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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
Conditions indicated with abnml Na+
Neurologic issues (i.e. seizures, trauma)
26
Define hypovolemic vs euvolemic vs hypervolemic hyponatremia (low Na)
Hypovolemic: GI / renal loss Euvolemic: SIADH Hypervolemic: congestive heart failure, cirrhosis, CKI
27
Causes of hypernatremia
Reduced H20 relative to Na (i.e. diarrhea) Skin loss Renal loss
28
Conditions indicated with abnml K+
Acid-base disorders that cause electrolyte shifts (DKA, sepsis, crush injuries, burns, etc.)
29
Importance of Cl-
Determines anion gap
30
Reason for hypercholeremia? for hypocholeremia?
Hyper: non anion gap metabolic acidosis Hypo: loss of body fluid, metabolic alkalosis
31
Importance of CO2
Determines cause of metabolic acidosis
32
Conditions indicated with abnml Ca2+
Cardiac dysrhythmias & electrolyte abnormalities
33
What is hypercalcemia associated w/
hyperparathyroidism or malignancy
34
What is hypocalcemia associated w/
hypoalbuminemia and hypomagnesemia
35
Conditions indicated with abnml Mg2+
Cardiac dysrhythmias, neuromuscular irritability, medication-induced electrolyte abnormalities
36
Conditions indicated with abnml PO4
Renal insufficiency, massive cell death (i.e. crush injury, hemolysis, tumor lysis, burns, etc.)
37
When to order LFTs?
Suspicion of liver inflammation, biliary obstruction, or hemolysis
38
What components are included in LFTs?
AST/ALT, Alk Phos, bilirubin
39
Where is ALT found? AST?
ALT: ONLY liver AST: Liver, heart, blood, skeletal M.
40
Where is Alk Phos found?
liver, bone, intestine, and placenta
41
Typical causes of direct (conjugated) vs indirect (unconjugated) hyperbilirubinemia
Direct: Gilbert's dz, blood issues (poor synthesis/lysing) Indirect: hepatic failure
42
When to order lipase/amylase?
suspicion of pancreatitis
43
Typical cardiac enzymes included in cardiac panel
1. Troponin I 2. BNP 3. D-Dimer
44
When to order Troponin I
Evaluate myocardial cellular damage (i.e. MI or myocardial ischemia) - detected in bloodstream 1-6 hrs after onset of chest pain
45
When to order BNP
Distinguish primary pulmonary causes of dyspnea from cardiac causes, >400 suggests heart failure
46
When to order D-Dimer
Rule out DVT or PE in low risk patients
47
When to order serum lactate
Confirm shock, Indications of hypoxic tissue, metabolic disorders (i.e. metabolic acidosis), toxin exposure
48
When to order coagulation studies (INR/PT, PTT)
- Evaluate patients on heparin & warfarin anticoagulants - PT for coumadin, PTT for heparin - Establish baseline of active bleeding patients - Evaluate clotting disorders
49
Presence of nitrates, leukocyte esterase, WBC’s, and bacteria in UA indicates
UTI
50
Common drugs screened for w/ urine toxicology?
Amphetamines, cocaine, benzodiazepines, barbiturates, opiates, marijuana, and PCP
51
When to order Fecal Occult Blood Test (FOBT) When NOT to order Fecal Occult Blood Test (FOBT)
order: detect hidden (occult) blood loss in stool don't order: rectal bleeding in patient hx or gross blood on digital rectal exam
52
Characteristics of heme FOBT
cheap, fast, less sensitive
53
Characteristics of globin FOBT
expensive, slower, more sensitive
54
Situations that give FOBT false negative. Situations that give FOBT false positive
false - : high vitamin C | false + : red meat, peroxidase-rich veggie consumption
55
When to order TSH/T4?
Diagnose hypothyroidism (levels would be low)
56
When to order arterial blood gas (ABG)?
assess ventilation, perfusion, acid-base status
57
What does ethanol (EtOH) level of 80 mg/dl indicate? How about >400?
``` 80 = impairment for driving >400 = fatal ```
58
Phases of aspirin (ASA) toxicity
Early respiratory alkalosis followed by late respiratory acidosis
59
Elevated acetone (aka ketone) indicates
DKA, starvation, isopropanol ingestion
60
When to order CRP?
Detect chronic inflammatory disorders & cardiac risk
61
When to order C-diff toxin?
Detect antibiotic-associate diarrhea and pseudomembranous coli
62
When to order sputum (gram stain)?
Identify organism causing lung/upper airway infection
63
When to order monospot?
Confirm mononucleosis caused by Epstein-Barr Virus (EBV) infection
64
What does Inf A/B test for?
Influenza A/B strains
65
What is ESR?
Acute phase reactant that indicates inflammation or serious underlying disease when elevated

PCM II Final (10 decks)

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