IPAP Clin Lab Test 1

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Harding University *

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Nov 24, 2024

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IPAP Clin Lab Test 1 | 140 Questions with 100% Correct Answers | Updated 2024 | Guaranteed A+ What are the factors that can affect lab results? ✔✔ Gender, Age, Race, Medication A test that has high sensitivity and negative predictive value is good for what? ✔✔ Screening What are the two main divisions of the lab? ✔✔ Anatomical (Histology, Cytology, and Autopsy) and Clinical (Micro, Hema, UA, Serology, Chemistry, Immunohematology) Which clinical pathology division of the lab will test for blood glucose, electrolytes, enzymes, hormones, lipids, and proteins? ✔✔ Chemistry What three phases of testing were established by the 1988 CLIA? ✔✔ 1. Before testing (ordering/specimen collection) 2. During testing (controls, performing test, interpretation/recording result) 3. After testing (result reporting, documentation, confirmatory, biohazard waste disposal) What are the four categories of test complexity as determined by the FDA? ✔✔ Minimal Complexity, Provider Performed Microscopy, Moderate Complexity, High Complexity

What type of testing is usually done when the specimen in labile, the primary instrument is the microscope, and it is performed personally by the provider (so no controls are available)? ✔✔ PPM Which tests are included in a Basic Metabolic Panel (BMP)? ✔✔ Electrolytes and Kidney Function (Na, K, Cl, CO2, BUN/Cr, Serum Glucose, Total Calcium) Which two tests comprise the Renal Function tests, and are used to estimate GFR? ✔✔ BUN/Cr If a patient has an abnormal calcium level, which test should also be ordered? ✔✔ Serum albumin, because it acts as a carrier for calcium and may also be affected Which tests are included in the Complete Metabolic Panel (CMP)? ✔✔ All of the tests in the BMP, plus Albumin (ALB), Alanine Transaminase (ALT), Alkaline Phosphatase (ALP), Aspartate Aminotransferase (AST), Bilirubin, and Total Protein (TP) Which test measures a protein made by the liver that acts as a carrier for calcium? ✔✔ Albumin Which enzyme is found in the highest amounts in the liver, and is tested in the CMP? ✔✔ Alanine Transaminase (ALT) Which enzyme is found in almost every body tissue, but especially in the liver, bile ducts, and bone, and is tested in the CMP? ✔✔ Alkaline phosphatase (ALP)

What is the enzyme found in high amounts in heart muscle, liver, and skeletal muscle, and is tested for in the CMP? ✔✔ Aspartate Aminotransferase (AST) What is the yellowish pigment found in bile, and is tested for in the CMP? ✔✔ Bilirubin Which test measures 2 classes of protein (albumin and globulin), and is tested for in the CMP? ✔✔ Total protein What would render a specimen unacceptable for a CBC? ✔✔ If the specimen is clotted or greater than 48 hours old Which tests are included in a CBC? ✔✔ RBC, WBC, Hct, Hb, Platelets, MCV, MCH, MCHC, RDW What does the red blood cell count in a CBC determine? ✔✔ Anemia What are the three types of data included in a CBC? ✔✔ RBC data, WBC data, and Platelet Count (PLT) What does the white blood cell count measure in a CBC? ✔✔ Functional status of immune system

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What is the % by volume of packed RBCs in a whole blood sample measured in a CBC? ✔✔ Hematocrit (Hct) What is the measure of protein in RBCs that carries oxygen in a CBC? ✔✔ Hemoglobin (Hb) What measures the deviation of the volume of RBCs and is included in a CBC? ✔✔ RDW When a CBC + Differential is ordered, what will be measured? ✔✔ Percentage of each type of leukocyte present in the specimen (Neutrophils/PMNs, Lymphocytes, Monocytes, Eosinophils, Basophils) What does a urinalysis screen consist of? ✔✔ A group of 10 chemical tests that are used to detect urinary tract infections, as well as metabolic and kidney disorders (Specific Gravity, pH, Protein, Glucose, Ketones, Blood, Leukocyte Esterase, Nitrite, Bilirubin, Urobilogen) What measures urine concentration? ✔✔ Specific gravity What measures the breakdown products of fat, usually present in small quantities? ✔✔ Ketones What measures the waste product produced in the liver from hemoglobin? ✔✔ Bilirubin Which test in the Lipid Panel looks for a steroid used to produce hormones and cell membranes? ✔✔ Cholesterol

Which test in the Lipid Panel looks for the type of cholesterol that carries fat from the liver to other parts of the body? ✔✔ LDL Which test in the Lipid Panel looks for the type of cholesterol that binds fat in the bloodstream and transports it to the liver for disposal? ✔✔ HDL Which test in the Lipid Panel looks for the type of cholesterol that distributes the triglycerides produced in the liver? ✔✔ VLDL When should healthy adults have their total cholesterol checked? What if it comes back with a high value? ✔✔ Every 5 years; if result is high, perform the full lipid profile Which type of sample requires that the blood clots within 20-30 minutes and leaves blood cells and fibrin (protein) separated from the rest? ✔✔ Serum Which type of sample has an added anticoagulant, and is put in a centrifuge that separates the RBCs from the still present coagulation proteins on top? ✔✔ Plasma What is the order of draw for the colored top collection containers? ✔✔ Blue (Citrate tube) Red (Serum tube) Yellow (Gel separator serum) Green (Heparin)

Purple (EDTA) Pink (K2 EDTA) Gray (Fluoride glucose) What is the Red Top tube used for? ✔✔ Does NOT contain anticoagulant, may have clot activator Yields serum What is the purpose of using gel in the serum separator? ✔✔ Separate serum from RBCs What is the Lavender/Purple top tube used for? ✔✔ Contains EDTA (anticoagulant) that yields plasma Used in hematology/blood bank testing What is the blue top tube used for? ✔✔ Contains sodium citrate (anticoagulant) that yields citrated plasma (1 part citrate to 9 parts blood) What could be the consequence if the 1:9 ratio is not followed with a blue top tube, and there is not enough blood (short draw)? ✔✔ Excess sodium citrate and inadequate amount of blood may cause blood to take prolong the test (too much anticoagulant) What is the green top tube used for? ✔✔ Contains either sodium or lithium heparin (anticoagulant) that yields plasma

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Used for cardiac testing, renal panel, liver function, and toxicology/therapeutic drug monitoring What is the gray top tube used for? ✔✔ Contains Potassium Oxalate (anticoagulant) and Sodium Fluoride (glucose preservative) and yield plasma Used for toxicology and BAC Which type of tube should be used for HLA and paternity testing? ✔✔ Yellow top Which type of tube should be used for coagulation tests? ✔✔ Light Blue top Which tube should be used for hematology tests? ✔✔ Lavender top Which tube should be used for transfusion services tests? ✔✔ Pink top Which type of testing should be done with a red top tube? ✔✔ Serum testing Which type of tube should be used for cardiac profiles? ✔✔ Green top Which type of tube should be used for glucose tests? ✔✔ Gray top

What order should pediatric tubes be drawn? Why? ✔✔ Opposite of the adult order (Purple, Green, then Red) because babies tend to clot faster, and the purple tube will be used for plasma and cannot clot The quality control program detects any progressive drift of values in one direction of at least how many days in the row? ✔✔ 5 days (trends) What is used to set the measuring points on a scale/instrument? What is used to ensure the procedure is working properly? ✔✔ Calibrator; Controls What are the important elements to ensure quality control when doing POCT? ✔✔ Documentation, ensure QC sheet is correct and up to date, ensure that controls are within expected range, ensure reagents are NOT expired What is the purpose of Quality Assessment-Proficiency testing? ✔✔ Fulfills CLIA requirements by having lab conduct testing of "blind samples" (from outside the organization) whose values are unknown to the testing lab and results must be tested and reported as if they were from a patient and lab is then graded on their performance to ensure they are meeting the standard What term describes the consistency or reproducibility of a test that considers chance/random errors? ✔✔ Reliability What term examines if the test is measuring what it is supposed to measure, and may be affected by bias, safety, acceptability, and cost? ✔✔ Validity

What are the four indicators that are most commonly used to determine the reliability and validity of a clinical lab test? ✔✔ Precision and Accuracy (how well test performs from day to day) as well as Sensitivity and Specificity (how well test is able to distinguish presence from absence of disease) What is a measure of repeatability, when repeated analyses on the same sample give similar results and the amount of random variation is small? ✔✔ Precision What is a measure of the truness of the test, when the results are compared to known controls and are compared to the gold standard? ✔✔ Accuracy What is the ability of a test to correctly identify individuals who have a given disease or condition? ✔✔ Sensitivity If a test has 100% sensitivity, what conclusion can we draw about someone with a negative result? ✔✔ The disease has absolutely been ruled out (absent) in this patient (SnOut) What are tests with high sensitivity best used for? ✔✔ Screening, (negative results are definitely negative) although they will have a higher number of false positives that must go on for confirmatory testing What is the ability of a test to correctly exclude individuals who do not have the given disease or condition? ✔✔ Specificity

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If a test has 100% specificity, what conclusion can we draw about someone who has a positive result? ✔✔ The disease can absolutely be ruled in (present) in this patient (SpIn) What are tests with a high specificity best used for? ✔✔ Confirmatory testing (positive results are definitely positive) What is the difficulty with changing the cut-point to make a test more sensitive or more specific? ✔✔ You can only improve one, never both (making a test more sensitive will increase number of false positives, making a test more specific will increase number of false negatives) What is the proportion of subjects with a positive test result who are correctly diagnosed? ✔✔ Positive predictive value What is the proportion of subjects with a negative test results who are correctly diagnosed? ✔✔ Negative predictive value What is the difference between apparent prevalence and true prevalence? ✔✔ Apparent prevalence is the total number of positive cases in the population divided by the number of individuals in the population, while the true prevalence also takes into account the actual number of diseased individuals (not just those who have a positive test result) What effect will a higher prevalence have on the PPV? ✔✔ Increased prevalence should increase the PPV

What effect will a lower prevalence have on the NPV? ✔✔ Decreased prevalence should increase NPV Why would a PPV appear higher in a specialty clinic than in a primary care setting for a disease? ✔✔ The patient population in a specialty clinic is more likely to be seen in the specialty because they have the disease, compared to primary care that may see a larger variety of diseases How are reference ranges established? ✔✔ By testing a significant number of healthy individuals so that approximately 95% of clinically normal individuals will have test results that fall within +/- 2 standard deviations What percent of the healthy population will yield an abnormal result? ✔✔ 5% (95% will fall within the 2 standard deviations) What is the difference between a pathological rage and a functional range? ✔✔ Pathological range diagnoses disease (only includes abnormal low, normal, and abnormal high) while Functional range assesses the risk for disease before it actually develops (includes abnormal low, functional low, functional range, functional high, and abnormal high) What type of microscope has a background that is lighter than the observed specimen, and the specimens require fixing and staining (CBC, urine sediment, etc)? ✔✔ Bright-field microscope The bright-field (light) microscope has ____ magnification but _____ resolution? ✔✔ High; low

What is the main benefit of phase-contrast microscopy? ✔✔ The structures being studied are unstained, which means they can still be alive (ex. Yeast) What is the ability to rotate or polarize light that is typically used to distinguish between gout and pseudogout? ✔✔ Birefringence (in polarizing light microscopes) What type of samples are best viewed under darkfield microscopes? ✔✔ Unfixed, unstained specimens, and living organisms especially Spirochetes (syphilis) What type of specimens are best viewed by fluorescence microscopes? ✔✔ Infectious diseases and fluorescent antibody techniques (Anti-nuclear antibodies/ANAs) What type of cells will be looked for in a urine sediment examination? ✔✔ RBCs, WBCs, Epithelial cells, Casts, Crystals What are casts? ✔✔ Formed elements of urine that originate from the kidney when there is an acidic environment, increased proteins, and stasis (no flow) that usually have a cylindrical appearance What type of crystals can be found in normal acidic urine? ✔✔ Uric acid, calcium oxalate

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What type of crystals can be found in normal alkaline urine? ✔✔ Calcium phosphate, magnesium phosphate, calcium carbonate, ammonium biurate What type of crystals can be found in abnormal urine? ✔✔ Cystine, Tyrosine, Leucine, Sulfonamide, Ampicillin What is a Saline Wet prep typically used for? ✔✔ Detect presence or absence of bacteria, fungi, parasites (especially used for vaginal smears to look for Trichomonas vaginalis, clue cells, and yeast) What are the requirements for Trichomonas to be identified? ✔✔ Must be motile (has flagella) Which test is often performed after the saline wet prep and dissolves tissue material in vaginal secretions, nails, and skin scraping to leave only fungal elements intact? ✔✔ Potassium hydroxide (KOH Prep) What is the purpose of the Fern test? ✔✔ Determines if rupture of the fetal membranes has occurred before the onset of labor (amniotic fluid crystallization) What is the purpose of the postcoital test? ✔✔ Evaluates infertility by collecting cervical mucus 2-8 hours after intercourse to look for consistency, ferning, and ability of spermatozoa to penetrate mucus

What are the three main areas that a semen analysis focuses on? ✔✔ Motility, morphology, and sperm count to determine infertility, successful vasectomy, or successful vasectomy What condition will a nasal smear most likely help to diagnosis? ✔✔ Allergic rhinitis What are the main benefits of POC testing? ✔✔ Shortened turnaround time for critical results, convenience for both patients and caregivers, and results in 30 minutes or less What are the main limitations of POC testing? ✔✔ Lack of knowledge and training, QA, accountability What are the main indications for therapeutic drug monitoring? ✔✔ Prescribed drug has low margin of safety, evaluate patient compliance, distinguish disease symptoms from drug toxicity, no objectively measured endpoint for treatment goal, prescribed drug has significant pharmacokinetic variability What is the term for when the same dosage of a drug produces a therapeutic effect in one patient and a toxic effect in another? ✔✔ Unpredictable dose response What are the four processes that can be quantified by pharmacokinetics? ✔✔ Absorption, distribution, metabolism, excretion What do insoluble drugs require in order to be distributed? ✔✔ Protein carrier (albumin)

What is the therapeutically active fraction of the drug? ✔✔ Free fraction (non-protein bound) What is the sum of the free and protein bound drug that most lab assays measure? ✔✔ Total drug concentration What is the range of drug concentrations within which the probability of the desired clinical response is high and the probability of an unacceptable toxicity is relatively low? ✔✔ Therapeutic range What occurs below the minimum effective concentration? Above the minimum toxic concentration? ✔✔ Below- therapeutic effect is not achieved; Above- symptoms of toxicity appear What is the lowest therapeutic concentration achieved during a dosing cycle that usually occurs right before the next dose? ✔✔ Trough value What is the highest therapeutic concentration achieved during a dosing cycle that should be below the minimum toxic concentration? ✔✔ Peak value How many half-lives are required after initiation of drug therapy to reach a nearly complete steady state? ✔✔ 5 half-lives (also required for near complete elimination)

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What is the term for when the rate of the drug entering the body is equal to the rate of the drug eliminated from the body? ✔✔ Steady state What is the primary site for drug metabolism? What about polar, non-lipophilic drugs? ✔✔ Liver; renal excretion How could a blood sample being drawn at the wrong time affect the results? ✔✔ May not get accurate results if steady state has not yet been achieved, or may not get accurate trough or peak levels if it is not the right time in the dosing cycle What is the specimen of choice for therapeutic drug monitoring? ✔✔ Serum (red top tube) How can a light blue top (sodium citrate) affect drug concentrations? ✔✔ Decreases concentration of anticonvulsants How can gel separator tubes affect drug concentrations? ✔✔ Some drugs will bind to gel separator, leading to falsely decreased results How can grey top tubes (sodium fluoride) affect drug concentrations? ✔✔ They preserve alcohol concentrations How can green top tubes (heparin) affect drug concentrations? ✔✔ Activates lipoprotein lipase and causes fatty acids to displace drug from albumin

If it has only been a short time since ingestion, what is the best specimen to test for a toxin? Moderate amount? Long time? ✔✔ Short- gastric (unless injected) Moderate- blood Long- urine What is the graph that utilizes a serum acetaminophen level plus a known time interval since ingestion to predict whether a toxic amount was ingested? ✔✔ Nomogram (Rumack-Matthew) What is typically used in drug screening? What about confirmatory drug testing? ✔✔ Labeled immunoassays (high sensitivity); Chromatography Methods (specific) Which type of drugs likely require monitoring more closely? ✔✔ Those with a narrow therapeutic window/range and those with a high % protein binding (in those with liver disease) What are the normal characteristics of CSF? ✔✔ Clear, colorless, sterile fluid with normal vol of 90-150 mLs that turns over every 5-7 hours A test for CSF will always be ___? ✔✔ STAT What are the different possible causes of meningitis? ✔✔ Bacterial (life-threatening) Viral (self-limiting)

Fungal (AIDS) Parasitic (99.9% fatal) What is the most common cause of encephalitis? ✔✔ Viral How much CSF should be collected during a lumbar puncture? ✔✔ 4 plastic tubes 10 drops of CSF in EACH tube (minimum) What will each tube of CSF collected be tested for? ✔✔ Tube 1: Chemical and Serologic tests (glucose/protein) Tube 2: Microbiology (gram stain/cultures) Tube 3: Hematology (total cell counts/differentials) Tube 4: Additional tests Normally, there are ____ RBCs, ____ WBCs, and ____ glucose in CSF ✔✔ No; 0-8 cells; 45-85 How will a bacterial infection present in CSF? ✔✔ 200-200,000 PMNs, low glucose, and high protein How will a viral infection present in CSF? ✔✔ 100-1000 lymphocytes, normal glucose, and high protein

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How will a fungal infection present in CSF? ✔✔ 100-1000 lymphocytes, low glucose, high protein How will a parasitic infection present in CSF? ✔✔ Eosinophils, normal-low glucose, high protein Which type of serology testing can be used to detect neurosyphillis in CSF? ✔✔ Venereal Disease Reseach Laboratory What are the main differences between Transudate and Exudate? ✔✔ Transudate forms because of a systemic disorder, has normal amounts of protein, no neutrophils, and normal glucose and LDH Exudate is a local accumulation of fluid that has increased protein, increased neutrophils, decreased glucose, and increased LDH What is the normal visual appearance of serous fluid? ✔✔ Clear and straw colored with low viscocity What substance differentiates synovial fluid from all other fluids in the body? ✔✔ Mucopolysaccharide hyaluronic acid What are the different classifications of synovial fluid in joint disease? ✔✔ Class I- Noninflammatory (osteoarthritis) Class II- Immunologic diseases (SLE/RA)

Class III- Infectious Hemorrhagic (trauma/injury) Crystal induced- Gout/pseudogout Why should all synovial fluids have a gram stain and culture performed? ✔✔ To rule out Acute Bacterial Arthritis (most rapidly destructive joint disease) How can you distinguish Monosodium Urate Crystals (Gout) from Calcium Pyrophosphate Crystals (Pseudogout)? ✔✔ Gout- yellow in parallel light, blue in perpendicular light Pseudogout- blue in parallel light, yellow in perpendicular light What are the guidelines for a proper semen specimen collection? ✔✔ Following 3 days of sexual abstinence, collect in a sterile container and deliver to lab within 30 minutes What are the conditions that can be tested with an amniotic fluid examination? ✔✔ Chromosomal defects, Neural tube defects (using AFP), Hemolytic disease, and Fetal Pulmonary Development

IPAP Clin Lab Test 1

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