Clinical Diagnostics Test Ii - Part One

Front 1

What are the tests included in a typical LFT panel?

Back 1

AST (Aspartate Aminotransferrase)
ALT (Alanine Aminotransferrase)
Alkaline Phosphatase
Total Bilirubin
Albumin
Total Protein

Hint 1

Triple A Tat

Front 2

AST Normal Value

Back 2

5-40 U/L

Front 3

ALT Normal Value

Back 3

5-40 U/L

Front 4

Alkaline Phosphatase Normal Value

Back 4

25-115 U/L

Front 5

When these enzymes are elevated it reflects hepatocyte damage?

Back 5

AST and ALT

Front 6

When these enzymes are elevated in serum it relfects cholestasis?

Back 6

Alkaline Phosphatase, 5-nucleotidase, GGT

Front 7

Enzymes that don't fit precisely into either pattern?

Back 7

Bilirubin (Direct and Indirect)

Front 8

Enzymes that reflect liver synthetic function?

Back 8

Globulins, Albumin, Coagulation Factors

Hint 8

GAC

Front 9

When are AST and ALTs released?

Back 9

When the hepatocyte membrane is damaged.

Front 10

AST:ALT greater than 3.1 is highly suggestive of what?

Back 10

Alcoholic liver disease

Front 11

With what conditions and at what elevation (#) is almost exclusively related with extensive hepatocellular injury?

Back 11

Elevation over 1,000 U/L

Conditions: Viral hepatitis, ischemia, or toxin/drug-induced injury

Front 12

___ is higher than or equal to ___ in most hepatocellular disorders?

Back 12

ALT is higher than or equal to AST in most hepatocellular disorders

Front 13

Alkaline Phosphatase and 5'-nucleotidase are generally more specific for ________ than GGT?

Back 13

Cholestasis

Front 14

three fold elevation of this enzyme can be found in almost any liver disease, while elevations > 4X normal occur primarily in cholestatic liver disorders and infiltrative liver disease (CA, amyloidosis)

Back 14

Alkaline Phosphatase

Front 15

What is a normal total bilirubin?

Back 15

1 mg/dL

Front 16

Elevation of bilirubin causes what?

Back 16

Jaundice and Icterus

Front 17

Direct Bilirubin accounts for up to how much of total bilirubin?

Back 17

30%

Front 18

If there is an elevation in direct bilirubin it implies that there is what?

Back 18

Liver or biliary tract disease, and can be seen in any type of liver disease

Front 19

An elevation in indirect bilirubin means what?

Back 19

It is rarely due to liver disease. Isolated elevation is usually due to hemolysis or inherited defects of hepatic uptake or conjugation such as Gilbert's, Crigler-Najjar)

Front 20

What is a normal albumin level?

Back 20

4 g/dL

Front 21

Which coagulation factor is made exclusively by the liver?

Back 21

VIII

Front 22

Factor VII's half lives are shorter than albumin, thus it is a better measure of what?

Back 22

Acute liver synthetic function.

Front 23

Serum Albumin is a better test for what type of dysfunction?

Back 23

Chronic liver dysfunction

Front 24

Amylase, Lipase and Trypsinogen are excreted by the what?

Back 24

Kidney

Front 25

Elevations of amylase and lipase, over three times normal, virtually clinch diagnosis of what?

Back 25

Acute pancreatitis

Front 26

What is a normal serum amylase?

Back 26

30-220 units/L

Front 27

What are the three reasons that serum amylase may be falsely normal in pancreatitis?

Back 27

Delay (2-5 days) before serum levels drawn

Chronic Pancreatitis

Hypertriglyceridemia (seriously low amylase)

Front 28

What is the single best enzyme to measure for diagnosis of acute pancreatitis?

Back 28

Serum Lipase
Normal = 0-160 U/L

Front 29

Serum Trypsinogen is elevated, decreased and normal in what disease states?

Back 29

Normal Trypsinogen = 28-58
Elevated in acute pancreatitis

Decreased in chronic pancreatitis with steatorrhea

Normal in chronic pancreatitis without steatorrhea

Front 30

What is the proper ordering of tubes 1-4 in a typical CSF Analysis?

Back 30

Tubes 1 and 4: Cell Count and Differential

Tube 2: Gram Stain and Culture

Tube 3: Glucose and Protein

Front 31

What is a normal CSF Pressure?

Back 31

60-220 mmH20 (6-20cm H20)

In obese patients up to 250 mmH20 (25cm H20)

Front 32

What are the affects of acute processes (meningitis, bleeding) on CSF pressure?

Back 32

Cause rapid elevation, resulting in intercranial hypertension

Front 33

What are the affects of chronic processes (trumor) on CSF pressure?

Back 33

Allow compensation until threshold reached.

Front 34

CSF is grossly blood when there are how many RBCs/uL involved?

Back 34

6000

NOTE: 200 WBCs/uL or 400 RBCs/uL will cause turbidity

Front 35

What is a pink or yellow discoloration that begins to occur within 2-4 hours of RBCs entering CSF and may persist for 2-4 weeks?

Back 35

Xanthochromia

Front 36

What are four other causes, besides Xanthocromia, for CSF discoloration?

Back 36

Microbes
CSF protein is >150 mg/dl
Serum bilirubin is > 10-15 mg/dl
Traumatic LP

Front 37

This is largely excluded by the blood-CSF barrier?

Back 37

CSF Protein

Normal CSF protein = 23-38 mg/dL

Front 38

CSF protein is falsely elevated in the presence of what?

Back 38

RBCs - approx. 1mg of protein/dL per 1000 RBC/uL

Front 39

What is the CSF panel in viral meningitis?

Back 39

WBC count is usually <250/uL and almost always <2,000/uL

CSF protein is <150 mg/dL

CSF glucose > 50% serum

Front 40

What is the CSF panel in bacterial meningitis?

Back 40

CSF WBC count >1,000/uL with neutrophils predominating

CSF protein is >250 mg/dL

CSF glucose is < 45 mg/dL
less than 18 mg/dL is strongly predictive of bacterial meningitis

Front 41

What is a normal CSF to serum glucose ratio?

Back 41

0.6

Front 42

If this is less than 18 mg/dL it is strongly predictive of bacterial meningitis.

Back 42

CSF Glucose

Front 43

If CSF WBCs are elevated, then could be secondary to a _______ ?

Back 43

Traumatic Tap or could be significant

Front 44

To help differentiate between a traumatic tap and elevated WBCs what can be used?

Back 44

Predicted CSF WBC

Front 45

How do you calculate predicted CSF WBC

Back 45

CSF RBC X (peripheral blood WBC/peripheral blood RBC)

Front 46

What are the five main categories of synovial effusion?

Back 46

Septic
Hemorrhagic
Inflammatory
Pseudoseptic
Noninflammatory

Hint 46

Shippin'

Front 47

Septic synovial effusion is caused by?

Back 47

Bacterial, mycobacterial, and fungal
May have co-existance of cyrstal and septic arthritis

Front 48

Hemorrhagic synovial effusion is caused by?

Back 48

Aspirin, anticoagulants, bleeding disorder

Front 49

Inflammatory synovial effusion is caused by?

Back 49

RA, SLE, and crystal arthropathy

Front 50

Pseudoseptic synovial effusion is caused by?

Back 50

Reaction to injection, excess inflammation

Front 51

Noninflammatory synovial effusion is caused by?

Back 51

osteoarthritis and trauma

Front 52

This is usually clear, colorless, highly viscous, protein approximately 1/3 of plasma concentration, glucose similar to plasma, acellular and no crystals.

Back 52

Normal Synovial Fluid

Front 53

Positive Likelihood Ratio for septic arthritis by synovial WBC:
25,000/mm: 2.9 >50,000: 7.7 >100,000: 28
Lower counts may be seen with mycobacteria, some neisseria, & several gram positives

Back 53

Positive Likelihood Ratio for septic arthritis by synovial WBC:
25,000/mm: 2.9 >50,000: 7.7 >100,000: 28
Lower counts may be seen with mycobacteria, some neisseria, & several gram positives

Front 54

Synovial crystal analysis

Urate?

Back 54

Strongly negatively birefringent
Yellow, Needle-like appearance
Gout

Front 55

Synovial crystal analysis

Calcium pyrophosphate

Back 55

Weakly positively birefringent
Blue rectangular or rhomboid appearence
Pseudogout

Front 56

What are the other crystals that can be associated with synovial fluid?

Back 56

Calcium oxalate, steroid, cholesterol, hydroxyapatite

Front 57

What is the proper handling technique for an arterial blood gas?

Back 57

Must go to lab for immediate interpretation

Must fill tubes adequately - need at least 2 mL of blood, or could have falsely low pH, secondary to acidic heparin preparation

Front 58

What is reported in an arterial blood gas? 5 things

Back 58

pH
pCO2
pO2
O2 sat
Total CO2

Front 59

Causes for false readings in arterial blood gas, what are they?

Back 59

Excess air bubbles, Profound leukocytosis, and false negatives in the presence of carbon monoxide poisoning

Front 60

Excess air bubbles in an arterial blood gas can cause what problems?

Back 60

False elevation of P02 and false decrease in PC02

Front 61

Profound leukocytosis can cause what problems in an arterial blood gas?

Back 61

Profound leukocytosis can cause falsely low p02 due to 02 consumption by leukocytes

Cooling (ice) slows down this process

Front 62

Carbon monoxide poisoning can give what false normal in arterial blood gas?

Back 62

Oxyhemoglobin saturation (02 sat) can be falsely normal in the presence of carbon monoxide poisoning.

Need to get carboxyhemoglobin levl if over 20% critical, if less than 3% normal, but up to 10% is normal in smokers

Front 63

State normal values for pH, PaCO2, and PaO2.

Back 63

pH = 7.4
PaCO2 = 40 mmHq (dissolved CO2)
Pa02 = 100 mmHg (dissolved 02)

Front 64

What must you order simultaneously with an ABG when you are measuring HC03?

Back 64

electrolyte panel

Front 65

Why is this necessary?

Back 65

Because the Total CO2 reported on the ABG is calculated from the Henderson-Hesselbach equation

(Need to verify that measured and calculated values are within 2 points of each other)

Front 66

If you have a low Pa02 it is what?

Back 66

Hypoxemic (<80 mmHg)

Front 67

PaCO2 is elevated it is?
PaCO2 is decreased it is?

Back 67

elevated PaCO2 = hypercapneic
decreased PaCO2 = hypocapneic

Front 68

Metabolic acidosis is?

Back 68

pH less than 7.4 due to elevated H

Front 69

What is respiratory acidosis?

Back 69

If the pCO2 is over 40

Front 70

What is metabolic acidosis?

Back 70

If the HCO3 is less than 24

Front 71

Alkalosis is?

Back 71

pH over 7.4 due to decreased H

Front 72

What is respiratory alkalosis

Back 72

If the PC02 is less than 40

Front 73

What is metabolic alkalosis

Back 73

If the HCO3 is over 24

Front 74

Respiratory Acidosis
Hypoventilation raises pCO2, lowering pH; HCO3 raises to compensate
Respiratory Alkalosis
Hyperventilation lowers pCO2, elevating pH; HCO3 lowers to compensate
Metabolic Acidosis
Low HCO3 lowers pH; PaCO2 lowers to compensate
Metabolic Alkalosis
High HCO3 elevates pH; PaCO2 elevates to compensate

Back 74

Respiratory Acidosis
Hypoventilation raises pCO2, lowering pH; HCO3 raises to compensate
Respiratory Alkalosis
Hyperventilation lowers pCO2, elevating pH; HCO3 lowers to compensate
Metabolic Acidosis
Low HCO3 lowers pH; PaCO2 lowers to compensate
Metabolic Alkalosis
High HCO3 elevates pH; PaCO2 elevates to compensate

Front 75

What is associated with hypochloremic metabolic acidosis? 3 things?

Back 75

Diarrhea, Renal Tubular Acidosis, Early Renal Failure

Front 76

High Anion gap metabolic acidosis must be corrected for what?

Back 76

Hypoalbuminemia - for every 1g/dL fall in albumin below 4, must add 2.5 to gap

Front 77

A high anion gap indicates presence of what?

Back 77

non-measured anion

Front 78

What symptoms can be associated with high anion gap metabolic acidosis?

Back 78

Ketoacidosis, lactic acidosis, ingestions (methanol, ethylene glycol), late renal failure (sulfates)

Front 79

Saline responsive metabolic acidosis details?

Back 79

Volume Depletion - vomiting or NG suction, Diuretics

Front 80

Saline non-responsive details?

Back 80

Volume expansion - Mineralcorticoid excess (first degree hyperaldosteronism)

Front 81

What is an additional test that can be used to detect high anion gap metabolic acidosis?

Back 81

Plasma Osmolal Gap

Front 82

What is an additional test than can be used to detect hyperchloremic metabolic acidosis?

Back 82

Urinary ion gap, urinary osmolal gap

Front 83

What is an additional test than can be used for metabolic acidosis?

Back 83

Urine Chloride