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301 Cards in this Set
- Front
- Back
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Free Living Amoeba
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Naegleria fowleri
Balamuthia mandrillaris - Gran ameob enceph Acanthamobea - GAE in IC Sappinia - soil - sinusitis -meningoenceph |
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Angiostrongylus
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Cantonensis - eos meningitis
- rat (pulm A) to larvae to snail/slug to L3 larvae to humans Costaricensis - mesenteric arteries - mimic appendicitis, eos granulomas in GI - rodent to slug |
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Fwd
Reverse DAT |
Fwd - cells + reagent
Rev - serum + reagent cells DAT - ab bound to rbc in vivo - if not transfused in past 3 mon = autoab |
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W. bancrofti
B. malayi B. timori |
Filaria - adults in lymphatics, microfilaria in blood
Vector: mosquito - lymphangitis, tropical pulm eos |
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Shigella
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Enterobacteriaceae
- human only - no animal reservoir A: S. dysenteriae B: S. flexerni C: S. boydii D: S. sonnei - Shiga toxin: AB5 - shuts down protein production Hektoen Enteric Agar - green or colorless with no black center |
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Rabies
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Lyssavirus
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Bacillus anthracis
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Gram Positive, Spore forming
SB Agar - resides in soil - toxins: edema factor, lethal factor, protective antigen - GI, Cutaneous, Pulm |
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Compensation of Acid - Base Disorders
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Met Acidosis
- dec HCO3 1.3 : dec pCO2 1.0 - pCO2 = last 2 digits of pH Met Alkalosis - inc HCO3 0.6 : inc pCO2 1.0 Respiratory - in same direction - acute pCO2 1 : HCO3 0.1 - chronic 1 : 0.4 |
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Flagellates
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Giardia lamblia
- falling leaf motility - central axostyle -cyst: 4 nuclei Chilomastix mesnili - nonpathogen - rotary motility, no central axostyle Dientamoeba fragilis - round, bincuc Trichomonas vaginalis Leishmania Trypanosomes - T. brucei - Tsetse fly - Af sleeping sick - T. cruzi - reduviid - kissing bug - Chagas |
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Bordatella pertussis
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Regan-Lowe Charcoal Agar
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Gram Positive Spore Formers
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Aerobic
- Bacillus - anthracis - cereus Anaerobic - Clostridium botulinum tetani perfringens difficile |
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Bartonella
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B. quintana
- Trench fever, louse B. henselae - Cat scratch, flea B. bacilliformis - Carrion's Dz, sandfly, acute febrile anemia, verroucus rash, verruga peruana, Oroya fever, Andes B. angiomatosis - 90% IC |
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Tularemia
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Francisella tularensis
- tick, fly, mosquito - transmit - cut, ingest, inhale, mucous memb - Ulceroglandular - Typhoidal |
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Yersinia
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Gram Neg Rod, LN, CIN Agar, Fac Intracellular
Y. pseudotuberculosis - appy like Y. enterocolitica - adenitis, septicemia Y. pestis - bipolar safety pin -res: rats, prairie dogs -vect: flea - Bubonic, Septicemic, Pneumonic |
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MNS
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M, N - clinically insig
s (89-97%); S (w 55%, b 31%) SsU can make potent anti U - IgG - HTR, occ HDFN, dosage |
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Leishmania
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Flagellate
- Tissue: 2-5 micro in histio - oval with transverse barlike kinetoplast - sandfly Cut: old world: tropica, major, aethiopica new: mexicana Sys: donavani - kala azar Mucocut: braziliensis |
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Campylobacter jejuni
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Gram Neg Rod (seagull), 5% O2, CO2, 42C
C.jejuni is hippurlate hydrolysis pos -fowl, puppies, kittens, milk flu like |
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Thrombin Time
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Add thrombin to plasma
Prolong: deficient fibrinogen defective fibrinogen heparin, hirudin, agatroban fibrin degradation prodcuts -Reptilase: Normal with heparin -Dysfibrinogenemia - not correct with mixing study -Hypofibrinogenemia - correct with mixing study |
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Neisseria
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GNC, Ox+, Cat+
Modified Thayer Martin, Marin Lewis Agar, NYC Medium - N. gonorrhea - glucose - N. meningitidis - gluose, maltose - N. lactamica - glucose, maltose, lactose |
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Immediate HTR - 4 most common
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anti-A
anti-Kell anti-JKa anti-Fya |
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Gram Positive Cocci
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Staph - catalase +
coagulase + S. aureus - novobiocin Sens S. epidermis Res S. saprophyticus Strep catalase neg Beta - Grp A - S. pyogenes - PYR + Grp B - S. aglactiae - CAMP + Alpha - S pneumo No - E. faecalis, E. faecium - PYR+ S. bovis - PYR - |
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Onchocerciasis
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River blindness
V: simulium black fly Adults in nodules, MF in skin Dx: Ab, skin snip |
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PTT
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Intrinsic (VIII, IX, XI, XII) and Common (X,V,II)
Add antiphospholipid, FXII activator, Ca to plasma - Heparin |
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Mixing Study
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Indications: PT, PTT > 5 sec norm and on no anticoag
2 stages: Immed and Incubation (1-2 hrs) Mix 1:1 plasma and pooled plasma (factors) *Correct immed, not incub: inhibitor *Correct immed, correct incub: deficiency *No immed, No incub: lupus anticoag PTT abn, PT can be N b/c more phospholipid added |
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Gram Neg Cocci
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Neisseria meningitis
gonorrheae +Ox, +Cat Moraxella catarrhalis - hockey puck sign +Ox, +Cat, +DNAse, no gluc, malt, lact |
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HDFN
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Kidd - JKa, JKb - amnestic
Rh - anti-D, anti-c Kell - K, suppress erythroid precursors Duffy - Fya, Fyb MNS - SsU Diego ABO - Grp O moms - mild because A/B not fully dev at birth |
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FFP, Cryo - Temp, Storage, Contains
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FFP: -18C, 12 mon, labile factors V, VIII
2-4mg fibrinogen / mL; about 300ml FFP thaw to sluch spin 4200 rpm for 10 min in 4C centriguge to make Cryo Cryo: 18C, 12 mon Thawed: FFP 24 hrs, regrig Cryo 4 hrs, rm temp |
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Yersinia
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CIN Agar (Cefsulodin-Irgasan-Novobiocin)
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Rh Ig Dose
Testing |
1 full dose (300microg) = 30ml whole or 15ml rbi
Tests: rosette test - as little as 10 cc Kleinhauer - Betke |
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Salmonella
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Hektoen Enteric Agar - blue-grn with blk centers
Gram Negative Rod -Non-tyhoidal -Enteric - typhi and paratyphi |
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Tubes
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No CHoiCE
Red - nothing Yellow - citrate + Green - Heparin Blue - citrate Purple - EDTA |
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Anion Gap Acidosis
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AG = Na - (Cl + HCO3)
DKA Lactic Acidosis Uremia Cyanide Tolune Ethylene Glycol Isoniazid Methanol Propylene glycol EtOH Salicylates |
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Kell
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K 10%, k 99%
McLeod Synd - X-linked recessive - musc dystrophy, chr granulom dz, retinitis pigment Sensitive to DTT or 2-ME treated rbc Imm stim Immed / Delayed HTR HDFN - suppress erythroid precursors |
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Mycobacteria
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Obligate Intracelleular
Tuberculosis Leprosy - transmit nasal secretions Ulcerans - Buruli ulcer, arthropods |
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Crytococcus
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Bird Seed Agar
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Vibria Cholerae
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Gram Neg Rd, Fac anaerobe, TCBS or TTGA Agar
01 / 0139 Cholera toxin - AB5, inc CAMP, inc NaCl, H2O follows 10% gravis |
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MacConkey Agar
MacConkey Sorbitol Agar Eosin-Methylene-Blue (EMB) Agar |
For Gram Negatives
Lactose fermenters are pink Non-lactose fermenters are clear Mac Sorb - E.coli (0157:H7) EMB - LF - green, blue-black, brown |
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Listeria
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Gram Positive Coccobacillus
-deli meats -Bacteremic mets - placenta, meningoenceph |
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Burkholderi pseudomalleri
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Gram Neg Rod
Meliodosis - acute pneum, sept, absc, sep arthr Soil - Thailand, North Australia mallei - glandes in horses cepacia - pneumonia in CF patients |
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G
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present on D+, C+ cells
reacts like a mix of anti-C, anti-D in lab testing - anti-C is stronger than anti-D |
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Rh
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37C, IAT
Dosage Enhanced by protease digestion which unmasks Rh antigens |
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Alpha Viruses
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EEV, VEEV, WEEV
Chikungunya - Aedes mosquito - febrile exanthem, arthralgia |
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Toxoplasma gondii
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Route: cysts in meat, feces, water, bld transf, organ transplant
Immunocompetent - mostly abysm Immunocompromised - enceph, pneumonitis, mycoard Congenital |
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Loa loa
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Filariasis, African eye worm
Vector: Deerfly Adults: SQ, MF: blood |
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Causes of delayed HTR
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anti-Jka - 1/3
anti-D anti-E anti-c anti-K anti-Fya |
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Cyclospora
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oocysts along brush border about 10 micron
explosive, crampy diarrhea |
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Hemoglobin Electrophoresis
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Alkaline
- CEOA2, SDGLepore, F, A + Acid - F, AGEDA2O, S, C + |
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Corynebacterium diptheriae
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Cystine Tellurite Bld Agar (brn halo), Tinsdale Agar (brn halo), Loeffler's medium
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P1
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IgM, natural
B9 Inhibited by hydatid cyst fluid, pigeon/turtledove eggs Autoab - Paroxysmal Cold Hemoglobinuria p and Pk are rare null phenotypes - severe HTR, HDFN, spon ab - need rare cells |
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Lutheran
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IgG, IgM, Lub (99%)
heterogeneously expressed - mixed field inhibited by red cell sulfhydryl reducing agents anti-Lua - insig anti-Lub - rare - mild HTR, HDFN |
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Fastidious Broth
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Neisseria
Haemophilus Streptococcus pneumoniae Bacteroides fragilis Clostridium difficile |
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Escherichia coli
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ETEC - LT, ST, self limited
EPEC - pili, babies EHEC/STEC - Shiga toxin; bldy diarrhea - no anbx b/c inc HUS EagEC- watery |
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Gram Pos Rods - Non-spore forming
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Aerobic
- Corynebacterium diptheriae - Listeria monocytogenes - Erysipelothrix - Nocardia - Streptomyces - Rhodococus Anaerobic - Actinomyces proprionibacterium - Actinomyces lactobacillus |
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Cryptosporidium
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brush border - 5 micro
-watery foul smelling diarrhea |
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Hanta Virus
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Old world - Hantaan (mice), Seoul (rat), Dobrova (mice), Puumala (vole)
- HFRS New world - Sin nombre, Andes - HPS |
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Duffy
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Fya, Fyb, Fy3, Fy5 (3 and 5 are high incidence)
- receptor for Plasmodium vivax - black - mut DARC gene promoter - Fyb expressed on non-erythroid - other ethnic - inactivating mutations - lack all Duffy - ab to Fy3 HTR, HDFN - need immune stim Dosage Abolished by digesting rbc with proteolytic enzymes |
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Anti-cardiolipin antibody
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-directed aga cardiolipin bound to B2-glycoprotein I
-80% antiphospholipid synd -False + = syphilis (RPR), Q fever, HIV |
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Campylobacter
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Skirrow's Agar, Campy CVA Agar
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Activated Protein C Resistance
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APC degrages aFV and aFVIII
-measure PTT with no added protein C and then after adding protein C (N 2:1) -FV Leiden mutation - subs glutamine for arginine |
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Microsporidia
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Oblig intracell, spore former
-diarrhea, keratoconjunc, sinusitis, renal insuff, pulm |
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Legionella
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Buffered Charcoal Yeast Extract
-needs L cysteine -urinary antigen only tests serogroup 1 |
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Delayed HTR
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anti- Jka, E, D, C
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Hb Electrophoresis
Alpha and Beta Thal |
-microcytic normal Fe
-A2 inc in B thal - b/c normal alphas pair more readily -A2 norm in alpha thal a thal - chromo 16 b thal - chromo 11 |
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Borrelia
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B. burgdorferi - Lyme, Ixodes
B. recurrentis - Epidemic Louse Born Relaps Fev B. hermsii, turicate, palari - Endemic Tick Born RF - Ornithoderas tick, res- rodents |
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Rickettisa
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Gram Neg, coccobacilli, oblig intracell, stain with giemsa
-infects endothelial cells - swelling, mononuclear vasculitis with intravascular thrombi -Spotted Fevers - ticks except 2 (mite, flea) -Typhus - Epidemic - R. prowazekii - louse, flying squirrel - Endemic - R. typhi, fleas, rat - Scrub - mites |
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Viral Hemorrhagic Fevers
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Filo, Flavi, Bunha, Arena
- DIC |
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Chocolate Agar
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Neisseria and Haemophilus
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Lewis
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Passively adsorbed
rare HTR, no HDFN Leb is synthesized from Lea due to secretor IgM, naturally occurring Enhanced by tx |
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Anion Gaps
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AG = Na - (Cl+HCO3)
Met Acid - dec HCO3, then dec PaCO2 Resp Acid - inc PaCO2, then inc HCO3 Met Alk - inc HCO3, then inc PaCO2 Resp Alk - dec PaCO2, then dec HCO3 |
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Osmolal Gap
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changed in measured osmolality - molal conc
Calculated = 2Na + (Glu/18) + (BUN/2.8) Causes: Ethanol, Methanol, Isopropanol, Ethyline glycol |
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Enzymes Enhanced / Destroyed by enzymes
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Enh: I/i, P, Le, Rh, Kidd
Dest: MNSs, Fya, Fyb, Lutheran, Chido |
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Cestodes
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Tapeworms
-Diphyllobrothium latum - raw fish, crustaceans - Vit B12 -Taenia - solium - cystercercosis - saginatum - asciatica -Echinococcus - cystic hydatid dz |
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Klebsiella granulomata
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+ Voges-Prokauer
large mucoid colonies Donovaniasis, granuloma inguinale |
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Kidd
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Jka, Jkb
-Enhanced by antigens -IgG, exposure, tend to disappear over time -Dosage -IHTR - intra but usually extra -DHTR -No HDFN |
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PT
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-Extrinsic (FVII) and Common (X,V,II,fibrinogen)
-Add tissue factor and phospholipid + Ca to PLASMA -More phospholipid added than PTT which is why it is freq normal in lupus anticoag -warfarin |
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Nematodes
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Round worms
-Ascaris - gut-liver-lung-gut -Hookworm - skin-lungs-gut -Trichuris - gut-liver-lungs-gut - colitis mimicing IBD -Strongyloides - skin-lung-gut - autoinfect, GNR sepsis in IC -Trichinella - cyst in meat-gut-adult-larvae-musc -Enterobius |
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Schistosomiasis
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Trematodes
mansoni - Katayama fever haematobium japonicum - Katayama fever intercalatum, guinensis, mekongi snail-cercarieae-bld vessel-portal circ-bladder-egg-water-miracidia-snail |
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Flavivirus
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Arbovirus
-JEV, WNV, SLE, MVE - mosquito -TBE, Powassan - tick -Yellow Fever - Aedes mosquito - liver - midzonal necrosis -Dengue - Aedes mosquito - - DHF: hemorr, thrombocyto, cap leak, fever, shock |
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Trematodes
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Intestine:
-Fasciolopsis buski - water plants Liver: -Fasciola hepatica - water plants -Clonorchis sinensis - raw fish -Opistorchis - raw fish Lung -Paragonimus - crustaceans |
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Protozoa - Amoeba
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E. histolytica
- troph - 25 micro, small central karyosome - cyst - no more than 4 nuclei E. coli - troph - 25 micro, eccentric karyosome - cyst - 8 or more nuclei E. hartmanii - troph - 5-10 micro Iodamoeba butschlii - cyst: promin iodine staining vacuole |
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Enterovirus
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Polio
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Rh Nomenclature
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R1 DCe r' dCe
R2 DcE r'' dcE R0 Dce r dce Rz DCE ry dCE |
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Bilirubin
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Indirect - Unconjugated
- Gilbert - dec uGT1A1 - Crigler-Najar - absent uGT1A1 Direct - Conjugated - in urine, measure by diazo-calorimetric method - Dubin Johnson - mutation secretor protein - black liver - Rotor syndrome - no pigment in liver Both: Hepatitis |
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Zygomycetes
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- Lid lifters
- Rhizopus - rhizoids across from sporangia - Absidia - internodal rhizoids - Mucor - no rhizoids - rhinocerebral, endobronchial, invasive pulm, gastric, cutaneous |
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Bernard-Soullier
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- Gp1b-IX-V binding complex
- AR, giant plts, thrombocytopenia - normal aggreg with all agonists but ristocetin (same as vWF) - tx- DDAVP (releases vWF) |
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May-Heglin
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- non-muscle myosin IIa - cells can't change shape
- AD, hearing loss, cataracts - wbc have dole like bodies and giant plts - defects in megakaryocytes |
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Gray platelet syndrome
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- group of disorders - no alpha granules
- AD/AR, bone marrow fibrosis |
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Glanzmann thrombasthenia
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- GpIIb-IIIa
- AR - test - all abnormal except ristocetin |
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Hermansky-Pudlak
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- absent dense granules (EM)
- AR, mutation in packaging of lysosomes |
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Factor X
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- primary amyloidosis can cause due to absorption
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Vitamin K dependent factors
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II, VII, IX, X
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Francisella tularensis
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-GNR - Req cysteine and cystine, urease neg
-Arthro - ticks, flies -Non-spec, ulceroglandular, oculoglandular, pneumonic, typhoidal |
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Brucella
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-GNR - urease pos
-B abortus - cows; B melitensis goats and sheep; B suis - pig |
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Capnocytophaga canimorsus
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-GNR, req high CO2
-Dog bites |
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Streptobacillus monoliformis
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-GNR, puffball colonies
-rat bite fever, Haverhill fever when ingested |
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Haemophilus species
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-Chocolate agar
-H.influenzae - X,V -H.para - V -H.haemolyticus - X,V,hemolysis -H.aegyptius - X,V,hemolysis - conjunctivitis -H.ducreyi - X - beefy, red ulcer with ragged edge school of fish gram stain |
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Pituitary - Somatropic (GH) Testing
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Stim test: insulin inc, glucose dec in normal
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Pituitary - Corticotroph (ACTH) Testing
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Petrosal sinus sampling: pit/periph >2 = pit orgin
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Pituitary - Cortisol / Cushing Testing
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Cushing - dec K, inc cortisol/glucose/Ca/bicarb
- Serum cortisol - diurnal variation - Urine free cortisol - false inc stress, EtOH - Salivary cortisol - as above - DST - low dose - screen = no suppression high dose - adrenal / ectopic = not suppress Ectopic - inc ACTH, Adrenal - dec ACTH pit = suppress |
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Pituitary - Posterior - ADH
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DI: inc dilute urine, low level hypernatremia
- Water deprivation + ADH - Normal - inc urine osm, - Central - no change uosm, ADH - overcome, inc uosm - Nephro - no change, ADH no change SIADH: Normovol, dec Na, inc uNa, inc uOsm |
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ITP
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-Autoab, IgG GPIIb/IIIa, GPIb-IX
-Bone marrow: inc megak, micromega, immat forms -Chemistry: plt boung IgG, plt assoc IgG -usually viral illness prior Chronic - lupus, HIV, B-cell neoplasms |
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Serratia marscens
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GNR, GF+, N+, Oxid-, Cat+
-pneumonia or noscomial in debilitated -Red pigment on SBA |
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Treponema
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Spirochete
-T pallidum pallidum - syphlilis -Tpallidum pertenue - Yaws skin contact, 1-pap lesion, diss-fever, late-destruct bone/cart/skin -T pallidum endemicum - Bejel mucous memb, -T carateum - Pinta skin contact, 1-hyperkeratotic plaque, late-pigm skin changes |
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Treponemal tests
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Nontrep - RPR, VDRL, TRUST
- IgG/M to anticardiolipin Trep - FTA-ABS, MHA-TP |
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Leptospira interrogans
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-Weil disease - triad mening, hepatitis, nephritis
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Strentrophomonas
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-Farm workers
-DNAse+ |
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Pancreatic Cyst Evaluation
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Pseudocyst - Inc Amylase, Dec CEA, Inc CA 19-9
Amorphous material, inflamm cells Serous Cystadenoma - Dec all Bland cuboidal epith Muc Cystadenoma - Dec Amylase, Inc CEA, nl-Inc CA Bland muc epith cells IPMN - Inc all Bland-atypical muc epith cells Solid Pseudopap - Dec all Bland, NE cells, myxoid stroma |
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Hereditary spherocytosis
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AD
insuff memb skeletal components - ankryin, band 3, spectrin, or band 4.2 decreased life span |
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G6PD Deficiency
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-G6PD reduces NADP to NADPH
-recessive X linked -intra and extravascular hemolysis -Heinz bodies - globin chains |
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Sickle Cell
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-point mutation in sixth codon of B chain G to V
-HbS polymerizes to cause sickling HbSC - symptomatic but more mild |
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Beta Thal
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-hypochromic, microcytic anemia
-target cells Major - MEd, Af, SE Asia, HbF markedly elevated, HbA2 N Minor - mild, inc HbA2, HbF N |
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Alpha Thal
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-Newborns: unpaired gamma chains - gamma tetramers = HbBarts
-Adults: B4 tetramers = HbH Silent Carrier Trait - microcytosis, min-no anemia HbH Dz - Asians - mod severe anemia Hydrops fetalis - distress in third trimester |
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Paroxysmal Nocturnal Hemoglobinuria
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-acquired mutations in PIGA
-red cells, plts, granulocyts susceptible to lysis or injury due to lack of GPI-linked factors -intravascular hemolysis -dysfunctional plts lead to thrombosis |
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Immunohemolytic Anemia
Warm Autoab |
IgG
50% - Primary Secondary - AI (lupus), drugs, lymphoid neoplasms |
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Immunohemolytic Anemia
Cold Autoab |
IgM
Mycoplasma, EBV, CMV, influenza, HIV |
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Paroxysmal Cold Hemoglobinuria
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IgG to P blood group antigen
binds in periphery most often in children after viral illness |
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Fe Deficiency anemia
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hypochromic, microcytic anemia
Fe low Ferritin low TIBC high |
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Anemia of Chronic Disease
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Normo, normo or hypo micro
Inc Fe Inc ferritin Low TIBC |
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Fanconi anemia
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AR
defects in multiprotein complex required for DNA repair BM hypofunction Hypoplasia of kidney spleen Bone defects - thumbs, radii |
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TTP / HUS
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Pentad of fever, thrombocytopenia, microangiopathic hemolytic anemia, transient neurologic deficits, renal failure
-excess activation of platelets which deposit thrombi in microcirculatory beds -assoc with def in ADAMTS13 - vWF metalloprotease |
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von Willebrand Disease
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Type 1 - dec quant, AD, mild to mod
Type 2A - qual, AD, large and intermed multimers are missing Type 3 - dec quant, AR, extremely low -ristocetin cofactor - reduced bc measurs active vWF -secondary dec in FVIII -prolong PTT (not always) -Tx: Desmopressin |
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Disseminated Intravascular Coagulation
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Excessive activation of coagulation which leads to thrombi in the microvasculature
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Lineweaver-Burke Plot
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-Enzyme inhibition
-Uninhibited -Noncompetitive - binds away from site, not overcome by substrate, x=same, y=different -Competitive - compete for same site, overcome by subs conc, x=dff, y=same -Uncompetitive - stabilizes enzyme-substrate complex both x, y diff |
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Albumin in pregnancy
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Decreases
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SPEP Nephrotic Syndrome
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Dec in all except alpha 2 because alpha 2 macroglobulin is too large
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Albumin in acute inflamm
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Decreases
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SPEP: Where is spike in monoclonal gammopathy?
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usually gamma but sometimes beta or alpha 2
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What is ddx of monoclonal gammopathy?
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MM
MGUS Plasmacytoma Waldenstroms macroglobulinemia CLL/SLL |
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What makes the Tau protein in CSF?
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Transferrin - asialated
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What are Bence-Jones proteins?
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monoclonal light chains
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Cryoglobulinemia: mono or polyclonal and what disease
Type I, Type II, Type III |
I: mono, MM, Waldenstrom
II: poly IgG and mono IgM, Hep C III: poly |
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Hypercalcemia - Causes
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CHIMPS
Cancer Hyperthyroidism Iatrogenic Multiple Myeloma Hyperparathyroidism Sarcoidosis |
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Primary Hyperparathyroidism - Cause, Ca, Phos
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Cause - Adenoma, Hyperplasia
Ca inc Phos dec |
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Secondary Hyperparathyroidism
(Pseudohypoparathyroidism) Cause, Ca, Phos |
Peripheral resistance to PTH in chronic renal failure, and vitamin D deficiency
Ca dec Phos inc Brown tumors due to persistent inc PTH |
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Tertiary Hyperparathyroidism
cause, Ca, Phos |
Post renal transplant - parathyroids become autonomous
Ca inc Phos dec |
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|
Hypervitaminosis D
Ca, Phos |
Ca inc
Phos inc enhances reabsoption of both Ca and Phos |
|
|
Increased Anion Gap and Osmolal Gap
|
Methanol (Windshield washer fluid)
Paraldehyde |
|
|
Trisomy 18
AFP, hCG, uE |
All decreased
|
|
|
Neural Tube Defects
AFP, hCG, uE |
AFP inc
hCG normal uE dec |
|
|
Trisomy 21 - Down Syndrome
AFP, hCG, uE, DIA |
AFP dec
hCG inc uE dec DIA inc It gets ME down (MSAFP, uE). |
|
|
Fetal Fibronectin
|
In the virtual space between placenta and uterus
Absence very high neg predicive value for impending preterm birth |
|
|
Cocaine metabolite
|
Benzoyl ecgonine
Methyl ester |
|
|
Heroin metabolite
|
6-acetyl morphine
|
|
|
Amphetamines metabolite
|
norepinephrine
phenylacetone |
|
|
PCP metabolite
|
hydroxylate and glucuronated
|
|
|
Cocaine and alcohol metabolite together
|
Cocaethylene (ethylbenzoylecgonine)
|
|
|
Codeine metabolite
|
Morphine
|
|
|
Osmolal gap > 10
Measured serum osmolarity - calculated Calculated: 2Na + BUN/2.8 + glucose/18 |
Toxic alcohol - ethylene glycol, methanol, isopropyl alcohol
|
|
|
Ethylene glycol
what and metabolite |
Antifreeze
oxalate and glycolate Ca oxalate crystals in urine anion gap acidosis and osmolal gap |
|
|
Isopropyl alcohol
what and metabolite |
Rubbing alcohol
Acetone does not cause acidosis or inc anion gap but does cause osmolal gap |
|
|
Methanol
what and metabolite |
windshield washer fluid
formate and formaldehye ocular toxicity, anion gap acidosis and osmolal gap |
|
|
Lead poisoning
Erythrocytes and measure what substance |
Basophilic stippling - RNA
Venous whole blood |
|
|
Lipoprotein - protein content
|
Chylomicrons - 1%
VLDL - 8% IDL - 15% LDL - 20% HDL - 50% |
|
|
Friedwald equation
|
LDL = TC - HDL - TG/5
Not valid: TG>400, chylomicrons present, type III dyslipidemia |
|
|
Test tube for glucose
|
Gray = Fluoride
|
|
|
DKA
|
Hyperglycemia, ketosis, metabolic acidosis
|
|
|
Serum Ketones - measured and not
|
Acetone, Acetoacetic acid
B-hydroxybutyrate - not measured but breaks down to other two so can seem to be increasing at the start of treatment |
|
|
CEA
|
Colon
|
|
|
CA125
|
Non-mucinous epithelial ovarian cancer
|
|
|
CA 19-9
|
Pancreatic
No produced by Le-neg |
|
|
AFP
|
HCC
Yolk Sac |
|
|
HCG
|
Chorio
Trophoblastic Dz |
|
|
Cushing - Pituitary Testing
|
Low dose - not suppressed
High dose - suppressed CRH Stim test - increases ACTH and cortisol |
|
|
Cushing - Adrenal / Ectopic Testing
|
Low dose - Not suppressed
High dose - Not suppressed CRH Stim test - No response |
|
|
11-B-Hydroxylase Deficiency
|
Inc in deoxycorticosterone with is weak mineralcorticoid
HTN Dec K Met Alk |
|
|
21-Hydroxylase Deficiency
|
Inc 17OH Progesterone
Salt wasting Dec Na Inc K Met acid Virlization |
|
|
Inc Aldosterone
|
Conn Syndrome
Causes: adrenal adenoma (dec renin) Secondary (inc renein) - renal A stenosis HTN with hypervol, Inc Na, Dec K, Met alk |
|
|
Inc Cortisol
|
Cushing - Adrenal, Pit, Ectopic, Iatrogenic
Inc gluc, Inc Na, Dec K |
|
|
Dec Cortisol
|
Addison - Adrenal (tb, met, amyloid, hemorr), Pituitary
Dec gluc, Dec Na, Inc K |
|
|
Vit glucose after death
|
Decreases
Preferred for dx of DKA, Inc gluc and ketones |
|
|
BUN Cr after death
|
Stable
|
|
|
Dehydration dx in autopsy
|
Mild nitrogen retention
Inc Na |
|
|
Vit Na and Cl
|
Stable
|
|
|
Vit K
|
rises linearly after death
Most reliable chemical test for postmortem interval |
|
|
UPEP Glomerular Proteinuria Pattern
|
strong albumin, alpha1, beta
|
|
|
UPEP Tubular Proteinuria Pattern
|
strong alpha1, alpha2, beta
|
|
|
UPEP Overflow Proteinuria Pattern
|
Usually - monoclonal light chain (gamma)
Others: myoglobin, hemoglobin |
|
|
Cryoglobulin type I association
|
are monoclonal Ig
Multiple myeloma Waldenstrom macroglobulinemia |
|
|
Chromosomes for Ig chains, TCR
|
Light:
Kappa = 2 Gamma = 22 Heavy: 14 TCR: 7 |
|
|
Myeloperoidase Deficiency
|
AR, mild immunodef
|
|
|
Bruton Agammaglobulinemia
|
X linked
Recurrent pyogenic infx starting around 6 mon Absent plasma cells in intest mucosa Dec in circulating B cells LN lacks GC Inc leuk/lymphoma Atk |
|
|
Common variable Immunodeficiency
|
Dec IgG, IgM, IgA
Normal # B cells but cannot diff Some def T-cells Hyperplastic GC Intst: Follicular hyperplasia Dec plasma cells |
|
|
Selective IgA Def
|
Recurrent respir and GI bacterial def
Defect in gran chemotaxis Inc eos Eczema |
|
|
Job syndrome
|
Hypergammaglobulinemia E - high serum IgE
Staph infx, eosinophilia, eczema Defect in gran chemotaxis |
|
|
DiGeorge Syndrome
|
Failure of 3-4th pharyngeal pouches
Hypoplastic thymus, hypoplastic parathyroids, anomalies of great vessels, bifid uvula, esophageal atresia Hypocalcemia and fungi, virus, PCP infx |
|
|
Severe Combined Immunodeficiency
|
Dec T-cell func, low Ig, thymic dysplasia
50% X-linked - IL-2 receptor 40% AR - def in enzyme adenosine deaminase |
|
|
Wiskott-Aldrich syndrome
|
X linked
Triad - eczema, thrombocytopenia, immunodef B and T cells |
|
|
Louis-Bar Syndrome - Ataxia-Telangiectasia
|
AR - mutations in ATM gene, 11q22.3
Cerebellar ataxia, oculocutaneous telangectasia, recurrent sinopulm infx, inc risk malignancy |
|
|
Chronic Mucocutaneous Candidiasis
|
T-cell defect
|
|
|
Duncan disease (X-linked lymphoproliferative dz)
|
Fulminant and often fatal immune response to EBV
Induces hemophagocytic syndrom, dev neoplastic B-cell proliferation, fulminant hepatic failure |
|
|
Chronic Granulomatous Disease
|
Defective intracellular oxidative killing of organisms
|
|
|
Chediak-Higashi
|
AR
Gran, lymph, monos have giant cytoplasmic granules - abnormally fused lysosomes Neutropenia, recurrent ifnx, thrombocytopenia, oculocutaneous albinism |
|
|
Alder-Reilly Anomaly
|
AD
Large azurophilic granules resembling toxic granulation Assoc with mucopolysaccharidoses |
|
|
Pelger-Huet Anomaly
|
AD
Dysfunctional segmentation of neuts |
|
|
Hereditary angioedema
|
C1 esterase inhibitor deficiency
During: uHist and sC1 inc, sCH50, C4, C2 decreased Between: C4 dec, C2 normal |
|
|
SLE ANA
|
anit-dsDNA, Sm
|
|
|
MCTD ANA
|
anti-RNP
|
|
|
Sjogren Synd ANA
|
Anti-Ro, La
|
|
|
Progressive Systemic Sclerosis ANA
|
anti-Scl-70
|
|
|
CREST ANA
|
anti-centromere
|
|
|
PBC Ab
|
anti-mitochondrial - anti-M2
|
|
|
Pernicious anemia Ab
|
Anti-parietal cell
|
|
|
Autoimmune hepatitis Ab
|
anti-Sm, LKM1, SLA/LP
|
|
|
Celiac disease Ab, HLA
|
anti-endomyseal, anti-tissue transglutaminase, anti-gliadin
HLA-DQ2,8 |
|
|
Hashimoto / Graves Ab
|
Hash - anti-microsomal, anti-thyroglobulin
Graves - LATS - long acting stim ab |
|
|
Gram + rod, B-hemolytic, reverse CAMP
pharyngitis |
Arcanobacterium haemolyticum
|
|
|
Gram - rod, catalase +
|
Edward's Salmon Eats Purple swarming Shigella.
Yer citro Kleans red Stool. Proteus Shigella Yersina Citrobacter Edwardsiella Escherichia Salmonella Klebsiella Serratia |
|
|
Acid Fast Bacteria
|
Mycobacterium
Nocardia Legionella micdadei Rhodococcus |
|
|
Acid Fast Fungi
|
Saccharomyces
Microsporidium |
|
|
Acid Fast Protozoa
|
Cryptosporidium
Isospora Cyclospora Sarcocystis |
|
|
Chocalate Agar
|
Haemophilus
|
|
|
MacConkey Agar
|
Gram Neg
Lactose differentiation Red colonies: E. coli |
|
|
Eosin Methylene Blue Agar
|
Gram Neg
Lactose diff Metallic green: E. coli Black purple: lactose fermenters |
|
|
Lactose Fermenters
|
SEEKPC
Serratia Escherichia Enterobacter Klebsiella Providencia Citrobacter |
|
|
Tinsdale (Telurite) Agar
|
Corynebacterium diptheriae
Gray black colonies |
|
|
Eggyolk Agar
|
Clostridium difficile
|
|
|
TCBS (Thiosulfate-citrate bile sucrose)
|
Vibrio cholera = yellow
V parahemolyticus, V vulnificus = green |
|
|
CIN Agar
|
Yersinia (room temp)
|
|
|
Oxidase +
|
Purple Campers Are Very Nineteen Seventies!
Pasturella Campylobacter Aeromonas Vibrio Neisseria PSeudomonas - Enterobacter |
|
|
Hektoen-Enteric (HE) Agar
|
Salmonella - green with black center
Shigella - green |
|
|
Mannitol Salt Agar
|
S. auerus is yellow
inhibits gram - |
|
|
Catalase
|
Staph
|
|
|
Coagulae
|
S. aureus
|
|
|
Novobiocin susceptibility
|
Resistant - S. saprophyticus
Susceptible - S. epidermis |
|
|
A Disk - Bacitracin
|
Sensitive - Grp A strep
|
|
|
Grp A strep
|
Strep pyogenes
|
|
|
Grp B strep
|
Strep agalactiae
|
|
|
Salt Tolerance Test
|
Enterococcus
|
|
|
CAMP Test
|
Arrowhead Shape
Group B strep (S. aureus is streaked down the middle) |
|
|
PYR test
|
Grp A and Grp D strep
Red |
|
|
Bile-esculin test
|
Enterococci and grp D strep
Blackening |
|
|
Bile solubility test
|
S. pneumoniae - clear because it is soluable
|
|
|
Optochin P-disk
|
S. pneumoniae sensitive
|
|
|
Indole
|
+ E.coli (lactose +, indole+, grow on Mac)
+ Proteus vulgaris - Proteus mirablis |
|
|
Voges-Proskauer +
Methyl red - |
Klebsiella
Enterobacter Serratia Hafnia |
|
|
Voges-Proskauer -
Methyl red + |
all other Enterobacteriacea
|
|
|
Urease
|
Rapid red - Proteus
Slow red - Klebsiella |
|
|
Staph Streak Test
|
Staph -> V and X factor
Haemophilus can grow |
|
|
DNAse
|
Moraxella catarrhalis
Strenotrophomonas maltophilia |
|
|
X and V factors
|
H influenzae, H haemolyticus, H aegyptius
|
|
|
V factor only
|
H parainfluenzae, H parahaemolyticus, H aphrophilus
|
|
|
X factor only
|
H ducreyi
|
|
|
Gram positive bacilli - small to medium
|
Corynebacterium
Listeria |
|
|
Gram positive bacilli - large
|
Clostridium perfringens
Bacillus |
|
|
Gram variable bacilli - drumsticks
|
Clostridium tetani
|
|
|
Gram positive - thin branching filamentous
|
Nocardia
Actinomyces |
|
|
Lactate dehydrogenase
LD1>LD2 indicates 3 things |
Acute MI, hemolysis, renal infarction
|
|
|
Alk Phos
Regan isoenzyme is seen in? what is it? |
malignant disease
identical to placental alk phos - derepression |
|
|
Alk Phos
what causes it to be mildly elevated? |
liver disease, pregnancy, bone dz (Pagets, mets),
CHF, hyperthyroidism, some drugs (ibupr, tylen) |
|
|
Alk Phos
what causes it to be majorly elevated? |
extrahepatic biliary obs, PBC, Paget
severe drug induced hepatocellular cholestasis |
|
|
GGT
where is it found? what causes elevation? |
bile duct, renal tubules, panc duct
DM, hyperthyroid, RA Acute MI, COPD |
|
|
Ammonia
what causes elevation? |
liver fail, inborn errors of urea cycle, TPN
urease prod bact in UTI, utreterosigmoidoscopy, valproic acid, cig smoking |
|
|
AST:ALT ratio >2 causes?
where are AST and ALT in the cell? |
toxic, ischemia, alcoholic
AST - mitochondria ALT - cytoplasm |
|
|
Amylase
causes of elevation? |
panc, DKA, peptic ulcer dz,
acute cholecystitis, ectopic preg, salpingitis, bowel isch, intest obs, macroamylasemia, renal insuff, opioids |
|
|
Pancreatic inherited diseases
mutations? |
PRSS-1 cationic trypsinogen
PSTI pancreatic secretory trypsin inhibitor CFTR cystic fibrosis transmembrane conductance regulator |
|
|
Panc Cyst Fluid
Pseudocyst |
Inc amylase
Nl CEA Inc CA 19-9 amorphous material, inflamm, no epithelium |
|
|
Panc Cyst Fluid
Serous cystadenoma |
dec amylase
dec CEA dec CA 19-9 bland cuboidal epithelial cells |
|
|
Panc Cyst Fluid
Mucinous cystadenoma |
Nl amylase
ince CEA inc CA19-9 bland mucinous epithelial cells |
|
|
Panc Cyst Fluid
IPMN |
inc amylase
inc CEA nl-inc CA 19-9 bland-atypical mucinous epithelial cells |
|
|
Panc Cyst Fluid
Solid Pseuodpap |
dec amylase
dec CEA dec CA 19-9 bland, NE like cells, myxoid stroma |
|
|
Macro-CK
where on electrophoresis? what condition? |
between MM and MB
autoimmune dz |
|
|
Mitochondrial-CK
where on electrophoresis? what condition? |
slightly slower than MM (away from MB)
advanced malignancy, poor prognosis |
|
|
Which elevated CK ratios demonstrate an enzyme leak?
|
CK-MB2/CK-MB1
CK-MM3/CK-MM1 |
|
|
what are the 2 cardiac muscle troponins?
|
cTnI, cTnT
|
|
|
What are not ischemic causes of inc TnI?
|
renal insuff, CHF, toxin
|
|
|
Serum electrophoresis
what cases 2 peaks in the serum albumin band? |
bisalbuminemia
|
|
|
Prealbumin
other names? what is purpose of measuring? |
transthyretin (TTR), thyroixine binding prealbumin (TBPA)
nutritional status b/c short 48 hr half life |
|
|
Serum electrophoresis
markedly decreased alpha 1 band? |
alpha-1 anti-trypsin deficiency
|
|
|
Serum electrophoresis
what causes increased alpha 1 band in acute inflamm states? |
alpha-1 acid glycoprotein
|
|
|
Serum electrophoresis
what causes alpha 2 band to be increased (condition and substance)? |
Nephrotic syndrome
alpha2- macroglobulin |
|
|
Haptoglobin
what happens in hemolysis and inflamm? |
hemolysis - binds free hemoglobin so dec
inflamm - acute phase reactant so inc |
|
|
Haptoglobin
which genotype is a risk factor for CV dz in DM |
Hp2-2
|
|
|
Transferrin
what does it do? when it is inc? what is it in the brain? |
purpose - transport ferric iron
inc - Fe def, preg, estrogen therapy CSF - asialted transferrin (tau protein) - double transferrin peak on CSF electrophoresis |
|
|
Serum electrophoresis
Beta-gamma bridging? |
cirrhosis due to inc IgA
|
|
|
Serum electrophoresis
where does monoclonal gammopathy cause a spike? |
usually gamma but sometimes beta or alpha2
10% have hypogammaglobulinemia - free light chains in urine |
|
|
UPEP
Glomerular proteinuria pattern |
strong albumin, alpha1, beta bands
large proteins (alpha2) and very small do not cross into urine |
|
|
UPEP
Tubular proteinuria pattern |
weak albumin band, strong apha1 and beta
impaired tubular reabsorption of low molecular weight |
|
|
UPEP
Overflow pattern |
myoglobin, hemoglobin, Bence Jones protein
|
|
|
Cryoglobulins
Type I - what is it? Conditions? |
monoclonal immunglobulins
Multiple myeloma, Waldenstrom macroglobulinemia |
|
|
Cryoglobulins
Type II - what is it? |
Mix of monoclonal IgM and polyclonal IgG
|
|
|
Cryoglobulins
Type III -what is it? |
mix of 2 polyclonal immunoglobulins usually IgG and IgM
|
|
|
Mixed Cryoglobulinemia (Types II and III)
causes? manifestations? |
HCV
lymphoprolif, chronic infx, chronic liv dz, autoimm dz palpable purpura, arthralgias, |
|
|
Hyponatremia
spurious pseudo |
spurious - drawn downstream from infusion or from central line
pseudo - hypertrigly, hyperchol, hyperprot due to incorrect assumption of water content of plasma |
|
|
Hypovolemic Hyponatremia
causes and K |
Diuretics - low K
Renal Medullary Dz Addison - high K RTA I Cerebral salt-wasting |
|
|
Euvolemic Hyponatremia
causes |
SIADH - high UNa, low-N K
Psychogenic polydipsia Hypothyr Addison Vasopressin like drugs |
|
|
Hypervolemic Hyponatremia
causes |
CHF, cirrhosis, nephrotic synd
|
|
|
Hypovolemic / Euvolemic hypernatremia
causes |
dehydration with inability to drink
extrarenal - diarrhea, vomit, burns renal - osmotic diuretics, loop diuretics, postobs diuresis, intrinsic medullary dz Euvolemic - also DI |
|
|
Hypervolemic hypernatremia
causes |
iatrogenic
|
|
|
Pseudohyperkalemia
causes? |
release from plt during clot formation - serum higher than plasma
passive leak from leukocytes (must be high) prolonged tourniquet, fist clench, bad order of tubes, small gauge needles |
|
|
Hypokalemia
causes |
transcellular shifts - met alk, DKA correction
GI loss Renal loss - diuretics, hypomag, anbx, RTA I&II, Bartter synd, Liddle synd, licorice consumption, hyperreninism |
|
|
Hyperkalemia
causes |
acidosis, renal fail, K-sparing diuretics
rhabdo, adrenal insuff, iatrogenic |
|
|
what binds calcium?
|
albumin
why ionized ca (free) is biologically active and more accurate reflection of calcium status |
|
|
primary hyperparathyroidism
ca and phos? causes? |
inc serum calcium
decreased serum phos parathyroid adenoma (90%), hyperplasia, carcinoma |
|
|
secondary hyperparathyroidism
ca and phos? causes? |
excessive secretion of PTH due to hypocalcemia
dec calcium inc phos norm-inc PTH chronic renal failure, vitamin D def |
|
|
tertiary hyperparathyroidism
cause |
autonomous parathyroid function following a period of persistent parathyroid stim - transplant
|
|
|
vitamin D
what does it do? which do you measure? |
enhances reabs of ca and phos
measure 25-di-hydroxy vit D active form is 1,25 but half life very short |
|
|
MDRD Equation - what are variables
|
serum creatinine
age sex race - AA or not |
|
|
Acute renal failure: Prerenal v. Renal
BUN/Cr ratio Urine spec grav Urine osmolarity FE Na FE urea |
prerenal: >20:1, high (>1.020), high (>500), <1%, <35%
renal: <20:1, low, low, >2%, >35% |
|
|
Lecithin/sphingomyelin ratio
what ratio indicates fetal lung maturity? what interferes? |
2.5 : 1
not as good in maternal DM meconium - dec blood - normalizes to 1.5 |
|
|
Phosphatidylglycerol (PG) concentration
presences means what? what interferes? |
presence indicates fetal lung maturity
neither blood or meconium interfere |
|
|
Lamellar body count
what instrument performs? what value indicates maturity? what interferes? |
plt channel of cell counter
>50,000/mL blood - decreases meconium - inc |
