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PCMII Final > Interpretation of Labs > Flashcards

Interpretation of Labs Flashcards

1
Q

What’s included in a CBC?

A

RBC, WBC, Hgb, Hct, Platelets

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2
Q

Neutrophil predominance

A

a bacterial, inflammatory, or neoplastic process

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3
Q

Lymphocyte predominance

A

viral (Mono), pertussis (bacteria), or lymphocytic leukemia

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4
Q

Basophilia

A

Allergies, hypothyroidism (which lab values correlate w/ this?), splenectomy, neoplasm (CML, polycythemia vera)

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5
Q

Eosinophilia

A

parasitic, allergies, GI, cutaneous

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6
Q

Neutropenia

A

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

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7
Q

Lymphopenia

A

immunodeficiencies, adrenocortical hormone excess or corticosteroid tx, impaired lymph drainage, chemo, lymphoma/carcinoma, HIV

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8
Q

If MCV is <80?

A

Microcytic anemia (iron deficiency or absorption issue, chronic disease, spherocytosis)

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9
Q

If MCV >100?

A

Macrocytic anemia (b12 or folate deficiency, or some anti-retrovirals)

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10
Q

What’s a BMP used for?

A

Monitor kidney function, electrolytes, acid-base and fluid balance

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11
Q

What can cause hypoglycemia?

A

Fasting, excess insulin or sulfonylurea effects, hepatic/adrenal/renal insufficiency, insulinomas

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12
Q

What constitutes a hyperglycemic lab value?

A

If a pt is >126 mg/dl on 2 SEPARATE visits or when they’re fasting or a single event of >200.

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13
Q

What is BUN important for?

A

Determining volume status, along w/ creatinine

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14
Q

When does BUN increase?

A

Pre-renal azotemia
Renal azotemia
Post-renal azotemia

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15
Q

What are the BUN/Cr ratios for the azotemias?

A

Pre-renal: BUN/Cr>10
Renal: BUN/Cr<10
Post-renal: Bun/Cr»10

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16
Q

What can cause pre-renal azotemia? Why?

A

Hypovolemia (dehydration, CHF, cirrhosis, GI bleed)

If you’re dehydrated, there is low flow. At low flow, the renal tubules increase reabsorption of urea relative to creatinine to increase osmolarity and retain more H2O.

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17
Q

What can cause renal azotemia?

A

Kidney isn’t excreting urea

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18
Q

What can cause post-renal azotemia?

A

Usually obstructive uropathy

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19
Q

When is BUN decreased?

A

Production of urea synthesis (liver disease or malnutrition)

Dilutional states (SIADH, 3rd tri. preg.)

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20
Q

What does creatinine measure?

A

Kidney function. Always take before contrast studies and to determine presence of renal injury (along w/ BUN)

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21
Q

When does creatinine secretion increase?

A

Increases w/ a decline in GFR. So, loss of renal fx= elevated creatinine

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22
Q

When might you get a false Cr increase?

A

With certain drugs. Salicylates, H2 blockers, fibrates.

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23
Q

What can cause increased renal loss?

A

hyperparathyroidism
renal tubular disease
chronic acidosis

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24
Q

What can cause cellular shift across bones?

A 
acute respiratory alkalosis
hyperalimentation
TPN
rapid tumor growth
respiratory failure tx
DKA
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25
When is Na+ important to assess?
Neurological disorders, dehydration.
26
What does serum osmolarity measure?
Measures the bodys electrolyte-water balance. Is affected by changes in water content, temp, and pressure. It is the number of osmoles of solure/L of solution.
27
What does a high serum osmolarity indicate?
Indicates a greater concentration of solutes in the serum. AKA dehydration.
28
What's the differency between osmolarity and osmolality?
Osmolarity (kg) | Osmolality (L)
29
What is the osmolar gap?
The difference between the measured osmolality and calculated osmolality.
30
What does it mean when you have an osmolar gap >10 mmol/L?
Indicates the presence of other osmotic reactive substances, like alcohol, methanol, mannitol, glucose.
31
What are the 3 types of hyponatremia and what conditions are present? Tx?
Hypovolemic hyponatremia (GI tract/renal losses --> judicious fluid replacement) Euvolemic hyponatremia (SIADH --> restrict fluids Hypervolemic (CHF, cirrhosis, CKI)
32
What is hypernatremia and what causes it?
Increase in sodium. | Caused by diarrhea, excess sweating, renal losses, DM, hypercalcemia, or hypOkalemia
33
why is K+ important?
Important in acid-base disorders that can cause electrolyte shifts
34
What can cause hyperkalemia?
``` Psuedohyperkalemia Reduced excretion Cellular shifts Meds decreasing RAAS K+ sparing diuretics NSAIDs ```
35
What can cause hypokalemia?
``` Poor diet GI and skin loss Renal loss Cellular shift Loop and thiazide diuretics Glucomineralcorticoids ```
36
Why is Cl- important?
Helps determine anion gap
37
What causes hyperchloremia
Non anion gap metabolic acidosis (diarrhea, RTA, lots of NaCl)
38
What causes hypochloremia
``` Prolonged vomiting Burns Diuretics Salt wasting Neuropathy Metabolic alkalosis ```
39
Why is CO2 important?
Important in determining presence and cause of metabolic acidosis CO2 <22 --> metabolic acidosis CO2 >29 --> metabolic alkalosis
40
What's included on a CMP?
BMP + LFTs, Mg2+, PO4, Ca2+
41
Why is Ca2+ important?
Important in cardiac dysrhythmias and is often tied to other electrolyte abnormalities
42
What is hypocalcemia most often due to?
Hypoalbunimia and hypomagnesemia. | May also be caused by CKI, pancreatitis, pseudohypoparathyroidism.
43
Why is Mg2+ important?
Cardiac dysrhythmias and neuromuscular irritability
44
What medications may make you want to check a Mg?
Meds that can cause electrolyte abnormalities, such as diuretics and digitalis
45
What can cause hypermagnesemia
Excess intake in pt w/ CKI Addisons hypoT lithium tox
46
What can cause hypomagnesemia
Malabsorption Chronic diarrhea Increased urinary loss
47
PO4 levels are important in...?
Renal insufficiency and any condition involving massive cell death (crush injury, hemolysis, tumor lysis, burns)
48
Which test is specific to liver?
ALT. AST also found in heart, blood, and skeletal muscle.
49
What values differentiate EtOH liver necrosis and chronic liver disease?
AST>ALT 2:1 = EtOH ALT>AST = CLD
50
Where is alk phos found?
Liver, bone, intestine, placenta
51
Most common causes for indirect bilirubinemia?
Gilberts, hemolysis, recent hematoma, ineffective erythropoiesis
52
Most common causes for direct bilirubinemia?
stones, intrahepatic cholestasis, hepatitis, cirrhosis, toxins
53
When do lipase levels peak?
Lipase levels elevate 3-6 hours after acute onset pancreatitis and peak at 24 hours
54
If both amylase and lipase are high?
Renal failure
55
If only lipase is high?
Cholecystitis, perfd peptic ulcer
56
Of only amylase is high?
``` Intestinal perf Ischemia Obstruction DKA ruptured ectopic ```
57
When does trop I peak?
Released within hours of MI/ischemia. Can be detected 1-6 hours following CP onset. Peak at 12-16 hours and remain elevated for 5-9 days.
58
What else may cause elevated trop I?
``` Myocarditis Cardiac surgery Angina Unstable angina CHF Renal Failure PE ```
59
What does BNP help you differentiate?
It is released by atria due to stretch. Distinguishes between pulmonary and cardiac causes of dyspnea.
60
What does an elevated BNP mean and what can cause it?
BNP > 400 suggest heart failure. MI, A-fib, Pulm HTN, CKI, sepsis, age
61
When to order a D-dimer?
RO PE or DVT. May get false + in inflammation, pregnancy, recent surgery
62
What indications would you order serum lactate in?
Hypoxia Metabolic disorders Toxins
63
What are reversal agents for coumadin tox. and heparin tox?
Coumadin: Vit. K Heparin: Protamine sulfate
64
What indicates a UTI on a UA?
Nitrates, leukocyte esterase, WBCs, and bacteria
65
What are the 2 FOBT tests?
1. Heme (cheap, fast) | 2. Globin (expensive, more sensitive/specific, slow)
66
When might you get a false negative FOBT?
Proximal GI lesions (lacking oxidation of heme)
67
When might you get a false + of FOBT?
Myoglobin/Hb in red meat | Some veggies
68
High TSH and low free T4....
Hypothyroidism. Need to replace thyroxine.
69
What EtOH levels are considered evidence of impaired driving?
80 mg/dL or higher. Fatal if at 400.
70
Classic ASA toxicity presentation?
Mixed acid-base disturbance Early respiratory alkalosis followed by elevated anion gap metabolic acidosis and possible late respiratory alkalosis
71
High sensitivity CRP is used to...?
Stratify cardiac risk
72
What causes a positive monospot test?
ebV. mono.

PCMII Final (2 decks)

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