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PAS 511 Foundations in Clinical Medicine > Lab Studies > Flashcards

Lab Studies Flashcards

1
Q

Specificty

A

SpPIN- positive rules the disease in…no false positives

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2
Q

Sensitivity

A

SnNou- negative rules the disease out…no false negatives

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3
Q

Routine lab CBC include:

A 
RBC (total #)
Hgb, Hct
MCV (average volume per RBC)
MCH (average Hgb per RBC.."_chromic")
MCHC (average concentration of Hgb in cell)
RDW (variation of RBC population
WBC (absolute # and differential for types)
Platelets
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4
Q

Basic metabolic panel or Chem 7 components

A 
Glucose, Na (dehydration)
K (hypo/hyperkalemia)
Cl (electrolyte, acid-base, H2O balance)
Bicarb (acid-base balance)
BUN (blood urea nitrogen is renally cleared)
Creatinine (more specific than BUN)
Ca
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5
Q

Coagulation panel

A

aPTT (1,2,5,8,9,10,11,12) monitor heparin

PT (1,2,5,7,10) monitor coumadin

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6
Q

Urinalysis

A

Macroscopic- color, turbidity
Dipstick chemical analysis- pH, specific gravity, protein, glucose, ketones, nitrite, leukocyte esterase
Microscopic- crystals, casts, squamous cells, bacteria

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7
Q

urinalysis- dipstick

A
  • pH 4.5-8
  • sg- 1.002-1.035 lower means kidneys can’t [ ] and higher means there are big molecules present
  • protein 150 mg/24 hrs or 10 mg/100 ml…detect with indicator dye bromphenol blue
  • glucose- diabetes mellitus
  • ketones-acetone, acetacetic acid, beta-hydroxybutyric acid result from calorie deprivation
  • nitrite- gram neg rod bacteria
  • leukocyte esterase- WBCs present
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8
Q

urinalysis-microscopic

A
  • RBC-may be swollen shrunken or dysmorphic (glomerular disease)
  • WBC- (pyria) upper/lower UTI or acute glomerulonephritis, >2 abnormal…could be contaminants
  • Epithelial- small # normal but nephrotic syndrome could increase numbers…squamous could be contaminants
  • Casts- formed in distal tubule or collecting duct…favored by low flow rate, high Na, low pH
    - haline
    - RBC glomerulonephritis or tubular damage
    - WBC inflammation
    - granular was in nephron for some time
    - broad from damaged and dilated tubules
  • bacteria- keep refridgerated, need culture
  • yeast- candida
  • Crystals- Ca oxalate, triple phosphate, amorphous phosphate
  • Misc…sperm, crud, pinworm ova, schistosomiasis ova
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9
Q

Specimen collection

A

clean catch, evaluate w/in 1 hr of collection (longer will result in decreased clarity, rise in pH, loss of ketones, cells, casts, overgrown bacteria)

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10
Q

Cardiac enzymes

A

*Troponin I/T: very specific for cardiac injury, rises 2-6 hrs after injury and peaks in 12-16
*Creatinine kinase- CK-MB, CK-MM, CK-BB
rises 4-6 hrs, peaks at 24 hrs returns to normal in 3-4 days
*Myoglobin- skeletal or cardiac, rises 2 hrs after Mi, peaks 6-8 hrs, returns to normal 20-36 hrs

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11
Q

Lipid panel

A

Cholesterol- most accurate after 10-12 hr fast
Triglycerides (80% VLDL, 15% LDL), 32 in men, 38 in women
LDL= total cholesterol- HDL- VLDL
VLDL= triglycerides/5
*total cholesterol 240 high

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12
Q

sputum evaluation

A
  • gram stain, bacterial culture, and acid-fast culture
  • transudative filtrate
  • Exudate contains debris and protein
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13
Q

indications for types of WBCs

A

neutrophils bacterial
lympocytes viral
eosinophils allergies or parasite

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14
Q

esophageal/gastric pathology

A

gastrin- produced by G cells and triggers release of gastric acid
*normal is <110 pg/ml (lowest in am)

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15
Q

quantitative stool studies

A

48-72 hrs for weight quantity (>250g/24 hr is diarrhea)

fecal fat 7-14 g/ 24 hr (>14g/24 hr= disorders of fat digestion)

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16
Q

stool osmolality

A

spot stool specimen, stool electrolytes (for osmotic diarrhea),

17
Q

stool laxative screen

A

magnesium, phosphate, and sulfate levels

18
Q

other stool screenings

A
  • fecal leukocytes (implies underlying inflammatory disorder, ova and parasites- giardia and E. histolytica)
  • occult blood
19
Q

stool culture

A

enteric pathogens

immunoassays for C.diff (bacteria), rotavirus (viral), protozoal antigens (giardia and e hystolytica)

20
Q

helicobacter pylori infections

A
  • spiral urease-producing micaerophilic gram- rod
  • causes gastritis, peptic ulcer disease, +/- gastric cancer
  • serologic test for IgG Ab, antigen in stool
  • urease breath test
21
Q

liver disease

A

enzymes
function evaluation- coagulation, protein
pathogens- viral hepatitis

22
Q

liver enzymes

A

ALT- contained in hepatocytes and release with injury or degeneration (sensitive but non-specific)
AST- contained in hepatocytes (plus others though so non-specific)
GGT- fairly non-specific
ALK-Phos- bile duct injury (also seen in bone, kidney, placenta, intestine, and lung)

23
Q

bilirubin

A

heme–>indirect/unconjugated bilirubin carried by albumin to liver–> direct/conjugated bilirubin attached to glucuronide and excreted in bile

24
Q

disorders with increased total or indirect bilirubin

A 
hemolytic anemia
physiologic jaundice
sickle cell anemia
transfusion reaction
pernicious anemia
pernicious anemia
resolution of a large hematome
25
Q

increased direct bilirubin

A

bile duct obstruction
cirrhosis
hepatitis

26
Q

hepatitis panel

A

a-e diagnosis based on detection of Ab and Ag
Acutely Infected Immune to HepB
HBsAg positive negative
anti-HBc positive negative
antiHBs negative positive
IgMantiHBs positive —

27
Q

ammonia levels NH3

A

increased levels of hepatic encephalopathy (liver normally clears it)

28
Q

coagulation profile- liver function test

A

decreased factros 2,5,7,9,10 cause prolonged PT and aPTT
decreased antithrombin III
platelets <100,00 in 2/3 of pts w/ liver failure

29
Q

ascites fluid analysis

A 
macroscopic (turbidity, color)
cell count (presence of WBCs, type)
cultures
albumin (portal hypertension)
exudate (any debris or proteins)
30
Q

pancreatic enzymes

A

amylase

lipase (specific to pancreas)

31
Q

renal function tests

A
  • creatinine- non-protein metabolism in proportion to mm mass…depends on GFR so clearance is used to determine GFR [(140-age)xweight/ serum creat]
  • BUN- protein metabolism (indicates pre-renal)
32
Q

PSA

A

prostate specific antigen
glycoprotein found in prostate acinar cell
usually greater than 4 is worrisome for cancer

33
Q

Genitourinary

A
  • serum hCG- elevated in cancer and pregnancy
  • STDs- assess w/ gram stain, cultures, DNA probe (herpes w/ tzanck test)
  • PAP smear- HPV, assess estrogen effect
34
Q

endocrine- how does the interaction of multiple glands control release of hormone?

  • thyroid
  • parathyroid
  • diabetes
A
  • hypofunction- stimulatory test, hyper- suppresssion
  • thyroid- pituitary releases TSH–>thyroid releases T3 and T4 (synthroid)–> levels negative feedback
  • parathyroid- PTH released when Ca is low
  • Diabetes mellitus- fasting blood sugar 2 hr oral glucose tolerance test for gestational diabetes, use glycosylated Hgb
35
Q

endocrine

adrenal-pituitary function

A
  • ACTH stimulation test…it stimulates adrenal gland to produce cortisol.
  • Dexamethasone suppression of pituitary ACTH secretion..r/o cushing’s
  • aldosterone
36
Q

endocrine

gonadal function

A 
chromosome analysis
estrogen in serum
FSH and LH
progesterone
testosterone (semen)
37
Q

endocrine

GH, somatomedin C, prolactin

A

GH- GHRH from hypothalamus
IGF-1- mediates growth promoting effects of GH
prolactin- most common pituitary tumor, causes gynecomastia

38
Q

hematology
RBC
bone marrow
Coombs test

A

*RBCs if concerned about anemias, assess contents and shape
*bone marrow looking for abnormal cells, usually from iliac crest
*Coombs test- direct- RBCs w/premade Abs
indirect- serum +standardized RBC

39
Q 
hematology
EPO
ferritin
haptoglobin
TIBC
serum iron
A

*from kidneys to maintain appropriate hgb, differential diagnosis for anemia
*correlates with total body iron stores
*binds free hgb..decreased in hemolytic anemia
*concentration of transferrin..rises in iron deficiency
*serum iron- variation though so poor test
IRON DEFICIENCY= low serum iron and ferritin, high TIBC

PAS 511 Foundations in Clinical Medicine (12 decks)

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