Test Answers on Clinical Chemistry – Flashcards
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Unlock answers| VLDL = |
[TG] : 5 in mg/dL or [TG] : 2.2 in mmol/dL not valid if: 1.[TG] > 400mg/dL 2.Chylomicrons present 3. b-VLDL --> Type III dyslipidemia (rare)
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Fridewald equation
LDL = |
LDL= Total Cholesterol - HDL - TG/5 not valid if: TG > 400mg/dL,Chylomicrons present, Type III dyslipidemia
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Lipid Disorders Phenotypes and Lipoproteins increased I IIa and IIb
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Chylomicrons b- region (II) LDL (II L's) + VLDL (IIb) ; ; ; |
LDL and VLDL --> major apolipoprotein?
HDL --> major apolipoprotein? |
Apo B (bad cholesterol) Apo A1 --> ( a-region) |
Total Cholesterol mg/dL - desirable - high |
< 200
> 240 |
LDL mg/dL - optimal - borderline - high |
< 100 130 -159 160 - 189 |
HDL mg/dL Low High |
< 40 > 60 |
LDL Targets - Risk groups - CHD or equivalents - 2 or >2 major risk factors - < 2 major risk factors |
< 100 mg/dL < 130 mg/dL < 160 mg/dL |
| Method of TG/Cholesterol measurement |
Enzymatic reactions--> dye product --> spectrophotometry |
Lipid Disorders: Phenotypes and Lipoproteins increased III, IV, V |
IDL ( intermediate - 1-5 = 3) VLDL (IV) pre b-region V = I + IV = VLDL + Chylomicrons
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Chylomicrons -Electrophoretic mobility -Major lipid / Protein % -Apolipoprotein |
Origin TG / 1% B-48, A-1,C, E |
VLDL -Electrophoretic mobility -Major lipid / Protein % -Apolipoprotein
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pre-b ("V for beta") TG / 8% B-100, C, E |
IDL -Electrophoretic mobility -Major lipid / Protein % - Apolipoprotein |
pre-b/b Cholesterol / 15% B-100, E |
LDL -Electrophoretic mobility -Major lipid / Protein % - Apolipoprotein |
b Cholesterol / 20% B-100
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HDL -Electrophoretic mobility -Major lipid / Protein % - Apolipoprotein |
a Cholesterol / 50% A-1, C, E ("ACE") |
Eruptive xanthomas, pancreatitis Cholesterol +, TG +++ DDx |
Familial LPL deficiency - Phenotype I Familial hypertriglyceridemias IV / V
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Pancreatitis Cholesterol +, TG +++ Dx |
Familial apo C-II deficiency Phenotype I / V |
Tendinous xanthomas, premature atherosclerosis Cholesterol +++, TG nml/ + |
Familial hypercholesterolemia (IIa) --> most common 1ocause of hypercholesterolemia <-- LDL Rc deficiency autosomal dominant
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Eruptive xanthomas, premature atherosclerosis Cholesterol +++, TG +++ DDx |
Apolipoprotein E deficiency - Phenotype IIb Familial dysbetalipoproteinemia - III |
Premature atherosclerosis Cholesterol + , TG + |
Familial combined hyperlipidemia II or IV |
Predominant hypertriglyceridemia --> most common 2o cause |
| heavy EtOH consumption |
Low Cholesterol, TG nml - increased, absent HDL & A-1 Tonsils, lymph nodes, vasculature, spleen --> cholesterol esters Dx? |
| Tangier disease |
Pregnancy: Relative Gluc intolerance Cause? |
| HPL (somatomammotropin) --> anti-insulin |
Measurement of Insulin Assay? Endogenous vs exogenous Insulin |
| Immunometric: C-peptide : Insulin = 5-15: 1 <-- rapid metabolization of C-peptide (endogenous) |
Gluc measurement Assay? |
Enzymatic: glucose oxidase / hexokinase --> G6PD --> plasma |
Point of care testing Un-calibrated whole blood Gluc compare with Glucplasma |
| 10-15% lower depending --> Hematocrit |
HgbA1c reflects Gluc control in the past-----? why? |
nonenzymatic: Gluc + HgbA --> HgbA1c ~ RBC-t1/2 = 60d --> younger RBCs little > 50% =>HgbA1c ~ Gluc control in past 1 month |
| Normal HgbA1c level-causes of false decrease Alternative test? |
< 6% Shortened Red cell survival - hemolytic anemias, Hemoglobinopathies fructosamine --> 2-3wks |
Moderade and gradual drop in Glucserum Altered mental status Dx: |
| "fasting" hypoglycemia |
Sweating,palpitations,tachycardia,nervousness Dx |
"Reactive" hypoglycemia --> profound and rapid <--hormonal response |
Hypoglycemic symptoms, [Gluc]plasma< 45mg/dL, relief of symptoms with Gluc, [Insulin]absolute=nml Dx? |
Insulinoma/Nesidioblastosis Insulin: Gluc > 180 |
| Cause of false elevation of c-peptide |
Renal impairement --> cleared by the Kidney "c=child=kid" |
Hypoinsulinemic hypoglycemia - low [beta-OH-butyrate] causes? |
nonketotic=> insulin-like activity Autoimmune, liver failure, stavation |
Patient with insulinoma What other test should be ordered? |
| [Ca++]serum --> MEN I |
| Post mortem test for hypoglycemia? |
c-peptide proinsulin |
Type I DM - frequency Antibodies? |
10% common in childhood Auto-Ab--> anti-GAD65, anti-ICA512, anti-IAA
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Fasting Glucplasma - DM - Impaired fasting Gluc (pre-diabetes) |
>125 mg/dL 99 - 126 mg/dL |
Criteria for + 100gram OGTT in pregnancy
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Any 2 of: >95mg/dL fasting, >180 @1hr, > 155 @2hr >140 @ 3hr |
Goal of therapy in diabetic patients? What test? |
HgbA1c < 7% --> should not be used in pregnancy |
DM Patient: difficulty to maintain glycemic control What other test? |
Magnesium --> hypomagnesemia--> complicate glycemic control |
DM I Pt with polyuria,polydipsia, nauseaa and abdominal pain, hyperglycemia, metabolic acidosis. Dx? |
early DKA late--> altered breathing (Kussmaul resp) --> altered mental status -->coma |
Major serom ketones? Measurement technique? |
1Acetone, 2acetoacetic acid, 3b-hydroxybutyrate Nitroprusside, semi-quantitative method DKA: [1+2] ~ 20%, [3] ~ 80% |
| DKA : [Na+]serum and [K+]serum |
[Na+]serum = initially low <-- urinary losses [K+]serum = initial elevated --> transcellular shifts and urinary losses => [K+]total decreased |
| Pt: Altered mental status, hyperglycemia > 600mg/dL, hemiplegia, hyperosmolarity, dehydration, pH, ketones, bicarbonate =nml --- Dx? |
Hyperglycemic hyperosmolar nonketotic coma DM II |
Pt: Insulin resistance, central obesity, dyslipidemia, hypertension, increased CRP, PAI-1. Dx? |
Metabolic syndrome (syndrome X) --> accelerated atherosclerosis PAI-1 =plasminogen activator inhibitor -1 |
| Factors that interfere with test results of fructosamine test |
| high levels of VitC, lipedemia, hemolysis, hyperthyroidism |
