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AMT MT Exam > Review Cards - Clinical Chemistry > Flashcards

Review Cards - Clinical Chemistry Flashcards

1
Q

Reference range: Bilirubin, total

A

0.2-1 mg/dL

SI units: 3.4-17.1 umol/L

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2
Q

Reference range: BUN

A

6-20 mg/dL

SI units: 2.1-7.1 mmol/L

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3
Q

Reference range: Calcium, total

A

8.6-10 mg/dL

SI units: 2.15-2.5 mmol/L

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4
Q

Reference range: Chloride

A

98-107 mEq/L

SI units: 98-107 mmol/L

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5
Q

Reference range: Creatinine

A

0.6-1.2 mg/dL

SI units: 53-106 mmol/L

Values can vary between males and females

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6
Q

Reference range: Glucose, fasting

A

70-99 mg/dL

SI units: 3.9-5.5 mmol/L

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7
Q

Reference range: Potassium

A

3.5-5.1 mEq/L

SI units: 3.5-5.1 mmol/L

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8
Q

Reference range: Potassium

A

3.5-5.1 mEq/L

SI units: 3.5-5.1 mmol/L

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9
Q

Reference range: Sodium

A

136-145 mEq/L

SI units: 136-145 mmol/L

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10
Q

Reference range: Total protein

A

6.4-8.3 g/dL

SI units: 64-83 g/L

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11
Q

Reference range: Uric acid

A

Male: 3.5-7.2 mg/dL
Female: 2.6-6 mg/dL

SI units:
Male: 208-428 umol/L
Female: 155-357 umol/L

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12
Q

Diurnal variation - analytes affected?

A

Increased in AM: ACTH, cortisol, iron

Increased in PM: growth hormone, PTH, TSH

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13
Q

Day-to-day variation - analytes affected?

A

> =20% for alanine aminotransferase (ALT), bilirubin, creatinine kinase, steroid hormones, triglycerides

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14
Q

Recent food ingesting - analytes affected?

A

Increased: glucose, insulin, gastrin, triglycerides, sodium, uric acid, iron, lactate dehydrogenase, calcium

Decreased: chloride, phosphate, potassium

Fasting required: fasting glucose, triglycerides, lipid panel

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15
Q

Alcohol - analytes affected?

A

Decreased: glucose

Increased: cholesterol, gamma glutamyl transferase (GGT)

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16
Q

Posture - analytes affected?

A

Increased: albumin, cholesterol, calcium

(when standing)

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17
Q

Activity - analytes affected?

A

Increased in ambulatory patients: creatinine kinase (CK)

Increased with exercise: potassium, phosphate, lactic acid, creatinine, protein, CK, aspartate, aminotransferase (AST), LD

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18
Q

Stress - analytes affected?

A

Increased: ACTH, cortisol, catecholamines

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19
Q

Age, gender, race, drugs - analytes affected?

A

Various

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20
Q

Use of isopropyl alcohol wipes to disinfect venipuncture site - effect?

A

can compromise blood alcohol determination

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21
Q

squeezing site of capillary puncture - effect?

A

increased potassium

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22
Q

pumping fist during venipuncture - effect?

A

increased: potassium, lactic acid, calcium, phosphorus

decreased: pH

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23
Q

Tourniquet >1 minute - effect?

A

increased: potassium, total protein, lactic acid

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24
Q

IV fluid contamination - effect?

A

Increased: glucose, potassium, sodium, chloride (depending on IV)

Possible dilution of other analytes.

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25
Q

Incorrect anticoagulant or contamination from incorrect order of draw - effect?

A

K2EDTA:
decreased calcium, magnesium
increased potassium

Sodium heparin: increased sodium if tube is not completely filled

Lithium heparin: increased lithium

Gels: some interfere with trace metals & certain drugs

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26
Q

Hemolysis - effect?

A

Increased potassium, magnesium, phosphorus, LD, AST, iron, ammonia

(May be method dependent. Refer to reagent package inserts.)

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27
Q

Exposure to light - effect?

A

decreased bilirubin

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28
Q

Temperature between collection & testing - effect?

A

chilling required for lactic acid, ammonia, blood gases

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29
Q

Inadequate centrifugation - effect?

A

poor barrier formation in gel tubes can result in increased: potassium, LD, AST, iron, phosphorus

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30
Q

Recentrifugation of primary tubes - effect?

A

hemolysis
Increased potassium

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31
Q

Delay in separating serum/plasma (unless gel tube is used) - effect?

A

Increased: ammonia, lactic acid, potassium, magnesium, LD

Decreased: glucose (unless collected in fluoride)

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32
Q

Storage temperature - effect?

A

Decreased at RT: glucose (unless collected in fluoride)

Increased at RT: lactic acid, ammonia

Decreased at 4*C: LD

Increased at 4*C: alkaline phosphatase (ALP)

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33
Q

Higher in plasma than serum

A

Total protein
LD
Calcium

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34
Q

Higher in serum than plasma

A

Potassium
Phosphate
Glucose
CK
Bicarbonate
ALP
Albumin
AST
Triglycerides

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35
Q

Higher in plasma than whole blood

A

Glucose

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36
Q

Higher in capillary blood than venous blood

A

Glucose (in postprandial specimen)
Potassium

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37
Q

Higher in venous blood than capillary blood

A

Calcium
Total protein

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38
Q

Higher in RBCs than plasma

A

Potassium
Phosphate
Magnesium

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39
Q

Higher in plasma than RBCs

A

Sodium
Chloride

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40
Q

Spectophotometry - principle?

A

A chemical reaction produces a colored substance that absorbs light of a specific wavelength.

The amount of light absorbed is directly proportional to the concentration of the analyte.

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41
Q

Spectrophotometry - component parts?

A

1.Light source:
a. Tungsten lamp - visible range
b. Deuterium lamp - UV range
2. Monochromator - diffraction grating
3. Cuvette
4. Photodetector
5. Readout device

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42
Q

Atomic absorption spectrophotometry - principle?

A

Measures light absorbed by ground-state atoms.

Hollow cathode lamp with cathode made of analyte produces wavelength specific for analyte.

Used to measure TRACE METALS.

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43
Q

Atomic absorption spectrophotometry - component parts?

A
  1. Hollow cathode lamp
  2. Atomizer
  3. Flame
  4. Mixing chamber
  5. Chopper
  6. Monochromator
  7. Detector
  8. Readout device
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44
Q

Fluorometry - principle?

A

Atoms absorb light of a specific wavelength & emit light of a longer wavelength (lower energy)

Detector at 90* to the light source so that only light emitted by the sample is measured.

More sensitive than colorimetry.

Used to measure DRUGS, HORMONES.

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45
Q

Fluorometry - component parts?

A
  1. Light source - mercury or xenon arc lamp
  2. Primary monochromator
  3. Sample holder (quartz cuvettes)
  4. Secondary monochromator
  5. Detector
  6. Readout device
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46
Q

Chemiluminescence - principle?

A

Chemical reaction that produces light. Usually involves oxidation of luminol, acridinium esters, or dioxetanes.

Doesn’t require excitation radiation or monochromators like fluorometry. Extremely sensitive. Used for immunoassays.

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47
Q

Chemiluminescence - component parts?

A
  1. Reagent probes
  2. Sample & reagent cuvettes
  3. Photomultiplier tube
  4. Readout device
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48
Q

Turbidimetry - principle?

A

Measures the reduction in light transmission by particles in suspension.

Used to measure proteins in urine & CSF.

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49
Q

Nephelometry - principle?

A

Similar to turbidimetry, but light is measured at an angle from the light source.

Used to measure antigen-antibody reactions.

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50
Q

Turbidimetry - component parts?

A
  1. Light source
  2. Lens
  3. Cuvette
  4. Photodetector
  5. Readout device
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51
Q

Nephelometry - component parts?

A
  1. Light source
  2. Collimator
  3. Monochromator
  4. Cuvette
  5. Photodetector
  6. Readout device
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52
Q

Visible light spectrum: 350-430 nm

Color absorbed?
Color transmitted (visible)?

A

Absorbed: Violet
Transmitted: Yellow

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53
Q

Visible light spectrum: 430-475 nm

Color absorbed?
Color transmitted (visible)?

A

Absorbed: Blue
Transmitted: Orange

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54
Q

Visible light spectrum: 475-495 nm

Color absorbed?
Color transmitted (visible)?

A

Absorbed: Blue-green
Transmitted: Red-orange

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55
Q

Visible light spectrum: 495-505 nm

Color absorbed?
Color transmitted (visible)?

A

Absorbed: Green-blue
Transmitted: Orange-red

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56
Q

Visible light spectrum: 505-555 nm

Color absorbed?
Color transmitted (visible)?

A

Absorbed: Green
Transmitted: Red

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57
Q

Visible light spectrum: 555-575 nm

Color absorbed?
Color transmitted (visible)?

A

Absorbed: Yellow-green
Transmitted: Violet-red

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58
Q

Visible light spectrum: 575-600 nm

Color absorbed?
Color transmitted (visible)?

A

Absorbed: Yellow
Transmitted: Violet

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59
Q

Visible light spectrum: 600-650 nm

Color absorbed?
Color transmitted (visible)?

A

Absorbed: Orange
Transmitted: Blue

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60
Q

Visible light spectrum: 670-700 nm

Color absorbed?
Color transmitted (visible)?

A

Absorbed: Red
Transmitted: Green

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61
Q

Wavelengths used in Spectrophotometry: 220-380 nm

Range?
Common light source?
Cuvette?

A

Range: near-ultraviolet

Light source: deuterium or mercury arc

Cuvette: Quartz (silica)

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62
Q

Wavelengths used in Spectrophotometry: 380-750 nm

Range?
Common light source?
Cuvette?

A

Range: visible

Light source: Incandescent tungsten OR tungsten-iodide

Cuvette: Borosilicate

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63
Q

Wavelengths used in Spectrophotometry: 750-2,000 nm

Range?
Common light source?
Cuvette?

A

Range: Near-infrared

Light source: Incandescent tungsten OR tungsten-iodide

Cuvette: Quartz (silica)

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64
Q

Separation of compounds based on different distribution between mobile phase & stationary phase

A

Chromatography

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65
Q

Thin-layer chromatography - components?

A
  1. Sorbent-coated glass or plastic plate
  2. Closed container
  3. Solvent
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66
Q

Thin-layer chromatography - use?

A

Screening for drugs of abuse in urine

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67
Q

Thin-layer chromatography - how are substances identified?

A

by retention factor (R1) value - distance traveled by compound/distance traveled by solvent

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68
Q

High-performance liquid chromatography (HPLC) - components?

A
  1. Solvent
  2. Pump
  3. Injection port
  4. Column
  5. Detector
  6. Recorder
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69
Q

High-performance liquid chromatography - use?

A

separation of thermolabile compounds

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70
Q

High-performance liquid chromatography - how is concentration determined?

A

by peak height ratio (height of analyte peak/height of internal standard peak)

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71
Q

High-performance liquid chromatography - what can be used as a detector for definitive identification?

A

mass spectrometry (MS)

(LC/MS)

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72
Q

Gas chromatography - components?

A
  1. Gas
  2. Injection port
  3. Column
  4. Oven
  5. Detector
  6. Recorder
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73
Q

Gas chromatography - use?

A

separation of volatile compounds or compounds that can be made volatile, e.g., therapeutic & toxic drugs

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74
Q

Gas chromatography - what are compounds identified by?

A

retention time

(area of peak is proportional to concentration)

MS can be used as detector for definitive ID (GC/MS).

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75
Q

Ion-selective electrodes - principle?

A

Potential difference between 2 electrodes is directly related to the concentration of the analyte.

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76
Q

Ion-selective electrodes - component parts?

A
  1. Reference electrode
  2. Indicator electrode
  3. Liquid junction
  4. Measuring device
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77
Q

Ion-selective electrodes - Use?

A

pH
PCO2
PO2
Sodium
Potassium
Calcium
Lithium
Chloride

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78
Q

Osmometry - principle?

A

Determines osmolality based on freezing-point depression.

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79
Q

Measurement of the number of dissolved particles in solution, irrespective of molecular weight, size, density, or type.

A

Osmolality

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80
Q

Osmometry - component parts?

A
  1. cooling bath
  2. thermistor
  3. probe
  4. stirring wire
  5. galvanometer
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81
Q

Osmometry - use?

A

Serum & urine osmolality

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82
Q

Electrophoresis - principle?

A

Separation of charged particles in an electrical field.

Anions move to positively charged pole (anode); cations move to negatively charged pole (cathode).

The greater the charge, the faster the migration.

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83
Q

Electrophoresis - component parts?

A
  1. Power supply
  2. Support medium
  3. Buffer
  4. Stain
  5. Densitometer
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84
Q

Electrophoresis - use?

A

Serum protein electrophoresis
Hemoglobin electrophoresis

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85
Q

Mass spectrometry - principle?

A

Generates multiple ions from the sample, then separates them according to their mass to charge ratio (m/z).

Extremely sensitive and specific.

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86
Q

Mass spectrometry - component parts?

A
  1. Ion source
  2. Analyzer
  3. Detector system
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87
Q

Mass spectrometry - use?

A

Drugs of abuse
Newborn screening
Hormones
Vitamins
Steroid analysis

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88
Q

Basic metabolic panel

A

Sodium
Potassium
Chloride
CO2
Glucose
Creatinine
BUN
Calcium

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89
Q

Comprehensive metabolic panel

A

Sodium
Potassium
Chloride
CO2
Glucose
Creatinine
BUN
Calcium

Albumin
Total protein
ALP
AST
Bilirubin

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90
Q

Electrolyte panel

A

Sodium
Potassium
Chloride
CO2

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91
Q

Hepatic function panel

A

Albumin
ALT
AST
ALP
Bilirubin (total & direct)
Total protein

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92
Q

Lipid panel

A

Total cholesterol
HDL
LDL
Cholesterol
Triglycerides

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93
Q

Renal function panel

A

Sodium
Potassium
CO2
Glucose
Creatinine
BUN
Calcium
Albumin
Phosphate

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94
Q

Glucose, fasting - reference range?

A

Normal: <100 mg/dL

(5.6 mmol/L)

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95
Q

Hyperglycemia - clinical significance?

A

Diabetes mellitus
Other endocrine disorders
Acute stress
Pancreatitis

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96
Q

analyte that is a major source of cellular energy

A

Glucose

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97
Q

Hypoglycemia - clinical significance?

A

Insulinoma
Insulin-induced hypoglycemia
Hypopituitarism

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98
Q

Is glucose increased or decreased at RT?

A

decreased

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99
Q

Which additive should be used when collecting blood for glucose to prevent glycolysis?

A

Sodium fluoride

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100
Q

Most common methods of determining glucose concentration?

A

glucose oxidase & hexokinase

Hexokinase = more accurate due to fewer interfering substances

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101
Q

Cholesterol, total - Reference range?

A

Desirable: <150 mg/dL

(5.2 mmol/L)

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102
Q

Cholesterol, total - clinical significance?

A

Limited value for predicting risk of coronary artery disease (CAD) by itself.

Used in conjunction with HDL & LDL cholesterol.

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103
Q

Most common method for measuring total cholesterol?

A

Enzymatic methods

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104
Q

HDL cholesterol - reference range?

A

Desirable: >=60 mg/dL

(1.5 mmol/L)

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105
Q

HDL cholesterol - clinical significance?

A

Appears to be inversely related to CAD.

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106
Q

Assays used to measure HDL cholesterol?

A

Homogenous assays - don’t require pretreatment to remove non-HDL

1st reagent - blocks non-HDL
2nd reagent - reacts with HDL

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107
Q

LDL cholesterol - reference range?

A

Optimal: <100 mg/dL

(2.6 mmol/L)

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108
Q

LDL cholesterol - clinical significance?

A

Risk factor for CAD

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109
Q

How is LDL concentration determined?

A

May be calculated from the Friedewald formula (if triglycerides are not >400 mg/dL) OR measured by direct homogenous assays.

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110
Q

Triglycerides - reference range?

A

Desirable: <150 mg/dL

(1.7 mmol/L)

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111
Q

Triglycerides - clinical signfiicance?

A

Risk factor for CAD.

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112
Q

What is the main form of lipid storage?

A

Triglycerides

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113
Q

Methods used for measuring triglyceride levels?

A

Enzymatic methods using lipase.

(Requires a fasting specimen)

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114
Q

Total protein - reference range?

A

6.4-8.3 g/dL

64-83 g/L

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115
Q

Increased total protein - clinical significance?

A

dehydration
chronic inflammation
multiple myeloma

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116
Q

Decreased total protein - clinical significance?

A

nephrotic syndrome
malabsorption
overhydration
hepatic insufficiency
malnutrition
agammaglobulinemia

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117
Q

What concentration of total protein is associated with peripheral edema?

A

<4.5 g/dL

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118
Q

Method of measuring total protein?

A

Biuret method

(Alkaline copper reagent reacts with peptide bonds)

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119
Q

Albumin - reference range?

A

3.5-5 g/dL

35-50 g/L

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120
Q

Decreased albumin - clinical significance?

A

dehydration

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121
Q

Increased albumin - clinical significance?

A

malnutrition
liver disease
nephrotic syndrome
chronic inflammation

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122
Q

What is the largest fraction of plasma proteins?

A

Albumin

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123
Q

Where is albumin synthesized?

A

liver

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124
Q

What is the function of albumin?

A

regulates osmotic pressure

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125
Q

How is albumin measured?

A

dye binding, e.g., bromocresol green (BCG), bromocresol purple (BCP)

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126
Q

Microalbumin (performed on urine sample) - reference range?

A

30-300 mg/24 hr

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127
Q

What is microalbuminuria predictive of?

A

diabetic nephropathy

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128
Q

Microalbumin - clinical significance?

A

increased in diabetics at risk of nephropathy

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129
Q

detects albumin in urine earlier than dipstick protein

A

microalbumin

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130
Q

alternative to measuring microalbumin in a 24 hr urine sample

A

albumin-to-creatinine ratio on a random sample

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131
Q

hormone that decreases glucose levels

A

insulin

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132
Q

action of insulin

A

responsible for entry of glucose into cells; increases glycogenesis

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133
Q

hormones that increase glucose levels

A

Glucagon
Cortisol
Epinephrine
Growth hormone
Thyroxine

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134
Q

responsible for entry of glucose into cells; increases glycogenesis

A

insulin

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135
Q

insulin antagonist; increases gluconeogenesis

A

cortisol

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136
Q

promotes glycogenolysis & gluconeogenesis

A

epineprhine

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137
Q

insulin antagonist

A

growth hormone

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138
Q

increases glucose absorption from GI tract; stimulates glycogenolysis

A

thyroxine

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139
Q

Type I diabetes mellitus - cause?

A

autoimmune destruction of beta cells

genetic predisposition - HLA-DR 3/4

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140
Q

absolute insulin deficiency; prone to ketoacidosis & diabetic complications

A

Type 1 DM

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141
Q

Type 2 diabetes mellitus - cause?

A

Insulin resistance in peripheral tissues.
-insulin secretory defect of beta cells
-associated with obesity

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142
Q

Gestational diabetes mellitus - cause?

A

placental lactogen inhibits action of insulin

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143
Q

GDM - risk to fetus?

A

death or neonatal complications - macrosomia, hypoglycemia, hypocalcemia, polycythemia, hyperbilirubinemia

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144
Q

When is GDM usually diagnosed?

A

during later 1/2 of pregnancy

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145
Q

Pre-diabetes - cause?

A

patients unable to utilize glucose efficiently but are not yet considered fully diabetic

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146
Q

Tests for DM - random plasma glucose

Pre-diabetes?
DM?

A

Pre-diabetes: none

DM: >=200 mg/dL

(>11.1 mmol/L)

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147
Q

When is a random plasma glucose test used?

A

only for use in patients with symptoms of hyperglycemia

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148
Q

Tests for DM - fasting plasma glucose (FPG)

Pre-diabetes?
DM?

A

Pre-diabetes: 100-125 mg/dL
DM: >=126 mg/dL

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149
Q

Tests for DM - oral glucose tolerance tests (OGTT)

Pre-diabetes?
DM?

A

140-199 mg/dL - 2 hours post-glucose ingestion indicates pre-diabetes

DM: Fasting >=95 mg/dL OR 1 hour >=180 mg/dL, OR 2 hr >=155 mg/dL

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150
Q

When is an OGTT test performed during pregnancy?

A

24-28 weeks gestation

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151
Q

Tests for DM - Hemoglobin A1C

Pre-diabetes?
DM?

A

Pre-diabetes: 5.7-6.4%
DM: >=6.5%

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152
Q

gives estimate of glucose control over previous 2-3 months

A

hemoglobin A1C

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153
Q

When should a hemoglobin A1C not be used?

A

patients with hemoglobinopathies or abnormal RBC turnover

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154
Q

Typical laboratory findings in uncontrolled DM:

Increased?
Decreased?

A

Increased:
1. blood glucose
2. urine glucose
3. urine SG
4. glycohemoglobin
5. ketones (blood & urine)
6. anion gap
7. BUN
8. Osmolality (serum & urine)
9. Cholesterol
10. Triglycerides

Decreased:
1. Bicarbonate
2. Blood pH

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155
Q

Metabolic syndrome - definition?

A

group of risk factors that seem to promote development of atherosclerotic cardiovascular disease & type 2 diabetes mellitus

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156
Q

Metabolic syndrome - risk factors?

A

decreased HDL-C
increased LDL-C
increased triglycerides
increased blood pressure
increased blood glucose

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157
Q

Aminoacidopathies - Phenylketonuria - cause?

A

deficiency of the enzyme that converts phenylalanine to tyrosine

phenylpyruvic acid in blood & urine

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158
Q

Aminoacidopathies - Phenylketonuria - effect?

A

mental retardation

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159
Q

Aminoacidopathies - Phenylketonuria - urine?

A

“mousy” odor

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160
Q

Aminoacidopathies - Phenylketonuria - diagnosis?

A

Guthrie bacterial inhibition assay, HPLC, tandem mass spectrometry (MS/MS), fluorometric & enzymatic methods.

All newborns are screened.

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161
Q

Aminoacidopathies - Tyrosinemia - cause?

A

disorder of tyrosine catabolism - tyrosine and its metabolites are excreted in urine

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162
Q

Aminoacidopathies - Tyrosinemia - effect?

A

Liver & kidney disease, death

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163
Q

Aminoacidopathies - Tyrosinemia - diagnosis?

A

MS/MS

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164
Q

Aminoacidopathies - Alkaptonuria - cause?

A

Deficiency of the enzyme needed in the metabolism of tyrosine & phenylalanine; buildup of homogentisic acid

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165
Q

Aminoacidopathies - Alkaptonuria - effect?

A

diapers stain black due to homogentisic acid in urine

later in life - darkening of tissues, hip & back pain

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166
Q

Aminoacidopathies - Alkaptonuria - diagnosis?

A

Gas chromatography & mass spectroscopy

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167
Q

Aminoacidopathies - Maple syrup urine disease (MSUD) - cause?

A

enzyme deficiency leading to the buildup of leucine, isoleucine, and valine

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168
Q

Aminoacidopathies - Maple syrup urine disease (MSUD) - effect?

A

Burnt-sugar odor to urine, breath, & skin.

Failure to thrive, mental retardation, acidosis, seizures, coma & death

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169
Q

Aminoacidopathies - Maple syrup urine disease (MSUD) - diagnosis?

A

Modified Guthrie test, MS/MS

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170
Q

Aminoacidopathies - Homocystinuria - cause?

A

deficiency in the enzyme needed for the metabolism of methionine; methionine & homocysteine buildup in plasma & urine

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171
Q

Aminoacidopathies - Homocystinuria - effect?

A

osteoporosis
dislocated lenses in the eye
mental retardation
thromboembolic events

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172
Q

Aminoacidopathies - Homocystinuria - diagnosis?

A

Guthrie test, MS/MS, LC-MS/MS

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173
Q

Aminoacidopathies - Cystinuria - cause?

A

Increased excretion of cystine due to defect in renal reabsorption

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174
Q

Aminoacidopathies - Cystinuria - effect?

A

recurring kidney stones

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175
Q

Aminoacidopathies - Cystinuria - diagnosis?

A

test urine with cyanide nitroprusside:

pos = red-purple color

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176
Q

Protein electrophoresis - rate of migration?

A

depends on size, shape, & charge of molecule

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177
Q

Protein electrophoresis - support medium?

A

cellulose acetate or agarose

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178
Q

Protein electrophoresis - buffer?

A

barbital buffer, pH 8.6

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179
Q

Protein electrophoresis - stains?

A

Ponceau S
amido blue
bromphenol blue
Coomassie brilliant blue

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180
Q

Protein electrophoresis - charge?

A

At pH 8.6, proteins are negatively charged & move toward the anode

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181
Q

Protein electrophoresis - order of migration (fastest to slowest)?

A

Albumin
alpha-1 globulin
alpha-2 globulin
beta globulin-1
beta globulin-2
gamma globulin

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182
Q

Protein electrophoresis - largest fraction?

A

albumin

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183
Q

Protein electrophoresis - electroendosmosis?

A

buffer flow toward cathode - causes gamma region to be cathodic to point of application

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184
Q

Protein electrophoresis - urine?

A

Must be concentrated first because of low protein concentration.

Bence-Jones proteins migrate to the gamma region in urine electrophoresis.

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185
Q

Protein electrophoresis - CSF?

A

Must be concentrated first because o flow protein concentration.

CSF has a prealbumin band.

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186
Q

Common serum protein electrophoresis patterns - normal

A
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187
Q

Common serum protein electrophoresis patterns - acute inflammation

A

Decreased albumin
Increased alpha-1 & alpha-2

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188
Q

Common serum protein electrophoresis patterns - chronic infection

A

Increased alpha-1, alpha-2, and gamma

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189
Q

Common serum protein electrophoresis patterns - cirrhosis

A

Polyclonal increase (all fractions) in gamma with beta-gamma bridging

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190
Q

Common serum protein electrophoresis patterns - monoclonal gammopathy

A

Sharp increase in 1 immunoglobulin (“M spike”), decrease in other fractions

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191
Q

Common serum protein electrophoresis patterns - polyclonal gammopathy

A

Diffuse increase in gamma

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192
Q

Common serum protein electrophoresis patterns - hypogammaglobulinemia

A

decreased gamma

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193
Q

Common serum protein electrophoresis patterns - nephrotic syndrome

A

decreased albumin
increased alpha-2

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194
Q

Common serum protein electrophoresis patterns - alpha-1-antitrypsin deficiency

A

decreased alpha-1

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195
Q

Common serum protein electrophoresis patterns - hemolyzed specimen

A

increased beta or unusual band between alpha-2 & beta

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196
Q

Common serum protein electrophoresis patterns - plasma

A

extra band (fibrinogen) between beta & gamma

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197
Q

List the nonprotein nitrogen compounds.

A
  1. BUN
  2. Creatinine
  3. Uric acid
  4. Ammonia
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198
Q

BUN - reference range?

A

8-26 mg/dL

(2.1-7.1 mmol/L)

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199
Q

BUN - clinical significance?

A

Increased - kidney disease

Decreased - overhydration or liver disease

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200
Q

How is BUN synthesized?

A

by the liver from ammonia

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201
Q

How is BUN excreted?

A

by the kidneys

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202
Q

BUN - reagent?

A

Urease

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203
Q

Which anticoagulants should not be used to collect a BUN sample?

A

sodium fluoride
EDTA
citrate
ammonium heparin

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204
Q

How is BUN measured?

A

Utilizes urease reaction, measure decrease in absorbance at 340 nm

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205
Q

How should a BUN urine specimen be stored?

A

Dilute urine 1:20 or 1:50 & refrigerate or acidify

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206
Q

Creatinine - reference range?

A

0.6-1.2 mg/dL

(53-106 mmol/L)

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207
Q

Creatinine - clinical significance?

A

Increased - kidney disease

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208
Q

waste product from dehydration of creatine (mainly in muscles)

A

creatinine

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209
Q

Creatinine - method of measurement?

A

Jaffe reaction (alkaline picrate) is nonspecific but kinetic version increases specificity; enzymatic methods are more specific.

Dilute urine 1:100.

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210
Q

normal BUN:creatinine ratio

A

12-20

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211
Q

Uric acid - reference range?

A

Male: 3.5-7.2 mg/dL
Female: 2.6-6 mg/dL

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212
Q

Uric acid - clinical significance?

A

increased - gout, renal failure, ketoacidosis, lactate excess, high nucleoprotein diet, leukemia, lymphoma, polycythemia

decreased - administration of ACTH, renal tubular defects

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213
Q

What does elevated uric acid increase the risk of developing?

A

renal calculi

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214
Q

Uric acid - method of measurement?

A

analyzed with uricase method

EDTA & fluoride interfere

adjust urine pH to 7.5-8 to prevent precipitation

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215
Q

Ammonia - reference range?

A

19-60 mcg/dL

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216
Q

Ammonia - clinical significance?

A

Increased - liver disease, hepatic coma, renal failure, Reye syndrome

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217
Q

High levels of what nonprotein nitrogen compound are neurotoxic?

A

ammonia

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218
Q

What anticoagulant tubes should be used when testing for ammonia?

A

EDTA or heparin

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219
Q

Why should serum not be used when testing for ammonia?

A

serum may cause increased levels as NH3 is generated during clotting

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220
Q

How should specimens for ammonia be collected?

A

EDTA or heparin tubes
Chilled immediately
Analyzed ASAP
Avoid contamination from ammonia from detergents or water

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221
Q

List the major electrolytes.

A
  1. sodium
  2. potassium
  3. chloride
  4. CO2, total
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222
Q

Sodium - reference range?

A

136-145 mmol/L

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223
Q

Sodium - clinical significance - hypernatremia

A

Increased intake
IV administration
hyperaldosteronism
excessive sweating
burns
diabetes insipidus

-causes tremors, irritability, confusion, coma

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224
Q

Sodium - clinical significance - hyponatremia

A

Renal or extrarenal loss (vomiting, diarrhea, sweating, burns)
Increased extracellular fluid volume

-causes weakness, nausea, altered mental status

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225
Q

What is the major extracellular cation?

A

Sodium

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226
Q

What electrolyte contributes almost half to plasma osmolality?

A

Sodium

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227
Q

Function of sodium in the body

A

maintains normal distribution of water & osmotic pressure

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228
Q

What are sodium levels regulated by?

A

aldosterone

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229
Q

Sodium- method of measurment

A

ion-selective electrode (ISE)

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230
Q

What is the normal sodium/potassium ratio in serum?

A

30:1

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231
Q

Potassium - reference range?

A

3.5-5.1 mmol/L

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232
Q

Potassium - clinical significance - hyperkalemia

A

increased intake
decreased excretion
crush injuries
metabolic acidosis

-can cause muscle weakness, confusion, cardiac arrhythmia, cardiac arrest

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233
Q

Potassium - clinical significance - hyperkalemia

A

increased GI or urinary loss
use of diuretics
metabolic alkalosis

-can cause muscle weakness, paralysis, breathing problems, cardiac arrhythmia, death

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234
Q

What is the major intracellular cation?

A

potassium

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235
Q

What can cause a artificial increase in potassium?

A

squeezing site of capillary puncture
prolonged tourniquet
pumping fist during venipuncture
contamination with IV fluid
hemolysis
prolonged contact with RBCs
leukocytosis
thrombocytosis

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236
Q

Why are serum potassium values 0.1-0.2 mmol/L HIGHER than plasma?

A

Due to release from platelets during clotting

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237
Q

Potassium - method of measurement

A

Ion selective electrode (ISE) with vancomycin membrane

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238
Q

Chloride - reference range?

A

98-107 mmol/L

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239
Q

Chloride - clinical significance - hyperchloremia

A

increased intake
IV administration
hyperaldosteronism
excessive sweating
burns
diabetes insipidus
excess loss of HCO3-

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240
Q

Chloride - clinical significance - hypochloremia

A

prolonged vomiting
diabetic ketoacidosis
aldosterone deficiency
salt-losing renal diseases
metabolic alkalosis
compensated respiratory acidosis

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241
Q

What is the major extracellular ion?

A

Chloride

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242
Q

Function of chloride

A

helps maintain osmolality, blood volume, electric neutrality

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243
Q

What passively follows sodium?

A

Chloride

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244
Q

Chloride - method of measurement

A

ISE

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245
Q

What test is used for the diagnosis of cystic fibrosis?

A

Sweat chloride test

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246
Q

CO2, total - reference range

A

23-29 mmol/L

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247
Q

CO2, total - clinical significance - increased

A

metabolic alkalosis
compensated respiratory acidosis

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248
Q

CO2, total - clinical significance - decreased

A

metabolic acidosis
compensated respiratory alkalosis

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249
Q

In what form is most CO2?

A

> 90% bicarbonate (HCO3-)

-remainder is carbonic acid (H2CO3) & dissolved CO2

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250
Q

Function of HCO3-

A

maintain acid-base balance

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251
Q

Why should you keep a sample being tested for CO2 capped?

A

to prevent loss of CO2

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252
Q

CO2, total - method of measurement

A

ISE or enzymatic method

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253
Q

Magnesium - reference range

A

1.6-2.6 mg/dL

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254
Q

Magnesium - clinical significance - increased

A

renal failure
increased intake (e.g., antacids)
dehydration
bone cancer
endocrine disorders

-can cause cardiac abnormalities, paralysis, respiratory arrest, coma

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255
Q

Magnesium - clinical significance - decreased

A

severe illness
GI disorders
endocrine disorders
renal loss

-can lead to cardiac arrhythmias, tremors, tetany, paralysis, psychosis, coma
-rare in non-hospitalized patients

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256
Q

Function of magnesium

A

essential cofactor for many enzymes

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257
Q

What electrolyte is 10x more concentrated in RBCs?

A

magnesium

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258
Q

Which anticoagulants/additives should be avoided when collecting a specimen for magnesium? Why?

A

EDTA, citrate, oxalate

-they bind magnesium

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259
Q

Does hemolysis affect magnesium test results?

A

yes

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260
Q

Calcium - reference range

A

Total: 8.6-10 mg/dL

Ionized: 4.60-5.08 mg/dL

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261
Q

Calcium - clinical significance - increased

A

primary hyperparathyroidism
cancer
multiple myeloma

-can cause weakness, coma, GI symptoms, renal calculi

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262
Q

Calcium - clinical significance - decreased

A

hypoparathyroidism
malabsorption
vitamin D deficiency
renal tubular acidosis

-leads to tetany (muscle spasms), seizures, cardiac arrhythmias

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263
Q

What is the most abundant mineral in the body?

A

calcium

99% in bones

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264
Q

What is calcium regulated by?

A

PTH
vitamin D
calcitonin

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265
Q

Magnesium - method of measurement

A

colorimetric methods

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266
Q

What anticoagulant/additives should be avoided when collecting a specimen for calcium? Why?

A

all except heparin

-they bind calcium

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267
Q

Calcium (total) - method of measurement

A

Colorimetric methods

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268
Q

What is the biologically active form of calcium and a better indicator of calcium status?

A

ionized (free) calcium

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269
Q

Calcium (ionized) - method of measurement

A

ISE

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270
Q

What factors affect the results of calcium measurement?

A

pH
temp

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271
Q

Phosphorus, inorganic (phosphate) - reference range

A

2.5-4.5 mg/dL

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272
Q

Phosphorus, inorganic (phosphate) - clinical significance - increased

A

renal disease
hypoparathyroidism

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273
Q

Phosphorus, inorganic (phosphate) - clinical significance - decreased

A

hyperparathyroidism
vitamin D deficiency
renal tubular acidosis

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274
Q

What is the major extracellular anion?

A

Phosphorus

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275
Q

Where in the body is most phosphorus located?

A

bones

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276
Q

Function of phosphorus

A

component of nucleic acids and many coenzymes

important reservoir of energy (ATP)

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277
Q

Phosphorus results are a limited value alone. What should results be correlated with?

A

calcium

(normally a reciprocal relationship)

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278
Q

True or False. Phosphorus is higher in children than adults.

A

True

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279
Q

Which anticoagulants/additives interfere with phosphorus results?

A

citrate
oxalate
EDTA

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280
Q

Is phosphorus higher in RBCs or plasma?

A

RBCs

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281
Q

Does hemolysis affect phosphorus results?

A

yes

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282
Q

Lactate (lactic acid) - reference range

A

4.5-19.8 mg/dL

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283
Q

Lactate (lactic acid) - clinical significance

A

sign of decreased O2 to tissues

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284
Q

What is lactate (lactic acid) a byproduct of?

A

anaerobic metabolism

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285
Q

Lactate (lactic acid) - collection considerations

A

Best NOT to use a tourniquet.
Patient should not make a fist.
Collect in heparin & put on ice OR use fluoride to inhibit glycolysis.

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286
Q

Lactate (lactic acid) - method of measurement

A

enzymatic methods

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287
Q

Iron - reference range

A

Males: 65-175 mcg/dL
Females: 50-170 mcg/dL

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288
Q

Iron- clinical significance - increased

A

iron overdose
hemochromatosis
sideroblastic anemia
hemolytic anemia
liver disease

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289
Q

Iron - clinical significance - decreased

A

iron deficiency anemia

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290
Q

What analyte is necessary for hemoglobin synthesis?

A

Iron

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291
Q

How is iron transported in the body?

A

by transferrin

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292
Q

Does hemolysis interfere with iron testing?

A

yes

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293
Q

Which anticoagulants/additives should be avoided when collecting a specimen for iron? Why?

A

Oxalate, citrate, EDTA

-they bind iron

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294
Q

Why is an early morning specimen preferred for iron testing?

A

because of diurnal variation

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295
Q

Iron - method of measurement

A

Colorimetric methods

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296
Q

Total iron binding capacity (TIBC) - reference range

A

250-425 mcg/dL

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297
Q

Total iron binding capacity (TIBC) - clinical significance - increased

A

iron deficiency anemia

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298
Q

Total iron binding capacity (TIBC) - clinical significance - decreased

A

iron overdose
hemochromatosis

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299
Q

Total iron binding capacity (TIBC) - method of measurement

A

Iron is added to saturate transferrin. The excess is removed. Then iron content is determined.

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300
Q

% saturation or transferrin saturation - reference range

A

20-50%

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301
Q

% saturation or transferrin saturation - clinical significance - increased

A

iron overdose
hemochromatosis
sideroblastic anemia

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302
Q

% saturation or transferrin saturation - clinical significance - decreased

A

iron deficiency anemia

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303
Q

% saturation or transferrin saturation - method of measurement

A

Calculated value.

304
Q

Transferrin - reference range

A

200-360 mg/dL

305
Q

Transferrin - clinical significance - increased

A

iron deficiency anemia

306
Q

Transferrin - clinical significance - decreased

A

iron overdose
hemochromatosis
chronic infections
malignancies

307
Q

What is transferrin?

A

Complex of apotransferrin (protein that transports iron) and iron.

308
Q

Transferrin - method of measurement

A

immunoassay

309
Q

Ferritin - reference range

A

Males: 20-250 mcg/L
Females: 10-120 mcg/L

310
Q

Ferritin - clinical significance - increased

A

iron overload
hemochromatosis
chronic infections
malignancies

311
Q

Ferritin - clinical significance - decreased

A

iron deficiency anemia

312
Q

What is the storage form of iron?

A

ferritin

313
Q

rough estimate of body iron content

A

ferritin

314
Q

Ferritin - method of measurement

A

immunoassay

315
Q

List the factors that influence enzymatic reactions.

A
  1. substrate concentration
  2. enzyme concentration
  3. pH
  4. temperature
  5. cofactors
  6. inhibitors
316
Q

Factors that influence enzymatic reactions - substrate concentration - first-order kinetics

A

[enzyme] > [substrate]

Reaction rate is proportional to [substrate].

317
Q

Factors that influence enzymatic reactions - substrate concentration - zero-order kinetics

A

[substrate] > [enzyme]

Reaction rate is proportional to [enzyme].

318
Q

Factors that influence enzymatic reactions - enzyme concentration

A

velocity of the reaction is proportional to [enzyme] as long as [substrate] > [enzyme]

319
Q

Factors that influence enzymatic reactions - enzyme concentration - unit of measure

A

international unit (IU)

320
Q

Factors that influence enzymatic reactions - enzyme concentration - enzyme catalytic activity measurement

A

the amount of enzyme that will catalyze 1 umol of substrate per minute under standardized conditions

321
Q

Factors that influence enzymatic reaction - pH

A

extremes of pH may denature enzymes

Most reactions occur at pH 7-8.

Use buffers to maintain optimal pH.

322
Q

Factors that influence enzymatic reactions - temperature

A

Increases of 10C doubles the rate of reaction until around 40-50C; then denaturation of enzyme may occur.

37*C is most commonly used in the US.

323
Q

Factors that influence enzymatic reactions - cofactors

A

nonprotein organic molecules that participate in reactions.

Must be present in excess.

324
Q

Factors that influence enzymatic reactions - cofactors - organic

A

called coenzymes - may serve as 2nd substrate in the reaction

(e.g., nicotinamide adenine nucleotide)

325
Q

Factors that influence enzymatic reactions - cofactors - inorganic

A

called activators - either required for OR enhance reaction

(e.g., chloride, magnesium)

326
Q

Factors that influence enzymatic reactions - cofactors - reaction most commonly used in enzyme determinations

A

NAD <–> NADH (reduced form of NAD)

NADH has absorbance at 340 nm; NAD does not.

327
Q

Factors that influence enzymatic reactions - inhibitors

A

interfere with the reaction

328
Q

Enzymes of clinical significance - Alkaline phosphatase (ALP) - location in body

A

almost all tissues

329
Q

Enzymes of clinical significance - Alkaline phosphatase (ALP) - clinical significance - increased

A

liver disease
bone disease
biliary tract obstruction (higher levels than hepatocellular disorders - hepatitis, cirrhosis)

330
Q

Enzymes of clinical significance - Alkaline phosphatase (ALP) - higher in what population?

A

children
adolescents
pregnant women
healing bone fractures

331
Q

Enzymes of clinical significance - Alkaline phosphatase (ALP) - optimal pH

A

pH = 9-10

332
Q

Enzymes of clinical significance - AST - location in body

A

Many tissues.

Highest in liver, heart, and skeletal muscle.

333
Q

Enzymes of clinical significance - AST - clinical significance - increased

A

liver disease (marked increased in viral hepatitis)

acute myocardial infarction (AMI)

muscular dystrophy

334
Q

Does hemolysis affect AST testing?

A

yes

335
Q

Enzymes of clinical significance - AST - method of measurement

A

Pyridoxal-5-Phosphate (P5P) is added as a cofactor in chemical reaction (Method of Henry).

P5P is one of the six active forms of B6 (activated in the liver).

336
Q

Enzymes of clinical significance - ALT - location in the body

A

Liver, RBCs

337
Q

Enzymes of clinical significance - ALT - clinical significance - increased

A

liver disease

-marked increase in viral hepatitis

338
Q

What enzyme is more specific for liver disease?

A. ALP
B. AST
C. ALT
D. GGT

A

C. ALT

339
Q

What is the most common product in both ALT and AST chemical reactions?

A

glutamate

340
Q

Enzymes of clinical significance - GGT - location in body

A

Liver, kidneys, pancreas

341
Q

Enzymes of clinical significance - GGT - clinical significance - increased

A

all hepatobiliary disorders
chronic alcoholism

-highest levels with obstructive disorders

342
Q

What enzyme is the most sensitive for all types of liver disease and is used by treatment centers to monitor abstention from alcohol?

A. ALP
B. AST
C. ALT
D. GGT

A

D. GGT

343
Q

Enzymes of clinical significance - LD - location in body

A

All tissues.

Highest in liver, heart, skeletal muscle, and RBCs

344
Q

Enzymes of clinical significance - LD - clinical significance - increased

A

acute myocardial infarction (AMI) - LD 1 & 2 elevated
liver disease - LD-5 elevated
pernicious anemia (highest levels) - LD-1 elevated

345
Q

What enzyme catalyzes lactic acid to pyruvic acid?

A

lactate dehydrogenase (LD)

346
Q

Does hemolysis affect LD testing?

A

yes

347
Q

What temperature should LD samples be stored at?

A

25C (NOT 4C)

348
Q

Enzymes of clinical significance - CK - location in body

A

cardiac muscle (CK-MB isotope)
skeletal muscle
brain

349
Q

Enzymes of clinical significance - CK - clinical significance - increased

A

AMI
muscular dystrophy (highest levels)

350
Q

What reaction does CK catalyze?

A

phosphocreatine + ADP <–> creatine + ADP

351
Q

What enzyme is the most sensitive for skeletal muscle disease?

A. LD
B. CK
C. AMS
D. LPS

A

B. CK

352
Q

Which factors can affect testing for CK?

A. all anticoagulants, except heparin
B. physical activity
C. intramuscular injections
D. All of the above

A

D. all of the above

-physical activity and IM injections can cause an increase in CK
-inhibited by all anticoagulants, except heparin

353
Q

Which isotope of CK is used in the diagnosis of AMI?

A

CK-MB

354
Q

Enzymes of clinical significance - Amylase (AMS) - location in body

A

salivary glands
pancreas

355
Q

Enzymes of clinical significance - Amylase (AMS) - clinical significance - increased

A

acute pancreatitis
other abdominal diseases
mumps

356
Q

Enzymes of clinical significance - Amylase (AMS) - function

A

breaks down starch to simple sugars

357
Q

Enzymes of clinical significance - Amylase (AMS) - levels in pancreatitis

A

Levels increased 2-12 hours after attack, peak at 24 hours, and return to normal in 3-5 days.

358
Q

Enzymes of clinical significance - Lipase (LPS) - location in body

A

pancreas

359
Q

Enzymes of clinical significance - Lipase (LPS) - clinical significance - increased

A

acute pancreatitis

360
Q

Enzymes of clinical significance - Lipase (LPS) - function

A

breaks down triglycerides into fatty acids & glycerol

361
Q

Enzymes of clinical significance - Lipase (LPS) - levels in pancreatitis

A

Usually parallel amylase, but may stay elevated longer.

-more specific than amylase for pancreatic disease

362
Q

Enzymes of clinical significance - Glucose-6-phosphate-dehydrogenase (G6PD) - location in body

A

RBCs

363
Q

Enzymes of clinical significance - Glucose-6-phosphate-dehydrogenase (G6PD) - measurement

A

Measured in hemolysate of whole blood.

364
Q

Enzymes of clinical significance - Glucose-6-phosphate-dehydrogenase (G6PD) - clinical significance

A

Inherited deficiency can lead to drug-induced hemolytic anemia.

365
Q

Diagnostic enzymology - hepatocellular disorders

A

AST
ALT
LD

366
Q

Diagnostic enzymology - biliary tract obstruction

A

ALP
GGT

367
Q

Diagnostic enzymology - skeletal muscle disorders

A

CK
AST
LD
aldolase

368
Q

Diagnostic enzymology - bone disorders

A

ALP

369
Q

Diagnostic enzymology - acute pancreatitis

A

Amylase
Lipase

370
Q

Cardiac markers for diagnosis AMI - CK-MB - elevation after chest pain

A

4-6 hours

371
Q

Cardiac markers for diagnosis AMI - CK-MB - duration of elevation

A

2-3 days

372
Q

Cardiac markers for diagnosis AMI - CK-MB - sensitivity/specificity

A

not entirely specific for AMI

373
Q

Cardiac markers for diagnosis AMI - CK-MB - methods of measurment

A

immunoassay

374
Q

Cardiac markers for diagnosis AMI - CK-MB - most often used in combination with what other cardiac marker?

A

troponin

375
Q

Cardiac markers for diagnosis AMI - Myoglobin - elevation after chest pain

A

1-4 hours

376
Q

Cardiac markers for diagnosis AMI - Myoglobin - duration of elevation

A

18-24 hours

377
Q

Cardiac markers for diagnosis AMI - Myoglobin - sensitivity/specificity

A

sensitive but not specific at all

378
Q

Cardiac markers for diagnosis AMI - Myoglobin - method of measurement

A

immunoassay

379
Q

Cardiac markers for diagnosis AMI - Cardiac troponins (cTnI or cTnT) - elevation after chest pain

A

3-10 hours

380
Q

Cardiac markers for diagnosis AMI - Cardiac troponins (cTnI or cTnT) - duration of elevation

A

4-10 days

381
Q

Cardiac markers for diagnosis AMI - Cardiac troponins (cTnI or cTnT) - sensitivity/specificity

A

high sensitivity & specificity

382
Q

Cardiac markers for diagnosis AMI - Cardiac troponins (cTnI or cTnT) - method of measurement

A

immunoassay

383
Q

What cardiac marker is considered the definitive marker for AMI?

A

troponin

384
Q

Testing recommendations for drawing blood for cardiac markers

A

Draw at admission, at 6-9 hours, & at 12-24 hours, if previous results were not increased.

385
Q

Which cardiac troponin is more specific, cTnI or cTnT?

A

cTnI

385
Q

Which cardiac troponin is more specific, cTnI or cTnT?

A

cTnI

386
Q

List cardiac tests used to diagnose heart failure.

A

B-type natriuretic peptide (BNP)

387
Q

Cardiac tests - BNP - clinical significance

A

Released from the heart muscle of the left ventricle when fluid builds from heart failure. Acts on the kidneys to increase excretion of fluid.

388
Q

List the cardiac tests used to assess risk of Coronary Artery Disease (CAD).

A
  1. High-sensitivity CRP (hs-CRP)
  2. Total cholesterol
  3. HDL cholesterol
  4. LDL cholesterol
  5. Triglycerides
389
Q

Tests to assess risk of CAD - High sensitivity CRP (hs-CRP) - clinical significance

A

Non-specific marker of inflammation.

Best single marker for predicting cardiovascular events.

390
Q

Tests to assess risk of CAD - High sensitivity CRP (hs-CRP) - why should it be tested on 2 occasions?

A

because of individual variability

391
Q

Tests to assess risk of CAD - High sensitivity CRP (hs-CRP) - methods of measurement

A

Nephelometry
Immunoassay

392
Q

Tests to assess risk of CAD - Total cholesterol - clinical significance

A

Most often used in conjunction with HDL & LDL cholesterol.

Desirable: <200 mg/dL

393
Q

Tests to assess risk of CAD - HDL cholesterol - clinical significance

A

Low level are a risk factor.

Desirable: >=60 mg/dL

394
Q

Tests to assess risk of CAD - LDL cholesterol - clinical significance

A

Major cause of CAD.

Primary target of therapy.

Optimal: <100 mg/dL

395
Q

Tests to assess risk of CAD - Triglycerides - clinical significance

A

Independent risk factor for CAD.

Desirable level: <150 mg/dL

396
Q

Primary lipid disorders - Lipoprotein Lipase Deficiency - laboratory findings

A

Extremely high triglyceride levels: 5,000-10,000 mg/dL

Elevated plasma chylomicrons.

Extremely “milky”-looking serum.

Erupted xanthomas are common manifestations of disease.

397
Q

Primary lipid disorders - Familial Combined Hyperlipidemia - laboratory findings

A

Triglycerides usually between 200-400 mg/dL.

-further classified by which lipid is elevated

398
Q

Primary lipid disorders - Familial Hypertriglyceridemia - laboratory findings

A

-moderate increase in plasma triglycerides
-increased VLDL
-sometimes decreased HDL

-milky serum after overnight refrigeration

399
Q

Primary lipid disorders - Familial Hypercholesterolemia - laboratory findings

A

-moderate increased in plasma LDL values (300=450 mg/dL)

-defect in the LDL receptor pathway leads to deposits of LDL in skin, tendons, and arteries.

400
Q

Primary lipid disorders - Tangier Disease (Hypoalphalipoproteinemia) - laboratory findings

A

-decreased or absent plasma HDL

-orange-colored tonsils often present

401
Q

Primary lipid disorders - Tangier Disease (Hypoalphalipoproteinemia) - pathophysiology

A
402
Q

Primary lipid disorders - Lipoprotein Lipase Deficiency - pathophysiology

A

ApoC-2 or LPL deficiency

403
Q

Primary lipid disorders - Familial Hypercholesterolemia - pathophysiology

A

LDL receptor deficiency

404
Q

Primary lipid disorders - Familial Hypertriglyceridemia - pathophysiology

A

VLDL overproduction

405
Q

Primary lipid disorders - Familial Combined Hyperlipidemia - pathophysiology

A

VLDL overproduction

405
Q

Bilirubin metabolism

A
406
Q

Total bilirbuin - reference range

A

0.2-1 mg/dL

407
Q

Total bilirubin - clinical significance - increased

A

liver disease
hemolysis
HDN

-in infants, >20 mg/dL is associated with brain damage (kernicterus)

408
Q

What is total bilirubin the sum of?

A

the sum of conjugated, unconjugated, & delta bilirubin

409
Q

What consideration should be taken when collecting a specimen for bilirubin testing?

A

Avoid hemolysis.

Protect from sunlight.

410
Q

Total bilirubin - method of measurement

A

Jendrassik-Grof method

-diazo reagent
-accelerator added so unconjugated bilirbuin reacts.

411
Q

Total bilirubin - method of measurement (neonates)

A

Bilirubinometry - measures reflected light from skin using 2 wavelengths.

412
Q

Conjugated bilirubin (direct bilirubin) - reference range

A

<0.8 mg/dL

413
Q

Conjugated bilirubin (direct bilirubin) - clinical significance - increased

A

liver disease
obstructive jaundice

414
Q

Conjugated bilirubin (direct bilirubin) - composed of?

A

bilirubin monoglucuronide
bilirubin diglucuronide & delta bilirubin (bound to albumin; only seen with significant hepatic obstruction)

415
Q

Conjugated bilirubin (direct bilirubin) - method of measurement

A

Jendrassik-Grof method

-diazo reagent
-NO accelerator required

416
Q

Unconjugated bilirubin (indirect bilirubin) - reference range

A

<0.2 mg/dL

417
Q

Unconjugated bilirubin (indirect bilirubin) - clinical significance - increased

A

prehepatic, posthepatic, & some types of hepatic jaundice

418
Q

Unconjugated bilirubin (indirect bilirubin) - method of measurement

A

Calculated value.

Total bili - direct bili = unconjugated bili

419
Q

Unconjugated vs. Conjugated bilirubin - bound to protein

A

Unconjugated - yes (albumin)

Conjugated - no (except delta bili)

420
Q

Unconjugated vs. Conjugated bilirubin - type of compound

A

Unconjugated - nonpolar

Conjugated - polar

421
Q

Unconjugated vs. Conjugated bilirubin - soluble in water?

A

Unconjugated - no

Conjugated - yes

422
Q

Unconjugated vs. Conjugated bilirubin - present in urine?

A

Unconjugated - no

Conjugated - yes

423
Q

Unconjugated vs. Conjugated bilirubin - reaction with diazotized sulfanilic acid

A

Unconjugated - indirect (only reacts in the presence of accelerator)

Conjugated - direct (reacts without accelerator)

424
Q

Unconjugated vs. Conjugated bilirubin - affinity for brain tissue (causes kernicterus)

A

Unconjugated - high

Conjugated - Low

425
Q

Differential Diagnosis of Jaundice - prehepatic jaundice

A

Total bili - increased
Direct bili - normal
Urine bilirubin - negative
Urine urobilinogen - increased

426
Q

Differential Diagnosis of Jaundice - hepatic jaundice

A

Total bilirubin - increased
Direct bili - variable
Urine bilirubin - variable
Urine urobilinogen - decreased

427
Q

Differential Diagnosis of Jaundice - post-hepatic jaundice

A

Total bilirubin - increased
Direct bilirubin - increased
Urine bilirubin - positive
Urine urobilinogen - decreased

428
Q

List the anterior pituitary hormones.

A
  1. ACTH
  2. FSH
  3. GH
  4. LH
  5. Prolactin (PRL)
  6. TSH
429
Q

List the posterior pituitary hormones.

A
  1. ADH
  2. Oxytocin
430
Q

Anterior pituitary hormone - ACTH - regulates?

A

production of adrenocortical hormones by the adrenal cortex

-cortisol
-androgens (progesterone, estrogen)
-aldosterone

431
Q

Anterior pituitary hormone - ACTH - regulated by?

A

corticotropin-releasing hormone (CRH) from the hypothalamus

432
Q

Anterior pituitary hormone - ACTH - diurnal variation

A

highest levels in early a.m., lowest in the afternoon

433
Q

Anterior pituitary hormone - ACTH - clinical significance

A

increased in Cushing’s disease

434
Q

Anterior pituitary hormone - ACTH - collection

A

Collect on ice. Store frozen.

434
Q

Anterior pituitary hormone - FSH - regulates?

A

sperm & egg production

435
Q

Anterior pituitary hormone - FSH - regulated by?

A

gonadotropin-releasing hormone (GHRH) from the hypothalamus

436
Q

Anterior pituitary hormone - FSH - clinical significance

A

Sharp increase just before ovulation.

437
Q

Anterior pituitary hormone - Growth hormone (GH) - regulates?

A

-Protein synthesis
-Cell growth & division

438
Q

Anterior pituitary hormone - Growth hormone (GH) - regulated by?

A

growth-hormone releasing hormone (GHRH) & somatostatin from the hypothalamus.

439
Q

Anterior pituitary hormone - Growth hormone (GH) - clinical significance

A

Increased - gigantism, acromegaly

Decreased - dwarfism

440
Q

Anterior pituitary hormone - Growth hormone (GH) - clinical significance

A

Increased - gigantism, acromegaly

Decreased - dwarfism

441
Q

Anterior pituitary hormone - Luteinizing hormone (LH) - regulates?

A

-Maturation of follicles
-Ovulation
-Production of estrogen, progesterone, testosterone

442
Q

Anterior pituitary hormone - Luteinizing hormone (LH) - regulated by?

A

gonadotropin-releasing hormone (GnRH) from the hypothalamus

443
Q

Anterior pituitary hormone - Luteinizing hormone (LH) - clinical significance

A

Sharp increase just before ovulation

444
Q

Anterior pituitary hormone - Luteinizing hormone (LH) - home tests

A

ELISA kits to detect ovulation

444
Q

Anterior pituitary hormone - Prolactin (PRL) - regulates?

A

lactation

445
Q

Anterior pituitary hormone - Prolactin (PRL) - regulated by?

A

prolactin-releasing hormone (PRF) & prolactin-inhibiting factor (PIF) from the hypothalamus

446
Q

Anterior pituitary hormone - TSH - regulates?

A

production of T3 & T4 by the thyroid

447
Q

Anterior pituitary hormone - TSH - regulated by?

A

thyrotropin-releasing hormone (TRH) from the hypothalamus

448
Q

Anterior pituitary hormone - TSH - clinical significance

A

Increased - hypothyroidism

Decreased - hyperthyroidism

448
Q

Posterior pituitary - ADH - regulates?

A

Reabsorption of water in distal renal tubules

449
Q

Posterior pituitary - ADH - where is it produced?

A

hypothalamus

450
Q

Posterior pituitary - ADH - where is it stored?

A

posterior pituitary

451
Q

Posterior pituitary - ADH - what is it’s release stimulated by?

A

-increased osmolality
-decreased blood volume
-decreased blood pressure

452
Q

Posterior pituitary - ADH - clinical significance

A

decreased in diabetes insipidus

453
Q

Posterior pituitary - Oxytocin - regulates?

A

-uterine contractions during childbirth
-lactation

454
Q

Posterior pituitary - Oxytocin - where is it produced?

A

hypothalamus

455
Q

Posterior pituitary - Oxytocin - where is it stored?

A

posterior pituitary

456
Q

Thyroid hormones - Thyroxine (T4) - regulates?

A

-metabolism
-growth
-development

457
Q

Which thyroid hormone is considered the principle thyroid hormone?

A

T4

458
Q

Thyroid hormones - Thyroxine (T4) - contains how many atom of iodine?

A

4

459
Q

Thyroid hormones - Thyroxine (T4) - regulated by?

A

TSH

460
Q

Thyroid hormones - Thyroxine (T4) - most bound to?

A

thyroxine-binding globulin (TBG)

461
Q

Thyroid hormones - Thyroxine (T4) - clinical significance

A

Increased - hyperthyroidism

Decreased - hypothyroidism

461
Q

Thyroid hormones - Triiodothyronine (T3) - regulates?

A

-metabolism
-growth
-development

462
Q

Thyroid hormones - Triiodothyronine (T3) - how is most formed?

A

from deiodination of T4 by the tissues.

463
Q

Thyroid hormones - Triiodothyronine (T3) - contains how many atoms of iodine?

A

3

464
Q

Thyroid hormones - Triiodothyronine (T3) - regulated by?

A

TSH

465
Q

Thyroid hormones - Triiodothyronine (T3) - clinical significance

A

Increased - hyperthyroidism

Decreased - hypothyroidism

466
Q

True or False. T3 is 4x-5x more potent than T4.

A

True

467
Q

Thyroid hormones - Calcitonin - regulates?

A

inhibition of calcium resorption

468
Q

Thyroid hormones - Calcitonin - clinical significance

A

important in diagnosis of thyroid cancer

469
Q

Thyroid hormones - Calcitonin - clinical significance

A

important in diagnosis of thyroid cancer

470
Q

Parathyroid hormone (PTH) - regulates?

A

calcium & phosphate

471
Q

Parathyroid hormone (PTH) - primary hyperparathyroidism - laboratory findings

A

Increased PTH
Increased calcium
Decreased phosphate

472
Q

Parathyroid hormone (PTH) - Hypoparathyroidism - laboratory findings

A

Decreased PTH
Decreased calcium
Increased phosphate

473
Q

Parathyroid hormone (PTH) - primary hypoparathyroidism

A
474
Q

Thyroid function testing - Primary hypothyroidism - laboratory findings

A

Increased TSH
Decreased Free T4 (FT4)
Decreased Free T3 (FT3)

475
Q

Thyroid function testing - Secondary hypothyroidism - laboratory findings

A

Decreased or normal TSH
Decreased Free T4
Decreased Free T3

476
Q

Thyroid function testing - Hyperthyroidism - laboratory findings

A

Decreased TSH
Increased Free T4
Increased Free T3

477
Q

Thyroid function testing - T3 Thyrotoxicosis - laboratory findings

A

Decreased TSH
Normal Free T4
Increased Free T3

478
Q

Thyroid function testing - Primary vs. Secondary Hypothyroidism

A
479
Q

List the adrenal hormones located in the adrenal cortex.

A
  1. aldosterone
  2. cortisol
480
Q

List the adrenal hormones located in the adrenal medulla.

A
  1. epinephrine
  2. norepinephrine

(adrenaline, noradrenaline)

481
Q

Adrenal hormones - cortex - Aldosterone - regulates?

A

reabsorption of sodium in the renal tubules

482
Q

Adrenal hormones - cortex - Aldosterone - clinical significance

A

Increased - causes hypertension due to water & sodium retention

Decreased - leads to severe water & electrolyte abnormalities

483
Q

Adrenal hormones - cortex - Cortisol - regulates?

A

-carbohydrate, fat, & protein metabolism
-water & electrolyte balance
-suppresses inflammatory & allergic reactions

484
Q

Adrenal hormones - cortex - Cortisol - regulated by?

A

ACTH

485
Q

Adrenal hormones - cortex - Cortisol - diurnal variation

A

Highest in a.m.

486
Q

Adrenal hormones - cortex - Cortisol - Cushing syndrome

A

Increased cortisol
Loss of diurnal variation

487
Q

Adrenal hormones - cortex - Cortisol - Addison disease

A

Decreased cortisol

488
Q

Adrenal hormones - medulla - Epinephrine, norepinephrine - regulates?

A

“Fight or flight syndrome.”
Stimulation of the sympathetic nervous system.

489
Q

What is the primary hormone of the adrenal medulla?

A

epinephrine

490
Q

Adrenal hormones - medulla - catecholamines

A

Epinephrine & norepinephrine

491
Q

Adrenal hormones - medulla - epinephrine & norepinephrine - metabolites

A

metanephrines => vanilylmandelic acid (VMA)

492
Q

Adrenal hormones - medulla - epinephrine & norepinephrine - clinical significance

A

Increased with pheochromocytoma (rare catecholamine producing tumor)

493
Q

Adrenal hormones - medulla - epinephrine & norepinephrine - tests

A

plasma & urine catecholamines & metanephrines

urine VMA

494
Q

Reproductive hormones - ovaries - estrogens - regulates?

A

-development of female reproductive organs & secondary sex characteristics
-regulation of the menstrual cycle
-maintenance of pregnancy

495
Q

What is the major estrogen produced by the ovaries (and most potent)?

A

Estradiol (E2)

(also produced in the adrenal cortex)

496
Q

Reproductive hormones - ovaries - progesterone - regulates?

A

preparation of uterus for ovum implantation and maintenance of pregnancy

497
Q

Reproductive hormones - ovaries - progesterone - also produced by?

A

the placenta

498
Q

Reproductive hormones - ovaries - progesterone - metabolite

A

pregnanediol

499
Q

Reproductive hormones - ovaries - progesterone - clinical significance

A

useful in infertility studies & to assess placental function

500
Q

Reproductive hormones - placenta - estrogen (estriol) - regulates?

A

no hormonal activity

501
Q

Reproductive hormones - placenta - estrogen (estriol) - clinical significance

A

used along with AFP, hCG, and inhibin A as part of the Quadrapole (Quad) screen to monitor fetal growth and development

502
Q

Reproductive hormones - placenta - progesterone - regulates?

A

maintenance of pregnancy

503
Q

Reproductive hormones - placenta - human chorionic gonadotropin (hCG) - regulates?

A

-progesterone production by the corpus luteum during early pregnancy

-development of fetal gonads

504
Q

Reproductive hormones - placenta - human chorionic gonadotropin (hCG) - clinical significance

A

-pregnancy
-gestational trophoblastic disease (e.g., hydatidiform mole)
-testicular tumor
-other hCG-producing tumors

505
Q

Reproductive hormones - placenta - inhibin A - regulates?

A

hormone made by the placenta - inhibits secretion of FSH by anterior pituitary

506
Q

Reproductive hormones - placenta - inhibin A - clinical significance

A

part of Quad screen - monitor fetal growth and development

-high levels seen with Down syndrome

507
Q

Reproductive hormones - testes - testosterone - regulates?

A

development of male reproductive organs & secondary sex characteristics

508
Q

Reproductive hormones - testes - testosterone - metabolites

A

-estradiol
-dihydrotestosterone (DHT)

509
Q

Pancreatic hormones - insulin - regulates?

A

carbohydrate metabolism

510
Q

Pancreatic hormones - insulin - where is it produced?

A

produced in the beta cells of the islets of Langerhans

511
Q

Pancreatic hormones - insulin - functions?

A

decreases plasma glucose levels by increasing movement of glucose into the cells for metabolism

512
Q

Pancreatic hormones - insulin - clinical significance

A

Decreased in diabetes mellitus.

Increased with insulinoma and hypoglycemia.

513
Q

Pancreatic hormones - glucagon - regulates?

A

glycogenolysis
gluconeogenesis
lipolysis

514
Q

Pancreatic hormones - glucagon - where is it produced?

A

produced in the alpha cells of the islets of Langerhans

515
Q

Pancreatic hormones - glucagon - function

A

increases plasma glucose levels

516
Q

Endocrine disorders - Addison Disease - laboratory findings

A

-decreased cortisol
-decreased aldosterone
-increased ACTH
-decreased sodium
-increased potassium

517
Q

Endocrine disorders - Addison Disease - endocrine gland affected

A

adrenal cortex

518
Q

Endocrine disorders - Addison Disease - diagnosis

A

-SCREEN for primary adrenal insufficiency with morning plasma cortisol
-CONFIRMATION: decreased response to cosyntropin stimulation

519
Q

Endocrine disorders - Addison Disease - common symptoms

A

-low blood pressure
-darkening of the skin

520
Q

Endocrine disorders - Cushing Disease - laboratory findings

A

-increased cortisol
-increased ACTH

521
Q

Endocrine disorders - Cushing Disease - endocrine gland affected

A

tumor of the pituitary gland

522
Q

Endocrine disorders - Cushing Disease - diagnosis

A

CONFIRM: overnight dexamethasone suppression test

523
Q

Endocrine disorders - Acromegaly - laboratory findings

A

increased growth hormone

524
Q

Endocrine disorders - Acromegaly - endocrine gland affected

A

pituitary gland

525
Q

Endocrine disorders - Acromegaly - diagnosis

A

CONFIRM: oral glucose tolerance test - growth hormone will remain abnormally elevated

526
Q

Endocrine disorders - Diabetes insipidus - laboratory findings

A

-elevated plasma sodium
-elevated plasma osmolality
-decreased urine osmolality

527
Q

Endocrine disorders - Diabetes insipidus - endocrine gland affected

A

hypothalamus OR kidneys

528
Q

Endocrine disorders - Diabetes insipidus - pathophysiology

A

Deficient production or action of ACTH

529
Q

Endocrine disorders - Diabetes insipidus - symptoms

A

polyuria
polydipsia

530
Q

Endocrine disorders - Pheochromocytoma - laboratory findings

A

-elevated plasma AND catecholamines (epinephrine & norepinephrine)
-elevated plasma AND metanephrines
-elevated urine VMA

531
Q

Endocrine disorders - Pheochromocytoma - common symptoms

A

-unexplained high blood pressure
-headaches
-sweating

532
Q

Endocrine disorders - Hyperprolactinemia - laboratory findings

A

elevated plasma prolactin

533
Q

Endocrine disorders - Hyperprolactinemia - endocrine gland affected

A

pituitary gland

534
Q

Endocrine disorders - Pheochromocytoma - endocrine gland affected

A

adrenal medulla

535
Q

Endocrine disorders - Hyperprolactinemia - hook effect

A

falsely decreased results, immunoassay

536
Q

Endocrine disorders - Hyperprolactinemia - falsely elevated results

A

macroprolactin

537
Q

lowest concentration of drug in blood that will produce desired effect

A

minimum effective concentration (MEC)

538
Q

lowest concentration of drug in blood that will produce an adverse response

A

minimum toxic concentration (MTC)

539
Q

ratio of MTC to MEC

A

therapeutic index

540
Q

lowest concentration of drug measured in blood; reached just before the next scheduled dose; shouldn’t fall below MEC

A

trough

541
Q

highest concentration of drug measured in blood; drawn immediately on achievement of steady state; should not exceed MTC

A

peak

542
Q

amount of drug absorbed & distributed = amount of drug metabolized & excreted; usually reached after 5-7 half lives

A

steady state

543
Q

the time required for the concentration of a drug to be decreased by half

A

half-life

544
Q

the rates of absorption, distribution, biotransformation, & excretion

A

pharmacokinetics

545
Q

Therapeutic drug groups - salicylates, acetaminophen

A

analgesics

546
Q

Therapeutic drug groups - phenobarbital

A

antiepileptics

547
Q

Therapeutic drug groups - phenytoin

A

antiepileptics

548
Q

Therapeutic drug groups - valproic acid

A

antiepileptics

549
Q

Therapeutic drug groups - carbamazepine

A

antiepileptics

550
Q

Therapeutic drug groups - ethosuximide

A

antiepileptics

551
Q

Therapeutic drug groups - felbamate

A

antiepileptics

552
Q

Therapeutic drug groups - gabapentin

A

antiepileptics

553
Q

Therapeutic drug groups - lamotrigine

A

antiepileptics

554
Q

Therapeutic drug groups - methotrexate

A

antineoplastics

555
Q

Therapeutic drug groups - aminoglycosides (amikacin, gentamicin, kanmycin, tobramycin), vancomycin

A

antibiotics

556
Q

Therapeutic drug groups - digoxin

A

cardioactives

557
Q

Therapeutic drug groups - disopyramide

A

cardioactives

558
Q

Therapeutic drug groups - procainamide

A

cardioactives

559
Q

Therapeutic drug groups - quinidine

A

cardioactives

560
Q

Therapeutic drug groups - tricyclic antidepressants

A

psychoactives

561
Q

Therapeutic drug groups - lithium

A

psychoactives

562
Q

Therapeutic drug groups - cyclosporine

A

immunosuppressants

563
Q

Therapeutic drug groups - tacrolimus (FK-506)

A

immunosuppressants

564
Q

Toxic agents - ethanol - analytic method

A

-gas chromatography
-enzymatic methods

565
Q

Toxic agents - carbon monoxide - analytic method

A

-differential spectrophotometry (cooximeter)
-gas chromatography

566
Q

Toxic agents - arsenic - analytic method

A

atomic absorption

567
Q

Toxic agents - lead - analytic method

A

atomic absorption

568
Q

Toxic agents - pesticides - analytic method

A

measurement of serum pseudocholinesterase

569
Q

Toxic agents - methanol - analytic method

A

gas chromatography

570
Q

Drugs of abuse urine screen - drugs routinely tested

A
  1. amphetamines
  2. barbiturates
  3. benzodiazepines
  4. cannabinoids
  5. cocaine
  6. methadone
  7. opiates
  8. phencyclidine (PCP)
  9. tricyclic antidepressants
571
Q

Drugs of abuse urine screen - adulterated urine

A

value outside physiological range or presence of a substance that isn’t found in human urine

-pH <3 or >=11
-nitrite >=500 mg/dL
-presence of chromium, halogens (bleach, iodine, fluoride), glutaraldehyde, pyridine, or surfactant

572
Q

Drugs of abuse urine screen - substituted urine

A

values that aren’t consistent with normal human urine

-creatine <2 mg/dL
-specific gravity <=1.0010 or >=1.0200

573
Q

Drugs of abuse urine screen - diluted urine

A

creatine and specific gravity lower than expected for normal human urine

-creatine >=2 mg/dL but <=20mg/dL
-specific gravity >=1.0010 but <=1.0030

574
Q

Drugs of abuse urine screen - method of measurement

A

immunoassay

575
Q

Drugs of abuse urine screen - confirmation

A

mass spectrometry

576
Q

Common tumor markers - alpha-Fetoprotein (AFP) - type of cancer for which marker is most often diagnosed

A

Liver

577
Q

Common tumor markers - alpha-Fetoprotein (AFP) - clinical use

A

-aid diagnosis
-monitor therapy
-detect recurrence

578
Q

Common tumor markers - alpha-Fetoprotein (AFP) - produced by?

A

fetal liver

579
Q

Common tumor markers - alpha-Fetoprotein (AFP) - clinical significance

A

increased:
-certain tumors
-hepatitis
-pregnancy

580
Q

Common tumor markers - CA 15-3 and CA 27.29 - type of cancer for which marker is most often used

A

breast

581
Q

Common tumor markers - CA 15-3 and CA 27.29 - clinical use

A

-stage disease
-monitor therapy
-detect recurrence

582
Q

Common tumor markers - CA 15-3 and CA 27.29 - clinical significance

A

-breast cancer

-can be increased with other cancers & non-cancerous conditions

583
Q

Common tumor markers - CA 19-9 - type of cancer for which marker is most often used

A

pancreatic

584
Q

Common tumor markers - CA 19-9 - clinical use

A

-stage disease
-monitor therapy
-detect recurrence

585
Q

Common tumor markers - CA 19-9 - clinical significance

A

-pancreatic cancer

-can be increased with other cancers & non-cancerous conditions

586
Q

Common tumor markers - CA 125 - type of cancer for which marker is most often used

A

ovarian

587
Q

Common tumor markers - CA 125 - clinical use

A

-aid diagnosis
-monitor therapy
-detect recurrence

588
Q

Common tumor markers - CA 125 - clinical significance

A

-ovarian cancer

-can be increased with other cancers & gynecological conditions

589
Q

Common tumor markers - carcinoembryonic antigen (CEA) - type of cancer for which marker is most often used

A

colorectal

590
Q

Common tumor markers - carcinoembryonic antigen (CEA) - type of antigen

A

fetal antigen re-expressed in tumors

591
Q

Common tumor markers - carcinoembryonic antigen (CEA) - clinical use

A

-monitor therapy
-detect recurrence

592
Q

Common tumor markers - carcinoembryonic antigen (CEA) - clinical significance

A

-colorectal cancer

-can be increased with other cancers, non-cancerous conditions, & in smokers

593
Q

Common tumor markers - hCG - type of cancer for which marker is most often used

A

-ovarian & testicular cancers
-gestational trophoblastic diseases

594
Q

Common tumor markers - hCG - clinical use

A

-aid diagnosis
-monitor therapy
-detect recurrence

595
Q

Common tumor markers - hCG - clinical significance

A

-ovarian cancer
-testicular cancer
-gestational trophoblastic diseases
-pregancy

596
Q

Common tumor markers - Prostate-specific antigen (PSA) - type of cancer for which marker is most often used

A

prostate

597
Q

Common tumor markers - Prostate-specific antigen (PSA) - clinical use

A

-screening
-aid diagnosis
-monitor therapy
-detect recurrence

598
Q

Which tumor marker is the most widely used?

A

PSA

599
Q

Common tumor markers - Prostate-specific antigen (PSA) - screening asymptomatic men is controversial

A

-some men with prostate cancer don’t have increased PSA
-PSA can be increased in other conditions

600
Q

Common tumor markers - Prostate-specific antigen (PSA) - free PSA

A

may be helpful when PSA is borderline

601
Q

Common tumor markers - Prostate-specific antigen (PSA) - free PSA

A

may be helpful when PSA is borderline

602
Q

Common tumor markers - Thyroglobulin - type of cancer for which marker is most often used

A

thyroid

603
Q

Common tumor markers - Thyroglobulin - clinical use

A

-monitor therapy
-detect recurrence

604
Q

Common tumor markers - Thyroglobulin - clinical significance

A

-thyroid cancer

-increased in other thyroid diseases

605
Q

Common tumor markers - Thyroglobulin - what should be measured at the same time?

A

antithyroglobulin antibodies

606
Q

-Log[H+] or log 1/[H+]

A

pH

607
Q

a chemical that can yield H+; proton donor; pH <7

A

acid

608
Q

a chemical that can accept H+ or yield OH-; pH >7

A

base

609
Q

a weak acid & its salt or conjugate base; minimizes changes in pH

A

buffer

610
Q

What buffer is the most important one for maintaining blood pH?

A. phosphates
B. bicarbonate/carbonic acid
C. proteins
D. hemoglobin

A

B. bicarbonate/carbonic acid

H+ + HCO3- <==> H2CO3 <==> H20 + CO2

611
Q

HCO3-; second largest fraction of anions; proton acceptor or base; equal to total CO2 - 1

A

bicarbonate

612
Q

What is bicarbonate (HCO3-) regulated by?

A

kidneys

613
Q

H2CO3; proton donor or weak acid; equal to PCO2 x 0.03

A

carbonic acid

614
Q

What is carbonic acid (H2CO3) regulated by?

A

lungs

615
Q

all forms of CO2

A

total CO2

(HCO3- + H2CO3 + dissolved CO2)

616
Q

partial pressure of CO2

A

PCO2

617
Q

What is PCO2 directly related to?

A

the amount of dissolved CO2

618
Q

Henderson-Hasselbalch equation

A

pH = 6.1 + log ([HCO3-]/[H2CO3])

OR

6.1 + log (HCO3-/PCO2) x 0.03

619
Q

Acidosis (acidemia) - laboratory findings

A

-blood pH <7.38
-decreased HCO3-:H2CO3 ratio (normal is 20:1)

620
Q

Acidosis (acidemia) - causes

A
  1. decreased HCO3- (metabolic acidosis)
  2. increased H2CO3 (respiratory acidosis)
621
Q

Alkalosis (alkalemia) - laboratory findings

A

-blood pH >7.42
-increased HCO3-:H2CO3 ratio (normal 20:1)

622
Q

Alkalosis (alkalemia) - causes

A
  1. increased HCO3- (metabolic alkalosis)
  2. decreased H2CO3 (respiratory alkalosis)
623
Q

What is compensated acidosis or alkalosis?

A

when compensatory mechanisms have succeeded in returning the 20:1 ratio & pH returns to normal.

-kidneys compensate for respiratory problems

-lungs compensate for metabolic problems

624
Q

Acid-Base imbalances - Respiratory acidosis

A

pH - decreased
PCO2 - increased
HCO3- - normal

Compensation: kidneys retain HCO3-, excrete H+

625
Q

Acid-Base imbalances - Metabolic acidosis

A

pH - decreased
PCO2 - normal
HCO3- - decreased

Compensation: hyperventilation (blow off CO2)

626
Q

Acid-Base imbalances - Respiratory alkalosis

A

pH - increased
PCO2 - decreased
HCO3- - normal

Compensation: kidneys excrete HCO3-, retain H+

627
Q

Acid-Base imbalances - Metabolic alkalosis

A

pH - increased
PCO2 - normal
HCO3- - increased

Compensation: hypoventilation (retain CO2)

628
Q

low O2 content in arterial blood

A

hypoxemia

629
Q

lack of O2 at cellular level

A

hypoxia

630
Q

barometric pressure x % gas concentration

A

partial pressure

631
Q

partial pressure of CO2 expressed in mm of Hg

A

PCO2

-directly related to the amount of dissolved CO2
-measure of the respiratory component (inversely proportional to respiration)

632
Q

partial pressure of O2

A

PO2

-assesses pulmonary function

633
Q

graph showing relationship between oxygen saturation & PO2

A

oxygen dissociation curve

634
Q

provides information about hemoglobin’s affinity for O2

A

oxygen dissociation curve

635
Q

phosphate compound in RBCs that affects O2 dissociation curve

A

2,3-Diphosphoglycerate (2,3-DPG)

636
Q

low levels of 2,3-Diphosphoglycerate (2,3-DPG)

A

inhibit release of O2 to tissues

637
Q

amount of O2 that is combined with hemoglobin, expressed as % of amount of O2 that can be combined with hemoglobin

A

oxygen saturation

1 g of hemoglobin can combine with 1.34 mL of O2

638
Q

partial pressure of O2 at which hemoglobin saturation is 50%

A

P50

639
Q

low value of P50

A

increased O2 affinity

(shift to the left in O2 dissociation curve)

640
Q

high value of P50

A

decreased O2 affinity

(shift to the right in O2 dissociation curve)

641
Q

Blood Gas Parameters - pH - measurement of?

A

[H+]

642
Q

Blood Gas Parameters - pH - derivation

A

pH electrode on blood gas analyzer

643
Q

Blood Gas Parameters - pH - reference range

A

7.35-7.45

644
Q

Blood Gas Parameters - PCO2 - measurement of?

A

partial pressue of CO2

645
Q

Blood Gas Parameters - PCO2 - derivation

A

PCO2 electrode on blood gas analyzer

646
Q

Blood Gas Parameters - PCO2 - reference range

A

35-45 mm Hg

647
Q

Blood Gas Parameters - PO2 - measurement of?

A

partial pressure of O2

648
Q

Blood Gas Parameters - PO2 - derivation

A

PO2 electrode on blood gas analyzer

649
Q

Blood Gas Parameters - PO2 - reference range

A

80-100 mm Hg

650
Q

Blood Gas Parameters - HCO3- - measurement of?

A

bicarbonate

651
Q

Blood Gas Parameters - HCO3- - derivation

A

calculated value on blood gas analyzer

652
Q

Blood Gas Parameters - HCO3- - reference range

A

22-26 mmol/L

653
Q

Blood Gas Parameters - total CO2 - measurement of?

A

bicarbonate + carbonic acid

654
Q

Blood Gas Parameters - total CO2 - derivation

A

calculated value on blood gas analyzer

655
Q

Blood Gas Parameters - total CO2 - reference range

A

23-27 mmol/L

656
Q

Blood Gas Parameters - base excess - measurement of?

A

-metabolic component of acid-base status
-difference between titratable bicarbonate of sample & that of normal blood sample

657
Q

Blood Gas Parameters - base excess - derivation

A

calculated value on blood gas analyzer

658
Q

Blood Gas Parameters - base excess - reference range

A

-2 to +2 mEq/L

*negative values indicate base deficit

659
Q

Blood Gas Parameters - oxygen saturation - measurement of

A

amount of oxygenated hemoglobin

660
Q

Blood Gas Parameters - oxygen saturation - derivation

A

measured by oximeter

661
Q

Blood Gas Parameters - oxygen saturation - reference range

A

94% - 100%

662
Q

Blood Gas Instrumentation - pH electrode - description

A

H+-sensitive glass electrode containing Ag/AgCl wire in electrolyte of known pH & reference (calomel) electrode (Hg/Hg2Cl2)
-measurement is potentiometric (change in voltage indicates activity of analyte)

663
Q

Blood Gas Instrumentation - pH electrode - measures?

A

[H+]

664
Q

Blood Gas Instrumentation - pH electrode - calibration

A

2 phosphate buffers of known pH

-store at RT
-don’t expose to air

665
Q

Blood Gas Instrumentation - PCO2 electrode - description

A

pH electrode covered with membrane permeable to CO2, with bicarbonate buffer between membrane & electrode

-measure is potentiometric - change in voltage indicates activity of analyte

666
Q

Blood Gas Instrumentation - PCO2 electrode - measures?

A

dissolved CO2

667
Q

Blood Gas Instrumentation - PCO2 electrode - calibration

A

2 gases of known PCO2

668
Q

Blood Gas Instrumentation - PO2 electrode (Clark electrode) - measures?

A

dissolved O2

669
Q

Blood Gas Instrumentation - PO2 electrode - calibration

A

2 gases of known PO2

670
Q

Blood Gas Instrumentation - PO2 - description

A

Platinum cathode & Ag/AgCl anode covered with semipermeable membrane.

-measurement is amperometric - amount of current flow is indication of O2 present

671
Q

Blood Gas Instrumentation - Co-oximeter - description

A

-spectrophotometer that reads absorbance or resistance at isobestic point (wavelength where reduced & oxyhemoglobin have same absorbance or reflectance, e.g., 805 nm)
AND
-differential point (wavelength where reduced & oxyhemoglobin have different absorbance or reflectance, e.g., 650 nm)

672
Q

Blood Gas Instrumentation - Co-oximeter - measures?

A

oxygen saturation

-some also measure carboxyhemoglobin, methemoglobin, & sulfhemoglobin by using additional wavelengths

673
Q

Blood Gas Instrumentation - Co-oximeter - calibration

A

calibration curve prepared from specimens with 0% & 100% oxygen saturation

674
Q

Sources of error in arterial blood gases - hyperventilation - effect

A

-decreased PCO2
-increased pH
-increased PO2

675
Q

Sources of error in arterial blood gases - specimen exposed to air - effect

A

-decreased PCO2
-increased pH
-increased PO2

676
Q

Sources of error in arterial blood gases - specimen at RT >30 minutes - effect

A

-increased PCO2
-decreased pH
-decreased PO2

677
Q

Albumin/Globulin (AG) ratio - calculation

A
678
Q

Albumin/Globulin (AG) ratio - normal range

A

1-2.5

679
Q

Albumin/Globulin (AG) ratio - clinical significance

A

reversed A/G ratio with multiple myeloma, liver disease

680
Q

Amylase:creatinine clearance ratio - calculation

A
681
Q

Amylase:creatinine clearance ratio - normal range

A

2%-5%

682
Q

Amylase:creatinine clearance ratio - clinical significance

A

increased - acute pancreatitis

decreased - macroamylasemia

683
Q

Anion gap - calculation

A
684
Q

Anion gap - normal range

A

7-16

685
Q

Anion gap - normal range

A

10-20

686
Q

difference between unmeasured anions and unmeasured cations

A

anion gap

687
Q

Anion gap - clinical significance - increased

A

-renal failure
-diabetic acidosis
-lactic acidosis
-methanol, ethanol, ethylene glycol, or salicylate poisoning
-laboratory error

688
Q

Anion gap - all determinations are increased or decreased

A

possible instrument error in 1 of the determinations

689
Q

True or False. Anion gap cannot be a negative number.

A

True

690
Q

BUN-to-creatinine ratio - calculation

A
691
Q

BUN-to-creatinine ratio - normal range

A

10-20

692
Q

BUN-to-creatinine ratio - clinical significance - renal disease

A

normal ratio

693
Q

BUN-to-creatinine ratio - clinical significance - pre-renal conditions

A

increased ratio with increased BUN & normal creatinine

694
Q

BUN-to-creatinine ratio - clinical significance - post-renal conditions

A

increased ratio with increased creatinine

695
Q

BUN-to-creatinine ratio - clinical significance - decreased ratio

A

decreased ratio with decreased urea production

(e.g., severe liver disease, decreased protein intake)

696
Q

Creatinine clearance - calculation

A
697
Q

Creatinine clearance - normal range

A

Males: 97-137 mL/min

Females: 88-128 mL/min

698
Q

Creatinine clearance - clinical significance

A

decreased in renal disease (early indicator)

699
Q

Indirect (unconjugated) bilirubin - calculation

A
700
Q

Indirect (unconjugated) bilirubin - normal range

A

<0.2 mg/dL

701
Q

Indirect (unconjugated) bilirubin - clinical significance

A

increased in pre-hepatic, post-hepatic, & some type of hepatic jaundice

702
Q

LDL cholesterol - calculation

A

Friedewald formula

703
Q

LDL cholesterol - normal range

A

Desirable level: <130 mg/dL

704
Q

LDL cholesterol - clinical significance

A

Increased LDL cholesterol is associated with increased with of CAD.

705
Q

LDL cholesterol - when are LDL levels not valid?

A

if triglycerides are >400 mg/dL

706
Q

Calculated osmolality - calculation

A
707
Q

Calculated osmolality - normal range

A

275-295 Osm/kg

708
Q

What does osmolality measure?

A

concentration of solute

709
Q

What contributes the most to osmolality?

A

electrolytes

710
Q

Osmolality - clinical significance

A

Increased - dehydration, uremia, uncontrolled diabetes, alcohol or salicylate poisoning, excessive electrolyte IVs

Decreased - excessive water intake

711
Q

Osmolal gap - calculation

A
712
Q

Osmolal gap - normal range

A

0-10 mOsm/kg

713
Q

similar to anion gap but based on osmotically active solute concentration rather than the concentrations of ions

A

osmolal gap

714
Q

Osmolal gap - clinical significance

A

> 10 indicates abnormal concentration of unmeasured substance (e.g., isopropanol, methanol, acetone, ethylene glycol)

-used to diagnose poisonings

715
Q

Urine-to-serum osmolality - calculation

A

Urine osmolality/serum osmolality

716
Q

Urine-to-serum osmolality - normal range

A

1-3

717
Q

Urine-to-serum osmolality - clinical significance

A

decreased in renal tubular deficiency and diabetes insipidus

718
Q

Beer’s Law

A
719
Q

A manual glucose assay gave the following results: Absorbance of 100 mg/dL standard = 0.3.
Absorbance of patient = 0.4.
What is the glucose concentration of the patient?

A

133 mg/dL

Note: If a dilution is run, multiply the answer by the reciprocal of the dilution.

720
Q

mg/dl to mEq/L - calculation

A
721
Q

A calcium is reported as 10 mg/dL. What is the concentration in mEq/L?
(Atomic weight of calcium = 40. Valence of calcium = 2+.)

A

5

722
Q

mg/dL to mmol/L - calculation

A
723
Q

A calcium is reported as 10 mg/dL. What is the concentration in mmol/L?
(Atomic weight of calcium = 40. Valence of calcium is 2+.)

A

2.5

724
Q

mEq/L to mmol/L - calculation

A
725
Q

A calcium is reported as 5 mEq/L. What is the concentration in mmol/L?
(Atomic weight of calcium = 40. Valence of calcium = 2+.)

A

2.5

726
Q

Molarity (M) calculation

A
727
Q

What is the molarity of a solution that contains 45 grams of NaCl per liter?
(Atomic weights: Na = 23, Cl = 35.5)

A

0.77

728
Q

Normality (N) calculation

A
729
Q

What is the normality of a solution that contains 98 grams of H2SO4 per 500 mL?
(Atomic weights: H = 1, S = 32, O = 16.)

A

4

730
Q

% concentration formula

A
731
Q

What is the concentration in % of a solution that contains 8.5 grams of NaCl per liter?

A

0.85%

732
Q

Calculation for finding normality when given the molarity

A
733
Q

What is the normality of a 3 M H2SO4 solution?

A

6

734
Q

Solution Dilution calculation

A
735
Q

How many mL of 95% alcohol are needed to prepare 100 mL of 70% alcohol?

A

73.7 mL

736
Q

Which of the following pairs of fasting plasma glucose values demonstrates unequivocal hyperglycemia that can be used toward the diagnosis of diabetes mellitus?

A. 160 mg/dL on two separate occasions
B. 100 mg/dL and 125 mg/dL
C. 75 mg/dL on two separate occasions
D. 93 mg/dL and 195 mg/dL

A

A. 160 mg/dL on two separate occasions

737
Q

Which photometric method is used primarily to measure antibody-antigen reactions?

A. Chemiluminescence
B. Turbidimetry
C. Nephelometry
D. Flow cytometry

A

C. Nephelometry

738
Q

Regarding serum protein electrophoresis, which condition is associated with a beta-gamma bridge pattern?

A. Liver cirrhosis
B. Nephrotic syndrome
C. Acute inflammation
D. Monoclonal gammopathy

A

A. Liver cirrhosis

739
Q

Which serum enzyme is elevated in all hepatobiliary disorders?

A. Gamma-glutamyl transferase
B. AST
C. Creatinine kinase
D. Amylase

A

A. Gamma-glutamyl transferase

740
Q

The Friedewald formula can be used to indirectly determine the concentration of which of the following analytes?

A. Triglycerides
B. Phospholipids
C. LDL cholesterol
D. Lipase

A

C. LDL cholesterol

741
Q

Which set of laboratory values corresponds to secondary hypothyroidism?

A. Increased TSH, decreased free T4, decreased free T3
B. Decreased TSH, decreased free T4, decreased free T3
C. Increased TSH, normal free T4, increased free T3
D. Decreased TSH, increased free T4, increased free T3

A

B. Decreased TSH, decreased free T4, decreased free T3

742
Q

For which of the following clinical chemistry analytes is it important to avoid hemolysis?

A. Potassium
B. Bilirubin
C. AST
D. All of the above are susceptible to hemolysis

A

D. All of the above are susceptible to hemolysis

743
Q

Aldosterone regulates the levels of which of the following electrolytes?

A. Sodium
B. Magnesium
C. Calcium
D. Bicarbonate

A

A. Sodium

744
Q

Laboratory findings for which of the following endocrine disorders include decreased morning plasma and/or salivary cortisol, decreased ACTH, and decreased sodium?

A. Cushing disease
B. Diabetes insipidus
C. Addison disease
D. Acromegaly

A

C. Addison disease

745
Q

A specimen for blood gas analysis that is left at room temperature for more than 30 minutes would be expected to show which set of changes?

A. Decreased PCO2, increased pH, increased PO2
B. Increased PCO2, decreased pH, decreased PO2
C. Decreased PCO2, decreased pH, decreased PO2
D. Increased PCO2, increased pH, increased PO2

A

B. Increased PCO2, decreased pH, decreased PO2

746
Q

Acid Base Balance: Mnemonic (ROME)

A
747
Q

Respiratory Acidosis

A
748
Q

Respiratory Alkalosis

A
749
Q

Metabolic Acidosis

A
750
Q

Metabolic Alkalosis

A

AMT MT Exam (12 decks)

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