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Clin Path 1
Quiz 1
| Question | Answer |
|---|---|
| Normal urine color? | Yellow or Amber |
| Reddish amber urine color? | urobilinogen |
| Milky urine color? | infection/diseases |
| Brownish yellow or green urine color? | bile |
| Red or smoky brown urine color? | blood |
| Yellow foam in urine? | bilirubin |
| White foam in urine? | albumin |
| Coca-cola color of urine? | AGN |
| Normal odor of urine? | Aromatic |
| Ammoniacal odor of urine? | bladdar retention |
| Fruity odor of urine? | Ketone bodies = DM |
| Foul odor of urine? | bacterial infection |
| Measurment of the dissolve substances present in the urine or expression of the concentration of urine? | specific gravity |
| Normal ranges for specific gravity? | 1.003 - 1.030 |
| Low specific gravity indicates what? | Diabetes insipidus |
| High specific gravity indiates what? | Diabetes Mellitus |
| Fixed specific gravity at 1.010 indicates what? | tubular injury/Advanced kidney failure |
| Normal pH levels? | 4.5-8.0 |
| Low pH levels of urine? | acidosis, fever, increased protein diet |
| High pH levls of urine? | alkalosis, infection |
| Presence of protein in urine is mostly indicative of what? | renal disease |
| The apearance of protein urine means what? | That it's not neccisarily renal disease |
| Urine strip for proteins is primarily sensitive to what protein? | albumin |
| Dominant constituent in proteinuria? | albumin because of its small molecular size |
| Type of proteinuria that is not associated with easily demonstrable systemic or renal damage and why? Causes of this type of proteinuria? | functional because there are no tests or aha lesions; orthostatic proteinuria |
| Type of proteinuria that is associated with demonstrable systemic disease or rernal pathology? | organic proteinuria |
| 3 types of organic proteinuria? | prerenal, renal, postrenal |
| Normal renal threshold of glucose is what? | 180mg/100ml serum glucose level |
| Causes of increased glucose in urine? | Any cause of increased blood glucose, endocrine disorders, major trauma, stroke, MI, burns, infections... |
| Causes of decreased glucose in urine? | Treatment with ascorbic acid, levodopa, or mercurial diuretics |
| Most common cause of glucosuria? | diabetes mellitus |
| Ketonuria appears when? | When there is an increased use of fat instead of carb for metabolism |
| Conditions of ketonuria include what? | DM, alcoholism, vomiting and inadequate intake of carbs due to starvation or weight reduction or pregnancy |
| Presence of intact RBC's in thet urine | hematuria |
| Presence of free Hb in the urine | hemoglobinuria |
| Causes of hematuria | trauma or irritation |
| Causes of hemoglobinuria | Lysis of RBC's in the urinary tract, intravascular hemolysis, or transfusion reactions. Very dilute or extremely alkaline urine can also lyse the cells. |
| Myoglobinuria indicates what and may appear in what? | muscular destruction; hypothermia, convulsions and extensive exertions |
| False negatives of hematuria include what? | failure to mix or large doses of vitamin C |
| a leukocyte esterase false positive can be because of what? | trichomonas organisms |
| Nitrites in urine tests for what? | gram-negative bacteria (bacteriuria) caused by nitrate reducing bacteria |
| Urine must be incubated in the bladder for how long to produce a positive nitrite test? | 4 hours |
| Appearance of urinary bilirubin can be a sign of what? | liver disease or extrahepatic or intrahepatic biliary obstruction |
| What tyep of bilirubin is found in the urine? | conjugated water soluble bilirubin |
| Reference range of RBC's, WBC's and casts under a microscopic exam of a urinary sediment? | 0-2 RBC, 0-5 WBC and an occasional cast per high power field |
| Best specimen for a microscopic exam of urine? | first-morning, mid-stream |
| Clinical significant hematuria under a microscope? | >3 RBC per hpf |
| Clinical significant pyuria under a microscope? | >5 WBC per hpf |
| Etiology of RBC's in urine under a microscope include? | benign hematuria or a vaginal contaminant |
| WBC's in urine? | pyuria |
| Pyuria of renal origin is usually accompanied by what? | significant proteinuria |
| UTI's tend to be accompanied by what? | bacteriuria |
| Suspicion of contamination of epithelial cells? | >10 squamous epi cells per lpf |
| Hyaline casts indicate what? | Casts seen in exercisers |
| Waxy casts indicate what? | advanced kidney failure |
| RBC casts indicate what? | AGN |
| WBC casts indicate what? | Acute pyelonephritis and WBC's uriginate in the kidney |
| Fatty casts inidcate what? | nephrotic syndrome |
| Fatty, RBC and WBC casts are always what? | significant |
| A few hyaline and granular casts have what? | no importance |
| To make blood? | Hematopoiesis |
| RBC's in bone marrow called? | medullary hematopoiesis |
| RBC's our of the bone marrow called? | Extramedullary hematopoiesis |
| To make RBC's | Erythropoiesis |
| Specific hormone which responds to hypoxia? Originating where? | Erythropoietin; kidney |
| Erthyrocyte stage where the RBC has a nucleus, nucleus has no function and the cytoplasm is orange/red in color | orthochromatic normoblast |
| Erthryocyte stage where there is no nucleus, cytoplasm is slight blute and is larger than the mature rbc? AKA what? | polychromatic erythrocyte; reticulocyte |
| Diameter of a mature erythrocyte? | 7.2 micra |
| 5 hemoglobin types? | gower 1, gower 2, Hb F, Hb A, Hb A2 |
| Majority of the Hb when you are a fetus? | Hb F |
| Majority of the Hb when you are an adult? | Hb A |
| Aged RBC's are phatocytized by the macrophages of the RE syste and broken down into iron, globin and protoporphyrin, majority of the Hb breakdown. | Extravasclar hemolysis |
| RBC's lyse within the circulation and is the minority of the Hb breakdown | Intravascular hemolysis |
| CBC includes what? | Hb, total RBC count, Hct, RBC indices, WBC count, Platelet count |
| Hb is great at detecting what? | anemias or erythrocytosis (Opposites) |
| Hb is (Increased/Decreased) in all anemias? | Decreased |
| Improper what will give you a false increase in Hb? | venipuncture technique, which may introduce hemoconcentration |
| RR for Hb? | 14g/dl +/- 2 g/dl in women; 16g/dl +/- 2 g/dl in men |
| Anemia exists when the Hb level is what? | <13 in males and <11 in females |
| What will increase the Hb levels? | Heavy smokers, exercise, living at high altitudes, higher in the morning |
| Fake anemia is called what and seen in who? | dilutional pseudoanemia seen in pregnancy and athletes |
| RR for RBC count? | 3.5-5.5 mill for women, 4.3-5.9 mill for men |
| Decrease in RBC's? | Various anemias |
| Increased in RBC's? | myelopoliferative neoplasms |
| Ratios of spun RBC's to plasma reflecting the volume of packed RBC's | Hematocrit |
| Equation for Hct | Hb x 3 |
| Falsely elevated Hct | prlonged stasis |
| Falsely decreased Hct | EDTA keeps blood from clotting |
| RR for Hct | 37-47% females, 40-54% males |
| What is used to determine the morphologic type of anemia? | RBC indicies |
| Average measurement of RBC volume | Mean Corpuscular(Cell) Volume (MCV) |
| RR of MCV | 80-100 femtoliters(fl) |
| Causes of increased MCV? | macrocytic anemias, myelodysplastic syndromes, alcoholism, liver disease, hypothyroidism, infants and newborns |
| Causes of decreased MCV? | iron deficiency anemias, Thalassemias, Hereditary sideroblasic anemia, lead poisening, chronic disease anemia |
| Etiology of macrocytosis | Folate or B12 deficiency, Chronic liver disease, chronic alcoholism, reticulocytosis, myxedema |
| Etiology of microcytosis | Chronic iron deficiency, alpha or beta thalassemia, anemia of chronic disease, sideroblastic anemia |
| Quantity(weight) of hemoglobin in the average RBC? | Mean Cell Hemoglobin(MCH) |
| RR of MCH | 27-33 picograms(pg) |
| Increased MCH | macrocytic anemias and infants |
| Decreased MCH | microcytic and normocytic anemias |
| Color or the average concentration of hemoglobin in the average RBC? | Mean Cell Hb Concentration(MCHC) |
| Decreased MCHC | Microcytic and normocytic anemias, pale |
| Increased MCHC | Macrocytic anemias, hereditary spherocytosis and infants |
| Better test for identifing hypochromasia? | MCHC |
| RR of MCHC | 32-36 g/dL |
| Index of RBC size differences and useful in drawing attention to anisocytosis, a marker for various anemias | RBC Distribution Width(RDW) |
| T/F: RDW is never decreased | True |
| First thing that changes in anemias? | RDW |
| RR of RDW | 11-15% |
| RR for WBC count | 4,500-11,000/microliter |
| Decreased WBC count? | Leukopenia |
| Increased WBC count? | Leukocytosis |
| Causes of leukopenia? | Viral infections |
| Causes of leukocytosis? | Bacterial infections |
| Platelets | Small discoid blood corpuscles, the primary link in achieving hemostasis |
| RR of platelets | 150,000-400,000/cu mm |
| Too many platelets called what? What causes this? | Thrombocythemia; Malignancy |
| Decreased platelet count? | Thrombocytopenia |
| <70,000 platelets is clinically evident for what? | Bleeding tendency |
| What two tests will give 90% of all the diagnostic info obtainable by the hematologic examinations? | PBS and Hb value |
| Peripheral blood smear tests for what? | To obtain differential counts of WBC and to study blood cell morphology |
| PBS are most helpful for the rapid identification of what? | anemias, leukemias and platelet abnormalities |
| Variation in RBC sizes and by what? | anisocytosis; by RDW |
| Variation of the shape of RBC | poikilocytosis |
| Bluish discoloration of RBC reflecting reticulocytes | polychromasia |
| What are the 2 anisocytosis sizes named and how are they tested? | microcytes and macrocytes; MCV |
| RBC fragmentation syndromes | Schistocytes |
| Spiky RBC's? and what causes them? | Acanthocytes; severe liver disease, anorexia nervosa |
| Causes of echinocytes? | artifact, liver disease, renal disease, hyperlipidemia |
| Causes of bite cells(degmacytes) | hemolytic anemia due to an oxidizing agent(Heinz body anemia) |
| Shaped cell seen in thalassemia? | Target cells |
| Causes of teardrop cells? | myeloid metaplasia, CML |
| Stacked up coins and what causes them? | Rouleaux; multiple myeloma |
| RBC type caused by lead poisoning? | Basophilic stippling |
| RBC type caused by magaloblastic anemias and thalassemia? | Howell-Jolly bodies |
| RBC type caused by an increased iron load? | Pappenheimer bodies |
| Pale RBC's caused by what? | hypochromic; iron deficiency anemia, thalassemia |
| Spherocytes are what color? | Hyperchromic |
| Reticulocytes are what color? | polychromatophilic |
| Shift to left means what? | infection |
| Neutrophils with > than 5 nuclear lobes is called what and seen in what? | hypersegmentation; pernicious anemia, b12 or folic acid deficiency |
| Reactive lymphocytes are seen in what and look like what? | viral infections like mono; too much blue cytoplasm |
| Presence of both immature WBCs and nucleated RBCs in the PBS is what? Caused by what? | leukoerythroblastosis; leukemia |
| Normal range of neutrophils and increased in what? | 50-70%; bacterial infections |
| Increased neutrophils is called what? | neutrophilic leukocytosis |
| Decreased neutrophils is called what? | neutrophilic leukopenia |
| Normal range for eosinophils? | 1-5% |
| Increased eosinophils is called what and what causes these to increase? | eosinophilia; parasites and acute allergic reactions |
| Normal range for basophils? | 0-1% |
| Increased basophils is called what? When is it increase? | basophilia; bad to be increased, seen in myeloproliferative disorders |
| Normal range of lymphocytes? | 20-40% |
| Increased lymphocytes is called what and what causes them to increase? | lymphocytosis; viral infections |
| Decreased lymphocytes is called what and what causes them to decrease? | lymphocytopenia; immunodeficiency syndromes (AIDS) |
| Normal range of monocytes? | 2-10% |
| Increased monocytes is called what and what does it mean to be increased? | monocytosis; good to have AFTER an infection, helps the recovery |
| Hematological test of inflammation? | erythrocyte sedimentation rate (ESR) |
| ESR Test | Filling a tube with anticoagulated whole blood and measuring the rate of RBC sedimentation during 1 hour. Most changes in sed rate are caused by alterations in plasma proteins, mainly fibrinogen |
| RR for ESR | children: 3-13mm/hr post-adolescent man: 1-15mm/hr post-adolescent woman: 1-20mm/hr |
| Formaula for ESR? | males = age/2 females = age + 10/2 |
| Bad nodes? | hard, non-movable, non-tender, hard to get finger around them |
| Basic neoplastic cell of Hodgkins is what and some of these cells take on a binucleated form called what? | malignant reticulum cell; Reed-Sternberg Cells |
| Male:female ratio? | 1.4:1 |
| Bimodal age distributions? | 15-34 than another after 54 |
| Clinical findings of Hodgkins? | localized, progressive, painless lymphadenopathy; unilater nodes at neck; intense pruritus; night sweats, Pel-Ebstein Fever, weight loss, anorexia; immediate pain after alcohol |
| Lab findings of Hodgkins? | Lymphocytopenia, anemia(33-50%)(hypochromic and microcytic), Eosinophilia (20%), elevated serum alkaline phosphatase (Bone Marrow or liver involvement) |
| Hodgkins Triad? | fever of unknown origin, pruritus and lymphadenopathy |
| Diagnosis of hodgkins from what? | lymph node biopsy |
| Disease which means many cells in the blood, also called what? | polycythemia vera; stem cell CA |
| Myeloproliferative clonal disorder marked by increased RBC(erythrocytosis) with excessive erythroid, myeloid and megakaryocytic elements in the BM. Increased RBC, WBC and Platelets. | Polycythemia vera |
| Hx of PV? | asymptomatic or present with nonspecific complaints, erythromelalgia (burning pain of feets/hands), pruritus |
| Physical exam of PV? | Organomegaly(liver and spleen), facial plethora(Redness of face) |
| Lab findings of PV? | Inc. RBC, Inc. Hct, Dec. EPO, Thrombocytosis, Leukocytosis, hyperuricemia, hypercholesterolemia |
| Management of PV? | phlebotomy |
| Secondary erythrocytosis | Hypoxia, high altitude, chronic lung disease, hormonal |
| Relative erythrocytosis | Falsely increased RBC's due to decrease in plasma volume. Etiology dehydration(cloudy urine) |
| Overview of leukemia? | Diminished production of normal RBC's, WBC's and platelets |
| Leukemia that the predominant cell is usually the blast WBC(young WBC) | Acute Leukemia |
| Leukemia that the predominant cell is the more mature WBC's | Chronic Leukemia |
| Leukemia in which the total peripheral blood WBC count is within the RR but a significant number of immature cells are present as well | Subleukemic Leukemia |
| Leukemia in which the PBS of WBC count is normal and no abnormal cells are found in the peripheral blood. | Aleukemic Leukemia |
| Etiology of Leukemia? | virus's, ionizing radiation, chemical leukemogens and genetic defects |
| Clinical findings of Leukemia? | splenomegaly, lymphadenopathy, fever, anemia, hemorrhage, infection |
| Pediatric Leukemia | Acute Lymphoblastic Leukemia (ALL) |
| History of ALL? | Bleeding, bone/jt pain, limp, refusal to bear weight, anemia, respiratory distress, renal failure, headache |
| Lab findings of ALL? | WBC elevated, Anemia, leukemic lymphoblasts in the peripheral blood smear(PBS) |
| Adult Leukemia | Acute Myeloid Leukemia(AML) |
| 2nd most common type of leukemia in adults? | AML |
| M:F Ratio of AML | Men>Females |
| History of AML? | Fatigue, bleeding, difficulty clearing infections |
| Lab findings of AML? | Leukocytosis, myeloblasts with auer rods |
| Most common form of leukemia in adults in the US? | Chronic Lymphocytic Leukemia(CLL) |
| Predominant age for CLL | elderly, 70 years old |
| History of CLL | Insidious onset normally discovered incidentally. Asymptomatic at the time of diagnosis. Enlarged nodes, early satiety, enlarged spleen, mucocutaneous bleeding and/or petechiae due to thrombocytopenia, fevers and night sweats. |
| Lab findings of CLL | Absolute lymphocytosis, ruptured lymphocytes(smudge cells) and mature-appearing small lymphocytes |
| Leukemia with the proliferation of myeloid precursors? | Chronic Myelogenous Leukemia (CML) |
| Hallmark of CML is what? | Philadelphia chromosome |
| History of CML? | Splenomegaly is usually moderate but may be extreme |
| Lab findings of CML? | WBC markedly increased, granulocytes in all stages of development, basophilia, eosinophila, platelets can be normal, elevated or low on occasion |
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