Chemistry Exam 3 Flashcards
Primary concern with medical, legal consequences of exposure.
Major focus: generate evidence
Forensic toxicology
Main focus: relationship between xenobiotics and disease states
Diagnostic testing and therapeutic intervention
Consider specialty
Clinical toxicology
The evaluation of environmental chemical pollutants and their impacts on human health
Environmental toxicology
Describe environmental exposure to chemicals or drugs
biotics
Describe substances from an animal, plant, mineral, or gas (venom,…)
poisons
Endogenous substances biologically synthesized either in living cells or in microorganisms
toxins
Highest mortality rate, poisoning cases
suicide
Most frequently in kids. Also common in teens and adults with both therapeutic or illicit drugs
Accidental
Correlates a single, acute oral dose range with the probability of a lethal outcome in
An average 70kg (154lb) male
The predicted dose that would produce a toxic response in 50% of population
Toxic dose TD50
Predicted dose that would result in death for 50% of population
Lethal dose LD50
Predicted to have a therapeutic benefit or be effective in 50% population
Effective dose ED50
Fewer toxic/adverse effects when dose is in the T.R.
larger therapeutic index
Therapeutic index
Ratio of TD50 or LD50 to the ED50
Toxicity that single, short-term exposure to a substance in which the dose is sufficient to cause immediate toxic effects
Acute
Toxicity that associated with repeated and frequent exposure for extended time periods (months to years) at doses that are insufficient to cause an immediate acute response
Chronic
Chronic may affect different systems than acute
True
Toxic agents exhibit unique absorption, distribution, metabolism and elimination
Toxicokinetic
“Trace element free” blood collection tubes
royal blue top
tube for specifically for lead testing
tan blue top tube
Most significant metabolism pathway for alcohols
Alcohol→(ADH)→Aldehyde→(ALDH)→Acid
Exposure common for alcohol
Excessive consumption—leading cause of economic, social, and medical problems in the world
ethanol
Legal limit for alcohols
Associated with decreased judgement and motor function
80 mg/dL
What causes severe metabolic acidosis—can lead to tissue injury and possible death
Common lab solvent
Responsible for optic neuropathy that can lead to blindness
Methanol Formic acid
Alcohol responsible for optic neuropathy that can lead to blindness
methanol
Rubbing alcohol
Metabolized by hepatic ADH to acetone (end product)
isopropanol
Common component of hydraulic fluid and antifreeze
Sweet taste
Results in severe metabolic acidosis
Rapid formation and deposition of calcium oxalate crystals in the renal tubules
May result in renal tubular damage
ethylene glycol
How many time does affinity of Hgb to CO higher than O2
200-225 times
Half life of CO
60-90 min
Any exposure to strong acids or bases associated with injury
Aspiration and ingestion—greatest hazards
Aspiration associated with pulmonary edema and shock
caustic agents
Used in electroplating and galvanizing
Pigments in paint and plastics
Itai-itai disease
Toxics to kidneys
Half life 30 years
cadmium
Half life of lead in bones and soft tissue
20 years and 120 days
TUMOR MARKERS
If cancer move to other parts of the body it is called
metastasis
Biomarker found in the blood or tissue and when elevated is linked to cancer
tumor marker
protein produced during fetal development and elevated in individuals with cancer
oncofetal antigens
Found on the surface of all nucleated cells
Used as a non-specific marker of the high cell turnover common in tumors
beta macroglobulin
Valuable in diagnosing neuroblastomas, pituitary and adrenal adenomas
endocrine tumor marker
Monoclonal defined antigens identified from human tumor extracts and cell lines
Carbohydrate and Cancer Antigen Tumor Markers
“non-serological” markers
Helps to choose between endocrine and cytotoxic therapies
receptor tumor markers
Tumor specific
Absent in healthy individuals
Readily detectable in body fluids
Ideal tumor marker
Study of the movement of drugs
in the body
pharmacokinetic
the major transporter of drug
albumin
the phenomenon in which a drug is metabolized an results in a reduced concentration of the drug before reaching the circulatory system
1st pass effect
The study of the biochemical and physiological effects of drugs and their mechanisms of actions:
pharmacodynamics
This tumor marker often is measured in both the total and free form:
PSA
The concentration range of a drug within which the drug produces the desired effect:
therapeutic range
This tumor marker is primarily used as a marker for ovarian cancer:
May be elevated in patients with endometriosis, 1st tri of pregnancy, or during menstruation
ca 125
This is found as a contaminant of homemade liquors and can cause optic neuropathy
methanol
This is a significant environmental pollutant and is easily taken up by crops – especially tobacco
cadmium
This is a cardioactive drug that is used to treat arrythmias and CHF. Biotin is known to interfere with this test:
digoxin
The most direct and effective route of administration of a drug
IV
This is a common malignant tumor in kids associated with high levels of plasma, epinephrine, norepinephrine and dopamine
neuroblastoma
This test is used along with hCG to classify nonseminomatous tumor
Often elevated in patients with hepatocellular carcinoma (HCC) and germ cell tumors
AFP
13) This is a kind of testing method that can be performed on solid tissue tumor markers
Immunohistochemistry
The predicted dose that would produce a toxic response in 50% of the population
TD50
This may occur when analyte concentrations exceed the analytical range excessively
hook effect
This drug is the hepatic metabolite of procainamide
NAPA`
This drug commonly is tested for both the total and free forms
phenytoin (dilantin)
Endogenous substances biologically synthesized either in living cells or in microorganisms
toxins
This method of analysis of toxic agent has good sensitivity but lacks specificity:
screening
These types of tumor markers are valuable in diagnosing neuroblastomas, pituitary and adrenal adenomas
endocrine tumor markers
This tumor marker is the prototypical oncofetal antigen and is used for monitoring colorectal cancer:
Increased in heavy smokers and some patients following radiation treatments
CEA
Uses the results from animal experiments to predict what level of exposure will cause harm to humans:
Descriptive Toxicology
This is a metal with 3 forms, one of which is liquid at room temp
MERCURY
This is a useful system to compare relative toxicities of substances as the predicted endpoint is death:
Dose-Response Relationship
B-macroglobulin and immunoglobulins are part of this group of tumor markers:
Serum Protein Tumor Markers
Chemicals and drugs that are not normally found in or produced by the body:
Xenobiotics
This is an example of something that can have significant interference in immunoassays by cross-linking with the capture/label antibody:
HAMAs
This drug is ototoxic enough that it is recommended that baseline audiology testing is performed:
Tobramycin
Largely a result of the high metabolic demand of these proliferative cells
Tend to correlate to tumor burden
enzyme tumor marker
Unique characteristics and concentrations of T.M.–2 major consideration
lack of standardization and wide range
Used to help diagnose carcinoid tumors, pheochromocytoma, & neuroblastoma
Catecholamines & metabolites
Rare tumor associated with hypertension
Elevated plasma metanephrines, urine vanillylmandelic acid, free catecholamines
Pheochromocytoma
Elevated levels correlate with cancer stage of CA125
50% stage 1
90% stage 2
>90% stage 3 or 4
Dimeric hormone secreted by trophoblasts
Elevated in trophoblastic tumors, mainly choriocarcinoma and germ cell tumors of ovary and testes
Prognostic for ovarian cancer
Diagnostic for classification of testicular cancer
HCG
produced in the epithelial cells of the acini and ducts of the prostate gland
glycoprotein
Mucin 1 (MUC1), Normally expressed in glandular or luminal epithelial cells
Best application is serial testing for breast cancer patients
CA 15-3
Best validated biomarker for pancreatic cancer
Modified Lewis (Le a ) blood group antigen
CA 19-9
Primarily used for ovarian cancer
Improved specificity over CA-125—which can be elevated in non-malignant conditions like endometriosis
HE4
Auxiliary test for neuroendocrine tumors
NSE
drug absorption of weak acids
in stomach
drug absorption of weak bases
in intestine
the movement of a drug between blood circulation and tissues and organs and the relative proportion of the drug in the tissues
drug distribution
interact with site of action & result in biological response
free/unbound drugs
The biochemical pathway responsible for a large portion of drug metabolism
MFO - Hepatic mixed-function oxidase
number doses typically needed before steady-state oscillation is achieved
5-7
The science of studying variations and developing drug therapies to compensate for the genetic differences impacting therapy regimens
pharmacogenomic
Prominent gene affecting drug metabolism
CYP450
Natural product extracted from bark to treat arrythmias
quinidine
Treat gram neg and some gram pos infections
Inhibit bacterial protein synthesis
aminoglycosides
Treats GNR—life threatening
gentamicin
Treat severe blood infections
Can be administered orally to reduce intestinal flora
amikacin
“redman syndrome”—extremity flushing
Against GPC and GPR
Poor GI absorption
vancomycin
Used to treat and suppress seizures
Only effective while drug metabolites are in the body
goal: get therapeutic benefit with little to no adverse effects
Antiepileptic Drugs (AEDs)
Grand mal seizures—when resistance to other AEDs
primidone
Severe adverse events—only use if no response to other AEDs
carbamazepine
Mood altering used to treat:
Bipolar disorder, recurrent depression, aggressive or self-mutilating behavior
Also preventative for cluster headaches or migraines
lithium
Used to treat depression, insomnia, extreme apathy, loss of libido
Ex: imipramine, amitriptyline, doxepin
TCA
Used to treat refractory schizophrenia
Absorption rapid and complete
clozapine
Treats schizophrenia, acute manic episodes, recurrence of bipolar disorders
Can be IM but usually oral
olanzapine
Cyclic polypeptide–suppress graft vs host rejection of heterotopic transplanted organs
cyclosporine
Antifungal agent used to prevent graft rejection in kidney transplants
sirolimus
Derived form sirolimus
Short half life—more rapid achievement of steady state pharmacokinetics
everolimus
prodrug that is rapidly converted in the liver to its active form, MPA (Mycophenolic Acid)
Mycophenolate mofetil
Assessment of therapeutic benefit not aided by TDM because pharmacodynamics are hard to establish
EX drug: methotrexate
Antineoplastics
Used to treat respiratory disorders
For patients who can’t use an inhaler or have nocturnal symptoms
theophylline
Describes the changes in health effects of a defined population based on the exposure to the xenobiotic
quantal dose-relationship
Toxic agents exhibit unique absorption, distribution, metabolism and elimination
toxicokinetics
Methods used for analysis of toxic agents
Immunoassays-common for most drug screens
Gas chromatography (GC) with mass spectrometry (MS)
Reference method for most organic compounds
Liquid chromatograph with tandem mass spectrometer (LC-MS)
Emerged as an important analytical technique
Inorganic compounds
Use inductively coupled plasma mass spec (ICP-MS) or atomic absorption (AA) methods
Nuclear magnetic resonance (NMR) spectroscopy has potential applications
Most significant metabolism pathway of alcohol
Alcohol→(ADH)→Aldehyde→(ALDH)→Acid
reactive intermediate, most converted to acetate but some is released in the free state
Acetaldehyde
osmolality ratio of osmo to serum ethanol
Serum osmo increases 10 mOsm/kg per 60 mg/dL increase in serum ethanol
Super-toxic substance
Used in industrial processes, insecticides, rodenticides
Binds to heme iron
High lactic levels commonly found
cyanide
Less harmful organic forms with foods
Clams, oysters, scallops, mussels, crustaceans, bottom feeding fish
arsenic
Potent inhibitor of many enzymes
Noteworthy effects on Vit D metabolism and heme synthesis
lead
Intentionally added to environment to harm or kill something
Insecticides, herbicides, fungicides, rodenticides
Found in occupational and home settings
pesticides
Reye’s syndrome with viral infections in kids
salicylates
common drug: Acetylsalicylic acid—aspirin
Overdose associated with severe hepatotoxicity
Alcoholics more susceptible
Tylenol
Confirmation testing for drug abuse
immunoassays -more common
Typical screening panel
Amphetamines, barbiturates, benzodiazepenes, cocaine, opioids, THC, tricyclic antidepressants
Originally sleep inducers
Most commonly abused
Used as “downer” after cocaine or amphetamine “high”
barbiturate
Depressants of CNS
Among drugs most commonly prescribed because of:
Efficacy, safety, low addiction potential, minimal side effects, high public demand for sedative and anti-anxiety
Benzodiazepines
Diazepam (Valium), chlordiazepovide (Librium), lorazepam (Ativan) alprazolam (Xanax)
Psychoactive compounds found in marijuana
Cannabinoids: Tetrahydrocannabinol (THC)
Effective local anesthetic, few adverse effects at therapeutic concentrations
Alkaloid salt
cocaine
Used to treat depression and mood disorders
Imipramine metabolizes to desipramine
Amitriptyline metabolizes to nortriptyline
Doxepin metabolizes to nordoxepin
Tricyclic Antidepressants (TCAs)
Amphetamine derivative “ecstasy”
Methylenedioxymethamphetamine (MDMA)
“angel dust”
Illicit drug with stimulant, depressant, anesthetic, and hallucinogenic properties
Phencyclidine (PCP)
Used to increase muscle mass to improve athletic performance
Can cause enlargement of the heart
Anabolic Steroids
A drug’s most direct and effective method of delivery to its site of action is:
Intravenous administration
Which of the following is not true regarding the absorption of drugs?
Drug absorption rates may change with age
Morphine may slow the gastrointestinal motility of a drug
Liquid medications are often absorbed slower than capsule medications
Crohn’s disease may alter the absorption of some drugs
Liquid medications are often absorbed slower than capsule medications
T/F Drugs are susceptible to hepatic metabolism, and this increases the concentration of the drug before it reaches the circulatory system.
false
Which of the following statements is true regarding drug elimination?
One drug half-life is the time needed for the drug concentration to increase by half
Five to seven drug doses are required to reach a steady state of drug concentration
Most medications are administered as a single dose versus a scheduled basis
Aminoglycoside antibiotics are reabsorbed by the renal tubules
Five to seven drug doses are required to reach a steady state of drug concentration
The relationship between a drug’s concentration at its target sites and its physiological responses is known as:
Pharmacodynamics
Which of the following is not true concerning therapeutic drug monitoring?
It ensures correct drug doses for the expected therapeutic range
It helps to identify non-compliance of the patient
It identifies drug-drug interactions if multiple drugs are taken simultaneously
It establishes a one-fit dosing model for all patients
It establishes a one-fit dosing model for all patients
A blood draw to determine a peak level of a drug should be drawn:
One hour after an orally administered dose
CYP450 is a gene that influences the effectiveness of a drug in an individual.
T/F
True
Which of the following is not true concerning aminoglycosides?
Ototoxic effects of the drug are reversible
Pharmacokinetics and drug concentration are influenced by which of the following factors?
Absorption, distribution, metabolism, excretion
Only bound fractions of drugs can interact with the site of action and result in a biological response.
False
Tolerance to drugs could be explained as:
Constant exposure of receptors to drugs that leads to a reduced response
This drug is used to treat arrhythmias and CHF.
Digoxin
This drug may have the adverse effect of “redman syndrome”
Vancomycin
This antiepileptic drug requires hepatic markers to be check frequently due to risk of hepatic dysfunction.
Valproic acid
Immunosuppressive drugs typically are collected as serum samples.
true/false
false
Common routes of exposure to toxins are through the gastrointestinal tract, lungs, and skin.
t/f
true
Which specimen type is preferred for analytes demonstrating variation in urinary elimination patterns?
24-hour collection
Which of the following is not true concerning analysis of toxic agents?
Screening tests have good specificity but lack sensitivity
All of the following statements are true regarding blood alcohol measurements except:
During venipuncture, the skin must be disinfected with iodine or chlorohexidine gluconate
Plasma and serum are acceptable specimen types for analysis
When testing will be delayed, sodium chloride can be used as a preservative to maintain specimen integrity
Specimens should remain capped to avoid evaporation
When testing will be delayed, sodium chloride can be used as a preservative to maintain specimen integrity
The affinity of carbon monoxide for hemoglobin is 20-25 times greater than oxygen
t/f
false
Toxic levels of acetaminophen are associated with
Hepatotoxicity
Which of the following statements is not true concerning testing for drugs of abuse?
Confirmatory testing must use methods with high specificity and low sensitivity
Which type of toxicology uses the results from animal experiments to predict what level of exposure will cause harm to humans?
Descriptive
Which is not a common route of exposure to toxic substances.
Ingestion
Intravenous
Inhalation
Transdermal absorption
IV
What phrase best describes what ED50 stands for?
A drug is predicted to have a therapeutic benefit for 50% of the population.
Chronic exposure to a toxin always has the same effect as acute exposures.
t/f
false
Which is not a common specimen type for analysis of toxic agents?
urine
blood
oral fluid
all are common
An alternative test that may be performed in order to estimate ethanol in serum is the osmolality.
t/f
true
This toxic substance can be found in its organic form in clams and oysters.
arsenic
This environmental pollutant has been linked to Itai-itai disease.
cadmium
Which of the following enzymes is increased in patients with cancer involving bone?
Alkaline phosphatase
Which tumor marker is associated with neuroblastoma?
HVA
The utilization of tumor markers is most important for:
Monitoring the effectiveness of treatment
Abnormally low tumor marker concentrations are associated with antigen deficiency and can cause false negative results
t/f
false
To accurately monitor tumor marker levels of the patient, it is important to use the same methodology each time of testing.
t/f
true
If tumor cells are found in both the original tumor and also in the regional lymph nodes, this would be classified as stage:
3
All tumor markers can be used to screen asymptomatic populations.
t/f
false
Which is not something that is a consideration when considering using immunoassay method for tumor markers.
Hook effect
Requires more specialized skill and experience
Assay linearity
HAMAs
Requires more specialized skill and experience
Serotonin secreting tumors from small intestine
carcinoid
Which is not an example of an enzyme tumor marker.
ALP
AST
PSA
LDH
AST
Which tumor marker is used primarily with hepatocelluar carcinoma and testicular cancer.
AFP
CA-125
CEA
hCG
AFP
Elevations in this tumor marker in CSF may indicate Creutzfeldt-Jakob disease.
NSE
A patient has a synovial fluid removed from their knee joint. The test results included a cell count with differential. The WBC count was 65,000 with 93% neutrophils. What is the most likely cause?
septic
A patient has CSF chemistries and microbiology samples performed. Chemistries yield a very low glucose value but no growth is reported in micro cultures. What is a possible pathology to explain these results? It is to be noted that the CSF had a clear, colorless appearance.
brain tumor
Which is not a common test to perform on a CSF sample?
glucose
uric acid
protein
lactate
uric acid
Increased CSF glucose levels can indicate acute bacterial meningitis.
T/F
false
Which would typically not be a cause of an exudative pleural effusion?
Pulmonary abscess
Lymphoma
Bacterial pneumonia
Hepatic cirrhosis
Hepatic cirrhosis
The unique structure of hemoglobin allows it to act as both an acid-base buffer and O2 buffer.
T/F
true
Breakdown of glycogen to glucose for use as energy
Glycogenolysis
Conversion of glucose to glycogen for storage
Glycogenesis
Formation of glucose of-6-phosphate from noncarbohydrate sources
Gluconeogenesis
Metabolism of glucose molecule to pyruvate or lactate for production of energy
Glycolysis
Which parameter on a blood gas analysis is calculated instead of being directly measured.
HCO3
The best collection tube to use for glucose tolerance testing is:
Gold top/serum
Grey top/NaF
Green top/lithium heparin
Lavender top/EDTA
Grey top/NaF
Grey top/NaF
What is the incremental fraction of oxygen at sea level?
21%
In external respiration, the partial pressure of oxygen in the alveolar membrane is __________, while the partial pressure of oxygen in the venous blood is _________.
100 mmHg, 40 mmHg
A decrease in H+ ions, an increase in pH, and a decrease in pCO2 results in what acid-base disorder?
Respiratory alkalosis
A patient with an HA1C of 12% would be most likely to have an estimated average glucose of:
298 mg/dL
A patient with a fasting glucose of 122 mg/dL would be considered to have a:
Impaired fasting glucose
This type of diabetes is noted to have insulin resistance with an insulin secretory defect due to progressive loss of adequate beta cell insulin secretion.
Type 2
As a CSF is collected, it is placed in a series of tubes for analysis. The correct order of testing should be:
Chemistry, Microbiology, Hematology
An increase in H+ ions, a decrease in pH, and an increase in pCO2 results in what acid-base disorder?
Respiratory acidosis
Which is not stimulated by epinephrine?
Insulin
Glucagon
Glycogenolysis
Gluconeogenesis
insulin
Match the type of pancreatic cell with what it produces.
Cell: Alpha cell, beta cell, delta cell
Product: glucagon, insulin, somatostatin
alpha - glucagon
beta - insulin
delta - somatostatin
Diabetic condition formed when a person’s own immune system destroys the islet cells of the pancreas, resulting in impaired production of insulin.
type 1
It is recommended that all adults have a lipid profile performed every _____.
5 years
Women, on average, have higher HDL levels and lower total cholesterol and triglyceride levels than men.
T/F
True
HDL has a major role in this type of lipid pathway
Reverse cholesterol pathway
Which is the type of lipoprotein that contains the apolipoprotein Apo B48?
Chylomicrons
Amphipathic lipid molecules contain both hydrophobic fatty acid chains and hydrophobic head groups.
T/F
False
Calculate the LDL from the following test results.
Total cholesterol: 223 mg/dL
HDL: 65 mg/dL
Triglycerides: 290 mg/dL
100
The function of the major lipid components of the very-low density lipoproteins is to transport:
Endogenous triglycerides
Turbidity in serum suggests elevation of:
Chylomicrons
Electrolytes that reabsorbed under influence of PTH
calcium
electrolytes that recovered from glomerular filtrate
bicarbonate
electrolytes that reabsorbed by passive transport in proximal tubule
chloride
Reabsorption occurs in Henle’s loop
Magnesium
A rare disease of water and salt imbalance.
Diabetes insipidus
Of the total serum osmolality; sodium, chloride, and bicarb normally contribute what percent?
92
What is the type of lipoprotein that is known to contribute to plaque formation.
LDL
A patient presents to the ER with flushed skin, severe agitation, low-grade fever, and complaints of being extremely thirsty. Given these symptoms, what pathology would you consider?
Hypernatremia
Which of the following is not associated with an increase in anion gap when it occurs in a single patient?
Renal failure
Ketoacidosis
Glycol poisoning
Instrument error
Instrument error
Causes of increased levels of protein in CSF include all but:
Decreased dialysis of proteins from the plasma
Lysis of contaminant blood from traumatic tap
Increased permeability of the epithelial membrane
Obstruction
Decreased dialysis of proteins from the plasma
In order to maintain electrical neutrality in the red blood cell, bicarbonate leaves the red blood cell and enters the plasma through an exchange mechanism with what electrolyte?
Chloride
Of total serum calcium, free ionized calcium normally represents approximately what percent?
45
The presence of only slightly visible hemolysis will significantly increase the serum level of which of the following analytes?
Potassium
What is the major intracellular cation?
potassium
What is the major extracellular cation?
Sodium
Unsaturated triglycerides are typically solid at room temperature.
T/F
false
The cation is the fourth most abundant cation in the body and second most abundant intracellularly. Hint: Consumption of processed foods can lead to inadequate intake and subsequent deficiency.
Magnesium
Water makes up what percentage of body weight?
40-75%
Which phrase does not describe phospholipids.
Hydrophobic head group
Synthesized in all organs
Amphipathic
Unsaturated steroid alcohol
Unsaturated steroid alcohol
Electrolyte essential for myocardial contraction and important to maintain normal levels for critically ill patients.
calcium
Type of CK isoenzyme with its specificity
CK: cardiac, muscle, brain
Specificity: CK-MB, CK-BB, CK-MM
Cardiac=CK-MB
Muscle=CK-MM
Brain=CK-BB
Amylase is more specific to pancreatitis than lipase.
T/F
false
This test has greater specificity to liver damage.
ALT
In many reactions, we are looking at the reaction of the cofactor NADH to NAD to determine the value of the enzyme.
T/F
true
This enzyme has a short half-life and is found in the heart, liver, skeletal muscle, and kidney.
AST
The hook effect refers to high concentrations of analyte producing a lower signal than expected.
T/F
true
These type of inhibitor associate with enzymes at places other than the active site.
non-competitive
These type of inhibitor share structural features found in the substrate.
competitive
These type of inhibitor bind only to the ES complex.
uncompetitive
In this state, not all enzyme sites are saturated with substrate and substrate concentration is the rate-limiting step.
1st order
An inactive, secreted form of the enzyme
zymogen
The following statement could be used to describe zero-order kinetics: T/F
Substrate is present in excess, rate of reaction is constant with time and dependent only on the concentration of enzyme in the system.
true
When measuring enzyme activity, if the instrument is operating at 50 C lower than the temperature prescribed for the method, how would the results be affected?
Lower than expected
What does an increase in serum enzyme levels indicate?
Tissue damage and necrosis
Pathological condition in which the proximal tubules in the kidneys do not reabsorb glucose, amino acids, uric acids, and bicarbonates resulting in their loss to the urine concentrate.
Fanconi Syndrome
This test can be used to monitor alcoholics with liver toxicity
GGT
Which of the following serves as the glomerular filtration rate for clinicians?
creatinine
Plasma creatinine levels are determined by all of the following except:
Relative muscle mass
Rate of creatine turnover
Renal function
Dietary intake of protein
Dietary intake of protein
A 56 year old male with gout is given allopurinol then returns to the ER a week later with a uric acid level of 8.6 mg/dL (2.4-7.0 mg/dL). What statement best describes the reason for the uric acid level?
The patient did not take prescribed medication
The patient overdosed on allopurinol
Allopurinol returned uric acid levels to normal
The patient did not take prescribed medication
What is an energy source utilized by muscles?
Creatine phosphate
This non-protein nitrogen compound is found in the highest concentration in the blood.
Urea nitrogen
Which is not a clinical application of measurement of urea.
Assess hydration status
Evaluate liver function
Verify adequacy of dialysis
Determine nitrogen balance
Evaluate liver function
Match the BUN:Creatinine ratio with the correct location of azotemia.
23 11 8
postrenal intrarenal prerenal
23 - pre
11 - post
8 - intrarenal
Which is not a likely cause of decreased BUN.
High protein dietary intake
Liver disease
Severe vomiting
Increased protein synthesis
high protein dietary intake
The most frequently used analytic method for creatinine testing is the:
Jaffe reaction
Which test has the most strict collection requirements that include transporting the specimen on ice and testing immediately.
Ammonia
disease associate with severe protein deficiency
Kwashiokor
disease associate with severe protein and calorie deficiency
Marasmus
Which is a negative acute phase reactant?
Transferrin
This protein is known for being a nephrotoxin.
Myoglobin
This test may be used to assess nutritional status.
Prealbumin
Proteins with 10-40% carbohydrates attached are
Glycoproteins
Proteins consist of the elements:
Carbon
Oxygen
Nitrogen
All of these
None of these
all
In the stomach ______ breaks down proteins into peptides.
pepsin
When a protein is disturbed and loses its functional and chemical characteristics, it is called:
Denaturation
Essential amino acids:
Must be obtained through diet
Are synthesized by the body
Must be obtained through diet
In cerebral spinal fluid, ______% of protein comes from plasma, while ______% comes from the brain.
95%, 5%
When proteins have a more positive charge they are more easily dissolved.
T/F
True
Which is not true of amino acid analysis?
Collect sample in a heparin tube
Blood samples should be drawn after a 2-3 hour fast
Analysis should be performed immediately or sample frozen
Plasma should be removed carefully to avoid platelets and white blood cells
Blood samples should be drawn after a 2-3 hour fast
This type of analytical method measures the amount of light that can pass through a sample at a 180O angle from the incident light.
Turbidimetry
Stray light refers to any wavelengths outside the band transmitted by the monochromator.
T/F
true
Dynodes are a series of anodes with successively higher voltages.
T/F
true
An advantage of a photocell over a phototube is that a photocell has an external power source and is more sensitive with lower amounts of light.
T/F
false
Calculate % transmittance through a tube containing 5 layers of solution with an absorbance of 20%.
33%
This type of lamp is used in visible and infrared regions and is the most common type:
tungsten
Visible light falls between the color ______ at 400 nm and _____ at 700 nm.
violet, red
Which is the order that you would expect to see in LD isoenzymes in a patient who has had a heart attack.
LD1>LD2>LD3>LD4>LD5
