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PCM I > Intro. to Laboratory > Flashcards

Intro. to Laboratory Flashcards

1
Q

What are the purposes of diagnostic testing?

A
  1. Diagnosis - rule in or rule out
  2. Screening - risk factors, occult disease
  3. Patient Management - severity, course, prognosis, and Rx
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2
Q

Factors to consider when ordering a test.

A
  1. History and physical exam findings
  2. Ability to do something with the results
  3. Potential advantages, costs, and disadvantages
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3
Q

What is a scope exam (gross pathology exam)? What are some examples?

A

Visualization of internal organ systems

  1. bronchoscopy
  2. colonoscopy
  3. flexible sigmoidoscopy - distal 2 ft of large intestine
  4. Esophagogastroduodenoscopy - endoscopic view of stomach and esophagus
  5. Cytoscopy - in bladder
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4
Q

What type of exam is an x-ray considered in this context?

A

According to Dr.Bentley, a gross exam.
Uses radiation to detect variations in density of tissue

Examples:
skeletal - fractures
lungs/chest - tumors/lung pathology
abdominal - pathology of kidney, ureters, bladder

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5
Q

What is a myelogram?

A

X-ray with radio-opaque dye to detect changes

- detects stones, tumors, blockages, spatial changes in bones

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6
Q

What is a CT scan?

A

X-ray of body tissues in small ‘slices’

  • can be done with or without contrast
  • contrast usu I, Ba, gastrografin based
  • can detect bleeds and small structures
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7
Q

What is an MRI?

A

Use of magnetic fields to produce cross-sectional images
- good for soft tissue - masses, tears, bleeds, damage to tissues from infection or injury

  • Can be done with gadolinium contrast - contraindicated in pregnant or patients with kidney disfunction
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8
Q

What is a biopsy?

A

A type of cellular path testing

  • skin, LN, bone, liver, chest
  • small piece of tissue removed and examined histologically
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9
Q

What is a puncture biopsy?

A

Removal of fluid for analysis

- lumbar puncture

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10
Q

What is a culture and sensitivities (C&S) assay?

A

Growth of a bacterium from body fluid to identify pathogen and antibiotic that it is sensitive to
- bacterial ‘lawn’ on plate, with antibiotic paper discs, sensitivity determined by diameter of clear agar around a disc

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11
Q

What is a fecal occult blood test?

A

Small card that indicates presence of blood

  • sample obtained during digital rectal exam
  • can indicate intestinal neoplasms
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12
Q

What is an ultrasound?

A

Use of sound waves to detect movement and fxn of organs
- no radiation exposure

Examples:
- carotid, venous, abdominal, echocardiogram, and fetus

Doppler - use of sound waves to detect abnormal blood flow in aa or veins

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13
Q

What is an electrogram?

A

Test for electrical activity of a tissue

- EKG, nerve conduction studies

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14
Q

What is an angiogram?

A

Use of radio-opaque dye to detect blockages

  • diffuses through pertinent structures
  • cardio, pulmonary, and lower extremity angiograms
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15
Q

Examples of organ-specific function testing.

A
  1. Ventilation perfusion scan
  2. Pulmonary function test
  3. Endoscopic retrograde cholangiopancreatography
  4. Percutaneous transhepatic cholangiography
  5. Ba swallow
  6. kidney radionucleotide scan
  7. DEXA
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16
Q

What is a CBC?

A

Complete Blood Count
- corresponds with anemias, infections, malignancies

Includes:

  • leukocytes (WBCs)
  • Erythrocytes (RBCs)
  • Hemoglobin (HgB)
  • Hematocrit (HCT)
17
Q

What changes levels of hemoglobin?

A

Increase - dehydration, burns, vomiting, polycythemia, extreme physical exercise
Decrease - all anemias, hypothyroidism, B12 and folate deficiencies, chronic disease

18
Q

What changes levels of hematocrit?

A

(ratio of volume of RBCs to tot vol of blood)

Increase -high altitude, smokers, tumors, polycythemia vera, heart disease

Decrease - anemias, acute of chronic blood loss, hemolysis, dilutional, alcohol, drugs

19
Q

What changes WBC levels in a CBC?

A

Usu make up 1% of tot blood volume
- alterations due to infections, hemotological malignancies, leukemias, lymphomas, steroid use, anemias, drugs and sepsis

20
Q

What is a CBC with a differential?

A

Breakdown of leukocytes according to cell type and number

Neutrophils: PMNs usu 60% of leukocytes

21
Q

Explain left shift versus right shift in a CBC w/ diff.

A

Left shift - immature cells predominate, indicates bact inf, toxemia, hemorrhage

Right shift - mature cells predominate, indicates liver disease, megaloblastic anemia, iron def disease

22
Q

What can lymphocyte levels in a CBC indicate?

A

Usu 30% of leukocytes

- increases in viral disease, acute and chronic lymphocytic leukemias, immune disorders

23
Q

What can eosinopil levels in a CBC indicate?

A

NAACP - neoplasm, addison’s disease, allergy, collagen vascular disease, parasites

24
Q

What can basophil levels in a CBC indicate?

A

increased - lymphoproliferative disorders, particularly chronic myelogenous leukemia

25
Q

What does prothrombin time test for?

A

Used to assess coag pathway forming blood clots

  • standardized to INR
  • very sensitive to vitamin k dep factors and liver disease

When using warfarin/blood thinners use INR to assess efficacy/titrate dose - should be 2-3x normal

26
Q

What does a peripheral blood smear test for?

A 
Evaluate morphology of blood cells
 Detects:
 - malaria
 - microcytic hypochromic anemia
 - lymphoblasts
 - Basophilic stippling (Pb poisoning, thalassemias)
27
Q

What is a basic metabolic panel and what does it test for?

A

Measures levels of noncellular elements of the blood, levels affected by different diseases

  • Na+
  • Cl-
  • HCO3- (buffer)
  • K+ (nerve excitation, mm contraction, myocardial potential)
28
Q

What is a blood glucose test?

A

Indicates variety of metabolic disorders if it falls outside normal fasting range of 7-100 mg/dL

29
Q

What is a hemoglobin A1c test for?

A

Measures levels of blood sugar over life of a circulating RBC - 6 weeks

  • 6 week timeline to monitor blood sugar levels, diabetes control
  • Fe deficiency anemia can elevate A1c levels
30
Q

What is a renal function study?

A

Measure of BUN and creatine levels
- BUN:Cr ratio is used to id source of pathology

BUN:Cr
>20:1 = prerenal
10-20:1 = normal
<10:1 = intrarenal

31
Q

What do bilirubin levels indicate in liver function tests?

A
  • mostly derived from breakdown of heme

Total: increased with hepatic damage, biliary obstruction, hemolysis
Direct, conjugated: increased with biliary obstruction, Dubin-Johnson syndrome, Rotor Syndrome
Indirect, unconjugated: caused by hemolysis, decreased hepatic uptake

32
Q

What do liver function enzymes indicate in a liver function study?

A

Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkalophosphatase (alk phos), and gamma glutamyl transferase (GGT)

Indicates malignancies, alcohol abuse (chronic), liver disease

33
Q

What does C-reactive protein indicate?

A

Acute phase, short half life

- indicates inflammation or tissue injury, particularly with MI

34
Q

What does a lipid panel indicate?

A

Total, with LDL and HDL and LDL as well as tot triglycerides

- important indicators about diet, health, and risk factors for CV disease

35
Q

What do thyroid studies measure?

A

TSH levels - thyroid stimulating hormone

  • secreted by pituitary, induces secretion of thyroxine from thyroid gland
  • important regulator of metabolism
  • high in hypothyroid patients
36
Q

Explain what urine analysis tests for and how it is performed.

A

Dipstick test

Evaluates:

  • appearance - cloudy, foamy, etc.
  • specific gravity
  • blood
  • ketones
  • protein
  • nitrites
  • leukocyte esterase

PCM I (10 decks)

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