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Herzing College - MLA > Unit 4 Part 1 - Clinical Chemistry > Flashcards

Unit 4 Part 1 - Clinical Chemistry Flashcards

1
Q

study of chemical components of the body in plasma or serum

A

clinical chemistry

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2
Q

3 groups of clinical chemistry in the lab

A
  1. routine chemistry
  2. routine chemistry urinalysis
  3. special chemistry
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3
Q

types of specimens in chemistry

A

blood (serum or plasma) – not RBC except for HgbA1C
urine
feces
CSF
sweat
hair
stones

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4
Q

first department to be automated

A

chemistry

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5
Q

benefits of automation

A

reduced medical errors
reduced sample volume
improved safety
faster TAT

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6
Q

step 1 in automated analysis

A

make sure specimen is properly collected

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7
Q

step 2 in automated analysis

A

instrument is programed to measure proper amount of specimen and reagent to yield a final conc

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8
Q

most of the automation is based on

A

photometry

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9
Q

step 3 in automated analysis

A

chemical reaction causes sample to change color

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10
Q

part of the instrument that measures how much light will pass through the sample

A

spectrophotometer

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11
Q

a reaction that results in a dark color would allow __ light to pass through, which means __ result

A

less, higher

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12
Q

a reaction that results in a light color would allow __ light to pass through, which means __ result

A

more, lower

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13
Q

blood glucose will produce a __ color after chemical reaction with a reagent

A

blue

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14
Q

dark blue color indicates ___ glucose result

A

high

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15
Q

medium blue color indicates ___ glucose result

A

normal

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16
Q

light blue color indicates ___ glucose result

A

low

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17
Q

step 4 in automated analysis

A

instrument programmed to measure the absorbance and give result

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18
Q

step 5 in automated analysis

A

reading results and see if it falls within certain parameters

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19
Q

machines test hundreds - thousands of ___ per hour

A

tests NOT specimens (1 patient can have more than 1 test done)

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20
Q

testing in this department includes processes used to detect levels of enzymes, suagrs, proteins, and otehr substances in the blood in order to determine conditions

A

clinical chemistry

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21
Q

formed by hgb breakdown, increased in liver damage

A

bilirubin

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22
Q

end product of protein metabolism and is excreted by the kidneys, increased in kidney damage

A

urea

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23
Q

measures the lipids in the body

A

cholesterol & triglycerides

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24
Q

metabolic waste, increase indicates kidney damage

A

creatinine

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25
Q

determines the correct dosage of a drug

A

drug analysis

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26
Q

test for electrolyte imbalance

A

electrolytes

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27
Q

test for diabetes (FBS, 2 hr PC, 1 hr post load, GTT, HGB A1C)

A

glucose

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28
Q

simple sugar formed when dietary carbohydrates are digested, absorbed in digestive tract into blood

A

glucose

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29
Q

the liver removes excess glucose from the blood and stores it as

A

glycogen

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30
Q

liver converts glycogen back to glucose when glucose is needed for energy by the body cells

this process is called

A

glycogenolysis

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31
Q

tests to diagnose and monitor diabetes

A

random glucose
fasting blood sugar
2 hour PC
1 hour post load
OGTT, GTT
Hgb A1C

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32
Q

glucose test taken any time, no requirements

1 blood sample needed

A

random blood glucose

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33
Q

glucose test where patient fasts for 8-12 hours

nothing to eat or drink during that time, except water

1 blood sample needed

A

fasting blood sugar (FBS)

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34
Q

normal FBS

A

3.9-6.1 mmol/L

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35
Q

glucose test taken exactly 2 hours after a meal (usually 1000 hrs, or 1400 hrs)

patient instructed to have substantial meal with good amount of carbs

A

2 hour postprandial blood glucose test

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36
Q

normal 2-hr PC

A

3.6-8.8 mmol/L

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37
Q

screening type used for type 2 diabetes

A

fasting blood sugar

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38
Q

2 types of screening methods for diabetes

A

non-gestational oral glucose tolerance test (non-pregnancy)
gestational oral glucose tolerance test (pregnancy)

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39
Q

other tests are done to screen diabetes when fasting blood sugar is BETWEEN

A

6.1-6.9 mmol/L

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40
Q

capillary blood glucose cut-off point for OGTT (non-gestational) with glucometer

if higher than this, test cannot continue

A

10 mmol/L

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41
Q

when you don’t have a glucometer for OGTT (non-gestational) collect __ to determine glucose level

A

FBS level

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42
Q

glucose level cut off for OGTT (non-gestational) without glucometer

A

7 mmol/L

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43
Q

if patient vomits or becomes sick during OGTT, test is __

A

discontinued

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44
Q

___ and glucometer determines eligibility for administering oral glucose

A

capillary blood glucose

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45
Q

during OGTT (non-gestational), patient must finish the ___ glucose drink within 5 mins and sit still

A

75 gm

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46
Q

2 hours after the glucose drink has been consumed, a venous blood sample is collected and labeled ___

A

2 hr post load

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47
Q

why is lab glucose level cut off lower than glucometer?

A

glucometer not accurate due to interstitial fluid and other things mixed in with capillary blood

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48
Q

total blood specimens collected during OGTT (non-gestational), assuming test is done throughout, with and without glucometer

A

with glucometer: (2, excluding capillary)
1 capillary
1 venous FBS
1 venous 2 hr post load

without glucometer: (2)
1 venous FBS
1 venous 2 hr post load

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49
Q

it is recommended that all pregnant women should be screened for diabetes between __

A

24-28 weeks

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50
Q

screening for gestational diabetes mellitus is a ___ approach

A

2 step

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51
Q

1st step in screening for gestational diabetes mellitus (type 2)

A

50 gm glucose challenge with a blood glucose level taken after 1 hr

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52
Q

patient does not have to fast in 50 gm glucose challenge (t/f)

A

true

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53
Q

in the 50 gm glucose challenge, if the blood glucose level is ___ or greater (determined by glucometer), the test cannot continue

A

15 mmol/L

54
Q

in the 1st step of the 50 gm glucose challenge, blood sample is collected __ after the drink has been consumed

A

1 hr

55
Q

in the 1st step of the 50 gm glucose challenge, we proceed to step 2 if the glucose level is between ___

A

7.8-11.0 mmol/L

56
Q

step 2 of the 50 gm glucose challenge is called the

A

OGTT

57
Q

in OGTT (gestational), patient fasts for

A

8-16 hours

58
Q

capillary blood glucose cut-off point for OGTT (gestational) with glucometer

if higher than this, test cannot continue

A

10 mmol/L

59
Q

glucose level cut off for OGTT (gestational) without glucometer

A

11 mmol/L

60
Q

in OGTT (gestational) the glucose drink give is ___ and must be finished within 5 mins

A

75 gm

61
Q

total blood specimens collected during OGTT (gestational), assuming test is done throughout, with and without glucometer

A

with glucometer: (3, excluding capillary)
1 capillary blood
1 venous FBS
1 venous 1 hr after drink
1 venous 2 hrs after drink

without glucometer: (3)
1 FBS
1 venous 1 hr after drink
1 venous 2 hrs after drink

62
Q

normal values for GTT

A

fasting: 3.9-6.1 mmol/L
1 hour: 8.8-9.4 mmol/L
2 hours: less than or equal to 6.6 mmol/L
3 hours: 3.9-6.1 mmol/L

  • goes down as time passes
63
Q

test used to determine the average blood glucose level in a patient over a 2-3 month period

A

Hgb A1C

64
Q

tube used for Hgb A1C

A

purple EDTA, need whole blood

65
Q

normal Hgb A1C

A

4.4-6.4%

66
Q

Hgb A1C is sent to ___ department, but is collected in __ tubes

A

chemistry, purple

67
Q

4 common electrolytes

A

sodium (Na)
potassium (K)
chloride (Cl)
carbon dioxide (CO2)

68
Q

electrolyte responsible for the normal distribution of water between extracellular and intracellular compartments and also functions in transmission of nerve impulses

A

sodium (Na)

69
Q

electrolyte that functions in muscle contractions, and conduction of nervous impulses, important for the heart

A

potassium (K)

70
Q

electrolyte that functions to maintain water balance, along with sodium

A

chloride (Cl)

71
Q

electrolyte that maintains the acid-base balance of the body

increase of this would lower pH of blood

A

carbon dioxide (CO2)

72
Q

tube used to collect electrolytes

A

lithium heparin (green)

73
Q

concentration of K in RBC is about ___ times that in serum or plasma

A

20

74
Q

examples of other electrolytes

A

calcium, magnesium

75
Q

tests used for renal function

A

urea
creatinine
uric acid
creatinine clearance (requires 24-hr urine and blood specimen)

76
Q

act as hormones or hormone precursors
energy storage and metabolic fuel
structural and functional component in cell membrane
insulation to allow conduction of nerve impulses or heat loss

A

lipids

77
Q

there is a correlation between lipids and ____ (which can lead to coronary heart disease)

A

atherosclerosis

78
Q

tests used for lipids

A

cholesterol
triglycerides
low density lipoprotein (LPL)
high density lipoprotein (HDL)

79
Q

3 chemistry tests used to diagnose a myocardial infarction or injury (heart attack)

A

troponin
myoglobin
creatine kinase myoglobin (CK-MB)

80
Q

heme protein found in striated skeletal muscle cells and cardiac muscle

early marker of injury to muscle tissue

rise in concentration can be detected in blood as early as 1-3 hours after the onset of MI symptoms

A

myoglobin (MB)

81
Q

gold standard of cardiac markers

complex of 3 proteins found in cardiac or skeletal muscle

remain elevated in blood for 4-10 days after MI

A

troponins

82
Q

complex of 3 proteins for troponins

A

troponin T (TnT)
troponin I (TnI)
troponin C (Tnc)

83
Q

can be elevated after tissue injury

cardio specific and is sensitive to early onset of MI

elevation can be seen within 4-6 hours of onset symptoms

A

creatine kinase myoglobin (CK-MB)

84
Q

alkaline phosphatase (Alk phos)

A

bone, liver

85
Q

gamma glutamyl transferase (GGT)

A

liver

86
Q

alanine transaminase (ALT)

A

heart, liver

87
Q

aspartate transaminase (AST)

A

heart, liver

88
Q

lactic dehydrogenase (LD)

A

liver, heart, muscle

89
Q

liver tests

A

ammonia
bilirubin
alk phos
GGT
ALT
AST
LD

90
Q

accelerate many metabolic reactions in the body, higher number means more damage to organ

usually end in “ase”

A

enzymes

91
Q

lipase (LPS)

A

pancreas

92
Q

pancreatic testing involves

A

lipase
isoamylase

93
Q

a chemical substance produced by a gland in one part of the body and carried to a distant target organ where a regulatory response is elicited

A

hormones

94
Q

thyroid tests

A

T3
T4
TSH

95
Q

most prevalent type of protein

A

albumin

96
Q

albumin is about ___ of total protein in our bodies

A

2/3

97
Q

other types of proteins are in a class called

A

globulins

98
Q

types of globulins

A

alpha 1 globulins
alpha 2 globulins
beta globulins
gamma globulins (most are antibodies)

99
Q

5 groups of gamma globulins

A

IgA - respiratory, gut, skin, renal infections
IgD - chronic bacterial infections
IgG - autoimmune responses, response after subsequent exposure to an Ag
IgE - asthma, allergic conditions
IgM - viral infections, blood stream infections, first response after exposure to Ag

100
Q

separates serum into 5 fractions, done in immunology

A

protein electrophoresis

101
Q

TDM

A

therapeutic drug monitoring

102
Q

helps manage patients being treated with certain drugs in order to establish a drug dosage and avoid toxicity

A

therapeutic drug monitoring

103
Q

2 parts to TDM

A

trough
peak

104
Q

taken before drug is given

A

trough level

105
Q

usually taken:

  1. 30 mins after IV administration
  2. 60 minutes after intramuscular injection
  3. 2 hrs after oral intake
A

peak levels

106
Q

examples of drugs for TDM

A

digoxin
theophylline
vancomycin
phenytoin

107
Q

trace metals are collected in

A

royal blue EDTA tubes

108
Q

can’t collect trace metals with

A

syringe
capillary methods

109
Q

trace metals include

A

aluminum
arsenic
cadmium
chromium
copper
lead
manganese
mercury
selenium
thallium
zinc

110
Q

most common trace metals

A

copper
lead
zinc

111
Q

testing done at patient’s bed side or ancillary bedside, or near patient testing (instead of lab)

A

point of care testing (POCT)

112
Q

device used to test blood sugar, commonly used by diabetics to monitor their blood sugar on a daily basis

example of POCT that does one test

A

glucometer

113
Q

most sources of POCT error

A

pre-analytical errors
operator incompetence
nonadherance to test procedures
use of uncontrolled reagents and equipment (expired or not tested properly)

114
Q

POCT is more expensive than central laboratory testing (t/f)

A

true

115
Q

an example of multiple test POC machine

depends on program or cartridge that is used

some include glucose, cholesterol, electrolytes, enzyme analysis, cardiac markers, hemoglobin, hematocrit, and INR

A

i-STAT

116
Q

performed as per manufacturer guidelines

usually involves performing liquid quality control on receipt of new shipment of kits and teaching new personnel

A

external quality control

117
Q

quality control where liquid is of a known result

liquid is applied to POCT instead of blood or other fluid

result should be exactly what known result is

A

liquid quality control

118
Q

means that the instrument can detect clotting, short samples, air bubbles, etc

A

electronic QC’s

119
Q

prevents users who are not authorized or do not adhere to QC procedures from using machine

A

automatic lockout feature

120
Q

when using glucometers, the ___ drop of blood is wiped away

A

first

121
Q

another example of POCT

usually requires a first morning urine specimen (highest concentration of hCG hormone)

must be colelcted in clean plastic container

can be refrigerated for up to 2 days, or frozen at -20 C for 1 year

A

pregnancy test

122
Q

POCT instruments usually found in the ICU or ER, can measure multiple tests

A

multiple-test-panels by POCT

123
Q

breakdown of red blood cells

A

hemolysis

124
Q

test result most affected by hemolysis

A

potassium (K)

125
Q

slight increase in results due to hemolysis

A

phosphate
tota protein
albumin
calcium
alk phos

126
Q

slight decrease in results due to hemolysis

A

haptoglobin
bilirubin

127
Q

moderate increase in results due to hemoplysis

A

ALT
CK
iron

128
Q

moderate decrease in results due to hemolysis

A

T4

129
Q

gross increase in results due to hemolysis

A

K
LD
AST

130
Q

gross decrease in results due to hemolysis

A

troponin
glucose

Herzing College - MLA (14 decks)

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