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PMY 3177 Clinical Therapeutics > Clinical Lab Tests Intro > Flashcards

Clinical Lab Tests Intro Flashcards

1
Q

List the common clinical laboratory tests.

A

U&E
FBC
LFTs
Bone profile
Iron profile
Lipid profile
Thyroid function
Coagulation screen

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2
Q

What are 12 other laboratory tests which can be done?

A

INR, Magnesium, CRP, HbA1c, Vitamin B12, Folate, ESR, Vitamin D, Creatine kinase, Troponin, Glucose, BNP.

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3
Q

What is the U&E test used for and what does it measure?
U&E - urea and electrolytes

A

Used to detect abnormalities of blood chemistry, renal function and dehydration.
Used to measure Na, K, Urea, Creatinine, eGFR.

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4
Q

What is the FBC blood test used for and what does it measure?
FBC - full blood count

A

Used to check the cells in your blood.
Used to measure platelets, WBCs, RBCs, Hb, MCV, MCH, MCHC.

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5
Q

What is MCV measured by FBC test?

A

MCV - mean corpuscular volume
Measures the average size of the red blood cells.

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6
Q

What is MCH and MCHC measured by FBC test?

A

MCH - mean corpuscular concentration
MCHC - mean corpuscular haemoglobin concentration
Measures the average amount of haemoglobin in a group of red blood cells.

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7
Q

What are LFTs used for and what does it measure?

A

LFTs are blood tests which measure different enzymes and proteins made by the liver and hence checks the overall health of the liver.
Used to measure GGT, AST, ALP, ALT and bilirubin levels.

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8
Q

What is bilirubin and what do low/high levels mean?

A

Bilirubin is a yellowish pigment that is made during the normal breakdown of red blood cells.
High levels measured = liver damage/disease
Low levels measured = develop white matter lesions in the brain

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9
Q

List the full names of the LFTs mentioned.

A

GGT - gamma-glutamyl transferase
AST - aspartate transaminase
ALT - alanine transaminase
ALP - alkaline phosphatase

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10
Q

What are bone profile tests used for and what does it measure?

A

Determines how well your body’s metabolic processes are affecting your bones.
Used to measure calcium levels, adjusted calcium and phosphate.

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11
Q

What are iron profile tests used for and what does it measure?

A

Checks the level of iron in your body and helps identify anaemia.
Used to measure ferritin, transferrin, iron, iron saturation.

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12
Q

What are lipid profile tests used for and what does it measure?

A

Measures the amount of cholesterol and triglycerides in your blood.
Used to measure triglycerides, cholesterol, HDL, LDL, non HDL, cholesterol/HDL ratio.

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13
Q

What is HDL and LDL in lipid profile tests?

A

HDL = high-density lipoprotein
- “good” cholesterol as it helps remove other forms of cholesterol from blood stream.
LDL = low-density lipoprotein
- “bad” cholesterol as a high level of LDL can lead to a build up of cholesterol in your arteries.

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14
Q

What are thyroid function tests used for and what does it measure?

A

Checks function of thyroid.
Used to measure free thyroxine and TSH (thyroid-stimulating hormone).

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15
Q

What are coagulation screen tests used for and what does it measure?

A

Measures the ability of your blood to clot and how long it takes for blood to clot.
Used to measure prothrombin time and APTT (activated partial thromboplastin time).

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16
Q

When might INR be measured?

A

When patient is on warfarin or has blood clotting issues.

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17
Q

What do high CRP levels mean?

A

CRP = C-reactive protein
Gives an indication of inflammation and infection.

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18
Q

What is HbA1c and what does it indicate?

A

It is a blood test which measures average blood sugar levels over the past 3 months.
Test used for prediabetes/diabetes.

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19
Q

What is ESR and what does it indicate?

A

Erythrocyte sedimentation rate.
Indicates infection and inflammation.

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20
Q

What is creatine kinase (CK) and what does it indicate?

A

CK is an enzyme found in skeletal muscle, heart muscle and brain. Damage to these tissues cause leakage of CK.

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21
Q

What is BNP and what does it indicate?

A

Brain Natriuretic Peptide.
High levels indicate heart failure.

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22
Q

In what situations are clinical laboratory tests ordered?

A
  1. To confirm or support a diagnosis.
  2. To assess the severity of a disease.
  3. To establish if the condition is being treated appropriately ie meeting targets.
  4. To assess electrolyte disturbances.
  5. To assess appropriate drug dosage.
  6. To monitor the response of a treatment.
  7. To monitor ongoing requirements.
  8. Review medication to stop/withhold/restarts.
  9. Prevent toxic side effects.
23
Q

When do pharmacists check clinical
laboratory tests?

A

Throughout the patient’s hospital stay
But also for medicines reconciliation, inpatient review and discharge.

24
Q

What is the NICE definition of medicines optimisation?

A

A person centered approach to safe and effective medicines use to ensure that people obtain the best possible outcomes from their medicines.

25
Q

What are the 4 points in the medicines optimisation tool by NICE?

A
  1. Aim to understand the patient’s experience
  2. Evidence based choice of medicines
  3. Ensure medicines use is as safe as possible
  4. Make medicines optimisation part of routine practice
26
Q

What are some samples that used for clinical laboratory tests?

A

Urine, faeces, sputum, blood, spinal fluid

27
Q

What is the purpose of urinalysis?

A

Investigates
- diabetes
- UTIs
- kidney and liver disorders

28
Q

What 3 ways can a urine sample be analysed?

A

Visual examination
Dipstick examination
Laboratory examination

29
Q

How is visual examination of urine done?

A

Examine the colour and cleanliness of urine.

30
Q

How is dipstick examination done?

A

A chemically treated strip is dipped into urine and changes colour if a substance is present e.g. blood, glucose, ketones, protein.

31
Q

How is laboratory examination done?

A

Urine sample is sent to lab for susceptibility testing and testing for presence of microorganisms.
Urine is examined under a microscope for WBC, RBC, bacteria, crystals.

32
Q

What is the purpose of stool sample analysis?

A

Investigates conditions affecting the GI tract e.g. infection, cancer, absorption issues.

33
Q

How is visual examination of stool sample done?

A

Examine the colour, odour, consistency, amount, shape and presence of mucus in the stool.

34
Q

What is the purpose of stool culture?

A

The test helps to identify and detect bacteria in stool.

35
Q

What does laboratory examination of stool sample involve?

A

Stool sample is examined further using microscopic examination and chemical and biological tests.

36
Q

What is POCT?

A

Point of care testing.
It is an analytical test undertaken outside a laboratory setting.

37
Q

In what locations can POCT test take place?

A

Wards, GP, outpatient clinics, patients’ homes, pharmacies.

38
Q

Who can perform POCT tests?

A

Nurses, doctors, pharmacists, allied healthcare professionals (AHP).

39
Q

What devices can be used for POCT tests?
(Staff need to be educated on device and how to interrupt results prior to use)

A

Dipsticks (for urine)
Hand-held devices (blood glucose monitors)
Desktop analysers (blood gases)

40
Q

How does patient self-monitoring work? (Home testing)

A

Patient self-monitors at home e.g. blood glucose.

41
Q

What are the benefits of self-monitoring?

A
  • more convenient
  • gives patient a sense of managing own condition (promote involvement in own care)
  • reduces appointments and HCPs’ time
    PATIENT MUST BE EDUCATED ON THIS ON A REGULAR BASIS
42
Q

Describe how a qualitative result can be obtained and give an example?

A

Obtained by observation.
e.g. scan, endoscopy

43
Q

Describe how a quantitative result can be obtained and give an example?

A

Obtained by a number or text and compared to a reference range/value.
e.g. in haematology, in biochemistry

44
Q

Describe how a semi-quantitative result can be obtained and give an example?

A

Obtained by a number or text and an observation.
e.g. in microbiology

45
Q

What is a reference range?

A

It is a pre-determined range of values that is referred to as ‘normal’ for the test results.
It represents 95% of the healthy population.

46
Q

What are the issues with having reference ranges?

A

Does not take age, sex, weight or ethnicity of patient into account.
Reference ranges may vary between laboratories depending on quality of equipment.

47
Q

Describe how reference range errors can occur?

A

Due to patient variation, sampling errors and analytical errors.

48
Q

List 7 ways in which sampling errors can occur on the ward.

A
  1. Specimen collection tube not filled correctly.
  2. Patient ID error.
  3. Inappropriate collection tube/container.
  4. Test request error.
  5. Empty collection tube.
  6. Fasting vs non-fasting example.
  7. Incorrect storage.
49
Q

What are 6 factors affecting blood test results?

A
  • sample collection, transport, storage and processing.
  • timing of sample.
  • age and sex.
  • medication.
  • nutrition.
  • dehydration.
50
Q

How can sample collection, transport, storage and processing affect test results?

A
  • some samples may require analysis within a short period of time.
  • exposed to extremes of temperature during transport and storage.
51
Q

How does timing of sample collection affect test results?

A
  • some tests must be taken at certain times e.g. digoxin serum test taken 6 hours post oral dose.
  • morning urine level better for detecting protein levels outside the reference range.
52
Q

How does age and sex affect test results?

A
  • serum urea and cholesterol rise with age.
  • there is a difference in reference ranges between men and women.
53
Q

How does medication affect test results? Give examples.

A
  • Amiloride can cause false high measurements of Cr and so decreased CrCl.
  • Levodopa can cause false positives for urinary glucose and ketones.
54
Q

How does dehydration affect test results?

A
  • Can be considered as a cause of sodium and potassium imbalances.
  • Can also affect others such as creatinine, urea, albumin, lipid and haematology.

PMY 3177 Clinical Therapeutics (3 decks)

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