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MSS PCM Exam 1 > Introduction to Laboratory Testing > Flashcards

Introduction to Laboratory Testing Flashcards

1
Q

use of diagnostic testing?

A

take info from H and P to come up with differential diagnosis

-testing will help guide the diagnostic work up and support your differential dx

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2
Q

3 main uses of diagnostic testing?

A

diagnosis, screening, patient management

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3
Q

how to decide what to order?

A
  1. H and P and DDx
  2. potential benefits vs. costs and disadvantages
  3. don’t order a test if you don’t know what to do with it**
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4
Q

how many diagnostic tests?

A

hundreds for various reasons

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5
Q

reference range?

A

use the range of the lab doing the testing

  • for 95% of the populations
  • 5% population varies outside this range
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6
Q

types of common tests?

A

gross pathology, cellular pathology, function, special tests

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7
Q

examples of gross pathology diagnostic testing?

A

scopes
x-rays
IVP
spinal myelogram

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8
Q

scope

A

visualize organ systems internally

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9
Q

x-rays

A

radiation to detect changes in density of tissues, bone and viscera

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10
Q

IVP

A

intravenous pyelogram
-view of kidneys, ureters and bladder, usually detect kidney stones, tumors and other blockages in system

**kidney stones

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11
Q

spinal myelogram

A

look for spatial changes in spinal canal

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12
Q

types of myelograms?

A

IVP and spinal myelogram

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13
Q

more advanced x-ray technology?

A

CT scan - x-ray of body tissues that produces slices (cross sections) of an area of the body
-evaluate large areas

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14
Q

CT scan

A

with or without contrast**

without contrast- spiral CT of kidneys
with contrast- IV or PO (oral) used to highlight bleeds, small structure in brain, kidneys, spine, and liver

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15
Q

contrast used in CT scan?

A

iodine, barium, gastrografin

radioactive agent
-make sure patient has good kidney function**

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16
Q

MRI

A

no radiaton**

uses magnetic fields and pulses to give cross sections

can identify masses, tears, bleeding, tissue damage from infection and injury anywhere in body

can be done with or without contrast

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17
Q

cellular pathology?

A

biopsy, puncture, FOBT, serum studies, urinalysis, cultures and sensitivies

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18
Q

puncture?

A

removal of fluid from area for analysis

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19
Q

fecal occult blood test?

A

blood in fecal matter

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20
Q

serum studies?

A

routine exam of blood

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21
Q

urinalysis

A

exam of urine for cells, tiny structues, bacteria, and chemicals

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22
Q

cultures and sensitivities

A

C and S
-growth of an organism from body fluid to identify an organism causing pathology and to identify what is best course of therapy

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23
Q

function diagnostic testing?

A

ultrasound and doppler studies
electrograms
angiograms/venograms

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24
Q

ultrasound

A

sound waves to detect movement and function of organs

**no radiation

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25
Q

doppler studies

A

sound waves and sonar to detect abnormal blood flow

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26
Q

electrogram

A

test for electrical activity of tissues

EKG or ECG
-electric activity of heart

also nerve conduction studies

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27
Q

angiograms/venograms

A

use dye to detect blockages in arteries and veins

**these are x-ray pictures

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28
Q

blood test

A

analysis on blood sample via venipuncture
-determine physiological and biochemical states

disease, mineral content, drug effectiveness, organ function

also used in drug tests

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29
Q

CBC

A

complete blood count
-cellular components of blood (RBC, WBC, platelets)

values usually correspond to one of many anemias affecting patient
-also correspond with infections and malignancies

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30
Q

shorthand of CBC?

A

left WBC
right platelet
top hemoblobin
bottom hematocrit

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31
Q

normal ration of hemoglobin to hematocrit

A

1/3

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32
Q

total erythrocyte range?

A

4.7e6 - 6.1e6

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33
Q

hemoglobin range

A

female - 12/16 g/dL

male - 14-18 g/dL

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34
Q

hematocrit range

A

female 37-47%

male 40-54%

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35
Q

hematocrit increase?

A

high altitude, smoker, tumors

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36
Q

hematocrit decrease?

A

anemia (iron, folate, B12), acute/chronic blood loss, hemolysis

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37
Q

hemoglobin increase?

A

dehydration, burns, vomiting

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38
Q

hemoglobin decrease?

A

all anemias, hypothyroidism, B12 and folate deficiency, chronic disease

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39
Q

normal range for WBCs?

A

4,800 - 10,800 cells/microliter

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40
Q

CBC and WBCs?

A

can be ordered with or without differential**

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41
Q

alteration of WBC levels?

A

infection, inflammation, hemotologic malignancies, leukemias, lymphoma, steroid use, aneimas, drugs, and sepsis

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42
Q

left shift of neutrophils?

A

predominance of immature cells

-infection, toxemia, hemorrhage

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43
Q

right shift of neutrophils?

A

predominance of mature cells

-liver disease, anemias, iron deficiency

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44
Q

most dominant WBC?

A

neutrophils (46-80%)

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45
Q

lymphocytes

A

increased in viral disease

-also acute and chronic lymphocytic leukemias

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46
Q

monocytes

A

increased in bacterial and protozial infection

-also infections mono

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47
Q

eosinophils

A

increased in allergy and parasites

48
Q

basophils

A

increased in chronic myeloid leukemia

49
Q

increased in platelets?

A

after stress

-trauma and surgical, childbirth, fractures, exercise

50
Q

prothrombin time

A

assess coagulation pathway
-common for patients on anti-coagulants

normal 11-15 seconds

INR - international normalized ratio

51
Q

normal platelet count?

A

150,000 - 450,000 microliters

52
Q

warfarin/coumadin?

A

use PT/INR to asses efficacy of drug

-reading should be 2-3x normal

53
Q

peripheral blood smear?

A

stain and scopes viewer can evaluate the size shape and content of blood cells

54
Q

things seen in peripheral blood smear?

A

macrocytes, schistocytes (helmet cells), howell jolly bodies

55
Q

plasmodium

A

parasite in malaria

56
Q

microcytic hypochromic

A

iron deficiency anemia

57
Q

lymphoblasts

A

elevated levels can indicate lymphoma

58
Q

basophilic stippling

A

remnants of DNA in RBCs

-lead poisoning or thalassemia

59
Q

diagnostic by PBS?

A

plasmodium, microcytic hypochromic, lymphoblasts, basophilic stippling

60
Q

basic metabolic panel

A

non-cellular elements of blood

-sodium and chloride

61
Q

sodium

A

predominant cation in ECF

creates most osmotic pressure, essential for proper neuron and muscle activity

62
Q

chloride

A

predominant anion in ECF
affects osmotic pressure of serum
tends to follow sodium

63
Q

increased sodium?

A

hypernatremia - excessive water loss or sodium injection, loss of ICF fluid characterized by extreme thirst and agitation

64
Q

decreased sodium?

A

hyponatremia - excessive sweating

  • also caused by diarrhea or vomiting
  • causes dizziness, confusion, weakness, low BP and shock
65
Q

increased chloride?

A

diarrhea

66
Q

decreased chloride?

A

vomiting, DM with ketoacidosis

67
Q

bicarbonate levels?

A

major buffer of blood when protons are produced by metabolism

used to transport CO2

excretion controlled by kidneys

68
Q

increased bicarbonate

A

metabolic alkalosis from respiratory acidosis

69
Q

decreased bicarbonate

A

metabolic acisosis from respiratory alkalosis

70
Q

potassium

A

predominant cation in cellular fluid

-changes in serum concentration greatly affects nerve excitation, muscle contraction, myocardial potential

71
Q

increased potassium

A

hyperkalemia
-renal failure of addisons disease causing weakness, abnormal sensations, cardiac arrhythmias with possible arrest, also in hemolysis of specimin, thrombocytosis, dehydration, massive tissue damage

72
Q

decreased potassium

A

hypokalemia

-in diuretics, vomiting

73
Q

increased glucose levels

A

hyperglycemia in DM

74
Q

decreased glucose levels

A

hypoglycemia in pancreatic disorders

75
Q

blood urea nitrogen

A

increased in renal failure or GI bleed

76
Q

creatinine

A

increased in renal failure, loss of muscle mass

77
Q

normal BUN:Cr ratio

A

10-20:1

-used to identify source of dysfunction when values are not in the normal range

78
Q

prerenal?

A

greater than 20:1

BUN reabsorption increased, dehydration suspected

79
Q

normal or postrenal

A

10-20:1

normal range and also postrenal disease

80
Q

intrarenal

A

less than 10:1

renal damage causes reduced reabsorption of BUN

81
Q

glucose level measurement?

A

fasting important**

82
Q

when to use kidney studies?

A

kidney function OR contrast studies

83
Q

direct vs. indirect bilirubin?

A

direct is conjugated

indirect is unconjugated

84
Q

bilirubin

A

from breakdown of heme

-insoluble in water, bound to plasma proteins until conjugated with glucuronic acid in liver

85
Q

total bilirubin levels?

A

less than 0.3 - 1 mg/dL

increased in hepatic damage

86
Q

direct bilirubin?

A

conjugated

increased in biliary obstruction, dubin johnson, rotor

87
Q

indirect bilirubin?

A

unconjugated

hemolysis, gilbert, crigler-najjar

88
Q

hemoglobin A1C

A

accurate measure of average blood sugar over average live of circulating erythrocyte
-approx 6 weeks

now used to diagnose and monitor diabetes control

89
Q

c-reactive protein

A

acute phase reactant with a short half life
-rises rapidly within 4-6 hours of the onset of inflammation or tissue injury

declines relatively rapidly with resolution, correlates with older very non-specific test called sedimentation rate (ESR)

90
Q

cholesterol

A

insoluble in water

  • carried by lipoproteins
  • ingested and synthesized by liver
91
Q

increased cholesterol?

A

hypercholesterolemia

-congenital, hypothyroidism, DM, fatty diet and obesity

92
Q

LDL

A

high levels - accelerated artherogenesis

93
Q

HDL

A

high levels protective

94
Q

triglycerides

A

absorbed in blood after fatty meal

  • broken down and stored as adipose
  • major form of energy at cellular level
  • increased levels also associated with accelerated artherogenesis
95
Q

liver profile and liver disease?

A

all enzymes are increased with liver disease

-cirrhosis

96
Q

enzymes in liver profile?

A 
alanine aminotransferase (ALT)
aspartate aminotransferase (AST)
gamma-glutamyl transferase (GGT)
97
Q

alcoholic hepatitis?

A

AST > ALT

98
Q

viral hepatitis?

A

ALT > AST

99
Q

thyroid hormone

A

essential in regulation of metabolism

100
Q

normal urinalysis?

A 
normal is clear/yellow
slightly acidic
negative for:
-bacteria, bilirubin, blood, ketone, glucose, protein, intrite, leukocyte esterase (if normal)
trace sediments normal:
-RBC, WBC
101
Q

abnormal urinalysis?

A
  • cloudy, foamy, dark yellow/green, red to black, purple to brown
  • increased acidity
102
Q

cloudy urinalysis?

A

pyuria, blood, mucus, bilirubin

103
Q

foamy urine?

A

proteinuria, bile salts

104
Q

dark yellow or green urine?

A

bile or bilirubin

105
Q

red to black urine?

A

RBCs, hemoglobin, myoglobin

106
Q

purple to brown urine?

A

specimens standing in sunlight from porphyrins

107
Q

increased urine acidity?

A

infections (proteus), systemic alkalosis, renal tubular acidosis

108
Q

increased specific gravity of urine?

A

volume depletion

109
Q

decreased specific gravity of urine?

A

infection, compulsive water drinking

110
Q

bilirubin in urine?

A

primarily conjugated

-obstructive biliary tract disease, liver disease

111
Q

blood in urine?

A

stones, tumors, coagulopathy, infection, menses (contamination)

112
Q

dipstick positive for blood?

A

no red cells present
-may be free Hg from trauma or a transfusion reaction or lysis of RBCs or there is myoglobin present because of crush injury, burn, or tissue ischemia

113
Q

glucose in urine?

A

positive in DM
-especially with serum glucose over 200mg/dL

also positive in pancreatitis

114
Q

ketones in urine?

A

positive in starvation/fasting, diabetic acidosis, vomiting, diarrhea

115
Q

protein in urine?

A

mostly albumin

-positive in pyelonephritis, nephrotic syndrome

116
Q

leukocyte esterase in urine

A

with nitrite test, predictive value for UTI of 74% if both tests positive

117
Q

nitrite test in urine?

A

positive in infection

MSS PCM Exam 1 (10 decks)

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