Health Assessment & Diagnostic Tests Flashcards
OLDCARTS mnemonic
Onset, Location, Duration, Characteristics, Aggravating/Associated factors, Relieving factors, Temporal factors and Severity
BMI Catergories
Underweight- <18.5 Normal weight- 18.5-24.9 Overweight- 25-29.9 Obesity- 30-39.9 Extreme obesity- >40
ABCDEs of malignant melanoma
Asymmetry, Borders irregular, Color blue/black/variegated, Diameter >6mm and Elevation
Head and Neck Lymph Nodes
Preauricular, postauricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior and deep cervical chains, supraclavicular
All should be <1cm in size, non-tender, mobile and soft
Assessment of extraocular movement (EOM) function
symmetrical movement through the six cardinal fields of gaze without lag or nystagmus
Adventitious lung sounds: crackles
caused by air flowing by fluid (pneumonia, bronchitis, early heart failure)
Adventitious lung sounds: rhonchi
air passing over solid or thick secretions in large airways (bronchitis, pneumonia)
Adventitious lung sounds: wheezes
air flowing through constricted passageways (asthma, chronic emphysema)
Adventitious lung sounds: pleural friction rub
inflammation of pleural tissue (pleuritis, pericarditis)
Extra heart sounds: physiologic murmur
mid-systole, 2nd-4th left ICS, grades 1-3, disappears/decreases when sitting, normal finding, common in pregnancy
Skene’s glands
posterior to and on each side of urethral meatus
Bartholin’s glands
located posteriorly on each side of vaginal orifice, not usually visible
Cervix characteristics
2.5cm in diameter, protrudes 1-3cm into vagina, may have darker red epithelial tissue around os if squamocolumnar junction is on ectocervix
Uterus characteristics
smooth, rounded, mobile, non tender
5.5-8cm long in nulliparous women
may be 2-3 cm longer in multiparous women
Ovary characteristics
smooth, firm, mobile, slightly tender
size during reproductive years 3cm x2cm x1cm
Prostate gland
heart shaped
4x3x2cm
smooth, rubbery, non tender
RBC count
measurements per cubic millimeter of blood
adult female: 4.2-5.4 million/mm
Low RBC count
hemorrhage, hemolysis, dietary deficiencies, hemoglobinopathies, bone marrow failure, chronic illness, medications
Elevated RBC count
dehydration, diseases causing chronic hypoxia such as congenital heart disease, polycythemia vera, medications
Hematocrit values (pregnant/non-pregnant)
percentage of total blood volume that is made of RBCs
Non pregnant female: 37-47%
Pregnant: >33% 1st/3rd trimester and >32% 2nd trimester
Hemoglobin values (pregnant/non-pregnant)
measurement of total Hgb with carries oxygen
non pregnant female: 12-16 g/dL
pregnant: >11g/dL in 1st/3rd trimesters, >10.5g/dL in 2nd trimester
Causes of low Hgb/Hct
anemia, hemoglobinopathies, cirrhosis, hemorrhage, dietary deficiency, renal disease, chronic illness
Causes of elevated hgb/hct
erythrocytosis, polycythemia vera, severe dehydration, severe COPD
MCV values
Mean corpuscular volume- average size of single RBC
80-95mm, normocytic
Microcytic (low MCV and low MCH)
iron-deficiency anemia and thlassemia
Macrocytic (high MCV and high MCH)
megaloblastic anemias such as vitamin B deficiency and folic acid deficiency
MCH values
mean corpuscular hemoglobin- average amount or weight of hgb within an RBC
27-31pg/cell
What is a peripheral blood smear used for?
Examination of smear to examine RBCs, platelets and leukocytes
WBC values
5000-10,000/mm
Low WBC
bone marrow suppression, autoimmune disorders, immunosuppressive disorders, overwhelming infection, cancer that spreads to bone marrow
Elevated WBC
dehydration, infection, inflammatory conditions, may be elevated in late pregnancy/during labor, traumatic injury
Elevated neutrophils
acute bacterial infection, inflammation, increased immature forms (band/stabs) sometimes called left shift with ongoing acute bacterial infection
Elevated basophils
hypersensitivity reaction, chronic inflammatory disorders, uremia
Elevated eosinophils
allergic reaction, parasitic infections, chronic inflammatory disorders
Elevated lymphocytes
acute viral infections, chronic bacterial infections, chronic inflammatory disorders
Elevated monocytes
chronic infections, recovery phase of infections
Platelet Count
Normal finding: 150,000-400,000/mm
Low platelet count
thrombocytopenia
autoimmune disorders, cirrhosis, sepsis, hemorrhage, leukemia, cancer chemotherapy, viral infection
elevated platelet count
thrombocytosis
malignant disorders, polycythemia vera, rheumatoid arthritis
PT/PTT
Measures number of seconds it takes for clot to form in a blood sample with prolonged indicating that blood clotting is taking longer than normal
American diabetes association criteria for diagnosis of DM (3 things)
classic symptoms of hyperglycemia plus random glucose >200mg/dL
fasting >126mg/dL
2 hour glucose >200
Always repeat testing on subsequent day to confirm
HbA1C values
> 6.5% is diagnosis for diabetes
5.7%-6.4% is pre diabetes
Total cholesterol value
<200mg/dL
May be elevated in pregnancy
Triglyceride value
35-135mg/dL
May be elevated in pregnancy
HDL value and what it does
removes cholesterol from peripheral tissues and transports to liver
>40mg/dL is normal
LDL value and what it does
cholesterol carried by LDL can be deposited into peripheral tissues
<130mg/dL is normal
BUN value and what it is
Indirect measure of renal/liver function
10-20mg/dL is normal
Increased/Decreased BUN
Increased: dehydration, GI bleeding, sepsis
Decreased: liver failure, malnutrition
Creatinine value and what it is
Indirect measure of renal function
0.5-1.1 mg/dL
Increased/Decreased Creatinine
Increased: renal disorders, dehydration
Decreased: debilitation and decreased muscle mass
Urine protein/creatinine (PC) ratio
Helps to evaluate kidney function when significant protein is found on urinalysis
May indicate kidney disease/damage, associated with pre e and diabetes
Thyroid stimulating hormone (TSH)
Normal: 0.4-4.12 mU/mL
Increased TSH
Seen with primary hypothyroidism and thyroiditis
Decreased TSH
Secondary hypothyroidism, hyperthyroidism, suppressive doses of thyroid medication
Free thyroxine (FT4)
Normal: 0.58-1.64 ng/dL
Increased FT4
hyperthyroidism and thyroiditis
Decreased FT4
hypothyrodism
Total/Indirect/Direct Bilirubin Values
Total: 0.3-1.0 mg/dL
Indirect: 0.2-0.8 mg/dL
Direct: 0.1-0.3 mg/dL
Albumin
Normal: 3.5-5.0 g/dL
Increased/Decreased Albumin
Increased: dehydration
Decreased: liver disease, malabsorption syndromes, malnutrition
Presence of Hgb S
Indicates sickle cell disease or trait
Definitive test performed after positive Hgb S
Hgb electrophoresis identities Hgb type and quantity
What is autoantibodies/antinuclear antibodies (ANA) used for?
Diagnostic workup for SLE and other autoimmune disorders
Reproductive hormone studies: reasons for increased/decreased estradiol E2
Increased: adrenal tumor, estrogen-producing tumor, hyperthyroidism
Decreased: postmenopause, ovarian failure, primary/secondary hypogonadism, Turner’s syndrome
Reproductive hormone studies: reasons for increased/decreased progesterone
Increased: pregnancy, ovulation, progesterone secreting ovarian tumor/cyst, hydatiform mole, congenital adrenal hyperplasia
Decreased: primary/secondary hypogonadism, threatened abortion, fetal demise, pre e or short luteal phase syndrome
Reproductive hormone studies: reasons for increased/decreased follicle stimulated hormone (FSH)
Increased: postmenopause, gonadotropin secreting pituitary tumor, ovarian failure, primary hypogonadism, Turner’s syndrome
Decreased: pregnancy, pituitary/hypothalamic dysfunction, hyperprolactinemia
Reproductive hormone studies: reasons for increased/decreased lutenizing hormone
increased: postmenopause, primary hypogonadism, gonadal failure
decreased: pituitary or hypothalamic dysfunction
Normal pH for urinalysis
4.6-8.0
Normal protein for urinalysis
0-8 mg/dL
Normal specific gravity
1.005-1.030
Positive urine culture
Single type of bacteria at >100,000 CFU/mL
Normal wet prep results
Vaginal pH 3.8-4.5
Negative whiff
Epithelial cells/few or no WBCs, lactobacilli
Bacterial Vaginosis wet prep
pH >4.5
positive whiff
>20% of epithelial cells are clue cells, 0-1 WBCs per epithelial cells, lactobacilli reduced/absent
Trichomonas wet prep
pH >4.5
positive/negative whiff
motile trichomondas, >1 WBC per epithelial cells, lactobacilli reduced or absent
Vulvovaginal candidiasis (VVC)
pH <4.5
Whiff negative
hyphae/spores (seen on KOH slide), >1 WBC per epithelial cell, lactobacilli present
HIV testing, what is it?
enzyme immunoassay (EIA)
What is used to confirm positive EIA when testing for HIV?
Western blot or immunofluorescence assay (IFA) is used to confirm reactive EIA
What test is used for to assess titer to rubella?
Hemagglutination inhibition (HAI) or rubella IgM antibody titer
What does a rubella titer of 1:10 mean?
Immunity to rubella
What does a rubella titer of >1:64 mean?
may indicate current rubella infection
When do IgM antibodies appear/disappear after infection with rubella?
1-2 days after onset of rash and then disappear 5-6 weeks after infection
What does Hepatitis B surface antigen (HBsAg) indicate?
Active HBV infection, this person is infectious
What does hepatitis B surface antibody (HbsAb) indicate?
The end of acute infectious phase and signifies immunity. Also indicates immunity after administration of HBV vaccine
What does hepatitis B core antibody (HBcAb) indicate?
Past infection and chronic hepatitis
What does positive hepatitis c (HCV) antibody assay indicate and what do you do?
Follow a positive antibody test with HCV RNA. If positive, current HCV infection. If negative, infection has resolved.
PPD positive guidelines based on risk (high, moderate and general population)
High: >5mm
Moderate: >10mm
General population: >15mm
What can cause a false negative PPD?
incorrect administration, administration after recent live virus vaccine or immunosuppression
What can cause false positive PPD?
prior immunization with calmette-Guerin (BCG) vaccine
What do IgG antibodies do?
Positive IgG antibodies indicates protection d/t previous infection
What do IgM antibodies do?
Indicates current infection
What is somatic mutation and what causes it?
It is acquired and occurs after conception. D/t ionizing radiation, chemicals or viruses during gestation or later in life
What is germ cell mutation and when does it occur?
Inherited mutation. Occurs during conception
What does it mean if something is autosomal dominant?
Only one mutated copy of gene in each cell. One affected parent.
What are examples of autosomal dominant genetic conditions?
huntington disease and BRCA1/BRCA2
What does autosomal recessive mean?
Two mutated copies need to be present to have disease. Usually both parents are just carriers
What are examples of autosomal recessive genetic conditions and the likelihood if both parents are carriers?
Cystic fibrosis, sickle cell anemia.
50% chance of being carrier, 25% chance of having disease and 25% chance of being unaffected
What does x-linked dominant mean?
Mutation in genes on x chromosome. Females more often affected. fathers cannot pass to sons.
What is an example of a x-linked dominant genetic condition and the chances of having it if the mother is affected?
Fragile x syndrome
If mother is affected, both male and female offspring have 50% of inheriting the disorder
What does x-linked recessive mean?
Mutation in genes on x chromosome. Males more frequently affected than females. Fathers cannot pass to sons.
What is an example of a x-linked recessive genetic condition and how do they inherit condition?
Hemophilia
Females need to inherit affected x from both parents to have condition.
Males only need to inherit the affected x from the mother to have the condition
What is a normal T score in bone density testing?
> -1
What T score indicates osteopenia?
-1 to -2.5
What T score indicates osteoporosis?
< -2.5
