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lab tests Flashcards

1
Q

what population does sensitivity focus on?

A

people who have the disease

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2
Q

what population does specificity focus on?

A

people without the disease

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3
Q

screening tests have ____ sensitivity and ___ diagnostic threshold

A

high
low

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4
Q

screening tests have ____ specificity and ___ diagnostic threshold

A

low
high

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5
Q

reference range encompases what percentage of people

A

95%

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6
Q

what are the common tests?

A

Urinalysis, urine microscopy, CBC with platelets +/- differential, Chemisteries

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7
Q

What are the chemistry tests

A

albumin, alkaline phosphatase, ALT, AST, bilirubin, BUN, calcium, chloride, creatinine, glucose, potassium, sodium

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8
Q

what does the therapeutic range measure? what does it screen for?

A

effectiveness of medication, screens for possible toxicity due to medication

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9
Q

what is the desirable range

A

prognosis related ranges, associate lab results with clinical outcomes

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10
Q

what is the type of test that detects disease in people who have it, but may be false positive in healthy people

A

sensitive test

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11
Q

why are some tests sensitive?

A

Want to make sure we aren’t missing someone who has the disease as the consequences may be deadly

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12
Q

what is the type of test where healthy people may have a normal/negative result, but may miss the disease in someone who has it

A

specific test

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13
Q

positive predictive value focuses on who?

A

people with a positive test result; likelihood that positive test result identifies someone with the disease

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14
Q

Negative predictive value focusees on who?

A

people with negative test result; likelihood that negative test result identifies someone without that disease

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15
Q

prevalence definition

A

number of existing cases in a population

ex 48% of American adults have HTN

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16
Q

incidence definition

A

number of new cases occurring within a period of time

usually one year

ex sore throat (many new cases of sore throat appear every year)

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17
Q

questions to ask before ordering test

A
  1. why is test being ordered
  2. what are consequences of not ordering the test
  3. how good is the test in discriminating between health vs disease
  4. how will test results influence patient management and outcome
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18
Q

what phase of lab testing do most errors occur in? what percent of errors?

A

Pre-analytic phase

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19
Q

ways to avoid lab pre-analytic errors

A
  1. ask right questions (when did you last eat/drink? when was your last dose of medication?
  2. use right samples (test tube, swab type, needle size)
  3. label sample correctly
  4. handle and transport sample correctlly
  5. obtain proper quantity of sample
  6. order test properly
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20
Q

what factors impact test results

A
  1. biological (age, sex)
  2. behavioral (smoking, exercise, stress)
  3. clinicial (diseases, drug therapy, pregnancy)
  4. specimen collecting and handeling
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21
Q

Approaches for establishing diagnosis

A

hypothesis deduction
pattern recognition
rifle vs shotgun approach

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22
Q

what is hypothesis deduction

A

use H&P to formulate differential diagnosis, then select labs likely to confirm a diagnosis

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23
Q

what is pattern recognition?

A

compare patients pattern for results of several lab tests
medical algorithms (decision trees)
logical and sequential
maximize clinicians efficiency
can minimize ordering unnecessary tests

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24
Q

what is rifle vs shotgun approach (try to hit bulls eye)

A

rifle: ordering specific tests based on diagnostic accuracy and predictive value
shotgun: indiscriminately order a large number of tests

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25
Q

costs of certain labs

A

CBC= $51
Lipid panel= $68
Urinalysis= $92
Hgb A1c= $61
TSH= $108
HIV= $92

if you ordered all of these for patient without insurance = $472 (doesnt include cost of visit)

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26
Q

Basic urinalysis (dipstick)

A

color
specific gravity
pH
heme/blood
albumin/protein
urinary glucose
ketones
nitrite
leukocyte esterase
bilirubin
urobilinogen

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27
Q

Basic UA- color

A

normal- pale yellow to amber
straw color- normal but low specific gravity (hydrated)
amber color- normal but high specific gravity (dehydrated)

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28
Q

colorless urine clinical applications

A

common/important
- large fluid intake
- untreated Diabetes mullitus
- diabetes insipidus
- alcohol

other
- reduction of perspiration
-chronic intersitital nephritis
- nervousness

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29
Q

orange urine clinical applications

A

common/important
-dehydrated/restricted fluid intake
- concentrated urine
- fever
- medications (pyridium/AZO)

other
-excessive sweating
-small quantity of bile
-medications- (sulfasalazine -GI)

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30
Q

brownish/greenish urine color means what

A

bilirubin

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31
Q

reddish or dark brown color means what

A

Blood (RBCs)
Hemoglobin
myoglobin
Porphyria (metabolic dz)
meidcation: Cascara/senna (laxitive)
Foods: beets, blackberries, rhubarb

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32
Q

milky urine color means what

A

fat, pus, WBC

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33
Q

Purple urine color means what

A

porphyria
purple urine bag syndrome (cath+infection)

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34
Q

what is porphyria

A

a rare hereditary disease in which the blood pigment hemoglobin is abnormally metabolized.

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35
Q

green urine means what

A

medications
food dyes

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36
Q

brown-black urine means what

A

hemoglobin
lysol poisining
melanin

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37
Q

black urine means what

A

alkaptonuria (metabolic dz)

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38
Q

what is normal specific gracity in UA

A

SG= 1.003-1.035

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39
Q

what is SG: 1.025-1.030+ mean?

A

concentrated urine

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40
Q

What does SG: 1.001-1.010 mean?

A

dilute urine

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41
Q

what does SG: 1.001-1.018 mean?

A

infants <2 years old

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42
Q

what can high specific gravity mean?

A

DM
dehydration
fever
vommiting
diarrhea
increase ADH (antidiuretic hormone)

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43
Q

what does low specific gravity mean?

A

Diabetes inspiidus
decrease ADH
glomerulonephritis
severe renal damage

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44
Q

average urine PH range

A

4.6-8 (6.0)

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45
Q

acidic urine can mean what?

A

uncontrolled DM
ketoacidocis
kidney stones
emphysema
diarrhea
starvation
dehydration
diet high in protein

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46
Q

alkaline urine can mean what?

A

UTI (some bacterial strains)
aspirin intoxication
kidney problems
diet high in fruits and veggies

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47
Q

what does fruity and foul urine odor mean?

A

Diabetes mellitus (Fruity)
Bacteria (foul)
other- metabolic diseases (ex maple syrup urine disease)

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48
Q

what is term for blood in urine

A

hematurina

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49
Q

false negative of hematuria is caused by what

A

vitamin C

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50
Q

false positive of hematuria is caused by what

A

menstrual blood, concentrated urine, vigorous exercise

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51
Q

positive urine blood clinical applications

A

common/important
-lower UTI
Nephrolithiasis
urinary tract cancers
renal cancers
urinary catheter (trauma)
anticoagulants
strenuous exercise

other
hemophilia
lupus
glomerulonephritis
heavy smokers

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52
Q

urine protein/albumin is the most important indication of what?

A

kidney disease (even in an apparently healthy person if persistent)

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53
Q

term for increased protein in urine

A

proteinuria (can be mild, moderate or severe)

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54
Q

urine protein/albumin

A

Normal value: none/negative
various kidney diseases DM
chronic urinary tract obstruction
malignant hypertension
fever
trauma
lupus (can affect kidneys)
poisoning

false negative for protein: numerous WBCs/epithelial cells in sample

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55
Q

urinary glucose

A

normal value: none/negative
kidneys normally reabsorb glucose
Glucosuria or glycosuria= increased urinary glucose
increased:
DM
Pituitary disease/brain injury
Various kidney diseases

Glucose not always abnormal: large meal/emotional stress

positive urine glucose requires evaluation for diabetes

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56
Q

Urinary glucose interfering factors

A

vitamin C- false negative
Ketones- false negative

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57
Q

Urinary ketones

A

normal value: none/negative
ketones are products of FA metabolism
Ketonuria- increased urinary ketones

clinical implications
DM (ketoacidosis)
starvation/fasting
high fat diets
low carb diet
prolonged vomiting
fever
anorexia
pregnancy/lacation

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58
Q

urinary ketones false positive causes

A

dehydration
medications

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59
Q

Urinary nitrite

A

normal value: negative
some bacteria convert nitrate into nitrite
nitrite can be negative during infection if: patient urinating frequently, infection with certain organisms, diet low in nitrates
getting a 1st morning urine is ideal

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60
Q

interferring factors with urine nitrite

A

pyridium/AZO:false positive
Vitamin C: false negative
Contamination: false positive

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61
Q

Urine leukocyte esterase

A

normal value: negative
LE is an enzyme in WBC

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62
Q

urine leukocyte esterase clinical implications

A

UTI
sterile pyuria
+ indicates pyuria, + should be evaluated microscopically (especially if nitrites are also present)

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63
Q

causes of false positive leukocyte esterase

A

vaginal discharge
trichomonas
parasites
contamination

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64
Q

causes false negative leukocyte esterase

A

pyridium/azo
vitamin C

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65
Q

urinary bilirubin

A

normal range: 0-.02mg/dL
clinical implications- trace amounts are abnormal and require further investigation

Interfering factors
Pyridium= false positive
vitamin C= false negative
light exposure cause bilirubin to rapidly decompose

Increased levels: think liver!
Hepatitis
infection or toxic agents
obstructive biliary tract diseases

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66
Q

Urine urobilinogen value and clinical applications

A

normal value= .1 -1.0mg/dL
clinical implications:
increased hemolysis
incrased liver disease
decreased biliary obstruction (gallstones)
decreased antibiotic therapy

67
Q

urine test specimen handling

A

test within one hour or refridgerate
otherwise- glucose levels drop, ketones dissipate, color deepens, pH more basic (alkaline), bilirubin and urobilinogen may be oxidized

68
Q

urine microscopy- bacteria

A

20+ bacteria/HPF may mean UTI, if nitrite is positive too= reliable indicator of infection

69
Q

what do WBCs in urine usually indicate

A

UTi or injury (5 or more per HPF (high power field), timing of test is critical

interfering factors - same as leukocyte esterase (vaginal discharge, trichomonas, parasites, heavy mucous discharge

70
Q

what do RBCs in urine usually indicate and when is it significant

A

significant if 2 or more RBCs/HPF

UTI
Renal cancer
bladder cancer
kidney stones

71
Q

what does it mean if you see epithelial cells in urine under the microscope?

A

The presence of squamous epithelia cells indicates contamination of sample (not clean catch)

72
Q

What do red blood cell casts mean when looking at urine under microscope?

A

Indicate hemmorrhage and always pathologic
-glomerulonephritis
renal infarction
lupus
others

73
Q

what do white blood cell casts mean if you see them in urine microscopy?

A

Come from kidney tubules, indicate renal parenchymal disease

may indicate
pyelonephritis
glomerulonephritis
another kidney disease

74
Q

urine microscopy-crystals types

A

Uric acid- acidic urine- normal or kidney stones
Oxalate- acidic urine- normal or kidney stones
Phosphate-ALKALINE urine- normal or kidney stones
Cystine-acidic urine- PATHOLOGIC

crystals are microscopic, stones are visible to eyes

75
Q

which urine microscopy crystal is pathologic?

A

Cystine

76
Q

bottom line- remember to consider if patient is taking what supplements/medications?

A

AZO/pyridium and vitamin C

77
Q

bottom line- positive nitrites and positive LE what does this indicate

A

Thisnk infection (esp if WBCs on micro too)

78
Q

bottom line- blood in urine what do you do?

A

requires further investigation!

79
Q

Bottom line- protein in urine?

A

Think kidney disease

80
Q

Bottom line- glucose in urine?

A

Check for diabetes

81
Q

Bottom line- epithelial cells in urine?

A

contaminated sample

82
Q

unclotted whole blood has what parts top to bottom?

A

Plasma (yellow)
buffy coat
Red blood cells

83
Q

Clotted whole blood has what parts top to bottom?

A

Serum (yellow)
clot

84
Q

what is included in CBC?

A

WBCs
RBCs
platelets
hemoglobin
hematocrit

performed on whole blood- lavender/purple tube with EDTA that prevents clotting

85
Q

what can alter CBC results? lavendar tube

A

stress
natural body rhythms
dehydration/overhydration
fat-laden meals may alter

do you need to fast before this? NO not necessary

86
Q

what is normal WBC range?

A

4000-11000 per microliter

87
Q

what is the term for increased WBCs and decreased WBCs?

A

leukocytosis and leukopenia

88
Q

what are the 5 types of WBCs

A

Neutrophils
Eosinophils
Basophils
Monocytes
Lymphocytes

89
Q

Leukocytosis is WBC count above ____?

A

11000microliters

usually result of increase in just one cell type

90
Q

types of leukocytosis

A

Neutrophilia
basophilia
eosinophilia
monocytosis
lymphocytosis

91
Q

Causes of Leukopenia?

A

WBC below 4000 microliters

Causes:viral infections, some bacterial infections, BAD infections (sepsis), meds that suppress bone marrow, bone marrow disorders (leukemia)

92
Q

Neurophils do what for your body?

A

Primary defense against microbial invasion
PMNs (Polymorphonuclear Leukocytes)
most numerous WBC

93
Q

Neutrophilia important causes

A

Bacterial infection
inflammation

Nonpathogenic
steroids

94
Q

Neutropenia important causes

A

overwhelming bacterial infection
viral infection

95
Q

What do lymphocytes do and where are they made and what types are there?

A

Lymphocytes migrate to areas of inflammation, made in bone marrow and play role in immune response, 3 types are B cells, T cells, and Natural Killer (NK) cells

96
Q

important lymphocytosis cause

A

Mononeucleosis (viral infection)

97
Q

important lymphopenia causes

A

chemo and radiation
AIDs

98
Q

What are Eosinophils and what do they contain?

A

Bilobed nuclei (also Polymorphonuclear Leukocytes)

Contains Granules–> has chemicals toxic to invaders and host cells

eosinophil counts affected by time of day, burns, post surgery

99
Q

Eosinophilia causes

A

“wheezes, sneezes, and weird diseases”

Allergies, asthma, parasitic tapeworm diseases, medications, eczema

100
Q

Eosinopenia causes

A

medication and early bacterial infection

101
Q

What are Basophils and what do they have

A

Granules that obscure the nucleus, produce histamine and other substances

Basophils are PMNs

102
Q

Basophilia causes

A

allergies (seasonal food drug)

103
Q

Basopenia

A

acute phase of infection, prolonged steroid therapy

104
Q

monocytes are what

A

big cells with big nuclei
second line of defense against infection

105
Q

monocytosis causes

A

infections (TB, parasites, ticks) and recovery

106
Q

Monocytopenia causes

A

prednisone treatment and HIV infection

107
Q

what cells do not have nuclei?

A

Red blood cells

108
Q

What do RBCs do

A

cary oxygen to tissues and bring CO2 back to lungs
use heloglobin to carry/deliver oxygen (need iron!)

lifespan- 120 days

109
Q

RBC count

A

differs men vs women
men 4.5-6 x 10^6/ml
women 4-5.0x10^6 /ml

110
Q

Erythrocytosis (RBC increase) causes

A

Polycythemia vera

Renal disease
high altitude
pulmonary disease
cardiovascular disease
tobacco
dehydration

111
Q

Erythropenia (RBC decrease) causes

A

Anemia
bone marrow/blood cancers
lupus

112
Q

What test differs betweeen men and women in RBC Hgb/Hct (H&H)

A

Hemoglobin AND Hematocrit differs, Hemoglobin is inital test to check for anemia

113
Q

How much more hematocrit do we have than hemoglobin?

A

Hct= Hgbx3

114
Q

what are platelets

A

smallest formed cellular elements, mostly formed in bone marrow and some in spleen

115
Q

what is the role of platelets

A

blood clotting, vasoconstriction
normal range= 150k-450k

116
Q

what is term for increased and decreased platelets

A

thrombocytosis
thrombocytopenia

117
Q

what causes thrombocytosis

A

cancers
acute infections

118
Q

what causes thrombocytopenia

A

some infections (viruses bacteria)
liver disease (cirrhosis)

119
Q

Basic metabolic panel components

A

Na+
K+
CL-
HCO3
BUN (blood urea nitrogen)
Creatinine
Serum glucose (blood sugar)
Ca2+

120
Q

what is BMP perofrmed on?

A

serum (gold tube)- gel helps serum separate from other blood components

or

plasma- light green tube
has heparin (anticoagulent) in it

121
Q

BMP-sodium- where is primary cation?

what is term for increased and decreased sodium?

A

extracellular fluid

Hypernatremia
Hyponatremia

122
Q

BMP- potassium K+- where is primary cation?

what is term for increased and decreased potassium

A

intracellular fluid

Hyperkalemia
Hypokalemia

123
Q

what to remember about potasium?

A

if blood sample is hemolyzed during collection, K+ LEAVES the cells and there is falsely elevated K+ level

124
Q

BMP-Chloride- where is primary anion found?

A

extracellular fluid

Na+Cl-= BFFs

125
Q

What is term for increased and decreased serum cloride?

A

Hyperchloremia and hypochloremia

126
Q

BMP-Bicarbonate (HCO3- ,CO2 content) what does it do?

A

Acts as a buffer when H+ is produced by metabolism of acids

127
Q

what is increased and decreased bicarbonate

A

alkalosis and acidosis

128
Q

BMP- BUN (blood urea nitrogen) what does it do

A

protein metabolism
ammonia production
urea synthesizes in the liver

129
Q

Increased BUN caused by what?

A

Kidney insufficiency
UTI

130
Q

Decreased BUN caused by what?

A

Low protein diet
Cirrhosis
starvation

131
Q

BMP-Creatinine is made how

A

muscle metabolizes creatine and produces creatinine

more muscle mass–> more creatinine production

132
Q

What does elevated Creatinine mean

A

decreased renal function

133
Q

what differs slightly between women and men that is produced by muscles?

A

creatinine

134
Q

does low or high GFR create a problem?

A

low GFR= kidneys not working well

135
Q

What is the Anion gap from the BMP?

formula?

A

Difference between serum cations and anions

formula: anion gap= Na - (Cl+HCO3)

136
Q

What does increased and decreased anion gap mean?

A

increased= type of acidosis

decreased= rare

137
Q

BMP-serum glucose is used for what?

A

primary energy source for metabolism

liver converts carbs to glucose
excess glucose converted to glycogen in liver/muscle- process needs insulin

138
Q

increased serum glucose name and what causes it?

A

hyperglycemia

causes: DM, endocrine disorders, severe infection, steroids

139
Q

decreased serum glucose name and what causes it

A

hypoglycemia

metabolic disorders, too much insulin medications, liver disease

140
Q

BMP- serum calcium Ca2+ term for increased and what does it cause

A

hypercalcemia

heart problems

141
Q

BMP-serum calcium Ca2+ term for decreased and what does it cause

A

hypocalcemia

muscle contactions, seizures

142
Q

what causes increased serum calcium?

A

hyperparathyroidism (bone breakdown)- releasing calcium
Too much vitamin D

143
Q

what causes decreased serum calcium?

A

Hypoparathyroidism (bone building)- breaking down calcium to build
vitamin D deficiency

144
Q

Elevated Hemoglobin A1c of 6.5% + is diagnostic of what?

A

Diabetes mellitus

145
Q

What test is not accurate during pregnancy that diagnoses DM?

A

Hemoglobin A1c

146
Q

What enzyme is produced by the pancreas faster than lipase?

A

Serum Amylase

147
Q

what causes increased serum amylase?

A

pancreatitis

148
Q

what casues decreased serum amylase?

A

pancreatic insufficency

149
Q

Serum lipase is produced where

A

pancreas
stays elevated longer in pancreatitis than amylase

150
Q

What causes increased serum lipase?

A

pancreatitis

151
Q

Serum AST (asparate aminotransferase) is produced where?

A

Liver

also found in heart, muscle, kidney which gets released when tissues injured

152
Q

increased serum AST causes what

A

liver problems

153
Q

Where is serum ALT (alanine aminotransferase) produced

A

Liver

small amounts in muscle and heart- gets released when tissues injured

increased- causes liver damage as well as AST

154
Q

Serum alkaline phosphatase is produced where and present where

A

Liver
present many types of cells (bone, biliary tract, intestines, placenta, kidneys)

Gets released when cells are destroyed or during growth periods

155
Q

decreased serum alkaline phosphatase causes what

A

osteoporosis

156
Q

increased serum alkaline phosphatase causes what

A

liver problems

157
Q

serum bilirubin comes from what?

A

Breakdown of RBCS
bilirubin conjugated in liver and excreted in bile

158
Q

increased serum bilirubin causes increased breakdown of RBCs (hemolysis)
certain liver and bile duct problems

A
159
Q

what is CMP

What does it include?

A

= comprehensive metabolic panel

includes everything in BMP plus
AST
ALRT
Alk Phos
Bilirubin
Total Protein
Albumin

160
Q

what is included in BMP

A

NA
K
Cl
HCO3- bicarb
BUN
Cr
Glucose
Ca

161
Q

serum GGT (gamma glutamyl transferase) is made where and found where

A

liver
found in kidney, prostate, spleen

increased= liver problems

162
Q

Point of care testing means what

A

inexpensive tests
performed at “point of care” (bedside)
performed with non-lab personal
get results faster than non-POCT
speed at expense of accurace

may need further/confirmatory testing

163
Q
A

Foundations (3 decks)

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