Review Flashcards
Which analytes are affected by diurnal variation and are increased in the AM?
ACTH, cortisol, iron
Which analytes are affected by diurnal variation and are increased in the PM?
growth hormone, PTH, TSH
Fasting samples are required for which chemistry tests?
fasting glucose, triglycerides, and lipid panel
Alcohol will have what affect on glucose?
alcohol will decrease glucose levels
Alcohol will have what affect on GGT and triglycerides?
alcohol will increase these analytes
Stress can increase which three anallytes?
ACTH, cortisol, and catecholamines
Which analytes require being chilled after sample collection?
ammonia, lactic acid, and blood gas
Which analytes will be decreased when exposed to light?
bilirubin and carotene
When pumping the fist during sample collection, what analytes may increase, which then affects the pH by (increasing/lowering) it?
Increase in K, lactic acid, Ca, Phosphorous
Lowered pH
Which analytes may increase in a sample that was collected with prolonged use of a tourniquet?
K, total protein, lactic acid
If a sample was delayed in separating serum/plasma, which analytes will be increased?
ammonia, lactic acid, K, Mg, LD
If a sample was delayed in separating serum/plasma, which analyte will be decreased?
glucose (unless collected in fluoride)
Total protein, LD and Ca are higher in serum or plasma?
plasma
K, phosphate, glucose, CK, HCO3, ALP, ALB, AST, and trigs are higher in serum or plasma?
serum
Glucose is higher in plasma or whole blood?
plasma
Glucose (postprandial) and K are higher in capillary blood or venous blood?
capillary
Ca and total protein are higher in capillary blood or venous blood?
venous blood
K, phosphate, and Mg are higher in plasma or RBCs?
RBCs
Na and Cl are higher in plasma or RBCs?
plasma
A basic metabolic panel tests for which 8 analytes?
Na, K, Cl, CO2, GLU, Crea, BUN, and Ca
A comprehensive metabolic panel tests for which 13 analytes?
Na, K, Cl, CO2, GLU, Crea, BUN, ALB, Total Protein, ALP, AST, Bili, and Ca
An electrolyte panel tests for which analytes?
Na, K, Cl, CO2
A hepatic function panel tests for which 7 analytes?
ALB, ALT, AST, ALP, Bili (total), Bili (conjugated), total protein
A lipid panel tests for which analytes?
total cholesterol, HDL, LDL, and Trigs
A renal function panel tests for which 9 analytes?
Na, K, CO2, GLU, Crea, BUN, Ca, ALB, and phosphate
What substance is a major source of cellular energy and has decreased levels at room temp?
glucose
What additive is used to prevent glycolysis?
sodium fluoride
What are the most common methods for measuring glucose?
glucose oxidase and hexokinase
Diabetes mellitus, other endocrine disorders, acute stress, and pancreatitis may result due to hyperglycemia or hypoglycemia?
hyperglycemia
Possible causes of hypoglycemia:
insulinoma, insulin-induced hypoglycemia, hypopituitarism
Which methods are most commonly used to test total cholesterol?
enzymatic methods
Since total cholesterol is of little value in predicting CAD, it is typically tested along with which other analytes?
HDL and LDL
Which analyte is inversely related to CAD?
HDL
Which two lipids are risk factors for CAD?
LDL and Trigs
Which cholesterol is good?
HDL
What is the Friedewald formula and what does it calculate?
LDL = (total cholesterol) - (HDL) - (Trigs/5)
Trigs cannot exceed 400 mg/dL
Calculates LDL
How are LDL levels determined?
Calculated via the Firedewald equation or measured via direct homogenous assays
What is the main form of lipid storage?
Triglycerides
What methods are used to measure Trigs?
enzymatic methods using lipase
What type of specimen is required for testing trigs?
fasting specimen
How does dehydration, chronic inflammation, and multiple myeloma affect total protein levels?
increases TP levels
Nephrotic syndrome, malabsorption, overhydration, hepatic insufficiency, malnutrition, and agammaglobulinemia affect TP how?
decreases TP
Very low levels of TP are associated with
peripheral edema
Total protein is measured via which method?
Biuret method
What is the Biuret method?
Used to measure total protein by using an alkaline copper reagent that reacts with peptide bonds
Which analyte is the largest fraction of plasma proteins?
albumin
Albumin is increased or decreased with dehydration?
increased
Albumin regulates…
osmotic pressure
Malnutrition, liver disease, nephrotic syndrome, and chronic inflammation will increase or decrease albumin?
decrease
How is albumin measured?
Via dye-binding (BCG or BCP)
Which analyte is predictive of diabetic nephropathy?
microalbumin
What specimen is used to test microalbumin?
24 hour urine
How can microalbuminuria be determined on a random sample?
using the ALB:Crea ratio
30-300 mg albumin/g creatinine
Which hormone decreases glucose levels?
insulin
What is responsible for entry of glucose into cells?
insulin
In the regulation of glucose, insulin increases…
glycogenesis
Which 5 hormones increase glucose levels?
glucagon, cortisol, epinephrine, growth hormone, and thyroxine
In the regulation of glucose, Glucagon stimulates…
glycogenolysis and gluconeogenesis
In the regulation of glucose, Glucagon inhibits…
glycolysis
Which hormones are insulin antagonists?
cortisol and growth hormone
In the regulation of glucose, cortisol increases…
gluconeogenesis
In the regulation of glucose, epinephrine promotes…
glycogenolysis and gluconeogenesis
In the regulation of glucose, thyroxine stimulates…
glycogenolysis
How does thyroxine act in the regulation of glucose?
increases glucose absorption for GI tract
What condition is prone to ketoacidosis and diabetic complications?
Type 1 Diabetes
Type 1 diabetes is an autoimmune disorder with the destruction of …… resulting in what deficiency?
destruction of beta cells resulting in absolute insulin deficiency
Which type of diabetes mellitus has a genetic predisposition?
Type 1
Insulin resistance in peripheral tissues can cause…
Type 2 diabetes
What are 2 possible causes for Type 2 diabetes?
insulin resistance in peripheral tissues and insulin secretory defect of beta cells
Which type of diabetes is associated with obesity?
Type 2
What cells secrete insulin?
beta cells
Which type of Diabetes typically has an onset later in life?
Type 2
Which type of diabetes is not dependent on exogenous insulin?
Type 2
What is the cause of gestational diabetes?
placental lactogen inhibits action of insulin
What test is performed only on a patient with symptoms of hyperglycemia and the sample can be collected at any time of the day without regard to time since their last meal?
Random plasma gluose
How long must a patient fast for a fasting plasma glucose?
at least 8 hours
What result for a random plasma glucose is indicative of diabetes mellitus?
> 200 mg/dL
What result for a fasting plasma glucose is indicative of diabetes mellitus?
> 126 mg/dL on 2 occasions
Which diabetes test is only used to test for gestational diabetes?
oral glucose tolerance test (OGTT)
When is an oral glucose tolerance test performed?
24-28 weeks gestation
What result for a Hgb A1C is indicative of diabetes?
> 6.5%
Which test gices an estimate of glucose control over the previous 2-3 months?
Hgb A1C
TRUE OR FALSE: Hgb A1C test can be used to diagnose diabetes in patients with hemoglobinopathies or abnormal RBC turnover.
FALSE
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
Blood glucose
increased
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
urine glucose
increased
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
urine specific gravity
increased
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
glycohemoglobin
increased
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
ketones
increased
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
anion gap
increased
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
BUN
increased
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
osmoality
increased
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
cholesterol
increased
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
triglycerides
increased
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
bicarbonate
decreased
Is the following typically increased or decreased in laboratory findings for diabetes mellitus?
blood pH
decreased
What is defined as: A group of risk factors that seem to promote development of atherosclerotic cardiovascular disease and Type 2 Diabetes Mellitus?
Metabolic Syndrome
What are the 5 risk factors of metabolic syndrome?
decreased HCL, increased LDL, Trigs, Blood pressure, and blood glucose
Which aminoacidopathy is caused by a deficiency of an enzyme that converts phenylalanine to tyrosine leading to phenylpyruvic acid in the blood and urine?
phenylketonuria
Due to the build up of phenylpyruvic acid, patients with PKU tend to have urine with what odor?
mousy odor
Which aminoacidopathy can lead to mental retardation due to phenylalanine build-up?
phenylketonuria
The Guthrie bacterial inhibition assay can be performed to diagnose…
PKU
All newborns are screened for which aminoacidopathy?
Phenylketonuria
Which aminoacidopathy is caused by a disorder of tyrosine catabolism, resulting in tyrosine and its metabolites excreted in urine?
Tyrosinemia
What is the effects of tyrosinemia?
Liver and kidney disease, death
Which aminoacidopathy is caused by a deficiency or an enzyme needed in tyrosine and phenylalanine metabolism, resulting in the buildup of homogentisic acid?
Alkaptonuria
A patient with alkaptonuria will have diapers that stain black due to the build up of…
homogentisic acid in urine
A patient with which aminoacidopathy will, later in life, have darkening of tissues along with hip and back pain?
alkaptonuria
Maple syrup urine disease is caused by the build up of which amino acids?
leucine, isoleucine, and valine
A burnt-sugar odor to urine, breath, and skin is associated with which aminoacidopathy?
Maple syrup urine disease
Failure to thrive, mental retardation, acidosis, seizures, coma, and death are effects of which aminoacidopathy?
maple syrup urine disease
Which aminoacidopathy is caused by the deficiency of an enzyme needed for methionine metabolism?
homocystinuria
What builds up in the plasma and urine in homocystinuria?
methionine and homocystine
Osteoporosis, dislocated optic lenses, mental retardation, and thrombolytic events are effects of which aminoacidopathy?
homocystinuria
Which aminoacidopathy is caused by defective renal reabsorption of cysteine?
cystinuria
A positive (red-purple color) result on a urine cyanide nitroprusside test is diagnostic for…
cystinuria
Recurring kidney stones is an effect of which aminoacidopathy?
cystinuria
Proteins are (negatively or positively) charged and move toward the (anode or cathode).
negatively charged and move toward the anode
What is the order of migration from fastest to slowest in protein electrophoresis?
ALB, alpha-1, alpha-2, beta, gamma
Bence Jones proteins migrate to which region in protein electrophoresis?
gamma globulin region
Which specimen will have a prealbumin band in protein electrophoresis?
CSF
An increase in alpha-1 and alpha-2 regions is a common serum protein electrophoresis pattern for…
acute inflammation
An increase in alpha-1, alpha-2, and gamma globulin regions is a common serum protein electrophoresis pattern for…
chronic infection
Beta-gamma bridging is a common serum protein electrophoresis pattern for…
Cirrhosis
A sharp increase in one immunoglobulin (M spike) and a decrease in all other fractions is a common serum protein electrophoresis pattern for…
monoclonal gammopathy
A diffuse increase in gamma globulins is a common serum protein electrophoresis pattern for…
polyclonal gammopathy
A decrease in the gamma globulin region is a common serum protein electrophoresis pattern for…
hypogammaglobulinemia
A decrease in albumin and an increase in alpha-2 is a common serum protein electrophoresis pattern for…
Nephrotic syndrome
A decrease in the alpha-1 region is a common serum protein electrophoresis pattern for…
Alph-1-antitrypsin deficiency
An increase in the beta region or an unusual band between alpha-2 and beta regions is a common serum protein electrophoresis pattern for…
hemolyzed sample
An extra band between the beta and gamma regions is a common serum protein electrophoresis pattern for…
plasma (fibrinogen)
What analyte is synthesized by the liver from ammonia?
BUN
An increase in BUN is clinically significant for
kidney disease
Which analyte is used as a urease reagent?
BUN
Which of the following tubes cannot be used for BUN? sodium fluoride EDTA citrate lithium heparin ammonium heparin
All except lithium heparin cannot be used for BUN
An increase in creatinine is clinically significant for…
kidney disease
What analyte is a waste product from dehydration of creatine?
creatinine
The Jaffe reaction uses which reagent to test for which analyte?
The Jaffe reaction uses picrate (alkaline) to test for creatinine.
What is the normal BUN:Crea ratio?
12-20
Increased uric acid can be clinically significant for…
gout, renal failure, ketoacidosis, lactate excess, high nucleoprotein diet, leukemia, lymphoma, polycythemia
A decrease in uric acid can be clinically significant for…
administration of ACTH, renal tubular defects
Increased levels of uric acid increase the risk for…
renal calculi and joint trophi
EDTA and fluoride interfere with the uricase method, which tests for…
uric acid
Why must urine pH be adjusted to 7.5-8 when determining uric acid levels?
to prevent precipitation
An increase in ammonia can be clinically significant for…
liver disease, hepatic coma, renal failure, Reye’s Syndrome
Which analyte is produced in the GI tract and high levels are neurotoxic?
ammonia
Ammonia should be collected in which tubes?
EDTA or heparin
Why will serum have increased levels of ammonia?
NH3 is generated during the clotting process
Causes of hypernatremia:
increased intake, IV administration, hyperaldosteronism, excessive sweating, burns, diabetes insipidus
Hypernatremia can cause:
tremors, irritability, confusion, coma
Causes of hyponatremia:
renal or extrarenal loss (vomiting, diarrhea, sweating, burns), increased extracellular fluid volume
Hyponatremia causes:
weakness, nausea, altered mental status
What is the major extracellular cation?
Sodium
Which analyte contributes to almost half of plasma osmolality?
sodium
Which analyte maintains normal distribution of water and osmotic pressure?
sodium
Sodium levels are regulated by…
aldosterone
What is the most common method for testing sodium?
ISE (ion-selective electrode)
Causes of hyperkalemia:
increased intake, decreased excretion, crush injuries, metabolic acidosis
Hyperkalemia can cause:
muscle weakness, confusion, cardiac arrhythmia, cardiac arrest
Causes of hypokalemia:
increased GI or urinary loss, diuretic use, metabolic alkalosis
Hypokalemia can cause:
muscle weakness, paralysis, breathing problems, cardiac arrhythmia, death
What is the major intracellular cation?
Potassium
Why are serum potassium levels higher than in plasma?
platelets release K during the clotting process
Squeezing the capillary site, prolonged tourniquet, pumping fist during venipuncture, IV fluid contamination, hemolysis, prolonged RBC contact, leukocytosis, and thrombocytosis can all increase which electrolyte values?
Potassium
What are the major electrolytes?
Na, K, Cl, and CO2 (total)
Causes of hyperchloremia:
Increased intake, IV administration, hyperaldosteronism, excessive sweating, burns, diabetes insipidus, excessive loss of HCO3
Sodium follows…
WATER
What is the major extracellular anion?
Chloride
Which electrolyte helps maintain osmolality, blood volume, and electric neutrality?
Chloride
Which electrolyte passively follows sodium?
Chloride
The sweat Cl test is diagnostic for…
cystic fibrosis
90% of total CO2 is in what form?
Bicarbonate (HCO3)
Increased total CO2 is clinically significant for…
metaboilic alkalosis and compensated repiratory acidosis
Total CO2 is composed of…
Mainly bicarb, but also carbonic acid and dissolved CO2
HCO3 is important in maintaining…
acid-base balance
Decreased total CO2 is clinically significant for…
metabolic acidosis and compensated respiratory alkalosis
If an electrolyte sample is uncapped, which electrolyte is affected and how?
Total CO2 will decrease
Causes of increased magnesium:
renal failure, increased intake (antacids), dehydration, bone cancer, endocrine disorders
Increased magnesium can cause:
cardiac abnormalities, paralysis, respiratory arrest, coma
Causes of decreased magnesium:
severe illness, GI disorders, endocrine disorders, renal loss
Decreased magnesium can lead to…
cardiac arrhythmias, tremors, tetany, paralysis, psychosis, coma
A decrease in which electrolyte is rare in non-hospitalized patients?
Magnesium
Oxalate binds which electrolyte?
Mg
Causes of increased calcium:
primary hyperparathyroidism, cancer, multiple myeloma
Increased calcium can cause:
weakness, coma, GI symptoms, renal calculi
Causes of decreased calcium:
hypoparathyroidism, malabsorption, vitamin D deficiency, renal tubular acidosis
Decreased calcium can cause:
tetany (muscle spasms), seizures, cardiac arrhythmias
What is the most abundant mineral in the body?
calcium (99% in the bones)
Which electrolyte is controlled by the parathyroid, vitamin D, and calcitonin?
calcium
Why is heparin the only anticoagulant used to calcium samples?
all other anticoagulants bind calcium
What is the biologically active form of calcium?
ionized (free) Ca
TRUE OR FALSE: Calcium is not affected by pH or Temp
FALSE
Causes of increased phosphorous:
renal disease, hypoparathyroidism
Causes of decreased phosphorous:
hyperparathyroidism, Vitamin D deficiency, renal tubular acidosis
What is the major intracellular anion?
phosphorous
Phosphorous is a component of…
nucleic acids and many enzymes
Phosphorous is a major reservoir for…
energy (ATP)
Phosphorous is correlated with which other electrolyte?
Calcium
The presence of lactate is a sign of…
decreased oxygen to tissues
Which electrolyte is a byproduct of anaerobic metabolism?
lactate
lactate samples should be collected in which tube?
heparin
What are collection requirements for lactate?
Use a heparin tube and put on ice immediately or use fluoride to inhibit glycolysis
What analyte is necessary for hemoglobin synthesis?
iron
Iron is transported by…
transferrin
What specimen is preferred for iron due to diurnal variation?
morning specimen
Clinical significances of increased iron:
iron overdose, hemochromatosis, sideroblastic anemia, hemolytic anemia, liver disease
Clinical significances of decreased iron:
iron deficiency anemia
How is the total iron binding capacity determined?
Iron is added to saturate the transferrin in a sample, the excess is removed, and iron content is determined
TIBC is (proportional/inversely) related to iron content.
inversely
What is the clinical significance of an increased TIBC?
iron deficiency anemia
What is the clinical significance of a decreased TIBC?
iron overdose, hemochromatosis
100 X (serum iron/TIBC) = ?
% saturation (or transferrin saturation)
What is the protein that transports iron?
apotranferrin
The apotransferrin - iron complex is considered…
transferrin
Increased transferrin is clinically significant for…
iron deficiency anemia
Decreased transferrin is clinically significant for…
iron overdose, hemochromatosis, chronic infections, malignancies
What is the storage form of iron?
ferritin
What analyte is a rough estimate of body iron content?
ferritin
Increased ferritin is clinically significant for…
iron overload, hemochromatosis, chronic infections, malignancies
Name 6 factors that influence enzymatic reactions.
substrate concentration, enzyme concentration, temperature, pH, cofactors, and inhibitors
Acid phosphatase (ACP) is found in which tissue(s)?
prostate
Alkaline phosphatase (ALP) is found in which tissue(s)?
almost all tissues
Aspartate aminotransferase (AST) is found in which tissue(s)?
highest in liver, heart, skeletal muscle
Alanine aminotransferase (ALT) is found in which tissue(s)?
Liver, RBCs
Gamma glutamyl transferase (GGT) is found in which tissue(s)?
liver, kidneys, pancreas
Lactate dehydrogenase (LDH) is found in which tissue(s)?
All tissues
Creatine kinase (CK) is found in which tissue(s)?
skeletal muscle, cardiac muscle, brain
Amylase (AMS) is found in which tissue(s)?
salivary glands, pancreas
Lipase (LPS) is found in which tissue(s)?
pancreas
Glucose-6-phosphate dehydrogenase (G6PD) is found in which tissue(s)?
RBCs
An increase in ACP in clinically significant for…
prostate cancer
Which enzyme is not used to diagnose prostate cancer due to being more specific than ACP?
PSA
Increased ALP is clinically significant for…
liver and bone disease
Higher levels of ALP are seen in hepatocellular disorders or biliary tract obstruction?
biliary tract obstruction
Which enzyme will be increased in children, pregnant women, adolescents, and patients with healing bone fractures?
Alkaline phosphatase (ALP)
Increased AST can be clinically significant for…
liver disease, viral hepatitis, acute MI, muscular dytrophy
Which enzyme will be markedly increased in viral hepatitis?
AST (and ALT)
Which is more specific to the liver: AST or ALT?
ALT
An increase in ALT is clinically significant for…
liver disease
What is the most sensitive enzyme for all types of liver disease?
GGT
Which enzyme can be used to monitor abstention from alcohol?
GGT
Increased GGT is clinically significant for…
all heptobiliary disorders, chronic alcoholism
Highest levels of GGT are seen with
obstructive disorders
Which enzyme catalyzes the reaction: lactic acid to pyruvate?
LDH
Highest levels of LDH are seen in…
pernicious anemia
Increases in LDH are clinically significant for…
pernicious anemia, AMI, liver disease
Which enzyme catalyzes the reaction: phosphocreatine + ADP to creatine + ATP?
CK
CK is inhibited by all anticoagulants except…
heparin
What is the most sensitive enzyme for skeletal muscle disease?
CK
Highest levels of CK are seen in…
muscular dystrophy
Increased CK can be clinically significant for…
AMI, muscular dystrophy
Which enzyme creaks down starch to simple sugars?
amylase
In acute pancreatitis, what is the rise, peak and fall of amylase?
rise: 2-12 hours
peak: 24 hours
fall: 3-5 days
Increased amylase is clinically significant for…
acute pancreatitis, other abdominal diseases, mumps
Increased lipase is clinically significant for…
acute pancreatitis
Which enzyme breaks down triglycerides into fatty acids and glycerol?
lipase
Which is more specific for pancreatic disease: lipase or amylase?
lipase
An inherited deficiency of this enzyme can lead to drug induced hemolytic anemia.
G6PD
CK-MB will be increased in which type of disorder?
cardiac disorder
AST, ALT, LDH will be increased in which type of disorder?
hepatocellular disorders
ALP and GGT will be increased in which type of disorder?
biliary tract obstruction
CK, AST, LDH, and aldolase will be increased in which type of disorder?
skeletal muscle disorders
ALP will be increased in which type of disorder?
bone disorders
amylase and lipase will be increased in which type of disorder?
acute pancreatitis
Name 3 cardiac markers for AMI.
CK-MB, myoglobin, troponin
Which cardiac marker is the first to rise after an AMI?
myoglobin
Which cardiac marker has the highest sensitivity and specificity for an AMI?
Troponin
What is considered a definitive marker for AMI?
Troponin
What substance is released from heart muscle of the left ventricle in CHF?
B-type natriuretic peptide (BNP)
What test tests for heart failure?
BNP
What is the clinical significance of using BNP as a test for heart failure?
B-type natriuretic peptide (BNP) is released from the heart muscle of the left ventricle when fluid builds from heart failure. The BNP then acts on the kidneys to increase excretion of fluid.
What is the best single marker for predicting cardiovascular events?
hs-CRP
What test can be used to identify individuals at risk of cardiovascular disease?
hs-CRP
Name 5 tests that can be used to test for Coronary Artery disease (CAD)
Cardiac C-reactive protein, total cholesterol, HDL, LDL, Trigs
What is the major cause of CAD and is a primary target for therapy?
LDL
Which enzyme is needed to conjugate bilirubin?
glucuronyl transferase
What is formed in the intestines from bacterial action on bilirubin?
urobilinogen
Increases in total bilirubin can be clinically significant for..
liver disease, hemolysis, HDFN, kernicterus (brain damage) in infants
What is a special requirement in the collection of bilirubin samples?
the sample must be protected from light
Jendrassik-Grof method is used to measure…
bilirubin
What is added to the Jendrassik-Grof method so unconjugated bilirubin reacts?
accelerator
What reagent is used in the Jendrassik-Grof method to measure bilirubin?
Diazo reagent
Another term for conjugated bilirubin is…
direct bilirubin
Increases in conjugated bilirubin can be clinically significant for…
liver disease, obstructive jaundice
Delta bilirubin is bilirubin that is bound to…
albumin
When is delta bilirubin only typically seen?
significant hepatic obstruction
Which form of bilirubin isn’t measured, but calculated?
unconjugated bilirubin
Increases in unconjugated bilirubin can be clinically significant for…
prehepatic, posthepatic, and some types of hepatic jaundice
Which types of bilirubin are bound to albumin?
unconjugated and delta bilirubin
Which bilirubin is soluble in water?
conjugated bilirubin
Which bilirubin is not present in urine?
unconjugated bilirubin
What type of reaction does unconjugated bilirubin have with diazotized sulfanilic acid?
indirect (reacts only in the presence of an accelerator)
What type of reaction does conjugated bilirubin have with diazotized sulfanilic acid?
direct (reacts without accelerator)
Which form of bilirubin has high affinity for brain tissue?
unconjugated bilirubin
Which form of bilirubin is nonpolar?
unconjugated bilirubin
Which form of bilirubin is polar?
conjugated bilirubin
What would the results of the following tests typically look like for prehepatic jaundice? Total bilirubin: Direct Bilirubin: Urine bilirubin: Urine urobilinogen:
Total bilirubin: increased
Direct Bilirubin: normal
Urine bilirubin: neg
Urine urobilinogen: increased
What would the results of the following tests typically look like for hepatic jaundice? Total bilirubin: Direct Bilirubin: Urine bilirubin: Urine urobilinogen:
Total bilirubin: increased
Direct Bilirubin: variable
Urine bilirubin: variable
Urine urobilinogen: decreased
What would the results of the following tests typically look like for posthepatic jaundice? Total bilirubin: Direct Bilirubin: Urine bilirubin: Urine urobilinogen:
Total bilirubin: increased
Direct Bilirubin: increased
Urine bilirubin: positive
Urine urobilinogen: decreased
Name 6 Anterior pituitary hormones.
ACTH, FSH, GH, LH, Prolactin, TSH
Which hormone regulates the production of adrenocortical hormones by the adrenal cortex?
ACTH
ACTH is regulated by which hormone secreted from the hypothalamus?
corticotropin-releasing hormone (CRH)
Which pituitary hormone is increased in Cushing’s disease?
ACTH
TRUE OR FALSE: ACTH expresses diurnal variation.
True - highest levels are in the morning
Which pituitary hormone needs to be collected on ice and stored frozen?
ACTH
Which pituitary hormone regulates sperm and egg production?
FSH
FSH is regulated by which hormone secreted from the hypothalamus?
gonado-tropin releasing hormone (GnRH)
Which pituitary hormones sharply increase just before ovulation?
FSH and LH
Which pituitary hormone regulates protein synthesis, cell growth and division?
growth hormone (GH)
Which hormones secreted from the hypothalamus regulate GH?
growth-hormone releasing hormone (GHRH) and somatostatin
Increased levels of GH can be clinically significant for…
gigantism and acromegaly
Decreased levels of GH can be clinically significant for…
dwarfism
Which pituitary hormone regulates follicle maturation, ovulation, production of estrogen, progesterone, testosterone?
LH
Which hormone secreted by the hypothalamus regulates the secretion of LH?
GnRH
Which pituitary hormone regulates lactation?
Prolactin
Which hypothalamus hormones regulate prolactin?
prolactin-releasing factor (PRF) and prolactin-inhibiting factor (PIF)
Which pituitary hormone regulates the production of T3 and T4 by the thyroid?
TSH
Which hypothalamus hormone regulates the secretion of TSH?
thyrotropin-releasing hormone (TRH)
Increased levels of TSH are seen in…
hypothyroidism
Decreased levels of TSH are seen in…
hyperthyroidism
Name 2 posterior pituitary hormones.
ADH and oxytocin
Which pituitary hormone regulates the reabsorption of water in the distal renal tubules?
ADH
Which pituitary hormones are actually produced in the hypothalamus, but then stored in the posterior pituitary?
ADH and oxytocin
The release of ADH is stimulated by…
increased osmolality, decreased blood volume or blood pressure
ADH is (increased or decreased) in diabetes insipidus.
decreased
Which pituitary hormone regulates uterine contractions during childbirth and lactation?
oxytocin
What is another name for thyroxine?
T4
What is another name for triidothyronine?
T3
T4 is short for which thyroid hormone?
thyroxine
T3 is short for which thyroid hormone?
triidothyronine
Which thyroid hormone(s) regulate metabolism, growth, and development?
T3 and T4
Calcitonin is a thyroid hormone that regulates…
inhibits calcium reabsorption
Name 3 thyroid hormones.
thyroxine (T4), triidothyronine (T3), and calcitonin.
T3 and T4 are regulated by which hormone?
TSH
Most T4 is bound to…
thyroxine-binding globulin (TBG)
What is the principle thyroid hormone that is the most concentrated?
T4
T3 and T4 are increased in…
hyperthyroidism
T3 and T4 are decreased in…
hypothyroidism
Most T3 is formed from…
deiodinized T4
How many atoms of iodine does T3 contain?
3
How many atoms of iodine does T4 contain?
4
Which thyroid hormone is the most potent?
T3
Which thyroid hormone has the highest concentration?
T4
Which thyroid hormone is important in diagnosing thyroid cancer?
calcitonin
Parathyroid hormone (PTH) regulates…
Calcium and phosphate
What would be the expected test results for the following in hyperparathyroidism?
PTH
Calcium
Phosphate
PTH: increased
Calcium: increased
Phosphate: decreased
What would be the expected test results for the following in hypoparathyroidism?
PTH
Calcium
Phosphate
PTH: decreased
Calcium: decreased
Phosphate: increased
A thyroid insufficiency is called…
primary hypothyroidism
A pituitary insufficiency in regards to hypothyroidism is termed…
secondary hypothyroidism
What is the most common cause of hyperthyroidism?
Graves Disease
What types of tests are used for thyroid testing?
immunoassays
In primary hypothyroidism, what results would be expected for the following?
TSH:
FT4:
FT3:
TSH: increased
FT4: decreased
FT3: decreased
In secondary hypothyroidism, what results would be expected for the following?
TSH:
FT4:
FT3:
TSH: decreased
FT4: decreased
FT3: decreased
In hyperthyroidism, what results would be expected for the following?
TSH:
FT4:
FT3:
TSH:decreased
FT4: increased
FT3: increased
In T3 thyrotoxicosis, what results would be expected for the following?
TSH:
FT4:
FT3:
TSH: decreased
FT4: normal
FT3: increased
TRUE OR FALSE: If the TSH test comes back normal, T3 and T4 should be tested next.
False. no further testing is needed
What is the biologically active form of T3 and T4?
Free T3 and Free T4
What is the first test used to screen for thyroid problems?
TSH
Due to free T3 not being helpful in diagnosing hypothyroidism, it is usually only tested when…
TSH is decreased and FT4 is not increased (possible thyrotoxicosis)
What is the next test ordered when TSH is abnormal?
FT4
Name the adrenal cortex hormones.
aldosterone and cortisol
Aldosterone regulates…
reabsorption of sodium in the renal tubules
Increases in aldosterone can cause…
hypertension (due to water and sodium retention)
Decreases in aldosterone can lead to…
severe water and electrolyte abnormalities
Cortisol regulates…
carbohydrate, fat, and protein metabolism, water and electrolyte balance, suppresses inflammatory and allergic reactions
Cortisol is regulated by…
ACTH
Which adrenal cortex hormone expresses diurnal variation?
cortisol
Cushing’s syndrome is…
when there is an increase in cortisol with loss of diurnal variation
Decreased levels of cortisol are seen in…
Addison’s disease
Which hormones are responsible for the “fight or flight syndrome”?
epinephrine and norepinephrine
What is the primary hormone of the adrenal medulla?
epinephrine
Epinephrine and norepinephrine regulate…
stimulation of the sympathetic nervous system
Epinephrine and norepinephrine are categorized as
catecholamines
What are the metabolites of epinephrine and norepinephrine?
metanephrines and VMA
What is the term used to describe a rare chatecolamine producing tumor?
pheochromocytoma
Increased levels of chatecholamines are seen with…
pheochromocytoma
Which hormones are responsible for the development of female reproductive organs and secondary sex charateristics that also regulate the menstrual cycle and maintain pregrgnancy?
estrogens
What is the major estrogen produced by the ovaries?
Estradiol
What is the most potent estrogen?
Estradiol
Other than the ovaries, where else can estrogen be produced?
adrenal cortex
Which hormone prepares the uterus for ovum implantation and helps maintain pregnancy?
progesterone
What reproductive hormone can be used to monitor fetal growth and development?
Estriol (estrogen)
Which hormone is useful in infertility studies and assess placental functions?
progesterone
Pregnanediol is a metabolite of…
progesterone
Which hormone is considered progesterone production by corpus luteum during early pregnancy and regulated the development of fetal gonads?
HCG
Which hormone is used to detect pregnancy?
HCG
Other that detecting pregnancy, HCG can be useful in detecting…
gestational trophoblastic disease, testicular tumor, and other HCG-producing tumors
Human placental lactogen (HPL) regulates..
estrogen and progesterone production by the corpus luteum.
development of mammary glands
Which hormone regulates development of male reproductive organs and secondary sex characteristics?
testosterone
Insulin regulates…
carbohydrate metabolism
Glucagon regulates…
glycogenolysis, gluconeogenesis, lipolysis
Insulin is produced in which cells of the islets of Langerhans?
bet cells
Glucagon is produced by which cells of the islets of Langerhans?
alpha cells
What hormone causes increased movement of glucose into cells for metabolism?
insulin
Which hormone increases plasma glucose levels?
glucagon
Which hormone decreases plasma glucose levels?
insulin
Insulin is decreased in which disease?
diabetes mellitus
Insulin is increased in which events?
insulinoma, hypoglycemia
What term is used to describe the lowest concentration of a drug in blood that will produce desired effect?
minimum effective concentration (MEC)
What term is used to describe the lowest concentration of drug in blood that will produce adverse response?
minimum toxic concentration (MTC)
What is therapeutic index?
ratio of MTC to MEC
What term is used to describe the lowest concentration of drug measured in blood that should be reached just before the next scheduled dose and should fall below the MEC?
Trough
What is the term to describe the highest concentration of drug measured in blood that is drawn immediately on achievement of steady state and should not exceed MTC?
Peak
What term is used to describe the amount of drug absorbed and distributed equals the amount of drug metabolized and excreted?
steady state.
How many half lives does it usually take to reach a steady state?
5-7 half-lives
What is a half-life?
Time required for concentration of a drug to be decreased by half
salicylates and acetaminophen are of which therapeutic drug group?
analgesics
Which therapeutic drug group does the following drug belong to? Phenobarbital
antiepileptics
Which therapeutic drug group does the following drug belong to? phenytoin
antiepileptics
Which therapeutic drug group does the following drug belong to? valproic acid
antiepileptics
Which therapeutic drug group does the following drug belong to? carbamazepine
antiepileptic
Which therapeutic drug group does the following drug belong to? ethosuximide
antiepileptic
Which therapeutic drug group does the following drug belong to? felbamate
antiepileptic
Which therapeutic drug group does the following drug belong to? gabapentin
antiepileptic
Which therapeutic drug group does the following drug belong to? lamotrigine
antiepileptic
Which therapeutic drug group does the following drug belong to? methotrexate
antineoplastics
Which therapeutic drug group does the following drug belong to? aminoglycosides (amikacin, gentamicin, kanamycin, tobramycin)
antibiotics
Which therapeutic drug group does the following drug belong to? vancomycin
antibiotics
Which therapeutic drug group does the following drug belong to? digoxin
cardioactives
Which therapeutic drug group does the following drug belong to? disopyramide
cardioactives
Which therapeutic drug group does the following drug belong to? procainamide
cardioactives
Which therapeutic drug group does the following drug belong to? quinidine
cardioactives
Which therapeutic drug group does the following drug belong to? tricylic antidepressants
psychoactives
Which therapeutic drug group does the following drug belong to? lithium
psychoactives
Which therapeutic drug group does the following drug belong to? cyclosporine
immunosuppressant
Which therapeutic drug group does the following drug belong to? tacrolimus
immunosuppressant
gas chromatography and enzymatic methods are used to detect which toxic substance?
ethanol
Differential spectrophotometry (co-oximeter) and gas chromatography are used to detect which toxic substance?
carbon monoxide
Atomic absorptions is used to detect which toxic substances?
arsenic and lead
Which toxic substance is detected by measuring serum pseudocholinesterase?
pesticides
(AFP) a-fetoprotein is a tumor marker for which type of cancer?
liver
Cancer antigen (CA) 15-3 is a tumor marker for which type of cancer?
breast
Cancer antigen (CA) 19-9 is a tumor marker for which type of cancer?
pancreatic
Cancer antigen (CA) 125 is a tumor marker for which type of cancer?
ovarian
Carcinoembryonic antigen (CEA) is a tumor marker for which type of cancer?
colorectal
Human chorionic gonadotropin (hCG) is a tumor marker for which type of cancer?
ovarian and testicular
Prostate-specific antigen (PSA) is a tumor marker for which type of cancer?
prostate
thyroglobulin is a tumor marker for which type of cancer?
thyroid
Name 4 clinical uses of tumor markers.
Aid in diagnosis, stage disease, monitor therapy, and detect recurrence
TRUE OR FALSE: Tumor markers alone can be used to diagnose cancer.
FALSE. Most are not useful in screening
Which tumor marker is produced by the fetal liver, re-expressed in certain tumors, and also increased in hepatitis and pregnancy?
a-fetoprotein (AFP)
Which tumor marker can be increased in smokers?
carcinoembryonic antigen (CEA)
What can be defined as a weak acid and it’s salt or conjugate base that minimizes changes in pH?
buffer
What is the most important buffer in the human body?
bicarbonate/carbonic acid (buffers blood pH)
What is the formula for the blood pH buffer?
H+ + HCO3- H2CO3 H2O + CO2
total CO2 - 1 = ?
bicarbonate
Bicarbonate is regulated by the…
kidneys
What is the Henderson-Hasselbalch equation?
pH = 6.1 + log(HCO3/H2CO3)
When blood pH decreases, this is an…
acidosis
When blood pH increases, this is an…
alkalosis
What compensates for a respiratory acid-base problem?
kidneys
What compensates for a metabolic acid-base problem?
lungs
What condition has:
decreased pH
increased PCO2
normal HCO3-
respiratory acidosis
What is the ideal ratio for PCO2:HCO3-?
20:1
What condition has:
decreased pH
normal PCO2
decreased HCO3-
metabolic acidosis
What condition has
increased pH
decreased PCO2
normal HCO3-
respiratory alkalosis
What condition has:
increased pH
normal PCO2
increased HCO3-
metabolic alkalosis
How is respiratory acidosis compensated?
Kidneys retain HCO3- and excrete H+
How is metabolic acidosis compensated?
hyperventilation (excrete CO2)
How is respiratory alkalosis compensated?
kidneys excrete HCO3- and retain H+
How is metabolic alkalosis compensated?
hypoventilation (retain CO2)
What is the term to describe low O2 content in arterial blood?
hypoxemia
What is the term to describe lack of O2 at the cellular level?
hypoxia
What is the term to describe baromertric pressure times % gas concentration?
partial pressure
What is the term to describe the amount of dissolved CO2 in blood?
PCO2
What is a measurement of respiratory component that is inversely proportional to respiration?
PCO2
What assesses pulmonary function?
PO2
What is the term to describe a graph showing the relationship between oxygen saturation and PO2?
oxygen dissociation curve
The oxygen dissociation curve provides information about…
hemoglobin’s affinity for O2
What is the phosphate compound in RBCs that at low levels, inhibits the release of O2 to tissues?
2,3-Diphosphoglycerate (2,3-DPG)
What is the term to describe the amount of O2 that is combined with hemoglobin and is expressed as % O2 that can be combined with hemoglobin?
oxygen saturation
1 g of Hgb can combine with how many mL of O2?
1.34 mL
What is the term to describe the partial pressure of O2 at which hemoglobin oxygen saturation is 50%.
P50
What does it mean if the value for P50 is low?
there is increased oxygen affinity (shift to the left in the O2 dissociation curve)
What does it mean if the value for P50 is high?
there is decreased oxygen affinity (shift to the right in the O2 dissociation curve)
What is the reference range for blood pH?
7.35-7.45
What is the reference range for PCO2?
35-45 mm Hg
What is the reference range for PO2?
80-100 mm/Hg
What is the reference range for arterial blood HCO3-?
22-26 mmol/L
What is the reference range for total CO2 in arterial blood?
23-27 mmol/L
A pH electrode measures..
[H+]
The Severinghaus electrode measures…
Dissolved CO2
The Clark electrode measures…
Dissolved O2
The co-oximeter measures…
oxygen saturation
If an arterial blood gas sample was at room temperature for more than 30 minutes, what would the effects be?
decreased PO2
decreased pH
Increased PCO2
If an arterial blood gas sample was exposed to air, what would the effects be?
decreased PCO2, increased pH, increased PO2
Albumin/(total protein-albumin) = ?
A/G ratio (1-2.5)
(Na+ + K+) - (Cl- + HCO3-) = ?
Anion gap (10-20
An increased BUN:Crea ration with increased BUN and normal Crea indicates…
prerenal condition
An increased BUN:Crea ratio with increased Crea indicates…
postrerenal condition
A reversed A/G ratio can be clinically significant for…
multiple myeloma and liver disease
Reasons for an increased anion gap.
Salicylate poisoning Lactic acidosis Unmeasured anions Methanol Polyethylene glycol Ethanol Diabetic ketoacidosis
(Urine Crea x Urine Volume mL) / (plasma crea x time in minutes) =?
creatinine clearance
A decreased creatinine clearance is an early indicator for…
renal disease
2(Na+) + (glu/20) + (BUN/3) = ?
calculated osmolality (275-295 Osm/kg)
Measured osmolality - calculated osmolality = ?
osmolal gap (0-10 mOsm/kg)
What are reasons for an osmolal gap to be >10?
Methanol Ethanol Diuretics Isopropyl alcohol Ethylene glycol
Decreased urine:serum osmolality can be clinically significant for…
renal tubular deficiency, diabetes insipidus
