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549 Exam Module 13
Lab Tests
163
Nursing
Graduate
12/07/2011

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Term
A sensitive test has low false ___?___
Definition
negatives
Term
A specific test has low false ___?___
Definition
positives
Term
What is the use of a sensitive test in clinical practice?
Definition
-identify individuals who do NOT have the dz
-low false negatives, so if negative can be confident the individual does NOT have the dz
Term
What is the use of a sensitive test in screening?
Definition
-identify individuals who MAY have the dz
-higher false positives, so if positive must follow up with specific test
Term
What is an example of a sensitive test?
Definition
D-Dimer
-very sensitive to clotting
-low false negatives, but with a positive result there only MAY be a DVT/PE

CK
-very sensitive to muscle damage, but not specific to MI
-low false negatives, but with a positive result need a more specific test to confirm MI (CK-MB, troponin)
Term
The sensitivity of a test is the % of individuals with the condition who have a ___?___ test result.
Definition
positive
Term
A sensitive test is most useful when the result is ___?___
Definition
negative
Term
The specificity of a test is the % of individuals without the condition with a ___?___ test result.
Definition
negtive
Term
What conclusion can be drawn from a negative result on a sensitive test?
Definition
the condition is NOT present
Term
What conclusion can be drawn from a positive result on a specific test?
Definition
the condition IS present
Term
What is the use of a specific test in clinical practice?
Definition
-identify individuals who DO have the dz
-higher false negatives, so if negative the individual MAY have the dz
Term
What is the use of a specific test in screening?
Definition
-identify individuals who do NOT have the dz
-low false positives, so if positive can be confident the individual DOES have the dz
Term
What is an example of a specific test?
Definition
CK-MB, troponin
-low false positives
-a positive result indicates MI
Term
How may tourniquet time > 1 min confound results?
Definition
-incr K
-incr protein
-incr PT
-incr Ca
-incr Hct
-incr Fe
-incr cholesterol
-incr lactic acid
Term
How may hemolysis (needle size, suction) confound results?
Definition
-incr K
-incr LDH
-incr AST
-incr ALT
-incr CK
-incr Fe
-decr troponin
-decr T4
Term
What are reasons for ordering CBC?
Definition
evaluate RBCs
-bleeding
-weakness
-SOB
-murmur
-syncope
evaluate WBCs
-infection
-bleeding
evaluate platelets
-petchiae
-purpura
-splenomegaly
Term
What is the shorthand for CBC results?
Definition
[image]
Term
What is the clinical term for elevated Hct?
Definition
polycythemia
Term
What are normal Hgb ranges for men? women?
Definition
-men: 14-18 g/dl
-women: 12-16 g/dl
Term
What is the relationship of Hct to Hgb values?
Definition
Hct = Hgb x 3
Term
What are normal ranges for WBC?
Definition
4,5000-11,000
Term
What is the clinical term for low Hct?
Definition
anemia
Term
What is the clinical term for low WBC?
Definition
leukopenia
Term
What is the clinical term for elevated WBC?
Definition
leukocytosis
Term
What are normal ranges for platelets?
Definition
150,000-450,000
Term
What is the clinical term for low platelets?
Definition
thrombocytopenia
Term
What is the clinical term for elevated platelets?
Definition
thrombocytosis
Term
What is the normal range for mean corpuscular volume (MCV)?
Definition
76-100 mcm3
Term
What is the MCV range for microcytic anemia?
Definition
< 80 mcm3
Term
What are causes of microcytic anemia?
Definition
-Fe deficiency
-thalassemia
-ACD: anemia of chronic dz
Term
What is the MCV range of macrocytic anemia?
Definition
> 100 mcm3
Term
What are causes of macrocytic anemia?
Definition
-B12 deficiency
-folate deficiency
Term
What are normochromic ranges for mean cellular hemoglobin concentration (MCHC)?
Definition
33-37 g/dl
Term
What are hypochromic ranges for mean cellular hemoglobin concentration (MCHC)?
Definition
< 33 g/dl
Term
What are causes of hypochromic anemia?
Definition
-Fe deficiency
-thalassemia
-volume overload
Term
What are hyperchromic ranges for mean cellular hemoglobin concentration (MCHC)?
Definition
> 37 g/dl
Term
What is a cause of hyperchromic anemia?
Definition
-dehydration
Term
What are reticulocytes?
Definition
juvenile RBCs
Term
How are reticulocytes reported?
Definition
Reticulocyte Production Index (RPI)
-reported % of RBCs x actual Hct / 45
- / correction factor (based on Hct, using table)
Term
What does RPI < 2 indicate?
Definition
inadequate bone marrow response
Term
What does RPI > 2 indicate?
Definition
appropriate bone marrow response
Term
When is a peripheral smear indicated?
Definition
any abnormal counts
Term
What is a peripheral smear?
Definition
-look at all cells in a sample
-look at shapes of RBCs
Term
What is the clinical term for variation in RBC shape?
Definition
poikilocytosis
Term
[image]
Definition
schistocytes
-hemolysis
-burns
Term
[image]
Definition
ovalocytes
-megaloblastic anemia
Term
[image]
Definition
Rouleau formation
-multiple myeloma
-liver dz
-hypergammaglobinemia
-artifact
Term
[image]
Definition
sickle cells
Term
[image]
Definition
target cells
-liver dz
-hemoglobin C or S deficiency
-microcytic anemia
-splenectomy
Term
[image]
Definition
tear drop cells
-thalassemia
-pernicious anemia
Term
What is included in a WBC differential and the normal breakdown?
Definition
-polymorphonuclear neutrophils 45-65%
-lymphocytes 15-40%
-monocytes 2-8%
-eosinophils 0-5%
-basophils 0-3%
Term
What are other terms for polymorphonuclear neutrophils?
Definition
-PMNs
-polys
-segmented neutrophils
-segs
Term
What is the normal range of bands/stabs?
Definition
0-5%
Term
What is a right shift in WBC and what does it indicate?
Definition
-increase in PMNs or bands
-possible infection
Term
The clinical term for a left shift in WBCs is ___?___
Definition
bandemia
Term
Bandemia is present when bands > ___?___% or bands + neutrophils > ___?___%
Definition
bands > 10%
bands + neutrophils > 80%
Term
What are causes of a WBC left shift/bandemia?
Definition
Pathological
-bacterial infection
-tissue damage or inflammation
-leukemia
-metabolic disorders

Normal
-steroids
-exercise
-late in pregnancy
-surgery
Term
How is Absolute Neutrophil Count (ANC) calculated?
Definition
% segs + % bands x WBC count
Term
What are ranges for Absolute Neutrophil Count (ANC)?
Definition
-normal: 3000-7000
-mild: 1000-1500
-moderate: 500-1000
-severe: < 500
Term
What are causes of decreased Absolute Neutrophil Count (ANC)?
Definition
-drugs
-marrow failure
-viral infections
-poisoning
-nutritional deficiencies
-autoimmune
Term
What are drug causes of decreased Absolute Neutrophil Count (ANC)?
Definition
-CA chemotherapy
-antimicrobial: PCN, sulfa, chloramphenicol
-anticonvulsants
-NSAIDs
-antithyroid: PTU, methimazole
-antipsychotic: thorazine, compazine, stelazine
-aldomet
-allopurinol
-cimetadine
-diurectics: spironolactone, HCTZ, ethacrynic acid
Term
What are causes of lymphocytosis?
Definition
-viral infection
-drug reaction
-stress: exercise, status epilepticus
-smoking
-CA: leukemia
-serum sickness
-endocrine illnesses
-HEALTHY children < 6 yrs old
Term
[image]
Definition
Neutrophils- bands and segs
Term
[image]
Definition
lymphocytes
Term
What is the cycle for eosinophil levels?
Definition
-diurnal
-peak MN-4 a.m.
Term
What cause an increase in eosinophil levels?
Definition
-allgery
-drugs
-neoplasm
-Addison's
-Collagen Vascular Dz
-pulmonary dz
-parasites
-chlamydia
Term
What cause a decrease in eosinophil levels?
Definition
-steroids
-Cushing's
-ACTH
-after stress
Term
[image]
Definition
eosinophil
Term
What are causes of increased monocytes?
Definition
Infections
-TB
-bacterial endocarditis
-malaria
-syphillis
Leukemias
Hodgkin's lymphoma
Autoimmune
-SLE
-IBD
-UC
Term
What are causes of thrombocytopenia?
Definition
Spurious
Decreased production
-B12 deficiency
-folate deficiency
-marrow failure
-drugs
-ETOH
-cocaine
-infection
Increased destruction
-dilution (e.g. transfusion)
-drugs: HIT, Zantac
-autoantibody: ITP, SLE, viral infection
-non-immune: pregnancy, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, DIC
-hypersplenism
Term
At what levels of thrombocytopenia may spontaneous bleeding occur?
Definition
platelets < 20,000
Term
At what levels of thrombocytopenia may bleeding with minor trauma occur?
Definition
platelets 20,000-50,000
Term
At what levels of thrombocytopenia may longer bleeding with severe trauma occur?
Definition
platelets 50,000-100,000
Term
What are causes of thrombocytosis?
Definition
Physiologic
-stress
-exercise
-epinephrine
Reactive
-blood loss
-hemolysis
-infection
-inflammation
-CA
-post op
-trauma
-drugs: cytokines, vincristine
Post-splenectomy
Familial
Myelodysplastic/myeloproliferative
Term
What is the use of prothrombin time?
Definition
evaluate the effects of warfarin
Term
What can cause an increase in prothrombin time?
Definition
-Vit K deficiency (abx killed off normal gut flora that would've absorbed it from food)
-liver dz
-DIC
Term
What are the target prothrombin times for DVT tx? with a mechanical valve?
Definition
-DVT: 2.0-3.0
-mechanical valve: 2.5-4.5
Term
What is the use of partial thromboplastin time (PTT)?
Definition
-evaluate effect of heparin
Term
What are goal partial thromboplastin times (PTTs)?
Definition
1.5-2.5x control (55-85 sec)
Term
What cause an increase in partial thromboplastin time (PTT)?
Definition
-factor deficiencies
-heparin contamination
Term
What is included in a Basic Metabolic Panel (BMP)?
Definition
-Na
-K
-Cl
-CO2
-glucose
-creatinine
-BUN
Term
What is added to the BMP in a Comprehensive Metabolic Panel (CMP)?
Definition
-Ca +/- Phos
-T protein
-albumin
-total bili
-alk phos
-AST
-ALT
Term
What are reasons to do chemistry testing (BMP, CMP)?
Definition
-evaluate renal function
-assess acid-base status
-check glucose levels
-evaluate fluid volume status
Term
BMP shorthand
Definition
[image]
Term
CMP shorthand
Definition
Ca-Pro-AST-T. bili
Phos-Alb-ALT-Alk Phos
Term
What are normal creatinine clearance rates for males? females?
Definition
-males: 97-137 ml/min
-females: 88-128 ml/min
Term
What equation is used to calculate creatinine clearance, taking weight, age, and sex into consideration?
Definition
Cockcroft-Gault
Term
What equation is used to calculate creatinine clearance, taking weight, age, sex, AND RACE into consideration?
Definition
Modification of Diet in Renal Dz (MDRD)
Term
What are normal Na ranges?
Definition
135-145
Term
What are normal K ranges?
Definition
3.5-4.5
Term
What are normal Cl ranges?
Definition
96-109
Term
What are normal HCO3- ranges?
Definition
22-31
Term
What are normal BUN ranges?
Definition
6-22
Term
What are normal Cr ranges?
Definition
0.6-1.3
Term
What are normal glucose ranges?
Definition
60-99
Term
What are normal Ca ranges?
Definition
8.4-10.5
Term
What are normal Phos ranges?
Definition
2.4-4.1
Term
What are normal protein ranges?
Definition
6.0-8.2
Term
What are normal albumin ranges?
Definition
3.5-5.3
Term
What are normal AST & ALT levels?
Definition
0-31
Term
What are normal T. bili levels?
Definition
0.1-1.2
Term
What are normal Alk Phos levels?
Definition
30-120
Term
What are causes of increased HCO3-?
Definition
Respiratory acidosis
Metabolic alkalosis
-vomiting
-volume contraction
Term
What are causes of decreased HCO3-?
Definition
Respiratory alkalosis
Metabolic acidosis
-starving
-DKA
-lactic
-alcoholic
-diarrhea
-renal failure
-drugs
-dehydration
Term
What are normal values for the anion gap?
Definition
8-16
Term
How is the anion gap calculated?
Definition
Na+ - (Cl- + HCO3-)
Term
What are causes for an increased anion gap?
Definition
Methanol
Uremia
DM
Dehydration
Paraldehyde
Ischemia
Ethylene glycol
Salicylate OD
Term
What is the diagnostic threshold for diabetes in fasting glucose levels?
Definition
126 mg/dl
Term
What is the diagnostic threshold for impaired fasting glucose?
Definition
100-124
Term
What is the diagnostic threshold for diabetes in random glucose levels in the presence of symptoms?
Definition
200 mg/dl
Term
What is the diagnostic threshold for diabetes in HgA1C?
Definition
8.6%
Term
What is the diagnostic threshold for diabetes in oral glucose tolerance test?
Definition
200 mg/dl
Term
What is the diagnostic threshold for impaired glucose tolerance in oral glucose tolerance test?
Definition
140-200 mg/dl
Term
What are causes of hyponatremia?
Definition
-confusion
-weakness
-lethargy
-cramps
-anorexia
-n/v
-depressed DTR
-hypothermia
-stupor
-coma
Term
What are causes of hypernatremia?
Definition
-iatrogenic
-seawater ingestion
Term
What are causes of hypovolemic hyponatremia?
Definition
-v/d
-sweating
-3rd spacing
-diuretics (HCTZ)
-osmotic diuresis (DM)
-ketonuria
-cerebral saltwasting
-mineralcorticoid deficiency
Term
What are causes of euvolemic hyponatremia?
Definition
-SIADH
-hypothyroid
-polydipsia
Term
What are causes of hypervolemic hypernatremia?
Definition
-CHF
-cirrhosis
-nephrotic syndrome
-acute or chronic renal failure
Term
What are PE findings of hypovolemia?
Definition
-orthostatic BP: 20 pt difference after 2 min
-dry mucous membranes
-poor skin turgor
-no JVD
-absent axillary sweat
Term
What are PE findings of hypervolemia?
Definition
-edema
-ascites
-JVD
-rales
-wheezes
-gallop
-pleural effusion
Term
How is true Ca calculated?
Definition
measured Ca - serum Ca + 0.8(4 - serum albumin)
Term
What are tests of liver synthetic function?
Definition
-albumin
-INR
-cholesterol
Term
What are general liver tests?
Definition
-T. bili
-AST
-ALT
-Alk phos
Term
___?___x normal AST/ALT values indicate moderate elevation.
Definition
3
Term
The AST:ALT ratio is > 1 in ___?___
Definition
ETOH
Term
What are causes of AST:ALT ratio > 1000?
Definition
-ischemia
-acute viral
-acute biliary obstruction
-drugs, toxins
-autoimmune
Term
In liver failure, ___?___ is increased while ___?___ and ___?___ are decreased.
Definition
-increased: INR
-decreased: albumin, cholesterol
Term
INR is normal until ___?___% of liver is compromised.
Definition
80%
Term
Albumin is sensitive to acute changes in liver function. T/F
Definition
false
-half-life is 3 weeks
-normal in 15% of severely compromised patients
Term
What are normal values for urine sp gr?
Definition
1.003-1.030
Term
What are causes of dilute urine?
Definition
-volume overload
-diuretic use
-DI
-poor concentrating
Term
What are causes of concentrated urine?
Definition
-dehydration
-SIADH
-IV contrast
Term
What are normal urine pH values?
Definition
4.6-8.0
Term
What are causes of alkaline urine?
Definition
-urea split
-organisms
-vegan diet
-citrus
-respiratory or metabolic alkalosis
-drugs: NaHCO3, acetazolamide
Term
What are causes of acidic urine?
Definition
-meat
-cranberries
-respiratory or metabolic acidosis
-medications: ammonia
Term
What is a normal range of RBCs in urine?
Definition
< 3/hpf
Term
What are causes of RBCs in urine?
Definition
-trauma
-stones
-tumor
-infxn
-anticoagulation
-transfusion reaction
-hemolysis
Term
What shape are RBCs in urine of renal origin? urologic?
Definition
-renal: dysmorphic
-urologic: round
Term
What are causes of false positives of RBC in urine?
Definition
-menses
-hemorrhoids
-Vit C
Term
What is a normal range of WBCs in urine?
Definition
< 5/hpf
Term
What are causes of WBCs in urine?
Definition
-inflammation
-WBC casts
-UTI
-vaginal contamination
-fever
-pregnancy
-steroids
-nephritis
-cytoxan
Term
What are causes of glucosuria?
Definition
-DM
-ICP
-Cushing's
-pheochromocytoma
-chronic liver dz
-chronic pancreatitis
-steroids
-thiazides
Term
What are causes of false glucosuria positives?
Definition
-Vitamin C
-ASA
Term
What are causes of ketonuria?
Definition
-DKA
-starvation
-pregnancy
-rapid weight loss
-ASA OD
-drugs
-captopril
-levodopa
-mucomyst
Term
What are causes of RBC casts in urine?
Definition
nephritic syndrome
Term
What are causes of WBC casts in urine?
Definition
-pyelonephritis
-tubulointerstitial dz
Term
What are causes of muddy casts in urine?
Definition
acute tubular necrosis
Term
What are causes of tubular epithelial casts?
Definition
acute tubular necrosis
Term
What are causes of fatty casts in urine?
Definition
-fat emboli
-nephrotic syndrome
Term
What is a cause of waxy casts in urine?
Definition
chronic renal insufficiency
Term
What are types of crystals in urine?
Definition
-uric acid
-calcium oxalate
-calcium carbonate
-ammonium urate
-sodium urate
-calcium phosphate
Term
What is the criteria for UTI diagnosis?
Definition
Microscopic
> 5 RBC/hpf
+/- WBC
+/- Epi
> 1,000 cfu/hpf of same bacteria
Cloudy: protein or crystals
Malodorous
Term
What are abnormal ranges for microalbuminemia?
Definition
-30-300 mg/d in 2 out of 3
- >300 nephropathy
Term
What are abnormal ranges for urine albumin: creatinine ratio (mg/mmol)?
Definition
-males: 2-20
-females: 2.8-28
-neuropathy: males > 20, females > 28
Term
A hemoglobin A1C value of 5 correlates with a mean glucose value of ___?___
Definition
97
Term
A hemoglobin A1C value of 6 correlates with a mean glucose value of ___?___
Definition
126
Term
A hemoglobin A1C value of 7 correlates with a mean glucose value of ___?___
Definition
154
Term
A current or recent infection is indicated by ___?___ titers.
Definition
IgM
Term
A previous infection is indicated by ___?___ titers
Definition
IgG
Term
What kinds of drugs require therapeutic drug monitoring?
Definition
-high risk
-narrow therapeutic window
Term
Which drugs require therapeutic drug monitoring?
Definition
-phenytoin
-carbamazepine
-lithium
-valproic acid
-cyclosporin
-tacrolimus
-sirolimus
-digoxin
-theophylline
-vancomycin
-tobramycin
-amikacin
-gentamicin
Term
When is a fasting blood sugar required?
Definition
-BP > 135/80
-dyslipidemia
-obesity
-family hx
-cardiac risks
-PE findings
Term
When is a lipid panel required?
Definition
-males: 35
-females: 45
-DM
-family hx: CAD
-CAD risks
-PE findings
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