Primary Skills

Front 1

What are the enzymes that the HIV virus uses? And what is the structure?

Back 1

Reverse transcriptase, integrase and protease. It is packaged in a cone shaped core composed of p24 capsid with surrounding p17

Front 2

What binds the CD4 molecule of the host cell facilitating viral T cell membrane fusion and viral infection?

Back 2

Gp41 and gp120

Front 3

What are the tests available for HIV diagnosis?

Back 3

Ab blood tests (Enzyme immunoassays, indirect IFA, Western blot, rapid Ab tests)

Front 4

What is the first step in screening for HIV diagnosis?

Back 4

EIA (enzyme immunoassay). The antigen-ab complex detects using anti-human IgG Ab conjugated to an enzyme like alkaline phosphatase or horse radish peroxidase (HRP)

Front 5

What are the different generations of EIA?

Back 5

1st- form of crude viral lysate. 2nd- recombinant viral antigens from immunodominant regions. 3rd- enzyme is conjugated to HIV antigen (instead of anti-human IgG)

Front 6

How does western blot identify Ab?

Back 6

It targets antigen of anti-HIV Abs based on molecular weight and charge

Front 7

What is an alternative to western blot following a positive EIA?

Back 7

Indirect immunofluorescence assay (IFA)

Front 8

What do nucleic acid amplificaition tests detect? When would it be useful in diagonsis of infection?

Back 8

HIV-1 RNA molecules in plasma. For individuals experiencing primary HIV infection symptoms, but have not yet seroconverted

Front 9

What are quantatative viral load assays used for?

Back 9

reliable, reproducable results. Assess disease prognosis, decisions regarding therapy, monitoring response to therapy

Front 10

What are qualitative viral load assays used for?

Back 10

Sensitivity at low thresholds. Blood donor screening, HIV diagnosis in infants

Front 11

How many analytes are in a basic and comprehensive metabolic panel?

Back 11

Basic- 8, Metabolic- 14 (BMP and 6 liver function tests)

Front 12

How is diabetes defined?

Back 12

Fasting >126, and plasma glucose >200

Front 13

What is included in a BMP?

Back 13

Na, K, Cl, HCO3, Ca, CO2

Front 14

How is hyonatremia and hypernatremia defined?

Back 14

Less than 135 mEq/L or greater than 145 mEq/L

Front 15

How can low insulin cause hyponatremia?

Back 15

When glucose is transported into cells under influence of insulin it is accompanied by K

Front 16

What is the BUN/creatinine ration for diagnosis of renal failure? End stage renal disease?

Back 16

4 for renal failure, 18 mg/dL for end stage renal disease

Front 17

What comprises Comprehensive metabolic panel?

Back 17

BMP and BUN, creatinine, Ca, liver fnc tests, protein, albumin, bilirubin, alkaline phosphatase, AST, ALT

Front 18

Elevated aminotransferases?

Back 18

Hepatocellular injury

Front 19

Elevated serum total bilirubin and alkaline phosphatase?

Back 19

cholectasis

Front 20

What is GGT an indicator of?

Back 20

liver and biliary tract disease

Front 21

Elevated alkaline phosphatase and lactate dehydrogenase

Back 21

space occupying lesion of the liver, most common condistion is metastic carcinoma of the liver

Front 22

What is the net filtration pressure?

Back 22

Glomerular hydrostatic pressure- Bowman's capsule - Glomerular oncotic pressure

Front 23

How does the kidney maintain filtration?

Back 23

By vasoconstrincting the efferent arteriole and vasodilating the afferent arteriole

Front 24

What factors affect relationship between GFR and BUN?

Back 24

Increase urea generation; GI bleed, hypercatabolic state- fever, Protein loading, Glucocorticoids, Tetracyclines

Front 25

What has a mask rise in BUN due to decreased urea production?

Back 25

Protein malnutrition, Severe liver disease

Front 26

What type of bacteria is strep pharyngitis?

Back 26

Gram positive, group A beta-hemolytic. Group specific carbohydrate (A antigen) and type-specific proteins (M protein)

Front 27

What are the four point criteria to stratify adult patients of group A strep pharyngitis?

Back 27

1- Fever >100.5, 2-Absence of cough, 3-Tender cervical lymphadenopathy, 4-Tonsillar exudates

Front 28

What do rapid tests detect?

Back 28

Presence of carbohydrate antigen unique to group A streptococci

Front 29

What is antimicrobial therapy?

Back 29

Penicillin, ampicillin, or amoxicillin, clindamycin, and certain cephalosporin and macrolides

Front 30

What is the immune response to H and N antigens?

Back 30

H protects against infection, N limits viral spread

Front 31

What does rapid influenza tests detect?

Back 31

Influenza viral antigen (viral nucleoprotein or neuraminidase)

Front 32

What is the hallmark confirmatory test for influenza?

Back 32

APCR- looing for viral nucelic acids by reverse transcriptase polymerase chain reaction. Detects both viable and non-viable influenza virus RNA

Front 33

What is antiviral therapy for both influenza A and B?

Back 33

NA inhibitors zanamivir and oseltamivir

Front 34

Lab tests for coagulation?

Back 34

PT, PTT, clotting factors

Front 35

Lab tests for platelets?

Back 35

Plt count, PBS

Front 36

Lab tests for fibrinolytic system?

Back 36

Fibrinogen, FDP, D-dimer

Front 37

How do we prevent clotting mechanism when blood is drawn into glass tubes?

Back 37

EDTA, citrate and oxalate binds Ca Heparin binds to free antithrombin 3

Front 38

What blood test would you use to evaluate thrombocytopenia and thrombocytosis?

Back 38

CBC

Front 39

What blood test would you use to evaluate large platelets and the absence of granules

Back 39

PBS

Front 40

Presentation: prolonged PTT, correction with mixing study; factor level assay confirms deficiency

Back 40

Hemophilia A

Front 41

Prolonged PT and Normal PTT

Back 41

Liver disease, decreased Vit K

Front 42

Prolonged PT and Prolonged PTT

Back 42

Von willebrand disease, liver disease, disseminated intravascular coagulation (DIC)

Front 43

Presentation: PT/PTT: prolonged, platelet count: markedly decreased, fibrinogen: decreased, fibrin split products: increased

Back 43

Disseminated intravascular coagulopathy = thrombo-hemorrhagic disorder

Front 44

When is the friedewald formula unreliable?

Back 44

in presence of chylomicronemia and hypertriglyceridemia

Front 45

What is one of the acute phase proteins that increase during systemic inflammation?

Back 45

C-reactive protein (CRP)

Front 46

What does the PLAC test measure?

Back 46

Lp-PLA2, lipoprotein-associated phospholipase A2)- inplicated in the formation of rupture-prone plaque

Front 47

What causes the leukoerythroblastic reaction?

Back 47

immature and mature cells in peripheral blood. Myeloblasts, nucleated RBC, tear drop cells (RBC) if myelofibrosis present

Front 48

How does age affect lab tests?

Back 48

Newborns: increase HbF, shifts left. Children: increase phosphorus, shifts right. Women: decrease serum Fe. Elderly: decrease testosterone

Front 49

Conditions where you have increased TBG

Back 49

Pregnancy, oral contraceptives and hormone replacement

Front 50

Conditions where you have decreased TBG

Back 50

anabolic steroids, nephrotic syndrome

Front 51

What disease? Decreased TSH, increased T3, T4

Back 51

Hyperthyroidism

Front 52

What disease? Increased TSH and decreased T3, T4

Back 52

Primary hypothyroidism

Front 53

What disease? Decreased TSH, decreased T3, T4

Back 53

Secondary hypothyroidism

Front 54

Pregnant patient with normal TSH, and elevated T4. What can this be due to?

Back 54

increased synthesis of TBG