What can cause Ulysses syndrome?

Incorrect test values, false positives, or isolated individual variations

What is included in the standard precautions?

Hand washing, gloves, mask/eye protection/face shield, gown

What are some appropriate reasons for screening patients?

Dz is prevalent, life-threatening, disabling, or financially burden

The utility, sophistication, variety, and availability of tests continue to grow along with _______.

The clinician's dependence upon them

What has new technology done regarding diseases?

Help identify them (such as hepatitis D, C, E, and others)

How is urine collected?

Spot (random/sterile), timed, or 24-hour

What are the three sources of the specimen?

Arterial, venous, or capillary blood

What are the four limitations (due to variability) regarding labs?

Biologic, pre-analytic, analytic, post-analytic

Why are improperly filled tubes bad?

Dilution of blood sample by anticoagulants and additives

Why do reference ranges vary from one laboratory to another?

Different methodologies, instrumentation, reagents, etc.

What is released from hemolysis?

Hemoglobin and other RBC contents (potassium, LDH, AST, ALT)

What is capillary blood composed of?

Venous/arterial blood and tissue fluid

How does hemolysis cause test interferences?

Changes the normal color of serum/plasma

What three things determine how well a lab test is able to distinguish disease from the absence of disease?

Sensitivity, specificity, and predictive values

What is hemoconcentration?

low venous return; causes leakage of cell contents

What are lab tests helpful for?

Confirm diagnoses and offer treatment options

What do monitoring tests evaluate?

The course of a dz, effectiveness of drug therapies, and/or complications

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Introduction to Clinical Laboratory Testing

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Questions 125

Answers

1
The clinician must use the ranges established for that laboratory.
True
False
2
What can cause Ulysses syndrome?
Overuse of imaging scans
Incorrect test values, false positives, or isolated individual variations
Poor doctor-patient communication
Lack of patient symptoms
3
What is included in the standard precautions?
Handwashing only after contact with visibly soiled surfaces
Only gloves and face masks for infectious patients
Hand washing, gloves, mask/eye protection/face shield, gown
Regular cleaning of the facility without personal protective equipment
4
What are some appropriate reasons for screening patients?
To increase hospital revenue
To provide unnecessary treatment
To conduct experimental research without consent
Dz is prevalent, life-threatening, disabling, or financially burden
5
Do alkaline phosphatase levels increase or decrease during pregnancy?
Decrease
Increase
Only increase postpartum
Remain constant
6
What describes the ability of a test result to be normal (negative) in patients that do not have a disease?
Sensitivity
Specificity
Predictive value
False positivity
7
What limitation describes bad lab technique/methods or equipment?
Analytic
Biologic
Pre-analytic
Post-analytic
8
What process allows cellular elements to be drawn to the bottom of the tube, where clear fluid serum sits on the top?
Centrifugation
Diffusion
Precipitation
Filtration
9
What serves as a basis of comparison in one patient compared to the statistics of a large population?
Predictive indexes
Sensitivity coefficient
Normal or reference ranges
Genetic predisposition
10
What have the new technologies done in areas such as immunology, neoplastic disease, metabolic, and genetic disorders?
Increased knowledge
Eliminated the need for blood tests
Reduced testing costs significantly
Made physical exams obsolete
11
What can occur from poorly flowing venipuncture or traumatic draws?
Increased platelet count
Increased calcium levels
Hyperglycemia
Hemolysis
12
How does lipemia (increased TAG) cause test interferences?
Alters glucose readings
Causes hemolysis
Decreases platelet count
Causes turbidity
13
Results may be within a reference range but be altered from a patient's _____.
Family history
Insurance records
Physician preference
Baseline
14
The more specific a test, the fewer _____ results it produces.
False-negative
True-positive
Indeterminate
False-positive
15
The result of a ______ gives a person the sense of being disease-free when in fact they are not.
False-negative
True-positive
False-positive
Predictive failure
16
The utility, sophistication, variety, and availability of tests continue to grow along with _______.
The number of medical schools
The clinician's dependence upon them
The reduction of diseases
The decline in medical costs
17
Does a plasma sample contain fibrinogen and unactivated coagulation proteins?
Yes
No
18
What has new technology done regarding diseases?
Eliminate the need for confirmatory tests
Prevent all genetic disorders
Reduce false positives to zero
Help identify them (such as hepatitis D, C, E, and others)
19
Out of the four lab limitations, which is the most important to consider?
Post-analytic
Pre-analytic
Analytic
Biologic
20
Is an anticoagulant used in a serum sample?
No
Yes
21
How is urine collected?
Spot (random/sterile), timed, or 24-hour
By blood filtration tests
Through intravenous extraction
Only through catheterization
22
What percentage of all expenditures for health care do lab tests generate?
15%
25%
5%
10%
23
What is the probability that a result correctly classifies the pt as normal/abnormal, correctly identifying dz state?
Predictive value (PV)
Specificity coefficient
Clinical accuracy score
Sensitivity ratio
24
What are the three sources of the specimen?
Plasma, serum, or whole blood
White blood cells, red blood cells, or platelets
Blood, cerebrospinal fluid, or urine
Arterial, venous, or capillary blood
25
What is it called if the test missed the disease when it was actually there?
Predictive failure
False negatives
True negatives
True positives
26
What are the four limitations (due to variability) regarding labs?
Patient age, diet, gender, and exercise
Cost, availability, regulation, and insurance coverage
Technological advances, equipment, personnel, and location
Biologic, pre-analytic, analytic, post-analytic
27
Why are improperly filled tubes bad?
Inaccurate protein measurements due to plasma loss
Increased oxygen concentration in the blood sample
Altered enzyme levels due to increased blood flow
Dilution of blood sample by anticoagulants and additives
28
What limitation describes race/ethnicity, gender, and individuality?
Analytic
Pre-analytic
Biologic
Post-analytic
29
What type of test is this example: a diabetic regularly monitors blood glucose as a point-of-care testing at home?
Monitoring test
Predictive test
Genetic test
Screening test
30
What is the ability of a test to detect a disease, where the disease is really there?
Predictive value
Sensitivity
Accuracy
Specificity
31
Why do reference ranges vary from one laboratory to another?
Patient demographics
Different methodologies, instrumentation, reagents, etc.
Government-mandated values
Geographic differences in disease prevalence
32
What is released from hemolysis?
Albumin and fibrinogen
Insulin and glucose
Platelets and leukocytes
Hemoglobin and other RBC contents (potassium, LDH, AST, ALT)
33
What is capillary blood composed of?
Only venous blood
Venous/arterial blood and tissue fluid
Only arterial blood
Only red blood cells
34
What describes the CDC guideline healthcare workers are mandated to follow to prevent the spread of all pathogens?
Infection risk management
Lab safety protocol
Personal protective equipment policy
Standard precautions
35
How does hemolysis cause test interferences?
Alters white blood cell count
Changes the normal color of serum/plasma
Decreases red blood cell count
Lowers glucose levels
36
What three things determine how well a lab test is able to distinguish disease from the absence of disease?
Sensitivity, specificity, and predictive values
Hospital location, test time, and staffing levels
Age, gender, and ethnicity
Cost, availability, and insurance coverage
37
A person may get a ______ if they test too soon after the initial infection (less than 6 weeks).
Indeterminate result
False-negative
False-positive
True-positive
38
Are lab tests perfect, even under the best of circumstances?
Yes
Only for infectious diseases
No
Only for genetic conditions
39
What is another name for the predictive value?
Laboratory accuracy value
True-positive rate
Sensitivity index
Post-test probability
40
Tumor markers are an example of what type of test?
Screening test
Reflex test
Monitoring test
Imaging test
41
What is hemoconcentration?
A decrease in red blood cells due to excessive blood loss
low venous return; causes leakage of cell contents
Increased oxygen transport in the blood
The dilution of plasma due to excessive fluid intake
42
What must you do with the tube during a whole blood sample?
Mix it well
Expose it to sunlight
Store it immediately at -20°C
Let it clot
43
What can cause errors in measurements?
Testing location
Test interference
Sample color
Patient hydration levels
44
Blood should be drawn from an arm with IV fluid being infused.
False
True
45
What are lab tests helpful for?
Eliminating the need for clinical evaluations
Confirm diagnoses and offer treatment options
Determining patient insurance costs
Replacing physical exams entirely
46
+/- 3 standard deviations include what percentage of the population?
60%
99.7%
80%
90%
47
What type of test would you perform if a patient comes in complaining of jaundice, light stools, dark urine?
Screening test
Allergy test
Diagnostic test
Genetic test
48
How does aspirin affect lab results?
Lowers cholesterol
Decreases platelet aggregation
Raises hemoglobin
Increases glucose levels
49
What do monitoring tests evaluate?
Patient stress levels only
The course of a dz, effectiveness of drug therapies, and/or complications
Insurance eligibility
Daily diet choices
50
Any laboratory result may be incorrect for a variety of reasons regardless of the high quality of the laboratory.
False
True
51
What should be included when labeling a tube?
Test type and physician name
Patient weight and blood type
Lab technician initials and patient name
Name AND ID #
52
Lab tests should ideally only be performed if they aid in what four components regarding patient care?
Diagnosis, prognosis, treatment, or management of the patient
Marketing, pharmaceutical sales, research funding, or clinic popularity
Hospital ranking, patient reviews, accreditation, or reputation
Billing, insurance approval, documentation, or legal evidence
53
Do TSH levels increase or decrease in pregnancy?
Increase
Fluctuate randomly
Remain unchanged
Decrease
54
Increased exercise levels increase which enzymes found in muscles?
White blood cells
Plasma enzymes
Hemoglobin levels
Iron stores
55
What is a true negative?
A weakly positive result
A positive test in a healthy person
A false lab result
Result of normal/no disease
56
Using Gaussian (Normal) distribution, what describes the average result calculated from the random sample?
The range
The median
The mode
The mean
57
Positive PV = ____/_____
Total true positive results; total + results [true pos + false pos]
Sensitivity coefficient; specificity coefficient
Total negative results; total tested patients
False positive rates; total test population
58
What is the definition of a baseline?
The lowest possible lab value
The average value of the general population
The highest recorded lab result
Values obtained when the patient is not ill
59
What determines “normal” values?
Patient-reported symptoms alone
Arbitrary selection by medical boards
Values assigned based on population preferences
random sample of “typical” members of a population is taken; 95% is normal
60
8-test panel, _% of patients have 1 or more abnormal results; 20-test panel, _% of patients have 1 or more abnormal
10%; 50%
20%; 64%
5%; 40%
30%; 75%
61
What limitation describes transcription and interpretation errors?
Biologic
Analytic
Pre-analytic
Post-analytic
62
What is a false positive?
A true positive with low sensitivity
A confirmed test result showing disease presence
A false result, pt was hold they are +, but does not truly have specific dz
A test result that is inconclusive
63
+/- 1 standard deviation includes what percentage of the population?
50%
95%
68%
99%
64
Is an anticoagulant used in a plasma sample?
No
Yes
65
Needles and sharp objects are discarded in a rigid, puncture-proof container w/o touching them or replacing needle caps.
True
False
66
An increased production of which neurotransmitters can cause an increase in glucose and cortisol?
GABA and melatonin
Dopamine and endorphins
Serotonin and catecholamines
Acetylcholine and histamine
67
+/- 2 standard deviations include what percentage of the population?
95%
75%
99.7%
50%
68
Besides an anticoagulant, what is contained in a whole blood test tube?
Only plasma
Plasma and cells
Only white blood cells
Only red blood cells
69
What term defines free from disease, “healthy,” average, typical, or usual?
Abnormal
Normal
Pathologic
False positive
70
What do the Universal Precautions emphasize?
The importance of only wearing gloves in high-risk situations
The need to treat all blood and body fluids as potentially infective
The elimination of handwashing in routine care
The need for separate testing protocols for each patient
71
What is often a better reference value than standard normal ranges?
The median range of healthy individuals
The hospital's average values
Previous baseline values
Population estimates
72
Do lipid levels increase or decrease during pregnancy?
Increase
Stay the same
Only increase in the first trimester
Decrease
73
What is an example of cyclical variations?
Lung capacity is different in the morning versus night
Stomach acid levels change based on dietary intake
All pituitary and certain other hormonesvariations (cortisol, melatonin)
Blood pressure fluctuates randomly throughout the day
74
What body fluid, besides blood, is very important?
Tears
Sweat
Urine
Saliva
75
What may someone be subjected to with a false positive test?
Potentially painful/dangerous treatment, more expense, unwarranted anxiety
Immediate release from hospital care
No further medical evaluation
Reduced medical costs
76
Are labs the end-all-be-all in treating a patient?
No, the clinician must also be mindful of patient individuality
Yes, lab results are the most accurate diagnostic tool.
Yes, lab values are always definitive.
Only when imaging studies confirm the results.
77
Typical implies healthy.
True
False
78
Which are considered specimen collection factors?
improperly filled tube
contamination by anticoagulants/additives
all of the above
Tourniquet use
79
Increased levels of CPK, AST, and LDH could be confused with what?
Diabetes
Osteoarthritis
Vitamin deficiency
Liver or heart disease
80
Screening tests look for diseases in ______ individuals.
Symptomatic
Immunocompromised
Asymptomatic
Hospitalized
81
What component becomes particularly important when seeking to exclude a dangerous dz?
Test availability
Patient history
Cost-effectiveness
Sensitivity
82
What describes a specific kind of screening where a patient with symptoms of one disease is tested for another disorder?
Case finding
Mass screening
Genetic profiling
Preventive medicine
83
Monitoring prothrombin time results for coumadin therapy is what type of test?
Reflex test
Genetic test
Monitoring test
Diagnostic test
84
Specificity = ____/____
Pts without disease who test negative; all patients without the disease
Sensitivity ratio; positive predictive value
Patients with disease who test positive; all tested patients
Total false positives; total false negatives
85
What limitation describes diet, exercise, and medications?
Analytic
Post-analytic
Biologic
Pre-analytic
86
What are four reasons for doing laboratory testing?
PR, medical licensing, hospital rankings, and government funding
Research studies, medical billing, marketing, and staff training
Hospital budgeting, pharmacy sales, new drug approvals, and media campaigns
Screening tests, case findings, diagnostic tests, monitoring tests
87
The results are _____ if they correctly detect the disease.
False positives
False negatives
Indeterminate
True positives
88
Can absorption of food constituents alter lab results?
Yes
Only in elderly individuals
No
Only in diabetic patients
89
Tourniquet use can lead to what?
Dehydration
Hemoconcentration
Hypoglycemia
Leukopenia
90
Negative PV = __/__
Total positive results; total tested patients
Total true negative results; total negative results [true neg + false neg]
Specificity ratio; sensitivity ratio
True positive rates; false negative rates
91
The more sensitive a test is, the fewer ______ results will be produced.
False negative
False positive
Indeterminate
True negative
92
76 out of 100 patients test negative that do not have a certain disease. What is the specificity?
50%
76%
90%
40%
93
Will a plasma sample clot?
Yes
No
94
What are some examples of conditions for screening (and case finding)?
Reflex test for blood disorders, ECG for skin infections
Total and HDL CHOL for CAD, fecal occult blood colon CA, PSA prostate CA
Allergy testing for broken bones, hearing test for migraines
EEG for diabetes, lung biopsy for osteoporosis, spinal tap for hypertension
95
What assesses all lab tests to minimize possibility of errors that may lead to erroneous diagnosis and treatment of pts?
General practitioner notes
Clinical laboratory medicine
Public health studies
Insurance claim assessments
96
The test detects 85 patients out of 100 people that we know have a certain disease. What is the sensitivity?
85%
50%
70%
95%
97
Patients without the disease could have a ____ negative or a ______ positive.
False; uncertain
True; false
True; indeterminate
Indeterminate; false
98
What causes alterations in normal physiologic state, such as biologic changes due to hormonal adaptations?
Medication side effects
Stress
Increased hydration
Temperature changes
99
Why can chilling or icing the specimen after collection alter the specimen itself?
Contamination with external bacteria
Decreased platelet function
Changes in metabolism and enzymatic processes
Increased risk of hemolysis
100
How does alcohol specifically affect lab results?
Increased platelet aggregation
Increased red blood cell count
Decreased glucose levels
Increased triglycerides
101
Prolonged fasting causes increased _____ circulation.
Glucose
Insulin
Ketone
Cortisol
102
What is the sensitivity of the ELISA test method?
50%
60%
Over 99%
75%
103
What is the most commonly used body specimen?
Saliva
Cerebrospinal fluid
Blood
Urine
104
How is glucose tolerance affected in pregnancy?
No change
Decreased
Only affected in the third trimester
Increased
105
T/F: Increasing lab tests has improved the quality of healthcare by providing more accurate diagnostic information.
True
False
106
Does thyroid hormone production increase or decrease during pregnancy?
Remain unchanged
Decrease
Increase
Only increase in the second trimester
107
What category does the majority of testing fall under?
Diagnostic test
Monitoring test
Experimental test
Screening test
108
What test assists the diagnosis of a patient with symptoms that may be common to several disorders?
Genetic markers
Screening tests
Diagnostic tests
Therapeutic tests
109
Healthcare workers use standard precautions in the care of all patients.
True
False
110
Values outside the range do not necessarily indicate disease.
True
False
111
How is capillary blood obtained?
urine test
Skin puncture
breath test
Bone marrow aspiration
112
Do medications frequently cause altered lab test results?
Yes
Only in patients with kidney disease
Only in elderly patients
No
113
What test method is usually used to screen for the HIV antibody?
ELISA
PCR
Flow cytometry
Western Blot
114
What is the definition of Ulysses Syndrome?
A rare autoimmune disease
Loss of time, money, and peace of mind
A disorder caused by excessive blood draws
A severe allergic reaction to laboratory testing
115
What are 5 tests that increase accuracy and diagnostic value due to newer technologies?
ECG, EEG, spirometry, urinalysis, biopsy
ELISA, Western blot, Gram staining, patch test, stress test
Monoclonal antibody, DNA probes, polymerase reaction, hormone assays, FC
MRI, CT scans, PET scans, ultrasound, X-ray
116
Is an anticoagulant used in a whole blood sample?
No
Yes
117
What test is used to monitor therapeutic progress in patients with known diseases?
Monitoring tests
Diagnostic tests
Predictive tests
Screening tests
118
How long should a serum sample sit to allow clotting to occur?
5 minutes
30 minutes
1 hour
15 minutes
119
What org rec should be followed in healthcare settings when working with patient blood/body fluids regardless Dx in UP
WHO
CDC
OSHA
FDA
120
What tests might require fasting for accurate results?
CBC, liver enzymes, electrolyte panel
Hemoglobin, platelet count, coagulation studies
White blood cell count, iron levels, vitamin D
Glucose, triglycerides, cholesterol
121
What are the six main physiologic factors regarding labs?
Diet, stress, exercise, cyclical variations, pregnancy, drug effects
Blood type, immune status, sunlight exposure, gender, age, diet
Social background, financial status, age, blood type, sleep, hydration
Genetics, height, weight, sleep, hydration, climate
122
What is used as an indicator of the physiologic status of an individual at a given point in time?
Physical examination
Medication list
Patient histor
Laboratory tests
123
Does a serum sample contain fibrinogen?
No
Yes
124
Sensitivity = ______/______
Total test costs; total hospital expenses
Total positive results; total negative results
Patients with disease who test positive; all patients with the disease
Patients without disease; patients with disease
125
The increased number, variety, and complexity of current tests do not cause confusion.
True
False

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