CA diagnostics

Question 1

what are the 8 components of a BMP?

Answer 1

1) calcium
2) carbon dioxide
3) chloride
4) creatinine
5) glucose
6) potassium
7) sodium
8) urea nitrogen (BUN)

Question 2

what is the only difference between the chem 7 and the chem 8?

Answer 2

calcium

Question 3

in what circumstances would you order a BMP? (5)

Answer 3

1) renal status
2) blood glucose
3) respiratory distress
4) abnormal cardiac rhythms
5) rule in/out electrolyte imbalance

Question 4

high calcium should make you think what?

Answer 4

hyperparathyroidism, bone cancer, breast cancer, multiple myeloma

90 percent of elevations caused by malignancy or hyperparathyroidism

Question 5

low CO2 should make you think what?

Answer 5

acidosis and possibly ketoacidosis (especially with low K and high glucose)

Question 6

low glucose should make you think what? (2)

Answer 6

diabetic insulin overdose, sepsis

Question 7

elevated BUN with a normal creatinine should make you think what?

Answer 7

patient is diuresed

Question 8

elevated BUN with an elevated creatinine should make you think what?

Answer 8

renal failure

Question 9

what is added to a BMP to make up the CMP? (6 things)

Answer 9

1) albumin
2) alkaline phosphatase
3) AST
4) ALT
5) total bilirubin
6) total protein

Question 10

low albumin should make you think what?

Answer 10

malnutrition, liver disease, thyrotoxicosis, chemotherapy

Question 11

increased alkaline phosphatase should make you think what?

Answer 11

GALLSTONES!

also hyperparathyroidism, neoplasms, hepatobiliary disease, sepsis, IBD

Question 12

an elevated AST or ALT should make you think what?

Answer 12

hepatitis or any condition involving death of hepatocytes, myocardial cells, erythrocytes, or skeletal muscle

Question 13

if you want to check liver function and/or nutritional status, what is your test of choice?

Answer 13

CMP

Question 14

what are the 5 components of a CBC?

Answer 14

1) RBC count
2) hemoglobin
3) hematocrit
4) WBC count
5) platelet count

Question 15

if you see low RBC, hemoglobin, hematocrit what should you think?

Answer 15

blood loss vs. anemia

Question 16

if you see high RBC, hemoglobin, hematocrit, what should you think?

Answer 16

hemoconcentration due to DEHYDRATION vs. polycythemia

Question 17

what should low platelets make you think of?

Answer 17

acute infection, bleeding, DIC, HELLP syndrome or pre-eclampsia during pregnancy

Question 18

when you add a differential to the CBC, what do you get?

Answer 18

breaks down the WBC into types

Question 19

high neutrophil counts should make you think of what? low neutrophils should make you think what?

Answer 19

high = acute bacterial infection

low = severe widespread bacterial or viral infection (shift to left)

Question 20

high lymphocytes should make you think of what?

Answer 20

a viral infection such as mononucleosis, mumps, or measles

Question 21

high eosoinophils should make you think of what? what about VERY high eosinophils?

Answer 21

high = acute allergic reaction

very high = parasitic reaction

Question 22

increased total bilirubin (direct or indirect) are increased in which 2 conditions? a disproportionate elevation of DIRECT bilirubin is seen in which 2 conditions?

Answer 22

increased total = liver damage, neonatal jaundice

disproportionately high direct = cholestasis and late in liver disease

Question 23

what does a D-dimer measure?

Answer 23

fibrin component – there are many positive D-dimers that are not indicative of PE or DVT

Question 24

if you see a urine glucose over 130 with ketones, what should you think?

Answer 24

poorly controlled diabetes or possible DKA

Question 25

if you see positive nitrites and/or leukocyte esterase on urinalysis, what should you think?

Answer 25

UTI

Question 26

if you see UTI symptoms with negative nitrites and/or leukocyte esterase, what should you think?

Answer 26

interstitial cystitis; chronic condition

Question 27

a moderate frequency beta-HcG is useful under which circumstances?

Answer 27

measures HcG in blood therefore allows for dating of pregnancy it is a predictive pattern: can be used to evaluate threatened pregnancy, ectopic pregnancy, or miscarriage

Question 28

if you want to test for mono, what test do you order? when do we see false positive? when do we see false negatives?

Answer 28

order heterophile antibody test false positives: hepatitis, leukemia, lymphoma, rubella, SLE false negatives: testing too early!

Question 29

what do you order to test for syphilis?

Answer 29

RPR using BLOOD sample

Question 30

what do you order to test for gonorrhea and chlamydia?

Answer 30

nucleic acid amplification URINE test

Question 31

what do you order to test for HSV?

Answer 31

blood sample; searches for antibodies to differentiate between HSV1 (oral) and HSV2 (genital)

Question 32

what do you order to test for HIV?

Answer 32

RNA based HIV early detection kit

Question 33

which imaging modality is very rarely used in emergent settings?

Answer 33

MRI

Question 34

if you want to look at the uterus, fallopian tubes, ovaries what should you order?

Answer 34

ultrasound

Question 35

to evaluate the appendix, gallbladder, biliary tree, and large intestine for diverticula what should you order?

Answer 35

ultrasound

Question 36

when you suspect a kidney stone, what two imaging modalities are available?

Answer 36

ultrasound and CT

Question 37

if you want to get a blood culture, how many samples should you get, from how many sites?

Answer 37

2-3 blood samples from at least 2 different veins so you don't miss bacteria or fungus

Question 38

what test is the marker for cellular hypoxia? who is it indicated for?

Answer 38

lactate! in patients with suspected sepsis or septic shock -- tells us who needs attention and aggressive managemetn

Question 39

routine urine testing for ketones is no longer necessary to diagnose DKA, what has replaced it?

Answer 39

capillary beta hydroxybutyrate has distinct advantage what

Question 40

how do we measure response to DKA treatment?

Answer 40

capillary blood ketones

Question 41

what will you see on ABG of diabetic ketoacidosis?

Answer 41

metabolic acidosis

Question 42

what will you see on ABG when patient has been vomiting?

Answer 42

metabolic alkalosis

Question 43

what conditions will produce a respiratory acidosis?

Answer 43

hyPOventilation due to pulmonary edema, pneumonia, COPD, respiratory depression from drugs (opioids, sedatives)

Question 44

what conditions will produce a respiratory alkalosis?

Answer 44

hypERventilation (PE, anxiety, pain, febrile illness)

Question 45

what is the most specific lab test for pancreatic function?

Answer 45

lipase

Question 46

approximately how many visits are made to the ED annually for chest pain? how about abdominal pain?

Answer 46

chest pain = 6 million abdominal pain = 129 million

Question 47

which lab test do we order to assess for CHF?

Answer 47

BNP

Question 48

when is BNP secreted by the heart?

Answer 48

in response to volume overload and resulting myocardial stretch

Question 49

____ are proteins that are essential to cardiac muscle contraction, myocardial injury results in a leak of these proteins

Answer 49

troponins

Question 50

troponin has replaced _____ as the biomarker of choice for the detection of _______

Answer 50

troponin has replaced CKMB in the detection of myocardial injury

Question 51

when is a troponin level not very helpful?

Answer 51

within 6 hours of symptom onset because troponin doesn't peak right away also those with intermittent symptoms monitor every 2-6 hours!

Question 52

the PT/INR measures the _____ pathway of coagulation

Answer 52

extrinsic

Question 53

which clotting factors are involved in the extrinsic pathway of coagulation?

Answer 53

2, 7, 9, 10

Question 54

what test do we order to monitor the effect of coumadin/warfarin? why?

Answer 54

order PT/INR coumadin inhibits production of vitamin K dependent factors produced in the liver (2, 7, 9, 10)

Question 55

PTT evaluates the _____ pathway and plays a relatively minor role in coagulation in the body (more involved with coagulation related to inflammation and innate immunity)

Answer 55

intrinsic pathway

Question 56

a normal PTT requires the presence of which factors?

Answer 56

1, 2, 5, 8, 9, 10, 11, 12 notice 7 is not on the list, but 2, 9, and 10 are

Question 57

the effect of which drug is measured using PTT? why?

Answer 57

heparin heparin potentiates the action of antithrombin-3, which binds with activated factor 10 to stop the procoagulant process at the beginning of the pathway

Question 58

a rapid strep test tests for which group of strep pharyngitis?

Answer 58

group A strep

Question 59

the influenza swab tests for influenza A, B, or both?

Answer 59

influenza A and B