  • Initial: 4 to 6 hours
  • 18 to 24 hours
  • 36 to 48 hours
74
Q

Which cardiac marker will be elevated longest after an acute myocardial infarction?

A

CTnI (cardiac troponin I)
- 7 to 10 days

75
Q

The “golden marker” for atherosclerosis

A

hs-CRP

76
Q

Normal range for BNP and NT-proBNP

A
  • BNP = <100 pg/mL
  • NT-proBNP = <300 pg/mL
77
Q

Reasons for increased BNP

A
  • CHF
  • MI
  • Renal failure
78
Q

Which, BNP or NT-proBNP, is more sensitive for CHF?

A

NT-proBNP

79
Q

Are obesity, spine, or chest wall deformities examples of restrictive or obstructive pulmonary disorders?

A

Restrictive

80
Q
A

CDP (13 decks)

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