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MTAP - CLINICAL CHEMISTRY 1 (LEC) > CC PART 7 (SPECIMEN) > Flashcards

CC PART 7 (SPECIMEN) Flashcards

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1
Q

The following analytes are affected by hemolysis:

KLAMPAT

A

○ K+: Potassium
○ L: LDH
○ A: AST, ACP, Aldolase
○ M2+: Magnesium
○ PO4-: Phosphate
○ A: Albumin
○ T: Total Protein

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2
Q

The primary intracellular anion

A

K+: Potassium

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3
Q

2ND MOST ABUNDANT ICF (Intracellular Fluid Cation)

A

M2+: Magnesium

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4
Q

■ MOST AFFECTED ENZYME in Hemolysis
■ Increased LD1 in RBC

A

L: LDH

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4
Q

■ MOST ABUNDANT ICF (Intracellular Fluid Cation)

A

PO4-: Phosphate

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5
Q

(3) Characteristics of Lipemia

A

○ Creamy
○ Turbid
○ Clear

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6
Q

● Chylomicrons
● EXOGENOUS Tg
● APO B48, non-fasting

A

If the sample looks like a creamy or opaque layer

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7
Q

● ≥ 400 mg/dL = sample will
appear turbid
● The highest lipid is triglycerides.
● The lipoprotein is VLDL.
● ENDOGENOUS, APO B100,
Fasting

A

If the sample looks turbid

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8
Q

● This is considered a rare case
because commonly, triglycerides are higher than cholesterol in
hyperlipidemia.
● Cholesterol can be collected
even without fasting.
● Use tube EDTA plasma since it
is done without fasting

A

If increase cholesterol = clear only, no turbidity

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9
Q

Ice for blood gases

A

IMPROPER TRANSPORT CONDITIONS

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10
Q

ABG sample is not transported with ICE; it will:

● Decrease ___
● Increase ____
● Decrease ___

A

● Decrease pH
● Increase pCO2
● Decrease pO2

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11
Q

● Short draws
● Wrong volume

A

IMPROPER BLOOD COLLECTION TUBE

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12
Q

Which level of triglyceride is difficult/hard to measure?

A. 600 mg/dL
B. 400 mg/dL
C. 200 mg/dL
D. 100 mg/dL

A

A. 600 mg/dL: This is already considered “milky.”

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13
Q

Remedy for Milky specimen:

A

Dilute sample

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14
Q

In the Friedewald equation, how many hours of fasting are needed for a lipid profile?

A. 10 hours
B. 12 hours

A

B. 12 hours

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15
Q

Reference range of Fasting for Lipid Profile is

A

10-12 hours.

● Explanation: In lipid metabolism, if you ate at 12PM
○ Food will be digested from the stomach down to the liver and to the small intestine in 1-3 hours. It takes 6–9 hours for a complete transport from the liver, then the
lipids’ level will return to its normal value.
○ However, ideally, 10–12 hours is the reference range of lipid profile.

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16
Q

TRUE OR FALSE:

● You can measure cholesterol without fasting? In what sample?

A

TRUE, in EDTA plasma, not
serum.

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17
Q

If bilirubin, hemoglobin, and lipids are high, what will you use?

A

Use Sample Blank

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18
Q

If the sample is icteric, lipemic, or hemolyzed?

A

Use Sample Blank

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19
Q

Which 3 analytes are the most seriously affected by hemolysis?

A

Potassium, LDH, and AST

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20
Q

● Liquid portion of the blood (plasma) from arterial and
venous
● Purpose: For STAT and POCT

A

WHOLE BLOOD

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21
Q

● Liquid of unclotted or anticoagulated blood (with
fibrinogen)

A

PLASMA

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22
Q

● Best Sample of Choice for STAT:

A

Lithium Heparin

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23
Q

● Best Sample of Choice for STAT: Lithium Heparin
● However, ______ is not used in enzyme assays because
it inhibits the enzymes.

A

PLASMA

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24
Q

● Most blood chemistry is run on blank serum samples.

A

SERUM

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25
Q

● Liquid portion of clotted blood without fibrinogen

A

SERUM

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26
Q

Why serum over plasma?

A

○ Serum is clearer than plasma.
○ It has no anticoagulant, which is a source of interference.

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27
Q

Ideally, ___ glucose tests should be performed alongside ____ protein tests

A

CEREBROSPINAL FLUID (CSF)

WHY? This test is used to differentiate between meningitis, tuberculosis, and other clinical
microscopy-related diagnoses.

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28
Q

CSF glucose =

A

CSF protein

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29
Q

3 TUBES of CEREBROSPINAL FLUID (CSF)

A
  1. Immunosero and Clinical Chemistry
  2. Microbiology
  3. Cell Count in Hematology
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30
Q

For GFR or creatinine clearance
○ If a person does not have kidney disease, you can compute the GFR, or creatinine clearance.
○ However, if the person is diabetic or has other
conditions, creatinine clearance can no longer be used.
■ Instead, it is estimated GFR (eGFR).

A

24 HOUR URINE

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31
Q

________ and _______ are good markers of GFR without computing eGFR.

A

Cystatin C and creatinine

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32
Q

DIURNAL VARIATION

CORTISOL

● Peaks at 4-6 AM
● Lowest 8 PM-12 AM
● 50% lower at 8 PM than 8 AM

A

● Peaks at _____
● Lowest _____
● 50% lower at 8 PM than_____

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33
Q

● Increases with stress

A

CORTISOL

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34
Q

CORTISOL
● Best time to collect:

A

6 am to 8 am (morning)

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35
Q

Cushing Disease

A

pituitary problem

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35
Q

is higher in the morning.

A

CORTISOL

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36
Q

Cushing Syndrome

A

adrenal problem

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37
Q

Cortisol ↑
ACTH ↑

A

Cushing Disease

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38
Q

● Lower at Night
● Higher value while standing than supine

A

PLASMA RENIN ACTIVITY

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38
Q

Cortisol ↑
ACTH - Not affected

A

Cushing Syndrome

39
Q

● Lower at night
● Increases with stress

A

ACTH

40
Q

● Lower at night

A

ALDOSTERONE AND INSULIN

41
Q

● Higher in the afternoon and evening

A

GH AND ACP

42
Q

● Increase with stress

A

THYROXINE

43
Q

● Higher with stress
● Higher levels at 4 and 8 am and 8 - 10 pm

A

PROLACTIN

44
Q

Drawn in successive days to avoid diurnal variation

A

Serum iron

44
Q

● Peaks early to late morning, decreases up to 30% during
the day

A

IRON

45
Q

● 4% decrease when in supine position

A

CALCIUM

46
Q

Increase
● ACTH
● Catecholamines
● Cortisol
● Albumin
● Insulin
● Prolactin
● Lactate

Decrease
● HDL
● Respiratory alkalosis

A

STRESS

47
Q

Increase
● Albumin
● Cholesterol
● Ca2+ when standing
● Aldosterone
● Bilirubin
● Cortisol
● Total Protein
● Triglycerides
● Rbcs
● Wbcs
● Thyroxine (T4)
● Plasma Renin
● Catecholamines

Decrease
● Lipids due to hemodilution

A

POSTURE

48
Q

concentration of these analytes increased within 10 minutes
from supine to standing

A

Catecholamines

49
Q

A marker for chronic alcoholism is

A

GGT

50
Q

Increase
● Tg and GGT

Decrease
● Glucose due to ethanol

A

ALCOHOL

51
Q

Increase
● Glucose
● Insulin
● Gastrin
● Tg
● Na
● Uric Acid
● Iron
● Ld
● Ca2+

Decrease
● Chloride
● Phosphate
● K+

A

RECENT FOOD INTAKE

52
Q

● Bilirubin
● CK
● Steroid Hormones
● Tg

A

DAY TO DAY VARIATION

53
Q

● The patient can drink water during fasting, unless the order is NPO.

A

FASTING

54
Q

FASTING:

↑ Plasma Tg; ↓ glucose

A

72 Hours

55
Q

FASTING:

↑ Bilirubin

A

48 Hours

56
Q

Increase
● Glucose
● Triglycerides
● Aspartate aminotransferase (AST)
● Bilirubin
● Blood Urea Nitrogen (BUN)
● Phosphorus
● Uric Acid
● Growth Hormone
● Cholesterol
● Lipoproteins
○ High-Density Lipoprotein (HDL)
○ Low-Density Lipoprotein (LDL)

A

NON-FASTING

57
Q

Urea increases

A

High-protein diet

58
Q

Ketones increase

A

High protein and low CHO

59
Q

○ Urine 5-HIAA (5-hydroxyindoleacetic acid)

A

Serotonin-rich food

60
Q

■ Banana
■ Tomato
■ Pineapple
■ Avocado
■ Chocolate
■ Coffee
■ Tea

A

Serotonin-rich food examples

61
Q

● Increases sample turbidity
● 400 mg/dL or more TAG = turbid serum; lipemia

A

TRIGLYCERIDES > 400 mg/dL

62
Q

Most common error in hemoglobin measurement

A

Hgb & Total Bilirubin

63
Q

Tourniquet may be reapplied after 2 minutes to avoid
hemoconcentration

A

PROLONGED TOURNIQUET > 1 MINUTE

64
Q

● Cardiac muscles:
● CK-MB = 20%
● CK-MM = 80%
○ Increased

A

IM INJECTIONS

65
Q

most cardiac-specific enzyme (first enzyme to increase during cardiac arrest)

A

CK-MB = 20%

66
Q

JAUNDICE:

The normal value of Hgb in plasma is

A

2-4 mg/dL

67
Q

≥ 2 mg/dL

A

indicative of Jaundice

68
Q

25 mg/dL

A

indicative of Icteric

69
Q

If there is diurnal variation, there is a systematic error.

Who has cushing’s syndrome?

● Patient 1; AM - 100; PM - 50
● Patient 2; AM - 100; PM - 100

A

Patient 1 has loss of diurnal ACTH.

70
Q

Which analyte is significantly affected by a change in posture from supine to a sitting or standing position?

A. Protein
B. Calcium
C. Aldosterone
D. Magnesium

A

Protein, increase 10% when standing.

70
Q

Which serve as first responders to stress by acting within seconds?

A. Cortisol
B. DHEA
C. Aldosterone.
D. Catecholamine

A

Catecholamine, Epinephrine, and Norepinephrine; cortisol increases within minutes.

71
Q

The level of cortisol in the morning __________.

A. Higher
B. Lower
C. No effect.
D. None of the choices

A

A. Higher

72
Q

What is the best time to collect a sample?

A

Basal state (early morning)

73
Q

How to determine if you have a high protein diet

A

If stool does not float, fiber is insufficient.

74
Q

Nothing to eat or drink (except
water) for at least 8 hours (except
lipids).

A

Fasting

75
Q

Place in a slurry of crushed ice
and water. Do not use ice cubes alone because RBCs may lyse

A

Chilling

75
Q

Use a 37-degree C heat block, heel warmer, or hold in hand.
Cryoglobulins are proteins that
precipitate at low temperatures.

A

Warming

76
Q

Wrap in aluminum foil.

Bilirubin is photosensitive.

A

Protection from direct light exposure

77
Q

LD 4 and 5 are labile at low
temperature = falsely decreased.

A

Freezing of sample

77
Q

Fill out the chain of custody form.

A

Chain of custody

77
Q

Centrifuged within 1 hour or
up to 2 hours

Minimize glycolysis

A

Delivery time

78
Q

If you’re the phlebotomist, which of the following will you prioritize?

a. FBS
b. Cortisol
c. CBC

A

a. FBS

Rationale: FBS and cortisol are both timed, but the most correct answer is A. FBS. If FBS was not
prioritized, the patient might become hyperglycemic or miss intake of their medicines or procedures.

79
Q

Serial bilirubin determination are charted below with the bet explanation for the results due to:

a. Sample hemolysis and hemoglobin deterioration
b. Sample exposure to light
c. Sample left in unwarm location
d. Reagent deterioration

A

b. Sample exposure to light

Notice the time difference bet the collection time and assayed time. The Shift of values from day
one, lowered in day 2, then increased on day 3, signifies the error and the point of investigation, which should be on day 2

79
Q

a photosensitive form, can cause
brain damage (kernicterus) if it crosses the blood-brain barrier. Newborn babies often struggle
to break down B1 into a soluble form in their liver.

A

B1 bilirubin

Exposing babies to morning sunlight helps convert B1 into a soluble form, preventing it from
entering the brain and causing harm

80
Q

● Use the opposite arm or
perform fingerstick if possible.
● Stop IV for 2-5 minutes

A

IV

81
Q

● Draw from opposite arm

A

Fistula

82
Q

● Draw first 5 mL then
discard.
● Draw blood below the IV
line if nothing is being transfused.

A

Indwelling lines and catheters, heparin locks, cannulas

83
Q

● Select other site

A

Sclerosed veins

84
Q

● Draw below

A

Hematoma

85
Q

● Hold pressure until bleeding
has stopped

A

Streptokinase/Tissue plasminogen Activator (TPA)

86
Q

● Select another site

A

Edema, Scars, Burns, Tattoos

87
Q

● Draw from the opposite arm

A

Mastectomy

88
Q

● Ask nurse to ID before
drawing

A

Unidentified patient

89
Q

Stop IV for

A

2-5 minutes

90
Q

Exposing babies to morning sunlight helps convert B1 into a ___________, preventing it from
entering the brain and causing harm.

A

soluble form

91
Q

The intern drew blood from the patient’s arm, resulting in a hematoma, even though the
intern was considered the best phlebotomist in the lab. What went wrong when the intern drew blood from the patient?

A

○ The patient’s folded his/her arm after the blood draw, combined with their antithrombotic therapy, led to a hematoma.
○ Always ask the patient if they are taking any medications such as warfarin, coumadin, etc.

MTAP - CLINICAL CHEMISTRY 1 (LEC) (8 decks)

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