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Clinical Chemistry > Exam 5 > Flashcards

Exam 5 Flashcards

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1
Q

Which fractions of bilirubin are increased in a hemolytic disorder?

A

unconjugated and total bilirubin

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2
Q

Which fraction of bilirubin might be expected to be increased in a hepatic disorder?

A

conjugated

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3
Q

In severe hemolytic jaundice, what would be the expected results for bilirubin and urobilinogen in the urine?

A

greatly increased urobilinogen

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4
Q

In severe hemolytic jaundice, what would be the expected results for bilirubin and urobilinogen in the feces?

A

increased urobilin

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5
Q

In severe hemolytic jaundice, what would be the expected results for bilirubin and urobilinogen in the blood?

A

increased unconjugated bilirubin

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6
Q

Where is urobilinogen formed?

A

intestines

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7
Q

From what substance is urobilinogen formed?

A

bilirubin

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8
Q

What is another name for pre hepatic jaundice?

A

hemolytic

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9
Q

What is another name for post hepatic jaundice?

A

obstructive

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10
Q

What is another name for unconjugated bilirubin?

A

indirect

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11
Q

What is another name for conjugated bilirubin?

A

direct

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12
Q

What is the normal range for total serum bilirubin?

A

0.2-1.0 mg/dL

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13
Q

What is the normal range of direct bilirubin?

A

0.0-0.2 mg/dL

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14
Q

Indirect bilirubin is converted to direct bilirubin by conjugation with what?

A

glucuronic acid

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15
Q

What organ conjugates indirect bilirubin with glucuronic acid to form direct bilirubin?

A

liver

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16
Q

In what condition is conjugated bilirubin increased?

A

biliary obstruction

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17
Q

In the Jendrassik-Grof method for bilirubin determination, bilirubin reacts with what reagent to form the purple compound azobilirubin?

A

diazotized sulfanilic acid

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18
Q

In the Jendrassik-Grof method, what reagent is used to dissolve free bilirubin?

A

caffeine

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19
Q

In the Evelyn-Malloy method for bilirubin, quantitation of the bilirubin is made my measuring what?

A

azobilirubin

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20
Q

What reagents are used in the Watson-Schwartz test?

A

Ehrlich’s reagent, chloroform, N-butanol, sodium acetate

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21
Q

How are porphobilinogen and urobilinogen distinguished from each other since both form a colored compound with p-aminobenzaldehyde?

A

extraction with chloroform

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22
Q

In the synthesis of heme, what is the direct precursor of porphobilinogen?

A

Delta ALA

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23
Q

What does ALA in Delta ALA stand for?

A

aminolevulinic acid

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24
Q

Why is the stool clay-colored in obstructive jaundice?

A

urobilinogen is absent because of obstruction

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25
Q

To what compound is free bilirubin in the plasma attached?

A

albumin

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26
Q

What compound is the precursor of uroporphyrin, coproporphyrin, and protoporphyrin?

A

porphobilinogen

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27
Q

If you know the total bilirubin and the conjugated bilirubin values, how can you determine unconjugated bilirubin?

A

(total) - (conjugated) = unconjugated

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28
Q

Name the three enzymes involved in heme synthesis that are inhibited by lead.

A

Delta ALA synthase, porphobilinogen deaminase, ferrochelatase

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29
Q

What is the composition of Ehrlich’s reagent?

A

diazotized sulfanilic acid

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30
Q

Why is unconjugated bilirubin not found in the urine?

A

it is not water soluble

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31
Q

What color is urine that contains large amounts of porphyrins?

A

port wine

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32
Q

Increased bile pigments in the body causes the condition of?

A

jaundice

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33
Q

In bilirubin methods, total bilirubin develops a color only after what reagent is added?

A

methyl alcohol

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34
Q

What is the biochemical defect associated with Gilbert’s disease?

A

defective transport of bilirubin from plasma to liver cells due to reduced activity of the enzyme glucuronyl transferase

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35
Q

What is the most common condition leading to porphyrinuria?

A

lead poisoning

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36
Q

What normal substance results in the formation of bilirubin when it is broken down?

A

hemoglobin

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37
Q

What substance is increased in the urine of patients with lead poisoning?

A

Delta ALA is present

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38
Q

Why is bilirubin unstable once the specimen has been centrifuged?

A

sensitivity to light

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39
Q

What observation is used to determine urinary porphyrins?

A

red fluorescence in UV light

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40
Q

What is the basic unit of the structure of porphyrins?

A

Pyrrole ring

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41
Q

What specific pigment for the color of normal adult feces?

A

urobilin

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42
Q

What is indicated by the presence of lactic acid in duodenal contents?

A

acute or chronic gastritis, stomach carcinoma

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43
Q

A sweat chloride is done to check for disorders of what organ?

A

pancreas

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44
Q

What value for sweat chloride is indicative of cystic fibrosis (CF)?

A

60 - 200 mEq/L

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45
Q

In what test is an ion-exchange resin used?

A

Diagnex blue test

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46
Q

In what conditions is the gastric acidity low or absent?

A

gastric carcinoma

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47
Q

What is the normal pH of gastric juice after stimulation by a test “meal”?

A

1.5 - 4.0

48
Q

Duodenal fluid testing is used to diagnose diseases of what organ?

A

pancreas

49
Q

What substance is used to induce sweating in sweat chloride analysis?

A

pilocarpine

50
Q

In the sweat test, what should be the next step once the electrodes are removed?

A

remove gauze from arm and weigh it

51
Q

What is measured by the Diagnex blue test?

A

free HCl in gastric secretions

52
Q

What organ, besides the intestinal tract, must be properly functioning to do the Diagnex blue test?

A

kidney

53
Q

What is included in the determination of total gastric acidity?

A

free HCl and combined gastric acidity

54
Q

What is the composition of Topfer’s reagent

A

dimethylaminobenzene

55
Q

Toxic effects from the ingestion of rat poison can occur due to the presence of?

A

fluoride

56
Q

Ferric ions are used in the detection of which common drug?

A

salicylates

57
Q

What poisons are tested for by the Reinsch test?

A

arsenic and mercury

58
Q

Why should you avoid contact with mercury?

A

absorbed by the skin

59
Q

What is the sample of choice for most cases of poisoning?

A

urine

60
Q

What specimens are preferred in cases of arsenic poisoning?

A

hair and nails

61
Q

What level of carboxyhemoglobin can be found in cigarette smokers?

A

5-15%

62
Q

What is the purpose of the Trindar reaction?

A

detection of salicylates

63
Q

What organ is acetaminophen particularly toxic to?

A

liver

64
Q

What enzyme is used to determine ethanol levels?

A

alcohol dehydrogenase

65
Q

What is an oncofetal antigen?

A

protein shown to exist in both embryo fetal tissue and cancer cells

66
Q

Which tumor marker is used to detect prostatic cancer?

A

PSA

67
Q

What tumor markers are used to detect testicular cancer?

A

beta hCG and AFP

68
Q

What color is the blood in cases of carbon monoxide poisoning?

A

bright cherry red

69
Q

What enzyme is decreased in insecticide poisoning?

A

pseudocholinesterase

70
Q

Name the POC test that is useful in the diagnosis of congestive heart failure.

A

BNP

71
Q

Name one cardiac marker that is used in the triage cardiac panel.

A

troponin

72
Q

What does AFP stand for?

A

alpha-fetoprotein

73
Q

What does CEA stand for?

A

carcinoembryonic antigen

74
Q

What are the metabolites of epinephrine, norepinephrine, and dopamine?

A

metanephrine, normetanephrine, VMA, and homovanillic acid (HVA)

75
Q

In the determination of 17-ketosteroids, what is Zimmerman reagent composed of?

A

metadinitrobenzene

76
Q

The renal excretion of sodium which in turn affects serum levels, is controlled by hormones produced where?

A

adrenal cortex

77
Q

What is the major hormone responsible for water and electrolyte balance?

A

aldosterone

78
Q

Explain the laboratory findings, in regards to TH and TSH, in hyperthyroidism.

A

increased TH and decreased TSH

79
Q

Explain the laboratory findings, in regards to TH and TSH, in hypothyroidism.

A

decreased TH and increased TSH

80
Q

1-nitroso-2-naphthol is used in the analysis of which amine metabolite?

A

5-HIAA

81
Q

What amine is 5-HIAA a metabolite of?

A

serotonin

82
Q

Where would you find a pheochromocytoma?

A

adrenal medulla

83
Q

Urinary 17-ketosteroids may be elevated in diseases of which endocrine gland?

A

adrenal gland

84
Q

Briefly explain the Pisano method.

A

Acid hydrolysis and absorption on an ion-exchange resin is followed by elution with ammonium hydroxide. Resulting compound is converted to vanillin and reacted with periodate. Colored product of the reaction is measured spectrophotometrically.

85
Q

Give a brief description of Graves disease.

A

autoimmune disorder that occurs 6x more frequently in women than men. frequency in general population about 0.04%. antibodies stimulate thyroid by binding to TSH receptors causing diffuse hyperplasia of the thyroid lab results indicate increased T3, T4, FT4I, T3U and decreased or normal TSH. May have exopthalmia and goiter

86
Q

What is the first and best indicator of hyper- or hypothyroidism?

A

TSH

87
Q

What are the catecholamines?

A

epinephrine, norepinephrine, and dopamine

88
Q

Which hormones does the thyroid gland produce?

A

calcitonin, T3, and T4

89
Q

What is another name for epinephrine?

A

adrenalin

90
Q

To which amino acid does the thyroid gland bind inorganic iodide from the plasma?

A

tyrosine

91
Q

What is the principle function of the pancreas?

A

production of insulin and glucagon

92
Q

Which organ is the major site of steroid metabolism?

A

liver

93
Q

Briefly explain Addison’s disease

A

under function of adrenal cortex, decreased output of aldosterone, epinephrine, cortisol, and some sex hormones; a primary adrenal insufficiency

94
Q

Cushing’s syndrome is also known as?

A

hyperadrenalcorticalism

95
Q

hCG is produced by what?

A

placenta

96
Q

How long after conception does hCG being to rise?

A

1-2 days

97
Q

What is the function of vasopressin?

A

stimulates reabsorption of water by the kidney tubules

98
Q

Where is the hormone epinephrine produced?

A

adrenal medulla

99
Q

Argentaffinomas produce elevated levels of what?

A

serotonin

100
Q

Briefly explain the function of oxytocin.

A

stimulate contractions of uterus during delivery and contractions of breast tissue cells to cause milk ejection

101
Q

What is the site of action of oxytocin?

A

smooth muscle

102
Q

What is the site of action of prolactin?

A

mammary glands

103
Q

In men, 2/3 of all 17-ketosteroids come from where?

A

adrenals

104
Q

In men, 1/3 of all 17-ketosteroids come from where?

A

testes

105
Q

name some conditions, other than pregnancy, where you may find increased hCG lvels

A

hydatidiform mole, choriocarcinoma, testicular tumors

106
Q

What foods should be excluded from the diet for at least two days prior to collecting a urine specimen for 5-HIAA?

A

bananas, avocados, pineapple, plums, walnuts, tomatoes, kiwi, and eggplant

107
Q

How is most plasma thyroxine found?

A

bound to globulin

108
Q

What is the chief hormone excreted by the adrenal cortex?

A

cortisol

109
Q

The most potent and biologically active estrogen is?

A

17-beta-estradiol

110
Q

What is the action of progesterone?

A

preparation of uterus for ovum implantation

111
Q

What is the most potent of the biologically active androgens?

A

testosterone

112
Q

What is the parent substance in the biosynthesis of all adrenal cortical steroids?

A

cholesterol

113
Q

Of the thyroid iodide hormones, which is the most biologically active?

A

T3

114
Q

What hormone regulates the rate of thyroid hormone synthesis and secretion?

A

TSH

115
Q

Where is TSH produced?

A

anterior pituitary

116
Q

Briefly explain the negative feedback mechanism in the relationship between cortisol and ACTH

A

increased cortisol levels cause the hypothalamus and pituitary to decrease production of CRH and ACTH; decreased ACTH causes adrenal glands to decrease cortisol production

Clinical Chemistry (5 decks)

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