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Reviewers > Clinical Chemistry (part 3) > Flashcards

Clinical Chemistry (part 3) Flashcards

1
Q

EC numerical code for ALP

A

3.1.3.1

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2
Q

Catalyze the hydrolysis of various phosphomonoesters at an alkaline pH (9.0 – 10.0) into alcohol and phosphate

A

ALP

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3
Q

ALP requires __ as an activator

A

Magnesium

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4
Q

Tissues sources of ALP

A

Liver, small intestine, kidney, bone, placenta

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5
Q

Diet may induce elevation in ALP activity of blood groups __ and __ individuals who are secretors

A

B and O

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6
Q

Not usually tackled ALP isoenzyme, but lectin may be used in electrophoresis to resolve it

A

Kidney ALP

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7
Q

Origin of ALP isoforms: genetic loci
Chromosome 1:
Chromosome 2:

A

Chromosome 1: Kidney, Liver, Bone
Chromosome 2: Intestinal, Placental

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8
Q
A
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9
Q

Normal ALP isoenzymes

A

Intestinal, placental, bone, liver

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10
Q

3 abnormal ALP isoenzymes (carcinoplacental ALPs)

A

Regan, Nagao, Kasahara

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11
Q

Abnormal ALP isoenzyme with the highest incidences is found in ovarian and gynecological cancers

A

Regan ALP

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12
Q

Abnormal ALP isoenzyme observed in pleural cancer and pancreatic and bile duct carcinomas

A

Nagao ALP

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13
Q

Abnormal ALP isoenzyme observed in hepatoma and GIT tumors

A

Kasahara ALP

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14
Q

Regan ALP is found in (4 carcinomas)

A

Lung cancer
Breast cancer
Ovarian cancer and gynecological
Colon cancer

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15
Q

Most heat-stable (including normal and abnormal ALP); Resist heat up to 60 deg C for 30 minutes

A

Regan ALP

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16
Q

Variant of Regan;
Found in metastatic carcinoma of pleural surfaces

A

Nagao

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17
Q

Most anodal ALP isoenzyme

A

Liver ALP

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18
Q

Least anodal ALP isoenzyme

A

Intestinal

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19
Q

Electrophoretic mobility of ALP isoenzymes towards the anode

A

Intestinal > Placental > Bone > Liver

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20
Q

3 methods to use to improve separation of bone and liver forms

A
  1. Neuraminidase
  2. Wheat germ lectin
  3. High resolution electrophoresis
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21
Q

Removes sialic acid

A

Neuraminidase

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22
Q

Bind other isoenzymes

A

Wheat germ lectin

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23
Q

Uses polyacrylamide gel and isoelectric focusing to remove multiple bands of ALP isoenzymes

A

High resolution electrophoresis

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24
Q

Heat stability is determined by heating serum at __

A

56 deg C for 10-15 minutes

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25
Q

Heat stability of ALP isoenzymes

A

Placental > Intestinal > Liver > Bone

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26
Q

Most heat-labile isoenzyme

A

Bone ALP

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27
Q

Most heat-stable of all normal ALP isoenzyme

A

Placental ALP

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28
Q

Regan ALP can resist heat up to ___

A

60 deg C for 30 minutes

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29
Q

After heat denaturation,
80% activity remains in: ___
20% activity remains in: ___

A

Placental
Bone

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30
Q

Inhibits placental, intestinal, Regan, and Nagao

A

L-phenylalanine

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31
Q

Inhibits liver and bone isoenzymes

A

Levamisol, L-homoarginine

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32
Q

Inhibits bone isoenzymes

A

2M urea

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33
Q

Inhibits Nagao isoenzyme

A

L-leucine

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34
Q

Denatures liver ALP rapidly than bone

A

20% ethanol

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35
Q

Enzyme often used in the evaluation of hepatobiliary disorders (obstructive conditions) and bone disorders

A

ALP

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36
Q

Highest elevation of Alp (5-10x ULN) is attributed to either __ or ___

A

Liver ALP or bone ALP

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37
Q

Biliary tract obstruction, biliary cirrhosis (type of ALP isoenzyme)

A

Liver ALP

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38
Q

Paget’s disease (Osteitis deformans), osteogenic sarcoma, hyperparathyroidism (type of ALP isoenzyme)

A

Bone ALP

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39
Q

Moderate ( up to 3x ULN) elevation of ALP is seen in:

A

Hepatocellular disorders – viral hepatitis and liver cirrhosis

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40
Q

ALP is elevated during pregnancy (3rd trimester until onset of labor) and normalizes after ___ of labor

A

6 days

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41
Q

ALP up to 3x ULN

A

Healing fractures and normal growth (children)

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42
Q

Decreased level of what enzyme is found in inherited condition of hypophosphatasia

A

ALP

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43
Q

Avoid hemolysis, ___ is 6 times more concentrated in RBCs than in serum

A

ALP

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44
Q

Run ALP asssays ASAP; ALP activity in serum increases __ at room temperature or refrigerated for several hours

A

3 – 10%

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45
Q

ALP values may be ___ higher following ingestion of a high-fat meal due to increase intestinal fraction

A

25%

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46
Q

Plasma should not be used - __, ___, ___ inhibit ALP activity

A

Citrate, oxalate, EDTA

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47
Q

Method of ALP determination

A

Bowers and Mc Comb

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48
Q

IFCC recommended method for ALP determination Szasz modification
Most specific method

A

Bowers and Mc Comb

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49
Q

Substrate used in the Bowers and Mc Comb of ALP determination

A

p-nitrophenyl phosphate

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50
Q

ALP isoenzyme found in extrahepatic biliary obstruction and intrahepatic cholestasis

A

Liver ALP

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51
Q

Optimum pH in Bowers and Mc Comb method for ALP determination

A

pH 10.5 at 30 deg C

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52
Q

Increased p-nitrophenol production is directly proportional to the activity of ALP in the sample; measured at ___

A

405 nm (yellow colored complex)

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53
Q

___ buffer is added to bind phosphorus in the sample (phosphorus inhibits ALP activity)

A

2-amino-2-methyl-1-propanol

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54
Q

Substrate and endproducts in Bessey, Lowry, Brock method of ALP determination

A

S: p-nitrophenyl phosphate
P: p-nitrophenol or yellow nitrophenoxide ion

“Bakit nahuli ng PNPP ang Bessey ko na nagnanakaw ng ALPo”

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55
Q

Substrate and endproducts in Huggins and Talalay (ALP determination)

A

S: Phenophthalein diphosphate
P: Phenolphthalein red

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56
Q

Substrate and endproducts in Moss (ALP determination)

A

S: Alpha naphthol phosphate
P: Alpha-naphthol

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57
Q

Substrate and endproducts in Klein, Babson, and Read (ALP determination)

A

S: Buffered phenolphthalein phosphate
P: Free phenolphthalein

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58
Q

Substrate and endproducts in Bodansky, Shinowara, Jones, Reinhart (ALP determination)

A

S: Beta-glycerophosphate
P: Inorganis phosphate + glycerol

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59
Q

Substrate and endproducts in King and Armstrong

A

S: Phenyl phosphate
P: Phenol

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60
Q

Gamma Glutamyl Transferase EC numerical code

A

2.3.2.2

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61
Q

Tissue sources of GGT

A

Kidneys, liver, prostate, pancreas

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62
Q

GGT present in the serum is predominantly derived from the __ tissue where it is concentrated in the lining of biliary ductules

A

Liver

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63
Q

Highest concentration of ALP and GGT

A

Biliary obstruction

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64
Q

In Myocardial infarction, the level of GGT is __

A

Normal

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65
Q

GGT in AMI

A

Occurs at 4th day
Peaks for another 4 days

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66
Q

If GGT is increased in MI, liver damage is secondary to __

A

Cardiac insufficiency

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67
Q

GGT is a sensitive indicator of hepatobilary disorders (biliary obstruction) ___ x ULN

A

5-30

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68
Q
A
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69
Q

Used to differentiate the source of ALP elevation

A

GGT

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70
Q

GGT is affected by enzyme-inducing drugs

A

Warfarin, phenobarbital, and phenytoin

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71
Q

GGT is slightly elevated in patients with ___

A

Diabetes mellitus

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72
Q

Hemolysis will not interfere with GGT

A

True

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73
Q

Preferred specimen for GGT

A

Serum

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74
Q

Anticoagulants that inhibit GGT activity

A

Citrate, oxalate, fluoride

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75
Q

Anticoagulant that causes turbidity in GGT determination

A

Heparin

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76
Q

GGT is stable with no loss of activity for ___ at ___

A

1 week at 4 deg C

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77
Q

Methodologies for GGT determination (3)

A

Szasz and Rosalki
Persijn and Van der Silk method
Goldberg method

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78
Q

IFCC recommended method for GGT determination
Optimum pH: 8.2
Subtrate: gamma-L-glutamyl-p-nitroanilide
Product: p-anilide (405-420 nm)

A

Szasz and Rosalki

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79
Q

Aka 5’-ribonucleotide phosphohydrolase

A

5’ nucleotidase

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80
Q

a metalloprotein with zinc as its integral component

A

5’ nucleotidase

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81
Q

More sensitive to metastatic liver disease than ALP

A

5’ nucleotidase

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82
Q

levels of 5’ NT after abdominal surgery

A

Increased

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83
Q

Similar to GGT, ___ is commonly used to determine the source of ALP elevation

A

5’ NT

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84
Q

Highest elevation of 5’NT is observed in ____

A

hepatobiliary disorders

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85
Q

Increased ALP, Normal GGT, Normal 5’NT

A

Pregnancy

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86
Q

Increased ALP, Increased GGT, Increased 5’NT

A

Hepatobiliary disorders

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87
Q

Increased ALP, Normal GGT, Normal 5’NT

A

Bone disorders

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88
Q

2 enzymes that can be used to estimate the degree r severity of liver cell damage

A

AST and GLD

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89
Q

___ elevation is observed in patients with hepatocellular disorder since GLD is a mitochondrial enzyme

A

GLD

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90
Q

4-5 x ULN in GLD:

A

Chronic hepatitis

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91
Q

2 x ULN in GLD:

A

liver cirrhosis

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92
Q

pronounced elevation of GLD is seen in ___

A

Halothane toxicity

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93
Q

Potential hepatotoxic drugs can lead to notable rise in ___ level

A

GLD

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94
Q

Type of GST with the highest concentration in the liver

A

Alpha

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95
Q

Evenly distributed in the liver acinus making it useful in determining all types of hepatocyte damage

A

GST

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96
Q

___ was found more valuable than AST in detecting early rejection episodes after liver transplant procedure

A

GST

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97
Q

True cholinesterase/ choline esterase I

A

Acetyl choline esterase

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98
Q

True cholinesterase is found in ___

A

RBCs

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99
Q

Enzyme that inhibits neurotransmission, and detection of neural tube defects

A

Acetyl choline esterase

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100
Q

Pseudocholinesterase

A

Serum cholinesterase/ butyryl cholinesterase

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101
Q

Only enzyme that decreased during infection or disease states

A

Pseudocholinesterase

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102
Q

Sensitive indicator of liver synthetic capacity

A

Pseudocholinesterase

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103
Q

In hepatitis, pseudocholinesterase is decreased by how many percent?

A

30 - 50%

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104
Q

In metastatic carcinoma and cirrhosis, pseudocholinesterase is decreased by how many percent?

A

50 -70%

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105
Q

Maker of organophosphate poisoning

A

Pseudocholinesterase

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106
Q

In surgical procedures, muslce relaxants are used. ___ is normally present to hydrolyze them

A

cholinesterase

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107
Q

EC numerical code of glycogen phoshorylase

A

Glycogen phosphorylase

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108
Q

Other names of glycogen phosphorylase

A

1,4-alpha-D-glucan (orthophosphate)
alpha-D-glucosyltransferase

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109
Q

3 isoenzymes of glycogen phosphorylase

A

GP-LL
GP-MM
GP-BB

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110
Q

GP found in liver and all other human tissues, except the heart, smooth muscle, and brain

A

GP-LL

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111
Q

GP found in adult skeletal muscle

A

GP-MM

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112
Q

GP found in human brain

A

GP-BB

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113
Q

EC numerical code of creatinine kinase

A

2.7.3.2

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114
Q

Catalyzes the transfer of phosphate to creatine

A

Creatinine kinase

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115
Q

Creatine + ATP –> creatinine phosphate +

A

ADP

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116
Q

Creatinine kinase requires __ and ___

A

Magnesium and thiol source (cysteine)

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117
Q

CK is inhibited by ___ and ___

A

Zinc and manganese
(excess magnesium can also inhibit CK)

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118
Q

CK is highly seen in what tissue source

A

striated muscle and heart muscle

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119
Q

__ and __ are devoid of CK actiivty

A

Erythrocytes and Liver

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120
Q

B subunit of CK is found in chromosome

A

14

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121
Q

M subunit of CK is found in chromosome

A

19

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122
Q

___ is responsible for rephosphorylation of ADP to ATP at pH 6.7 or pH 9.0

A

CK

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123
Q

It activates CK but present in minimal concentration because it is inhibitory

A

Magnesium

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124
Q

other sulfhydryl-binding reagent sulfhydryl compounds

A
  1. N-acetyl cysteine
  2. Dithiothreitol
  3. Glutathione
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125
Q

” The brain type “ CK

A

CK-BB

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126
Q

“The hybrid type” CK

A

CK-MB”

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127
Q

“The muscle type” CK

A

CK-MM

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128
Q

Tumor associated marker-prostatic carcinoma and other carcinomas

A

CK-BB

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129
Q

CK-BB is ___ (usually within 10 - 50 U/L) in carcinomas

A

> 5 U/L

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130
Q

Half-life of CK-BB

A

2-3 hours

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131
Q

CK type that is fastest to move to anode

A

CK-BB

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132
Q

CK type seen in acute myocardial infarction (1st to ride)

A

CK-MB

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133
Q

AMI in CK-MB

A

Rise within 4-8 hours
Peak at 12-24 hours
Returns to normal within 48-72 hours

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134
Q

CK-MB in the serum is derived only in __

A

myocardium

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135
Q

CK-MB that is >6% of the total CK is indicative of ___

A

myocardial damage

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136
Q

Half-life of CK-MB

A

12 hours

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137
Q

CK type seen in myocardial infarction and skeletal muscle disorders

A

CK-MM

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138
Q

Highest elevation of CK is seen in ___

A

Duchenne’s muscular dystrophy

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139
Q

Major isoenzyme of CK found in serum

A

CK-MM

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140
Q

Half life of CK-MM

A

15 hours

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141
Q

AMI markers
“MyTROPICAL”

A

Myoglobin
Troponin I
CK-MB
AST
LDH

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142
Q

20% if CK-MB is found in ___

A

Cardiac tissue

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143
Q

CK-MB concentration in healthy serum

A

<5 ug/L

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144
Q

More specific during myocardial damage

A

Troponins

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145
Q

2 atypical forms of CK

A

CK-MI
Macro-CK

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146
Q

Chromosome 15
Constitutes up to 15% of the total CK

A

CK-MI

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147
Q

Largely comprises CK-BB complexed with IgG
Some comprises CK-MM complexed with a lipoprotein

A

Macro-CK

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148
Q

CK is not present in RBCs, but ___, which catalyzes a similar reaction as that of CK is present - False increase in CK

A

adenylate kinase

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149
Q

CK is stored in ___

A

Dark
(since recent studies show that CK is inactivated by direct light exposure)

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150
Q

Removes adenylate kinase

A

adenosine monophosphate

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151
Q

specimen of choice for CK

A

Serum
(heparinized plasma can be used; other anticoagulants inhibit CK activity)

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152
Q

2 methodologies in CK determination

A

Tanzer-Gilvarg
Oliver-Rosalki

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153
Q

ATP + creatine –> ADP + creatine phosphate
ADP formed is reacted with pyruvate kinase and lactate dehydrogenase
PK: ADP + phosphoenol pyruvate –> ATP + pyruvate
LDH: pyruvate + NADH –> lactate and NAD

NADH absorbs light at 340 nm (pH 9.)

A

Tanzer-Gilvarg method

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154
Q

ADP + creatine phosphate –> ATP + creatine
ATP formed from the reaction is reacted with Hexokinase and G6PD
pH: 6.7
Reverse reaction that is 6x faster than forward reaction
Addition of adenosine monophosphate inhibits adenylate kinase

A

Oliver-Rosalki (reverse reaction)

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155
Q

EC Numerical code for Lactate dehydrogenase

A

1.1.1.27

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156
Q

Catalyzes the reversible conversion of lactate and NAD into pyruvate and NADH
Lactate + NAD –> pyruvate + NADH

A

LDH

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157
Q

pH of the forward reaction in LDH determination

A

8.8 - 9.8

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158
Q

pH of the reverse reaction in LDH determination

A

7.4 - 7.8

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159
Q

One of the components of LDH determination methods

A

Zinc

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160
Q

LD-M is found in chromosome

A

11

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161
Q

LD-H is found in chromosome

A

12

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162
Q

Most abundant and most heat-stable LD

A

LD-2

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163
Q

Least anodal and most cold-labile LD (4 deg C loss of activity)

A

LD-5

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164
Q

Normal LD pattern

A

LD2> LD1 > LD3 > LD4 > LD5

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165
Q

Electrophoretic mobility of LD
(least anodal to most anodal)

A

LD5 - LD4 - LD3 - LD2 - LD1

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166
Q

LD isoenzyme present in post-pubertal human testes (not found in human serum but in seminal fluid)

A

LD-X or LD-C
(XXXX or CCCC)

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167
Q

LD observed in arteriosclerotic cardiovascular failure

A

LD6

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168
Q

3 clinical significance of LDH

A

Hemolytic anemia
Hepatic and non-hepatic metastases
Myocardial infarction

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169
Q

LD is ___ x ULN in megaloblastic anemia (pernicious anemia)

A

50 (highest elevation)

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170
Q

LD flipped pattern (LD1 > LD2) is seen in

A

myocardial infarction

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171
Q

AMI in LD

A

Rises within 12-24 hours
Peaks at 48-72 hours
remains elevated for long periods of time
Returns to normal within 10 days

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172
Q

Specimen of choice for LD

A

Serum
(anticoagulant may inhibit LD activity)

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173
Q

LD is present __ times in RBCs than in serum

A

100 - 150

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174
Q

Moderate elevations of LD

A

Acute viral hepatitis
Cirrhosis

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175
Q

Slight elevations of LD is seen in

A

Biliary tract disease

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176
Q

2 methods of LD determination

A

Wacker (forward reaction)
Wroblewski and La Due (reverse reaction)

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177
Q

Measure enzymatic activity as lactate is converted to pyruvate
UV kinetic or colorimetric

A

Wacker method (LD determination)

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178
Q

Measures increase in absorbance at 340 nm as NAD is converted to NADH (LD determination)

A

Colorimetric method (Wacker)

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179
Q

Colorimetric method (Wacker):
Addition of phenazine methosulfate and nitroblue tetrazolium which reacts with NADH to produce a positive ___

A

blue-purple color

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180
Q

Colorimetric method (Wacker):
Addition of p-nitrophenylhydrazine (or 2,4-dinitrophenylhydrazine) which reacts with pyruvate producing phenylhydrazone – ___ color at alkaline pH measured at 440 or 525 nm

A

Golden brown

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181
Q

Measures enzymatic activity as pyruvate is converted to lactate
Measures the decrease in absorbance at 340 nm as NADH is converted to NAD
3 times faster than forward reaction of LD determination

A

Wroblewski and La Due (reverse reaction)

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182
Q

Catalyzes an early step in glycolysis for glucose

A

Aldolase

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183
Q

Highest level in skeletal muscle disease or injury, metastatic carcinoma of the liver, granulocytic leukemia

A

Aldolase

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184
Q

AMI in Aldolase

A

Rises 6-8 hours and stay elevated up to 3-4 days

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185
Q

RBC alsolase is __ times as high as the serum level

A

150

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186
Q

Specimen of choice of Aldolase determination

A

Plasma
(because of the possible release of platelet enzyme during clotting

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187
Q

3 tetramers of aldolase

A

ALD A - skeletal muscle
ALD B - WBC, Liver, Kidney
ALD C - Brain tissue

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188
Q

Acid orthophosphoric monoester phosphohydrolase

A

Acid phosphatase

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189
Q

factor conversion of ACP

A

860 - Total ACP
853 - Non-prostatic ACP

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190
Q

catalyze the hydrolysis of various phosphomonoesters at an optimal pH of below 7.0 (5.0 - 6.0)

A

acid phosphatase

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191
Q

Highest concentration in prostate and RBCs, mod amounts in bone, platelets, liver, and spleen

A

ACP

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192
Q

Isoenzymes of ACP and their location

A

Prostatic ACP - Chr 13
Bone ACP - Chr 19 (TRACP)
Lysosomal ACP - Chr 11
Erythrocytic ACP - Chr 2
Macrophage ACP - Chr 19

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193
Q

Metastatic carcinoma of the prostate

A

ACP

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194
Q

Enzyme used in the medico legal evaluation of rape (up to 4 days in vaginal washings)

A

ACP

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195
Q

TR-ACP is found in (3 conditions)

A

Bone diseases
Gaucher’s disease
Hairy cell leukemia (leukemic reticuloendotheliosis)

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196
Q

ACP is labile at room temperature - acidification of sample is needed (___ is used to achieve a pH of 6.2 to 6.6)

A

Acetate buffer (20 uL : 1 ml serum)

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197
Q

Preferred sample for ACP determination

A

Plasma

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198
Q

Preferred anticoagulant for ACP determination

A

Citrate

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199
Q

Anticoagulant that inhibits ACP

A

Fluoride

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200
Q

Anticoagulant that false decrease ACP

A

Heparin and oxalate

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201
Q

ACP isoenzyme that remains in the origin

A

Erythrocytic ACP

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202
Q

ACP isoenzyme that migrates the fastest

A

Prostatic ACP

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203
Q

Inhibits the activity of the prostatic ACP and Lysosomal ACP

A

L-tartrate

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204
Q

Formula for prostatic ACP

A

Prostatic ACP = Total ACP - Nonprostatic ACP

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205
Q

2% formaldehyde and 1 mM cupric sulfate solutions inhibit the activity of ___

A

erythrocytic ACP

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206
Q

Other methods for total ACP activity

A

Thymolphthalein monophosphate
Alpha-naphthyl phosphate

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207
Q

The substrate of choice for most endpoint reactions of Total ACP activity

A

Thymolphthalein monophosphate

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208
Q

Substrate of choice for most continuous monitoring assays of Total ACP activity

A

Alpha-naphthyl phosphate

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209
Q

6 other methods of ACP determination

A

Bodansky
Gutman, King, Armstrong
Hudson
Babson and Reed
Roy
Reitz, Guilbault

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210
Q

Bodansky subtrate and product;
nonspecific to prostatic ACP; lengthy assay

A

S: Beta-glycerophosphate
P: Glycerol

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211
Q

Gutman, King, Armstrong substrate and product;
non-specific to prostatic ACP

A

S: phenyl phosphate
P: Phenol

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212
Q

Hudson substrate and product;
non-specific to prostatic ACP; rapid assay

A

S: p-nitrophenyl phosphate
P: p-nitrophenol

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213
Q

Babson and Reed substrate and product;
less sensitive to prostatic ACP

A

S: Alpha-naphthyl phosphate
P: Alpha-naphthol

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214
Q

Roy (most specific) substrate and product;
most specific method for prostatic ACP; less interferences from bilirubin and hemoglobin

A

S: THymolphthalein monophosphate
P: Thymolphthalein
(has a strong absorbance at 590 nm)

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215
Q

Reitz, Guilbault substrate and product;
fluorescence method

A

S: 4-methylumbeliferonephosphate
P: methylumberliferone

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216
Q

Catalyzes the breakdown of starch and glycogen

A

Amylase (diastase)

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217
Q

Enzyme that requires calcium and chloride for activation

A

Amylase (diastase)

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218
Q

Smalles enzyme; only enzyme present in urine

A

Amylase

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219
Q

Highest tissue concentration of amylase

A

acinar cells of the pancreas and salivary glands

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220
Q

2 isoenzymes of amylase

A

P-amylase
S-amylase

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221
Q

Other name of P-amylase

A

Amylopsin

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222
Q

Other name of S-amylase

A

Ptyalin

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223
Q

Tissue source of P-amylase

A

Predominantly from pancreatic tissue

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224
Q

Tissue source of S-amylase

A

salivary glands

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225
Q

Electrophoretic mobility of P-amylase

A

Slowest towards the anode

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226
Q

Electrophoretic mobility of S-amylase

A

Fastest towards the anode

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227
Q

Presence in sample of P-amylase

A

Found in urine

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228
Q

Presence in sample of S-amylase

A

Found in serum

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229
Q

Acute pancreatitis (Amylase)

A

Rises within 2-12 hours
Peaks at 24 hours
Returns to normal within 3-5 days

230
Q

Amylase 5 or more x ULN

A

Pancreatic pseudocyts
Morphine administration
Lung and ovarian tumors

231
Q

Amylase 3-5 x ULN

A

Pancreatic carcinoma
Mumps
Perforated peptic ulcer
Ionizing radiation

232
Q

Amylase can be detected in serum, urine, and __

A

peritoneal fluid

233
Q

Saliva contains ___ times more amylase than serum

A

700

234
Q

Red cells do not contain amylase (T/F)

A

T

235
Q

__ and ___ falsely elevate amylase

A

Morphine and opiates

236
Q

Macroamylasemia, lipemia, bilirubin ___, and insulin falsely decrease amylase

A

> 20 mg/dl

237
Q

Urine samples for amylase determination

A

24-hour urine sample
adjusted to a pH of 7.0 (using either 0.1 N NaOH or 0.1 N HCl)

238
Q

inhibits amylase activity

A

Calcium-binding anticoagulants

239
Q

What is the level of amlase in patients with acute pancreatitis and hyperlipemia?

A

Normal
(since the excess AMY is inhibited by triglyceride)
nagcancel out kaya naging normal

240
Q

4 methods of amylase determination

A

Saccharogenic
Amyloclastic
Coupled enzymatic reaction
Chromogenic

241
Q

Amylase determination method
Sugar-generating;
Includes Folin-Wu and Somogyi-Nelson;
Measures reducing sugars produced by hydrolysis of starch;
“Sugar-cutting”

A

Saccharogenic

242
Q

Amylase determination method;
Starch-cutting or iodometric method;
Includes method of Caraway;
Measures decrease in substrate concentration;
Starch + iodine –amylase–> dark blue colored compound;
endpoint: absence of blue starch-iodine complex
Reduction in the intensity of the blue colored compound is directly proportional to the activity of amylase

A

Amyloclastic

243
Q

Amylase determination method;
Coupling of several enzyme systems;
Often used for automated procedures;
Substrate: matopentose or maltotetraose;
Optimal pH: 6.9;
Coupled enzymes used:
(1) amylase-glucosidase-glucoamylase
(2) amylase-glucosidase-hexokinase-G6PD
(most commonly used)

A

Coupled enzymatic reaction

244
Q

Amylase determination method;
starch is bound to a chromogenic dye;
the complex is hydrolyzed by amylase releasing dye-substrate fragments;
increase in color intensity is proportional to the activity of amylase

A

Chromogenic

245
Q

Hydrolyzes the ester linkages of fats to produce alcohol and fatty acids

A

Lipase

246
Q

Primary tissue source of lipase

A

Pancreas

247
Q

Clinical significance of lipase (2)

A

Acute pancreatitis
Chronic pancreatitis

248
Q

Acute pancreatitis in Lipase

A

Rises within 4-8 hours
Peaks at 24 hours
Remains elevated for 5 days to 2 weeks

249
Q

More sensitive enzyme in detecting acute pancreatitis

A

Lipase

250
Q

Complete absence of lipase resulting to fat malabsorption and severe steatorrhea

A

Chronic pancreatitis

251
Q

Result of hemolysis in lipase

A

False decrease

252
Q

Cause of false increase lipase concentration

A

Bacterial contamination

253
Q

3 methods of lipase determination

A

Cherrry and Crandall
Turbidimetric
Colorimetric

254
Q

Substrate in Cherry and Crandall method that liberates fatty acids and measured by titration with NaOH after 24-hour incubation

A

Olive oil

255
Q

Substrate in Cherry and Crandall that is used for a more pure form of triglycerides

A

Triolein

256
Q

Used to determine the amount of acid released in Cherry and Crandall method of lipase determination

A

Copper salt

257
Q

___ measurement of copper indicates the amount of fatty acids present corresponding to the level of enzyme activity

A

Colorimeteric

258
Q
A
258
Q

Simpler and more rapid of lipase determination;
measurement of rate of clearing as an estimate for lipase activity

A

Turbidimetric method

259
Q

Coupled reactions with peroxidase or glycerol kinase of lipase determination

A

Colorimetric method

260
Q

Tissue source of G6PD

A

RBC

261
Q

For assessment of X-linked disorder of G6PD deficiency;
Decreased with hereditary disposition to hemolytic crises after ingestion of oxidant drugs

A

G6PD

262
Q

In G6PD deficiency, ___ is used

A

Red cell hemolysate

263
Q

G6PD excess uses this type of specimen

A

serum

264
Q

Pseudocholinesterase is found in these tissue sources

A

Liver
Brain
Serum

265
Q

Sensitive indicator of liver synthetic capacity;
insecticide poisoning;
organophosphate poisoning (Decrease in concentration)

A

Pseudocholinesterase

266
Q

aka serum cholinesterase, butyrylcholinesterase;
used to hydrolyze muscle relaxants administered in surgical operations

A

Pseudocholinesterase

267
Q

Enzymes used for pancreatic profile

A

LIpase, amylase

268
Q

Enzymes used to assess hepatic disorders

A

AST, ALT, (GST, GGT)

269
Q

Enzymes used to assess hepatobiliary disorders

A

ALT, GGT, 5’NT

270
Q

Average water content of the human body

A

40% to 70% (45% to 75%)
(2/3 ICF, 1/3 ECF)

271
Q

test measures the solute concentration of plasma

A

osmolality

272
Q

In response to an increased plasma osmolality, ____ is secreted by the posterior pituitary gland stimulated by the hypothalamus

A

arginine vasopressin hormone (formerly ADH)

273
Q

Normal plasma osmolality

A

275 - 295 mOsm/kg of plasma H2O

274
Q

Determines state of hydration
Increased POV = dehydrated

A

Osmolality

275
Q

Stimuli (increased BP and Plasma volume)
Prevents salt-induced hypertension and congestive heart failure

A

Natriuretic peptides

276
Q

2 body water compartments

A

Extracellular compartment (1/3)
Intracellular compartment (2/3)

277
Q

2 types of extracellular water compartment

A

Physiological
Transcellular

278
Q

Plasma osmolality and __ are maintained within a narrow range

A

Sodium

279
Q

Principal determinant of plasma osmolality

A

Sodium

280
Q

Produced primarily in the atrium of the heart
Reduced venous pressure due to increase blood volume;
Increases vascular permeability;
Promotes natriuresis and diuresis;
Inhibits salt appetite, water intake, and ADH and cortisol secretion in the brain

A

Atrial Natriuretic peptide

281
Q

More potent natriuretic and diuretic

A

Urodilatin

282
Q

Produced primarily from the ventricles of the heart;
Has cardiovascular, natriuretic, and diuretic effects

A

Brain natriuretic peptide

283
Q

Produced in the brain, vascular endothelial cells and renal tubules
Most potent vasodilator but has no natriuretic effect

A

C-type natriuretic peptide

284
Q

Charged particles

A

Electrolytes

285
Q

Electrolyte panel

A

Sodium
Potassium
Chloride
Bicarbonate

286
Q

Anticoagulant of choice for electrolyte analysis

A

Heparin

287
Q

Balance of charges (equal no. of cations and anions)

A

Electroneutrality

288
Q

Major extracellular cation (90%)
largely determines the plasma osmolality

A

Sodium

289
Q

sodium levels are mainly controlled by

A

Aldosterone

290
Q

Sodium levels in blood is dependent on (4 factors)

A
  1. sodium intake and excretion
  2. renal regulation
  3. arginine vasopressin hormone
  4. aldosterone
291
Q

PISO

A

Potassium In (2 molecules)
Sodium out (3 molecules)

292
Q

Causes of hypernatremia

A

Increased water loss relative to sodium loss
Decreased water intake
Increased sodium intake or retention
Diabetes mellitus
Hyperaldosteronism

293
Q

Causes of hyponatremia

A

Increased sodium loss
Increased water retention
Water imbalance
Hypoaldosteronism
Potassium deficiency
Ketonuria
Salt-losing nephropathy
Vomiting, diarrhea, SIADH

294
Q

Primary intracellular cation

A

Potassium

295
Q

NV or potassium

A

3.5 - 5.5 mmol/L

296
Q

Only electrolyte clinically affected by hemolysis

A

Potassium

297
Q

Involved in the proper transmission of nerve impulses

A

Potassium

298
Q

Important for heart contraction - abnormal levels can lead to altered electrocardiographic patterns

A

Potassium

299
Q

Causes of Hyperkalemia

A

Decreased renal excretion
Increased potassium intake
Hemolysis, thrombocytosis, prolonged tuorniquet applications, excessive fist clenching

300
Q

Causes of hypokalemia

A

GI loss
Decreased potassium intake
Renal loss
Cellular shift (alkalosis, insulin overdose)

301
Q

Major extracellular anion

A

Chloride

302
Q

Counterion of sodium - to maintain electroneutrality

A

Chloride

303
Q

Maintains water balance, osmotic pressure, and anion-cation balance in the ECF
Responsible for chloride shift

A

Chloride

304
Q

Exchange mechanism between chloride and bicarbonate across RBC membrane

A

Chloride shift

305
Q

Causes of hyperchloremia

A

Excess loss of bicarbonate
Renal tubular acidosis
Metabolic acidosis

306
Q

Causes of hypochloremia

A

Prolonged vomiting
Diabetic ketoacidosis
Hypoaldosteronism
Salt-losing nephropathy
High serum bicarbonate

307
Q

5th most abundant cation
Contributor to structure of bone and teeth;
Coagulation factor IV;
for proper contraction of heart muscles and a neurotransmission regulator

A

Calcium

308
Q

Causes of hypercalcemia

A

Primary hyperparathyroidism
Familial hypocalciuric hypercalcemia
Ectopic secretion of PTH by neoplasms
Malignancy associated
Vitamin D intoxication
Thyrotoxicosis
Hypoadrenalism

309
Q

Causes of hypocalcemia

A

Primary hypoparathyroidism
Severe hypomagenesemia
Pseudohypoparathyroidism
Vitamin D deficiency
Chronic renal failure
Fanconi’s syndrome
Rhabdomyolysis

310
Q

Most reabsorbed in kidneys as CO2

A

Bicarbonate

311
Q

Increased in metabolic alkalosis
Decreased in metabolic acidosis

A

Bicarbonate

312
Q

Second most abundant anion in ECF
Account for more than 90% of the total CO2;
Major component of the buffering system in blood
Diffuses out of the cell in exchange for chloride

A

Bicarbonate

313
Q

Regulation controlled largely by kidneys
PTH increases renal reabsorption and intestinal reabsorption
Aldosterone and thyroxine increase renal excretion

A

Magnesium

314
Q

Increased in renal failure, acute diabetic acidosis, dehydration;
decreased in chronic alcoholism, malabsorption, severe diarrhea, pancratitis

A

Magnesium

315
Q

Second most abundant intracellular cation
Low levels cause tetany

A

Magnesium

316
Q

Kidneys play major role in regulation;
PTH decreases it while Vitamin D and GH increase its levels

A

Phosphate

317
Q

Hyperphosphatemia

A

Acute or chronic renal failure
Neonates with increased intake
Increased breakdown of cells
Lymphoblastic leukemia

318
Q

Hypophophostemia

A

Diabetic ketoacidosis
COPD
Asthma
Malignancies
Inflammatory bowel disease

319
Q

Only electrolyte affected by diurnal variation
Highest levels in the late morning and lowest in the evening

A

Phosphate

320
Q

Concentration of inorganic and organic phosphates in adults

A

60 grams

321
Q

Electrolyte that is not specifically regulated;
Liver is the major organ that removes it

A

Lactate

322
Q

Lactate is increased in :

A

Hypoxic conditions
(shock, MI, CHF, pulmonary edema, blood loss)
Metabolic origin
(DM, severe infection, leukemia, liver and kidney diseases, and toxins)

323
Q

By-product of an emergency mechanism that produces a small amount of ATP when oxygen is severely diminished

A

Lactate

324
Q

Specimen considerations in sodium determination

A

Serum, plasma, 24 hr urine, sweat, CSF

325
Q

Formula for sodium determination

A

Na = CO2 + Cl + 10 or
Na = CO2 + Cl + 12

326
Q

3 methodologies for Sodium determination

A

Flame Emission Photometry
Atomic Absorption Spectrophotometry
Ion Selective Electrode (most common method)

  • emits light at 590 nm
327
Q

Method wherein sodium produces yellow color when exposed to flame
- sodium emits light at 590 nm
- serum is diluted with high purity water (1:100 or 1:200)

A

Flame emission photometry

328
Q

NV of serum sodium

A

135 to 145 mmol/L

329
Q

Normal value of 24-hour urine sample (sodium)

A

40 to 220 mmol/day

330
Q

NV of CSF serum

A

138 to 150 mmol/L

331
Q

Specimen considerations for potassium

A

Serum/Plasma
No to prolonged tourniquet application

332
Q

3 methods of potassium determination

A

Flame Emission photometry
AAS
ISE (most common method)

  • emits light at 768 nm
333
Q

In sodium determination using ISE, what is the membrane used?

A

Valinomycin

334
Q

NV of serum potassium

A

3.4 to 5.0 mmol/L

335
Q

NV of potassium in 24 hour sample

A

25 to 125 mmol/day

336
Q

Electrolyte that has the most narrow reference range and is most strictly regulated by the body

A

Potassium

337
Q

Anticoagulant of choice for chloride measurements

A

lithium heparin

338
Q

4 methods of chloride determination

A

ISE
Amperometric-Colorimetric titration
Mercurimetric titration
Colorimetric method

339
Q

Most commonly used method of chloride measurement

A

ISE

340
Q

Membrane used in ISE for the determination of chloride

A

Combination of silver wire coated with AgCl

341
Q

Principle of Amperomeric-Colorimetric titration of chloride measurement

A

Cotlove Chloridometer

342
Q

Principle of mercurimetric method of chloride determination

A

Sshales and Schales method

343
Q

What leads to a positive error in mercurimetric titration in chloride determination

A

Bromide

344
Q

Uses mercuric thiocyanate and ferric nitrate to form ferric thiocyanate (red colored complex with a peak absorbance at 480 nm)
- used in autoanalyzer (Technicon) in chloride measurement

A

Colorimetric method

345
Q

NV serum chloride

A

98 to 107 mmol/L

346
Q

NV of chloride in 24 hr urine

A

110 to 250 mmol/day

347
Q

In 24 hr urine calcium, the sample is acidified using ___

A

6M HCl (1ml per 100 ml urine)

  • to prevent precipitation of calcium
348
Q

2 methodologies in calcium determination

A

Orthocresolphthalein complexone
Arsenzo III

349
Q

Conversion factor of calcium

A

0.25

350
Q

A calcium chelator
-produces reddish complex (570 to 578nm)
-used in autoanalyzer (Hitachi and Dimension)

A

Orthocresolphthalein complexone

351
Q

Method used in calcium measurement
- used in autoanalyzer (Vitros and Synchron)

A

Arsenzo III

352
Q

NV of Total Calcium

A

Child: 2.20 - 2.70 mmol/L
Adult: 2.15 - 2.50 mmol/L

353
Q

NV of Ionized calcium

A

Child: 1.20 - 1.38 mmol/L
Adult: 1.16 - 1.32 mmol/L

354
Q

NV of 24 hour urine calcium

A

2.50 - 7.50 mmol/day

355
Q

24 hour urine ___ is acidified with __

A

6M HCl

356
Q

5 methods of magnesium measurement

A

-Colorimetric method
-Dye lake method
-Fluorometry
-AAS: Reference method
-ISE: most common

357
Q

Magnesium measurement wherein the titan yellow dye (clayton yellow/thiazole yello) forms a red lake with magnesium)

A

Dye-lake method

358
Q

NV for serum magnesium

A

0.63 - 1.0 mmol/L

359
Q

Method for phosphate measurement

A

Fiske-Subbarow Method

360
Q

Reagent used in Fiske-Subbarow method

A

Molybdate

361
Q

NV for serum magnesium

A

Neonate: 1.45 - 2.91 mmol/L
Child: 1.45 - 1.78 mmol/L
Adult: 0.87 - 1.45 mmol/L

362
Q

NV or 24 hour urine phosphate

A

13 - 42 mmol/day

363
Q

Difference between unmeasured anions and unmeasured cations;
-useful in indicating an increase in one or more of the unmeasured anions in the serum
-serves as a form of quality control for the analyzer used to measure these electrolytes

A

Anion gap

364
Q

Formula for anion gap

A

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

365
Q

NV of anion gap

A

7 - 16 mmol/L or
10 - 20 mmol/L

366
Q

Increased AG

A

Methanol
Uremia
Diabetic ketoacidosis
Iron, inhalants, isoniazid. ibuprofen
Lactic acidosis
Ethylene glycol poisoning, ethanol ketoacidosis
Salicylates, starvation

367
Q

Decreased AG

A

Hypoalbuminemia
Severe hypercalcemia
Multiple Myeloma
Instrument error

368
Q

Substance that can yield a hydrogen ion when dissolved in water

A

Acid

369
Q

Substance that can yield hydroxyl ion when dissolved in water

A

Base

370
Q

The relative strength and ability of acids and bases to dissociate in water

A

Dissociation constant or ionization constant K value

371
Q

5 Buffer systems

A

Bicarbonate
Ammonia-Ammonium
Protein
Phosphate
Hemoglobin

“BAPPH”

372
Q

Important buffer of H in red blood cells
-binds and release H to facilitate its buffering effect

A

Hemoglobin Buffer System

373
Q

Most abundant buffer in the ICF and blood plasma
-most circulating proteins have a negative charge capable of binding H

A

Protein Buffer System

374
Q

Important buffer system in the secretion of H via urination

A

Ammonia-ammonium buffer system

375
Q

If pH is too high:
(what is the response of the carbonic acid-bicarbonate buffer system)

A

HCO3 is excreted while H is reabsorbed

376
Q

if pH is too low
(what is the response of the carbonic acid-bicarbonate buffer system)

A

H will be excreted while HCO3 is reabsorbed

377
Q

Normal ratio of bicarbonate to carbonic acid

A

20:1

378
Q

2 organs that play important roles in regulating blood pH

A

Lungs, kidneys

379
Q

The interrelationship of lungs and kidneys in maintaining pH is depicted by the ___

A

Henderson-Hasselbach equation
(recall)

380
Q

Important regulator of pH in the cytosol
- buffers acid in urine
-secretes excess H in the kidney tubule
-combines with HPO4 to produce H2PO4

A

Phosphate buffer system

381
Q

___ is expressed in concentration of dissolved carbon dioxide

A

H2CO3

382
Q

Concentration is controlled by the kidneys; Non-respiratory or “metabolic” component

A

HCO3

383
Q

Concentration is controlled by the lungs;
- respiratory component

A

H2CO3

384
Q

___ is computed by multiplying partial pressure of carbon dioxide (mmHg) by alpha (solubility coefficient of carbon dioxide)

A

dCO2

385
Q

Normal average of pCO2 is equal to __

A

40 mmHg

386
Q

THe solubility coefficient of CO2 is ___

A

0.03 mmol/K/ mmHg

387
Q

the Pka is equal to 6.1, with a bicarbonate concentration of ___

A

24 mmol/L

388
Q

The normal ratio of bicarbonate to carbonic acid, which is expressed in dCO2 is ___

A

20:1

389
Q

The normal blood pH is 7.4. the normal range is from

A

7.35 to 7.45

390
Q

Blood pH <7.35

A

acidosis

391
Q

Blood pH >7.45

A

alkalosis

392
Q

Action of the body to restore acid-base homeostasis whenever an imbalance occurs
-alters the factor not primarily affected by the pathologic process

A

Compensation

393
Q

In metabolic/nonrespiratory acidosis or alkalosis: ____ compenstation
- response is short-term and often incomplete

A

Respiratory

394
Q

In respiratory acidosis or alkalosis: ___ compensation
-response is slower but long term and potentially complete

A

Renal

395
Q

If the pH has returned to the normal range, meaning the 20:1 ratio has been restored, it is considered ____

A

Fully compensated

396
Q

If the pH is approaching the normal range, it is considered

A

Partially compensated

397
Q

Due to a decreased bicarbonate level

A

Metabolic acidosis

398
Q

Metabolic acidosis is caused by:

A
  1. Renal tubular acidosis
  2. Direct administration of acid-producing substances (ammonium chloride, calcium chloride)
  3. Excessive formation of organic acids (diabetic ketoacidosis, starvation)
  4. Excessive loss of bicarbonate (diarrhea)
399
Q

Primary compensation for metabolic acidosis

A

lungs blow off CO2 to raise pH

400
Q

Significant laboratory findings of metabolic acidosis

A

Decreased pH, normal pCO2, decreased HCO3

401
Q

Due to decreased alveolar ventilation (hypoventilation)

A

Respiratory acidosis

402
Q

Respiratory acidosis results to ___

A

hypercapnia

403
Q

Respiratory acidosis is caused by:

A
  1. Lung diseases (COPD, bronchopneumonia)
  2. Hypoventilation caused by drugs (barbituates, morphine, alcohol)
  3. Mechanical obstruction or asphyxiation
  4. Asthma
  5. Severe pulmonary infection
404
Q

Primary compensation of respiratory acidosis

A

Renal compensation (it takes days to weeks to complete)

405
Q

Significant laboratory findings of respiratory acidosis

A

Decreased pH, increased pCO2, normal HCO3

406
Q

Due to an increased bicarbonate level; ratio is greater than 20:1 because of increased HCO3

A

Metabolic alkalosis

407
Q

Metabolic alkalosis is caused by:

A
  1. Excessive loss of acid (vomiting and nasogastric suctioning)
  2. Prolonged use of diuretics
  3. Excessive sodium bicarbonate administration
  4. Hyperaldosteronism and Cushing’s syndrome
  5. Ingestion of bicarbonate-producing salts (sodium, lactate, citrate, and acetate)
408
Q

Primary compensation of metabolic alkalosis

A

lungs retain CO2 to lower pH

409
Q

Significant laboratory findings of metabolic alkalosis

A

Increased pH, normal pCO2, Increased HCO3

410
Q

Due to an increased alveolar ventilation (hyperventilation)

A

Respiratory alkalosis

411
Q

Causes of respiratory alkalosis

A
  1. Hysteria
  2. Pulmonary emboli and pulmonary fibrosis
  3. Fever
  4. Increased in environmental temperature
  5. Drugs that stimulates respiratory center (salicylates)
  6. Congestive heart failure
412
Q

Primary compensation of respiratory alkalosis

A

Renal compensation

413
Q

Significant laboratory findings in respiratory alkalosis

A

Increased pH, decreased pCO2, normal HCO3

414
Q

NV
Blood pH
pCO2
HCO3
pO2
Total CO2
Oxygen saturation

A

NV
Blood pH: 7.35 - 7.45
pCO2: 35 - 45 mmHg
HCO3: 22 - 26 mmol/L
pO2: 80 - 110 mmHg
Total CO2: 23 - 27 mmol/L
Oxygen saturation

415
Q

3 methods for blood gas analysis

A

-Spectrophotometric (Co-oximeter)
-Blood Gas analyzers
-Stow-Severinghaus ISE method
-Enzymatic methods

416
Q

Method for blood gas analysis that determines oxygen saturation and the actual percent of oxyhemoglobin

A

Spectrophotometric (Co-oximeter)

417
Q

Method for blood gas analysis that use electrodes as sensing devices to measure pO2, pCO2, and pH

A

Blood Gas Analyzers

418
Q

pO2 measurement is ___

A

amperometric

419
Q

pCO2 measurement is ___

A

potentiometric

420
Q

Method for blood gas analysis that measures total CO2 with the use of an acid reagent

A

Stow-Severinghaus ISE method

421
Q

Method for blood gas analysis that use phosphoenolpyruvate carboxylase and malate dehydrogenase

A

Enzymatic methods

422
Q

Preferred sample for blood gas analysis

A

Arterial blood

423
Q

Air trapped in syringe for blood gas analysis leads to

A

increased pO2, decreased pCO2

424
Q

Anticoagulant used in blood gas analysis and its corresponding concentration

A

Liquid heparin - 0.05 ml per ml of blood

425
Q

If processing for blood gas analysis is delayed, what is the next course of action

A

Transport the specimen in chilling condition

426
Q

Specialized organs capable of producing hormone

A

Endocrine system

427
Q

3 structural classes of hormones

A

Steroid hormones
Protein hormones
Amine hormones

428
Q

Site of production of steroid hormones

A

Adrenal glands, gonads, placenta

429
Q

Chemical component of steroid hormones

A

Cholesterol

430
Q

Carrier of steroid hormones

A

Protein

431
Q

Examples of steroid hormones

A

Cortisol
Aldosterone
Testosterone
Estrogen
Progesterone

432
Q

Site of production of protein hormones

A

Anterior pituitary, placenta, and parathyroid glands

433
Q

Chemical component of protein hormones

A

Protein

434
Q

Production and storage of protein hormones

A

Synthesized then stored in cell as secretory granules until needed

435
Q

Examples of protein hormones

A

FSH
LH
TSH
hCG
Glucagon
Parathyroid hormone
GH
Prolactin

436
Q

Site of production of amine hormones

A

Thyroid and adrenal glands

437
Q

Chemical component of amine hormones

A

Amino acids

438
Q

Examples of amine hormones

A

Epinephrine
Norepinephrine
Thyroxine
Triiodothyronine

439
Q

Butterfly-shaped organ located on the posterior portion of the neck

A

Thyroid gland

440
Q

ligament that separates the left and right lobes of the thyroid gland

A

isthmus

441
Q

2 cell types of the thyroid gland

A

Follicular cells
Parafollicular cells

442
Q

Produces metabolic hormones T3 and T4

A

Follicular cells

443
Q

AKA perfollicular cells or C-cells; produces calcitonin

A

Parafollicular cells

444
Q

T3 is composed of

A

MIT + DIT
-more biologically active

445
Q

T4 is composed of

A

DIT + DIT
- greater concentration

446
Q

Primary Hypothyroidism
(T3, T4, TSH levels)

A

Low T3 and T4 levels, Increased TSH levels

447
Q

Secondary Hypothyroidism

A

Low T3, T4, and TSH levels

448
Q

Primary hyperthyroidism

A

High T3 and T4 levels, low TSH levels

449
Q

Secondary hyperthyroidism

A

High T3, T4, TSH levels

450
Q

Basal metabolic rate and sympathetic response in hypothyroidism

A

Decreased

451
Q

Hypothyroidism, weight ___

A

Gain

452
Q

Temperature tolerance in hypothyroidism

A

Cold intolerance
Decreased sweating

453
Q

GIT function in hypothyroidism

A

Constipation
Decreased appetite

454
Q

Cardiovascular function in hypothyroidism

A

Decreased cardiac output
Bradycardia

455
Q

Respiratory function in hypothyroidism

A

Hypoventilation

456
Q

General appearance in hypothyroidism

A

Myxedema
Deep voice
Impaired growth (in children)

457
Q

General behavior in hypothyroidism

A

Mental retardation (infant)
Mental and physical sluggishness
Somnolence

458
Q

Basal metabolic rate and sympathetic response in hyperthyroidism

A

Increased

459
Q

Weight in hyperthyroidism

A

Loss

460
Q

Temperature tolerance in hyperthyroidism

A

Heat intolerance
Increased sweating

461
Q

GIT function in hyperthyroidism

A

Diarrhea
Increased appetite

462
Q

Cardiovascular function in hyperthyroidism

A

Increased cardiac output
Tachycardia and palpitation

463
Q

Respiratory function in hyperthyroidism

A

Dyspnea

464
Q

General appearance in hyperthyroidism

A

Exophthalmos
Decreased blinking
Enlarged thyroid

465
Q

General behavior in hyperthyroidism

A

Restlessness
Irritability and anxiety
Hyperkinesis and wakefulness

466
Q

-Decreased T3 and T4
-Decreased TSH
-Increased or Normal TRH
-TSH before administration is low

A

Secondary hypothyroidism

467
Q

-Decreased T3 and T4
-Decreased TSH
-Decreased TRH
-TSH before administration is low
After administration is high

A

Tertiary hypothyroidism

468
Q

Anti-microsomal antibodies (anti-thyroid peroxidase antibodies)
-Anti-thyroglobulin antibodies
-primary hypothyroidism

A

Hashimoto’s thyroiditis

469
Q

Anti-TSH receptor antibodies
-primary hyperthyroidism

A

Grave’s disease

470
Q

Major transport protein for T3 and T4 (approximately 70 - 75%)

A

Thyroid-Binding Globulin (TBG)

471
Q

Percentage of T4 that is unbound

A

0.03 - 0.05%

472
Q

Percentage of T3 that is free

A

0.5%

473
Q

Which is more potent, T3 or T4?

A

T3

474
Q

Other names of T4

A

Thyroxine

475
Q

Methods for T4 measurement

A

RIA
Fluorometric enzyme immunoassay
Fluorescence polarization immunoassay (FPIA)

476
Q

Other name of T3

A

Triiodothyronine

477
Q

Methods for T3 determination

A

RIA
Microparticle enzyme immunoassay
Fluorometric enzyme immunoassay

478
Q

THBR other names

A

Thyroid hormone binding ratio
T3 uptake test
T uptake test

479
Q

Methods for THBR measurement

A

Resin uptake
RIA

480
Q

Methods for FT4 determination

A

Equilibrium dialysis
Immunometric assay (chemiluminescence)

481
Q

Methods for FT3 determination

A

RIA

482
Q

FT4 index methods of measurement

A

Calculation from T4 and THBR

483
Q

FT3 index method of measurement

A

Calculation from T3 and THBR

484
Q

Methods for TSH measurement

A

RIA
Immunometric assay (IMA)

485
Q

3 classes of steroid hormones

A

Mineralcorticoids
Glucocorticoids
Sex steroids

486
Q

Function of mineralocorticoids

A

fluid and electrolyte balance

487
Q

Function of glucocorticoids

A

glucose production and protein metabolism

488
Q

Function of sex steroids

A

regulate sexual development and control many aspects of pregnancy

489
Q

Hormone under mineralocorticoids

A

Aldosterone

490
Q

3 hormones under glucocorticoids

A

Cortisol
Cortisone
11-deoxycortisol

491
Q

3 hormones under sex steroids

A

Androgens
Estrogens
Progesterone

492
Q

Most abundant hormone in post-menopausal women

A

Estrone (E1)

493
Q

Most potent ; most abundant in pre-menopausal women

A

Estradiol (E2)

494
Q

Metabolite of estradiol; estrogen found in maternal women; major estrogen secreted by placenta

A

Estriol (E3)

495
Q

steroid transport protein that nonspecific and carries many steroids

A

albumin

496
Q

Steroid transport protein that carries cortisol and derivatives; progesterone

A

Cortisol-binding globulin

497
Q

Steroid transport protein for testosterone and estradiol

A

Sex hormone-binding globulin

498
Q

3 colorimetric assays in steroid hormone analysis

A

Zimmerman reaction
Porter-Silber assay
Kober reaction

499
Q

Measurement of 17-ketosteroids (metabolites of several precursors to cortisol) to assess androgen production by the adrenal glands

A

Zimmermann reaction

500
Q

Primary reagent in Zimmermann reaction

A

m-dinitrobenzene in alcoholic KOH solution

501
Q

Result of Zimmermann reaction

A

Purple color (520 nm)

502
Q

For urine cortisol and derivatives (cortisone and 11-deoxycortisol)

A

Porter-Silber assay

503
Q

Primary reagent in Porter-Silber assay

A

2,4-dinitrophenylhydrazine

504
Q

Result of Porter-Silber assay

A

Yellow derivative (410 nm)

505
Q

FOr urine estrogen determination: sufficiently sensitive to quantitate total urine estrogen during the middle and latter stages of pregnancy

A

Kober reaction

506
Q

Primary reagent in Kober reaction

A

Strong aqueous sulfuric acid solution containing hydroquinone

507
Q

Result of Kober reaction

A

Reddish-brown color (472 nm, 512 nm, and 556 nm)

508
Q

Formed by the conversion of tyrosine

A

Catecholamines

509
Q

2 best known catecholamines

A

epinephrine
norepinephrine

510
Q

Catecholamines are synthesized and stored by the __

A

Chromaffin cells of the adrenal medulla

511
Q

2 end products of catecholamine metabolism

A

Homovanillic acid
Vanillylmandelic acid

512
Q

Method of determination of catecholamines

A

Pisano method

513
Q

Colorimetric assay for total metanephrines
-involves extraction followed by colorimetric reaction
-conversion to vanillin (absorbance maximum at 360 nm) is accomplished through periodate oxidation

A

Pisano method

514
Q

Increased levels of catecholamines are seen in

A

Pheochromocytoma
Neuroblastoma
Essential hypertension
Hypothyroidism
Diabetic acidosis
Cardiac disease
Burns
Septicemia
Depression

515
Q

Decreased levels of catecholamines are seen in

A

Hyperthyroidism
long term diabetes mellitus

516
Q

Involves analysis, assessment and evaluation of circulating concentrations of drugs in serum, plasma, or whole blood ;to ensure that a given dosage of drug produces maximal therapeutic benefit and minimal toxic side effects

A

Therapeutic Drug Monitoring (TDM)

517
Q

Concerned with the application or administration of drugs to patients for the purpose of prevention and treatment of disease

A

Pharmacotherapeutics

518
Q

Describe what the drug does to the body

A

Pharmacodynamics

519
Q

Describe how drugs are received and handled by the body

A

Pharmacokinetics

520
Q

The rate of administration is equal tot he rates of metabolism and excretion

A

Steady state

521
Q

Refers to the serum concentration of drug established to achieve desired clinical effect

A

Therapeutic range

522
Q

Drugs enter hepatic portal system first before entering the general circulation

A

First pass metabolism

523
Q

Refers to the spread of drug from its point of entry throughout the systemic circulation and into various tissues

A

Drug distribution

524
Q

Represents the time needed for the serum concentration of a drug to decrease by half

A

Half-life

525
Q

preferred sample for TDM

A

Serum

526
Q

Why are samples for TDM not collected in serum separator tubes

A

Drugs are reabsorbed in gel

527
Q

Maximum specimen; collected 30 - 60 minutes after drug administration but may vary depending on the type of drug

A

Peak specimen

528
Q

Minimum concentration; collected before administration of the next dose

A

Trough specimen

529
Q

Laboratory results should contain 2 factors

A

Time of last dose
Time of extraction

530
Q

Effective dose; predicted to be effective or have therapeutic benefit in 50% population

A

ED50

531
Q

Toxic dose; predicted to produce toxic response in 50% population

A

TD50

532
Q

Lethal dose; predict death in 50% of population

A

LD50

533
Q

Refers to a constellation of clinical signs and symptoms that suggest a specific class of poisoning

A

Toxidromes

534
Q

Most commonly abused chemical substance

A

Alcohol

535
Q

Method of alcohol determination

A

Flame ionization gas chromatography
Headspace gas chromatography

536
Q

Most ingested ethanol is converted to __

A

acetic acid

537
Q

Alcohol is increased in __

A

GGT, AST, AST/ALT ratio (>2.0), increased HDL, MCV

538
Q

Disinfectatn use for alcohol measurement

A

Benzalkonium chloride

539
Q

Methods for cyanide determination

A

Photometric analysis
Headspace gas chromatography

540
Q

Characteristic odor of cyanide

A

Bitter almonds

541
Q

Cyanide binds to hemoglobin causing ___

A

hypoxia

542
Q

Methods for carbon monoxide measurement

A

Gas chromatography
Spot test for CO exposure
Differential spectrophotometry

543
Q

Colorless, tasteless, odorless gas;
common sources are car exhausts and cigarette
-Has 250 times greater affinity for hemoglobin compared to oxygen
-produces cherry red color of the blood

A

Carbon monoxide

544
Q

Odor of garlic;
highly keratinophilic, carcinogenic;
specimen toxicity analysis include skin, hair, or nails

A

Arsenic

545
Q

can cause toxic effects in brain and can lead to anemia
(measurement of blood level)

A

Lead

546
Q

Previously used in sphygmomanometer, thermometers, and manometers
- toxicity: can alter proteins and cause severe kidney damage

A

Mercury

547
Q

Found in pesticides and insecticides
Toxicity decreases cholinesterase

A

Organophosphatases

548
Q

Sedative hypnotics drugs

A

Barbiturates
Benzodiazepines

549
Q

Derived from the leaves of marijuana plant Cannabis sativa

A

Cannabinoids

550
Q

Alkaloid found in a plant Erythroxylon coca

A

Cocaine

551
Q

Structurally similar to serotonin; found in fungus Claviceps purpura

A

Lysergic Acid Drugs (LSD)

552
Q

Stimulants and hallucinogen

A

Amphetamines

553
Q

Produced directly by the tumor as an effect of the tumor in a healthy tissue

A

Tumor markers

554
Q

Ideal characteristics of tumor markers

A
  1. Tumor specific
  2. Absent or present in very narrow range in healthy individuals
  3. Readily detectable in body fluid
555
Q

Tumor marker for hepatic and testicular cancers

A

AFP

556
Q

Tumor marker for pancreatic cancer

A

Amylase

557
Q

Tumor marker for breast or ovarian cancer

A

BRCA-1

558
Q

Tumor marker for ovarian cancer (treatment and recurrence)

A

CA 125

559
Q

Tumor marker for breast cancer

A

CA 15.3, Cathepsin-D, Estrogen receptor , HER-2/neu

560
Q

Tumor marker for gastric, pancreatic, and colorectal cancers

A

CA 19.9

561
Q

Tumor markers for gastric and pancreatic cancers (treatment and recurrence)

A

CA 50

562
Q

Tumor marker for breast cancer (treatment and recurrence)

A

CA 27-29

563
Q

Tumor marker for medullary thyroid cancer

A

Calcitonin

564
Q

Tumor marker for colorectal, stomach, breast, lung cancer (treatment and recurrence)

A

CEA

565
Q

Tumor marker for small cell lung cancer, prostate cancer

A

CK-1

566
Q

TUmor cancer for hepatoma

A

GGT

567
Q

Tumor marker for urinary bladder cancer

A

Nuclear matrix protein (NMP)

568
Q

Tumor markers for monitoring breast cancer

A

CA 15-3, HER-2/neu, CA 27-29

569
Q

Tumor marker for monitoring ovarian cancer

A

CA 125

570
Q

Tumor marker for monitoring pancreatic cancer

A

CA 19-9

571
Q
A

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