Diagnostics in the ED -- CA

Question 1

What four labs are considered to be “high frequency” in the ED?

Answer 1

BMP or CMP

CBC

UA

beta-hCG

Question 2

What’s the difference between a Chem 7 and a Chem 8?

Answer 2

Calcium is included in a Chem 8

Question 3

We would order this test for find out the current status of a person’s kidneys, electrolyte balance, acid/base balance, blood glucose, and calcium levels.

Answer 3

BMP

Question 4

90% of cases of hypercalcemia are caused by these two things

Answer 4

Malignancy and hyperparathyroidism

Question 5

What might a low carbon dioxide value cue you into?

Answer 5

Acidosis and possibly ketoacidosis

Question 6

When we do we see low glucose?

Answer 6

Diabetic insulin overdose and sepsis

and yes we just learned hyperglycemia for sepsis. don’t ask me

Question 7

Elevated BUN and Creatinine?

Answer 7

Renal failure

Question 8

Elevated BUN but a normal creatinine?

Answer 8

Diureased

Question 9

What does a CMP have that a BMP doesn’t?

Why would we order a CMP?

Answer 9

Albumin, ALP, AST, ALT, bilirubin and total protein

CMP also looks at liver function and nutritional status

Question 10

What does low albumin indicate?

Answer 10

Malnutrition (possible liver disease or reaction to chemo)

Question 11

What does increased alk phos likely indicate?

Answer 11

gallstones

Question 12

What does increased AST, ALT likely indicate?

Answer 12

Hepatitis

Question 13

What does increased total bilirubin likely indicate?

Answer 13

Cirrhosis, hepatitis

Question 14

Low RBC, hemoglobin, and hematocrit – think about?

Answer 14

Blood loss vs. anemia or other blood dyscrasia

Question 15

High RBC, hemoglobin, hematocrit, think about?

Answer 15

hemocentration due to dehydration vs polycythemia

Question 16

Low platelets, think about?

Answer 16

acute infection, bleeding, DIC, HELLP syndrome, or preeclampsia during pregnancy

Question 17

What does a differential white count do?

Answer 17

Breaks down the WBC count into types – neutrophils, lymphocytes, monocytes, eosinophils, and basophils

Question 18

What type of white blood cell makes up the majority?

Answer 18

Neutrophils

followed by lymphocytes, monocytes, eosinophils, then basophils

Question 19

High neutrophils, think about?

Answer 19

Acute bacterial infection

Question 20

low neutrophils, think about?

Answer 20

severe widespread bacterial or viral infection – this is known as a left shift

Question 21

High lymphocytes, think about?

Answer 21

Viral infection, such as mono, mumps, or measles

Question 22

High eosinophils, think about?

Answer 22

Acute allergic reaction

Question 23

Very high eosinophils, think about?

Answer 23

Parasitic infection

Question 24

Urine glucose, think about?

Answer 24

Poorly controlled diabetes or possibly DKA

Question 25

Positive nitrites and/or leukocyte esterase, think about?

Answer 25

UTI

Question 26

UTI symptoms with negative nitrites and/or leukocyte esterase, think about?

Answer 26

Interstitial cystitis

Question 27

What can serum beta-hCG do that urine beta-hCG can't?

Answer 27

Allows for dating of pregnancy

Question 28

What is the primary test used to screen for syphilis?

Answer 28

Rapid plasma reagin (RPR)

Question 29

What do you do if a first screening test for syphilis is positive?

Answer 29

You do another blood test

Question 30

What test do we do for gonorrhea?

Answer 30

Nucleic acid amplification test

Question 31

Is a nucleic acid amplification test a blood or urine test?

Answer 31

Urine

Question 32

Whats the problem with using urine tests for STD's?

Answer 32

They will not detect a vaginal, cervical, anal, or pharyngeal infection.

Question 33

What test do we do for chlamydia?

Answer 33

Nucleic acid amplification (NAA)

Question 34

Is the genital herpes test a blood or urine test?

Answer 34

Blooooood

Question 35

How many samples need to be collected for blood cultures?

Answer 35

two or three

Question 36

Do we use blood from the same vein for blood cultures?

Answer 36

No! Need different veins

Question 37

For what infections might we want to get blood cultures?

Answer 37

Meningitis, osteomyelitis, pneumonia, kidney infection, or sepsis

Question 38

Lactate is a marker for cellular ________.

Answer 38

hypoxia

Question 39

Once someone's lactate is above _______ mmol/L the mortality rate increases form 7 percent to _____ percent.

Answer 39

4 27

Question 40

This test result can help in assessment of a patient's gas exchange, ventilatory control and acid-base balance

Answer 40

Arterial blood gas

Question 41

What might cause metabolic acidosis?

Answer 41

DKA

Question 42

What might cause metabolic alkalosis?

Answer 42

Vomiting

Question 43

What might cause respiratory acidosis?

Answer 43

Hypoventilation due to pulmonary edema, pneumonia, chronic obstructive pulmonary disease, respiratory depression from drugs

Question 44

What might cause respiratory alkalosis?

Answer 44

Hyperventilation, pulmonary embolism, anxiety, pain

Question 45

Do we need to test urine to diagnose DKA?

Answer 45

No

Question 46

What should be measured in order to monitor the response to DKA treatment?

Answer 46

capillary blood ketones

Question 47

This test is used to evaluate a patient for the presence of thrombosis, pulmonary embolism, and clot

Answer 47

D-dimer

Question 48

This is secreted in response to volume overload and results in myocardial stretch

Answer 48

BNP

Question 49

Increased or persistent elevation in _______ despite treatment, suggests progression of disease or resistance to treatment. *This is in reference to CHF

Answer 49

BNP

Question 50

Cardiac _________ are proteins essential to cardiac muscle contraction

Answer 50

troponins

Question 51

Troponin has replaced _______ as the biomarker of choice for detection of myocardial injury

Answer 51

CK-MB

Question 52

Which value evaluates the extrinsic pathway of coagulation?

Answer 52

PT/INR

Question 53

Is the intrinsic or extrinsic pathway responsible for most of the procoagulant activity within the body?

Answer 53

Extrinsic

Question 54

What drug inhibits the production of vitamin K dependent factors produced in the liver?

Answer 54

Coumadin

Question 55

What test is used to evaluate the intrinsic pathway of coagulation?

Answer 55

PTT

Question 56

The effect of what drug is measured using the PTT test?

Answer 56

Heparin

Question 57

What test will diagnose mononucleosis between 2 and 6 weeks after the onset of the illness?

Answer 57

Monospot

Question 58

What are some causes of a false-positive monospot?

Answer 58

Toxoplasmosis, rubella, lymphoma, and certain malignancies

Question 59

What is a cause of false negative "monospot" test?

Answer 59

Testing too early

Question 60

What is a rapid diagnostic test that is widely used in clinics to assist in the diagnosis of bacterial pharyngitis caused by group A strep?

Answer 60

Rapid strep

Question 61

Detects influenza A and B?

Answer 61

Influenza swab

Question 62

The digestive enzyme _______ is secreted by the pancreas and salivary glands

Answer 62

Amylase

Question 63

What is the main enzyme that breaks down fats?

Answer 63

Lipase

Question 64

Is Amylase or Lipase more specific to the pancreas?

Answer 64

Lipase

Question 65

According to Conley's lecture, what are the two most common complaints in the ED?

Answer 65

1. abdominal pain | 2. chest pain