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Patient presents with a certain disease that is unknown to you. What would be your best guess to what disease the patient has with this one lab value.
Specific gravity = 1.088 (normal is 1.003 - 1.035)
- Specific gravity is increased in Diabetes Mellities
- and decreased in Diabetes Insipidus
*Obviously this isn't the only value you would have
Your 2nd great aunt who spends all day every day cleaning her house with lysol heard you are a doctor and asks you at a family reunion why her urine has been blue/green?
- -lysol poisening
- -pseudomonas toxemia
You catch your 5 year old son peeing on his pancakes. You ask him why he is doing that? What might his response be
"Mommy I pee maple syrup!" The child is suffering from a genetic disorder called Maple sugar urine disease (its in pocketpods I promise).
On urinalysis patients pH is 5.3. Is it likely the patient has UTI?
No, UTIs present basic. Normal pH is 4.6 - 8.0
What are 3 things that can cause a persons urine pH to be basic?
- Old urine specimen
What are 4 things that can cause someones urine to be acidic?
- High-protein (meat) diet
A positive blood in urine test has 3 possible implications, RBCs, free Hb, and myoglobin. Of these three which type might you see in someone with MS?
- Hematuria (RBC's) -UTI
- Hemoglobinuria (free Hb) -Crush injury
- Myoglobinuria (a muscle protein) - musclular dystrophies
What other reasons might someone have glucosuria besides diabetes?
- -brain injuries
- -severe stress
- -drugs (ASA, epinephrine)
Patient presents with bence-jones protein in urine. What disease does the patient have?
EXTRA CREDIT: Why do we call "left shift" left shift?
When lab reports were written by hand, the bands were writeen first on the left side of the page and the segments to the right, hence the terms "left shift" and "right shift"
Above what percent of bands constitutes a left shift?
Ive heard > 7% or 700 microliters. Normal is 0-5%.
Neutrophils (total) normal value is 50 - 70%
What is an average Hgb and Hct?
- Hgb normal: male 16, female 14
- Hct normal: 45% (higher in males)
I learned from Cocheba via James Toney
- Hgb Hct
- 10 30 Normal
- 8 28 Transfuse if symptomatic
- 5 25 Transfuse
What does MCV measure? and what would cause microcytic, normocytic, and macrocytic anemia?
Mean corpuscular volume - measures the average volume occupied by a single RBC
- Microcytic Anemia: MCV < 80 Iron deficiency, thalassemia, blood loss, lead poisening
- Normocytic Anemia: MCV 80-100 Chronic dz, bone marrow failure, hemolysis
- Macrocytic Anemia: MCV >100 Folate acid deficiency, vitamin B12 deficiency, liver disease, drugs: phenytoin, cytotoxic meds
An increase in reticulocyte count would indicate where might be the source of anemia?
Reticulocyte count is a reflexion of bone marrow function.
what is a normal bleeding time?
2-9 minutes (this is the time from a forearm scratch until a clot is formed.)
What is a normal INR?
What is a normal platelet count?
150,000 - 300,000
At what level of platelet count does spontaneous bleeding occur below?
25,000 - 50,000
Which factors require vitamin K?
II, VII, IX, X
Which factors are in the extrinsic pathway?
Which factors are involved in intrinsic pathway?
VIII, IX, XI, XII
Which factors are involved in common pathway?
I, II, V, X, XIII
What is a normal value for PT? and what is it increased in?
- Normal value: 11-16 sec
- Measures extrinsic pathway:
- -Vitamin K deficiency
- -biliary obstruction
- -liver dz
- -Coumadin Tx
- -deficiencies in Extrinsic or common pathway factors
What is a normal value for PTT? What diseases is it increased in?
- 25 - 35 sec.
- Measures intrinsic pathway
- Increased with:
- Hemophilia A (factor VIII deficiency)
- Hemophilia B "Christmas dz" (factor IX deficiency)
- von Willebrand's dz
- deficiencies oin intrinsic or common pathway factors
- liver dz
- heparin tx
Wht is the activated partial thromboplastin time?
- Normal value: 20 - 35 sec
- A modified PTT that is frequently used to monitor heparin therapy because it is more sensitive test than PTT
Describe the extrinsic pathway from tissue damage to the formation of a fibrin clot
- Tissue damage
- Release of a protein-tissue thromboplastin III
- Factor VII + ca activates III
- III-VIIa-ca activates X
- Va, platelets, ca activate X
- X-Va-ca-platelets convert prothrombin to thrombin
- Thrombin converts fibrinogen to fibrin
- Factor XIIIa converts fibrin to a fibrin clot
Describe the intrinsic pathway from blood vessel damage to fibrin clot
- Blood vessel damage (exposed collagen) activates XII
- XIIa activates XI
- XI and ca activate IX
- ca - platelets - VIIIa - IXa converts Xa to Xa-Va-Ca-plat
- The above complex converts prothrombin to thrombin
- Thrombin converts fibrinogen to fibrin
- XIIIa converts fibrin to a fibrin clot
What protein makes up more than half of plasma protein and is used to transport many substances (medications) in their inactive state. If this protein is deficient medications can reach toxic levels.
- Normal 3.5-5.5
- Increased in:
- Decreased in:
- -liver dz
- -severe burns
Differentiate between conjugated (direct) and unconjugated (indirect) bilirubin.
- An increase in direct usually indicates obstructive jaundice
- An increase in indirect usually indicates destruction of RBS (hemolysis)
- Jaundice is apparent when the serum bilirubin rises over 3mg%
What would increase bilirubin and decrease?
- -bile duct obstruction
- -hemolytic anemia
- -hepatocellular damage
- -meds PCN