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Advanced Pathophysiology Exam 1 (100 OUT OF
100) Questions and Answers (Latest Update)
Lab Tests Q: Which of the following is an example of a semi-quantitative test? A. Colony forming units (CFU/mL) B. Pregnancy test C. Serum potassium D. White blood cell count A. Colony forming units (CFU/mL) Q: Which of the following is most true regarding how reference ranges are established? A. Critical value(s) must be included within upper and lower limits B. Includes 99.7% of individuals within reference population C. Range obtained by testing a sick sample
D. Statistically derived using mean and standard deviation D. Statistically derived using mean and standard deviation Q: Hemoconcentration results in which of the following apparent laboratory abnormalities? A. Elevated hemoglobin B. Hypokalemia C. Hyponatremia D. Thrombocytopenia A. Elevated hemoglobin Q: Which of the following is most true regarding laboratory interpretation? A. An isolated abnormal value should be considered a reliable indicator of disease B. Patient specific baseline level has no impact on interpretation C. Should be utilized in conjunction with signs and symptoms D. Values outside the reference range are always clinically relevant
High sensitivity definition Few false negatives (screening for a lot of things, "senses" everything that's there) An example of why you would use screening a patient without symptoms of the disease, but may be at risk of developing it (pap smear, PSA) Diagnostic test characteristics People WITH symptoms High SPECIFICITY More COMPLEX DEFINITIVE High specificity definition Few false positives (a confirmatory test, don't want to incorrectly diagnose someone)
Example of when you would use diagnostic test Measuring A1C in patient with signs/symptoms of diabetes Quantitative test Exact numeric measurements Compare to reference range Qualitative test Positive or negative result Positive = Abnormal Semi-quantitative test Negative or varying degrees or positive e.g. 1+, 2+, 3+ Common in urine screens Biomarker definition Measured and evaluated as indicator of normal biological or pathogenic processes or pharmacological responses to a therapeutic intervention
How does pregnancy influence results May have different expected reference ranges/proteins How does specimen analyzed affect results Different expected ranges for different fluids e.g. serum, blood (venous or arterial), CSF, urine Reference ________ normal Reference DOES NOT EQUAL normal Pt may have value outside of range, but the value is normal for the patient How does timing affect lab values Timing of meals, drugs administered, time of day the test was taken could all affect the results Examples of lab errors Result inconsistent with trend Great magnitude or error NOT in agreement with confirmatory result Inconsistent with clinical signs or symptoms
Examples of patient factors Age (affects reference ranges) Genetics, ethnicity, gender Biologic rhythms Drugs Pregnancy Sample obtainment Organ function Diet Posture Altitude When should you take labs At the same time every day How does the location of sample obtainment affect labs Labs should be drawn from the same line as drug administration e.g. during vanc treatment to get accurate values How does posture affect lab values Renin metabolism What is hemodilution Increased fluid volume without anything to stimulate Hg production.
CBC: WBC reference range 4.4-11.3 x 10^3 cells/mm^ Increased WBC abnormalities Infection, glucocorticoids, cancer, clot Decreased WBC abnormalities Chemotherapy, autoimmune CBC: Hb/Hct male reference range 14 - 17.5 g/dL / 42-50% CBC: Hb/Hct female reference range 12.3-15.3 g/dL / 36-45% Increased Hb/Hct abnormalities Hemoconcentration, polycythemia, cancer Decreased Hb/Hct abnormalities Hemodilution, anemia, bleeding, cancer, chemotherapy
Trick for estimating Hct Hb x 3 ~~ Hct CBC: Platelets reference range 140 - 440 x 10^3 /mm^ Increased platelet abnormality Infection, asplenia, cancer, hemolysis Decreased platelet abnormality Coagulopathy, bleeding, HIT, cancer Case: NH has not been eating or drinking much after recent minor stroke. She has a history of chronic anemia with usual Hb around 10 g/dL and Hct around 30%. BP has remained stable, but heart rate increased from 70s to 90s over the past 5-7 days. Her mucous membranes are dry, skin turgor diminished, urine output decreased. New CBC reveals Hb 13 g/dL and Hct 40%. Has anemia resolved? No NH has a history of anemia so their Hb and Hct are normally low.
Exclude unmeasured effective osmoses. Must correct because very high glucose can make Na+ appear abnormal when it's not. Corrected Na equation Corrected Na = Na + [(Glc-100) * 0.016] What is very important when considering sodium levels? To evaluate extracellular fluid volume (volume status) Serum osmolarity equation 2 (Na+) + Glc/18 + BUN/2. Serum osmolarity reference range 275 - 295 mOsm/kg Hypervolemia physiological signs Edema, fluid balance +, JVD (jugular venous distention) Euvolemia physiological signs No evidence of edema or dehydration Hypovolemia physiological signs
Poor skin turgor, dry membranes Hypervolemic urine osm > urine na < CHF, cirrhosis Hypervolemic urine osm < urine Na > Renal failure Euvolemic urine osm < urine na < Polydipsia, hypotonic fluid intake Euvolemic Urine Osm > Urine Na > SIADH, hypothyroid, drug-induced Hypovolemic Urine Osm >
Diuretics, high-dose PCNs, aminoglycosides, sodium polystyrene sulfonate Diarrhea, vomiting (fluid loss) Renal assessment Complex Exogenous CrCl Endogenous: Cystatin C, Serum creatinine (SCr), BUN, 24-hour urine creatinine Renal estimation Typically use estimation Use Cockcroft-vault equation to estimate CrCl Cockcroft-Gault Equation ((140-age) x kg) / (72 x SCr)) x 0.85 if female Liver panel reference ranges Liver panel: Albumin and prealbumin
Protein synthesis Liver panel: ALT and AST Hepatocellular injury Liver panel: ALP, total bilirubin, direct bilirubin, GGT Excretion into bile ducts and drainage into duodenum Liver panel: Ammonia Detoxification Renal Disease Q: Which of the following is true about the anatomy and function of the kidney? A. Endocrine functions of the kidney include secretion of renin and production of erythropoietin B. Renin is a hormone that helps maintain phosphorus balance C. The Loop of Henle is the site for reabsorption of glucose D. Three anatomic regions include the pelvis, medulla, and diaphragm
Q: Which of the following is true about chronic kidney injury? A. Common causes in acute tubular necrosis, dehydration, and reduced blood flow to the kidney B. It can be caused by dehydration or pre-renal injury C. It is defined as urine output less than 0.5 ml/kg/hour for 24 hours D. It is irreversible D. It is irreversible Q: Which of the following is true about the tests of renal structure and function? A. Blood urea nitrogen (BUN) will be increased in patients that have higher muscle mass B. Serum creatinine and WBCs are useful indicators of renal function C. When serum creatinine increases, GFR is reduced D. 24 hour urine collection should be performed in all patients C. When serum creatinine increases, GFR is reduced Where are the kidneys located Retroperotineal space Right kidney is slightly lower than the left
renal pelvis real medulla renal cortex renal pelvis: urinary collecting structors (calices) real medulla: renal pyramids (collecting ducts, loops of henle) renal cortex: outer rim, glomeruli, nephron tubules approximate renal blood flow 1,200 mL/min process 200 qt of blood to filter 2 qt or waste products and extra water renal endocrine functions renin secretion prostaglandin, kinin, erythropoietin production vit D3 activation gluconeogenesis insulin and steroid metabolism renal excretion functions glomeruli filtration tubular secretion and reabsorption rate of excretion = rate of filtration + secretion - reabsorption
