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Family medicine > Lab tests in primary care > Flashcards

Lab tests in primary care Flashcards

1
Q

Sensitivity

A

The ability of a test to correctly identify those who have the disease “true positive rate”

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2
Q

Specificity

A

The ability of a test to correctly identify those who do not have the disease “true negative rate”

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3
Q

Positive predictive value

A

Describes the likelihood that a person whose test shows a positive result, actually has the disease

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4
Q

Negative predictive value

A

Describes the likelihood that a person whose test showa a negative result does not have the disease

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5
Q

How to estimate PPV?

A

Demographics (age, sex) , risk factors, symptoms and signs, past medical history

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6
Q

What are the criteria for typical anginal pain?

A

1) retrosternal 2) exercise or stress related 3) relieved by nitro

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7
Q

Atypical angina

A

Two criteria

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8
Q

Non-anginal

A

one criterium

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9
Q

DM screening

A

Pat should be screened at 3-year intervals beginning at age 45y. Should be considered at an earlier age / more often if increased risk.

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10
Q

Risk factors of DM

A
  • Family history of DM
  • Overweight defined as BMI > 25kg/m2
  • Habitual physical inactivity
  • Belonging to high risk ethnic/ racial group: Pacific islanders, american-indians, african-american, asian-american, hispanic
  • Previously identified IFG or IGT
  • HT
  • Dyslipidemic
  • History of GDM or delivery of a baby weighing > 4kg
  • PCOS
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11
Q

Abnormal test result in DM

A
  • Further MX: glycemic, cholesterol, troponin, Ig´s
  • Pat: 1) suspected disease 2) presence of sx 3) screening
  • Results: ask how much abnormal?
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12
Q

Biologic variables that affect test results

A
  • Biologic rhythms: circadian(daily), ultradian (24h), infradian (longer like menstruation)
  • Constitutional factors: age, gender, genotype
  • Extrinsic factors: 1) Posture 2) Exercise 3) Diet (caffeine) 4) Drugs 5) Alcohol 6) Pregnancy 7) intercurrent illness
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13
Q

What to do with abnomal test result?

A
  1. Test repating
  2. Other tests ordering
  3. Specialist / hospital referral
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14
Q

What is included in lab staff?

A

Clinical pathologist, microbiologist, hematologist

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15
Q

PCR

A
  • Genetic material, DNA and RNA
  • Is a type of nucleic acid amplification technology
  • Improved Dx in virology, slow growing and fastidious organisms
  • Polymerase is an enzyme that catalyses formation of nucleotides into DNA molecules before cell division, or RNA before protein synth
  • Used for: bacterial inf, parasite, virus ass w cancer, HIV, genetic disorders (DM, breast ca), disorders of blood (thalassemia), muscle disorders
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16
Q

ESR

A
  • Blood components separate faster in illness
  • Determined by the effect of serum proteins on the neg. electric charge on the erythrocyte surface
  • A marker of inflammation and malignant disease
  • Presence of all acute phase proteins (esp. fibrinogen) as well as Ig
  • Should be used for asymptomatic pat to screen for presence of disease
  • Lag phase of 24-48h btw onset of inflammation and production of proteins increasing ESR. Also delay after resolution
  • Norm is <20 mm/h, (adult male 17-50y = 1-10, >50y = 2-15 / female 17-50y = 3-12, >50y = 5-20)
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17
Q

What may be suspected in very high ESR, 100++

A

Giant cell arthritis, MM, TB, polymyalgia rheumatica, deep abscess, endocarditis, osteomyelitis

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18
Q

Low ESR <1

A

Idiopathic, sickle cell, polycythemia, CHF, hypofibrinogenemia, high WBC, NSAIDs, old specimen, low serum protein (CKD, liver disease)

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19
Q

Very high ESR + normal CRP

A

May indicate giant cell arteritis or polymyalgia rheumatica

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20
Q

CRP

A
  • Product of acute-phase response, tissue inflammation
  • Non-specific marker of inflammation and neoplastic disease
  • Rise within 6h, double every 8h, reaching peak at 50h
  • Can fall very rapidly but resolve w 24h half life
  • > 100mg/L have 80% sens & 88% spec for bacterial inf
  • 10-40mg/L has sens 69% and 54% spec for viral inf
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21
Q

Rules of inflammation in CRP

A

< 10 is norm (5 i Norge)
4-10 = mild
10- 20 = moderate
> 40 = marked

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22
Q

What can one use CRP for ?

A

1) Response to Tx 2) Activity of disease

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23
Q

What is CRP not affected by ? (unlike ESR)

A

Pregnancy

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24
Q

What test do you use for Adenovirus

A

Serum Ab levels, PCR for feces and resp specimen

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25
Q

Cat-scratch disorder

A

Serum Ab

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26
Q

VZV

A

Clinical Dx, blood w Abs/ PCR or culture from vesicle

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27
Q

HSV

A

PCR of genital lesions

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28
Q

Chlamydia pneumonia

A

Blood sample w Ab

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29
Q

Chlamydia trachomatis

A

Swabs or endotracheal aspirate for culture and PCR or urine sample

30
Q

Clostridium dificile

A

Fresh feces, toxin and culture

31
Q

CMV

A

blood sample Abs

32
Q

EBV

A

Blood film (?), mono spot & Paul Bunnell, Abs to viral capsule

33
Q

Hep

A

Blood for immunoassay for Abs and HBV Ag, PCR for viral load w HBV/HBC, genotyping to see tx benefit

34
Q

HIV

A

Blood abs for HIV1 and HIV2, detuned ELISA-> time of infection, CD4 count, HIV viral load

35
Q

Influenza

A

Blood Abs 2-4w serum. Has low sens and unhelpful for tx as Dx is retrospective. PCR of nasal swabs

36
Q

Mumps

A

Blood abs -> decide immune status and IgM assay

- IgG in CSF= meningitis

37
Q

Mycoplasma pneumonia

A

blood abs, IgM

38
Q

Parvivirus B19

A

blood abs, suspected 5th disease

39
Q

Pat w fine maculopapular rash. Serology can be performed for the following:

A

Measles (IgM), Rubella, Parvovirus B19, Echovirus, EBV, CMV, (Ross river virus, Barmah forrest virus) Dengue fever

40
Q

N. gonorrhea

A

Culture (urethral, cervical, rectal, pharyngeal), PCR on swabs or urine

41
Q

Syphilis

A

Serology ( RPR, TPHA, FTA-ABS, EIA)

42
Q

Trichomonas

A

Microscopy from vaginal swab

43
Q

Lymphogranuloma venerum

A

Chlamydia serology, LN biopsy

44
Q

Chancroid

A

Microscopy/culture for Hempphilus ducrei

45
Q

Granuloma inguinale (Klebsiella)

A

biopsy

46
Q

UTI

A
  • WBC > 10 pr uL is abnormal = local inf
  • Higher counts have greater significance
  • Epithelial cells = possibly contamination in female
  • Culture: >10^5 per mL are more significant
47
Q

Serum level of iron decrease

A

Falls gradually below normal when iron in body decrease after reserves bc exhausted. Level of transferrin then increase (iron transport)

48
Q

Norm iron

A

14-30 umol/L

49
Q

Transferrin

A

A carrier protein that binds most of the iron in serum. TIBC = total iron binding capacity = total amount of iron that can be bound to serum protein

50
Q

Transferrin saturation

A

Which extent the iron binding sites on transferrin are occupied by iron 20-50 % (markedly elevated in hemochromatosis)

51
Q

Serum Fe

A

Direct relationship to the amount of iron stores in the body. 20-250ug/L in males and 10-150 in female

52
Q

Liver function tests

A

Consists of plasma bilirubin, albumin, plasma transferase, plasma alkaline phosphatase( ALP), gamma-glutamyl-transferase (GGT)

53
Q

Increased plasma bilirubin

A

Unconjugated: breakdown of RBC
Conjugated: after metabolism in liver

54
Q

Albumin

A

Transport protein produced in liver and maintains oncotic pressure. Has half life of 20 days. Norm 3,5-5,5 g/dL. Reduced w advancing liver disease, nephrotic sd, protein loosing enteropathy, malnutrition, and some inflammatory diseases. Elevation is unusual except in dehydration.

55
Q

ALP

A

Present on surface of hepatocyte and in bile canaliculi and duct. Not specific to liver, but indicator of cholestasis = obstruction, infiltration and cirrhosis

56
Q

GGT

A

Present in bile canaliculi. Raised w cholestasis, other liver disease and drug/ alcohol intake

57
Q

Acute hepatitis jaundice

A

ALP norm to <3 x norm and ALT/AST 10-100x normal

58
Q

Obstruction jaundice

A

ALP >3x norm, ALT/AST <10 x norm

59
Q

Alcohol abuse

A

1) GGT limited sens/spec 2) MCV: macrocytosis but limited sens/spec 3) Carbohydrate deficient transferin

60
Q

TFT

A
  • TSH have high sensitivity
  • T3 = serum free tri-iodothyrine
  • T4 = thryoxine
  • TPO-anti = thyroid peroxidase antibodies
  • Anti-thyroglobulin abs
  • Thyroxine-binding globulin and thryoglobulin
61
Q

Hypernatremia

A

> 145mmol/L
Causes: Water depletion (DI), diarrhea, corticosteroid excess, excess IV hypertonic Na solution
Clinical: thirst, confusion, oliguria, orthostatic hypotension, muscle twiching/cramps, seizure, delirium, hyperthermia, coma

62
Q

Hyponatremia

A

<135mmol/L
Causes: Water retention, kidney failure, GI loss (diarrhea/ vomiting), drugs/diuretics/ACEi
Clinical: lethargy, confusion, mental change, convulsions, coma, death

63
Q

Elevated amylase

A

Pancreas: Acute/chronic pancreatitis, pseudocyst, cancer, trauma
Nonpancreatic: Salivary glans disorder, intestinal perforation/ischemia/obstruction, DKA, perforated peptic ulcer, ruptured ectopic pregnancy, renal failure, macroamylasemia, pregnancy

64
Q

Elevated lipase

A

Acute/chronic pancreatitis, DKA, small bowel oust., acute cholecystitis(!) , renal failure

65
Q

BUN

A

7-18 mg/dL. Elevated in hypovolemia, increased protein intake, corticosteroid use, hyper catabolism, GI bleed
Renal function:
- 10:1 suggest intrinsic renal pathology
- >20: 1 suggest prerenal or postern cause.
Reduced in severe liver disease, malnutrition, SIADH

66
Q

ANA very useful for dx of

A

SLE, systemic sclerosis

67
Q

ANA somewhat useful for dx of

A

Sjögren, polymyositis-dermatositis

68
Q

ANA useful for monitoring Px

A

Drug associated lupus, MCTD, autoimmune hepatitis

69
Q

ANA not useful or has no proven value for Dx, monitoring or Px in

A

RA, MS, thyroid dis, inf, ITP, fibromyalgia

70
Q

Hyperkalemia

A

K>5mmol. Causes: Kidney failure, acidosis, Addison, excessive intake of K, drugs (spironolactone, ACEI, NSAID)
Clinical: muscle weakness, flaccid paralysis, cardiac arrest, peaked T-wave on ECG, decreaset QT, increased PR -> arrhythmia

71
Q

Hypokalemia

A

<3,5. Causes: kidney disease, GI loss (V/D), alkalosis, mineralocorticoid excess, loss in ECF > ICF ( burns, trauma) decreased intake, drugs (furosemide, thiazide)
Clinical: Lethargy, muscle weakness, cramps, confusion, flaccid paralysis, tetany, coma,

Family medicine (14 decks)

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