Labs Flashcards
Hemoglobin
Normal nonpreg female: 12-16
Normal pregnant white female: 11+ in 1st and 3rd, 10.5+ in second
Normal pregnant black: female: 10.2+ in 1st and 3rd, 9.7 in second
Hematocrit
Normal nonpreg female: 37-47
Normal pregnant white female: 33+ in 1st and 3rd, 32+ in second
Normal pregnant black female: 31+ in 1st and 3rd, 30 + in second
MCV
Mean corpuscular volume
Average size/volume of a RBC
Normal:80-95
MCHC
Mean corpuscular hemoglobin concentration: avg conc of hgb in single RBC
Normal: 32-36: normochromic
Neutrophilia
High neutrophils: bacterial infection
Lymphocytosis
High lymphocytes: virus
Monocytosis
High monocytes: debris (recovery phase)
Eosinophilia
high eosinophils: allergens, parasites
Basophilia
high basophils
anaphylaxis
Left shift of neutrophils
More young neutrophils (bands elevated) –> acute bacterial infection
Elevated direct bilirubin
AKA elevated conjugated bilirubin
gallstones, obstruction of extrahepatic duct
Elevated indirect bilirubin
AKA elevated unconjuated bilirubin
hepatocellular dysfunction (hepatitis, cirrhosis), hemolytic anemia
What level of serum hcg should you be able to visualize IUP on u/s?
1500-2000, if cannot see it - ectopic
How soon can urine hcg be detected?
as early as 28 days from LMP, levels as low as 5-50 in urine
What does increased estradiol indicate?
Adrenal tumor,
estrogen-producing tumor,
hepatic cirrhosis,
hyperthyroid
What does decreased estradiol indicate?
post-menopause,
ovarian failure,
primary or secondary hypogonadism,
Turner’s syndrome,
anorexia nervosa
What does increased progesterone indicate?
pregnancy
ovulation
progesterone-secreting ovarian tumor or cyst
congenital adrenal hyperplasia
hydatidiform mole
What does decreased progesterone indicate?
primary or secondary hypogonadism
threatened abortion
fetal demise
PEC
short luteal phase syndrome
What does increased FSH indicate?
postmenopause
gonadotropin-secreting pituitary tumor
ovarian failure
primary hypogonadism
Turner’s syndrome
What does decreased FSH indicate?
pregnancy
pituitary or hypothalamic dysfunction
hyperprolactinemia
anorexia nervosa
What does increased LH indicate?
postmenopause
primary hypogonadism
gonadal failure
What does decreased LH indicate?
pituitary or hypothalamic dysfunction
anorexia nervosa
What are normal findings on a urinalysis?
No nitrates, ketones, cyrstals, casts, glucose
Clear, amber yellow, aromatic
pH 4.6-8
Protein 0-8 mg/dL
Specific gravity 1.005 to 1.030
Leukocyte esterase negative
WBCs 0-4 per high-power field
RBCs at 2 or less
What does high specific gravity indicate?
dehydration, shock, increased sugar
What does low specific gravity indicate?
kidney damage, renal failure, too much fluid
Urine culture results:
When to treat?
Considered + with presence of a single type of bacteria at 100,000 CFU/mL
Lower CFU of 1000 CFU/mL or greater may be used to indicated infection when UTI s/s are PRESENT
Growth of several types of bacteria is likely d/t specimen contamination
What are normal vaginal in-office diagnostic findings?
pH
Whiff
Wet mount
Vaginal pH: 3.8-4.5
whiff negative
wet mount: epithelial cells, few or no WBCs, lactobacilli present
In-office BV findings?
pH
whiff
wet mount
pH > 4.5
whiff test positive
wet mount: > 20% of epithelial cells are clue cells, 0-1 WBC per epithelial cell, lactobacilli reduced or absent
POC sialidase test +
In-office Trich findings?
pH
whiff
wet mount
pH > 4.5
whiff + or -
Wet mount: motile trichomonads, > 1 WBC per epithelial cell, lactobacilli reduced or absent
POC rapid antigen test is positive
In office vulvovaginal candidiasis findings?
pH
Whiff
Wet mount
pH </= 4.5
whiff negative
wet mount: hyphae/spores (best seed post KOH), > 1 WBC per epithelial cell, lactobacilli present
What is CDC recommended test for trich?
NAAT
When is a yeast culture indicated?
If wet mount neg, but suspicious for yeast based on s/s
OR can identify species with recurrent/persistent yeast infections
HIV testing and time frames:
EIA (enzyme immunoassay):
- can be lab or rapid POC
- needs to be confirmed by Western blot or immunofluorescence assay
HIV antibody is detectable in 95% of individuals by 6 months
HIV-1 p24 antigen test detects HIV-1 antigen as early as 2-6 weeks post infection, but declines once antibodies develop
Rubella titers
1:10 or greater = immunity
> 1:64 may indicate current infection
Rubella IgM appears 1-2 days post rash and disappear 5-6 weeks post infection
Positive Hepatits B surface antigen (HBsAg)
- indicates active HBV infection (individual is infectious)
- Individual is considered a carrier if levels persist
- rises before onset of clinical symptoms, peaks during first week of symptoms and returns to normal by the time jaundice subsides
Positive Hepatitis B surface antibody (HBsAB)
- Indicates end of acute infectious phase and signifies immunity to subsequent infection
- Immunity after vaccine
- appears 4 weeks after disappearance of surface antigen
Hepatitis B core antibody (HBcAB)
indicates past infection, chronic hepatitis
Hepatitis B e-antigen (HBeAg)
seen with acute infection - infective
Hepatitis B e-antibody (HBeAB)
- seen with convalescence, decreased infectivity
How to test for HCV
HCV antibody test –> if positive follow up with HCV RNA
+HCV RNA = current infection
-HCV RNA = resolved HCV or false antibody positive
Best test for chlamydia?
NAAT urine or endocervical
Best test for gonorrhea?
NAAT urine or endocervical
What are the nontreponemal tests for syphilis?
- VDRL or RPR
- Non specific: many things besides syphilis make it positive (mono, - etc)
- Becomes positive 1-2 weeks after chancre
- If reactive –> need to confirm with treponemal test
- also reported as a titer
- false positives often have a low titer (1:8, etc)
- Titers are also used to follow up for successful treatment –> usually becomes non-reactive with treatment
What are the treponemal tests for syphilis?
FTA-ABS or TPI
- specific
-reported as positive or negative, not quantitative
- usually remains positive indefinitely, even after treatment
What is the recommended test for HSV lesion?
PCR assay is more sensitive than tissue culture
How long does HSV take to seroconvert?
4-6 weeks to detect HSV1 or HSV2 antibodies in serum
- serology recommended only if hx is suggestive of HSV or there is a negative culture, but you suspect HSV; partner has known HSV; patients with HIV
How to test for chancroid?
culture from lesion or bubo
How to interpret PPD test?
5 mm: positive in high risk
10 mm: positive in moderate risk
15 mm: positive in general population
what causes a false positive ppd?
previous BCG vaccination
what causes a false neg ppd?
immunocompromised, incorrect administration
What is normal bone density from DEXA?
T score greater than -1 (BMD within 1 standard variation of young normal adult)
What BMD score indicates osteopenia?
T-score between -1 and -2.5 (BMD between 1 and 2.5 standard deviations below young normal adult)
What BMD score indicates osteoporosis
T-score at or less than -2.5: BMD 2.5 SD or more below that of young adult
How to diagnose DM?
- FBS 126 or greater
- 2 hour (75 g glucose test) 200 or greater
- classic symptoms of DM with random non-fasting glucose of 200 or more
-repeat the above tests on a subsequent day to confirm dx - a1c 6.5 or greater
FBS results interpretation
no caloric intake x 8 hours
normal: < 100
impaired fasting glucose: 100-125
DM: 126 or greater
2 hour glucose test results interpretation
Normal: less than 140
impaired glucose tolerance: 140-199
DM: 200 and higher
A1c results interpretation
<5.7% = normal
5.7-6.4 = preDM
6.5 or greater = DM
McBurney’s sign
localized tenderness in right lower abdominal quadrant = possible
sign of appendicitis
Rosvig’s sign
referred rebound tenderness –> pain in right lower quadrant when left-sided pressure is applied and quickly withdrawn = possible appendicitis
Murph’s sign
sharp increase in tenderness and sudden stop in inspiratory effort with upward pressure under the right costal margin while client takes a breath = possible cholecystitis
Where are Skene’s glands
just posterior to and on each side of urethral meatus
Where are bartholin’s glands?
posteriorly on each side of vaginal orifice
Describe a normal non pregnant cervix
smooth, firm, mobile, nontender, about 2.5 cm in diameter, protrudes 1-3 cm in vagina
Describe a normal non pregnant uterus
smooth, rounded contour, firm, mobile, nontender, 5.5-8 cm long and pear-shaped.
** parous female 2-3 cm longer **
