Lab Med 3 Assortment

Front 1

Stool occult measures

Back 1

Hgb in stool (occult blood)

Front 2

False pos of stool occult:

Back 2

External Hemorrhoid

Front 3

When to do stool occult

Back 3

-CPR
-Abdominal/pelvic/rectal complaint
-Screen for colon CA
-Detect bleeding from PUD

Front 4

53 year old guy, 15 lb unintentional weight loss overpast few months. Feeling fatigued & tired. What's ondifferential?

Back 4

Cancer, colon cancer, GI cancer, anemia, malignancy of some other sort,psychiatric issues, a billion things à need more Hx, PE etc.

Front 5

1st steps w/ this pt``

Back 5

1. anemia (anemia this age = colon CA until proven otherwise)
2/ Rectal exam & hemoccult

Front 6

Procedure/timing of getting hemocult
1. in office
2.

Back 6

Sen pt to lab, get 3 hemoccult cards
2 samples, 1 from each end of 3 diff stooles
Even if 1/6 pos -- W/U

Front 7

Other false pos of hemoccult

Back 7

Red meat, Vit C interfering w/ peroxidase, intermettent bleeding, sample error

Front 8

Pt w/ diarrhea, order (3)

Back 8

Fecal leuk
Stool C & S
+/-C dif

Front 9

Fecal leuk pos if >__ segs

Back 9

3

Front 10

Inflammatory cs of diarrhea

Back 10

Shigella
Salmonella
E coli entamoeba
Inflammatory bowel = UC & Chrons

Front 11

Non inflammatory cz of diarrhea

Back 11

Rotavirus
Norwalk
Vibrio cholera
Cryptosporidium
Giardia
Sprue

Front 12

Fecal leuk results
-Inflammatory
-NOn Inflammatory

Back 12

-Pos
-Neg

Front 13

Pathophys of most kids w/ diarrhea
-Must obtain:

Back 13

URI --> swallow virus --> 2 or 3 day have gastroenteritis
-Hx of URI! Otherwise look for other cz

Front 14

Always do Fecal leuk in conjuction w/

Back 14

C & S

Front 15

Stool Culture tests for:

Back 15

Causative organism, tests for routine pathogens (must specify if something other than routine)

Front 16

Routine pathogens of stool culture

Back 16

Salmonella
Shigella
Enteropathic E coli
Bacillus cereus

Front 17

Some specific pathogens that must be requested on C & S

Back 17

C jejuni
Y enterocolitica
V cholera

Front 18

Which specific pathogen is associated w/ Guillion Barre

Back 18

Campylobacter jejuni

Front 19

Guillion Barre symptoms

Back 19

Ascending paralysis

Front 20

Stool Sample procedure

Back 20

Nun's hat - under seat to collect sample & 2 bottles(anaerobe & aerobe); scoop to fill to level;

Front 21

Common post abx agent of diarrhea; Made of toxin A& B

Back 21

Clostridium

Front 22

Tx of most post abc diarrhea

Back 22

Fluids, probiotics etc

Front 23

Tx of C diff

Back 23

IMPORTANT! If I miss this I'll be sued

Front 24

Difference in C diff presentation & other post abx diarrhea

Back 24

None

Front 25

Stool Culture tests for:

Back 25

Causative organism, tests for routine pathogens (must specify if something other than routine)

Front 26

Routine pathogens of stool culture

Back 26

Salmonella
Shigella
Enteropathic E coli
Bacillus cereus

Front 27

Some specific pathogens that must be requested on C & S

Back 27

C jejuni
Y enterocolitica
V cholera
C diff

Front 28

Which specific pathogen is associated w/ Guillion Barre

Back 28

Campylobacter jejuni

Front 29

Guillion Barre symptoms

Back 29

Ascending paralysis

Front 30

Stool Sample procedure

Back 30

Nun's hat - under seat to collect sample & 2 bottles(anaerobe & aerobe); scoop to fill to level;

Front 31

Common post abx agent of diarrhea; Made of toxin A& B

Back 31

Clostridium

Front 32

Tx of most post abc diarrhea

Back 32

Fluids, probiotics etc

Front 33

Tx of C diff

Back 33

IMPORTANT! If I miss this I'll be sued

Front 34

Difference in C diff presentation & other post abx diarrhea

Back 34

None

Front 35

When should you test for C diff?

Back 35

On making determination of routine abx induced diarrhea

Front 36

C diff test Toxin A
Toxin B

Back 36

Titer
Culture

Front 37

C dif causes what potentially fatal condition

Back 37

Pseudomembranosus colitus

Front 38

Tx of C dif

Back 38

Flagyl (metronidazole)

Front 39

Standard screen for Mycobacterium tuberculosis

Back 39

purified protein derivative PPD AKA Mantoux

Front 40

PPD procedure

Back 40

Inject .1 cc intermediate strength PPD INTRAEPIDERMAL & measure induration in 48-72 hours

Front 41

Symptoms of TB

Back 41

Coughing, night sweats, weight loss, lesion on CXR

Front 42

3 types of induration to look at when determining PPD pos or neg

Back 42

5mm pos in IC
--HIV
10 mm at intermediate risk
--Health care, immigrants
-15 mm low risk
--Farmer in middle of nowhere

Front 43

Further investigations of pos PPD

Back 43

CXR!!
Gram stain
Acid fast bacili stain
Sputum culture

Front 44

Control for PPD to rule out anergy (inability to mount a response)

Back 44

Inject Ag to Candida or Mumps on other forearm - everyone has been vaccinated for mumps & exposed to yeast

Front 45

-Respond to Mumps/ Candida but not to TB =
-Respond to neither mumps/candida =

Back 45

TB Negative
TB pos

Front 46

___ done instead of anergy challenge now

Back 46

CXR & culture

Front 47

___ causes false pos PPD

Back 47

Prior vaccination w/ BCG (Bacillus Calmetta Guerrin)

Front 48

After pos PPD --> future test results & screening

Back 48

Always pos
CXR screen

Front 49

2 things that cause cavitating lesions of lung

Back 49

TB
Staph

Front 50

Screen of prostatic CA

Back 50

Prostate Specific Ag (PSA)

Front 51

What is PSA

Back 51

Glycoprotein produced only by prostatic tissue

Front 52

PSA in prostatic CA

Back 52

Incr 10x

Front 53

PSA in benign prostatic hypertrophy

Back 53

Not increased X10

Front 54

-NL PSA
-Diurnal Variation?

Back 54

4
No diurnal variation

Front 55

Other measures looked at when evaluating PSA (besides cutoff of 4)
(2)

Back 55

Velocity
Age

Front 56

If pt had PSA of .3 last year --> 3 this year, what should you do?

Back 56

W/U

Front 57

W/U of abnl PSA

Back 57

US OR biopsy

Front 58

PSA & age

Back 58

WILL incr w/ age ("live long enough will get prostate CA)
-Age of pt with ^ PSA will play large role in tx

Front 59

False pos of PSA

Back 59

BPH
Prostatitis
Prostatic trauma
DRE

Front 60

When to draw PSA in reference to DRE

Back 60

<1 hr - PSA will incr after 1 hr of DRE

Front 61

Usually most providers only to DRE if ____ & rely on ___ instead

Back 61

Decr stream, tender, pain etc; PSA

Front 62

3 routine screens on male > 50

Back 62

Colonoscopy
Hemoccult
PSA

Front 63

Price continuum of streptococcal studies

Back 63

ASO --> Rapid strep --> Strep culture

Front 64

-Rapid strep detects:
-Need live organisms?

Back 64

-Ag of group A beta hemolytic streptococcus pyogenes;
-Don't need live

Front 65

Can you do rapid strep 1 week after tx to see status
& why?

Back 65

No; rapid doesn't need live bug - so will still be pos b/c dead bug still present

Front 66

Strep culture tests for

Back 66

Live cells;

Front 67

Time frame of events of Strep culture

Back 67

2 days
-1 to grow & ID Gm+/-
-1 to tell sensitivity

Front 68

2 wks post strep, pt swollen, proteinuria, periorbital edema =

Back 68

Post strep glomerulonephritis

Front 69

Tests of post test glomerulonephritis

Back 69

UA
CBC
ASO

Front 70

-ASO titer tests:
--Used to document ___ (complications) after ___ d of strep

Back 70

-Ab to enzyme toxin from group A strep
- acute glomerulonephritis, or rhematic fever AFTER 10d strep infxn

Front 71

When to do strep tests?

Back 71

If you are NOT going to tx

Front 72

Tx if pharyngitis ends up being viral

Back 72

Rx for antihistamine & steroid; gargle & swallow

Front 73

Differential for strep (long lasting) & test for it

Back 73

Mono;
Monospot - Positive heterophil agglutination test (Monospot) by fourth week

Front 74

Epigastric complaints, long duration, get:

Back 74

Helicobactor pylori

Front 75

H pylori tests fo:

Back 75

Ab to H pylori in serum (don't need live bug)

Front 76

Cost & time of H pylori

Back 76

$60; 10 min

Front 77

Tests to determine failure of tx for H pylori

Back 77

Can't redo H pylori culture, must do:
-Urea breath test
-EGD biopsy

Front 78

Urea breath test

Back 78

Pt breaths radioactive stuff, H pylori converts it

Front 79

EGD biopsy
-Procedure
-Look for

Back 79

-Biopsy of mucosa & grow bug
-H pylori, gastri CA
--McNeill recommends this

Front 80

Tx of H pylori

Back 80

Abx
-Clarithromycin
Proton pump inhibitor
Pepto/milk magnesia/prilosec

Front 81

Best screen for colon CA

Back 81

colonoscopy & hemoccult

Front 82

AFP elevated in (other than NL covered in OBGYN)

Back 82

-Certain gonadal tumors
-Hepatoma, gastric CA, pancreatic CA, lung CA, hepatitis

Front 83

AFP absent in:

Back 83

Pure testicular seminoma

Front 84

CA 242 & 19-9 markers for ___ CA

Back 84

Pancreatic/colorectal

Front 85

CA 27-29 & 15-3 assoc w/
Used in conjuction w/

Back 85

Breast carcinoma
-CEA

Front 86

___ & ___ assoc w/ predisposition to developing breast & ovarian CA

Back 86

BRCA1 & 2

Front 87

Sweat chloride tests for:

Back 87

Cystic fibrosis

Front 88

Sweat chloride procedure

Back 88

Pilocarpine iontophoresed (low current) onto forarm (patch), sweat collected, assayed for chloride (must be done in lab)

Front 89

Sweat chloride > ___ = cystic fibrosis

Back 89

>60 mmol

Front 90

Why sweat chloride used for CF?

Back 90

CF is dz of choride channel

Front 91

Indications for SwCT

Back 91

FTT
Recurrent lung infxn (thick mucus)
Nasal polyp
Prob w. GI tract & bowel movements

Front 92

5 most common IV fluids

Back 92

1 NS
2 Half NS
3 D5NS
4 D5 Half NS
5 Lactated ringers

Front 93

Indications for
-D50
-3% NS

Back 93

-Amp for diabetic coma
-SEVERE hyponatremia (better have someone holding your hand to do this) - NEVER do

Front 94

Indications for D5 & D10 in WATER

Back 94

If EVERYTHING else is hyper

Front 95

-Lactated ringer contains:
-Indications:

Back 95

-4 meq of K
-Burns/trauma until blood is available. shock

Front 96

D5 indications

Back 96

Pt not eating

Front 97

Remember to give ____ in renal failure or CHF

Back 97

Volume decr

Front 98

TKO use:

Back 98

Heplock

Front 99

Heplock mechanism

Back 99

Screws into cath, closes off cath; squirt heparin to keep cath from infiltrating/clotting

Front 100

Baseline fluid
-70 kg =
- Not 70 kg

Back 100

-35 ml/kg/24
a first 10 kg = 100 ml
b send 10 = 50 ml
c remainder = 20 ml

Front 101

Na requirement adult
peds

Back 101

-180 meq/24 hr
-3-4 meq/24

Front 102

K electrolyte requirement meq/kg/d

Back 102

2-3 meq/kg/d