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lefebvre clin lab remediation Flashcards

1
Q

Most important values for bone

A

ALP, calcium, globulins (protein)

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2
Q

ALP changes

A

up: blastic activity (growing/post fracture) or blastic lesion (mets, osteosarcoma, paget’s), sometimes with lytic lesions

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3
Q

Ca changes

A

up with MM and many osteolytic metastatic bone cancers (NOT osteoporosis)

inc Ca suggests hyperparathyroidism (order PTH)

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4
Q

globulin changes

A

up in MM (may have reverse A/G ratio, follow up with protein electrophoresis)

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5
Q

creatinine

A

jt/msl: down in primary myopathies or sig. msl breakdown (creatine kinase goes up with it)

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6
Q

uric acid

A

suggests gout

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7
Q

diabetes

A

glucose >100 pre-diabetes, >126 diabetes (order HgbA1C)

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8
Q

MI

A

inc AST, LDH, troponins, CPK-MB (troponin/CPK most imp)

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9
Q

Angina

A

no chem changes

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10
Q

heart dz risk factors

A

inc cholesterol, LDL, trigs, glucose, dec. HDL, and low level inflammation indicated by hsCRP

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11
Q

kidney

A

inc creatinine (best test), BUN, sometimes uric acid are relatively late signs of renal failure (24hr urinary creatinine clearance better for early failure). glomerulonephritis (R cast) and pyelonephritis (W cast) do not usually cz much chem panel change, may cz brief inc. in BUN and creatinine. Ca may also go down..

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12
Q

liver

A

inc. BAAAGL (bilirubin, ALP, AST, ALT, GGTP and/or LDH)

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13
Q

hemolytic anemia

A

unconjugated bilirubin, LDH in blood

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14
Q

starvation/malabsorption

A

dec albumin and total protein (same signs as liver failure or nephortic syndrome)

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15
Q

ALP

A

inc. with bone blastic, liver dz, pregnancy and 3mo post partum

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16
Q

BUN

A

inc with kidney dz and inc protein intake

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17
Q

globulin

A

up with viral infection (along with esr/lymphocytes), and MM

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18
Q

Microcytic, hypochromic anemia

A

Iron deficiency, thalassemia, chronic Dz, Sideroblastic anemia

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19
Q

macrocytic, normochromic anemia

A

megaloblastic anemia, chronic alcoholism, reticulocytosis, liver dz, hpothyroidism

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20
Q

normocytic/chromic, good marrow response

A

> 3% retic/>2% index: acute blood loss, hemolytic anemia, drugs/toxins, post-reatment or early stage of deficiency syn

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21
Q

nomocytic/chromic, bad marrow response

A

<3% retic: chronic dz, marrow failure, interference with erythropoietic pathway, stress/drugs

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22
Q

ID

A 
inc RDW/TIBC
dec SI/%TS/serum ferritin
chronic bleeding (colonoscopy, stool guaiac)
dietary/inc demand (ie. preg)
malabsorption
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23
Q

thalassemia

A

N RDW
MCV <70, other irons N or up
Hgb electrophoresis, reverse HgbA1/A2 ratio if beta
target cells

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24
Q

chronic dz

A

N RDW
dec. SI, N/dec TIBC, N/up serum ferritin!
sometimes inc. crp/wbc/esr

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25
sideroblastic anemia
PBS: micro & microcytic cells
26
megaloblastic anemia
up MCV (esp if >110), N/dec WBC/platelet up LDH, and unconj bilirubin PBS: macroovalcytes, hypersegmented PMNs A. folic acid def: dec RBC folic acid and serum folic acid B. B12 def C. Pernicious anemia: methylmalonic acid + anti-gastric parietal cell antibody)
27
chronic alcoholism
inc. GGTP, NH4 (if cirrhotic) | dec. protein (albumin), trigs, BUN,
28
reticulocytosis
inc. reticulocyte early post bleeding period cz by other conditions
29
liver dz
``` inc MCV (from cholesterol), NH4 dec protein, trigs, BUN ```
30
Hypothyroidism
TSH screen
31
acute blood loss
+ stool guaiac (hemocult) (can be assoc with acute gi bleeding)
32
hemolytic anemia
inc LDH, unconjugated (indirect) bilirubin, SI dec. haptoglobin A. Hemoglobinopathies (+ HgB electrophoresis, abnormal PBS) (sickle cell trait via sickledex, sickle cell anemia, Hgb C dz) B. Immunohemolytic dz (+ coombs test) C. Hereditary spherocytosis (osmotic fragility) D. jarring exercise E. splenic dz
33
chronic dz
inc. wbc/esr/crp
34
marrow failure
dec rbc/wbc/platelet A. neoplasms (in bone) ie. MM/mets B. aplastic anemia (from drugs/infection/idiopathic) (MM m/c primary bone cancer, viral infection, toxin)
35
interference with erythropoietic pathway
hormonal (thyroid/adrenal) renal dz (erythropoietin) severe liver dz
36
prevelence of selected rheumatic dz
``` oa gout pmr ra temporal arteritis lupus scleroderma/crest ```
37
LBP
esr/crp (20/50, >50 req special imaging) cbc blood chem ua/special tests
38
jt p
esr/crp (can be used to monitor ra dz activity and response to therapy)
39
oa
plain radiograph (good neg. predictive value, limited positive predictive value)
40
RA
RF (higher = more aggressive dz), anti-ccp (more sensitive and specific) CBC ESR Dx can't be made on blood tests alone pos liklihood ratio 12 anti ccp, 4 rf
41
lupus
ANA (v. sensitive, not v. specific unless titer of 1:80 or more) follow up with anti ds DNA (v. specific, not sensitive) inc esr/crp. (ESR only elevated when dz is active, CRP when arthritis is involved too). can create normocytic anemia, and even dec. WBC/Neutrophils/platelets. Targets kidneys often, cz inc. creatinine/BUN, proteinurea and sometimes R casts
42
septic arthritis
wbc/esr can't rule in/out
43
temporal arteritis & pmr
esr >50 (sometimes >100). normal esr can't rule out, esp if also have jaw claudication and scalp tenderness may have up platelets
44
Nephrotic Syndrome
dec. albumin and total protein
45
Hepatitis
inc. AST, ALT (way up, 4x)
46
obstructive liver conditions
inc. ALP and bilirubin the most
47
liver failure
dec. normal output of liver (albumin, total protein, BUN, cholesterol), inc: NH4
48
Hemolytic anemia
Inc. bili, LDH, SI dec. haptoglobin coomb's test for immunohemolytic dz
49
syndrome x
dec. HDL, inc: trig/glucose. risk factor for heart dz
50
elevated ESR
+LR 18 for cancer related to LBP
51
anemia + LBP
red flag for disease, ie. dec. HCT has +LR 18 for cancer
52
Bladder infection (dipstick)
leukocyte esterase, nitrites, WBC | if infection moves up to kidney, LE will be negative
53
Renal (dipstick)
Hb, protein
54
bladder infection (lab)
>2 WBC, bacteria ct, antibiotic sensitivity test
55
renal (lab)
rbc/wbc casts (glomer/pyelo)
56
WBC: viral infection
WBC N/dec neu N/dec lymp inc
57
WBC: bacterial infection
WBC inc Neut inc (or inflam condition)
58
inc eosinophils
weed/worms/weird | allergies/parasites/randoms (ie. leukemia)
59
lymphocytes >50
~mono (follow w/ spot test...cheap or heterophil antibody test..most acc)
60
wbc > 40k
leukemia
61
wbc > 18k
appendix
62
>10% atypical lymphocytes
viral infection or leukemia
63
hga1c
amt of Hb w/ sugar attached. diabetes
64
hlab27
AS
65
high BUN
high protein diet or kidney issue
66
inc Ca
HPT or cancer
67
MM
M spike, reverse A/G ratio (inc G), inc total protein

Clin lab (1 decks)

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