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SMUPASPG19-MED 1 > LABS > Flashcards

LABS Flashcards

1
Q

URINALYSIS COLLECTION

A

50% midstream collection F contamination (>10 epithelial cells/HPF)

infection from catheterized specimen: 1-3%
20% if elderly or debilitated

Urine Dipstick basic U/A

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2
Q

Urine Microscopy Cells

A

urinary sediment
Cells: white, red, squamous cells, others
Labs
Urgent care and ED only

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3
Q

Leukocyte esterase

A

Enzyme produced by neutrophils
50% of pts with bacteriuria do not have pyuria
May be vaginal/penile contaminant, not diagnostic

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4
Q

Nitrite

A

Gram negative bacteria convert nitrate to nitrite. E. Coli most common
UTI
Send urine for microscopic analysis, +/- culture

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5
Q

RBC’s / heme

A

Rhabdomyolysis- myoglobin
lysed RBC
Free hemoglobin
intact Erythorocytes

Blood usually Cancer or menstral cycle

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6
Q

Specific gravity

A

Concnetrated_Hydration, solutes

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7
Q

Protein

A

Transietn common. Renal Fx

Seen w/ exercise

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8
Q

Bilirubin

A

Liver FX

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9
Q

Ketones

A

hydration/nutrition status, diabetes; product of ketone metabolism

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10
Q

glucose

A

usually none. Present = renal tubules overwhelmed

>200 HIGH glucose if seen in urine

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11
Q

Urine Microspy Cast

A

Fat laden histiocytes (oval fat bodies / macrophages) : nephrotic syndrome and proteinuria

Nephropathies or non-glomerular renal dz
Crystals

Casts – “active sediment” indicates renal disease
Erythrocyte casts = glomerular nephritis
Leukocyte casts = interstitial disease

Normal crysals- uric acicd, Ca, Phos
Abnorma- cholestrol, acylovir, sulfa

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12
Q

Urine Microspy Crystals

A

Urate, phosphate, oxalate, cystine crystals: stone formers

Uric acid crystals: gout

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13
Q

Urine Cultures

A

Obtained if infection unknown, at risk or “special” pt, sick patient

Collection method is key – females vs catheterization

Infection species significant/cause if >100K colony

2-3 days results

Treat all pts presumptively for gram neg infection; send cultures on all resistant/recurrent/”special” infections
Microscopy B4 culture

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14
Q

Erythrocytes: RBC’s

A 
Normal = 80-100
oxygen transport from lungs to tissues
protein: hemoglobin
survive 120d
Absolute number counted
MCV = Mean Corpuscular Volume

Ht: Hgb 3:1 (if nt acute blood loss)

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15
Q

Hematocrit

A

Males: 38-50%, Females 34-44% (kids age variable)

Percent of blood volume occupied by erythrocytes

Derived from (MCV and total RBC count)

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16
Q

Hemoglobin

A

Males 14-18 g/dL
Females 12-16g/dL (pregnant 11-14g/dL, kids
Unique for its ability to carry and unload O2
defines anemia

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17
Q

Blood Smears

A

not common-Information on red cell size, morphology, variation, hypochromia

cell types

% immature cells; i.e. bands, stabs

Presence of precursor cells usually restricted to marrow (blasts, nucleated erythrocytes)
Helpful for abn anemia, anemia not improving w/ tx, or Ht:Hgb ratio off

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18
Q

Döhle bodies

A

are intra-cytoplasmic structures composed of agglutinated ribosomes;

inflammation and increased granulocytopoiesis
toxic neutrophils.

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19
Q

Heinz bodies

A

inclusions within RBC’s composed of denatured hemoglobin .

hemolytic anemia

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20
Q

Howell-Jolly bodies

A

are spherical blue-black inclusions of red blood cells seen on Wright-stained smears.

condensed DNA,

hemolytic anemias, dysfunctional spleens, splenectomy.

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21
Q

Iron deficiency

Thalassemias

Hemolytic anemia

Lyme dz

A

Microcytic Anemia: MCV < 80

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22
Q

Hemorrhage
Chronic disease
Bone marrow failure
Lead poisoning

A

Normocytic Anemia: MCV 80-100

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23
Q

Vitamin B12 deficiency
Folate deficiency
Hypothyroidism
Hepatic failure

A

Macrocytic Anemia MCV > 100

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24
Q

Leukocytes

A

4.5 – 11k
WBC counts and differential evaluate bacterial infection

Elevated neutrophil (PMN’s) count 
Inc. in the proportion of immature neutrophils (bands)= key sign of bacterial infection (left shift- more immature WBC seen)

Monitor w/ chemotherapy
RA, chronic inflam- 11-13K

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25
Q

Platelet Count

A

Formation critical for effective hemostasis w/vessel injury

150-400

Thrombocytopenia < 100
< 50 severe bleeding from trauma
< 10 spontaneous cerebral hemorrhage

26
Q

Chemistry Panels

A

electrolyte metabolism, fluid balance, acid-base status, renal function – from venous blood draw

27
Q

Na+

A

N-135 – 145
Holds water in extracellular fluid space

Regulated by the kidneys in response to hormonal, neural, and vascular signals reflecting intravascular fluid volume

hypo-osmolarity
hyper-osmolarity

28
Q

Hypertonic Hyponatremia

A

Extracellular osmotic substance accumulates causing water to shift from intracellular to extracellular space lowering Na

correct the sugar 1st, sodium low bc glucose is high
Every inc (100 mg/d)l in glucose above normal multiply by 1.6 to add the corrected mEq of Na.

Corrected sodium for the pt in head while correct sugar :
7 x 1.6 = 11.2 + 124 = 135 (normal total body sodium)

Causes-
hyperglycemia, mannitol (diuretic)
Normal water excretion: low solute load in extracellular space from added water
Hypotonic hypernatremia
Psychogenic polydipsia – huge water intake
Massive beer drinking (Potomania)
Impaired water excretion – kidney issue
Volume loss: diuretics, GI loss, bleeding
Edematous states: cirrhosis, CHF
Renal failure
Cortisol deficiency: adrenal / hypopituitary:
Severe hypothyroidism
SIADH

29
Q

Hypernatremia

A

Dehydration – hypertonic hyperosmolar
water loss :Fever, hyperthermia, diaphoresis, loss of thirst sensation, burns, hyperventilation

Neurogenic diabetes insipidus- no antidiuretic hormone

Nephrogenic diabetes insipidus- kidney dont respond to antidiuretic hormone

Osmotic diuresis-glycosuria, mannitol, high protein intake

30
Q

K+

A

N 3.5 - 5.0 extracellular levels (6-7 no s/s lab handling, RBC lyis)

intracellular ion exchange

INC or DEC =life threatening electrolyte issue

31
Q

Chem 7

A

chemistry metabolic panel Basic

Na, K, BUN, Creatine, Glucose, CO2, HCO3

32
Q

Chem 12_16-20

A

Basic + LFTs (AST, ALT, PHos, bilirubin) Albumin, Ca

33
Q

CBC w. differential

A

Common, cheap
CBC basic- Hg, Ht, RDW, MCV, MCH, WBC
Diff: neutrophils, lymphocytes, basophils, eosinophils
used when looking for particular infection.

34
Q

Hyperkalemia
Levels > 6.0 myocardial irritability and fatal arrhythmias

Common causes
Renal failure
Release of intracellular K+ into the extracellular space
Metabolic acidosis, massive tissue breakdown, insulin deficiency

A

Inc. Potassium

35
Q

Potassium Abnormal? Think: Get an EKG!

A

Hyperkalemia
Peaked T waves
Widened PR and QRS intervals
Flattening / loss of P waves

Hypokalemia
	U waves
	Flat or inverted T waves
	ST  depression
	Decreased QRS voltage
36
Q

Low Potassium

A

Hypokalemia
Question is-True body loss vs. shift to intracellular

Decreased dietary intake/nutrition – alcoholics
Diarrhea / vomiting
Diuretics

37
Q

Chloride

A

N 98 – 109 mEq/l extracellular
Major role as anion companion to Na +

Changes in Cl – reflect changes in other extracellular ions* bicarb

38
Q

N 20-30 mEq/l
major extracellular buffer
disorders of the acid/base balance

Serum CO2/HCO3 is ~5% higher then arterial bicarbonate (ABG – arterial blood gas)
very sick if off

A

Bicarbonate

39
Q

Blood Urea Nitrogen

A

Normal 10 – 20

Urea = end product of protein metabolism

related to -dietary protein, liver disease, tissue breakdown, dec renal blood flow, renal pathology

1/2 renal function lost before BUN or creatinine inc.
Azotemia (early renal failure) = elevated BUN

If dec. enough to cause a rise in BUN / creatinine then U/A will reveal proteinuria and abnormal urinary sediment
Decreased renal blood flow = increased BUN

BUN/creatinine ratio 10-15

40
Q

Creatinine

A

Normal 0.6 – 1.2 mg/dl
#1 indicator of renal function
End product of metabolism of creatine,

Produced in liver, stored in muscle, phosphocreatine; storage for high energy phosphate

Daily muscle cell metabolism= excretion of 1g creatinine/d

Inc= loss of glomerular filtration

2x inc= indicates half of renal function

Decision to begin dialysis Tx made on clinical symptoms rather than absolute #’s
Chronic RF pts may tolerate creat > 20 mg/dl;
Acute RF pt may not tolerate creat > 6

41
Q

Bilirubin- LFT

A

End product of heme metabolism breakdown of RBC’s

conjugated in the liver and secreted into bile
Increased conjugated
(direct) 0.1-0.5 nml
Liver dx. hepatic obstruction inc. level, w/ bilirubinuria)

Increased unconjugated
(indirect) 0.3-1.9 nml
hemolysis or congenital defects in bilirubin transport (no associated bilirubinuria)

42
Q

LFT-ALT Alanine Tranferase

A

Hepatocyte enzyme

Normal 3 – 35

Specific: elevation seen in pts with liver disease

43
Q

Normal 10 – 40
Enzyme present in large concentration in liver, heart, skeletal tissue

Less specific than ALT for liver disease

*Significant elevation in pts with massive hepatic necrosis, MI, Rhabdo

A

LFT Aspartate Aminotransferase (AST)

44
Q

LFT-ALT/AST

A

ALT and AST elevated in liver dz. ratio ALT : AST= > 1

alcoholic hepatitis and massive hepatic necrosis the ratio of ALT : AST =< 1

45
Q

N 25 – 100
Monophosphate concentrated in hepatocytes, bone, gut, lung

Inc.= obstruction anywhere in the biliary tract
pulmonary, renal, splenic infarction / inflammation, carcinoma

A

LFT- ALP Alkaline Phos

46
Q

LFT- Albumin

A

Normal 3.5 - 5.0
abundant protein in blood plasma; 40-60% of total protein
“acid”

Dec :
Primary liver disease
Tissue damage / inflammation
Malnutrition
Malabsorption syndrome     
Renal failure
47
Q

Ca+

ELEVATED

A

N- 8.5-10.5

Hyperparathyroidism
*Malignancy
Thyrotoxicosis
Vitamin D intoxication
Sarcoidosis
48
Q

Renal disease
Vitamin D deficiency
Hypoparathyroidism
Mg deficiency

A

Ca+ DECREASED

49
Q

Magnesium

INCREASED

A

Renal failure
Iatrogenic ingestion
Adrenal insufficiency

50
Q

Magnesium DECREASED

A 
Decreased intake
Diarrhea
Alcoholism
Hyperthyroidism
SIADH (sydrome of inappro ADH)
Some diuretics
51
Q

Imminent renal failure
Hypoparathroidism
Acromegaly
Vitamin D intoxication

A

Phosphorous

INCREASED

52
Q

Phosphorous

DECREASE

A 
Primary hyperparathyroidism
Mg deficiency
Vitamin D deficiency
Alcoholism
Soda
Osteoporosis
53
Q

Creatinine kinase 38-120 ng/ml

Myoglobin <85-90

Found in heart/skeletal muscle. Presence = damage
Not specific.

Used much less since advent of troponin

A

Cardiac Markers

54
Q

Troponin

A 
nl <0.01 – 0.03 ng/mL (Lab/method dependent)
#1 Gold Standard for cardiac ischemia

cardiac protein controls calcium mediated interaction of actin/myosin;

Inc= degradation of actin and myosin filaments in the area of myocardial damage. “Trop leak”

Rises 4-6 hours after MI
At least two serial serum levels 6 hours apart are required to r/o acute MI in pt’s w/ acute CP

If last episode of CP >6hrs prior – single troponin acceptable
elevated for as long as 10 days after myocardial injury.

55
Q

BNP

Brain Natriuretic Peptide

A

Normal: <100pg/ml
response to left ventricular stretching and increased wall tension

predict prognosis/death in heart failure in Pts w/ sx
Not a screening test

High negative predictive value = if test is negative, rules out heart failure better than a positive test predicts it

affect this test: HTN drugs, exercise, etc

Useful and expensive (>$200)

56
Q

Lipid Panel

A

Total cholesterol, HDL, TGS
LDL calculated (not good lipids, indirectly)
TC <200
HDL >35
TG< 150 (while fasting) > 400 inaccurate LDL
LDL depends on CV
Finger prick or Lab

57
Q

lactic Acid

A

N < 2.0
2.0-3.9- consider sepsis
>4.0 sepsis

  • Gold stardard for use of TX w/ severe infection
    Shock/sepsis= anerobic, O2 delivery inadequate. By product Lactic acidosis=hypoeffusion, hypoxia
    Not routine test- IN Pt or ED
58
Q

PT Prothrombine Time

A

N 10-13s
injured vessles release thromboplasin, activates exrinisit pathways for coagulation

Assess for anticoag TX
Vit K deficiency

59
Q

INR international normalized Ratio

A 
N 0.5-1.2
If anticoag drugs 2-3.5
#1 monitor for anticoag TX
INT= Pts PT/control PT
Warfarin
ordered w/ PT
60
Q

Ammonia

A

N 30-70 ug/dl

Indicates hepatic parenchymal damage
Liver dz
Asterixis- hepatic encephalopathy (can't convert NH3 to urea, damages CNS)
Cirrohis
Alcholics
Not routin LFT

SMUPASPG19-MED 1 (27 decks)

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