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Diagnostic Test Interpretation > Final Review > Flashcards

Final Review Flashcards

0
Q

Hypercalemia causes:

A
  1. Malignancy
  2. Primary Hyperparathyroidism: adenoma of the PT gland
  3. Other cause:
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1
Q

Hypercalcemia Sx:

A 
Sx:
-Mental status changes
-N/V
-Cardiac Arrest 
    (decreased concentration)
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2
Q

Malignancies that cause hypercalemia:

A

a.Tumor metastasis to bone
(ie: Prostate CA)
b.Paraneoplastic Syndromes
(Ectopic PTH; Lung CA)
c. Primary malig. of bone or marrow
(Myeloma- plasma cell in bone
marrow tumor
(Leukemia- ALL, CLL, AML, CML)

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3
Q

Other causes of Hypercalcemia:

A

a. Excess Vit. D
b. Decreased BP/ Hyponatremia- causes excessive Na+ excretion
causes excessive Ca+ reabsorption
c. Acidosis/cellular release-
increased H+= increased K+= and Ca2+
d. Paget’s Dz- excessive bone reabsorption-> Sr
e. Lithium- stimulates PTH secretion
f. Thiazides diuretics - causes Na excretion and ca+ reabsorption
g. Sarcoidosis- if in bone

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4
Q

Calcium Range:

A

8.5- 10.5 mg/ dL

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5
Q

Hypercalcemia:

A

[Sr] > 10.6 mg/dL

*** Emergency Tx is indicated for pt with moderate hypercalcemia 12-13.9mg/dL or severe which is even higher

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6
Q

Hypocalcemia Sx:

A
  • Tetany

- Cardiac Arrhythmias

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7
Q

Hypocalcemia Causes: (6)

A
  1. Hypoparathyroidism- thyroidectomy
  2. Burns:
    Sarcopenia occurs (breakdown of
    muscle and bone)
    hypoalbuminemia decreased
    binding capacity+ decreased vital
    skin to activate Vit. D
  3. Malabsorption syndromes-
    decreased vital skin to activate
    Vit. D.
  4. Alkalosis
  5. Increased BP + hypernatremia-
    Excessive Na reabsorption causes
    Excess Ca++ excretion
  6. Vitamin D deficiency
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8
Q

Calcium Functions (6):

A
  1. Bone formation and growth
  2. Skeletal and cardiac muscle
    Contraction- Troponin
  3. Smooth muscle Contraction
    Binds to Calmodulin
  4. Activation of Coag. factors
  5. Activation of enzymes and activity
  6. Transmission of neural impulses.
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9
Q

Serum Calcium: (forms)

A
  1. Bound to albumin
  2. Free (unionized)
  3. Bound to anions
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10
Q

BUN range:

A 
Children: 
   5-18 mg/dL
Adult:
   5-20 mg/dL
Elderly:
   8-21 mg/dL
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11
Q

Major categories if Elevated BUN:

A

1) Pre-renal
2) Intra-renal
3) Post-renal
4) non-Renal causes

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12
Q

Pre-renal causes of ^ BUN:

A 
A. Decreased profusion to glomerulus
     Due to decreased CO
       - Severe sepsis
       - Shock
       - CHF
       - Dehydration
       - Burns
B Liver Dz ( cirrhosis & hepatitis)
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13
Q

Intra-renal causes of ^ BUN:

A

A. Glomerulus-> glomerular nephritis
B. Tubules-> pyelonephritis
C. Vasculature -> HTN & athrosclerosis
D. Interstitial-> Polycystic Kidney Dz

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14
Q

Post-renal causes if ^ BUN:

A

A. Obstruction and backup:
Azotemia: BUN > 115 mg/dL
1) renal calculi
2) upper and lower UTIs

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15
Q

Non-renal causes:

A 
A. GI bleeding -> bacteria in gut breaks 
    down blood products into urea N.
B. Steroids-> induced proteolysis in a
     hypermet.  state & dehydration
C. Severe Sepsis-> decreased afferent 
     Flow 
D. Antibiotics that are nephrotixic-> 
      -Tetracyclines
      - Aminoglycosides
      - Amphotericin B
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16
Q

BUN/ Cr ratio more sensitive to varying pathology:

A
  1. > 20 :1 PRE-renal cause
  2. 10-20:1 POST-renal
  3. <10:1 INTRA-renal
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17
Q

Azotemia Sx:

A
  • N/V
  • Stupor
  • Coma
  • Acidosis
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18
Q

Cr Range (female):

A

0.6-1.1 mg/dL

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19
Q

Cr Range (male):

A

0.8-1.3 mg/dL

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20
Q

Causes of ^ Cr: (6):

A
  • Exercise ( ^ muscle breakdown)
  • Pregnancy
  • Dehydration
  • Reduced Renal perfusion
    • Sepsis
    • Shock
    • CHF
  • Acute or Chronic renal failure
    • UTI obstruction
    • Nephritis
  • Rhabdomyolysis
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21
Q

Causes of decreased Cr:

A
  • Malnutrition
  • Debilitation

( not as concerning as elevated Cr )

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22
Q

Components of Cr Clerance:

A
  1. Urine Cr concentration
  2. Serum Cr concentration
  3. Volume of Urine
  4. Time period of collection (24hrs)
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23
Q

Benefits of the Cr test:

A
  1. BEST way to quantify proteinuria
    (Distinguish between nephritic and
    nephrotic syndrome)
  2. Can get Sr from a venous stick
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24
Q

Nephrotic syndrome:

A

Loss of a lot of protein
Proteinurea (>3.5g in 24hrs)

++++ Protein
Urine looks frothy

Tip: Nephrotic & Protein both have an “O” which may help you remember!

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25
Q

Nephritic syndrome:

A

Loss of a lot of blood- Haematuria

+++ Blood – May be microscopic or macroscopic haematuria

Red cell casts – distinguishing feature, form in nephrons & indicate glomerular damage

Podocytes develop large pores which allow blood & protein through

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26
Q

Preparation Instructions:

A

A Do not do strenuous activity for up to
2 days before
B Do not eat high meat meals the day
before
C Drink fluids
D Don’t drink caffeine (diuretic)

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27
Q

GFR (Cr clearance) reference ranges

(Female):

A

60- 115 mL/ min

*** if GFR < 60 mL/min,
CANNOT receive contrast dye

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28
Q

GFR (Cr clearance) reference ranges

(Male):

A

70-135 mL/ min

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29
Q

PE findings with Chronic Renal failure: (CRF)

A 
- Bloody urine (seen when cysts  
            rupture in Polycystic kidney dz)
- peripheral edema (poor fluid 
                                excretion)
-Oliguria (making a small amt. of urine)
-HTN
-Back/ flank pain
-Early findings: mild hematuria with 
                        decreased GFR
-Late findings: moderate proteinuria 
           with granular and waxy casts
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30
Q

Potassium Range:

A

3.5- 5.3 mEq/L

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31
Q

Hyperkalemia ( ^ K+) Potassium:

Main consequences:

A
  1. Myocardial contractility issues
    (Arrhythmias, Arrest)
  2. Acid- Base Disturbances
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32
Q

When you see hyperkalemia consider:

A
  1. Is this a hemolysis specimen of blood (pseudohyperkalemia)?
    • Artificially elevated; needs redrawn
  2. What is the renal function?
    • look at BUN/ Cr
      (in conjunction w/ PE findings)
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33
Q

Causes of pseudohyerkalemia:

A 
I.    Excessive vacuum suction
II.   Small gauge needle
III.  Delay of specimen processing
IV.  Excessive tube shaking
V.   Excessive time w/ tourniquet on
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34
Q

Causes of HYPERkalemia (4):

A 
1. Hemolysis
     A. Hemolytic anemia: 
     B. Artifactual ( pseudohyperkalemic)
2. Excessive K+ Intake (KCl subs)
3. Potassium- Sparing diuretic
4. Metabolic acidosis
35
Q

5 Hemolytic Anemias that can cause hyperkalemia:

A
  1. G6PD
  2. Thalassemia
  3. Hemolytic Dz of Newborn
  4. Autoimmune
  5. Hereditary spherocytosis
38
Q

Potassium naturally in body:

A

Most in intracellular fluid gained by diet

39
Q

Potassium function:

A
  1. Cellular H2O balance (acid- base)

2. Electrical muscle cell contraction

40
Q

Na+ range:

A

135- 145

41
Q

Cl range:

A

95-105

42
Q

HCO3 range:

A

21-29

43
Q

Hgb range:

Female

A

12-16

44
Q

Hgb range:

Male

A

14-18

45
Q

WBC range:

A

4.5 - 11 thousand

46
Q

Hct range:

Female

A

37-47%

47
Q

Hct range:

Male

A

42-52%

48
Q

Plt range:

A

150-450 thousand

49
Q

Indications for monitoring K+: (5)

A
  1. Cardiac dysrhythmias
  2. Renal dysfun
    • restricted diet
    • NaHCO3 Tx
  3. Mental confusion
  4. GI distress: prolonged diarrhea or
    vomiting ( loss of K+)
  5. IV K+ replacement
    (Can usually go up to 10 mEq/L K+)
50
Q

Causes of HYPOkalemia: (4)

A
  1. Starvation (ETOH, Malnut, Anorexia)
  2. GI loss (Vomiting/Diarrhea)
  3. Renal losses:
    -SE of diuretics
    -Hyperaldosteronism- aldosterone
    secreted when receptors detect
    low blood volume -> hyper ->
    Excessive Na+ reabsorption & K+
    excretion
  4. Intracellular shifts:
    -Alkalosis
51
Q

Glucose Range:

A

60-100

52
Q

RBC range: (male)

A

5.5 x10^6 mL

53
Q

RBC range: (female)

A

4x10^6 mL

54
Q

MCV range:

A

Mean cell volume

80-100 fl

55
Q

MCH range:

A

Mean corpuscular hemoglobin

26-34 pg

56
Q

MCHC range:

A

[Mean corpuscular Hemoglobin]

33- 36 %

57
Q

RDW range:

A

Red cell distribution width:

<14.5 - variation in cell size

58
Q

Plt range:

A

150-450 thousand

59
Q

Ret range:

A

Reticulocyte count:

0.5- 2

60
Q

Neutrophil range:

A

50-70%

Abnormal = anemia

61
Q

Lymphocyte Range:

A

25-35%

Abnormal= Viral infection

62
Q

Monocyte Range:

A

4-6%

63
Q

Eosinophils range:

A

1-3%

Abnormal= Allergies

64
Q

Basophil range:

A

0.4-2%
Abnormal = Bacterial infection or
Parasitic infection

65
Q

Low RBC and Hgb are indicative of?

A

Anemia

66
Q

WBC are made where?

Abnormal count can indicate?

A

Bone marrow

Count up or down can indicate infection

67
Q

Absolute Neutrophil count (ANC) is the measure of the amount of neutrophil granulocytes present in the blood

The fraction of neutrophils to the while WBC count dropping indicates?

A

Concerning pathology

neutropenic pathway

68
Q

Mild Neutropenia range:
Moderate:
Severe:

A

Severe Moderate. Mild

500 500- 1000-1500 microL

69
Q

If WBC is abnormal always look at?

It will tell you if there is a ____ problem or ______ problem.

Next look at _____ to see if they are low.

A

Differential
Determine production vs. destruction problem

**Look at RBC/ Plts, see if they are low

70
Q

Indications for bone marrow aspiration

A
  1. Pancytopenia

2. Suspected Malignancy

71
Q

Pt neutropenic, do ___ next.

A

CXR to r/o

Lung infection

72
Q

Low WBC count, make sure you do what

A

Get a culture

** could be fatal if delay in culture **

73
Q

^ WBC look at what

A

Band cells to see if they are being produced

74
Q

If H&H are low look immediately at ____!!!

A

MCV to see if there is anemia

75
Q

Low MCV = _____ seen in:

A

Microcytic Anemia seen in:

  • Iron def. anemia
  • Thalassemia
  • Anemia of Chronic Dz
  • Sideroblastic Anemia
76
Q

MCHC

Low:
Normal:

A

Low: Hypochromic
Normal: Normochromic

77
Q

To determine if GI bleed:

A
  • Stool occult test

- Iron tests

78
Q

Serum Iron:

A

Iron in blood

79
Q

Ferritin

A

Stored iron in the body

80
Q

TIBC:

A

Total binding iron capacity

All protein available to bind to iron

81
Q

Transferrin:

A

% Of transferrin that is saturated w/ iron

  • made in liver, will be low in liver dz
82
Q

UIBC:

A

Unsaturated Iron Binding Capacity:

Portion of transferrin that is NOT bound to iron

83
Q

Iron deficiency Anemia iron study shift:

A

Fe: decreased -> deficiency
Ferritin: decreased -> low stores used up
Transferrin: increased ->
binding affinity increases as stores and supply are low

TIBC: increased -> as less available to be bound proteins open to be bound with

**Fe and transferrin inversely proportional

84
Q

To determine if a pt needs transfused look at hemoglobin

A

Transfuse uncomplicated pt if hemoglobin reaches 7

85
Q

Transfuse Pts with comorbid irises before Hgb reaches 7 like:

A
  • COPD
  • heart dz
  • CHF
  • sickle cell anemia
  • all effect the ability of the body to oxygenate tissue so more sensitive to decreased profusion from anemia
86
Q

If need iron give: ( not I severe cases 1st )

A
  • iron rich foods
  • iron folate
  • follow up make sure Reticulocyte counties ^ing
87
Q

Peripheral smear shows:

A

Shape and color of RBCs

88
Q

Hemolytic anemias

A
  • sickle cell
  • thalassemias
  • hemolytic anemia of newborns
  • hereditary spherocytosis
  • G6 BD

Diagnostic Test Interpretation (1 decks)

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