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CLS 701 > Day 1 > Flashcards

Day 1 Flashcards

1
Q

Accuracy and precision relate to QA or QC?

A

QC - looks at the accuracy and precision of analyzers

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2
Q

State regulations are overseen by… National regulations are overseen by…

A

LFS (Dept of Health)

CLIA, enforced by CMS

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3
Q

What hospital standards are nurses and hospital staff more familiar with? Clinical labs?

A

JCAHO

CAP

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4
Q

Plasma is collected in the tube with this colored cap… Serum is collected in the tube with this colored cap…

A

Purple

Red

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5
Q

A blood tube that is yellow in color is due to…

A

Icterus (bilirubin)

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6
Q

A blood tube that is red in color is due to…

A

Hemolysis

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7
Q

A blood tube that is turbid is due to…

A

Lipemic

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8
Q

What will happen if a calcium test is collected in an EDTA (purple top) tube?

A

Absorbs calcium, value very low

  • erroneous results
  • anti-coagulants become involved in testing
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9
Q

3 types of spectrophotometry measurements

A

Colorimetric

Endpoint

Initial Rate

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10
Q

Colorimetric - measuring absorbance of an ___

A

Analyte

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11
Q

Endpoint - measuring absorbance of some ___ with the analyte, then calculating the concentration of the analyte using reaction formula

A

Product of a reaction

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12
Q

Initial rate - measuring the ___ over time, then using that rate to calculate analyte concentration

A

Change in absorbance

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13
Q

Proteins absorb UV at this wavelength

A

280 nm

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14
Q

The BUN measurement is this type of spectrophotometric measurement

A

Initial rate

-rate can be positive or negative, depending on measurement of product or reactant

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15
Q

Turbidity vs nephelometry - what does each measure?

A

Turbidity = light absorbed/blocked

Nephelometry = light scattered

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16
Q

How are reference intervals determined?

A

Mean +/- 2 SD

  • accepts 95% of population, excludes 5%
  • values from 120 patient population
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17
Q

What is a delta check? Delta checks are useful for determining pre-analytical, analytical, or post-analytical errors?

A

Review of previous results, looking for a relative change of an analyte
-tells us if analyzer has changed significantly

Pre-analytical and analytical

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18
Q

What are the 6 types of reagent grade water as classified by CLSI?

A 
Clinical laboratory reagent water (CLRW)
Special reagent water (SRW)
Instrument feed water
Manufacturer supplied
Autoclave/wash
Commercially purified/bottled
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19
Q

Thirst is stimulated by this part of the brain… Which is in response to this physiological condition…

A

Hypothalamus

Increased osmolality of blood

  • due to elevated sodium level
  • drinking water increase water content of extracellular fluid, diluting sodium and decreasing osmolality of the plasma
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20
Q

This hormone, ___, acts on the cells of the collecting ducts of the kidneys to increase water reabsorption to decrease osmolality. The hormone is secreted by…

A

Vasopressin (ADH = antidiuretic hormone)

Posterior pituitary gland
-hormone made in hypothalamus first

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21
Q

Where is aldosterone made? What does aldosterone do? How is it different than vasopressin?

A

Adrenal gland

Causes nephron distal tubules to reabsorb sodium and water

  • absorb salt first, which causes water to follow via osmosis
  • increases blood volume

Vasopressin reabsorbs water
Aldosterone reabsorbs Na and water

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22
Q

Cushing’s disease and Addison’s disease both involve this organ…

A

Adrenal gland

-disorders are opposite of each other

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23
Q

What is seen in Cushing’s disease and Addison’s disease in terms of the amount of hormones being released?

A

Cushing’s disease = excessive cortisol release
-mnemonic: Cushing’s = cortisol

Addison’s disease = low cortisol AND low aldosterone

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24
Q

What are natriuretic peptides?

A

Compounds that cause sodium excretion in urine. Compounds have an opposite effect to the Renin-angiotensin-aldosterone system

  • pee out more water
  • similar to diuretic, except pee is salty
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25
Diabetes insipidus is due to deficiency in which hormone? What is a common symptom of the disease?
ADH (vasopressin) - disruption in production, release, breakdown, or cells responding to - 4 main categories Always thirsty, even after drinking - pee a lot - very dilute urine
26
What is the name for the force that tends to move water from dilute solutions to concentrated solutions?
Osmotic pressure (osmosis)
27
How many mOsm (milliosmoles) per kg are present for the following compounds, each at 15 mmole solute per kg water: glucose, NaCl, CaC12
Glucose: 15 mOsm/kg -1 ion only NaCl: 30 mOsm/kg -dissociates into 2 ions CaCl2: 45 mOsm/kg -dissociates into 3 ions
28
Osmolality can be measured in two ways
Freezing point depression -1 osmol of solute/kg lowers freezing point of water by 1.86C Vapor pressure depression - solute added to solvent - vapor press of solvent in equilibrium with liquid phase decreased
29
What is the osmolal gap? What is the normal osmolal gap?
The difference between the osmolality of blood that is measure vs what is calculated -something else in the blood not taken into account in calculation < 10 mOsm/kg = normal > 10 mOsm/kg = abnormal (abnormal concentration of unmeasured substances)
30
Which are extracellular and which are intracellular: chloride, phosphates/proteins, potassium, sodium, bicarbonate (HCO3-), magnesium
Extracellular: chloride, sodium, bicarbonate Intracellular: phosphates/proteins, potassium, magnesium
31
Name an extracellular buffer. Name an intracellular buffer
Bicarbonate (HCO3-) Phosphates/proteins
32
What would falsely increase in a hemolyzed specimen?
Intracellular ions | -potassium, phosphates/proteins
33
Difference between osmosis and diffusion? What is active transport?
Diffusion = passive movement of solutes Osmosis = passive movement of fluids Active transport = uses ATP (active) to move solutes against concentration gradient
34
In any compartment, the total charges of positive and negative electrolytes must be ___
Equal
35
The electrolyte balance in blood, serum or plasma is determine by the ___ measurement
Anion Gap - sum of "routinely measured" cations minus the sum of the "routinely measured" anions in the blood - value must always be positive; negative values may indicate lab error interference
36
Why is it okay to normally leave potassium out of the anion gap calculation?
Potassium values low and intracellular | -increased during hemolysis or tissue damage
37
When sodium is above the renal threshold, is blood sodium is high or low? Will sodium show up in the urine?
High Yes -excreted
38
When sodium is below the renal threshold, is blood sodium is high or low? Will sodium show up in the urine?
Low No - kidneys reabsorb sodium - should see some sodium in urine in healthy people
39
Is a mildly hemolyzed specimen acceptable for a sodium measurement? Is a severely hemolyzed specimen acceptable for a sodium measurement?
Yes -most sodium is extracellular No - will dilute sodium in serum - lowers measured value
40
What is the term for high sodium? 3 main causes for high sodium levels...
Hypernatremia Excess water loss Decreased water intake Increase intake/retention of sodium
41
What is the term for low sodium? 3 main causes for high sodium levels...
Hyponatremia Excess sodium loss Increased water retention Water imbalance
42
Excess of interstitial fluid, locally, due to inflammation, hypersensitivity or venous blockage is called...
Edema
43
In diabetes insipidus, sodium levels are __ in the blood and osmolality is ___ in the urine
High Low
44
Why would a person with diabetes (hyperglycemia) have hyponatremia?
High glucose in blood increases blood osmolality, which causes water to flow into blood due to osmosis, diluting serum sodium concentration
45
What do hypervolemia and hypovolemia mean?
Hypervolemia = too much fluids in blood Hypovolemia = too little fluids in blood
46
Is transport of potassium into cells in exchange for sodium an active or passive transport?
Active | -sodium-potassium pump
47
What is the renal threshold for potassium?
None
48
Is a hemolyzed specimen acceptable for a potassium measurement? Why or why not?
No Potassium is intracellular -falsely high potassium results
49
Do kidneys reabsorb potassium? Why or why not?
No Very little potassium in blood, most intracellular -easily replenish blood potassium with daily intake
50
What is the term for high potassium? 2 main causes for high potassium levels...
Hyperkalemia Decreased renal excretion Cellular shift -false elevation: hemolysis, thrombocytosis, fist clenching
51
What is the term for low potassium? 3 main causes for low potassium levels...
Hypokalemia GI loss Renal loss Cellular shift
52
In cystic fibrosis patients, if we measure their sweat, we can see this electrolyte has increased
Chloride
53
Increased chloride is called... Decreased chloride is called...
Hyperchloremia -compensate loss of HCO3- Hypochloremia -vomit, diabetic ketoacidosis, aldosterone deficiency, pyelonephritis
54
Chloride closely follows the patterns of this other electrolyte...
Sodium
55
When this molecule, ___, is used up trying to balance blood sodium, chloride can be used to compensate
Bicarbonate (HCO3-) - consumed by reaction with H+ produced in metabolic acidosis - increased Cl- reabsorption (Na+ with Cl-)
56
Where is magnesium mostly found?
Bone, tissue - very little in blood - extracellular magnesium used to maintain intracellular levels
57
Increased magnesium is called... Decreased magnesium is called...
Hypermagnesemia Hypomagnesemia
58
ISE is a method used to measure bound or free electrolytes?
Free (ionized) - one electrode is selective for ion - other electrode is reference
59
Increased calcium IN BLOOD is called ___. Increased calcium IN URINE is called ___.
Hypercalcemia Hypercalcuria
60
Are phosphates/phosphorus mostly extracellular or intracellular?
Intracellular
61
When glucose levels in the blood goes above the renal threshold, it will appear in the ___, and the condition is called...
Urine Glucosuria
62
High blood sugar stimulates the release of this hormone, ___, which triggers the production of... Low blood sugar stimulates the release of this hormone, ___, which triggers the release of...
Insulin = glycogen Glucagon = release stored glycogen -glycogen converted into glucose
63
Diabetes mellitus - what is the classic triad of symptoms? Are these symptoms seen in Type I or Type II?
``` Excessive urination (polyuria) Excessive thirst (polydypsia) Excessive hunger (polyphagia) ``` Type I diabetes
64
Do ketones go up or down with Type I diabetes mellitus? Why?
Up Body thinks it's starving due to lack of insulin, breaks down lipids for energy -lipid breakdown = pH decrease (ketoacidosis)
65
Is the anion gap increased or decreased with diabetes mellitus?
Large increase - ketone bodies increase - potassium goes out of cells to compensate for low pH due to ketoacidosis - bicarbonate decreased to reduce negative charges
66
In renal diabetes, the blood glucose level is ___, and the urine glucose level is ___. Why?
Normal High Glucosuria due to low sugar threshold in kidneys - kidneys fail to reabsorb normal amount of glucose back into blood - glucose above threshold excreted into urine
67
Is glucagon increased or decreased in diabetes mellitus?
Increased - body thinks it's starving due to insulin deficiency - in both Type I and II diabetes
68
Difference between Type I and Type II diabetes
Type I = insulin deficiency - from autoimmune disease - usually before age 20 - ketones and glucagon present Type II = insulin resistance - acquired diabetes - insulin and glucagon present
69
In both Type I and Type II diabetes mellitus, the blood glucose is... The urine glucose is...
Hyperglycemic Glucosuria
70
The gold standard test for diabetes mellitus is...
A1C - higher glucose conc = higher A1C level - < 7% of total hemoglobin in healthy people - may falsely increase in certain conditions, pregnancy
71
What is hemoglobin A1C?
Glycosylated hemoglobin - glucose molecules stick to hemoglobin - reflects average glucose over 6-8 week period - cutoff at 6.5% = good sensitivity/specificity
72
How does the oral glucose tolerance test (OGTT) work?
Give patient 100g glucose orally - draw blood at specific interval - establishes when glucose reaches highest concentration and how rapidly it returns to normal levels
73
What are the OGTT test results for a normal person vs a diabetic?
Normal - venous blood sugar does not exceed 200 mg/ 100 ml blood. Returns below 120 mg in 2 hours Diabetic - glucose level peaks above 200 mg. Does not return below 120 mg after 2 hours
74
What is the precursor form of insulin called? What does it break down into (2)?
Proinsulin Insulin C-peptide
75
How can we tell if insulin is made endogenously vs exogenous insulin from an insulin shot?
Endogenous insulin - proinsulin breaks down into insulin and c-peptide. C-peptide can be measured Exogenous insulin - no c-peptide
76
What is gestational diabetes and when does it resolve?
Insulin resistance due to hormones blocking insulin's effect (similar to Type II diabetes) -begins around 20-24 weeks Resolves after delivery -hormone levels return to normal
77
What is the term for ketones in the urine? Is this condition present in Type I or Type II diabetics?
Acetouria Type I only
78
Vomiting causes the loss of this electrolyte and can cause this condition
Chloride = hypochloremia
79
Plasma vs serum tubes - which one has anti-coagulants added? Which one is devoid of fibrinogen and other clotting factors?
Plasma Serum
80
In addition to stimulating glycogen release, glucagon also promotes the enhancement of this process to make more glucose...
Gluconeogenesis
81
What does the potassium-hydrogen ion exchange do? Under what condition is it used?
K pumped out of cell and H+ go into cells to increase blood pH Acidosis
82
What test should we use to distinguish bacterial from viral meningitis?
CSF glucose testing - bacteria = low (< 40% of serum glucose) - viral = normal
83
Besides Type I diabetes, ketones appearing in the urine can also be as indicator for...
Congestive heart failure | -also ketogenic diet
84
What is the best anticoagulant for potassium?
Heparin | -EDTA causes huge potassium spike
85
Which electrolyte is the major extracellular anion?
Chloride

CLS 701 (10 decks)

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