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ASCPi April 2025 > Clinical Chemistry > Flashcards

Clinical Chemistry Flashcards

1
Q

Main hypoglygemic hormone

A

Insulin

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2
Q

Main hyperglycemic hormone

A

Glucagon

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3
Q

Most specific enzyme for glucose

A

GLUCOSE OXIDASE

NOTE: Most specific enzyme but not reference because of uric cid and ascorbic acid (reducing agents) that causes falsely decreased results.

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4
Q

Most specific method for glucose determination

A

HEXOKINASE METHOD

NOTE: Hemolysis and bilirubin causes falsely decreased results.

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5
Q

Responsible for the specificity of the Hexokinase method

A

G6PD

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6
Q

Trisonomy 21is also known as

A

DOWN SYNDROME

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7
Q

When does hemoglobinuria happen?

A

WHEN HAPTOGLOBIN IS DEPLETED

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8
Q

Increase ammonia, decrease urea

A

LIVER DISEASE

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9
Q

a. beta cells produces
b. alpha cells produces

A

A. INSULIN
B. GLUCAGON

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10
Q

What lowers the HbA1c level?

A

HEMOLYSIS, ACUTE BLOOD LOSS, BLOOD TRANSFUSION, SPLENECTOMY, DECREASE RBC LIFESPAN

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11
Q

It monitors kidney function of people with DM

A

MICROALBUMINURIA

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12
Q

C-peptide level in insulin overdose hypglycemia

A

DECREASED/UNDETECTABLE

NOTE: low insulin = low c-peptide

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13
Q

Compliance to therapy or medication of DM

A

KETONES

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14
Q

Kidney function by the determination of urinary albumin excretion of diabetic patients should be done…

A

ANNUALLY

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15
Q

Increased insulin and detectable c-peptide

A

INSULINOMA

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16
Q

Whole blood glucose in 100mg/dL, what is the plasma glucose?

A

115md/dL

NOTe: 100 x 1.15

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17
Q

a. Binds retinol (vitamin A) and tyroxine, sensitive marker of poor nutritional status
b. Most abundant protein in blood, highest dye binding capacity**, major contributor to oncotic pressure, assessment of nutritional status

A

A. PREALBUMIN
B. ALBUMIN

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18
Q

Neutralizes trypsin and elastase; deficiency results to pulmonary emphysema and juvenile cirrhosis

A

ALPHA1 ANTITRYPSIN

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19
Q

Binds free hemoglobin, conserve the iron, decreases in intravascular hemolysis

A

HAPTOGLOBIN

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20
Q

Transports iron, also known as siderophilin

A

TRANSFERIN

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21
Q

Binds heme, decreased in intravascular and extravascular hemolysis

A

HEMOPEXIN

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22
Q

Essential role in immune response

A

COMPLEMENT PROTEIN

NOTE:C3 is the most abundant complement protein

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23
Q

Precursor of fibrin clot, present in plasma but not in serum

A

FIBRINOGEN

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24
Q

Antibodies, protection against foreign antigens

A

IMMUNOGLOBULIN/ GAMMA GLOBULINS

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25
Q

A. Most abundant immunoglobulin, can pass the placenta
B. Biggest immunoglobulins

A

A. IgG
B. IgM

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26
Q

Protein Determination
a. Routine method
b. Reference method

A

A. Biuret method
B. Kjeldahl Method

NOTE: kheldahl method principle: measures nitrogen content

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27
Q

Used for albumin determination; binds to the dye causing a shift in the absorption maximum **

A

DYE-BINDING TECHNIQUES **

NOTE: Bromcresol green= common;Bromcresol purple= sensitive, specific & precise

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28
Q

A.high AFP
B. Low AFP

A

A. Neural Tube Defects
B. Down syndrome (trisonomy 21)

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29
Q

Capable of detecting as low as 0.05 mg/dL of risk for Cardiovascular Disease **

A

hs-CRP **

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30
Q

CERULOPLASMIN

a. Ceruloplasmin deficiency, decrease production
B. Severe copper deficiency, decrease absorption

A

A. Wilson’s Disease
B. Menke’s Disease

NOTE: Copper deposits is present in Wilson’s disease, and absent in Menke’s Disease **

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31
Q

SERUM PROTEIN ELECTROPHORESIS

A.H A1, A2 and B regions
B. H Y region
C. A1 flat curve
D. B and Y bridging **
E. A2 spike, H A2 and B regions
F.Y spike

A

A.Acute Inflammation
B. Chronic Inflammation
C. A1 antitrypsin deficiency
D. Hepatic Cirrhosis**
E. Neprotic Syndrome
F. Monoclonal Gammopathy
- follow up: Immunofixation electropheresis **

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32
Q

CSF ELECTROPHORESIS

A. Oligoclonal bands in CSF **
B.Oligoclonal bands in both CSF and serum

A

A. Multiple sclerosis, Guillian-Barre Syndrom, “MEN” malignancies, encephalitis, neurosyphilis **
B. HIV infection, systemic infection

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33
Q

A. Oligoclonal bands in CSF **
B.Oligoclonal bands in both CSF and serum

A

A. Multiple sclerosis, Guillian-Barre Syndrom, “MEN” malignancies, encephalitis, neurosyphilis **
B. HIV infection, systemic infection

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34
Q

Cylomicron and lipoprotein are responsible

A

POSTPRANDIAL LIPEMIA **

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35
Q

A. Largest but least dense lipoprotein
B. Smallest but most dense lipoprotein

A

A. Chylomicron
B. HDL

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36
Q

A. Minor lipoprotein, sinking pre-B lipoprotein
B. Abnormal lipoprotein, floating B lipoprotein

A

A. Lp(a)
B. B-VLDL

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37
Q

Method of choice for the precipitating reagents of HDL

A

Heparin-manganese-chloride

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38
Q

Indirect measure of TAG

A

Glycerol

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39
Q

URINE ELECTROPHORESIS

A. Strong albumin, A1 and B bands
B. Weak albumin, strong A1, A1 and B bands
C. Strong Y bands

A

A. Glomerular proteinuria
B. Tubular proteinuria
C. Overflow proteinuria, hemoglobinuria, myoglobinuria

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40
Q

Migrating in Y region (Bence-Jones Protein)

A

Monoclonal Light Chains

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41
Q

A. Main cation in the ECF
B. Main cation in the ICF

A

A. Sodium
B. Potassium

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42
Q

A. Most abundant anion in the ECF
B. Second most abundant anion in the ECF
C. most abundant cation in the body
D. Main anion in the intracellular compartment

A

A. Chloride
B. Bicarbonate
c. Calcium
D. Phosphate

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43
Q

Main hypernatremic hormone

A

ALDOSTERONE

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44
Q

A. Chief countercurrent of sodium
B. Chief counterion/counterbalance of sodium

A

A. potassium
B. Chloride

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45
Q

Essential cofactor/ activator of more than 300 enzymes **

A

MAGNESIUM **

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46
Q

Increase the activity of sodium/potassium ATPase pump **

A

INSULIN OVERDOSE (hypokalemia) **

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47
Q

Aldosterone, Na+ an d K+ level of Cushing’s syndrome and Conn’s disease

A

H aldosterone = H NA+ and L K+

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48
Q

H lipids and H protein

A

PSEUDOHYPONATREMIA

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49
Q

Na+ is low, other electrolytes are nomal ***
A. Measure serum glucose
B. Measure sodium using indirect ISE

A

A

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50
Q

Na+ is low, serum/plasma osmolality normal, other electrolytes are normal ***
A. Measure serum glucose
B. Measure sodium using direct ISE

A

B

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51
Q

Most common cause of primary hyperparathyroidism ***

A

PARATHYROID ADENOMA/ CARCINOMA ***
NOTE: H iCa, H PTH

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52
Q

Hyperthyroidism, multiple myeloma, sarcoidosis, iathrogenic causes ***

A

METASTATIC CARCINOMA ***
NOTE:H iCa, N PTH

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53
Q

A. increase in blood urea **
B. Increase in blood urea due to renal failure **

A

A.AZOTEMIA
B. UREMIA

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54
Q

Indicators of GFR, better indication of the source of BUN and creatinine elevation

A

BUN:CREA RATIO

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55
Q

What is seen in the true renal disease?

A

NORMAL RATIO WITH ELEVATED BUN AND CREA LEVELS

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56
Q

pCO2 and HCO3 ratio if the kidneys and lungs are properly functioning

A

20:1

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57
Q

A. Categorized by presence and absence of anion gap and osmolal gap.
B. Categorized by chloride responsiveness or resistance.

A

A. METABOLIC ACIDOSIS
B. METABOLIC ALKALOSIS

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58
Q

a. Osmolal gap NV
B. Anion gap NV

A

A. <10
B. <20

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59
Q

pCO2 is sensitive to what? ***

A

pH ***

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60
Q

Enumerate some possible errors in blood gas analysis

A
  1. Specimen exposed to room air (HpO2= LpCO2, HpH)
  2. Sealed specimen left at room temperature (LpO2= HpCO2, LpH)
  3. Excess heparin (acid mucopolysaccharide= LpH)
61
Q

ENZYME KENETICS

A. The rate of reaction is dependent on substrate concentration.
B. The rate of reaction is dependent on enzyme concentration.

A

A. E > S (glucose oxidase, hexokinase method)
B. E < S (enzyme determination method)

62
Q

Norma Values

A. pH
B. pCO2
C. HCO3

A

A. 7.35-7.45
B. 35-45 (35-44 BOC)
C. 22-26 (23-29)

63
Q

A. Metabolic Acidosis; for each _____ mEq decreased in HCO3, the pCO2 decreases by ____.
A. Metabolic Alkalosis; for each _____ mEq increasaed in HCO3, the pCO2 increased by ____.

A

A. 1.3 mEq; 1.0mmHg
B. 0.6 mEq; 1.0 mmHg

64
Q

Respiratory Acidosis and Alkalosis

A. ACUTE: for each 1mmHg change in pCO2, there is ____ change in HCO3 in the same direction.
B. CHRONIC: for each 1mmHg change in pCO2, there is ____ change in HCO3 in the same direction.

A

A. 0.1 mEq
B. 0.4 mEq

65
Q

OSMOLAL GAP FORMULA
A. Mg/dL
B. Mmol/L

A

A. Osm= 2Na + glucose/18 + BUN/2.8 mg/dL
B. Osm= 2Na + glucose + bUN mmol/L

NOTE: NV: <10

66
Q

ANION GAP CALCULATION

A

AG= (Na +K) - (Cl + HCO3)

67
Q

Considered as least specific enzyme

A

Lactate Dehydrogenase (LDH)

68
Q

LDH under normal conditions

A

LD2> LD1> LD3> LD4> LD5> LD6

69
Q

MAJOR ISOENZYMES FROM LD1 TO LD6

A

LD1- heart, RBCs
LD2- heart, RBCs
LD3- intestines ,lungs pancreas
LD4- liver, skeletal muscles
LD5- liver, skeletal muscles
LD6- alcohol dehydrogenase; heart disease with liver disease

70
Q

Highest elevation of isoenzymes is often seen in

A

MEGALOBLASTIC ANEMIA
PERNICIOUS ANEMIA

71
Q

Alkaline phosphatase (ALP) in normal condition

A

BONE> LIVER> INTESTINAL> PLACENTAL

72
Q

a. Highest elevation in alkaline phosphatase is seen in
b. Physiologic elevation can be seen in

A

a. PAGET’S DISEASE, OSTATIS DEFORMANS
b. PREGNANCY, BONE GROWTH (children)

73
Q

Enzyme that best correlates with ALP ***

74
Q

A. High GGT
B. Normal GGT

A

A. Liver disease, hepatobiliary
B. bone disease

75
Q

MAJOR ALP ISOENZYMES

A. Electrophoresis (anode to cathode)
B. Heat denaturation (stable to labile)

A

A. LIVER - BONE - PLACENTAL - INTESTINAL
B. PLACENTAL - INTESTINAL - LIVER - BONE (heat labile)

76
Q

A cardiac marker that requires pyridoxal phosphate as coenzyme (vitamin b6), highly affected by hemolysis

77
Q

Most liver specific amonitransferase, not affected by hemolysis

78
Q

Inhibited by lipids, triglycerrides, cholesterol ***

A

AMYLASE ***

79
Q

TWO ISOENZYMES
A. Ptyalin
B. amylopsin

A

A. Salivary amylase
B. Pancreatic amylase

80
Q

Most specific marker for acute pancreatitis ***

A

LIPASE ***

81
Q

High amylase, normal lipase (parotitis) **

82
Q

Low amylase, low lipase, depletion of organ source **

A

CHRONIC PANCREATITIS ***

83
Q

a. Bilirubin + Diazo reagent =
B. Bilirubin + accelerator + Diazo reagent =

A

A. Azobilirubin that measure B2
B. Azobilirubin that measure B1 and B2 (total bilirubin)

84
Q

Evelyn-Malloy vs Jendrassik-Grof
A. pH
B. Dissociating agent
c. Diazo product
D. Wavelength used

A

A. Acid; alkaline
B. 50% methanol; caffeine sodium bonnzoate
c. Red; blue
D. 560 nm; 600nm

85
Q

Differentiate B1 and B2

A

B1= unconjugated bilirubin, indirect bilirubin, pre-hepatic bilirubin, water insoluble, non-polar
B2= conjugated bilirubin, direct bilirubin, post-hepatic bilirubin, water soluble, polar

86
Q

Common manifestation of bilirubin dearrangements

87
Q

Test performed if patient has jaundice and pancreatic enlargement

88
Q

UNCONJUGATED (B1)

A. Transport defect with UDPGT deficiency
B. Conjugation defect due to UDPGT deficiency
C. Presence of antibodies against UDPGT

A

A. Gilbert’s Syndrome
B. Crigler-Nejjar Syndrome
C. Lucey-Driscoll Syndrome

89
Q

CONJUGATED (B2)

A. Impaired transport of conjugated bilirubin into the canaliculi
A.reduction in the concentration or activity of ligandin

A

A. DUBIN-JOHNSON SYNDROME
B.ROTOR SYNDROME

90
Q

A. High B1, normal B2, high urobilinogen, (-) urine bilirubin
B. High B1, high B2, high urobilinogen, (+) urine bilirubin
C. High B1, high B2, low urobilinogen, (+) urine bilirubin

A

A. PRE-HEPATIC
B. HEPATIC
C. POST-HEPATIC

91
Q

Bilirubin cannot pass through, no stool color (gray-colored stool)

A

BILIARY OBSTRUCTION, PANCREATIC CANCER, CHOLESTASIS, CHOLELITHIASIS

92
Q

A. Earliest enzymatic cardiac marker
B. Earliest cardiac marker

A

A. CK-MB
B. Myoglobin

NOTE: “MiCAL” Myoglobin, Trop I are PROTEINS. CK-MB, AST and LDH are enzymes

93
Q

a. Main hormone released from the thyroid gland, most abundant thyroid hormone
B. Most active thyroid hormone, majority comes from peripheral deiodinization of T4

A

A. T4/ THYROXINE/ TETRAIODOTHYRONINE
B. T3/ TRIIODOTHYRONINE

94
Q

A. Primary hypothyroidism
B. Primary hyperthyroidism

A

A. Hashimoto’s throiditis
B. Grave’s disease

95
Q

Normal thyroid but unusually low T3 and T4

A

EUTHYROID SICK SYNDROME

96
Q

A . Cold intolerance, weight gain, decreased basal metabolic rate and sympathetic response
B. Heat intolerance, weight loss, increased basal metabolic rate and sympathetic response

A

A. Hashimoto’s thyroiditis (primary hypothyroidism)
B. Grave’s disease (primary hyperthyroidism)

97
Q

SUBLINICAL

A. Subclinical hypothyroidism
B. subclinical hyperthyroidism

A

A. NT3, NT4, high TSH
B. NT3, NT4, low TSH

98
Q

Promote sodium and water reabsorption by the kidney to help maintain blood pressure and tonicity, regulated by the renin-angiotensin-aldosterone system (RAAS)

A

ALDOSTERONE

99
Q

Plasma cortisol values normally display diurnal variation,with the ______________ occuring in the morning and the ______________________ in the early evening. **

A

Highest levels; lowest levels **

100
Q

Exhibits diurnal variation;regulated by ACTH production through the HPA axis

101
Q

First responders to stress**

A

Catecholamine **

102
Q

high thyroid hormones= _____ lipid = ____ metabolism**

A

High thyroid hormones = low lipids = high metabolism***

NOTE: HYPOTHYROIDISM causes weight gain while HYPERTHYROIDISM causes weight loss.

103
Q

HYPOTHYROIDISM (hashimoto’s throiditis) ***
A. Primary= __ TRH, __ TSH, __ T3, T4
B. Secondary = __ TRH, __ TSH, __ T3, T4
C.Tertiary = __ TRH, __ TSH, __ T3, T4

A

A. Primary= high TRH, high TSH, low T3, T4
B. Secondary = high TRH, low TSH, low T3, T4
C.Tertiary = low TRH, low TSH, low T3, T4

104
Q

HYPERTHYROIDISM (grave’s disease) **
A. Primary= __ TRH, __ TSH, __ T3, T4
B. Secondary = __ TRH, __ TSH, __ T3, T4
C.Tertiary = __ TRH, __ TSH, __ T3, T4

A

A. Primary= low TRH, low TSH, high T3, T4
B. Secondary = low TRH, high TSH, high T3, T4
C.Tertiary = high TRH, high TSH, high T3, T4

105
Q

Hormone that is highest concentration in the brain

106
Q

Hormone that is highest concentration in the CNS

A

NOREPINEPHRINE / NORADRENALINE

107
Q

Group of clinical and metabolic disorders characterized by adrenocortical hyperfunction. Clinical findings includes hirutism, obesity, hypertension, buffalo hump, moon-shaped face.

A

CUSHING’S SYNDROME **

NOTE: high cortisol and aldosterone

108
Q

A. Primary cushing’s syndrome
B. secondary cushing’s syndrome

A

A. Adrenal cushing’s (high cortisol, normal pituitary, low ACTH)
B. Pituitary cushing’s (high cortisol, high pituitary, high ACTH)

109
Q

It is the true cushing’s disease

A

PITUITARY CUSHING’S

High cortisol, high pituitary, high ACTH

110
Q

Decreased aldosterone, cortisol and other steroids. Can be due to defect in hypothalamus, pituitary or adrenal gland.

A

ADDISON’S DISEASE (hypoadrenalism)

111
Q

Aldosterone-secreting adrenal adenoma. It is the primary aldosteronism.

A

CONN’S DISEASE

112
Q

Tumor of the adrenal medulla resulting to overproduction of catecholamines.

A

PHEOCHOMOCYTOMA

NOTE: high catecholamines = hyperglycemia***

113
Q

Fatal malignant condition in children results to excessive neropinephrine production.

A

NEUROBLASTOMA

114
Q

DRUG DISPOSISTION

A. Release of drug
B. Drug leaves the administration site, transport of drug
C. Equilibrium of drug with body issue and plasma protein, delivery of drug tissues
D. Chemical modification of drug by cells, usually occurs in the liver
E. Drugs and its motabolites are excreted from the body, occurs in the liver

A

A. LIBERATION
B. ABSORPTION
C. DISTRIBUTION
D. METABOLISM
E. EXCRETION

“LADME”

115
Q

a. Specimen collection for the peak levels of drug
B.specimen collection for the trough level

A

A. 1 hour after the dosage
B. Right before the next dose

116
Q

a. Time required to reduce a drug level to half of its initial value
B. Time during which the concentration of the drug in the body stays consistent

A

A. HALF-LIFE (ex. 4 hr interval)
B. STEADY LIFE (ex. 4-7 doses)

117
Q

The half-life of the drug is 2 hrs. When can you achieve the steady state? **

A

2hrs x 4doses = 8 HRS***

118
Q

Hepatotoxic that is responsible for coma. AST/ALT enzymes evaluates the toxic effect of ____________. **

A

ACETOMINOPHREN ***

119
Q

Orally administered drugs. Low bioavailability.

A

FIRST-PASS METABOLISM

120
Q

Decease production of ceroluplasmin.

A

Wilson’s disease

121
Q

Present copper deposits

Choices
A. Wilson’s disease (kayser-fleischer ring)
B. Menke’s disease (kingky hair)

122
Q

High protein, high lipid (hypercholesterolemia, hypertriglyceridemia)

A

PSEUDOHYPONATREMIA

123
Q

A. Major protein of HDL
b. Major protein of LDL
c. Major protein of VLDL

A

A. Apolipoprotein A
B. Apolipoprotein B
C. Apolipoprotein C

124
Q

A. Exogenous (dietary) TAG
B. Endogenous TAG
C. Cholesterol to cells (heart)
D. Cholesterol out of cells (heart)

A

A. Chylomicrons
B. VLDL
C. LDL
D. HDL

NOTE:
• HDL is helpful; takes cholesterol from the cells
• LDL is lethal; brings cholesterol to the cells
• VLDL has longest initials; pre-beta and endogenous TAG

125
Q

Method used for the calculation of LDLc and VLDLc

A

Friedewald method

NOTE: cannot use when TAG is more than 400mg/dL

126
Q

What disease is a branched chain ketoaciduria?

A

Maple syrup urine disease

127
Q

Protein breakdown in the body produces

A

Urea and ammonia

128
Q

ALPHA 2 GLOBULINS

a. High in acute phase and nephrotic syndrome, low in hemolysis and liver disease
B. High acute phase and pregnancy, low in Wilson’s disease

A

A. Haptoglobin ; binds free hemoglobin
C. Ceruloplasmin; transports copper

129
Q

Produced in muscles including heart, high in muscle damage including AMI

130
Q

Mass CK2 assays measures concentration rather than activity.

131
Q

Out of three forms of troponin, these two are mose specific for AMI identification.

A

Trop I and Trop T

132
Q

A. Rises within 3O mins, peaks within 4-10 hrs and returns to normal within 24 hrs.
B. Rise within 6-10hrs, peaks within 24hrs and returns to normal within 2-3 days.
C. Rise within 4-8 hrs, peaks within 12-24 hrs and returns to normal within 10 days.

A

A. Myoglobin
B. CKMB
C. Troponin

133
Q

Early marker of AMI

A

IMA (ischemia modified albumin)

134
Q

_____ causes ACTH and cortisol levels to be highest in the early morning and lowest at night.

A

Diurnal variation

135
Q

Liver specific, highest from biliary obstruction or after alcohol ingestion.

136
Q

Elevated liver enzymes are as easy as ABC

A

Alcoholism
Biliary obstruction
Cirrhosis

137
Q

CUSHING’S SYNDROME
A. Pituitary Cushing
B. Adrenal Cushing

A

A. high cortisol, high pituitary, high ACTH
B. High cortisol, normal pituitary, low ACTH ***

138
Q

Enzymes indicating muscle disorders

A

ALT, CKMB, aldolase

139
Q

Clinical findings:

Hirsutism, obesity, hypertension, buffalo hump, moon-shaped face

A

Cushing’s Syndrome

144
Q

Decreased cortisol, aldosterone and other steroids

A

Addison’s Disease

ASCPi April 2025 (3 decks)

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