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LAB DIAG > M1: Specimen Collection I > Flashcards

M1: Specimen Collection I Flashcards

0
Q

Specimen volume: should be ______. If not, _______ request.

A

Adequate. Prioritize

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1
Q

Timing of Specimen Collection: Best time to collect is during _________ of illness and ______________ therapy.

A

Acute Phase. Before Antimicrobial.

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2
Q

Specimen volume: __________ swab on a plastic shaft.

A

Polyester-tipped

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3
Q

Avoid in Collecting Swab Specimens: if collecting for viral culture, could inactivate HSV.

A

Calcium Alginate

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4
Q

Avoid in Collecting Swab Specimens: toxic to N. Gonorrhea

A

Cotton

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5
Q

Avoid in Collecting Swab Specimens: toxic to C. Trachomatis

A

Wooden shaft (wood)

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6
Q

Specimen Volume: Swabs are not optimal for detection of _______, _______ & ________.

A

Anaerobes, Mycobacteria & Fungi “AMF”

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7
Q

Specimen Volume: _____________ is always superior than swab.

A

Actual tissue/Fluid aspirate

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8
Q

Specimen Collection: site of _______ & _______ container.

A

Infection. Sterile.

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9
Q

Specimen Collection: Include all the following(_______ the container). Name & ________ of patient. ________ of specimen. And _________ collected.

A

Label. Indentification number. Source. Date & Time.

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10
Q

Specimen Transport: all specimen must be in a _________ bag. And transported ________.

A

Biohazard. ASAP.

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11
Q

Specimen Transport: Delays. Refrigerate.

A

Urine, Stool & Sputum other respiratory specimen “USS”

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12
Q

Specimen Transport: Delays. Do not Refrigerate. (Keep @ room temp)

A

CSF & body fluids, Specimens for recovery of N. Gonorrhea & Blood “CSB”

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13
Q

For detection of C. Trachomatis & viruses.

A

Stool

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14
Q

Specimens Rejected: Specimen/s in ________.

A

Formalin

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15
Q

Specimens Rejected: ______ sputum.

A

24°

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16
Q

Specimens Rejected: _______ samples.

A

Leaking

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17
Q

Specimens Rejected: Specimen inoculated into agar that has ________ or ________.

A

Dried/Outdated

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18
Q

Specimens Rejected: Contaminated by

A

Chemical dyes, Oily chemicals & Barium “COB”

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19
Q

Specimens Rejected: Foley catheter _____.

A

Tips

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20
Q

Specimens Rejected: _______ specimen received within 24° period.

A

Duplicate specimen

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21
Q

Specimens Rejected: Blood catheter tip from patient without concominant ______________.

A

Positive blood culture

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22
Q

Rejected for Anaerobic Culture: _______ washing.

A

Gastric

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23
Q

Rejected for Anaerobic Culture: Urine other than __________.

A

Suprapubic aspirate

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24
Q

Rejected for Anaerobic Culture: Stool (except for recovery of __________)

A

C. Difficile

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25
Q

Rejected for Anaerobic Culture: Oropharyngeal specimen (except __________ specimen obtained during surgery)

A

Deep tissue

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26
Q

Rejected for Anaerobic Culture: ______ & swabs for ________.

A

Sputum. Ileostomy.

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27
Q

Rejected for Anaerobic Culture: ________ specimens.

A

Superficial

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28
Q

Universal Precaution: Ideally, all specimens, but at a minimum respiratory specimens and those submitted for detection of mycobacteria or fungi must be opened in a _____________.

A

Biological Safety Cabinet

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29
Q

Personal Protective Equipment

A

Gloves & Lab coat, Masks & Goggles and Gowns or Aprons

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30
Q

Referral Testing: All infectious shipping packages must be labelled, containing ________ & _______ as well as __________ of person responsible for the shipment.

A

Address. Contents. Name & Address.

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31
Q

Dangerous Goods Shipping Guidelines: no more than ______.

A

40mL

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32
Q

Dangerous Goods Shipping Guidelines: Cultures of bacteria & fungi placed on _________ in tubes.

A

Solid media

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33
Q

Dangerous Goods Shipping Guidelines: Capped & sealed with _________.

A

Waterproof tape

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34
Q

Dangerous Goods Shipping Guidelines: Placed in a ____________.

A

Secondary container

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35
Q

Dangerous Goods Shipping Guidelines: If several primary container, it must be ___________ or separated to prevent contamination between containers.

A

Individually wrapped

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36
Q

Secondary packaging/container, must be ________, capped and placed in a corrugated fireboard or hard plastic. Must be able to withstand _______ & _________ it will be subjected to.

A

Leakproof. Temp & air pressure.

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37
Q

Dangerous Goods Shipping Guidelines: Itemized list must be enclosed in between the ________ & __________.

A

Secondary & Outer packaging

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38
Q

Dangerous Goods Shipping Guidelines: _______ if needed, must be placed outside second container.

A

Dry ice

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39
Q

Most important function of microbiology laboratory

A

Detection of blood borne pathogens

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40
Q

Is essential for identifying bacteria responsible for bacteremia, sepsis, infections of native or prostatic valves, suppurative thrombophlebitis, mycotic aneurysm & infections of vascular grafts.

A

Culture of blood

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41
Q

Blood is important in the diagnosis of invasive or disseminated infections caused certain fungi especially

A

Candida spp, Cryptococcus neoformans, Histoplasma capsulatum & Fusarium spp “CCHF”

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42
Q

Are detected using peripheral blood smear

A

Parasites

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43
Q

Blood should be collected for culture ____________ when one or combination of the following are present: Fever(38 or higher), Hypothermia(36 or lower), Leukocytosis(esp. Left shift), Granulocytopenia & Hypotension.

A

Before antimicrobial therapy

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44
Q

Specimen Collection of Blood: Timely collection and accurate identification of organisms depend on

A

Appropriate collection, Transportation & Processing specimen “ATP”

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45
Q

Specimen Collection of Blood: To minimize contamination of normal flora. Venipuncture site should be prepared with a ____________. 70% of _________ alcohol, 1-2% of _______ solution and _______ or Chlorhexidine.

A

Bactericidal. Isopropyl/Ethyl. Iodine. Iodophor.

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46
Q

Specimen Collection of Blood: For maximum antisepsis, drying are for _______ before venipuncture.

A

1-2mins

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47
Q

Appropriate Timing for Detection of Bacteremia & Fungemia: Optimal time if just _______ a chill. (Not predictable) Collected after onset of ______ & ______.

A

Before. Fever & Chills.

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48
Q

Appropriate Timing for Detection of Bacteremia & Fungemia: Procedure. Blood- bottles of culture media- _______ several times to ensure mixing- transported to laboratory at ______ temperature.

A

Inverted. Room.

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49
Q

Specimen volume: Adults,_______ blood per culture set. Infants & Children, _______.

A

20-30mL. 1-5mL.

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50
Q

Recommended number of blood specimen to collect depend on ____________.

A

Nature of bacteremia

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51
Q

Associated with undrained abscess

A

Intermittent Bacteremia

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52
Q

Hallmark of intravascular infection. Occurs during first weeks typhoid fever and brucellosis.

A

Continuous Bacteremia

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53
Q

Manipulation of a focus of infection. Instrumentation of a contaminated mucosal surface. Surgical procedure in a contaminated site. Occurs early in course of many systemic & localized infections.

A

Transient Bacteremia

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54
Q

Patients with Endocarditis: two to three ____ blood samples drawn over ______ period and equally distributed into aerobic and anaerobic blood culture bottles.

A

20mL. 24hr.

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55
Q

Patients with Endocarditis: _____ blood cultures drawn within 24hrs with ________ interval for the first ____ sets, another one to two dets drawn over remaining 24hrs if __________ persists (inc yield of potential pathogens by 20%)

A

Four. 30-60mins. 2. Septicemia.

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56
Q

Patients with Endocarditis: If antimicrobial therapy initiation is urgent, it should be collected ______ therapy begun, from separate sites within few minutes.

A

Before

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57
Q

Host Factors that might impede recovery of MO

A

Complement, Antibodies & WBC(phagocytic) “CAW”

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58
Q

Mech to Counteract Host Factors: Diluting blood specimens. 1:10 ratio to neutralize serum bacterial activity.

A

Broth medium

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59
Q

Mech to Counteract Host Factors: inhibits coagulation, phagocytosis, complement activation and inactivates aminoglycosides.

A

Incorporate 0.02%-0.05% Sodium Polyethanol

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60
Q

Mech to Counteract Host Factors: Counteract microbial agents

A

Antibiotic-adsorbent resins & Lysis-centrifugation System

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61
Q

Biphasic system. For aerobic & facultative bacteria & yeast. Broth medium in a bottle with attached chamber containing agar media on a paddle. Procedure. Bottle is tipped- blood broth mixtures enter chamber and flow over agar and media- colonies from agar media- used for identification & susceptibility testing.

A

Antibiotic Adsorbent Resins

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62
Q

Inhibits coagulation and complement cascade. Lyse blood cells. Provide cushion for MO during centrifugation. Smaller tubes for low volume samples. Procedure. Blood- tube- inverted several times- transported asap- centrifuged for _____ @ _________- supernatant discarded- sediment mixed in vortex mixer- plated to agar.

A

Lysis-Centrifugation System. 30mins. 3000g.

63
Q

Advantages of Lysis-Centrifugation System: Excellent for recovery of ________ some _______ and ______.

A

Staph A., Enterobacteriaceae & Fungi

64
Q

Advantages of Lysis-Centrifugation System: Best for recovery of ________.

A

Histoplasma capsulatum

65
Q

Advantages of Lysis-Centrifugation System: __________ of colonies for identification & susceptibility testing. Carry out _______ cultures.

A

Direct availability. Quantitative.

66
Q

Disadvantages of Lysis-Centrifugation System: Labor _______.

A

Intensive

67
Q

Disadvantages of Lysis-Centrifugation System: Less likely to recover _______, _______ or anaerobes.

A

Streptococcus pneumoniae & Haemophilus influenzae

68
Q

Disadvantages of Lysis-Centrifugation System: Risk of ______ increased.

A

Contamination

69
Q

Advantages of Lysis-Centrifugation System: _____, special media can be inoculated to recover organisms with specific growth requirements like _________ & __________.

A

Flexible. Legionella & Mycobacteria.

70
Q

Based on detection of CO2 produced during microbial growth. Procedure. Inoculated bottles continuously rocked- if bacteria is present- production of CO2- released to broth- pH dec- sensor change color- green to yellow.

A

Calorimetric

71
Q

Calorimetric: medium available. Routine _____ of blood. PediBacT </= _____ of blood.

A

5-10mL. 4mL.

72
Q

Enhances detection of fungi & bacteria from patient under antimicrobials

A

Fastidious Antibiotic Neutralization

73
Q

CO2 sensor generates hydrogen ions- dec pH- inc fluorescence- change signal- computer generates growth curves- data analyzed bia growth algorithms.

A

Fluorescent technology

74
Q

Medium Available in Fluorescent technology: Aerobic & anaerobic low volume. _______ blood.

A

5-7mL

75
Q

Medium Available in Fluorescent technology: High volume

A

8-10mL of blood

76
Q

Medium Available in Fluorescent technology: Peds plus

A

0.5-5mL blood

77
Q

Medium Available in Fluorescent technology: recovery of fungi & mycobacteria

A

Myco F Lytic

78
Q

Procedure. Inoculated vial fitted with disposable connector that contains recessed needle- penetrates bottle stopper and connects bottle headspace to sensor probe- sensor monitors consumption and or production of all gases- creates data points in computer. Medium available is aerobic & anaerobic media ______ broth + 0.1-10mL blood. EZ draw(direct draw) _____ broth + 0.1-5mL blood.

A

Measuring Gas Consumption. 80mL. 40mL.

79
Q

Positive blood cultures with commonly isolated aerobic organisms are detected within _________ of incubation. The initial report is ______ only. Identification & susceptibility report within _______ after gram stain report.

A

12-36hrs. 24-48hrs.

80
Q

Cultures containing _______ not detected for 48-72hrs. Identification is not available for _______ after that.

A

Anaerobes. 3-4 days.

81
Q

Fastidious organisms, such as those found in the HACEK group may not be detected until 3-5days

A

Haemophilus, Actinobacillus, Cardiobacterium, Eikenella & Kingella

82
Q

Blood specimens are most commonly collected to monitor response of infection to antiviral therapy by using ___________ to measure viral load of HIV, HCV, HBV & CMV.

A

Quantitative PCR

83
Q

For HIV & HCV, Blood specimens may also be collected for

A

Genotyping

84
Q

Used to confirm an initial positive HCV antibody result

A

PCR

85
Q

Useful for monitoring for development of disease and for diagnosis of disease in specific functions

A

Viral load

86
Q

Used to predict those at high risk for development of CMV disease and direct the initiation or pre emptive therapy in immunocompromised patients, transplant recipients & AIDS.

A

Determining the level of CMV DNA

87
Q

Indicated in transplant recipients at high risk for EBV associated lymphoproliferative disease.

A

Epstein Barr virus DNA serum or plasma by quantitative PCR

88
Q

Test of choice for diagnosing disease caused by parvovorus B19 in immunosupressed patients or in the fetus.

A

Quantitative PCR from whole or peripheral blood for diagnosing HHV 6 & HHV 7

89
Q

Are useful for detection of malaria, babesiosis, trypanosomiasis & some filariasis.

A

Blood specimens

90
Q

Detection of Parasites: Specimens should be collected in tubes with ________ & transported promptly to the laboratory.

A

Anticoagulant

91
Q

Detection of Parasites: If smears must be sent to a reference laboratory, they should be fixed in _______ soon after they are made.

A

Absolute alcohol

92
Q

Detection of Parasites: The simple technique for detecting parasites in a sample of blood is the _________, prepared by placing one drop of blood on a glass slide, covering it with a cover glass, and examining it immediately.

A

Direct mount

93
Q

Detection of Parasites: Are excellent for diagnosis of trypanosomiasis or filariasis because trypomastigotes and the microfilariae easily can be seen moving often with low or medium power.

A

Direct mounts

94
Q

Detection of Parasites: the definitive diagnosis is made by

A

Staining smears

95
Q

Detection of Parasites: made as for hematologic work and stained in a similar manner, is the standard preparation for determining species of plasmodium, babesia, trypanosoma & microfilaria.

A

Thin smear

96
Q

Detection of Parasites: thin smears for parasitologic work are fixed and then preferably stained manually with _________, but automated hematologic staining is adequate.

A

Giemsa stain

97
Q

Detection of Parasites: are first scan with low power to detect microfilariae, which are large objects (between 100 & 200 um) and easily seen, usually at the lateral edges of the smear.

A

Smears

98
Q

Detection of Parasites: after they are located, ________ should be studied under oil immersion for identification.

A

Microfilariae

99
Q

Detection of Parasites: Following scanning with low power, the smear is examined with a high dry objective, searching for

A

Trypanosomes

100
Q

Detection of Parasites: and finally under oil immersion, to find and identify

A

Plasmodium, Babesia & Trypanosoma “PBT”

101
Q

Detection of Parasites: are useful for detecting all the parasites mentioned and are part of minimum laboratory work up for their diagnosis

A

Thick smears

102
Q

Is collected to diagnose meningitis and less frequently viral encephalitis

A

CSF

103
Q

A medical emergency requiring early therapy to prevent death or serious neurologic sequelae. Divided into acute, subacute & chronic clinical syndromes based on duration of symptoms

A

Infectious meningitis

104
Q

Duration is 1-7days. Caused by enteroviruses & pyogenic bacteria.

A

Subacute

105
Q

Persisting at least 4 weeks with many pathologic causes

A

Chronic

106
Q

Less than 24 hours. Caused by pyogenic bacteria.

A

Acute

107
Q

Are the agents most commonly responsible for meningitis and they should be considered first in the differential diagnosis of meningitis in a child or adolescent during the late summer and early fall.

A

Enteroviruses

108
Q

Responsible for meningitis vary with the age of the affected individual

A

Pyogenic bacteria

109
Q

CSF: usually obtained by

A

Lumbar puncture

110
Q

CSF: sometimes it is aspirated from the _______ or collected from a ______.

A

Ventricles. Shunt.

111
Q

CSF: tube for cell counts and differential stains

A

Tube 3

112
Q

CSF: tube for preparation of smears to stain with the Gram’s stain or other stains and for a culture

A

Tube 2

113
Q

CSF: protein & glucose

A

Tube 1

114
Q

CSF: tube only if indicated, special test such as the cryptococcal antigen, serologic test for syphilis & cytology.

A

Tube 4

115
Q

CSF: normal WBC

A

5 (lymphocytes)

116
Q

CSF: normal protein

A

14-45mg/dL

117
Q

CSF: normal glucose

A

45-100mg/dL

118
Q

CSF: CSF should be transported ______ to the laboratory & processed as ________ as possible.

A

Promptly. Rapidly.

119
Q

CSF: If a brief delay in processing is unavoidable, the specimen should be heal at _________ unless viral culture is requested, in which case a portion may be refrigerated at a short time.

A

Room temp

120
Q

Processing of CSF includes concentration if 1mL or more is received. Preparation of smear by __________. (Gram stain)

A

Centrifugation

121
Q

Concentrate the fluid by centrifugation of ______g for ____mins

A
  1. 15.
122
Q

Decanted into sterile tube

A

Supernatant

123
Q

Leave 0.5mL of sediment and fluid- mixed on vortex mixer or ________.

A

Forceful aspiration

124
Q

Requires a special request

A

Chronic bacterial meningitis

125
Q

Routine bacterial culture. Media are incubated for 2-3 weeks.

A

Brucelossis

126
Q

May be cultured during the first few weeks of illness

A

Leptospira interogans

127
Q

Pleocytosis. Elevated protein concentration. Positive VDRL test.

A

Neurosyphilis

128
Q

Involvement of CNS. Detection of IgM & IgG in antibodies in CSF & serum.

A

B. Burgdorferi (Lyme dse)

129
Q

Only useful method for detecting antibodies to Treponema Pallidum in the CSF

A

VDRL test

130
Q

Detected only if the findings in the CSF shows pleocytosis or decreased glucose or elevated protein values.

A

Mycobacteria

131
Q

Nucleic acid amplification for direct detection

A

Mycobacterium tuberculosis

132
Q

Media for processing CSF for detection of fungi

A

Brain-heart infusion or SABHI agar w/out antibiotics

133
Q

Most useful in diagnosing partially treated meningitis and confirming a positive Gram-stained smear. May be performed with the use of the supernatant of a centrifuged specimen or the original fluid. For detection of antigens of streptococcus agalactiae & S pneumoniae. Disadvantage is compared to gram stain, its sensitivity is not significantly greater and more expensive.

A

Latex Agglutination test

134
Q

Meningitis is primarily caused by

A

Cryptococcus Neoformans

135
Q

Two test for diagnosis of meningitis

A

Latex agglutination & ELISA and Indian Ink Preparation

136
Q

Allow the visualization of encapsulated yeast cells. Performed by mixing 1 drop of CSF sediment with 1 drop of india ink. Sensitivity is low, except in HIV-infected persons

A

Indian Ink Prep

137
Q

Specific for capsular antigen. Highly specific and have sensitivities of more than 90%. Recommended for diagnosis. Supernatant can be used. Should be performed before culture or on separate sample to avoid problem.

A

ELISA & Agglutination test

138
Q

False positive latex agglutination occur due to the presence of _________ or to the introduction of condensation form agar into the test fluid.

A

Trichosporon asabii

139
Q

Are used most often for dx of viral infections in CSF.

A

Nucleic Acid Amplification Test (NAAT)

140
Q

Primarily for detection of enteroviruses although PCR is preferred

A

Conventional cell culture

141
Q

For viruses that cause encephalitis

A

Serologic test

142
Q

Are prepared directly from the specimen and from the sediment by first shaking the tube gently and the centrifuging the specimen at 250g for 10mins.

A

Wet preparations

143
Q

Preparations are examined under the microscope with the condenser in a low position to allow visualization of trophozoites or by

A

Phase contrast microscopy

144
Q

This volume is adequate for isolating most bacteria

A

1-5mL

145
Q

Is optimal for recovery of mycobacteria & fungi

A

10-15mL

146
Q

To diagnose peritonitis associated with chronic ambulatory peritoneal dialysis, collection of at least _______ of fluid may improve recovery of the responsible pathogen.

A

50mL

147
Q

Are among the most common cause of pericarditis

A

Coxsackie viruses A & B (enteroviruses)

148
Q

Strongly recommended for virus isolation from persons with suspected enteroviral pericarditis

A

Collection of throat washing or stools

149
Q

A smear of the sediment is prepared for staining with Gram stain or __________.

A

Calcoflour white

150
Q

Are rarely collected for detection of parasites

A

Body fluids

151
Q

May be found in the pericardial, pleural or peritoneal cavity. Result of rupture of an abscess of the liver into those cavities. Perforatiom of amoebic ulcers into the peritoneal cavity.

A

Entamoeba Histolytica

152
Q

Are infrequently diagnosed by examination of body cavity fluid also due to rupture of a cyst into a viscus contiguous to the cavity in question. Contains hyatid sand but rarely is turbid because of superimposed bacterial infection.

A

Hydatid cysts (Echinococcus spp)

153
Q

Examination of wet preparations of a body cavity of fluid may demonstrate the microfilariae

A

Filarial infection

154
Q

Larvae may be detected in body cavity fluids

A

Strongyloides hyperinfection

155
Q

Serves not only to differentiate between infection and malignancy but also to distinguish between a suppurative & granulomatous process

A

Histopathology of the lesion

156
Q

Used to inoculate all of the necessary culture media and is the stored under refrigeration for atleast 2 weeks before being discarded.

A

Suspensions

LAB DIAG (6 decks)

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