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Clinical Chemistry II - 4378 > Blake Exam C flashcards > Flashcards

Blake Exam C flashcards

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1
Q

How many miligrams per deciliter are contained in 145mEq/L of Na+

A

1.) convert miliqulivalence per liter to equivalence per liter = (145mEq/1.00L)( 1Eq/110^3L)= .145Eq/1L
2.) .145Eq/L= X g of NA/ (22.99AW of NA/ 1 Val)/ 1L of sol
3.) .145= (X g of Na/ 22.99)
4.) .14522.99= 3.33g/L or X
5.) convert g/L to miligrams/dl
3.33g/L( 1L/10dl)( 1000mg/g)= 333mg/dl

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2
Q

How do you to convert from mg/dl to meq/L. if sodium MW is 23 and the concentration of NA is 350mg/dl

A

1.) convert Mg/dl to g/dl=350mg/dl( 1g/1000mg)(10dl/1L)=3.5g/l
2.) Plug-in g/L into your equation ( g/L of Na/ AW of Na/1VA)= 3.5/ (22.99/1Val)= .1522eq/L
3.) .1522Eq/L( 1000mEq/1Eq)= 152.2mEq/L

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3
Q

Pseudohyponatremia and pseudohypocalcemia occur with what methodology to detect lithium( Red color), K+ ( violet color), and Na( yellow color) occur with

A

Flame emmision spectroscopy

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4
Q

Is calcium low with hypoalbuminemia and Ionized calcium is not affected

A

True

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5
Q

What is slightly higher in Heperinzed plasma then in serum

A

K+

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6
Q

The normal range for K+

A

3.5-5.0mEq/L

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7
Q

Sodium normal range

A

135-145 mEq/L

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8
Q

Calcium normal range is

A

9.2-11.0 mEq/L

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9
Q

Magnesium normal range is

A

1.3-2.1mEq/L

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10
Q

Bicarb normal range is

A

21-28mEq/L

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11
Q

Chloride normal range is

A

95-103mEq/L

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12
Q

phosphorous normal range is

A

2.3-4.7 mg/dL

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13
Q

Iron normal range is

A

60-150ug/dl

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14
Q

therapeutic lithium normal range is

A

0.5-1.4 mEq/L
1.0-1.6mEq/L

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15
Q

what is the main regulator of ADH

A

is Osmolality, neurons within the hypothalamus respond to change in blood osmolality

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16
Q

what are the intracellular electrolytes and what will falsely elevate theses

A

K+, Mg2+, Phosphorous, Fe. so hemolysis will falsely elevate these

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17
Q

what are the extracellular electrolytes

A

Cl-, bicarb, Na, and Ca2+

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18
Q

Hyponatremia- A low sodium concentration

conditions

A

vomiting and diarrhea
excessive sweating and burns
Renal reabsorption disease ( PCT, ALOT, and DCT)
hypoaldosteronism
Polyuria and osmotic diuresis

results in GI leakage and neural problems

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19
Q

Hypernatremia causes a high sodium concentration

caused by

A

CHF
liver disease–> low protien–> low oncotic pressure–> excrete more water–> high NA
renal disease
Hyperaldosteronism
severe dehydration
nasogastric feeding of high protein concentration w/o sufficient fluid intake
high protein
Hypothalamic injury to thirst mechanism (Ex. adipsia)
excessive intake of NA with therapy aka Na Herparin is used when patient has a bleeding problem
Pregnancy

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20
Q

Hypokalemia

A

Vomiting, diarrhea
Cushing’s Syndrome - hyperaldosteronism
Renal reabsorptive disease - renal tubular necrosis (PCT, ALOH, DCT)
Metabolic alkalosis
H+ shift
Insulin excess
Diuretic therapy - high urine → K follows water
Low intake over a long period of time

results in
K depletion

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21
Q

Hyperkalemia- There is a high potassium concentration.

A

Hypoaldosterone - Addison’s Disease
Renal failure
Acidosis
High H+ (low pH) → H+ exchange with intracellular K
Insulin deficiency
High glu plasma → high filtration → high water in tubule → dehydration → high K
Translocation of K
Excess intake
Cellular breakdown
Exercise - physical stress stimulate muscle cells to release K
Hospital administration of infusion solutions containing K if patient cannot excrete
Anoxia, shock
Very low oxygen → low ATP → no Na/K ATPase activity → K permeability → K leakage
Continued metabolism → high CO2 → acidosis → damage membrane → release K
Artificial False Elevation
Elevated platelet, WBC counts - high clot → cells squished → K leak
Tourniquet left on too long - hypoxia due to low blood → sicked shape RBC → squished → K leak
Results in:
Interference with heart electrical impulses

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22
Q

Dehydration will cause elevated levels of

A

Na+

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23
Q

Urinary blockage causes elevated levels of

A

Na+

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24
Q

High potassium is associated with Cushings or Addisons

A

Addisons disease( hypoaldosteronism)

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25
Q

H+ will enter the cell in _______ will leave the cell causing hyperkalemia and vice versa

A

K+

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26
Q

Chloride will enter the cell and Bicarb will exit in states of

A

Acidosis

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27
Q

A high amount of insulin will cause a low ____

A

Potassium

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28
Q

High bicarb is associated with

A

metabolic alkalosis

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29
Q

High CO2 is associated with

A

Respiratory acidosis

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30
Q

Hypochloremic metabolic alkalosis occurs when

A

There is a loss of chloride ions and occurs due to a loss of gastric fluid.

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31
Q

When does hyperchloremia occur

A

in chronic metabolic acidosis; aka chloride ions need to take up H ions.

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32
Q

Anion gap calculations

A

(Na + K) - (Cl + HCO3) = 15 mmol/L (10-20)
Na - (Cl + HCO3) = 12 mmol/L (7-16)

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33
Q

two methods to determine Na and K

A

FEP and ion selective electrode potentiometry

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34
Q

Total CO2 exists as

A

dissolved CO2( 3%), Carbamino ( 33%) and bicarb ( 64%)

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35
Q

what is the major form of CO2 transported in blood

A

most of the CO2 in blood exists as Bicarb and is formed from the reaction of CO2 + H20–> HCO3 by carbonic anhydrase.

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36
Q

administration of insulin on K+ levels

A

Lowers the amount of serum K because glucose and K are both taken up into the cell.

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37
Q

Acidosis cause elevated or decreased K + levels in the serum

A

Elevated because of K+ and H+ shift in the cell

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38
Q

Alkalosis will cause an increase or decrease in K+ in the serum

A

Decrease in the serum potassium as K+ into the cell H+ moved out. As K+ is moved in it stimulates the distal cells of the nephron to secrete more K+.

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39
Q

as pH is decreased, Ca2+ _________

A

H+ disrupts Ca2+ from binding to binding sites and causes an increase in ICa2+.

high free calcium, high divalent pH.

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40
Q

As the pH is Increased Albumin becomes more

A

negatively charged and binds with calcium therefore decreasing the amount of ICa2+.

low free calcium and high monovalent pH

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41
Q

What is a cause of low Calcium, low PTH, and high phosphate

A

Pseudohypoparathyrosm

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42
Q

what is a cause of a of low Ca, low PTH, and high pH

A

PseudohypoPh because you will have a low calcium, low PTH, and high phosphate, which will cause phosphate to bind with H+ to become Phosphorous.

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43
Q

how is alkaline phosphatase inhibited

A

By serum calcium levels, if alkaline phosphatase comes into contact with serum calcium, then it will crystalized.

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44
Q

Where is alkaline phosphatase secreted?

A

in bone formation from osteoblast which is regulated by PTH and PTH stimulates the release of ALP from bone It also stimulates phosphorous excretion into the urine and calcium reabsorption from the gut

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45
Q

when there is low Mg2+, there is low what

A

Calcium and PTH, Mg2+ is required for enzymes that cause PTH to be released and if there is a decrease in Mg2+ then there will be a decrease in Calcium.

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46
Q

what condition will cause a low absorption and high excretion of Mg2+

A

Alcoholism and intestinal sprue.

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47
Q

Magnesium blocks ______ entry into the cell

A

Calcium

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48
Q

What conditions cause a decrease in mg2+ and calcium secondarily

A

intestinal reabsorptions issues, alcoholism, magnesium sulfate therapy, secondary hypoparathyroidism

49
Q

what is the most widely used method for phosphate

what Is the reducing agent

A

Molybdenum blue method

Phosphate + molybdenum –> complex structures

after reduction, molybdenum+ phos is converted to molybdenum blue at 660nm.

ANS is the reducing agent

50
Q

Why is EGTA added to magnesium studies?

A

to act as a chelator and chelate calcium to remove interferences

51
Q

why is hydroxyquinoline added to calcium studies

A

To chelate Magnesium and to remove interferences

52
Q

Why is KCN added to both calcium and magnesium studies?

A

to avoid heavy metal interferences and to stabilize the product

53
Q

Anemia of chronic infection has what Iron level, % T,< TIBC, and Ferritin

A

Decreased Iron, TIBC, % T, but an increase in ferritin

54
Q

IDA has a

A

Decreased Iron level, Decrease %T, Increased TIBC, and an decrease Ferritin.

55
Q

What causes does an acidic medium have on IRON.

A

it will cause the % transferrin to lower because iron will be removed from transferrin, thereby increasing the TIBC

56
Q

What causes does an alkali medium have on IRON.

A

it will cause Iron to be stay on transferrin and will decrease the TIBC

57
Q

What increases ammonia and question gave us normal creatinine and BUN so renal is normal

A

Liver disease

58
Q

why is serum osmolality compared to calculated osmolality

A

In order to detect the presense of unmeasured cosmetically active substances, mainly volatile substances, that only contribute to the measured osmolality

59
Q

Osmolality equations

A

2NA + glucose + urea= mmol/L
2NA + glucose/18 + Urea/2.8= Mg/dL

60
Q

What is used to treat bipolar disorders

A

Lithium

61
Q

lactic acid tube anticoagulant

A

sodium flouride

62
Q

what anticoagulant should not be used in lactic acid test

A

Flouride oxalate because it inhibits LDH activity

63
Q

what electrode measures H+ and uses Bicarb as a buffer

A

PCO2 electrode

64
Q

[CO2]=

A

a* PCO2 where a is bunsen coefficient and = .0301 mmol* L

65
Q

Respiratory Acidosis

A

([HCO3-]/ high αpCO2) < 20

66
Q

(low [HCO3-] / αpCO2)< 20 in

A

Metabolic acidosis

67
Q

why is EDTA not used in blood gas analysis

A

because it can chelate divalent cations

68
Q

Given the following information calculate the total CO2 in Meq/L. HCO3= 24 mEq/L and pCO2=40 mmHg

Hint: You do not need the pH just the solubility coefficient of pCO2.

A

TCCO2= ApCO2 + HCO3-

( 0.0301 * 40mmHg) + 24 mEq/L = 25.2mEq/L

69
Q

The impact of the following blood gas sampling errors

-Exposing to air

A

pH: increases (function of pCO2)
pCO2: decreases since the pCO2 of atmospheric air is lower than blood
pO2: increases since the pO2 of atmospheric air is higher than blood

70
Q

The impact of the following blood gas sampling errors

  • delayed transport time, not exposed to air
A

pH: decrease, caused by cell glycolysis
pCO2: increases, caused by cell glycolysis
pO2: decrease, caused by cell respiration

71
Q

The impact of the following blood gas sampling errors

Not collected on ice

A

pH: decrease
pCO2: increase
pO2: decrease

72
Q

standard transport time for blood gases

A

specimens should be placed on ice and analyzed within 10-15min

Glass tubes should be help for up to 2 hours but plastic tubes should be analyzed within 15 minutes

if the sample was out for 2.5 hours then reject it and recollect

73
Q

what is the anticoagulant of choice for blood gas analysis

A

Lithium heperin

74
Q

what is the most common method for Ketones

A

Enzymatic with beta hydroxybutyrate dehydrogenase

Beta Hydroxybutyrate dehydrogenase is used for catalyzing NAD(+) to give acetoacetate and NADH + H(+) and is the most common method used to determine acetone amounts.

75
Q

how do you calculate molarity

A

Moles of solute/ L of solution

76
Q

what do you use to bind inorganic phosphate

A

Molybdenum blue

77
Q

Hypernatremia is associated with what aldosterone disease

A

Cushings disease

78
Q

Hyponatremia is associated with what aldosterone disease

A

Addisons disease

79
Q

Calcium and magnesium have a _______ relationship

A

Direct

80
Q

Chloride and sodium have a _______ relationship.

A

DIrect

81
Q

If you have a metabolic acidosis, chloride will move into the cell and bicarb will move ____

A

out

82
Q

if you have a metabolic alkalosis Chloride will move out of the cell and Bicarb will move ___

A

in the cell

83
Q

Hyperchloremia is indicative of

A

metabolic acidosis

84
Q

Hypochloremia is indicative of

A

metabolic alkalosis

85
Q

You make a 1:5 dilution. how much diluent do you use

A

1 sample: 4 part diluent

86
Q

850mililiter to microliters

A

850,000 microliters

87
Q

Validation is used to check if the

A

QC is good by what the manufacturer says.

88
Q

Verification is what the MLS must do before

A

Sending out results

89
Q

Hypoparathyroidism, hypocalcemia, tetany, malabsorption, and alcoholism are all associated with

A

Mg2+ deficiency

90
Q

How does magnesium inhibit calcium?

A

by allosteric regulation

91
Q

In IDA and ACI what is the FEP and serum iron and % T

A

Increased FEP and decreased serum Iron

%T is decreased

92
Q

In IDA and ACI what is the soluble transferrin receptor %

A

Increased in IDA and normal in ACI

93
Q

Primary hyperparathyroidism has

A

Increased PTH, calcium and a decrease in Phosphate

94
Q

Secondary hyperparathyroidism has

A

Increased PTH, low Ca2+ or normal, and low to high phosphate.

95
Q

Primary hypoparathyroidism has what

A

Decreased PTH and Ca2+, and increased phosphate

96
Q

Secondary hypoparathyroidism

A

Decreased PTH and decreased Ca2+ and increased or decreased phosphate. depends on the severity of the hypomagnesemia. In acute= Increased, in chronic= decreased

97
Q

If samples were received at 8;30 and not received in the lab until 11 for an arterial sample what should you do

A

Request a new sample

98
Q

Calibration is the

A

functional relationship between measured values and analytical quantities

99
Q

Defincieny of what is assoicated with poor wound healing

A

Zinc

100
Q

How to calculate total CO2

A

Ph= PK + log( HCO3-)/(apCO2)

101
Q

If you dont have Bicarb then

A

HCO3= TCO2- a* pCO2( this is dissolved CO2)

102
Q

If you dont have PCO2 then pCO2=

A

(TCO2-[HCO3]) * .03010

103
Q

what is the purpose of EDTA

A

to Chelate calcium; decreases interferences

104
Q

Increased Ammonia is due to what pathology

A

hepatic encephalitis ( causes neural abnormalities because NH3 can cross the BBB( coma and seizers)

105
Q

When preparing 10% sulfuric acid to make 100ml of solution. what do you add first

A

90mL of DI water

remember add acid to base

106
Q

what is the purpose of the west guard rules

A

to evaluate controls from multiple runs

107
Q

The purpose of running controls is to check for

A

Accuracy

108
Q

what is the Confidence limit of a sample falling within 2SD of the mean

A

95%

109
Q

In QC total range refers to

A

mean +,- 2SD

110
Q

How to calculate CV

A

SD/mean* 100

111
Q

b-HCG allows for more

A

Sensitivity/ Specificity

112
Q

Iron is reduced from 3+ to 2+ in what environment

A

Acidic

113
Q

Concentration= %(W/V)

A

= (mass of solution(g)/ volume of solution(Mg)) * 100

114
Q

Tech looks at the QC machine and sees 6 linear points out of my mean what is this

A

Shift

115
Q

Metabolic acidosis= what Ionized Calcium and phosphorus levels

A

Increased leading to a stone

116
Q

How would you make 500mL of a 10% bleach solution

A

you add 50mL of bleach to 450mL of water

117
Q

What is the principle of the active calcium measurements

A

OCPC red complex

118
Q

How to measure ionized calcium

A

by ISE

119
Q

what is caused by a high PTH and high calcium and low Phosphorous level and bone lesions( osteitis fibrosa)

A

Primary hyperparathyrodism

Clinical Chemistry II - 4378 (28 decks)

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