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AMT MLT Study Guide > Clinical Chemistry > Flashcards

Clinical Chemistry Flashcards

1
Q

analytes affected by diurnal variation

A

increased in AM: ACTH, cortisol, iron

increased in PM: growth hormone, PTH, TSH

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2
Q

analytes affected by day-to-day variation

A

> =20% for ALT, bili, CK, steroid hormones, triglycerides

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3
Q

analytes affected by recent food ingestion

A

increased: glucose, insulin, gastrin, triglycerides, sodium, uric acid, iron, LD, calcium
decreased: chloride, phosphate, potassium

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4
Q

analytes that require the patient to be fasting

A

fasting glucose
trigylcerides
lipid panel

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5
Q

analytes affected by alcohol

A

decreased: glucose
increased: triglycerides, GGT

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6
Q

analytes affected by posture

A

increased albumin, cholesterol, calcium when standing

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7
Q

analytes affected by activity

A

increased in ambulatory patients: creatinine kinase (CK)

increased with exercise: potassium, phosphate, lactic acid, creatinine, protein, CK, AST, LD

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8
Q

analytes affected by stress

A

increased: ACTH, cortisol, catecholamines

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9
Q

analytes affected by age, gender, race, drugs

A

various

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10
Q

analytes affected by the use of isopropyl alcohol wipes to disinfect venipuncture site

A

blood alcohol

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11
Q

analytes affected by squeezing the site of a capillary puncture

A

increased potassium

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12
Q

analytes affected by pumping fist during venipuncture

A

increased: potassium, lactic acid, calcium, phosphorus
decreased: pH

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13
Q

analytes affected by applying the tourniquet >1 minute

A

increased: potassium, total protein, lactic acid

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14
Q

analytes affected by IV fluid contamination

A

increased: glucose, potassium, sodium, chloride (depending on IV)

possible dilution of other analytes

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15
Q

analytes affected by incorrect anticoagulant or contamination from incorrect order of draw

A

K2EDTA: decreased calcium, magnesium; increased potassium

sodium heparin: increased sodium if tube not completely filled

lithium heparin: increased lithium

gels: some interfere with trace metals and certain drugs

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16
Q

analytes affected by hemolysis

A

increased: potassium, magnesium, phosphorus, LD, AST, iron, ammonia

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17
Q

analytes affected by exposure to light

A

decreased bilirubin, carotene

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18
Q

analytes affected by temperature between collection and testing

A

chilling required for lactic acid, ammonia, blood gases

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19
Q

analytes affected by inadequate centrifugation

A

poor barrier formation in gel tubes can result in increased potassium, LD, AST, iron, phosphorus

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20
Q

analytes affected by recentrifugation of primary tubes

A

hemolysis, increased potassium

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21
Q

analytes affected by delay in separating serum/plasma (unless gel tube is used)

A

increased: ammonia, lactic acid, potassium, magnesium, LD
decreased: glucose (unless collected in fluoride)

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22
Q

analytes affected by storage temperature

A

decreased at RT: glucose (unless collected in fluoride)
increased at RT: lactic acid, ammonia
decreased at 4C: LD
increased at 4C: ALP

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23
Q

higher in plasma than serum

A

total protein
LD
calcium

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24
Q

higher in serum than plasma

A 
potassium
phosphate
glucose
CK
bicarbonate
ALP
albumin
AST
triglycerides
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25
Q

higher in plasma than whole blood

A

glucose

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26
Q

higher in capillary blood than venous blood

A

glucose (in post-prandial specimen)

potassium

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27
Q

higher in venous blood than capillary blood

A

calcium

total protein

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28
Q

higher in RBCs than plasma

A

potassium
phosphate
magnesium

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29
Q

higher in plasma than RBCs

A

sodium

chloride

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30
Q

chemical reaction produces colored substance that absorbs light of a specific wavelength; amount of light absorbed is directly proportional to concentration of analyte

A

spectrophotometry

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31
Q

light source of spectrophotometer

A

tungsten lamp for visible range

deuterium lamp for UV

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32
Q

component parts of spectrophotometer

A 
light source
monochromator (diffraction grating)
cuvette
photodetector
readout device
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33
Q

measures light absorbed by ground-state atoms; hollow cathode lamp with cathode made of analyte produces wavelength specific for analyte; sensitive

A

atomic absorption spectrophotometry

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34
Q

component parts of an atomic absorption spectrophotometer

A 
hollow cathode lamp
atomizer
flame
mixing chamber
chopper
monochromator
detector
readout device
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35
Q

used to measure trace metals

A

atomic absorption spectrophotometer

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36
Q

atoms absorb light of specific wavelength and emit light of longer wavelength (lower energy); detector at 90* to light source so that only light emitted by sample is measured

A

fluorometry

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37
Q

component parts of fluorometer

A 
light source
primary monochromator
sample holder (quartz cuvettes)
secondary monochromator
detector
readout device
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38
Q

light source of a fluorometer

A

mercury or xenon arc lamp

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39
Q

more sensitive than colorimetry and is used to measure drugs and hormones

A

fluorometry

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40
Q

chemical reaction that produces light; usually involves oxidation of luminol, acridinium esters, or dioxetanes

A

chemiluminescence

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41
Q

component parts of chemiluminescence

A

reagent probes
sample and reagent cuvette
photomultiplier tube
readout device

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42
Q

used for immunoassays; doesn’t require excitation radiation or monochromators like fluorometry; extremely sensitive

A

chemiluminescence

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43
Q

measures reduction in light transmission by particles in suspension

A

turbidmetry

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44
Q

component parts of turbidmetry

A 
light source
lens
cuvette
photodetector
readout device
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45
Q

used to measure proteins in urine and CSF

A

turbidmetry

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46
Q

similar to turbidity, but light is measured at an angle form light source

A

nephelometry

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47
Q

component parts of nephelometry

A 
light source
collimator
monochromator
cuvette
photodetector
readout device
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48
Q

used to measure ag-ab reactions

A

nephelometry

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49
Q

wavelength 350-430
color absorbed?
color transmitted (color seen)?

A

absorbed: violet
transmitted: yellow

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50
Q

wavelength 430-475
color absorbed?
color transmitted (color seen)?

A

absorbed: blue
transmitted: orange

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51
Q

wavelength 475-495
color absorbed?
color transmitted (color seen)?

A

absorbed: blue-green
transmitted: red-orange

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52
Q

wavelength 495-505
color absorbed?
color transmitted (color seen)?

A

absorbed: green-blue
transmitted: orange-red

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53
Q

wavelength 505-555
color absorbed?
color transmitted (color seen)?

A

absorbed: green
transmitted: red

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54
Q

wavelength 555-575
color absorbed?
color transmitted (color seen)?

A

absorbed: yellow-green
transmitted: violet-red

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55
Q

wavelength 575-600
color absorbed?
color transmitted (color seen)?

A

absorbed: yellow
transmitted: violet

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56
Q

wavelength 600-650
color absorbed?
color transmitted (color seen)?

A

absorbed: orange
transmitted: blue

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57
Q

wavelength 670-700
color absorbed?
color transmitted (color seen)?

A

absorbed: red
transmitted: green

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58
Q

wavelength 220-380
range?
common light source?
cuvette?

A

near-ultraviolet
deuterium or mercury arc
quartz (silica)

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59
Q

wavelength 380-750
range?
common light source?
cuvette?

A

visible
incandescent tungsten or tungsten-iodide
borosilicate

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60
Q

wavelength 750-2,000
range?
common light source?
cuvette?

A

near-infrared
incandescent tungsten or tungsten-iodide
quartz (silica)

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61
Q

use of thin-layer chromatography

A

screening test for drugs of abuse in urine

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62
Q

use of high-performance liquid chromatography

A

separation of thermolabile compunds

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63
Q

use of gas chromatography

A

separation of volatile compounds or compounds that can be made volatile, e.g., therapeutic or toxic drugs

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64
Q

potential difference between 2 electrodes directly related to concentration of analyte

A

ion-selective electrodes

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65
Q

use of ion-selective electrodes

A

pH, Pco2, Po2, sodium, potassium, calcium, lithium, chloride

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66
Q

determines osmolality based on freezing-point depression

A

osmometry

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67
Q

measurement of number of dissolved particles in solution, irrespective of molecular weight, size, density or type

A

osmolality

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68
Q

use of osmometry

A

serum and urine osmolality

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69
Q

separation of charged particles in electrical field; anions move to positively charged pole (anode); cations move to negatively charge pole (cathode); the greater the charge, the faster the migration

A

electrophoresis

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70
Q

use of electrophoresis

A

serum protein electrophoresis, hemoglobin electrophoresis

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71
Q

List analytes tested in a BMP.

A 
sodium
potassium
chloride
CO2
glucose
creatinine
BUN
calcium
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72
Q

List analytes tested in a CMP.

A 
sodium
potassium
chloride
CO2
glucose
creatinine
BUN
calcium
albumin
total protein
ALP
AST
bilirubin
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73
Q

List analytes tested in a electrolyte panel.

A

sodium
potassium
chloride
CO2

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74
Q

List analytes tested in a hepatic function panel.

A 
albumin
ALT
AST
ALP
bilirubin (total and direct)
total protein
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75
Q

List analytes tested in a lipid panel.

A

total cholesterol
HDL
LDL
triglycerides

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76
Q

List analytes tested in a renal function panel.

A 
sodium
potassium
CO2
glucose
creatinine
BUN
calcium
albumin
phosphate
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77
Q

reference range of fasting glucose

A

70-99 mg/dL

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78
Q

clinical significance of increased fasting glucose

A 
(hyperglycemia)
diabetes mellitus
other endocrine disorders
acute stress
pancreatitis
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79
Q

clinical significance of decreased fasting glucose

A

(hypoglycemia)
insulinoma
insulin-induced hypoglycemia
hypopituitarism

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80
Q

major source of cellular energy

A

glucose

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81
Q

most common methods of measuring glucose

A

glucose oxidase

hexokinase (more accurate, fewer interfering substances)

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82
Q

Does glucose increase or decrease at RT?

A

decreases

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83
Q

desirable range for total cholesterol

A

<200 mg/dL

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84
Q

most common method of measuring total cholesterol

A

enzymatic methods

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85
Q

clinical significance of total cholesterol

A

limited value for predicting risk of CAD by itself; used in conjunction with HDL and LDL cholesterol

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86
Q

desirable range for HDL cholesterol

A

> =60 mg/dL

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87
Q

clinical significance of HDL cholesterol

A

appears to be inversely related to CAD

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88
Q

most common method for measuring HDL cholesterol

A

homogeneous assay don’t require pre-treatment to remove non-HDL; the first reagent blocks non-HDL, the second reacts with HDL

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89
Q

optimal range for LDL cholesterol

A

<100 mg/dL

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90
Q

clinical significance of LDL cholesterol

A

risk factor for CAD

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91
Q

method for measuring LDL cholesterol

A

may be calculated from Friedewald formula (if triglycerides not >400 mg/dL) or measure by direct homogeneous assays

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92
Q

desirable range for triglycerides

A

<150 mg/dL

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93
Q

clinical significance of triglycerides

A

risk factor for CAD

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94
Q

main form of lipid storage

A

triglycerides

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95
Q

method for measuring triglycerides

A

enzymatic methods using lipase

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96
Q

reference range for total protein

A

6.4-8.3 g/dL

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97
Q

clinical significance of elevated total protein

A

dehydration
chronic inflammation
multiple myeloma

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98
Q

clinical significance of decreased total protein

A 
nephrotic syndrome
malabsorption
overhydration
hepatic insufficiency
malnutrition
agammaglobulinemia
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99
Q

What is <4.5 g/dL of total protein associated with?

A

peripheral edema

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100
Q

method for measuring total protein

A

Biuret method; alkaline copper reagent reacts with peptide bonds

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101
Q

reference range for albumin

A

3.5-5.0 g/dL

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102
Q

clinical significance of elevated albumin

A

dehydration

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103
Q

clinical significance of decreased albumin

A

malnutrition
liver disease
nephrotic syndrome
chronic inflammation

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104
Q

largest fraction of plasma proteins

A

albumin

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105
Q

protein synthesized by the liver

A

albumin

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106
Q

plasma protein that regulates osmotic pressure

A

albumin

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107
Q

method for measuring albumin

A

dye binding

e.g., bromocresol green (BCG), bromocresol purple (BCP)

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108
Q

reference range for microalbumin (on urine)

A

50-200 mg/24 hr

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109
Q

clinical significance of increased urine microalbumin

A

risk of neprhopathy in diabetics

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110
Q

detects albumin in urine earlier than dipstick protein

A

microalbumin (urine)

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111
Q

method for measuring microalbumin

A

immunoassays on 24-hr urine; alternative is albumin-to-creatinine ratio on random sample

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112
Q

microalbuminuria

A

30-300 mg albumin/g creatinine

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113
Q

hormone that decreases glucose levels

A

insulin

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114
Q

responsible for entry of glucose into cells; increases glycogenesis

A

insulin

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115
Q

hormones that increase glucose levels

A 
glucagon
cortisol
epinephrine
growth hormone
thyroxine
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116
Q

stimulates glycogenolysis and gluconeogenesis; inhibits glycolysis

A

glucagon

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117
Q

insulin antagonist; increases gluconeogenesis

A

cortisol

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118
Q

promotes glycogenolysis and gluconeogenesis

A

epinephrine

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119
Q

insulin antagonists

A

cortisol and growth hormone

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120
Q

increases glucose absorption from GI tract; stimulates glycogenolysis

A

thyroxine

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121
Q

DM caused by autoimmune destruction of beta cells

A

Type 1 DM

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122
Q

absolute insuline deficiency

A

Type 1 DM

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123
Q

DM with genetic predisposition (HLA-DR 3/4)

A

Type 1 DM

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124
Q

DM caused by secretory defect of beta cells

A

type 2 DM

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125
Q

insulin resistance in peripheral tissue

A

type 2 DM

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126
Q

DM associated with obesity

A

type 2 DM

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127
Q

DM caused by placental lactogen inhibiting the action of insulin

A

Gestational diabetes mellitus (GDM)

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128
Q

complications of gestational diabetes mellitus

A

intrauterine death

neonatal complications: macrosomia, hypoglycemia, hypocalcemia, polycythemia, hyperbilirubinemia

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129
Q

DM: random plasma glucose

A

> =200 mg/dL

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130
Q

patient prep for fasting plasma glucose

A

fast of at least 8 hrs

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131
Q

DM: fasting plasma glucose

A

> =126 mg/dL on 2 occasions

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132
Q

patient prep for 2 hr plasma glucose

A

75-g glucose load

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133
Q

DM: 2-hr plasma glucose

A

> =100 mg/dL on 2 occasions

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134
Q

patient prep for oral glucose tolerance test (OGTT)

A

fast of at least 8 hours; 75-g glucose load

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135
Q

DM: oral glucose tolerance test (OGTT)

A

fasting >=92 mg/dL OR 1 hr >=180 OR 2 hr >=153

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136
Q

When is an oral glucose tolerance test performed on pregnant women?

A

24-28 weeks of gestation

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137
Q

DM: hemoglobin A1C

A

> =6.5%

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138
Q

gives an estimate of glucose control over previous 2-3 months

A

hemoglobin A1C

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139
Q

Is blood glucose INCREASED or DECREASED in uncontrolled DM?

A

INCREASED

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140
Q

Is urine glucose INCREASED or DECREASED in uncontrolled DM?

A

INCREASED

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141
Q

Is urine specific gravity INCREASED or DECREASED in uncontrolled DM?

A

INCREASED

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142
Q

Is glycohemogobin INCREASED or DECREASED in uncontrolled DM?

A

INCREASED

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143
Q

Are blood and urine ketones INCREASED or DECREASED in uncontrolled DM?

A

INCREASED

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144
Q

Is the anion gap INCREASED or DECREASED in uncontrolled DM?

A

INCREASED

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145
Q

Is the BUN INCREASED or DECREASED in uncontrolled DM?

A

INCREASED

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146
Q

Are serum and urine osmolality INCREASED or DECREASED in uncontrolled DM?

A

INCREASED

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147
Q

Is cholesterol INCREASED or DECREASED in uncontrolled DM?

A

INCREASED

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148
Q

Are triglycerides INCREASED or DECREASED in uncontrolled DM?

A

INCREASED

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149
Q

Is bicarbonate INCREASED or DECREASED in uncontrolled DM?

A

DECREASED

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150
Q

Is blood pH INCREASED or DECREASED in uncontrolled DM?

A

DECREASED

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151
Q

group of risk factors that seem to promote development of atherosclerotic cardiovascular disease and type 2 diabetes mellitus

A

metabolic syndrome

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152
Q

List the risk factors of metabolic syndrome.

A 
decreased HDL-C
increased LDL-C
increased triglycerides
increased blood pressure
increased blood glucose
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153
Q

aminoacidopathy caused by a deficiency of an enzyme that converts phenylalanine to tyrosine; phenylpyruvic acid in the blood and urine

A

phenylketonuria

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154
Q

effect of phenylketonuria

A

mental retardation

urine has a “mousy” odor

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155
Q

diagnosis of phenylketonuria

A

Guthrie bacterial inhibition assay
HPLC
tandem mass spec (MS/MS)
fluorometric and enzymatic methods

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156
Q

aminoacidopathy caused by a disorder of tyrosine catabolism; tyrosine and its metabolites are excreted in urine

A

tyrosinemia

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157
Q

effect of tyrosinemia

A

liver and kidney disease

death

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158
Q

diagnosis of tyrosinemia

A

MS/MS

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159
Q

aminoacidopathy caused by a deficiency of an enzyme needed in metabolism of tyrosine and phenylalanine; buildup of homogenistic acid

A

alkaptonuria

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160
Q

effect of alkaptonuria

A

diapers stain black due to homogenistic acid in urine

later in life - darkening of tissues, hip and back pain

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161
Q

diagnosis of alkaptonuria

A

gas chromatography

mass spectroscopy

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162
Q

aminoacidopathy caused by enzyme deficiency leading to buildup of leucine, isoleucine, and valine

A

maple syrup urine disease (MSUD)

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163
Q

effect of maple syrup urine disease

A 
burnt-sugar odor to urine, breath, and skin
failure to thrive
mental retardation
acidosis
seizures
coma
death
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164
Q

diagnosis of maple syrup urine disease

A

modified Guthrie test

MS/MS

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165
Q

aminoacidopathy caused by deficiency in enzyme needed for metabolism of methionine; methionine and homocysteine build up in plasma and urine

A

homocystinuria

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166
Q

effect of homocystinuria

A

osteoporosis
dislocated lenses in eye
mental retardation
thromboembolic events

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167
Q

diagnosis of homocystinuria

A

Guthrie test
MS/MS
LC-MS/MS

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168
Q

aminoacidopathy caused by increased excretion of cystine due to defect in renal reabsorption

A

cystinuria

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169
Q

effect of cystinuria

A

recurring kidney stones

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170
Q

diagnosis of cystinuria

A

test urine with cyanide nitroprusside

POS = red-purple color

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171
Q

During protein electrophoresis, what does rate of migration depend on?

A

size
shape
charge of molecule

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172
Q

support medium for protein electrophoresis

A

cellulose acetate or agarose

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173
Q

buffer for protein electrophoresis

A

barbital buffer, pH 8.6

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174
Q

stains used for protein electrophoresis

A

Ponceau S
amido blue
bromphenol blue
Coomassie brilliant blue

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175
Q

charge for protein electrophoresis

A

at pH 8.6, proteins are negatively charged and move toward the anode

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176
Q

order of migration (fastest to slowest) of proteins during protein electrophoresis

A 
albumin
alpha-1 globulin
alpha-2 globulin
beta globulin
gamma globulin
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177
Q

largest fraction of protein

A

albumin

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178
Q

buffer flow toward cathode; causes gamma region to be cathodic to point of application

A

electroendosmosis

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179
Q

Why must urine be concentrated first before performing protein electrophoresis?

A

because of low protein concentration in urine

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180
Q

Where do Bence Jones proteins migrate during urine electrophoresis?

A

migrate to the gamma region

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181
Q

Why must CSF be concentrated first before performing protein electrophoresis?

A

because of low protein concentration in CSF

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182
Q

What protein band does CSF have that urine doesn’t in electrophoresis?

A

CSF has a prealbumin band

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183
Q

serum protein electrophoresis: acute inflammation

A

increased alpha-1 and alpha-2

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184
Q

serum protein electrophoresis: chronic inflammation

A

increased alpha-1, alpha-2, and gamma

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185
Q

serum protein electrophoresis: cirrhosis

A

polyclonal increase (all fractions) in gamma with beta-gamma bridging

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186
Q

serum protein electrophoresis: monoclonal gammaopathy

A

sharp increase in 1 immunoglobulin (“M spike”), decrease in other fractions

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187
Q

serum protein electrophoresis: polyclonal gammopathy

A

diffuse increase in gamma

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188
Q

serum protein electrophoresis: hypogammglobulinemia

A

decreased gamma

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189
Q

serum protein electrophoresis: nephrotic syndrome

A

decreased albumin

increased alpha-2

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190
Q

serum protein electrophoresis: alpha-1-antitrypsin deficiency

A

decreased alpha-1

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191
Q

serum protein electrophoresis: hemolyzed specimen

A

increased beta or unusual band between alpha-2 and beta

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192
Q

serum protein electrophoresis: plasma

A

extra band (fibrinogen) between beta and gamma

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193
Q

List the non-protein nitrogen compounds.

A

BUN
creatinine
uric acid
ammonia

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194
Q

reference range for BUN

A

8-26 mg/dL

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195
Q

clinical significance of increased BUN

A

kidney disease

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196
Q

clinical significance of decreased BUN

A

overhydration or liver disease

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197
Q

Where is BUN synthesized?

A

in the liver from ammonia

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198
Q

Where is BUN excreted?

A

kidneys

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199
Q

What reagent is used to test for BUN?

A

urease reagent

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200
Q

reference range for creatinine

A

0-7-1.5 mg/dL

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201
Q

clinical significance of increased creatinine

A

kidney disease

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202
Q

waste product from dehydration of creatine (mainly in muscles)

A

creatinine

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203
Q

methods for measuring creatinine

A

Jaffe’s reaction (alkaline picrate) - nonspecific

enzymatic methods

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204
Q

normal BUN:creatinine ratio

A

12-20

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205
Q

reference range for uric acid

A

males: 3.5-7.2 mg/dL
females: 2.6-6.0 mg/dL

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206
Q

clinical significance of increased uric acid

A 
gout
renal failure
ketoacidosis
lactate excess
high nucleoprotein diet
leukemia
lymphoma
polycythemia
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207
Q

clinical significance of decreased uric acid

A

administration of ACTH

renal tubular defects

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208
Q

method for measuring uric acid

A

uricase method

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209
Q

Which tube additives interfere with uric acid?

A

EDTA and fluoride

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210
Q

What do you do to a urine specimen to prevent precipitation of uric acid?

A

adjust urine pH to 7.5-8.0

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211
Q

Increased uric acid increases risk of __________ and _______________.

A

renal calculi and joint trophi

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212
Q

reference range of ammonia

A

19-60 ug/dL

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213
Q

clinical significance of increased ammonia

A

liver disease
hepatic coma
renal failure
Reye’s syndrome

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214
Q

site of ammonia production

A

GI tract

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215
Q

high levels of ammonia (toxicity)

A

neurotoxic

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216
Q

tubes that should be used for ammonia

A

EDTA or heparin

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217
Q

Why should serum tubes not be used to collect specimens for ammonia?

A

may cause increased levels as NH3 is generated during clotting

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218
Q

reference range for sodium

A

136-145 mmol/L

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219
Q

clinical significance of increased sodium (hypernatremia)

A 
increased sodium intake or IV admin
hyperaldosteronism
excessive sweating
burns
diabetes insipidus
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220
Q

effects of hypernatremia

A

tremors
irritability
confusion
coma

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221
Q

clinical significance of decreased sodium (hyponatremia)

A

renal or extrarenal loss (vomiting, diarrhea, sweating, burns)
increased extracellular volume

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222
Q

effects of hyponatremia

A

weakness
nausea
altered mental status

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223
Q

major extracellular cation

A

sodium

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224
Q

contributes to almost half to plasma osmolality

A

sodium

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225
Q

maintains normal distribution of water and osmotic pressure

A

sodium

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226
Q

regulates sodium levels

A

aldosterone

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227
Q

most common method of sodium measurement

A

ion-selective electrode

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228
Q

normal sodium/potassium ratio in serum

A

approx. 30:1

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229
Q

reference range of potassium

A

3.5-5.1 mmol/L

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230
Q

clinical significance of increased potassium (hyperkalemia)

A

increased intake
decreased excretion
crush injuries
metabolic acidosis

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231
Q

effects of hyperkalemia

A

muscle weakness
confusion
cardiac arrythmia
cardiac arrest

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232
Q

clinical significance of decreased potassium (hypokalemia)

A

increased GI or urinary loss
use of diuretics
metabolic alkalosis

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233
Q

effects of hypokalemia

A 
muscle weakness
paralysis
breathing problems
cardiac arrythmia
death
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234
Q

major intracellular cation

A

potassium

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235
Q

causes of artificial potassium increases

A 
squeezing site of capillary puncture
prolonged tourniquet
pumping fist during venipuncture
contamination with IV fluids
hemolysis
prolonged contact with RBCs
leukocytosis
thrombocytosis
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236
Q

Why are serum values 0.1-0.2 mmol/L higher than plasma?

A

due to release from platelets during clotting

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237
Q

most common method of measuring potassium

A

ISE with valinomycin membrane

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238
Q

reference range for chloride

A

98-107 mmol/L

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239
Q

clinical significance of increased chloride (hyperchloremia)

A 
increased intake
IV administration
hyperaldosteronism
excessive sweating
burns
DI
excess loss of HCO3-
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240
Q

clinical significance of decreased chloride (hypochloremia)

A 
prolonged vomiting
diabetic ketoacidosis
aldosterone deficiency
salt-losing renal diseases
metabolic alkalosis
compensated respiratory acidosis
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241
Q

major extracellular ion

A

chloride

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242
Q

helps maintain osmolality, blood volume, electric neutrality

A

chloride

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243
Q

passively follows sodium

A

chloride

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244
Q

most common method of measuring chloride

A

ISE

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5
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245
Q

sweat chloride test

A

test for diagnosis of cystic fibrosis

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246
Q

reference range for CO2, total

A

23-29 mmol/L

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247
Q

clinical significance of increased CO2, total

A

metabolic alkalosis

compensated respiratory acidosis

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248
Q

clinical significance of decreased CO2, total

A

metabolic acidosis

compensated respiratory alkalosis

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249
Q

What percentage of CO2 total is bicarbonate (HCO3-)? What makes up the remaining percentage?

A

> 90%

carbonic acid (H2CO3-) and dissolved CO2

250
Q

important in maintaining acid-base balance

A

CO2

251
Q

Why should a CO2 specimen remain capped?

A

to prevent loss of CO2

252
Q

method of measuring CO2

A

ISE or enzymatic method

253
Q

reference range for magnesium

A

1.6-2.6 mg/dL

254
Q

clinical significance of increased magnesium

A 
renal failure
increased intake (e.g., antacids)
dehydration
bone cancer
endocrine disorders
255
Q

effects of increased magnesium

A

cardiac abnormalities
paralysis
respiratory arrest
coma

256
Q

clinical significance of decreased magnesium

A

severe illness
GI disorders
endocrine disorders
renal loss

rare in non-hospitalized patients

257
Q

effects of decreased magnesium

A 
cardiac arrythmias
tremors
tetany
paralysis
psychosis
coma
258
Q

analyte that is an essential cofactor for many enzymes

A

magnesium

259
Q

Why should you avoid hemolyzing a specimen being tested for magnesium?

A

because magnesium is 10x more concentrated in RBCs and will falsely elevate results

260
Q

Why should you not collect a specimen for magnesium testing in a tube with EDTA, citrate, or oxalate?

A

because they bind magnesium and results will be falsely decreased

261
Q

method of measuring magnesium

A

colorimetric methods

262
Q

reference range for total calcium

A

8.6-10.0 mg/dL

263
Q

reference range for ionized calcium

A

4.60-5.08 mg/dL

264
Q

clinical significance of increased calcium

A

primary hyperparathyroidism
cancer
multiple myeloma

265
Q

effects of increased calcium

A

weakness
coma
GI symptoms
renal calculi

266
Q

clinical significance of decreased calcium

A

hypoparathyroidism
malabsorption
vitamin D deficiency
renal tubular acidosis

267
Q

effects of decreased calcium

A

tetany (muscle spasms)
seizures
cardiac arrythmias

268
Q

most abundant mineral in body

A

calcium

269
Q

Where is 99% of calcium located in the body?

A

bones

270
Q

What 3 analytes regulate calcium?

A

PTH
vitamin D
calcitonin

271
Q

Why should you not use tubes with anticoagulants other than heparin?

A

because they bind calcium

272
Q

method for measuring total calcium

A

colorimetric methods

273
Q

biologically active form of calcium and a better indicator of calcium status

A

ionized calcium

274
Q

method for measuring ionized calcium

A

ISE

275
Q

What is the ionized calcium value affected by?

A

pH and temperature

276
Q

reference range for phosphorus, inorganic (phosphate)

A

2.5-4.5 mg/dL

277
Q

clinical significance of increased phosphorus

A

renal disease

hypoparathyroidism

278
Q

clinical significance of decreased phosphorus

A

hyperparathyroidism
vitamin D deficiency
renal tubular acidosis

279
Q

major intracellular anion

A

phosphorus

280
Q

Where is phosphorus mostly found?

A

bones

281
Q

important reservoir for energy (ATP); component of nucleic acids, many coenzymes

A

phosphorus

282
Q

What analyte should phosphorus be correlated with?

A

calcium

normally reciprocal relationship

283
Q

True or False. Phosphorus is usually higher in children.

A

True

284
Q

Which tube additive interfere with phosphorus?

A

citrate
oxalate
EDTA

285
Q

Is phosphorus higher in RBCs or plasma?

A

RBCs

286
Q

reference range for lactate (lactic acid)

A

4.5-19.8 mg/dL

287
Q

clinical significance of lactate (lactic acid)

A

sign of decreased oxygen to tissues

288
Q

What is lactate a byproduct of?

A

anaerobic metabolism

289
Q

reference range for iron

A

M: 65-175 ug/dL
F: 50-170 ug/dL

290
Q

clinical significance of increased iron levels

A 
iron overdose
hemochromatosis
sideroblastic anemia
hemolytic anemia
liver disease
291
Q

clinical significance of decreased iron levels

A

iron deficiency anemia

292
Q

What is iron necessary for?

A

hemoglobin synthesis

293
Q

What is iron transported by?

A

transferrin

294
Q

Does hemolysis interfere with iron tests?

A

yes

295
Q

What tube additives bind iron?

A

oxalate
citrate
EDTA

296
Q

Why are early morning specimens preferred for iron tests?

A

because of diurnal variation

297
Q

reference range for total iron binding capacity (TIBC)

A

250-425 ug/dL

298
Q

clinical significance of increased TIBC

A

iron deficiency anemia

299
Q

clinical significance of decreased TIBC

A

iron overdose

hemochromatosis

300
Q

reference range for % saturation or transferrin saturation

A

20-50%

301
Q

clinical significance of increased % saturation or transferrin saturation

A

iron overdose
hemochromatosis
sideroblastic anemia

302
Q

clinical significance of decreased % saturation or transferrin saturation

A

iron deficiency anemia

303
Q

% saturation or transferrin saturation calculation

A

(100 x serum iron)/TIBC

304
Q

reference range for transferrin

A

200-360 mg/dL

305
Q

clinical significance of increased transferrin

A

iron deficiency anemia

306
Q

clinical significance of decreased transferrin

A

iron overdose
hemochromatosis
chronic infections
malignancies

307
Q

complex of apotransferrin (protein that transports iron) and iron

A

transferrin

308
Q

reference range for ferritin

A

M: 20-250 ug/L
F: 10-120 ug/L

309
Q

clinical significance of increased ferritin

A

iron overload
hemochromatosis
chronic infections
malignancies

310
Q

clinical significance of decreased ferritin

A

iron deficiency anemia

311
Q

storage form of iron; rough estimate of body iron content

A

ferritin

312
Q

How does substrate concentration influence enzymatic reactions?

A

first order kinetics: [enzyme] > [substrate] = reaction rate proportional to [substrate]

zero order kinetics: [substrate] > [enzyme] = reaction rate proportional to [enzyme]

assays are zero order (excess substrate)

313
Q

How does enzyme concentration influence enzymatic reactions?

A

velocity of reaction is proportional to [enzyme] as long as [substrate] > [enzyme]

314
Q

How does pH influence enzymatic reactions?

A

extremes of pH may denature enzymes

315
Q

At what pH do most enzymatic reactions occur?

A

pH 7-8

316
Q

How does temperature influence enzymatic reactions?

A

increase of 10C doubles rate of reaction until around 40-50C; then denaturation of enzyme may occur

37*C is most commonly used in the US

317
Q

nonprotein molecules that participate in enzymatic reactions and must be present in excess

A

cofactors

318
Q

What are inorganic cofactors called?

A

activators

319
Q

How do inorganic cofactors influence enzymatic reactions?

A

either required for or enhance reactions

320
Q

What are organic cofactors called?

A

coenzymes

321
Q

How do organic cofactors influence enzymatic reactions?

A

may serve as 2nd substrate in reaction

322
Q

Give some examples of inorganic cofactors.

A

chloride, magnesium

323
Q

Give an example of organic cofactors.

A

nicotinamide adenine dinucleotide

324
Q

reaction commonly used in enzyme determinations

A

NAD NADH

NADH = reduce form of NAD

NADH has absorbance at 340 nm; NAD does not

325
Q

How do inhibitors influence enzymatic reactions?

A

interfere with reaction

326
Q

What tissue is the enzyme acid phosphatase (ACP) found?

A

prostate

327
Q

clinical significance of increased acid phosphatase (ACP)

A

prostate cancer

328
Q

What tissues is alkaline phosphatase (ALP)?

A

almost all tissues

329
Q

clinical significance of increased ALP

A

liver and bone disease

levels higher in biliary tract obstruction than in hepatocellular disorders (hepatitis, cirrhosis)

330
Q

In what parts of the population is ALP increased?

A

children
adolescents
pregnant women
healing bone fractures

331
Q

optimum pH for ALP

A

pH 9-10

332
Q

What tissues is aspartate aminotransferase (AST) found?

A

many; highest levels in liver, heart, and skeletal muscle

333
Q

clinical significance of increased AST

A

liver disease (marked increase with viral hepatitis)
acute myocardial infarction
muscular dystrophy

334
Q

Is AST affected by hemolysis?

A

yes

335
Q

What tissues is alanine aminotransferase found?

A

liver

RBCs

336
Q

clinical significance of increased ALT

A

liver disease (marked increase with viral hepatitis)

337
Q

Which is more specific for liver disease, AST or ALT?

A

ALT

338
Q

What tissues is gamma glutamyl transferase (GGT) found?

A

liver
kidneys
pancreas

339
Q

clinical significance of increased GGT

A

hepatobiliary disorders

chronic alcoholism

340
Q

most sensitive enzyme for all types of liver disease

A

GGT

341
Q

Highest levels of GGT is found in what type of disorders?

A

obstructive

342
Q

used by treatment centers to monitor abstention from alcohol

A

GGT

343
Q

What tissues is lactate dehydrogenase (LD) found?

A

all tissues; highest in liver, heart, skeletal muscle, and RBCs

344
Q

clinical significance of increased LD

A

AMI
liver disease
pernicious anemia

345
Q

LD catalyzes lactic acid into __________.

A

pyruvic acid

346
Q

storage temp for LD specimens

A

25C, NOT 4C

347
Q

What tissues is creatine kinase (CK) found?

A

cardiac muscle
skeletal muscle
brain

348
Q

clinical significance of increased CK

A

AMI

muscular dystrophy

349
Q

function of CK

A

catalyzes phosphocreatine + ADP creatine + ATP

350
Q

most sensitive enzyme fo skeletal muscle disease

A

CK

351
Q

highest levels of LD

A

pernicious anemia

352
Q

highest levels of CK

A

muscular dystrophy

353
Q

anticoagulants that inhibit CK

A

all anticoagulants EXCEPT heparin

354
Q

clinically insignificant causes of elevated CK

A

physical activity

IM injections

355
Q

CK isoenzyme used in diagnosis of AMI

A

CK-MB

356
Q

What tissues is amylase (AMS) found?

A

salivary glands

pancreas

357
Q

clinical significance of increase amylase

A

acute pancreatitis
other abdominal diseases
mumps

358
Q

function of amylase

A

breaks down starch to simple sugars

359
Q

levels of amylase in acute pancreatitis

A

increase 2-12 hours after attack
peak at 24 hours
return to normal in 3-5 days

360
Q

What tissues is lipase (LPS) found?

A

pancreas

361
Q

clinical significance of increased lipase

A

acute pancreatitis

362
Q

function of lipase

A

breaks down triglycerides into fatty acids and glycerol

363
Q

more specific than amylase for pancreatic disease

A

lipase

364
Q

levels of lipase in acute pancreatitis

A

levels usually parallel amylase but may stay increased longer

365
Q

Where is glucose-6-phosphate dehydrogenase (G6PD) found?

A

RBCs

366
Q

clinical significance of decreased G6PD

A

inherited deficiency can lead to drug-induced hemolytic anemia

367
Q

method of measuring G6PD

A

measured in hemolysate of whole blood

368
Q

enzymes used in diagnosing cardiac disorders

A

CK-MB

369
Q

enzymes used in diagnosing hepatocellular disorders

A

AST
ALT
LD

370
Q

enzymes used in diagnosing biliary tract obstructions

A

ALP

GGT

371
Q

enzymes used in diagnosing skeletal muscle disorders

A

CK
AST
LD
aldolase

372
Q

enzymes used in diagnosing bone disorders

A

ALP

373
Q

enzymes used in diagnosing acute pancreatitis

A

amylase

lipase

374
Q

elevation of CK-MB after chest pain

A

4-6 hours

375
Q

duration of elevation of CK-MB in AMI

A

2-3 days

376
Q

sensitivity/specificity of CK-MB for AMI

A

not entirely specific for AMI

377
Q

elevation of myoglobin after chest pain

A

1-4 hours

378
Q

duration of myoglobin elevation in AMI

A

18-24 hours

379
Q

sensitivity/specificity of myoglobin for AMI

A

sensitive but not specific

380
Q

negative predictive maker for AMI

A

myoglobin

if not elevated within 8 hours of chest pain, AMI ruled out

381
Q

elevation of troponin after chest pain

A

4-10 hours

382
Q

duration of troponin elevation for AMI

A

4-10 days

383
Q

sensitivity/specificity of troponin for AMI

A

high sensitivity and specificity

384
Q

considered definitive marker for AMI

A

troponin

385
Q

tests for heart failure

A

B-type natriuretic peptide (BNP)

386
Q

function of BNP

A

released from heart muscle of left ventricle when fluid builds from heart failure; acts on kidneys to increase excretion of fluid

387
Q

nonspecific marker of inflammation

A

cardiac C-reactive protein (cCRP)

388
Q

best single biomarker for predicting cardiovascular events

A

cardiac C-reactive protein (cCRP)

389
Q

Why should cCRP be tested on 2 occasions?

A

because of individual variability

390
Q

List the 5 tests used to assess risk of CAD

A
  1. cardiac C-reactive protein
  2. total cholesterol
  3. HDL cholesterol
  4. LDL cholesterol
  5. triglycerides
391
Q

reference range for total bilirubin

A

0.2-1.0 mg/dL

392
Q

clinical significance of increased total bilirubin

A

liver disease
hemolysis
HDN

393
Q

total bilirubin levels in infants associated with brain damage (kernicterus)

A

> 20 mg/dL

394
Q

sum of conjugated, unconjugated, and delta bilirubin

A

total bilirubin

395
Q

reference range for conjugated bilirubin (direct bilirubin)

A

<0.2 mg/dL

396
Q

clinical significance of increased conjugated bilirubin (direct bilirubin)

A

liver disease

obstructive jaundice

397
Q

methods of measurement for TBIL and DBIL

A

Jendrassik-Grof method; Diazo reagent

398
Q

reference range for unconjugated bilirubin (indirect bilirubin)

A

<0.8 mg/dL

399
Q

clinical significance of increased unconjugated bilirubin (indirect bilirubin)

A

prehepatic, posthepatic and some types of hepatic jaundice

400
Q

calculation for unconjugated bilirubin (indirect bilirubin)

A

Total bili minus direct bili

401
Q

structure of unconjugated bilirubin

A

bilirubin

402
Q

Is unconjugated bilirubin bound to protein?

A

yes - albumin

403
Q

Is unconjugated bilirubin polar or nonpolar?

A

nonpolar

404
Q

Is unconjugated bilirubin soluble in water?

A

no

405
Q

Is unconjugated bilirubin present in urine?

A

no

406
Q

Is the reaction between unconjugated bilirubin and diazotized sulfanilic acid indirect or direct?

A

indirect - only reacts in presence of accelerator

407
Q

unconjugated bilirubin affinity for brain tissue

A

high

408
Q

structure of conjugated bilirubin

A

bilirubin monoglucuronide
bilirubin diglucuronide
delta bilirubin

409
Q

Is conjugated bilirubin bound to protein?

A

no (except delta bilirubin)

410
Q

Is conjugated bilirubin polar or nonpolar?

A

polar

411
Q

Is conjugated bilirubin soluble in water?

A

yes

412
Q

Is conjugated bilirubin present in urine?

A

yes

413
Q

Is the reaction between conjugated bilirubin and diazotized sulfanilic acid indirect or direct?

A

direct - reacts without accelerator

414
Q

conjugated bilirubin affinity for brain tissue

A

low

415
Q 
Prehepatic jaundice:
TBIL?
DBIL?
Urine bilirubin?
Urine urobilinogen?
A

TBIL = increased
DBIL = normal
Urine bilirubin = negative
Urine urobilinogen = increased

416
Q 
Hepatic jaundice:
TBIL?
DBIL?
Urine bilirubin?
Urine urobilinogen?
A

TBIL = increased
DBIL = variable
Urine bilirubin = variable
Urine urobilinogen = decreased

417
Q 
Posthepatic jaundice:
TBIL?
DBIL?
Urine bilirubin?
Urine urobilinogen?
A

TBIL = increased
DBIL = increased
Urine bilirubin = positive
Urine urobilinogen = decreased

418
Q

List the 6 anterior pituitary hormones.

A
  1. ACTH
  2. FSH
  3. Growth Hormone (GH)
  4. LH
  5. Prolactin (PRL)
  6. TSH
419
Q

regulates production of adrenocortical hormones by adrenal cortex

A

ACTH

420
Q

clinical significance of increased ACTH

A

Cushing’s disease

421
Q

What is ACTH regulated by?

A

corticotropin-releasing hormon (CRH) from hypothalamus

422
Q

ACTH - diurnal variation - levels in AM and PM?

A

highest levels in early AM

lowest in late afternoon

423
Q

collection specifics for ACTH

A

collect on ice

store frozen

424
Q

regulates sperm and egg production

A

FSH

425
Q

What is FSH regulated by?

A

gonadotropin-releasing hormone (GnRH) from hypothalamus

426
Q

What part of a woman’s cycle does a sharp increase in FSH occur?

A

just before ovulation

427
Q

regulates protein synthesis, cell growth, and divison

A

growth hormone (GH)

428
Q

What is growth hormone regulated by?

A

GHRH and somatostatin from hypothalamus

429
Q

clinical significance of increased GH

A

gigantism

acromegaly

430
Q

clinical significance of decreased GH

A

dwarfism

431
Q

regulates maturation of follicles, ovulation, production of estrogen, progesterone, testosterone

A

LH

432
Q

What is LH regulated by?

A

GnRH from hypothalamus

433
Q

What part of a woman’s cycle does a sharp increase in LH occur?

A

just before ovulation

434
Q

regulates lactation

A

Prolactin (PRL)

435
Q

What is prolactin regulated by?

A

prolactin-releasing factor (PRF) and prolactin-inhibiting factor (PIF) from hypothalamus

436
Q

regulates production of T3 and T4 by thyroid

A

TSH

437
Q

What is TSH regulated by?

A

thyrotropin-releasing hormone (TRH) from hypothalamus

438
Q

clinical significance of increased TSH

A

hypothyroidism

439
Q

clinical significance of decreased TSH

A

hyperthyroidism

440
Q

regulates reabsorption of water in distal renal tubules

A

ADH

441
Q

Where is ADH produced?

A

hypothalamus

442
Q

Where is ADH stored?

A

posterior pituitary

443
Q

List the 2 posterior pituitary hormones.

A

ADH

oxytocin

444
Q

stimulates release of ADH

A

increased osmolality

decreased blood volume or blood pressure

445
Q

clinical significance of decreased ADH

A

diabetes insipidus

446
Q

regulates uterine contractions during childbirth and lactation

A

oxytocin

447
Q

Where is oxytocin produced?

A

hypothalamus

448
Q

Where is oxytocin stored?

A

posterior pituitary

449
Q

List the 3 thyroid hormones.

A
  1. thyroxine (T4)
  2. triiodothyronine (T3)
  3. calcitonin
450
Q

regulates metabolism, growth, and development

A

T4 and T3

451
Q

principle thyroid hormone

A

T4

452
Q

Where is most T4 found?

A

bound to TBG

453
Q

clinical significance of increased T4

A

hyperthyroidism

454
Q

clinical significance of decreased T4

A

hypothyroidism

455
Q

regulated by TSH

A

T4 and T3

456
Q

50x more concentrated than T3

A

T4

457
Q

4-5x more potent than T4

A

T3

458
Q

clinical significance of increased T3

A

hyperthyroidism

459
Q

clinical significance of decreased T3

A

hypothyroidism

460
Q

important in diagnosis of thyroid cancer

A

calcitonin

461
Q

regulates inhibition of calcium resorption

A

calcitonin

462
Q

functions in regulation of calcium and phosphate

A

parathyroid hormone (PTH)

463
Q

Primary hyperthyroidism:
PTH?
Calcium?
Phosphate?

A 
PTH = increased
Calcium = increased
Phosphate = decreased
464
Q

Hypoparathyroidism:
PTH?
Calcium?
Phosphate?

A 
PTH = decreased
Calcium = decreased
Phosphate = increased
465
Q

Primary hypothyroidism:
TSH?
FT4?
FT3?

A 
TSH = increased
FT4 = decreased
FT3 = decreased
466
Q

Secondary hypothyroidism:
TSH?
FT4?
FT3?

A 
TSH = decreased
FT4 = decreased
FT3 = decreased
467
Q

Hyperthyroidism:
TSH?
FT4?
FT3?

A 
TSH = decreased
FT4 = increased
FT3 = increased
468
Q

T3 Thyrotoxicosis:
TSH?
FT4?
FT3?

A 
TSH = decreased
FT4 = normal
FT3 = increased
469
Q

biologically active form of T4

A

Free T4

470
Q

regulates reabsorption of sodium in renal tubules

A

aldosterone

471
Q

clinical significance of increased aldosterone

A

hypertension due to water and sodium rentention

472
Q

clinical significance of decreased aldosterone

A

severe water and electrolyte abnormalities

473
Q

regulates carbohydrate, fat, and protein metabolism; water and electrolyte balance

A

cortisol

474
Q

suppresses inflammatory and allergic reactions

A

cortisol

475
Q

What is cortisol regulated by?

A

ACTH

476
Q

clinical significance of increased cortisol

A

Cushing’s syndrome

loss of diurnal variation

477
Q

slinical significance of decreased cortisol

A

Addison’s disease

478
Q

Does cortisol show diurinal variation?

A

yes, highest in AM

479
Q

List hormones of the adrenal cortex.

A

aldosterone

cortisol

480
Q

List hormones of the adrenal medulla.

A

epinephrine, norepinephrine

481
Q

regulates “fight or flight syndrome;”r regulates stimulation of sympathetic nervous system

A

epinephrine, norepinephrine

482
Q

primary hormone of adrenal medulla

A

epinephrine

483
Q

epinephrine and norepinephrine = ______

A

catecholeamines

484
Q

metanephrines and VMA

A

metabolites

485
Q

clinical significance of increased epinephrine/norepinephrine

A

pheochromocytoma (rare catecholamine producing tumor)

486
Q

List hormones of ovaries.

A

estrogens

progesterone

487
Q

regulates development of female reproductive organs and secondary sex characteristics

A

estrogens

488
Q

regulates menstrual cycle

A

estrogens

489
Q

regulates maintenance of pregnancy

A

estrogens

490
Q

major estrogen produced by ovaries; most potent estrogen

A

estradiol

491
Q

Where is estradiol produced other than the ovaries?

A

adrenal cortex

492
Q

regulates preparation of uterus for ovum implantation and maintenance of pregnancy

A

progesterone

493
Q

Where is progesterone produced other than the ovaries?

A

placenta

494
Q

metabolite of progesterone

A

pregnanediol

495
Q

hormone useful in infertility studies and to assess placental function

A

progesterone

496
Q

hormone used to monitor fetal growth and development but has no hormonal activity

A

estrogen (estriol)

497
Q

List hormones of the placenta.

A

estrogen (estriol)
progesterone
HCG
human placental lactogen (HPL)

498
Q

regulates progesterone production by corpus luteum during early pregnancy; development of fetal gonads

A

HCG

499
Q

used to detect pregnancy, gestational trophoblastic disease (e.g., hydatidiform mole), testicular tumors, and other HCG-producing tumors

A

HCG

500
Q

regulates estrogen and progesterone production by corpus luteum and development of mammary glands

A

human placental lactogen (HPL)

501
Q

hormone used to assess placental function

A

human placental lactogen (HPL)

502
Q

List hormones of the testes.

A

testosterone

503
Q

regulates development of male reproductive organs and secondary sex characteristics

A

testosterone

504
Q

Where is testosterone produced other than the testes?

A

adrenal cortex

505
Q

List the 2 pancreatic hormones.

A

insulin

glucagon

506
Q

regulates carbohydrate metabolism

A

insulin

507
Q

Where is insulin produced in the pancreas?

A

beta cells of islets of Langerhans

508
Q

causes increased movement of glucose into the cells for metabolism

A

insulin

509
Q

clinical significance of decreased insulin

A

diabetes mellitus

510
Q

clinical significance of increased insulin

A

insulinoma

hypoglycemia

511
Q

regulates glycogenolysis, gluconeogenesis, lipolysis

A

glucagon

512
Q

Where is glucagon produced in the pancreas?

A

alpha cells of islets of Langerhans

513
Q

causes increases in plasma glucose levels

A

glucagon

514
Q

clinical significance of increased glucagon

A

glucagonoma
diabetes mellitus
pancreatitis
trauma

515
Q

lowest concentration of drug in blood that will produce desired effect

A

minimum effective concentration (MEC)

516
Q

lowest concentration of drug in blood that will produce adverse response

A

minimum toxic concentration (MTC)

517
Q

ratio of MTC to MEC

A

therapeutic index

518
Q

lowest concentration of drug measured in blood; reached just before next scheduled dose; shouldn’t fall below MEC

A

trough

519
Q

highest concentration of drug measured in blood; drawn immediately on achievement of steady state; should not exceed MTC

A

peak

520
Q

amount of drug absorbed and distributed = amount of drug metabolized and excreted; usually reached after 5-7 half-lives

A

steady state

521
Q

time required for concentration of drug to be decreased by half

A

half-life

522
Q

rates of absorption, distribution, biotransformation, and excretion

A

pharmacokinetics

523
Q

salicylates, acetaminophen

A

analgesics

524
Q

phenobarbital, phenytoin, valproic acid, carbamazepine, ethosuximide, felbamate, gabapentin, lamotrigine

A

antiepileptics

525
Q

methotrexate

A

antineoplastics

526
Q

aminoglycosides, vancomycin

A

antibiotics

527
Q

amikacin, gentamicin, kanamycin, tobramycin

A

aminoglycoside antibiotics

528
Q

digoxin, disopyramide, procainamide, quinidine

A

cardioactives

529
Q

tricyclic antidepressants, lithium

A

psychoactives

530
Q

cyclosporine, tacrolimus (FK-506)

A

immunosuppressants

531
Q

analytic methods for ethanol

A

gas chromatography

enzymatic methods

532
Q

analytic methods for carbon monoxide

A 
differential spectrophotometry (co-oximeter)
gas chromatography
533
Q

analytic methods for arsenic

A

atomic absorption

534
Q

analytic methods for lead

A

atomic absorption

535
Q

analytic methods for pesticides

A

measurement of serum pseudocholinesterase

536
Q

value outside physiological range or presence of substance that isn’t found in human urine

A

adulterated urine

537
Q

values that aren’t consistent with normal human urine

A

substituted urine

538
Q

creatinine and specific gravity lower than expected for normal human urine

A

diluted urine

539
Q

urine pH <3 or >11

A

adulterated urine

540
Q

urine nitrite >=500 mg/dL

A

adulterated urine

541
Q

presence of chromium, halogens (bleach, iodine, fluoride), glutaraldehyde, pyridine, or surfactant in urine

A

adulterated urine

542
Q

creatinine <2 mg/dL and specific gravity <=1.0010 or >=1.0200

A

substituted urine

543
Q

creatinine >=2 mg/dL but <=20 mg/dL and specific gravity >=1.0010 but <=1,0030

A

diluted urine

544
Q

tumor marker for liver cancer

A

alpha-fetoprotein (AFP)

545
Q

clinical use of AFP

A

aid diagnosis
monitor therapy
detect recurrence

546
Q

produced by fetal liver; re-expressed in certain tumors

A

AFP

547
Q

clinical significance of increased AFP

A

tumors
hepatitis
pregnancy

548
Q

tumor marker for breast cancer

A

CA 15-3

CA 27.29

549
Q

clinical use for CA 15-3 and CA 27.29

A

stage disease
monitor therapy
detect recurrence

550
Q

clinical significance of increased CA 15-3, CA 27.29

A

tumors
other cancers
non-cancerous conditions

551
Q

tumor marker for pancreatic cancer

A

CA 19-9

552
Q

clinical use for CA 19-9

A

stage disease
monitor therapy
detect recurrence

553
Q

clinical significance of increased CA 19-9

A

pancreatic cancer
other cancers
non-cancerous conditions

554
Q

tumor marker for ovarian cancer

A

CA 125

555
Q

clinical use of CA 125

A

aid diagnosis
monitor therapy
detect recurrence

556
Q

clinical significance of increased CA 125

A

ovarian cancer
other cancers
gynecological conditions

557
Q

tumor marker for colorectal cancer

A

carcinoembryonic antigen (CEA)

558
Q

clinical use of CEA

A

monitor therapy

detect recurrence

559
Q

clinical significance of increased CEA

A

colorectal cancer
other cancers
non-cancerous conditions
smokers

560
Q

tumor marker for ovarian and testicular cancer; and marker for gestational trophoblastic diseases

A

human chorionic gonadotropin (hCG)

561
Q

clinical significance of increased hCG

A

pregnancy
ovarian cancer
testicular cancer
gestational trophoblastic diseases

562
Q

clinical use of hCG

A

aid diagnosis
monitor therapy
detect recurrence

563
Q

tumor marker for prostate cancer

A

prostate-specific antigen (PSA)

564
Q

clinical use for PSA

A

screening
aid diagnosis
monitor therapy
detect recurrence

565
Q

Can men have increased PSA but not have prostate cancer?

A

yes

566
Q

tumor marker for thyroid cancer

A

thyroglobulin

567
Q

clinical use for PSA

A

monitor therapy

detect recurrence

568
Q

clinical significance of increased PSA

A

prostate cancer

non-cancerous conditions

569
Q

clinical significance of increased thyroglobulin

A

thyroid cancer

other thyroid disease

570
Q

What should be measured at the same time as thyroglobulin?

A

antithyroglobulin antibodies

571
Q

-Log[H+] or log (1/[H+])

A

pH

572
Q

chemical that can yield H+; proton donor; pH <7

A

acid

573
Q

chemical that can accept H+ or yield OH-; pH >7

A

base

574
Q

weak acid and its salt or conjugate base; minimizes changes in pH

A

buffer

575
Q

most important buffer for maintaining blood pH

A

bicarbonate/carbonic acid

576
Q

Are phosphates a buffer?

A

yes

577
Q

Are proteins a buffer?

A

yes

578
Q

Is hemoglobin considered a buffer?

A

yes

579
Q

second largest fraction of anions; HCO3-; proton acceptor or base

A

bicarbonate

580
Q

What is bicarbonate regulated by?

A

kidneys

581
Q

____ minus ____ = bicarbonate

A

CO2 minus 1

582
Q

proton donor or weak acid; H2CO3

A

carbonic acid

583
Q

What is carbonic acid regulated by?

A

lungs

584
Q

_____ x _____ = carbonic acid

A

PCO2 x 0.03

585
Q

total CO2

A

HCO3- + H2CO3 + dissolved CO2

586
Q

partial pressure of CO2; directly related to the amount of dissolved CO2

A

Pco2

587
Q

Henderson-Hasselbalch equation

A

pH = 6.1 + log ([HCO3-]/H2CO3])

or

pH = 6.1 + log (HCO3-/PCO2) x 0.03

588
Q

blood pH <7.38

HCO3-:H2CO3 ratio decreased

A

acidosis (acidemia)

589
Q

blood pH >7.42

increased HCO3-:H2CO3 ratio

A

alkalosis (alkalemia)

590
Q

decreased pH
increased Pco2
normal HCO3-

A

respiratory acidosis

591
Q

compensation for respiratory acidosis to re-establish 20:1 ratio

A

kidneys retain HCO3-; excrete H+

592
Q

decreased pH
normal Pco2
decreased HCO3-

A

metabolic acidosis

593
Q

compensation for metabolic acidosis to re-establish 20:1 ratio

A

hyperventilation (blow off CO2)

594
Q

increased pH
decreased Pco2
normal HCO3-

A

respiratory alkalosis

595
Q

compensation for respiratory alkalosis to re-establish 20:1 ratio

A

kidneys excrete HCO3-; retain H+

596
Q

increased pH
normal Pco2
increased HCO3-

A

metabolic alkalosis

597
Q

compensation for metabolic alkalosis to re-establish 20:1 ratio

A

hypoventilation (retain CO2)

598
Q

low oxygen content in arterial blood

A

hypoxemia

599
Q

lack of oxygen at cellular level

A

hypoxia

600
Q

barometric pressure x % gas concentration

A

partial pressure

601
Q

osmolalitly normal range

A

275-295 Osm/kg

602
Q

concentration of solute

A

osmolality

603
Q

Which analytes contribute the most to osmolality?

A

electrolytes

604
Q

clinical significance of increased osmolality

A 
dehydration
uremia
uncontrolled diabetes
alcohol intoxication
salicylate intoxication
605
Q

clinical significance of decreased osmolality

A

excessive water intake

606
Q

normal range for osmolal gap

A

0-10 mOsm/kg

607
Q

similar to anion gap but based on osmotically active solute concentration rather than concentration of ions

A

osmolal gap

608
Q

clinical significance of >10 mOsm/kg

A

abnormal concentration of unmeasured substance (e.g., isopropanol, methanol, acetone, ethylene glycol_

609
Q

Which calculated chemistry value is used in the diagnosis of poisonings?

A

osmolal gap

610
Q

calculation for osmolal gap

A

measured osmolality minus calculated osmolality

611
Q

normal range for urine-to-serum osmolality

A

1-3

612
Q

calculation for urine-to-serum osmolality

A

urine osmolality divided by serum osmolality

613
Q

Beer’s Law: Concentration of unknown

A

(abs. of unknown/abs. of standard) x conc. of standard

614
Q

A calcium is reported as 10 mg/dL. What is the concentration in mEq/L?

A

Atomic weight of calcium = 40
Valence of calcium = 2+
GEW = gram equivalent weight (gram molecular weight divided by valence)

mEq/L = [(mg/dL)/GEW] x 10

mEq/L = [(10 x 10)/20) = 5

615
Q

A calcium is reported as 10 mg/dL. What is the concentration in mmol/L?

A

Atomic weight of calcium = 40
Valence of calcium = 2+
GMW = gram molecular weight

mmol/L = [(mg/dL)/GMW] x 10

mmol/L = [(10 x 10)/40] = 2.5

616
Q

A calcium is reported as 5 mEq/L. What is the concentration in mmol/L?

A

mmol/L = [(mEq/L)/valence]

mmol/L = 5/2 = 2.5

617
Q

What is the molarity of a solution that contains 45 grams of NaCl per liter?
(Atomic weights: NA = 23, Cl = 35.5)

A

Molarity (M) = grams per liter/GMW

M = 45/58.5 = 0.77

618
Q

What is the normality of a solution that contains 98 grams of N2SO4 per 500 mL?
(Atomic weights: H=1, S=32, O = 16)

A

Normality (N) = grams per liter/GEW

N = 196/49 = 4

619
Q

What is the concentration in % of a solution that contains 8.5 grams of NaCl per liter?

A

(8.5 g/1000 mL) x (x/100 mL)
1000x = (8.5) x 100
x = 0.85%

620
Q

What is the normality of a 3 M H2SO4 solution?

A

N = 3 x 2 = 6

621
Q

What is the molarity of a 0.3 M H2SO4 solution?

A

M = 0.3/2 = 0.15

622
Q

How many mL of 95% alcohol are needed to prepare 100 mL of 70% alcohol?

A

V1C1 = V2C2

```
x)(95) = (100)(70
x = 73.7 mL
~~~

AMT MLT Study Guide (3 decks)

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