Adjuncts Quiz 1

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1.

high seNsitivity - reflects

low false Negatives: 100 - sens% is

"false neg" rate

25.

pH > 6.0 alkalosis due to

(4)

kidney failure, carbonic anhyd

inhib poisoning (acetazolamide),
proteus, time at RT

2.

sNout - test w/ high

sensitivity

"rules out" - because has low false

neg rate

26.

glomerulonephritis
allows to pass

albumin(smaller than globulins) >

edema (dec cap oncotic
pressure/suct)

3.

sensitivity - measured as

% of people w/ disease who test

abnormal/pos

4.

high sPecificity - reflects

low false Positives: 100 - spec% is

"false pos" rate

27.

pregnant women proteinuria indicator of

pre-eclampsia, w/ increased BP

5.

sPin - test w/ high

specificity

"rules in" - because has low false

pos rate

28.

functional proteinuria
causes (3)

musc exertion, orthostatic/upright

(renal congest)

6.

specificity - measured as

% of people w/o disease who test

normal/neg

29.

proteinuria; pre-renal
causes (6)

7.

predictive value
measure of

sens, spec, prev - higher

sens/spec better

fever, ven congest/HF, renal

hypoxia, HTN, myxedema, BJprotein/mult myeloma

30.

precision measure of

how wide range of normal is (chol

wide, K narrow)

proteinuria; renal
causes (3)

glomerulonephritis, nephrotic
synd, parenchymal destr

31.

normal range generally

2 stand deviations from mean 95.5% normal

proteinuria post-renal
causes (4)

inf renal pelvis/ureter, cystitis,

ureth/prostatitis, vag sec

32.

test supernate of centrifuge

# of increased tests
performed

normal -> false positive

proteinuria may be due

to RBC/WBC - elim by

33.

protein normal range

ROT: probably a true

abnormality if

2 or more pos tests w/ high

specificity

normal <8 mg/dL; 3+ = 5, 4+ = > 10

mg/dL

34.

up to: .5, 1, 3, 5, 10

chance of wellness w/
result <25% above norm

1 in 20

protein levels (trace,

1/2/3/4+)

35.

chance of wellness w/
result >25% above norm

1 in 333 (3 in 1000)

normal renal threshold

glucose reabsorption

180 mg / 100 ml of serum glucose,

rest "spills"

36.

glucose reabsorbed in

PCT

14.

reproducibility (get
same repeatedly) okay if

Coefficient of Variation < +/- 4% of

true value (aka Rel SD)

37.

glycosuria w/o hypergly

pregnancy, nephrotox: CO, Pb,

HgCL2

15.

pyridium (for stones,

urinary

turns urine red/orangetract

analgesic)

38.

hyperglycemia/uria due
to

16.

turns urine red - besides

blood

porphyria, urates,
phenolphthalein,
dihydroxyanthaquinone (lax)

DM, inc ICP/tumor/hemor/fract,

endocrine/cushing/pheo,
hyperthy, post MI, anesth

39.

most glucose tests use

glucose oxidase enzyme paper

40.

other glucose test - not

specific

Clinitest (CuSO4 reduct/Benedict's

reagent) color precip

8.

9.

10.

11.

12.

13.

turns urine brown besides blood (acid

hematin)

alkaptonuria (on standing),

melanin

41.

glucose False positive due to

H202, hypochlorites

18.

conc urine (high SG)

caused by

dehydration, dec renal flow

42.

urine glucose False

negative -

19.

dilute urine caused by

DI, hyperthyroid, SC anem, renal

failure (early), diuresis

high vit C, homogentisic acid

(alkaptonuria), levodopa, large
doses of ASA

43.

ketones - BHBA, DAA,

acetone signifies

inc in fatty acid catabolism,

impaired carb metab

44.

ketones can be used as

energy source for
cardiac/skeletal

BHBA, DAA (not acetone)

45.

impaired carb metab

due to

DKA, starvation/fasting, alcoholism,

high protein diet

17.

20.

sg - hydrometer

older, less reliable

21.

sg - refractometer

affected by protein, gluc, x-ray

contrast agents

22.

sg - dipstick/ion

affecty by protein

23.

sg normal range

<1.03

24.

pH normal range

5.0 - 6.0 (4.5-8.0)

46.

problem w/ elevated
ketones

high blood levels alters pH (more

acidic)

63.

microscopic
hematuria
due to

bleeding/clotting (purpura, anticoags),

dyscrasias, renal infarction, malign HTN, bact
endocarditis, collagen disease, lower UTI, vag
contam (red & epith)

47.

most ketone tests use

nitroprusside (no BHBA detection)

48.

ketonuria only really

diagnostic for

DM - severe metabolic acidosis

64.

pyuria with
proteinuria
suggests

renal; less proteinuria in lower UTI

49.

aspirin injestion
impacts ketone levels

increases; toxicity reduces glucose

production

50.

hemoglobin urine
tests - sensitivity

Hemastix/Orthotolidine > Hematest

65.

bacteria in
clumps
suggests

renal; casts w/ protein binding

51.

Hgb testing good

when

hemolyzed - alk or dilute urine; can't

see microscopically

66.

false neg in
UTI's

25% will not test pos for bacteria

52.

causes false neg Hgb

urine

Vit C (large dose)

67.

time limit
for WBC
count

1 hr; lyse in hypotonic or alkaline urine

53.

causes false pos Hgb

urine

Iodine, myoglobin, vag secr/menses

68.

54.

urine: leukocyte/wbc
testing looks for

leukocyte esterase (enzyme)

produced by leukocytes; Chemstrip
L; pos in UTI

chronic
renal failure
causes urine
to

be diluted; loses ability to reabsorb it

55.

increase accuracy for

UTI: combine
Chemstrip L test w/

Nitrite test

69.

PCT
function

Na, Cl reabsorbed - water follows w/

56.

causes false pos

leukocyte/wbc
(esterase) testing

trichomonas

70.

thick
ascending
(Loop of
Henle)

Na actively reabsorbed - water stays; imperm

57.

nitrites suggest
presence of bacteria

reductase (released by bacteria)

converts nitrates to nitrites

71.

DCT, coll
ducts

water reabsorbed w/ Na (ADH controls); max

conc, cast formation

58.

bilirubin is

end reslult of RBC breakdown; not

normal in urine

72.

alkaline or dilute urine

form of bilirubin
usually in urine

conjugated; disease after

conjugation, liver working obstructive (serum more useful)

proteinuria
req for
casts; but
dissolve in

59.

73.

hyaline
casts made
of

mostly protein; dull transp, hard to see; benign

after exercise

74.

granular
casts

after exercise; renal diseases

75.

fatty casts
assoc w/

nephrotic!; DM, GN, renal, mercury, fat emboli

(insect bites)

76.

broad casts

sever stasis, wider more distally -> renal failure

77.

wbc casts
suggest

pyelonephritis (also PSGN)

78.

rbc casts
suggest

bleeding kidney (GN, tumor, inj/inf)

79.

waxy casts
suggest

chronic renal disease; failure

80.

epithelial
cells suggest

vag/urethral contam if > 10 hpf; tumor, inf,

casts, GN

81.

acid urine stones;

uric acid, cystine, cal oxalate*mc stones

60.

bilirubin in urine
suggests

tract obstruction; after-hepatic =

duct; gallstones

61.

urobilinogen
increases due to
(rarely needed LFT
cover)

inc in serum unconj bilirubin

(hemolytic processes); also liver can't
metabolize from intest

gross urinary bleeding

due to

stones, agn, tumor

62.

82.

uric acid crystals =

gout

107.

HGb recycling

heme stripped/conv to biliverdin,- rubin;

iron recycled & stored in phagocytes or
transported via transferrin

83.

phosphate & calcium

oxalate crystals =

parathyroid or malabsorption
problems

84.

alk urine - stones;

(Proteus)

MAP; staghorn calculi

108.

neutrophils

gran; left shift when increase

109.

eosinophils

gran; phagocytes attracted to foreign

compounds reacted w/ antibodies
(allergies/parasites)

85.

trichomonas - looks
like

wbc w/ tail; protozoal parasite

86.

yeast - looks like

similar to RBC; but ovoid, budding,

more opaque

110.

basophils

gran; migrate to damaged tissue, release

histamine/hep

87.

whole blood - plasma

vs formed

46-63% vs 37-54% (slightly more

plasma)

111.

monocytes

agran; become macrophages in tissue

112.

lymphocytes

agran; T, B cells, NK cells

88.

formed elements breakdown %

99.9% RBC, 0.1% Platelets/WBC

113.

cell lineage;

lymphoid = T, B, NK cells; all rest myeloid

114.

platelets

89.

Hct Normal

42-52 M; F 37-76 %; preg >33 %

transport TXA2, serotonin; temp patch &

contraction

90.

Hgb Normal

14-18; F 12-16 g/dL

115.

91.

MCV normal

80-100 fL

platelets released

by megakaryocytes; stim by thrombopoeitin, -stim factor, IL-6, multi CSF

92.

MCH - mean
corpuscular
hemoglobin

27-31

116.

platelets
circulate

9-12 days; removed by phagocytes

117.

93.

MCH concentration

32 - 36

CBC w/
differential gives

Hg, Hct, RBC indices, WBC ct, smear,

platelet ct

94.

Retic count normal

< 1.5 %

118.

# cells in 1mm3 - periph/venous blood

95.

RBC count

4.7-6.1 m cells/mm3 ; F 4.2-5.4; dec

>10% anemic

RBC/erythrocyte
count

119.

anemic when

RBC's - 10% low

96.

WBC/leukocyte
normal

4.5-11k / microL (1000x less wbc vs

rbc)

120.

causes of low
RBC

97.

neutrophils normal

50-70%; 60%

MC dietary def: iron (micro), B12 (macro);

chronic illness, renal failure,
overhydrat/dilut, prosthetic valves,
pregnancy

98.

lymphocytes normal

20-30% (half; 30%)

121.

99.

monocytes normal

<8%

gentamycin, methyldopa; dehydr, cong.

HD, high WBC

100.

eosinophils normal

<4%

causes of high
RBC - hypoxia,
PCV &

basophils normal

<1%

122.

101.

0.5 - 1.5%

102.

plasma - breakdown
%

92 % water, 7 proteins, 1
electro/nutrients/wastes

retic count
absolute - ARC;
normal

123.

plasma protein breakdown %

albumin 60%, globulin 35%,

Fibrinogen 4%, enzyme/hormones

reticulocyte
index (RI) =

ARC x (HCT/normal HCT)

103.

124.

globulins - function

transport ions, hormones, lipids;

immune function

reticulocyte
index (RI);
normal

1-3% >3% abnormal

104.

105.

Hemoglobin % of
protein in RBC

95%; 2 pairs polpypeptide subunits

125.

causes of elev
retics

106.

rbc rate of
replacement

3 bn per sec;

acute blood loss; splenectomy, hemolytic

anemia (SS, thal major) ,membrane
defect G6PD

126.

causes of decr
retics

aplastic anemia, marrow failure

(chemo/sepsis); RBC maturation disorder
(Fe, B12, Folate def, ACD, hypothy),
transfusion, liver disease

127.

Hgb - slightly
dec in elderly;
critical range

<5 or >20;

128.

decreased Hgb causes

strain on CV system: angina, heart

attack, CHF, stroke

150.

methhemoglogin
chemistry

Fe+3 instead of Fe+2; oxidated

form unable to combine w/
oxygen; left shift

129.

increased Hgb causes

sludging -> stroke, infarc

130.

Hct - % of total blood

vol that is RBC's;
roughly

Hct = 3X HgB ; 3:1 ratio

151.

methhemoglobin - shift

left; at tissue pressure, % sat of

He is increased (will not
unload)

131.

transfusion indicated
if

Hgb <8, or Hct <24

152.

methhemoglobin affected
by

nitrates/ites in diet; aniline

dyes, sulfonamides, NTG

132.

RDW range - normally

11-14.5

153.

ferritin measured by

radioimmunoassay

133.

most informative of
all hematologic tests

smear; RBC, WBC, platelets

(quant/size/shape/ w/ WBC diff)

154.

% iron in RBC's/HgB vs
ferritin/stored

70% hemoblobin; 30%

ferritin/hemosiderin

134.

poikilocytosis shape

spotted, mottled, varied

155.

typical % transferrin sat

135.

wbc's increased /
decreased

leukemia / marrow failure

30%; < 15% in Fe def anemia

(w/ TIBC high)

156.

RBC - basophillic
stipling indicate

lead poisoning, thal ; aggregates of

RNA

associated w/ increased
transferrin levels

pregnancy; estrogen therapy

(Iron def Anemia - seeking)

157.

high (> 50%?)

RBC - Howell Jolly

bodies indicate

asplenia, megaloblastic anemia;

hemolytic anemia, (nuclear
remnant not expelled)

transferrin saturation in
megaloblastic/hemolytic
anemia or iron overload

158.

RBC - Heinz bodies

indicate

G6PD deficiency, alpha thal,

hemolytic anemia, (inclusions of
denatured Hgb "bitten out")

ACD (inf, neoplasia,

cirrhosis)

low serum Fe, LOW TIBC,

normal transf sat

159.

pregnancy levels - Fe, TIBC,

transferrin satu

low serum Fe, high TIBC (high

prot in general), low transf sat

139.

G6PD can be induced

by

oxidant drugs - primaquine

160.

false pos: serum iron

testing

chloramphenicol, OC

140.

microcytic
hypochromic anemia

thal, lead poisoning, late iron def

161.

false neg: serum iron

testing

corticotropin/ACTH

141.

microcytic
normochromic
anemia

renal disease

162.

wbc; critical value

<2.5k or > 30k

163.

wbc; normal

5k-10k

164.

wbc leukocytosis; due to

macrocytic
normochromic
anemia

B12, folic acid def, hydantoin,

chemo

eating, stress,
pregnancy/delivery, drugs

165.

drugs causing
leukocytosis

epi, ASA, heparin, steroids

143.

sickle cell testing (also

SS trait; HgbC & H,
thal maj/min)

only as screening; electrophoresis

confirms; transfusions w/in 3 mths
can alter

166.

wbc leukopenia due to

144.

ESR - gen marker of

inflam; increases in

preg, TB, dyscrasias,

RA/rheumatoid, cancers

antibiotics, anticonvulsants,
antihistamines,
immunosuppressants, sulfa
drugs.. (long list)

167.

platelets normal

150k-400k / mm3 of blood

145.

ESR most useful in

diagnosing

temporal arteritis vs headache;

elderly

168.

platelets critical

<50k or > 1mm

CRP; especially useful

for

MI; atheromatous plaque/future

CV events; post surgical detects
infection

169.

146.

petechiae sign of

platelet dysfunction; don't

blanche

170.

hemarthorisis - blood in
joint

not just platelet; gen clotting

issue

171.

ASA impact on platelets

irreversible; other NSAIDS

reversible

172.

thrombocytopenia caused
by

marrow failure; B12/folate def,

splenomegaly; DIC, Liver &
kidney disease, SLE, chemo

136.

137.

138.

142.

147.

CRP does not rise w/

viral infections

148.

CRP secreted by

liver; IL-6 by macrophage/Tcells

stim it

149.

methhemoglobin
(color of blood)

dark blood; chocolate colored

173.

thrombocytosis
caused by

Fe def anemia; leukemia, post

splenectomy, pregn/estrogen,
cirrhosis, trauma/hemorrhage

174.

most platelets are

in bloodstream; 25% in liver/spleen

175.

increased levels of
platelets caused by

...

176.

clotting factors
that are vitamin K
dependent

2, 7, 9, 10

177.

intrinsic triggered
by

contact w/ collagen (left side, takes

longer, heparin, PTT)

178.

extrinsic triggered
by

tissue thromboplastin (III) faster/thrombin burst, warfarin, PT

179.

Heparin acts at
factor

Xa

180.

Warfarin; long
acting 7-14 days

2, 7, 9, 10 - inhibits vitamin K

181.

Vitamin K reverses
Warfarin in

12-24 hrs

182.

increased clotting
factors

pregnancy/OC; increased VIII, IX (also

are acute phase; stress,illness, etc)

183.

PT (prothrombin
time) normal range

11-12.5 sec; crit > 20

184.

PT Warfarin
therapy goal

PT 1.5 - 2X = 25 sec

185.

PT test prolonged
by

ETOH, diarrhea/malabsorption of VitK;

cimetadine, ASA, sulfas, phenytoin

186.

PT test shortened
by

high fat, leafy vegetables inc VitK;

steroids, antihistamines, OC, diuretics

187.

Activated Partial
Thromboplastin
Time normal

25-40 sec (60-70 PTT)

188.

APTT critical (PTT)

> 70 sec; > 100 sec

189.

Prolonged PTT due

to

congenital; VW, Hemophilia - cirrhosis,

DIC

190.

Decreased PTT due

to

early DIC; cancer

191.

Bleeding time platelet factors normal

1-9 min

192.

Bleeding time critical

> 15 mins

193.

Bleeding time
interfering factors

body temp; drugs

194.

ACT - activated
clotting time monitors

heparin DURING surgery

195.

ACT normal & goal during

surgery

7 - 120 sec; goal 150-210

sec