Term
| A sensitive test has low false ___?___ |
|
Definition
|
|
Term
| A specific test has low false ___?___ |
|
Definition
|
|
Term
| What is the use of a sensitive test in clinical practice? |
|
Definition
-identify individuals who do NOT have the dz
-low false negatives, so if negative can be confident the individual does NOT have the dz |
|
|
Term
| What is the use of a sensitive test in screening? |
|
Definition
-identify individuals who MAY have the dz
-higher false positives, so if positive must follow up with specific test |
|
|
Term
| What is an example of a sensitive test? |
|
Definition
D-Dimer
-very sensitive to clotting
-low false negatives, but with a positive result there only MAY be a DVT/PE
CK
-very sensitive to muscle damage, but not specific to MI
-low false negatives, but with a positive result need a more specific test to confirm MI (CK-MB, troponin) |
|
|
Term
| The sensitivity of a test is the % of individuals with the condition who have a ___?___ test result. |
|
Definition
|
|
Term
| A sensitive test is most useful when the result is ___?___ |
|
Definition
|
|
Term
| The specificity of a test is the % of individuals without the condition with a ___?___ test result. |
|
Definition
|
|
Term
| What conclusion can be drawn from a negative result on a sensitive test? |
|
Definition
| the condition is NOT present |
|
|
Term
| What conclusion can be drawn from a positive result on a specific test? |
|
Definition
|
|
Term
| What is the use of a specific test in clinical practice? |
|
Definition
-identify individuals who DO have the dz
-higher false negatives, so if negative the individual MAY have the dz |
|
|
Term
| What is the use of a specific test in screening? |
|
Definition
-identify individuals who do NOT have the dz
-low false positives, so if positive can be confident the individual DOES have the dz |
|
|
Term
| What is an example of a specific test? |
|
Definition
CK-MB, troponin
-low false positives
-a positive result indicates MI |
|
|
Term
| How may tourniquet time > 1 min confound results? |
|
Definition
-incr K
-incr protein
-incr PT
-incr Ca
-incr Hct
-incr Fe
-incr cholesterol
-incr lactic acid |
|
|
Term
| How may hemolysis (needle size, suction) confound results? |
|
Definition
-incr K
-incr LDH
-incr AST
-incr ALT
-incr CK
-incr Fe
-decr troponin
-decr T4 |
|
|
Term
| What are reasons for ordering CBC? |
|
Definition
evaluate RBCs
-bleeding
-weakness
-SOB
-murmur
-syncope
evaluate WBCs
-infection
-bleeding
evaluate platelets
-petchiae
-purpura
-splenomegaly |
|
|
Term
| What is the shorthand for CBC results? |
|
Definition
|
|
Term
| What is the clinical term for elevated Hct? |
|
Definition
|
|
Term
| What are normal Hgb ranges for men? women? |
|
Definition
-men: 14-18 g/dl
-women: 12-16 g/dl |
|
|
Term
| What is the relationship of Hct to Hgb values? |
|
Definition
|
|
Term
| What are normal ranges for WBC? |
|
Definition
|
|
Term
| What is the clinical term for low Hct? |
|
Definition
|
|
Term
| What is the clinical term for low WBC? |
|
Definition
|
|
Term
| What is the clinical term for elevated WBC? |
|
Definition
|
|
Term
| What are normal ranges for platelets? |
|
Definition
|
|
Term
| What is the clinical term for low platelets? |
|
Definition
|
|
Term
| What is the clinical term for elevated platelets? |
|
Definition
|
|
Term
| What is the normal range for mean corpuscular volume (MCV)? |
|
Definition
|
|
Term
| What is the MCV range for microcytic anemia? |
|
Definition
|
|
Term
| What are causes of microcytic anemia? |
|
Definition
-Fe deficiency
-thalassemia
-ACD: anemia of chronic dz |
|
|
Term
| What is the MCV range of macrocytic anemia? |
|
Definition
|
|
Term
| What are causes of macrocytic anemia? |
|
Definition
-B12 deficiency
-folate deficiency |
|
|
Term
| What are normochromic ranges for mean cellular hemoglobin concentration (MCHC)? |
|
Definition
|
|
Term
| What are hypochromic ranges for mean cellular hemoglobin concentration (MCHC)? |
|
Definition
|
|
Term
| What are causes of hypochromic anemia? |
|
Definition
-Fe deficiency
-thalassemia
-volume overload |
|
|
Term
| What are hyperchromic ranges for mean cellular hemoglobin concentration (MCHC)? |
|
Definition
|
|
Term
| What is a cause of hyperchromic anemia? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How are reticulocytes reported? |
|
Definition
Reticulocyte Production Index (RPI)
-reported % of RBCs x actual Hct / 45
- / correction factor (based on Hct, using table) |
|
|
Term
| What does RPI < 2 indicate? |
|
Definition
| inadequate bone marrow response |
|
|
Term
| What does RPI > 2 indicate? |
|
Definition
| appropriate bone marrow response |
|
|
Term
| When is a peripheral smear indicated? |
|
Definition
|
|
Term
| What is a peripheral smear? |
|
Definition
-look at all cells in a sample
-look at shapes of RBCs |
|
|
Term
| What is the clinical term for variation in RBC shape? |
|
Definition
|
|
Term
|
Definition
schistocytes
-hemolysis
-burns |
|
|
Term
|
Definition
ovalocytes
-megaloblastic anemia |
|
|
Term
|
Definition
Rouleau formation
-multiple myeloma
-liver dz
-hypergammaglobinemia
-artifact |
|
|
Term
|
Definition
|
|
Term
|
Definition
target cells
-liver dz
-hemoglobin C or S deficiency
-microcytic anemia
-splenectomy |
|
|
Term
|
Definition
tear drop cells
-thalassemia
-pernicious anemia |
|
|
Term
| What is included in a WBC differential and the normal breakdown? |
|
Definition
-polymorphonuclear neutrophils 45-65%
-lymphocytes 15-40%
-monocytes 2-8%
-eosinophils 0-5%
-basophils 0-3% |
|
|
Term
| What are other terms for polymorphonuclear neutrophils? |
|
Definition
-PMNs
-polys
-segmented neutrophils
-segs |
|
|
Term
| What is the normal range of bands/stabs? |
|
Definition
|
|
Term
| What is a right shift in WBC and what does it indicate? |
|
Definition
-increase in PMNs or bands
-possible infection |
|
|
Term
| The clinical term for a left shift in WBCs is ___?___ |
|
Definition
|
|
Term
| Bandemia is present when bands > ___?___% or bands + neutrophils > ___?___% |
|
Definition
bands > 10%
bands + neutrophils > 80% |
|
|
Term
| What are causes of a WBC left shift/bandemia? |
|
Definition
Pathological
-bacterial infection
-tissue damage or inflammation
-leukemia
-metabolic disorders
Normal
-steroids
-exercise
-late in pregnancy
-surgery |
|
|
Term
| How is Absolute Neutrophil Count (ANC) calculated? |
|
Definition
| % segs + % bands x WBC count |
|
|
Term
| What are ranges for Absolute Neutrophil Count (ANC)? |
|
Definition
-normal: 3000-7000
-mild: 1000-1500
-moderate: 500-1000
-severe: < 500 |
|
|
Term
| What are causes of decreased Absolute Neutrophil Count (ANC)? |
|
Definition
-drugs
-marrow failure
-viral infections
-poisoning
-nutritional deficiencies
-autoimmune |
|
|
Term
| What are drug causes of decreased Absolute Neutrophil Count (ANC)? |
|
Definition
-CA chemotherapy
-antimicrobial: PCN, sulfa, chloramphenicol
-anticonvulsants
-NSAIDs
-antithyroid: PTU, methimazole
-antipsychotic: thorazine, compazine, stelazine
-aldomet
-allopurinol
-cimetadine
-diurectics: spironolactone, HCTZ, ethacrynic acid |
|
|
Term
| What are causes of lymphocytosis? |
|
Definition
-viral infection
-drug reaction
-stress: exercise, status epilepticus
-smoking
-CA: leukemia
-serum sickness
-endocrine illnesses
-HEALTHY children < 6 yrs old |
|
|
Term
|
Definition
| Neutrophils- bands and segs |
|
|
Term
|
Definition
|
|
Term
| What is the cycle for eosinophil levels? |
|
Definition
|
|
Term
| What cause an increase in eosinophil levels? |
|
Definition
-allgery
-drugs
-neoplasm
-Addison's
-Collagen Vascular Dz
-pulmonary dz
-parasites
-chlamydia |
|
|
Term
| What cause a decrease in eosinophil levels? |
|
Definition
-steroids
-Cushing's
-ACTH
-after stress |
|
|
Term
|
Definition
|
|
Term
| What are causes of increased monocytes? |
|
Definition
Infections
-TB
-bacterial endocarditis
-malaria
-syphillis
Leukemias
Hodgkin's lymphoma
Autoimmune
-SLE
-IBD
-UC |
|
|
Term
| What are causes of thrombocytopenia? |
|
Definition
Spurious
Decreased production
-B12 deficiency
-folate deficiency
-marrow failure
-drugs
-ETOH
-cocaine
-infection
Increased destruction
-dilution (e.g. transfusion)
-drugs: HIT, Zantac
-autoantibody: ITP, SLE, viral infection
-non-immune: pregnancy, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, DIC
-hypersplenism |
|
|
Term
| At what levels of thrombocytopenia may spontaneous bleeding occur? |
|
Definition
|
|
Term
| At what levels of thrombocytopenia may bleeding with minor trauma occur? |
|
Definition
|
|
Term
| At what levels of thrombocytopenia may longer bleeding with severe trauma occur? |
|
Definition
|
|
Term
| What are causes of thrombocytosis? |
|
Definition
Physiologic
-stress
-exercise
-epinephrine
Reactive
-blood loss
-hemolysis
-infection
-inflammation
-CA
-post op
-trauma
-drugs: cytokines, vincristine
Post-splenectomy
Familial
Myelodysplastic/myeloproliferative |
|
|
Term
| What is the use of prothrombin time? |
|
Definition
| evaluate the effects of warfarin |
|
|
Term
| What can cause an increase in prothrombin time? |
|
Definition
-Vit K deficiency (abx killed off normal gut flora that would've absorbed it from food)
-liver dz
-DIC |
|
|
Term
| What are the target prothrombin times for DVT tx? with a mechanical valve? |
|
Definition
-DVT: 2.0-3.0
-mechanical valve: 2.5-4.5 |
|
|
Term
| What is the use of partial thromboplastin time (PTT)? |
|
Definition
| -evaluate effect of heparin |
|
|
Term
| What are goal partial thromboplastin times (PTTs)? |
|
Definition
| 1.5-2.5x control (55-85 sec) |
|
|
Term
| What cause an increase in partial thromboplastin time (PTT)? |
|
Definition
-factor deficiencies
-heparin contamination |
|
|
Term
| What is included in a Basic Metabolic Panel (BMP)? |
|
Definition
-Na
-K
-Cl
-CO2
-glucose
-creatinine
-BUN |
|
|
Term
| What is added to the BMP in a Comprehensive Metabolic Panel (CMP)? |
|
Definition
-Ca +/- Phos
-T protein
-albumin
-total bili
-alk phos
-AST
-ALT |
|
|
Term
| What are reasons to do chemistry testing (BMP, CMP)? |
|
Definition
-evaluate renal function
-assess acid-base status
-check glucose levels
-evaluate fluid volume status |
|
|
Term
|
Definition
|
|
Term
|
Definition
Ca-Pro-AST-T. bili
Phos-Alb-ALT-Alk Phos |
|
|
Term
| What are normal creatinine clearance rates for males? females? |
|
Definition
-males: 97-137 ml/min
-females: 88-128 ml/min |
|
|
Term
| What equation is used to calculate creatinine clearance, taking weight, age, and sex into consideration? |
|
Definition
|
|
Term
| What equation is used to calculate creatinine clearance, taking weight, age, sex, AND RACE into consideration? |
|
Definition
| Modification of Diet in Renal Dz (MDRD) |
|
|
Term
| What are normal Na ranges? |
|
Definition
|
|
Term
| What are normal K ranges? |
|
Definition
|
|
Term
| What are normal Cl ranges? |
|
Definition
|
|
Term
| What are normal HCO3- ranges? |
|
Definition
|
|
Term
| What are normal BUN ranges? |
|
Definition
|
|
Term
| What are normal Cr ranges? |
|
Definition
|
|
Term
| What are normal glucose ranges? |
|
Definition
|
|
Term
| What are normal Ca ranges? |
|
Definition
|
|
Term
| What are normal Phos ranges? |
|
Definition
|
|
Term
| What are normal protein ranges? |
|
Definition
|
|
Term
| What are normal albumin ranges? |
|
Definition
|
|
Term
| What are normal AST & ALT levels? |
|
Definition
|
|
Term
| What are normal T. bili levels? |
|
Definition
|
|
Term
| What are normal Alk Phos levels? |
|
Definition
|
|
Term
| What are causes of increased HCO3-? |
|
Definition
Respiratory acidosis
Metabolic alkalosis
-vomiting
-volume contraction |
|
|
Term
| What are causes of decreased HCO3-? |
|
Definition
Respiratory alkalosis
Metabolic acidosis
-starving
-DKA
-lactic
-alcoholic
-diarrhea
-renal failure
-drugs
-dehydration |
|
|
Term
| What are normal values for the anion gap? |
|
Definition
|
|
Term
| How is the anion gap calculated? |
|
Definition
|
|
Term
| What are causes for an increased anion gap? |
|
Definition
Methanol
Uremia
DM
Dehydration
Paraldehyde
Ischemia
Ethylene glycol
Salicylate OD |
|
|
Term
| What is the diagnostic threshold for diabetes in fasting glucose levels? |
|
Definition
|
|
Term
| What is the diagnostic threshold for impaired fasting glucose? |
|
Definition
|
|
Term
| What is the diagnostic threshold for diabetes in random glucose levels in the presence of symptoms? |
|
Definition
|
|
Term
| What is the diagnostic threshold for diabetes in HgA1C? |
|
Definition
|
|
Term
| What is the diagnostic threshold for diabetes in oral glucose tolerance test? |
|
Definition
|
|
Term
| What is the diagnostic threshold for impaired glucose tolerance in oral glucose tolerance test? |
|
Definition
|
|
Term
| What are causes of hyponatremia? |
|
Definition
-confusion
-weakness
-lethargy
-cramps
-anorexia
-n/v
-depressed DTR
-hypothermia
-stupor
-coma |
|
|
Term
| What are causes of hypernatremia? |
|
Definition
-iatrogenic
-seawater ingestion |
|
|
Term
| What are causes of hypovolemic hyponatremia? |
|
Definition
-v/d
-sweating
-3rd spacing
-diuretics (HCTZ)
-osmotic diuresis (DM)
-ketonuria
-cerebral saltwasting
-mineralcorticoid deficiency |
|
|
Term
| What are causes of euvolemic hyponatremia? |
|
Definition
-SIADH
-hypothyroid
-polydipsia |
|
|
Term
| What are causes of hypervolemic hypernatremia? |
|
Definition
-CHF
-cirrhosis
-nephrotic syndrome
-acute or chronic renal failure |
|
|
Term
| What are PE findings of hypovolemia? |
|
Definition
-orthostatic BP: 20 pt difference after 2 min
-dry mucous membranes
-poor skin turgor
-no JVD
-absent axillary sweat |
|
|
Term
| What are PE findings of hypervolemia? |
|
Definition
-edema
-ascites
-JVD
-rales
-wheezes
-gallop
-pleural effusion |
|
|
Term
| How is true Ca calculated? |
|
Definition
| measured Ca - serum Ca + 0.8(4 - serum albumin) |
|
|
Term
| What are tests of liver synthetic function? |
|
Definition
|
|
Term
| What are general liver tests? |
|
Definition
-T. bili
-AST
-ALT
-Alk phos |
|
|
Term
| ___?___x normal AST/ALT values indicate moderate elevation. |
|
Definition
|
|
Term
| The AST:ALT ratio is > 1 in ___?___ |
|
Definition
|
|
Term
| What are causes of AST:ALT ratio > 1000? |
|
Definition
-ischemia
-acute viral
-acute biliary obstruction
-drugs, toxins
-autoimmune |
|
|
Term
| In liver failure, ___?___ is increased while ___?___ and ___?___ are decreased. |
|
Definition
-increased: INR
-decreased: albumin, cholesterol |
|
|
Term
| INR is normal until ___?___% of liver is compromised. |
|
Definition
|
|
Term
| Albumin is sensitive to acute changes in liver function. T/F |
|
Definition
false
-half-life is 3 weeks
-normal in 15% of severely compromised patients |
|
|
Term
| What are normal values for urine sp gr? |
|
Definition
|
|
Term
| What are causes of dilute urine? |
|
Definition
-volume overload
-diuretic use
-DI
-poor concentrating |
|
|
Term
| What are causes of concentrated urine? |
|
Definition
-dehydration
-SIADH
-IV contrast |
|
|
Term
| What are normal urine pH values? |
|
Definition
|
|
Term
| What are causes of alkaline urine? |
|
Definition
-urea split
-organisms
-vegan diet
-citrus
-respiratory or metabolic alkalosis
-drugs: NaHCO3, acetazolamide |
|
|
Term
| What are causes of acidic urine? |
|
Definition
-meat
-cranberries
-respiratory or metabolic acidosis
-medications: ammonia |
|
|
Term
| What is a normal range of RBCs in urine? |
|
Definition
|
|
Term
| What are causes of RBCs in urine? |
|
Definition
-trauma
-stones
-tumor
-infxn
-anticoagulation
-transfusion reaction
-hemolysis |
|
|
Term
| What shape are RBCs in urine of renal origin? urologic? |
|
Definition
-renal: dysmorphic
-urologic: round |
|
|
Term
| What are causes of false positives of RBC in urine? |
|
Definition
-menses
-hemorrhoids
-Vit C |
|
|
Term
| What is a normal range of WBCs in urine? |
|
Definition
|
|
Term
| What are causes of WBCs in urine? |
|
Definition
-inflammation
-WBC casts
-UTI
-vaginal contamination
-fever
-pregnancy
-steroids
-nephritis
-cytoxan |
|
|
Term
| What are causes of glucosuria? |
|
Definition
-DM
-ICP
-Cushing's
-pheochromocytoma
-chronic liver dz
-chronic pancreatitis
-steroids
-thiazides |
|
|
Term
| What are causes of false glucosuria positives? |
|
Definition
|
|
Term
| What are causes of ketonuria? |
|
Definition
-DKA
-starvation
-pregnancy
-rapid weight loss
-ASA OD
-drugs
-captopril
-levodopa
-mucomyst |
|
|
Term
| What are causes of RBC casts in urine? |
|
Definition
|
|
Term
| What are causes of WBC casts in urine? |
|
Definition
-pyelonephritis
-tubulointerstitial dz |
|
|
Term
| What are causes of muddy casts in urine? |
|
Definition
|
|
Term
| What are causes of tubular epithelial casts? |
|
Definition
|
|
Term
| What are causes of fatty casts in urine? |
|
Definition
-fat emboli
-nephrotic syndrome |
|
|
Term
| What is a cause of waxy casts in urine? |
|
Definition
| chronic renal insufficiency |
|
|
Term
| What are types of crystals in urine? |
|
Definition
-uric acid
-calcium oxalate
-calcium carbonate
-ammonium urate
-sodium urate
-calcium phosphate |
|
|
Term
| What is the criteria for UTI diagnosis? |
|
Definition
Microscopic
> 5 RBC/hpf
+/- WBC
+/- Epi
> 1,000 cfu/hpf of same bacteria
Cloudy: protein or crystals
Malodorous |
|
|
Term
| What are abnormal ranges for microalbuminemia? |
|
Definition
-30-300 mg/d in 2 out of 3
- >300 nephropathy |
|
|
Term
| What are abnormal ranges for urine albumin: creatinine ratio (mg/mmol)? |
|
Definition
-males: 2-20
-females: 2.8-28
-neuropathy: males > 20, females > 28 |
|
|
Term
| A hemoglobin A1C value of 5 correlates with a mean glucose value of ___?___ |
|
Definition
|
|
Term
| A hemoglobin A1C value of 6 correlates with a mean glucose value of ___?___ |
|
Definition
|
|
Term
| A hemoglobin A1C value of 7 correlates with a mean glucose value of ___?___ |
|
Definition
|
|
Term
| A current or recent infection is indicated by ___?___ titers. |
|
Definition
|
|
Term
| A previous infection is indicated by ___?___ titers |
|
Definition
|
|
Term
| What kinds of drugs require therapeutic drug monitoring? |
|
Definition
-high risk
-narrow therapeutic window |
|
|
Term
| Which drugs require therapeutic drug monitoring? |
|
Definition
-phenytoin
-carbamazepine
-lithium
-valproic acid
-cyclosporin
-tacrolimus
-sirolimus
-digoxin
-theophylline
-vancomycin
-tobramycin
-amikacin
-gentamicin |
|
|
Term
| When is a fasting blood sugar required? |
|
Definition
-BP > 135/80
-dyslipidemia
-obesity
-family hx
-cardiac risks
-PE findings |
|
|
Term
| When is a lipid panel required? |
|
Definition
-males: 35
-females: 45
-DM
-family hx: CAD
-CAD risks
-PE findings |
|
|
