PALS Exam I Questions and Answers

Primary utilizations of laboratory tests for pharmacists: - ANSWER -Health screenings -Monitoring of drug therapy -Evaluation of clinical course of a disease -NOT FOR DIAGNOSIS Potassium - ANSWER Plays a key role in: -Regulation of nerve excitability -Acid base balance -Muscle function Cardiac function and neuromuscular function can be significantly affected by either an increase or decrease in potassium levels. Basic Metabolic Panel - ANSWER Provides information about the current health of your kidneys and respiratory system as well as electrolyte, acid/base balance, and glucose levels. When is it used? For diagnosis of a problem affecting kidneys, electrolyte imbalance, or acid base imbalance. Can be helpful when someone has general symptoms like fatigue, confusion, prolonged vomiting or breathing problems. Sodium (Na+): 135-147 mEq/L Potassium (K+): 3.5-5.0 mEq/L Chloride (Cl-): 95-105 mEq/L CO2 content (Bicarbonate - HCO3): 22-28 mEq/L Serum Creatinine (SCr): 0.6-1.2 mg/dL Blood Urea Nitrogen (BUN): 6-20 mEq/L Glucose (Glu): 70-99 mg/dL Sodium - ANSWER Important in regulating: -serum osmolality -fluid balance -acid-base balance In addition, sodium also assists in maintaining the electric potential necessary for transmission of nerve impulses. Chloride - ANSWER Passive role in the maintenance of fluid balance and acid-base balance. Serum chloride values are useful in identifying fluid or acid-base balance disorders. Bicarbonate (HCO3) - ANSWER CO2 content is composed mostly of bicarbonate and is a base. CO2 content is regulated by the kidneys. Glucose - ANSWER Important energy source for most cellular functions Blood Urea Nitrogen - ANSWER End product of protein catabolism. It is produced in the liver, transported in the blood, and cleared by the kidneys. BUN concentration serves as a marker of renal function. Comprehensive Metabolic Panel - ANSWER Includes all of the BMP components along with the addition of the health of your liver and important blood proteins. When is it used? Often used to evaluate liver function, kidney function, and nutrient levels. Offers a broad loo at different functions of the body. Electrolyte panel - ANSWER Helpful for detecting a problem with the body's fluid and electrolyte balance Liver panel - ANSWER also called Hepatic Function Panel. Used to screen for, detect, evaluate and monitor acute and chronic liver inflammation (hepatitis), liver disease, and/or damage Renal panel - ANSWER Also called kidney function panel. Contains tests such as albumin, creatinine, BUN, and eGFR to evaluate kidney function When is it ordered? As a diagnostic when you have symptoms that can be explained by a kidney problem or general symptoms without a clear cause, or when being evaluated in an emergency setting. As a screening if you have risk factors for kidney disease like HBP, diabetes, and family history. For these people it can be part of a normal checkup. For monitoring if you have had kidney problems, an abnormal renal panel, on treatment for kidney injury or disease, medical procedure that can impair kidney function. Thyroid Function Panel - ANSWER When is it ordered? To help evaluate thyroid gland function and to help diagnose thyroid disorders. And to monitor treatment of hyperthyroidism and assess patients receiving levothyroxine therapy. Complete Blood Count (CBC) - ANSWER When is it ordered? During routine medical exams, when you have signs and symptoms that may be related to a condition that affects red blood cells, to monitor treatment or disease status, when recieving treatment known to affect red blood cells. Hemoglobin (Hgb): 14-18 g/dL Hematocrit (Hct): 12-16 g/dL White Blood Cells (WBC): 4,500 - 10,000 mcL Platelets (Plts): 150,000 -450,000 mcl Hemoglobin - ANSWER direct indicator of the oxygen-carrying capacity of the blood Hematocrit - ANSWER Describes the volume of blood that is occupied by RBCs. White Blood Cells - ANSWER The total number of WBCs in a given volume of blood. Platelets - ANSWER A critical element in blood clot formation Lipoprotein Panel (Lipid Panel) - ANSWER When is it ordered? To evaluate risk of cardiovascular diseases like heart disease, stroke, and heart attack. Evaluates cardiovascular health by analyzing cholesterol in the blood. Total Cholesterol (TC): <200 mg/dL Triglycerides (TG): <150 mg/dL HDL: >40 mg/dL LDL: <130 mg/dL Total Cholesterol (TC) - ANSWER Associated with an increased risk of developing coronary heart disease (CHD) Triglycerides (TG) - ANSWER The main storage form of fatty acids, and they account for greater than 90% of dietary fat intake. High-Density Lipoprotein (HDL) - ANSWER High-density lipoproteins are responsible for transport of 20-30% of serum cholesterol. HDL removes excess cholesterol from peripheral tissues to the liver. It is considered the "good" cholesterol, and elevated HDL levels are associated with a decreased risk for CHD. Low-Density Lipoprotein (LDL) - ANSWER Low-density lipoprotein is a major cholesterol transport protein which comprises 60-70% of total serum cholesterol. LDL is considered the "bad" cholesterol, and has been linked to atherosclerosis. Urinalysis - ANSWER When is it ordered? When you have symptoms, such as abdominal pain, back pain, frequent urination, painful urination, pregnancy check up, pre surgical. Appearance/color: clear - dark yellow Specific Gravity: 1.002-1.030 pH: 4.5-8 Protein: 0-1 Glucose: Negative Ketones: Negative Blood: Negative to trace Bilirubin: 0-trace Leukocyte esterase: 0-trace Nitrites: Negative Specific Gravity (SG) - ANSWER An indication of the ability of the kidney to concentrate urine pH - ANSWER Urine is normally acidic Protein - ANSWER Repeated positive tests or proteinuria of >150 mg/dL may be a marker of renal disease. Glucose (Urinalysis) - ANSWER Glucose begins to spill into urine when serum blood glucose is >_ 180mg/dL. Ketones - ANSWER Form when carbohydrate metabolism is altered Blood - ANSWER May indicate urinary tract damage Bilirubin - ANSWER Bilirubin in the urine usually produces a dark yellow or brown color. May be associated with liver disease. Leukocyte esterase - ANSWER Positive leukocyte esterase provides an indication of WBCs in the urine Nitrites - ANSWER Gram-negative bacteria are capable of converting dietary nitrates to nitrites. Point of Care tests - ANSWER -Most commonly done with handheld devices/kits -Convenient Pharmacists use POC testing to: -Increase access to care -Identify patients in need of education -Assist in monitoring patients response to therapy Common Point of Care Tests - ANSWER -Self-Monitoring Blood Glucose -Hemoglobin A1c -International Normalized Ratio -Lipid Panel Self-Monitoring Blood Glucose - ANSWER Common indication: Prediabetes and diabetes Invasive? Yes. Requires at least 1 mL (1 drop) of blood When is it used? Used in prediabetes and diabetes monitoring, monitor response to therapy Hemoglobin A1c - ANSWER Common indication: Diabetes Invasive? Yes. Requires ~ 1-2 drops of blood When is it ordered? Screening for prediabetes and diabetes (high risk patients), diagnosing for diabetes and prediabetes, and for monitoring diabetes. International Normalized Ratio (INR) - ANSWER Common indication: Patients on warfarin Invasive? Yes. Requires 1 drop of blood When is it ordered? It is used when a patient is on warfarin or other blood thinning medications to check for bleeding conditions, blood clotting problems, and how well your liver is working. Lipid Panel - ANSWER Common indication: Dyslipidemia Invasive? Yes, requires 3 drops of blood Common Screening Tests - ANSWER -Pregnancy -Ovulation -HIV -Fecal Occult Blood Test Guaic Smear Metod (gFOBT) -Immunochemical method (iFOBT/FIT) Pregnancy Test (hCG test) - ANSWER Tests for presence of human chorionic gonadotropin (hcG) Invasive? No, requires urine sample When is it ordered? Pregnancy symptoms and when the patient has symptoms that suggest gestational trophoblastic disease or germ cell tumor. Ex. vaginal bleeding during pregnancy and enlarged uterus after pregnancy. Ovulation Test - ANSWER Measures Luteinizing Hormones (LH) Invasive? No. Requires urine or saliva sample When is it ordered? When women are having trouble getting pregnant or having irregular or heavy menstrual bleeding. For men when their partner can't get pregnant, low sperm count, low muscle mass, or decreased sex drive. In children when early or delayed puberty is suspected. In all people if there are symptoms of a pituitary or hypothalamic disorder. Human Immunodeficiency Virus (HIV) Test - ANSWER -Home Access HIV-1 Test: requires finger prick blood sample -OraQuick In Home HIV Test: Requires check swabs for oral fluid samples When is it ordered? Routine screening test is completed at annual doctors visit, diagnostic test after possible exposure to HIV, or in patients with symptoms of an HIV infection. Fecal Occult Blood Test Guaic smear method (gFOBT) - ANSWER -Chemical based paper that detects presence of blood in stool -Positive test: abnormal bleeding in digestive tract -Can indicate: Ulcers, hemorrhoids, tumors When is it used? Colorectal cancer screening test that should be completed once annually at age 45, also used when there is blood in the stool. Immunochemical method (iFOBT/FIT) - ANSWER -Antibodies that detect hemoglobin in stool -Positive test: bleeding in lower digestive tract -More specific than gFOBT (Follow up test must be done if positive) When is it used? Colorectal cancer screening test that should be completed once annually at age 45, also used when there is blood in the stool. Recommended Lab Monitoring for Diuretics - ANSWER -Electrolytes -Renal function -Glucose -Uric acid Monitoring for ACE Inhibitors and ARBs - ANSWER -Serum Creatinine -Potassium -Blood Pressure Monitoring for Statins - ANSWER -Lipids -Liver enzymes (ALT- alanine aminotransferase) -Creatinine kinase (for pts w/ increased risk of rhabdomyolysis) -Creatinine and Urinalysis - if severe muscle symptoms or fatigue -Monitor for new onset diabetes Monitoring for Metformin - ANSWER -Hemoglobin A1c -Renal panel (serum creatinine) -Self-monitoring of blood glucose Monitoring for Digoxin - ANSWER -Digoxin level monitoring (for elderly, kidney/liver disease, toxicity symptoms, taking an interacting med) -Serum creatinine Monitoring for Warfarin - ANSWER -Prothrombin Time (PT) -Internationalized National Ratio (INR) Monitoring for Levothyroxine - ANSWER Thyroid Stimula