Lecture 1 Flashcards by Brendan Wong

What are some examples of laboratory and diagnostic studies?

CBC with differential
UA
Wet mount/microscopy
Body fluid Analysis
Stool studies
Miscellaneous rapid screens
X-ray
CT scan/MRI
Misc lab studies

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What is typically elevated in a CBC due to infection?

WBC
Leukocytosis

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What are the granulocytes?

Neutrophils
Eosinophils
Basophils

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What are the agranulocytes?

Lymphocytes
Monocytes

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What is the most abundant WBC?

Neutrophils

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What are immature neutrophils referred as?

Left shift or bands

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What does neutrophils defend against?

Mainly bacterial infections

Also in fungal and physiological stress

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What are the types of lymphocytes?

B cells
T cells
NK cells

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Where could you find lymphocytes? How abundant are they?

Bloodstream
Lymph
Lymph nodes
Lymphoid organs
Most common WBC in lymph

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What is the target WBC?

Monocytes

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What can monocytes become?

Macrophages (phagocytic cells

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What can cause an increase amount of monocytes?

Late or chronic infection

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Where are eosinophils found in?

Skin
Airways
Blood

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What do eosinophils defend against?

Allergic and parasitic infecitons

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What do basophils defend against?

Hypersensitivity reactions

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What do basophils release?

Histamine
Leukotrienes
Serotonin

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How long should urine be in the bladder before getting a urine sample?

2-3 hours

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What should everyone do before getting a “clean catch”?

Clean the area where urine exits

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What does cloudy/turbid urine indicate?

Pyuria

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What does a strong/fishy odor in urine indicate?

Infection

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What does a chemical dipstick testing measure?

Leukocyte esterase
Nitrates
Urobilinogen
Protein
pH
Blood
Specific gravity
Ketones
Bilirubin
Glucose

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What does an microscopic examination measure?

WBC
RBC
Epithelial Cell
Microorganisms
Casts
Crystals

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What substances are normally not in urine?

RBCS
Microorganisms
Epithelial cells

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Why is measuring leukocyte esterase important?

It is produced by WBCs so if we have an increase of leukocyte esterase its suggestive of an infection

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What type of bacteria produce nitrates?

Gram "-" bacteria

What are wet prep/KOH prep used for?

To indicate vaginal, cervical, or urethral discharge Skin scrapings and wound discharge as well

What is the difference between a wet prep and KOH prep?

A wet prep uses a saline solution but a KOH uses Potassium Hydroxide

What cells do you look at in a wet prep?

Epithelial cells WBC RBC Clue cells Protozoans

What is KOH prep usually used for?

Fungal cells

What are clue cells?

Epithelial cells of the vagina that gets their distinctive striped appearance by being covered with bacteria.

When do we obtain a CSF analysis?

When a patient has... Sudden, severe headache and/or stiff neck Fever Confusion, hallucinations, seizures, difficulty with speech, light sensitivity, dizziness Lethargy, muscle weakness

What position does the patient have to be when performing a lumbar puncture for a CSF analysis?

Lateral decubitus when opening pressure is needed Upright position when opening pressure isn't needed

How many tubes do we need for a CSF analysis? What are each used for?

4 Cell count and differential Glucose and protein levels Gram stain, C&S Other

What characteristics signify a NORMAL CSF?

Clear, colorless, with the same viscosity as water

What does it mean when the CSF is cloudy/turbid?

Infection

what does it mean when xanthochromia is present in CSF?

Bleeding

What does does a think viscous CSF indicate?

Infection or malignancy

What does the presence of RBCs in the CSF analysis indicate?

CNS bleed or traumatic tap

What is a normal WBC count in CSF?

What does an elevated protein level in CSF indicate?

Infection Malignancies Autoimmune disease

How low does glucose have to drop to be considered for any infection or malignancy?

<40mg/dL

What other tests could be measured in the CSF?

Lactic acid: bacterial/fungal infections Lactate dehydrogenase(LDH): bacterial infections, leukemia C-reactive protein: bacterial infection, inflammation

What are some complications that could arise in a lumbar puncture?

Headache Traumatic Tap Dry Tap Infection Hemorrhage Cerebral herniation

What should you do before getting a lumbar puncture?

CT scan or MRI of the brain

What is contraindicated for lumbar punctures?

Coagulopathy, use of anticoagulants Skin infection at puncture site Increased intracranial pressure

What procedure do we perform to get pleural fluid?

Through thoracentesis

What is indicated for a pleural fluid analysis?

Positive chest x-ray findings - pleural effusion Large pleural effusion Pleural effusion of unknown etiology

Why do we check for cytology in a pleural fluid microscopic exam?

Suspected mesothelioma or metastatic CA

What do we check in a pleural fluid infectious disease test?

Gram stain Bacterial C&S(culture) Individualized testing

What is transudate in pleural fluid?

Imbalance between pressure within blood vessels and amount of protein in blood Results in abnormal accumulation of fluid

What causes transudate in pleural fluid?

CHF or cirrhosis

What causes exudate in pleural fluid?

Injury or inflammation of the pleura resulting in pleural effusion

What types of findings do you get in transudate vs exudate?

Transudate has... Clear fluid Low protein/albumin/LDH Low cell count Exudate is opposite

What criteria classifies pleural effusion to be likely exudative?

Pleural fluid protein: serum protein ratio >0.5 Pleural fluid LDH: serum LDH ratio >0.6 Pleural fluid LDH >0.6 or >2/3 times the normal upper limit for serum LDH

What does a normal/transudate look like?

Light yellow and clear

If pleural fluid has a milky appearance, what could that indicate?

Lymphatic system involvement

If pleural fluid has a reddish appearance, what could that indicate?

Presence of blood

If pleural fluid is cloudy, thick, what would that indicate?

Presence of microorganisms and/or WBC

What affects glucose levels in pleural fluid?

Infection causes a decrease If pH also decrease it indicates malignancy

What affects lactate levels in pleural fluid?

Increases with infectious pleuritis

What affects amylase levels in pleural fluid?

Increase with pancreatitis, esophageal rupture, or malignancy

What affects TG levels in pleural fluid?

Increase with lymphatic system involvement

What affects tumor markers in pleural fluid?

Increases with cancer

What presenting symptoms cause of pericarditis or pericardial effusion?

CP Coughing Difficulty breathing Fever Fatigue Changes in heart rhythm Enlarged heart size on CXR Abnormal Echo

Where do you insert the needle in a pericardiocentesis?

Between diploid and left costal margin

How do you insert the needle in pericardiocentesis?

Direct towards the left shoulder at a 40 degree angle

What are some complications of pericardiocentesis?

Myocardial perforation Bleeding Pneumothorax Arrhythmia Acute pulmonary edema

Why do we perform a paracentesis?

Help diagnose the cause of peritonitis or ascites

Why do we preform an arthrocentesis?

To find the cause of joint effusions

What are some symptoms of joint effusions?

Joint pain Joint swelling Erythema Warmth

What does a normal fluid look like after an arthrocentesis?

String-like, clear, and translucent

What does yellow/green fluid indicate in arthrocentesis? Red, rusty, or brown?

Inflammation or infection (yellow/green) Fresh or old brown (red/brown)

What does a turbid/opaque indicate in arthrocentesis?

Abnormally large number of cells

What does it mean to have an increased viscosity in arthrocentesis? decreased?

Septic arthritis (increased) Inflammation (decreased)

What are the diagnostic testing for arthrocentesis?

Crystal analysis White cell count with dif Gram stain Bacterial culture and sensitivity

Why and what symptoms do we check for a chest x-ray?

Check for signs and symptoms for pulmonary infection Dyspnea, SOB Cough Fever, chills Pleuritic chest pain

What do you look for in a chest x-ray?

Consolidation Infiltrates Cavitations Nodules Effusions

Does a chest x-ray give you the cause of the problem?

No, only a diagnosis.

What is a CT scan used best for?

For bones

What is a MRI best used for?

Softer tissue

What dye do we use to stain cells?

Crystal violet dye

What do you use to decolorize cells after the iodine solution?

Alcohol and acetone

What does G+ cells look like in a gram stain?

Purple Thick cell walls retain the dye

What does G- cells look like in a gram stain?

Pinkish-red Thin cell walls so dye gets washed away then it gets countered stained with safranin red

What type of bacterial no not typically stain?

Atypical

Lecture 1 Flashcards

(85 cards)