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Diagnostic studies 4
| Question | Answer |
|---|---|
| Gram stain | method to preliminarily classify as gram-positive or gram-negative and identify the morphology of the organism |
| Culture | Organism is grow on culture medium and identified |
| Susceptibility testing | Identified organism on culture is compared to different antibiotics |
| Molecular tests | identifies pathogen DNA or RNA (PCR) |
| Antigen detection tests | available as POC tests or laboratory enzyme immunoassays |
| Serologies | detect host antibodies that are produced in response to an infectious agent |
| Antibodies | produces as response to antigen |
| IgM | main immunoglobulin produced early in the primary response |
| First antibody to appear after exposure | IgM |
| IgG | important defense mechanism against viruses and bacteria |
| Antibody that remains for a long time | IgG |
| IgA | found in secretions and helps prevent attachment of microorganisms to mucous membranes |
| IgE | mediates hypersensitivity reactions and has defense against certain parasites |
| Bartonella test via | Serologies- PCR blood or tissue |
| Botulism test via | Clinical dx, but could stool |
| Campylobacter jejui test via | stool culture or PCR |
| Chancroid test via | Clinical dx, but could PCR lesions |
| Chlamydia test via | NAAT or culture |
| Cholera test via | Clinical dx, but could stool |
| Clostridiodes difficile test via | Stool PCR, molecular assay for toxin |
| Diphtheria test via | Clinical dx, could culture or PCR for toxin |
| Gonococcal test via | NAAT or culture |
| MRSA test via | Culture or PCR from site of infection |
| Rheumatic fever test via | Clinical dx, or ABO ABD |
| Rocky Mountain spotted fever test via | Clinical dx, or serologies (IgM, IgG) or PCR |
| Salmonellosis test via | stool culture |
| Shigellosis test via | stool culture or PCR |
| Tetanus test via | Clinical dx |
| Blastomycosis test via | Culture from sputum, wound, or urine |
| Candidiasis test via | Budding yeast and pesudohyphae on KOH smear, blood culture |
| Coccidioidomycosis test via | IgM and IgG antibodies, antigen detection in urine, blood or CSF |
| Cryptococcosis test via | Encapsulated yeast on India ink staining, cryptococcal antigen in CSF, blood culture |
| Histoplasmosis test via | Sputum culture, antigen in sputum or urine, blood culture |
| Pneumocystis test via | Staining or PCR of respiratory specimen (do not culture) |
| Amebiasis test via | Stool ova and parasites, stool PCR |
| Giardiasis test via | Stool microscopy or PCR |
| Malaria test via | Giemsa-stained blood smear |
| Pinworms test via | Tape test to evaluate for eggs |
| Toxoplasmosis test via | CD4 <100, anti-toxoplasma IgG antibodies, CSF PCR, ring enhancing lesions on MRI |
| Trichomoniasis test via | NAAT or pH and microscopy of vaginal discharge |
| Atypical mycobacterial disease test via | Blood culture, acid fast smear on sputum, lung biopsy |
| TB test via | Sputum acid fast bacilli, sputum culture, lung biopsy |
| Lyme disease test via | clinical diagnosis, serologies |
| Syphilis test via | treponemal test and nontreponemal |
| Congenital varicella test via | PCR |
| Herpes simplex virus test via | Viral culture or PCR |
| Group B strep test via | Culture from blood, CSF, pleural fluid, or urine, could also antigen detection in CSF |
| Zika virus test via | Serum or urine IgM |
| Coronavirus test via | Respiratory PCR on nasal swab |
| CMV test via | PCR, serologies, tissue biopsy |
| EBV test via | EBV antibodies, heterophile antibody (mono spot) |
| Erythema infectious test via | Clinical dx, serologies (IgM and IgG) |
| HSV test via | PCR, viral culture, multinucleated giant cell on Tzank smear |
| HIV/AIDS test via | HIV 1/2 antibodies/antigen, HIV RNA |
| Human papillomavirus test via | HPV DNA or RNA indication |
| Influence test via | Respiratory PCR on nasal swab |
| Measles test via | Clinical dx, serologies, PCR |
| Mumps test via | Clinical dx, serologies |
| Polio test via | PCR from stool, oropharyngeal swab or CSF |
| Rabies test via | Hx, Clinical dx, Negri bodies in brain |
| Roseola test via | Clinical dx |
| Rubella test via | Clinical dx, IgM antibodies |
| Varicella-zoster virus | Clinical dx, PCR on lesion |
| Most common infectious source of sepsis | Pneumonia |
| Blood culture gram stains are available when | about 24 hours after sample is taken |
| Final blood culture provides | organism identification and antimicrobial susceptibility |
| Organism identification are available when | 2-5 days after sample taken, sometimes longer |
| Calcitonin | released by the thyroid and helps to maintain calcium homeostasis |
| Procalcitonin | Precursor of calcitonin |
| Highest levels of procalcitonin are seen in | sepsis and septic shock |
| Lactate level | used to evaluate the degree of tissue hypoxemia in patients with shock |
| Elevated levels of Lactic acid are seen in | sepsis and septic shock |
| Trending lactate levels | used to monitor response to treatment |
| Lactate dehydrogenase | an enzyme that catalyzes the oxidation of lactate to pyruvate |
| Elevated Lactate dehydrogenase may be seen in | PJP |
| CD4 <200 | AIDS |
| Screening test for HIV | combo antigen/antibody test |
| Combo antigen/antibody test covers | IgM and IgG with p24 |
| Screening test of choice in america for HIV | combo antigen/antibody test |
| Combo antibody/antigen test for HIV will be positive how long after the infection | 18-45 days after infection |
| HIV-1/HIV- differentiation assay | confirmatory and tells you which you have |
| Western blot - IgG antibodies to HIV 1 | older test used to confirm initial reactive immunoassay |
| HIV RNA or DNA detection | viral load test |
| HIV RNA will be positive how long after the infection | 10-30 days after infection |
| What to do if you get stuck with a needle | immediately clean the site, determine HIV and Hep B statis, initiate PEP for HIV, baseline and follow up HIV testing |
| What we want the viral load under in HIV patients | 200 |
| Normal CD4 levels | 500 to 1400 |
| When to prophylaxes for PJP | CD4 <200 |
| When to prophylaxis for Toxoplasmosis | CD4<100 and + T gondii IgG |
| When to prophylaxis for MAC | CD4<50 and not on ART |
| Treponemal test | just positive with syphilis- positive for life |
| Nontreponemal | not specific to syphilis and not positive for life |
| Gold standard test for Mono | EBV antibodies |
| IgM VCA | appears in early mono and persists for life |
| IgG VCA | appears early in mono and persists for life |
| IgG to early antigen (EA) | appears after anti-VCA, wanes over time |
| IgG to EMV nuclear antigen | appears 6-12 w after mono symptom onset and persist for life |
| Qualitative CMV PCR | used to monitor patients at risk for CMV, monitor response to therapy, or diagnose acute illness |
| Qualitative CMV PCR uses | PCR of CSF |
| When to screen HTN | All adults over 18 |
| How often do you screen HTN | yearly |
| When to screen Pre-DM/T2DM | Adults 30-70 who are overweight |
| How to screen DM | Fasting plasma glucose, HgA1C, or glucose tolerance test |
| How often to screen DM | every 3 years |
| When to screen osteoporosis | Women 65+ or younger than 65 with increased ris |
| How to screen osteoporosis | DEXA of hip and lumbar spine |
| When to screen AAA | Men 65-75 who have ever smoked, selective men 65-75 who have never smoked |
| How to screen AAA | Abdominal ultrasound |
| How often to screen AAA | Once in their life |
| When to screen breast cancer | Women 40-74 |
| How to screen breast cancer | mammography |
| How often to screen breast cancer | every two years |
| When to screen for cervical cancer | women 21-65 |
| How to screen for cervical cancer | cervical cytology, HPV testing, or co testing |
| How often to screen for cervical cancer | Every 3-5 years depending on the test |
| When to screen for prostate cancer | Men 55-69 |
| How to screen for prostate cancer | PSA |
| When to screen for colorectal cancer | Adults 45-75, and some 76-85 |
| How to screen for colorectal cancer | stool-based test or direct visualization |
| How often to screen for colorectal cancer | every 1-3years or 5-10years |
| When to screen for lung cancer | any adult 50-80 with a smoking history |
| How to screen for lung cancer | Low dose CT |
| How often to screen for lung cancer | yearly |
| When is HCG produced | begins at time of implantation |
| HCG is detected first in urine or blood | Blood |
| HCG peaks in | Week 10 |
| For it to be a viable pregnancy you need to see | Gestational sac and yolk sac or fetal pole |
| Fetal pole is | the embryo |
| How determine due date | Crown to rump or mean sac diameter |
| How to measure fetal HR | M mode |
| Heterotopic pregnacy | Intrauterine and ectopic pregnancy |
| Normal fetal HR | 120-160 |
| When to use a pelvic ultrasound | Vaginal bleeding, pelvic pain, rule in uterine pregnancy, determine viability, ovarian pathology, or uterine pain |
| Tips for pelvic untrasound | Full bladder |
| Transvaginal ultrasound | Higher frequency higher resolution |
| When to do transvaginal ultrasound | 1st trimester |
| Tips for transvaginal ultrasound | Empty bladder |
| Transabdominal ultrasound | Helps you see bigger picture |
| When to do a pelvic a exam | pain, pap, IUD |
| Pap smear 21-29 | every 3 years just the pap |
| Pap smear 30-65 | every 5 years do both pap and HPV, or every 3 pap and HPV every 5 |
| When you can stop Pap smears | 2 negative smears in a row |
| If someone has an issue with their breasts <40 | Ultrasound |
| Screening for breast cancer | Both palpation and mammogram |
| Stage breast cancer with | TNM |
Created by:
kendallmk