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Laboratory Part 2 > Miscellaneous Qualitative Tests and Common Lab Values > Flashcards

Miscellaneous Qualitative Tests and Common Lab Values Flashcards

1
Q

What is the carrier of malaria?

A

Female anopheles mosquito.

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2
Q

What are injected into humans when the female anopheles mosquito bites?

A

Sporozoites.

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3
Q

Where in the body do sporozoites develop and become shizonts?

A

The liver.

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4
Q

What do immature trophozoites feed on, and what residue do they make that causes symptomatic reactions such as elevated temperature?

A

They feed on Hgb inside RBCs.

They leave a pigment called malarial pigment which is composed of hematin and protein.

Increased levels cause symptomatic reactions like elevated temperature.

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5
Q

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

A

P. falciparum.

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6
Q

What does the ring form of P. falciparum look like?

A

Light blue circular structures with red chromatin dot.

  • Double chromatin dots are common.
  • Multiple ring forms are common.
  • Marginal or appliqué.
  • RBCs usually normal in size.
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7
Q

What does a macrogametocyte (female) look like?

A

Curved sausage/banana shape with central large chromatin dot covered with centralized mass of hemazoin.

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8
Q

What does a Microgametocyte (male) look like?

A

Shorter and wider than female with rounded ends, diffused chromatin seen with hemazoin granules.

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9
Q

What cell is considered diagnostic for malaria?

A

Gametocyte of P. falciparum

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10
Q

What are the fever lengths of all four types of malaria?

A

Plasmodium Falciparum
-Every 48 hours or every 2nd day

Plasmodium Vivax
-Every 48 hours or every 2nd day

Plasmodium Ovale
-Every 48 hours or every 2nd day

Plasmodium Malariae
-Every 72 hours or every 3rd day

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11
Q

What is the most fatal form of malaria?

A

P. falciparum, likely to cause intravascular hemolysis. Fever is prolonged and intensified.

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12
Q

What type of erythrocytic cycle does each form of malaria take?

A

P. falciparum
-Malignant Tertian

P. vivax
-Benign Tertian

P. ovale
-Benign Tertian

P. malariae
-Benign Quartan

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13
Q

What are the two types of specimen collection methods for malaria testing?

A

Capillary collection in EDTA tube

Venous blood (optional) in purple top tube with EDTA

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14
Q

When should whole blood be tested for malaria after collection? (Capillary and Venous)

A

Capillary:
-Fill entire tube and test immediately.

Venous:

  • Test whole blood as soon as possible. It may be stored for up to 3 days at 2-30C if necessary.
  • Be sure to let blood return to room temperature (15-30C) before testing.
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15
Q

The malaria testing kit Reagent A has a Tris buffer kit containing what two substances?

A

Detergent and sodium azide.

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16
Q

How many drops of Reagent A should be placed on the white pad?

A
  1. Allow first drop to absorb before placing the next one.
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17
Q

If the reagent mixture does not run through the entire malaria test strip in one minute, what should be done?

A

Apply an additional drop of reagent.

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18
Q

When should malaria test results be read?

A

At 15 minutes. Results are invalid if read after 15 minutes.

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19
Q

Malaria test result interpretations

A

“C” line must appear for results to be valid.

T1: positive for P. falciparum

T2: positive for P. vivax, malariae, or ovale. May indicate mixed infection of those three parasites.

T1 and T2: positive for P. falciparum and other types of malaria.

Only C line: test is negative.

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20
Q

When must malaria test samples be obtained?

A

When the patient is febrile.

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21
Q

How must malaria test results be confirmed?

A

With a thick and thin smear which is sent to the NEPMU.

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22
Q

Why can’t malaria test kits be used to monitor a patient’s treatment?

A

Because residual antigens from the parasite will be present in the body several days post elimination of the parasite.

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23
Q

What conditions will give malaria false positives?

A

Rheumatoid arthritis

Chronic viral infections - Hepatitis C

Patient with other blood parasite - Babesia

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24
Q

Smears should be done frequently, but no more than __?

A

Hourly.

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25
Q

This is a highly contagious, acute viral infection of the respiratory tract.

A

Influenza

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26
Q

Which strain of influenza is more common?

A

A is more common than B and produces more serious illness.

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27
Q

When is influenza best diagnosed?

A

Within the first 2-3 days.

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28
Q

What are the benefits of the rapid influenza test?

A

Enables appropriate therapy.

Facilitates prompt treatment.

Some antivirals are only effective if given within 48 hours of symptom onset.

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29
Q

You should use the swabs provided in the influenza test kit. If you can’t, what type of swabs should be used?

A

Sterile rayon, foam, polyester or HydraFlock flocked solid shaft swabs can be used.

Standard swabs in the kits are flexible nasopharyngeal swabs

30
Q

When should influenza results be read?

A

15 minutes after closing the testing device. Results read before or after may be inaccurate.

31
Q

How does a negative flu sample appear?

A

BLUE control line in the BOTTOM THIRD of the window turns pink-purple. No other line appears.

32
Q

How does a Flu A Positive sample appear?

A

BLUE control line turns pink-purple and a second pink-purple sample line apparatus above it in the MIDDLE THIRD of the window.

33
Q

How does a Flu B Positive sample appear?

A

BLUE control line turns pink-purple and a second pink-purple sample line appears above it in the TOP THIRD window.

34
Q

When is a flu test invalid?

A

If the control line remains blue or is not present at all.

Repeat invalid tests with a new test card.

35
Q

When may a false-positive flu test occur?

A

If the disease prevalence in the community is low, typically at the beginning and end of flu seasons.

36
Q

When may false negative flu results occur?

A

When disease prevalence is high in the community, like during the height of flu season.

37
Q

How soon should flu test specimens be collected?

A

As early in the illness as possible, within 4-5 days.

38
Q

The rapid flu test may fail to detect viruses that have undergone what?

A

Minor amino acid change at their target epitope.

39
Q

What provides an important baseline of a patient’s basic physiology?

A

The metabolic panel.

It measures 8 analytes and calculates an anion gap.

40
Q

What can the metabolic panel assess?

A

Kidney status, electrolyte and acid/base balance, and blood glucose.

41
Q

Changes in sodium most often reflect changes in what?

A

Water balance rather than sodium balance.

42
Q

What is hyper and hyponatremia?

A

Hyper: high sodium greater than 145 mEq/L - indicates need for water.

Hypo: low sodium below 136 mEq/L - indicates over hydration.

43
Q

What is Urea Nitrogen? What is it used for?

A

BUN. It is the concentration of nitrogen which is produced in the liver and is the end product of protein metabolism and filtered by the kidneys.

It is used to help diagnose liver and kidney diseases.

44
Q

Low and High BUN indications.

A

Low: 6-8mg/dL indicates overhydration or liver disease.

High: 50-150mg/dL indicates serious impairment of renal function.

Normal: 10-20mg/dL.

45
Q

99% of calcium is found where in the body? How is hypercalcemia caused?

A

Bones. Remaining 1% is found in blood.

Caused by either a malignancy or hyperparathyroidism.

46
Q

What is used to evaluate the acid base balance of blood?

A

Carbon Dioxide.

High levels are seen in respiratory acidosis.

Low levels seen in respiratory alkalosis.

47
Q

What is the most abundant cellular anion? What are they used to identify?

A

Chloride.

Sodium chloride values are used as confirmatory tests to identify fluid balance and acid base abnormalities.

48
Q

What is hyper and hypochloremia seen in?

A

Hyper: dehydration and acidemia.

Hypo: vomiting, overhydration and alkalemia.

49
Q

What can creatinine levels be used to measure?

A

Renal insufficiency.

50
Q

What does potassium regulate, and what are the primary causes of hyper and hypokalemia?

A

Regulation of muscle and nerve excitability.

Hyper: renal failure.

Hypo: alkalosis, diuretic use, alcoholism, fluid loss.

51
Q

What can cause refractory hypokalemia?

A

Low magnesium.

52
Q

What is involved with metabolism and energy production? What is it needed for?

A

Phosphorous. It is needed for normal muscle contractility and neurologic functions, as well as oxygen-carrying by hemoglobin.

53
Q

What portion of the LFT measures liver injury?

A

ALT and AST

54
Q

What is the half life of albumin?

A

20 days.

55
Q

Increased levels of bilirubin cause what?

A

Jaundice. They are seen in various types of liver damage.

56
Q

Elevated ALT and AST indicates what form of hepatocyte damage?

A

Active, not previous damage.

57
Q

In alcoholic hepatitis, AST is generally ___ the ALT, and AST is rarely above ___u/L.

A

Twice.

300u/L.

58
Q

Almost all prescription drugs can raise ALT and AST. What type of drugs are of particular concern?

A

STATINs, when levels are >3x the upper limit.

59
Q

What is a screening for nutritional deficiencies and gammopathies?

A

Total protein.

Increase is seen with myeloma and hypovolemia.

Decrease seen in malnutrition, liver diseases and severe skin diseases.

60
Q

Where besides the liver can AST be found?

A

Cardiac and skeletal muscle, kidneys, brain, lungs and intestines.

Levels can be increased due to myocardial infarction, renal infarction, brain tumor or vigorous exercise.

61
Q

All adults over __ should get a fasting glucose every __ years.

A

20

5

62
Q

What is the most accurate reflection of thyrometabolic status?

A

Free Thyroxine (T4)

High levels indicate hyperthyroidism, low indicates hypothyroidism.

63
Q

What is a glycoprotein secreted by the anterior pituitary gland that can be tested to assess true metabolic status?

A

Thyroid Stimulating Hormone.

TSH is high/low in hyper/hypothyroidism.

64
Q

What glucose test gives the big picture of the average levels of glucose over a 2-3 month period?

A

A1C

65
Q

What is the best indication of glucose homeostasis?

A

Fasting glucose.

<100mg/dL is normal.

≥100 and <126 indicates prediabetes.

≥126 is a provisional diagnosis of diabetes.

Two occasions of that is a confirmed diagnosis.

66
Q

What are major causes of high and low glucose values?

A

High:
DM-I/II, excessive intake.

Low:
Insulin overdose, sulfonylureas, other hypoglycemic agents.

67
Q

An A1C ≥6.5% indicates what?

A

Poor glucose control.

68
Q

What are biomarkers measured to evaluate heart function?

A

Cardiac markers. Typically discussed in the context of an MI.

69
Q

Increased levels of ___ are indicative of an MI.

A

Troponin.

Following an MI, troponin lecels will rise above upper reference levels within 3-12 hours and will peak at 24 hours.

70
Q

What is an enzyme predominantly found in cardiac muscle that appears within 3-12 hours after the onset of symptoms of an MI?

A

CK-MB. Levels peak at 24 hours.

71
Q

Critical Metabolic Panel Values

A

1) Sodium <120 mEq/L | >160 mEq/L
2) Calcium <6.0mg/dL | >14.0mg/dL
3) Creatinine None | >3.0mg/dL
4) Potassium <2.5 mEq/L | >6.5 mEq/L
5) Magnesium <1.2mg/dL | >4.9mg/dL

72
Q

What is the pre-erythrocytic cycle of malaria?

A

Development in the liver.

Laboratory Part 2 (3 decks)

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