Clinical Chemistry quick review all area for ASCP or AMT exa – Flashcards
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| Glucose is (higher/lower) in newborns that adults |
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| lower |
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| Why is the A1C test invalid in a patient with hemoglobin S or C? |
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| because of the shortened life span of the RBCs |
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| Describe the solubility properties of lipids in the blood. |
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| In the blood, liids are soluble due to their combination with protein (lipoprotein |
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| What is the main storage form of lipid storage in the body? |
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| Triglycerides in adipose tissue |
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| What is the major site of cholesterol synthesis |
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| liver |
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| What is the most common method for cholesterol determination? |
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| enzymatic using cholesterol esterase and cholesterol oxidase |
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| How is LDL cholesterol determined |
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| Friedwald formula (Total cholester - HDL cholesterol)- (triglycerides/5) This formula is not valid if triglycerides > 500 mg/dL |
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| What is the main storage form of lipid storage in the body? |
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| Triglycerides in adipose tissue |
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| What is the major site of cholesterol synthesis |
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| liver |
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| What is the most common method for cholesterol determination? |
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| enzymatic using cholesterol esterase and cholesterol oxidase |
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| How is LDL cholesterol determined |
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| Friedwald formula (Total cholester - HDL cholesterol)- (triglycerides/5) This formula is not valid if triglycerides > 500 mg/dL |
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| What are chlylomicrons? |
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| Largest and least dense of lipoproteins. They transport EXOgenous triglycerides and account for the turbidity of serum following a meal |
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| What is the major waste product of protein catabolism? |
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| urea |
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| Which element if found in protein but not in carbohydrates or lipids |
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| nitrogen |
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| What is the most common method for measuring serum total protein? |
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| biuret method Cuprous ions react with peptide bonds at al alkaline pH to produce a colored complex |
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| Why is biuret method of protein analysis not used for urine or CSF |
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| It is not sensitive enough Trichloracetic acid can be used to precipitate protein in urine and CSF |
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| How does hemolysis affect serum total protein |
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| It would increase it |
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| How is the concentration of globulins determined in a chemistry profile? |
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| Total protein minus albumin |
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| In the body, what charge do most proteins carry |
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| at pH 7.4 proteins are negatively charged |
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| What is electroendosmosis |
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| The flow of bufferr toward the cathode due to the negative surface charge present in the support medium. On cellulose acetate, this results in gamma globulins being swept toward the cathode |
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| What stains are used in serum protein electrophoresis |
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| Coomassie brilliant blue (CBB), amido black, Ponceau S, and bromphenol blue. CBB is more widely used because it is more sensitive |
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| What is the name of the instrument used to quantitate rotein fractions following serum protein electrophoresis |
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| densitometer |
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| What causes increased albumin concentrations |
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| dehydration |
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| What causes decreased alpha-1 globulin |
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| alpha 1 antitrypsin deficiency. this is seen in emphysema |
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| What causes a decreased gamma globulin fraction |
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| hypogammaglobuliemia |
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| Describe the acute phase reactant or inflammatory pattern |
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| Albumin is decreased alpha 1, alpha 2, and BETA globulins are increased |
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| Describe the chronic response pattern |
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| Albumin is decreased alpha 1, alpha 2, and GAMMA globulins are increased |
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| What is the name of the instrument used to quantitate rotein fractions following serum protein electrophoresis |
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| densitometer |
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| What causes increased albumin concentrations |
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| dehydration |
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| What causes decreased alpha-1 globulin |
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| alpha 1 antitrypsin deficiency. this is seen in emphysema |
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| What causes a decreased gamma globulin fraction |
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| hypogammaglobuliemia |
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| Describe the acute phase reactant or inflammatory pattern |
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| Albumin is decreased alpha 1, alpha 2, and BETA globulins are increased |
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| Describe the chronic response pattern |
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| Albumin is decreased alpha 1, alpha 2, and GAMMA globulins are increased |
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| When is beta-gamma bridging seen |
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| cirrhosis |
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| Describe pattern for monoclonal gammopathy |
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| Sharp peak in the gamma region |
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| When is beta-gamma bridging seen |
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| cirrhosis |
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| Describe pattern for monoclonal gammopathy |
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| Sharp peak in the gamma region |
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| What causes the hyperproteinemia seen in multiple myeloma |
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| An increase in one of the immunoglobulins or free light chains |
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| Which immunoglobulin is increased in waldenstroms macroglobulinemia |
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| IgM |
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| A patient has a monoclonal gammopathy on serum protein electrophoresis. What test can be done to determine which immunoglobulin is increased |
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| immunofixation |
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| What is the substrate for starch |
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| amylase |
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| Why shouldn't EDTA plasma be used for an amylase determination? |
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| Ca++ is needed for the reaction and EDTA chelates Ca++ |
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| Which enzyme is most specific for acute pancreatitis |
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| Lipase |
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| In which disease does the highest elevations of alkaline phospatase (ALP) occur? |
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| Paget's disease (bone disease characterized by excessive bone destruction and unorganized bone repair |
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| What is the clinical significance of ACP (acid phosphatase) |
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| Highest levels of ACP are seen in the prostate. It is most significant use is in rape cases |
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| In which condition is the highest levels of CK seen |
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| muscular dystrophy |
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| Which cardiac enzyme is most specific |
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| CKMB is the most specific cardiac enzyme but not the most specific cardiac biomarker. Cardiac troponins are more specific for AMI |
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| How is cardiac troponin measured |
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| immunoassays using monoclonal antibodies |
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| Which cardiac marker is most likely to be elevated 4 days after a suspect myocardial infarction? |
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| Cardiac troponins. CK-MB would have returned to normal |
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| What is the clinical significance of B-type natriuretic peptide |
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| It is a cardiac hormone produced by the heart ventricles in response to ventricular volume expansion. It is a predictor of congestive heart failure. The test is an immunoassay tha can be performed at point of care |
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| What is significance of highly sensitive C-reactive protein (hs-CRP) |
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| CRP is a marker of inflammation and appears to be assoicated with increased risk for coronary heart disease, sudden death, and peripheral artery disease |
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| Which enzymes are most useful for assessment of liver function |
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| ALT AST ALP GGT and LD Other liver tests include total protein, albumin, and total and conjugated bilirubin |
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| Which enzyme is most sensitive for all types of liver disease |
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| GGT Levels are highest with biliary obstruction |
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| Which disease has the highest elevation of AST and ALT |
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| acute hepatitis |
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| Where is LD found |
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| In all cells of body. In liver disease, LD does not increase as much as AST and ALT |
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| What effect does hemolysis have on LD |
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| Increasedd LD is 100 to 150 times more concentrated i the RBCs |
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| How should specimens for LD be stored |
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| 25C and analyzed with in 48 hours They should not be refrigerated because LD decreases more rapidly at 4C |
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| What clinical condition results in the highest level of LD |
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| pernicious anemia |
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| Bone disease enzyme |
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| ALP |
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| Muscle disorder enzymes |
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| CK, AST, LD, and aldolase |
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| What is clinical significance of low pseudocholinesterase levels |
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| Low levels are seen following exposure to insecticides and nerve gases |
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| Name 3 substances that are elevated in renal disesase |
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| BUN, creatinine, and uric acid |
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| What is urea |
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| End product of protein metabolism |
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| Where is 98% of the body's creatinine located? |
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| the muscles |
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| Where is 98% of the body's creatinine located? |
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| the muscles |
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| what is uric acid |
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| end product of purine metabolism The purines are adenosine and guanine. Uric acid is increased with gout and renal disease |
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| what is uric acid |
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| end product of purine metabolism The purines are adenosine and guanine. Uric acid is increased with gout and renal disease |
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| What reagent is commonly used to mearure uric acid |
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| uricase |
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| Where is ammonia formed |
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| mainly in the intestines from deamination of amino acids. it is converted to urea by the liver |
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| When is ammonia elevated |
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| with Reye's syndrome and hepatic failure |
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| Which protein transports bilirubin |
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| albumin |
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| Name the 3 type of bilirubin |
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| unconjugated, conjugated, and delta |
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| Which type of bilirubin is bound to albumin |
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| delta bilirubin It is ONLY present with hepatic obstruction |
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| What is the significance of clay colored stools |
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| obstruction of the bile duct Urobilin is not being produced because bilirubin is not reaching the intestines |
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| Which form of bilirubin can only be excreted in teh urine |
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| conjugated bilirubin |
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| Which form of bilirubin can only be excreted in teh urine |
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| conjugated bilirubin |
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| Which methods are used to determine bilirubin levels |
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| jendrassik grof and malloy-evelyn Both use a diazo reagent to react with bilirubin and produce a colored azobilirubin. Malloy-Evelyn is carried out at an acid pH. Jendrassik Grof at an alkaline pH. |
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| Name the accelators for the two methods of bilirubins |
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| Malloy-Evelyn - methanol Jendrassik-Grof - caffeine |
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| What is the precursor in the iosynthesis of all steroid hormones |
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| cholesterol |
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| What is main action of FSH (follicle stimulating hormone) |
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| stimulates production of egg and sperm produced in anterior pituitary |
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| What is function of growth hormone |
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| Stimulates protein and cell growth and division produced in anterior pituitary |
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| Where is TSH produced |
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| anterior pituitary. stimulates thyroid to produce t3 and t4 |
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| What is main action of ADH (anti diuretic hormone) |
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| Produced in hypothalamus and stored in posterior pituitary Regulates reabsorptio of water from teh distal convoluted tubules. Increased in diabetes insipidus |
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| What is addisons disease |
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| adrenal insufficiency decreased cortisol and increased ACTH The adrenal gland is unable to respond appropriatey to ACTH |
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| Cushing syndrome |
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| ELevated levels of cortisol. May be due to tumors |
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| What does aldosterone do |
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| It increases the retention of Na and excretions of K and H+ |
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| What does aldosterone do |
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| It increases the retention of Na and excretions of K and H+ |
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| What is main action of parathyroid hormone (PTH) |
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| increases calcium and decreases phosphorus |
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| What is major intracellular ANION |
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| phosphate |
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| What is major intracellular ANION |
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| phosphate |
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| What is major extracellular ANION |
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| chloride |
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| What is major extracellular ANION |
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| chloride |
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| Which hormone regulates the concentration of sodium |
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| aldosterone |
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| What is the approximate ration of potassium between RBCs and serum |
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| 20:1 |
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| Wht clinical condition results from potassium that is very high or very low |
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| cardiac arrhythmmias |
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| What is chloride's role in the body |
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| maitains hydration, osmotic pressure, and electrolyte balance |
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| What happens to lactate in the blood following collection |
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| it increases due to glycolysis |
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| Which substance contributes most to serum osmolality |
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| sodium |
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| What is a buffer |
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| a weak acid and its salt |
