INTRODUCTION TO CLINICAL CHEMISTRY Flashcards
1
Q
Clinical chemistry tests measure ____ of substances (ions, molecules, complexes in body fluids.
A
concentrations or activities
2
Q
This is a Quantitative science section in laboratory medicine that primarily quantity or counts the CONCENTRATION of the different analytes in the body and specifically with the substances such as whole blood, plasma, serum, urine, and cerebrospinal fluid in our system.
A
Clinical Chemistry
3
Q
Clinical chem entails 3 factors in laboratory, what are those?
A
handling, maintenance, and troubleshooting
4
Q
Machines are called
A
automated analyzers
5
Q
- It is a branch of laboratory medicine that is concerned with the ____ in body fluids to facilitate the diagnosis of diseases.
A
quantitative measurement of analytes
6
Q
– substances that we measure are called
A
analytes
7
Q
give an example of analytes
A
Proteins
Enzymes
Metabolites (sugar and lipids)
Drugs
Ions,
salts,
minerals (calcium, potassium, sodium, etc.)
8
Q
Clinical importance of protein allows us to diagnose and check the status of what organ
A
liver
9
Q
why do high presence of protein in blood shows possible damaged of liver?
A
associated to liver disorders as most of the proteins are synthesized by the liver
10
Q
what is the importance of enzyme in cc?
A
To detect organ damage
11
Q
What is the importance of metabolites (sugar and lipids ) in CC?
A
Increase in cases of sedentary lifestyle. Also, Metabolites are usually high if there’s metabolic syndromes
12
Q
What is the importance of drugs in CC?
A
it will measure a concentration of drugs
13
Q
A method that will measure the concentration of drugs is called ___
A
TDM - therapeutic drug monitoring
14
Q
what is the most common body fluid in cc?
A
blood
15
Q
What type of blood sample will you expect in CC section?
A
Serum
16
Q
- The methods to measure these substances are carefully designed to provide accurate assessments of the concentrations
Where does the method come from?
A
Derived from the reference method
17
Q
is a method of acceptable accuracy and precision
All the analytes have undergone different studies and they all have their own reference method
A
reference method
18
Q
clinical chem can be a science, service, and industry
- as a ___, it links the knowledge of general chemistry, organic chemistry, and biochemistry with an understanding of human physiology–
A
science
19
Q
clinical chem can be a science, service, and industry
- as a ___, it produces objective evidence from which medical decisions may be made
A
service
20
Q
clinical chem can be a science, service, and industry
- as an ___, clinical laboratories are businesses, which operate under the regulations and practices that guide commerce in the United States.
Clinical chem can open a clinical laboratory
A
industry
21
Q
what are the scope of cc
A
computers
biochemistry
instrumentation
pharmacology’
endocrinology
immunology
toxicology/forensic toxicology
analytical chemistry
22
Q
scope of clinical chemistry that is also called laboratory information system
A
computers
23
Q
connecting the patient information, the details in a laboratory information system or computer “Technology” we are dealing with the incorporation of different laboratory identifiers or identifications to the technology or computer
A
laboratory infomation system
24
Q
one of the scopes of the clinical chem that is Dealing with the four fundamental biomolecules
A
biochemical
25
what are the 4 fundamental biomolecules
lipids, protein, glucose, nucleic acid
26
one of the scope of clinical chem that is focused in
Automations, Machines, and the way we troubleshoot. – Analyzer
27
one of the scope of clinical them that is focused on drugs
pharmacology
28
* The branch of physiology and medicine concerned with endocrine glands and hormones.
e.g. measure the level of the hormones
endocrinology
29
one of the scope in cc
The toxic substances in the body could also trace them.
e.g. blood alcohol level testing
TOXICOLOGY/ FORENSIC TOXICOLOGY
30
Deals with the measurement also of
different substances
Different measurement
Different apparatus
analytical chemistry
31
2 types of test in Clinical Chem
Core test and specialized test
32
type of test in clinical chem that is
Routinely being ordered or done
They are very easy to perform
core test
33
a core test: glucose
is one of the testing diagnosis for what health condition?
Diagnosis of Diabetes Mellitus
34
what are the test we can conduct in glucose?
* Fasting blood sugar or FBS
* Random blood sugar (RBS)
* (HbA1c)Hemoglobin A1C or Glycosylated hemoglobin
* Glycated albumin or fructosamine
* Oral glucose tolerance test
* 2 hour postprandial test
35
a glucose test that is Requiring 6-8 hours of fasting
fasting blood sugar or FBS
36
a glucose test that Does not require fasting//can measure anytime of the day
random blood sugar or RBS
37
Measure of the average blood glucose level – average of 3 months period
* (HbA1c)Hemoglobin A1C or Glycosylated hemoglobin
38
Measure of the average blood glucose level – average of 17-21 days period
* Glycated albumin or fructosamine
39
A confirmatory test for gestational diabetes mellitus
* Oral glucose tolerance test
40
how many blood collection does oral glucose tolerance test need?
3-4 times blood collection
41
Measures how well your body metabolizes sugar
* 2 hour postprandial test
42
blood sample needed for a glucose test that needs fasting
fbs - serum
43
blood sample needed for a glucose test that is related to fbs but doesn't need fasting
rbs - serum
44
blood sample needed for a glucose test that measures the average blood glucose level in an average of 3 months
HbA1c - WHOLE BLOOD
45
blood sample needed for a glucose test that measures the average blood glucose level in an average of 17-21 days
whole blood for* Glycated albumin or fructosamine
46
blood sample needed for a glucose test that is for the confirmatory test for gestational dm
serum for oral glucose tolerance test
47
blood sample for a glucose test that measure how well your body metabolize sugar
serum for 2 hr post prandial test
48
* Test that detects the status of the kidney
renal function test
49
renal function test detects the ability of the kidney to what?
to excrete, reabsorb, concentrates
50
* They are being done in order for us to test for the function of your kidney
renal function test
51
termed as Renal blood flow test or NPN’s (non-protein nitrogens)
urea- creatinine- uric acid
52
give the tests under liver or hepatic function panel
bilirubin test, TPAG, ALP, AST, ALT,
53
3 bilirubin test
b1, b2, and tb
54
which bilirubin test is the indirect bilirubin
b1
55
which bilirubin test is the DIRECT bilirubin
b2
56
how do we compute for the TB or the total bilirubin test?
adding b1 and b2
57
what does TPAG stands for
total protein, albumin/globulin
58
ALP test stands for
alkaline phosphatase
59
AST test stands for
Aspartate Aminotransferase/ aspartate transaminase /
60
AST or Aspartate Aminotransferase/ aspartate transaminase is also known as
SGOT
61
ALT test stands for
Alanine aminotransferase/ Alanine Transaminase/
62
ALT test – Alanine aminotransferase/ Alanine Transaminase/ is also known as
SGPT
63
are alp, ast, and alt enzymes or electrolytes?
enzymes
64
lipid profile consists of how many test test?
Constitute of 4-5 test
65
give the example of tests under the lipid profile
Total cholesterol test (Lipid)
Triglyceride/ TAG or triacylglycerol (Lipid)
HDL – high density lipoprotein (lipoprotein)
LDL – low density lipoprotein (lipoprotein)
Very low lipoprotein (lipoprotein)
66
examples of test under enzymes
amylase, lipase, creatine kinase
67
enzyme test that are primarily used for the diagnosis of acute pancreatitis
amylase and lipase
68
enzyme test that is employed for the diagnosis of Myocardial Infarction (heart attack
creatine kinase
69
test for this one is the assessment for the body hydration and most commonly they are routinely ordered by the doctor
electrolytes
70
give some hormone test under the specialized test
t3, t4, tsh, ft3 and ft4
T3- triiodothyronine (found in thyroid gland)
T4- thyroxine (found in thyroid gland)
Tsh – thyroid stimulating hormone found in hypothalamus
71
tests under specific protein
C reactive protein
Immunoglobulins
Ceruloplasmin
72
marker of wilson’s disease
ceruloplasmin
73
what are the example of trace elements test
vitamin and drug tests
74
can we test vitamin c under a specialized test?
no
75
we can only test which vitamin?
explain the principle
We can only test Vit D as it’s related to calcium and parathyroid hormone
76
an antibiotic that is used to treat Gram-positive cocci and test multidrug-resistant cocci, also assesses the level of vancomycin inside the human body
vancomycin
77
common analytes in cc
Ions, Salts, and Minerals, give the examples under this one
Sodium,
Potassium,
Calcium
Chloride
CO2,
Lead
Iron
78
common analytes in cc
Small Organic Molecules
*Metabolites
give the examples under this one
Glucose
Cholesterol
Uric acid
79
common analytes in cc
Small Organic Molecules
therapeutic drugs
give the examples under this one
Vancomycin
Theophylline
Digoxin
80
common analytes in cc
Small Organic Molecules
Toxicology
give the examples under this one
Alcohol
Salicylate
Acetaminophen
81
common analytes in cc
Small Organic Molecules
Drugs of Abuse
give the examples under this one
Cocaine Alcohol
Salicylate
Acetaminophen
Barbiturates
Amphetamine
82
common analytes in cc
LARGE Organic Molecules
*Transport Proteins
give the examples under this one
Albumin
Transferrin
Haptoglobin
83
common analytes in cc
LARGE Organic Molecules
*Enzymes
give the examples under this one
Lipase
Amylase
Creatinine Kinase
84
common analytes in cc
LARGE Organic Molecules
* *Specific Proteins
give the examples under this one
Immunoglobulins
C-reactive proteins
Complement
85
common analytes in cc
LARGE Organic Molecules
* *Diabetes Marker
give the examples under this one
Hemoglobin A1c
HbA1c
86
* Most common specimen in Clinical chemistry
BLOOD
87
why basilic is the last option?
Because it’s near the brachial artery
88
what re the 3 forms of blood/
whle blood, plasma and serum
89
a form of blood that is actually the blood which contains all the formed elements and the liquid portion
whole blood
90
– Liquid portion of non-clotted Blood that contains Anticoagulant
PLASMA
91
what is present in the plasma but absent in serum?
Fibrinogen
92
The act of drawing a blood sample from a blood vessel. For clinical chemistry testing blood is usually drawn from a vein, typically a vein in the arm or back of the hand. Collecting blood from a vein is called ___.
venipuncture
93
the next common sample aide from the blood?
urine
94
a sample used for evaluating kidney functions and tests that look at waste products excreted by kidneys
urne
95
For Chemistry testing, _____urine is usually used to test metabolites (urea, creatinine, excretions rates may vary by the time of the day)
24-hour
96
What method of collection is very important in urine collection under CC lab?
24-hour urine collection
97
What are the clinical chemistry test we can conduct in 24 hour urine sample?
Creatinine clearance
24 hr urine protein
Urine electrolytes test
98
What is the greatest source of error in any clearance test?
Improperly timed specimen collection as it needs to be a 24-hr collection
99
is clear and colorless fluid surrounding the brain and spinal cord
CEREBROSPINAL FLUID
100
its function is to * To lubricate and provides the nutrients for the brain and spinal cord
CEREBROSPINAL FLUID
101
* Csf is produced in the
choroid plexus
102
* Method of Collection of csf
o Lumbar Puncture / Spinal Tap/ lumbar tap
- collected on 3-4 to 4-5 lumbar/vertebral space
103
csf is intended for the diagnosis of
Intended for Diagnosis of Meningitis and Neurological problems or diseases
104
how many tubes are used in csf?
3-4 tubes
105
1st tube used in clinical chem is for
Clinical Chemistry, Immunology and Serology
106
how much percentage does glucose constitute in csf?
60-70%
107
how much mg/dl does protein constitute in csf?
Protein – 15-45mg/dL
108
the 2nd tube used for csf is for
Microbiology/Bacteriology
109
the 3rd tube used for csf is for
hematology
110
the 4th tube used for csf is for
Specialized section: Histopathology or Immunoserology
Cell cytology
For cancers
111
they are called the "serous fluid"
PLEURAL FLUID
PERICARDIAL FLUID
PERITONEAL
112
serous fluid Found in Lung cavity
PLEURAL FLUID
113
manner of collection of PLEURAL FLUID
Thoracentesis
114
serous fluid found in Heart
PERICARDIAL FLUID
115
PERICARDIAL FLUID 's manner of collection
Pericardiocentesis
116
serous * Found in Gastrointestinal
PERITONEAL FLUID
117
PERITONEAL FLUID's manner of collection
Paracentesis
118
PERITONEAL FLUID is also called
ascitic fluid/ascites
119
clinical chem test for serous fluid
Protein
Glucose
LDH – lactate dehydrogenase
120
other body fluids produced by the pregnant women which the site is on the amniotic sac
amniotic fluid
121
MOC of amniotic fluid
Amniocentesis
122
clinical chem test for amniotic fluid
L/S ratio or lecithin sphingomyelin ratio
Creatinine
AFP or Alpha fetoprotein
123
an amniotic cc test for the diagnosis of FLM (fetal lung maturity)
L/S ratio or lecithin sphingomyelin ratio
124
some doctors punctured the bladder – if there’s a high level of ____, there’s a cross contamination with the urine and amniotic fluid
creatinine
125
amniotic test in cc that is - For the diagnosis of trisomy 21 or Down syndrome
AFP or Alpha fetoprotein
126
synovial fluid's MOC
Arthrocentesis
127
rejected specimens are those with :
* Unlabeled, improperly labeled, mismatched specimen, insufficient quantity (QNS)
* Incorrect collection tube
* Underfilled /overfilled collection tube (with anticoagulant)
* Hemolyzed
128
in specimen labeling, there must be 2 identifies, what are those?
Name
Date of birth
129
* Specimen submitted must bear a completed request form (must include the following
Name
Age
Date
Time
Test
Sex
Physician
Diagnosis
130
explain the principle under the underfilled collection tube AC
Underfilled – not enough specimen or wrong ratio can cause dilution in sample
WILL CAUSE FALSELY DECREASED VALUES
131
explain the principle under the overfilled collection tube AC
Overfilled – too much: susceptible to clot
WILL CAUSE CLOTTING OF BLOOD
132
one of the common error in specimen rejection
hemolyzed sample
133
Hemolyzed samples are Unsuitable for tests such as:
Potassium
Magnesium
Phosphorus
Enzyme (ACP, LDH, AST)
134
CONSEQUENCES OF SPECIMEN REJECTION
1. Repeated specimen collection
2. Delay in the analysis and reporting of result.
3. Delay in the treatment of the patient
135
according to college of American pathologist, ___ minutes of clinical treatment is being delayed if you have specimen rejection.
65 minutes
136
LABORATORY WORKFLOW IN CLINICAL CHEMISTRY SECTION
REQUISITION – Request from the Doctor
SPECIMEN COLLECTION
TRANSPORT AND PROCESSING
RESULT TRANSMISSION/DELTA CHECKING/REPEAT
TESTING – Done by Pathologist
INTERPRETATION OF RESULT – Done by attending physicians
137
– comparison of the previous result from the present result
Importance: for quality control or quality assurance
Delta checking
138
______–quality standards for all clinical laboratories to ensure accuracy, reliability and timeliness of patient test results regardless of where the test was performed–defines clinical laboratories broadly
Clinical Laboratory Improvement Amendments (CLIA) of 1988
139
Two Levels of Regulations of the CLIA
Waived Tests an nonwaived tests
140
one of the two level of the regulation from the clia
simple laboratory examinations and procedures that are cleared by the U.S. Food and Drug Administration (FDA) for home use
- Test that can be done at the comfort of or home without medtechs
- E.g. blood glucose
waived tests
141
one of the two regulation of the clia
moderately and highly complex tests as defined by the requirements for operator skill, reagent preparation, and automation and the difficulty of interpretation of results. These are regulated under guidelines that cover quality standards for proficiency testing (PT), patient test management, quality control, personnel qualifications, and quality assurance.
- requires a skill and reagents and undergo proficiency testing.
non waived test
142
comparison of one lab result to another lab result
proficiency testing
143
* In 1828, ____ (1800-82) found that urea, an ‘organic’ substance, could be synthesized in vitro without any ‘vital force’ or living organism.
Friedrich Wöhler
144
- ___ is the one who observed analyte
- He introduced the concept of clinical chemistry
- Before, they thought that the analytes inside the body can not be found outside
-
Friedrich Wöhler
145
friedrich wohler
- They tried to boil ___ resulting to Urea
ammonium cyanate
146
the first analyte that builds the foundation of clinical chemistry
- the discovery of ___ cancelled the concept of Vital force
urea
147
___ –looked back on experiments of Antoine-Laurent de Lavoisier in pneumatic chemistry.
Henry Bence Jones
148
a protein name was been coined from him, protein found in immunologic disorder
Bence Jones
149
–“few and scanty, indeed, are the rays of light which chemistry has flung on the vital mysteries.”
Robert James Graves (1796-1853
150
complained that clinicians do not use their chemistry laboratory services except when needed for “luxurious embellishment for a clinical lecture.
Clin chem is only for lectures.
Max Josef von Pettenkofer (1818-1901
151
a year when *–urine test for diabetes and carbohydrate metabolism investigations started
1815
152
first used the term “clinical chemical laboratory (klinisch chemischem Laboratorium)
Johann Joseph Scherer (1814-1869
153
an outstanding clinical chemist able to give an excellent interpretation of analytical results obtained from in body fluids. Published a book in 1932 along with John P. Peetersentitled Clinical Chemistry.
Donald D. van Slyke (1883-1971)
154
He is also the founder of Modern Clinical Chemistry
Donald D. van Slyke
155
a year or stage when Crude techniques but advances to understand the living material were made despite limitations.
1. Discovery of starch, fats and some blood proteins were isolated and characterized
2. Cholesterol in gall stones
3. Chemical composition of urine
19th century
156
invented the Technicon AutoAnalyzer
Dr. Leonard Skeggs
157
year when the Radioisotopes were used in assay Scintillation counting devices
Incorporation or linkage of computers to laboratory
1. Equipment ability for data processing monitoring of data produced
2. ensured accuracy
3. correlations and relationships with previous information (Delta check
1970
158
