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PCM II Final > Interpretation of Labs > Flashcards

Interpretation of Labs Flashcards

1
Q

What is the most important and first thing that must be done prior to performing lab testing?

A

Obtain patient consent

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2
Q

Patient comes in with sluggish, altered mental state. What test helps distinguish if they have hypoglycemia or stroke & should be done ASAP?

A

Glucose check

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3
Q

What is the reasoning behind administering glucose as IVPB (IV piggy back)?

A

Gives body time to process glucose (not all at once)

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4
Q

Difference between CBC & CBC w/ diff?

A

CBC w/ diff = CBC + absolute differential counts (WBC breakdown)

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5
Q

What is tested in a BMP (chem 7)?

A

kidney fx, electrolytes, acid-base fluid balance

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6
Q

What is tested in a CMP?

A

BMP + LFTs + Mg + PO4 + Ca

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7
Q

Conditions indicated w/ leukocytosis (neutrophil predominance)

A

Bacterial infection, inflammation, neoplastic issue

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8
Q

Conditions indicated w/ leukocytosis (lymphocyte predominance)

A

Viral (EBV) / Bacterial (pertussis) infection, lymphocytic leukemia (ALL, MLL)

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9
Q

Conditions indicated w/ leukocytosis (basophilia)

A

Allergic rxn, hypothyroidism, splenectomy, neoplastic issue

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10
Q

Conditions indicated w/ leukocytosis (monocytosis)

A

GI issues, sarcoidosis, B. marrow suppression

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11
Q

Conditions indicated w/ leukocytosis (eosinophilia)

A

Parasitic infections, allergic rxns, GI issues, cutaneous issues

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12
Q

Conditions indicated w/ leukopenia (neutropenia)

A

Overwhelming bacterial infection, AIDS, hypersplenism, cachexia, anaphylactic shock

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13
Q

Conditions indicated w/ leukopenia

lymphopenia

A

immunodeficiency, excess adrenocortical/corticosteroid (exogenous/endogenous), HIV, lymphatic obstruction, cancer, chemo drugs

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14
Q

Condition indicated by RBC MCV < 80

A

microcytic anemia (iron deficiency, spherocytosis, chronic diseases)

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15
Q

Conditions indicated by RBC MCV > 100

A

macrocytic anemia (megaloblastic folate/B12 deficiency, anti-retrovirals)

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16
Q

Conditions indicated RBC low Hct

A

acute bleed

plasma volume need 12-24 hrs to equilibrate

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17
Q

Thrombocytopenia-related conditions associated with the following values:

  1. 50K-70K:
  2. <10K-20K:
A
  1. 50K-70K = clinical evidence of bleeding

2. <10K-20K = major spontaneous bleeding

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18
Q

When should a blood transfusion be considered?

A

Thrombocytopenia such that:

  1. <70K-100K w/ acute bleed OR
  2. <10K asymptomatic
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19
Q

Conditions indicated w/ thrombocytosis

A

Reactive or myeloproliferative disorder

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20
Q

Conditions associated w/ low glucose hypoglycemia

A

Fasting, excess insulin/sulfonylurea drugs. hepatic/renal/adrenal insufficiency, insulinomas

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21
Q

3 scenarios where BUN increases

A

Azotemias (Pre-renal, renal, post-renal)

Pre-renal: BUN/Cr > 10, hypovolemia (i.e. dehydration, cirrhosis)

Post-renal: BUN/Cr&raquo_space; 10, obstructive uropathy

Renal: BUN/Cr < 10, kidney not excreting urea

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22
Q

What 2 measurements together determine volume status?

A

BUN & creatinine

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23
Q

2 scenarios where BUN decreases

A

Urea synthesis (liver disease, malnutrition)

Dilutional state (SIADH, 3rd trimester preg)

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24
Q

What does creatinine measure?

What does it mean if it’s elevated compared patient’s baseline?

A

Kidney/renal fx

Loss of renal fx

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25
Q

Conditions indicated with abnml Na+

A

Neurologic issues (i.e. seizures, trauma)

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26
Q

Define hypovolemic vs euvolemic vs hypervolemic hyponatremia (low Na)

A

Hypovolemic: GI / renal loss
Euvolemic: SIADH
Hypervolemic: congestive heart failure, cirrhosis, CKI

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27
Q

Causes of hypernatremia

A

Reduced H20 relative to Na (i.e. diarrhea)
Skin loss
Renal loss

28
Q

Conditions indicated with abnml K+

A

Acid-base disorders that cause electrolyte shifts (DKA, sepsis, crush injuries, burns, etc.)

29
Q

Importance of Cl-

A

Determines anion gap

30
Q

Reason for hypercholeremia?

for hypocholeremia?

A

Hyper: non anion gap metabolic acidosis
Hypo: loss of body fluid, metabolic alkalosis

31
Q

Importance of CO2

A

Determines cause of metabolic acidosis

32
Q

Conditions indicated with abnml Ca2+

A

Cardiac dysrhythmias & electrolyte abnormalities

33
Q

What is hypercalcemia associated w/

A

hyperparathyroidism or malignancy

34
Q

What is hypocalcemia associated w/

A

hypoalbuminemia and hypomagnesemia

35
Q

Conditions indicated with abnml Mg2+

A

Cardiac dysrhythmias, neuromuscular irritability, medication-induced electrolyte abnormalities

36
Q

Conditions indicated with abnml PO4

A

Renal insufficiency, massive cell death (i.e. crush injury, hemolysis, tumor lysis, burns, etc.)

37
Q

When to order LFTs?

A

Suspicion of liver inflammation, biliary obstruction, or hemolysis

38
Q

What components are included in LFTs?

A

AST/ALT, Alk Phos, bilirubin

39
Q

Where is ALT found? AST?

A

ALT: ONLY liver
AST: Liver, heart, blood, skeletal M.

40
Q

Where is Alk Phos found?

A

liver, bone, intestine, and placenta

41
Q

Typical causes of direct (conjugated) vs indirect (unconjugated) hyperbilirubinemia

A

Direct: Gilbert’s dz, blood issues (poor synthesis/lysing)
Indirect: hepatic failure

42
Q

When to order lipase/amylase?

A

suspicion of pancreatitis

43
Q

Typical cardiac enzymes included in cardiac panel

A
  1. Troponin I
  2. BNP
  3. D-Dimer
44
Q

When to order Troponin I

A

Evaluate myocardial cellular damage (i.e. MI or myocardial ischemia) - detected in bloodstream 1-6 hrs after onset of chest pain

45
Q

When to order BNP

A

Distinguish primary pulmonary causes of dyspnea from cardiac causes, >400 suggests heart failure

46
Q

When to order D-Dimer

A

Rule out DVT or PE in low risk patients

47
Q

When to order serum lactate

A

Confirm shock, Indications of hypoxic tissue, metabolic disorders (i.e. metabolic acidosis), toxin exposure

48
Q

When to order coagulation studies (INR/PT, PTT)

A
  • Evaluate patients on heparin & warfarin anticoagulants
    - PT for coumadin, PTT for heparin
  • Establish baseline of active bleeding patients
  • Evaluate clotting disorders
49
Q

Presence of nitrates, leukocyte esterase, WBC’s, and bacteria in UA indicates

50
Q

Common drugs screened for w/ urine toxicology?

A

Amphetamines, cocaine, benzodiazepines, barbiturates, opiates, marijuana, and PCP

51
Q

When to order Fecal Occult Blood Test (FOBT)

When NOT to order Fecal Occult Blood Test (FOBT)

A

order: detect hidden (occult) blood loss in stool

don’t order: rectal bleeding in patient hx or gross blood on digital rectal exam

52
Q

Characteristics of heme FOBT

A

cheap, fast, less sensitive

53
Q

Characteristics of globin FOBT

A

expensive, slower, more sensitive

54
Q

Situations that give FOBT false negative.

Situations that give FOBT false positive

A

false - : high vitamin C

false + : red meat, peroxidase-rich veggie consumption

55
Q

When to order TSH/T4?

A

Diagnose hypothyroidism (levels would be low)

56
Q

When to order arterial blood gas (ABG)?

A

assess ventilation, perfusion, acid-base status

57
Q

What does ethanol (EtOH) level of 80 mg/dl indicate?

How about >400?

A 
80 = impairment for driving
>400 = fatal
58
Q

Phases of aspirin (ASA) toxicity

A

Early respiratory alkalosis followed by late respiratory acidosis

59
Q

Elevated acetone (aka ketone) indicates

A

DKA, starvation, isopropanol ingestion

60
Q

When to order CRP?

A

Detect chronic inflammatory disorders & cardiac risk

61
Q

When to order C-diff toxin?

A

Detect antibiotic-associate diarrhea and pseudomembranous coli

62
Q

When to order sputum (gram stain)?

A

Identify organism causing lung/upper airway infection

63
Q

When to order monospot?

A

Confirm mononucleosis caused by Epstein-Barr Virus (EBV) infection

64
Q

What does Inf A/B test for?

A

Influenza A/B strains

65
Q

What is ESR?

A

Acute phase reactant that indicates inflammation or serious underlying disease when elevated

PCM II Final (10 decks)

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