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Chemistry Flashcards

1
Q

What are the levels for the following

         AFP   uE   hCG    DIA  Downs 18 NTD
A

AFP uE hCG DIA
Downs L. L. H. H
18. L. L. L. L
NTD. H. L. N N

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2
Q

Name 2 causes of pseudo M spikes in the b2 regions

A

Fibrinogen
C3 - APR

IgA runs in this area

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3
Q

Where are they found?

LD1 and 2
LD4 and 5
LD3

A

LD1 and 2 in heart, RBC, kidney
LD4 and 5 in liver and skeletal muscle
LD3 in lung, spleen, lymphocytes and pancreas

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4
Q

When is LD1> LD2

A

Acute MI, hemolysis, renal infxn

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5
Q

Where is alk phos found?

A

Bone liver intestines placenta

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6
Q 
Fill in the following
                      Borderline         Hyperglycemia
FPG                  
2hr OGTT     
A1c
A

Borderline Hyperglycemia
FPG 100-125 >=126
2hr OGTT 140-199 >=200
A1c 5.7-6.4 % >=6.5

Need two

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7
Q

CrCl =

A

Urine volume X Urine creatine / Plasma creatine

Expressed in ml/min or mL/min/1.73M^2
80-120 ml/min is the typical range

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8
Q

What is NH4? NH3?

A

NH4 : Ammonium

NH3 : Ammonia

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9
Q

What enzyme in the Urea cycle is x-linked and leads to increase level of Ammonia?

A

Ornithine transcarbamoylase

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10
Q

BUN=

A

UREA/ 2.14

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11
Q

Fractional excretion of Na =

A

Una x Pcr / Pna x Ucr x 100

If >1, consider acute tubular necrosis

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12
Q

Name 3 things that runs in the alpha 1 and 2 lanes

A

Alpha 1: Anti-trysin, anti-chymotrypsin, acid glycoprotein

Alpha 2: macroglobulin, haptoglobin, ceruloplasmin

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13
Q

What runs in the B1 and B2?

A

B1- transferrin

B2- IgA and C3

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14
Q

Where are these found?
CK1
CK2
CK3

A

CK1 : BB Brain
CK2/MB Skeletal 1% and Cardiac 30%
CK3 MM : Skeletal 99% and cardiac 70%

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15
Q

When is macro CK 1 and CK2 seen?

A 
Macro CK1 (cytoplasmic)  in elderly women and autoimmune disease
Macro Ck2 (mitochondrial) , associated with malignancy
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16
Q

What is the reference interval for Tn?

A

99%

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17
Q

LD1 and 2 are found in?
LD4 and 5 are found in?
LD3 found in?

A

LD1/2 : Heart RBC Kidney
LD4/5 : Liver, skeletal
LD3 : lung, spleen, lymphocytes, pancreas

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18
Q

When is LD1>LD2? “Flipped”

A

Acute MI, hemolysis, renal infarction

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19
Q

How is delta bilirubin formed?

A

bilirubin bound to albumin

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20
Q

Name the sydrome

Poor uptake of unconjugated bili
Impaired conjugation
Impaired transmembrane secretion of conjugated bili

A

Poor uptake of unconjugated bili : Gilbert
Impaired conjugation : Crigler Najjar
Impaired transmembrane secretion of conjugated bili : Dubin johnson and Rotor

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21
Q

Anion gap =

A

Anion gap = Na- Cl- HCO3

Normal is <12

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22
Q

Osmolal gap =

A

Osmolal gap = Osm (measured) - (2NA + glucose/18 + BUN/2.8)

Normal is <10

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23
Q

Whats the ratio of Lecithin/sphingomyelin for fetal lung maturity?

A

> = to 2.5:1

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24
Q

Name the apolipoproteins

Chylo
VLDL
IDL
LDL
HDL
A

Chylo ApoCII ApoE ApoB48
VLDL ApoCII ApoE ApoB100
IDL ApoE ApoB100
LDL ApoB100
HDL ApoA1

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25
Q

Whats the major cholesterol carrier? TG carrier?

A

Cholesterol: LDL
TG: VLDL

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26
Q

Increase TG seen in?

A

I Chylo
IV VLDL
V Chylo and VLDL

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27
Q

Increase of LDL seen in?

A

IIa LDL aka Familial hypercholesterolemia AD

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28
Q

Incease in TG and LDL seen in?

A

IIb LDL and VLDL

III IDL aka dysbetalipoproteinemia

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29
Q

Gilbert and Crigler Najjar is associated with?

A

Unconjugated/Indirect bili

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30
Q

Dubin-Johnson and Rotor is associated with? How can you grossly tell them apart?

A

Conjugated/Direct bili

Dubin Johnson is Black

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31
Q

What do these drugs raise? ( Uncojugate or Direct)

Rifampin, probenacid, estrogen, cyclosporine

A

Elevated Unconjugated bili : Rifampin and probenaicd

Elevated Conjuagated bili: Estrogen, cyclosporine

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32
Q

In neonatal jaundice, total bili exceeds __ mg/dl with a daily increase of __ mg/dl and a conjugated bilirubin that exceeds __ mg/dl

A

In neonatal jaundice, total bili exceeds 12 mg/dl with a daily increase of 5mg/dl and a conjugated bilirubin that exceeds 2 mg/dl

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33
Q 
Pancreas
                                       Amylase    CEA
Pseudocyst                            
IPMN                                   
Serous cystadenoma       
Solid Pseudopapillary     
Mucinous
A

Amylase CEA
Pseudocyst H -
IPMN H H
Serous cystadenoma L L
Solid Pseudopapillary L L
Mucinous - H

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34
Q

Name 3 major alpha 1 globulin

A

anti-trypsin
anti-chymotrypsin
anti-acid glycoprotein

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35
Q

Name 3 major alpha 2 globulins

A

macroglobulin
ceruloplasmin
haptoglobin

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36
Q

Name the major B globulin

A

Transferrin

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37
Q

Name 3 Neg acute phase reactants

A

Albumin, prealbumin, transferrin

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38
Q

type 1 cryoglobulin is a

A

monoclonal Immunoglobulin

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39
Q

Type 2 cryoglobulin is a

A

Mix of monoclonal IgM and polyclonal IgG

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40
Q

Type 3 cryoglobulin is a

A

2 polyclonal immunoglobulin

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41
Q

Name causes of metabolic acidosis with

Anion gap
Non anion gap

A 
Anion Gap (>=12)     
MUDPILES
Cyanide                         
Lactic Acid                     
Uremia
Methanol  - O
Paraaldehyde --O
Salicylate
Ethylene glycol --O
Ketoacidosis

Non Anion gap
Renal tubular acidosis
Diarrhea

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42
Q

Elimination of most drugs follows ___ kinetics

A

1st order, except for ethano which is 0 order

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43
Q

Steady state reaches after?

A

5 doses

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44
Q 
For alcohol what are the clinical effects for the %
<0.05
0.05-0.1
0.1-0.2
0.2-0.3
0.3-0.4
>0.4
A 
<0.05   Sobriety
0.05-0.1   Euphoria
0.1-0.2     Excitement
0.2-0.3    Confusion
0.3-0.4    Stupor
>0.4        Coma and death
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45
Q

Signs of Anticholinergic effect? Agents?

A

Hyperthermia, dry skin, flushing, altered mental status, psychosis

Atropine, anti-histamine, TCA, scopolamine

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46
Q

Signs of Cholinergic effect? Agents?

A

Salivation, lacrimation, urination, diarrhea, GI cramps, ememsis, diaphoresis , miosis, wheezing

Organophosphates, pilocarpine

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47
Q

Signs of Adrenergic?

A

HTN, tachy, mydriasis, anxiety, hyperthermia

amphetamines, cocaine, PCP

48
Q

Tangier’s disease?

A

AR characterized by low cholesterol, increased TG absent HDL, and absence of ApoA1. Cholesterol deposits on tonsils (orange) and others.

49
Q

Abetaliproproteinemia

A

AR,
Fat metabolism disorder, Normal HDL, but low LDL, IDL, TG
Acanthocytes

50
Q

In diabetes, what are some autoantibodies? What is DM1 assoc with?

A

Islet cell antibody
Insulin antibody
Antibodies to glutamic acid decarboxylase
insulinoma associated protein

Strong association with HLA DR and DQ

51
Q

Graves associated with which antibodies?

A

Anti-microsomal 60%

Anti-thyroglobulin 30%

52
Q

Hashimotos associated with which antibodies?

A

Anti tissue peroxidase

anti-thyroglobulin 90%

53
Q

What happens in vitreous and body?

Glucose
Na
Cl
K

A

Vitreous: Glucose drops, K increases linearly, Na and Cl remain stable

Body: Glucose Increase, K double increase, Na and Cl drops

54
Q

Urine dipstick is sensitive to what protein? Sugar? Ketone?

A

albumin
Glucose
acetoacetic acid

55
Q

Name nitrite producing organisms and infections that doesn’t produce it

A

E.coli produce nitrite

Enterococci, gonorrhea, and TB does not

56
Q

Normal urine pH? In Renal tubular acidosis?

A

pH6

In RTA, pH>6.5

57
Q

The most common kidney stone is?

A

Calcium oxalate

58
Q

Calcium oxalate stones are promoted by?

A

Low urine volumes
low urinary citrate
hypercalciuria
oxaluria

pH does NOT effect it

59
Q

Who gets oxaluria?

A

Crohns patient with small bowel resection

increased ingestion of oxalate (spinach, nut, rhubarbs)

60
Q

Calcium stones are formed where?

A

in the pelvis, attached to papillae

61
Q

Whats the main component of the struvite stone?

A

Magnesium ammonium phosphate

aka triple phosphate

62
Q

How is struvite stones made?

A

by UTI, proteus mirablilus and other urea spillite organism

Alkaline pH

63
Q

Name two stones associated with alkaline pH, and acidic pH

A

Alkaline: Calcium phosphate and Struvite stones
Acidic: Urate stones

64
Q

Name stone associated with inherited disease, AR, characterized by defective renal and intestinal dibasic amino acid transport affecting cystine, ornitine, lysine, and arginine (COLA)

A

Cystine stones

65
Q

Low levels of anti-mullerian hormones suggest?

A

menopause, premature ovarian failuire

66
Q

High levels of anti-mullerian hormones suggest?

67
Q 
Name the associated disease
anti-actin antibody : 
anti-Liver Kidney Microsome antibody : 
anti-mitochondiral (M2) antibody : 
anti-neutrophil cytoplasmic antibody : 
anti-soluble liver antigen antibody :
A

anti-actin antibody : AIH type 1
anti-Liver Kidney Microsome antibody : AIH type 2
anti-mitochondiral (M2) antibody : Primary biliary cirrhosis
anti-neutrophil cytoplasmic antibody : Primary sclerosing colangitis
anti-soluble liver antigen antibody : AIH type 1

68
Q

Whats in the blue top tube?

A

Blue : Citrate

69
Q

Whats in the Purple top tube?

A

Purple : EDTA irreversibly binds Ca+

70
Q

Whats in the Green top tube?

A

Green : Heparin (Heparin interferes with PCR also if its Lithium heparin- interferes with lithium levels)

71
Q

Whats in the Red top tube?

A

Glass: None

Plastic : silica clot activator

72
Q

Whats in the Grey top tube?

A

Sodium fluoride (inhibits glycolysis)

73
Q

What tube is best for coag studies?

A

Blue - citrate binds Ca+ REVERSIBLE

74
Q

What tube is best for glucose/lactate studies?

A

grey top - sodium fluoride inhibits glycolysis

75
Q

What tube is best for serum chem, serology , immunology, blood bank (crossmatch) studies?

76
Q

What tube is best for plasma chem studies?

77
Q

What tube is best for hematology and blood bank (crossmatch) studies?

A

Purple - EDTA like citrate binds Ca+, unlike citrate is NOT reversible

78
Q

What tube is best for flow/fish?

A

Green top (sodium heparin)> Purple (EDTA)

79
Q

What tube is best for HLA and DNA studies studies?

80
Q

Whats in a yellow top tube?

A

Citrate and dextrose (ACD): best for blood bank/genetic testing

81
Q

Name that cast!

Glomerulonephritis

A

Red cell cast

82
Q

Name that cast!

pyelonephritis

A

White cell cast

83
Q

Name that cast!

Tubular necrosis

A

Tubular cast

84
Q

Name that cast!

Severe renal disease

A

Waxy casts

85
Q

Name that cast!

nephrotic syndrome

A

fatty casts

86
Q

Name that cast!

nonspecific, renal disease, dehydration, exercise

A

granular and hyaline casts

87
Q

Name that cast!

ESRD

A

Broad casts - these are hyaline, granular or waxy thats unusually broad

88
Q

Name that crystal!

coffin lid

A

triple phosphate aka MAP

89
Q

Name that cast!

envelope

A

calcium oxalate

90
Q

Postmortem chem pattern:

Dehydration

A

High Na, Cl, BUN, Cr

91
Q

Postmortem chem pattern:

Uremia

A

high Bun, Cr

92
Q

Postmortem chem pattern:

Decomp

93
Q

AST highest in?

94
Q

Decreased stool elastase and chymotrypsin is indicatie of?

A

Pancreatic exocrine insufficiency

95
Q

A pseudo M spike at alpha2 and beta interface

A

Hemoglobin

96
Q

In urine protein electrophoresis:

strong albumin, a1, and b

A

glomerular

97
Q

In urine protein electrophoresis:

weak albumin, strong a1 and b

98
Q

Name two causes of acidosis with hypokalemia

A

RTA 1 and 2

99
Q

Cyanide inhibits? Treatment?

A

Cytochrome a3; sodium nitrite, amyl nitrite, and thiosulfate

100
Q

Arsenic inhibits? Test?

A

oxidate phosphorylation, 24hr urine or nail/fingernail

101
Q

Lead inhibits?

A

delta-ALA-dehydratase and ferrochelatase ( FEP, ZPP increased)
5’nucleotidase
mitochondria

102
Q

N-acetyle-P-benzoquinone imine causes?

A

Zone 3 necrosis

formed when acetominophen is metabolized by p450

103
Q

Feer and Ertheism is asociated with?

A

mercury- 24 hr ur
Feer- or Acrodynia: autonomic manifestation with desquamative rash of palms/sole
Erethism: Personality change

104
Q

In the Third adult Treatment panel, whats the target LDL if 0-1 risk factors?

105
Q

In the Third adult Treatment panel, whats the target LDL if 2 or more risk factors?

106
Q

In the Third adult Treatment panel, whats the target LDL if CHD or equivalent?

107
Q

Whats a CHD equivalent?

A

DM, vascular disease, framingham risk of MI within 10 years >20%

108
Q

Risk factors according to the TAT?

A 
Smoking
HTN >140/90
<40 HDL 
family history of CHD,
Age (M>45, F>55)
109
Q

CA27.29 or CA15-3 is seen in?

A

Breast CA, protein product of MUC1 gene

110
Q

For carcinoides, what do they produce?
Foregut
Midgut
Hindgut

A

Foregut - histamine, catecholamines, 5HTP
Midgut - serotonin
Hindgut - nothing

111
Q

NMP22 is a marker of what carcinoma?

A

Urothelial

112
Q

BTA (Bladder tumor antigen) test detects?

A

Complement factor H (CFH) and related proteins

113
Q

Light criteria is used for?

A

classify effusions
Pleural fluid: Serum protein ratio > 0.5
Pleural fluid: Serum LD ratio >0.6
Pleural fluid LD>2/3 of the upper limit of normal for serum LD

114
Q

Rumack-Matthew nomogram is for?

A

Acetaminophen toxicity

115
Q

In portal hypertension, the serum ascited albumin gradient is?

A

> 1.1 g/dl

116
Q

In Ranson criteria, what are the values checked at admission/

A 
Age >55
WBC >16
Glucose >200
AST>250
LD>350

Pathology (16 decks)

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