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CDM I > Labs Review > Flashcards

Labs Review Flashcards

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

A

Increased

17
Q

Unconjugated bilirubin in Hemolysis

A

Increased

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
Q

WBC of 13.2 DDx

A
  • Infection
  • Acute or chronic inflammation
  • Neoplasms
    (Leukemia, P. vera, essential thrombocythemia)

Medications:
- GCs, catecholamines (epi), lithium

Cigarette smoking
Stress/exercise
Obesity

26
Q

T/F? If a pt is on Lithium, they should stop and be on more modern Rx

A

False
if pt is doing well on Lithium-leave them be.
Dont change their life

27
Q

T/F? Smoking creates a state of chronic inflammation

A

True

28
Q

LFTs:

AST Predominant

A

Alcohol associated Hepatitis

29
Q

LFTs:

ALP predominant

A

Biliary obstruction or Bone

30
Q

How to Determine cause of ALP elevation?

A

Check Bilirubin

31
Q

LFTs:

ALP predominant, Bili elevated

A

liver/gallbladder obstruction

32
Q

LFTs:

ALP predominant, Bili not elevated

A

fracture,
osteomyelitis,
bone lesion,

33
Q

LFTs:

ALT predominant

A

Drug-induced liver injury

34
Q

K+ of 2.4 causes

A

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
Q

COMMON causes of ↑ D-Dimer

A 
DVT/PE
DIC
COVID-19
Severe infection-sepsis
Surgery/trauma
MI/CVA
Liver disease
Renal disease
Malignancy
Pregnancy

CDM I (9 decks)

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