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Clinical Chemistry Flashcards

1
Q

Act of obtaining a blood sample from a vein using a needle attached to a syringe or a stoppered evacuated tube;
The most common way to collect blood specimens

A

Venipuncture

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2
Q

Major veins for venipuncture

A
  1. Median cubital vein
  2. Cephalic vein
  3. Basilic vein
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3
Q

Most common site for venipuncture

A

antecubital fossa

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4
Q

The ___ pattern is displayed by approximately 70% of the population

A

H pattern

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5
Q

vein located near the center of the antecubital fossa;
Preferred vein - large and closer to the surface, the most stationary
Easiest and least painful to puncture
Least likely to bruise

A

Median cubital vein

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6
Q

Second choice vein;
Harder to palate than median cubital vein
Fairly well-anchored;
often the only vein felt in obese patients

A

Cephalic vein

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7
Q

Last choice of vein
Not well anchored and rolls easily
Increased risk of puncturing a median cutaneous nerve branch or the brachial artery
not recommended unless no other vein in either arm is more prominent

A

Basilic vein

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8
Q

Veins on the back of the hand and wrist may also be used for venipuncture

A

True

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9
Q

Veins on the underside of the wrist should never be used for venipuncture

A

True

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10
Q

Leg, ankle and foot veins are sometimes used but not without permission of the patient’s physician, due to potential for significant medical complications

A

True

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11
Q

3 Types of Blood specimens

A
  1. Serum
  2. Plasma
  3. Whole blood
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12
Q

Not normally a clear, pale yellow fluid;
Separated from clotted blood by centrifugation
Many chemistry tests are performed using this specimen

A

Serum

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13
Q

Non fasting serum can be cloudy due to ____

A

lipids

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14
Q

Normal clotting time for serum

A

30 mins

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15
Q

Does serum contain fibrinogen and other coagulation factors?

A

No

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16
Q

Centrifugation speed and time to obtain serum specimen

A

10 minutes at an RCF of 1,000 to 2,000 g

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17
Q

Normally a clear to slightly hazy, pale yellow fluid;
Separates from the cells when blood in an anticoagulant tube is centrifuge;
Contains fibrinogen

A

Plasma

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18
Q

Is fibrinogen present in the plasma

A

Yes

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19
Q

Fibrinogen is not present in the serum because ___

A

It was used in clot formation

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20
Q

Stat and other tests requiring a fast Tat are often collected in tubes containing ___ anticoagulant because they can be centrifuged immediately to obtain plasma

A

Heparin

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21
Q

contains both cells and plasma;
Must be collected in an anticoagulant tube to keep it from clotting;
used for most hematology tests and many POCTs, especially in acute care and Stat situations

A

Whole blood

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22
Q

3 Methods of venipuncture

A
  1. ETS
  2. Needle and syringe
  3. Butterfly set
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23
Q

Preferred method of venipuncture because blood is collected from the vein into the tube, minimizing the risk of specimen contamination and exposure to the blood

A

ETS

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24
Q

discouraged by CLSI due to safety and specimen quality issues; sometimes used on small, fragile or damaged veins

A

Needle and syringe

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25
Q

Can be used with ETS or a syringe; often used to draw blood from infants and children, hand veins, Difficult-draw situations.

A

Butterfly set

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26
Q

Restrict venous flow but not arterial flow

A

Tourniquet

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27
Q

Tourniquets must not be left on longer than

A

1 minute

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28
Q

Length and width of the tourniquet

A

1 inch wide x 15 inches long

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29
Q

Gauge and bore are inversely related

A

True

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30
Q

Gauge considered standard for routine venipuncture

A

21 gauge

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31
Q

Gauge used for pediatrics

A

23 gauge

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32
Q

3 basic components of the ETS

A

Multisample needle, tube holder, evacuated tubes

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33
Q

Includes a plastic syringe, a needle, and a transfer device

A

Syringe system

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34
Q

23 gauge most commonly used for phlebotomy

A

Butterfly system

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35
Q

Handheld medical device that helps medical staff visualize veins before phlebotomy.

A

AccuVein

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36
Q

AccuVein emits ___ and is held about 7 inches over the potential phlebotomy site

A

infrared light

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37
Q

Tube color without an anticoagulant or additive (Glass itself can activate clotting)

A

Red

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38
Q

Activates intrinsic pathway

A

Negatively charged surface
Negatively = iNtrinsic

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39
Q

Extrinsic pathway is activated by

A

Tissue factor
“Ng dahil Kay EX, kinailangan mo ng TISSUE”

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40
Q

Type of EDTA tube that can shrink RBCs to (Low HCT, Low MCV) , but it can be used for PBS

A

K3EDTA (liquid form)

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41
Q

More preferred in routine CBC

A

K2EDTA

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42
Q

Tube color and anticoagulant/additive used for whole blood/ blood bank and molecular diagnostics

A

Pink (Pray-dried K2EDTA)

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43
Q

Tube color and anticoagulant/additive used for molecular diagnostics

A

White (EDTA and gel)

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44
Q

Blood to anticoagulant ratio for light blue (sodium citrate)

A

9:1

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45
Q

More preferred Na citrate concentrations

A

3.2%

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46
Q

Tube and anticoagulant used for sedimentation rate

A

Black (sodium citrate)

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47
Q

Blood to anticoagulant ratio for ESR

A

4:1

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48
Q

Alternative top for ESR

A

Lavender

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49
Q

Intravenous anticoagulant ;
Universal anticoagulant

A

Heparin

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50
Q

Top and anticoagulant used for toxicology

A

Royal blue (sodium heparin, K2EDTA)

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51
Q

Binds magnesium, thus inhibiting the MG-depended enzyme, enolase

A

Sodium fluoride

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52
Q

Antiglycolytic agent in gray top tube

A

Sodium fluoride

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53
Q

Anticoagulant in gray top tube

A

Potassium oxalate

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54
Q

Sterile containing sodium polyanetholesulfonate; used for microbiology culture

A

Yellow

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55
Q

Top and anticoagulant used blood bank phenotyping and paternity testing

A

Yellow (acid citrate dextrose)

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56
Q

Top and anticoagulant used for lead testing

A

Tan (sodium heparin)

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57
Q

Top used for faster clotting (5-10 minus clotting time); contains thrombin

A

Yellow/ Gray and orange

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58
Q

CLSI Order of Draw

A
  1. Sterile tube
  2. Coagulation tube
  3. Serum tube with or without clot activator, with or without gel
  4. Heparin tube with or without gel separator
  5. EDTA tube with or without gel separator
  6. Glycolytic inhibitor tube

“Stop, light red! Stay put, Green Light, go!”

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59
Q

Preferred specimen for newborn screening tests

A

Capillary blood

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60
Q

Length of lancet to be used for capillary puncture

A

less than 2.0 mm

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61
Q

Sites for capillary puncture

A

Palmar surface of 3rd and 4th fingers for adults
Lateral plantar heel surface (newborns)
Earlobes (alternative)

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62
Q

Capillary order of Draw

A
  1. EDTA specimens
  2. Other additive specimens
  3. Serum specimens
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63
Q

For blood gas analysis and pH measurements

A

Arterial puncture

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64
Q

In arterial puncture, __ are used instead of evacuated tubes because of the pressure in an arterial blood vessel

A

Syringes

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65
Q

Preferred anticoagulant for arterial puncture

A

Heparin

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66
Q

Arterial puncture collects without a tourniquet

A

True

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67
Q

Primary arterial sites (in order of preference)

A

Radial, brachial, femoral arteries

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68
Q

Major complications of arterial puncture

A

Thrombosis, hemorrhage, and possible infection

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69
Q

Done before collecting an arterial blood from Radial artery to determine whether the ulnar artery can provide collateral circulation to the hand after the Radial artery puncture

A

Modified Allen Test

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70
Q

Peaks at 4-6 AM;
lowest at 8 PM - 12 AM;
50% lower at 8PM than at 8 AM

A

Cortisol

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71
Q

Peaks early to late morning; decreased up to 30% during the day

A

Iron

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72
Q

Increased after recent food ingestion

A

Glucose, insulin, TAG, gastrin, ionized calcium

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73
Q

Decreased after recent food ingestion

A

Chloride, phosphorus, potassium, amylase, ALP

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74
Q

T or F
Potassium doesn’t increase post prandially, thus it does not require fasting

A

T

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75
Q

Increased when an individual is stressed

A

ACTH, cortisol, catecholamines, prolactin

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76
Q

What is the first to increase during stress?

A

Catecholamines

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77
Q

Array of signs and symptoms resulting from increased cortisol

A

Cushing’s syndrome

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78
Q

Elevated ACTH from the pituitary gland resulting to increased cortisol

A

Cushing disease

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79
Q

Require fasting

A

FBS, GTT, TAG, LP, Gastrin, Insulin, Ald/Renin

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80
Q

Require Ice (immediate cooling)

A

Lactic acid, ammonia, blood gas (if not cooled = decreased pH and pO2)
“LAB ICE”

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81
Q

Increased when an hemolysis occurs

A

Potassium, pO4, Fe, Mg, ALT, AST, LD, ALP, Cathecolamines, CK (marked hemolysis)

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82
Q

Ideally, specimens must be delivered to the laboratory within ___ of collection

A

45 minutes

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83
Q

Specimens must be centrifuged within ___ of arrival if serum or plasma is needed

A

1 hour

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84
Q

Maximum time limit for serum or plasma separation is ___ after collection

A

2 hours

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85
Q

Medical term meaning “immediately” (from the Latin “statim”)

A

Stat collections

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86
Q

Given the highest priority and are usually ordered from the emergency department and critical care units

A

Stat collections

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87
Q

Analytical patient testing activities provided within the institution, but performed outside the physical facilities of the clinical laboratories

A

POCT

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88
Q

Laboratory testing tat is performed outside the central or core laboratory and generally at the site of clinical care or close to the patient

A

POCT

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89
Q

The highest volume POCT in most health care institutions

A

POC glucose

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90
Q

A drop of blood most frequently obtained via ___ is applied to a test strip

A

capillary puncture

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91
Q

Common POCTs (Tests requiring immediate decisions)

A

Glucose, blood gases, cardiac markers, urinalysis, creatinine, PT/INR, Infectious diseases (HIV, RSV, influenza), drug screening

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92
Q

Most common error in specimen collection

A

Misidentification of patient

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93
Q

Most common reason for specimen rejection

A

Hemolysis or lipemia

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94
Q

Next most common fluid for determination after blood; quantitative analysis require timed samples (usually 24 hours)

A

Urine

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95
Q

assess fetal lung maturity, congenital diseases, hemolytic diseases, genetic defects, gestational age

A

Amniotic fluid

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96
Q

Specifications established by the ACS
Suitable for use in most analytic laboratory procedures

A

Analytical Reagent

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97
Q

Additional purification steps
For use in specific procedures such as chromatography, atomic absorption, immunoassays, molecular diagnostics, standardization or other techniques that require extremely pure chemicals

A

Ultrapure

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98
Q

Used to manufacture drugs; Purity criterion are not based on laboratory needs

A

United Stated Pharmacopeia / National Formulary

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99
Q

Impurity specifications are not stated

A

Chemically pure or pure grade

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100
Q

Used primarily in manufacturing and should never be used in the clinical laboratory

A

Technical/ Commercial Grade

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101
Q

Highly purified chemical that can be measured directly to produce a substance of exact known concentration and purity

A

Primary standard

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102
Q

substance of lower purity with concentration determined by comparison with a primary standard

A

Secondary standard

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103
Q

Type of water purity having the most stringent requirements and generally suitable for routine laboratory use.

A

Type I water

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104
Q

Pipet design that holds or contains a particular volume but does not dispense that exact volume

A

To contain

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105
Q

Pipet design that will dispense the volume indicated

A

To deliver

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106
Q

Continuous etched ring or two small, close continuous rings located near the top of the Pipet

A

Blowout

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107
Q

allows the contents of the Pipet to drain by gravity

A

Self-draining

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108
Q

Measuring or graduated pipets

A

Serologic
Mohr
Bacteriologic
Ball, Kolmer or Kahn
Micropipet
“SMBBM”

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109
Q

Transfer pipets

A

Volumetric
Ostwald-Folin
Pasteur pipets
Automatic macropipet or micropipet
“VOPA”

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110
Q

Graduation marks to the tip; generally a blowout pipet

A

Serologic

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111
Q

No graduations to the tip; self-draining, but the tip should not be allowed to touch the vessel while the Pipet is draining

A

Mohr

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112
Q

Pipet with a total holding of less than 1 ml

A

Micropipet

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113
Q

Dispense or transfer aqueous solutions; self-draining

A

Volumetric

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114
Q

For biologic fluids having a viscosity greater than that of water; blow out

A

Ostwald-Folin

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115
Q

Pipet with no calibration marks

A

Pasteur Pipets

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116
Q

Most routinely used Pipet

A

Automated macropipet or micropipets

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117
Q

2 types of automated pipets

A

Air-displacement and positive displacement

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118
Q

Piston-operated devices. A disposable, onetime use polypropylene tip is attached to the Pipet barrel. The Pipet tip is placed into the liquid to be aspirated and is drawn into and dispensed from this tip

A

Air-displacement

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119
Q

Use a capillary tip that may be siliconized galss, glass, or plastic. this type of Pipet is useful if a Reagent reacts to plastics. Used a Teflon-tipped plunger that fits tightly inside the capillary. The tips are reusable, and carry-over is negligible if the Pipet is properly maintained. Some procedures require a washing or flushing step between samples.

A

Positive-displacement pipets

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120
Q

Used to dispense a particular volume of liquid during titration

A

Burets

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121
Q

Sometimes used to transfer small volumes in blood gas analysis or in separation techniques such as chromatography or electrophoresis

A

Syringes

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122
Q

hygroscopic substances used as excellent drying substances; used to prevent moisture absorption by chemicals, gases, and instrument components

A

Desiccant

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123
Q

Closed, airtight chamber used with Desiccant

A

Desiccator

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124
Q

Required for preparation of primary standards; the mechanical analytic balance is also known as a substitution balance

A

Analytic balances

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125
Q

Single-pan balances that use electromagnetic force to counter balance the weighed samples mass

A

Electronic balances

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126
Q

Allows the tubes to attain a horizontal position when spinning and a vertical position when the head is not moving
Can attain speeds of up to approximately 3000 rpm –> excessive heat buildup due to increased air friction

A

Horizontal or swinging bucket

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127
Q

Having angled compartments for the tubes and allow small particles to sediment more rapidly
Angle is fixed at around 52 degrees
common in the laboratory

A

Fixed-angle or angle-head

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128
Q

High speed centrifuge used to separate layers of different specific gravities
they are commonly used to separate lipoproteins (used in the reference method for lipoproteins quantitation)
Chamber is refrigerated to counter heat produced through friction

A

Ultra centrifuge

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129
Q

Centrifuge calibration is done every

A

3 months (quarterly)

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130
Q

Disinfect centrifuge ____

A

Weekly

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131
Q

Used to check speed of centrifuge

A

tachometer or strobe light (can also be a timer)

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132
Q

Conversion factor for TAG

A

0.0113

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133
Q

Conversion factor for AST

A

0.0167

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134
Q

Conversion factor for Creatinine clearance

A

0.0167

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135
Q

Conversion factor for cholesterol

A

0.026

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136
Q

Conversion factor for cortisol

A

0.0276

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137
Q

Conversion factor for glucose

A

0.0555

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138
Q

Conversion factor for uric acid

A

0.0595

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139
Q

Conversion factor for vitamin B12

A

0.0738

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140
Q

Conversion factor for iron

A

0.179

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141
Q

Conversion factor for calcium

A

0.25

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142
Q

Conversion factor for phosphorus

A

0.323

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143
Q

Conversion factor for BUN

A

0.357

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144
Q

Conversion factor for magnesium

A

0.5

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145
Q

Conversion factor for ammonia

A

0.587

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146
Q

Conversion factor for Bicarbonate

A

1

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147
Q

Conversion factor for chloride

A

1

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148
Q

Conversion factor for lithium

A

1

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149
Q

Conversion factor for osmolality

A

1

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150
Q

Conversion factor for potassium

A

1

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151
Q

Conversion factor for sodium

A

1

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152
Q

Conversion factor for folic acid

A

2.27

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153
Q

Conversion factor for albumin

A

10

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154
Q

Conversion factor for hemoglobin

A

10

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155
Q

Conversion factor for total protein

A

10

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156
Q

Conversion factor for Thyroxine

A

12.9

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157
Q

Conversion factor for bilirubin

A

17.1

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158
Q

Conversion factor for creatinine

A

88.4

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159
Q

Method of determining the concentration of substance in solution by measuring the amount of light absorbed by that solution after appropriate treatment

A

Spectrophotometry

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160
Q

Photons travelling in waves

A

electromagnetic radiation

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161
Q

distance between 2 peaks; inversely related to energy

A

wavelength

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162
Q

distance between peak and trough (height of the wave)

A

amplitude

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163
Q

Visible light falls between

A

400 nm to 700 nm

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164
Q

Range of infrared light

A

> 700 nm

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165
Q

Range of UV light

A

<400 nm

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166
Q

Wavelength of red light

A

around 600 - 700 nm

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167
Q

States that the concentration of a substance is directly proportional to the amount of light absorbed or inversely proportional to the logarithm of the transmitted light

A

Beer-Lambert Law (Beer’s Law)

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168
Q

Most common source of light for work in the visible and near infrared regions

A

Incandescent tungsten or tungsten-iodide lamp

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169
Q

Light source Most commonly used for UV work

A

Deuterium - discharge lamp and Mercury-arc lamp

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170
Q

Isolates the desired wavelength

A

Monochromators

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171
Q

Most commonly used as monochromators

A

Diffraction gratings

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172
Q

Contains the sample

A

Sample cell/cuvette

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173
Q

Has an advantage over round cuvets in that there is less error from the lens effect, orientation in the spectrophotometer, and refraction

A

Square sample cell

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174
Q

Sample cell used for applications in the visible range

A

Glass

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175
Q

Sample cell used for applications requiring UV radiation

A

Quartz

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176
Q

Used in instruments designed to be extremely sensitive to very low light levels and light flashes of very short duration

A

Photomultiplier tube

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177
Q

Parameters routinely monitored in Spectrophotometry

A

Wavelength or photometic accuracy, absorbance check, linearity, stray light

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178
Q

Photometric accuracy can be assessed easily using ___

A

special glass-type optical filters

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179
Q

Filter that has abroad absorption peak around 600 nm

A

Didymium glass

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180
Q

Filter that has multiple absorption peaks with a sharp peak occurring at 360 nm

A

Holmium oxide

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181
Q

Performed using glass filters or solutions that have known absorbance values for a specific wavelength

A

Absorbance check

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182
Q

The ability of a photometric system to yield a linear relationship between the radiant power incident upon its detection and the concentration

A

Linearity

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183
Q

The linearity of a spectrometer can be determined using __

A

optical filters or solutions that have known absorbance

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184
Q

Any light that impinges upon the detector that does not originate from a polychromatic light source

A

Stray light

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185
Q

Stray light can be evaluated by using

A

special cut off filters

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186
Q

Measures the quantity of light reflected by a liquid sample that has been dispensed onto a grainy or fibrous solid support

A

Reflectometry

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187
Q

Applications of Reflectometry

A

Urine dipstick analysis,
Dry slide chemical analysis

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188
Q

Measurement of concentration is done by detecting the absorption of electromagnetic by atoms rather than molecules. when a ground state atom absorbs light energy, an excited atom is produced. the excited atom then returns to the ground state, emitting light of the same energy as it absorbed

A

Atomic Absorption Spectrophotometry

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189
Q

Components of AAS

A

Hollow-cathode lamp, Flame, Monochromator

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190
Q

Usual light source in AAS

A

Hollow-cathode lamp

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191
Q

Breaks chemical bonds and form free, unexcited atoms; serves as sample cells (instead of a cuvet)

A

Flame

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192
Q

Used to isolate the desired wavelength; also protects photo detector from excessive light emanating from flame emissions

A

Monochromators

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193
Q

Application of AAS

A

Measurement of unexcited trace metals (calcium and magnesium)

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194
Q

Measurement of light emitted by excited atoms

A

Flame photometry

195
Q

Application of Flame Photometry

A

Determine the concentration of Na, K, Li

196
Q

Lithium (Flame with characteristic color)

A

Red

197
Q

Sodium (characteristic color in FP)

A

Yellow

198
Q

Magnesium characteristic color in FP

A

Blue

199
Q

Rubidium characteristic color in FP

A

Red

200
Q

Potassium characteristic color in FP

A

Violet

201
Q

Measurement of the concentration of solutions that contain fluorescing molecules

A

Fluorometry

202
Q

Most common light source in fluorometry

A

Xenon lamp

203
Q

Application of fluorometry

A

in Drugs

204
Q

Chemical energy generated in a chemiluminiscent reaction produces excited intermediates that decay to a ground state with the emission of photons; no excitation is required unlike in fluorometry

A

Chemiluminescence

205
Q

made with a Spectrophotometer to determine concentration of particulate matter in sample. The amount of light blocked by a suspension of particles depends not only on concentration but also on size

A

Turbidimetry

206
Q

Applications of turbidimetry:
Detection of bacterial growth and bacterial culture
Antibiotic sensitivity
Coagulation studies
Protein concentration in CSF and urine

A

True

207
Q

Light scattered by small particles is measured at an angle to the beam incident to the cuvet. Measure particles that are too large for spectrophotometry, such as antibody-antigen complexes formed in enzyme immunoassays.

A

Nephelometry

208
Q

Involves measurement of the current or voltage generated by the activity of specific ions.

A

Electrochemistry

209
Q

Analytic techniques involved in electrochemistry

A

Potentiometry
Coulometry
Voltammetry
Amperometry

210
Q

Measurement of potential (voltage) between 2 electrodes in a solution to measure analyte concentration

A

Potentiometry

211
Q

Applications of potentiometry

A

pH, pCO2, Na, Ca, K, NH4

212
Q

Measurement of the current flow produced by an oxidation-reduction reaction

A

pO2 (Clark electrode), glucose, peroxidase

213
Q

Electrochemical titration in which the titrant is electrochemical generated

A

Coulometry

214
Q

Application of coulometry

A

chloride

215
Q

Potential is applied to an electrochemical cell and the resulting current is measured

A

Voltammetry

216
Q

Applications of voltammetry

A

Anodic stripping Voltammetry (for lead and iron)

217
Q

Separation of charged compounds based on their electrical charge

A

Electrophoresis

218
Q

Most commonly used support medium in electrophoresis

A

cellulose acetate

219
Q

maintains pH

A

Buffer

220
Q

Movement of buffer ions and solvent relative to the fixed support

A

Electroendosmosis

221
Q

Most common and reliable way for quantitation of separated protein fractions

A

Densitometry

222
Q

Separation of complex mixtures on the basis of different physical attractions between the individual compounds and the stationary phase of the system

A

Chromatography

223
Q

Components of chromatography

A

Mobile phase
Stationary phase
Column
Eluate

224
Q

It carries the complex mixture in chromatography

A

Mobile phase

225
Q

Substance through which the mobile phase flows

A

Stationary phase

226
Q

Holds the stationary phase

A

Column

227
Q

separated components in chromatography

A

Eluate

228
Q

uses pressure for faster separations

A

High-Performance Liquid Chromatography

229
Q

Separate mixtures of compounds that are volatile or can be made volatile

A

Gas-Chromatography

230
Q

Sample in a __ is first volatilized and ten ionized to form charged molecular ions and fragments that are separated according to their mass-to-charge ratio

A

Mass Spectrometry

231
Q

Application:
Allows definitive identification when used on samples eluting from GC or HPLC
Gold standard for drug testing when coupled with GC

A

Mass Spectrometry

232
Q

Two-step procedure or MALDI-TOF

A
  1. MALDI
  2. Time-of-flight (TOF)
233
Q

A laser pulse irradiated the sample, causing desorption and ionization for both the matrix and the sample

A

MALDI-TOF MS

234
Q

The molecular weight of the proteins acquired by mass Spectrometry is used to determine the identity of the sample and is helpful in determining post translational modifications that may have occurred

A

MALDI-TOF MS

235
Q

Analysis of biomolecules such as peptides and proteins (application of MALDI-TOF MS

A

True

236
Q

Three basic approaches with instruments

A

Continuous flow, centrifugal analysis, and discrete analysis

237
Q

large number of specimens in one run

A

Batch analysis

238
Q

Analyzer that offers random-access or Stat capabilities

A

Discrete analyzers

239
Q

Type of analysis which uses air bubbles in the sample and Reagent streams. Air is injected into each stream as a series of small bubbles which travel along with the reaction system. The air bubbles minimize diffusion of reagents and mixing between samples preserving the integrity of each individual reaction

A

Continuous-Flow Analysis

240
Q

Sample and Reagent are placed in a rotor. When centrifugal force is applied, the rotor spins and causes the two components to flow into a reaction chamber where they combine to form a product.

A

Centrifugal analysis

241
Q

Slides contain all the materials necessary for a single analysis. No reagents were needed to prepare the slide for use

A

Dry-slide technology

242
Q

Composition of a dry slide

A

Spreading layer
Scavenger layer
Reagent layer
Indicator layer
Support layer

243
Q

Point of contact with the sample.
Spreads the sample equally over a defined area. Also serves as a sieve

A

Spreading layer

244
Q

Optional layer. Removes materials present into the sample which may interfere with the reaction. Example: slide for uric acid containing ascorbate oxidase to remove Vitamin C

A

Scavenger layer

245
Q

Optional layer. Contains a dye or some other type of indicator which reacts with the products of reaction taking place in the Reagent layer, forming a colored complex

A

Indicator layer

246
Q

Should be translucent to allow light used in reflectance spectroscopy to pass through

A

Support layer

247
Q

Light of a selected wavelength shines through the bottom of the cell. the light beam, reflects off the underside of the spreading layer and passes through the Reagent and indicator layers to a photodetector. Any absorbance which takes place must be due to the colored material formed by reactions in the slide

A

Reflectance Spectroscopy

248
Q

Instrument analysis patient samples only for those constituents specifically ordered and Stat samples can be carried out by momentarily interrupting the normal sequence of patient analyses. The instrument must also be capable of incorporating new tests into the Analytical scheme by addition of appropriate reagents and simple reprogramming for the new test parameters.

A

Random Access Analysis

249
Q

All samples are loaded at the same time and a single test is conducted on each sample

A

Batch testing

250
Q

More than one test is analyzed concurrently on a given clinical specimen

A

Parallel testing

251
Q

Multiple tests analyzed one after the another on a given clinical specimen

A

Sequential testing

252
Q

Reagents from other manufacturers may be used

A

Open Reagent system

253
Q

Operator can only use manufacturer’s reagents

A

Closed Reagent system

254
Q

Process by which lab ensures quality results by closely monitoring preanalytical, analytical, and postanalytical stages of testing

A

Quality assurance

255
Q

Everything that precedes test performance

A

Preanalytical

256
Q

Everything related to assay

A

Analytical

257
Q

Everything that comes after test analysis

A

Postanalytical

258
Q

Comparing results from current to previous

A

Delta check

259
Q

Part of analytical phase of quality assurance; process of monitoring results from control samples to verify accuracy of patient results

A

Quality control

260
Q

Controls are run __

A

Daily

261
Q

Difference between highest and lowest value; easiest measure of spread

A

Range

262
Q

Most frequently used measure of variation

A

Standard deviation

263
Q

An index of precision used to compare the dispersion of two or more groups of data with different units or concentrations

A

Coefficient of variation

264
Q

Used to determine if there is a significant difference between the means of two groups pf data (Compares accuracy)

A

T- test
ATM
Accuracy
T-test
Mean

265
Q

Used to determine if there is a significant difference between the SD of two groups of data (compares precision)

A

F-test
SPF
SD
Precision
F-test

266
Q

Describes many continuous laboratory variables and shares several unique characteristics

A

Gaussian Distribution (Normal Distribution)

267
Q

In the Normal Distribution, the mean , median, mode are identical

A

True

268
Q

The distribution In the Normal Distribution curve is symmetric (Bell Curve)

A

True

269
Q

The total area under the Gaussian curve is __

A

1.0 or 100%

270
Q

The ____ summarizes relations between the area under the Gaussian distribution and the SD

A

68-95-99 Rule

271
Q

___% of data fall between 1 +/- SD from the mean

A

68

272
Q

___% of the data fall between +/- 2 SDs from the mean

A

95

273
Q

__% fall between +/- 3SDs from the mean

A

99

274
Q

Nearness or closeness of assayed values to the true value

A

accuracy

275
Q

Nearness or closeness of assayed values to each other

A

Precision

276
Q

Ability of an analytical method to maintain accuracy and precision over an extended period of time

A

Reliability

277
Q

degree by which a method can easily be repeated

A

Practicability

278
Q

ability to measure the smallest concentration of the analyte of interest

A

Analytical sensitivity

279
Q

ability to measure only the analyte of interest

A

Analytical specificity

280
Q

Also known as linearity; range of values over which lab can verify accuracy of test system

A

Reportable range

281
Q

Formerly called normal value / normal range
Can vary for different patient population

A

Reference interval

282
Q

Reference interval is established by testing minimum of __ healthy subjects and determining range in which 95% fall

A

120

283
Q

Verifying a reference interval (transference) can require as few as __ study individuals

A

20

284
Q

Establishing a new reference interval my require from ___ to as many as ___ study individuals

A

120 - 700

285
Q

Transference and validation of a reference interval requires as few as ___ study individuals

A

40

286
Q

Reporting a positive result in a patient who has the disease

A

True Positive

287
Q

Reporting a positive result in a patient who doesn’t have the disease

A

False positive

288
Q

Reporting a negative result in a patient who doesn’t have the disease

A

True negative

289
Q

Reporting a negative result in a patient wo has the disease

A

False negative

290
Q

% of population with the disease that test positive; ability of the analytical method to detect the proportion of individuals with the disease

A

Diagnostic sensitivity

291
Q

% of population without the disease that test negative; ability of the analytical method to detect the proportion of individuals without the disease

A

Diagnostic specificity

292
Q

% of time that a positive result is correct

A

Positive predictive value

293
Q

% of time that a negative test result is correct

A

Negative predictive value

294
Q

assayed on a regular schedule to verify that a laboratory procedure is performing correctly

A

QC samples

295
Q

New instrument or new lot of reagents: analyze QC materials for ___ days

A

20

296
Q

2 parameters needed for QC

A

Mean, standard deviation

297
Q

Other name of Levey-Jennings Control Chart

A

Shewart plot

298
Q

Most common representation for evaluating QC results

A

Levey-Jennings Control Chart

299
Q

Control values increasing or decreasing for six consecutive runs

A

Trend

300
Q

Main cause of a trend

A

Deterioration of reagents

301
Q

six consecutive control values ont he same side of the mean

A

Shift

302
Q

Main cause of a shift

A

Improper calibration of the instrument

303
Q

Highly deviating values; control result outside established limits

A

Outliers

304
Q

Warning rule

A

1(2S)

305
Q

Present in all measurements; due to chance; no means of predicting it

A

Random error

306
Q

error that doesn’t recur in regular pattern

A

Random error

307
Q

Associated with violations of the 12s, 13s, and R4s Westgard rules

A

Random error

308
Q

Error that influences ALL observations consistently in one direction

A

Systematic error

309
Q

Recurring error inherent in test procedure

A

Systematic error

310
Q

Associated with violations of the 22s and 41s Westgard rules

A

Systematic error

311
Q

Error due to dirty glassware

A

Random error

312
Q

Use of wrong pipet

A

Random error

313
Q

Voltage fluctuation

A

Random error

314
Q

Sampling error

A

Random error

315
Q

Anticoagulant or drug interference

A

Random error

316
Q

Dirty photometer

A

Systematic error

317
Q

Faulty ISE

A

Systematic error

318
Q

Evaporation or contamination of standards or reagents

A

Systematic error

319
Q

Also known as external quality assessment

A

Proficiency testing

320
Q

Consists of evaluation of method performance by comparison of results versus those of other laboratories for the same set of samples

A

Proficiency testing

321
Q

Failed Delta check

A

> 20% deviation

322
Q

Test results that indicate a potentially life-threatening situation

A

Critical values

323
Q

critical or panic values for serum glucose

A

< 40 mg/dL
> 500 mg/dL

324
Q

Approach focusing on process improvement as a means to meet a set standard

A

Quality management

325
Q

Provides a culture, infrastracture, methodology, and metric for quality improvement

A

Lean Six Sigma

326
Q

3 Roles of Lean Six Signa team

A

Black belts (Project coaches/leaders)
Green belts (Project team members)
Blue belts (Project sponsors)

327
Q

full time quality improvement leaders who dedicate 100% of their time to proactively addressing process and quality problems

A

Project coaches/leaders (Black belts)

328
Q

Contribute 20% of their on project time while maintaining their normal jobs

A

Project team members (Green Belts)
“20% discount sa Green Belt”

329
Q

Mid-to-senior level sponsors who review the project, remove organizational barriers, and encourage the team members

A

Project sponsors (Blue belts)

330
Q

Uses a problem-cause-solution methodology to improve any process through waste elimination and variation reduction.

A

Lean Six Sigma

331
Q

The belief that quality improvement requires sound problem solving

A

DMAIC Methodology

332
Q

Meaning of DMAIC

A

Define, Measure, Analyze, Improve, and Control

333
Q

Major energy source; storage form of energy; components of cell membranes; structural component in plants, bacteria, insects

A

Carbohydrates

334
Q

Where is glycogen stored in the body?

A

Liver and muscle

335
Q

Bond that links 2 sugar units

A

Glycosidic bond

336
Q

Breakdown polymers to dextrins and dissacharides

A

Salivary amylase and pancreatic amylase

337
Q

Glucose + fructose

A

Sucrose

338
Q

Glucose + galactose

A

Lactose

339
Q

Glucose + glucose

A

Maltose

340
Q

____ are absorbed by the gut via active transport (glucose and galactose) or facilitated diffusion (fructose). They are then transported into the liver through the portal circulation

A

Monosaccharides

341
Q

___ is the only carbohydrate to be used directly for energy

A

Glucose

342
Q

After glucose enters the cell, it undergoes phosphorylation into glucose-6-phosphate through the action of __ or ___

A

hexokinase or glucokinase

343
Q

Most common enzyme deficiency in the glycolysis pathway (Embden-Meyerhof pathway)

A

Pyruvate kinase deficiency

344
Q

Pyruvate kinase deficiency leads to

A

Hemolytic anemia

345
Q

Marker of hypoxia

A

Lactate

346
Q

Main purpose of glycolysis

A

Generates ATP

347
Q

The Hexose-Monophosphate shunt generates ___

A

NADPH

348
Q

NADPH –> reduced

A

glutathione

349
Q

Most common enzyme deficiency in the Hexose-Monophosphate shunt

A

G6PD deficiency

350
Q

Metabolism of glucose molecule to Pyruvate or lactate for production of energy

A

Glycolysis

351
Q

Formation of glucose-6-phosphate from non-carbohydrate sources

A

Gluconeogenesis

352
Q

Breakdown of glycogen to glucose for use as energy

A

Glycogenolysis

353
Q

Conversion of glucose to glycogen for storage

A

Glycogenesis

354
Q

Conversion of carbohydrates to fatty acids

A

Lipogenesis

355
Q

Decomposition of fat - ketone production

A

Lipolysis

356
Q

G6PD leads to

A

Hemolytic anemia (Heinz bodies)

357
Q

Produced by the beta cells of the islets of Langerhans (pancreas)

A

Insulin

358
Q

Marker of endogenous insulin production

A

C-peptide

359
Q

Prepoinsulin –> Proinsulin –>

A

Insulin

360
Q

Hypoglycemic hormone

A

Insulin

361
Q

T or F (Physiologic effects of insulin)
Increases utilization of glucose by the cells by increasing cellular uptake and hepatic glycolysis

A

T

362
Q

T or F (Physiologic effects of insulin)
Increases glycogenesis and inhibits glycogenolysis

A

T

363
Q

T or F (Physiologic effects of insulin)
Inhibits gluconeogenesis

A

T

364
Q

T or F (Physiologic effects of insulin)
Stimulates lipogenesis while inhibiting lipolysis

A

T

365
Q

T or F (Physiologic effects of insulin)
Stimulates protein synthesis and stimulates uptake of amino acids into muscles

A

T

366
Q

Produced by the alpha cells of the islets of Langerhans

A

Glucagon

367
Q

BIGADS

A

Beta cells: Insulin
Glucagon: Alpha cells
Delta cells: Somatostatin

368
Q

T or F (Physiologic effects of glucagon)
Promotes liver glycogenolysis

A

T

369
Q

T or F (Physiologic effects of glucagon)
Increases glyconeogenesis

A

T

370
Q

T or F (Physiologic effects of glucagon)
Inhibits glycolysis

A

T

371
Q

Increases gluconeogenesis; Decreases glucose uptake and utilization by extra hepatic tissues

A

Cortisol (Glucocorticoids)

372
Q

Stimulates glycogenolysis

A

Catecholamines

373
Q

Increases glucose absorption in the small intestines

A

Thyroid hormone

374
Q

Inhibit glucagon and insulin secretion

A

Somatostatin

375
Q

Increases liver gluconeogenesis; inhibits glycolysis; inhibits glucose transport

A

Growth hormone

376
Q

Hypercortisolism

A

Cushing’s syndrome

377
Q

Pituitary tumor; Increased ACTH; Increased Cortisol

A

Cushing’s disease

378
Q

Stress hormones (increases in long-term stress)

A

Cortisol and Catecholamines

379
Q

First to increase during stress

A

Catecholamines

380
Q

Elevated growth hormone (childhood onset)

A

Gigantism

381
Q

Elevated growth hormone (adult onset)

A

Acromegaly

382
Q

Heterogenous group of multifactorial, polygenic syndromes characterized by an elevated fasting blood glucose caused by a relative or absolute deficiency in insulin

A

Diabetes Mellitus

383
Q

Characterized by an absolute deficiency of insulin caused by an autoimmune attack on the beta cells of the pancreas

A

Type 1 DM

384
Q

Characterized by a combination of insulin resistance and dysfunctional beta cells (defective receptors of target cells or organs)

A

Type 2 DM

385
Q

Juvenile onset DM / Insulin Dependent DM

A

Type 1 DM

386
Q

Adult onset DM / Non-insulin Dependent DM

A

Type 2 DM

387
Q

Most common in children and young adults DM

A

Type 1 DM

388
Q

Most common with advancing age DM

A

Type 2 DM

389
Q

Frequency of Type 1 DM

A

5 - 10%

390
Q

Frequency of Type 2 DM

A

90 - 95%

391
Q

Autoantibodies in Type 1 DM

A

Anti-islet cell cytoplasmic antibody
Insulin autoantibodies
Anti-GAD

392
Q

Genetic has a stronger effect in this Type of DM

A

Type 2 DM

393
Q

Pathogenesis: Destruction of pancreatic beta cells, usually autoimmune

A

Type 1 DM

394
Q

Pathogenesis: No autoimmunity; insulin resistance and progressive insulin deficiency

A

Type 2 DM

395
Q

C- peptide levels in Type 2 DM

A

Detectable

396
Q

Type of DM where the plasma insulin is high in early disease; low to absent in disease of long duration

A

Type 2 DM

397
Q

Type of DM prone to keto acidosis and diabetic complications due to uncontrolled lipolysis

A

Type 1 DM

398
Q

Ketone bodies and their percentages

A

Beta-hydroxybutyric acid - 78%
Acetoacetic acid - 20%
Acetone - 2%

399
Q

Glucose intolerance with onset or first recognition during pregnancy

A

Gestational Diabetes Mellitus

400
Q

Large % of patients develop DM in GDM within ___ years

A

5 to 10 years

401
Q

Screening for GDM

A

2-hour GTT using a 75 g glucose load

402
Q

Diagnostic criteria for DM
Random plasma glucose

A

> /= 200 mg/dl

403
Q

Diagnostic criteria for DM
Fasting plasma glucose

A

> /= 126 mg/dl

404
Q

Diagnostic criteria for DM
Two-h plasma glucose

A

> /= 200 mg/dl

405
Q

Symptoms of DM

A

polyuria, polydypsia, polyphagia

406
Q

Normal fasting plasma glucose

A

< 100 mg/dl

407
Q

Normal 2-hour plasma glucose level (after 75 g load)

A

< 140 mg/dl

408
Q

HbA1c prediabetes range

A

5.7 - 6.4%

409
Q

Impaired fasting glucose level

A

100 - 125 mg/dl

410
Q

Impaired glucose tolerance level

A

140 - 199 mg/dl

411
Q

Fasting plasma glucose level for DM

A

> /=126 mg/dl

412
Q

2-hour plasma glucose level for DM

A

> /= 200 mg/dl

413
Q

Detection of GDM

A

Oral Glucose Tolerance Test

414
Q

Before an OGTT is performed, individuals should ingest at least ___ of carbohydrates for 3 days preceding the test

A

150 g/day

415
Q

Fasting duration for OGTT

A

8-14 hours

416
Q

In OGTT, an FBG greater than ___ necessitates that the test be stopped immediately.

A

140 mg/dl

417
Q

Glucose load for adults

A

75 g

418
Q

Glucose load for children

A

1.75 g/kg body weight

419
Q

Glucose load for pregnant women

A

75 g or 100 g

420
Q

Patient should finish glucose load within ___

A

5 - 15 minutes

421
Q

Patient should not vomit. If patient vomits, ___

A

discontinue the test

422
Q

Gestational diabetes Mellitus is diagnosed if ___ are exceeded

A

> /= 2 plasma glucose levels

423
Q

Rate of formation of HbA1c is proportional to the average blood glucose concentration over the previous ___

A

3 months

424
Q

For every 1% increase in HbA1c, there is corresponding ___ change in plasma glucose

A

35 mg/dl

425
Q

The Ada also recommends that a HbA1c be tested ___ to monitor long-term glycemic control

A

at least twice a year

426
Q

False decrease HbA1c

A

decreased RBC lifespan

427
Q

Glycated albumin

A

Fructosamine

428
Q

Fructosamine monitors glucose control over past ___

A

2 - 3 weeks

429
Q

Lifespan of albumin in circulation

A

20 days

430
Q

False decrease in Fructosamine testing

A

Hypoalbuminemia

431
Q

At about ____, glucagon and other glycemic factors are released

A

50 - 55 mg/dl

432
Q

Insulinoma, various liver disorders, and gastrointestinal disorders and surgery all causes hypoglycemia

A

T

433
Q

Whipple’s Triad

A

Fasting hypoglycemia (<50 mg/dl)
Symptoms of hypoglycemia
Immediate relief of symptoms with intravenous glucose

434
Q

Warning signs and symptoms of hypoglycemia are all related to the central nervous system

A

True

435
Q

Test for hypoglycemia in which the glucose values drop around 4 and 5 hours

A

5-h OGTT

436
Q

Test for hypoglycemia in which normal individuals can maintain glucose levels at normal levels within 3 days; noticeable drop in blood glucose over the 3 days of the fast

A

72-h fast

437
Q

Half-life of albumin

A

30 days

438
Q

target HbA1c

A

7%

439
Q

Controlled DM

A

<7%

440
Q

Uncontrolled DM

A

> 7%

441
Q

Controlled DM is tested every

A

6 months

442
Q

Uncontrolled DM is tested every

A

3 months

443
Q

Standard clinical specimen for glucose testing

A

Fasting venous plasma

444
Q

Fasting blood sugar should be obtained after ___ of fasting

A

8 - 10 hours

445
Q

Whole blood glucose levels ___ VS plasma levels

A

10 - 15% lower

446
Q

Glucose is metabolized at room temperature at a rate of ___

A

7 mg/dl/hr

447
Q

At 4 deg C, glucose decreases by approximately ___

A

2 mg/dl/hr

448
Q

Evacuated tube for glucose testing

A

gray top (for long delay)

449
Q

Anticoagulant in gray top tube

A

Sodium oxalate

450
Q

Antiglycolytic agent in gray top tube

A

Sodium fluoride

451
Q

Alternative Antiglycolytic agent in gray top tube

A

Iodoacetate

452
Q

CSF glucose levels ___ of plasma levels

A

60 - 70%

453
Q

As little as 10% contamination with 5% dextrose will elevate glucose in a sample by ___

A

500 mg/dl or more

454
Q

Prevention of dextrose contamination.
Stop the line, wait for ___, discard 1st tube, the 2nd tube is used for analysis

A

5 - 10 mins

455
Q

CSF glucose ___ in bacterial meningitis

A

decreases

456
Q

Methods for Glucose measurement (2)

A

Chemical, Enzymatic

457
Q

Method of glucose measurement that relies on the reducing property of sugars

A

Chemical method

458
Q

Glucose and other carbohydrates are capable of converting cupric ions in alkaline solution to cuprous ions

A

Chemical method

459
Q

Chemical methods of glucose measurement (2)

A

Oxidation-reduction method and Condensation method

460
Q

Oxidation-reduction method for glucose measurement (2)

A

Alkaline Copper Reduction method and Alkaline Ferric Reduction method

461
Q

Alkaline Copper Reduction method (4)

A

Folin-Wu
Nelson-Somogyi
Neocuproine method
Benedict’S method

462
Q

Hagedorn-Jensen method

A

Alkaline Ferric Reduction method

463
Q

Dubowski method

A

Condensation method

464
Q

Enzymatic methods of glucose measurement (2)

A

Glucose oxidase method
Hexokinase method

465
Q

Glucose oxidase method (2)

A

Colorimetric method and Polarographic method

466
Q

Most specific enzyme reacting with only beta-D-glucose

A

Glucose oxidase

467
Q

Cu + phosphomolybdate –> phosphomolybdenum blue

A

Folin-Wu

468
Q

Cu + arsenomolybdate -> arsenomolybdenum blue

A

Nelson-Somogyi

469
Q

Glucose oxidase method that uses a side reaction that consumes H2O2

A

Colorimetric method

470
Q

Glucose oxidase method that measures the rate of disappearance of oxygen using an oxygen electrode

A

Polarographic method

471
Q

Reference method for glucose determination

A

Hexokinase method

472
Q

More accurate than glucose oxidase methods Because the coupling reaction using G6PDH is highly specific; therefore it has less interference than the coupled glucose oxidase procedure

A

Hexokinase method

473
Q

NADPH has a strong absorbance at ___

A

340 nm

474
Q

Hexokinase method is not affected by ascorbic acid or uric acid

A

T

475
Q

Most common cause of lactose intolerance

A

Lactase deficiency

476
Q

Congenital deficiency of one of three enzymes involved in galactose metabolism, resulting in increased levels of galactose in plasma

A

Galactosemia

477
Q

Classic galactosemia; most common; usually presents with hepatomegaly, jaundice, hypoglycemia, convulsions, cataracts and lethargy

A

Galactose-1-phosphate uridyl transferase

478
Q

May result in cataract development but otherwise asymptomatic unlike the more severe classic galactosemia

A

Galactokinase

479
Q

Result of the deficiency of a specific enzyme that causes an alternation of glycogen metabolism

A

Glycogen storage diseases

480
Q

Most common congenital form of glycogen storage disease

A

Von Gierke Disease

481
Q

Autosomal recessive disease, characterized by hepatomegaly, severe hypoglycemia, metabolic acidosis, ketonemia, and elevated lactate and alanine; G6P deficiency

A

Von Gierke Disease

482
Q

Types of Glycogen storage diseases
“Viagra Pill Causes A Muscle Hardening Tight”
“GG Di Ba MaLi Po”

A

Von Gierke - Glucose-6-phosphatase
Pompe - Glucosidase
Cori/Forbes - Debranching enzyme
Andersen - Branching enzyme
McArdle - Muscle phorphorylase
Hers - Liver phosphorylase
Tarui’s disease - Phosphorylase

483
Q
A

Reviewers (14 decks)

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