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Clinical Medicine I
Clinical Laboratory Overview
52
Medical
Graduate
01/10/2010

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Cards

Term

The diagnostic value of a test is defined by it's

4

Definition

1-sensitivity

2-specificity

3-predictive value

4-efficiency

Term

 

1-Sensitivity
2-Specificity
Definition
1-probability of a positive test in a diseased person (TP)-true positive
2- probability of a negative test in a non-diseased person (TN)-true negative
Term

Equations

1-Predictive Value of a Positive Result (%)

   

2- Predictive Value of a Negative Result (%)

Definition

1)   __TP___ X 100

                               TP + FP

2)    __TN___ X 100

     FN + TN

Term
Test Efficiency
Definition

 The efficiency of a test is the percentage of the times the test give the correct answer compared to the total number of tests.

 ___TP + TN______ X 100 = Efficiency of a Test Result (%)
TP + TN + FP + FN

Term

Ideal Characteristics of Dx Tests

4

Definition

—High Sensitivity

—High Specificity
—High Predictive Values
—High Test Efficiency
MOST TESTS DO NOT MEET ALL  THESE CHARACTERISTICS
Term

 

1-Types of Tests 3
2-Normal ranges
Definition

1- qualitative, semi-quantitative, quantitative

-Normal Ranges are + 2 S.D. of normal healthy population
—Test Precision (free of random error—reproducible)
—Test Accuracy (closeness to true value)
Term
Clinical Laboratory Divisions
Definition

—Hematology

—Blood Bank
—Urinalysis
—Microbiology
—Serology
—Chemistry
—Special Chemistry
—Histology/Cytology
Term
Hematology Tests
Definition

 —CBC (Complete Blood Count)

—WBC
—RBC   MCV-Mean cell volume
—Hgb-hemoglobin  MCH- Mean Cell (Corpuscular) Hemoglobin
—Hct-hematocrit    MCHC-Mean Cell (Corpuscular) Hemoglobin                                                      Concentration
—Platelet count
Term

Normal Values for CBC

1-Platelets (count and volume)

 

 

2)Terms for abnormalities
Definition

1) Normal 140,000-440,000/uL

Mean Platelet Volume  7-11 fL

 

2) thrombocytopenia-decreased platlet count (bone marrow failure)

thrombocythemia or thrombocytosis- Elevated platelet count

Term

Normal Values for CBC

1) Hemoglobin

males, females
2) Hematocrit
       males, females
Definition

1) Hemoglobin

14-18 g/dL  males
12-16 g/dL  females
2) Hematocrit
-42-52%    males
-37-47%    females
Term

Normal Values for CBC

-what do these abnormalities mean

          —anemia

—polycythemia
—macrocytosis
—microcytosis
—Pancytopenia
Definition

  —anemia- iron deficiency

—polycythemia- increase in RBCs (expanded blood volume and blood viscosity) 
—macrocytosis-is the enlargement of  rbc with near-constant hgb concentration, and is defined by a mean corpuscular volume (MCV) of greater than 100 femtolitres
—microcytosis- RBCs are unusually small when their MCV is measured
—Pancytopenia-a reduction in the number of red and white blood cells as well as platlets
Term
1-Reticulocyte Count

2-ESR (Erythrocyte Sedimentation Rate)
Definition
Reticulocyte Count
indirect measure of hematopoiesis
# reticulocytes/1000 RBC’s

ESR (Erythrocyte Sedimentation Rate)
measures how far a column of RBC’s falls in one hour’s time
Term
4 main Hematology Test Indications
Definition

 

Anemia-low RBC count
Infection
Bleeding, bruising
Leukemia-proliferation of blood cells
Term
Anemia Profile
Definition

—(CBC with RBC morphology)

—(Reticulocyte count)
—Ferritin level
—Serum iron and TIBC
—[Serum folic acid level, B12 levels]
—[Lead levels and porphyrins]
Term

Coagulation Tests

PT (Prothrombin Time)

1-measures what

2- used to monitor

3-the normal INR reading in healthy people?

4-what is the reading in pt's on coumadin that is therapuetic

Definition

 1-measures extrinsic and common pathway of coagulation

2-used to monitor warfarin therapy (coumadin)

-INR  (international normalized ratio)

-patient test result/control result

3-normally 1.0 in healthy individuals

4)2.0-3.0 in patients on coumadin is therapeutic

Term

Coagulation Tests

 

—aPTT (Activated Partial Thromboplastin Time)
1-measures what?
2-used to monitor
3-abnormal reading in persons w/?
4-what unit of time does it report in?
5-how long does it take to coag? in normal people?
Definition

 —measures the intrinsic and common pathways of coagulation sequence

—used to monitor old heparin therapy—not needed with LMW heparin commonly used today
—abnormal in persons with Factor VIII deficiency
—reported in seconds 
—normal in healthy persons 21-45 seconds
Term

Coagulation Tests

D-Dimer

1-measures what

2-what color top tube do you use

3-Used in pt's with suspected what 3

Definition

—measures breakdown products of fibrin

—blue-top tube required
—used in patients with suspected= PE, DVT, DIC
PE-pulmonary embolism, DVT-Deep Vein Thrombosis, DIC- Disseminated intravascular coagulation
Term

Immunohematology

1-Bloodtyping

2- Crossmatching

3-Coombs' Test

-Direct

-Indirect

Definition

1- Bloodtyping-ABO and Rh typing by antigen/antibody agglutination testing

2-Crossmatching-testing patient’s serum against donor antigens on RBC’s 

3- Coombs’ Test

—Direct--detect antigens on patient RBC’s
—Indirect--detect unusual antibodies in patient serum
Term

Microbiology/Virology

1-name the 3 kinds of cultures

-DNA probes

-PCR testing(polymerase Chain Reaction)

-Sensitivity testing

2-Name he thre stains of clinical specimens

Definition

1- Bacterial, Myobacterial, Viral

2-Gram's, Acid fast, Silver

Term

Serology Tests

1- Tests for syphilis

2-testd for HIV

3- tests for Mononucleosis

Definition
1-Tests for syphlis
-RPR/VDRL (Rapid Plasma Reagin/Venereal Disease Research Lab)
-FTA-ABS        (Fluorescent Treponemal Antibody-Absorption)
2- Tests for HIV
-ELISA      (Enzyme Linked Immunosorbent Assays) 
-Western Blot
3- Tests for Infectious Mononucleosis
—Mono Spot/Heterophile
—(CBC with WBC Differential)
Term

Serology Tests

 

1-Hepatitis tests 4
2-Rheumatologic Tests (think autoimmune with the soft tissues and joints)
Definition

1-(LFT’s) liver function tests

    -Hep A antibody

    -Hep B surface antigen, core antigen, antibody,..

    -Hep C antibody

2- (Sed rate, or ESR)-Erythrocyte sedimentation rate- tests for auto immune shit (may indicate an inflammatory process)

-RF, ANA, Anti-DNA  (Rheumatoid Factor-tests for mainly rheumatoid arthritis; Anti-nuclear Antibodies-good test for SLE, Anti-DNA- good tesst for SLE)

Term

Urinalysis

Macroscopic

Biochemical

Microscopic
Definition

Macroscopic

color, clarity, odor
Biochemical
pH, S.G.-specific gravity, protein, glucose, ketones, leukocyte esterase, nitrites, blood (RBC’s, hemoglobin), bilirubin, ...
Microscopic
casts, parasites, epithelial/tubular/renal cells,
RBC’s, WBC’s, bacteria, crystals, mucus
Term

Miscellaneous Chemistries

—Serum Magnesium-1

—Acid Phosphatase-2
—PSA (Prostatic Specific Antigen)
—Hormones
—Drug Levels
—Therapeutic monitoring
—Drug screens for drugs of abuse
Definition

1-

 

2-Acid Phosphatase- in tissues like the prostate, High levels in semen, good test for swabs of rape victims rectums and vaginas

Term

Chemistry

-“Profiles”-screen for specific disorders

LFT’s, RFT’s, T(hyroid)FT’s, Cardiac Profile, Lipid Profile, Electrolytes,...
-“Panels” -general  screening 
SMA-12, SMAC, Chem-18, Chem -6/7
Workshop Cases
Definition
Term

Cardiac Profile

5

Definition

 —Troponins—total; cTnT; cTnI

—CK—Total; MB fraction, MB:total ratio
—LDH—Total; LDH1:LDH2
—AST
—Cholesterol--HDL, LDL, HDL:LDL ratio
—(ECG, exercise ECG, Echocardiogram)
Term

Lipid Profiles

2

Definition

—Cholesterol

—LDL, HDL, HDL-C
—Triglycerides

Lipoprotein Electrophoresis

Term

Thyroid Profile

4

Definition

 —TSH level (Thyroid Stimulating Hormone)

—T3 Uptake, T4, T7
—T3  RIA
—Free T4
Term

Liver Function Tests

1-enzymes (5)

2-Anabolism-building up (3)

3-Catabolism (1)

Definition

1-Enzymes=AST, ALT, GGT, LDH, ALK Phos

2-Anabolism=Proteins (TP, Albuman, Globulins)

-Glucose

-Lipids

3-Catabolism= Bilirubin, direct and indirect

Term
Why do we test for free enzymes in the blood?
Definition
Because when there is cell death, the cell breaks down and the enzymes that where inside the cell are now floating freely in the blood. The free enzymes in the blood prove cell damage to a certain area, because different tissues of different organs have cells that contain specific enzymes
Term

non-specific enzymes that are released from damaged/dead cells of organs of the body

5

Definition

     —AST--aspartate aminotransferase 

—ALT--alanine aminotransferase
—GGT--gamma glutamyl transferase
—LDH--lactate dehydrogenase
—AP--alkaline phosphatase
Term
Enzyme AST
Definition

 AST--aspartate aminotransferase 

formerly known as SGOT
found in highest concentration in heart
also found in liver, skeletal muscle, kidneys, brain, pancreas,…
released with cell damage/death
non-specific enzyme
Term
Enzyme ALT
Definition

 —ALT:  alanine aminotransferase

—found primarily in liver; lower concentrations in heart, skeletal muscle, kidney
—prior name: SGPT
—released with cell necrosis
—more specific for liver disorders than AST
Term
Enzyme GGT
Definition

 —GGT--gamma glutamyl transferase

—Most sensitive marker for liver disease, ETOH consumption, or obstructive jaundice
—Found in kidneys, liver, prostate, spleen.
Term
Enzyme AP
Definition

 —AP--alkaline phosphatase

—found primarily in bone, liver, and placenta; lesser quantities in kidneys and intestines
—five measurable iso-enzymes
—1. Liver
—2. Bone
—3. Intestine
—4. Kidney
—5. Placenta
Term
Enzyme LDH
Definition

 —LDH--lactate dehydrogenase

—found in multiple body tissues
—highest concentrations in heart, liver, brain, skeletal muscles, kidneys, and RBC’s
—five isoenzymes
—LDH 1-5
—1-2 flip flop in MI= (LDH2 is usually higher than LDH1, but with an MI they are reversed)
Term

Products of Anabolism

Total Proteins

1- composed of how many diffeent protiens

2-which protein comprises the largest fracion of total proteins

3-

4-

 

Definition

 

composed of ~100 different proteins
Albumin comprises largest fraction of Total Proteins
Globulins, lipoproteins, coag factors
A/G ratio= Albumin/Globulin ratio
(TP-Albumin=globulins) TP may be normal, but albuman may be decreased and globulins increased.
Term

Products of Anabolism

-Glucose

1-Primary sorce of?

2-Stored where? as what?

-Cholesterol

1-formed by what organ?

2-component of what kind of hormones?

Definition

 —Glucose

1-primary source of energy for all body functions

2-stored in liver as glycogen

—Cholesterol
1-formed by liver
2-component of steroid hormones
Term

Products of Catabolism

Bilirubin

1-byproduct the degradation of what?

2-direct and indirect fractions?

3- too much in the body causes what?

Definition

 —Bilirubin

1-byproduct of hemoglobin degradation

2-direct-(conjugated bilirubin)  indirect-(free or unconjugated bilirubin before it is converted in the liver and excreted as bile)

3-jaundice

—prehepatic
—hepatic
—posthepatic
Term

Renal Function Tests

8

Definition

—(Urinalysis)

—BUN and Creatinine
—Uric Acid
—Total Protein
—Albumin, A/G ratio
—Calcium, Phosphorus
—Arterial blood gases
—Osmolality
Term

Electrolytes

name 4 and then the other 3

Definition

—Sodium--Na

—Potassium--K
—Chloride--
—CO2
—(Calcium, Phosphorus, Magnesium)
Term

Electrolytes

 

1-Sodium (Na) is the main what and where in relation to the cell?

2-Potassium (K) is the main what and where in relation to the cell?

3-Chloride is predominantly located where in relation to the cell and has what charge

Definition

1-Sodium--main extracellular cation

2-Potassium--principle intracellular cation

3-Chloride--predominately extracellular anion-(negativly charged ion)

—CO2
—(Calcium, Phosphorus, Magnesium)
Term

Creatinine

1-Breakdown product of what

2-what kind of rat is this produced

3-Dependent on what for each individual

4-what organ normally excretes creatinine

Definition

—Breakdown product of muscle metabolism

—Produced at constant rate
—Dependent on muscle mass of individual
—Kidneys normally excrete creatinine
Term

Uric Acid

1- Nitrogen containing end product of what?

2-Excreted in what?

3-Increased levels more commonly associated with __________ than ___________.

Definition

—Nitrogen containing end product of purine metabolism

—Excreted in urine dependent upon renal function--glomerular filtration and tubular secretion
—Increased levels more commonly associated with renal failure than gout
Term

BUN

1-what does is it stand for

2-End product of ______ metabolism formed in the liver as _________, then detoxified and transported to the __________ for excretion

3-Levels are influenced by _____ and rate of _______ catabolism as well as _________

4-measure of what in body?

Definition

—BUN    (Blood urea nitrogen)

—end product of protein metabolism formed in liver as ammonia, then detoxified and transported to the kidneys for excretion
—levels influenced by diet and rate of protein catabolism as well as excretion
—measure of toxin accumulation in body
Term

Calcium and Phosphorus

1- Calcium--most abundant _________ in body

-50% bound to ______ and 50% _______

-decreased TP=decreased total _______

2-Phosphorus

-storage/liberation of body ___________

-regulation of body ______

-formation of ________

Definition

1-Calcium--most abundant cation in body

-50% bound to protein; 50% free

-decreased TP-->decreased total calcium

2-Phosphorus

-storage/liberation of body energy (ADP/ATP)

-regulation of body pH

-formation of bone

Term

Ca/P Levels in Disease States

Disease/Condition

Calcium Level (total)

Phosphorus Level

Hyperparathyroidism

       ________

      __________

Hypoparathyroidism

      _________

      __________

Renal Insufficiency

       __________

     __________

Rickets, Osteomalacia

       ___________

      _________

Growing children

       ___________

     __________

Bone cancer, Multiple myeloma

       ____________

       __________

Definition

Disease/Condition

Calcium Level (total)

Phosphorus Level

Hyperparathyroidism

       Increased

      Decreased

Hypoparathyroidism

       Decreased

      Increased

Renal Insufficiency

       Decreased 

      Increased

Rickets, Osteomalacia

       Decreased

      Decreased

Growing children

       Increased

      Increased

Bone cancer, Multiple myeloma

       Increased

       Normal

Term

Arterial Blood Gases

4

Definition

—pH 

—pCO2
—pO2
—Bicarbonate
Term

Chemistry Panels

 

 

Screening tests
Relatively inexpensive
Single specimen for multiple analyses
Number of false positive results increases with number of tests performed
Definition
Term

Biochemical Profiles

 

Chemistry Profiles (4)

Definition

1-Chem Panel

2-SMA-12 or -24 (Simultaneous Multiple Analyses)

3-chem 19

4-chem 7

Term

CHem-6/7 or SMA-6/7

(4)

Definition

1)Electrolytes

-NA

-K

-Cl

-Cl

2)BUN

3)Creatinine

4)Glucose

 

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