MISCELLANEOUS QUALITATIVE (POINT OF CARE) TESTS AND COMMON LABS VALUES Flashcards by Tim Mackey

What is a parasitic infection caused by the introduction of the protozoan organisms into the blood by the bite of a female anopheles mosquito?

Malaria

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What is plasmodium?

malaria parasite

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Is it the male or female Anopheles mosquito that bites humans?

Female

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What is injected into a human when bitten by a mosquito?

Sporozoites

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Sporozoites enter what cells of the liver to become chizonts?

parenchymal cells

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Sporozoites development in the liver is referred to as what?

Pre-erythrocytic cycle.

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Further sporozoites development in the liver after RBC invasion is known as what?

Exoerythrocytic cycle.

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Inside parenchymal cells, Schizonts rupture, releasing _____, which then burst out of liver cells to invade RBCs.

merozoites

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Merozoites develop to form immature what?

(ring stage) trophozoites

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After merozoites develop to form immature (ring stage) trophozoites they become actively amoeboid and begin to feed on what?

Hgb inside RBC’s

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What is a pigment composed of hematin and protein, increased levels being responsible for symptomatic reactions (elevated temps) in malaria?

Malarial pigment

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Mature trophozoites develop into what?

schizonts

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When RBC’s rupture in malaria, schizonts rupture, releasing what?

merozoites

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Gametocytes are derived from what?

Merozoites

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True or False

Gametocytes are ingested by mosquitos

True

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Gametocytes ingested by mosquitos is the beginning of sexual reproduction, resulting in the production of what?

Zygotes

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Fertile zygote encysts, penetrates the midgut wall of mosquito forming what?

oocyst

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When oocyst matures, it ruptures and releases what inside the mosquito?

sporozoites

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Once released by oocyst, sporozoites migrate to where in the mosquito to be injected into a new host?

salivary glands

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All stages of asexual cycle of malaria can be demonstrated in a peripheral blood smear with the exception of what?

P. falciparum.

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Only in rings and gametocytes do RBC membranes become sticky as the parasite matures, cells begin to adhere to what parts of the internal organs interfering with normal blood flow?

endothelial lining of capillaries of internal organs

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What is a light blue circular structure with a red chromatin dot?

Ring form of P. falciparum

Double chromatin dots are common
Multiple ring forms common
Marginal or applique
RBC - usually normal in size

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What kind of gametocyte of P. falciparum is curved sausage/ banana shaped with central large chromatin dot covered with centralized mass of hemazoin?

Macrogametocyte (female)

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What kind of gametocyte of P. falciparum is shorter and wider than female with rounded ends, diffused chromatin seen with hemazoin granules?

Microgametocyte (male)

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True or False Gametocyte of P. falciparum is considered diagnostic

True

How many types of malaria are found in humans?

Four types

Which form of malaria is this? 1. Erythrocytic cycle (Malignant Tertian): Fever every 48 hours or every 2nd day. 2. Most Fatal: Likely to cause intravascular hemolysis (destruction of the RBCs). a. Fever is prolonged and intensified.

Plasmodium Falciparum:

Which form of malaria is this? 1. Erythrocytic cycle (Benign Tertian): Fever every 48 hours or every 2nd day 2. Most common

Plasmodium Vivax

What form of malaria is this? Erythrocytic cycle (Benign Tertian): Fever every 48 hours or every 2nd day

Plasmodium Ovale

What form of malaria is this? Erythrocytic cycle (Benign Quartan): Fever every 72 hours or every 3rd day

Plasmodium Malariae

When collecting a blood sample for malaria what kind of tube is used?

EDTA

A malaria blood sample can be stored for up to three days at what temperature range if it cannot be tested immediately?

2-30 degrees Celsius

IF the blood sample is refrigerated, should you allow it to return room temperature prior to performing the test for malaria?

Yes 15-30 degrees Celsius

What is Reagent A of the Rapid Malaria test composed of?

Tris buffer containing detergent and sodium azide.

Priming the Sample (purple) pad. For the venipuncture method for malaria testing how many MICROLITERS of blood do you collect?

15 microliters

Priming the reagent (white) pad Place how many drops of Reagent A onto the reagent pad? Allowing the first drop to absorb before placing the next drop.

2 drops

Priming the reagent (white) pad You should allow the mixture to run through the whole test strip

yes

Priming the reagent (white) pad True or False If the mixture does not run through the whole test strip in a minute, an additional drop of reagent a must be applied.

True

Priming the reagent (white) pad Before the mixture reaches the top of the test strip, add an additional ___ drops of reagent strip to the wash pad. Allow each drop to fully absorb.

Four

Results for the Rapid Malaria test are invalid after how long?

after 15 minutes

True or False With the Rapid Malaria test the “C” Control line must appear in order for the test to be valid.

True

Result interpretation Positive for Plasmodium Falciparum would be what line on the Rapid Malaria test?

Result interpretation Positive for Plasmodium Vivax, Malariae, or Ovale. May indicate mixed infection of the three malaria parasites would be what line on the Rapid Malaria test?

Result interpretation Positive for Plasmodium Falciparum and other types of malaria in a mixed infection would be what line on the Rapid Malaria test?

T1 and T2

Result interpretation Only the C line on the Rapid Malaria test would indicate what?

Negative result

True or False The test is invalid if the Control "C" line does not appear

True

True or False Rapid Malaria samples must be obtained when the patient does not have a fever

False Samples must be obtained when patient is febrile.

Who must the test be sent to after it is confirmed with a thick and thin smear?

NEPMU

False positive malaria test results can appear in patients with what conditions?

1. Rheumatoid arthritis 2. Chronic viral infections - Hepatitis C 3. Patient with other blood parasite – Babesia

True or False You need to send unstained smears to the Navy Environmental and Preventive Medicine Unit (NEPMU) as soon as possible for identification and confirmation.

True

What is a highly contagious, acute, viral infection of the respiratory tract?

Influenza

What is a communicable disease that is easily transmitted through coughing and sneezing of aerosolized droplets containing the live virus?

Influenza

What causes annual cold weather outbreaks of acute febrile upper and lower respiratory tract illness with characteristic accompanying systemic failures?

Influenza

True or False Influenza B is usually more common than A

False Influenza A is usually more common than B, and produces more serious illness

Influenza is best diagnosed within how long?

the first 2-3 days

What are these symptoms of? 1. Fever or feeling feverish 2. Chills 3. Cough 4. Sore throat 5. Runny or stuffy nose 6. Muscle or body aches 7. Headaches 8. Fatigue 9. Vomiting and diarrhea (more common in children)

Influenza

What are some benefits of Influenza testing?

1. Enable appropriate therapy | 2. Facilitate prompt treatment

True or False Some antivirals used for Influenza are only effective if administered within 48 hours of symptom onset

True

What alternative swabs can be used for the Rapid Influenza test?

1. Sterile rayon 2. Foam 3. Polyester 4. HydraFlock flocked (standard tip)

Do Rapid Influenza elution solution test vials come pre-filled?

Yes

Sample preparation Influenza When inserting the swab into the test vial how many times should you vigorously rotate it in the liquid?

three times

Testing Procedure Influenza After filling the pipette, you will SLOWLY drop by drop add the entire contents of the pipette onto the WHITE sample pad, what is the total content of the pipette you are adding to the MIDDLE of this sample pad?

100uL

Sample preparation Influenza True or False After pressing the swab against the inside of the vial and turning to remove the sample and discarding the swab, you can wait to test the liquid sample.

False, you need to test it as soon as possible

Testing Procedure Influenza True or False You do not add sample to the pink/purple colored pad

True

Testing Procedure Influenza After adding your sample, you immediately peel off the adhesive liner from the test device and close and secure the device. How long do you wait to read the result in the window?

15 minutes after closing the device

Testing Procedure Influenza True or False Test results read before or after 15 minutes can be inaccurate

True

Result interpretation Influenza What result is this? The BLUE Control Line in the BOTTOM THIRD of the window turns to a pink-to-purple color. No other line appears

Negative sample

Result interpretation Influenza What result is this? BLUE Control Line turns a pink-to-purple color AND a second pink-to-purple Sample Line appears above it in the MIDDLE THIRD of the window.

Flu A Positive Sample

Result interpretation Influenza True or False Any Sample Line, even when very faint, is positive.

TRUE

Result interpretation Influenza What result is this? BLUE Control Line turns a pink-to-purple color AND a second pink-to-purple Sample Line appears above it in the TOP THIRD of the window.

Flu B positive sample

Result interpretation Influenza What result is this? Control Line remains BLUE or is not present at all, whether a Sample Line(s) is present or not.

Invalid

Result interpretation Influenza True or False Repeat Invalid tests with a new test card

True

Result Suggested Report Influenza POSITIVE Flu A

Positive for Flu A protein antigen.

Result Suggested Report Influenza POSITIVE Flu B

Positive for Flu B protein antigen.

Result Suggested Report Influenza Negative

Negative for Flu A and Flu B protein antigens.

What happens when influenza disease prevalence in the community is low (beginning and end of the influenza seasons) what may happen?

False-positives may occur

What happens when influenza disease prevalence is high in the community (at the height of the influenza season) ?

False-negative may occur

How can you minimize false influenza test results?

1. Use rapid diagnostic tests with high sensitivity and specificity 2. Collect specimens as early in the illness as possible (within 4-5 days) 3. Follow manufacturer’s instructions, including handling of specimens

True or False Influenza tests should be used in conjunction with clinical findings to make an accurate diagnosis

True

True or False No additional testing is required to differentiate any specific influenza A and B subtypes or strains

False Additional testing is required to differentiate any specific influenza A and B subtypes or strains

Does influenza test performance depend on the amount of antigens in the specimen?

Yes

What lab test provides an important baseline of a patient's basic physiology?

Basic Metabolic Panel

What lab test measures 8 analytes and calculates an anion gap?

Basic Metabolic Panel

True or False The basic metabolic panel is used to assess kidney status, electrolyte, and acid/base balance, and blood glucose

True

What is the normal value for Sodium in a basic metabolic panel?

136-142 mEq/L

What is the normal value for Urea Nitrogen (BUN) in a basic metabolic panel?

8-23 mg/dL

What is the normal value for Calcium in a basic metabolic panel?

9.2-11 mg/dL

What is the normal value for Carbon Dioxide in a basic metabolic panel?

19-24 mmol/L

What is the normal value for Chloride in a basic metabolic panel?

95-103 mEq/L

What is the normal value for Creatinine in a basic metabolic panel?

0.6-1.2 mg/dL

What is the normal value for Potassium in a basic metabolic panel?

3.8-5.0 mEq/L

What is the normal value for Magnesium in a basic metabolic panel?

1.3-2.1 mEq/L

What is the normal value for Phosphorus in a basic metabolic panel?

2.3-4.7 mg/dL

What are the critical values for Sodium in a basic metabolic panel?

Low: <120 mEq/L High: >160 mEq/L

What are the critical values for Calcium in a basic metabolic panel?

Low: <6.0mg/dL High: >14.0 mg/dL

What are the critical values for Creatinine in a basic metabolic panel?

Low: None High: >3.0 mg/dL

What are the critical values for Potassium in a basic metabolic panel?

Low: <2.5 mEq/L High: >6.5 mEq/L

What are the critical values for Magnesium in a basic metabolic panel?

Low: <1.2mg/dL High: >4.9mg/dL

True or False Changes in serum sodium most often reflect changes in water balance rather than sodium balance

True

Hyponatremia (low sodium) is a serum concentration below what? And may indicate what?

1. <136mEq/L | 2. Over hydration

Hypernatremia (high sodium) is a serum concentration of what? And may indicate what?

1. Greater than 145mEq/L | 2. Indicates the need for water

What is the concentration of nitrogen (as urea) which is produced in the liver and is the end product of protein metabolism and filtered by the kidneys?

Urea Nitrogen (BUN)

What part of the basic metabolic panel is used to help diagnose liver and kidney diseases?

Urea Nitrogen (BUN)

A low BUN of 6-8 mg/dL may be a sign of what?

Overhydration or liver disease

A BUN range of 10-20mg/dL indicates what?

Normal kidney function

A BUN range of 50-150mg/dL implies what?

serious impairment of renal function

Of the body's total percentage of calcium, 99% is located in the bones and teeth and what percentage is located in the blood?

90% of hypercalcemia is caused by what?

1. a malignancy | 2. hyperparathyroidism

What part of the basic metabolic panel is used to evaluate the acid-base balance of the blood?

Carbon Dioxide

High levels of CO2 as seen in respiratory acidosis and low levels are associated with what?

respiratory alkalosis

What is the confirmatory test within the basic metabolic panel used to identify fluid balance and acid-base abnormalities?

Chloride

Hyperchloremia is seen in what?

dehydration and acidemia

What could be the result of vomiting, over hydration and alkalemia?

Hypochloremia

What is a byproduct of creatine, produced in the muscle, filtered by the kidneys, and levels can be used to measure renal insufficiency?

Creatinine

What is used in the regulation of muscle and nerve excitability ?

Potassium

What is the primary cause of hyperkalemia?

Renal failure

What is seen with Hypokalemia?

1. alkalosis 2. diuretic use 3. alcoholism 4. fluid loss

True or False Low magnesium can cause refractory hypokalemia

True it wont get fixed without fixing magnesium

What is involved in metabolism and energy production, needed for normal muscle contractility and neurological functions as well as oxygen-carrying by hemoglobin?

Phosphorus

What is a screening for liver damage, especially if someone has a condition or is taking a drug that may affect the liver?

Liver function test

What measures liver injury?

ALT and AST

Liver function test What is the normal value for Albumin?

3.2-5.6 g/dL

Liver function test What is the normal value for Alkaline Phosphates (ALP)?

20-130 units/L

Liver function test What is the normal value for Bilirubin Total?

0.1-1.2 mg/dL

Liver function test What is the normal value for Alanine aminotransferase (ALT)?

4-36 units/L

Liver function test What is the normal value for Aspartate aminotransferase (AST)?

8-33 units/L

Liver function test What is the normal value for Total Protein?

6-7.8 g/dL

What is used to help maintain plasma oncotic pressure? Due to a long half life of 20 days, you may see normal results even with a cessation of production. Decreased levels may be due any liver condition affecting protein synthesize.

Albumin

What refers to a group of enzymes. Moderately elevated levels usually 4X with no rise in ALT or AST is indicative of biliary disease. Levels less than 4X with elevated ALT or AST indicate liver damage.

Alkaline Phosphates

What is a byproduct of breakdown of heme pigments in RBC. Increased levels are seen in various conditions of liver damage. Elevated levels of bilirubin are responsible for jaundice.

Bilirubin

What are used to assess hepatocellular damage. Normally located in the liver cells an increase in there levels indicate active hepatocyte damage, not damage previously

ALT/AST

A ratio of ___ to ___ may be of value in diagnosing alcoholic hepatitis where the AST is generally a least twice the ALT and the AST is rarely above 300u/L.

AST to ALT

Besides the liver where else is AST located?

it may be found in cardiac muscle, skeletal muscle, kidneys, brain, lungs and intestines. Consequently, AST may be elevated due to a variety of conditions such as myocardial infarction, renal infarction, brain tumor or even vigorous exercise.

True or False Almost all prescription drugs can cause a rise in ALT/AST

True

What is a screening for nutritional deficiencies and gammopathies?

Total protein

An increase in Total protein is seen in what?

1. myeloma | 2. hypovolemia

A decrease in total protein is seen in what?

1. Malnutrition 2. Liver diseases 3. Severe skin diseases

What measures total cholesterol, high-density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, and triglycerides?

Lipid profile

A physician may order a lipid profile as part of an annual exam or if there is specific concern about cardiovascular disease, especially what?

Coronary artery disease

Lipid Panel What is the normal value for Total Cholesterol?

<200mg/dL

Lipid Panel What is the normal value for Triglycerides?

< 150 mg/dL

Lipid Panel What is the normal value for LDL?

<100mg/dL

Lipid Panel What is the normal value for HDL?

>40mg/dL

Is it recommended that all adults over the age of 20 to get a fasting lipid screening every 5 years?

Yes

What is a collective term for blood tests used to check the function of the thyroid?

Thyroid function tests (TFTs)

Thyroid Function Test What is the normal value of Free Thyroxine (FT4)?

0.9-2.3 ng/dL

Thyroid Function Test What is the normal value of Total Serum Thyroxine (T4)?

5.5-12.5 mcg/dL

Thyroid Function Test What is the normal value of Thyroid Stimulating Hormone (TSH)?

0.5-5.0 milliunits/L

True or False Free Thyroxine (T4) measures the unbound T4 in the serum and is the most accurate reflection of thryrometabolic status

True

High levels of Free thyroxine is associated with what? What about low levels?

High: Hyperthyroidism Low: Hypothyroidism

What is a glycoprotein secreted by the anterior pituitary gland?

Thyroid-Stimulating Hormone

What is a fasting test that gives an indication of the current glucose level?

Fasting Glucose

True or False The A1C gives the big picture of what average levels are over a two to three month period

True

What is the normal value for Glucose and A1C?

Glucose: 70-100mg/dL | A1C 4-6%

What is the critically low value for glucose? What is the critical high value?

Low: <40mg/dL High: >500mg/dL with no history of Diabetes

What test is the best indication of glucose homeostasis?

Fasting glucose

What value represents a normal fasting glucose?

<100mg/dL

What value represents prediabetes in fasting glucose?

> or equal to 100 and < 126mg/dL

What value can give you a provisional diabetes diagnosis with fasting glucose?

> or equal to 126mg/dL

What value in fasting glucose can give you a confirmed diagnosis of diabetes?

> or equal to 126mg/dL on two occasions

What are the major causes for high glucose levels?

1. Type 1 and 2 Diabetes | 2. Excessive intake