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Clin Lab > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

Describe the role of the clinical laboratory.

A

Medical lab testing plays a crucial role in the detection, diagnosis and treatment of disease in patients.

Laboratory tests help determine the presence, extent, or absence of disease and monitor the effectiveness of treatment.

Generate information.

Educate providers and other staff.

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2
Q

Name 5 reasons why one should order lab tests.

A

Identify changes in patients heath.

Diagnose a disease or condition.

Plan a treatment for a disease or condition.

Evaluate the response to a treatment.

Monitor the course of a disease over time.

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3
Q

What are the 7 things that affect lab results?

A
  • Gender
  • Age
  • Race
  • Medication
  • How closely prep instructions were followed
  • Variations in lab techniques
  • Variation from one lab to another
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4
Q

The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.

A

Evidence based medicine

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5
Q

What are the 3 pillars of EBM?

A

Individual clinical expertise

Best external evidence

Patient values and expectations

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6
Q

The medical laboratory testing plays a crucial role in the ______ of disease in patients.

A

Detection

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7
Q

Discuss the long reaching consequences of ordering unnecessary or inappropriate lab test.

A

Carpet bombing leads to false positives.

Missed diagnosis/incorrect diagnosis

Abnormal results.

Increased costs.

Adverse outcomes.

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8
Q

Histology
Autopsy
Cytology

A

Anatomic pathology

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9
Q

List the six sections under clinical pathology.

A 
Microbiology
Hematology 
Urinalysis 
Serology 
Chemistry 
Immunohematology
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10
Q

Which section of the lab deals with…

Cultures/sens 
Gram stain 
Parasitology 
Mycology 
Virology
A

Microbiology

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11
Q

Which section of the lab deals with…

CBC
ESR
Coagulation
Body fluids

A

Hematology

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12
Q

Which section of the lab deals with…

Routine urine testing
HCG - pregnancy test

A

Urinalysis

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13
Q

Which section of the lab deals with…

Ab titer
Immune function
Autoimmune disorders

A

Serology and immunology

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14
Q

Which section of the lab deals with…

Routine profiles
Urine/CSF
TDM (therapeutic drug monitoring)
Toxicology

A

Chemistry

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15
Q

Which section of the lab deals with…

Blood bank
Blood donation
Therapeutic phlebotomy

A

Immunohematology

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16
Q

List 4 lab support services.

A

Central process/Client services

Phlebotomy

Clerical services

Lab information systems

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17
Q

This section of anatomic pathology deals with the study of the microscopic examination of cells and tissues.

A

Histology

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18
Q

This section of anatomic pathology deals with the study of cells in terms of structure, function, and chemistry.

A

Cytology

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19
Q

Aids to diagnose anemia, hemophilia, blood clotting disorders, and leukemia.

Looks specifically at blood components such as cells counts and bone marrow cells.

Study of blood and its disorders.

A

Hematology

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20
Q

Describe urinalysis.

A

Performs routine urine screening tests for the detection of disease related to the kidneys and urinary tract.

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21
Q

In the chemistry section of the lab, what are the most common specimens?

A

Blood and urine

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22
Q

Test in the chemistry section of the lab may include…. (6 examples).

A 
Blood glucose
Electrolytes 
Enzymes
Hormones
Proteins
Lipids and other metabolic substances
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23
Q

What type of lipid helps estimate risk for coronary heart disease?

A

High density lipoprotein (good)

Low density lipoprotein (bad)

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24
Q

What type of lipid can signal coronary heart disease?

A

Cholesterol

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25
Q

Together with levels of cholesterol, this lipid can help indicate risk for coronary heart disease.

A

Triglycerides

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26
Q

BUN (blood urea nitrogen) is used to evaluate…

A

Kidney or liver function

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27
Q

Measurement of uric acid in a lab test can help detect…

A

Gout

Kidney disease and other tissue damage

28
Q

This protein can signal liver or kidney disease or malnutrition.

A

Albumin

29
Q

This protein can signal infection or inflammation and certain blood cancers.

A

Globulins

30
Q

Which enzyme can signal heart damage from a heart attack?

A

Creatine kinase

31
Q

Which enzymes can signal a liver disorder?

A

Alanine aminotransferase (ALT)

Aspartate or aminotransferase (AST)

32
Q

Which enzymes can signal inflammation or cancer of the pancreas?

A

Amylase and lipase

33
Q

What do Transfusion Services do?

A

Ensures donated blood or blood products are safe before they are used in blood transfusions.

Includes typing the blood for transfusion and testing for infectious disease.

34
Q

Responsible for identifying agents in the blood, urine, sputum, feces, cerebrospinal fluid, and other body fluids.

A

Microbiology

35
Q

A microbiology test that can identify disease causing organisms and test for effectiveness of antibiotics.

A

Culture and sensitivity of burns and wounds

36
Q

A microbiology test that can identify lower respiratory tract infections such as pneumonia.

A

Sputum culture

37
Q

A microbiology test that can identify bacteria causing GI upset or parasites that cause disease, such as pinworms.

A

Stool culture

38
Q

A microbiology test that can identify disease causing microbes in the kidneys and urinary tract.

A

Urine culture

39
Q

What 3 things do immunology and serology tests focus on?

A

Identifying antibiotics

Investigation problems with the immune system

Determining organ compatibility

40
Q

The use of this immunology and serology test is to…

Determine the state of an immunodeficiency and certain cancers.

A

Immunoglobulins

41
Q

The use of this immunology and serology test is to…

Classify arthritis and diagnose rheumatoid arthritis.

A

Rheumatoid factor

42
Q

The use of this immunology and serology test is to…

Test antibody response.

A

Infectious disease

43
Q

The use of this immunology and serology test is to…

Diagnose syphilis, which them must be confirmed with a more specific test.

A

Venereal Disease Research Lab (VDRL)

44
Q

The use of this immunology and serology test is to…

Determine compatibility in organ transplantation, to determine paternity and to diagnose HLA-related disorders.

A

HLA Typing (Human leukocyte antigens)

45
Q

What are the 5 sites of testing?

A 
Central lab
Satellite lab
Point of care testing 
Reference Laboratory 
Provider Office
46
Q

Who has ownership of the lab?

A

Pathologist or PhD

47
Q

What defines educational requirements, training, and competency requirements?

A

Clinical Lab Improvement Amendments (CLIA)

48
Q

Established quality standards for laboratories to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test is performed.

A

1988 Clinical Lab Improvement Amendments (CLIA)

49
Q

When CLIA established their standards, deficiencies decreased approximately _______%

A

40%

50
Q

What are the 5 primary laboratory accrediting organizations?

A

Commission on Office Lab Accreditation (COLA)

College of American Pathologist (CAP) - lab

The Joint Commission (TJC) - hospital

American Association of Blood Banks (AABB)

Clinical and Lab Standard Institute (CLSI)

51
Q

According to CLIA, what are the 3 phases of testing?

A
  1. Before testing (test ordering and specimen collection)
  2. During testing (control testing, test performance, and result interpretation/recording)
  3. After testing (result reporting, documentation, confirmatory testing, biohazard waste disposal)
52
Q

What are the 4 categories of test complexity as determined by the FDA and describe each.

A

Minimal complexity - commonly referred to as waived testing (Walgreens pregnancy test, almost impossible to screw up, low probability of causing harm).

Provider Performed Microscopy - subcategory of moderate complexity testing (tests that clinicians are allowed to do).

Moderate complexity - lab

High complexity - analytics, proteins on outside the cell, pathologist interprets numbers.

53
Q

What are the 5 pieces of criteria for classification of testing complexity according to CLIA?

A
  1. Risk of harm to patient.
  2. Risk of erroneous result.
  3. Type of testing method used.
  4. Degree of independent judgement/interpretation.
  5. Availability of the test in questions for home use.
54
Q

Employ methodologies that are so simple and accurate as to render the likelihood or erroneous results negligible.

Pose no reasonable rose of harm to the patient of the test is performed incorrectly.

Cleared by the FDA for home use.

A

Waived test

55
Q

What are some examples of waived tests?

A

Dipstick or tablet reagent urinalysis

Fecal occult blood

Ovulation tests

Urine pregnancy tests

Erythrocyte sedimentation rate

Hemoglobin

Most “bed side” testing

56
Q

A higher level of specimens manipulation is required prior to analysis and/or interpretation is required to determine the test result.

A

Moderate complexity testing

57
Q

These fall into what type of testing?

General chemistry 
Specific proteins 
Drugs of abuse/toxicology 
TDM 
Hematology testing
A

Moderate complexity testing

58
Q

Must be categorized as moderately complex.

Primary instrument is the microscope.

The specimen is labile.

Controls are not available.

There is limited specimen handling.

A

Provider Performed Microscopy

59
Q

Direct wet mount preparations for the presence of bacteria, fungi, parasites, and cellular elements for vaginal, cervical, and skin.

KOH preps

Pinworm exams

Fern Test

Urine sediment exam

Nasal smears for granulocytes (allergies)

These are examples of..

A

PPM examples

60
Q

Tests that require clinical laboratory expertise beyond normal automation to perform.

When the output of data requires some expertise.

A

High Complexity Test

61
Q

Examples include cytology, immunohistochemistry, peripheral smears, flow cytometry, gel electrophoresis, and most molecular diagnostic tests including RT-PCR, gene chip arrays, etc.

A

High complexity testing

62
Q

Why are all the different types/levels of tests and agencies important to the PA?

A

Understand what testing may be performed at bed side or in office.

Appreciate various regulatory agencies and how the failure to report PPM may yield a finding during an accreditation inspection.

63
Q

Your order a follicle stimulating hormone test on your patient, but the lab gives you results for luteinizing hormone. Which lab department do you call to discuss the discrepancy?

A

Chemistry

64
Q

A test must meet which criterion to be classified as a waived test?

A

Pose no reasonable risk of harm to the patient if the test is performed incorrectly.

65
Q

The two main divisions of a clinical lab are?

A

Anatomic and clinical

Clin Lab (4 decks)

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