Final Flashcards by Stewart Stinton

Summarize the purpose of CLIA

Regulates labs/facilities that test human specimens for health assessment or to diagnose, prevent, or treat disease

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What makes a “perfect test”?

Accurate
Precise
Discriminating
Risk free
Pain free
Inexpensive
Useful

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Describe what makes a “waived” complexity CLIA test and name some examples

Simple tests, small chance of error or risk
Can be OTC
- Urine dipstick
- Influenza A/B
- Strep A
- HCG urine
- THC
- PT/INR
- COVID

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Describe what makes a “moderate” complexity CLIA test and name some examples

Available on automated equipment in a facility
- CBC
- Chem/electrolyte profiles
- Urinalysis microscopic

Provider performed microscopy
- KOH scraping
- Semen analysis
- Nasal eosinophils

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Describe what makes a “high” complexity CLIA test and name some examples

Requires clinical expertise beyond normal automation to perform
- Cytology
- Peripheral smears
- Viral loads
- Gel electrophoresis

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Describe sensitivity and specificity

Sensitivity
- Helps rule OUT a disease when test is negative
- Few false negative results

Specificity
- Helps rule a disease IN when test is positive
- Few false positive results

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Which phase of testing, pre-analytic, analytic, or post-analytic has the highest chance of errors?

Pre-analytic

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Describe the pre-analytic phase of lab testing. What does it start and end with?

Specimen receiving
- Most vulnerable part of testing process
- Starts with patient assessment
- Ends with specimen received in laboratory

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Describe the analytic phase of lab testing. What does it start and end with?

Testing
- Begins when patient specimen is prepared for testing
- Ends when test result is interpreted and verified

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Describe the post-analytic phase of lab testing. What does it start and end with?

Result reporting
- Starts with result review and release to the clinician
- Ends with diagnostic and therapeutic decision making

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Describe the screening guidelines for colon cancer

USPSTF
- Age 50 to 75 (A)
- Age 45 to 49 (B)

ACS
- Start age 45

Stool tests
- gFOBT (guaiac-based fecal occult blood test) - blood in stool most common
- FIT - blood in stool
- FIT-DNA - blood and altered DNA in stool

Camera
- Flexible sigmoidoscopy - Every 5 years, (or every 10 if annual FIT) NO sedation
- Colonoscopy - Every 10 years if no increased risk of colon cancer, requires bowel prep, sedation

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Describe the screening guidelines for breast cancer

USPSTF
- Women aged 40 to 74
- Mammogram every two years (B)

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Describe the screening guidelines for cervical cancer

USPSTF
- Women aged 21 to 29 - PAP every 3 years (A)
- Women aged 30 to 65 - Continue PAP every 3 years, OR HPV every 5 years, OR PAP + HPV every 5 years (A)

ACS
- Women aged 25 to 65 - HPV every 5 years

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Describe the screening guidelines for chlamydia and gonorrhea

CDC
- All sexually active women under 25 and any men who have sex with men - NAAT every year

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Describe the STI screening guidelines for pregnant women

CDC
- All pregnant women tested for syphilis, HIV and Hep B early in pregnancy

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Describe the screening guidelines for HIV

Everyone aged 15 to 65 tests at least once in their lifetime - ELISA, confirmed with repeat ELISA, and then Western Blot

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Describe the screening guidelines for syphilis

Indications = symptomatic or high risk patients

No chancre
- Nontreponemal -> Treponemal

Chancre
- Dark field microscopy

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Describe the screening guidelines for osteoporosis and how to interpret results

USPSTF
- Women aged 65+ or postmenopausal - DEXA scan (B)

-1 and above = NORMAL
-1.1 to -2.4 = OSTEOPENIA
-2.5 and below = OSTEOPOROSIS

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Name the components included in a BMP

Glucose
Calcium
Sodium
Potassium
CO2/Bicarb
Chloride
BUN
Creatinine

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True or false. A patient needs to fast prior to a BMP

True
- Fasting 10-12 hours

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Name the components included in a CMP

BMP
- Glucose
- Calcium
- Sodium
- Potassium
- CO2/Bicarb
- Chloride
- BUN
- Creatinine
PLUS LFTs
- Total protein
- Albumin
- Total bilirubin
- ALP
- AST
- ALT

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When in doubt over differences in normal reference ranges for a lab value, which one should be used?

Always use the reference range supplied by the lab that performed the test

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Normal range for blood glucose

60 to 100 mg/dL

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Reasons for blood glucose to be increased/decreased

Increased
- Diabetes
- Acute stress response
- Corticosteroid therapy

Decreased
- Insulin overdose

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Normal range for serum calcium

8.7 to 10.7 mg/dL

Reasons for serum calcium to be increased/decreased

Increased - Hyperparathyroidism - Nonparathyroid PTH-producing tumor (lung/renal carcinoma) - Granulomatous infection (sarcoidosis, TB) - Hyperthyroidism - Thiazide diuretics Decreased - Hypoparathyroidism - Vitamin D deficiency - Hypoalbuminemia

Normal range for sodium

135 to 145 mEq/L

Describe the three kinds of hyponatremia

Hyponatremia = sodium <135 mEq/L Hypovolemic - Na and H2O deficit - Diuretic excess - Vomiting/diarrhea Euvolemic - Slight increase in H2O - SIADH Hypervolemic - Na and H2O excess - Cardiac failure

Normal range for potassium

3.5 to 5.3 mEq/L

Reasons for potassium to be increased/decreased

Increased - Renal failure (acute and chronic) - Excess K+ intake - NSAIDs - K+ sparing diuretics Decreased - Thiazide/loop diuretics - Vomiting/diarrhea/laxatives - Severe eating disorders

Reasons for chloride to be increased/decreased

Increased - Dehydration - Metabolic acidosis - Respiratory alkalosis Decreased - Overhydration - Metabolic alkalosis - Respiratory acidosis

Normal range for BUN

8 to 18 mg/dL

Describe pre-renal, renal, and post-renal causes for increased/decreased BUN

Pre-renal increase - Hypovolemia - Dehydration Pre-renal decrease - Overhydration - SIADH Renal increase - Renal disease (glomerulonephritis, pyelonephritis, ATN) Post-renal increase - Urethral/bladder obstruction

Normal range for creatinine

Male: 0.6 to 1.2 mg/dL Female: 0.5 to 1.1 mg/dL

Reasons for increased creatinine

- Hyperthyroidism - Pyelonephritis - Reduced renal blood flow (decrease not significant)

Normal BUN:Creatinine ratio range

12 to 16

Describe pre-renal, renal, and post-renal azotemia causes and their corresponding BUN:Creatinine ratios

Pre-renal - BUN:Cr *more* than 20:1 - Most common - Reduced renal blood flow Renal - BUN:Cr *less* than 20:1 - Direct kidney injury - Acute tubular necrosis Post-renal - BUN:Cr >20:1 *then* <20:1 - Any urinary tract obstruction

Normal range for magnesium

1.3 to 2.1 mEq/L

Reason for increased magnesium levels

Diuretics

Four components of a urinalysis

- Macroscopic = color, clarity, specific gravity - Dipstick reagent = chemical analysis - Microscopic - Culture

Normal pH range for urine

4.6 to 8.0

True or false. CBC requires fasting

False - CBC does NOT require fasting

Reasons for increased/decreased red blood cell count

Increased - High altitude - Polycythemia vera - Severe COPD Decreased - Anemia - Advanced cancer

Normal range for hemoglobin

Male: 14 to 18 g/dL Female: 12 to 16 g/dL

Reasons for increased/decreased hemoglobin

Increased - Polycythemia vera - COPD - High altitude Decreased - Anemia - Neoplasia

Normal hematocrit level

3 times Hb

Normal range for MCV

80 to 100 fL

Reasons for MCV to be increased/decreased

Increased (macrocytic) - B12/folate deficient Decreased (microcytic) - Iron deficiency - Thalassemia - Anemia of chronic disease

Normal range for platelets

130 to 400

Reasons for platelets to be increased/decreased

Increased - Iron deficiency anemia - Polycythemia vera - Malignancy Decreased - Autoimmune destruction - Malignancy (yes, again)

Name the five types of white blood cells seen on a differential and the expected proportion of each

- Neutrophils (60%) - Lymphocytes (30%) - Monocytes (6%) - Eosinophils (3%) - Basophils (1%)

Normal range for white blood cells

3,200 to 9,800

What is a "left shift" and what does it indicate?

- 80-90% neutrophils - Increased immature neutrophils ("bands" or "stabs") - Acute bacterial infection

Reasons for increased lymphocytes

- Acute viral infection - Chronic bacterial infection

Reasons for increased eosinophils and basophils

- Allergic reactions - Parasites - Inflammatory reactions

Describe the following blood pressure levels - Normal - Elevated - Stage 1 HTN - Stage 2 HTN

Normal - <120 *and* <80 Elevated - 120-129 *and* <80 Stage 1 HTN - 130-139 *or* 80-89 Stage 2 HTN - 140+ *or* 90+

Describe screening guidelines for hypertension

USPSTF - Adults ages 18+ screen at every visit (A)

What components are included in a lipid panel?

- Total cholesterol - LDL - HDL - VLDL - Triglycerides

Normal range for total cholesterol

Less than 200 mg/dL

Reasons for increased/decreased total cholesterol

Increased - Hypercholesterolemia - Hyperlipidemia - Uncontrolled diabetes - Hypertension Decreased - Liver disease

Normal range for HDL

Male: >45 mg/dL Female: >55 mg/dL

Normal range for LDL

Normal adult: <130 mg/dL Moderate risk: <100 mg/dL High risk: <70 mg/dL

Diagnostic criteria for acute MI

Requires *two of three* 1. Chest discomfort 2. Elevated cardiac enzymes 3. EKG findings

Gold standard for diagnosis CAD

Cardiac catheterization

Reasons for increased myoglobin

- Myocardial infarction - Rhabdomyolysis

Which, CK-MM, CK-MB, or CK-BB, is most specific to the heart?

CK-MB = heart - CK-MM = skeletal muscle and heart - CK-BB = brain

Reasons for increased CK-MB

- Acute myocardial infarction - Severe rhabdomyolysis

Which cardiac troponin, T or I, is more specific to the heart?

Cardiac troponin I

Reasons for increased troponins

- Myocardial infarction - Pulmonary embolism

Which cardiac marker is first to elevate, peak, and return to baseline in acute myocardial infarction?

Myoglobin

In acute myocardial infarction, when does myoglobin: - Initially elevate - Peak - Return to baseline

- Initial: 1 to 4 hours - Peak: 4 to 12 hours - Return: 10 to 24 hours

In acute myocardial infarction, when does CTnI: - Initially elevate - Peak - Return to baseline

- Initial: 2 to 6 hours - Peak: 10 to 24 hours - Return: 7 to 10 *days*

In acute myocardial infarction, when does CKMB: - Initially elevate - Peak - Return to baseline

- Initial: 4 to 6 hours - 18 to 24 hours - 36 to 48 hours

Which cardiac marker will be elevated longest after an acute myocardial infarction?

CTnI (cardiac troponin I) - 7 to 10 *days*

The "golden marker" for atherosclerosis

hs-CRP

Normal range for BNP and NT-proBNP

- BNP = <100 pg/mL - NT-proBNP = <300 pg/mL

Reasons for increased BNP

- CHF - MI - Renal failure

Which, BNP or NT-proBNP, is more sensitive for CHF?

NT-proBNP

Are obesity, spine, or chest wall deformities examples of restrictive or obstructive pulmonary disorders?

Restrictive