Term
| eight parts of the clinical lab |
|
Definition
routuine chemistry
hematology
immunology
immunohematology
endocrine
theraputic drug monitoring
toxicology
urinalysis |
|
|
Term
| what are the 10 parts to a rotuine chemisty |
|
Definition
glucose
HBA1C
pre-albumin
kidney function
protein
C-reactive protein
electrolytes
cardiac
lipid
liver function |
|
|
Term
| what are the two renal function tests |
|
Definition
|
|
Term
| what electrolytes are measured during rotuine chemistry |
|
Definition
|
|
Term
| what are the three liver function tests, why |
|
Definition
albumin
bilirubin
prothrobin time
the liver will not produce albumin or clotting factors when failing, it will not remove bilirubin from the blood if damaged |
|
|
Term
| what are the three liver damage tests, what type of damage do they indicate, which is the best |
|
Definition
ALT: hepatocyte damage (hepatitis), most sensitive and specific enzyme test for the liver
AST: hepatocyte damage (hepatitis)
ALP: aminotransferase alkalinephospherase. duct damage (stones)
GGT: do if you have elevated ALP to determine where it is coming from. indicates duct damage |
|
|
Term
| what are the three cardiac function tests |
|
Definition
| CK-MB, troponin, myglobin |
|
|
Term
| what do leukocytes and neutrophil levels indicate for, explain |
|
Definition
neutrophils indicate bacterial infection
leukocytes indicate viral infection
50% of systemic infection has low leukocytes and neutrophils but the differential will have a high WBC count |
|
|
Term
| what is the most common lab and hematologytest |
|
Definition
| Complete blood count (CBC) |
|
|
Term
| what is tested for in theraputic drug monitoring |
|
Definition
|
|
Term
| what does IgM in a lab indicate |
|
Definition
| recent of acute infection (dissipears later in infection) |
|
|
Term
| what does IgG in a lab indicate |
|
Definition
| past or convalescent infection (replaces IgM) |
|
|
Term
| how is a titer done, how is it read |
|
Definition
a patient comes in and you do a titer and see IgM or the antigen and you know they have the disease right now
if you dont see IgM or antigen but you see IgG you dont know if they came in contact in the past or still have it and production just switched over.
do a titer today and obtain the dilution level
do a titer later and if there is a 4x increase in IgG they have the disease now, if there isnt they have just been exposed to it before |
|
|
Term
| how is haeatitis diagnosed |
|
Definition
| IgM positive or 4 fold change in IgG titer |
|
|
Term
| what would a blood test for hep B immunization look like |
|
Definition
| hep B surface antigen antibody ONLY (anti-HBsAg) |
|
|
Term
| immunohematology two parts |
|
Definition
blood typing and matching
blood component harvesting |
|
|
Term
|
Definition
|
|
Term
| what is the best marker for diagnosis of a UTI, how did that marker get there |
|
Definition
leukocyte esterase
leukocytes spill over |
|
|
Term
| what three things can be tested for on a urine wet prep |
|
Definition
trichomonas and yeast - cervix
pregnacy testing |
|
|
Term
| finish the statement: if you have acuracy you have.... |
|
Definition
if you have acuracy you have percision
you can have percision without acuracy |
|
|
Term
|
Definition
| is it correct? are the arrows in the center of the target? |
|
|
Term
|
Definition
| is it reproducable? are the arrows grouped? |
|
|
Term
| which is more important, accuracy or percision, why |
|
Definition
| percision because the result can be corrected to become accurate if needed |
|
|
Term
| why is it bad to do lots of lab tests, give some numbers to qualify your answer |
|
Definition
the more tests the more chance the results will be wrong
1 test 5% chance
2 tests 10%
3 tests 14%
12 tests 46% |
|
|
Term
|
Definition
those with the disease and need treatment
how likley the test will detect a sick person |
|
|
Term
| how is sensitivity calculated |
|
Definition
|
|
Term
| what are the two components to sensitivity, define them |
|
Definition
true positive: patient is sick and tests positive
false negative: patient is sick and tests negative |
|
|
Term
|
Definition
measure of those without the disease
how likley does a negative test indicate no disease |
|
|
Term
|
Definition
|
|
Term
| what are the two components of specificity, define them |
|
Definition
true negative: patient isnt sick and tests negative
false positive: patient isnt sick and tests positive |
|
|
Term
| give four examples of wet preps and what they test for |
|
Definition
cervical swab with saline: trich (strawberry cervix), and candida (yeast)
feces + iodine = fecal parasites like giardia intestinalis, giardia duodenalis
feces + methylene blue = fecal leukocytes like in inflammatory condition (usually low) or INVASIVE condition like shigella
KOH prep = dermatophyte fungi (dissolves all but hyphe) |
|
|
Term
| explain the process of a gram stain |
|
Definition
make smear and heat fix
add crystal violet and sit 5-10s
add iodine (fixing mortant)
decolorize with alcohol
gram positive cells will retain purple color
counterstain with safranin red to stain non-gram postive cells |
|
|
Term
| what are some generalizations to remember which are gram positive |
|
Definition
all cocci except neisseria and morxella
all sporeforms are gram positive rods |
|
|
Term
| what stuff does a giemsa (wright) stain test for (8) |
|
Definition
blood smear for WBC differential
blood borne pathogens
malaria
thalciprum
babesiosis
parasitic worms filarial and trichinella
giant cell multinucleated viruses |
|
|
Term
| malaria: worse kind, second worse, how does it live, how can it be identified |
|
Definition
thalciprum is worst
plasmodium is second
hides in RBC and liver
trophozoites show rings |
|
|
Term
| thalciprum: what is it, what does it do to the body 3), what disease does it cause |
|
Definition
malaria strain
lyses RBC, pee blood, life threatning
black water fever |
|
|
Term
| babesois: where does it come from, how can it be identified |
|
Definition
mouse gets the disease, deer or black leg tick bites mouse, tick bites us
maltease cross on RBC (different from malaria!) |
|
|
Term
| what does trichrome test for |
|
Definition
|
|
Term
| what does acid fast mostly test for |
|
Definition
|
|
Term
| what organisms are partially acid fast (4) |
|
Definition
nocardia
legionella
cryptosporidium
isospora cysts (protozoa) |
|
|
Term
| explain how an acid fast stain is done, what are the two types |
|
Definition
make smear and fix then add carbolfuschin
if doing siehl nelsen add heat, if doing kinyoun dont
decolorize with acid alcohol and acid fast retain the dye
counterstain everything else with methylene blue
acid fast cells are "red snappers" |
|
|
Term
| what is another name for the acid fast fluorescent stain, what is the benifit, what does it look for, how does it work |
|
Definition
auramine-rhodamine
99% specific
mostly for TB
uses acid alcohol to decolorize all by mycolic acid
uses rhodamine instead of carbofuschion |
|
|
Term
| how long does a culture take in general |
|
Definition
slow
minimum 18 hours / overnight
viral cultures take days because hospitals dont do them |
|
|
Term
| what are the challenges with cultures |
|
Definition
slow
different requirements per microbe
some stuff isnt culturable
viruses are hard to culture
positive culture is more meaningful than negative. |
|
|
Term
| what are the microbes that cannot be cultured 93) |
|
Definition
| chyamydia, syphilis, leprosy |
|
|
Term
| why are viruses hard to culture |
|
Definition
require cells to live in
diagnose with sigs and symptoms |
|
|
Term
| general purpuse agar: how does it work, what does it grow, 2 examples |
|
Definition
no inhibitors
non-fastidious pathogens and flora
tryptic soy and sheep blood |
|
|
Term
| enriched bacteria: how does it work, what does it grow, one example |
|
Definition
extra supplements for fastidious bacteria
chocolate agar |
|
|
Term
| chocolate agar: what is it made of, what does it do, 2 examples |
|
Definition
selective agar made of charcoal, blood and antibiotics
lysed blood gets rid of inhibitors of growth
grows bordetella pertussis and bordetella parapertussis |
|
|
Term
| differential agar; how does it work, one example |
|
Definition
has visual indicators, often selective
sheep agar for hemolysis (grows everything) |
|
|
Term
| differential selective agar: how does it work, two types |
|
Definition
inhibits with dyes, antibiotics, or salts
MacConkey, Mannitol salt |
|
|
Term
| MacConkey: what does it grow, what does it inhibit |
|
Definition
grows gram negative rods
inhibits gram positive cocci
detects lactose fermentation in purple
detects lactose fermentation in purple: klevisella pneumpnia, E. coli, enterobaccter colace |
|
|
Term
| what is the only gram negative lactose fermenter, what are the two other lactose fermenters that show up on MacConkey |
|
Definition
E. coli
klebsiella pneumpnia, enterobacter cloace |
|
|
Term
| mannitol salt: what does it grow, what does it inhibit, how is it interperteted |
|
Definition
grows gram positive cocci
inhibits gram negative rods
mannitol fermentrs will turn agar yellow (staph aureus)
coagulase negative staph make clear colonies (cannot ferment mannitol) |
|
|
Term
|
Definition
| staph aureus turns Mannirol salt yellow then grows on oxicilin to proove resistance |
|
|
Term
| charcoal blood agar (regan lowe): what does it show, how is it interperted |
|
Definition
bordetella pertussia
a: partial digestion
b: total digestion
gamma: no digestion, no hemolysis |
|
|
Term
| what rules are there for blood collection (6) |
|
Definition
clean with betadine or chlorhexidine) EtOH does nothing)
collect from two sites three times
collect before starting antibiotics
never draw from ports or lines
draw distal to port or line
COLLECT BEFORE STARTING ANTIBIOTICS |
|
|
Term
| what is the most likley blood contaminant |
|
Definition
| coagnegative staph (S. epidermiditis) |
|
|
Term
| what are the 5 most likley blood pathogens |
|
Definition
| s. aureus, S. pneumoniae, E. coli, K. pneumonia, P. aeruginosa |
|
|
Term
| compare A and B hemolytic |
|
Definition
B is a pathogen
A isnt except for strep pneumo |
|
|
Term
| optichin: use, interpertation |
|
Definition
used in cell culture
strep pneumo is sensitive other viridans are resistant |
|
|
Term
| bacitracin: use, interpertation |
|
Definition
differentiate group A and B strep
group a is susceptibe
group b is resistant (kills babies) |
|
|
Term
| cAMp test: how is it interperted, what is the point |
|
Definition
distinguish between group a and b strep
a is negative
b is positive arrow head |
|
|
Term
| what organism is caralase positive, how can you tell |
|
Definition
staph
converts H2O2 to water and O2 making bubbles |
|
|
Term
| what organisms are catalase negative |
|
Definition
|
|
Term
| what organisms are coagulase positive |
|
Definition
|
|
Term
| what organisms are coagulase negative, where are they found |
|
Definition
non staph aureus staph
Staph epi: common on skin and blood pathogen
staph saprophyticus, UTI |
|
|
Term
|
Definition
minimal inhibitor concentration
lowest level that inhibits bacterial replication |
|
|
Term
| minimal bacteriacidal concentration: define, how is it done |
|
Definition
lowest level that kills bacteria (homocidial)
take MIC, plate it, at lowest concentration no growth means min level of drug |
|
|
Term
| kirby bauer disk: how does it work |
|
Definition
measure diameter of zones of inhibition around antibiotic
NEED KEY - zone diameter is dependant on dose etc
not quantative, no sensitivity without key |
|
|
Term
| what WBC are granulocytes |
|
Definition
neutrophils
eosinophils
basophils |
|
|
Term
| what WBC are agranulocytes |
|
Definition
|
|
Term
| what is the nucleucs like in neutrophils, what are the the two common types of neutrophils |
|
Definition
multilobed
polymorphic and segmented |
|
|
Term
| what are the functions of neutrophils |
|
Definition
| phagocytosis of baceria, debris, bing things. then they die |
|
|
Term
| bandemia: aka, what does it mean, what does it suggest clinically |
|
Definition
aka: shift to the left
immature neutrophils come into the blood because they die when they eat and the marrow has to replace them (its ok for 2-3% of them to be immature normally)
sugests trauma, bactria, leukemia |
|
|
Term
| what does lots of segmented neutrophils suggest |
|
Definition
|
|
Term
| eosinophils: color of granules, functions (4) |
|
Definition
red granules
increase allergies
fight parasites (worms)
induces histamine release
minor phagocyosis |
|
|
Term
| basophils: granule color, function |
|
Definition
purple granules
contain and release histamine |
|
|
Term
| lymphocytes: what types of cells, what do they do, when do you see more lymphocytes |
|
Definition
T cells: immune regulation and cytotoxic functions
B cells: make antibodies
null cells: cytotoxic cells
increase in VIRAL infection |
|
|
Term
| monocytes: what do they do |
|
Definition
|
|
Term
| what does more than 5 segs mean for the neutrophil, what does it mean clinically |
|
Definition
hypersegmented neutrophils
megaloblastic anemia - B12 and folate deficiency |
|
|
Term
| what does a hematocrit represent |
|
Definition
| percent packed RBC vomule |
|
|
Term
| what are the three RBC indices, explain them |
|
Definition
mean cell volume (MCV): average RBC size
MCH
MCHC - mean cell Hb concentration: abverage Hb concentration |
|
|
Term
| define leukocytosis, what is the most common cause |
|
Definition
increased WBC - commonly indicates infection
neutrophilia is most commonly the cause |
|
|
Term
| define lymphocytosis, what does it suggest clinically |
|
Definition
increased lymphocytes
points to viral infection |
|
|
Term
| define neutrophilia, what does it point to clinically |
|
Definition
increased neutrophils
points to bacterial infection |
|
|
Term
| define leukopenia, what does it point to clinically |
|
Definition
decreased WBC
commonly points to a big bacterial or viral infection
moderate decrease: viral
large decrease: bacterial (sepsis) or marrow supression
lymphocytopenia, neutrophils |
|
|
Term
|
Definition
|
|
Term
| define neutropenia, what will this end up leading to |
|
Definition
decreased neutrophils
left shift will occur in the future |
|
|
Term
| how is total neutropil count determined |
|
Definition
| add all the forms of neutropils together, no matter their level of maturation |
|
|
Term
| what is flow cytometry, how does it work, what does it look for |
|
Definition
flourescently tagged monoclonial antibodies attach to specific cell membrane proteins to sort, separate, and store them
can stain surface markers to get good counts, especially CD4 for HIV |
|
|
Term
| when do we treat HIV, when is AIDS classified, whan does the risk for PCP infection ncrease |
|
Definition
treat at <350 CD4
<200 CD4 diagnosed with AIDs for life and INCREASED PCP RISK |
|
|
Term
| what lab tests are done for spinal fluid analysis |
|
Definition
| CBC, urine culture (UTI can get to blood and brain), blood cultures, LP |
|
|
Term
| how is WBC in CSF interperted |
|
Definition
increased neutrophils: bactreial
increased lymphocytes: viral
eraly meningitis: strange levels of WBC |
|
|
Term
| how is glucose intereperted in CSF analysis |
|
Definition
bacterial infection: CSF glucose < 1/2BG
viral: CSF glucose > 1/2BG |
|
|
Term
| protein interpertation in the CSF |
|
Definition
meningitis increases CSF protein
bacterial will have extremely high protein
slightly high in viral |
|
|
Term
| what is the general rule for the difference between viral and bacterial meningitis |
|
Definition
| viral is more mild, lymphocytes increased |
|
|
Term
| where can ALT be found, what does it indicate |
|
Definition
| specific to the liver, hepatocyte function |
|
|
Term
| where can AST be found, what does it tell us |
|
Definition
liver, muscle, heart
tells liver function, heart attack marker, hepatocyte function |
|
|
Term
| what is GGT, what does it indicate, where is it found |
|
Definition
gamma-glutamyl transaminase, gives info about the duct
liver ductal cells
can indicate chronic alcoholism |
|
|
Term
| where is ALP found, what does it indicate |
|
Definition
bone, placenta, kidney, liver
ductal damage |
|
|
Term
| what are the liver damage tests, why do they indicate damage |
|
Definition
ALT, AST, GGT, ALP
because when the cell dies they are released |
|
|
Term
| what are the acute phase proteins |
|
Definition
| C reactive protein, fibrinogen, mannan binding lectin (MBL) |
|
|
Term
| C reactive protein: what is it, what does it do |
|
Definition
phosphorylchiline
binds abcterial surface
opsonizes bacteria and activates complement |
|
|
Term
| fibrinogen: when does it appear, what does it do |
|
Definition
| inflammation increases it and causes stickey RBC which increases ESR |
|
|
Term
| mannan binding lectin: what does it do |
|
Definition
binds to bacteria surface mannose and opsonizes them
activates complement |
|
|
Term
| how are acute phase proteins made |
|
Definition
| macrophages make IL-6 which acts on hepatocytes to make them |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| titer Moa, how is it read |
|
Definition
patient comes in and you see IgG so you dont know if they have the disease in the past or just recently moved from IgM to IgG production
acute sera: do a titer now and get dilution level
convalescent sera: do titer later too. if there is a 4x increase then they currently have the disease if there isnt an increase they were just exposed to it before |
|
|
Term
| what are the two parts of a titer, explain them |
|
Definition
acute sera: titer taken at time of initial sytpms
convalescent sera: titer taken on road to recovery |
|
|
Term
| what is the difference between IgM and IgG when thinking clinically, what is their relationship |
|
Definition
IgM shows recent or acute infections
IgG shows past infection or vaccine (2-4 weeks later)
4 fold or more increase in IgG = 1 IgM |
|
|
Term
| viral window: define, what is the issue ir brings |
|
Definition
time between the appearnce of viremia and synthesis of IgM
if you test at this time a positive patient could get a false negative |
|
|
Term
| what are the ways to declaire an acute infection |
|
Definition
| finding of IgM or a 4 fold or more change in IgG |
|
|
Term
| what does ELISA stand for, what is the point |
|
Definition
enzyme linked immunosorbant assay
detect or measure immunoglobins or antibodies |
|
|
Term
|
Definition
enzyme or reporter molecule is linked to an antibody covalently
antigen antibody binding occurs (immunosorbant part)
bound reporter gives signal and produces assay |
|
|
Term
| what are the three uses of ELISA |
|
Definition
detect antigen (hormone, enzyme, microbe antigen drug)
detect antibody (infectious agent of exposure, HIV)
tests variety of fluids (blood, spinal fluid, urine, enivrionmental) |
|
|
Term
| what are the 3 types of ELISA |
|
Definition
| direct, indirect, sandwhich |
|
|
Term
|
Definition
probe for antigen with a single labeled antibody
looks directly at the cause of the infection (antigen) |
|
|
Term
|
Definition
probe for antibodies to an antigen
labeled antibody
lebeled antibody binds to unlabeled antibody
lookes at antibodies involved |
|
|
Term
| how is an indirect ELISA done |
|
Definition
plastic contains bound antigen
we want to see if they have an antibody. so add patient serum to antigenic site (epitpoe)
now we have this antibody bound to antigen but we can't see it. so we need to add anti-human antibodies with an enzyme or something on it that gives a color reaction (reporter enzyme)
add a substrate that changes the color of only bound reporter enzymes |
|
|
Term
|
Definition
antigen is sandwiched between two
usually looking for antigens |
|
|
Term
| percipitatation curve general idea |
|
Definition
| depending on the level of antibody in the solution the curve will shift |
|
|
Term
| three zones of the percipitation curve, explain each |
|
Definition
prosone: antibody excess, antibodies left over aftr formation of antigen antibody complexes. very high antibodies will produce a negative result
equlivance: no free antigens or antibodies, remain in solution after certerfugation of antigen antibody compled (max percipitation)
antigen excess: high levels of free antigen in solution after formation of anrigen antibody complex |
|
|
Term
| what zone of the percipitation curve shows max percipitation |
|
Definition
|
|
Term
| how is the percipitation curve interpertered |
|
Definition
if the screen is negative, dilute the serum down and retest if the pt seems clinically positive
if it is popsitive the first test was false negative due to prozone!! |
|
|
Term
| western blot: how does it work, what does it test, |
|
Definition
multi target indirect elisa on nutricelluose paper
protein detection
HIV test conformation |
|
|
Term
| what antibodies will someone who has never been in contact with HebB will that have |
|
Definition
|
|
Term
| what antibodies will someone with HepB have |
|
Definition
| surface antigen plus more parts of hep B antigens |
|
|
Term
| what are the three morphologies of gram positive cells |
|
Definition
| diplococci, staphlococci, streptococci |
|
|
Term
| whiff test: how do you do it, what are the results, what do they tell you |
|
Definition
| add KOH to cervical swab if there is a strong amine odor it is trich or more likley bacterial vaginosis (garderella vaginalis) |
|
|
Term
| what microbe is mixed up with malaria, what can help distinguish it |
|
Definition
| babesia - maltease cross in RBC |
|
|
Term
| what is the relationship between MIC and MBC |
|
Definition
|
|
Term
| what are three situations where neutrophils are decreased |
|
Definition
| viral infections, overwhelming bacterial infections, some leukemias |
|
|
Term
| what do north south and west blots test for |
|
Definition
west: protein
north: RNA and mRNA
south: DNA |
|
|
Term
| pyogenic bacterial meningitis: appearance of CSF, PMN amount, lymph amount, protein amount, glucose amount |
|
Definition
yellow turbid
increased PMN
slight increase or normal lymphs
increased protein
decreased glucose |
|
|
Term
| viral meningitis: appearance of CSF, PMN amount, lymph amount, protein amount, glucose amount |
|
Definition
clear CSF
slight increase or normal PMN
increased lymphs
slight increase or normal protein
normal glucose |
|
|
Term
| TB meningitis; appearance of CSF, PMN amount, lymph amount, protein amount, glucose amount |
|
Definition
yellowish and viscous CSF
slight increase or normal PMN
increased lymphs
slight increase or normal protein
decreased glucose |
|
|
Term
| fungal meningitis: appearance of CSF, PMN amount, lymph amount, protein amount, glucose amount |
|
Definition
yellow and viscous CSF
slight increase or normal PMN
increased lymphs
slight increased or normal proteins
normal or decreased glucose |
|
|
Term
| what is the normal amount of urine produced in adults per minute and per day. what is the estimated amounts |
|
Definition
1.2 ml/min and 1700 ml/day
1 ml/min and 1440 ml/day |
|
|
Term
| what word describes no urine? what amount qualifies this? |
|
Definition
|
|
Term
| what word describes too little urine? what amount qualifies this? |
|
Definition
|
|
Term
| what word describes too much urine? what amount qualifies this? |
|
Definition
|
|
Term
| what does GFR stand for, what does it tell us |
|
Definition
| glomerular filtration rate |
|
|
Term
| what two values reflect the GFR |
|
Definition
BUN/creatinine
creatinine clearance |
|
|
Term
| what does kidney function loss do to the GFR and the two values that reflex GFR |
|
Definition
| decreases GFR, increases blood BUN and creatinine |
|
|
Term
| define creatinine clearance |
|
Definition
| plasma volume cleared of creatinine per minute |
|
|
Term
| how is creatinine clearance calculated, explain how this value then relates to renal function |
|
Definition
((140-age) x kg x (0.85 if female)) / (72 x serum Cr)
CrCl ~ % renal function |
|
|
Term
| how can creatinine clearance be estimated, why can't you use this all the time |
|
Definition
100 / serum creatinine
little old lady exception (because real formula uses age and weight and if it isnt a normal ratio it throws it off too much) |
|
|
Term
| calculate the CrCl of a 30 yo diabetic female at 80 kg and serum Cr 1.1 |
|
Definition
|
|
Term
| calculate a 85 yo diabetic female CrCL at 60 kg and serum Cr 1.1 |
|
Definition
|
|
Term
| what are the three types of genitourinary tract analysis |
|
Definition
macroscopic
microscopic
culture |
|
|
Term
| what are the two parts to the macroscopic urine exam |
|
Definition
color and appearance
chemical analysis (dip stick) |
|
|
Term
| what are the 10 parts to a urine chemical analysis |
|
Definition
glucose
bilirubin
ketones
specific gravity
blood
pH
protein
urobillinogen
nitrate
leukocyte esterase |
|
|
Term
| what are the 2 parts of a urine microscopic exam, what three things are they looking for |
|
Definition
high power and low power exam
cells, casts, crystals |
|
|
Term
| what urine test show diabetes (all by itself), how |
|
Definition
| hyperglycemia on the glucose test |
|
|
Term
| what urine test shows liver function |
|
Definition
| bilirubin is the crude test for liver function |
|
|
Term
| what three things can ketones in the urine tell you |
|
Definition
ketonurie = prolonged fasting or low carb diet
diabetic ketoacidosis |
|
|
Term
| how is diabetic ketoacidosis diagnosed from urine |
|
Definition
| ketones, hyperglycemia, acidic urine |
|
|
Term
| what can specific gravity tell us |
|
Definition
high= dehydrated
low= hydrated |
|
|
Term
| what can acidic urine tell us |
|
Definition
| high protein diet, metabolic acidosis |
|
|
Term
| what is the normal pH of the urine |
|
Definition
|
|
Term
| what are 3 causes of proteinuria in urine |
|
Definition
functional
renal: glomerulonephritis
post renal: cystitis |
|
|
Term
| what does urobilinogen in the urine indicate |
|
Definition
| increased hepatic processing of bilirubin |
|
|
Term
| what do nitrites in the urine indicate |
|
Definition
| infection. not all infections make nitrites but all E. coli does |
|
|
Term
| what factors of a urine dip stick can tell us about infection |
|
Definition
leukocyte eserase is the most sensitive indicator for UTI
nitrates present when it is E. coli |
|
|
Term
| why is leukocyte esterase the most sensitivie indicator for UTI, what is the down fall |
|
Definition
you can have leukocytes without an infection but you cant have an infection without leukocytes
WBC must always be lysed first to release leukocyte esterase so compare with microscopic exam and urine culture |
|
|
Term
|
Definition
|
|
Term
| what is found in the urine when someone has pyelonephritis |
|
Definition
leukocyte and granular casts (indicate kidney damage, Tamm horsfall casts are ok to have some)
renal tubular cells indicate kidney damage (it is ok to have epithelial cells) |
|
|
Term
| what is the most common form of acute glomerulonephritis |
|
Definition
| post strep glomerulonephritis in children comes after srep throat or skin strep infection (impetigo) |
|
|
Term
| what is the #1 cause of UTI |
|
Definition
|
|
Term
| what is the #2 cause of UTI |
|
Definition
| schistosoma haematobium: parasite that infects bladder and causes hematuria |
|
|
Term
| what are 5 qualifications to be considered an uncomplicated UTI |
|
Definition
healthy (no acute illness either: fever, nausea, vomit, flank pain)
adult (>12 yo)
female
non-pregnant
structurally and functionally normal UT |
|
|
Term
| what is the diangosis process of an uncomplicated UTI |
|
Definition
| dipstick or urinalysis, no culture or lab tests |
|
|
Term
| what type of infection does a uncomplicated UTI get, what is the duration |
|
Definition
|
|
Term
| what qualifies someone as a complicated UTI (11) |
|
Definition
structural or functionally abnormal UT
foley cathater
renal caliculi
bacteriema
cystitis of long deruation
hemorrhagic cystitis
pregnacy
comorbidities
all males
urosepsis/hospitalization
pyelonephritis |
|
|
Term
| how is a complitated UTI diagnosed (3) |
|
Definition
| urinalysis, urine culture, labs |
|
|
Term
|
Definition
|
|
Term
| what are the 4 symptoms of pyelonephritis, which are the hallmark ones |
|
Definition
fever and chills are hall mark
vomiting, headache |
|
|
Term
| what is used to diagnose pyelonephritis (4) |
|
Definition
| urinalysis, urine culture, CBC, chemistry |
|
|
Term
| what are the two complications of pyelonephritis |
|
Definition
renal abscess what wont respond to antibodies
nephrolithiasis: stones with severe flank pain |
|
|
Term
| when should nephrolithiasis be suspected in a UTI patient |
|
Definition
|
|
Term
| when should renal abscess be suspected in a UTI patient |
|
Definition
| pt not improving with antibiotics |
|
|
Term
| what organism can cause kidney stones, how is this organisms identified, how does it cause stones |
|
Definition
| proteus mirabilis: makes urease and shifts the pH upward to percipitate Mg-Ammonium-phosphate and produce struvite stones |
|
|
Term
| what are symptoms of prostatitis (12) |
|
Definition
pain: perineum, lower abdomen, testicles, penis
pain with ejaculation
blood in semen
bladder obstruction
fever, chills, dysuria, malaise, myalgia |
|
|
Term
| how is prostatitis diagnosed (6) |
|
Definition
DRE: edematous tender prostate
increased PST
urinalysis
urine culture
two cup test |
|
|
Term
| how are lab results for clean catch interperted |
|
Definition
>10^5 cfu/mL is infected
<10>5 cfu/mL could be contaminated
more than one bacteria is probablly contaminated |
|
|
Term
| how are lab results for suprabubic or catheter interperted |
|
Definition
| any bacteria is infection |
|
|
Term
| what are the 2 main bacteria that cause commonity acquired UTI |
|
Definition
E. coli
coagulase negative staph saphrociticus |
|
|
Term
| what is the main cause of hospital acquired UTI, what is the concern here |
|
Definition
proteus mirabilis
beware of resistance |
|
|
Term
| how is proteus mirabilis diagnosed |
|
Definition
| when grown on plate it swarms it and grows over the entire thing |
|
|
Term
| what is schistoma hematoboium classified as, what does it cayse |
|
Definition
termatode parasite
hematuria which appears in pyleonephritis and cystitis |
|
|
Term
| what protozoa cause STIs (1) |
|
Definition
|
|
Term
| what fungi cause STIs (1) |
|
Definition
|
|
Term
| what types of HPV cause warts (2) |
|
Definition
|
|
Term
| what types of HPV cause cancer |
|
Definition
|
|
Term
| how are the drips categorized, why |
|
Definition
chlydmia cannot be cultured
so there are gonorrhea and non gonococcal urethritis |
|
|
Term
| what are the non-conococcal urethritis (2) |
|
Definition
| chalmydia and mycoplasmas |
|
|
Term
| what is the number one STI by incidence |
|
Definition
| most new cases in a year HPV |
|
|
Term
| what is the number one STI by prevelence |
|
Definition
| most poeple with the disease: HPV |
|
|
Term
| what is the number one bacterial cause of STI |
|
Definition
|
|
Term
| what is the rule for categorizing HPV |
|
Definition
all warts are caused by HPV, not all HPV causes warts.
HPV that causes cancer does not cause warts |
|
|
Term
| what is the most cause of an abnormal pap, why is this not a super huge concern |
|
Definition
| HPV. most people come in contact with HPV and most will auctally clear it. so it is only life long in theory |
|
|
Term
| what are the 3 signs of HPV |
|
Definition
asymptomatic - most common
warts
cancer: cervical, anal, penile |
|
|
Term
| what types of HPV does gardisil protect against, what symptoms are you avoiding by that |
|
Definition
16, 18: anogenital cancer
6, 11: anogenital warts
6, 16: oropharyngeal warts |
|
|
Term
| what are the causes of nongonoccal urethritis and gonococcal urethritis (full names) |
|
Definition
chlamydia trachomatis
genital mycoplasmas: ureaplasma, mycoplasma genitalium
gonogoccal: neisseria gonorrhea |
|
|
Term
|
Definition
| thayer margin agar: antibiotics and chocolate agar. inhibits normal flora, selects for gonorrhea (gram negative intracellular diplococci) |
|
|
Term
| chlamydia: full name, symptoms in names (3), symptoms in females (4) |
|
Definition
chlamydia trachomatis
males: watery discharge, painful urination, 50% asymptomatic!!
females: vaginal discharge, burning, itching, 75% asymptomatic!! |
|
|
Term
| what happens if you dont treat chlamydia (7) |
|
Definition
PID and infertility!!
cervicitis
urethritis
venereum
bubos and abscess on groin rectum pharynx |
|
|
Term
| why does chlamydia cause infertility (3) |
|
Definition
| causes PID, scars fallopian tube, inflammation |
|
|
Term
| what are concerns for a pregnant mother with chlamydia (2) |
|
Definition
| can give conjunctivitis or pneumonia to the baby |
|
|
Term
| what is a sign on the physical exam for chylamidia in a female (2) |
|
Definition
| mucopurulent cervicitis (friable cervix) |
|
|
Term
| what are the signs of gonorrhea in man (3) and women (4) |
|
Definition
men: 50% asymptomatic, yellow pus, painful urination
females: 80% asymptomatic, vaginal discharge, painful urination, PID |
|
|
Term
| how do you test for gonorrhea (4) |
|
Definition
bacterial culture: men and women
gram stain: men
nucleic acid hybridization
DNA amplification assay |
|
|
Term
| why can only men be gram stained for diplococci, what does it look like |
|
Definition
gram negative intracellular diplococci is diagnostic for gonorrhea in males
women have normal flora (neisseria lactima, neisseria other) intra and extracellularly |
|
|
Term
| what can PID be secondary to (2) |
|
Definition
|
|
Term
| what are the non-STI vaginal discharges (3), why are they called this |
|
Definition
could be STI but can come from other sources too
trichomonis, candidiasis, bacterial vaginosis |
|
|
Term
| trichomonis: is there an odor, is there vaginal tenderness, is there discharge, what does it look like |
|
Definition
sometimes there is an odor
there is vaginal tenderness
frothy yellow-green discharge |
|
|
Term
| candidiasis: is there an odor, is there vaginal tenderness, is there discharge, what does it look like |
|
Definition
no odor
vaginal tenderness
white curdy discharge |
|
|
Term
| bacterial vaginosis: is there an odor, is there vaginal tenderness, is there discharge, what does it look like |
|
Definition
fishy amine odor
no vaginal tenderness
homogenous gray discharge |
|
|
Term
| trhciomonas: pH changes, epithelial cell changes, wep prep findings |
|
Definition
pH > 4.7
normal epithelial cells
swimmers on wet prep |
|
|
Term
| candidisis: pH changes, epithelial cell changes, wep prep findings |
|
Definition
pH <4.5
normal epithelial cells
budding yeast on wet prep |
|
|
Term
| bacterial vaginosis: pH changes, epithelial cell changes, wep prep findings |
|
Definition
pH > 4.7
clue cells: glittery bacilli sticking to epithelium |
|
|
Term
| what is the whiff test, how is it done, what does it tell you |
|
Definition
| add a drop of KOH to vaginal sample. strong fishy amine loke odor beans bacterial vaginosis 70% of the time and the rest is trich |
|
|
Term
| what is the normal vaginal pH |
|
Definition
|
|
Term
| trichomonas: full name, appearance |
|
Definition
trichomonas vaginalis
microscopic pear shaped flagellated ptotozoa |
|
|
Term
|
Definition
discharge: smelly, green-yellow, foamy
itching |
|
|
Term
| how does someone get secondary syphilis, when does it happen, how long does it last, what are the signs (3) |
|
Definition
systemic dissemination of sphirochetes
2-8 weeks after chancere, lasts 2-10 weeks
lymphadenopathy, rash on palms and soles, mucous patches |
|
|
Term
| how does someone get tertiary syphilis, what are the signs |
|
Definition
latency of 1-30 years
paralytic dementia, aortic anrueysm, aortic insuffiency, tabes dorsalis, gummas |
|
|
Term
|
Definition
| large internal and external sores seen in syphilis |
|
|
Term
| syphilis: incubation time |
|
Definition
|
|
Term
| what are the signs of primary syphilis (4), what is the concern in this time |
|
Definition
early: macule (visble) > papule (palpable) > ulcer
later: painless indurated ulcer with smooth firm borders (VERY INFECTIOUS) |
|
|
Term
| what are the symptoms of genital herpes (4) |
|
Definition
vesicles > painfil ulcers > crusting
likley reoccurance |
|
|
Term
| what type of herpes causes genital ulcers |
|
Definition
if you have HSV1 in genital region it is more mild and will likley only show up once than come back
HSV2 is more common and more symptomatic |
|
|
Term
| what type of herpes causes oral ulcers |
|
Definition
HSV2 is more mild and will likley only show up once than come back
HSV1 is more symptomatic and reoccurs more |
|
|
Term
|
Definition
|
|
Term
| what are the complications of herpes (3) |
|
Definition
neonatal transmission: to C section
enhanced Hiv transmission: more spreading to others
psychosocial issues |
|
|
Term
| which STDs cause cancer (3) |
|
Definition
|
|
Term
| which STDs have a vaccine (2) |
|
Definition
|
|
Term
| which STDs can be prevented by a condomn |
|
Definition
| all can be prevented but not eliminated |
|
|
Term
| what are 6 things that can cause acquired immunodeficiency |
|
Definition
burns
iatrogenic: corticosteroids, chemotherapy
malignancies
malnutrtion
HIV |
|
|
Term
| what parts does HIV need to attach to people, how does it work |
|
Definition
GP160 splits into GP41 and GP120
GP120 attaches to the CD4 receptor. GP41, CXR/CXCR stabilize and pull the virus in
GP41 injects the virons in like a syringe |
|
|
Term
| how do we identify HIV (2) |
|
Definition
we look for antibodies to P24 core capsid antigen
find GP160 |
|
|
Term
| what types of cells does HIV attach to(4) |
|
Definition
| macrophages, monocytes, dendeitic cells and CD4 cells all have CD4 receptors or Fc gamma receptors that are very simillar |
|
|
Term
|
Definition
| cell that can make viruses |
|
|
Term
|
Definition
|
|
Term
| what are the AIDS defining diseases we need to know |
|
Definition
candidiasis of the esophagus, bronchi, trachea, or lungs
cryptococcus in the CNS
Karposki's sarcoma
pneymocystis juvoreci pneumonia (PCP) |
|
|
Term
| what is the most common way for a male to get HIV |
|
Definition
|
|
Term
| what is the most common way for a female to get HIV |
|
Definition
|
|
Term
| how can HIV get into the blood (4) |
|
Definition
open cuts
breaks in skin
breaks in mucous membranes
direct injections |
|
|
Term
| what are the three routes of transmission of HIV |
|
Definition
| sexual contact, blood exopsure, perinatal |
|
|
Term
| what are the sexual contact ways to get HIV (3) |
|
Definition
male to male
male to female
female to female |
|
|
Term
| what are the three ways to het HIV through blood exposure |
|
Definition
sharing drug needles
occupational exposure
transfusion of blood products |
|
|
Term
| how can HIV be transmitter perinatally (3) |
|
Definition
in utero
during delivery
breast milk |
|
|
Term
| what has a higher risk of transmission through blood than HIV |
|
Definition
|
|
Term
| where is HIV found in the body (7) List from fluid with highest to fluid with lowest concentration |
|
Definition
| blood, semen, vaginal secretions, amniotic fluid, saliva, urine, breast milk |
|
|
Term
| what is the most common route of HIV transmission |
|
Definition
| 80% through unprotected intercourse (vaginal, anal, oral, genital) |
|
|
Term
| why is someone with HIV and STDs more HIV infective |
|
Definition
| someone with STDs sheds more HIV (increased semen viral load) due to inflammation increasing CD4 count |
|
|
Term
| what are the initial symptoms of HIV, when do they show up (14) |
|
Definition
brief flu like symptoms: fever, muscle ache, rash, loss of appetite, swollen nodes
if more immune supressed: fever, night sweats, weight loss, chronic fatigue, bruising, headaches, cough, diarrhea, bloody stool |
|
|
Term
| when do HIV antibodies show up |
|
Definition
|
|
Term
| how long does it take HIV to turn into AIDs |
|
Definition
|
|
Term
| what is the most common disease and cause of death in AIDs |
|
Definition
|
|
Term
|
Definition
| positive HIV test + AIDs defining illness or CD4<200 |
|
|
Term
| when do you begin to treat HIV/AIDs |
|
Definition
positive HIV test + one of these
1. AIDS defining illness
2. CD4 <200
3. CD4 200-350 offer treatment
4. viral load >100,000 offer treatment |
|
|
Term
| what are 4 AIDs defining illnesses |
|
Definition
candidiasis of the esophagus, bronchi, trachea, or lungs
cryptococcus, extrapulmonary
karposi sarcoma
pneumocystis jiroveci pneumonia |
|
|
Term
|
Definition
| early time where macrophages are targeted |
|
|
Term
|
Definition
| period of time where an infected person tests negative for the anti-HIV virus |
|
|
Term
| what is the timline for getting acurate tests, avoiding the viral window (3) |
|
Definition
10% test positive within 3-6mo of exposure!!
70% test positive within 3 weeks of exposure
90% test positive within 3 months of exposure |
|
|
Term
| why does it take time for someone with HIV to test positive |
|
Definition
| seroconversion takes time |
|
|
Term
| what are the diagnostic parts of HIV (4) |
|
Definition
gp160 (needed)
gp41 and gp120 OR p24 |
|
|
Term
| what is the rapid HIV test, what kind of test is it |
|
Definition
|
|
Term
| what is the conformation test for HIV (2), how are they read |
|
Definition
western blot: need one gp160 and either gp12-+41 or p24. no bands is negative, 1-2 bands is inderterminate (test again in 2-4 months)
PCR is becoming the new standard, it can test smaller samples and you don't have to wait 2-4 months |
|
|
Term
| you do a western blot and the pt has less than 3 bands but has one now what |
|
Definition
| indeterminate, do a PCR or wait and do it later. probablly were in viral widow |
|
|
Term
| what will replace western blot as gold standard for HIV test |
|
Definition
|
|
Term
|
Definition
| splits into GP120 and GP41 |
|
|
Term
|
Definition
| attaches to CD4 receptor and pullsHIV close to cell |
|
|
Term
|
Definition
attaches to CD4 receptor and pullsHIV close to cell
injects viral particles into the cell |
|
|
Term
|
Definition
| binds to gp120 and pulls it close to stabilize it |
|
|
Term
|
Definition
| core capsid antigen of HIV |
|
|
Term
| wwhat three enzymes does HIV have what do they do |
|
Definition
reverse transcriptase: turns viral RNA into DNA
integrase: puts viral DNA into host genome
protease: fit and trim viron particles |
|
|
Term
| what are the symptoms of HIV in immune supression (8) |
|
Definition
fever
night sweats
weight loss
chronic fatigue
bruising
hedache
coough
diarrhea
bloody stool |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| rash from kaposkis sarcoma |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| chalmydia effect on cervix |
|
|
Term
|
Definition
| babesia in RBC showing maltease cross |
|
|
