Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YR3S2- clinical therapeutics > wk3- pathology testing > Flashcards

wk3- pathology testing Flashcards

1
Q

is there medicare rebate for pods when referring pt to pathology

A

no- so best to go through with GP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

types of pathology testing

A

1.kidney function (creatinine, eGFR)
2. hepatic function (LFTs - liver function tesst)
3. microbiology (bacterial, fungal)
4. aspirates
5. blood tests (ESR, CRP, FBC/CBC)
6. histology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

reasons for pathology testing

A
  1. identifying dysfunction
  2. guides pharmacotherapeutics
  3. monitors response to treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ways the liver helps with metabolism

A
  1. functionalisation (addition of a functional group to make it more water soluble)- CYP450 enzymes help with this
  2. conjugation reaction (addition of polar group from endogenous substance to the drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

liver function tests tell us what

A

-screen liver damage
-tracking acute liver disease on a day by day basis
-response to treatment
-tests do not always correlate with severity or prognosis

-can still have normal LFTs and have liver function issues
Example:cirrhosis can have normal LFTs
-abnormal LFT is common and may reflect problems outside the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

patterns of liver function tests

A
  1. hepatocellular- injury to hepatocytes

2.cholestatic- injury to bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are you testing with an LFT

A

Concentrations of

  1. alanine aminotransferase (ALT)- linked to hepatocellular damage
  2. aspartate aminotransferase (AST)- hepatocellular damage, same as ALT
  3. Gamma glutaryl transferase (GGT)-

which can be caused by:
-viral infections
-drug/alcohol abuse
-viral infection
-anoxia
-obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ratio of ALT/AST can indicate what

A

severity of condition

normal- 1.15
deviations above and below this indicates disease, and the further away, the more severe

examples in lecture slides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

elevated levels of gamma glutaryl transferase (GGT) may indicate what?

A

Cholestasis
* Enzyme induction
* Alcohol, phenytoin, barbiturates, rifampicin
* Congestive heart failure
* Cirrhosis
* Hepatic ischemia, necrosis, or tumour
* Hepatitis
* Hepatotoxic drugs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

if there is hepatic impairment or low therapeautic index what is the best thing to do when initiating drugs that are cleared by the liver

A

reduce dose by 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

major functions of the kidney

A
  1. Filtration of blood:
    * Removes metabolic wastes from the body, esp. those containing nitrogen
  2. Regulation/ reabsorption
    * Blood volume and composition
    * Electrolytes
    * Acid-Base Balance
    reabsorb essential compoounds
  3. Endocrine:
    * Erythropoietin (EPO)
    * Renin
    * 1,25 dihydroxycholecalciferol (1,25 Vitamin D)
  4. Secretion through urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Glomerurlar filtration rate

A

volume of plasma filtered
approx- 180L/day (1-2L/day loss through urine and 99% of filtrate is reabsorbed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

approx urine output

A

1-2L/DAY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How much filtrate is reabsorbed

A

99%

180L- GFR
1-2L - urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what influences GFR

A

-BP and flow
-obstruction to urine outflow
-loss of protein free fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what makes up renal clearance

A

Glomerular filtration
secretition
passive rebsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what changes are made to drugs when renal function is less than 50% and the drug is cleared by kidneys more than 50%

A

dose adjustments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

main site for clearance of water soluble drugs from the blood

A

kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

why is kidney function important for drug use

A

if there is renal impairment, normal amounts of drug consumption will eventually exceed the amount of drug being cleared and plasma levels will continue to rise causing toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

example of antibiotics cleared by the kidneys (renal)

A

penicillins and cephalosporins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

renal function tests include

A
  1. creatinine clearance
    -waste product of skeletal muscle breakdown that can only be excreted by filtration (no reabsorption), this is used to measure the GRF of kidneys
    -cockcroft gault formula
  2. eGFR
    -uses serum cretinine, age, gender, ethnicity to calculate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

normal eGFR values for 20-70 YRS OLD

A

20- 116mL
40- 99mL
60- 85mL
70-75mL

the older you get the lower the renal clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

downfalls of creatinine clearance testing

A

very expensive and time consuming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

as people age, their GRF levels change therefore

A

they will need dose adjustments as their clearance will decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

ways you can adjust dose for renal/heptic impiarment

A
  1. reduce dose amount
  2. extend dosing interval
  3. both
26
Q

drugs that may require dose adjustments in RENAL impairment (kidneys)

A
  1. antibiotics - Amoxicillin, Amoxicillin plus Clavulanic acid, Cefalexin, Ciprofloxacin, Dicloxacillin, Flucloxacillin, Roxithromycin
  2. antifungals - terbinafine
  3. opiates - codeine
  4. gout - colchicine

AMH have dose adjustment recommendations

27
Q

when is microbiology typically used by a pod

A

in a hospital setting

28
Q

what types of microbiology are there

A
  1. swab
  2. biopsy/aspirate
  3. blood culture
29
Q

different types of culture based tests

A
  1. disk diffusion
  2. broth dilution
  3. agar dilution

used to diagnose and direct treatment with anti microbials for bacterial infections

30
Q

fungal microscopy v culture time period

A

microscopy quick
culture slow (approx 4 weeks)

31
Q

when would u use a aspirate

A

needle that draws out fluid
- septic arthritis
-septicemia
- gouty arthritis

32
Q

what is CRP

A

globulin released by the liver during an inflammatory reaction

33
Q

what can elevated CRP indicate

A
  • acute infection
    -diabetes/obesity

normal - 5mg/L

34
Q

what is CRP not good for

A

chronic inflammation,
it is an acute phase marker

35
Q

ESR what is it

A

aggregation of RBCs increases ESR

36
Q

what is ESR good at indicating

A

-chronic phase inflammation

37
Q

what is CBC (complete blood count) good for

A

diagnosising
-anaemia
-thromboctyopenia
-viral fevers
-autoimmune conditions
-infections
-nutrition defiencies
-haemopoitic malignancies

monitor drug therapy

38
Q

neutrophils react to what

A

bacterial infection

39
Q

lymphocytes react to what

A

viral infection

40
Q

monocytes react to what

A

chronic inflammation

41
Q

eosinophils react to what

A

parasitic infection

42
Q

basophils react to what

A

allergic response

43
Q

histopathology

A

examining of tissue for disease

-cancer
-growths

44
Q

if a patient has a bacterial infection in foot what blood tests could help with diagnosis and treatment

A

complete blood count- change in WBC showing infection

CRP- for acute infection phase

45
Q

is 8.4% HBA1C concerning in an 88yr old, what other test could we look at

A

measure of glucose bound to RBC

if they’re older than its less of a concern because as people age, they have a higher chance of anaemia - this causes glucose binding to the small amount of RBC which pushes up his HBA1C

so you would want to look at his RBC tests to see if he is anaemic and this can explain the high HBA1C

46
Q

how often are you meant to measure BGL

A

multiple points during the day according to guidelines

not just one in the morning

47
Q

liver function tests reveal what?

A

its not a direct measure of liver function

it represents liver damage (when it is damage it releases these eznymes ALP, ALT, GGP,etc)

However, they can also be elevated in damage to different areas not the liver (eg damage to bone can cause an increase in these enzymes)

48
Q

why shouldnt you swab all wounds

A

limited sensitivity and specificty to wound swabbing

every wound is colonised with bacteria and if you swab youll probably grow something and not need to treat it

antimicrobial stewardship, there needs to be clinical signs of infection

49
Q

what do you place a wound swab into (formalin or saline)

A

formalin- good for preserving tissues- kills bacteria (not good for wound swabs)

saline- want to keep bacteria alive so saline is used

50
Q

if someone is on dialysis what does that mean

A

kidney function is severely declined to the point where they would die if they weren’t from toxicity

51
Q

what would you do with someone on dialysis

A

dose adjustments- need multiple people to work on this

52
Q

what tests could you use for a swollen, red hot joint

A

joint aspiration- referral
xray
systemic symptoms (fever, respiratory, HR)

53
Q

what do prescriptions need to include

A

full details of prescriber
name, qualifications, profesion (pod with ESM), PBA registration number, practice address

patients name, address, DOB

medication, quantity, form, dose, number of repeats

directions for use (unless complex, itll be on another form)

signed by prescriber

54
Q

how long is an S4 prescription valid for

A

12 month

55
Q

how long are s8 prescriptions valid for

A

6 months

56
Q

low RBC means

A

anaemic

57
Q

low neutophils and lymphocytes means

A

leuokopenia- makes the patient at risk for infections because dont have adequate WBC to fight infections

58
Q

D-dimer test and thrombosis

A

????

59
Q

INR means

A

clotting time

60
Q
A

YR3S2- clinical therapeutics (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions