Labs Review Flashcards

(35 cards)

1
Q

BMP shows K+ of 5.6

Whats your differential? (Meds, Conditions, Lab issues)

A

Meds: potassium supplement, ACEI, ARB, Bactrim, spironolactone, amloride

Medical conditions: CKD or AKI, hemolysis/bleeding, tumor lysis syndrome, metabolic acidosis, insulin deficiency, tissue breakdown ie: rhabdo

Lab issues: hemolyzed specimen

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2
Q

You see a patient with a BUN of 49 and a Cr of 1.5

What 2 things are on your differential?

A

GIB
Because blood is absorbed as it passes through the small bowel and patients may have decreased renal perfusion. The higher the BUN:Cr ratio, the more likely an upper GIB

PRERENAL AKI
Dehydration, ↓ effective circulating volume (cirrhosis, CHF, nephrotic syndrome), shock/hypotension, hemorrhage

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3
Q

Patient has an MCV of 105.

What is on your DDx?

A
Vit B12 deficiency, folate deficiency
Alcohol
Liver disease
Myelodysplastic syndrome
Hypothyroidism

Meds: LOTS! Some common ones: allopurinol, immunosuppressants, Bactrim, H2 blockers, PPIs, metformin

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4
Q

If you see a high MCV, what is the 1st thing you should do?

A

Check B12 and folate

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5
Q

MCV is 76, what is at the top of your DDx?

What else?

A

IDA!!!!

Thalassemia, lead poisoning, copper deficiency, zinc poisoning, GI bleeding (possible colon cancer)

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6
Q

You see an ↑ total Bili

What are 2 main categories you are thinking of?

A

Liver Dz & Hemolytic Anemia

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7
Q

Causes of a Platelet count of 700

A

Reactive thrombocytosis
- Infection, blood loss/anemia, non-infectious inflammation, post-splenectomy

Blood malignancies
- Polycythemia vera, CML, MDS (myelodysplastic syndrome), AML

Familial thrombocytosis

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8
Q

Characterisitc findings in CML

A

“The CLM (chronic myelogenous leukemia) CAB (chronic, accelerated, blast crisis stages) is FULL (abd fullness) in PHILADELPHIA (chromosome), and the driver is FATIGUED”

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9
Q

Characteristic findings in AML

A

Fatigue, pallor, weakness, gingival bleeding, ecchymosis, epistaxis, anemia, thrombocytopenia

> 20% blasts

Auer Rods (Myeloid origin)

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10
Q

T/F? Platelets are an acute phase reactant

A

True

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11
Q

T/F: You should order a BMP for r/o hemolytic anemia

A

False

Need LFTs

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12
Q

T/F: There is a hemolysis panel order set

A

False
Need to order:
UA &
Each individual lab (CMP, Haptoglobin, LDH, Peripheral blood smear, Reticulocyte count, Unconjugated bilirubin)

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13
Q

Haptoglobin in Hemolysis (Increased or decreased)?

A

Decreased

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14
Q

LDH in Hemolysis

A

increased

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15
Q

Peripheral blood smear in hemolysis

A

Abnormal RBCs

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16
Q

Reticulocyte count in Hemolysis

17
Q

Unconjugated bilirubin in Hemolysis

18
Q

UA findings in Hemolysis

A

Urobilinogen

(+) for blood

19
Q

Causes of MG of 1.2 (Conditions, Meds, etc)

A
GI losses
Diarrhea>vomiting
Meds
Chronic PPI usage (impairs absorption by intestinal epithelial cells)
Loop & thiazide diuretics
Alcohol use disorder
Post transplant patients
20
Q

Labs of Polycythemia Vera.

Tx?

A

↑ PLTs
↑ H&H
↑ WBCs

Therapeutic phlebotomy, Give ASA

21
Q

Labs of Polycythemia Vera.

Tx?

A

↑ PLTs
↑ H&H
↑ WBCs

Therapeutic phlebotomy, Give ASA

22
Q

What conditions require PPI’s indefinitely?

A
  • GIB
  • Barretts esophagus
  • H. Pylori
  • Hospitalized folks
23
Q

Bad S/E of PPIs

A
  • Osteoporosis (↑ Fx risk)
  • C-diff (via ∆pH of GI tract)
  • CKD
24
Q

T/F: Your pt returns for f/u post-hospital DC and is on PPI’s, so you must keep them on PPI’s

A

False

if not being actively treated for GIB or Barretts, etc, pt may go off PPI’s

25
WBC of 13.2 DDx
- Infection - Acute or chronic inflammation - Neoplasms (Leukemia, P. vera, essential thrombocythemia) Medications: - GCs, catecholamines (epi), lithium Cigarette smoking Stress/exercise Obesity
26
T/F? If a pt is on Lithium, they should stop and be on more modern Rx
False if pt is doing well on Lithium-leave them be. Dont change their life
27
T/F? Smoking creates a state of chronic inflammation
True
28
LFTs: | AST Predominant
Alcohol associated Hepatitis
29
LFTs: | ALP predominant
Biliary obstruction or Bone
30
How to Determine cause of ALP elevation?
Check Bilirubin
31
LFTs: | ALP predominant, Bili elevated
liver/gallbladder obstruction
32
LFTs: | ALP predominant, Bili not elevated
fracture, osteomyelitis, bone lesion,
33
LFTs: | ALT predominant
Drug-induced liver injury
34
K+ of 2.4 causes
Conditions: - GI losses, mostly diarrhea - Significant sweat loss - Dialysis Rx: - Thiazide & loop diuretics - Hyperaldosteronism - Hypomagnesemia Things that drive K+ into cells: - Insulin, - beta agonists (eg albuterol), - alkalosis
35
COMMON causes of ↑ D-Dimer
``` DVT/PE DIC COVID-19 Severe infection-sepsis Surgery/trauma MI/CVA Liver disease Renal disease Malignancy Pregnancy ```