Laboratory Tests And Values Flashcards
PART 1
PART 1
What are the different types of tests for SARS-CoV-2?
- Molecular test
- Antigen test
- Antibody test
The molecular test detects the virus’s _________ and diagnoses active coronavirus infection.
genetic material
The antigen test detects specific _______ found on the surface of the virus. This is also known as the rapid diagnostic test and diagnoses active coronavirus infection.
proteins
The antibody test tests for specific antibodies that are made by immune cells (__________) in response to a threat. These tests are also called ________ tests. They are _________ accurate but negative tests often need to be repeated to confirm findings using a ________ test.
- lymphocytes
- serological tests
- highly
- molecular
Lab values provide a PT with _________ information. These values are gleaned from taking a ________ (chart review).
- supplemental
- history
Knowing lab values aids a PT in developing the best _____, utilizing the most appropriate ___________, and treating the patient _______.
- POC
- interventions
- safely
- Abnormal lab values represent _________ deviations that may require modification of PT treatment plan/intervention or even contraindicate PT intervention.
- Abnormal lab values reflect disrupted ____________.
- physiological
- homeostasis
What are reference values?
Comparative ranges or “normal values”
Normal reference range may vary across characteristics such as what?
- Age
- Gender
- Location
- Ethnicity
- Culture
- Economic
Reference ranges are established by testing large number of _________ individuals.
healthy
Reference ranges within __ standard deviations of the mean are typically considered normal.
2
- Do all ill patients fall outside the reference range?
- Do all non-ill patients fall inside the reference range?
- No
- No
What are the 3 uses for laboratory values?
- Screening
- Diagnosis
- Monitoring
- Is screening diagnostic?
- It is used on __________ in an effort to ________ individuals who are at risk for certain diseases.
- For those individuals identified at risk, ________ testing should be the next step.
- No
- populations, identify
- diagnostic
PART 2
PART 2
-Some lab tests are sufficiently ________ and ________ allowing for diagnosis of pathology (cardiac enzymes), while others may only be a piece of the diagnostic puzzle (CRP).
- sensitive
- specific
Some lab values are clear _______________ for receiving physical therapy, whereas others are suggestive that therapy provided should be less physiologically __________. (Hgb and HCT; platelets)
- contraindications
- demanding
- What are normal blood glucose levels?
- At what blood gluose levels should we avoid physical activity?
- 70-99mg/dl (fasting)
- <140mg/dl (2hrs after meal)
-Avoid physical activity if fasting glucose is >250mg/dl and ketosis is present, and use caution if glucose levels >300mg/dl and no ketosis is present.
Electrolytes are present in the human body, and the balance of the electrolytes in our bodies is essential for normal function of our cells and our organs. What are 4 common electrolytes that are measured?
- Sodium
- Potassium
- Magnesium
- Chloride
- Sodium (Na+) is a critical determinant of __________.
- What is the normal adult value?
- blood volume
- 135-145mEg/L
- Elevated sodium plasma concentrations can suggest water __________.
- Depressed sodium concentrations can suggest water __________.
- loss
- retention
-Sodium (Na+) excretion at the level of the ______ is a critical determinant of blood volume.
kidney
What is an increase/decrease in sodium concentration called?
- Increase= Hypernatremia
- Decrease= Hyponatremia
Hypernatremia can result from:
- _________ fluid loss (sweating)
- _________ gland dysfunction
- Limited H2O intake (________ population)
- Diuretics; ACE inhibitors, ARBs
- ________ dietary intake
- increased
- adrenal
- geriatric
- excessive
Hyponatremia can result from:
- _________ H2O intake (hypervolemia)
- CHF, ________ failure, liver disease (hypervolemia)
- Severe _______ and _________
- ________ gland dysfunction
- excessive
- kidney
- vomiting and diarrhea
- adrenal
- Potassium (K+) is particularly important for normal function of ________ cells.
- What is the normal range of potassium?
- excitable
- 3.5-5.5mEq/L
Potassium abnormalities can change the __________ and hence the excitability of excitable cells.
RMP
What is an increase/decrease in potassium concentration called?
- Increase= Hyperkalemia
- Decrease= Hypokalemia
Does hyperkalemia result in the RMP being closer or further from the AP threshold? What does this result in?
- Closer
- Arrhythmias
Hypokalemia leads to _____polarization and makes the RMP more negative and more ________ to stimulate.
- hyperpolarization
- difficult
Potassium Deficit Mnemonic (A SIC WALT):
- A=
- S=
- I=
- C=
- W=
- A=
- L=
- T=
- Alkalosis
- Shallow Respirations
- Irritability
- Confusion, Drowsiness
- Weakness, Fatigue
- Arrhythmias
- Lethargy
- Thready Pulse
Potassium Excess Mnemonic (MURDER):
- M=
- U=
- R=
- D=
- E=
- R=
- Muscle cramps
- Urine abnormalities
- Respiratory distress
- Decreased cardiac contractility
- EKG changes
- Reflexes
- Calcium (Ca+) is associated with primary ______parathyroidism.
- What is the normal range of calcium?
- hyperparathyroidism
- 2.1-2.6 mmol/L
What is an increase/decrease in calcium concentration called?
- Increase= Hypercalcemia
- Decrease= Hypocalcemia
Hypocalcemia can result from ______ disease.
renal
What are the results of short term deficiencies of calcium?
- numbness and tingling
- muscle cramps and tetany
- lethargy
- convulsions
- negative chronotropic and ionic effect
What are the long term effects of hypocalcemia?
- Osteopenia
- Osteoporosis
Hypercalcemia is associated with primary _________________ caused by excessive release of parathyroid hormone from the parathyroid gland.
-hyperparathyroidism
What is an easy way to remember how hypercalcemia presents?
Stones, Bones, and Groans +Tachycardia
- Stones- kidney stones
- Bones- bone pain
- Groans- abdominal pain, N/V
PART 3
PART 3
What are the normal FASTING plasma glucose levels for:
- Adults
- Adults >60
- Children
- Neonates
- Adults= 70-100 mg/dl
- Adults >60= 80-110 mg/dl
- Children= 60-100 mg/dl
- Neonates= 40-80 mg/dl
What is the standard test for determining the test of diabetes?
Oral Glucose Tolerance Test
- A glucose value between 140 and 200 mg/dL 2 hours after drinking the glucose solution is called __________ ________ __________ (___).
- This is associated with glucose resistance and is often called ___ diabetes or type __.
- Impaired Glucose Tolerance (IGT)
- pre-diabetes or Type II
Are people with IGT at risk of developing Type I diabetes?
Yes, over time
A glucose value in excess of 200 mg/dL 2 hours after drinking the glucose solution is diagnostic of Type __ DM.
Type I
Do insulin levels rise/fall as glucose does?
Yes, unless diabetic
Is diabetes a condition of hyper or hypoglycemia?
Hyperglycemia
Describe the Oral Glucose Tolerance Test.
- ) Patient is fasted
- ) Blood is sampled
- ) Patient consumes a high CHO drink
- ) Blood is sampled at 60 and 120 minutes
- ) Does the serum glucose levels increase and then return to normal levels
_____________ is a test of long-term glyemic control.
Hemoglobin A1C
What does the Hemoglobin A1C test specifically measure?
Measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated).
List the A1C levels for:
- Adult Normal
- Good Glucose Control
- Fair Glucose Control
- Poor Glucose Control
- Adult Normal= 4-6%
- Good Glucose Control= 2.5-5.9%
- Fair Glucose Control= 6-7%
- Poor Glucose Control= greater than 7%
Food consumption ________ blood glucose, whereas insulin and exercise _________ it.
- increases
- decreases
What level is considered HYPOglycemia?
- <70 mg/dl
- What are some symptoms of hypoglycemia?
- Severe diabetic hypoglycemia leads to what?
- headache, nervousness, irritability, decreased coordination, shaking, tachycardia, complaints of weakness
- Coma
What level is considered HYPERglycemia?
- > 200 mg/dl
What causes hyperglycemia?
Insufficient insulin in the body or the body is unable to use insulin properly.
A subject with a consistent range between ___ and ____ mg/dl is considered hyperglycemic, while above ___ mg/dl is generally held to reflect diabetes.
- 100 and 126
- 126
What are some symptoms of chronic hyperglycemia (diabetes)?
- Polyphagia (hunger)
- Polydipsia (thirst)
- Polyuria (increased urine production)
- Blurry vision
- Fatigue
- Weight loss
- Poor wound healing
- Cardiac dysrhythmias
Individuals who have poorly controlled hyperglycemia can develop ketoacidosis, what is this?
Develops when the use of glucose is limited severely resulting in increased breakdown of fats resulting in high levels of KETONE BODIES which lowers the pH of blood.
How will ketoacidosis present?
Fruity smell of breath
If a patient is hyperglycemic, what 3 things do they need?
- Hydration
- Insulin
- Electrolytes
What do we give someone who is hypoglycemic?
SNICKERS
What are some comorbidities associated with hyperglycemia (diabetes) / A1C levels above 7%?
- loss of vision secondary to retinal damage
- decline in renal function secondary to reduce effectiveness of glomeruli in damaged kidney
- cardiac syndrome (arrhythmias)
- peripheral neuropathy
Difference between Type I and Type II diabetes?
- Type I- reduced availability of insulin
- Type II- insulin ineffectiveness
What percent of american teenagers are obese and failed to meet exercise guidelines?
40%`
PART 4
PART 4
Creatine is released from ___________ in constant amounts and is excreted by the _______ in constant amounts. Therefore blood and serum creatine levels should exist in a constant ratio if the ________ are functioning normally.
- striated muscle
- kidneys
- kidneys
As the kidneys fail we will see an _________ in serum creatinine.
-increase, suggesting a decline in the kidney’s capability to excrete wastes.
- Creatinine clearance changes with age, _________ state and medical conditions.
- Serum creatine levels are larger in males or females?
- physiological
- males (.6-1.2)
- What is a Blood Urea Nitrogen (BUN) test?
- What are normal urea nitrogen levels?
- Measure of urea nitrogen, which is a waste product of liver catabolism of amino acids.
- Normal= 6-20 mg/dL
BUN levels rise with ___________ renal function and renal clearance.
decreased
Elevated BUN levels are associated with:
- ______ failure (not being cleared)
- __________ bleeding
- Hypovolemia (dehydration) (not being cleared)
- ________ disease/failure (not being cleared)
- Shock (not being cleared)
- _________ tract obstruction (being cleared but backs up into the blood)
- heart
- GI
- Kidney
- Urinary
- Bilirubin is also used to assess _____ function.
- What is normal bilirubin levels?
- liver
- 0.1-1 mg/dL
What is bilirubin?
A reddish-yellow substance formed when hemoglobin is broken down, the resulting bilirubin is further processed by the liver then excreted in the bile.
(retention of iron)
Normally RBC ______ = RBC __________.
production = destruction
Bilirubin is one of the by-products of the ____ molecule found in the RBCs. Liver damage/disease _______ the amount of bilirubin that it modifies and removes from the blood resulting in ___________ of bilirubin in the blood.
- heme
- reduces
- accumulation
Bilirubin ______ products from the liver enter the biliary tract and onto the small intestine and are responsible for the color of feces.
degredation
Blood accumulation of bilirubin can lead to what?
Jaundice, yellow discoloration of the skin.
Why is jaundice associated with bruising?
Bruising bringing blood to interstitial space, causing discoloration (yellowing).
What are 3 main causes of elevated serum bilirubin?
- Cirrhosis (scarring of the liver)
- Increased RBC destruction
- Anatomic obstruction
What 3 things can cause cirrhosis?
- Hepatitis
- Alcohol liver disease
- Liver tumors
Increased RBC destruction causes an increase in bilirubin which can not be effectively dealt with. What are 3 things that cause RBC destruction?
- Sickle Cell Anemia
- Hemolytic anemia
- Transfusion reaction
Anatomical obstruction limits movement of bilirubin to the ___________. What are 2 examples of anatomical obstruction leading to increased bilirubin?
-small intestine
- biliary structures
- gall stones
- Albumin is a protein synthesized in the ______ and plays an important role in what?
- What are normal albumin levels?
- liver, plays an important role in keeping fluid in blood from leaking out into the tissues (defines oncotic pressure)
- 3.5-5.5g/dl
- Albumin constitutes __/__’s of blood proteins.
- Lower-than-normal levels of serum albumin may be caused by _____ disease (inability to synthesize normal amounts) and ___________ (lack of raw materials).
- 2/3
- liver
- malnutrition
Conditions associated with “low” serum levels of albumin include:
- _______ (abdominal edema)
- _______:high vascular permeability (loss from blood).
- ______________ (kidney disease)
- ___________ syndromes (Crohn, celiac, or whipple disease)
- ____________
- ascites
- burn
- glomerulonephritis
- malabsorption
- malnutrition
In regards to glomerulonephritis:
-Normally albumin ______ filtered by the kidney-albumin is too big a molecule to enter the tubules
Kidney disease allows albumin to enter the kidney tubules and hence to be _________
Albuminuria-too _____ albumin in urine
Microalbuminuria: Modest increase, associated with increased risk for developing _________
- isn’t
- excreted
- much
- diabetes
- What are 4 other markers (enzymes) of liver function?
- Should we see activity of these enzymes in the blood?
- AST and ALT (Aspartate/Alanine Aminotransferase), LDH (Lactate dehydrogenase), GGT (Gamma-glutamyl transpeptidase)
- No, if we see activity it means there is tissue damage allowing leakage of these enzymes from the liver into circulation.
What diagram should we remember in regards to Complete Blood Cell Count (CBC)?
\ /
\ Hbg /
W \ /
B |—————————| Plt
C / \
/ HCT \
/ \
RBC normal numbers for males and females?
Male: 4.5-5.3 X 10⁶/mm³
Female: 4.1-5.1 X 10⁶/mm³
Hemoglobin (Hb) normal levels for males and females?
Male: 13-18 g/dl
Female: 12-16 g/dl
Hematocrit (Hct) normal levels for males and females?
Male: 37-49%
Female: 36-46%
- Is a WBC count a measure of all leukocytes or just neutrophils?
- What is the primary implication related to the presence of an infection?
- All leukocytes
- Elevated leukocyte count
_________ is a risk factor for developing an infection.
Neutropenia
- What is an ANC?
- This reflects the body’s ability to do what?
- What is the most common cause of decreased ANC?
- What ANC reflects a drastic increase in infection risk?
- Absolute neutrophil count (estimate)
- Fight infection
- Chemotherapy
- ANC <500/mm³
- Platelets initiate the ______ sequence to plug damaged blood vessels. As platelet count decreases, bleeding risk ____________.
- What is normal platelet count?
- clotting
- increases
-150,000-450,000 cells/mm³
What are 2 tests used to test coagulation and what are their normal time ranges?
- prothrombin time (PT) = 12-15s
- activated partial thromboplastin time (aPTT) = 30-40s
- _________ is a standardized method of determining clotting time and hence bleeding risk.
- INR = (_________ test / _________ control)
- International normalized ratio
- prothrombin, prothrombin
INR can be prolonged in:
- Presence of ______________
- ______ dysfunction
- Vitamin __ deficiency
- _________ factors deficiency
- anticoagulants
- liver
- K
- coagulation
______ urine has less color, increased color suggests __________ urine.
- dilute
- concentrated
Specific gravity urinalysis reflects the concentration of _______ molecules in the urine. The more molecules that get _____________, the greater the specific gravity and hence is a measure of _______ function.
- excreted
- excreted
- kidney
- What is the normal pH value of a urinalysis?
- What can cause a high pH (alkaline)?
- What can cause a lows pH (acidic)?
- 4.6-8
- A higher pH (alkaline) can be caused by severe vomiting, a kidney disease, some urinary tract infections, and asthma.
- A low (acidic) pH may be caused by severe lung disease (emphysema), uncontrolled diabetes, aspirin overdose, severe diarrhea, dehydration, starvation, alcohol or drinking antifreeze
