Clinical Chemistry Flashcards
Error where there is continued difference between test and comparative method values
Constant error
Error where difference between test and comparative method values are proportional to analyte concentrate
Proportional error
Deterioration of reagents is a problem encountered in what phase of clinical analysis
Analytical phase
Ratio of WARNING to MANDATORY Westgard rules
3:3
QC Chart that demonstrates the Westgard Multirules
Levey-Jennings
Most widely used QC Chart in the clinical laboratory
Levey-Jennings
QC Chart used to compare results of different laboratories
Youden Twin Plot
Plot that gives the earliest indication of trend
CuSum graph
Closeness of measured value to the true value
Accuracy
An ability to give repeated results on the same sample that agree with one another
Precision
Measures of the diagnostic accuracy of the a test
Specificity & Sensitivity
Relates to the lowest concentration of a substance that can be detected in a test system
Analytical sensitivity
Ability to detect only the desired chemical with no interference from other chemicals
Analytical specificity
Ability to detect the presence of disease
Diagnostic sensitivity
Indicates the ability of the test to generate more true POSITIVE and few false negative results
Diagnostic sensitivity
Reflects the ability of the method to detect true NEGATIVE with very few false positive
Diagnostic Specificity
Indicates the number of patients with an abnormal test result who HAVE the disease
Positive Predictive Value (PPV)
PPV Formula
True Positive / (True Positive + False Positive)
Indicates the number of patients with a normal test result who DO NOT HAVE the disease
Negative Predictive Value (NPV)
NPV Formula
True Negative / (True Negative + False Negative)
Part (s) of descriptive statistics
Central tendency, dispersion
Measures of dispersion
Variance, SD, CV, Range
The lower the CV, the _________ the precision
Higher
The average of the given set of values
Mean
Middle or midpoint of a distribution
Median
Most frequent observation in a set of data
Mode
At least how many control values should be gathered before interpretation is done?
20
Normal Gaussian curve appearance
Bell-shaped
Normal Gaussian distribution curve occurs if mean __ median __ mode
Mean = median = mode
+/- 2SD is equivalent to what % in Gaussian curve?
95%
Statistically derived value representing values of “healthy” people
Reference value
How many subject specimens are needed to ESTABLISH a reference range interval?
At least 120
How many subject specimens are needed to VERIFY a reference range interval?
As few as 20
How should a laboratory verify the reference range it uses for a particular test?
Test samples from healthy people
Sample used for interlaboratory (external) quality testing
Blind sample
Evaluation of method performance by comparing results with other lab
Proficiency testing (EQA)
Comparison between patient’s most recent result & previous determined value
Delta check
Important criteria in evaluating instruments
Specificity & sensitivity
A good standard curve
Line is straight.
Line connect all points.
Line goes through the origin of X & Y axes.
There is a perfect correlation of values in linear regression if values falls on __
1
Test performed usually by nonlaboratorian personnel (nurses, RTs, etc.)
Point-of-care testing
Nonlaboratory personnel are reaponsible for __ % errors with regard to lab results
29%
Specimen used for point-of-care testing (POCT)
Capillary blood
QC of POCT instruments should be done every ___
Everyday (Once each day of use)
Usual cause of random error in clinical laboratory
Clerical error
Vapor & osmotic pressure, boiling & freezing points are example of ___
Colligative properties
Used to measure osmolality
Freezing point depression & boiling point depression
Specimen (s) for osmolality determination
Serum
The relative concentration of a solution
Dilution
How much diluent needs to be added to 0.2 ml of serum to make 1:20 dilution?
3.8 mL
It is the amount of 1 substance relative to the amount of other substance in the solution
Concentration
Instrument that use diffraction gratings (commonly used monochromator)
Spectrophotometer
Beer’s law mathematically establishes relationship between concentration and ____
Absorbance
A solution that has a transmittance of 1.0% T would have an absorbance of ___
Formula:
Absorbance = 2-log (%T)
2.0
Formula for the concentration of the unknown sample (using spectrophotometer)
Unknown Concentration (Cu) = (Au/As) x Cs
Visible region
400 to 700 nm
<400 nm
UV region (VERY SHORT wavelength)
> 700 nm
Infrared region
Light source in the visible region
Tungsten lamp
Light sources in the UV region
Mercury arc, Deuterium, Hydrogen & Xenon Lamp
Light sources in the Infrared region
Merst glower & Glober
Zeroing the spectrophotometer before testing is done usually using ___
Reagent blank
Used to correct for absorbance caused by color of reagents
Reagent blank
Monochromator specification to measure true absorbance of compound with absorbance bandwidth of 30nm
5nm bandpass
Most commonly used photodetector, and the most sensitive to low levels of light
Photomultiplier tube
Detects light scattered towards a detector
Nephelometry
Detects amount of light blocked by a particulate matter (for measuring proteins)
Turbidimetry
Nephelometry is used for determination of
Ag-Ab complexes
Measurement of differences between 2 electrodes in terms of voltage at a constant current
Potentiometry
Gold standard for drug testing
GC-MS
Non destructive technique for detecting structure of organic compound (lipoprotein particle)
Nuclear magnetic resonance spectrophotometer (NMRS)
Effect on quenching on fluorescence
Decreased
Support media for zone electrophoresis
Agarose, cellulose acetate, polyacrylamide
Most commonly used stain for serum protein electrophoresis (SPE)
Ponceau S
A type of chemistry analyzer that uses reagents from different manufacturers / suppliers
Open system analyzer
Most basic or simplest pipette
Pasteur (glass/plastic) pipette
Parts of positive displacement pipet
Piston, piston seal, capillary
Glassware resistant to heat, corrosion & thermal shock
Borosilicate
Water that has passed through resin with charged particles is known as
Deionized water
Purpose of desiccators / desiccant?
Absorbs moisture
In general, oxidizers should never be placed with chemicals that are
Reducing agents
10% bleach inactivates hepatitis B virus within how many minutes?
10 minutes
10% bleach inactivates HIV within how many minutes?
2 minutes
Laboratory hazard prevention strategies include
Work practice controls, engineering controls, PPE, and emergency equipment
Equipment used to contain and expel noxious & hazardous fumes from chemical reagents
Fume hood
First step in pre-analytical phase
Test order
Instructing the patient to undergo fasting is part of ___
Patient preparation
Disinfectant for ethanol analysis blood collection
Benzalkonium chloride
Preferred site for venipuncture
Antecubital veins (Median cubital > Cephalic > Basilic)
Light source used by vein finders
Infrared
Most commonly used area for adult skin puncture
2nd, 3rd, 4th finger
Type of blood specimen for newborns
Blood spot
Ideal site of capillary blood collection in infants
Medial or lateral plantar surface of the heel
Shelf life (expiration date) of an evacuated tube is defined by
Vacuum retention & stability of the additive
The lower the temperature, the lower the gas pressure, the ________ the drawn volume in evacuated tube
Higher
The higher the temperature, the higher the gas pressure, the ________ the drawn volume in evacuated tube
Lower
Higher altitudes result to ______ blood volume
Lower
EDTA anticoagulant elevates ________ & ________ and lowers ________ & ________.
Elevates = Sodium & Potassium
Lowers = Calcium & Iron
Anticoagulant that produces least interference with analyses
Heparin
Preferred anticoagulant for electrolyte testing
Heparin
CTAD coagulant is used for
Coagulation testing
Temperature for lyophilization
-40C or less
Normal color of serum
Straw / pale yellow
Conversion of glucose to lactate or pyruvate
Glycolysis
Conversion of non-carbohydrate compound into glucose
Gluconeogenesis
Ability to maintain steady glucose concentration in the blood
Glucoregulation
Glucose hormone produced by the ALPHA-cells of the Islets of Largerhans in the pancreas
Glucagon
Routine examination that assesses glucose homeostasis
FBS (Fasting Blood Sugar)
In OGTT, patient undergoes UNRESTRICTED diet of ___ CHO per day for ___ before testing
150 grams; 3 days
Standard glucose load for OGTT according to WHO
75 grams
Mode of administration of tolbutamide in the tolbutamide tolerance test
Intravenous
Part of “Glucose tolerance factor”
Chromium
Plasma glucose returns to normal level ____ hours after eating
1 1/2 to 2 hours
Long term glucose MONITORING (2-3 months)
Glycosylated hemoglobin (HBA1C)
Short term glucose monitoring
Fructosamine
Fasting blood glucose is _____ than in serum or plasma
10-15% lower
Venous blood glucose is _____ than capillary blood (due to tissue metabolism)
7 mg/dL lower
Capillary blood glucose is _____ with arterial blood glucose
Same
10% contamination with 5% dextrose will increase glucose by _____
500 mg/dL
Effect of hemolysis and bilirubin on plasma glucose using hexokinase method
False decrease
Glycolysis at ROOM temperature
7 mg/dL/hr
Glycolysis at REFRIGERATION temperature
2 mg/dL/hr
End product of glucose determination using Folin-Wu method
Phosphomolybdenum blue
End product of glucose determination using Nelson -Somogyi method
Arsenomolybdenum blue
The most specific enzyme reacting with only B-D-glucose
Glucose oxidase
The most specific glucose method
Hexokinase
Reference method for blood glucose determination
Hexokinase
Hallmark of Diabetes Mellitus
Hyperglycemia
Causes of hyperglycemia during pregnancy
Hormonal changes
A type of GLUCOSE INTOLERANCE with onset or first recognition during pregnancy
Gestational Diabetes Mellitus
Overzealous treatment of DM may lead to _____
Hypoglycemia
Symptoms of hypoglycemia appear at what glucose level?
50-55 mg/dL
Blood glucose level diagnostic for hypoglycemia
< 50 mg/dL
Biological substances that are insoluble in water & most biologic fluids
Triglyceride
Steroids are derived from _____
Non-glyceride lipids
Lipoprotein found in obstructive jaundice and LCAT deficiency
Lipoprotein X
Fasting period to produce reliable lipid profile result
12 hours
Lipid greatly affected by non-fasting specimens
Triglycerides
Fasting has a little effect on
Cholesterols
Triglycerides will increase how many hours after a meal?
2 hours
Serum is lipemic when triglyceride levels exceed
400 mg/dL
Triglyceride level if plasma is CLEAR
<200 mg/dL
Triglyceride level that causes HAZY/TURBID plasma
> 300 mg/dL
Triglyceride level that causes MILKY plasma
> 600 mg/dL
What is the purpose of acetic anhydride in Liebermann-Burchard assay?
Solvent & dehydrating agent
Enzymatic methods for cholesterol determination uses what enzyme (s)?
Cholesterol esterase & Cholesterol oxidase
LDL can be calculated from measurement of __________, __________, __________ by Friedewald approximation
Total cholesterol, HDL, and Triglycerides
LDL Formula
LDL = Total cholesterol - HDL - (Triglyceride/5)
What is the formula for VLDL using Friedewald method
VLDL = TAG/5 (mg/dL) or TAG/2.175 (mmol/L)
What is the formula for VLDL using De Long method
VLDL = TAG/6.5 (mg/dL) or TAG/2.825 (mmol/L)
Friedewald equation should not be used when plasma TAG exceeds
400 mg/dL
Reference method for quantitation of lipoproteins
Ultracentrifugation
24-hour plasma standing test is used to test
Chylomicrons
Produces floating creamy layer
Chylomicrons
Largest lipoprotein
Chylomicrons
Minor lipoproteins
IDL, Lp (a)
Lipoprotein that is the primary target of cholesterol lowering therapy; PRIMARY MARKER FOR CHD DISEASE
LDL
Lipopathy associated with acanthocytosis, abetlipoproteinemia, & mutations in MTTP gene
Bassen-Kornzweig syndrome
Familial HDL deficiency
Tangier’s disease
Thyroid disorder with LOW cholesterol and triglycerides
Hyperthyroidism
Thyroid disorder with HIGH cholesterol and triglycerides
Hypothyroidism
Xanthelasma is most commonly caused by?
Hyoercholesterolemia
In SPE, using a buffer solution at pH 8.6, proteins exhibit
Net negative charge
The most negatively charged serum protein
Albumin
Serum protein electrophoretic patter (anode to cathode)
Albumin > a1 > a2 > B > y
Why are plasm samples not recommended for standard protein electrophoresis?
Pseudo-gamma bridging effect
Cause of relative hyperproteinemia
Dehydration
Cause of artifactual hyperalbuminemia
Prolonged tourniquet application
Cause of dysproteinemia
Clonal proliferation of B plasma cells
Common in multiple myeloma and Waldenstrom’s macroglobulinemia
Increased IgM
Kayser-Fleischer rings are associated with what disease?
Wilson’s disease
In Wilson’s disease, ceruloplasmin levels are ___
Decreased
Myoglobin level of >300 ug/L, when will you report result?
Immediately
Biomarker for thrombosis / pulmonary embolism
D-dimer
Popular marker for congestive heart failure
Brain natriuretic peptide (BNP)
According to Kjeldhal, 1 gram of nitrogen is equivalent to _____ grams of protein
6.54
Disease (s) associated with low A/G ratio
Multiple myeloma, cirrhosis, kidney disease, autoimmune infection
Made up of alkaline CuSO4, NaOH, KI, and NaK tartrate (Rochelle salt)
Biuret reagent
Bromcrescol green (BCG) is more sensitive to _____ than hydroxybenzene benzoic acid (HABA)
Albumin
Plays a vital role in controlling blood pressure and fluid balance
Renin
Causes vasodilation of the afferent arterioles and constriction of the efferent arterioles *VACE
Angiotensin II
A hormone that also acts as an enzyme
Renin
Measures the ability of the kidneys to eliminate substance from the blood
Clearance test
Measure of completeness of a 24-hour urine collection
Creatinine clearance
Most commonly used clearance test to estimate GFR
Creatinine clearance
What is 1440 in the creatinine clearance formula?
Constant (24 hours = 1440 minutes)
It is freely filtered by glomerulus, not reabsorbed, BUT MINIMALLY SECRETED by the renal tubules
Creatinine
UV method uses _____ enzyme to convert uric acid (⬆️ absorbance) into allantoin (⬇️ absorbance)
Uricase
Uric acid absorbs light strongly in the region around _____ nm
285 (UV region)
Reference method for NPNs (urea)
IDMS
Reagent in the urea determination that uses colorimetry forming a yellow end-product
Diacetyl monoxime (DAM)
Jaffe reaction is the most frequently used method to measure CREATININE that uses _____ reagent
Alkaline picrate
Accurate results are obtained when Fuller’s earth or Lloyd’s reagent is used for _____ measurements
Creatinine
Creatinine levels in the blood are affected by _____
Muscle mass
Normal BUN:CREATININE ratio
(10-20) : 1
Product of purine metabolism
Uric acid
Use of chemotherapeutic agents increases what NPN?
Uric acid
What condition is associated when metabolism of uric acid, and not of other NPNs is impaired
Gout
An elevated condition of urea (& creatinine) in the blood is called
Azotemia
Very high plasma concentration accompanied by renal failure is called
Uremia / Uremic syndrome
Three main categories of azotemia
Prerenal azotemia
Renal azotemia
Postrenal azotemia
BUN and creatinine will be significantly elevated if the GFR is decreased by at least ___ %
50%
Major waste product of protein catabolism
Urea
Product of amino acid deamination
Urea/Ammonia
Marker for hepatic coma (hepatic encephalopathy)
Ammonia
Appropriate sample for ammonia determination
Freshly drawn blood
Effect of cigarette smoking on plasma ammonia determination
Increased
Liver function tests are usually based on which principle?
Photometry
Formula for total bilirubin
TB = CB + UB
Normal value for total bilirubin in adults
0.2 - 1.0 mg/dL
(3 - 17 umol/L)
Jaundice is clinically evident when bilirubin level exceeds
2 mg/dL
In the liver, bilirubin is conjugated by addition of
Glucuronyl groups (glucuronic acid)
Bilirubin fraction increased in PRE-HEPATIC (hemolytic) jaundice
Unconjugated
Bilirubin fraction increased in HEPATIC jaundice
Conjugated & Unconjugated
Bilirubin fraction increased in POST-HEPATIC (obstructive) jaundice
Conjugated
Bilirubin fraction that DOES NOT require an accelerator to react
Conjugated (direct) bilirubin
Form of bilirubin that is soluble in water
Conjugated (direct) bilirubin
Form of bilirubin that is insoluble in water
Unconjugated (indirect) bilirubin
Form of bilirubin that has LONGER HALF-LIFE than other forms of bilirubin
Delta bilirubin
Elevation of bilirubin in newborns (due to immature liver)
Physiologic jaundice
Kernicterus is an abnormal accumulation of UNCONJUGATED BILIRUBIN in the
Brain tissues
Neonate bilirubin level is 28 mg/dL. When will you report the result?
Immediately
The danger of kernicterus is a certainty at bilirubin levels exceeding _____
20 mg/dL
True or false: Enzymes are proteins
True
Reaction rate is directly proportional to SUBSTRATE concentration
First order kinetics
Reaction rate only depends on ENZYME concentration
Zero order kinetics
Phase in which enzyme activity is usually measured
Linear phase
Two general methods that are used to measure the extent of an enzymatic reaction
Fixed-time
Kinetic assays
In this assay, multiple measurements of change in absorbance are made during the reaction
Kinetic / continuous monitoring assay
In this assay, reactants are mixed; reaction proceeds for designated time; and reaction is stopped & measurement is made
Fixed-time assay
What is this called? “E + S = ES = E + P”
Enzyme catalytic reaction
What is this called? “Vmax (S) / Km + S”
Michaelis-Menten equation
This is needed to achieve full enzyme activity
Coenzyme
Non-protein molecule necessary for enzyme activity
Cofactor
ACP, ALP, ALT, AMY, AST, CK, GGT, LD, and LPS are?
Macroenzymes
ALP isoenzyme electrophoretic pattern (anode to cathode)
Liver > Bone > Placental > Intestinal
ALP isoenzyme heat stability (most heat stable to most heat labile)
Placental > Intestine > Liver > Bone
Levamisole inhibits what ALP isoenzyme (s)?
Bone and Liver ALP
Phenylalanine inhibits what ALP isoenzyme (s) ?
Placental and Intestinal ALP
3M Urea inhibits what ALP isoenzyme (s) ?
Bone ALP
Buffer used in ALP analysis
AMP (amino methyl propanol)
Physiologic increase in serum ACP has been reported in specimens obtained from patients after _____ exam
Rectal
Enzyme that is also useful in forensic clinical chemistry, in the investigation of rape cases
ACP
Effect of high concentration of bilirubin & hemoglobin to ACP determination
Increased (specimen is hemolyzed)
Enzyme that catalyzes the conversion of starch to glucose and maltose
Amylase
Assay for amylase that involves formation of maltose
Coupled-enzyme
Assay for amylase that measures the disappearance of starch SUBSTRATE
Amyloclastic
Assay for amylase that measures the appearance of PRODUCT
Saccharogenic
Assay for amylase that measures increasing COLOR from production of PRODUCT
Chromogenic
Enzyme that is best indicator of PANCREATIC function
Lipase
Least specific enzyme (found in many tissues)
Lactate dehydrogenase
Cause (s) of flipped LD pattern
Acute Myocardial Infarction (AMI), renal infarction, hemolysis
Major tissue sources of AST
Cardiac tissue
Liver
Skeletal muscle
LIVER specific enzyme
ALT
Old name for AST
SGOT
Old name for ALT
SGPT
Enzyme indicator used in measuring ALT activity
Lactate dehdrogenase
Enzyme indicator used in measuring AST activity
Malate dehydrogenase
More sensitive and specific screening test for post-transfusion hepatitis
ALT
Enzyme increased in alcoholism
GGT
Enzyme whose significance is DECREASED ACTIVITY
Pseudocholinesterase
Positive result in the turbidimetric method for lipase
Decreased turbidity
Chloride shift is maintained by a reversible exchange process between _____ & _____
Bicarbonate & chloride
Formula for Anion Gap; Normal value: 10-20 mmol/L
AG = (Na + K) - (Cl + HCO3)
Formula for Anion Gap; Normal value: 7-16 mmol/L
AG = Na - (Cl + HCO3)
The difference between the unmeasured cations and unmeasured anions is called
Anion gap
It is a form of quality control for the analyzer used to measure electrolytes
Anion gap
Hypernatremia occurs when serum sodium is
> 145 mmol/L (increased)
Hyponatremia occurs when serum sodium is
<135 mmol/L (decreased)
Hormone that regulate sodium reabsorption
Aldosterone
Relationship of ADH and sodium levels
Inverse
Effect of low ADH on serum sodium
Increased sodium
Effect of high glucose on serum sodium concentration
Decreased sodium
Promotes natriuresis, blocks aldosterone secretion, inhibits vasopressin
Atrial natriuretic factor
Hyperlipidemia causes artifactual _____
Hyponatremia
Low sodium caused by pseudohyponatremia, what to do?
Test for osmolality
Electrolytes, BUN, crea, osmolality are done on patient who ingested ethanol. What to do?
Determine osmolal gap
Electrolytes that transmits nerve impulses
Potassium
Marked hyperkalemia may lead to
Cardiac arrest
Potassium is falsely _____ in hemolyzed blood samples
Increased
Factors affecting serum calcium levels include
⬆️ Vitamin D
⬆️ Parathyroid hormone
⬇️ CALCITONIN
Milk-alkali syndrome may lead to
Hypercalcemia
A pro-oxidant contributing to DNA damage; lipid peroxidation; carcinogenesis, etc
Iron
It REGULATES intracellular iron TRANPORT from intestinal surface to inside the cell
DMT-1
For _____ testing, blood should be collected in a tube containing 10 mg NaF & 2 mg K2C2O4 per mL pf blood
Lactate
It refers to the dissociable substance that can yield hydroxyl ions
Base
A substance that can yield hydrogen (H+) or hydronium (H3O) ion when dissolved
Acid
Most important buffer pair in plasma
HCO3 : H2CO3 pair
Weak acid or weak base and their related salts; resists any change in pH & H+ ion concentration
Buffer
__________ include bicarbonate, carbonic acid, plasma proteins, hemoglobin and inorganic phosphate
Blood buffers
It is the primary substance in the carbonic acid-bicarbonate buffer system
Bicarbonate
Normal ratio of BICARBONATE TO CARBONIC ACID
20:1
During onset of fever, pCO2 increases by _____ and pO2 decreases by _____
3% 7%
Electrode used for pH
Gas electrode
Electrode used for pCO2
Severinghaus electrode
Electrode used for pO2
Clark electrode
Electrode used for K+
Valinomycin-based electrode
Used to calibrate pH meter
Buffer
Most common preanalytic error in blood pH measurement
Excess heparin
When a blood sample is exposed to air, pH and pO2 levels _____ while pCO2 _____
Increases; decreases
When a capped blood is allowed to stand at RT, pH and pO2 levels _____ & pCO2 _____
Decreases; increases
Hormone secreted in endocrine cell and released into interstitial space
Paracrine
Known as the “master gland”
Pituitary gland
The anterior pituitary gland is positioned in what part of the skull?
Sphenoid bone
Hormones produced by the anterior pituitary gland
TSH, Prolactin, FSH, LH, ACTH, GH
Most abundant hormone of the anterior pituitary gland
Growth hormone (GH)
Hormone markedly increased during deep sleep
Somatotropin (GH)
ADH is secreted by what gland
Posterior pituitary gland
ADH is produced by what gland
Hypothalamus
Excess growth hormone in adults
Acromegaly
Increased growth hormone in adults (acromegaly) can cause
Hyperglycemia
Mineral compound found in teeth
Hydroxyapatite (Ca phosphate)
Part of the thyroid gland that produces hormones
Follicles
Thyroid follicles are spheres of thyroid cells surrounding a core of viscous substances called
Colloid
Trace element important in thyroid hormone synthesis
Iodine
Most abundant thyroid hormone
Thyroxine
Thyroid hormones are derived from what amino acid
Tyrosine
Thyroxine is present in the body in the largest amount as _____
Thyroxine-bound to globulin (TBG)
Comparably, T3 in the circulation is _____ than T4
Lower
Indirectly assesses the concentration of circulating free T4
Free thyroxine index (FT4I)
Used to confirm results of FT3 & FT4, or abnormalities in the relationship of total T4 and THBR test
Thyroxine-bound globulin (TBG)
Single screening test for thyroid disease
TSH Assay
If a screening test is high, which test is likely to be ordered next?
FT4
Test to differentiate drug induced TSH elevation and hypothyroidism
FT4 Test
Test that quantitates the concentration of TBG
T3 uptake
T3 uptake is _____ proportional to T3 and T4 concentrates
Directly
Screening test for congenital hypothyroidism
T4 (decreased)
Confirmatory test for congenital hypothyroidism
TSH (increased)
Most likely interferes with quantitation of thyroglobulin
Anti-thyroglobulin autoantibodies
Testing for this HORMONE requires EARLY MORNING specimen collection
Cortisol
Specimen for ACTH determination
Pre-chilled EDTA blood
ACTH is highest between _____ to _____ and lowest between _____ to _____
Highest = 6:00 - 8:00 am
Lowest = 6:00 - 11:00 pm
Excess growth hormone in children
Gigantism
Cortisol is highest between _____ to _____ and lowest between _____ to _____
Highest = 8:00 to 10:00 am
Lowest = 10:00 pm to 12:00 mn
Increased cortisol, decreased ACTH
Cushing’s syndrome
Increased cortisol, increased ACTH
Cushing’s disease
Oral salt loading test is a confirmatory test for
Conn’s disease
Increased catecholamines is seen in
Pheochromocytoma
Major metabolite of catecholamines
Vanillylmandelic acid (VMA)
Metabolite of dopamine
Homovanillic acid
Specimen (s) for catecholamine measurements
Plasma, 24 hour urine
_____ will result in male and female inferitility
Hypogonadism
Hormone that prepares the endometrium for embryo implantation and maintains it throughout pregnancy
Progesterone
Most potent estrogen
Estradiol
Most potent androgen
Testosterone / Dihydrotestosterone
Estrogen found in both men and women
Estradiol
Estradiol is produced by what gland
Ovaries
Method used for measuring URINARY ESTROGENS
Kober reaction
Method used for measuring 17-hydroxycorticosteriods (17-OHCS)
Porter-Silber method
Method for measuring 17-ketogenic steroids
Zimmerman reaction
Method for measuring METANEPHRINES and NORMETANEPHRINES
Pisano method
Hormone that inhibits gastric emptying, stimulates pancreatic secretions and gallbladder contractions
Cholecystokinin (CCK)
Absorption, circulation, distribution, metabolism, clearance, age, medium, gastric pH, liver and kidney functions are all factors for
Drug metabolism
Trough concentrations for most drugs are drawn _____ before the next dose
Right before
Peak concentrations are drawn _____ after an orally administered dose
1 hour
Anticoagulant suitable for therapeutic drug monitoring
Heparin
Anti-tussive opiate
Codeine
Most prominent benzodiazepine
Valium
Most commonly used assay for aspirin determination
Trinder reaction
Used to treat bipolar disorder; may cause hypercalcemia
Lithium
Drug of choice for controlling petit mal seizures
Ethosuximide
Most sensitive organ to alcohol ingestion
Liver
Form of alcohol not suitable for comsumption
METHANOL, isopropyl alcohol
Drug of abuse with direct toxicity on myocardium
Cocaine
Metabolite of cocaine
Benzoylecgonine
Derived from the flowers of the hemp plant Cannabis sativa
Marijuana
Psychoactive substance of marijuana
Tetrahydrocannabinol (THC)
A marijuana user may still test positive for THC even after ___ days of last use
45
Methylenedioxymethampethamine is commonly known as
Ecstasy
Reporting of absence of analyte for drug abuse
Negative
Plumbism is associated with an increased in amounts of
Lead
“GARLIC ODOR” breath and metallic taste
Arsenic toxicity
“BITTER ALMONDS ODOR” breath and altered mental status
Cyanide toxicity
Metal with high affinity to keratin
Arsenic
Interferes with sulfhydryl groups, reduce oxidative phosphorylation & ATP production
Arsenic
Form of mercury that is considered an environmental pollutant
Organic mercury
