Clinical Chemistry Flashcards
Random errors
12S, 13S, R4S
1 control value exceeds the mean +/- 2s
12S / Warning rule
1 control value exceeds the mean +/- 3s
13S
1 control value exceeds +2s and ANOTHER value exceeds -2s
R4S
2 CONSECUTIVE control values exceeds the same mean +/- 2s
22S
8 consecutive values fall on 1 SIDE of the mean
8x
Errors that occurs BY CHANCE
Random errors
Errors that are consistent in ONE DIRECTION
Systematic
RANDOM OR SYSTEMATIC:
Pipetting errors, mixing, timing (variation in handling techniques)
Random
RANDOM OR SYSTEMATIC:
Variation in operators
Random
RANDOM OR SYSTEMATIC:
Environmental conditions
Random
RANDOM OR SYSTEMATIC:
Fluctuations in line voltage
Systematic
RANDOM OR SYSTEMATIC:
Technologist interactions
Systematic
RANDOM OR SYSTEMATIC:
Dispensing of reagents
Random
RANDOM OR SYSTEMATIC:
Aging reagents
Systematic
RANDOM OR SYSTEMATIC:
Aging calibrators
Systematic
RANDOM OR SYSTEMATIC:
Calibrator reconstitution
Random
RANDOM OR SYSTEMATIC:
Temperature analyzer
Random
RANDOM OR SYSTEMATIC:
Instability of instrument
Random
RANDOM OR SYSTEMATIC:
Wear and tear of instruments and instrument components
Systematic
ABRUPT change in the mean
Shift
Main cause of shift
Improper calibration of instrument
Drift of values to ONE SIDE of the mean
Trend
Main cause of trend
Deterioration of reagents
Variables: CHAXI
Concentration
Horizontal
Abscissa
X-Axis
Imdependent
Variables: AVOYD
Absorbance
Vertical
Ordinate
Y-Axis
Dependent
F-test
SD and Precision
T-test
Mean and Accuracy
Interlab QC; long-term monitoring; monthly or quarterly
External QC
Intralab QC; short-term monitoring; daily
Internal QC
Solution that uses 1 ANALYTE for CALIBRATION or REFERENCE
Standard
Solution that uses 2 ANALYTES to ENSURE CORRECT RESULTS
Control
Isolates specific or individual wavelength of light
Monochromator
Measures LIGHT TRANSMITTED by a solution to determine the concentration
Spectrophotometer
Determines the amount of LIGHT BLOCKED by a particulate matter in a turbid solution
Turbidimetry
Determines the amount of LIGHT SCATTERED by a particulate matter in a turbid solution
Nephelometry
Measure the amount of LIGHT EMITTED by a molecule AFTER EXCITATION by EMR, over a zero background
Fluorometry
Measures the electrical potential / DIFFERENCES BETWEEN 2 ELECTRODES in terms of voltage at constant current
Potentiometry
Samples flow through a COMMON vessel or pathway
Continuous Flow Analysis
Each sample-reagent mixture is handled SEPARATELY in its own reaction vessel
Discrete Analysis
Multiple tests one sample at a time; most popular and versatile type of automation
Discrete analysis
Uses acceleration and deceleration of ROTOR to transfer the reagents and sample
Centrifugal Analysis
Vertical when not spinning horizontal when spinning
Horizontal Head centrifuge / Swinging bucket centrifuge
Speed of swinging bucket centrifuge
1,650 g
Fixed angle centrifuge with speed of 9000
Angle-head centrifuge
Has continuous ETCHED RINGS on top; exact volume obtained when LAST DROP IS BLOWN OUT
Blowout pipet
The simplest pipet
Pasteur pipet
Relies on PISTON FOR SUCTION creation to draw sample into a DISPOSABLE TIP
Air displacement pipet
Reagent water for preparation of STANDARD SOLUTIONS
Type 1
GENERALLY USED reagent water for chemistry, microbiology, hematology, and immunology; also used for WASHING GLASSWARES
Type 2
Reagent water for urinalysis, parasitology, and histology
Type 3
Bleach inactivates HBV for how many minutes?
10
Bleach inactivates HIV for how many minutes?
2
Diurnal variation: Increase in the MORNING (AM)
🌞*ACIA
ACTC
Cortisol
Iron
Aldosterone
Diurnal variation: Increase in the AFTERNOON (PM)
🌛*GAPT
Growth hormone
ACP
PTH
TSH
Affected by posture; increases from supine to sitting / standing
Albumin
Calcium
Enzymes
*I CLAAAAAMPP
Iron, Catecholamines, CK, LD, ALT, AST, ALP, ACP, Ammonia, Magnesium, Potassium, Phosphate _____ when sample is HEMOLYZED
Increases
If antecubital veins are unsuitable for venipuncture, what are the alternative sites?
Wrist and hand
When BP cuff is used as a tourniquet, it should be inflated at ___ mmHg
60 mmHg
Blood specimens on serum separator gel tubes must be processed within _____
30 minutes
Normal BMI
18.5 - 24.9
BMI of underweight / malnourished
< 18.5
BMI of obese
30 and above
SI unit for length
Meter (m)
SI unit for mass
Kilogram (kg)
SI unit for Themodynamic temperature
Kelvin (K)
SI unit for amount of substance
Mole (mol)
10^6
Mega
10^3
Kilo
10^9
Giga
10^12
Tera
10^-3
Milli
10^-6
Micro
10^-9
Nano
10^-12
Pico
Celsius to Farenheit
F = (C x 1.8) + 32
Farenheit to Celsius
C = (F - 32) x 5/9
Conversion factor of glucose
0.0555
BUN to Urea
2.14
Conversion factor of BUN
0.357
Conversion factor of creatinine
88.4 umol/L
Conversion factor of uric acid
0.0595
Conversion factor of triglycerides
0.0113
Conversion factor of sodium, potassium, chloride
1
Conversion factor of cholesterol
0.026
Conversion factor of TPAG
10 (g/dL) 0.01 (mg/dL)
Conversion factor of bilirubin
17.1 umol/L
Conversion factor of thyroxine
12.9 nmol/L
Effect of high WBC count on blood glucose determination
Decreased
Uses arsenomolybdate reagent
Nelson-Somogyi
Uses phosphomolybdate reagent
Folin-Wu
Results produced by REDUCTION methods for glucose are _____ higher than those of ENZYMATIC methods
5-15 mg/dL
To establish Diabetes Mellitus, symptoms (3P’s) should be accompanied by RBS level of:
200 mg/dL
Beta-cells destruction
Type 1 DM
Insulin resistance
Type 2 DM
Detectable C-peptide levels
Type 1 DM
DM with Autoantibodies
Type 1 DM
Common DM
Type 1 DM
Uses oral agents as medication
Type 2 DM
Uses insulin absolute as medication
Type 1 DM
Glycogen storage disease with G6PD deficiency
Von Gierke
Most common phospholipid found in cell membranes
Lecithin
Apo A1
HDL
Apo B100
LDL, VLDL
Apo B48
Chylomicrons
Reverse cholesterol transport
HDL
Endogenous triglycerides
VLDL
Exogenous triglycerides
Chylomicrons
Least dense
Chylomicrons
Most dense
HDL
Lipoprotein that carries TRIGLYCERIDES
CM, VLDL
Lipoprotein that carries CHOLESTEROL
LDL
Lipoprotein that carries PROTEIN and PHOPHOLIPIDS
HDL
Bad cholesterol
LDL
Good cholesterol
HDL
SPE Migration Pattern of lipoproteins
Chylomicrons (origin)
LDL
VLDL
HDL (anode)
Lipoprotein ultracentrifugation pattern
Chylomicrons (top)
VLDL
LDL
HDL (bottom)
Floating B-lipoprotein
B-VLDL
Sinking Pre-B-lipoprotein
Lp(a)
Borderline value for total cholesterol
200-239 mg/dL
> 240 value of TOTAL cholesterol
Higher risk for CHD
SERUM cholesterol value with MODERATE RISK for age 20-29
> 200 mg/dL
SERUM cholesterol value with HIGH RISK for age 20-29
> 220 mg/dL
<40 HDL
High risk for cardiovascular disease
> 60 HDL
Low risk for cardiovascular disease
Borderline value for LDL Cholesterol
130-159 mg/dL
Cholesterol determination 1-STEP method
Liebermann-Burchard
(Pearson/Stern/Mac-Gavack)
Cholesterol determination 2-STEP method
Bloors
< 3% CV
Cholesterol
< 5% CV
Triglycerides
< 4% CV
LDL, HDL
Fredrickson classification: high CHYLOMICRONS
Type 1 (Familial LPL Deficiency)
Fredrickson classification: high VLDL
Type 4 (Familial hypertriglyceridemia)
Fredrickson classification: high CM & VLDL
Type 5
Fredrickson classification: high LDL, abnormal LDL receptor gene
Type 2 (Familial hypercholesterolemia)
Negative APRs
Prealbumin
Albumin
Transferrin
Indicator of nutrition; binds thyroid hormone and retinol-binding protein
Prealbumin
Major contributor to oncotic (osmotic pressure)
Albumin
Binds copper
Ceruloplasmin
Protease inhibitor
Alpha 1 antitrypsin
The principal use of serum protein electrophoresis is to detect
Monoclonal spike
Beta-gamma bridging
Liver cirrhosis
Monoclonal spike
Multiple myeloma
Alpha 1 globulin flat curve
AAT (alpha 1 antitrypsin deficiency)
Alpha 2 globulin spike
Nephrotic syndrome
Alpha 1, Alpha 2 globulin spikes
Acute inflammation
Polyclonal gammopathy
Chronic inflammation
Low albumin, very high alpha2-macroglobulin (10-fold or more)
Nephrotic syndrome
Protein based on phenolic amino acid oxidation with the HIGHEST SENSITIVITY
Folin-Ciocalteu
Biochemical marker for bone resorption
Cross-linked C Telopeptide
Useful marker of nutrition
Fibronectin
Most concentrated NPN
Urea
2nd most concentrated NPN
Amino acid
Least concentrated NPN
Ammonia
Ammonia is associated with what kidney function
Excretion
Osmolarity is associated with what kidney function test
Tubular function
Inexpensive urea assay, LACKS specificity
Colorimetric: diacetyl
More expensive urea assay; GREATER specificity
Enzymatic: NH3 formation
Simple and nonspecific creatinine assay
Colorimetric: end point
Uric acid assay that assess problems with turbidity
Colorimetric
SPECIFIC uric acid assay which requires mercury arc vapor lamp
Enzymatic UV
Azotemia caused by renal diseases, acute and chronic renal failure
Renal azotemia
Azotemia caused by urinary tract obstruction, renal calculi, bladder or prostate tumors, severe UTI
Post-renal azotemia
_____ is the single marker to diagnose renal failure; _____ test is used to assess the renal tubular integrity
Creatinine; B2-microglobulin
Exogenous substance used as ALTERNATIVE test for creatinine clearance to screen for kidney dysfunction
Cystatin C
Proteins such as albumin, cholinesterase, coagulation proteins, cholesterol, bile salts and glycogen are associated with what liver function
Synthetic
Bilirubin, ammonia, and drugs are associated with what liver function *BAD
Detoxification
Bile acids and bilirubin are associated with what liver function
Excretion
Test for PATENCY of billiary ducts and hepatocellular metabolism of bilirubin
Direct and total bilirubin ratio
Test for OVERALL patency of billiary ducts
Serum bile acid
Test for abnormality of bile-duct epithelium
ALP “obstructive” enzymes
Test for capacity to conjugate bilirubin and secrete bile
Serum bilirubin level
Test for hepatocellular damage and necrosis
Serum AST levels
Bilirubin fraction covalently attached to albumin; also known as “Biliprotein”
Delta bilirubin
Characterized by PARTIAL deficiency of UDPGT
Criggler-Najar syndrome Type II / Arias syndrome
Principle of Malloy and Evelyn method & Jendrassik and Grof method
Van den Berg reaction
Accelerator for Malloy and Evelyn method
Methanol
Accelerator for Jendrassik and Grof method
Caffeine-Sodium benzoate
Enzyme activity: Substrate and coenzyme _____, product and altered coenzyme _____
Decreases; increases
Enzyme classifications *OTHLIL
Oxydoreductase
Transferase
Hydrolase
Lyase
Isomerase
Ligase
LDH and G6PD are under what category of enzymes
Oxidoreductase
AST, ALT, GGT are under what category of enzymes
Transferase
Kinases (CK and HK) are under what category of enzyme
Transferase
Esterases (ACP, ALP, CHS, 5-NT, LP) are under what category of enzyme
Hydrolase
Trypsin and pepsin are under what category of enzyme
Hydrolase
Amylase and Galactosidase are under what category of enzyme classification
Hydrolase
ALDOLASE and DECARBOXYLASE are under what enzyme classification
Lyase
Enzymes involved in INTRAMOLECULAR ARRANGEMENT are called
Isomerases
Synthases / joining of two molecules
Ligase
CK-MB onset of elevation
4-6 hours
1st to elevate in AMI, but NOT cardiac-specific
Myoglobin
CARDIAC-specific marker of AMI
Troponin
1st to elevate in acute pancreatitis, but NOT pancreas-specific
Amylase
Late marker, but PANCREAS-SPECIFIC
Lipase
P-nitrophenylphosphate (PNPP) is the MOST SPECIFIC substrate used in what ALP method
Bowers and McComb
Thymolphthalein monophosphate is a substrate used in what ACP method
Roy and Hillman
End product of AST enzymatic method
Oxaloacetate
The formation of MALTOSE is observed in what enzymatic method of AMS
Coupled-enzyme
Reference method of LPS (lipase) that measures the titration of fatty acids with NaOH
Cherry Crandal
Forward/direct reaction of LDH
(*FLP = lactate to pyruvate)
Wacker
Reverse/indirect reaction of LDH
Wrobkeuski La Due
Forward/direct method for CK
Tanzer-Gilvarg
Reverse/indirect method for CK
Oliver-Rosalki
Bile duct obstruction, Osteitis deformans, Billiary cirrhosis, Osteogenic sarcoma (*BOBO) is _____ elevation of _____
Pronounced (5x); ALP
Pregnancy. _____ elevation of _____
Slight (3x) ALP
Megaloblastic anemia and renal infaction. _____ elevation of _____
Pronounced (5x); LDH
Myocardial infarction, pulmonary infarction, and hemolytic conditions. _____ elevation of _____
Moderate (3-5x); AST
Cholangitis. _____ elevation of _____
Slight (3x); LDH
Acute hepatocellular damage, myocardial infarction, and acute pancreatitis (*AMA) indicates _____ elevation of _____
Pronounced; AST
Duchenne’s muscular dystrophy is _____ elevation of _____
Pronounced; CK
Major extracellular cation
Sodium
Major regulator of water balance, osmolality, and osmotic pressure for electrolytes
Sodium
Major intracellular cation
Potassium
Countercurrent ion of sodium
Potassium
Major extracellular anion
Chloride
Counterion of sodium that maintains electroneutrality
Chloride
Electrolytes involved in MYOCARDIAL rhythm and contractility
*PoMaCa
Potassium (K)
Magnesium (Mg)
Calcium (Ca)
Electrolytes involved in volume and OSMOTIC REGULATION
Sodium (Na)
Potassium (K)
Chloride (Cl)
Electrolytes that serves as COFACTORS in enzyme activation
*ZiMaCa
Magnesium
Calcium
Zinc
Electrolytes involved in ACID-BASE balance
Chloride (Cl)
Bicarbonate (HCO3)
Potassium (K)
Electrolytes involved in BLOOD COAGULATION
Calcium (Ca)
Magnesium (Mg)
Electrolytes involved in NEUROMUSCULAR excitability
*PoMaCa
Potassium (K)
Magnesium (Mg)
Calcium (Ca)
Included in the electrolyte profile
Na, K, Cl, HCO3
Increased Anion Gap
*SEDULA & MUDPILES
Starvation
Exogenous poisons (sallicylates)
Diabetic ketoacidosis
Uremic acidosis
Lactic acidosis
Alcoholic ketosis
Normal Anion Gap
*HERD
Hyperalimentation
Early renal failure
Renal tubular acidosis
Diarrhea
Decreased Anion Gap
*CHEE
Cationic myeloma patients
Hypercalcemia
Hyperlipidimia
Erroneous report
Diabetes insipidus causes _____ (hypernatremia/hyponatremia) due to _____
Hypernatremia; increased water loss
Potassium deficiency, diuretics, and severe burns causes _____ (hypernatremia/hyponatremia) due to _____
Hyponatremia; increased sodium loss
Renal failure causes _____ (hypernatremia/hyponatremia) due to _____
Hyponatremia; increased water retention
Excess water intake, SIADH, and pseudohyponatremia causes _____ (hypernatremia/hyponatremia) due to _____
Hyponatremia; water imbalance
Most common cause of hyperkalemia
Decreased renal excretion
Addison’s disease (hyperkalemia/hypokalemia)
Hyperkalemia
Sample hemolysis, thrombocytosis, prolonged tourniquet use or excessive fist clenching causes _____ hyperkalemia
Artifactual
Henderson Hasselbach Equation
pH = pKa + log (HCO3/H2CO3)
Method for measurement of pH and pCO2
Potentiometry
Method for measurement of pO2
Amperometry
Determine the acid-base balance disorder: Alcoholism
Metabolic acidosis
Determine the acid-base balance disorder: Vomiting
Metabolic alkalosis
Determine the acid-base balance disorder: Diarrhea
Metabolic Acidosis
Determine the acid-base balance disorder: Hyperkalemia
Metabolic acidosis
Determine the acid-base balance disorder: Emphysema
Respiratory acidosis
Determine the acid-base balance disorder: Hyperventilation
Respiratory acidosis (⬆️ CO2 loss)
Compensatory mechanism in metabolic acidosis
Hyperventilation
Compensatory mechanism in metabolic alkalosis
Hypoventilation
Compensatory mechanism in respiratory acidosis
Increased HCO3 reabsorpion
Compensatory mechanism in respiratory alkalosis
Decreased HCO3 reabsorption
Acidemia occurs when the blood pH is
<7.35
Alkalemia occurs when blood pH is
> 7.45
Amino acids (stimulate/inhibit) growth hormone secretion
Stimulate
Glucose loading (stimulate/inhibit) growth hormone secretion
Inhibit
Insulin deficiency (stimulate/inhibit) growth hormone secretion
Inhibit
Thyroxine deficiency (stimulate/inhibit) growth hormone secretion
Inhibit
Screening test for Acromegaly
Somatomedin-C
Confirmatory test for Acromegaly
Glucose suppression test (OGTT)
Increased T3 and T4
Increased T3 uptake
Decreased TSH
Primary hyperthyroidism
Decreased T3 and T4
Decreased T3 uptake
Decreased TSH
Secondary hypothyroidism
Increased T3 and T4
Increased T3 uptake
Increased TSH
Secondary hyperthyroidism
Decreased T3 and T4
Decreased T3 uptake
Increased TSH
Primary hypothyroisism
Fluorophore-labeled thyroxine; polarized light
Fluorescent polarization immunoassay (FPIA)
Fluorogenic substrate-labeled thyroxine
Fluorescent substrate-labeled inhibition immunoassay
Addition of luminol; measured by luminometer
Chemiluminescence
Similar to ELISA
Microparticle enzyme immunoassay (MEIA)
Mineralocorticoids, aldosterone. What adrenal cortex layer
Zona glomerulosa
First responder to stress by acting within seconds
Catecholamines
Increased cortisol, increased ACTH
Cushing’s disease
Screening tests for Cushing’s syndrome
Midnight salivary cortisol test
Overnight dexamethasone suppression test
24-hour urinary free cortisol test
Confirmatory test for Cushing’s syndrome
LOW-dose dexamethasone suppression test
Low testosterone, high LH and FSH
Primary hypogonadism / Klinefelter’s syndrome
Low testosterone, low LH and FSH
Secondary hypogonadism
TRANSPORT of drug from the site of administration to the blood
Absorption
DELIVERY of the drug to the tissues
Distribution
HIGHEST CONCENTRATION of a drug obtained in the dosing interval
Peak concentration
Time required to reduce drug level to HALF of its initial value
Half-life
Procainamide is an example of _____ drug
Cardioactive
Phenobarbital (barbiturate) is an example of _____ drug
Anti-epileptic
Cyclosporine, tacrolimus, rapamycin are examples of _____ drug
Immunosuppresive
Aspirin, acetaminophen, ibuprofen and salicylates are examples of _____ drug
Anti-inflammatory / analgesic
Methotrexate is an example of _____ drug
Chemotherapeutic
Theophyline and theobromine are what type of drug
Bronchodilator
Lithium is an example of _____ drug
Psychoactive / antidepressant
Treatment for petit mal (absence) and grand mal seizures
Valproic acid / valium
Treatment for various seizure disorders
Carbamazepine
Most commonly abused substance in the entire world
Alcohol
Mental confusion, dizziness, strongly impaired motor skills (staggering, slurred speech)
0.18-0.30
Unable to stand of walk, vomiting, impaired consciousness
0.27-0.40
Coma and possible death
0.35-0.50
Symptoms of alcohol intoxication begin
> 0.05%
Legally intoxicated
> 100 mg/dL
Presumptive evidence of driving under influence of alcohol
> 0.10%
Not a natural opiate
Pentazocine
Vitamin B9
Folic acid
Vitamin C
Ascorbic acid
Beri-beri is deficiency of what vitamin
Vitamin B1 / Thiamine
Pellagra is deficiency of what vitamin
Vitamin B3 / Niacin
Megaloblastic anemia is associated with what vitamin deficiency
Vitamin B9 / Folic acid
Scurvy is associated with what vitamin deficiency
Vitamin C
Serum potassium critical value
> 6.5 mEq/L
Serum bicarbonate critical value
<10 or >40 mEq/L
Cholesterol determination 3-STEP method
Abell-Kendall
