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pharmacotherapy > module 4 lab interpretation > Flashcards

module 4 lab interpretation Flashcards

1
Q

when should laboratory tests only be ordered?

A

If the results of the test will affect decisions about the patient care.
The serum, urine, and other body fluids can be analyzed routinely.

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2
Q

name the divisions of clinical microbiology

A

Has several different sciences: bacteriology,virology,parasitology,immunology, andmycology.

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3
Q

name the divisions of clinical chemistry

A

This area includes analysis of blood specimens, including tests related to enzymology,toxicologyandendocrinology

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4
Q

name the divisions of hematology

A

This area includes analysis of blood cells. It also often includescoagulation.

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5
Q

name the divisions of blood bank

A

Involves the testing of blood specimens in order to provide blood transfusion and related services.

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6
Q

name the divisions of DNA diagnostics

A

DNA testing may be done here, along with a subspecialty known ascytogenetics.

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7
Q

give an example of Improper handling or processing in the lab

A

hyperkalemia due to hydrolysis of blood specimen

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8
Q

give an example incorrect sampling timing

A

fasting BG level taken shortly after a meal

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9
Q

give an example of Incomplete Collection

A

24 hrs urine collection that does not span a full 24 hrs

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10
Q

meat ingestion can cause a false-positive _________.

A

guaiac test

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11
Q

cardioversion leads to increased levels of _________.

A

creatinine kinase

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12
Q

what leads to Increased Hemoglobin

A 
polycythemia vera 
copd 
vigourous exercise 
residents at high altitudes
chronic smokers
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13
Q

what leads to decreased hemoglobin

A 
anemia 
blood loss
hemolysis 
fluid replacement 
pregnancy
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14
Q

give another name for hematocrit

A

packed cell volume

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15
Q

define hematocrit

A

Volume of blood that is occupied by RBCs.

It is expressed as a percentage of total blood volume.

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16
Q

reasons for decreased hct are all except

a. dehydration and shock
b. cirrhosis
c. hyperthyroidism
d. leukemia

A

a. dehydration and shock

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17
Q

which of the following leads to increased RBCs

a. cirrhosis
b. polcythemia vera
c. copd

A

b. polcythemia vera

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18
Q

The higher the MCV, _____________________________.

A

the larger the average size of the RBC.

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19
Q

what kind of deficiency causes increased MCV? ie marocytic RBCs

A

folate deficiency and vitamin b12 deficiency

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20
Q

which medications lead to macrocytic RBCs

A

valproic acid, zidovudine, antimetabolites (methotrexate)

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21
Q

what kind of deficiency causes decreased MCV? ie microcytic RBCs

A

iron deficiency anemia

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22
Q

what is the cause for normochromic normocytic anemias

A

blood loss, hemolysis

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23
Q

what is the cause for hypochromic microcytic anemias

A

iron deficiency

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24
Q

what is the cause for normochromic macrocytic

A

folate deficiency and vitamin b12 deficiency

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25
Q

low ferritin may be a sign of _________ deficiency.

A

iron deficiency

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26
Q

reasons for Increased Reticulocytes

A

Hemolytic anemia

Hemorrhage

Sickle cell disease.

Indicative of response to treatment of anemias secondary to iron, vitamin b12, or folate deficiency.

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27
Q

reasons for decreased reticulocytes

A 
Infection
Alcoholism
Renal disease (from decreased erythropoietin)
Toxins
Untreated iron deficiency anemia 
Drug-induced bone marrow suppression.
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28
Q

causes of Increased WBCs (leukocytosis)

A

Infection, leukemia, trauma, thyroid storm, and corticosteroid use. Emotion, stress, and seizures

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29
Q

causes of decreased WBCs (leukopenia)

A

Viral infection, aplastic anemia

In bone marrow depression caused by the use of chemotherapy or immunosuppressants

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30
Q

when do false elevations in hgb and MCH occur

A

when WBCs count > 50,000 cells/mm3

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31
Q

nuetrophils are involved in the pathogenesis of inflammatory disorders such as

A

RA and IBD

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32
Q

what are bands

A

bands are immature neutrophils

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33
Q

the use of which medications increase neutrophils

A

corticosteroids

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34
Q

Decreased neutrophils is due to

A

Viral infections (eg, mononucleosis, hepatitis),
Septicemia (blood poisoning by bacteria)
Use of chemotherapy drugs.

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35
Q

what is ANC

A

absolute neutrophil count

total number of circulating segs and bands

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36
Q

risk of diseases increases as ANC __________.

A

decreases

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37
Q

what is the main function of lymphocytes

A

antigen recognition and immune response

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38
Q

reasons for Increased Lymphocytes (Lymphocytosis)

I perceive this major clash in infectious viral pneumonia

A 
Influenza 
Pertussis 
Tuberculosis 
Mumps 
Cytomegalovirus Infection 
Infectious Mononucleosis 
Infectious Hepatitis 
Viral pneumonia
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39
Q

reasons for Decreased Lymphocytes

A burden at Bombay airforce station noted mmg

A 
Acute infections
Burns
AIDS 
Bone Marrow suppression 
Aplastic Anemia  
Steroids 
Neurologic Disorders 
Multiple Sclerosis 
Myasthenia Gravis 
Guillian Barre Syndrome
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40
Q

where do eosinophils reside

A

in the intestinal mucosa and lungs

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41
Q

why must the eosinophil count be taken daily

A

due to diurnal variation

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42
Q

reasons for decreased eosinophils

A

Commonly attributed to an increase in adrenal steroid production

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43
Q

Increased Eosinophils (eosinophilia)

A 
Allergic disorders
Collagen vascular disease
Parasitic infections
Immunodeficiency disorders
Some malignancies.
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44
Q

Increased Monocytes (monocytosis)

A

May be observed in the recovery phase of some infections e.g. subacute bacterial endocarditis, TB, Syphilis, Malaria
Leukemia & lymphoma.

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45
Q

Decreased Monocytes (monocytopenia)

A

bone marrow suppressive agents or severe stress

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46
Q

Increased basophils (basophilia)

A

Increased basophils (basophilia)
May be seen in hypersensitivity reactions to food or medications
Certain leukemias
Polycythemia Vera.

47
Q

Marked leukocytosis is usually due to increased _________ or ________.

A

neutrophils or lymphocytes

48
Q

risk of bleeding is low unless platelet count falls below __________.

A

50,000 cells/ microL

49
Q

Increased Platelets (thrombocytosis, thrombocythemia)

A

Infection, malignancies, splenectomy
Chronic inflammatory disorders e.g. RA
Polycythemia vera, hemorrhage, iron deficiency anemia, or myeloid metaplasia.

50
Q

Decreased Platelets (thrombocytopenia)

A

May occur in autoimmune disorders such as idiopathic thrombocytopenic purpura
With aplastic anemia, radiation, chemotherapy
Bacterial or viral infections
Drugs e.g. heparin, valproic acid.

51
Q

Microscopy

A

For direct detection of parasites & some fungi

52
Q

Electron microscopy

A

Detection of viruses

53
Q

Culture & sensitivity

A

For bacteria

Can be done for almost any body fluid or tissue

54
Q

Antigen detection (Serology)

A

e.g. HBsAg (hepatitis B surface antigen)

55
Q

Molecular biology assays (Molecular diagnostics)

A

Most commonly used is Polymerase Chain Reaction (PCR) to detect DNA / RNA of viruses and bacteria

56
Q

Viral Load Tests

A

Measures the amount of virus in the sample.

57
Q

Alpha-fetoprotein (AFP)

A

May be raised in various cancers (liver, germ cell testicular cancers, bowel, stomach, lung, breast, lymphoma)
Non-cancerous conditions (e.g. chronic hepatitis, cirrhosis)

58
Q

Carbohydrate antigen 125 (CA 125)

A

May be raised in many gynaecological conditions e.g. benign ovarian cysts, endometriosis, pregnancy & ovarian cancer.

59
Q

Lactate dehydrogenase (LDH)

A

Levels can be raised for a variety of reasons where cellular destruction is present (e.g. lymphoma, pancreatitis, liver and kidney disease)

60
Q

Carcinoembryonic antigen (CEA)

A

The preferred marker to monitor patients with colorectal cancer during treatment, but it is not useful for screening or diagnostic
Can also be raised in cancer of lung, breast, thyroid, pancreas, liver, stomach, ovary and bladder.
non-cancerous diseases and smoking might increase it

61
Q

Prostate-specific antigen (PSA)

A

Specific tumour for prostate cancer & used for screening

level can also be raised in patients with BPH, elderly men and those with larger prostates.

62
Q

give examples of detection of recurrent cancer with tumor markers.

A

PSA (for prostate cancer) and CA 125 (for epithelial ovarian cancer)

63
Q

what is the main indicator for SLE

A

ANA

64
Q

apart from SLE ANA may be positive in

A 
RA
sjorgens syndrome 
mixed connective tissue disease 
polymyositis 
scleroderma 
autoimmune liver disease
65
Q

RF is a diagnostic indicator for?

A

RA

66
Q

Conditions, other than RA, with a high levels of RF are:

A 
SLE 
other connective tissue diseases 
chronic inflammatory/ infectious disorders
malignancy 
sjorgens syndrome
67
Q

Chronic inflammatory diseases such as ______and ______ can be monitored using serial CRPs.

A

SLE & RA

68
Q

what does CRP monitor. how long does it take to rise and how many days does it take to resolve.

A

Monitors the presence, intensity, and recovery of inflammatory process.
CRP is the most useful of the acute phase inflammation
CRP rises sharply 4–8 hrs after tissue damage by infection, inflammation or trauma & returns to normal 2–3 days after disease activity stops

69
Q

which is a more useful marker for inflammatory disorder

a. CRP
b. ESR

A

a. CRP

70
Q

what is Erythrocyte Sedimentation Rate (ESR)

A

a measure of how quickly RBCs settle in a tube of blood

71
Q

ESR is a non specific indicator of?

A

inflammatory disease and protein abnormalities

72
Q

why is ESR not very effective for diagnosis

A

In an acute illness, the ESR may take a week or more to start to rise and stay elevated for some weeks after its resolution in contrast to other markers.

73
Q

define anion gap

A

it is reflective of the unmeasured anions and cations in serum

74
Q

what does an increase in anion gap suggest? what is it indicative of?

A

An increase in anion gap suggests an increase in the number of negatively charged weak acids in the plasma.
High anion gap is an indication of metabolic acidosis

75
Q

name some conditions that may cause high anion gap

A

ketoacidosis, renal failure, salicylate, methanol and ethylene glycol toxicity.

76
Q

formula or calculating anion gap

A

Na+ - [Cl- + HCO3-]

77
Q

what happens in metabolic acidosis

A

arterial ph decreases, bicarbonate decreases, paco2 decreases

78
Q

what happens in respiratory acidosis

A

arterial ph decreases, paco2 increases, bicarbonate increases

79
Q

what happens in metabolic alkalosis

A

arterial ph increases, bicarbonate increases, paco2 increases

80
Q

what happens in respiratory alkalosis

A

arterial ph increases, paco2 decreases, bicarbonate decreases

81
Q

to protect body proteins acid base balance must be controlled within the extracellular ph __________ and intracelluar ph of _______.

A

pH of 7.35 - 7.45

pH of 7.0 - 7.3.

82
Q

The body’s principal buffer system is the __________________________.

A

carbonic acid/bicarbonate (H2CO3/ HCO3−) system.

83
Q 
Severe acid–base disorders can affect multiple organ systems:
Cardiovascular
Pulmonary
Renal
Neurologic
A

Cardiovascular: it might cause impaired contractility leading to arrhythmias
Pulmonary: it might cause impaired oxygen delivery leading to respiratory muscle fatigue & dyspnea
Renal: it might cause hypokalemia & nephrolithiasis
Neurologic: it might cause decreased cerebral blood flow leading to seizures & coma.

84
Q

a CK-MB level of _____________ is indicative of MI

A

greater than 4-8%

85
Q

CK-MB takes _______ to rise and returns to normal is ________.

A

4-8 hours to rise

2-3 days

86
Q

CK-MB peaks between _______.

A

12-24 hours

87
Q

What are the sensitive markers of cardiac injury

A

troponin I and troponin T

88
Q

troponin Rise within __________________.

Levels should be drawn on _________ and ______________.

A

4 hours of onset of chest pain.

admission and 8 - 12 hours thereafter.

89
Q

Approximately_____of patients with no elevation in CK-MB may demonstrate elevated troponin and thus may be diagnosed with a___________.

A

30%

non-Q-wave MI.

90
Q

what is PT

A

PT is a blood test that measures how long it takes for the blood to clot
PT is the time needed to convert prothrombin to thrombin.

91
Q

the action of PT depends on

A

Its action depends on adequate Vitamin K intake and absorption

92
Q

name drugs that increase TSH

A

metoclopromaide and dooamine antagonists

93
Q

which medications decrease TSH

A

Medications with dopaminergic activity (e.g. dopamine, levodopa, and glucocorticoids) can decrease TSH levels.

94
Q

reasons for increased T4 hyperthyroidism

A

Pregnancy
Hepatitis
Medications: Estrogen Replacement Therapy, Oral Contraceptives, Tamoxifen, And Raloxifene.

95
Q

decreased T4 (hypothyroidism)

A

Renal failure
Malnutrition
Liver disease
Medications that compete for T4 binding proteins (e.g. salicylates).
Medications that increase the clearance of T4 (e.g. phenytoin, phenobarbital, and carbamazepine)

96
Q

Why is free T4 a better indicator of thyroid function

A

Free T4 is a more accurate reflection of clinical thyroid status because Total T4 levels can be affected by conditions that alter the amount of thyroxine binding proteins.

97
Q

free T4 may be increased or decreased by ______,______ and _______.

A

amiodarone, iodides, and lithium

98
Q

Increased T3

A 
Hyperthyroidism
Thyrotoxicosis (Graves' Disease)
With High Doses Of Levothyroxine
Pregnancy 
Use Of Estrogens or Oral Contraceptives
99
Q

Decreased T3

A

Hypothyroidism
Malnutrition
Anorexia
Corticosteroids and Propranolol decrease conversion of T4 to T3 (hence may result in reduced T3)

100
Q

High serum ALT concentrations are indicative of

A

hepatocellular disease e.g. hepatitis, alcoholic liver disease, mononucleosis, and cholestasis.

101
Q

medications causing elevation in ALT

A

HMG-CoA Reductase inhibitors, phenytoin, and valproic acid.

102
Q

______ is a marker of liver disease.

A

ALT

103
Q

which is a more specific marker of liver disease ALT or AST

A

ALT

104
Q

In alcoholic liver disease, the ratio of AST to ALT is usually _________.

A

greater than 2:1.

105
Q

Elevations of AST may also be seen with drugs like?

A

paracetamol and methyldopa

106
Q

medications that cause false elevations in AST by interfering with assay

A

erythromycin, levodopa, tolbutamide

107
Q

name drugs that increase GGT

A

Enzyme inducers such as phenobarbital, rifampin, phenytoin, carbamazepine, and ethanol may also increase GGT levels.

108
Q

GGT is considered a sensitive marker of _____________.

A

Ethanol intake.

109
Q

An elevated GGT associated with an increased ALP suggests ?

A

a hepatic source for the abnormal ALP.

110
Q

Jaundice occurs when total bilirubin exceeds _______.

A

2mg/dl

111
Q

signs of hyperbilirubinemia apart from jaundice

A

scleral icterus and dark urine

112
Q

name a class of drug that causes elevated bilirubin

A

antimalarials

113
Q

causes of elevated bilirubin

A 
Hemolysis
Pernicious anemia
Large hematomas 
Gilbert syndrome
Elevated direct bilirubin may be associated with hepatocellular disease and cholestasis
Drugs e.g. Antimalarials
114
Q

CHF causes hypoalbuminemia. t/f

A

true

pharmacotherapy (6 decks)

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