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Clin lab > lefebvre clin lab remediation > Flashcards

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
Q

sideroblastic anemia

A

PBS: micro & microcytic cells

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26
Q

megaloblastic anemia

A

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)

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27
Q

chronic alcoholism

A

inc. GGTP, NH4 (if cirrhotic)

dec. protein (albumin), trigs, BUN,

28
Q

reticulocytosis

A

inc. reticulocyte
early post bleeding period
cz by other conditions

29
Q

liver dz

A 
inc MCV (from cholesterol), NH4
dec protein, trigs, BUN
30
Q

Hypothyroidism

A

TSH screen

31
Q

acute blood loss

A

+ stool guaiac (hemocult) (can be assoc with acute gi bleeding)

32
Q

hemolytic anemia

A

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
Q

chronic dz

A

inc. wbc/esr/crp

34
Q

marrow failure

A

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
Q

interference with erythropoietic pathway

A

hormonal (thyroid/adrenal)
renal dz (erythropoietin)
severe liver dz

36
Q

prevelence of selected rheumatic dz

A 
oa
gout
pmr
ra
temporal arteritis
lupus
scleroderma/crest
37
Q

LBP

A

esr/crp (20/50, >50 req special imaging)
cbc
blood chem
ua/special tests

38
Q

jt p

A

esr/crp (can be used to monitor ra dz activity and response to therapy)

39
Q

oa

A

plain radiograph (good neg. predictive value, limited positive predictive value)

40
Q

RA

A

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
Q

lupus

A

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
Q

septic arthritis

A

wbc/esr can’t rule in/out

43
Q

temporal arteritis & pmr

A

esr >50 (sometimes >100). normal esr can’t rule out, esp if also have jaw claudication and scalp tenderness

may have up platelets

44
Q

Nephrotic Syndrome

A

dec. albumin and total protein

45
Q

Hepatitis

A

inc. AST, ALT (way up, 4x)

46
Q

obstructive liver conditions

A

inc. ALP and bilirubin the most

47
Q

liver failure

A

dec. normal output of liver (albumin, total protein, BUN, cholesterol), inc: NH4

48
Q

Hemolytic anemia

A

Inc. bili, LDH, SI
dec. haptoglobin

coomb’s test for immunohemolytic dz

49
Q

syndrome x

A

dec. HDL, inc: trig/glucose. risk factor for heart dz

50
Q

elevated ESR

A

+LR 18 for cancer related to LBP

51
Q

anemia + LBP

A

red flag for disease, ie. dec. HCT has +LR 18 for cancer

52
Q

Bladder infection (dipstick)

A

leukocyte esterase, nitrites, WBC

if infection moves up to kidney, LE will be negative

53
Q

Renal (dipstick)

A

Hb, protein

54
Q

bladder infection (lab)

A

> 2 WBC, bacteria ct, antibiotic sensitivity test

55
Q

renal (lab)

A

rbc/wbc casts (glomer/pyelo)

56
Q

WBC: viral infection

A

WBC N/dec
neu N/dec
lymp inc

57
Q

WBC: bacterial infection

A

WBC inc
Neut inc
(or inflam condition)

58
Q

inc eosinophils

A

weed/worms/weird

allergies/parasites/randoms (ie. leukemia)

59
Q

lymphocytes >50

A

~mono (follow w/ spot test…cheap or heterophil antibody test..most acc)

60
Q

wbc > 40k

A

leukemia

61
Q

wbc > 18k

A

appendix

62
Q

> 10% atypical lymphocytes

A

viral infection or leukemia

63
Q

hga1c

A

amt of Hb w/ sugar attached. diabetes

64
Q

hlab27

A

AS

65
Q

high BUN

A

high protein diet or kidney issue

66
Q

inc Ca

A

HPT or cancer

67
Q

MM

A

M spike, reverse A/G ratio (inc G), inc total protein

Clin lab (1 decks)

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