Final Review Flashcards
What is the specificity of the following CK Isoenzyme: CK-MB
Cardiac
What is the specificity of the following CK Isoenzyme: CK-MM
Muscle
What is the specificity of the following CK Isoenzyme: CK-BB
Brain
T/F:
Amylase is more specific to pancreatitis than lipase.
FALSE
T/F:
In many reactions, we are looking at the reaction of the cofactor NADH to NAD to determine the value of the enzyme.
TRUE
What test has greater specificity for liver damage?
ALT
What enzyme has a short half-life and is found in the heart, liver, skeletal muscle, and kidney?
AST
T/F:
The hook effect refers to high concentrations of analyte producing a lower signal than expected.
TRUE
What type of inhibitor matches the following description:
These associate with enzymes at places other than the active site.
Non-Competitive
What type of inhibitor matches the following description:
These share structural features found in the substrate.
Competitive
What type of inhibitor matches the following description:
These bind only to the ES complex.
Uncompetitive
In this state, not all enzyme sites are saturated with substrate and substrate concentration is the rate-limiting step.
First-order kinetics
What is a zymogen?
An inactive, secreted form of the enzyme
T/F:
The following statement could be used to describe zero-order kinetics:
Substrate is present in excess, rate of reaction is constant with time and dependent only on the concentration of enzyme in the system.
TRUE
When measuring enzyme activity, if the instrument is operating at 50 C lower than the temperature prescribed for the method, how would the results be affected?
Lower than expected
What does an increase in serum enzyme levels indicate?
Tissue damage and necrosis
Pathological condition in which the proximal tubules in the kidneys do not reabsorb glucose, amino acids, uric acids, and bicarbonates resulting in their loss to the urine concentrate.
Fanconi Syndrome
This test can be used to monitor alcoholics with liver toxicity
GGT
Which of the following serves as the glomerular filtration rate for clinicians?
Creatinine
Plasma creatinine levels are determined by all of the following except:
Dietary intake of protein
A 56 year old male with gout is given allopurinol then returns to the ER a week later with a uric acid level of 8.6 mg/dL (2.4-7.0 mg/dL). What statement best describes the reason for the uric acid level?
The patient did not take prescribed medication
What is an energy source utilized by muscles?
Creatine phosphate
This non-protein nitrogen compound is found in the highest concentration in the blood.
Urea nitrogen
Which is not a clinical application of measurement of urea:
- Assess hydration status
- Evaluate liver function
- Verify adequacy of dialysis
- Determine nitrogen balance
Evaluate liver function
Given the following BUN/Creatinine ratio, what is the correct location of azotemia: 23
Prerenal
Given the following BUN/Creatinine ratio, what is the correct location of azotemia: 11
Postrenal
Given the following BUN/Creatinine ratio, what is the correct location of azotemia: 8
Intrarenal
Which is not a likely cause of decreased BUN.
- High protein dietary intake
- Liver disease
- Severe vomiting
- Increased protein synthesis
High protein dietary intake
The most frequently used analytic method for creatinine testing is the:
Jaffe reaction
Which test has the most strict collection requirements that include transporting the specimen on ice and testing immediately.
- Ammonia
- BUN
- Uric acid
- Creatinine Clearance
Ammonia
This disease is commonly seen in children who have been given aspirin during a viral infection.
Reye’s syndrome
Given the following information, calculate the creatinine clearance:
Urine creatinine: 120 mg/dL
Plasma creatinine: 1.5 mg/dL
Urine volume for 12hours: 600 mL
Patient BSA: 2.13
53.8
Creatinine Clearance Equation
Creatinine Clearance = (urine creatinine/plasma creatinine) x (urine volume in mL / time in min) x (1.73/BSA)
Calculate the A/G ratio with a total protein of 7.7 g/dL and an albumin of 4.7 g/dL.
1.6
What disease state is the following description associated with:
Severe protein deficiency
Kwashiokor
What disease state is the following description associated with:
Severe protein and calorie deficiency
Correct match:
Marasmus
Which is a negative acute phase reactant?
- Alpha-1 antitrypsin
- Transferrin
- Alpha-2 macroglobulin
- Haptoglobin
Transferrin
This protein is known for being a nephrotoxin.
Myoglobin
This test may be used to assess nutritional status.
Prealbumin
Proteins with 10-40% carbohydrates attached are
Glycoproteins
Proteins consist of the elements:
Carbon, Oxygen, Nitrogen
In the stomach ______ breaks down proteins into peptides.
Pepsin
When a protein is disturbed and loses its functional and chemical characteristics, it is called:
Denaturation
The most common secondary structure of a protein is:
Alpha helix
Essential amino acids:
Must be obtained through diet
In cerebral spinal fluid, ______% of protein comes from plasma, while ______% comes from the brain.
95%, 5%
Which protein has a function to maintain oncotic pressure?
Albumin
T/F:
When proteins have a more positive charge they are more easily dissolved.
TRUE
Which is not true of amino acid analysis?
- Collect sample in a heparin tube
- Blood samples should be drawn after a 2-3 hour fast
- Analysis should be performed immediately or sample frozen
- Plasma should be removed carefully to avoid platelets and white blood cells
Blood samples should be drawn after a 2-3 hour fast
This type of analytical method measures the amount of light that can pass through a sample at a 180O angle from the incident light.
Turbidimetry
T/F:
Stray light refers to any wavelengths outside the band transmitted by the monochromator.
TRUE
T/F:
Dynodes are a series of anodes with successively higher voltages.
TRUE
T/F:
An advantage of a photocell over a phototube is that a photocell has an external power source and is more sensitive with lower amounts of light.
FALSE
Calculate % transmittance through a tube containing 5 layers of solution with an absorbance of 20%.
33 %
Beer’s Law is:
The concentration of a substance is directly proportional to the amount of light absorbed or inversely proportional to the logarithm of the transmitted light
Place in the correct order. Light gets converted to:
- Amps
- Volts
- Electrons
- Absorbance
Light gets converted to:
1) electrons
2) amps
3) volts
4) absorbance
This type of lamp is used in visible and infrared regions and is the most common type:
Tungsten
Visible light falls between the color ______ at 400 nm and _____ at 700 nm.
violet, red
Which is the order that you would expect to see in LD isoenzymes in a patient who has had a heart attack.
LD1>LD2>LD3>LD4>LD5
Which is the order that you would expect to see in LD isoenzymes in a normal patient.
2, 1, 3, 4, 5
T/F:
stray light refers to any wavelengths outside the band transmitted by the monochromator.
TRUE
The area between the upper limit of quantitation and the lower limit of quantitation is know as:
The linear range
This is the color of visible light seen at 400 nm
Violet
A patient has a synovial fluid removed from their knee joint. The test results included a cell count with differential. The WBC count was 65,000 with 93% neutrophils. What is the most likely cause?
Septic
A patient has CSF chemistries and microbiology samples performed. Chemistries yield a very low glucose value but no growth is reported in micro cultures. What is a possible pathology to explain these results? It is to be noted that the CSF had a clear, colorless appearance.
Brain tumor
Which is not a common test to perform on a CSF sample?
- Glucose
- Uric acid
- Protein
- Lactate
Uric acid
T/F:
Increased CSF glucose levels can indicate acute bacterial meningitis.
False
Which would typically not be a cause of an exudative pleural effusion?
- Pulmonary abscess
- Lymphoma
- Bacterial pneumonia
- Hepatic cirrhosis
Hepatic cirrhosis
T/F:
The unique structure of hemoglobin allows it to act as both an acid-base buffer and O2 buffer.
TRUE
Define GLYCOGENOLYSIS
Breakdown of glycogen to glucose for use as energy
Define GLYCOGENESIS
Conversion of glucose to glycogen for storage
Define GLUCONEOGENESIS
Formation of glucose of-6-phosphate from noncarbohydrate sources
Define GLYCOLYSIS
Metabolism of glucose molecule to pyruvate or lactate for production of energy
Which parameter on a blood gas analysis is calculated instead of being directly measured.
HCO3
pH, pO2, and pCO2 can all be directly measured
The best collection tube to use for glucose tolerance testing is ___
Grey top/NaF
What is the incremental fraction of oxygen at sea level?
21%
What is the best interpretation of the following results?
pH=7.53 (7.35-7.45)
CO2= 37 (35-45)
HCO3= 33 (22-29)
Metabolic alkalosis with no compensation
In external respiration, the partial pressure of oxygen in the alveolar membrane is __________, while the partial pressure of oxygen in the venous blood is _________.
100 mmHg, 40 mmHg
The following illustration of spinal fluid is representative of two distinct circumstances. Identify the proper circumstances leading to the appearance of both example C and example D.
C. previous cerebrovascualar hemorrhage
D. traumatic Tap
A decrease in H+ ions, an increase in pH, and a decrease in pCO2 results in what acid-base disorder?
Respiratory alkalosis
What is the best interpretation of the following results?
pH=7.28 (7.35-7.45)
CO2= 55 (35-45)
HCO3= 25 (22-29)
Respiratory acidosis with no compensation
A patient with an HA1C of 12% would be most likely to have an estimated average glucose of ___
298 mg/dL
A patient with a fasting glucose of 122 mg/dL would be considered to have a ___
Impaired fasting glucose
This type of diabetes is noted to have insulin resistance with an insulin secretory defect due to progressive loss of adequate beta cell insulin secretion.
Type 2
An increase in H+ ions, a decrease in pH, and an increase in pCO2 results in what acid-base disorder?
Respiratory acidosis
As a CSF is collected, it is placed in a series of tubes for analysis. The correct order of testing should be:
Chemistry, Microbiology, Hematology
Which is not stimulated by epinephrine?
Correct answer:
- Insulin
- Glucagon
- Glycogenolysis
- Gluconeogenesis
Insulin
What hormone does the following pancreatic cell produce: Alpha cells
Glucagon
What hormone does the following pancreatic cell produce: Beta Cells
Insulin
What hormone does the following pancreatic cell produce: Delta Cells
Somatostatin
Diabetic condition formed when a person’s own immune system destroys the islet cells of the pancreas, resulting in impaired production of insulin.
Type I diabetes
It is recommended that all adults have a lipid profile performed every _____.
5 years
T/F:
Women, on average, have higher HDL levels and lower total cholesterol and triglyceride levels than men
TRUE
HDL has a major role in this type of lipid pathway
Reverse cholesterol pathway
Which is the type of lipoprotein that contains the apolipoprotein Apo B48?
Chylomicrons
T/F:
Amphipathic lipid molecules contain both hydrophobic fatty acid chains and hydrophobic head groups.
False
Calculate the LDL from the following test results.
Total cholesterol: 223 mg/dL
HDL: 65 mg/dL
Triglycerides: 290 mg/dL
100
The function of the major lipid components of the very-low density lipoproteins is to transport:
Endogenous triglycerides
Turbidity in serum suggests elevation of:
Chylomicrons
What happens to the following electrolyte in the renal tubes: Calcium
Reabsorbed under influence of PTH
What happens to the following electrolyte in the renal tubes: Bicarbonate
Recovered from glomerular filtrate
What happens to the following electrolyte in the renal tubes: Chloride
Reabsorbed by passive transport in proximal tubule
What happens to the following electrolyte in the renal tubes: Magnesium
Reabsorption occurs in Henle’s loop
A rare disease of water and salt imbalance.
Diabetes insipidus
Of the total serum osmolality; sodium, chloride, and bicarb normally contribute what percent?
92
Anions have what charge?
Negative
Cations have what charge?
Positive
What is the type of lipoprotein that is known to contribute to plaque formation.
LDL
A patient presents to the ER with flushed skin, severe agitation, low-grade fever, and complaints of being extremely thirsty. Given these symptoms, what pathology would you consider?
Hypernatremia
Which of the following is not associated with an increase in anion gap when it occurs in a single patient?
- Renal failure
- Ketoacidosis
- Instrument error
- Glycol poisoning
Instrument error
Causes of increased levels of protein in CSF include all but:
- Decreased dialysis of proteins from the plasma
- Lysis of contaminant blood from traumatic tap
- Increased permeability of the epithelial membrane
- Obstruction
Decreased dialysis of proteins from the plasma
In order to maintain electrical neutrality in the red blood cell, bicarbonate leaves the red blood cell and enters the plasma through an exchange mechanism with what electrolyte?
Chloride
Of total serum calcium, free ionized calcium normally represents approximately what percent?
45
The presence of only slightly visible hemolysis will significantly increase the serum level of which of the following analytes?
Potassium
What is the major intracellular cation?
Potassium
What is the major extracellular cation?
Sodium
Calculate the anion gap using the following lab data.
Na: 135
K: 4.0
Cl: 94
HCO3: 28
17
T/F:
Unsaturated triglycerides are typically solid at room temperature.
FALSE
The cation is the fourth most abundant cation in the body and second most abundant intracellularly. Hint: Consumption of processed foods can lead to inadequate intake and subsequent deficiency.
Magnesium
Given the following results, calculate the plasma osmolality:
Sodium: 135
Glucose: 96
BUN: 22
282
Water makes up what percentage of body weight?
40-75%
Which phrase does not describe phospholipids.
- Hydrophobic head group
- Synthesized in all organs
- Amphipathic
- Unsaturated steroid alcohol
Unsaturated steroid alcohol
Electrolyte essential for myocardial contraction and important to maintain normal levels for critically ill patients.
Calcium
Calculate the osmol gap given the following information:
Sodium: 140
Glucose: 62
BUN: 35
Measured osmo: 300
5
A drug’s most direct and effective method of delivery to its site of action is:
Intravenous administration
Which of the following is not true regarding the absorption of drugs?
- Drug absorption rates may change with age
- Morphine may slow the gastrointestinal motility of a drug
- Liquid medications are often absorbed slower than capsule medications
- Crohn’s disease may alter the absorption of some drugs
Liquid medications are often absorbed slower than capsule medications
T/F:
Drugs are susceptible to hepatic metabolism, and this increases the concentration of the drug before it reaches the circulatory system.
False
Which of the following statements is true regarding drug elimination?
- One drug half-life is the time needed for the drug concentration to increase by half
- Five to seven drug doses are required to reach a steady state of drug concentration
- Most medications are administered as a single dose versus a scheduled basis
- Aminoglycoside antibiotics are reabsorbed by the renal tubules
Five to seven drug doses are required to reach a steady state of drug concentration
The relationship between a drug’s concentration at its target sites and its physiological responses is known as:
Pharmacodynamics
Which of the following is not true concerning therapeutic drug monitoring?
It establishes a one-fit dosing model for all patients
A blood draw to determine a peak level of a drug should be drawn:
One hour after an orally administered dose
T/F:
CYP450 is a gene that influences the effectiveness of a drug in an individual.
True
Which of the following is not true concerning aminoglycosides?
- They are a class of drugs that is administered in the inpatient setting
- Toxic levels can cause hearing impairment
- They are used to treat gram positive and gram negative infections
- Ototoxic effects of the drug are reversible
Ototoxic effects of the drug are reversible
Pharmacokinetics and drug concentration are influenced by what factors?
Absorption, distribution, excretion, metabolism
(“All drugs enter me”)
T/F:
Only bound fractions of drugs can interact with the site of action and result in a biological response.
FALSE
Tolerance to drugs could be explained as:
Constant exposure of receptors to drugs that leads to a reduced response
This drug is used to treat arrhythmias and CHF.
Digoxin
This drug may have the adverse effect of “redman syndrome”
Vancomycin
This antiepileptic drug requires hepatic markers to be check frequently due to risk of hepatic dysfunction.
Valproic acid
T/F:
Immunosuppressive drugs typically are collected as serum samples.
FALSE
T/F:
Common routes of exposure to toxins are through the gastrointestinal tract, lungs, and skin.
TRUE
Which specimen type is preferred for analytes demonstrating variation in urinary elimination patterns?
24-hour collection
Which of the following is not true concerning analysis of toxic agents?
Correct answer:
- Screening tests have good specificity but lack sensitivity
- Confirmatory tests report the concentration of the analyte
- Screening tests are a rapid test intended to detect the presence of a substance
- The reference method for most compounds is gas chromatography with a mass spectrometer (GC-MS_
Screening tests have good specificity but lack sensitivity
All of the following statements are true regarding blood alcohol measurements except:
- During venipuncture, the skin must be disinfected with iodine or chlorohexidine gluconate
- Plasma and serum are acceptable specimen types for analysis
- When testing will be delayed, sodium chloride can be used as a preservative to maintain specimen integrity
- Specimens should remain capped to avoid evaporation
When testing will be delayed, sodium chloride can be used as a preservative to maintain specimen integrity
T/F:
The affinity of carbon monoxide for hemoglobin is 20-25 times greater than oxygen
FALSE
Toxic levels of acetaminophen are associated with
Hepatotoxicity
Which of the following statements is not true concerning testing for drugs of abuse?
- A two-tired testing approach includes screening and confirmatory testing
- Confirmatory testing must use methods with high specificity and low sensitivity
- Screening tests detect classes of drugs
- GC-MS is the reference method used for confirmation
Confirmatory testing must use methods with high specificity and low sensitivity
Which type of toxicology uses the results from animal experiments to predict what level of exposure will cause harm to humans?
Descriptive
Which is not a common route of exposure to toxic substances.
- Ingestion
- Intravenous
- Inhalation
- Transdermal absorption
Intravenous
What phrase best describes what ED50 stands for?
A drug is predicted to have a therapeutic benefit for 50% of the population.
T/F:
Chronic exposure to a toxin always has the same effect as acute exposures.
False
Which is not a common specimen type for analysis of toxic agents?
- Urine
- Blood
- Oral fluid
- All are common types
All are common types
What is a common source for the following type of alcohol: Isopropanol
Rubbing alcohol
What is a common source for the following type of alcohol: Methanol
Homemade liquors
What is a common source for the following type of alcohol: Ethylene glycol
Antifreeze
What is a common source for the following type of alcohol: Ethanol
Tequila
T/F:
An alternative test that may be performed in order to estimate ethanol in serum is the osmolality.
TRUE
This toxic substance can be found in its organic form in clams and oysters.
Arsenic
This environmental pollutant has been linked to Itai-itai disease.
Cadmium
(Farmers)
What is the descriptor phase for the following drug: Amphetamines
Stimulant with high abuse potential
What is the descriptor phase for the following drug: Barbiturates
“Downer” originally used as sleep inducer
What is the descriptor phase for the following drug: Benzodiazepines
High demand as sedative and anti-anxiety
What is the descriptor phase for the following drug: Opioids
Correct match:
Substances capable of analgesia, sedation, and anesthesia
Which of the following enzymes is increased in patients with cancer involving bone?
- Amylase
- Alkaline phosphatase
- Neuron-specific enolase
- Gamma glutamyl transferase
Alkaline phosphatase
What tumor marker is associated with neuroblastoma?
Homovanillic acid (HVA)
What tumor marker is classified as an oncofetal antigen?
Carcinoembryonic antigen (CEA)
The utilization of tumor markers is most important for:
Monitoring the effectiveness of treatment
Tumor marker methodology include all of the following except:
- Immunoassays
- Gas chromatography
- Immunohistochemistry
- Enzyme analysis
Gas chromatography
T/F:
Abnormally low tumor marker concentrations are associated with antigen deficiency and can cause false negative results
FALSE
T/F:
To accurately monitor tumor marker levels of the patient, it is important to use the same methodology each time of testing.
TRUE
If tumor cells are found in both the original tumor and also in the regional lymph nodes, this would be classified as stage:
3
This type of tumor marker is valuable in diagnosing neuroblastomas, pituitary and adrenal adenomas.
Endocrine tumor markers
These type of tumor markers help to choose between endocrine and cytotoxic therapies.
Receptor tumor markers
T/F:
All tumor markers can be used to screen asymptomatic populations.
False
Which is not a reason that serial results can be difficult to interpret:
- Assay design
- Variation in reference ranges
- Differences in antibody specificity
- A and B
- All of the above
All of the above
Which is not something that is a consideration when considering using immunoassay method for tumor markers.
- Hook effect
- Requires more specialized skill and experience
- Assay linearity
- Requires more specialized skill and experience
- HAMAs
Requires more specialized skill and experience
What type of tumor does the following description describe: Neuroblastoma
Common malignant tumor in kids
What type of tumor does the following description describe: Pheochromocytoma
Rare tumor associated with hypertension
What type of tumor does the following description describe: Carcinoid
Serotonin secreting tumors from small intestine
Which is not an example of an enzyme tumor marker.
- ALP
- AST
- PSA
- LDH
AST
Which tumor marker is used primarily with hepatocelluar carcinoma and testicular cancer.
Alpha fetoprotein (AFP)
Elevations in this tumor marker in CSF may indicate Creutzfeldt-Jakob disease.
Neuron-specific enolase (NSE)
