AMT Chem Flashcards
Protein soluble in water
albumin
What diff proteins from carb/lipid
nitrogen
conjugated protein
protein plus prosthetic grp
lipo, glyco/muco, nucleo
5 plasma proteins
albumin, alpha 1, alpha 2, beta, gamma
Primary protein structure
amino acids
Secondary protein structure
alpha helix, beta pleated sheets
Tertiary protein structure
3D
Quaternary protein structure
2+ polypeptide chains
Enzyme deficiency with decreased enzymes leading to buildup of ketoacids
inherited metabolic disorder involving leucine, isoleucine, and valine (a group of branch chain amino acids).
maple syrup disease
Aminoacidpathy caused by defiency in the enzyme to metabolize phenylalanine
mousy urine
Phenylketonuria, PKU
Aminoacidopathy due to enzyme deficiency due to lack of enzyme to break down tyrosine/phenylalanine leading to buildup of homo-gentistic acid
deficiency of a single enzyme called homogentisate 1,2 dioxygenase
urine turns a dark brownish-black color when exposed to air
Alkaptonuria
Cystinuria
Tyrosinemia
inherited metabolic,
excessive amount of undissolved cysteine, doesn’t get reabsorbed by kidney, kidney stones
Tyrosine/metabolites excreted in urine
Deficiency in enzyme needed to metabolize methionine
Increased levels of this amino causes stroke, CVD, alzheimers, osteoporesis, nutrional def
Homocystinuria
build up of methionine and homo-cysteine (metabolite of methionine)
4 causes of hypoproteinemia
Not getting/making enough:
malnutrition
liver disease(doesn’t make protein)
Protein loss:
burns(protein loss thru wound)
nephrotic syndrome(loss thru urine)
3 Causes of hyperproteinemia
dehydration
Multiple myeloma, Waldenstroms
5 immunoglobulin
G,A,M,E,D
4 measurements of TP…
TP g/dL…
Biuret
Dye binding
Kjeldahl
Refractometry
TP 6.4-8.3 g/dL
TP g/dL
albumin g/dL
microalbumin in urine mg/24hr
TP 6.4-8.3g/dL
Albumin 3.5-5 g/dL (about 60% of TP) rest is globulins
microalbumin 50-200 mg/24hr
Calculation of A/G ratio
Albumin/TP-albumin
Total protein method that reacts with >= 2 peptide bonds in proteins
Biuret
Biuret reaction for TP uses…
which forms what color complex
copper salts
which forms a purple color
What does a biuret reaction for total protein analysis depend on?
Peptide bonds
Under strongly alkaline conditions, Cu2+ ions form multivalent complexes with peptide bonds in proteins. The absorbance attributable to proteins is measured spectrophotometrically at 540 nm, and the biuret reaction reacts equally with all proteins and peptides longer than two amino acids
4 dyes in dye binding for TP
Bromophenol Blue
Coomassie brilliant blue
Ponceau S
Amido black
Reference method for TP, not used often
Kjeldahl
TP method that measures nitrogen
Kjeldahl
This reaction follows Beers law for a reasonable range of protein
Depends on presence of at least two peptide linkages
Is insensitive to low protein in urine…
Biuret reaction
Beers law:
concentration of analyte=
Abs unknown/Abs std x con std
3 things that can interfere with Biuret method for TP
hemoglobin, hemolysis and lipemia
Two dyes used in dye binding method for albumin
BCP less interference
BCG
Bromcresol
BCP/BCG is used in what method…
are used to determine…
Dye-binding method
for albumin
Principle of protein strip measurement called
pH
color change from,to…
Most sensitive to…
false pos seen in what pH..
protein error of indicators:
-indicatir is nonionized
pH 3.0
yellow to green: due to ion/union changing
Most sensitive to albumin
False pos: alkaline urine
*Not affected by bence Jones
Breakdown of protein turns to… liver converts it to
Gut bacteria make ammonia
Liver turns to urea
B2 microgobulin used as a marker for
reduced GFR
CSF protein
How many mg, What percent of plasma
15-45mg/dL, 1%
3 Methods for Urine/CSF protein, BAD acronym
Biuret
Acid: SSA precipitation
Dye: Coomassie brillant blue
Increased CSF protein in these 3
meningitis, tramatic tap, MS
Protein in Spina bifida
AFP
alpha fetoprotein
CEA stands for, is a
carcino-embryonic antigen
oncofetal antigen
CEA nonspecific for
colorectal carcinoma/colon cancer
AFP
alpha fetoprotein
tumor associated; secreted by fetal liver
Increased AFP 4 conditions
liver/heptocellular cancer
neural tube defects
(spina bifida)
ovarian
testicular cancer
Decreased AFP in
Down syndrome
HCG
Made by…
Has…
human chorionic gonadotropin
made by placenta after implantation by trophoblastic cells
alpha+beta subunits
NONcovalently bound
NONidentical
HCG seen in these two cancers
ovarian
testicular
PSA
Made by…
Seen in..
prostate specific antigen
made by prostatic epi cells
prostatic cancer
CA-125
ovarian cancer
CA19-9
pancreatic
GI, adenocarcinoma
CA15-3, 27.29
mestatic breast
Two markers in breast cancer
CA27-29, CA15-3
Thyroglobulin marker for
thyroid
All proteins carry a net…charge due to protein being a higher pH than its isoelectric point
and travel towards
net negative, anode
Fastest/smallest protein toward anode
albumin
Which globulin migrates to cathode due to electro/endosmosis
Several gels used routinely for protein electrophoresis attract positive ions from the buffer and form a positive ion cloud. This ion cloud moves in the opposite direction to the cathode. This phenomenon is called electroendosmosis or endosmosis.
The tension created by these oppositely moving ion clouds can affect the movement of sample macromolecules. The migration of some proteins can be slowed, some proteins can become immobile, and other proteins are pushed toward the cathode.
gamma
pH of electrophoresis
8.6
Anode
positively charged electrode
Cathode
negatively charged electrode
Protein in highest concentration and made in liver
% of plasma protein
Albumin
65%
Method of detection for albumin and reagents used
dye binding, bromcresol purple
methyl orange
Albumin function
transport/binds protein
osmotic pressure
Albumin decreased in these 3 things
malnutrition
liver disease
nephrotic syndrome/renal loss/kidney disease
Albumin increased in this
dehydration
Another name for prealbumin and used to assess…
trans-thy-retin
nutrional status
Liver makes these 4 globulins and RE/plasma cells make this
liver: albumin, alpha 1/2, beta
RE/plasma: gamma
two alpha 1 globulins
AAT: alpha1 antitrypsin
inhibits the neutrophil elastase activity in the lung and hence can protect it from proteolytic damage.
AFP: alpha fetoprotein
AAT
increased in… and ….
decreased causes this…
increased in acute phase/prego
(Action of Neutrophils cause AAT to try to keep it from damaging tissue)
decreased in emphysema
(Def means neutrophil byproducts are damaging tissue)
AFP
increased these 4…
decreased in…
increased in:
neural tube defects
liver cancer
ovarian/testicular
decreased in Downs
Globulin increased in acute inflamation
alpha 2
Large globulin made in liver, inhibits trypsin/pepsin/plasmin
nephrotic/kindey disease
diabetes
lupus
increased in prego
alpha 2 macroglobulin
Increased levels of alpha-2-macroglobulin are found in nephrotic syndrome when lower molecular weight proteins are lost, but alpha-2-macroglobulin is retained because of its large size. In patients with liver cirrhosis and diabetes, the levels are found to be elevated.
three alpha 2 globulins
alpha 2 macroglobulin
Haptoglobin
ceruplasmin
Alpha 2 globulin made in liver
acute phase reactant that binds hmg
Haptoglobin
haptoglobin increased/decreased in these two
increased in acute phases, nephrotic syndrome
(Increased α2-macroglobulin is seen in nephrotic syndrome due to increased synthesis and inability to pass through the glomerulus)
decreased in transfusion, hemolysis
Alpha2 globulin transports 65-90% copper, made in liver, acute phase reactant
Ceruloplasmin
Disease with decreased serum ceruloplasmin and decreased serum, increased urine copper. Increased storage of copper in organs/cornea
wilsons
Disease with decreased ceruloplasmin due to decreased absorption, decreased serum copper
Menkes
Ceruplasmin is a …. that transports…
increased in these two…
decreased in these two conditions…
glycoprotein that transports copper
increased in acute phase/inflammation, prego
decreased in Wilsons disease and Menkes
Beta globulins examples
Beta2 microglobulin
beta lipoprotein/LDL
transferrin
hemoplexin
complement
fibrinogen
CRP
Beta globulin that is a heme scavenger
hemopexin
Beta globulin that transports iron
transferrin
examples of glycoproteins
transferrin
ceruloplasmin
mucins
AFP
immunoglobulins, antibodies
FSH, LH, HCG, TSH
Fibrinogen
A non-glycoprotein that are temp sensitive proteins that precipitate from serum/plasma at temps lower than 37C (4C)
Cryoglobulin
Striated muscle/cardiac; increased in heart attack, muscle dystrophy, crush
myoglobin
complex of 3 proteins in striated/cardiac; muscle contration, most sensitive for heart attach
3 subunits
Troponin
TnI, TnT, TnC
Urine/CSF concentration first
Bence Jones in urine migrate to..
Prealbumin band seen in…
BJ to gamma region
Prealbumin in CSF
globulin increased
globulin decreased in viral hepatitis
gamma increased
albumin decreased
globulins increased…
globulin decreased…
maligment tumor
alpha 1/2 increased
albumin decreased
beta-gamma bridge,
broad gamma seen in
active cirrhosis/liver
M spike seen in
Monoclonal gammopathy
increased alpha 2/gamma ratio
Decreased albumin seen in
nephrotic syndrome
liver makes less albumin
Migration of globulins from anode to cathode and % of each…
albumin 65%, alpha1 2%,
alpha2 8%, beta 10%, gamma 15%
Polar hydrophillic and nonpoloar hydrophobic fatty acid chains; cell membranes are made of these
phospholipids
Examples of phospholipids
lecithin
sphingomyelin
PG(phosphatidyl glycerol)
Long chain polyunsaturated fatty acids that activates inflammation
Stimultes clotting; also stimulates cervix to dialate and contractions
a group of lipids with hormone-like actions that your body makes primarily at sites of tissue damage or infection
PG
Prostaglandins
Transports lipids, classified w/ultracentrifugation
Protein part of lipoproteins/structural components…
transports lipids: lipoproteins
Protein part: Apoprotein
Order of lipids from heaviest to lighest
HDL, LDL, VLDL, Chylo
Alpha lipoprotein is…
Beta lipoprotein is…
Prebeta lipoprotein is…
Migration of liproteins from origin/cathode to anode
Influenced by size and charge/amt protein
alpha: HDL most protein, fastest
Beta: LDL
PreBeta: VLDL, bigger than LDL
Chylo: least protein, slowest
Origin to Anode:
Chylo, LDL, VLDL, HDL
Largest lipoprotein, carrier of exo Trig
Apoproteins associated with it
Chylomicron
ApoB-48
Exogenous/dietary lipids and it’s liproprotein/carrier
Triglycerides
chylomicrons
most artherogenic lipid causing CHD, mostly composed of cholesterol and transported to the heart
Third fastest to anode
LDL
Endogenous lipid made of mostly triglycerides
Second fastest to anode
VLDL
Lipid transports lipid out of liver, heaviest and smallest
HDL
primary form of lipid storage…
transported by these two…
triglycerides
exo/dietary: chylomicrons
endo:VLDL
Lipid made monstly in liver, manufacture/repair cell membranes, makes biles salts/vitD, precurosr to steroids….
two kinds:
transports to cells…
transports out of cells…
cholesterol
to: LDL
out of: HDL
% of Cholesterol made in liver…
% of Trig made in liver versus diet…
Cholesterol 85%
Trig 10% liver, 90 diet
Apoprotein B-100 are part of these two lipids
LDL, VLDL
Apoprotein A is part of this lipoprotein
HDL
Apoprotein B-48 is part of this lipoprotein
Chylo
LDL % carrries lipids
LDL % carrries lipids
60-70
HDL % carries lipid
HDL % carries lipid
20-35
VLDL % carries lipid
VLDL % carries lipid
5-12%
Major protein in HDL
Apolipoprotein A
Major protein in LDL/VLDL
Apolipoprotein B
Protein versus lipid density
protein more dense than lipid
Disease with very low HDL
Tangier
Method for cholesterol
purpose of saponification step
cholesterol oxidase
convert cholesterol esters to free cholesterol
Liebermann Burchard reaction used to determine
cholesterol
2 reagents used for color developemnt in Liebermann Burchard reaction for cholesterol
acetic anhydride
sulfuric acid
Lieberman has cholesterol
goes to a.a. and s.a.
Lieberman Burchard reaction for cholesterol
Reagents are:
Acetic
Anhydride
and
Sulfuric
Acid
Lipid w/3 fatty acids/glycerol
storage form
90% in diet, 10% liver
lipemia from chylomicrons
Trig
Enzyme method for triglycerides…
Hydrolyzes to…
Lipase hydrolyzes triglyceride to form glycerol
Fredewald calculation for LDL
TC- (TG/5+ HDL)
Friedwald calculation for VLDL
TG/5
Cannot used Friedwald calculation for LDL/VLDL if…
TG is >400mg/dL
Risk factors for CHD
age by genders
history of
bp, HDL
two conditions
> 45men, >55 women
family history of CHD
smoking
bp >120, HDL <40
D.mellitus, metabolic syndrome
Lipid goals
TC
Trig
LDL
HDL
TC <200
Trig <150
LDL<100
HDL>35
Condition where blood cholesterol is increased
hypothyroidism
Thyroid hormones help your liver process blood. When your thyroid hormone levels are low, your liver processes blood more slowly, which can lead to higher levels of cholesterol in your bloodstream
Examples of ….
lipid deposits in vascular/legs/arms
CAD, AMI, arteries
lipid in brain, stroke
atheriosclerosis
Disease with increased TC, LDL and decreased HDL
Calculate coronary risk index using these two parameters
Elevated beta liproprotein is what lipid and leads to which kind of disease
CHD
TC, HDL
LDL, cardiovascular
4 non protein nitrogen
urea, ammonia
uric acid
creatinine
non protein nitrogen increased in plasma in renal impairment called
azotemia
Best way to evaluate renal impairment and what is most common analyte to monitor it
GFR
creatinine
Creatinine clearance calc
based off the principle that creatinine passes into the ultrafiltrate
U creat/P creat x mL/1440
vol in mL, min/24hr
Correction for clerance by body surface area
creat clearx1.73/area
Used with eGFR to stage/monitor CKD
urine albumin
Made from creatine in muscle
Creatinine
Method for creatinine
reacts with
color formed
Jaffe
alkaline picrate
yellow-red
Rises more rapidly than serum creatinine in acute renal failure
BUN
BUN increased in these two things
renal impairment
high protein
diacetyl monoxime used in determining…by measuring…
can be used in untreated urine because…
BUN
urea
method isn’t measuring ammonia
Type of method for BUN that measures urea…
reagent that reacts with urea…
Colorimetric method
reacts with diacetyl monoxime
Enzymatic method for BUN uses….
which hydrolyzes…to…
urease
which hydrolyzes urea into ammonia
Unlike the colorimetric method using diacetyl monoxime used for BUN/urea
diacetyl monoxime-
urease-
diacetyl monoxime-
BUN/urea
urease-
BUN/ammonia
BUN mg/dL
Creatinine mg/dL
BUN/creatinine ratio
elevated creatinine will result in elevated BUN of how much
BUN 6-20mg/dL
Creatinine around 1mg/dL
10:1 to 20:1
BUN will be elevated
GFR marker made by nucleated cells
cystatin c
NOT c peptide
end product of purine metabolism from nuclei, allantoin
uric acid
The colorimetric method for uric acid is an alkaline oxidation where uric acid reduces…to…
phospho-tungistic acid to tungsten blue
phosphotungistic acid used in
uric acid
*Acid=uric acid
Uric acid NV mg/dL
2.6-7.2
Hyperuricemia causes
-gout
-leukemia/lymphoma (overproduction of new cells, more breakdown)
-Lesch-Nyhan
(The HGPRT deficiency causes a build-up of uric acid in all body fluids. The combination of increased synthesis and decreased utilization of purines leads to high levels of uric acid production.)
Disease where there is over production of uric acid that arent recycled; mostly males
The HGPRT deficiency causes a build-up of uric acid in all body fluids. The combination of increased synthesis and decreased utilization of purines leads to high levels of uric acid production.)
Lesch-Nyhan
Uric acid is measured by… at 290nm before/after treatment with…
UV absorption at 290
before/after treatment with uricase
Also use isotope dilution/MS
This is from bacterial action on contents of colon and metabolized by liver
ammonia
Analyte that is a prognostic indicator of liver failure
ammonia
not eliminated by kidneys
Increased ammonia in these 3 main reasons
liver disease
(cirrhosis, viral hep)
impaired renal
(increased urea,ammonia)
Reye’s Syndrome
Reye’s syndrome is a rare condition that happens in children after a viral infection or illness, especially if they took aspirin (salicylate) to treat their symptoms. Reye’s syndrome targets their brain, blood and liver.
Syndrome that leads to increased ammonia, mostly kids, previous virus, salicylate
Reyes
Bromphenol blue or GLDH used to measure
ammonia
Nessler used to detect
used to detect ammonina
potassium iodide plus
mercury iodide/chloride plus
sodium hydroxide in water
dirty brown precipitate
Disaccharide with 2 glucose
maltose
Disaccharide with 1 glucose, 1 galactose
lactose
disaccharide with 1 glucose, 1 fructose
sucrose
monosaccharide with 6 carbons
hexose
process that uses glucose for energy, changed to lactic acid for energy
glycolysis
process of glucose to glycogen
glycogenesis
process of glycogen to glucose
glycogenolysis
process of glucose from noncarb sources
gluconeogenesis
renal threshold for glucose
CSF glucose % of plasma
best anticoagulant
160-180mg/dL
CSF 60-65% of plasma
sodium flouride
Diabetes melliutus
plasma/OGTT
A1C
> 200mg/dL
=6.5%
Hypoglycemia mg/dL
70mg/dl
Hormones that regulate glucose
which one decreases?
all the rest increase
insulin, only one decreases
glucagon: alpha cells
Stomatostain: delta cells
epineph/cortisol
GH, ACTH
T3/T4(Thyroxine)
hormones made in pancreas:
alpha cells/increase or decrease
beta cells/increase or decrease
delta cells/increase or decrease
alpha: glucagon, increase
beta: insulin, decrease
delta: stomatostain, increase
peptide hormone made in beta cells and decreases blood glucose/goes into cells
insulin
steroid hormone that is a glucocorticoid, made in adrenal cortex, and increases blood glucose
cortisol
peptide hormone made in alpha cells, increases blood sugar by making glucose from glycogen
glucagon
hormone made in delta cells, inhibits secretion of insulin making more glucose in blood
stomatostain
hormone that is adrenaline, neurotransmitter and regulates glucose
epinephrine
glycogen storage disease
increased or decreased glucose
von Gierkes
decreased
diabetes where glucose is normal
insipidus
condition with tumor that results in increased insulin
increased or decreased glucose
insulinoma
decreased glucose
two conditions that increase glucose
Thyroid, adrenal cortex
hashimotos
(Hypothyroidism, which is caused by Hashimoto’s disease, decreases glucose absorption, leading to an accumulation of sugar. In turn, this accumulation of sugar causes more insulin to be produced to utilize excess glucose, eventually leading to insulin resistance.)
cushings(increased cortisol)
most employed automated method for glucose uses what two enzymes where there’s oxidation that forms a chromagen
contamination can happen with
glucose oxidase, peroxidase
contamination with catalase
Gold standard for glucose testing/higher specificity…
Two enzymes used….
Amount of… is proportional to glucose
Is read at…nm
Hexokinase method
Hexokinase, G6PD
NADH formed is proportional to glucose
340nm
hexokinase method:
what is reduced and measured?
measured at what nm?
NAD coenzyme reduced to NADH
measured at 340nm
Normal fasting blood glucose
70-110mg/dL
Test to confirm prenatal borderline blood glucose
3 hr GTT
HmgA1C binds to hmg and monitors long term diabetes/largest fraction of HbA
how long of picture of glucose?
Normal?
Diabetic?
2-3mth
Normal 4.0-6.0%
Diabetic 6.5%
How is the formation of HbA1c related to plasma glucose concentration?
Directly proportional
The rate at which a glucose molecule attaches to hemoglobin to form a ketoamine is directly proportional to the glucose concentration in the plasma.
Juvenille onset, insulin dependent, autoimmune destruction of beta cells
ketoacidosis
Type 1
adult onset, non insulin, insulin resistance, no ketoacidosis, obsesity
Which of the following is a non-insulin dependent diabetes, is characterized by insulin resistance and progressive hyperglycemia, and is called “adult-onset diabetes”?
Type 2
What is a byproduct of insulin and can differentiate between medication/exo insulin and what the body makes/endogenous insulin?
C-peptide
not cystatin(kidney)
Diabetes caused by placental lactogen inhibiting insulin
GDM
gestational diabetes mellitus
Measurement of light intensity, chemical rxn forms color and is absorbed at specific wavelenth
visible light 400-700, frequency inverse to wavelength, uses quartz cuvette for UV range
tungsten or deuterium
spectrophotometry
Filter used for QC of spectrophotometer and what it tests
holmium oxide
glass filter
wavelength accuracy
*Glass filter for spectrometry
Meaasurement of emission of color when element is burned
flame photometry
Measurement of light abosorption of electromagnetic radiation
atomic absorption spectrophotometry
Atomic=radiation
Absorption
Spectrometry=light
Atomic absorption measures using what light source
also uses monochormator, flame sample cell, PM tube
hollow cathod lamp
term that decreases fluorescent intensity of a substance
is a disadvantage of…
quenching
fluorometry
Measurement using electrode, ref electrode, liquid, potential diff between the two equals concentration
ISE
Measurement of light scattered by particles in a solution and measured at an angle, seen in ag-ab rxn…
Measurement of reduction in light transmission by particles in suspension ie proteins
scattered: nephelometry
reduced transmisson: turbidimetry
In immunoelectrophoresis there must be excess…
and a constant…. ……
excess antibody
constant trough distance
Used to separate volatile or able to volatile and to confirm toxicology
Is a reference for alcohol…
This is used to enhance sensitivity and specificity…
gas chromatography
MS(mass spectro)
Technique w/sorbent coated and solvent screens for drugs/urine
Uses Rf value
Rf value is…
TLC Thin layer chromatography
Rf= drug distance/solvent distance
Osmometry based off
measures
m-Osmol/kg
freezing point depression
measure osmolality of urine/serum
(dissolved particle in sln)
Tubular fnc
Hmg-Verdo-hmg
Plasma/store: biliverdin-iron-globin
Liver: bilirubin-albumin
Conjugataed: Bili diglucuronide
…
Ehrlich, p-DMAB reagent measures
Urobilinogen
Increased in liver damage, hemolytic disease
Negative in bile duct obstruction
p-DMAB stands for, used in the
…method for…
p-Di-Methyl-Amino-
Benzaldehyde
Ehrlich method for urobilnogen
Color produced with Erlichs reagent w/porphobilinogen and urobilinogen
reagent used to distinguish the two
red/pink color
chloroform,
urobilinogen will be soluble
porphobilinogen will be insoluble and stay in aqueous phase
Protein that carries unconjugated bilirubin..
Where is bilirubin conjugated…
Name of conjugated/direct bili…
albumin carries unconjugated
conjugated in liver
conjugated is bilirubin diglucuronide
Jendrassik-Grof measures
uses
turns into
bilirubin
uses diazo-tized sulfanilic
turns into purple, measures green azobilirubin
Alkaline tartrate eliminates interference
Bilirubin that is seen is not solube, thus not secreted in urine, cause of hemolytic trans rxn, prehaptic jaundice
indirect bili/unconjugated bili
Bilirubin that is formed/converted in intestine
urobilinogen
bilirubin that is oxidized/green in RE system
biliverdin
oxidized form of urobilinogen excreted in
urine…
stool…
urobilin: urobilinogen goes to kidney; yellow
stercobilin: urobilinogen oxidized, brown stool
Evelyn Malloy method used for…
Interference..
bilirubin
hemolysis
Jaundice with increasd unconjugated and increased urine urinobilinogen
Prehepatic jaundice
Disease where all bili is increased, bili/uro in urine
hepatic
condition where unconjugated is normal, decreased uro, but increased conjugated bilirubin in urine
Posthepatic obstruction
Have diff/mobility rates due to different aminos/structure
Different Electrophoretic property
Different rxns
Same substrate
Isoenzyme
Metals ions in enzymatic reactions act as
activators
This contant determines rate of conversion of substrate to product by differing
substrate concentrations
and
rate of dissociation of complex
(Enzyme acting on substrate making product)
Michaelis-Menten
Order rxn where large excess substrate allows for amt of enzyme activity to be limiting factor when all enzyme is bound to substrate
substrate: A reactant in a chemical reaction is called a substrate when acted upon by an enzyme.
zero order
LD catalyzes lactate +NAD to… And…
pyruvate + NADH
LD isoenzyme that migrates the fastest to anode and highest in heart/rbc (Most negatively charged)
LD1 HHHH
LD isoenzyme in healthy, HHHM
LD2
LD isoezyme that migrates the slowest (most positively charged)
LD5
Increased in LD1,2,3
PA
pernicious anemia
Enzyme greatly affected by hemolysis because its in all cells
LD
CK increased in these 3: stress to muscles
heart attack
muscular dystrophy
exercise
3 CK isoenzymes are dimers
Fastest to slowest
Brain faster than muscle
CKBB, CKMB, CKMM
CK isoenzyme slowest, in skeletal muscle
CKMM
CKMB sensitive for AMI
rises w/in…down in…
2-4hrs
2-4 days
Most sensitive for AMI and two most used…
rise/fall…
Troponin
TnT,TnI
4-8hrs, 10 days
LD rises, days last
rises 8-12hrs, 10-14 days
Myoglobin rises, normal
30min, 24hrs
condition can’t pump, fluids in lungs, cause CAD, BNP to diagnose
CHF
Condition were lack of oxygen, ischemia, leads to CHF/angina/heart attack
Narrowing of the small blood vessels that supply blood and oxygen to the heart.
CHD
Coronary heart disease (CHD) is also called coronary artery disease
3 conditions elevated AST
1 not elevated
acute heart
liver disease
muscular
not elevated in acute pancreatitis
2 Liver enzymes not affected by hemolysis
ALT, GGT
Increased ALP in 3 things in liver
obstruction of biliary tract/jaundice
acute viral hep
biliary cirosis
ALP increased in these 3 bone disorders
increased in 1 random
Pagets:
overgrowth
osteomalacia:
soft bones, decreased D/Ca
Rickets: Vit d def
prego (increased in mom and baby’s bones)
High ALP but no other liver increased
bone
pH for ACP
increased in
5.0
acid
prostatic disease
Enzyme in alcoholics, heptobiliary, obstructive jaundice, cirrhosis
GGT
Enzyme in mumps and acute pancreatitits
enzyme most specific for pancreatittis
mumps: amylase
pancreatitis: lipase
Cherry Crandall used to determine…
substrate…
lipase
olive oil
Disease with highest level of aldolase
muscular dystrophy
Aldolase is necessary for glycolysis in muscle as a “rapid response” pathway for production of adenosine triphosphate, independent of tissue oxygen.
Zollinger-Ellison is a… increased…
gastrinoma
gastrin HCl
diacetyl monoxime used to determine
BUN
phospho-tungistic acid to tungsten blue used to determine
Uric acid
most uric acid in plasma is what form…
increased in…
monosodium urate
gout
Kayser-Fleischer
Cooper deposits in cornea
To evaluate ionized calcium you need to know these two things and why
pH and protein
ionized calcium is pH dependent;
ph will increase if CO2 is lost
Ca will increase with increased protein
things that regulate calcium
2 increase/1 decrease
VitD/PTH: increase Ca
-VitD increases GI absorption of Ca
-low Ca will stimulate PTH production
Calcitonin: decrease Ca
-inhibits bone reabsorption
Hypocalcemia causes
Tetany (decreased Ca,Mg)
VitD def, hypoPTH
hypo mag, albumin
Normally, the parathyroid glands release a hormone that increases blood calcium levels when they are low. Magnesium is required for the production and release of parathyroid hormone, so when magnesium is too low, insufficient parathyroid hormone is produced and blood calcium levels are also reduced (hypocalcemia).
hypercalcemia
Vit excess, hyperPTH
Malignancy
8-hydroxy-quinoline removes…
In determination of…
Mg
Ca
In the complexometric titration for Ca, the pH is adjusted to prevent…
Complexometric titrations are used mainly to determine metal ions by use of complex-forming reactions.
complexometric titration:
pH is adjusted to prevent
interference from Mg
with 8-hydroxy-quinoline removes Mg
Method for Ca where its precipitated as Ca oxalate and converted to oxalic acid w/sulfuric acid and measured by titration against K permanganate
Clark-Collip
precipitated as Ca oxalate and converted to oxalic acid w/sulfuric acid and measured by titration against K permanganate
Clark-Collip measures…
it will be precipitated as…
Calcium
oxalate
In determining calcium, lanthanum is used to
lanthanum binds phosphate
Most phosphorus is in… at pH
bone 7.4
Phosphorus is controlled by this and how does it affect it, opposite of Ca
PTH:
decreases Pho
increases Ca
Affect on Phos
PTH
Calcitonin, Vit D
PTH decreased Pho
Calcitonin, Vit D increases phosphate
Reagent used for phosphate
molybdate
molybdeum blue
Hyperparathyroidism= increased PTH,
Phosphorus is
decreased
Hypoparathyroidism= decreased PTH
Phosphorus…
increased
Magnesium is controlled by kidney thru tubular reabsorption, what is renal threshold
1.5-2.1mg/dL
Treatment for preeclampsia/contractions will result in what lab result to be increased
magnesium
hypermagnesemia
Condition decreased iron/ferritin/% sat, increased transferrin/TIBC
IDA
Reagent for magnesium
titan yellow
2 Conditions with increased iron/ferritin/%sat and decreased transferrin/TIBC
sideroblastic and hemocromatosis
trace metal involved in melanin, inorganic cofactor, bound to albumin, transported/bound mostly by ceruloplasmin
copper
Fat soluble vitamins
A,D,E,K
Water soluble vitamins
All B, C
Fat soluble Retinol, cause of night blindness
A
Fat soluble calciferol, hormone precursor, Rickets
D
Fat soluble Tocopherol, antioxidant/immunity
Hemolytic anemia
E
Fat soluble phylloquinine, for clots
hemmorage
K
Water soluble B1
condition
thiamin
Beriberi
water soluble riboflavin
B2
water soluble B3, condition
niacin
pellegra
water soluble pyridoxal
B6
water soluble B7
Biotin
water soluble B9, condition
folate
megaloblastic
water soluble cobalamin, condition
B12
PA/IF
cause of Scurvy
C
Major extracellular cation…
NV…
Sodium 135-145
Hormone that increases Na reabsorption and acts on distal convoluted tube
Released by adrenals
Aldosterone
Hypoaldosterone Na
Hyperaldosterone Na
Hypo: decreased Na
Hyper: increased Na
Normal values
Na
Cl
K
Na 135-145
Major extracellular cation
Cl 98-106
Major extracellular anion
K 3.5-5.0
Major intracellular cation
BUN
Creatinine
BUN 6-20
Creatinine 0.7-1.5
CO2/Bicarb
23-29
Na 165
Cl 125
K 3.5
Saline contamination
Diabetes mellitus
Fasting…
Nonfasting…
Glucose
126, 200
Increased K causes
Phleb issues…
Tube additive…
Condition…
Hemolysis, tourniquet, squeezing
EDTA
Diabetic ketoacidosis
(Insulin promotes potassium entry into cells. When circulating insulin is lacking, as in diabetic ketoacidosis, potassium moves out of cells, thus raising plasma potassium levels even in the presence of total body potassium deficiency )
Used to enhance sensitivity of ISE electrode for K
Valino-mycin
Hypokalemia is less than
Hyperkalcemia greater than
Potassium
<3.5
> 5
Chloride shift
Cl is inverse HCO3, when one leaves the other goes in
High Cl, low HCO3=metabolic acidosis
Causes of increased Cl
IV
Dehydration
Metabolic/diabetic acidosis
(lose HCO3, chloride shift)
Low Cl
4 things
Diarrhea, vomiting
Renal failure: not reabsorbed
metabolic alkalosis: excess bicarb, less CO2
Chloride measured with titration methods such as
C.A. and S.S.
C.A. is…
S.S. is…
Coulometric amperometric
Schales-Schales
Coulometric amperometric method uses a… Method
It’s is the…
Analyte measured…
Titration
Time needed to get to end pt
Chloride
Schales-Schales is what kind of method…
For…
Violet color formed from reaction with…
Mercurimetric titration
Chloride
Excess Hg++
C-A and S-S are both these kind of reactions…for…
Titration
Chloride
Most CO2 in blood is
Bicarb
Specimen Least ordered, not used for CO2
Urine
Anion Gap, NV
Na+K-(Cl+HCO3)
10-20
Increased anion Gap
Diabetic ketoacidosis
Lactic acidosis
Salicylate
Methanol
Ethanol
Poly glycol
Unmeasured
Decreased anion Gap used as, due to
Analytical QC
Analyzer error
Glass, Ag/AgCl, measures H for measurement of
pH
Platinum+Ag/AgCl, amperometric measures
pO2
Henderson Hasselbalch
pH= pKa + log [salt]|[acid]
[A base]|[HA acid]
pH=log HCO3/pCO2
pH=log kidney/lungs
pH=log metabolic/respiratory
Bicarb: carbonic acid ratio in plasma
20:1
Acidosis
Normal
Alkalosis
<7.38
7.35-7.45, around 7.4
> 7.42
Metabolic acidosis: pH, HCO3 levels compensation
Decreased pH, HCO3
Lung: Hyperventilating releases CO2
Metabolic alkalosis 2 parameters influenced, compensation
Increased pH, HCO3
Lung: Hypoventilation increases CO2
Respiratory acidosis 2 parameters, compensation
Decreased pH,
Increased CO2
Kidneys: increase bicarb
Respiratory alkalosis 2 parameters, compensation
Increased pH,
decreased pCO2
Kidneys compensate
Beer-Lambert law
The Beer-Lambert law relates the concentration of a sample to the amount of light the sample absorbs as it passes through the sample.
Synovial: joints, hyaluronic acid makes viscous, obtain by arthrocentesis
2 Synovial crystals/conditions
Uric acid: gout
Pyro-phosphate: pseudogout
Amniotic fluid:
access neural tube defects/AFP
4 Fetal lung tests…
L/S: >2
PG
FLM 2
Lamellar
Sweat:
Analyte
Condition, death cause
Cl
Cystic fibrosis, pneumonia
Sperm:
mL, live%, motility %, #/mL
2-5mL
>75% alive
>50% motility
# 20-250 million/mL
Decreased CSF glucose seen in
Increased CSF glucose seen in
Decreased CSF glucose:
Bacterial meningitis
Increased CSF glucose:
Diabetes
CSF tube order/department
1 chem
2 micro
3 heme
CSF protein mg/dL
15-45
CSF glucose
60-70% plasma
CSF diff
70% lymph
30% mono
4 causes of increased CSF Protein
Meningitis
Intracranial hemorrhage
Traumatic tap
MS
Decreased CSF TP seen in
Leak, tear
Increased CSF IgG index and oligoclonal banding seen in…
MS
Multiple scelerosis
Oligoclonal bands are proteins called immunoglobulins. The presence of these proteins indicates inflammation of the central nervous system. The presence of oligoclonal bands may point to a diagnosis of multiple sclerosis.
Urine ph normal…
If left at rt becomes..
normal 6.0 (4.5-8)
alkaline at RT
Normal urine volume:
poly>
olig <
noc
anuria
1200-1500
poly >2500
olig<500
noc: more at night
anuria: none
left at RT, what
decreases…
increases…
False pos…
decreases:
glucose/ketones
bili/uro
cells/casts
increases:
nitrites/bacteria
turbidity(bacteria)
pH(amm)
False pos: protein
3 things kidneys make
2 hormones that influence kidney
renin, erythropoeitin, PG
aldosterone, ADH
Urine is made of 7 things
95% water
urea, uric acid, creatinine
Cl/Na/K
Urine RBCs color
smoky, red/brown urine
Urine bili/pyridum color
dark yellow/amber/orange
Phenazopyridine (Pyridium) is a dye that’s a red-orange color
Met/Hmg and homogentistic acid urine color
brown black upon standing
Reabsorbs H2O only…
Rebabsorbs solutes only…
H2O only Descening Loop
solutes only ascending loop
Specific gravity NV…
increased in these 3
decreased in this
1.003-1.030
increased in:
-renal damage(isotheniuria 1.010)
-diabetes mellitus
-xray
decreased in diabetes insipidus
3 methods to determine sg
refractometer
reagent strip
harmonic oscillation:
densitometry; current helps measure sg
Urine strip protein method name…
ph…and can leach to the pH strip and …the pH
what protein it binds to…
color…
confirm with…
protein error of indicators
3.0 and can leach to the pH strip and lower the pH
albumin
sulf. acid precipitation
How many neprons per kidney….
filtration ml/min
1 million
90-120mL/min
Protein of indicators on dipstick description…
has nothing to do with…
not affected by…
What will cause false pos…
Most of the indicator is non-ionized.
The protein will combine with the non-ionized form and will change the ratio of ionized and nonionized
Has nothing to do with pH and not affected by bence jones
False pos due to alkaline/buffered urine
Renal threshold for glucose
dipstick measures only glucose
two enzymes in rxn
160-180mg/dL
glucose oxidase, perioxidase
Clinitest/Benedicts is a… …method for…
Can screen for…
but reacts with…
False neg with these two…
copper reduction method for glucose
screen for galctosemia
reacts with all reducing substances
false neg with Vit C and pass thru
Occult blood on urine dipstick depends on
perioxidase activity of rbc/hmg
Nitrite:
bacteria type…
2 names for rxn:
GNR (E.coli)
Diazo, Griess rxn
RBC dipstick:
false neg with one vitamin and mistaken with 3 things…
false pos…
false neg: vitC
yeast, oil,
calcium oxalate crystals
false pos: oxidizing like bleach
UTI, renal calculi, acute glomerulonephritis you’ll see these cells
RBCs
reagent for LE, color
diazo reagent, purple
Cell related to glitter cell, UTI/pyelonephritis…
type seen in UTI…
white
neutrophils
Seen in diabetes mellitus, breakdown of lipids…
reagent…
color…
confirm with…
ketones
sodium nitroprusside
purple
Acetest (Acetoacetic/diacetic acid, acetone)
Sodium nitroprusside used in determination of…on dipstick
ketones
Acetest is used to confirm…
detects these two..
confirm ketones
diacetic acid, acetone
False pos: highly pigmented, levadopa
Ictotest, Diazo rxn used for
Bilirubin
VitC false neg
Bike duct obstructions, liver, ciirhosis
Reagent used in Erlich
p-DMAB
Erlich, p-DMAB used in
Urobili
Leukocyte in DILUTE HYPOTONIC urine where granules appear to move/Brownian Mvt
glitter cell
Large epithelial seen in catherterization, renal pelvis, ureter, bladder
transitional
Cell seen in tubular necrosis, renal tubles, oval fat bodies are made from
renal tubular
glycoprotein made from TRE that makes up casts (two names)
Tamm horsfall mucoprotein
Uromodulin
Cast are formed in what part of tubules
distal convoluted tubule
Casts seen in chronic renal disease, urinary stasis
waxy
cast seen in stress/exercise, normal
hyaline
cast seen in nephron/acute glomerulonephritis
RBC
Cast from dialated collecting ducts
broad
cast seen in acute glomerulonephritis and is decomposition of cellular
granular
cast from break down of epi casts/oval fat bodies, nephrotic syndrome
fatty
cell in pyleonephritis
wbc
4 urine parasites
T.vag
E.vermiculares (bread loaf ova)
strongy
S.haematobium
5 abnormal crystals
Cysteine: 6 sides
Leucine: concentric circles
Tyrosine: needles
Bili: yellow/brown needles
Cholesterol: notched plates
3 normal crystals in acidic urine
Uric acid: rhomboid/pleomorphic
amorphouse urates: pink sediment
Calcium oxalate: envelope/oval/dumbell,
*monohydrate form in antifreeze
4 normal crystals in alkaline urine
amorphous phosphates
triople phosphate: coffin lid
calcium carbonate: dumbell
amm. biurate: thorny apple
NV for… 50-200 mg/24hr
microalbumin
AAT globulin
Alpha-1-antitrypsin
Alpha1 globulin
inhibits the neutrophil elastase activity in the lung and hence can protect it from proteolytic damage.
Tangier low in
HDL
Colorimetric method for BUN measures…uses…
Enzymatic method for BUN measures…uses…
Which one can be used for untreated urine, why
Colorimetric measures urea and uses diacetyl monoxime, can be used with untreated urine since it’s not measuring ammonia
Enzymatic measures ammonia and uses urease
Hexokinase
Glucose method reduces this coenzyme…
To…
At…nm
NAD coenzyme is reduced to NADH and measured at 340nm
diazo rxn/Jendrassik-Grof
Bilirubin
Jendrassik-Grof and
Evelyn Malloy
measure
Bilirubin
Jendrassik-Grof=
Bilirubin+Diazo (caffeine)=azobili
Jendrassik-Grof=
Bilirubin+Diazo (caffeine)=azobili
Evelyn Malloy method uses…as an accelerator
Jendrassik-Grof uses…as an accelerator
Measures…
Evelyn Malloy method uses methanol as an accelerator
Jendrassik-Grof uses caffeine benzoate acetate as an accelerator
bilirubin
LD1 HHHH
Fastest, marker for these two
heart/rbc
sideroblastic and hemocromatosis
Iron,ferritin,%sat, transferrin/tibc high or low
increased iron/ferritin/%sat
decreased transferrin/TIBC
Sideroblastic anemia is a type of anemia that results from abnormal utilization of iron during erythropoiesis.
Hemochromatosis, or iron overload, is a condition in which your body stores too much iron. It’s often genetic.
Pyrophosphate seen in
pseudogout
Porter-Silber reaction uses phenylhydrazine to detect…
Zimmerman reaction detects…
PS=phenylhydrazine=
corticosteroids
Zimm=
17-KS/17-ketosteroids
Phenlyhydrazine used to detect corticosteroids in what reaction
PS=Porter-Silber
17-ketosteroids/17-KS is detected in what reaction…
Is a metabolite of…
Zimmerman
Zimmerman is a man that takes 17-KS/steroids
metabolite of androgens
Porter and Zimmerman take steroids
…
Hypothalmus makes releasing/inhibiting hormones that act on the pituitary
Pituitary then makes hormones that have their effects on organs that make the end product/action
…
Primary caussed by…
secondary caused by…
tertiary caused by…
Primary…end organ
Secondary:pituitary
Tertiary: Hypothalamus
Increased GH causes these two things
kids versus adults
Decreased GH causes
kids: giantism
adults: acromegaly
dwarfism
Hormone that solely initiates and maintains lactation
prolactin
increased prolactin cause of these two
Hypogonadism:
In hyperprolactinemia, which induces hypogonadism, the excess prolactin interferes with secretion of gonadotropin-releasing hormone, resulting in decreased testosterone and erectile dysfunction.
and
prolactinoma
(pituitary tumor)
menstral disorder and inadequate lactation due to
decreased prolactin
Vasopression is also called
antidiuretic hormone
ADH acts on…to increase…
decreased in…
acts on renal tubles to increase water reabsorption
diabetes insipidus
Hormone that stimulates urterine contraction/myoepithelial cells in breast thus ejecting milk
oxytocin
Hormone that forms male sex characteristics, spermatogensis, facial hair, deep voice, sex drive
testosterone
Testosterone is made from…
cholesterol (as is a lot of steriods)
hormones that stimulate sex organ development, linear growth, epiphyseal fusion
androgens
infertility men/women
polycystic ovarian due to
adrenal hyperplasia:
A group of genetic conditions limiting hormone production in the adrenal glands.
hypertestosteronemia
hypogonadism due to
hypotestosteronemia
TRH, GRH, CRH GHRH
PIF, GHIH released by
hypothalamus
GH, PRL, TSH, LH, FSH, ACTH released by the … …
anterior pituitary
ADH, oxytocin released by
posterior pituitary
Hormone that induces ovulation, prmotes ovary secretion of estrogens/progesterone for possible pregnancy and stimulates testes to produce testosterone
Luteinizing hormone
GnRH,
gonadotropin-releasing hormone
stimulates this organ to produceb these 2 hormones… which affects these two organs
GnRH stimulates pituitary to make LH and FSH to affect ovaries or testes
GHIH is also called
Somatostatin
GHIH/Somatostatin
GHRH: growth hormone-releasing hormone
Somatostatin from the hypothalamus inhibits the pituitary gland’s secretion of growth hormone and thyroid stimulating hormone.
GHRH: growth hormone-releasing hormone
Somatostatin inhibits the pituitary gland’s secretion of…and…
Somatostatin from the hypothalamus inhibits the pituitary gland’s secretion of GH and TSH
FSH stimulates, secretion of
females:
males:
females: egg development, estrogen
males: sperm, testosterone
hypothalmus makes CRH, Corticotrophin-releasing hormone
that act on pituitary to make ACTH,
Adrenocorticotropic hormone
this stimulates the adrenal cortex to make steroid hormones made from cholesterol
3 steroids made in adrenal cortex…
mineralcoritcoids(aldosterone)
glucocorticoids(cortisol)
sex hormones (androgens, estrogens)
What converts angiotensinogen to angiotensin I which converts to II and stimulates cortex to make aldosterone
Renin
hormone that induces secretion of glucorticoids(cortisol) of adrenal cortex
ACTH
adreno-cortiotropic hormone
CRH stimulates the…to make… which causes… to release cortisol, aldoseterone, estrogens and testosterone
CRH stimulates the pituitary to make ACTH
causing the adrenal cortex to make cortisol, aldosterone, estrogens/testosterone
Mineralocorticoids, glucorticoids, and androgens released by
adrenal cortex
aldosterone is an example of a…
maintains…and…
by retaining…and…
and excreting…
mineralocorticoid
maintains H2O and electrolytes by retaining water and Na and excreting K
Cortisol is a type of
glucocorticoid
Hyperadolsoterone, increased Na, decreased K, hypertension
Conns Disease
Conns Disease has increased…and thus increased…
decreased…
leading to….due to increased…
has increased aldosterone and thus increased Na
Decreased K
leading to hypertenstion due to increased fluid retention
Hypoaldosterone, decreased Na/Cl, decreased cortisol
everything down
Addisons Disease
Increased cortisol, increased glucose, increased Na
buffalo hump
Cushings
everything up
Testosterone is a type of
androgen
male sex hormone
metabolite of androgen…
reaction used to detect…
17-ketosteroid, 17-KS
Zimmerman reaction
3 types of catecholamines
purpose
epineph
norepi
dopamine
These hormones are released into the body in response to physical or emotionalstress.
Two GI hormones
Gastrin
serotonin
Hormone increased in Zollinger Ellison syndrome
gastrin
Hormone made in GI, vascoconstricter of PLTs/brain/tissue
serotonin
5HIAA is a urinary metabolite of…
increased in chromaffin cell tumors of GI, drugs, bananas, pineapples etc
serotonin
Catecholamines produced in…by…
adrenal medulla
by chromaffin cells
Metabolites of epineph
metanephrine, VMA
Metabolites of norepineph
normetaneph,VMA
Metabolites of dopamine
HVA
Pheochromocytoma is a small vascular tumor of the adrenal medulla, causing irregular secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and headache
with increased…
VMA
Pheochromocytoma is a small vascular tumor of the adrenal medulla, causing irregular secretion of…and…
metabolite is…
epinephrine and norepinephrine
VMA
Neuroblastoma is a childhood cancer that starts in immature nerve cells (neuroblasts)
with increased…
HVA
Most of the releasing and inhibiting hormones (except for ACTH) are producted by the…
hypothalamus
Thyroid hormones: stimulate metabolic processes
In tissues…is coverted to….
99.97% of…is bound to mosntly TBG, some TB-PA, albumin
99.5% of….is also bound
In tissues T4 is converted to T3
99.97% of T4 is bound to TBG
99.5% of T3 is bound
TSH stimulates the … to make these two
thyroid, T3/T4
3 things hormones made by thyroid
thyroxine/T4, triiodothyronine/T3
calcitonin
Thyroxine/T4 and Triiodothyronine/T3 increases…
Calcitonin increases…
Thyroxine, Triiodothyronine: metabolism
Calcitonin: Ca reabsorbtion
3 calcitropic hormones
PTH, VitD, calcitonin
Low PTH lowers these two…
increases this…
Lowers serum Ca, D
Increases Phos
TRH stimulates pituitary to release… which acts on…
TSH, acts on thyroid
TSH stimulates thyroid to make…
T3,T4
Free… stimulate negative feedback loop and inhibit secretion of…
Free T3/4 inhibit TSH
primary Hyperparathyroidism also called…
symptoms
Graves
weight loss, heat, hair loss, anxious
Graves is hyper or hypo…
T3/T4 levels…
TSH levels…
thyroid overproduces… due to… …
hyper: T3/T4
decreased TSH to stop production of T3/T4
Primary means thyroid overproduces T3/T4 due to TSH antibodies
Primary Hypothyroidism is called…
symptoms
Hashimotos
weight gain, tired, cold
Hashimotos is hyper or hypo…
T3/T4 levels…
TSH levels…
due to… …
hypo: T3/T4
increased TSH to decreased T3/T4 levels
Thyroid autoab
Major binding protein for thyroxine/T4
How is it measured
TBG
thyroid binding globulin
By measuring T3 uptake (amount of TBG bound to thyroid hormones)
3 good indicators for hypothyroidism
1 not good indicator
FT4, TT4, s-TSH (singles best)
Most is T4 not T3
not good T3 uptake (indirect, not used)
Ovaries productes these two hormones
estrogen, estadiol
hormone female sex charac, hyper=amenorrhea, hypo=menopause
Estrogen
hormone that’s active form of estrogen, evaluates fetoplacental function
estadiol
Progesterone made by the… … … and then by the…in pregnancy
ovarian corpus luteum and then placenta in pregnancy
Progesterone is also secreted by the ovarian corpus luteum during the first ten weeks of pregnancy, followed by the placenta in the later phase of pregnancy.
corpus luteum: yellowish mass of progesterone-secreting endocrine tissue that forms immediately after ovulation
prepares uterus for prego, maintains endometrium lining, inhibits uterine contractions, prepares breasts for lactation
progesterone
progesterone levels
perimenopause
postmenopause
peri: increased progesterone
post:decreased progesterone
What hormone maintains progesterone in early pregnancy
HCG
HCG increased/decreased…
increased: prego, mutiple pregos, tumors
decreased: spontaneous abortion
HCG subunits are…
alpha, beta subunits
NON-covalently bound subunits
NONidentical
subunit that cross reacts with LH,FSH,TSh
alpha
subunit that has analytical specificity
beta
Trimester with highest level of HCG…
When does it show up, how long does it last…
first
seen in days, peaks 2-3mths
Toxicology, best specimen for screening/qualitative, best for quantitative
Urine-QL
Blood-QNT
Creatitinine, pH, or oxidizing activity, dilute/substituted/adultered as a measure of
validity
Major disadvantage of immunoassay drug detection…
best 2 ways to confirm for drugs that have positive screens…
Immunoassays can’t simultaneously assay multiple drugs in one specimen
gas chromatography/MS
Aminoglycosides and Glycoprotein are two kinds of
antibiotics
Kind of Glycoprotein/antibiotic
that inhibits.. ..synthesis of gram…
Vancomycin
inhibit cell wall synthesis, treat gp
gentami/tobramy/amika/kana-cin are all…
they inhibit… … of gram…
aminoglycosides
inhibit protein synthesis, treat gn
Monitor toxic range of antibiotics to prevent damage to…and…
hearing/ototoxic
kidneys/nephrotoxic
Phenobarbital, phenytoin/dilantin
Valproic acid, Carbamazepine
ethosuximide are all
anti-epileptic/anti-convulsants
Bronchodialator
asthma, IV/oral, 10-20ug/mL, toxic >20ug
Theophylline
active metabolite in neotates is caffeine, also caffeine given as a brochodilator
Cyclosporine, Tacrolimus, Sirolimus,MPA
all are
immunosuppressive
Methotrexate are all
antineoplastics/antitumor
Cyanide, arsenic, mercury all are
heavy metals
Substances/acute poisoning
acetaminophen-liver damage
salicylates
alcohols-ethanol,isopro,glycol
cyanide
carbon monoxide(carboxyhmg 200x infinity)
organophosphates/pesticide:
-CNS, decrease cholinesterase
Must wait until…to TDM
how many half lives to reach…
how many half lives to clear…
metabolized by liver, excreted in urine
steady state
5.5
Specimen drawn imme before next dose is called…
Peaks drawn…hrs
Trough
1-2hrs after oral dose
AID:
Amtriphtyline, Imipramine, Doxepin
Lithium are all
pyschotropics
Amtriphtyline, Imipramine, Doxepin are all
tricyclics
Digoxin, Quinidine, Procainamide,
Disopyramide, Lidocaine all are
Antiarrythmics/cardiactive
Increased alpha 2 in these two
Acute inflammation
nephrotic syndrome
Tetany decreased in these two
Ca,Mg
LD 4,5 related to
Liver disease
Elevation in LD1/LD2 in a flipped pattern is related to
Myocardial infarction
Increased total serum LD 4,5 related to
Acute viral hepatitis
Increased LD 1,2 related to
Hemolytic anemia
Gilbert, Crigler-Najjar and Dubin-Johnson syndromes all are issues with what analyte
Billirubin
Syndrome that’s genetic liver disease, reduced glucuronyl transferase, thus increased bili
Gilbert syndrome
Name of syndrome where there’s two types,
the type and name where there’s compete absence of glucuronyl transferase, severe unconjugated bili and kernicterus…
Type work decreased glucuronyl transferase, chronic increased bili
Crigler-Najjar Syndrome
Complete:Type 1
Decreased: Type 2
Syndrome that’s genetic with defect in bilirubin transport across membrane, leads to dark pigment, porphyrin excretion
Dubin-Johnson syndrome
Dubin-Johnson syndrome
Syndrome that’s genetic with defect in bilirubin transport across membrane, leads to dark pigment, porphyrin excretion
2 Hepatitis fecal, oral
A, E
3 Recent Hep B infection markers
HBsAg,HBeAg
Anti-HBc IgM
DNA hep, with a core and envelope
BF, sex, IV drug
Hep B
B=body fluids
RNA, blood-to-blood contact:
blood transfusion, needles, no vaccine
Development of cirrhosis
Hep c
C=cirrosis
Hep that needs HBV, coinfection
Hep D
Tetany caused by these two
(decreased Ca,Mg)
2 Sex hormones…
Type of…
Made in…
Androgen: testestosterone
Estrogen: estradiol
Steroid
Made in adrenal cortex
Electrode w/silver chloride anode, platinum wire cathode
suspended in KCl w/a permeable membrane measures
PO2
H+ concentration (pH) has what kind of electrode
glass
An electrochemical tecnique used to measure the amount of electricity passing between 2 electrodes in and electrochemical cell.
Quantity of amount of electricity directly proportional to the chemical reaction at the electrode.
Coulometry
Coulometry is an automated method that generates silver ions and often is used to measure..in…
chloride in sweat
C=chloride, Coulometry
Application of coulometry is titration of…with silver ions generated by electrolysis from a silver wire at the anode
titration of chloride
glass electrode
reference electrode
specimen put in a capillary tube surrounded by buffer solution
the tube is made of … sensitive glass across which a potential difference is generated, which is proportional to the…
pH
PO2 electrode is uses this principle where theres measurement of a electrical current at a constant voltage or potential
amperometry
Clark electrode or polargraphic electrode
….molecules diffuse across a plastic membrane to small platinum or gold 2nm diameter wire cathode in a glass rod immersed in a phosphate buffer with KCl
…is reduced and this creates current flow between the cathode and silver/silver chloride anode.
increasing the voltage increases the current up to a plateau determined by the rate of supply of …molecules & proportional to the concentration.
PO2 measurement
A self contained potentiometric electrode measures….
…gas from the sample diffuses thru the selective membrane and dissolves in the internal electrolyte layer.
Carbonic acid is formed and dissociates, shifting ph
PCO2
CO2 gas
modified glass electrode
comprises of a glass pH electrode that is permeable to…
…diffuses from the specimen into the …solution where it dissociates with a change in pH which is measured by the electrode potential difference is proportional to concentration
PCO2
HCO3
Glucose method that is glucoses specific colorimetric method
glucose oxidase
In the hexokinase method for glucose, what is the end product measured
NADH from the reduction of NAD
Procedure for calcium that uses lanthanum chloride to eliminate interfering substance…
what substance does it bind to…
…atomic absorption spectrophometry
…Binds to phosphate
AAS measures calcium by detecting its atomic absorption by electromagnetic radiation.
Atomic absorption spectrometry (AAS) detects elements in either liquid or solid samples through the application of characteristic wavelengths of electromagnetic radiation from a light source. Individual elements will absorb wavelengths differently, and these absorbances are measured against standards.
…
Phosphates present can complex with calcium. Addition of lanthanum chloride competes for the phosphate and prevents interference with calcium
Both Malloy Evelyn and Jendrassik-Grof measure… which determines…
measures azobilirubin
determines bilirubin
Coenzyme and reduced used in LD reaction
NAD/NADH
Increased LD4,5 in these two
liver and skeletal musdscle
increased LD3 in
pulmonary edema
Steady state theurapeutic drug achieved between… and…doses
4-7
Benzoylecgonine is a metabolite of what drug
cocaine
Pheytoin is also called…
is what kind of drug…
Dilantin
anticonvulsant
IU is amt of enzyme that would convert…of substrate per min
1 IU=
1micro mol
1IU=micro mol/min
Fraction increased in biliary cirrhosis
gamma
elevated gamma w/beta gamma bridging due to increased IgA
Fraction increased due to nephrotic syndrome
Alpha2 globulin
loss of albumin, increased alpha 2 is compensatory
Lack of alpha1 globulin due to these two
alpha1 AT def
servere emphysema
Emphysema is caused by the protease-antiprotease imbalance when smoking-induced release of neutrophil elastase in the lung is inadequately inhibited by the deficient levels of AAT, the major inhibitor of neutrophil elastase.
Electrophoretic pattern of plasma will show a
sharp fibrinogen peak
Slight increase in alpha 2 and decrease albumin due to
acute inflammation, acute phase reactants
Broad increase in gamma electrophoresis due to…
polyclonal gammopathy/chronic inflammation
Condition with decreased activity of glucuronyl transferase leading to increased unconjugated bili/kernicterus in neonates
Crigler
Najjar
Syndrome
Immunosuppressants
T, C, S, M
Tacro, Cyclo, Siro, Myco
Tricyclics
AID
Amt, Imi,Dox
Antiarrhythmic
Digoxin
-dine, -amide, -caine
…
High alpha 2 only
Acute inflammation
High alpha 2/gamma ratio
Nephrotic syndrome
High alpha 1&2 with low albumin
Malignant tumor
High gamma with low albumin
Viral hepatitis
Beta game bridge, broad gamma
Active cirrosis/liver
From anode, migration of serum proteins…
Percentages…
Albumin, alpha1, alpha2, beta, gamma
65, 2, 8, 10, 15
Alpha1 globulins
Alpha1 antitrypsin, AAT
Alpha1 glycoprotein
Alpha liprotein
AFP
Alpha 2 globulins
Alpha2 macroglobulin
Haptoglobin
Ceruplasmin
Beta globulins
Beta2 microglobulin
Beta lipoprotein
Transferrin
Hemoplexin
Complement
Fibrinogen
CRP
Acute phase reactant, binds hmg…
Increased in…
Decreased in these 3…
Haptoglobin
Increased in inflammation
Decreased in HA
hemolytic transfusion reaction
Hemolytic disease of newborn
(Lots of loose hmg needs to be picked up)
2 alpha2 globulins that are acute phase reactants, increase with inflammation
Haptoglobin
Ceruplasmin
Ceruplasmin will be… When there’s excess storage of copper
Seen in…
Decreased
Wilson’s
Ceruplasmin will be… When there’s decreased absorption of copper…
Seen in…
Decreased…
Menkes
GLDH, coupled enzyme rxn for…
Urea, BUN
In GLDH for urea, what is formed at end
NAD
Conductimetric uses gold electrode to measure…
Urea
What is measured in conductimetric method for urea…
NH4 conductivity
Ref method for creatinine and uric acid
Isotope dilution M/S
-ISE, pH
-Spectro/blue dye
-enzyme: GLDH
Used for
Ammonia
Most common ammonia method used
GLDH
Enzymatic
Fluorescein isothiocyanate
and
Phycoeryrhrin are…
Two fluorochromes in fluorescent immunoassay
Method where there’s absorption of one wavelength and emission of a longer, lower one
Fluorometry
Luminol and acridinium esters are used in this method
Chemiluminescent
Method where light is made from chemical reaction;
Rapid increase in intensity of emitted light followed by gradual decayb to ground state with emission of photons
Chemiluminescent
Labeled antigen is called a…in radio immunoassays
Tracer
The basic principle of radioimmunoassay is competitive binding, where a radioactive antigen (“tracer”) competes with a non-radioactive antigen for a fixed number of antibody or receptor binding sites.
Cintillation counter and gamma counter are used in
Radio immunoassays
Isotopes used in radio immunoassays
3^H, 125^I
Enzymes used in immunoassays increase…
Analytical specificity
The pCO2 electrode is a…electrode but… doesn’t affect sample.
Electrode measures… …
pH electrode measures dissolved CO2
Method that measures light adsorption of electromagnetic radiation by atoms
Atomic adsorption spectrometry
Hollow cathode lamp is light source for
AAS
Atomic adsorption spectrometry
Measures coulombs needed for a reaction
Analytical technique that measures the amount of electricity (in coulombs) required to fully react with a sample.
Coulometry
Measures current at a single potential
Detection of ions in a solution based on electric current or changes in electric current.
Amperometry
A=alone
Measures current flow of solution as a function of an applied voltage
an electromechanical technique of analyzing solutions that measures the current flowing between two electrodes in the solution as well as the gradually increasing applied voltage to determine respectively the concentration of a solute and its nature
Polarography
Chromatography that uses Rf value to id drugs of abuse
Thin layer chromatography, TLC
Rf in TLC is the … Of the… Over the …of the…
Distance of drug over
Distance of solvent
Chromatography that consists of a stationary phase in LC (liquid) of small diameter particles
High performance liquid chromatography
Chromatography that’s a ref method for alcohol, drugs of abuse
Gas chromatography
What enzyme increased at RT
ALP
3 enzymes not affected by hemolysis
ALT, GGT
Amylase
Peptide used to diagnose CHF…
Common causes of CHF…
BNP, Btype natriuretic peptide
CAD
Hyperparathyroidism, antacids, dextrose sln all… phosphorus
Decrease
Hypoparathyroidism and renal failure can… phosphorus
Increase
Final site urine concentration
Collecting duct
Sg seen in severe renal damage
1.010
Isothenuria
Oval fat bodies: highly refractile RTE w/fat
Form…
Seen in…
Maltese cross
Nephrotic syndrome
Crystal seen in renal calculi and ethylene glycol poisoning
Calcium oxalate
… Protein is a form of transferrin present in csf
Tau protein
Lipoprotein
Origin/cathode to anode:
Chylo, beta, pre beta, alpha
5’NT
Nucleotidase is in.. But not…
In liver but not bone
Decreased cholinesterase seen in
Organophosphate/pestiside poisoning
Major anion of extra cellular
Cl
HCO3 NV versus pCO2 NV
HCO3 22-26
pCO2 35-45
pO2 NV
85-105
Alkaline urine gives… … With protein
Falsely positive
Water soluble…
Fat soluble…
Water: B, C
-pee out
Fat: ADEK
-risk of toxicity
Homocystinuria
maple syrup disease
Phenylketonuria, PKU
Alkaptonuria
All are amino acid…
Two that aren’t are…
Deficiencies
Two that aren’t are are Cystinuria, Tyrosinemia
LDL % carrries most of the lipids
60-70
HDL % carries lipid
20-35
VLDL % carries the least lipid
5-12%
…
Glu-glu: mal
Glu-galac: lac
Glu-fruc: sucr
…
Holmium oxide glass filter…
Hollow cathod lamp….
Holmium oxide glass filter…
Spectrometer wavelength accuracy
Hollow cathod lamp….
Atomic adsorption
Both measure…
Jendrassik-Grof uses, turns into…
Evelyn Malloy method affected by…
Bilirubin
Jendrassik-Grof measures:
uses diazo-tized sulfanilic
turns into purple azobilirubin
Evelyn Malloy method affected by hemolysis
Calcium: titration
complexometric: titration interference from Mg,
8-hydroxy-quinoline removes Mg
Clark-Collip:
precipitated as CALCIUM OXALATE and converted to oxalic acid w/sulfuric acid and measured by titration against K permanganate
lanthanum:
binds PHOSPHATE so it doesn’t interfere with calcium
Cl NV…
CO2/bicarb…
Cl 98-106
Major extracellular anion
CO2/bicarb 23-29
Lose Cl thru Diarrhea, vomiting and loss thru Renal failure, not reabsorbed
Increased in metabolic acidosis
…
Lipid carried:
LDL carries %…
HDL carries %…
VLDL carries %…
LDL carries %… 60-70
-carries the most lipids
HDL carries %… 20-35
VLDL carries %… 5-12
Method for cholesterol:
cholesterol oxidase
-purpose of saponification step is to convert cholesterol esters to free cholesterol
Liebermann Burchard reaction:
-2 reagents used for color developemnt: acetic anhydride
sulfuric acid
Lieberman has cholesterol and goes to a.a. and s.a.
…
Uric acid: 2.6-7.2 mg/dL
The colorimetric method:
-is an alkaline oxidation where
uric acid reduces phospho-tungistic acid to tungsten blue
Uricase/enzymatic:
-UV absorption at 290
before/after treatment with uricase
Ammonia:
Bromphenol blue or GLDH used to measure
Nessler
…
Bilirubin:
Jendrassik-Grof:
uses diazo-tized sulfanilic,
turns into purple azobilirubin
Evelyn Malloy:
Watch for hemolysis
Calcium:
Titrant is added until the reaction is complete. To be suitable for determination, the end of the titration reaction must be easily observable
complexometric titration:
*pH is adjusted to prevent
interference from *Mg
with 8-hydroxy-quinoline removes Mg
Clark-Collip:
-precipitated as Ca oxalate and converted to oxalic acid w/sulfuric acid and measured by titration against K permanganate
*lanthanum binds *phosphate
calcium:
pH, Mg
CC, oxalate
Lanthanum, phosphate
Chloride measured with titration methods such as
C.A. and S.S.
Titrant is added until the reaction is complete. To be suitable for determination, the end of the titration reaction must be easily observable
Coulometric amperometric: time
-Titration
-Time needed to get to end pt
Schales-Schales: excess Hg
-Mercurimetric titration
-Violet color formed from reaction with excess Hg++
…
Migration of lipoproteins from cathode(-) to anode (+)…
Chylo, beta, pre beta, alpha
Named in order from anode to cathode…
+Alpha, pre beta, beta, chylo
-Chylo slowest, HDL fastest
-Pre beta before beta
Bicarb NV
HCO3 22-26
Which of the following determinations is used to assess the total body lead poisoning burden?
Whole blood lead
Whole blood lead levels are the most commonly used biomarker of human lead exposure. In lead poisoning, impaired iron delivery or utilization within the mitochondrion has the similar effect of increasing erythrocyte zinc protoporphyrin.
Which analyte rises first in response to inflammation?
Associated with this disease…
C-reactive protein, or CRP, is one of the first acute-phase proteins to increase as a result of inflammation.
Increase in serum of CRP concentrations is associated with a risk of future CHD events.
Which of the following instruments ionizes the target molecule then separates and measures the mass-to-charge ratio?
Mass spectrometer
Mass spectrometer instruments measure mass-to-charge ratios rather than molecular mass but are referred to as mass spectroscopy.
In a developing embryo, which type of deficiency can lead to death or severe neurological birth defects?
Folate
A folate deficiency in a developing embryo can lead to death or severe neurological birth defects. Folate and single-carbon metabolism are imperative to both cell growth and division.
What are the two most common aminotransferases measured in the clinical laboratory?
AST,ALT
SSA stands for…
used for…
Sulfosalicylic acid
Proteins are precipitated by 5-sulphosalicylic acid. Any resulting turbidity will give an estimation of the amount of protein present in the urine which can be subjectively quantitated visually or more precisely quantitated using photometry. Cells and casts in the urine must be removed by centrifuging before carrying out the test. The test can detect albumin, hemoglobin, myoglobin, and Bence Jones proteins.
A refractometer is an instrument that measures how light bends as it passes through a sample. The degree to which a sample bends light is correlated to the number and size of solute particles. When a refractometer tests a urine sample, it measures the specific gravity of the urine.
The urine’s specific gravity indicates the kidneys’ ability to balance water content and excrete waste. Typical values range between 1.005 to 1.030. A low specific gravity suggests an inability to concentrate urine, excessive hydration, or diabetes insipidus. A high specific gravity could indicate dehydration or diabetes mellitus.
pass thru refractometer
A screening test for diagnosing intermittent porphyria, although it might also become positive in porphyria cutanea tarda (a skin form of porphyria). In this method, porphobilinogen is detected by a color reaction with Ehrlich reagent and confirming that the color is not removed by chloroform. As the test is just a screening test, it usually is confirmed by a more specific test such as a Hoesch test.
Watson-Schwartz differentiation test
Test that is a colorimetric screening for porphobiloinogen in urine. More sensitive and specific. Color directly relates to amount.
Inverse Erlich reaction: volume of urine to reagent reversed, acidity prevents urobilinogen from reacting. Positive is pink at interface
Hoesch test
PH urine
4.5-8.0
Amount of urine..
normal:
anuria:
oliguria:
polyuria:
normal: 1200-1500ml
anuria: none
oliguria: <400
polyuria: >2500
3 urine substances false positive with bleach
Glucose, blood, WBC
Alkaline urine:
False pos in, false neg in
False pos protein
False neg SG
Highly pigmented/Medication color false pos is urine 4 substances
Ketones, nitrite
urobilinogen, Bilirubin
4 urine substances false neg with vitC
Glucose, blood
bilirubin, nitrite
What tubule reabsorbs 80% of the fluid, electrolytes…
Proximal
Water, NaCl,K, aminos etc
Loop of Henley:
Which one reabsorbs water only
Which one reabsorbs solutes only
Descending: water only
Ascending: solutes only
Casts formed in…
Final concentration in…
Casts formed in… Distal
Final concentration in… Collecting
Most frequently used supravital stain in microscopic exam trying
Urine
Sternheimer Malbin
The Sternheimer-Malbin (SM) stain is a commonly used supravital stain containing crystal-violet and safranin. WBC’s, epithelial cells, and casts stain well with SM stain. Sedi-Strain (Clay Adams, Sparks, MD) and Kova stain (ICL Scientific) are among those commercially available. Nuclei and cytoplasm of various cells can be stained with a 0.5% solution of toluidine blue.
Name of and 3 colors of CSF supernatant due to hemoglobin, hemorrhage
Xanthochromia
Pink, orange, yellow
abnormally high urea nitrogen in the blood is called…
A significant increase in
the plasma concentrations of urea and creatinine, in
kidney insufficiency, is known as…
Once instance urea levels are lower…
high urea nitrogen: uremia
increase in plasma concentration of urea and creatinine is azotemia.
During pregnancy, lower-than normal urea levels are often seen.
Azotemia can result
from prerenal, renal, or postrenal causes:
* Prerenal azotemia is the result of poor perfusion of the kidneys and therefore diminished
glomerular filtration. The kidneys are otherwise normal in their functioning capabilities.
Poor perfusion can result from dehydration,
shock, diminished blood volume, or congestive heart failure. Another cause of prerenal
azotemia is increased protein breakdown, as
in fever, stress, or severe burns.
* Renal azotemia is caused primarily by diminished glomerular filtration as a consequence
of acute or chronic renal disease. Such diseases include acute glomerulonephritis,
chronic glomerulonephritis, polycystic kidney disease, and nephrosclerosis.
* Postrenal azotemia is usually the result
of any type of obstruction in which urea is
reabsorbed into the circulation. Obstruction
can be caused by stones, an enlarged prostate
gland, or tumors
HER2/neu a marker for
Breast, Ovarian, and Cervical Cancer
Markers
oncogene
HER2/neu as a prognostic indicator and a marker
related to the choice of therapy. This is particularly useful since the introduction of Herceptin as
a chemotherapeutic agent that targets the HER2/
neu receptor. Breast cancer patients who express
HER2/neu in their cancers have a poor prognosis
example of aminoglycoside antibiotic…
example of glycopeptide antibiotic…
Aminoglycoside antibiotics such as gentamicin
Glycopeptide antibiotics such as vancomycin
carbamazepine, phenytoin, ethosuximide,
phenobarbitone, valproic acid are all examples of
Anticonvulsant (antiepileptic) drugs
digoxin is a
cardioactive
amitriptyline, clomipramine, desipramine, dothiepin,
imipramine, nortriptyline
(AID)
Tricyclic antidepressants
HOW LONG CAN URINE SIT OUT AT RT
A fresh urine specimen is particularly important
for reliable results. If the urine cannot be examined
within 2 hours, it should be refrigerated as soon as
possible after collection. Specimens left at room
temperature for more than 2 hours are not acceptable.
AChE
Acetylcholinesterase
enzyme in cns,rbc, fetal serum
confirm pos afp
open neural tube defect
% of CSF made by chroidal cells in choroid plexus
% of CSF made by ependymal cells
70% of CSF made by chroidal cells
30% of CSF made by ependymal cells
CSF found in…
obtained between these two or these two
subarachnoid space
3/4th or 4/5th
CSF storage
chemical…
micro…
cell…
CSF storage
chemical…frozen
micro…RT
cell…fridge
Albumin not normal in CNS
CSF/serum albumin index of… is normal
<9
4 bands in CSF protein electrophoresis
Prealbumin/transthyretin
albumin
Tranferrin (Beta1)
T Transferrin(Beta 2)
What CSF protein confirms presence of CSF
T tranferrin(beta 2)
3 most common bacteria in bacterial meningitis in CSF
N.meningiitis
H.influenzae
S.pneumo
transudates wbcs
exudates wbcs
transudates <1000 wbc
exudates >1000 wbc
Caused by increase purine metabolism, uric acid, Monosodium urate crystals
gout
knee, Ca pyrophosphate dihydate crystalsj
pseudogout
Sperm
get to lab within…
liquefy within…
ml…
ct….
pH…
witin1 hr to lab
30min to liquify, by 60 min
2-5mL
20-250million
ph 7.2-7.8
Reagent strip protein sensitive to…
SSA sensitive to…
reagent to albumin
SSA to all protein
Micro-Bumintest (Bayer) tests for
microalbuminuria
Rous test for
Hemosiderin
Test that diff urobilinogen from porphobilinogen
Watson-Schwart
EM Quant (Merkoquant)
Vit C when interference
Test for porphobilinogoen and inverse Erlich
Hoesch
Which of the following determinations is used to assess the total body lead poisoning burden?
most commonly used biomarker of human lead exposureWhole blood lead
In lead poisoning, impaired iron delivery or utilization within the mitochondrion has the similar effect of increasing erythrocyte zinc protoporphyrin.
triglycerides
Normal, borderline, high, very high
Normal — Less than 150 milligrams per deciliter (mg/dL), or less than 1.7 millimoles per liter (mmol/L)
Borderline high — 150 to 199 mg/dL
High — 200 to 499 mg/dL
Very high — 500 mg/dL or above
Which drug is used in treatment of congestive heart failure, requires TDM, and is part of the cardiac glycosides class of medications?
Digoxin, with the proprietary name Lanoxin, is one of a group of cardiac glycosides obtained from digitalis plants. Digoxin also acts to restore the force of cardiac contraction in congestive heart failure.
The degree of wavelength isolation is a function of the monochromator type and
width of entrance and exit slits.
The degree of wavelength isolation is dependent on both the type of monochromator used and the width of the entrance and exit slits.
What additional information is typically required to measure enzymatic activity in a 24-hour urine test?
Weight, height, and total volume of 24-hour collection
The volume of urine excreted indicates the balance between fluid ingestion and water lost from the lungs, sweat, and intestine.
The measurement of the decrease in intensity of an incident light beam as it passes through a solution of particles defines which of the following methods?
Turbidimetry
While both turbidimetry and nephelometry measure scattered light. Turbidimetry is a method to measure the decrease in intensity of an incident light beam as it passes through a solution of particles.
The kidneys are the site of the active form of which vitamin?
Vitamin D
The kidneys convert vitamin D from supplements/ the sun to the active form of vitamin D. With chronic kidney disease, low vitamin D levels can be found.
In a urine reagent strip, methyl red is used to indicate what pH change?
Methyl red is used to indicate a pH change from 4.4 to 6.2 with a color change from red to yellow.
The speed at which light travels through air divided by the speed at which it travels through a substance is the
refractive index.
The speed at which light travels through air divided by the speed at which it travels through a substance is the refractive index. This value varies directly with the number of dissolved particles in the solution. Although not identical to specific gravity, refractive index varies and corresponds with specific gravity.
Which two chemicals are used during a pH reagent strip test with a double indicator system?
Bromothymol blue and methyl red
The reagent strip test for pH uses methyl red and bromothymol blue double indicator system that measures the urine pH from 5 to 9.
What can cause turbidity in a room temperature, fresh random specimen?
Crystalized chemicals
Normal but concentrated urine typically crystalizes certain chemicals out of solution at room or refrigerator temperature.
What is the identification of oval fat bodies confirmed with?
Sudan III
Sudan III and Oil Red O are stains used to identify fat in substances. With these stains, lobules of triglyceride or neutral fat appear orange or red.
Which of the following crystals should be accompanied by a positive test for urine bilirubin?
Tyrosine crystals are also seen with leucine crystals. Both are associated with severe liver disease.
Modern HPLC systems can work at pressures up to _________ psi.
5000 to 6000
Modern HPLC systems can work at pressures up to 5000 to 6000 psi.
Which of the following are the two methods used to characterize monoclonal proteins?
Immunoelectrophoresis and Immunofixation Electrophoresis
Immunoelectrophoresis (IEP) and immunofixation electrophoresis (IFE) are used to characterize monoclonal urine and serum proteins. In clinical labs, IFE, however, has essentially replaced IEP.
What is a simple sugar, or monosaccharide, derived from the breakdown of dietary carbohydrates?
Glucose
Intestinal absorption of carbohydrates occurs in the small intestine, where monosaccharides, the single- sugar units of carbohydrates, are absorbed.
Whole blood % versus plasma glucose
WB 10-15% less
Prep for GTT
High carb 3 days
In fasting, arterial/capillary glucose is… Higher than venous
2-5mg
Diagnostic for diabetes…
fasting plasma (8hrs)…
random plasma…
2hr plasma…
OGTT…
A1C….
fasting plasma (8hrs)…126
random plasma…200
2hr plasma…
OGTT…fasting 92
A1C….6.5
Electrolyte panel 4 items
Na, K, Cl, CO2
BMP 8 things
4 electrolytes, 3 renal related, 1 mineral
Na, Cl, K, CO2
glucose, creatinine, BUN
Ca
CMP
4 electrolytes, 3 renal related, 1 mineral
plus 5 liver
Na, Cl, K, CO2
glucose, creatinine, BUN
Ca
albumin, TP, ALP, AST, bilirubin
Liver function panel 6 things
albumin, TP, ALT, AST, ALP, bili
renal panel 9 things…
Electrolytes, renal, mineral
Na, K, CO2
glucose, creatinine, BUN, albumin, phoshate
Ca
5 analytes that increase glucose, 1 that doesnt
Keeps glucose in blood:
glucagon: break down glycogen, keep glucose up
cortisol, epinephrine: energy from other sources
GH
Thyroxine: glucose in GI absorbed
Takes glucoses out of blood:
insulin
onset 1-3hrs
peak 6-10hrs
normal 1-2days
Myoglobin: onset, peak, returns normal fastest
H2 breath test where bacteria acts on unabsorbed disaccharides used to diagnose
Lactase deficiency
Biliary obstruction has this increased in serum
Conjugated bilirubin
Which method for bilirubin uses alcohol that causes issues with turbidity from precipitated proteins
Evelyn Malloy
Which method for bilirubin uses a serum blank, thus not being affected by turbidity from precipitated proteins
Jendrassik Grof
In acute pancreatitis, amylase and lipase rise within
Amylase returns to normal in
In acute pancreatitis, amylase and lipase rise within a few hours
Amylase returns to normal in 3 days
LD 1 and 2 seen in these two
Heart, HA
Pulmonary LD
Liver LD
Pulmonary LD 3
Liver LD 4,5
Best in carcinoma of prostate marker
Total prostatic specific antigen
Hyperlipidemia
1: Exogenous triglyceride; young; cant remove chylo/VLDL
2: increaed LDL
3: dysbetalipo
4: endogenous
5: mixed exo/endo
Oral GGT test
Prego grams:
Standard grams:
if 1hr >140, give…
and compare fasting, 1,2,3hrs
Oral GGT test
Prego grams: 50
Standard grams: 75
if 1hr >140, give…100
and compare fasting, 1,2,3hrs
Hypoglycemia…
Clinical sig hypo…
hypo <70 mg/dl
clinical <54 mg/dl
A1C
glucose attaches to….of Hmg A
N-terminus valine
Test for diabetes where glucose attaches to proteins, average over 2-3 weeks, intermediate control
Fructosamine, total glycated protein
5NT
5-nucleotidase
see in…but not…
seen in liver but not bone
Destroys acetylcholine, decreased levels indicate organophosphate poisoning
cholineesterase
CRP and homocsysteine can be markers to access for risk of
cardiac risk
Procalcitonin/PCT is made in the thyroid and helps rule out…
sepsis
Equation of logarithmic expression of ionization constant equation of a weak acid
Henderson-Hasselbalch
Henderson equation
pH-pKa + log (HCO3/H2CO3) salt/acid
kidney/lungs
metabolic/respiratory
In acidbase disorder,
it will be respiratory issue if CO2 is going ….. to pH
it will be metabolic disorder if HCO3 is going…as ph
it will be respiratory issue if CO2 is going opposite to pH
it will be metabolic disorder if HCO3 is going same direction as ph
pH 7.35-7.45
HCO3 22-26
CO2 35-55
O2 85-105
pH…
HCO3…
CO2…
pH 7.35-7.45
HCO3 22-26
CO2 35-55
Cocaine compound tested
benzoylecgonine
2 opiates
codeine, morphine
2 general classes of antibiotics
aminoglycosides: cin
-gentamicin, tobramycin, amikacin
glycoprotein:
-vancomycin
Quinidine
Procainamide
Disopyradmide
Lidocaine all
antiarrhymmic/cardioactive
Phenytoin/Dilantin
Phenobartitol
Valproic acid all
anticonvulsant
Amitriptyline
Imipramine
Doxepin all
lithium
psychotrpoics
Cyclosporine
Tacroliumus
Sirolimus
Mycophenolic acid all
immunsuppressants
Hyper/Hypo
Primary is…
Secondary is…
Tertiary is…
Hyper/Hypo
Primary is…end organ
Secondary is…pituitary
Tertiary is…hypothalamus
Tissue T4, bound to TBG
T3 is tissue T4 converted, active
Graves T4/3 are…. with antibodies to
increased, antibodies to TSH receptors
Hashimotoes T4/T3 are..with antibodies to
decreased T4/T3, antibodies to TRab, TPO
thryoid autoab
Metabolic acidosis or alkalosis can compensate quicker, may have compensated CO2.
Metabolic alkalosis
high pH, HCO3
high TCO2
Metabolic acidosis
low ph, HCO3
low CO2
Additive for blood gas…
glycolsis affect on ph and CO2…
parameters measured directly in automated…
calculated…
Additive for blood gas…heparin
glycolsis affect on ph and CO2…rise in CO2, fall ph
parameters measured directly in automated…ph, CO2,O2
-HCO3 and oxg sat are calculatedbn
which best for renal tubular function…
osmolality over creatinine clearance
best in diabetes
if Na, K, glucose, BUN are normal osmal gap is
275-295
degree kidney concentrates filtrate determined by…
urine to serum osmolality ratio
serum >300, urine <300 is diabetes insipidis
not concentrating urine
Coulometry is an automated method to measure….using silver ions
chloride
Lanthanun Chloride eliminates interence in atomic absorption spectrophotometry to measure…
calcium
Assays for….measure hormone not bound to TBG/TBPA, or albumin
free T4
Congential hypothyroidism screen with
Free T4 blood spot
Predominating estrogen useful for prenatal screen
estriol
Hormone triggers ovulation
LH
LH-ovulation-follicle-corpus leteum
Normal pregnancy,
hcG peaks at…
and after….weeks of last period…
peaks 2-3months
peaks 2-2.5mths after period
8-10weeks
this increases vasoconstriction and thus stimulationg formation of aldosterone
angiogensin II
half life is how many doses…
If half life is 6hrs, given every 6 hrs, when is stead state…
5-7
24-42 hrs (6x5-6x7)=24-42
Salicylate is called
aspirin
Best sample for forensic toxicity of drugs of abuse
random urine
