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Biomedicine (Semester II) > 20. Laboratory - Conventional > Flashcards

20. Laboratory - Conventional Flashcards

1
Q

Why is case taking essential?

A

Identify what is likely to be causing symptoms
Screen for potential systemic illnesses that might be undiagnosed
Identify why a patient has come to see you

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2
Q

What percentage of the information obtained from a case history makes up a diagnosis?

A

80%

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3
Q

What are good case-taking skills?

A 
Developing rapport
Using open-ended questions
Good listening 
Empathy
Clinical curiosity
Follow-up questions
Asking questions in a way the patient will understand
Communication
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4
Q

What are conventional diagnostic techniques?

A 
X-rays
Ultrasound
MRI
CT scan
Laboratory tests
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5
Q

What do x-rays investigate?

A

Dense materials:
Bones
Tumours
Blood clots

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6
Q

What do x-rays increase the risk of?

A

Mutations

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7
Q

What do ultrasounds investigate?

A

Soft tissues

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8
Q

What do ultrasounds use for imaging?

A

Sound waves

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9
Q

What do MRIs investigate?

A

Dense and soft tissue

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10
Q

What do CT scans use for imaging?

A

Powerful x-rays

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11
Q

What do CT scans investigate?

A

Dense and soft tissue

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12
Q

What do laboratory tests investigate?

A

Blood
Stool
Urine

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13
Q

What can blood test readings indicate?

A

Disease processes

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14
Q

Why is it important to repeat blood tests?

A

A snapshot in time

Easily influenced by factors such as time of day, food eated

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15
Q

What may not show up in blood tests?

A

Sub-clinical hypothyroidism

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16
Q

What does a full blood count measure?

A 
Amount of haemoglobin
No of RBC
% of RBC vs total blood volume
Volume of RBC
Average amount of haemoglobin in RBC
No of WBC
% of different WBC
No of platelets
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17
Q

What is the RBC count?

A

No of RBC in a quantity of blood

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18
Q

What is the haemoglobin count?

A

Amount of Hb in a quantity of blood

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19
Q

What can low RBC/low Hb indicate?

A

Anaemia

Bone marrow diseases

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20
Q

What can high RBC/low Hb indicate?

A

Dehydration

Polycythaemia

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21
Q

What does haematocrit measure?

A

Amount of blood volume taken up by RBCs (%)

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22
Q

How is haematocrit calculated?

A

Centrifugation

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23
Q

What can low haematocrit indicate?

A

Anaemia

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24
Q

What can high haematocrit indicate?

A

Dehydration

Polycythaemia

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25
Q

What is mean corpuscular volume (MCV)?

A

Average volume (and hence size) of a RBC

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26
Q

What can low MCV indicate?

A

Microcytic anaemia

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27
Q

What can high MCV indicate?

A

Megaloblastic anaemia

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28
Q

What is mean corpuscular haemoglobin (MCH)?

A

Amount of haemoglobin in one RBC

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29
Q

Why is MCH similar to MCV?

A

The value is directly proportional to the amount of haemoglobin and the size of the erythrocyte

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30
Q

What can low MCV indicate?

A

Microcytic anaemia

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31
Q

What can high MCV indicate?

A

Macrocytic anaemia

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32
Q

What is RBC distribution width (RDW)?

A

Indication of the variation in RBC size

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33
Q

What is the variation in RBC size also known as?

A

Anisocytosis

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34
Q

What can high RDW indicate?

A

Anaemias due to various deficiencies - iron, B12, folate

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35
Q

What happens when there is insufficient iron for normal haematopoiesis?

A

Bone marrow produces microcytes (microcytic anaemia)

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36
Q

When does RDW increase rapidly?

A

In the initial stages when the small RBCs are mixed in with normal sized RBC

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37
Q

What is haematinics?

A

The nutrients required for the formation of RBC

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38
Q

Which nutrients are needed for the production of RBC?

A

Ferritin (iron)
Vit B12
Folate (B9)

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39
Q

What is ferritin?

A

An intracellular protein that stores iron

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40
Q

Where is most ferritin produced?

A

Liver

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41
Q

What can raised iron levels indicate?

A

Inflammation

Liver disease

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42
Q

What can low iron levels indicate?

A

Iron deficient anaemia

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43
Q

What is a differential WBC count?

A

The quantity of each type of leukocyte present in the blood specimen

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44
Q

What is released by WBCs in response to an acute infection, trauma or inflammation?

A

Colony-stimulating factor

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45
Q

What does colony-stimulating factor do?

A

Increases bone marrow production of leukocytes

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46
Q

What is a low WBC count called?

A

Leukopenia

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47
Q

What is a high WBC count called?

A

Leukocytosis

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48
Q

What can leukopenia be a result of?

A 
Chemo
Radiotherapy
Aplastic anaemia
Immune suppressive medication
Stress
Alcohol
HIV/AIDS
Viral infections
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49
Q

What can leukocytosis be a result of?

A

Bacterial infections
Inflammation
Leukaemia

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50
Q

What is a low thrombocyte count called?

A

Thrombocytopenia

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51
Q

What is a high thrombocyte count called?

A

Thrombocytosis

52
Q

What can thrombocytopenia be a result of?

A 
Leukaemia
Lymphoma
Viral infections
Heavy alcohol intake
Chemo
Some AI diseases (RA, SLE)
Massive blood loss
53
Q

What can thrombocytosis be a result of?

A

Exaggerated response to an infection
Splenectomy
Haemolytic anaemias (spleen too busy to break down thrombocytes)

54
Q

What can erythrocyte sedimentation rate (ESR) be a measure of?

A

Inflammation

55
Q

Why should ESR measurements be read with caution?

A

High sensitivity but low specificity

can be indicative of many diseases

56
Q

How is the ESR measured?

A

Anticoagulated blood is placed in an upright tube
Rate at which the red blood cells fall (sediment) in an hour is measured
Reported in mm/h

57
Q

What happens in blood when an inflammatory process is present?

A

High serum fibrinogen causes red blood cells to stick together
Causes more rapid sedimentation

58
Q

When to ESR levels tend to rise?

A

With age

Generally higher in women

59
Q

What can an ESR of up to 50 mm after one hour indicate?

A

Inflammatory diseases e.g. RA, SLE
Hypothyroid function
Menstruation

60
Q

What can an ESR of 50-100 mm after one hour indicate?

A 
Chronic polyarthritis
Appendicitis
Acute bacterial infections
Chronic liver disease
Post MI
61
Q

What can an ESR of over 100 mm after one hour indicate?

A

Malignancies
Tuberculosis
Sepsis
Peritonitis

62
Q

What is c-reactive protein (CRP)?

A

General marker for inflammation

63
Q

What is CRP?

A

Acute phase protein produced by the liver

64
Q

Why should CRP measurements be read with caution?

A

Many things can elevate CRP

65
Q

Which is a better indicator of inflammation - ESR or CRP?

A

CRP

66
Q

Why is CRP a better indicator of inflammation?

A

Can monitor fast changes as it doesn’t depend on fibrinogen or immunoglobulin levels
Not affected by RBC numbers and shape

67
Q

What can raised CRP be indicative of?

A

Inflammatory disorders e.g. RA, Crohn’s
Tissue injury e.g. burns, necrosis, MI
Infections - bacterial
Malignancy

68
Q

What links raised CRP and CVD?

A

High CRP levels are associated with poorer prognosis in atherosclerosis CVD
Inflammation a key component of atherosclerosis development

69
Q

What can raised antinuclear antibodies (ANAs) be indicative of?

A

SLE

70
Q

What can raised antiphospholipid antibodies be indicative of?

A

SLE

71
Q

What can raised rheumatoid factor be indicative of?

A

RA

72
Q

What percentage of RA patients are tested positive for RF?

A

80%

73
Q

What can raised IgA anti-tissue transglutaminase be indicative of?

A

Coeliac’s disease

74
Q

What can raised endomysial antibodies (EMAs) be indicative of?

A

Coeliac’s disease

75
Q

What can thyroid antibodies be indicative of?

A

AI thyroid diseases

76
Q

What can blood lipids be linked with?

A

CVDs

77
Q

What does a lipid profile include?

A

Total cholesterol
LDL
HDL
Triglycerides

78
Q

What do low density lipoproteins (LDL) do?

A

Carry cholesterol from the liver to body cells

79
Q

What do high density lipoproteins (HDL) do?

A

Collect cholesterol from the body’s tissues and return it to the liver

80
Q

What is hyperlipidaemia?

A

Presence of elevated lipids in the blood

81
Q

What can cause hyperlipidaemia?

A 
Genetic - familial
Obesity
DM
Hypothyroidism
High sugar consumption
Alcohol abuse
Kidney diseases
Cushing's disease
Certain meds e.g. steroids, COCP
82
Q

What is blood glucose testing useful for?

A

Diagnosis and monitoring of diabetic patients

83
Q

What is recommended as a diagnostic test for diabetes?

A

Glycated haemoglobin (HbA1c)

84
Q

What does the HbA1c test do?

A

Gives an average of previous two/three months’ blood sugar levels

85
Q

What does the HbA1c test measure?

A

Glucose bound to haemoglobin

86
Q

What symptom can trigger a request for thyroid function tests?

A

Fatigue

87
Q

What is HIGH TSH and LOW thyroid hormone levels indicative of?

A

Hypothyroidism

Hashimoto’s, post-thyroidectomy, post-radioactive iodine, iodine deficiency

88
Q

What is LOW TSH and LOW thyroid hormone levels indicative of?

A

Hypothyroidism

Pituitary tumour

89
Q

What is LOW TSH and HIGH thyroid hormone levels indicative of?

A

Hyperthyroidism

Grave’s disease

90
Q

What is HIGH TSH and HIGH thyroid hormone levels indicative of?

A

Hyperthyroidism

Pituitary tumour

91
Q

Which sex hormones are commonly measured?

A 
Oestrogen
Progesterone
FSH
LH
Testosterone
Prolactin
92
Q

Why to blood samples in women need to be taken at a specific time in the menstrual cycle?

A

As hormones fluctuate throughout the month

93
Q

What are the typical hormonal changes during menopause?

A 
Reduced oestrogen
Reduced progesterone
Decline in ovulation
High FSH
High LH (negative feedback due to reduced O + P
94
Q

What are the typical hormonal changes during PCOS?

A 
Low sex hormone binding globulin (SHBG)
High LH
Hyperinsulinemia 
High blood glucose
Increased androgens
95
Q

What does high unconjugated bilirubin indicate?

A

Gilbert’s syndrome (reduced activity of the enzyme which conjugates bilirubin)
Haemolytic anaemia

96
Q

What does high conjugated bilirubin indicate?

A

Liver disease

Biliary obstruction

97
Q

What can albumin be a marker of?

A

Hepatic function

98
Q

What does low albumin indicate?

A

Chronic liver disease
Nephrotic syndrome
Malnutrition
Oedema

99
Q

What does high albumin indicate?

A

Acute infections

100
Q

What is ALP?

A

Liver enzyme produced from bile duct cells

Sensitive to any bile duct obstruction

101
Q

What can raised ALP indicate?

A

Acute liver damage

Liver tumours

102
Q

What is GGT?

A

Liver enzyme produced by liver cells

103
Q

When is GGT released?

A

Into the blood following liver cell damage or destruction

104
Q

What can raised GGT indicate?

A

All liver diseases

Biliary tree disease

105
Q

What can raised ALT indicate?

A

Leakage from damaged liver cells

106
Q

What can raised AST indicate?

A

Alcohol-induced liver disease
Cirrhosis
Hepatitis

107
Q

What can raised pancreatic enzymes indicate?

A

Pancreatitis

Pancreatic cancer

108
Q

Why do pancreatic enzymes become raised in pancreatitis?

A

Proteolytic enzymes become activated in the pancreas, rather than intestines, and enter the blood

109
Q

Which enzymes are useful to test in acute pancreatitis?

A

Serum amylase

Serum lipase

110
Q

What can be tested to measure renal function?

A

Estimated glomerular filtration rate (eGFR)
Creatinine
Urea
Uric acid

111
Q

Why should eGFR results be read with caution?

A

Calculated using blood creatinine

Value can easily influenced by age, sex, muscle bulk and meat ingestion

112
Q

What are patients advised to do before a renal function test?

A

Avoid eating meat 12 hrs before

113
Q

What does a GFR of <15 indicate?

A

Renal failure

114
Q

Types of blood glucose tests useful in the diagnosis and monitoring of diabetics?

A

Random
Fasting blood glucose
Two-hour oral glucose tolerance test (OGGT)

115
Q

What does stool analysis begin with?

A

Observation

116
Q

What can be observed in a stool analysis?

A 
Colour
Odour
Consistency
Presence of blood
Mucus
Pus
117
Q

What can stool microscopic analysis test?

A 
Water concentration
Occult blood
Tumour markers
Calprotectin
Bacteria
118
Q

What can occult blood in the stool be a sign of?

A

GIT malignancy

Ulceration

119
Q

What can tumour markers in the stool indicate?

A

Raised M2-PK

Colorectal cancer

120
Q

What can calprotectin in the stool indicate?

A

IBD

NSAID use

121
Q

Which bacteria can be tested for in the stool?

A 
Salmonella
Campylobacter
C. difficile
E. coli
Shigella
Cholera
Protozoan
122
Q

What can a skin prick test assess?

A

Immediate allergic response to multiple substances at once

123
Q

What kinds of allergies can be tested for in a skin prick test?

A 
Foods
Pollen
Certain drugs
Animal dander
Dust mites
124
Q

What happens during a skin prick test?

A

Drop of each allergen applied to a certain point on skin
Each location is then pricked with a thin needle
Within 20-30 min the skin is observed for signs of an allergic response

125
Q

What are the skin signs of an allergic response?

A

Raised, red, itchy bump

Biomedicine (Semester II) (20 decks)

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