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final exam Flashcards

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1
Q

what fractions of bilirubin are increased in hemolytic disorder?

A

unconjugated bilirubin

total bilirubin

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2
Q

which fraction might be expected to be inreased in a hepatic disorder?

A

conjugated bilirubin

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3
Q

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

A

urine: greatly increased urobilinogen
feces: increased urobilinogen
blood: increased unconjugated bilirubin

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4
Q

where and fromw hat substance is urobilinogen formed?

A

bilirubin in intestines

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5
Q

what is another name for prehepatic jaundice?

A

hemolytic

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6
Q

what is another name for posthepatic jaundice?

A

obstructive

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7
Q

another name for indirect bilirubin is?

A

unconjugated

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8
Q

what is another name for direct bilirubin?

A

conjugated

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9
Q

what is the normal range for total serum bilirubin?

A

0.2-1.0 mg/dl

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10
Q

what is the normal range for direct bilirubin?

A

0.0-02 mg/dl

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11
Q

indirect bilirubin is converted to direct bilirubin by conjugation with _____ by the _____

A

glucoronic acid

liver cells

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12
Q

in what condition is conjugated bilirubin increased?

A

biliary obstruction

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13
Q

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

A

diazetised sulfunilic acid

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14
Q

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

A

caffeine

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15
Q

in the Evelyn-Malloy method for bilirubin, quantitation of the bilirubin is made by measuring _____

A

azobilirubin

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16
Q

what reagents are used in the Watson-Schwartz test?

A

erlich’s reagent
chloroform
sodium acetate
N-Butanol

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17
Q

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

A

prophobilinogen is extracted by the chloroform

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18
Q

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

A

DELTA ALA

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19
Q

why is the stool clay-colored in obstructive jaundice?

A

urobilinogen is absent because of blockage

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20
Q

to what compound is free bilirubin in the plasma attached?

A

albumin

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21
Q

what compound is the precursor of uroporphyrin, coproporphyrin, and protoporphyrin

A

porphobilinogen

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22
Q

if you know the total bilirubin and the conjugated bilirubin values, how can you determine the value for the unconjugated bilirubin?

A

total minus conjugated

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23
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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24
Q

what is the composition of Erhlich’s reagent

A

diazotized fulfanilic acid

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25
Q

why is unconjugated bilirubin NOT found in the urine

A

because it is not water soluble

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26
Q

what color is urine which contains large amounts of porphyrins?

A

port wine or magenta

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27
Q

increased bile pigments in the body causes the condition of_____

A

jaundice

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28
Q

in bilirubin methods, total bilirubin develops a color only after the reagent_____ is added

A

methyl alcohol

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29
Q

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

A

defective transportation of bilirubin from liver cells to plasma due to decreased activity of the enzyme gluconyl transferase

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30
Q

what is the most common condition leading to porphyrinuria?

A

lead poisoning

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31
Q

what normal substances result in the formation of bilirubin when it is broken down?

A

hemoglobin

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32
Q

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

A

delta ALA

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33
Q

why is bilirubin unstable once the specimen has been centrifuged?

A

light sensitivity

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34
Q

what observation is used to determine urinary porphyrins

A

pyrol ring

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35
Q

what specific pigment is possible for the of normal adult feces?

A

urobilinogen

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36
Q

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

A

acute/chronic gastritis

stomach carcinoma

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37
Q

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

A

pancreas (but really cystic fribrosis)

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38
Q

what value for sweat chloride is indicative of cystic fibrosis?

A

60-200 meq/L

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39
Q

in what test is an ion-exchange resin used

A

diegnese blue

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40
Q

in what conditions is the gastric acidity low or absent?

A

gastric carcinoma

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41
Q

what is the normal pH of gastric juice after stimulation by a test meal?

A

1.5-4.0

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42
Q

duodenal fluid testing is used to diagnose diseases of the ____

A

pancreas

43
Q

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

A

pilocarpine

44
Q

in the sweat test, what should be the NEXT step once the electrodes are removed?

A

remove gauze and weigh it

45
Q

what is measured by the Diagnex blue test?

A

gastric juices,

free HCL

46
Q

what organ, besides the intestinal tract, for the Diagnex blue test must be properly functioning?

A

kidneys

to be filtered and interpreted

47
Q

what is included in the determination of total gastric acidity?

A

free Hcl combined acidity

48
Q

what is the composition of topfer’s reagent

A

dimethylaminobenzene

49
Q

toxic effects from the ingestion of rat poison can occur due to the presence of ____

A

chloride

50
Q

ferric ions are used in the detection of which common drug

A

salicylates (aspirin)

51
Q

what poisons are tested for by the Reinsch test?

A

arsinic and mercury

52
Q

why should you avoid contact with mercury?

A

exceedingly toxic and can be absorped through the skin

53
Q

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

A

urine

54
Q

what specimens are preferred in cases of arsenic poisoning?

A

hair/nails

55
Q

what level of carboxyhemoglobin can be found in cigarette smokers?

A

5-15 %

56
Q

what is the purpose of the Trindar reaction?

A

to detect salicylates

57
Q

acetaminophen (tylenol) is particularly toxic to the ____

A

liver

58
Q

what enzyme is used to determine ethanol levels?

A

alcohol dehydroganase

59
Q

what is an oncofetal antigen

A

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

60
Q

which tumor marker is used to detect prostatic cancer?

A

PSA

61
Q

which tumor marker is used to detect testicular cancer?

A

AFP

beta-Hcg

62
Q

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

A

bright cherry red

63
Q

what enzyme is decreased in insecticide poisoning?

A

pseudocholinesterase

64
Q

name the point-of-care test that is useful in the diagnosis of congestive heart failure

A

BNP

65
Q

name one cardiac marker that is used int he triage cardiac panel the specimen for which can be collected in the ER by fingerstick

A

troponin

66
Q

what does AFP stand for?

A

alphafetoprotein

67
Q

what does CEA stand for?

A

carcinoembryonic antigen

68
Q

name the metabolites of epinephrine, norepinephrine, and dopamine

A

metanephrine
normetanephrine
VMA
homovanilic acid (HVA)

69
Q

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

A

metadinitrobenzene

70
Q

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

A

adrenal cortex

71
Q

what is the major hormone responsible for water/electrolyte balance?

A

aldosterone

72
Q

explain laboratory findings, in regards to thyroid hormones and TSH, in hyperthyroidism and hypothyroidism

A

hyper- increased thyroid hormones and decreased TSH

hypo- decreased thyroid hormones and increased TSH

73
Q

1-nitroso-2-napthol is use din the analysis of which amine metabolite? what amine is this a metabolite of?

A

5-HIAA

serotonin

74
Q

where would you find a pheochromocytoma?

A

adrenal medulla

75
Q

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

A

adrenal gland

76
Q

briefly explain the Pisano method. what is it used to measure?

A

acid hydrolysis and absorption on an ion-exchange resin is followed by elution with ammonium hydroxide. Resulting compound is converted to vanilin and reacted with periodate. colored product of the reaction is measure spectrophotometrically. with VMA, sodium metaperiodate is used but measruement performed the same as other catecholamines.

77
Q

give a brief description of graves disease

A

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

78
Q

what is the first and best indicator of hyper- or hypothyroidism

A

TSH

79
Q

what are the catacholamines?

A

epinephrine,
norepinephrine
dopamine

80
Q

which hormones dos the thyroid gland produce?

A

calcitonin
T3
T4

81
Q

what is another name for epinephrine

A

adrenalin

82
Q

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

A

tyrosine

83
Q

what is the principle function of the pancreas

A

production of insulin and glucagon

84
Q

which organ is the major site of steroid metabolism

A

liver

85
Q

briefly explain addison’s disease

A

underfunction of the adrenal cortex
decreased output of aldosterone, epinephrine, and cortisol as well as some supplementary sex hormones
it is primary adrenal insufficiency

86
Q

cushing’s syndrome is also known as

A

hyperadrenalcorticalism

87
Q

HCG is produced by the ____ and begins to rise within ____ after conception

A

placenta

1-2 days

88
Q

briefly explain the function of vasopressin

A

stimulates reabsorption of water by the kidney tubules

89
Q

where is the hormone epinephrine produced

A

adrenal medulla

90
Q

argentaffinomas produced elevated levels of what

A

serotonin

91
Q

briefly explain the function of oxytocin

A

site of action = smooth muscle
main functions to stimulate contractions of the uterus during delivery and contractions of breast tissue cells to cause milk ejaculation

92
Q

what is the site of action for prolactin

A

mammary glands

93
Q

in men, 2/3 of all 17-ketosteroids come from the ____ and 1/3 from the ____

A

adrenals

testes

94
Q

name some conditions other than pregnancy where you may find increased HCG levels

A

hydatidiform ole
choriocarcinoma
testicular tumors

95
Q

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

A 
bananas
avocados
pineapple
walnuts
tomatoes
kiwi
eggplant
96
Q

how is most plasma thyroxine found

A

bound to globulin

97
Q

what is the chief hormone excreted by the adrenal cortex?

A

cortisol

98
Q

the most potent and biologically active estrogen is ____

A

17-beta-estradiol

99
Q

what is the action of progesterone

A

preparation of uterus for ovum implantation

100
Q

what is the most potent of the biologically active androgens

A

testosterone

101
Q

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

A

cholesterol

102
Q

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

A

T3

103
Q

what hormones regulates the rate of thyroid hormones synthesis and secretion and where is it produced?

A

TSH

anterior pituitary

104
Q

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

A

increased cortisol levels cause the hypothalmus 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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