Serology Notes Flashcards
Represents the waste products of digested food. It includes bile, mucus, shed epithelial cells, bacteria, and inorganic salts.
Stool
Matching Stool
__ Normal
__ Blood, undigested meats, beets
___ upper GI bleed, ulcer
__ Biliary obstruction
___ green leafy vegtables, broad spectrum antibiotics
a) Black and tarry
b) Brown
c) Green
d) Red
e) Clay, Tan
- Brown = normal
- Clay = biliary obstruction
- Red = lower GI bleed, undigested meats, beets
- Black and tarry = Upper GI bleeds
- Green = veggies and BSA
Hard, small spherical mass of stool
Scybala
Stool consistency noted with increased fats from gallbladder disease
Pasty stools
Stool form noted with cystic fibrosis
Greasy/buttery
T/F Mucuous in the stool is consistent with megacolon
FALSE
- Mucus = mucous colitis, if bloody mucus clinign to a fecal mass, think neoplasm or inflammatory process of the rectum
- Megafeces = megacolon
Stool characteristic found in ulcerative colitis and chronic dysentery, abscesses, fistulas
Pus
Part of screening for colorectal cancer in patients > 50
Guiac FOBT
-Guiac Fecal Occult Blood Test
Lower GI bleeds = red stools
Upper GI bleeds = dark tarry stools
Infections usually present as ____ diarrhea, excessive _______, abdominal discomfort, and fever
Acute diarrhea
Excessive flatus
T/F Normal flora can never be pathologic
FALSE
-E. coli is normal flora in the GI, but can become pathologic in most cases of UTI
Important factor for pathology. The less number of bacteria needed to cause an infection, the least number it is.
Virulence
Proteins in the blood
-_______ one of the many types of globulins
Albumin and globulin
-Gamma globulin is one of the many types of globulins.
Ig Types:
____ constitutes 75% of serum Ig
___ constitutes 15% of serum Ig. Present in respiratory and GI secretions and in saliva and tears and small amounts in blood
___ responsible for ABO blood and RF and elevated in many infections
____ Often mediates allergic response
___ Rarely elevated
a) IgD
b) IgM
c) IgG
d) IgE
e) IgA
igG = 75%
IgA = 15%, respiratory and GI secretions, saliva, tears, small amount of blood
IgM = ABO blood type, RF, elevated in many infections
IgE = mediates allergic response
IgD = rarely elevated
Screening test to semiquantitatively measure various proteins which are electrically separated
Electrophoresis
Part of cellular immunity. Precursors migrate to the thymus
T cells
B cell maturation (Humeral immunity) occurs in bone marrow and lymphoid tissue
Substances capable of binding to an antibody
Antigens
Antibody = produced by lymphocytes from the patients serum.
T/F If the antigen and the antibody form a reaction, agglutination or clumping will occur
True
Antigen (test) and the antibody (patients serum)
Indicates the strength of the antibody
-if it decreases, the patient is getting ________
Titer
-Patient is getting better (serial dilutions are done until the positive test becomes negative)
T/F The higher the titer, the less virulent the organism
FALSE
-Higher titer = higher virulence
Syphilis is an STD caused by the bacteria___________
Trepenoma pallidium
-Spirochete
Stage of syphilis. Goes systemic and has variable symptoms, fever, malaise, rash, may have CNS involvement. Typically followed by a latent period lasting years.
Secondary Syphilis
PRIMARY = 3-4 weeks after infection painless ulcer (Chancre)
TERTIARY = 3-10 years post infection. Soft granuloma lesions (Gummas). CNS involvement or CNS involvement (neurosyphilis, Charcots joints)
Darkfield examination is diagnostic for what stage of syphilis
Primary stage syphilis
Tests used in patient’s suspected of having syphilis (screening tests)
Nontreponemal test
- VDRL
- RPR
Nontreponemal tests should be confirmed with treponemal tests to help exclude false positives (measles, mono, malaria, TB, pregnancy). Tests measure IgM and IgG antibody not specific for T. pallidum
T/F Treponemal tests are used to confirm nontreponemal tests (detect specific antibodies for treponema)
True
Causative agent of lyme disease
Borrelia burgdorferi
Early symptoms of Lyme disease may include fever, ________, fatigue, depression, and a characteristic skin rash called ________
Headache
-Erythema migrans (bulls eye rash)
What is the two tiered protocol recommended by the CDC to confirm Lyme disease?
1) Sensitive ELISA test, if +, perform:
2) More specific Western blot
T/F Visual inspection of the pharynx can help determine if the causative agent is viral or bacterial
FALSE
-Need CBC to see how the body is reacting to the infection to see if viral or bacterial
Test measures antibodies produced against extracellular toxins, increased titer indicates recent or current infection.
Antistreptolysin O titer (ASOT)
-done only if we suspect a post-streptococcal complication. If we think they have stept, we would do a rapid stress test and a CBC
Caused by an RNA virus of the togavirus family. Can be devastating to the fetus, especially in the ___ trimester.
Rubella (German Measles)
-1st trimester
What is the main concern to determine in pregnant women with a suspicion of rubella?
Immune status
-want to make sure the mom does not have or has antibodes against rubella
When the CD4 count drops below ___ due to advanced HIV, the person is diagnosed with ______
CD4 < 200
AIDS
-Normal range = 600-1,500
T/F Viral load tests how well the immune system is functioning
FALSE
- Viral load = measure the amount of HIV in the blood. Lower levels are better than higher levels (how rapidly HIV is progressing)
- CD4 count = how well the immune system is functioning
Opportunistic infections and malignancies associated with AIDS
- Kaposi Sarcoma
- Pneumocystis jarevieci/carrini
Screening test for HIV antibodies
-If positive, what test is also done
ELISA- screening
Western blot- Confirmatory
T/F Patient with normal blood values has a positive ELISA and Western blot for HIV. Patient has AIDS
FALSE.
-Patient has a HIV infection, if his CD4 count drops below 200 = AIDS
T/F Any FDA approved rapid test should be confirmed with a Western blot if HIV is suspected
True
Rheumatoid Types (Seropositive)
- RA
- SLE
- Scleroderma
- Jaccoud’s
(Need RF test to confirm X-ray findings like rat bite erosions, uniform loss of joint space, juxtaarticular osteoporosis)
Seronegative Spondyloarthopathies
RF-, HLA B27+
- Ankylosing Spondylitis
- Psoriatic Arthritis
- Reiter’s Disease (Reactive Arthritis)
- Enteropathic Arthritis
ANA is a groups of antinuclear antibodies used to diagnose ________.
SLE
- Positive results found in 95% of SLE cases
- Other rheumatic diseases are still associated with ANA
Chronic inflammatory disease that affects most joints especially the MCPs PIPs, and wrist, however any synovial joint can be involved.
RA
Reactive IgM that can be tested in people with Rheumatoid
Rheumatoid Factor
- Considered positive if found in titers >1:80
- Negative RF does not rule out RA
Patient has had morning stiffness for over 6 weeks will bilateral symmetric swelling of the MCP joints with Haggards nodes
-What is the Dx?
RA
If we find evidence of rat bite erosion with uniform loss of joint space on all the MCPs of the hands, what labs or additional films would we need?
Radiographic evidence looks like RA
- LAB: do a RF and CBC (confirm rheumatoid and check for anemia of chronic disease)
- X-ray: Do flexion/extension films of the cervical spine to assess the ADI for instability
T/F The most common cause of increased ADI in the world is rheumatoid
True
Why does periarticular osteoporosis occur in someone with RA?
Due to hyperemia secondary to inflammation
A diagnostic adjunct in certain rheumatoid disoders, particularly ________ in which 90% are positive
Human Leukocyte Antigen B27
(HLA B27)
T/F 100% of cases of AS have sacroiliitis
True
Which is not true of AS?
a) MC seronegative spondyloarthropathy
b) definite female preponderance
c) Produces inflammatory infiltrate causing pannus
d) MC in 15-35 year olds
B)
has a MALE preponderance
If X-ray shows unilateral sacroiliitis, what pathologies and labs would be appropriate?
- Infection
- Could be a early seronegative spondyloarthropathy
Need HLA B27, CBC, ESR, and biochemical profile to help DDx
You notice bilateral symmetric sacroiliitis, so you run some labs that show:
- HLA B27 negative
- Elevated Ca+2
What is the Dx most likely?
Hyperparathyroidism
- HLA B27 negative rules out the spondyloarthopathies
- Elevated calcium points toward HPTH
X-ray shows a shiny corner sign, Dagger sign, Romanus lesion, and Trolley Track sign.
What is the Dx?
AS
We notice either a shiny corner sign of a blastic mets lesion. What film view would help us differentiate between the two?
View of the SI joints
- Involvement = probably AS
- No involvement = Blastic mets or DDD
