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Clinical Medicine I > Lab Medicine > Flashcards

Lab Medicine Flashcards

1
Q

Roles of Laboratory Medicine

A

Diagnosis of disease
Monitoring of disease, therapies and interventions,
Screening for disease
Reserach

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2
Q

Gaussian Distribution

A

95% of the normal healthy population falls within the normal test range
5% do not fall within the range when they are healthy

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3
Q

Screening Test

A

Identifies asymptomatic people who MAY have a disease

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4
Q

Diagnostic Test

A

Determines presence or absence of disease when a patient SHOWS SIGNS/SYMPTOMS

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5
Q

Fecal occult blood test screens for

A

Colorectal cancer

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6
Q

Blood pressure screens for

A

hypertension

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7
Q

Bone densitometry screens for

A

osteoporosis & osteopenia

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8
Q

PSA screens for

A

prostate cancer

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9
Q

PPD test screens for

A

tuberculosis

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10
Q

Validity

A

how well a test tells who has a disease and who doesn’t

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11
Q

Reliability

A

consistency of a test at different/times conditions (getting same result)
“Consistent”

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12
Q

Specificity

A

Health oriented
Identifies those WITHOUT disease correctly
Minimizes FALSE POSITIVES
“SPIN”

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13
Q

Sensitivity

A

Disease-oriented
Identifies those WITH disease correctly
Minimizes FALSE NEGATIVES
“SNOUT”

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14
Q

RBC Reference Range (per microliter)

A

Male: 4.73-5.49
Female: 4.15-4.87

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15
Q

Mean cellular (corpuscular) volume (MCV)

A

Average volume of blood cells
Normal (76-100 micrometers^3)
Helps classify anemia type

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16
Q

Increased MCV

A

(macrocytosis)

vitamin B12 or folic acid deficiency

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17
Q

Decreased MCV

A

(microcytosis)

iron deficiency anemia

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18
Q

Hemoglobin Reference Range

A

Male: 14.40-16.60 gm/dl
Female: 12.2-14.7 gm/dl

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19
Q

Hematocrit Reference Range

A

Men: 42.9-49.1%
Women: 37.9-43.9%

Percentage of RBC making up total blood volume

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20
Q

Elevated hemoglobin causes

A 
Loss of plasma volume (dehydration)
High altitude
Smokers (w/ COPD)
Congenital heart disease
Polycythema vera (overproduction of RBC)
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21
Q

Low hemoglobin causes

A 
^ destruction of RBC
Decreased RBC production
Blood loss
Pregnancy
Vitamin deficiency (iron)
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22
Q

WBC Reference Range

A

4,500-11,000 per mm^3

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23
Q

WBC Granulocytes

A

Neutrophils, eosinophils, basophils

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24
Q

WBC agranulocytes

A

Lymphocytes and monocytes

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25
Q

Elevated Neutrophils
(most common WBC)
Normallly 56%

A

BACTERIAL INFECTIONS
Inflammatory conditions
Other infections

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26
Q

Elevated Basophils

Normally 0.5%

A

Elevated CML (chronic myeloid leukemia)
Aftermath of splenectomy
Polycythemia

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27
Q

Decreased basophils

A

rheumatic fever, pregnancy, post-radiation therapy, and steroid therapy

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28
Q

Elevated eosinophils

Normally 2.7%

A

allergies, parasitic infection or skin disease

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29
Q

Elevated lymphocytes

Normally 34%

A

Viral infection or lymphocytic leukemia

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30
Q

Elevated monocytes

Normally 4%

A

Phagocytosis of bacterial infections

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31
Q

Elevated WBC

“Leukocytosis”

A 
Acute (viral/bacterial) infections, leukemia, post-splenectomy, steroids (prednisone)
WITHOUT DISEASE (high stress, excitement, pain, trauma, heat)
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32
Q

Low WBC

“Leukopenia”

A

Viral infection; overwhelming bacterial infection, hypersplenism (enlarged spleen); meds/toxins suppressing bone marrow

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33
Q

Platelet Reference Range

A

150,000 - 400,000 per cubic mililiter

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34
Q

Low Platelets

A

Enlarged spleen, platelet destruction (DIC, ITP), decreased platelet production (bone marrow suppression, viral infection, vit. deficiency), alcoholism

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35
Q

Elevated platelets

A

Hemorrhage
Splenectomy
Inflammation

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36
Q

Urinalysis identifies:

A

stones, UTI and urologic malignancy, systemic disease

SAMPLE CAUGHT MID-STREAM; examined within 1-2 hrs

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37
Q

Urinalysis Physical Exam

A

Color, clarity, odor

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38
Q

Urinalysis Chemical Exam

A

Dipstick

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39
Q

Urinalysis Microscopic Exam

A

Looks for RBC, WBC, casts or crystals

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40
Q

Red urine (hematuria)

A

Kidney stones, UTI or bladder cancer

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41
Q

Yellow urine

A

Dehydration or foods (carrots)

42
Q

Brown urine

A

Glomerulonephritis, myoglobin, or bile pigments (kidney/liver functions)

43
Q

Orange

A

medication side affects

44
Q

Urinalysis (Chemical Exam)

Increased Specific Gravity (usually 1.001-1.035)

A

Volume depletion

45
Q

Urinalysis (Chemical Exam)

Decreased Specific Gravity (usually 1.001-1.035)

A

Excessive fluid intake, diuretic therapy, or diabetes insipidus

46
Q

Urinalysis (Chemical Exam)
Increased pH
(Usually 4.6-8.0)

A

vomiting, urination infections, or kidney disease

47
Q

Urinalysis (Chemical Exam)
Decreased pH
(Usually 4.6-8.0)

A

Aspirin overdose, starvation, alcohol ingestion, high protein diet

48
Q

Urinalysis (Chemical Exam)

Protein presence

A

Glomerulonephritis, pre-eclampsia, complications from diabetes

49
Q

Urinalysis (Chemical Exam)

Glucose presence

A

diabetes, burns, pancreatitis, corticosteroid use, Cushing’s disease

50
Q

Urinalysis (Chemical Exam)

Ketone presence

A

starvation, alcoholism, diabetic ketoacidosis (break down of fat stores)

51
Q

Urinalysis (Chemical Exam)

Bilirubin presence

A

Biliary obstruction and liver injury

52
Q

Urinalysis (Chemical Exam)

Blood presence

A

Kidney stones, urinary trauma, UTI, strenuous exercise, bladder cancer

53
Q

Urinalysis (Chemical Exam)

Leukocyte Esterase

A

UTI

by product of neutrophils - high in bacterial infections

54
Q

Urinalysis (Chemical Exam)

Urobilinogen excess

A

hemolysis and hepatocellular disease

55
Q

Urinalysis (Chemical Exam)
Nitrites
*shouldn’t have them

A

Infection

*some bacteria convert nitrates to nitrites

56
Q

Urinalysis (Microscopic Exam)

RBC and WBC count?

A

WBC: 0-5 per high power field
RBC: 0-3 per high power field

57
Q

Bence Jones protein in urine

A

Multiple Myeloma

58
Q

Crystals in urine

A

Kidney stones (cysteine, calcium, oxalate, struvite)

59
Q

Casts (formed in distal convoluted tubule)

RBC vs WBC?

A

RBC: glomerulonephritis
WBC: phelonephritis - (upper kidney infection)

60
Q

Aspartate aminotransferase (AST)
Normal: 7-42 IU/liter
Elevated with:

A

liver, muscle or cardiac injury

61
Q 
Alanine aminotransferase (ALT)
Normal: 1-45 IU/liter
A

More sensitive for liver injury

62
Q

Alkaline Phosphatase
Normal: 25-160 IU/L
Elevated with:

A

Bile duct obstruction
In liver: cholecystitis
Outside liver: viral hepatitis or cirrhosis
*could be associated with metastatic bone cancer

63
Q

Gamma glutamyl transpeptidase (GGT)

Elevated with:

A

liver injury, or biliary obstruction

Marker of alcohol use***

64
Q

Unconjugated bilirubin

Elevation?

A

Bilirubin bound to albumin
Not water soluble
Elevated with hemolysis

65
Q

Conjugated bilirubin

A

Bilirubin cleaved of albumin (occurs in liver)
Water soluble
Elevated with bile duct obstruction

66
Q

Albumin

A

Marker of liver function

67
Q

Prothrombin time (PT)

Normal 11.5-13.5 seconds

Monitored with:

A

Time required for coagulation to occur

Marker of liver function because clotting factors are produced in liver

Monitor in COUMADIN THERAPY (extrinsic clotting - factors I, II, V, VII, X)

68
Q

Indications for coagulation studies

A

Unexplained bleeding/excessive bruising
Consecutive pregnancy loss
Patients receiving heparin or Coumadin therapy (blood thinning)

69
Q

Partial thromboplastin time (aPTT)

Normal 27-38 seconds

Monitored with:

A

Heparin therapy

Intrinsic clotting

70
Q

Increased Amylase and lipase levels (pancreas enzymes)

A

Pancreatitis
Biliary Obstruction
Pancreatic Carcinoma

71
Q

Lipase or Amylase: MORE specific for pancreatic inflammation

A

Lipase
Remains elevated longer
Norm:

72
Q

Lipase or Amylase: LESS specific for pancreatic inflammation

A

Amylase
Peaks earlier and declines more rapidly
Norm: 10-130 U/L

73
Q

Indications for ordering electrolytes

A

Pts receiving IV fluid;
Metabolic/endocrine abnormalities;
Meds that interfere with electrolytes;
Severe vomiting/diarrhea

74
Q

Elevated Sodium

Norm: 136-145 mmol/L)

A

Dehydration
Vomiting/diarrhea
Endocrine (SIADH, aldosteronism, diabetes inspidius)

75
Q

Decreased Sodium

Norm: 136-145 mmol/L)

A 
Overhydration
Endocrine (Cushing's disease)
76
Q

Elevated Potassium

Norm: 3.5-5.0 mEq/L

A

Cell injury, kidney failure, endocrine disorders (addisons)

77
Q

Decreased Potassium

Norm: 3.5-5.0 mEq/L

A

Malnutrition, vomiting/diarrhea, diuretic medications

78
Q

Elevated Chloride

Norm: 97-107 mEq/L

A

dehydration, overactive parathyroid glands

79
Q

Decreased Chloride

Norm: 97-107 mEq/L

A

Vomiting (lost of gastric acid)

80
Q

Elevated Magnesium

Norm: 1.3-2.1 mg/dL

A

kidney disease

use of antacids (M.O.M.)

81
Q

Decreased Magnesium

Norm: 1.3-2.1 mg/dL

A 
Inadequate absorption (poor diet, alcoholism, diarrhea)
Diuretic medication
82
Q

Metabolically active Calcium

A

IONIZED

when bound to proteins it is not

83
Q

Elevated calcium

Norm: 8.2-10.2 mg/dL

A

Hyperparathyroid hormones
cancer
excessive Vit D

84
Q

Decreased calcium

Norm: 8.2-10.2 mg/dL

A

Hypoparathyroid hormones
Deficient protein
Vit. D deficiency

85
Q

Elevated glucose in blood

A

diabetes, endocrine disorders, prednisone therapy, or pancreatitis

86
Q

Hemoglobin A1C

A

Norm

87
Q

Elevated Blood Urea Nitrogen (BUN)
Norm: 5-20 mg/dL
Kidney test

A

Impaired kidney function

88
Q

Decreased Blood Urea Nitrogen (BUN)
Norm: 5-20 mg/dL
Kidney Test

A 
Liver failure (less urea produced)
Malnutrition (less proteins)
Endocrine disorders (SIADH)
89
Q 
Elevated Creatinine (Cr)
Norm: Men (0.9-1.2); Women (0.6-1.1)
A

Impaired renal function

Large muscle mass

90
Q 
Decreased Creatinine (Cr)
Norm: Men (0.9-1.2); Women (0.6-1.1)
A

Decreased muscle mass

Liver disease

91
Q

Elevated Uric Acid

Norm: Men (3.4-8.0); Women (2.4-6 mg/dl)

A

excessive cell breakdown of nucleonic acids (gout)
excessive destruction of cells (leukemia)
inability to excrete uric acid (renal failure)

92
Q

Hyperthyroidism

A

Elevated T4 and T3

Decreased TSH

93
Q

Hypothyroidism

A

Decreased T4 and T3

Increased TSH

94
Q

Blood culture when

A

bacteremia is present

95
Q

Urine culture when

A

suspected UTI or pyelonephritis

96
Q

Throat culture

A

Golf standard from streptococcal pharyngitis

97
Q

Sputum culture

A

diagnosis and treatment of pneumonia and TB

98
Q

Sedimentation rate (Sed rate)

A

Marker of inflammation

99
Q

D-Dimer

A

Marker of clotting process

Screen for VENOUS THROMBOSIS (DVT or PE)

100
Q

Brain natriuretic peptide (BNP)

A

Increased with ventricular volume expansion and pressure overload
(Congestive heart failure)

Clinical Medicine I (2 decks)

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