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CAPSTONE > Chemistry 51-70 :) > Flashcards

Chemistry 51-70 :) Flashcards

1
Q

Name 3 substances that are increased in the blood with renal disease.

A

BUN, Creatinine, and Uric Acid

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2
Q

What is urea?

A

Byproduct of protein metabolism

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3
Q

Why should tubes containing fluoride or citrate not be used when collecting blood for urea if analysis will be by the urease method?

A

Fluoride and citrate inhibit urease.

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4
Q

Where is 98% of the body’s creatinine located?

A

In the muscles

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5
Q

What reaction is used to measure creatinine?

A

Jaffee Method

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6
Q

What is the significance of the BUN:creatinine ratio?

A

It helps to determine the cause of increased BUN

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7
Q

What non-protein nitrogen doesn’t change easily?

A

Creatinine because its related to muscle mass and is not affected by diet

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8
Q

What is uric acid?

A

Byproduct of purine catabolism

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9
Q

What reagent is commonly used to measure uric acid?

A

Uricase

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10
Q

What may result from high levels of uric acid?

A

Urate crystals may precipitate in joints and tissue

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11
Q

Why must the pH of urine for uric acid determination be adjusted to 7.5-8?

A

To prevent precipitation of uric acid because it precipitates at acid pH.

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12
Q

Where is ammonia formed?

A

Mainly in the intestines from deamination of amino acids and is converted to urea by liver

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13
Q

When is ammonia elevated?

A

Hepatic failure and Reyes syndrome

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14
Q

What is Reye’s syndrome?

A

An acute, fatal degeneration of the liver usually in children with viruses and aspirin use.

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15
Q

What are 2 technical difficulties in performing ammonia determination?

A

Levels increased rapidly after drawing and need to be put on ice immediately and plasma separated from cells. Also can be contaminated from detergents, water, and smoke.

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16
Q

Which amino acid is increased in the blood of patients with PKU?

A

Phenylalanine

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17
Q

What may result if blood PKU is drawn before 24 hours of age?

A

False negative

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18
Q

Which amino acids are increased in maple syrup disease?

A

Leucine, isoleucine, and valine

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19
Q

What is bilirubin?

A

Byproduct of heme catabolism

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20
Q

Which protein transports bilirubin in the blood?

A

Albumin

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21
Q

Explain what happens to bilirubin in the liver.

A

It is conjugated with glucaronic acid by the enzyme UDPG. After conjugation, it is excreted into the intestines via bile duct and is reduced by bacteria into urobilinogen.

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22
Q

What is the significance of clay-colored or light stools?

A

Obstruction of bile duct. Urobilin is not being produced because bilirubin is not reaching the intestines.

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23
Q

What urine abnormality is seen with complete obstruction of the biliary tract?

A

Decreased urobilinogen

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24
Q

Compare the solubility of direct and indirect bilirubin.

A

Direct bilirubin is soluble in water, indirect is not.

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25
Q

Which form of bilirubin can be excreted in the urine?

A

Only direct

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26
Q

What is a common method to measure bilirubin levels?

A

Diazo reaction

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27
Q

Name 2 accelerators that are used in total bilirubin reaction.

A

Alcohol or caffeine .

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28
Q

Two sources of error that can decrease the level of bilirubin

A

Exposure to light and hemolysis

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29
Q

Total bilirubin normal range

A

0.2 - 1.0 mg/dL

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30
Q

What would cause an increase in total bilirubin with a normal concentration of direct bilirubin

A

Prehepatic jaundice

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31
Q

What causes physiologic jaundice of the newborn?

A

Bilirubin metabolism is impaired because the newborn’s immature liver doesn’t produce the enzyme required for bilirubin conjugation.

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32
Q

In HDNB, which fraction of bilirubin is elevated or why?

A

Indirect due to excessive breakdown of RBCs by maternal antibody.

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33
Q

What is the risk to the newborn from a high level of indirect bilirubin?

A

Indirect bilirubin has a high affinity for brain tissue and necrosis (kernicterus)

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34
Q

What method is used to determine neonatal bilirubin?

A

Direct spectrophotometry at 454 nanometers.

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35
Q

Name two conditions in which direct bilirubin is elevated.

A

Hepatic and posthepatic jaundice

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36
Q

What are the typical lab findings in posthepatic jaundice?

A

Increased total bilirubin and direct bilirubin, decrease urine urobilinogen, and clay colored stool

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37
Q

Which disorder results in the highest levels of conjugated bilirubin?

A

Obstruction liver disease

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38
Q

What type of method is used for most hormone assays?

A

Immunoassays

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39
Q

What is the precursor in the biosynthesis of all steroid hormones?

A

Cholesterol

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40
Q

List 5 steroid hormones

A

Cortisol, aldosterone, estrogen, testosterone, and progesterone

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41
Q

Which endocrine gland releases tropic hormones that regulate other endocrine glands?

A

Anterior pituitary

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42
Q

Where is growth hormone (GH) produced and what is its main action?

A

Anterior pituitary and stimulates protein synthesis and cell growth/division

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43
Q

Where is FSH produced and what is its main action?

A

Anterior pituitary and stimulates egg/sperm production.

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44
Q

Where is TSH produced and what is its main action?

A

Anterior pituitary and stimulates T3 and T4 production by the thyroid

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45
Q

Where is ACTH produced and what is its main action?

A

Anterior pituitary and stimulates adrenal cortex to produce corticosteroids

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46
Q

Where is ADH produced and what is its main action?

A

Hypothalamus and stored in posterior pituitary. And it regulates reabsorption of water from distal convoluted tubules.

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47
Q

Where is cortisol produced and what is its main action?

A

Adrenal cortex and regulates fat, carbs, and protein metabolism, water and electrolyte balance, and suppresses inflammatory and allergic reactions.

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48
Q

What is Addison’s disease?

A

Adrenal insufficiency, with decreased cortisol and increased ACTH.

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49
Q

What is Cushing’s syndrome?

A

Elevated cortisol with tumors in pituitary or adrenal glands, .

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50
Q

Where is aldosterone produced and what is its main function?

A

Adrenal cortex and increases retention of sodium and excretion of potassium and hydrogen.

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51
Q

What are catecholamines?

A

Hormones secreted by the adrenal-medulla (epinephrine, norepinephrine, and dopamine)

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52
Q

Where is progesterone produced and what is its main action?

A

Ovaries and prepares uterus for pregnancy and stimulates lactation

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53
Q

What is the major estrogen produced by the ovaries?

A

Estradiol (E2)

54
Q

Which hormones are used to asses fetal well-being?

A

Estriol and progesterone

55
Q

Which hormone is used to detect pregnancy?

A

HCG

56
Q

Which hormone can be measured by a home testing kit to determine the time of ovulation?

A

Luteinizing hormone (LH) secreted by the anterior pituitary

57
Q

Why are estrogen and progesterone receptor assays performed?

A

To establish a prognosis for patients with breast cancer

58
Q

Where is T4 produced and what is its main action?

A

Thyroid and controls metabolic rate, growth, and development, and sexual maturation.

59
Q

Which is the physiologically active form of T4?

A

Free T4 but most T4 is bound to TBG protein

60
Q

What is the recommended screening test for thyroid function?

A

TSH because it may be increased before symptoms and normal TSH excludes a primary thyroid problem.

61
Q

What further thyroid testing is recommended when the TSH is abnormal?

A

Free T4

62
Q

What further thyroid testing is recommended when TSH is low and free T4 is low/normal?

A

Total T3

63
Q

How can primary hypothyroidism be differentiated from secondary?

A

Primary will have increased TSH as pituitary tries to stimulate thyroids to produce more T3 and T4. Secondly is a pituitary disorder with low TSH.

64
Q

What are typical lab findings for primary hypothyroidism?

A

High TSH and low free T4.

65
Q

What are typical lab findings for hyperthyroidism?

A

Low TSH and high free T4

66
Q

What is Grave’s disease?

A

Autoimmune disease that is most common hyperthyroid disorder in US

67
Q

Where is PTH produced and what is its main function?

A

Parathyroid gland and increases serum calcium and decreases phosphates

68
Q

Where is glucagon produced and what is its main function?

A

Alpha cells of pancreas and increases glucose levels

69
Q

What are electrolytes?

A

Substances that carry electrical charge when dissolved in water

70
Q

What are the major electrolytes

A

Sodium, potassium, chloride, and bicarbonate

71
Q

What is the major extracellular cation

A

Sodium

72
Q

What is the major intracellular cation

A

Potassium

73
Q

What is the major extracellular anion

A

Chloride

74
Q

What is the major intracellular anion

A

Phosphate

75
Q

Normal sodium range

A

135-145 mEq/L

76
Q

Which hormone regulates sodium concentration

A

Aldosterone

77
Q

How are sodium and potassium usually measured

A

ISE (ion selective electrodes)

78
Q

Why is potassium slightly higher in serum than in plasma

A

Potassium is released from platelets during clotting

79
Q

Before reporting elevated potassium, what must be checked

A

Hemolysis or excessive delay in operating the serum/plasma from the RBCs

80
Q

What clinical condition results from very high or very low potassium levels

A

Cardiac arrhythmias

81
Q

What is chlorides role in the body

A

Maintains hydration, osmotic pressure, and electrolyte balance

82
Q

Which disease is characterized by a high concentration of sodium and chloride in sweat?

A

Cystic fibrosis

83
Q

What is the most accepted test for diagnosis of cystic fibrosis

A

The sweat test.

84
Q

Which sweat test is recommended by the Cystic Fibrosis Foundation?

A

Gibson-Cooke quantitative sweat test

85
Q

Anion gap formula

A

(Na + K) - (Cl + Co2)

86
Q

What is the most abundant mineral in the body

A

Calcium

87
Q

What anticoagulants cause a false decrease in calcium?

A

EDTA, citrate, and oxalate. All prevent coagulation by binding calcium.

88
Q

Which form of calcium is physiologically active?

A

Ionized

89
Q

Why is pH an important consideration in ionized calcium determinations

A

As pH decreases, calcium dissociates from it complexed forms, increasing free ionized calcium in serum

90
Q

What is the reference method for total calcium

A

Atomic absorption

91
Q

What happens to calcium when phosphorus is increased

A

It decreases. There is a reciprocal relationship between calcium and phosphorus

92
Q

What substances regulate calcium levels

A

PTH, calcitonin, and vitamin D

93
Q

What is tetany

A

Muscle cramps, spasms, and irritability due to decreased calcium or magnesium

94
Q

What happens to calcium when phosphorus is increased

A

It decreases. There is a reciprocal relationship between calcium and phosphorus

95
Q

Phosphorus is _______ in growing children than in adults.

A

Higher

96
Q

What must be done to urine prior to performing a urine phosphorus analysis

A

Acidified to pH of 6 to prevent precipitation

97
Q

How does hemolysis affect iron level

A

Falsely elevated results because of high iron concentration in hemoglobin

98
Q

Which protein transports iron

A

Transferrin

99
Q

Where is most of the iron in the body

A

Hemoglobin

100
Q

2 storage forms of iron

A

Ferritin (primary storage form) and hemosiderin

101
Q

How are the iron and TIBC affected in iron deficiency anemia

A

Serum iron is decreased and TIBC is increased.

102
Q

TIBC is in indirect measurement of?

A

Transferrin

103
Q

What is the most sensitive test for detection of iron deficiency anemia?

A

Serum ferritin - decreased means iron deficient

104
Q

What happens to lactate in blood following collection

A

Increases due to glycolysis

105
Q

What is a colligative property

A

One that depends on number of solute particles, regardless of size or weight. The colligative properties are osmotic pressure, vapor pressure, boiling point, and freezing point.

106
Q

How is osmolality measured in clinical labs

A

Freezing point depression

107
Q

What does the urine to serum osmolality ration indicate

A

Degree to which the kidneys concentrate the glomerular filtrate

108
Q

Formula for calculated osmolality

A

2 Na+ + glucose/20 + BUN/3

109
Q

Osmolal gap

A

Difference between calculated osmolality and measured.

110
Q

Define pH

A

log [H+]

111
Q

Henderson-Hasselbalch formula

A

6.1 + log [HCO3]/[H2CO3]

112
Q

Normal pH for arterial blood

A

7.35 - 7.45

113
Q

Acidosis

A

Blood pH <7.35 and result of decreased bicarb:carbonic acid ratio

114
Q

Alkalosis

A

Blood pH >7.45 and result of increased bicarb:carbonic acid ratio

115
Q

What is a buffer?

A

A weak acid and its salt. It minimizes change in pH.

116
Q

How do the lungs affect blood pH

A

By regulating PCO2 and carbonic acid concentration. Hyperventilation decreases PCO2 and Hypoventilation increases PCO2/carbonic acid ratio.

117
Q

What are the typical lab findings in respiratory acidosis

A

Decreased pH, increased PCO2, and normal bicarb. Kidneys will compensate by retaining bicarb.

118
Q

What are the typical lab findings in respiratory alkalosis

A

Increased pH, decreased PCO2, and normal bicarb. Kidneys will compensate by excreting bicarb

119
Q

What are the typical lab findings in metabolic acidosis

A

Decreased pH and bicarb, normal PCO2. Lung will compensate through hyperventilation to reduce carbonic acid.

120
Q

Typical lab findings in metabolic alkalosis

A

Increased pH and bicarb, normal PCO2. Lungs will attempt to compensate through hypoventilation to increase carbonic acid.

121
Q

Relationship between pH and H+ concentration?

A

Inverse

122
Q

What is the relationship between pH and PCO2?

A

Inverse

123
Q

If patient was hyperventilating, how would blood gas be affected

A

PCO2 would be decreased, pH increased, PO2 increased

124
Q

What is the compensatory mechanism to reestablish pH in a patient with high HCO3 level?

A

Hypoventilation

125
Q

What specimen is needed for blood gasses?

A

Heparinized arterial blood

126
Q

If patient was hyperventilating, how would blood gas be affected

A

PCO2 would be decreased, pH increased, PO2 increased

127
Q

If arterial blood sample was held at room temp for one hour before testing, how would the results be affected?

A

Cells would continue to use oxygen and produce carbon dioxide so PO2 would decreased and PCO2 would increase. pH would decrease

128
Q

What is P50

A

Partial pressure of oxygen at which oxygen saturation is 50%

129
Q

How is the oxygen dissociation curve affected by decreased 2,3-DPG

A

It is shifted to left. Increased affinity for hemoglobin for oxygen results in decreased release of oxygen to the tissues

130
Q

How can altered urine specimen for drug testing be detected

A

Specific gravity less than 1.003 and creatinine less than 20 mg/dL

131
Q

Creatinine clearance formula

A

Urine creatinine / serum creatinine X Urine volume / time

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