ClinChem Flashcards
Conversion of glucose to pyruvic or lactic acid
Glycolysis
Production of glycogen from glucose
Glycogenesis
Production of glucose from glycogen
Glycogenolysis
Production of glucose from non-carbohydrate sources
Gluconeogenesis
What is the end product of anaerobic glycolysis?
Lactic Acid
Which sugars accounts for nearly all blood sugar and is the body’s major source of cellular energy?
Glucose
What is the reference range for a glucose in an adult?
70-110 mg/dl
Presence of sugar in the urine
Glucosuria
High blood sugar. It is most often due to diabetes mellitus
Hyperglycemia
A glycated protein that can be used to determine glycemic control over the past 2-3 weeks?
Fructosamine
What is the main form of lipid storage in the body
Triglycerides
Name two substances that play a role in the digestion of lipids
Lipase
Bile Salts
What is the major site of cholesterol synthesis?
Liver
Which lipoprotein transports most cholesterol?
Low Density Lipoprotein (LDL)
What is the desirable level for HDL cholesterol
> 40 mg/dl
Which lipid is the major component plaques in arteries?
LDL
Made of one molecule of glycerol an d three molecules of fatty acid
Triglycerides
Largest lipoproteins that transport exogenous triglycerides and account for the turbidity of serum following a meal
Chylomicrons
What specimen is required for a lipid profile?
Serum collected after a 10-12 hour fast
What causes a cream layer on top of plasma after overnight refrigeration
High levels of triglycerides or chylomicrons
What might lead you to suspect that a specimen was non-fasting?
Lipemia
Which element is found in protein but
not in carbohydrates or lipids?
Nitrogen (16%)
What is the waste product of protein catabolism?
Urea
What is the most common method for measuring serum total protein?
Biuret Method
What does low total protein cause in the patient?
Edema
What are the most common dyes used for direct analysis of a albumin?
Bromcresol Green
Bromcresol Blue
How is the concentration of globulins determines in a chemistry profile?
By subtracting albumin from total protein
The property of proteins to assume a positive, negative or neutral charge depending on the pH of the medium
Amphoterism
What is the name of the instrument used to quantitate protein fractions following serum protein?
Densitometer
Which protein fraction normally accounts for over half of the serum total protein?
Albumin
In electrophoresis of serum at pH 8.6, which fraction is the fastest moving?
Albumin
What causes increased albumin?
Dehydration
What causes decreased alpha-1 globulin?
Alpha 1 trypsin deficiency
What causes a decreased gamma globulin fraction?
Hypogammaglobulinemia
Which immunoglobulin is increased in Waldenstrom’s macroglobulinemia?
IgM
Which band is normal in urine electrophoresis?
Albumin
A spike is observed in the gamma region on urine electrophoresis. What is present?
Bence Jones Protein
Name a band that is seen in normal CSF electrophoresis but not normal in serum protein electrophoresis?
Pre-albumin
Gamma globulins that precipitate in the col and present with multiple myeloma, rheumatoid arthritis, polycythemia, leukemia…
Cryoglobulins
An organic catalyst
Enzyme
An organic cofactor required for an enzymatic reaction?
Coenzyme
Slightly different forms of an enzyme that catalyze the same reaction
Isoenzyme
What specimen is required for most enzyme determination
Serum
What is the substrate for lipase?
Triglycerides
What is the substrate for amylase?
Starch
Which enzyme is most specific for acute pancreatitis?
Lipase
In which disease do the highest elevations of alkaline phosphatase occur?
Paget’s Disease
With which clinical condition are the highest levels of CK seen?
Duchenne’s muscular dystrophy
Which clinical condition results in the highest levels of LD?
Pernicious Anemia
What is the most specific cardiac marker?
Cardiac Troponin
What are the substrate for AST?
Aspartate
A-ketoglutarate
Which disease state has the highest elevation of AST and ALT?
Acute Hepatitis
Which enzyme is sensitive indicator of alcoholism?
Gamma-glutamyltranspeptidase
Which enzyme would be helpful in establishing of bone disease?
Alkaline Phosphatase
Which enzymes would be helpful in establishing a diagnosis of muscle disorders?
CK
AST
LD
Aldolase
Name three substances that are elevated in the blood with renal disease
BUN/Urea
Creatinine
Uric Acid
The end product of protein metabolism
Urea
What is the formula for converting BUN to urea?
Urea = BUN x 2.14
Where is 98% of the body’s creatine located
Muscles
The anhydride of creatine and is formed from creatine by splitting out of water
Creatinine
What reaction is used to measure creatinine
Jaffe Reaction
What is the least variable nitrogenous constituent of blood?
Creatinine
The end product of purine metabolism
Uric Acid
What reagent is commonly used to measure uric acid?
Uricase
An acute, often fetal encephalopathy and fatty degradation of the liver seen primarily in children
Reye’s Syndrome
Which amino acid is increased in the blood of patients with phenylketonuria?
Phenylalanine
What may result if blood for PKU is drawn before 24 hours of age?
False negative
Which amino acids are increased in maple syrup urine disease?
Leucine
Isoleucine
Valine
The degradation product of heme
Bilirubin
Which protein transports bilirubin in the blood?
Albumin
What substances related to bilirubin metabolism are normally found in the urine?
Urobilinogen
Name the two types of bilirubin
Conjugated Bilirubin
Unconjugated Bilirubin
Which bilirubin fractions are analyzed in the laboratory?
Total and Direct
Which form of bilirubin can be excreted in the urine?
Direct Bilirubin
Name a source of error that can decrease the level of bilirubin in a specimen
Exposure to light
In hemolytic disease of the newborn, which bilirubin fraction is elevated?
Indirect
Which disorder results in highest levels of conjugated bilirubin?
Obstructive liver disease
What type of method used for most hormones?
Immunoassays
What is the pre-cursor in the biosynthesis of all steroid hormones?
Cholesterol
Which endocrine gland releases tropic hormones that regulate other endocrine glands?
Anterior Pituitary
What hormone stimulates production of sperm and eggs?
Follicle Stimulating Hormone
What hormone stimulates the thyroid to produce T3 and T4?
Thyroid Stimulating Hormone
What hormone stimulates the adrenal cortex to produce corticosteroids?
Adrenocorticotropic Hormone
What hormone produced in the hypothalamus and stored in pituitary that regulates reabsorption of water from the DCT?
Antidiuretic Hormone
What hormone produced in adrenal cortex that increases retention of Na and excretion of K and H?
Aldosterone
A tumor of adrenal medulla that produces large amounts of catecholamines and causes hypertension?
Pheochromocytoma
Produced in the ovaries that prepares the uterus for pregnancy and stimulates lactation
Progesterone
What is the major estrogen produced by the ovaries?
Estradiol
Which hormone are used to asses fetal well-being?
Estriol
Which hormone is used to detect pregnancy?
Human Chorionic Gonadotropin
Which hormone can be measured by a home testing kit to determine the time of ovulation?
Luteinizing Hormone
What further thyroid testing is recommended when the TSH is abnormal?
Free T4
Produced in the parathyroid glands that increases serum calcium and decreases phosphates
Parathyroid Hormone
Produced in the alpha cells in the pancreas that increases glucose levels
Glucagon
Substances that carry electric current when dissolved in water
Electrolytes
What are the major electrolytes?
Sodium
Potassium
Chloride
Bicarbonate
What is the major extracellular cation?
Sodium
What is the major intracellular cation?
Potassium
What is the major extracellular anion?
Chloride
What is the major intracellular anion?
Phosphate
Which hormone regulates the concentration of sodium?
Aldosterone
How are sodium and potassium usually measured?
Ion Selective Electrodes
What is the approximates ration of potassium between RBCs and serum?
20:1
What is the approximate ration of sodium to potassium in serum?
30:1
What clinical condition results from very high or very low potassium levels?
Cardiac Arrythmias
Which disease is characterized by a high concentration of sodium and chloride in sweat?
Cystic Fibrosis
A topical drug used in the sweat test to stimulate sweat glands
Pilocarpine
What happens to CO2 if the sample is exposed to air?
Decreases
Which form of calcium is physiologically active?
Ionized
What is the reference method for total calcium?
Atomic Absorption
What is the most common cause of hypercalcemia?
Primary Hyperparathyroidism
What happens to calcium when phosphorus is increased?
Decrease
Which protein transports iron?
Transferrin
Where is most of the iron in the body?
Hemoglobin
Name two storage forms of iron
Ferritin
Hemosiderin
An intermediary in carbohydrate metabolism
Lactic acid
What specimen is required for blood gases?
Heparinized arterial blood
A volumetric pipette has an accuracy of?
1:1000
A pipette with bulb close to the delivery tip used for viscous fluids and is called
Ostwald-Folin
Which of the following is considered as the “gold standard” technique for drug analysis and why?
GC/MS because of its specificity and sensitivity.
In the non-enzymatic method for the determination of triglycerides is converted to glycerol and finally to formaldehyde. What is the method of choice for the determination of formaldehyde?
Hantzch
Which of the following has the symptoms of toxicity that mimics the cardinal signs of pheochromocytoma?
Mercury
Two consecutive values have fallen outside of the same 2s limit. This rule can apply to a single level during 2 consecutive runs or both levels of control during the same run. Which Westgard rule is described and what error does it suggest?
22s rule; Systematic error
Which of the following statements may be associated with the activity of insulin?
Stimulates glycogenesis in the liver
Which of the following is formed through anaerobic metabolism in the skeletal muscles during exercise?
Ammonia
What is the form of EDTA that is a di-potassium salt and has better stability?
Sequestrene
In neonatal thyroid screening, what thyroid condition is detected?
Hypothyroidism
An admitted patient has the following laboratory tests scheduled today: FBS, lipid profile, CBC, prothrombin time, and blood culture. What color tube sequence should be followed by the phlebotomist when collecting her blood sample?
Yellow, light blue, red, lavender
Given the laboratory results:
Blood pressure — Pulse — Urine metanephrines —
High
100 bpm
greater than 2 times the upper limit
Pheochromocytoma
What are the products formed by the forward reaction of aspartate aminotransferase?
Oxaloacetate and glutamate
Which among the following is the most sensitive indicator for liver damage from ethanol intake?
GGT
Analysis of CSF for oligoclonal bands is used to screen for which of the following disease states?
Multiple Sclerosis
Which of the following multi-rule combinations is considered the classic “Westgard Rules”?
12s/22s/R4s/41s/10x
Which of the following is the final volume of the solution divided by the amount of solute used?
Dilution factor
The process wherein ALP catalyzes the hydrolysis of 4-nitrophenylphosphate (4-NPP) follows what principle?
Kinetic Colorimetric
Which of the following conditions is caused by the leakage of blood out of a vein and under the skin during venipuncture and can cause discomfort or pain and can complicate further collections from that site?
Hematoma
What stimulates the thyroid gland to release thyroid hormones?
Pituitary Gland
A commonly used method for the quantitation of serum total proteins is the biuret procedure. What is responsible for the formation of the color produced in the biuret reaction?
The number of peptide bonds
The Kjeldahl technique is the reference method for the determination of serum total protein. What is the basis for this method?
Quantitation of the nitrogen content of protein
Which of the following methods for Urea measures the rate of disappearance of nicotinamide adenine dinucleotide?
UV enzymatic method
Ethanol, also known as “grain alcohol”, is one of the major substance abuse problems in the world. It could lead to blurry vision, incoordination, slurred speech and hangover. What metabolite is responsible for this hangover effects?
Acetaldehyde
Which among the following substances is most closely associated with the measurement of the pressure of dissolved CO2 (pCO2) in the blood?
Bicarbonate
Which glucose method can employ a polarographic oxygen electrode?
Glucose oxidase
Which of the following reagent systems contains the components sulfanilic acid, hydrochloric acid and sodium nitrite?
Diazo
What could likely be the result of an impaired generation of GnRH from the hypothalamus?
Hypogonadism
What part of the spectrophotometer is used to adjust the machine into 0% transmittance?
Zero control knob
When an acute myocardial infarction occurs, in what order (first to last) will the following enzymes become elevated in the serum?
1. AST
2. Lactate dehydrogenase
3. Creatine kinase
C-A-L (3-1-2)
Trinder’s reagent consisting for mercuric chloride, ferric nitrate, and hydrochloric acid may be used to quantitate which drug?
Salicylate
Which of the following sequence of procedures is correct during venipuncture?
Apply tourniquet, check for puncture site, insert the needle, pull the plunger
Serum protein electrophoresis is routinely performed on the serum obtained from a clotted blood specimen. What results would one get if a plasma specimen is used instead?
Electrophoresis will show an extra fraction in the beta-gamma region (INCREASED)
Which of the following statements is not true about anabolic steroids?
1. Toxic effects appear with short-term use of the drug 2. Utilized as a treatment for male hypogonadism
3. It is chemically related to testosterone
4. Toxic effects in males include hirsutism
1,4
Which of these steps is not essential in the enzymatic method for cholesterol determination?
Preliminary saponification of cholesteryl esters w/ warm KOH
Which of the following is not a characteristic of hemolytic jaundice?
1. Unconjugated serum bilirubin level increased 2. bilirubin level increased
3. Urinary urobilinogen level decreased
4. Fecal urobilin level decreased
2,3,4
In pediatric patients, parents must be asked to leave the room to avoid distractions during the venipuncture procedure. Potential venipuncture sites in pediatric patients include the medial backside of the wrist, the dorsum of the foot, the scalp, and the medial ankle.
First statement is false, second statement is true.
A “To-Contain” pipet is called as such for which of the following reasons?
It holds a particular volume but does not deliver the exact volume.
Which of the following conditions is caused by the leakage of blood out of a vein and under the skin during venipuncture and can cause discomfort or pain and can complicate further collections from that site?
Hematoma
Which of the following is the appropriate analyte to evaluate the sufficiency of renal function and the severity of kidney damage?
1. Creatinine 2. Urea
3. Uric acid 4. Ammonia
1, 2, 3 (Creatinine, Urea, Uric Acid)
What are the products formed by the forward reaction of aspartate aminotransferase?
Oxaloacetate and glutamate
Which of the following statements is not true about partially compensated respiratory alkalosis?
1. pCO2 is higher than normal
2. Bicarbonate is higher than normal
3. More CO2 is eliminated through the lungs by hyperventilation 4. Renal reabsorption of bicarbonate is decreased
1,2, 4
The Chemistry section head is having a demanding workload during her morning shift. She did not bother to separate the serum from the clot after spinning the gold top vacutainer tube and proceeded with the analysis. What could be the possible outcome of the result if the sample is to be tested for glucose and for what reason?
The result will have low amounts of glucose level since the blood cells have metabolized some of the glucose present in the serum.
Two consecutive values have fallen outside of the same 2s limit. This rule can apply to a single level during 2 consecutive runs or both levels of control during the same run. Which Westgard rule is described and what error does it suggest?
22s rule; Systematic error
A commonly used method for the quantitation of serum total proteins is the biuret procedure. What is responsible for the formation of the color produced in the biuret reaction?
The number of peptide bonds
The process wherein ALP catalyzes the hydrolysis of 4-nitrophenylphosphate (4-NPP) follows what principle?
Colorimetric
When present in increased concentration, which of the following apolipoproteins would be associated with a decreased risk of coronary artery disease?
Apo AI
Marsha is employed as Medical Technologist after passing the licensure exams. She is assigned within the Clinical Chemistry section and today she is tasked to run the tests in the analyzer. She proceeded to load the samples and two levels of controls. When the results were out, she noticed that the controls were outside of the control range. Upon investigation, she found out that a scheduled preventive maintenance activity was not performed the previous day. Marsha completes the preventive maintenance, recalibrates and does a re-run of the controls and samples. The results for the controls are now within range, Marsha documents the missed preventive maintenance and how the problem was resolved. Are Marsha’s actions part of the quality control program?
Yes, a quality control program includes reagents, controls, equipment and preventive maintenance.
In the peripheral tissues, the bicarbonate diffuses out of the red blood cell. To maintain electrical neutrality, this diffusion of bicarbonate is accompanied by a shift of chloride out of the red blood cells.
Both statements are true
Basic arterial blood gas collection rules state that we are only to use green-top, heparin- containing vacutainer tubes for ABG. Why?
Heparin is the only anticoagulant that doesn’t alter the blood pH.
Basic arterial blood gas collection rules state that we are only to use green-top, heparin- containing vacutainer tubes for ABG. Why?I
Heparin is the only anticoagulant that doesn’t alter the blood pH.
You are the assigned phlebotomist for the AM shift. Your first patient is to be tested for STAT serum potassium. The patient is bedridden and a little overweight so you had to do a bit of ‘probing’ in order to draw blood. You forwarded the specimen to the laboratory for processing. The serum potassium concentration had been reported as 5.9 mmol/L. This value was abnormally high when compared to the reference range for potassium. The medical technologist assigned in the clinical chemistry department did the test twice and the 2nd run yielded a result of 6.1 mmol/L. She releases the result and made sure she put “TEST DONE TWICE” in the remarks. Did the medical technologist make the right call by releasing the result after the 2nd run?
No, the probing of the vein could’ve contributed to hemolysis thereby falsely increasing values.
What is the ideal collecting device for arterial puncture?
1-3 mL, disposable, self-filling, plastic syringe
Which glucose method can employ a polarographic oxygen electrode?
Glucose oxidase
Glucose oxidase catalyzes the oxidation of glucose to gluconic acid and hydrogen peroxide. In the presence of the enzyme peroxidase, a reduced chromogen is oxidized to give a colored compound whose absorbance is measured spectrophotometrically. Which of the following chromogen-end color product is incorrectly matched?
O-toluidine—blue
Protein classes may be differentiated on the basis of their physical characteristics. What property distinguishes albumin from globulin?
Solubility in sulfosalicylic acid
In the visible light spectrum, the color red is in what nanometer range?
620—750 nm
What is the final concentration if a 2% solution is diluted to 1:100?
0.02%
The Kjeldahl technique is the reference method for the determination of serum total protein. What is the basis for this method?
Quantitation of the nitrogen content of protein
Which among the following substances is most closely associated with the measurement of the pressure of dissolved CO2 (pCO2) in the blood?
Bicarbonate
The Kjeldahl technique is the reference method for the determination of serum total protein. What is the basis for this method?
Quantitation of the nitrogen content of protein
Which of the following laboratory results characterizes menopausal period as experienced by women between the ages of 45-55 years old?
1. Increased FSH
2. Decreased LH
3. Decreased estradiol 4. Increased estrone
1,3,4
Which among the following conditions would present an increased serum anion gap?
Lactic acidosis
Which of the following methods for Urea measures the rate of disappearance of nicotinamide adenine dinucleotide?
GLDH coupled enzymatic
Mia, who had just given birth, has been drug-free for almost 2 months. Lately, she has been experiencing a myriad of symptoms such as hypothermia, palpitations, cold sweats, and nightmares. But she has been thinking of going back to her lifestyle of being reliant on certain drugs to make her forget about her newborn’s recent passing. Her baby had a number of complications, way beyond saving, which led to an untimely death. What could’ve been the substance that Mia was addicted to?
Heroin
What quadrant on the hazard labeling system by NFPA symbolizes “flammability hazard information”?
Red quadrant
In most cases, which among the following conditions is paralleled with hyperchloremia?
Hypernatremia
Jessa, a medical technologist, will dispense 0.5 mL serum to a test tube. What is the best pipette she must use
100-1000ul Micropipette
Serum is mixed with alkaline picrate and the rate of change in absorbance is measured. The detection of color formation is timed to avoid interference of non-creatinine chromogens. Which of the following methods for creatinine determination is described by this principle?
Jaffe-Kinetic Reaction
Uricase acts on uric acid to produce _____________, carbon dioxide and hydrogen peroxide. Hydrogen peroxide reacts with chromogen, ___________ and DHBS to yield quinoneimine, a red-colored complex. Which pair of words will complete the blanks?
allantoin; amino-4-antipyrine
