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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
Q

When is Na+ important to assess?

A

Neurological disorders, dehydration.

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26
Q

What does serum osmolarity measure?

A

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.

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27
Q

What does a high serum osmolarity indicate?

A

Indicates a greater concentration of solutes in the serum. AKA dehydration.

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28
Q

What’s the differency between osmolarity and osmolality?

A

Osmolarity (kg)

Osmolality (L)

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29
Q

What is the osmolar gap?

A

The difference between the measured osmolality and calculated osmolality.

30
Q

What does it mean when you have an osmolar gap >10 mmol/L?

A

Indicates the presence of other osmotic reactive substances, like alcohol, methanol, mannitol, glucose.

31
Q

What are the 3 types of hyponatremia and what conditions are present? Tx?

A

Hypovolemic hyponatremia (GI tract/renal losses –> judicious fluid replacement)

Euvolemic hyponatremia (SIADH –> restrict fluids

Hypervolemic (CHF, cirrhosis, CKI)

32
Q

What is hypernatremia and what causes it?

A

Increase in sodium.

Caused by diarrhea, excess sweating, renal losses, DM, hypercalcemia, or hypOkalemia

33
Q

why is K+ important?

A

Important in acid-base disorders that can cause electrolyte shifts

34
Q

What can cause hyperkalemia?

A 
Psuedohyperkalemia
Reduced excretion
Cellular shifts
Meds decreasing RAAS
K+ sparing diuretics
NSAIDs
35
Q

What can cause hypokalemia?

A 
Poor diet
GI and skin loss
Renal loss
Cellular shift
Loop and thiazide diuretics
Glucomineralcorticoids
36
Q

Why is Cl- important?

A

Helps determine anion gap

37
Q

What causes hyperchloremia

A

Non anion gap metabolic acidosis (diarrhea, RTA, lots of NaCl)

38
Q

What causes hypochloremia

A 
Prolonged vomiting
Burns
Diuretics
Salt wasting
Neuropathy
Metabolic alkalosis
39
Q

Why is CO2 important?

A

Important in determining presence and cause of metabolic acidosis

CO2 <22 –> metabolic acidosis

CO2 >29 –> metabolic alkalosis

40
Q

What’s included on a CMP?

A

BMP + LFTs, Mg2+, PO4, Ca2+

41
Q

Why is Ca2+ important?

A

Important in cardiac dysrhythmias and is often tied to other electrolyte abnormalities

42
Q

What is hypocalcemia most often due to?

A

Hypoalbunimia and hypomagnesemia.

May also be caused by CKI, pancreatitis, pseudohypoparathyroidism.

43
Q

Why is Mg2+ important?

A

Cardiac dysrhythmias and neuromuscular irritability

44
Q

What medications may make you want to check a Mg?

A

Meds that can cause electrolyte abnormalities, such as diuretics and digitalis

45
Q

What can cause hypermagnesemia

A

Excess intake in pt w/ CKI
Addisons
hypoT
lithium tox

46
Q

What can cause hypomagnesemia

A

Malabsorption
Chronic diarrhea
Increased urinary loss

47
Q

PO4 levels are important in…?

A

Renal insufficiency and any condition involving massive cell death (crush injury, hemolysis, tumor lysis, burns)

48
Q

Which test is specific to liver?

A

ALT. AST also found in heart, blood, and skeletal muscle.

49
Q

What values differentiate EtOH liver necrosis and chronic liver disease?

A

AST>ALT 2:1 = EtOH

ALT>AST = CLD

50
Q

Where is alk phos found?

A

Liver, bone, intestine, placenta

51
Q

Most common causes for indirect bilirubinemia?

A

Gilberts, hemolysis, recent hematoma, ineffective erythropoiesis

52
Q

Most common causes for direct bilirubinemia?

A

stones, intrahepatic cholestasis, hepatitis, cirrhosis, toxins

53
Q

When do lipase levels peak?

A

Lipase levels elevate 3-6 hours after acute onset pancreatitis and peak at 24 hours

54
Q

If both amylase and lipase are high?

A

Renal failure

55
Q

If only lipase is high?

A

Cholecystitis, perfd peptic ulcer

56
Q

Of only amylase is high?

A 
Intestinal perf
Ischemia
Obstruction
DKA
ruptured ectopic
57
Q

When does trop I peak?

A

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
Q

What else may cause elevated trop I?

A 
Myocarditis
Cardiac surgery
Angina
Unstable angina
CHF
Renal Failure
PE
59
Q

What does BNP help you differentiate?

A

It is released by atria due to stretch. Distinguishes between pulmonary and cardiac causes of dyspnea.

60
Q

What does an elevated BNP mean and what can cause it?

A

BNP > 400 suggest heart failure.

MI, A-fib, Pulm HTN, CKI, sepsis, age

61
Q

When to order a D-dimer?

A

RO PE or DVT. May get false + in inflammation, pregnancy, recent surgery

62
Q

What indications would you order serum lactate in?

A

Hypoxia
Metabolic disorders
Toxins

63
Q

What are reversal agents for coumadin tox. and heparin tox?

A

Coumadin: Vit. K

Heparin: Protamine sulfate

64
Q

What indicates a UTI on a UA?

A

Nitrates, leukocyte esterase, WBCs, and bacteria

65
Q

What are the 2 FOBT tests?

A
  1. Heme (cheap, fast)

2. Globin (expensive, more sensitive/specific, slow)

66
Q

When might you get a false negative FOBT?

A

Proximal GI lesions (lacking oxidation of heme)

67
Q

When might you get a false + of FOBT?

A

Myoglobin/Hb in red meat

Some veggies

68
Q

High TSH and low free T4….

A

Hypothyroidism. Need to replace thyroxine.

69
Q

What EtOH levels are considered evidence of impaired driving?

A

80 mg/dL or higher. Fatal if at 400.

70
Q

Classic ASA toxicity presentation?

A

Mixed acid-base disturbance

Early respiratory alkalosis followed by elevated anion gap metabolic acidosis and possible late respiratory alkalosis

71
Q

High sensitivity CRP is used to…?

A

Stratify cardiac risk

72
Q

What causes a positive monospot test?

A

ebV. mono.

PCMII Final (2 decks)

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