Labs and Imaging Flashcards
UA consists of
- color and appearance
- chemical findings
- microscopic findings
SX that warrent UA
abdominal pain, back pain, frequent or painful urination, blood in your urine, or other urinary problems
what dose red or pink urine mean?
- BPH
- kidney stones
- cysts
- cancer
- hard exercise
- beets
- blackberries
- rhubabrb
- rifampin
- phenazopyridine
- senna
Orange urine
- Phenazopyridine
- senna
- rifampin
- sulfasalazine (Azulfidine)
- adriamycin
- Vitamin A
- Vitamin B12
- dehydration
- cholestasis
- acute heaptitis
- alcoholic liver disease
- oral contraceptives
blue or green urine means
- dyes
- amitriptyline
- cimetidine
- triamterene
- indomethacin
- propofol
- hypercalcemia
- UTI by some bacteria
dark brown or cola-colored urine
- fava beans
- rhubarb
- aloe
- Chloroquine and primaquine
- metronidazole
- nitrofurantoin
- senna
- Methocarbamol
- phenytoin
- statins
- UTI
- exterme exercise
- viral heaptitis
- cirrhosis
- dehydration
- rhabdomyolysis
cloudy urine
- kidney stones
- UTI
- dehydration
- STI
- diabetes
- vaginitis
Urine dip stick includes
- nitrite
- leukocyte esterase
- specific gravity
- pH
- protien
- glucose
- bilirubin
- urobilinogen
- ketones
- blood
Nitrites indicate
normal: negative
abnormal: any shade of pink
* Cystitis
* E coli
* Klebsiella
* Proteus
* Enterobacter
* Cirtobacter
Leukocyte Esterase indicates
Bacterial infection
Trichomonas
Chlamydia
Balanitis
Urethritis
TB
Bladder tumors
Nephrolithiasis
Foregin bodies
Exercise
Glomerulonephritis
Specific Gravity indicates
Hyposthenuria (<1.010)
* Damage to kidney tubule cells (renal tubular necrosis)
* Diabetes insipidus
* Drinking too much fluid
* Kidney failure
* Low sodium level in the blood
* Severe kidney infection (pyelonephritis)
Hypersthenuria (>1.010)
* Adrenal glands do not produce enough hormones (Addison disease)
* Heart failure
* High sodium level in the blood
* Loss of body fluids (dehydration)
* Narrowing of the kidney artery (renal artery stenosis)
* Shock
* Sugar (glucose) in the urine
* Syndrome of inappropriate ADH secretion (SIADH)
Normal: 1.005 to 1.030
Bilirubin
Viral hepatitis (Hepatitis A-E)
Alcoholic liver disease (alcoholic steatosis, alcoholic hepatitis, cirrhosis)
Non-alcoholic steatohepatitis
Autoimmune hepatitis
Wilson disease
Hemochromatosis
Dubin-Johnson syndrome
Rotor syndrome
Primary biliary cirrhosis
Ischemic hepatitis
Sarcoidosis
Pregnancy
Drug-induced liver injury
Sepsis
Gallstones
Biliary stricture
Biliary atresia
Choledochal cyst
Cholangitis (bacterial, recurrent pyogenic, primary sclerosing, secondary sclerosing)
Cholangiocarcinoma
Intrahepatic malignancy
Extrahepatic malignancy (lymphoma, pancreatic cancer)
Chronic pancreatitis
Urobilinogen indicates
Hepatitis
Cirrhosis
Carcinoma
Hemolytic disorders
Bilirubin findings
Trace
Small
Moderate
Large
Urobilinogen findings
0.2 mg/dl
1 mg/dl
2 mg/dl
4 mg/dl
8 mg/dl
Protein results
trace 10 to 20 mg per dL
1+ (30 mg per dL),
2+ (100 mg per dL)
3+ (300 mg per dL)
4+ (1,000 mg per dL).
Protien causes
Minimal change disease
Idiopathic membranous glomerulonephritis
Focal segmental glomerulonephritis
Membranoproliferative glomerulonephritis
IgA nephropathy
DM
Collagen vascular disorders
Amyloidosis
Preeclampsia
Infection
Gastrointestinal and lung cancers
Lymphoma
Drugs
Hypertensive nephrosclerosis
Uric acid nephropathy
Acute hypersensitivity interstitial nephritis
Fanconi syndrome
Heavy metals
Sickle cell disease
Multiple myeloma
Myoglobinuria
Glucose cause
DM
Tubular damage
Ketones cause
DM
pH cause
High: Renal tubular acidosis
Low: DM or renal/bladder calculi
Blood cause
Renal calculi
Glomerulonephritis
Pyelonephritis
Hyaline cast
Conglomerations of protein indicating proteinuria
Hyaline cast cause
Acute:
Following strenuous exercise
Orthostatic proteinuria
Fever
Chronic:
Glomerulonephritis
Pyelonephritis
CHF
Chronic renal failure
RBC casts
Clump of RBC due to breakdown of glomerulus and stasis
RBC casts cause
Glomerulonephritis
SBE
Subacute bacterial endocarditis
Renal infarcts
Vasculitis
Sickle cell anemia
SLE
Malignant HTN
Goodpasture’s syndrome
PSGN
WBC casts cause
Acute pyelonephritis
Glomerulonephritis
Lupus nephritis
Renal tubular epithelial cell casts
Nephrosis
Amyloidosis
Heavy mental or other poisoning
Glomerulonephritis
Acute tubular necrosis
Pyelonephritis
Waxy or broad casts cause
Chronic renal failure
Crystals cause
Nephrolithiasis
Uric acid
Microalbumin cause
Moderate: Early detection of kidney disease
High: Kidney failure
24-h urine protein findings
N 150 mg/24 h
Proteinuria 150-500 mg/24h
>2000 mg/24 h
>3500 mg/24h
24-h urine protein cause
Glomerular
Nephrotic syndrome
Renal disease
HTN
Toxicity from heavy metals/ solvents
Preeclampsia/eclampsia
Fractional excretion of sodium findings
Increased sodium in urine = intrinsic kidney path
Normal sodium = prerenal cause
FENa > 2 damage to tubules
FENa < 1 decrease blood flow
Creatinine clearance findings
24-h urine collected and blood draw
M 90-139 ml/min
F 80-125 ml/min
Creatinine clearance cause
Tubular damage
Glomerulonephritis
Kidney failure
Albumin creatinine ratio findings
30-300 mg/day
Albumin creatinine ratio cause
Kidney damage in pt with DM
Uroflowmetry or “Uro Flow Test” findings
Measures voided volume, voiding time, average flow rate, max flow rate (Qmax) N urine volume >200ml over 15-30 sec
N peak flow: Male 20-25 ml/s, Female 20-30 ml/s
Uroflowmetry or “Uro Flow Test” cause
Decrease: Suggests bladder outlet obstruction (BOO) (most common in M), or weak detrusor muscle contraction
Increase: Suggests bladder spasticity
Intermittent flow: Straining to overcome resistance (sphincter tone)
Cytometry findings
Assesses bladder storage capacity, pressure as bladder fills, how full when urge triggered
Detrusor contractions before bladder fills to 150-250ml is abnormal
Cytometry indications
neurogenic bladder, MS, spinal cord injury, diabetes, BPH
Pressure Flow Study
Measures intravesical and detrusor muscle pressure required for voiding and flow rate (ml/s)
Normal voiding pressure not > 30cm of H2O pressure
Pressure Flow Study cause
If bladder pressure is >50cm of H2O along with low urine flow: urethral overactivity (detrusor-sphincter dyssynergia) or urethral stricture or BOO (bladder outlet obstruction) may be cause
Postvoid Residual Measurement findings
Measures amt of urine in bladder after micturition
PVR >100 ml is abnormal
Urethral Pressure Profile finding
Measures intraluminal pressure along length of urethra (usu done in female-body pt)
Urethral Pressure Profile cause
obstruction or incontinence
High pressure = Resistance
Low pressure = Compromised function
Electromyography findings
In Females, it can assess pelvic floor or periurethral muscle activity for abnormal contraction or relaxation contributing to urinary obstruction or incontinence.
Can also check electrical activity in the bladder neck
CBC with differential contains
- RBCs
- WBCs
- platelets
- hemoglobin
- hematocrit
- MCV
- MCH
- MCHC
- RDW
RBCs findings
increased
* polycythemia vera
* smoking
* dehydration
* cor pulmonale
* renal cell carcinoma
* hypoxia
* congential heart disease
* pulmonary fibrosis
* medication
normal
decreased
* anemia
* bleeding
* multiple myeloma
* leukemia
* malnutriton
* pregnancy
* hemolysis
* B12/6/9 deficency
* iron and copper
* overhydration
* medications
Hemoglobin cause
decreased
* bone marrow defects
* renal disease
* cell destruction
* blood loss
* hemogloninopathies
* lead poisoning
* iron deficiency
* pregnancy
* over-hydration
increased
* polycythemia vera
* renal tumors
* COPD
* pulmonary fibrosis
* heart disease
* dehydration
hypochromasia
increase in the red cells central pallor which occupies more than the normal third of the red cell diameter
found in: iron deficency and thalassaemia
hematocrit
the volume of erythrocytes expressed as a precentage of the volume of whole blood
hematocrit cause
increased
* erythrocytosis
* congenital heart disease
* polycythemia vera
* dehydration
* severe COPD
decreased
* anemia
* hemoglobinopathies
* hemolytic anemia
* hemorrhage
* nutrient deficiencies
* bone marrow failure
* prosthetic valves
* renal disease
* pregnancy
* blood cancers and malignancies
hemoglobin interfering factors
very high WBC counts
severe lipidemia
RBC abnormalities
increased turbidity
increased bilirubin
hematocrit interfering factors
RBC size
extremely high WBC counts
over and under hydration
pregnancy decreases due to hemoduilution
high altitudes increase due to hypoxia
post-hemorrhage values not reliable for several hours
drugs
MCV (mean corpuscular volume)
average volume of RBCs how big they are
decreased MCV: microcytic RBCS <80
increased MCV: macrocyctic RBCs >100
normal: normocytic
MCV interfering factors
- high WBC
- high platelets
- agglutinated RBCs
- RBC fragments
mean corpuscular hemoglobin concentration (MCHC)
ratio of the average concentration of hemoglobin in a given volume of RBCs
normal MCHC: 32-36 normochromic
decreased <30 hypochromic
normocytic, normochromic anemia
chronic illness
renal disease
acute blood loss
aplastic anemia
autoimmune hemolytic anemia
microcytic, hypochromic anemia
iron deficiency
sideroblastic
lead poisoning
anemia of chronic disease (later stage)
thalassemia
macrocytic, normochromic anemia
vitamin B12 or folate deficiency
pernicious anemia
side effects of chemotherapy
myelodysplastic syndrome
acute myelogenous leukemia
Platelet count
thrombocytopenia: <150,000
thrombocytosis: > 400,000
thrombocythemia: > 1,000,000
platelet count cause
thrombocytopenia
* hypersplenism
* hemorrhage
* leukemia
* myelofibrosis
* thrombotic thrombocytopenia purpura
* ITP
* aplastic anemia
* graves diasese
* pre-eclampsia
* DIC
* SLE
* pernicious anemia
* hemolytic anemia
* cancer chemotherapy
* severe infection
* drug reactions
thrombocytosis
* malignant disorders
* polycythemia vera
* acute infections
* sepsis
* post-splenectomy
* rheumatoid arthrtis
* iron deficiency
* primary thrombocytosis
Platelet interfering factors
high altitude
strenous exercise
prior to menses
estrogen
drugs
WBC findings
total WBC count
ER
low: less than 500 per mm
high: greater than 30,000
WBC cause
leukocytosis
* infections
* leukemic neoplasia
* other malignancy
* trauma
* stress
* hemorrhage
* tissue necrosis
* inflammation
* dehydration
* thyroid storm
* post splenectomy
leukopenia
* drug toxicity
* bone marrow depression/failure
* severe infections
* dietary deficiencies
* marrow aplasia
* marrow infiltration
* autoimmune disease
* hypersplenism
* chemotherapy
differential WBC count
normal
Neutrophil 60%
lymphocyte 30%
monocyte 6%
eosinophil 3%
basophil 0%n
Neutrophils cause
neutrophillia
* acute infection
* trauma
* physical/emotional stress
* inflammatory disorders
* metabolic disorders
* myelocyctic leukemia
* cushing’s sundrome
neutropenia
* overwhelming bacterial infection
* viral infection
* aplastic anemia
* radiation therapy
* addisons disease
* chemotherapy
* dietary deficiency
eosinophils cause
eosinophilia
* parasitic infections
* allergic reactions
* asthma, hay fever
* hodgkin’s disease
* eosinophil myaliga syndrome
* eczema
* leukemia
* autoimmune disease
* ovarian cancer
eosinopenia
* cushing syndrome
* endogenous or exogenous cortisol excess
* stress
Basophils cause
basophilia
* myleoproliferative disease: polycythemia
* granulocytic leukemia
* chromci muelocytic leukemia
* hodgkin’s lumphoma
Basopenia
* acute phase infection
* hyperthyroidism
* stress reactions
* prolonged steroid therapy
lymphocytes cause
lymphocytosis >4000
* viral infections: CMV, HIV
* pertussis, TB
* lymphocytic leukemia
* multipe myeloma
* infecitous mononucleosis/EBV
* infecitous hepatitis
* hypoadrenalism (addison’s disease)
Lymphopenia <1000
* myelocytic leukemia
* hodgkin’s disease
* sepsis
* immunodefiency diseases
* SLE
* adrenocorticosteroids and chemotherapy
* radaition
monocytes cuase
monocytosis >500
* EBV
* TB
* subacute bacterial endocarditis
* syphilis
* chronic UC
* parasites (malaria)
* monocytic leukemia
moncytopenia <100
* prednisone
* HIV
* hairy cell leukemia
* aplastic anemia
Mean platelet volume (MPV) cause
average volume of a population of platelets
MPV cause
increased
* valvular heart disease
* ITP
* sepsis
* severe hemorrhage
* B12/folate def
* myelocytic leukemia
decreased
* aplastic anemia
* cancer chemotherapy
* wiskott-aldrich syndrome
bleeding time cause
increased
* thrombasthenia
* bernard-soulier
* storage pool disease
* asprin
* platelet count <75,000
* von wilebrand disease
* uremia
* liver failure
Prothrombin time
evalutates extrinsic system
Inceased
* deficency of VII, X, V, prothrombin, or fibrinogen
* vit K def
* liver disease
* warfarin
* DIC
* heparin
International normalised ration (INR)
PT is expressed as a ratio of prothrombin clotting time for patient plasma divided by time for control plasma
INR 1 is normal
>1 clotting time is elevated
activated partial thromboplastin time (aPTT)
evaluates intristic system
increased
* def in VIII, IX, XI, or XII
thrombin time
measurement of the conversion of fibriongen to fibrin
Factor assays
factor IX
factor VIII
Direct Coomb test (Direct antiglobulin test)
used to detect antibodies that are stuck to the surface of red blood cells
abnormal:
* autimmune hemolytic anemia
* chronic lymphocytic leukemia
* erythroblastosis fetalis
* infectious mononucleosis
* mycoplasma infection
* syphilis
* SLE
* tranfusion reactions
Indirect coombs test
looks for antibodies that are floating in the blood, to determine a reaction to blood transfusion
abnormal
* Erythroblastosis fetalis
* Incompatible blood match
blood typing
measures the antigen and markers on the surface of RBCs
ABO
RH C or c, D or d, E or e
Kell K or k
Duffy Fya, Fyb, FY
kidd Jk, Jka, Jkb, Jkab
erythrocyte sedimentation rate
sedimentation rate, non-spefic measurment of inflammation
erythrocyte sedimentation rate cause
- RA
- psoriatic arthritis
- gout
- reactive arthritis
- sarcoidosis
- sjogren’s syndrome
- calcium pyrophsophate depisition disease
- urticaria
- ankylosing spondylitis
- juvenile RA
- acute prostatitis
- crohn’s disease
- SIBO
- UC
- polymyalgia rheumatic
- osteoarthritis
- gastroenteritis
Comprehensive metabolic panel contains
- glucose
- calcium
- sodium
- potassium
- carbon dioxide
- chloride
- albumin
- total protien
- ALP
- ALT
- AST
- bilirubin
- BUN
- creatinine
glucose on CMP
increased
* daibetes
* hyperthyroidism
* pancreas disorders
* stress
decreased
* side effect of medications
* not eating enough
* more physically active
* liver disease
* kidney disease
* hypothyroidism
* alcohol use disorder
* Underactive adrenal or pituitary,
calcium on CMP
total calcium: bound and free
increased
* hyperparathyroidism
* cancer of the bone
* paget’s disease
* too much Vit D
decreased
* malnutriton
* liver disease
* hypoparathyroidism
* Vit D, mag, calcium def
* pancreatitis
* kidney disease
Sodium on CMP
increased hypernatermia
* dehydration
* gastroenteritis, vomiting, prolonged nasogastric drainage, burns, and excessive sweating
* intrinsic renal disease, post-obstructive diuresis, and with the use of osmotic or loop diuretics
* daibetes insipidus
* diabetic ketoacidosis
Hyponatermia
* diuretics
* kidney disease
* decreased sodium intake
* diuretics
* SIADH
* heart faliure
* stroke, hemorrhage, infection, trauma, and psychosis,
* ADH tumor
* drugs
* pneumonia
* hypothyroidism
* adrenal insufficency
* HIV
potassium
Hyperkalemia
* kidney disease
* diet
* medications
* addisons
* burns or severe injuries
* diabetes
hypokalemia
* alcohol
* chronic kidney disease
* daibetic ketoacidsosis
* diarrhea
* diuretics
* laxatives
* excessive sweating
* folic acid def
* primary aldosteronism
* vommiting
carbon dioxide
increased hypercapnia
* cushing’s syndrome
* kideny faliure
* COPD
* sleep apnea
* stroke
* hypothyroirism
* MS
* ALS
* muscular dystrophy
* spinal cord injuries
* flail chest
* ankylosing spondylitis
* tetanus
* botulism
* pulmonary embolism
* vascular disease
* dehydration
decreased
* addison disaese
* diabetic ketoacidosis
* shock
* kidney disorders
chloride
increased
* addison disease
* carbonic anhydrase inhibitors
* diarrhea
* ethylene glycol poisoning
* ketoacidosis
* kidney disease
* lactic acidosis
* methanol poisoning
* renal tubular acidosis
* salicylate toxicity
* ureteral diversion
* cancer
* hypoglycemia
* alcohol
* seziures
decreased
* bartter syndrome
* burns
* congestive heart failure
* cushing syndrome
* dehydration
* excessive sweating
* hyperaldosteronism
* COPD
* asthma
* pulmonary fibrosis
* scoliosis
* drugs
* sleep apnea
* SIADH
* vomiting
albumin
increased
* dehydration
* diarrhea
decreased
* infection
* sepesis
* surgery
* IBD
* kidney disease
* cirrhosis
* fatty liver disease
* liver cancer
* hepatitis A, B, or C
* malnutrition
* hypothyroidism
total protien
increased
* multpile meyeloma
* waldenstrom disease
* HIV
* hepatitis B or C
decreased
* kidney
* liver
* malnutriton
* celiac disease
* crohn’s disease
ALP
increased
* cholestasis of pregnancy
* cirrhosis of liver
* hepatitis
* biliary atresia
* biliary stricture
* cholangiocarcinoma and pancreatic head adenocarcinoma
* mononucleosis
* bone metastasis
* paget’s disease of the bone
* osteogenic sarcoma
* fractures that are healing
* hyperparathyroidism
* hyperthyroidism
* osteomalacia
* Vit D def
* celiac disease
decreased
* malnutrition
* zinc def
* mag def
* hypothyroidism
* hypophosphatasia
* Wilson disease.
ALT
increased
* Alcohol-induced liver injury.
* Fatty liver disease
* Hepatitis
* Cirrhosis
* Taking medications that are toxic to your liver.
* Liver tumor or liver cancer.
* Liver ischemia
* Hemochromatosis
* Mononucleosis
decreased
* B6 def
* chronic kidney disease
AST
increased
* Alcohol-induced liver injury.
* Hepatitis
* Cirrhosis
* Taking medications that are toxic to your liver.
* Liver tumor or liver cancer.
* liver ischemia
* Heart attack
* Mononucleosis
* Muscle disease.
* Pancreatitis.
* burns
* seizures
* surgerys including heart
* intense exercise
decreased
* Vit B6 def
* chronic kidney disease
in CMP bilirubin
increased
* erythroblastosis fetalis
* hemolytic anemia
* sickle cell disease
* premature birth
* mononucleosis
* wilson disease
* Crigler-Najjar syndrome
*
* Transfusion reaction
* cirrhosis
* hepatitis
* gilbert disease
* biliary stricture
* cancer of pancrease or gallbladder
* gallstones
decreased
BUN
increased
* dehydration
* burns
* medications
* urinary tract obstruction
* congestive heart failure
* recent heart attack
* Gastrointestinal bleeding
* Shock
* high protein diet
* kidney disease
decreased
* malnutrtion
* lack of protien
* liver disease
* overhydration
creatinine on CMP
increased
* obstruction of urinary tract
* kidney damage, faliure, infection, or reduced blood flow
* eclampsia
* preeclampsia
decreaased
* malnutriton
* muscular dystrophy
* liver disease
* low protien diet
total serum testosterone
decreased
* klinefelter syndrome
* testicle injuries
cancer treatments, such as chemotherapy and radiation
stress
AIDS
alcohol use disorder
kidney disease
cirrhosis of the liver
pituitary gland conditions
autoimmune disease
infection
obesity
metabolic syndrome
using certain medications
increased
* tumor
* steroid use
* congenital adrenal hyperplasia
* PCOS
* ovarian cancer
* disorder of pitutary gland
FSH
