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Chem I > Final Review > Flashcards

Final Review Flashcards

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1
Q

What is the specificity of the following CK Isoenzyme: CK-MB

A

Cardiac

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2
Q

What is the specificity of the following CK Isoenzyme: CK-MM

A

Muscle

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3
Q

What is the specificity of the following CK Isoenzyme: CK-BB

A

Brain

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4
Q

T/F:

Amylase is more specific to pancreatitis than lipase.

A

FALSE

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5
Q

T/F:

In many reactions, we are looking at the reaction of the cofactor NADH to NAD to determine the value of the enzyme.

A

TRUE

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6
Q

What test has greater specificity for liver damage?

A

ALT

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7
Q

What enzyme has a short half-life and is found in the heart, liver, skeletal muscle, and kidney?

A

AST

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8
Q

T/F:

The hook effect refers to high concentrations of analyte producing a lower signal than expected.

A

TRUE

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9
Q

What type of inhibitor matches the following description:

These associate with enzymes at places other than the active site.

A

Non-Competitive

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10
Q

What type of inhibitor matches the following description:

These share structural features found in the substrate.

A

Competitive

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11
Q

What type of inhibitor matches the following description:

These bind only to the ES complex.

A

Uncompetitive

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12
Q

In this state, not all enzyme sites are saturated with substrate and substrate concentration is the rate-limiting step.

A

First-order kinetics

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13
Q

What is a zymogen?

A

An inactive, secreted form of the enzyme

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14
Q

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.

A

TRUE

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15
Q

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?

A

Lower than expected

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16
Q

What does an increase in serum enzyme levels indicate?

A

Tissue damage and necrosis

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17
Q

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.

A

Fanconi Syndrome

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18
Q

This test can be used to monitor alcoholics with liver toxicity

A

GGT

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19
Q

Which of the following serves as the glomerular filtration rate for clinicians?

A

Creatinine

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20
Q

Plasma creatinine levels are determined by all of the following except:

A

Dietary intake of protein

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21
Q

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?

A

The patient did not take prescribed medication

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22
Q

What is an energy source utilized by muscles?

A

Creatine phosphate

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23
Q

This non-protein nitrogen compound is found in the highest concentration in the blood.

A

Urea nitrogen

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24
Q

Which is not a clinical application of measurement of urea:

  • Assess hydration status
  • Evaluate liver function
  • Verify adequacy of dialysis
  • Determine nitrogen balance
A

Evaluate liver function

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25
Q

Given the following BUN/Creatinine ratio, what is the correct location of azotemia: 23

A

Prerenal

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26
Q

Given the following BUN/Creatinine ratio, what is the correct location of azotemia: 11

A

Postrenal

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27
Q

Given the following BUN/Creatinine ratio, what is the correct location of azotemia: 8

A

Intrarenal

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28
Q

Which is not a likely cause of decreased BUN.

  • High protein dietary intake
  • Liver disease
  • Severe vomiting
  • Increased protein synthesis
A

High protein dietary intake

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29
Q

The most frequently used analytic method for creatinine testing is the:

A

Jaffe reaction

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30
Q

Which test has the most strict collection requirements that include transporting the specimen on ice and testing immediately.

  • Ammonia
  • BUN
  • Uric acid
  • Creatinine Clearance
A

Ammonia

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31
Q

This disease is commonly seen in children who have been given aspirin during a viral infection.

A

Reye’s syndrome

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32
Q

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

A

53.8

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33
Q

Creatinine Clearance Equation

A

Creatinine Clearance = (urine creatinine/plasma creatinine) x (urine volume in mL / time in min) x (1.73/BSA)

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34
Q

Calculate the A/G ratio with a total protein of 7.7 g/dL and an albumin of 4.7 g/dL.

A

1.6

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35
Q

What disease state is the following description associated with:

Severe protein deficiency

A

Kwashiokor

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36
Q

What disease state is the following description associated with:

Severe protein and calorie deficiency

A

Correct match:
Marasmus

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37
Q

Which is a negative acute phase reactant?

  • Alpha-1 antitrypsin
  • Transferrin
  • Alpha-2 macroglobulin
  • Haptoglobin
A

Transferrin

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38
Q

This protein is known for being a nephrotoxin.

A

Myoglobin

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39
Q

This test may be used to assess nutritional status.

A

Prealbumin

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40
Q

Proteins with 10-40% carbohydrates attached are

A

Glycoproteins

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41
Q

Proteins consist of the elements:

A

Carbon, Oxygen, Nitrogen

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42
Q

In the stomach ______ breaks down proteins into peptides.

A

Pepsin

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43
Q

When a protein is disturbed and loses its functional and chemical characteristics, it is called:

A

Denaturation

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44
Q

The most common secondary structure of a protein is:

A

Alpha helix

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45
Q

Essential amino acids:

A

Must be obtained through diet

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46
Q

In cerebral spinal fluid, ______% of protein comes from plasma, while ______% comes from the brain.

A

95%, 5%

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47
Q

Which protein has a function to maintain oncotic pressure?

A

Albumin

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48
Q

T/F:

When proteins have a more positive charge they are more easily dissolved.

A

TRUE

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49
Q

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
A

Blood samples should be drawn after a 2-3 hour fast

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50
Q

This type of analytical method measures the amount of light that can pass through a sample at a 180O angle from the incident light.

A

Turbidimetry

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51
Q

T/F:

Stray light refers to any wavelengths outside the band transmitted by the monochromator.

A

TRUE

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52
Q

T/F:

Dynodes are a series of anodes with successively higher voltages.

A

TRUE

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53
Q

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.

A

FALSE

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54
Q

Calculate % transmittance through a tube containing 5 layers of solution with an absorbance of 20%.

A

33 %

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55
Q

Beer’s Law is:

A

The concentration of a substance is directly proportional to the amount of light absorbed or inversely proportional to the logarithm of the transmitted light

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56
Q

Place in the correct order. Light gets converted to:

  • Amps
  • Volts
  • Electrons
  • Absorbance
A

Light gets converted to:

1) electrons
2) amps
3) volts
4) absorbance

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57
Q

This type of lamp is used in visible and infrared regions and is the most common type:

A

Tungsten

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58
Q

Visible light falls between the color ______ at 400 nm and _____ at 700 nm.

A

violet, red

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59
Q

Which is the order that you would expect to see in LD isoenzymes in a patient who has had a heart attack.

A

LD1>LD2>LD3>LD4>LD5

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60
Q

Which is the order that you would expect to see in LD isoenzymes in a normal patient.

A

2, 1, 3, 4, 5

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61
Q

T/F:

stray light refers to any wavelengths outside the band transmitted by the monochromator.

A

TRUE

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62
Q

The area between the upper limit of quantitation and the lower limit of quantitation is know as:

A

The linear range

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63
Q

This is the color of visible light seen at 400 nm

A

Violet

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64
Q

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?

A

Septic

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65
Q

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.

A

Brain tumor

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66
Q

Which is not a common test to perform on a CSF sample?

  • Glucose
  • Uric acid
  • Protein
  • Lactate
A

Uric acid

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67
Q

T/F:

Increased CSF glucose levels can indicate acute bacterial meningitis.

A

False

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68
Q

Which would typically not be a cause of an exudative pleural effusion?

  • Pulmonary abscess
  • Lymphoma
  • Bacterial pneumonia
  • Hepatic cirrhosis
A

Hepatic cirrhosis

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69
Q

T/F:

The unique structure of hemoglobin allows it to act as both an acid-base buffer and O2 buffer.

A

TRUE

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70
Q

Define GLYCOGENOLYSIS

A

Breakdown of glycogen to glucose for use as energy

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71
Q

Define GLYCOGENESIS

A

Conversion of glucose to glycogen for storage

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72
Q

Define GLUCONEOGENESIS

A

Formation of glucose of-6-phosphate from noncarbohydrate sources

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73
Q

Define GLYCOLYSIS

A

Metabolism of glucose molecule to pyruvate or lactate for production of energy

74
Q

Which parameter on a blood gas analysis is calculated instead of being directly measured.

A

HCO3

pH, pO2, and pCO2 can all be directly measured

75
Q

The best collection tube to use for glucose tolerance testing is ___

A

Grey top/NaF

76
Q

What is the incremental fraction of oxygen at sea level?

A

21%

77
Q

What is the best interpretation of the following results?

pH=7.53 (7.35-7.45)

CO2= 37 (35-45)

HCO3= 33 (22-29)

A

Metabolic alkalosis with no compensation

78
Q

In external respiration, the partial pressure of oxygen in the alveolar membrane is __________, while the partial pressure of oxygen in the venous blood is _________.

A

100 mmHg, 40 mmHg

79
Q

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.

A

C. previous cerebrovascualar hemorrhage

D. traumatic Tap

80
Q

A decrease in H+ ions, an increase in pH, and a decrease in pCO2 results in what acid-base disorder?

A

Respiratory alkalosis

81
Q

What is the best interpretation of the following results?

pH=7.28 (7.35-7.45)

CO2= 55 (35-45)

HCO3= 25 (22-29)

A

Respiratory acidosis with no compensation

82
Q

A patient with an HA1C of 12% would be most likely to have an estimated average glucose of ___

A

298 mg/dL

83
Q

A patient with a fasting glucose of 122 mg/dL would be considered to have a ___

A

Impaired fasting glucose

84
Q

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.

A

Type 2

85
Q

An increase in H+ ions, a decrease in pH, and an increase in pCO2 results in what acid-base disorder?

A

Respiratory acidosis

86
Q

As a CSF is collected, it is placed in a series of tubes for analysis. The correct order of testing should be:

A

Chemistry, Microbiology, Hematology

87
Q

Which is not stimulated by epinephrine?
Correct answer:

  • Insulin
  • Glucagon
  • Glycogenolysis
  • Gluconeogenesis
A

Insulin

88
Q

What hormone does the following pancreatic cell produce: Alpha cells

A

Glucagon

89
Q

What hormone does the following pancreatic cell produce: Beta Cells

A

Insulin

90
Q

What hormone does the following pancreatic cell produce: Delta Cells

A

Somatostatin

91
Q

Diabetic condition formed when a person’s own immune system destroys the islet cells of the pancreas, resulting in impaired production of insulin.

A

Type I diabetes

92
Q

It is recommended that all adults have a lipid profile performed every _____.

A

5 years

93
Q

T/F:

Women, on average, have higher HDL levels and lower total cholesterol and triglyceride levels than men

A

TRUE

94
Q

HDL has a major role in this type of lipid pathway

A

Reverse cholesterol pathway

95
Q

Which is the type of lipoprotein that contains the apolipoprotein Apo B48?

A

Chylomicrons

96
Q

T/F:

Amphipathic lipid molecules contain both hydrophobic fatty acid chains and hydrophobic head groups.

A

False

97
Q

Calculate the LDL from the following test results.

Total cholesterol: 223 mg/dL

HDL: 65 mg/dL

Triglycerides: 290 mg/dL

A

100

98
Q

The function of the major lipid components of the very-low density lipoproteins is to transport:

A

Endogenous triglycerides

99
Q

Turbidity in serum suggests elevation of:

A

Chylomicrons

100
Q

What happens to the following electrolyte in the renal tubes: Calcium

A

Reabsorbed under influence of PTH

101
Q

What happens to the following electrolyte in the renal tubes: Bicarbonate

A

Recovered from glomerular filtrate

102
Q

What happens to the following electrolyte in the renal tubes: Chloride

A

Reabsorbed by passive transport in proximal tubule

103
Q

What happens to the following electrolyte in the renal tubes: Magnesium

A

Reabsorption occurs in Henle’s loop

104
Q

A rare disease of water and salt imbalance.

A

Diabetes insipidus

105
Q

Of the total serum osmolality; sodium, chloride, and bicarb normally contribute what percent?

A

92

106
Q

Anions have what charge?

A

Negative

107
Q

Cations have what charge?

A

Positive

108
Q

What is the type of lipoprotein that is known to contribute to plaque formation.

A

LDL

109
Q

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?

A

Hypernatremia

110
Q

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
A

Instrument error

111
Q

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
A

Decreased dialysis of proteins from the plasma

112
Q

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?

A

Chloride

113
Q

Of total serum calcium, free ionized calcium normally represents approximately what percent?

A

45

114
Q

The presence of only slightly visible hemolysis will significantly increase the serum level of which of the following analytes?

A

Potassium

115
Q

What is the major intracellular cation?

A

Potassium

116
Q

What is the major extracellular cation?

A

Sodium

117
Q

Calculate the anion gap using the following lab data.

Na: 135

K: 4.0

Cl: 94

HCO3: 28

A

17

118
Q

T/F:

Unsaturated triglycerides are typically solid at room temperature.

A

FALSE

119
Q

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.

A

Magnesium

120
Q

Given the following results, calculate the plasma osmolality:

Sodium: 135

Glucose: 96

BUN: 22

A

282

121
Q

Water makes up what percentage of body weight?

A

40-75%

122
Q

Which phrase does not describe phospholipids.

  • Hydrophobic head group
  • Synthesized in all organs
  • Amphipathic
  • Unsaturated steroid alcohol
A

Unsaturated steroid alcohol

123
Q

Electrolyte essential for myocardial contraction and important to maintain normal levels for critically ill patients.

A

Calcium

124
Q

Calculate the osmol gap given the following information:

Sodium: 140

Glucose: 62

BUN: 35

Measured osmo: 300

A

5

125
Q

A drug’s most direct and effective method of delivery to its site of action is:

A

Intravenous administration

126
Q

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
A

Liquid medications are often absorbed slower than capsule medications

127
Q

T/F:

Drugs are susceptible to hepatic metabolism, and this increases the concentration of the drug before it reaches the circulatory system.

A

False

128
Q

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
A

Five to seven drug doses are required to reach a steady state of drug concentration

129
Q

The relationship between a drug’s concentration at its target sites and its physiological responses is known as:

A

Pharmacodynamics

130
Q

Which of the following is not true concerning therapeutic drug monitoring?

A

It establishes a one-fit dosing model for all patients

131
Q

A blood draw to determine a peak level of a drug should be drawn:

A

One hour after an orally administered dose

132
Q

T/F:

CYP450 is a gene that influences the effectiveness of a drug in an individual.

A

True

133
Q

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
A

Ototoxic effects of the drug are reversible

134
Q

Pharmacokinetics and drug concentration are influenced by what factors?

A

Absorption, distribution, excretion, metabolism

(“All drugs enter me”)

135
Q

T/F:

Only bound fractions of drugs can interact with the site of action and result in a biological response.

A

FALSE

136
Q

Tolerance to drugs could be explained as:

A

Constant exposure of receptors to drugs that leads to a reduced response

137
Q

This drug is used to treat arrhythmias and CHF.

A

Digoxin

138
Q

This drug may have the adverse effect of “redman syndrome”

A

Vancomycin

139
Q

This antiepileptic drug requires hepatic markers to be check frequently due to risk of hepatic dysfunction.

A

Valproic acid

140
Q

T/F:

Immunosuppressive drugs typically are collected as serum samples.

A

FALSE

141
Q

T/F:

Common routes of exposure to toxins are through the gastrointestinal tract, lungs, and skin.

A

TRUE

142
Q

Which specimen type is preferred for analytes demonstrating variation in urinary elimination patterns?

A

24-hour collection

143
Q

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_
A

Screening tests have good specificity but lack sensitivity

144
Q

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
A

When testing will be delayed, sodium chloride can be used as a preservative to maintain specimen integrity

145
Q

T/F:

The affinity of carbon monoxide for hemoglobin is 20-25 times greater than oxygen

A

FALSE

146
Q

Toxic levels of acetaminophen are associated with

A

Hepatotoxicity

147
Q

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
A

Confirmatory testing must use methods with high specificity and low sensitivity

148
Q

Which type of toxicology uses the results from animal experiments to predict what level of exposure will cause harm to humans?

A

Descriptive

149
Q

Which is not a common route of exposure to toxic substances.

  • Ingestion
  • Intravenous
  • Inhalation
  • Transdermal absorption
A

Intravenous

150
Q

What phrase best describes what ED50 stands for?

A

A drug is predicted to have a therapeutic benefit for 50% of the population.

151
Q

T/F:

Chronic exposure to a toxin always has the same effect as acute exposures.

A

False

151
Q

Which is not a common specimen type for analysis of toxic agents?

  • Urine
  • Blood
  • Oral fluid
  • All are common types
A

All are common types

152
Q

What is a common source for the following type of alcohol: Isopropanol

A

Rubbing alcohol

153
Q

What is a common source for the following type of alcohol: Methanol

A

Homemade liquors

154
Q

What is a common source for the following type of alcohol: Ethylene glycol

A

Antifreeze

155
Q

What is a common source for the following type of alcohol: Ethanol

A

Tequila

156
Q

T/F:

An alternative test that may be performed in order to estimate ethanol in serum is the osmolality.

A

TRUE

157
Q

This toxic substance can be found in its organic form in clams and oysters.

A

Arsenic

158
Q

This environmental pollutant has been linked to Itai-itai disease.

A

Cadmium

(Farmers)

159
Q

What is the descriptor phase for the following drug: Amphetamines

A

Stimulant with high abuse potential

160
Q

What is the descriptor phase for the following drug: Barbiturates

A

“Downer” originally used as sleep inducer

161
Q

What is the descriptor phase for the following drug: Benzodiazepines

A

High demand as sedative and anti-anxiety

162
Q

What is the descriptor phase for the following drug: Opioids

A

Correct match:
Substances capable of analgesia, sedation, and anesthesia

163
Q

Which of the following enzymes is increased in patients with cancer involving bone?

  • Amylase
  • Alkaline phosphatase
  • Neuron-specific enolase
  • Gamma glutamyl transferase
A

Alkaline phosphatase

164
Q

What tumor marker is associated with neuroblastoma?

A

Homovanillic acid (HVA)

165
Q

What tumor marker is classified as an oncofetal antigen?

A

Carcinoembryonic antigen (CEA)

166
Q

The utilization of tumor markers is most important for:

A

Monitoring the effectiveness of treatment

167
Q

Tumor marker methodology include all of the following except:

  • Immunoassays
  • Gas chromatography
  • Immunohistochemistry
  • Enzyme analysis
A

Gas chromatography

168
Q

T/F:

Abnormally low tumor marker concentrations are associated with antigen deficiency and can cause false negative results

A

FALSE

169
Q

T/F:

To accurately monitor tumor marker levels of the patient, it is important to use the same methodology each time of testing.

A

TRUE

170
Q

If tumor cells are found in both the original tumor and also in the regional lymph nodes, this would be classified as stage:

A

3

171
Q

This type of tumor marker is valuable in diagnosing neuroblastomas, pituitary and adrenal adenomas.

A

Endocrine tumor markers

172
Q

These type of tumor markers help to choose between endocrine and cytotoxic therapies.

A

Receptor tumor markers

173
Q

T/F:

All tumor markers can be used to screen asymptomatic populations.

A

False

174
Q

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
A

All of the above

175
Q

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
A

Requires more specialized skill and experience

176
Q

What type of tumor does the following description describe: Neuroblastoma

A

Common malignant tumor in kids

177
Q

What type of tumor does the following description describe: Pheochromocytoma

A

Rare tumor associated with hypertension

178
Q

What type of tumor does the following description describe: Carcinoid

A

Serotonin secreting tumors from small intestine

179
Q

Which is not an example of an enzyme tumor marker.

  • ALP
  • AST
  • PSA
  • LDH
A

AST

180
Q

Which tumor marker is used primarily with hepatocelluar carcinoma and testicular cancer.

A

Alpha fetoprotein (AFP)

181
Q

Elevations in this tumor marker in CSF may indicate Creutzfeldt-Jakob disease.

A

Neuron-specific enolase (NSE)

Chem I (14 decks)

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