Lab diagnosis 2 final

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Lab diagnosis 2 final
2011-03-23 15:07:48
Lab dia sherman

Flashcards based on Dr.Gibbons Lab diagnosis 2 at Sherman
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  1. Lab tests for bones/joints
    • Uric acid
    • Calcium
    • Phosphorous
    • Alkaline Phosphatase (ALP)
    • Total Protein
    • Albumin
  2. Lab tests for Cardiac injury
    • CK (total)
    • CK-MB
    • Troponin
    • Myoglobin
  3. Lab tests to accesss cardiac risk
    • Cholesterol
    • Triglycerides
    • HDL
    • Glucose
    • ApoA/ApoB ratio
  4. Lab tests for Liver (hepatic)
    • AST (SGOT)
    • ALT (SGPT)
    • ALP
    • SGGT (gamma-glutamyl transpeptidase)
    • Total bilirubin
    • Albumin
    • PT (prothrombin time)
  5. Renal tests
    • BUN
    • Creatinine
    • Total protein
    • Albumin
    • Electrolytes (Na, K, Cl, CO2)
    • Glucose
    • Urine tests (urinalysis, 24 hour creatinine, 24 hr. protein, Creatinine clearance)
  6. Parathyroid tests
    • Calcium
    • Phosphorous
    • Magnesium
    • ALP
    • Total protein
    • Albumin
    • Creatinine
    • Urinary calcium
  7. Thyroid tests
    • T4 (thyroxine)
    • T3 (triiodothyroinie)
    • TSH
  8. Pancreatic tests
    • Amylase
    • Lipase
    • Glucose
    • Calcium
  9. General health screening tests
    • Glucose
    • BUN/Creatinine
    • Cholesterol
    • Triglyceride
    • AST
    • ALP
    • Total bilirubin
    • LDH (lactate dehydrogenase)
    • Calcium
    • Sodium
    • Potassium
  10. Hypertension tests
    • BUN/Creatinine
    • Sodium
    • Potassium
    • Chloride
    • CO2
    • T4
    • Urinary free cortisol
    • Urinary VMA/Catecholamines
    • Urinalysis/Culture and sensitivity
  11. Acute hepatitis tests
    • HBsAg - positive
    • HBeAg - positive
    • AntiHBs - negative
    • AntiHBc (IgM) - positive
    • AntiHBe - negative
    • AntiHAV (IgM)
  12. Hepatits vaccination
    Only Anti-HBs will be positive
  13. Previous infection
    • Anti-HBs and Anti-HBc - positive
    • All Ag - negative
  14. Chronic hepatitis tests
    • HBsAg - Positive
    • Anti-HBs - Negative
    • HBeAg - Positive indicates high infectivity
    • Anti-HBe - Positive indicates low infectivity
    • Anti-HBc - IgG
  15. Diabetic panel
    • Glucose (FBS)
    • 2 hour post prandiol (eating)
    • Elecrolytes
    • Cholesterol
    • Triglycerides
    • Glycosylated hemoglobin (hemoglobin A1c)
  16. Collagen and arthritis tests
    • ESR
    • C-reactive protein
    • RF latex (RA)
    • Uric acid
    • ANA
  17. SLE (systemic lupus)
    • ANA
    • Anti-DNA antibody
    • C3
    • C4
  18. Coagulation tests
    • PT
    • PTT
    • Platelet count
    • Bleeding time
    • Fibrinogen
    • D-dimer
  19. Malignancy tests
    • AFP (alpha-fetoprotein) - liver cancer
    • CEA (carcinoembryonic antigen) - colorectal cancer
    • pAcP (prostatic acid phosphate)
    • b-HCG (beta-human chorionic gonadotropin) - testicular cancer
    • LDH
    • Alkaline phosphorous (AP)
  20. Tests for metastasis
    • LDH
    • AST
    • AP
    • Total protein
    • Albumin
    • CEA
  21. Microcytic hypochromic anemia
    • Iron deficiency
    • Thalessemia
    • Lead Poisoning
    • Sideroblastic (too much iron)
  22. Tests to differentiate microcytic (low MCV) hypochromic (low MCH)
    • Iron
    • Transferrin (Total iron binding capacity)
    • Ferritin
  23. Tests to differentiate macrocytic (high MCV)
    • B12
    • Folic acid
    • Schilling test - for pernicious anemia
    • Anti-IF antibodies - for pernicious
    • Anti-Parietal antibodies - for pernicious
  24. Types of WBCs and when they are elevated
    • PMN (neutrophils) - acute bacterial infections
    • Lymphocytes - viral infections
    • Monocytes - chronic conditions
    • Eosinophils - parasites, skin diseases, chronic allergies, asthma
    • Basophils - Acute allergies (hypersensitivity type I)
  25. ASO titer
    Strep, rheumatic fever, acute post strep glomerulonephritis, erythema nodosum
  26. Heterophile antibody test
    Infectious mononucleosis
  27. C-reactive protein
    Acute-phase reactant, inflammation, bacterial infection, necrosis, early coronary artery disease
  28. ESR
    Generalized inflammtion/necrosis
  29. ELISA
    Screening test for antibodies
  30. Western blot
    Confirmatory test for antibodies
  31. RPR, VDRL
    Screening test for syphilis
    Confirmatory tests for syphilis
  33. FANA
    systemic lupus
  34. RF latex
    Rheumatoid arthritis
  35. Anti-DNA test
    Systemic lupus, more specific than ANA
  36. PSA
    prostate screening for enlargement and cancer
  37. DNAse B
  38. Tests affected by hemolysis
    Potassium, LDH, Phosphorous
  39. Tests indicating critical condition if too high or too low
    • Glucose
    • Potassium
    • Calcium
    • Sodium
    • Potassium
    • CK (only if too high, possible MI or stroke depending on type of CK)
    • Bilirubin (infants, only if high)
  40. What tests must you fast before because they are greatly influenced by food?
    • Glucose
    • Lipids (cholesterol and triglycerides)
    • PO4
  41. Calcium
    • Hypercalcemia occurs in primary hyperparathyroidism, malignancy, vitamin D intoxication, metastatic bone tumors
    • Hypocalcemia occurs in malnutrition, renal disease, secondary hyperparathyroidism, vitamin D deficiency, low albumin (most common)
  42. Phosphorous (phosphate)
    • Hyperphosphatemia occurs in hypoparathyroidism, renal failure, secondary hyperparathyroid, excess vitamin D
    • Hypophosphatemia occurs in primary hyperparathyroidism, vitamin D deficiency, malabsorption
  43. Uric acid
    Hyperuricemia is from excess cell break down or excess purine metabolism (ex. gout), renal disease
  44. Alkaline phosphate (ALP)
    • Bone (highest concentration) - osteoblasts
    • Liver (2nd highest)- obstruction
  45. AST (SGOT)
    Liver or heart
  46. ALT (SGPT)
    Liver only
  47. SGGT (GGT)
    most senstive to alcohol usage, also elevated in liver diseases
  48. Conjugated Bilirubin
    Will be elevated in blood and urine in Gallstones (cholelithiasis, liver cancer, duct obstruction)
  49. Unconjugated Bilirubin
    Will be elevated in blood only, urobilinogen will will elevated in urine in pre-hepatic and many liver conditions
  50. Albumin
    decreases in malnutrition/malabsorption, liver disease, inflammatory diseases, 3rd degree burns, nephrotic syndrome
  51. Vitamin K
    need for clotting
  52. Ammonia
    Increases in advanced liver failure, reyes syndrome (asprin overdose in young children with virus --> brain and liver damage)
  53. alpha-fetoprotein
    pre-natal testing (birth defects) or liver cancer (adults)
  54. alpha-1-antitrypsin (AAT)
    decreased levels in emphysema, neonatal respiratory distress syndrome, low serum proteins
  55. CEA
    tumor marker, particularly colorectal and breast cancer
  56. CK
    • CK-MM (CK-3) is increased in muscle injury or disease, as well as after strenouous exercise
    • CK-MB (CK-2) is increased after damaged to heart
    • CK-BB (CK-1) is increased after brain injury
  57. Troponin
    Used to estimate the amount of damage from an MI
  58. Myoglobin
    Increased after MI or muscle trauma or disease
  59. Cholesterol
    • Increased if genectic, hyperlipidemia, hypothyroid, uncontrolled diabetes, nephrotic syndrome, MI, stress, atherosclerosis, biliary cirrhosis
    • Decreased if malnutrition, malabsorption, hyperthyroid, liver diesease
  60. Triglycerides
    • Increased in hyperlipidemias, genetic, high carb diet, hypothyroid, nephrotic syndrome, diabetes, chronic renal disease, glycogen storage disease
    • Decreased in malabsorption, malnutrition, abetalipoproteinemia, hyperthyroid
  61. HDL
    • Increases due to genetics, excessive exercise, moderate alcohol consumption, estrogen
    • Decreases due to genetics, hepatitis, nephrotic syndrome, malnutrition
    • Want higher numbers
  62. LDL and VLDL
    • Increases due to genetics, nephrotic syndrome, hypothyroid, glycogen storage disease, chronic liver disease, excess alcohol consumption, multiple myeloma, cushing's
    • Decreases due to genetics, malabsorption, malnutrition, hyperthyroid
    • Want lower numbers
  63. Apo A: Apo B
    Want a higher ratio (more Apo A) (high Apo B is Bad - indicates high risk of heart disease)
  64. Increased risk of Coronary artery disease
    High fibrinogen, Insulin, Lp-PLA2 (PLAC - also used to evaluate stroke risk), Chlamydia pneumoniae, homocysteine, C-reactive protein
  65. Most common lipoprotein phenotype
    Type IV - very high triglycerides because of eating habits, lack of exercise, diabetes (very little genetic influence for this type)
  66. BNP
    Congestive heart failure - differentiate from respiratory conditions
  67. Pheochromocytoma
    tumor in chromaffin cells of adrenal medulla secretes catecholamines (epinephrine and norepinephrine) leading to excess VMA (breakdown product) - can detect with 24 hour urine collection
  68. D-dimer/FSP (fibrin split product)
    DIC (disseminated intravascular coagulation - tiny clots all over body) or DVT (deep vein thrombosis)
  69. Creatinine
    • Best blood test for kidney
    • Increases indicate kidney problem
    • Decreases indicate muscular dystrophy or decreased muscle mass
  70. Creatine
    Increases in muscular dystrophy and muscle damage
  71. BUN
    • Urea is the main nonprotein nitrogen end product of protein metabolism
    • Increases in kidney problems (kidneys cannot filter out)
    • Note: high levels cause disorientation and convulsions
  72. Albumin
    Decreases (causes edema) is caused by hepatic disease, malnutrition, malabsorption, nephrotic syndrome, CHF, eclampsia, burns
  73. Specific gravity/osmolality urine
    tests for concentrating and diluting ability of kidney, specific gravity is screening, osmolarity is confirmatory
  74. PSA, Acid phosphatase (AcP)
    tests for prostate cancer
  75. Nitrate/nitrite test
    screen for bacterial infection in urine
  76. Total protein
    • Low (more common) occurs with nephrotic syndrome, liver disease, malabsorption
    • High occurs in multiple myeloma (increased globulin), dehydration
  77. Globulin
    increases in multiple myeloma, chronic infections
  78. C3/C4
    Glomerulonephritis, SLE, servere recurrent bacterial infections, nephritis, RA, immune complex disorders all decreased levels
  79. T3/T4
    • Increases in graves disease, plummer disease, acute thyroiditis (hashimotos)
    • Decreases in chronic thyroiditis , myxedema, cretinism
  80. TSH
    • Increases in hashimoto's (primary hypothyroidism), severe and chronic illness
    • Decreases in secondary hypothyroidism, hyperthyroidism
  81. LATS/TSI
    Hyperthyroid antibodies
  82. Anti-thyroglobulin antibodies, anti-microsomal antibodies
  83. Activation of the adrenal gland
    Hypothalamus releases CRH which stimulates the Anterior pituitary to release ACTH which stimulates the adrenal cortex to release all of its hormones
  84. What hormones does the adrenal cortex release?
    Mineralcorticoids, Glucocorticoids and Androgens
  85. Mineralcorticoids
    Aldosterone, found in blood and urine, reabsorbs sodium, excretes potassium, regulated by the renin-angiotensin system (decreased renal blood flow --> glomeruli releases renin --> liver secretes angiotensin I --> lungs and kidney convert it to angiotensin II --> simulates aldosterone production in adrenals), stimulated by ACTH, low sodium, high potassium, diurinal higher in AM
  86. Glucocorticoids
    17OHCS (in urine) and cortisol (in blood, only found in urine if there is too much in blood) stimulate the metabolism (breakdown) of carbs, lipids, and proteins - strongests effect on glucose (inhibits insulin- stressful job will cause secondary diabetes), vary diurnally, highest in morning, lowest at night, increased by stress
  87. Androgens
    17 KS stimulates male sex characteristics
  88. Dexamethasone suppression test
    • distinguishes cause of hyperfunctioning adrenal gland (cushing's), ACTH is suppressed, possible reactions:
    • If cushing's is due to bilateral hyperplasia then cortisol and 17-OHCS will decrease by about 1/2
    • If cushing's is due to a tumor (malignant or benign) of adrenal gland than there will be no change
  89. What test distinguishes primary and secondary low adrenal output?
    ACTH (adrenocorticotropic hormone) - if increased then indicates secondary, if decreased indicates primary, also can be increased by stress
  90. Plasma renin activity
    used in conjuction with aldosterone to diagnose primary hyperaldosteronism (decreases) from secondary (normal or increases)
  91. Cushing's symptoms
    • Rounded, moon face
    • Truncal obesity
    • Slender extremeties
    • Buffalo hump
    • Muscle wasting/weakness
    • Thin, atrophic skin
    • Hirsuitism
    • Purple striae on abdomen
    • Intolerance to heat
  92. Cushing's lab results
    Increase cortisol, does not decrease at night, also present in urine, increased blood glucose (secondary hyperglycemia), dexamethasone test determines if primary or secondary
  93. Addison's symptoms
    • Increased pigmentation (increased melanin)
    • Hypotension
    • Fainting spells
    • Decreased cold tolerance
    • Nausea/vomiting/diarrrhea
    • Weakness/fatigue
    • Salt cravings
    • Muscle cramping (from increased potassium)
  94. Addison's lab results
    Hyponatremia, hyperkalemia, decreased cortisol, decreased aldosterone, increased PRA
  95. Conn's disease
    • Tetany
    • Paresthesias
    • Hypertension
    • Periodic muscle weakness
    • Renal dysfunction - polyuria, nocturia, albuminuria
  96. Conn's lab results
    Hypokalemia, increased aldosterone, decreased PRA, hypernatremia
  97. ADH (anti-diuretic hormone/vasopressin)
    formed by the hypothalamus, stored in and released from the posterior pituitary, release of ADH is stimulated by increase in serum osmolaltiy or a decrease in intravascular blood volume, ADH then stimulates the collecting ducts to absorb water only
  98. What conditions will increase ADH levels?
    • SIADH (syndrome of inappropriate ADH secretion)
    • CNS tumors/infections, ectopic ADH secretion, hypovolemia, drugs (barbs, nicotine, acetaminophen, some diuretics, narcotics)
  99. What conditions will decrease ADH levels?
    Diabetes insipidus, hypervolemia, alcohol
  100. What will changes in ADH levels result in?
    • Increased ADH will decrease serum osmolality, increase urine osmolality, and decrease sodium in blood
    • Low ADH will do the opposite and will also cause polyuria and polydipsia
  101. Amylase
    secreted by acinar cells of pancreas, catabolizes carbs in duodenum, increases will occur in acute pancreatitis, mumps and salivary gland inflammation
  102. Lipase
    secreted by the acinar cells into the duodenum where it breaks down triglycerides into fatty acids, increases in pancreatic diseases
  103. Cystic fibrosis (fibrocystic diease of the pancreas)
    autosomal recessive, most common inherited disease in white children, affects mucous glands (increases production) of bronchioles, sweat glands and pancreas leading to obstruction --> hyponatremia, hypochloremia, dry nonproductive cough, dyspnea, tachypnea, severe atelectasis, emphysema, failure to thrive, malabsorption
  104. Diagnosis of cystic fibrosis
    Sweat test (pilocarpine nitrate stimulates sweat production, high chloride), family history, chest x-rays, stool sample (absence of trypsin, elevated fat)
  105. Glucagon
    stimulated by low glucose levels, stimulates glycogenolysis in liver, made in alpha cells of the pancreas
  106. Insulin
    secreted in respone to high glucose levels, stimulates uptake of glucose into cells, made in beta cells of pancreas
  107. Other hormones influencing glucose levels
    ACTH, Epinephrine and thyroxine all increase blood glucose levels
  108. Causes of hyperglycemia
    Diabetes mellitus, Acute stress, Cushing's, pheochromocytoma, hyperthyroid
  109. Causes of hypoglycemia
    Insulinoma, Addison's, insulin overdose, extensive liver diease
  110. 2 hour post prandial (after eating)
    safe way to screen for DM or hypoglycemia, glucose levels should normalize within 2 hours after eating, a value of >200 indicates diabetes
  111. What are 2 pathologies that are medical emergencies?
    hyperglycemia (due to diabetes), hypoglycemia (insulin shock)
  112. Gestational diabetes
    most common medical complication of pregnancy, carbohydrate intolerance, to test give 50 grams of glucose then test after 1 hour >140 indicates gestational diabetes, should confirm with a glucose tolerance test
  113. Glucose tolerance test
    used to detect DM and hypoglycemia, first obtain fasting blood glucose then give 100 grams of glucose then test after 30 minutes, 1 hour, 2 hours and 3 hours (both blood and urine samples are taken at each interval)
  114. Glycosuria
    under normal conditions glucose is not present in urine (renal threshold is 160 to 170 mg/dL - up to this value all glucsoe will be reabsorbed), note: glucose clearance declines with age
  115. Interpretation of results of glucose tolerance test
    within 1 to 2 hours levels should be normal, modest elevation at 2 hours and normal at 3 hours suggests impaired glucose metabolism, hyperthyroidism and liver disease give a sharp rise and decline to subnormal
  116. Glycosylated hemoglobin (hemoglobin A1c)
    A1c can combine with glucose depending on the amount of glucose in the blood, remains bound for the lifespan of the RBC (120 days), long term indicator of diabetes (used to moniter patient)
  117. Hyperglycemia
    • Primary Type 1 = primary insulin dependent DM (Juvenile) (IDDM)
    • Primary Type 2 = Non-insulin dependent DM (adult onset) (NIDDM)
    • Secondary -stress, pancreatic disease and endocrine diseases (cushing's, adrenal medulla/pheochromocytoma, thyrotoxicosis, hyperaldosteronism/Conn's), bronze diabetes (hemochromotosis), genetics, chronic renal disease, liver failure, infections, steroids, oral contraceptives, phenytoin (dilantin - antisiezure meds)
  118. Bronze diabetes
    absorb too much iron, interferes with production of insulin
  119. Contributing factors to hyperglycemia
    stress, steroids, diuretics, drugs, obesity, adrenal infections, pregnancy, anesthesia
  120. Symptoms of diabetes
    polyuria, polydypsia, polyphagia, Kussmaul's breathing, sores that don't heal, especially on lower extremity, many other symptoms (see notes pg. 96) but these are the many ones
  121. Which has lower sugar levels blood or CSF? What gets deprived in hypoglycemia?
    CSF has lower levels, brain is deprived more than the rest of the body
  122. Whipple's triad
    • method for diagnosing hypoglycemia:
    • 1. symptoms appear
    • 2. Take blood sample
    • 3. Give food --> symptoms diappear
  123. types of hypoglycemia
    • insulin OD - "brittle diabetic" - takes wrong does of insulin (doesn't bother taking blood sugar first)
    • Reactive - most common in non-diabetics - blood sugar drops 2 to 4 hours after a meal (body overresponds to glucose in meal)
    • Insulinoma - most common in 40 to 60 in islet cell of pancreas
    • Fasting or organic (pathological - chronic alcoholic, liver disease)
    • Glycogen storage disease (ex. von Gierke's)
    • Persistent neonatal hypoglycemia
    • Hypoadrenalism/Addison's
  124. Symptoms of hypoglycemia
    • Mild: Lethargic, irritable/anxious, GI complaints, Headache, shaky/trembling, slurred speech
    • Advanced: Tachycardia, hypothermia, neurological abnormalities, convulsions, unconscious/coma, muscle spasms, shock/death
  125. Electrolytes included on a biochem profile
    sodium, potassium, chloride, carbon dioxide, anion gap (calculated)
  126. What regulates the acid-base balance in your body?
    lungs and kidney
  127. What regulates the osmotic balance in your body?
    hypothalamus, posterior pituitary kidneys
  128. Natermia
    sodium - main extracellular cation
  129. Kalemia
    potassium - main intracellular cation
  130. Chloremia
    chloride - main extracellular anion
  131. Anion Gap
    • Body must have equal positive and negative charges, difference is calculated from sodium, potassium, choloride and CO2 to account for unmeasured anions (serum protein, phosphates, sulfates, ketones, lactic acid) and cations (calcium and magnesium), normal is 8 to 16 anions are unaccounted for
    • Increased anions occurs in uremia, ketosis, lactic acidosis, toxic ingestion (all causes of metabolic acidosis)
    • Increased cations occur in lithium intoxication, hypermagnesemia and multiple myeloma
  132. Sodium regulation factors
    aldosterone, natriuretic hormone, carbonic anhydrase, ADH, kidney reabsorption
  133. Hypernatremia
    Due to cushing's, hyperaldosteronism/conn's, diabetes inspidous
  134. Hyponatremia
    Addison's, diarrhea, vomiting, suction, hyperglycemia, CHF, Peripheral edema, SIADH
  135. What system is most affected by electrolyte imbalance?
  136. Potasssium
    important in cardiac function, affected by hemolysis as well, concentration depends on aldosterone, sodium reabsorption, acid-base balance, if deficient will see a U wave on ECG
  137. Hyperkalemia causes
    Addison's, Renal failure (most common), hemolysis, acidosis
  138. Hypokalemia causes
    GI (vomiting/diarrhea), Conn's/Cushing's, licorice (mimics conn's/cushing's), alkalosis
  139. Chloride
    increases and decreases with sodium except during chloride shift (CO2 increases --> bicarbonate moves out of cells --> Chloride moves into cells)
  140. Carbon dioxide
    • estimate of pH (arterial blood gases is more definitive), exists in 3 forms - dissolved in water, undissociated H2CO3 and HCO3 ion (most are in ion form), regulated by kidney, proportional to pH
    • Increases with metabolic alkalosis, COPD, aldosteronism
    • Decreases with metabolic acidosis, renal failure, diabetes, shock
  141. Blood pH controls
    respiration, renal titration and buffers (hemoglobin has histadine which binds H, plasma proteins bind H, RBC and plasma phosphates
  142. Henderson-Hasselbach formula
    pH = 6.1 + log (base/acid)
  143. Metabolic acidosis
    caused by MI, Diabetic ketoacidosis, renal failure, salicylate OD, methanol OD, intestinal vomiting, body will compensate by hyperventilating to remove CO2 (called Kussmaul's breathing in diabetics)
  144. Metabolic alkalosis
    Primary hyperaldosteronism, Conn's, ingestion of sodium bicarbonate, licorice OD, body compensates by decreasing breathing rate (hypoventilation)
  145. Respiratory acidosis
    Acute asthma, hypoventilation, COPD, Flail chest, Pickwickian syndrome (sleep apnea due to obestiy), body will try but fail to compensate with air hunger (desperately sucking in air) then will adjust renal titration to reabsorb more HCO3
  146. Respiratory alkalosis
    excess CO2 is lost, high altitudes, anxiety, CNS disease, body will respond by adjusting renal titration to get rid of more HCO3, if body cannot correct quickly may result in tetany
  147. Hypercapnia
    too much CO2, usually due to respiratory failure
  148. Magnesium
    decreases caused by DM (most common), chronic alcoholism, increased intestinal losss or decreased intake causes calcium to drift out of the bones and may lead to abnormal calcification of aorta and kidneys as well as weakness/tremors, chovstek/trousseaus
  149. Melena
    black tarry stool indicating an upper GI bleed, excess iron intake, antacids, charcoal
  150. Hematochezia
    red stool indicates lower GI bleeding, hemorrhoids, red food coloring, beets, pyridium/rifampin
  151. Pale, gray, chalky, yellow stool
    bile duct obstruction, gall bladder or liver issue, increased dairy or barium studies
  152. Gray stool
    steatorrhea, cystic fibrosis, fat malabsorption, chocolate overdose
  153. Green yellow stool
    hemolytic jaundice, biliverdin, green veggies
  154. Rice water stool
  155. pencil thin/ribbon like stool
    growth, tumor, polyp, intestinal constriction
  156. large/floating
  157. small, hard, round pellets
  158. loose/watery stool
    lactose intolerance, food poisoning, antibiotics, diet changes, inflammatory bowel disease, irritable bowel
  159. alternating bouts of diarrhea and costipation
    irritable bowel syndrome
  160. foul odor
    imbalance of intestinal bacteria or eating too much protein
  161. occult blood
    detected by guaiac test/hemoccult test, based on perocidase activity so many false positives, vitamin C intake will give false negative
  162. bacteria which are always pathogens (never normal)
    salmonella and shigella (most common food poisoning), campylobacter, yersinia
  163. Clostridial toxin assay
    antibiotins may lead to over growth of anti-biotic resistance bacteria such as C.difficile causing watery and voluminous diarrhea
  164. Fecal fat
    many malabsorption pathologies cause steatorrhea
  165. lactose intolerance
    lack enzyme (lactase) which converts lactose to glucose and galactose, give patient 50 grams of lactose to test then run blood glucose levels, in normal person would increase, remain normal is lactose intolerant person
  166. synovial fluid
    • arthrocentesis (sample fluid):
    • Inflammatory diseases will often have auto-antibodies and increased WBCs slightly
    • Non-inflammatory will be clear, normal
    • Purulent will give increased WBCs (very high) and decreased glucose
    • Hemorrhagic will have RBCs
    • Gouty arthritis will have monosodium urate crystals
    • CPPD (pseudogout) will have calcium pyrophosphate crystals
  167. Chorionic villus sampling
    safer alternative to amniocentessi, gives karyotypes and genetics, can be done earlier in pregnancy
  168. amniotic fluid (amniocentesis)
    • early pregnancy: genetic and chromosomal abnormalitites, mother-fetal Rh compatibility, sex of fetus, neural tube defects (alpha-fetoprotein)
    • Late pregnancy: fetal maturity, risk of respiratory distress, fetal distress/meconium presence
  169. Fetal maturity tests
    lecithin/sphingomyelin ration, phosphatidylglycerol (PG), lamellar body count - all determine if lungs are mature
  170. sputum
    should be a true bronchial secretion, no saliva, no nasal, first in morning is best in a sterile container
  171. Appearance
    • Mucoid (pearly gray) - bronchitis
    • Frankly purulent - infective process, acute bacterial pneumonia
    • Green - virido peroxidase from WBCs
    • Uniform rust with no pus - pneumococcal pneumonia
    • Uniform rust without pus - CHF/mitral valve desease
    • Bright streaks in a viscid sputum "red current jelly" - Klebsiella pneumonia (alcoholics)
    • Episodic small hemorrhages - TB
    • Episodic large hemorrhages - pulmonary infarction, cavitary TB, fungal pneumonia
    • Few persistent streaks in mucoid - bronchogenic carcinoma
    • Pink and frothy sputum - pulmonary edema
  172. Main lung pathogens
    Strep pneumonia (salmon color), hemophilus influenza, staph, gram negative rods (E. coli, Klebsiela), Entamoeba histolytica
  173. lung cytology
    • increased eosinophils and charcot leyden crystals - asthma
    • Curschmann's spirals coiled mucous filaments - asthma, acute bronchitis, bronchopenumonia, any problem with small bronchi
  174. Highest priority tests in lab
    #1 is stroke, #2 is CSF
  175. CSF aspiration
    • Tube 1 - chemistries and immunologies (contaminated on way in, can't use for cultures)
    • Tube 2 - cultures
    • Tube 3 - cell counts and microscopic exams (no blood should be left from any nicks that occured on the way in
  176. Color of CSF (abnormal)
    • Xanthochromia (yellowish/pink tinge) from old hemorrhage, protein, meningeal melanoma, hypercarotenemia (vitamin A overdose)
    • Bloody - traumatic tap, fresh hemorrhage
  177. Cloudy CSF
    indicates presence of WBC's and/or protein
  178. Glucose in CSF
    normal for viral meningitis, decreased in bacterial meningitis
  179. What is the most pathological finding in CSF?
    increased protein
  180. LDH in CSF
    bacterial meningitis - LD 1 and 2 indicate CNS involvement
  181. lactic acid in CSF
    increased in bacterial and fungal meningitis but not viral
  182. glutamine in CSF
    increased in heptic encephalopathy and hepatic coma/reyes syndrome
  183. most common meningitis
    • hemophilus influenza in children
    • neisseria or strep in adults
  184. CAGE test
    Alcoholic questionnaire: do you ever feel you need to Cut down on your drinking? are you Annoyed by people critizing your drinking? do you ever feel Gulity about your drinking? do you ever need an Eye opener to start the day? - if answered yes to any question indicates problem with drinking
  185. RAST test
    allergy blood test for IgE in response to certain antigens (used in place of skin test)
  186. TORCH test
    test panel of infections that may be detrimental to a fetus: Toxoplasmosis, Other (syphilis), Rubella, CMV, Herpes/HIV - all can cause abortion or premature labor
  187. Screening tests for syphilis
    RPR (done today), VDRL, Wasserman
  188. Confirmatory
    TPI (treponemal pallidum immobilization), dark field, FTA, TP-MHA, HATTS (hemagglutination)