Clin Lab Test 1

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Clin Lab Test 1
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2011-09-19 13:03:13
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Clin Lab Test 1 Quick Info WUSOP
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  1. Sodium
    135-145 mEq/L (BMP Order Set)
  2. Potassium
    3.5 - 5.0 mEq/L (BMP Order Set) Directly related to Mg
  3. Bicarbonate
    24-30 mEq/L (BMP Order Set)
  4. Chloride
    96-106 mEq/L (BMP Order Set)
  5. Glucose
    70-110 mg/dL (BMP Order Set)
  6. Calcium
    8.5-10.8 mg/dL (BMP Order Set) Inversely related to PO4
  7. Magnesium
    1.5-2.2 mEq/L (Individually ordered) Directly related to K
  8. Phosphate
    2.6-4.5 mg/dL (Individually ordered) inversely related to Ca
  9. RBCs males
    males 4.5-5.9 X 10^6 cells/uL (CBC order set)
  10. RBCs females
    females 4.1-5.1 X 10^6 cells/uL (CBC order set)
  11. Hgb males
    males 14-17.5 g/dL (CBC order set)
  12. Hgb females
    females 12.3-15.3 g/dL (CBC order set)
  13. Hct males
    males 42-50% (CBC order set)
  14. Hct females
    females 36-45% (CBC order set)
  15. Erythrocyte Sedimentation Rate ESR males males 1-15 mm/hr (individually ordered)
    males 1-15 mm/hr (individually ordered)
  16. Erythrocyte Sedimentation Rate ESR females
    females 1-20 mm/hr (individually ordered)
  17. WBC
    4.4-11.3 X 10^3 cells/mm^3 (CBC order set)
  18. Platelets Plt
    150,000-450,000 cells/uL (CBC order set)
  19. Prothrombin Time PT
    10-13 seconds (coags order set)
  20. International normalized ratio INR
    1.00-2.00 ratio (coags order set)
  21. Activated partial thromboplastin time aPTT
    22-38 seconds (coags order set)
  22. Analyte
    substance being measured
  23. Qualitative Tests: Sensitivity - definition
    ability to identify the % of patients who actually have the disease, portion of true positives ex. Sensitivity = 100% = test is positive in every patient who has the disease
  24. Qualitative Tests: Sensitivity - formula
    Sensitivity = {(True Positive / (True Positive + False Negative)}X100
  25. Qualitative Tests: Specificity - definition
    ability of test to identify patients who do NOT have the disease, determines the portion of true negatives. higher the specificity = lower chance of a false positive
  26. Qualitative Tests: Specificity - formula
    Specificity = {(True Negative / (True Negative + False Positive)}X100
  27. Positive Predictive Value PPV - definition
    proportion of people with positive tests
  28. Negative Predictive Value NPV - definition
    proportion of people with negative tests
  29. Positive Predictive Value PPV - formula
    PPV = {TP / (TP+FP)} X 100
  30. Negative Predictive Value NPV - formula
    NPV = {(TN / (TN+FN)} X 100
  31. Accuracy
    = {(TP+TN)/#of samples tested}X100
  32. Precision
    The assay reproducibility, agreement of results when speciman assayed many times
  33. Quantitative Test: Normal Range
    +/- 2 standard deviations from the mean lab value
  34. Quantitative Test: Critical Values
    lab values far enough outside normal range to indicate morbidity or mortality
  35. Hypovolemic
    acute weight loss. SE = tachycardia, orthostatis, BUN/Scr>20, dry mouth, skin, skin turger. Causes = diuretics, diarrhea, vomitting
  36. Hypervolemic
    acute weight gain (~4lbs). SE = edema in extremities and pulmonary, ascites (liver failure), anasarca (nephrotic syndrome).
  37. Hypernatremia Hypervolemic
    Na > 145 mEq/L; weight gain; excessive hypertonic saline fluids; Treat= Fluid restriction, discontinue hypertonic saline fluids
  38. Hypernatremia Euvolemic
    Na > 145 mEq/L; no change in weight; Diabetes Insipidus or reduced ADH secretion via head trauma or CNS tumor or Resistance to ADH due to Li, Phenytoin Demeclocycline; Treat= Fluid restriction, remove tumor/discontinue or lower medication dosage
  39. Hypernatremia Hypovolemic
    Na > 145 mEq/L; weight loss; inability to access water, vomitting, diarrhea, increased sweating, fatigue; Treat: Fluid repletion
  40. Hyponatremia Hypovolemic
    Na < 135 mEq/L; weight loss; ability to access water or excessive doses of thiazide or loop diuretics; Treat: Fluid repletion, discontinue/lower medication dosage
  41. Hyponatremia Euvolemic
    Na < 135 mEq/L; no change in weight; Increased ADH secretion via tumor/CNS disorder or sensitization to ADH due to Carbamazepine, Cyclophosamide, NSAIDs, SSRIs, or HYPOthyroidism, polygenic polydipsia, Addison's Disease; Treat: Fluid restriction, remove tumor/discontinue or lower medication dosage/treat undelying disease states
  42. Hyponatremia Hypervolemic
    Na < 135 mEq/L; weight gain; Fluid retentive disease states (Ascites, Anasarca, Peripheral/Pulmonary edema - heart failure); Treat= Fluid restriction, Treat underlying disease states
  43. Hyperkalemia and HyperMagnesium
    K>5.0 mEq/L; Mg>2.2 mEq/L; Excessive intake and decrease output (renal failure, drugs - K+ sparing diuretics) K=Metabolic Acidosis
  44. Hypokalemia and HypoMagnesium
    • K<3.5 mEq/L; Mg<1.5 mEq/L; decreased intake and increased output
    • (renal failure, drugs - K+ sparing diuretics) K=Metabolic Alkalosis
  45. Vit D3 affect on Ca
    Bone: Increase Ca; Stomarch: Increase Ca; Kidney: Increase Ca; Chronic Renal Disease (decreased vit D3 activation and decreaseds response to PTH): Decrease Ca
  46. Parathyroid Hormone PTH affect on Ca and PO4
    Bone: Increase Ca; Stomarch: Increase Ca; Kidney: Increase Ca and Decrease PO4; Chronic Renal Disease (decreased vit D3 activation and decreaseds response to PTH): Decrease Ca and Increase PO4
  47. Hyponatremia <135 mEq/L; 125?
    125 = Nausea and Vomitting
  48. Hyponatremia <135 mEq/L; 115-120?
    115-120 = Headache, tremors incoordination, lethargy, deliruium, obtundation
  49. Hyponatremia <135 mEq/L; 110-115?
    110-115 = seizures, coma
  50. Hypernatremia >145 mEq/L; 160?
    signs start to appear at 160 mEq/L, cerebral dehydration - thirst, lethargy, restlessness, hyperreflexia, irritability, muscle twitching, seizure, coma
  51. Hypercalcemica > 10.8, but <13?
    10.8-13 = asymptomatic
  52. Hypercalcemica > 10.8, but 13-15?
    13-15 = polyuria, nocturia, polydipsia, nausea, vomitting, constipation
  53. Hypercalcemica > 10.8, >15?
    >15 = lethargy, obtundation, psychosis, coma, death, acute renal failure, soft tissue calcification (Ca X PO3 >55), nephrolithiasis, CRI, atherosclerosis
  54. Hypophosphatemia <2.6, but <2.0?
    Asymptomatic until less than 2.0 = weakness, numbness, parasthesias, myalgia, rhabdomyolysis, Card + Resp failyre, confusion, obtundation, hallucination, delirium, seizures, coma, hemolysis, WBC + platelet dysfunction
  55. Myocardial Conduction Dysfunction ?
    Arrhythmas
  56. Myocardial Coronary Perfusion ?
    Ischemia
  57. Acute Coronary Syndrome ACS - definition
    an umbrella term referring to symptoms associated with myocardial ischemia - significant reductions in blood flow to heart muscle linked to heart disease, reduction in blood flow may/may not lead to an acute MI
  58. Acute Coronary Syndrome ACS - Outcomes (3)?
    Unstable Agina UA, Non ST segment elevation MI NSTEMI, or ST segment elevation MI STEMI
  59. Distinguishes b/n UA, NSTEMI, STEMI
    Electrocardiography and Biochemical Markers
  60. Acute Coronary Syndrome ACS - Clinical Presentation
    Cannot distinguish between UA, NSTEMI, or STEMI. but 1. 75% or patients will have chest pain (substernal, pressure sensation, fullness, sqeezing, occurs on exertion) and Radiating pain (to jaw, neck, shoulder, arms, or back) 2. 1/3 of patients will have shortness of breath and epigastric discomfort 3. Hypotension, new 3rd heart sound, jugular venous distention, rales on auscultation
  61. Acute Coronary Syndrome ACS - Electocardiography ECG - Myocardial Contraction
    Depolarization of the atria (P wave) and ventricles (QRS complex)
  62. Acute Coronary Syndrome ACS - Electocardiography ECG - Myocardial Repolarization
    Repolarization of the ventricles (T wave)
  63. ECG - Limb leads produce what view?
    produce a sagittal and frontal view
  64. ECG - chest leads produce what view?
    produce a horizontal view
  65. ECG - Conduction amongts the leads determine:
    Presence of myocardial ischemia, injury, or infarction; location of infarction; site of occlusion in the coronary artery involved
  66. ECG in ACS: T wave inversion =
    T wave inversion = Ischemia
  67. ECG in ACS: ST wave depression =
    ST wave depression = Ischemia
  68. ECG in ACS: ST segment elevation =
    ST segment elevation = Infarct (complete occlusion)
  69. ECG in ACS: Appearance of Q waves =
    Appearance of Q waves = Infarct
  70. Biochemical Markers: Criteria for the ideal marker (4)
    1. High sensitivity and specificity 2. Rapid release into blood after injury, without rapid clearance 3. Strong correlation between concentration and extent of tissue damage 4. Assay is readily available, easy to perform, inexpensive, and rapid
  71. Myoglobin Elevation
    1-4 hours
  72. Myoglobin Peak
    6-7 hours
  73. Myoglobin Returns to Normal
    24 hours
  74. Myoglobin Origin
    Heme protein found in cardiac and skeletal muscle
  75. Myoglobin Sensitivity / Specificity
    Highly sensitive (>85% at 5 hours), but lacks specificity
  76. Creatine Kinase Sensitivity / Specificity
    Excellent Sensitivity 98%, but poor specificity 67%
  77. Creatine Kinase Elevation
    3-12 hours
  78. Creatine Kinase peak
    24 hours
  79. Creatine Kinase returns to normal
    2-3 days
  80. Creatine Kinase Origin
    Enzyme that stimulates the transfer of high energy phosphate groups
  81. Creatine Kinase 3 isoenzymes?
    CK-MM = in skeletal muscle, CK-BB = in brain, CK-MB = most in myocardium, some in skeletal muscle
  82. Creatine Kinase: Other causes of CK-MB increase
    Trauma, skeletal muscle injury, surgical procedures involving GI tract, uterus, or prostate
  83. Myoglobin: Other Causes of Increase
    skeletal muscle damage, trauma, renal failure
  84. Time to give Myoglobin to patient
    Less than 6 hours from onset of chest pain
  85. Time to give Creatine Kinase to patient
    Less than 6 hours from onset of chest pain
  86. Time to give Troponin to patient
    Greater than 6 hours from onset of chest pain
  87. Relative Idex (RI) Definition
    used to distinguish cardiac and noncardiac sources of CK-MB elevations
  88. Relative Idex (RI) formula
    • RI = (measured CK-MB / Total CK Activity) X 100
    • RI>2 - suggestive of AMI
  89. Troponin Origin
    protein complex located along the thin filaments of myofribrils, regulate Ca mediated interaction of actin and myosin, Troponin C expressed in myocardial and skeletal muscle is identical
  90. Troponin CTnI and CTnT elevation
    3-12 hours
  91. Troponin CTnI and CTnT peak
    CTnI = 24 hours; CTnT = 12-48 hours
  92. Troponin CTnI and CTnT Returns to Normal
    CTnI = 5-10 days; CTnT = 5-14 days
  93. Troponin Sensitivity / Specificity
    Both very high, in an AMI = levels increase 20 times; in severe occlusion and unstable plaque = low elevated levels
  94. Troponin Other Causes for Elevation
    heart failure, pulmonary embolism, renal failure, rhabdomyolysis
  95. Other uses for Biochemical Markers (3)
    Risk-stratification, Reinfarction, Post Intervention
  96. Acute Myocardial Infarction AMI effects on glucose
    increases post MI (likely due to stress)
  97. Acute Myocardial Infarction AMI effects on WBC
    increases post MI likely due to increased cortisol levels
  98. Acute Myocardial Infarction AMI effects on ESR
    Increase due to inflammation
  99. Acute Myocardial Infarction AMI effects on lipid panel
    decreases for upwards of 6-8 weeks
  100. BNP - Brain Naturetic Peptide: Use of Test
    Test to assist in diagnosis of HF, Monitors response to therapy, and Established prognosis of HF
  101. BNP - Brain Naturetic Peptide - Range/Sensitivity/Specificity
    0-100 pg/ml, 74%, 91%
  102. TIMI Risk Score High Risk?
    High Risk is greater than or equal to 5
  103. What imaging study test to get if TIMI is High Risk?
    Cardiac Catherization with coronary angioplasty
  104. What test to get if TIMI is Low or Medium Risk?
    Cardiac Stress Test
  105. What imaging study test to get if positive cardiac stress test?
    Cardiac Catherization with coronary angioplasty
  106. A negative cardiac stress test means ?
    Noncardiac origin
  107. When is Imaging Studies needed? NSTEMI or STEMI
    NSTEMI - evaluate risk stratification for coronary occlusion
  108. Imaging Studies: Cardiac Stress Test - Purpose
    Identification of >75% stenosis of large coronary arteries
  109. Imaging Studies: Cardiac Stress Test - Methods
    Exercise Induced Stress or Pharmacologic Induced Stress (Adenosine - vasodilator; Dipyridamole - vasodilator; Dobutamine - Contractility and HR)
  110. Imaging Studies: Nuclear Imaging - Methods
    Technitium is injected at rest followed by a gamma camera scan, patient is then stressed, technitium injected after stress, gamma camera rotated around patient
  111. Imaging Studies: Nuclear Imaging - Purpose
    Radiactive element concentrates in necrotic tissue, myocardial uptake of technitium directly proportioned to coronary patency
  112. Imaging Studies: Cardiac Catherization - Purpose
    Diagnostic = assess myocardial integrity and blood flow, assess coronary artery patency; Therapeutic = used to conduct coronary angioplasty or place a stent
  113. Imaging Studies: Cardiac Catherization -Method
    Thin catheter inserted in bloeed vessel of arm or leg, passed through either right or left side of heart, contrast media injected through catheter to visualize heart
  114. Imaging Studies: Echocardiography "Echo"-Method
    high frequency soundwaves projected, ultrasonic echoes produced as they strike tissues of different densities to produce image
  115. Imaging Studies: Echocardiography "Echo" - Purpose
    Assess myocardial integrity and motion defects; mostly walls, valves, chamber blood

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