Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/166

Click to flip

166 Cards in this Set

  • Front
  • Back
Acquired Immunity
- Cell Mediated
link between T-lymphs and phagocytic cells
humoral immunity
antibody mediated
Active vs. Passive Antibodies
- Active - formed by host; natural or artificial (vaccine_
- Passive - received from another source (natural transfer or artificial - plasma infusion; RhoGam)
IgG
- major Ig in normal serum
- can cross placenta
- able to activate complement
- adult levels by age 16
IgM
- large in size and limited to intravascular areas
- produced early in response
IgA
- predominant in secretions - teras, aliva, colostrums, breast milk
- IgA helicobacter in the stomach
IgD
- found on surface of B lymphs in associated with IgM
IgE
- elevated in hypersensitivity reactions, allergies, and parasitic infx.
- boinds to mast cells and basophils
Type I hypersensitivity
- immediated
- IgE mediated
Type II hypersensitivity
- cytotoxic / cell-mediated
DAT
- Direct Antiglobulin test
- tests for presence of antibody coating RBCs after hypersensitivity (II) has occurred
- lavender tube
Indirect Coomb's test
- used in crossmathching blood
- tests for Ab in the tranfused unit with specific Ag on patient's RBC
- red tube
Type III hypersensitivity
- immune complex
- see decresae in C3, C4, and CH50
Type IV hypersensitivity
- delayed hypersensitivty
Direct Immunofluoresence (DFA)
- looking for Ag
- Ab is tagged with FITC (fluorescein isothiocyanate
Indirect Immunofluoresence (IFA)
- looking for Ab
- ex - ANA, FTA-ABS
Radioimmunoassay
- radioisotoes used to measure concentration
- extrememly sensitive and detects trace amounts of analyte )T4, T3, TSH, B-HCG)
* quantitative rather than qualitative
Latex agglutination
- latex particles coated with specific Ag for the Ab to be detected
- monospot, strep screen
flocculation
- clumping of particles to form visible masses similar to agglutination
- ex: RPR
ANA
- antinuclear antibodies
- screen test for collagen, rheumatic, CT,
- SLE
- nl is negative <1:20
homogenous pattern of ANA fluorescence
- associated with SLE
peripheral or rim pattern of ANA fluorescence
- active SLE
fine speckled pattern of ANA fluorescence
- mixed, CT disease, Sjogren's, scleroderma
discrete, speckled pattern of ANA fluorescence
- CREST, Raynauds
nucleolar pattern of ANA fluorescence
sleroderma, polymyositis
ENA
- extractable Nuclear Antigens
- anti-RNP, anti-SM, anti-SSA, anti-SSB, anti-Scl70
ANCA
- Antineutrophilic cytoplasmic antibodies
- associated with Wegner's granulomatosus, churg-Strauss
High Thyroid titer
- Hashimoto's Disease
- Grave's Disease
- Thyroid Cancer
ASMA
- Anti-Smooth Muscle Ab
- liver and bile duct autoimmune disease
- 20% intrinsic asthma patients
AMA
anti-mitochondrial Ab
- liver and bile duct autoimmune disease
APCA
Anti-Parietal Cell Antibody
- pernicious anemia and chronic gastric disease
Rheumatoid Factor
- correlates w/ severity of disease and presence of nodules
- + if >30 IU
- negative does NOT rule out RA
- RF is not specific for RA
ASO
- diagnosis of prior NOT acute strep infection
RPR
Rapid Plasmin Ragin
- secondary and latent stages of syphilis
- titers 1:16 or greater are considered + for syphilis diansis
- will eventually become non-reactive with tx
FTA-ABS
- Fluorescent treponemal antibody absorption
- confirms diagnosis of syphilis
- detects antibody to Treponema pallidum
- SLE and pregnant patiens may yield false rxn
VDRL
Veneral Disease Research Lab
- detects reaginAb in CSF to aid in diagnosis of tertiary syphilis
CEA
- Tumor Marker
- Carcinoembryonic Ag - se en in colorectal, stomach, pancreatic, breast, lung, stomach, and hepatobiliary cancers
- not relaible screen for colorectal cancers b/c not all produce CEA
AFP
- alpha-fetoprotein
- testicular and hepatic cancers
- found in 90% of pts. with hepatomas
- not specific for hepatomas but levels > 500ng/ml are diagnositc for hepatomas
- also used to dx neural tube defects
- picked up 16-18 wks. gestation
B-HCG
- beta subunit of human chorionic gonadotropin
- trophoblastic tumors, hydatidform moles, breast, and testicular cancers
- pregnancy tests
PSA
- Prostatic Specific Ag
- seen in prostate cancer and in BPH
- Nl<4 ng/ml
- If >4 and <10 then order a free PSA to assess risk of cancer
PAP
- Prostatic Acid Phosphatase
- less spcific than PSA
- predicted PSA = 0.12* galnd volume
CA-125
- increased in 80% w/ ovarian cancer
- used to screen high risk w/ strong family hx
- may be increased in endometriosis
CA 15-3, CA 27.29
- used in breast cancer staging and monitoring treatment
CA19-9
- pancreatic and hepatobiliary cancers
stool specimen collection
- 3 specimens collected every other day prior to administration of antibiotics or anti-diarrheal agents
- avoid use of mineral oil and bismuth
- wait 10 days after barium study to do O and P
Indirect Immunofluoresence (IFA)
- looking for Ab
- ex - ANA, FTA-ABS
Radioimmunoassay
- radioisotoes used to measure concentration
- extrememly sensitive and detects trace amounts of analyte )T4, T3, TSH, B-HCG)
* quantitative rather than qualitative
Latex agglutination
- latex particles coated with specific Ag for the Ab to be detected
- monospot, strep screen
flocculation
- clumping of particles to form visible masses similar to agglutination
- ex: RPR
ANA
- antinuclear antibodies
- screen test for collagen, rheumatic, CT,
- SLE
- nl is negative <1:20
homogenous pattern of ANA fluorescence
- associated with SLE
peripheral or rim pattern of ANA fluorescence
- active SLE
fine speckled pattern of ANA fluorescence
- mixed, CT disease, Sjogren's, scleroderma
discrete, speckled pattern of ANA fluorescence
- CREST, Raynauds
nucleolar pattern of ANA fluorescence
sleroderma, polymyositis
ENA
- extractable Nuclear Antigens
- anti-RNP, anti-SM, anti-SSA, anti-SSB, anti-Scl70
ANCA
- Antineutrophilic cytoplasmic antibodies
- associated with Wegner's granulomatosus, churg-Strauss
High Thyroid titer
- Hashimoto's Disease
- Grave's Disease
- Thyroid Cancer
ASMA
- Anti-Smooth Muscle Ab
- liver and bile duct autoimmune disease
- 20% intrinsic asthma patients
AMA
anti-mitochondrial Ab
- liver and bile duct autoimmune disease
Flotation
- employs reagnest with higher specific gravities than eggs and cysts so parasites can float to top to be skimmed off
Protozoa
- amoeba, flagellates (mobile), sporozoans
Helminths
worms
Protozoa-Amebae
* Entamoeba histolytica (amebic dysentery)
- Entameba coli
- Endolimax nana
- Blastocystis hominis
- Iodamoeba butschii
Protozoa - Flagellates
* Giardia Lamblia
- dientameoba fragilis
- trichomonas vaginalis
- trypanosoma cruzi (Chaga's)
- Leishmania donovani
Giardia Lamblia
- Cyst, fecal-oral transmission 1-2 wks after ingestion
- Sx: diarrhea, foul-smelling stools, bloating, flatuence, weight loss
- both trophozite and cyst (infective form) forms
- seen in daycares
- "old man" cyst
Giardia Lamblia Dx and Tx
- Dx: O and P. Find cyst in solid / semi-solid stools or trophozoites in liquid stools.
- Giardia antigen - ELISA
- old man cyst on ova and parasite
- Tx: Flagyl (metroniazole). Metallic taste, antabuse rxn w/ ETOH.
Leishmania
- intermediate host is the sand fly
- infective stage: promastigote found in the gut of sand fly
- can cause granulomas
Protozoa - Sporozoans
- Plasmodium vivax
- Plasmodium falciparum
- Plasmodium malariae
- Plasmodium ovale
- Toxoplasma gondii
- Pneumocystis carnii
- Cryptosporidium pavum
Malaria
- caused by plasmodium species
- cyclic rupture of RBCs as result of parasite maturation causes classic symptoms of recurrent fever and chills at regular 2-3 day intervals
- often associated with hypoglycemia
Labs and Tx for Malaria
- Labs - Giemsa-stained thick and think smears
- Tx - Larium (mefloquine)--> porphylaxis.
- Peds get Malarone
Nematodes
- roundworms
- alimentary tract is simple tube from mouth to anus
- 20-200,000 eggs daily
- adults can have oral hooks, teeth, or plates
Enterobium Vermicularis
- pinworm
- most common helminth infx in US
- eggs hatch in small intestines
- deposit eggs at anus
- perianal puritis
-Tx: Vermox
Trichuris trichiura
- whipworm
- can prolapse the rectum
Ascaris lumbricoides
- round worm
- hand/mouth transmission
- dry, windy climates and eggs are swallowed
- Tx: Vermox, recheck O&P in 2 months after tx to check for clearance
S&S, diagnosis, and treatment of Ascaris lumbricoides
- S&S - Loeffler's pneumonia - abdominal obstruction or malabsorption
- Dx: O&P, eosinophila on peripheral smear, larvae in sputum, CXR with perihilar infiltrates
- tx: Vermox
Loa Loa
eyeworm
flukes
- symmetrical, leaf-shaped, non-segmented
- no anal opening - regurgitate waste
(Lung fluke, liver fluke, blood fluke)
Pityriasis versicolor
- Tinea versicolor
- distinguis from vitiligo - "mantle distribution"
Superficial mycoses and Woods Lamp
- tinea capitis - bright gray or green
- tinea corporis - blue/green
- tinea versicolor - yellow/ green
- vitiligo - will not fluroesce and only shows reflected light
Sporotrichosis
- sporothrix schenckii
- gardners and greenhouse workers
- frequently from punctures with splinters or thorns
- follows lymphatics
- necrotic ulcer eventually
Histoplasmosis
- Histoplasma capsulatum
- bird/bat feces
- culture requires 4-6 weeks
- DNA probes provide ID in 1-3 wks.
- Histoplasma antigen detected by RIA in urine or serum sample for immunodeficient
- sputum only pos in 10-15%
- complement fixation antibodies (1:32 titers)
- 75-95% positive 6 weeks after exposure
Coccidioides immitis
- inhaled spores
- Labs: WBC < 10,000, eosinophilia, elevated ESR
Cryptococcus neoformans
- only pahthogenic fungus to form a capsule
- immunocompromised host
- Tests: India ink - cryptococcal antigen in blood or CSF, positive cultures
Blastomyces dermatidis (Gilchrist's Disease)
- inhlaed or cutaneous to systemic
- no serologic skin test b/c cross reacts with Histoplasma
- specific fluorescently labeled Ab will react with histologic tissue sections
titer
- dilution of serum with the Ab
- four fold or greater rise compared to the acute titer = active infection
- used in serology
Epstein-Barr Virus
- Human Herpes Virus 4
- incubation 4-8 weeks
- acute phase 1-3 weeks
- Labs: atypical lymhs, EBV serology
- Monospot - current infx,
EBV in Africa and China
- In Africa associated w/ Burkitt's Lymphoma
- In China associated w/ nasopharyngeal carcinoma
- lifelong EBV carries and can reactivate for chronic fatigue syndrome
EBV Serology
- EBNA - first antigen to appear. Abs develop later.
- Anti-VCA develops in early infx
- IgM - 1-2 mo duration
- IgG - lifelong duration
- Anti-EBNA develops 3-6 weeks, lifelong duration
- anti-VCA and anti-EBNA = past infx
- anti-VCA and NOT anti-EBNA = recent infection
anti-EBNA
- seen with EBV and remains for life and represents past infection
CMV
- herpes family
- most common cause of blindness in HIV with CD4<100
- "owl's eyes"
Influenzae-RNA virus Labs
- proteinuria
- antibody titers acute and convalescent 10-14 days apart
- nasopharyngeal swab for viral culture
Viral Influenzae Treatment
- avoid ASA (Reyes syndrome)
- Amantadine - type A effective
- Tamiflu
- Relenza
Influenzae Prevention
- Vaccine
- Flumist - live, attenuated vaccine against A and B
Shingles
- varicella zoster
- dermatomal distribution
- Valtrex (Tx)
HIV testing
1. ELISA
2. Western Blot - confirms
3. IFA (Indirect Immunofluorescence Assay) - confirms + ELISA faster
Parvovirus
- fifth disease
- slapped cheek, fever, doilie rash, arthralgias
- order parvovirus Ab IgG and IgM
- IgM may be positive 3 days after viremia occurs
Rubella Ab (German Measles)
- birth defects esp if contracted during first trimester
- If suspected in newborn order IgM Ab to confirm active infx.
- IgG only shows maternal transfer
Hepatitis B carrier
- anti-HBs antibody appears and increases during recovery and lasts lifelong
- when anti-HBs does not develop and HBS Ag persists, patient is a CARRIER
Hepatitis B serology
- Anti-HBC is in serum when symptoms begin
- No test for Anti-HBcIgG
- Core window - AntiHBcIgM
Hepatitis Carrier vs. Immunity
- Carrier has HBs antigen that persists
- Immune - Anti-HBs
Dx. Hepatits C
- Hepatitis C antibody
- Hep C by PCR (amplifies virus)
- RIBA-2 is a confirmatory test
* No vaccine
Hepatits D
- can replicate only when Hep B is present
cirrhosis and hepatocellular carcinoma
- can be caused by Hep B and Hep C
Autologous vs. Allogenic transfusion
- Autologous - blood donor and recipient are the same
- Allogenic - blood transfused to somebody other than the donor
ABO typing
- Ag is the same as the blood type
RhoGam
- tags red cells before mom has ability to produced the Abs.
- prevents Abs from attacking baby in 2nd pregnancy
- given within 72 hours of delivery of Rh positive baby
Hemolytic Disease of the Newborn
- Rh+ male and Rh- female
- If baby from 1st preg is Rh+ some of blood will cross into mom. mom makes anti-Rh Abs that will attack the red blood cells of the baby in the next pregnancy if it is Rh+
Kleinhauer-Betke Test
- measuring fetal blood in maternal blood
- determine amount of RhoGam
One unit of blood
= 450 ml
shelf life of blood
35 days
Packed RBCs - life span and affect on Hbg and Hct
- storage up to 42 days
- frozen up to 10 years
- 1 unit raises Hbg by 1gm/dl or hematocrit by 3%
crystalloid
- normal saline only crystalloid compatible with packed RBCs
Packed RBCs characteristics (4)
1. leukocyte poor
2. Frozen RBCs
3. Washed RBCs
4. Deglycerolized RBC
Platelet storage
- stored up to 5 days
- transfused platelet survives 3-5 days
cryoprecipitate
- better for Factor 8 deficiencies
- each bag exposes recipient to 10 donors
Crossmatching
1. Major - donor RBCs/Patient Serum
2. Minor - patient RBCs/donor serum
BMP
- Basal Metabolic Profile, chem-7, sma-7
- K, Cl, Na, CO2, BUN, creatinine, glucose
LFT
- Liver Function Tests
- AST, ALT, bilirubin
azotemia
Increased BUN
rhabdomyolysis causes...
Increased serum creatinine
BUN:Creatinine >15:1
pre-renal causes (hemorrhage, shock, trauma, sepsis, dehydration)
Normal Range for Na
136-145 mEq/L
Factors that Affect Na
1. Aldosterone - kid reaborb Na
2. Natiuretic Hormone - inc renal loss of Na
3. ADH - reabsorption of water
Hyponatremia
- most common electrolyte disturbance in hospitalized pts. (b/c dilute with IV)
Hyponatremia Tx
- Never replenish >12mEq/day or risk pontine myelinolysis
Hypernatremia - sx and causes
- thirst
- hyperreflexia
- C: burns, diabetes insipidous, hyperaldosteronism, Cushings, inc water loss
Normal K Range
3.5-5.0 mEq/L
Factors that Affect K
1. ADH - promotes K secretion
2. Aldosterone - K secretion
3. INsulin and EP - promote cellular reuptake of K
4. ACE-I - inc K
Hyperkalemia EKG
- *peaked T waves
- wide QRS
- depressed STs
- V-fib
Hypochloremia vs. Hyperchloremia
-Hypo - tetany, metabolic alkalosis, resp acidosis
-Hyper - weakness, lethargy, met acidosis, eclampsia
Anion Gap
- Normal Range: 8-12 mEq/L
- Na - (Cl+CO2)
- used to classify metabolic acidosis and mixed acid-base disturbances
Hypomagnesium
- cardiac irritability
- inc cardiac dysrhythmias
- assocaiated with dec K and dec Ca
EKG of Hypermagnesium
- conduction slowing
- wide PR,QT,QRS intervals
Hypophosphatemia
- hyperparathyroidism
- inc Ca
- ETOH
- alkalosis
Hyperphosphatemia
- hypoparathyroidism
- renal failure
- dec Ca
- acidosis
primary cause of hypercalcemia
hyperparathyroidism with malignancy being 2nd leading cause
Hypocalcemia S&S
- tetany
- Chvostek's sign
- Trousseau's sign
- cardiac dysrhythmias
glucagon
- causes glycogen to break down to increase the blood sugar
insulin
moves glucose from bloodstream to the cells to decrease blood sugar
Diagnosing a Diabetic (BS levels)
- fasting BS >200 one time
- fasting BS>126 on 2 ocassions
Non-Ketotic Hyperosmolar Syndrome
- glucose 700-800 range and ketones are not increased
- Hbg A1C - marker or glucose over past 3 mo.
- C-peptide (see how well the pancreas is making its own insulin)
Hemoglobin A1C
- 5% corresponds to glucose of 90
- for every 1% inc, add 30 to glucose
Glucose Tolerance Test
- persistent elevated 2 hour levels are abnormal
Conjugated vs. Unconjugated bilirubin
Spleen --> RBC broken down into Hbg --> heme --> broken down into bilirubin --> unconjugated goes to liver --> gets conjugated --> bile duct --> bowels (or kidney --> urine)
unconjugated bilirubin and LFTs
- bound to albumin
- can cross BBB
- >15mg/dl in newborns require tx to avoid brain damage
Jaundiced Patients
- bilirubin >2.5
- dark urine
- light colored stools
Increased direct bilirubin causes
-extra-hepatic dyfunction
-biliary obstruction
-cholestasis
Increased indirect bilirubin causes
- hepatocellular dysfunction
- hepatitis
- Gilbert's Disease
when AST (SGOT) levels are elevated
- AMI
- CHF
- hypotension
- liver disease
- Reye's syndrome
- pancreatitis
when AST levels are decreased
- severe diabetes w/ ketoacidosis
- liver disease
- chronic hemodialysis
Alkaline Phosphatase
- liver enzyme
- can be heat fractionated to identify source (bone, kidney, placental liver)
- if only elevated LF test then fractionate it
- sensitive marker for liver metastasis
- inc in active bone formation
GGT
- Gamma-Glutamyl Transferase
- no longer part lipid panel
- obstructive enzyme
- indicator ETOH use
Pre-Albumin
- 1/2 life only 2 days
- acute process indicator
- used to check malnutriion and hepatic dysfunction
Ammonia
- normally transfomed into urea - but in liver dysfunction it cannot be catabolized
- inc in neonates w/in 48 hrs. of birth
1st Cardiac Marker in a MI
Myoglobin
Troponin
- inc w/ heart injury but not specific to MI
- Troponin-I and troponin-T
- 2-4 hrs. post MI
- elevated 9-14 days
Most commonly used cardiac marker
Troponin-I
CPK
- Creatinine phosphokinase
- cardiac enzyme/marker
- 3 enzymes CK-BB, CK-MM, CK-MB
CK-MB
- cardiac muscle; depends on muscle mass
- primarly used to dx AMI
- ordered every 8 hr x 3
- inc after cardiac surgery, pericarditis, myositis
Last Cardiac Marker
Lactic Dehydrogenase
-LDH1 - heart
BNP
-brain natriuretic peptid
- >100 = heart failure
HDL
-good chol
-transport
-Tangier's Disease - HDL deficient resulting in chol deposit in tissues
Amylase
- produced mainly in salivary glands and pancreas
- inc = pancreatic origin or salivary gland inflammation
Tumors that increase Amylase
1. serous ovarian tumors
2. lung carcinoma
Lipase
*follows clinical course of pancreatitis more closely than amylase
- found in pancreas