By T. Killian. Colorado State University.

What imaging tests were performed generic arava 10 mg free shipping symptoms qt prolongation, and what Avoid activity that could raise the pressure in the was the finding in each test? Fall at work about 15 to 20 years ago and four sub- sequent lumbar surgeries Subarachnoid hemorrhage 10mg arava fast delivery symptoms 16 weeks pregnant, epidural abscess, and transverse myelitis 2. How will lymphedema be controlled should Pain management physical therapy be undertaken? What medications did the patient receive and Compression stockings why was each given? What was the nature of the foreign body in the It resulted in a large perforation. Retained tympanostomy tubes The edges were freshened sharply with a pick, and a 3. See Medical words von Recklinghausen disease, 406 Rules for Singular and Plural Suffixes This table presents common singular suffixes, the rules for forming plurals, and examples of each. Questions involving light the content you did not know, and study it until com- combinations of statements (multiple, multiple choice) mitted to memory. The test item classification consists of the presentation used in laboratory science lectures. Taxonomy 2 questions require calculation, correlation, comprehension, or relation. Taxonomy 3 questions require Design of Questions problem solving, interpretation, or decision making. Test questions used in certification examinations are mul- This question design allows you to compute a score, tiple choice. Each consists of a question, incomplete state- which helps you to identify strengths and weaknesses in ment, or problem to be solved called the stem and four various content areas and tasks. One of the alternatives is the correct time on a particular content area or on practicing with response and the remaining three are incorrect (these may questions of a specific taxonomy level. For example, if you be wrong, incomplete, partially correct, or less correct answer several mycology questions incorrectly, then you than the most appropriate response). If, xiii xiv Introduction however, you miss several recall questions (taxonomy minimum passing score usually falls within the range of 1 level) over several different content areas such as hema- 65%–70% correct responses. Poor perfor - you have not mastered the material in this area, and that mance with questions that require mathematical solutions further study is required. Begin with a review of the exam content outline that pretation or problem solving (taxonomy 3 level) is iden- is made available by the certification agency. For example, tified as a weakness, then the best approach is to study the if 20% of the exam is Microbiology but only 2% of the explanation that follows each question in order to under- exam is Laboratory Management, you should spend sig- stand the logic or reasoning behind the answer. Within each Because the answers and explanations appear on the content area will be subcategories (e. If 60% of the tear off the perforated flap and use it as a blocker to cover Microbiology content is Bacteriology and only 10% the answers while answering the questions. When you is Parasitology, then devote significantly more time to have answered a question, slide the blocker down the page studying the former. The blocker is Allow yourself sufficient time prior to the exam to re- printed with a compilation of reference ranges for com- view each content area no less than three times. Begin mon analytes that will assist you with answering some studying your strongest subject, then progress to your questions. Study your class notes first, then use this review book to test your knowledge of the respective content Prepare for Your Certification Examination area. Devote time to reading the explanation for each Ideally, an examination score should reflect your knowl- question, regardless of whether you answered it correctly edge of the content without the influence of other or not. However, variables such as stress, wellness, self- view it before answering the questions in this book a confidence, emotional state, and alertness all influence second time. In addition, examination skills often factor questions on your certification exam; however, you are into exam scores and can be decisive. A single question likely to encounter variants of the questions, and the answered correctly can make the difference between pass- explanations will help prepare you to answer these cor- ing or failing, the only two meaningful scores for a certi- rectly. If you There are two types of computer-based examinations, tra- score lower in Clinical Chemistry, devote more time to ditional and adaptive. Therefore, everyone taking the exam recall-type questions, make note cards with charts and does so at the same time and receives the same set of ques- tables, and study them regularly until the information on tions. Note your progress from in length, but every exam is different because the difficulty the first to the second round.

Unused units can be added to the general donor blood inventory Blood bank/Apply knowledge of standard operating procedures/Autologous donation/2 4 cheap 10 mg arava medicine that makes you throw up. An autologous unit of whole blood was collected Answers to Questions 18–20 on a 33-year-old woman in preparation for a knee replacement procedure in 3 weeks discount arava 20mg amex medications derived from plants. D This is a common scenario with women who have blood unit had her hyphenated last name, first recently married, and have not changed their license name, and last four digits of her social security or other form of identification given to the collection number for identification. Checking that other demographic information system, however, only had her married name and matches is sufficient if approved by the medical first name, medical record number, and social director, because an autologous unit is very difficult security number. C Vaccines developed by recombinant technology admissions make the correction in the carry no deferral period. Ensure that social security numbers match, confirm the name with donor and have admissions make the correction in the computer system with the medical director’s approval, then make the unit available for transfusion Blood bank/Standard operating procedures/Autologous donation/3 19. Perform an elution on the cord cells the cells of an Rh-positive baby Blood bank/Select course of action/Hemolytic disease of D. A fetal screen yielded negative results on a mother baby’s red cells if they did not contain the K antigen; who is O negative and infant who is O positive. B If the fetal screen or rosette test is negative, indicating the fetal maternal blood is negligible in a possible B. Issue one full dose of RhIg RhIg candidate, standard practice is to issue one dose C. Perform an antibody screen on the mother Blood bank/Select course of action/Hemolytic disease of 3. A The identification of the antibody is very important the newborn/Rosette test/3 at this stage of the pregnancy. What should be done when a woman who is may determine the strength of the antibody and 24 weeks pregnant has a positive antibody screen? No need to do anything until 30 weeks gestation who already has an antibody might cause a C. Administer Rh immune globulin (RhIg) transfusion reaction and/or evoke an even stronger D. Adsorb the antibody onto antigen-positive cells antibody response, possibly causing more harm to the fetus. Blood bank/Apply knowledge of standard operating procedures/Hemolytic disease of the newborn/Antibody 5. A If the cord cells contain excessive Wharton’s jelly, testing/2 then further washing or obtaining another cord sample will not solve the problem. Early induction of labor Blood bank/Apply knowledge of standard operating procedures/Hemolytic disease of the newborn/Clinical interventions/2 158 4. O-negative mother; A-positive baby; second fetus pregnancy; no anti-D in mother D. Yes, if the baby’s type is Rh negative anti-K, she will be monitored to determine if the C. Yes, if the baby’s type is Rh positive antibody level and signs of fetal distress necessitate D. C RhIg is immune anti-D and is given to Rh-negative Blood bank/Correlate clinical and laboratory data/ mothers who give birth to Rh-positive babies and Hemolytic disease of the newborn/RhIg/3 who do not have anti-D already formed from 8. Should an A-negative woman who has just had a previous pregnancies or transfusion. Yes, but only if she does not have evidence of the fetus is unknown, termination of a pregnancy active Anti-D from any cause presents a situation in which an B. Yes, but only a minidose regardless of trimester is used if the pregnancy is terminated in the first D. The on a woman who is 6 weeks pregnant with woman is weak D positive, and, therefore, is not a vaginal bleeding as O negative. Typically, a test for weak D is not tells the emergency department physician she is done as part of the obstetric workup. Is A-positive baby and has no anti-D formed from a this woman a candidate for RhIg? Yes, based upon the Provue results immunization typically has a titer >4, compared with passive administration of anti-D, which has a Blood bank/Correlate clinical and laboratory results/ titer <4. All of the following are routinely performed on a 40 fetal cells in 2,000 maternal red cells.

Urinary chorionic gonadotropin a direct reflection of current fetal placental function generic arava 20mg with visa symptoms umbilical hernia. When all four assays are combined with adjustments for maternal age purchase 20mg arava mastercard medicine garden, gestational age, race, maternal weight, and diabetes, the detection rate is approximately 70–80% and the false-positive rate 7%. Elevated levels in amniotic fluid are specific for dependent upon gestational age, upper reference spina bifida limits depend upon last menstrual period dating. When Body fluids/Apply principles of special procedures/ serum levels are high, ultrasound is used to Alpha fetoprotein/2 determine fetal age and rule out twins. When performing marker screening tests for and estriol do not discriminate well between Down syndrome, why are results expressed in 21 trisomy and normal pregnancy before the multiples of the median (MoM) rather than second trimester. MoM normalizes for gestational age (almost twofold higher in Down syndrome) and C. Mean cannot be determined accurately for these which has a median in Down syndrome less than analytes half of that seen in normal pregnancy. These two markers used together with high-resolution Body fluids/Apply knowledge of special procedures/ ultrasound to determine nuchal fold thickness Trisomy screening/1 (swelling at the base of the neck) have a sensitivity of 85%–90%. It eliminates interlaboratory variation in reference ranges seen when concentration units are reported. Laboratories using different methods (antibodies or calibrators) may have significantly different mass unit results for the same sample, necessitating different reference ranges. The reference range in concentration units is also dependent upon the gestational age at the time of sample collection; however, the average result for normals is always 1. Use of MoM obviates the need to report specific reference ranges based on method or gestational age and makes calculation of risk less complicated. Which statement regarding the fetal fibronectin Answers to Questions 14–17 test is true? B The fetal fibronectin test is used mainly to rule of delivery within 14 days out the likelihood of preterm delivery in high-risk B. Te test should not be performed before pregnancies or in women with signs of preterm labor. Te test is used to identify amniotic fluid after cervical secretions in early pregnancy but disappears rupture of the fetal membranes by about week 20. When there is inflammation to the membranes preceding delivery, fibronectin is released Body fluids/Apply principles of special laboratory and can be found in cervicovaginal secretions. A procedures/Fetal fibronectins/1 positive test (>50 ng/mL) has a sensitivity of about 15. Vaginal Body fluids/Apply knowledge of fundamental biological fluid is normally acidic, with a pH between 5. What is the most common cause of male Nitrazine paper or a swab containing Nitrazine yellow. Body fluids/Correlate clinical and laboratory data/ The tail is divided into the midpiece, principal piece Seminal fluid/2 (mainpiece), and endpiece. Which of the following values is the lower anterior end of approximately 5 μ containing a 9 + 2 limit of normal for sperm concentration? It is thinner than the midpiece and lacks the health and disease states/Seminal fluid/2 outer radial fibers. Mumps, Klinefelter’s syndrome, and malignancy cause testicular failure which accounts for about 10% of infertility cases in men. The sperm concentration is multiplied by the seminal fluid volume to determine the sperm count. This often results from obstruction of the ejaculatory duct or testicular failure. Which morphological abnormality of sperm is Answers to Questions 18–21 most often associated with varicocele? Cytoplasmic droplet below the neckpiece lengthened neckpiece are the most common C. Sperm morphology should be evaluated by classifying 200 Body fluids/Correlate clinical and laboratory data/ mature sperm in duplicate by strict criteria. A Eosin Y is excluded by living sperm and is used Body fluids/Apply principles of special procedures/ to determine the percentage of living cells. Which of the following semen analysis results is are used to evaluate sperm morphology. Motility 50% progressive movement count (sperm/mL × volume) and can be caused by Body fluids/Evaluate data to recognize abnormal absence of the seminal vesicles or prostate, ductal results/Seminal fluid/2 obstruction, or retrograde ejaculation of seminal fluid into the urinary bladder.

The exogenous administration of electrolytes results in the distribution of that ion to the usual fluid com- partment of highest preferential concentration buy arava 10mg line medicine 5 rights. Electrolytes When an electrolyte dissolves in water generic arava 10mg with visa symptoms vitamin d deficiency, it releases positive and nega- tive ions. Although, as noted above, their concentrations vary between fluid compartments, the distribution of water across fluid compart- ments seeks to equalize the concentration of total solutes and other osmotically active particles. When considering electrolyte problems, it is useful to use the milliequivalent (mEq) measure of their chemical combining capacity. In some cases, this must be converted from the weight expression milligram (mg) expressed on the laboratory report. A milliosmole (mOsm) is a measure of the number of osmotically active particles in solution. Since mOsm does not depend on valence, the mM dissolved in solution will be the same as mOsm. The osmolarity of a solution depends on the number of active parti- cles per unit of volume (mOsm/L). This can be modified by addition of urea con- centration, especially in conditions of uremia. Maintenance Requirements There are several principles that underlie the prescription for replacing fluid and electrolytes in surgical patients. This includes a knowledge of normal maintenance requirements as well as replacement for losses. Water The normal losses of water include sensible (measurable) losses from urine (500–1500mL/day) and feces (100–200mL/day), as well as insensible (unmeasurable) loses from sweat and respiration (8– 12mL/kg/day). Cutaneous insensible losses increase by approxi- mately 10% for each degree C above normal. A method to roughly calculate daily normal water requirements is shown in Figure 4. The water of biologic oxidation (catabolism) contributes up to 300mL/day and can be subtracted from these calculations. For healthy adults, an estimated daily maintenance fluid requirement approximates 30 to 35mL/kg/day. Sodium Sodium losses in urine can vary widely but, in general, approximate daily intake. Since the renal conservation of potassium is not as efficient as for sodium, this is the minimum level of daily replacement in healthy adults (0. The rate of infusion should be adjusted to achieve water replacement as outlined above. Perioperative Fluid and Electrolyte Requirements The management of fluid and electrolytes in the stressed surgical patient requires a systematic approach to the changing dynamics and demands of the patient. Consideration of existing maintenance requirements, deficits or excesses, and ongoing losses requires regular monitoring and flexibility in prescribing. While the majority of patients require only minor, if any, adjustments in parenteral fluid intake, some present challenging and life-threatening situations. Fluid Sequestration Following injury or operation, the extravasation of intravascular fluid into the interstitium leads to tissue edema (“third space”). Estimates of this volume for general surgery patients range from 4 to 8mL/kg/h and this volume may persist for up to 24 hours or longer. Fluid, Electrolyte, and Acid–Base Disorders in the Surgery Patient 67 Gastrointestinal Losses Additional ongoing losses from intestinal drains, stomas, tubes, and fistulas also must be documented and replaced. The fluid volume and electrolyte concentration of such losses vary by site and should be recorded carefully. Replacement of such losses should approximate the known, or measured, concentration of electrolytes (Table 4. Intraoperative Losses Careful attention to the operative record for replacement of fluids during surgery always is warranted.