2. Clinical Chem

Question 1

CMP

Answer 1

BMP
Ca
LFTs

Question 2

CHEM -7

Answer 2

electrolytes
Na
K
Cl-

Question 3

renal function

Answer 3

BUN (blood nurea Nitogen)
creatinine
glucose

Question 4

LFTs

Answer 4

albumin
total protein
ALP
ALT
ASR
total bilirubin, direct bilirubin, indirect bilirubin (liver eliminated bili)

Question 5

when to order LFT

Answer 5

sx jaundice, dark urine, n/v, fatigue 
if it it safe to admin drug
herbal remedies damaging liver
response to tx
AUD

Question 6

bilirubin

Answer 6

from breakdown of hemoglobin, then conjugated in liver

measured in 2 assasys (total and direct) - subtract direct from total to give indirect

elvaluate wide range of disease states, production of bile, uptake storing and excreting

indirect bili - unconjugated - hemolysis, inc production

direct bili - conjugated liver and billiary conditions, hepatocellular damage from Rx, toxins

Question 7

albumin

Answer 7

cruicial protein formed in liver, large part of plasma proteins

TAXI- binda ca, water, Na, K, FAs, hormones, billi, T4, vits

assess nutritional status, liver diseases

Question 8

hypoalbuminemia vs hyper

Answer 8

hypo: liver disease, nephrotic synd, late pregnanyc, easting disorders, chronic disease states
hyper: dehydraion (common), Vit A deficency

Question 9

Transaminases

Answer 9

ALT- orimarily in liver, indications of lover injury
AST - liver, brain, pancrease, heart, kidny, lung, muscles - elevations is damage to any of these tissue
AST/ALT ratio

Question 10

AST/ALT ratio

Answer 10

<1 non alc fatty liver disease
=1 acute viral hepatitis, Rx related tox
>1 = cirrohsis
2:1 oe > alcoholic liver disease

Question 11

alkaline phosphaphatase

Answer 11

used to dephosphorylate compounds, integral role in liver metabolism and development of skeleton

dx diseases such as hepaitits, PTH disease and osetomalacia

Question 12

pancreatic enzymes

Answer 12

amalyase - digest carbs, made in pancreas gland which make saliva,

when pancreas is inflamed or infected amalyse released into body

Lipase: produced by pancrease digest FATS, break down TGs, also produced in tongue stomach and liver

INC when pancreas is inflamed, or gallstone blocks pancreatic duct

BOTH raised in acute pancreatitic, mar not be raised in chronic pancreatitis

Question 13

Dx pancreatitis

Answer 13

USE lipase >5x upper limit of normal

More likely miss amalyse elevation then lipase elevation

lipase has greater pancreas specificity then amalyse (95%)

Question 14

LA

Answer 14

degree of tissue hypoxia

elevated in anaerobic met

shock, vasc occlusion, ischemic bowel

correlated w severity of illness

Question 15

cardiac enzymes

Answer 15

troponin test
creatinine kinase (CK-MB)
lactate dehydrogenase (LDH)
myoglobin (Mb)
glycerin phosphorlyase isoenzyme BB (GPBB)

Question 16

troponin

Answer 16

cardiac enzymes

most sensitive and specific test for myocardial damage

T and I are specific to myocardium

T can be elevated in CKD pts

released 2-4 hrs after injury and can persist up to 14 + days

peaks 12 hrs after injury

Question 17

CK-MB

Answer 17

cardiac enzymes

released by any muscle - isoform of CK and is espressed in heart muscles

if other muscle damage can be falsely elevated

3-5 hrs after injury persists 36-48 hrs

CL-BB (CK1) - brain and lung
CK-MB (CK2) myocardial cells, small amount of sk muscle
CK-MM (CK3) - Sk muscle

Question 18

LDH

Answer 18

cardiac enzymes

nor used regularly
was used in combo w AST and CK-MB prior to triponin

Question 19

myoglobin

Answer 19

cardiac enzymes

rapidly released from damaged tissue

low specificity for MI

can be beneficial in detecting MIs early

released in minutes of injury but persistes <12 hrs

peask 2 hrs after injury

Question 20

GPBB

Answer 20

prsent in heart and brain

BBB prevents GPBB that is release in brain from enetering blood so GPBB detected in blood is cradiac specific

“new cardiac marker” to help detect early ACS

1-3 hrs after injury and persists 24 hr

peak 7 hr after injur

Question 21

triponin assay

Answer 21

sensitive are used in US

High sensitive in other countries

PRO HS: detects MI earlier

CON: detects triponin elevation in chronic diseases no clear threshold and risk of unnecessary procedures

Question 22

arterial blood gas

Answer 22

tell respiratory and metabolic state

evaluate gas exchange in lungs

acid-base balance
O2 status

COMES FROM ARTERY

perform allens test prior

Question 23

allens test

Answer 23

to test collateral circulation in wrist

radial and ulnar arteries

radial is easier

Question 24

CI of ABG

Answer 24

no pulse
cellulutus
compromised skin
no ulnar artery
AV fistula
coagulopathy

Question 25

reading ABG

Answer 25

pH -

PCO2 - pp of CO2 if we breathe fast CO2 leaves and PCO2 will drop, controlled by lungs

HCO3 - CO2 in blood is bicarbm measure of metabolic component of acid-base equaton. controlled by kidnets as HCO3- INC, pH INC kidneys used to compensate

Question 26

metabolic acidosis

Answer 26

ketoacidosis
lactic acidosis
diharreah
renal failure

Base ions are lost

Question 27

respiratory acidosis

Answer 27

COPD
trauma
oversedation

reduced ventillation, INC PCO2

Question 28

metabolic alkalosis

Answer 28

hypokalemia
hypochloremia
high volume gastric suction

acid hydrogen ions lose
HCO3 ions are relatively high

Question 29

respiratory alkalosis

Answer 29

hypoxemia
CHF
CO poisining
PE

CO2 blown off