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Clinical Lab Analysis > Labs > Flashcards

Labs Flashcards

1
Q

Generally, when should you order lab tests?

A

When it will possibly change the treatment or clinical outcome

(for a reason)

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2
Q

What 2 organ systems would it be considered “too late” when the physical exam reveals an abnormality?

A

Liver and Kidney

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3
Q

What time should you put on a lab order if you want the results right away?

A

STAT (always in ER/ICU)

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4
Q

What time should you put on a lab order if you want the results by next shift?

A

No time

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5
Q

What time should you put on a lab order if you want the results at a specific time?

A

State the exact time

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6
Q

True or False: when writing a lab order, “now” is mutually acceptable as “STAT”

A

False

“now” should never be written

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7
Q

Which lab consists of the following items?

WBC, RBC, Hb, Platelets, Differential on WBCs, Indices, and Hct

A

CBC

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8
Q

This is a listing of the absolute and the percentage of the specific types of WBCs

A

Differential

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9
Q

What 2 main reasons should you order a CBC?

A

Detecting Disease

Monitoring disease

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10
Q

What are the 6 WBC types that are found on the differential for a CBC?

A

Neutrophils

Lymphocytes

Monocytes

Eosinophils

Basophils

Bands (immature WBCs)

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11
Q

What are “segs”?

A

Neutrophils (their nucleus is segmented)

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12
Q

What is a “left shift”?

A

The trend towards less mature WBC’s or towards an increase in neutrophils.

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13
Q

What would infection, inflammation, anoxia, drugs, or stress/pain do to WBC production?

A

↑ production and release of immature cells

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14
Q

What are thee 6 etiologies for neutrophilia?

A

Metabolic disorders

Acute infection

Drugs/toxins

Hematological disorders

Acute inflammation

Tissue necrosis

(MAD HAT)

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15
Q

Viral infections, some bacterial infections, chronic inflammatory disorders, and blood diseases will raise which WBC?

A

Lymphocytes

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16
Q

Bacterial infections, viral infections, hematological disorders, and collagen vascular disease will raise which WBC?

A

Monocytes

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17
Q

Parasitic diseases, allergic disease, skin disorders, and malignancies will raise which WBC?

A

Eosinophils

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18
Q

Define the following acronyms:

MCHC MCV MCH RDW

A

MCHC- mean corpuscular hemoglobin concentration

MCV- mean corpuscular volume

MCH- mean corpuscular Hb

RDW- RBC distribution width

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19
Q

What are the 3 broad topics that describe a decrease in RBC count?

A

Microcytic hypochromic anemia

Normocytic normochromic anemia

Macrocytic anemia

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20
Q

What are the 2 broad topics that increase the RBC count?

A

Polycythemia vera (PV)

Secondary polycythemia

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21
Q

What will a B12 or folate deficiency do to MCV?

A

increase it

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22
Q

What are the 2 main conditions that cause a ↓ MCV?

A

Iron deficiency anemia

Hemolytic anemia

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23
Q

Infections or myeloproliferative disorders will cause what change in platelet count?

A

↑ platelets

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24
Q

What 2 general things can cause a decreased platelet count?

A

↓ production (marrow depression)

↑ destruction (autoimmune)

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25
Q

What will toxins and drugs do to reticulocyte count?

A

↓ reticulocytes

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26
Q

What 2 things will ↑ reticulocyte count?

A

Hemolytic anemia

Acute blood loss

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27
Q

What will anemia, blood loss, fluid retention, or edematous states (CHF) do to [Hb]?

A

↓ Hb

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28
Q

If a patient has blood loss, anemia, or state or hydration, what measurement can you use to evaluate it?

A

Hct

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29
Q

Generally, which lab test screens for Renal + Electrolytes?

A

BMP

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30
Q

What does a BUN:Cr > 20 indicate?

A

Prerenal azotemia

(Dehydration causes ↑ BUN reabsorption, which ↑ this ratio)

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31
Q

What does a BUN:Cr from 10-15 indicate?

A

Renal state

(normal)

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32
Q

What does a BUN:Cr <20 indicate?

A

Postrenal azotemia

(Obstruction ↓ BUN reabsorption, which ↓ this ratio)

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33
Q

What is the difference between azotemia and uremia?

A

Azotemia- ↑ BUN and Cr in blood (lab Dx)

Uremia- ↑ urine in blood, refers to end-stage kidney disease/renal failure.

(all uremic pts are azotemic, but not all azotemic pts are uremic)

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34
Q

What is the formula to determine creatinine clearance when only the serum creatinine is known? Males and Females

A

Male: (Kg)*(140-age)/72*(serum Cr)

Female: (Kg)*(140-age)*(0.85)/72*(serum Cr)

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35
Q

What is the main reason to order a serum Cr level?

A

Assess GFR (renal fxn)

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36
Q

What is a common cause of hypercalcemia based on elevated PTH?

A

Primary hyperparathyroidism with an adenoma

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37
Q

What is the most common cause of hypocalcemia?

A

Hypoalbuminemia

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38
Q

What is the eqn to adjust serum Ca under a depressed albumin?

A

Adjusted Ca = (serum Ca) - (serum albumin) + 4.0

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39
Q

What metabolic state causes decreased CO2?

A

Metabolic acidosis

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40
Q

Respiratory alkalosis, renal disease (pyelonephritis), severe dehydration, and DI can cause an increase in which ion?

A

Cl-

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41
Q

What 3 things can cause a loss of Cl-?

A

Renal loss (loop diuretics)

GI loss

Metabolic alkalosis (vomiting HCl)

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42
Q

Diabetes, Acute pancreatitis, endocrine dysfxn, and drugs can cause what change in [glucose] in the blood?

A

Hyperglycemia

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43
Q

What mg/dl of fasting blood sugar do you need to be diagnosed with diabetes mellitus?

A

> 126 mg/dl

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44
Q

What mg/dl of random blood sugar do you need to be diagnosed with diabetes mellitus?

A

> 200 mg/dl

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45
Q

This is the test for diabetes that uses a specific glucose pill that is given every 30 minutes and recorded as a curve. (not done anymore)

A

Glucose tolerance test

46
Q

What are the 4 times in the day that you should check blood sugars with a home glucometer?

A

6am 11am 4pm 9pm

47
Q

What is the most important electrolyte to measure?

48
Q

What 4 things can cause hypokalemia?

A

GI loss (vomiting, diarrhea)

Move to intracellular (alkalosis, insulin)

Urine loss (diuretics)

Decreased intake

49
Q

What are the 3 reasons to have hyperkalemia?

A

Renal failure

IV therapy

Thrombocytosis/leukocytosis

50
Q

What are the 2 reasons to cause isotonic hyponatremia?

A

Hyperproteinemia

Hyperlipidemia

51
Q

What are the 2 reasons to cause hypertonic hyponatremia?

A

Hyperglycemia

Medication

52
Q

What are the 2 reasons to cause hypotonic hyponatremia?

A

Renal loss with diuretics

Edema with CHF

53
Q

What is added to the BMP to make a CMP?

A

Liver markers

54
Q

This is the test that is a nonspecific indicator of illness over time, where albumin decreases and alpha2globulin increases.

55
Q

This is quantitively the most significant protein synthesized by the liver.

56
Q

What can subacute and chronic debilitating diseases, liver disease, malabsorption, and malnutrition do to albumin levels?

A

↓ albumin

57
Q

What 4 liver conditions can lead to an elevated serum Alkaline Phosphatase (AP)?

A

Cholestasis

CHF

Obstructive and Hepatocellular processes

58
Q

What 2 bone conditions can lead to an elevated serum Alkaline Phosphatase (AP)?

A

Metastatic malignancy

Hyperthyroidism

59
Q

What can a late MI or pregnancy do to AP levels?

60
Q

What does ALT and AST stand for?

A

ALT- alanine aminotransferase

AST- aspartate aminotransferase

61
Q

What can liver disease, CHF, infectious mononucleosis, and acute pancreatitis do to aminotransferase levels?

A

↑ aminotransferases

62
Q

Antibiotics, antiepileptics, statins, NSAIDS, sulfonylureas, substances of abuse, and herbs may increase what “enzymes” in the blood?

A

Liver enzymes

63
Q

What is the 1 condition in each of the following areas that may increase AST?

Liver

Heart

Skeletal muscle

RBC’s

A

Liver- Hepatitis

Heart- acute MI

Skeletal muscle- Trauma

RBC’s- Hemolytic anemia

64
Q

Liver disease, congenital hyperbilirubinemia, hemolytic anemia, and malnutrition may increase levels of what marker in the blood?

65
Q

Chronic infection, dehydration, collagen-autoimmune disease, and hemolysis may increase what marker in the blood?

66
Q

What is the most sensitive marker for acute MI and is independent of renal fxn?

A

Troponin I

67
Q

What underlying condition may cause troponin T levels to be inaccurate in the diagnosis of an MI?

A

Renal insufficiency

68
Q

What is the newest reason to obtain a total CPK level?

A

Rhabdomyolysis with statins

69
Q

What 3 areas is LDH-1 distributed?

A

Heart

Erythrocytes

Renal Cortex

70
Q

What 2 conditions can you use LDH-1 to diagnose?

A

Acute MI

Hemolytic anemia

71
Q

What 2 areas is LDH-3 distributed?

A

Lung

Lymphocytes

72
Q

LDH-3 is good for determining what conditions?

A

Acute Pulmonary Infarction (PI?)

Lymphocytosis

73
Q

What 2 areas is LDH-5 distributed?

A

Liver

Skeletal muscle

74
Q

LDH-5 is good for determining what conditions?

A

Hepatitis

SkM injury

75
Q

What cardiac serum marker exhibits the following characteristics?

Rise- 0.5-2hr

Peak- 5-12hr

Return to normal- 18-30hr

76
Q

What cardiac serum marker exhibits the following characteristics?

Rise- 3-8hr

Peak- 9-30hr

Return to normal- 2-3d

77
Q

What cardiac serum marker exhibits the following characteristics?

Rise- 3-6hr

Peak- 10-24hr

Return to normal- 5-15d

A

Troponin I

78
Q

What cardiac serum marker exhibits the following characteristics?

Rise- 8-18hr

Peak- 2-3d

Return to normal- 6-10d

79
Q

Who is recommended to have an LDL level <160?

80
Q

Who is recommended to have an LDL level < 130?

A

Those with > 1 risk factor

81
Q

Who is recommended to have an LDL level < 100?

A

Those with identified CAD, DM, any atherosclerotic disease, or multiple CAD risk factors

82
Q

Who is recommended to have an LDL level < 70?

A

Those with identified CAD or DM

83
Q

What is the main reason to get an ESR?

A

Minor tissue inflmmation

84
Q

What is the test used to diagnose DM, and estimates the glucose control for the previous 2-3 months?

85
Q

What is the method to get blood cultures?

A

2 different sites at 2 different times (15 mins apart)

86
Q

Out of the 3 following Syphilis tests, which one is confirmatory?

RPR

VDRL

FTA-ABS

87
Q

What condition in each of the following areas causes an increased serum amylase?

Pancreas

Salivary

GI

Liver

A

Pancreas- pancreatitis

Salivary- Parotitis

GI- Perforated bowel

Liver- hepatitis, alcoholism

88
Q

What marker is superior to total amylase for specificity and sensitivity for acute pancreatitis?

89
Q

Which lab do you use to monitor warfarin (coumadin) effect?

90
Q

What drug do you monitor with the PTT?

91
Q

What are the 2 commonly ordered thyroid tests?

A

TSH, free T4

92
Q

How often should you order cardiac enzymes/markers for an evolving MI?

A

Q6 hours x 3

93
Q

How often should you order liver enzymes for a patient on statins?

A

After 1 month and then q 3-4 months

94
Q

With treatment, how often will insurance pay for HbA1c checks?

A

q 3 months

95
Q

How often should you obtain HIV RBA viral load and CD4 counts?

A

q 1-3 months

96
Q

When should you order PSAs?

A

Yearly at 50

Yearly with family Hx at age 40

97
Q

The CEA marker is indicative for what cancer?

98
Q

The CA125 marker is indicative for what cancer?

99
Q

The AFP marker is indicative for what cancer?

A

Hepatocellular CA

100
Q

Review:

Which panel includes kindey and electrolytes?

101
Q

What is the only liver fxn test?

102
Q

Review:

Which panel includes kindey, electrolytes, and liver?

103
Q

Review:

Which panel includes only liver markers?

A

Hepatic Function Panel

104
Q

Review:

Which panel includes CO2, Cl-, K, and Na?

A

Electrolyte panel

105
Q

What does this stick diagram measure?

106
Q

Fill in this stick diagram

107
Q

What does this stick diagram measure?

108
Q

Fill in this stick diagram

109
Q

What does this stick diagram measure?

110
Q

Fill in the stick diagram

Clinical Lab Analysis (1 decks)

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