Clinical Chemistry

Front 1

Antecubital fossa

Back 1

Most common site for venipuncture?

Front 2

Gauge 21 & 20 Respectively

Back 2

Most common gauge used in syringe method? What is the gauge used for hemostasis or coagulation studies?

Front 3

median cubital vein

Back 3

Most common vein for venipuncture because it is largest and most stable

Front 4

Cephalic vein

Back 4

only visible vein for obese patients?

Front 5

Evacuated tube system

Back 5

method of blood collection that is done in a closed system and the most common method of venipuncture?

Front 6

None

Back 6

Red glass anticoagulant?

Front 7

Clot activator

Back 7

Red plastic anticoagulant

Front 8

Tripotassium EDTA in liquid form. Other name: SEQUESTRENE

Back 8

What is the lavender glass anticoagulant?

Front 9

Chelates (binds) calcium

Back 9

Mechanism of EDTA?

Front 10

Yellow (SPS), Blue (Citrate), Red (No Anticoag), Green (lithium heparin), Lavender (Sequestrene), Gray (sodium fluoride

Back 10

Order of Draw for normal venipuncture?

Front 11

Sodium citrate 3.2%

Back 11

what is the anticoagulant for Blue top? And what concentration is mostly preffered?

Front 12

Fe, Aldosterone, Cortisol, ACTH

Back 12

Analytes that are increased during morning ?

Hint 12

Morning F.A.C.A

Front 13

Ketoacidosis

Back 13

Hallmark of DM type 1?

Front 14

Type 1

Back 14

DM with absolute insulin deficiency?

Front 15

DM type 2

Back 15

Relative insulin deficiency?

Front 16

8-10 hours ; 16 hours

Back 16

In OGTT a patient should fast within ______ but not more than _____ hours.

Front 17

75 grams

Back 17

Glucose load for adults?

Front 18

1.75 g/ kg body weight

Back 18

Glucose load for children?

Front 19

100 g

Back 19

Glucose load for pregnant women?

Front 20

< 6.5

Back 20

Glycosylated Hemoglobin (HBA1C) Normal value?

Front 21

2-3 months

Back 21

HBA1C measures average glucose levels for how many months?

Front 22

Glycated albumin

Back 22

Other name of fructosamine?

Front 23

2-3 weeks

Back 23

Fructosamine measures average glucose level for how many weeks?

Front 24

Phospholipid and unesterified cholesterol (free cholesterol)

Back 24

Lipids considered as amphoteric?

Front 25

3Fatty acids + 1 glycerol

Back 25

composition of triglyceride?

Front 26

1 glycerol , 2 fatty acids , 1 phosphate group

Back 26

composition of phospholipid?

Front 27

HDL

Back 27

Apo - A1 for?

Front 28

LDL , VLDL

Back 28

Apo B-100 for?

Front 29

Chylomicrons

Back 29

Apo B48 for?

Front 30

VLDL, LDL, HDL

Back 30

Apo E?

Front 31

Lipoprotein (a)

Back 31

Apo (a) for?

Front 32

75 Grams

Back 32

Glucose load for 2 Hour Glucose test?

Front 33

100 Grams

Back 33

Glucose load for 3 Hour glucose test?

Front 34

140-200 mg/dl

Back 34

Impaired Random Glucose (Pre-diabetic)

Front 35

100-126 mg/dl

Back 35

Impaired Fasting Blood Sugar (pre-diabetic)

Front 36

70-100 mg/dl

Back 36

Normal values of Fasting Blood Sugar?

Front 37

< 140 mg/dl

Back 37

Normal values of Random Blood Sugar

Front 38

50-55 mg/dl

Back 38

At what amount of glucose could you say that patient is hypoglycemic?

Front 39

Fasting Venous plasma

Back 39

Standard specimen for glucose determination?

Front 40

8-10 Hours

Back 40

Fasting time for FBS?

Front 41

10-15%

Back 41

Whole blood glucose is lower by _____ % than others

Front 42

7 mg/ dl/ hour

Back 42

Glucose is metabolized at a room tenperature at the rate of?

Front 43

2 mg/dl/ Hour

Back 43

At 4 degree celsius Glucose decreases by the rate of?

Front 44

Chylomicron

Back 44

what lipoprotein transports triglycerides exogenously from outside the body to inside?

Front 45

VLDL

Back 45

What transports triglycerides from the liver to the cells?

Front 46

LDL

Back 46

What transports cholesterol and has the highest cholesterol content?

Front 47

HDL

Back 47

Transports cholesterol reversely from cell to liver?

Front 48

Beta VLDL

Back 48

Floating Beta Lipoprotein found in Type Iii Hyperlipoproteinemia

Front 49

Lp (a)

Back 49

Sinking pre-beta lipoprotein which increases the risk of atherosclerosis?

Front 50

Phosphomolybdate; Phosphomolybdenum blue

Back 50

Folin - Wu is an Alkaline copper reduction method. What is the reducing agent used? End product reaction?

Front 51

Arsenomolybdate ; Arsenomolybdenum blue

Back 51

Reducing agent for Nelson-Somogyi and end product result?

Front 52

Hexokinase method

Back 52

What type of the enzymatic methods of determining glucose is the reference method?

Front 53

Glucose Oxidase method

Back 53

What enzymatic method is best for determining B-D-Glucose?

Front 54

Abell-Kendall Method

Back 54

Reference method for cholesterol measurement?

Front 55

Free cholesterol

Back 55

What does Abell-Kendall method measures?

Front 56

Green

Back 56

When Liebermann - Buchard reagent reacts with cholesterol it produces what color?

Front 57

Acetoacetic acid (20%)

Back 57

The only ketone body detected in serum is?

Front 58

150 g for 3 consecutive days

Back 58

In the OGTT test, patient is asked to consume at least how many grams of carbohydrate for how many days?

Front 59

FBS, Aldosterone/Renin, Triglycerides, Gastrin, Lipid profile, Insulin, GTT

Back 59

Analytes affected by fasting

Hint 59

F.A.T.G.L.I.G

Front 60

Lactic Acid, Ammonia, Blood Gas

Back 60

These analytes if not chilled will result to decrease pH and pO2

Hint 60

Ice = L.A.B

Front 61

Sodium

Back 61

in case of marked hemolysis this analyte may be decreased

Front 62

L/S Ratio

Back 62

Test that assesses fetal lung maturity?

Front 63

Glucose, Fructose, Galactose

Back 63

what are the monosaccharide sugars?

Front 64

Oligosacharrides. Example ; Dextrins

Back 64

These are sugars with 3-10 units. Samples of which are?

Front 65

Glycosidic bonds

Back 65

What bond connects sugar units?

Front 66

Cellulose

Back 66

What is the most abundant Carbohydrate in the planet?

Front 67

Salivary Amylase (" Ptyalin" )

Back 67

What enzyme is produced by the parotid gland and what is it's other name?

Front 68

Glucose

Back 68

The only carbohydrate that could be used directly for energy?

Front 69

EMP, HMP, and Glycogenesis

Back 69

3 pathways glucose could go to after entering the cell?

Front 70

Glycolysis

Back 70

A process in which glucose is metabolize to become pyruvate (aerobic) or lactate (anaerobic) for energy prod'n

Front 71

Gluconeogeneseis

Back 71

Production of G6PD from Noncarbohydrate sources is called?

Front 72

Hexose Monophosphate Pathway

Back 72

What pathway produces Reduced NADPH to decrease glutathione?

Front 73

Glycogenolysis

Back 73

Breakdown of glycogen into glucose for energy is called?

Front 74

Glycogenesis

Back 74

Conversion of glucose to glycogen?

Front 75

Lipogenesis

Back 75

Conversion of Carbohydrates to fatty acids?

Front 76

Lipolysis; Ketone Bodies

Back 76

Breakdown of fatty acids?End product of these process?

Front 77

Insulin and glucagon

Back 77

2 Hormones that control glucose metabolism?

Front 78

Beta cells of the pancreas

Back 78

What cells produces Insulin?

Front 79

Alpha cells of the pancreas

Back 79

What cells produces Glucagon?

Front 80

Increase glucose in Blood

Back 80

What is the stimulus for production of insulin

Front 81

C peptide

Back 81

what is removed from Proinsulin to become insulin?

Front 82

Cortisol

Back 82

What hormone helps in the gluconeogenesis and is produced in the adrenal cortex?

Front 83

Catecholamines

Back 83

What hormone helps in the glycogenolysis that is produced in the adrenal medulla?

Front 84

Somatostatin

Back 84

what hormone produced by the delta cells of the pancreas inhibits both the secretion of insulin and glucagon?

Front 85

Thyroid hormone

Back 85

What hormone also helps in glycogenolysis but is produced in the thyroid gland?

Front 86

Growth Hormone

Back 86

What hormone inhibits insulin?This is produced in the amterior pituitary

Front 87

Glycogenesis & Glucose uptake;

Glycogenolysis & Lipolysis

Back 87

Insulin's action Increases ____________ & __________ also it Decreases ____________& _____________

Front 88

Normal ratio : 1:1 (B:A)

Extreme Ketoacidosis : 6:1 (B:A)

Back 88

Normal B- Hydroxybutyrate to acetoacetate ratio? What happens in DM with extreme ketoacidosis? What is the ratio?

Front 89

Fasting statE: TAG is high in VLDL

Non Fasting State: TAG is high in CHYLOMICRON

Back 89

Where is TAG found in fasting states & non fasting states?

Front 90

Bacterial Meningitis

Back 90

Decreased CSF glucose (<40 g/dL) and increased WBC (Neutrophil) is a sign of what?

Front 91

TYPE I GSD: Von Gierke (Assctd w/ hyperlipidemia)

Back 91

Most common Glycogen Storage disorders?

Front 92

Adults : 40-70

Children: 60-80 g/dL

Back 92

Normal value of CSF Glucose in adults and children?

Front 93

B-cell (Pancreas) Funxn

Back 93

C peptide levels are meausred by immunoassay what function does it measure?

Front 94

21 & 23 gauge: 1 to 1.5 inches

Butterfly infusion: 1/2 or 3/4 length

Back 94

Length of Needle for 21 & 23 gauge

Length of needle for butterfly infusion?

Front 95

HLA DR3

HLA DR4

Back 95

What HLA is associated w/ DM type I?

Front 96

Chlorhexidine gluconate

Back 96

Disinfectant used for blood cultures of infants?

Front 97

70% Alcohol added with iodophor

Back 97

what is the most common way to disinfect blood culture puncture site?

Front 98

Precision study

-Run two controls twice for 10-20 days

Back 98

First step in method evaluation is?

Front 99

Mean

Back 99

The only measure of systematic error is?

Front 100

Galactose-1-phosphate-uridyl-transferase (most common)

GALE & GALK

Back 100

Defect in Galactosemia

Hint: 3 enzymes

Front 101

CV

Back 101

Percentile expression of mean?

Front 102

Glucose

Lactate & Alcohol

Sodium flouride prevents decrease of alcohol

while blocking further glycolysis of lactate

Back 102

Gray top tube could be used to test what?

Front 103

Shewhart Levy Jennings

Back 103

Dot chart? Is?

Front 104

60 mmHg

Back 104

if blood pressure cuff is to be used as a tourniquet it is inflated up to?

Front 105

Yoden chart

-Low and High standard values of other laboratories

Back 105

Twin Plot?

Front 106

Fructose Kinase deficiency

Fk converts Fructose to Fructose-1-phosphate

Back 106

Defect in Essential Fructosuria?

Front 107

Deteriorating reagents

-It is a gradual loss of reliability

Back 107

Main cause of trend?

Front 108

silica particles - 15-30 min

gel separators 30 min

clot activators - 5 min

red stoppered tube - 60 min

Back 108

give clotting time of each

silica particles

gel separators

clot activators

red stoppered tube

Front 109

Improper calibration

Change in reagent

Back 109

Main cause of Shift?

Front 110

20 days consecutive

Back 110

If you have a new reagent how many days will you observe it?

Front 111

Fructose-1,6- Biphosphate-aldolase-B-activity in kidneys, liver and intestine

Back 111

defect in Hereditary Fructose intolerance?

Front 112

Random Error / Imprecision

Back 112

What mainly affects Precision?

Front 113

Systematic Error

Back 113

What mainly affects Accuracy?

Front 114

in IS/BB it interferes with some reactions

In TDM it absorbs some drugs causing FALSE LOW RESULTS

Back 114

Gel separators couldn't be used in IMMUNOLOGIC REAXNS & BLOOD BANK why?

also couldn't be used in TDM? Why?

Front 115

Control values

Back 115

What is mainly plotted in the dot chart?

Front 116

Borosilicate glass

Back 116

most common glassware used for the reason thst it has high degree of thermal resistance? Strain point 501 degrees

Front 117

Fructose-1,6-biphosphate

Glucose generation by liver through gluconeogenetic precursors lactate & glycerol

Back 117

defect in Fructose-1,6-biphosphate deficiency

Front 118

Blown out type

Back 118

Pipet with two etched rings?

Front 119

Inversely proportional

-The higher the SD the greater the dispersion of values (LOW precision)

-The lower the SD the lower the disepersion of values (HIGH precision)

Back 119

Relation of SD to Precision?

Front 120

Ostwald Folin

Back 120

pipet for viscous fluids with etched ring?

Front 121

Distilled Water - TD

Mercury - TC

Back 121

Mediums used to calibrate TC & TD

Front 122

Positive air displacement pipet

Back 122

what pipet does not require pipet tips for use?

Front 123

Air displacement pipet

Back 123

pipet wherein piston does not come in contact with the fluid?

Front 124

Children <2.0 mm

Adults < 2.5 mm

Back 124

Depth of incision for capillary puncture of adults and children?

Front 125

Production of TAG from FA by the liver

1.)Synthesis of VLDL (contains Apo B100 & apo E)

2.) VLDL --- LPL---> IDL

3.) IPL (Removed by liver) through Apo E or! IPL (Converted to) LDL

4.) Ch rich LDL particles got by the liver or tses for steroid synthesis

or part of cell membranes

Back 125

Describe endogenous pathway

Front 126

lateral plantar surface of heel surface

Back 126

most common site for arterial capillary puncture?

Front 127

Lipids rich in Fatty Acids

TAG, Fatty Acids

Back 127

Lipids that are a source of energy are?

Front 128

1.)HDL gets Cholesterol from tse and either reintroduce for continued metabolism or excretion

2.)LCAT esterifies chole in HDL3 to HDL2

3.) This faction could be transferred to VLDL to participate in metabolism of membrane and steroid synthesis or excreted into Bile

Back 128

Describe Reverse cholesterol pathway

Front 129

glucose

phosphorus

potassium

Back 129

if blood isn't separated with blood for 30 minutes these analytes might be unstable

Front 130

Increase in Potassium

Decrease sodium

in plasma or serum

Back 130

what happens when there is a shift in electrolytes?

Front 131

Icteric sample

Hemolyzed sample

Back 131

What mainly affects the hexokinase method?

Front 132

Short Chain (4-6)

Medium Chain (8-12)

Long Chain (> 12)

Branched: Unsaturated (Double bond) (TRANS)

Unbranched: Saturated (CIS)

Back 132

Fatty acids are classified according to length of chain

branched or unbranched. Give the classification

Front 133

CETP (Cholesterol ester transfer protein)

-GETS TAG from apoB in exchange of GIVING cholesterol ester

-Def. of this protein leads to large cholesterol laden HDL

-Connects forward & reverse cholesterol transport pathways

Back 133

Another pathway of HDL?

Front 134

Ascorbic acid

Uric Acid

Back 134

Hexokinase unlike Glucose oxidase method, is not affected by:

Front 135

Lipoprotein Lipase (LPL)

Back 135

Hydrolyzes TAG breaks it into FA & Glycerol is the role of?

Front 136

500mg /dL

Back 136

Plasma glucose increases by how much in 10% contamination of 5% dextrose?

Front 137

Hepatic Lipase

Back 137

Hydrolyzes TAG & phospholipids from HDL

Hydrolyzes lipids on VLDL & IDL

Both are roles of?

Front 138

300 mg/dL

Back 138

Ketone test is requested when plasma glucose reaches?

Front 139

False increase

Back 139

Bleach could cause?____ in glucose oxidase method?

Front 140

LCAT

Lecithin Cholesterol Acyl Transferase

Back 140

Catalyzes the esterification of cholesterol from HDL

Enables accumulation of Chole into Chole Ester in HDL

Are roles of?

Front 141

Endothelial lipase

Back 141

Hydrolyzes phospholipids and TAG in HDL?

Front 142

ABCA1

ATP-Binding Cassette Protein A1

Back 142

For efflux of cholesterol from peripheral cells into HDL

Front 143

Apolipoprotein

Back 143

What do you call the protein part of a lipoprotein?

Front 144

Its amphipathic helix

Back 144

What does apolipoprotein use to bind to lipids?

Front 145

MAJOR

-Chylomicron

-VLDL

-LDL

-HDL

MINOR

-IDL

-Lp (a) / Lipoprotein A

Back 145

What are the major & minor lipoproteins?

Front 146

CM <0.95 kg/L

VLDL 0.95 - 1.006 kg/L

LDL 1.019-1.063 kg/L

HDL 1.063- 1.210 kg/L

Back 146

Provide the density of each Major lipoprotein?

Front 147

Chylomicron

Fnxn: Transports exogenous / dietary TAG to liver, muscle & fat depot

Back 147

Lipoprotein that is largest but least dense

Produced from dietary fat

Front 148

apo B48

apo A1, apo C, apo E

Back 148

Apolipoproteins of Chylomicrons

Front 149

Pre Beta Lipoprotein

Back 149

Another name for VLDL?

Front 150

1.) TAG & Cholesterol is taken up in the intestine

2.) Chylomicrons are formed and released in the lymph nodes and blood

3.) Chylomicrons release TAG in adipose tse as they circulate

4.) LPL liberates Fatty Acids from TAG thereby reducing the skze kf chylomicrons to become remnants

5.) Remnants are taken up by the liver

6.) Free Fatty Acids are taken up by muscle and adipose tse

Back 150

Explain Dietary or exogenous pathway?

Front 151

VLDL

Back 151

It is a lipoprotein secreted by the liver

Fnxn: transports endogenous TAG from the liver to muscle, fat, tse

Front 152

The amount of glucose consumed is proportional to the glucose concentration

Back 152

What is the principle of polarographic glucose oxidase?

Front 153

Apo B100

Apo C & Apo E

Back 153

Apolipoprotein of VLDL?

Front 154

Non fasting specimen

B-VLDL px

Back 154

Friedewald equation is not suitable for?

Front 155

The amount of NADPH generated is proportional to the amount of glucose present

Mutarotase is added to shorten the amount of reaction time

Back 155

In glucose dehydrogenase method what is the principle? What is added to shorten the time to reach equilibrium?

Front 156

LDL

Fnxn: transports CHOLESTEROL to the peripheral tse

Back 156

-Lipoprotein synthesized in liver

-Major end product of Catabolism of VLDL

-Major source of CHOLESTEROL of tse.

Front 157

Plasma TAG

-----------------

5

Back 157

How to measure VLDL?

Front 158

LDL

Back 158

most cholesterol rich in lipoproteins and therefore most atherogenic?

Front 159

LDL

Back 159

primary target if cholesterol lowering therapy and primary marker for congestive heart dse?

Front 160

Beta lipoprotein

Back 160

Another name for LDL?

Front 161

Apo B100 & apo E

Back 161

Apolipoproteins of LDL?

Front 162

HDL

Back 162

Smallest lipoprotein but most dense

Fnxn: Transports cholesterol from tissues to the liver and more cardioprotective

Front 163

True

Back 163

The phospholipid part of HDL is more important than its protein or cholesterol part true or false?

Front 164

Apo A1 & apo A2

Apo C

Back 164

Apolipoproteins of HDL?

Front 165

LDL

Back 165

What lipoprotein is measured in Coronary Heart Disease? or what lipoprotein is watched out for?

Front 166

Reference value: 40 mg/dL

Interpretation: <35mg/dL (High Risk for CHD)

>60mg/dL (high HDL = Protective) OK!

Back 166

Ref. value for HDL?

Interpretation of HDL?

Front 167

IDL

Back 167

VLDL remnant?

Front 168

Apo E III

Back 168

Defective clearance if IDL in type 3 hyperlipoproteinemia is probably due to deficiency of?

Front 169

Apo B100

Density: 1.006- 1.019 mg/dL

Back 169

Maj. apolipoprotein of IDL?

Density?

Front 170

Lp (a)

Back 170

Sinking pre-B lipoprotein?

Front 171

When there is insulin shock or there is hyperglycemic ketonic coma

Back 171

When is Random Blood Sugar requested?

Front 172

Between 24 and 28th week of gestation

Back 172

Screening for gestational diabetes should be performed when?

Front 173

Type 2 DM

-Since C peptide is a by product of production of insulin and insulin is still produced at type 2

Back 173

At what type of DM is C peptide detectable?

Front 174

Nephelometry

Back 174

Machine that best measures Ag-Ab reaction?

Front 175

LOW Na

HIGH K

Back 175

Describe the electrolyte imbalance of Na & K in DM?

Front 176

SD

---- x 100

Mean

Back 176

Formula of CV?

Front 177

5-hr OGTT

-hypoglycemic "DIP" often is not seen not until after 3 hrs

Back 177

Diagnostic test for HYPOGLYCEMIA?

Front 178

180 mg/dL

Back 178

GLUCOSURIA occurs when the plasma levels exceeds?

Front 179

Acetyl coA

Back 179

Ketosis develops in DM when there is excessive synthesis of?

Front 180

6:1

Back 180

In severe DM the ratio of B-hydroxybutyrate to acetoacetate becomes?

Front 181

Yes

6-8 HRS Fasting

Back 181

Does amino acid collection need fasting if yes how many hours?

Front 182

2 Hr OGTT

75 grams glucose load

Back 182

Screening test & Diagnostic test for GDM?

Front 183

Back 183

Revised criteria for GDM?

Front 184

Dilantin and pentamidine

Back 184

Drugs that promote b cell dysfunction

Front 185

Thiazide and glucocorticoids

Back 185

Drugs that impair insulin reaction

Front 186

2 Hr Post Prandial Blood Sugar

2 Hr OGTT

Back 186

measurs how well fhe body metabolizes glucose?

Front 187

Janney-Isaacson (Single Dose)

Back 187

most commonly used GTT method?

Front 188

Intravenous Glucose Tolerance Test (IGTT)

-0.5 g of glucose/kg body weight (given within 3 min.)

Back 188

Tolerance test for DM px w/ gastrointestinal disorders?

Front 189

GAD65 - Assctd w/ adults

IAA (Insulin Auto Antibody) - Assctd w/ children

Back 189

autoantibodies found in DM type 1?

Front 190

DM Type 1

Back 190

Brittle Diabetes?

Front 191

DM type 2

Back 191

Stable Diabetes, Ketone Resistant Diabetes

Front 192

7 mg/dL

Back 192

Venous blood glucose is ___ LOWER than capillary & arterial blood glucose because of tse metabolism

Front 193

60%

Back 193

CSF Glucose is approximately ___ of the plasma cncentration

Front 194

true

Back 194

RBC and WBCs contribute greatly to glucose metabolism that is why more than 30 minutes of not separating serum from blood is an unacceptable sample for fbs true or false?

Front 195

Collect FBS

Give glucose load (drink w/in 5 min)

Collect after 1 hr, 2hr, 3hr respectively

Back 195

Procedure for OGTT for pregnant woman?

Front 196

Collect only the FBS & 2 HR sample

Back 196

Procedure for OFTT for non pregnant, adult etc

Front 197

Back 197

Category of OGTT?

Front 198

Modified folin wu methd

Back 198

Benedicts method is a modified?

Front 199

Citrate or Tartarate

Back 199

Benedicts test uses what as a stabilizing agent?

Front 200

Nelson Somogyi

Back 200

Reference chemical method of measurement of glucose?

Front 201

HBA1C (Glycated Hemoglobin)

Back 201

A reliable method in monitiring long term glucose control?

Front 202

2-3 months

Back 202

HBA1C reflects ave. blood glucose level over the previous? ___ months

Front 203

> or = 6.5% on at least two occassions

methods should meet National Glycohemohlobin Standardization Program & DCCT method

Back 203

Before an HBA1C be diagnostic of DM it should meet what standards?

Front 204

Fructosamine (Glycated albumin)

Useful for monitoring DM individuals w/ Chronic hemolytic anemia & Hgb Variants

Back 204

Useful for monitoring short term glucose about ___ wks

Front 205

IDA & Old RBC have HIGH HBA1C

disorders with Shortened RBC lifespan have LOW HBA1C

Back 205

What should you consider when measuring HbA1C?

Front 206

Low plasma albumin (< 30 g/ L) low fructosamine

Back 206

Fructosamine should not be measured in cases of?

Front 207

205-285 umol/L

Back 207

NV of Fructosamine?

Front 208

Glomerular filtration rate

Back 208

Is a measure of the clearance of normal molecules that are not bound to proteun and are freely filtered by the glomeruli neither reabsorbed or secreted by the tubules

Front 209

Glomerular Filtration Rate

Back 209

It is considered as the overall indicator of the level of kidney function?

Front 210

150 L

Back 210

How many liters of glomerular filtrate is produced daily?

Front 211

Clearance

Back 211

The removal of substance from plasma into urinr over a fixed time?

Front 212

INVERSELY PROPORTIONAL

Back 212

Plasma concentration is _____ proportional to clearance

Front 213

B2-Microglobulin

-Readily filtered by the glomerulus

Increased in: Renal failure, MM, RA, SLE & HIV

Back 213

Plasma protein that is a light chain compinent of the HLA?

Needed in the production of CD8 Cells

Front 214

remember: Haptoglobin is DECREASED in Intravascular hemolysis while transferrin is NORMAL or INCREASED in IDA

Back 214

remember: Haptoglobin is ____ in Intravascular hemolysis while transferrin is ___ or ___ in IDA

Front 215

Albumin & Transferrin

Back 215

Considered as Negative Acute Phase reactants?

Front 216

Transferrin

Back 216

Major contributor to B2 region in Electrophoresis?

Front 217

Siderophilin

Back 217

Another name for transferrin?

Front 218

Heme : Hemopexin

Hemoglobin: Haptoglobin

Iron: Transferrin

Back 218

Give the transporter fof each:

Heme

Hemoglobin

Iron

Front 219

Pseudoparaproteinemia

Back 219

In severe IDA there is INCREASED Transferrin which results to?

Front 220

Accumulation of iron in apoferritin or in histiocytes

Back 220

Transferrin is decreased in?

Front 221

Fibrinogen

Back 221

Most abundant coagulation factor?

Front 222

True

-Fibrinogen coats cells making them sediment faster in clumps

Back 222

High levels of fibrinogen in plasma = INCREASE ESR? True or false?

Front 223

True

-Exists as non functional precursors however

Back 223

Complement is naturally found in the plasma true or false?

Front 224

Complement C3

Back 224

What form of complement is most abundant in the serum?

Front 225

DIC , Hemolytic anemia

Back 225

Complement is DECREASED in?

Front 226

CRP C-Reactive Protein

Back 226

A member of the pentraxin protein family

Binds to the C-polysaccharide of the pneumococcus

Front 227

C Reactive protrein

Back 227

Highest plasma protein in terms of inflammation?

Front 228

Myoglobin

Back 228

Heme protein found in skeletal & cardiac muscles that transports oxygen from Hgb to contractile cells?

Front 229

Fnxn: Regulator of actin & myosin

Present in: Cardiac & skeletal muscles

Significance: MOST IMPORTANT MARKER FOR AMI

3 types: TROP I, C, T

TROP C: Binds Ca that regulate muscle contractions

TROP I & T: Almost absent in NORMAL serum

Back 229

What are the troponins?

Front 230

Elevates: after 1-3 Hrs

Peak: 5-12 Hrs

Normalize: 18-30 Hrs

Back 230

Myoglobin elevates when during AMI?

Front 231

Back 231

Formula for clearance

Front 232

Inulin clearance

Back 232

What is the reference method for GFR?

Front 233

Continous IV infusion and requires timed urine collections - Too hassle

Primary dose: 25mL of 10% inulin

Continous infusion: 500mL of 1.5% inulin solution

Reference values:

M: 127 mL/min

F: 118 mL/min

Back 233

Inulin clearance is not routinely done because of?

Front 234

Radioactive markers

-125 Iothalamate

-99mTc-DTFA

-51cr EDTA (Don't need urine spx)

-Non Labelled Isothalamate

Back 234

other substitutes for inulin clearance?

Front 235

Creatinine clearance

Back 235

Most commonly used clearance test?

A measure of completeness of 24 hr urine collection?

In normal states its excretion is almost equal to its production

Front 236

Advantage: Freely filtered by glomeruli and NOT reabsorbed

Disadvantage: Is SECRETED by tubules

Back 236

advantage and disadvantage of creatinine clearance?

Front 237

Muscle mass

Back 237

Excretion of creatinine is directly related to?

Front 238

M: 85-125 mL/min

F: 75- 112 mL/min

Back 238

reference values for creatinine clearance?

Front 239

Back 239

Cases of increased creatinine and decrease creatinine?

Front 240

Urea Clearance

Disadvantage: It is reabsorbed especially in high urine osmolarity & high urea conc.

Could be used: in advanced renal failure since as renal function declines reabsorption of ures declines. Wheareas tubular secretion of creatinine increases

Note: The faster the urine flow the less reabsorption of urea

Back 240

Urea clearance's disadvantage? when is it sensitive?

Front 241

it is reabsorbed

Back 241

Disadvantage of csystatin C?

Front 242

-Blood Urea Nitrogen

-Creatinine

-Blood Uric Acid

Back 242

Tests that measure Renal Blood Flow?

Front 243

Troponin T

Back 243

Significant marker for unstable angina (chest pain at rest)

assesses early & late AMI

Front 244

-Excretion Test

-Concentration test

Back 244

Tests for tubular function?

Front 245

Elevate: 3-4 Hours

Peak: 10-24 Hours

Normalize: 7 days (Could last up to 10-14 days)

Back 245

During AMI when will Trop T elevate?

Front 246

Blood Urea Nitrogen

Back 246

major end product of protein (dietary) and amino acid catabolism? this is 45% of total NPN?

Front 247

True

Back 247

The concentration of urea is expressed only by the nitrogen content of urea true or false?

Front 248

2.14 x BUN = Urea (mg%)

Back 248

To obtain the concentration of Urea from BUN?

Front 249

True

-Since Trop T is also elevated in muscular dystrophy & renal disease it is not specific

Back 249

Trop I is more cardiac specific than Trop T true or false?

Front 250

8-23 mg/dL (2.9-8.2 mmol/L)

Back 250

Reference value of BUN?

Front 251

BUN: Creatinine

10:1

20:1

Back 251

BUN:Creatinine ratio?

Front 252

BUN

Back 252

good indicator of nitrogen intake and state of hydration?

Front 253

Elevates: 3-6 Hrs

Peaks: 12-18 Hrs

Normalizes: 5-10 days

Back 253

Trop I elevates during?

Front 254

Improperly timed specimen

Back 254

The most common cause of error in clearance tests?

Front 255

Fluoride & citrate

Back 255

___ & ___ both inhibits urease and affects BUN?

Front 256

Isotope Dilution Mass Spectrometry (IDMS)

Back 256

Reference method for measurement of BUN?

Front 257

B type-Natriuretic Peptide

Back 257

Protein that is sensitive to ventricular & diastolic dysfunction? Diagnostic of CHD?

Front 258

Cystatin C

Increased in: renal disease

Back 258

Protein that inhibits cysteine proteinase inhibitor

determines GFR proposed as alternative test for Creatinine clearance test

Front 259

1.) Alcoholism, Chronic Renal Failure, Steroid treatment - Prealbumin

2.)Cystic Fibrosis - Albumin

3.)Inflammation, Pregnancy, Contraceptive use- A1-Anti Trypsin

4.)Neural tube disorder & Down Syndrome -A1 Fetoprotein

5.)Stressful conditions, myoglobinuria - Haptoglobin

6.)Nephrotic syndrome,Diabetes, liver dse- A2 Macroglobulin

7.)Renal Failure, MM, RA,SLE,HIV- B2- Microglobulin

8.)Hemochromatosis, IDA - Transferrin

9.)Inflammatory conditions- Complement

10.)Acute Rheumatic fever, AMI, RA, Gout, Bacterial & viral infxn - CRP

Back 259

Review: Give the INCREASED Plasma protein in each situation

1.) Alcoholism, Chronic Renal Failure, Steroid treatment

2.)Cystic Fibrosis

3.)Inflammation, Pregnancy, Contraceptive use

4.)Neural tube disorder & Down Syndrome

5.)Stressful conditions, myoglobinuria

6.)Nephrotic syndrome,Diabetes, liver dse

7.)Renal Failure, MM, RA,SLE,HIV

8.)Hemochromatosis, IDA

9.)Inflammatory conditions

10.)Acute Rheumatic fever, AMI, RA, Gout, Bacterial & viral infxn

Front 260

End product: Yellow

Back 260

Direct method of measuting BUN?

Front 261

Urea + Urease = NH3(ammonia) + CO2

Back 261

Enzymatic method or indirect method to measure BUN?

Front 262

1.)Poor Nutrition - Prealbumin

2.)Active Nephrotic Syndrome - Albumin

3.)Emphysematous pulmonary dse & juvenile hepatic cirrhosis- A1-Antitrypsin

4.)Intravascular hemolysis & hemoglobinuria- Haptoglobin

5.)Wilson's Disease, Menkes Dse - Ceruloplasmin

6.)Extensive coagulation - Fibrinogen

7.)DIC, Hemolytic anemia & malnutrition - Complement

Back 262

Review: Give the plasma protein DECREASED in each situation

1.)Poor Nutrition

2.)Active Nephrotic Syndrome

3.)Emphysematous pulmonary dse & juvenile hepatic cirrhosis

4.)Intravascula hemolysis & hemoglobinuria

5.)Wilson's Disease, Menkes Dse

6.)Extensive coagulation

7.)DIC, Hemolytic anemia & malnutrition

Front 263

Back 263

Comditions with increased and decreased BUN?

Front 264

Creatinine

Back 264

End product of muscle metabolism derived from creatine (a-methyl guanidoacetic acid)

Front 265

Creatinine: Not affected by protein diet ; not easily removed by dialysis

BUN: Affected by protein diet & easily removed by dialysis

Back 265

Advantage of creatinine to BUN

Front 266

Creatinine

-As gestation progresses more creatinine id excreted by the fetus in the amniotic fluid (2mg/dL)

Back 266

a measure of fetal kidney maturity?

Front 267

Male: 0.9-1.3 mg/dL

Female: 0.6-1.1 mg/dL

Back 267

Reference value of creatinine?

Front 268

icteric and hemolyzed

Back 268

in measuring creatinine avoid?__ &___ spx

Front 269

Isotope dilution mass spectrometry

Back 269

Reference methid for measurement of creatinine?

Front 270

Chemical Method = Direct Jaffe Method

Princple: Creatinine + Alk. picrate rgt = Red Orange tautometer of creatinine picrate

Back 270

Principle of Chemical method for Creatinine measurement

Front 271

Back 271

Reference value of HDL?

Front 272

Type 2 Hyperlipidemia / Familial Hypercholesterolemia

Back 272

Type of lipid disorder where there is defect of LDL receptor?

Front 273

Dysbetalipoproteinemia / Type 3 Hyperlipidemia

Back 273

Lipid disorder where there is rich B-VLDL

There is presence of abnormal broad band between VLDL & LDL?

Presence of apo E2/2 (Rare form of apo E)

Front 274

Back 274

Reference value of LDL?

Front 275

<1:1

Diabetes insipidus

>1:1

Glomerular Disease

Back 275

Urine:Serum osmolality of <1:1 and >1:1 means

Front 276

Osmolal gap

Back 276

The difference between measured and calculated plasma osmolality is?

Front 277

Molecular studies

Back 277

Pink top and white top tubes are used for?

Front 278

Enzymes

Back 278

proteins that hastens chemical reactions

measured in terms of activity and NOT by absolute values

Front 279

Enz conc.

-The higher the conc. the faster the reaxn

Substrate conc.

-The more subst. the faster the reaxn

Cofactors

-Nonprotein entities that bind to enz for reaxn to occur

Inhibitors

-Decrease enz. activity

Isoenzymes

-Same reaxn diff amino acid sequence

-Enz activity is enhance by fractionizing isoenz.

Temperatures

-37 degrees (Optimal)

-40-50 degrees (Denatured enz)

-60-65 degrees (Inactivated enz)

Hydrogen Ion Conc. for pH

-pH 7-8 (Optimal)

Storage

- -20 degrees (Preservation of enz for longer period)

-2 to 8 ideal storage temp for substrate and coenzymes

-RT ideal for LDH (LD4&5)

Hemolysis

-Increased enz conc.

Lactescence or milky spx

-Decreased enz conc.

Back 279

Factors that affect activity of enzymes?

Front 280

Coenzyme

-Organic compound (Secobd substrates)

-Essential to achieve absolute enz activity

-Example: NAD & NADP

Activators

-Inorganic ions

-Alters the spatial configuration of the enzymes for proper substrate binding

-Examples: Ca, Mg, Cl,Zn

Metalloenzyme

-Inorganic attached to molecule

-Example:Catalase, cytochrome oxidase

Back 280

What are thr cofactors?

Front 281

Competetive

-Substrate and inhibitor compete gor active site

-Addition of substrate makes it reversible

-Dilution of serum lessens the inhibitor

Noncompetitive

-The inhibitor binds to another site DOES NOT compete with the substrate in the active site

-Addition of substrate DOES NOT stop inhibition

Uncompetitive

-Inhibitor binds to enz-substrate complex

-Addition of substrate ONLY INCREASES inhibition

Back 281

Types of inhibitors

Front 282

E.C 3.1.3.2 - ACP

E.C 3.1.3.1 -ALP

E.C.2.6.1.2- ALT

E.C.2.6.1.1.- AST

E.C.3.4.15.1- Angiotensin Converting Enz

E.C.1.1.1.49- G-6-P-D

E.C.1.1.1.27 - LDH

E.C.3.1.3.5 - 5' Nucleotidase

Back 282

E.C 3.1.3.2?

E.C 3.1.3.1?

E.C.2.6.1.2?

E.C.2.6.1.1.?

E.C.3.4.15.1?

E.C.1.1.1.49?

E.C.1.1.1.27?

E.C.3.1.3.5?

Front 283

Back 283

Classofication of enzy?

Front 284

Active site- where substrate binds

Allosteric site- other sites than actibe site where receptor may bind

Back 284

What is active site & allosteric site?

Front 285

Apoenzyme(enzyme) + Prosthetic group (coenzyme) = Holoenzyme

Back 285

What is a holoenzyme

Front 286

Emil Fisher

Back 286

Who proposed the lock and key theory?

Front 287

Kochland proposed this theory

-Substrate binds to active site

Back 287

Who proposed induce fit theory?What is it?

Front 288

Back 288

Reference value of LDL?

Front 289

abetalipopriteinemia (Bassen-Kornzweig syndrome)

Back 289

Lipid disorder where there is a defective apo B synthesis?

VLDL, LDL, Chylomicrons are absent in plasma

Presence of acanthocytes

Fat malabsorption due to fat solunle vitamins

Front 290

Hypolipoproteinemia

Back 290

apo B deficiency

Decresead LDL & TC?

Front 291

Niemann Pick Disease

Back 291

Accumulation of sphingomyelin in the bone marrow, spleen & lymph node

Front 292

Tangier's Disease

Back 292

Rare disease where there is complete absence of HDL due to mutation of ABCA1 Gene on chromosome 9

Front 293

Type 1 Hyperlipidemia / Familial Hyperchylomicronemia

-Since LPL not only hydrolyzes TAG but also converts chylomicrons to chylomicron remnant its deficency leads to accumulation of chylomicrons in plasma

Back 293

LPL Deficiency leads to?

Front 294

LCAT Deficiency

Back 294

LCAT gene mutation leads to?

Front 295

Fisher eye

Back 295

What is a milder form of LCAT deficiency?

Front 296

Tay Sachs Disease

Back 296

deficiency of hexosaminidase A which results to accumulation of sphingolipids in the brain?

Front 297

Chylomicron Retention Disease (Andersen's Disease)

Back 297

Deficiency of apo B48 is?

Front 298

Chylomicrons : 80-95% TAG

LDL: 6-8% Free Cholesterol

HDL: 40-55% Protrein

Back 298

Values you need to remember in the chemical composition of Lipoproteins?

Front 299

Type 1 "Chylomicronemia"

HIGH: TAG & CM

Type 2a: "Cholesterolemia"

HIGH: LDL & Cholesterol

Type 2b: "COMBINED"

ONLY NORMAL: CM

Type 3: "DYSBETALIPO"

HIGH: VLDL, TAG, Cholesterol

Type 4: "TRIGLYCEREMIA"

HIGH: TAG, VLDL

Type 5:

ONLY NORMAL: LDL

Back 299

Summarize Fredrickson classification of Hyperlipidemias

Front 300

High HDL = Low CHD

High LDL = High CHD

Back 300

Relation of HDL & LDL to CHD?

Front 301

Immunohlobulins & vWF

Back 301

Only proteins that are not synthesize by the liver is?

Front 302

Requires automated equipment

Principle: Serum id mixed w/ alkaline picrate and the rate of change in absorbance is measured between 2 points

Interferences: a-keto acids & cephalosporins

Back 302

What is kinetic jaffe method?

Front 303

Interference: Negative interference are Bilirubin & Catecholamines

2 ENZYMATIC METHODS

1.)Creatinine Aminohydrolase (Creatininase) CK Method

-Not widely used because requires large amount of enz

d because requires large amount of enz

Enz in order: Creatinine aminohydrolase, CK, PK, LDH

End product: Lactate + NAD

2.)Creatinase-H2O2 Method

-Potential to replace jaffe

-Not affected by acetoacetate & cephalosporins

Enz used: Creatininase, Creatinase, Sarcosine oxidase, peroxidase

Endproduct: Benzoquinonemine dye (Red)

Back 303

what are the eenzymatic methods to measure creatinine?Interferences in measurement?

Front 304

Isotope dilution mass spectrometry

Back 304

Still the reference method for measurement of Creatinine?

Front 305

True

Back 305

Plasma creatinine conc. is assctd with Abn. renal fnxn but is relatively insensitive since it will only increase when there is > 50% renal deterioration true or false?

Front 306

Azotemia

-ELEVATED conc. of nitrogenous substances like UREA & CREATININE in blood

Uremia

-MARKED ELEVATION in plasma urea and other nitrogenous substance

-accompanied by ACIDEMIA & ELECTROLYTE IMBALANCE (K elevation)

-Anemia (NORMOCHROMIC & NORMOCYTIC)

-BURR CELLS & ELLIPSOIDAL CELLS

Back 306

Disease related with renal blood flow?

Front 307

Back 307

Formula for calculating VLDL?

Front 308

PRE-RENAL (Low GFR)

-DIMINISHED glomerular filtration w/ NORMAL renal fnxn

Causes: Dehydration (High BUN plasma crea is N), Shock, congenital heart disease

RENAL(Low GFR)

-Damaged w/in kidneys

-Striking BUN level, slow rising plasma crea, anemia & electrolyte imbalance

Causes: Acute/ Chronic renal dse, glomerulo nephritis

POST RENAL(Low GFR)

-Urinary tract obstruction

-Urea is HIGHER than crea due to back diffusion of ure to the circulation

Causes: Renal calculi(nephrolithiasis) cancer of GUT

Back 308

Types of azotemia?

Front 309

Low BUN:Crea - Usually affected by problems in Protein, liver(producer of protein), and in reabsorption of Urea

High BUN:Crea (Increased crea)

- usually affected by damaged kidneys since defect in renal fnxn increases crea

High BUN:Crea (N crea) -If crea is unaffected or kidneys are unaffected

Back 309

Causes of Low BUN: Crea

High BUN:Crea (N crea)

High BUN:Crea (increased Crea)

Front 310

Primary Structure

Back 310

Structure of proteins that is linear and determines the identity, binding capacity, and recognition ability

Front 311

<20 ug/ min

Back 311

Normal excretion rate of albumin present in urine?

Front 312

Purine (adenine & guanine) catabolism

-Formed from xanthine by the action of xanthine oxidase in the liver and intestine

Back 312

Blood Uric acid comes from?

Front 313

secondary structure

Back 313

winding of the polypeptide chain

Front 314

Glomerular or Tubular dyafunction

Back 314

Proteinuria (> 0.5g/day) usually results from?

Front 315

Monosodium Urate

Back 315

A weak acid at pH 7.4 >95% of Blood Uric acid exists as?

Front 316

Catabolism of INGESTED nucleoproteins

Catsbolism of ENDOGENOUS nucleoproteins

Transformation of ENDOGENOUS purine nucleotides

Back 316

Blood uric acid is derived from 3 sources what are they?

Front 317

Back 317

Reference value (uricase)

Front 318

Tertiary Structure

Back 318

Responsible for the 3D structure of proteins

Folding pattern

Responsible for physical and chemical properties

Front 319

Quaternary Structure

Back 319

Association of 2 or more polypeptide chain to form a functional protein molecule

Front 320

Lipoprotein X

-Apo C & Albumin

Back 320

Abnormal lipoprotein found in obstructive jaundice & LCAT deficiency

-Specific and sensitivr indicator of cholestiasis

Front 321

Albumin - Only single polypeptide chain

Back 321

Which protein has no Quaternary structure?

Front 322

HYPERURICEMIA

1.)Gout

-Deposition of Uric acid in joints

-Birefringent crystals ib synovial fluid is definitive

-High risk for nephrolithiasis

2.)increased nuclear metabolism

-Leukemia, lymhpoma, polycythemia,multiple myeloma, hemolytic & megaloblastic anemia

-allopurinol drug (for treatment)

3.)Chronic renal dse

- decreased GFR, imcreased tubular secretion

-BUA >10 mg/dL could cause urinary calculi

4.)Lesch Nyhan Syndrome(Inborn error of Purine metabolism)

-Deficiency of hypoxanthine guanine phosphoribosyl transferase (HGPT)

HYPOURICEMIA

1.) Fanconi's syndrome

2.) Hodgkins

3.) Wilson's Disease

Back 322

Disease related to Blood Uric Acid?

Front 323

Spx: Fasting sample is preferred for diagnosis

Anticoagulant NOT used: Potassium oxalate

Maj. Interferences: Bilirubin and Ascorbic acid

Back 323

When measuring BUA what are the px prep? Major interferences?

Anticoagulant that SHOULD NOT BE USED

Front 324

Simple proteins

Back 324

This are types of proteins that when polypeptide chains are hydolyzed they yield only amino acid

Front 325

Fibrous (E.g Fibrinogen, Collagen, Troponin)

Globular (E.g Hgb, Plasma proteins, enz, peptide hormones) - Compact no space for water inside

Back 325

2 shapes of simple proteins?

Front 326

Conjugated proteins

Back 326

Type of protein where there is a combination of protein (apoprotein) & non protein moiety (prosthetic group)

Front 327

Lamellar body

Back 327

Phospholipids is produced by pneumocytes type II as?

Front 328

Sphingomyelin

Back 328

The only phospholipid not produced from glycerol but instead from sphingosine is?

Front 329

Sphingomyelin

Back 329

wjatvis an essential component of cell membranes (RBC and Nerve sheath)

Front 330

Live and spleen

Back 330

In Niemmann pick disease (Lipid storage disorders) sphingomyelin accumulates where?

Front 331

Lecithin/Phosphatidyl choline -70%

Sphingomyelin- 20%

Cephalin- 10%

Back 331

give the forms of phospholipids and their corresponding percentage

Front 332

1.)Chemical method

Principle: Reduction-Oxidation (RED-OX)

Uric acid + Phosphotungstic acid ---- NaCN/ Na2CO3---> Tungsten blue + Allantoin + CO2

a.)NaCN = Folin, Brown, Newton, Benedict

b.)Na2CO3= Archibald, Henry, Caraway

2.)Enzymatic method

Principle: Uric acid has a maximum peak of absorption 293mm allantoin does not. The DECREASE in absorbance is proportional to the concentration of uric acid

Uric Acid + O2 ---Uricase--> Allantoin + CO2 + H2O

Back 332

2 methods od measuring BUA?

Front 333

L/S of > or = 2

Back 333

Mature lung function correlates at an L/S ratio of what?

Front 334

Isotope dilution mass spectrometry (IDMS)

Back 334

The reference method for uric acid measurement?

Front 335

< 39 weeks

Back 335

Fetal lung maturity should be done in ____ wks

Front 336

Anabolism - Synthesis

Catabolism - Breakdown

Back 336

What is anabolism & catabolism?

Front 337

Nitrogen balance

Back 337

A balance between catabolism & anabolism?

Front 338

NEGATIVE Nitrogen balance

Back 338

When CATABOLISM exceeds anabolism it is called?

Front 339

POSITIVE nitrogen balance

Back 339

When ANABOLISM exceeds catabolism this is called?

Front 340

Transthyretin

Back 340

Another name for prealbumin?

Front 341

True

Back 341

Sphingomyelin serves as the reference method during the 3rd trimester of pregnancy because its concentration is constant as opposed to lecithin true or false?

Front 342

-Prealbumin, Albumin

-Globulin

-A1-Antitrypsin, A1-Fetoprotein,

-Hemopexin, Haptoglobin, Ceruloplasmin

-A2-macroglobulin

-Transferrins, complements, C-Reactive Protein

-Immunoglobulins

Back 342

Summarize the plasma proteins?

Front 343

2 days

Back 343

Half life of transthyretin?(prealbumin)

Front 344

1st : Albumin

2nd: Prealbumin

Back 344

Most abundant protein in CSF? 2nd?

Front 345

1st: Albumin

2nd: Globulin

Back 345

Most abundant protein in serum?

Front 346

EXCRETION TEST

1.) Para amino hippurate test (Diodrast test)

2.)Phenolsulfonthalein dye test

CONCENTRATION TEST

1.)SG

2.)Osmolality

Direct method: Freezing point

Vapor pressure

Indirect method:

1.86 x Na + Glucose + BUN

----------- ------

18 2.8

Back 346

What are the test that measures tubular function ?

Front 347

Transport T4 & Retinol (Vit.A)

Used to detect malnutrition

Confirm if spx is really CSF

Back 347

Functions of Prealbumin?

Front 348

18-45 mg/dL

Back 348

Reference value for Prealbumin?

Front 349

Loss of concentrating ability of kidney

Equivalent to glomerular filtrate

Back 349

SG of 1.010 means?

Front 350

-A general transport protein

-Maintains osmotic pressure

-Reservoir for circulating amino acids

-Negative acute phase reactant

Back 350

Functions of albumin?

Front 351

There are radiographic dyes present

Back 351

High SG >1.030 means?

Front 352

Cystic Fibrosis

Back 352

Albumin is a sensitive, highly prognistic marker in cases of?

Front 353

1.005-1.030

Back 353

Reference value of SG?

Front 354

Active Nephrotic Syndrome

Back 354

Lowest plasma albumin levels are seen in?

Front 355

3.0-5.0 g/dL

Back 355

Reference value of Albumin?

Front 356

SG- Measures total number And Mass of particles

Osmolality- only measures the number of solute particles present/kg of solvent (moles/kg solvent)

Osmolality More accurate than SG in measuring tubular funxn

Back 356

Difference between SG and Osmolality?

Front 357

Absolute specificity: One enz one substrate one reaction

Group Specificity: One enz. combine with All substrate in a chem. gr.

Bond Specificity:enz. reacting w/ specific chemical bonds

Back 357

Enzyme kinetics

Provide description of each:

Absolute specificity:

Group Specificity:

Bond Specificity:

Front 358

Zero Order Kinetics: Reaction rate depends on Enzyme concentration

First Order Kinetics: Reaction rate DIRECTLY PROPORTIONAL to Substrate concentration

Back 358

What is:

Zero Order Kinetics

First Order Kinetics

Front 359

Fixed Time- Reactants combined, reaction proceeds for a designated time, reaction is stopped and measurement is made

Continous monitoring/Kinetic assay- Multiple measurements of change in absorbance. More preferred

Back 359

2 general methods to measure enzymatic reactions?

Front 360

International Unit (IU)

umol of substrate/ min

Katal Unit

mole of substrate/min

Back 360

2 Units for expressing enzymatic activity?

Front 361

CHANGES IN:

Substrate concentration

Product concentration

Coenzyme concentration

Back 361

Enzymes are measurd in terms of?

Front 362

Back 362

Causes of elevated plasma enzyme levels

Front 363

Michaelis Menten Constant

Back 363

What is Km? in enzyme

Front 364

In order to achieve zero order kinetics you must have >99Km

An enz. DO NOT alter the FREE ENERGY or DIRECTION of the reaction but it alters the ENERGY OF ACTIVATION by forming a metastable intermediate the ES COMPLEX

Back 364

An enzyme accelerates the rate of reaction

A constant change in absorbance per unit of time only occurs in zero order kinetics

In order to achieve zero order kinetics you must have ____Km

An enz. DO NOT alter the ___ or ____ of the reaction but it alters the ______ by forming a metastable intermediate the ES COMPLEX

Front 365

enzymes are used as REAGENTS

Back 365

In first order kinetics the enzymes are used as ____ to measure a specific analyte

Front 366

Substrate or Product

Back 366

Endpoint measurement determines the conc. of ___ or ____ at a specific time after addition of the sample (bedside glucose testing)

Front 367

Liver - in healthy sera ALP is derived here

Bone- High in children, growth, adults older than 50, increases w/ osteoblastic activity

Placental- In normal pregnancy increased ALP is detected 16-20 wks

Intestinal- Depends on blood secretor or H gene status

B and O has high intestinal ALP

A and AB has low intestinal ALP

Back 367

Major sources of ALP?

Front 368

The liver

Especially in obstructive jaundice

Back 368

If ALP is elevated the main contributor faction is?

Front 369

The liver

Especially in obstructive jaundice

Back 369

If ALP is elevated the main contributor faction is?

Front 370

Pagets Disease (Osteitis deformans)

-Bone ALP isoform B1x was detected in serum of Dialysis patients

Back 370

Highest elevation of Bone ALP occurs in what condition?

Front 371

Regan

-Most heat stable ALP (65 Degrees in 30 minutes)

-Inhibited by: Phenylalanine

Nagao

-Variant of regan ALP

-inhibited by: L-Leucine & Phenylalanine

Back 371

2 carcinoplacental ALP

Front 372

Electrophoresis

-Most anodal: Bone and Liver ALP

-Least anodal: Intestinal ALP

-Use NEURAMIDASE & WHEAT GERM LECTIN to separate Bone and liver ALP

Heat Fractionation/Stability Test

-56 degrees for 10-15 min

-Most Heat Stable: Placental ALP

-Most Heat Labile: Bone ALP

Decreasing order of stability: Placental, intestinal, liver, bone

Chemical Inhibition Test

-Usage of Phenylalanine, 3M Urea, Levamisole

Inhibited by Phenylalanine reagent: Placental & Intestinal ALP

Inhibited by 3M Urea: Bone ALP

Inhibited by Levamisole: Bone and Liver ALP

Back 372

methods to measure ALP?

Front 373

Bowers and Mc Comb

-pH environment of 10.15

- read at 405nm

-Since Phosphorus is innhibitory to ALP, AMP Buffer is added to bind phosphorus

Back 373

Most specific method of measuring ALP, IFCC recommended method?

Front 374

Zinc is a component Of ALP and Magnesium is the enzyme activator

Back 374

___ is a component of ALP and ___ is the enz activator

Front 375

Diffirentiating whether a tumor in pineal body is a pinealoma or a germ cell tumor

Back 375

Placental Alkaline Phosphatase is useful in?

Front 376

Diffirentiating whether a tumor in pineal body is a pinealoma or a germ cell tumor

Back 376

Placental Alkaline Phosphatase is useful in?

Front 377

Liberates inorganic phosphate from organic phophate ester with the concomitant production of alcohol

Back 377

Function of ALP?

Front 378

Same with ALP except it is active at pH 5.0

Back 378

Function of ACP?

Front 379

Presence of seminal fluid

Back 379

ACP > 50 IU/L indicates what?

Front 380

-For detection of Prostate carcinoma

-After surgical treatment of prostate cancer ACP falls faster than PSA .

-Also used in forensic studies during rape cases

-Seminal fluid (>50 IU/L) ACP activity could persist up to 4 days

Back 380

Diagnostic significance of Measuring ACP?

Front 381

Thymolphthalein monophosphate is the specific subatrate of choice for quantitative endpoint reaxnA-Naphthyl PO4 is preferred for continoud monitoring methods

Back 381

____ is the specific subatrate of choice for quantitative endpoint reaxn

____ is preferred for continoud monitoring methods

Front 382

ACP activity in bones is assctd w/OSTEOCLASTS

ALP activity in bones is assctd w/ OSTEOBLASTS

Back 382

ACP activity in bones is assctd w/____

ALP activity in bones is assctd w/___

Front 383

Transfer of amino acid from Aspartate to a-keto acids w/ formation of oxaloacetate & glutamate

Back 383

Funxn of AST?

Front 384

Cytoplasm

-More predominant form in the serum

Mitochondrial

Back 384

2 isoenzyme of AST?

Front 385

Major Tissue Source: Cardiac Tissue, Liver and Skeletal Muscle

Other Sources: Kidney, Pancreas, RBC

Back 385

Tissue sources of AST?

Front 386

AST on AMI

Rise: 6-8 Hours

Peak:24 hours

Elevate: 5 days

Back 386

With regards to AMI what is thr rising, peak and normalizing point of AST?

Front 387

-Evaluation of myocardial infarction, hepatocellular disorders, and skeletal muscle involvement

-Used for monitoring therapy w/ potentially hepatotoxic drugs a result of more than three times the upper border of normal should signal cessation of therapy

Back 387

Diagnostic significance of AST

Front 388

Karmen Method

-Uses malate dehydrogenase (MD) and monitors change in avsorbance at 340 nm

Back 388

Method used to measure AST?

Front 389

Tranfer of amino group from Alanine to a-keto glutarate with the formation of glutamate and pyruvate

Highest concentration in liver more liver specific than AST

Back 389

Funxn of ALT?

Front 390

Maj. tse source: LIVER

Other sources: Kidney, pancreas, RBC, Heart, skeletal muscles, lungs

Back 390

Tissue source of ALT?

Front 391

Coenzyme: pyridoxal phosphate (vit. B6)

Hemolysis should be avoided, increases AST 10x

Back 391

Aminotransferases (AST & ALT) requires what as coenzyme?

Front 392

Acute hepatitis

Back 392

Highest elevation of Transaminases (AST &ALT) Is seen in?

Front 393

>1.0

Back 393

In acute hepatitis the De Ritis ratio? (ALT:AST)

Front 394

At end stage cirrhosis the transaminase levels are LOW due to massive tissue destruction

Back 394

At end stage cirrhosis the transaminase levels are ___ due to massive tissue destruction

Front 395

Breakdown of Starch and glycogen

Back 395

What is the function of Amylase?

Front 396

Amylase

Back 396

Smallest enzyme in size?

Front 397

S-type (ptyalin)

P-type(amylopsin)

Back 397

Earliest pancreatic marker -Amylase

P3- is the most predominant pancreatic amylase isoenzyme

So what are the 2 isoenzymes of amylase?

Front 398

Maj. tse source: Acinar cells of the pancreas and the salivary glands

Other tissue source: Adipose tse, Fallopian tubes, small intestine, and skeletal muscles

Back 398

Tissue sources of amylase?

Front 399

Acute pancreatitis (AMS Reaxn)

Rise: 2-12 hours

Peak:24 hours

Normalize:3-5 days

Back 399

AMS levels in acute pancreatitis? Rise, peak and normalize when?

Front 400

Parotitis

Back 400

What is another name for salivary gland inflammation?

Front 401

SG- Measures total number And Mass of particles

Osmolality- only measures the number of solute particles present/kg of solvent (moles/kg solvent)

Osmolality More accurate than SG in measuring tubular funxn

Back 401

Difference between SG and Osmolality?

Front 402

Urea, chloride, sodium

Back 402

3 most prevalent solute excreted in concentration tests?

Front 403

Total protein - Serum Albumin = Serum Globulin

Back 403

How to compute for the serum globulin?

Front 404

Solute

Back 404

Osmolality is more of a measure of?

Front 405

Plasma: 275-295 mOsm/kg

24hr urine: 300-900mOsm/kg

Back 405

Reference value of Osmolality in plasma and 24 hr urine

Front 406

An INCREASE in osmolality (solute) DECREASES freezing point and vapor pressure

Back 406

An INCREASE in osmolality (solute) _____ freezing point and vapor pressure

Front 407

1:1

Back 407

Normal ratio of Urine:Serum osmolality?

Front 408

Glucose; stored as Glycogen

Back 408

The only carbohydrate to be used directly for energy or stored as _____

Front 409

insulin

Back 409

Glucose enters the muscle cells with the aid of?

Front 410

Pyruvic acid

Lactic acid

Acetylcoenzyme A

Back 410

Glucose metabolism generates what 3 products?

Front 411

Carbon dioxide

Water

Adenosine Triphosphate

Back 411

Oxidation of glucose generates what products?

Front 412

Sucrose

Back 412

The most common nonreducing sugar?

Front 413

Endocrine: Release Glucagon, Insulin, Somatostatin (From Alpha, Beta, Delta Cells of the islets of langerhans respectively)

Exocrine: Release of Pancreatic amylase to break ingested complex carbohydrates

Back 413

Pancreas as an endocrine does what?As an exocrine?

Front 414

true

Back 414

In early cirrhosis Total protein becomes normal because the increase of globulin makes up for the loss of albumin true or false?

Front 415

2.3-3.5 g/dL

Back 415

Ref. value of globulin?

Front 416

Fat

Muscle

Liver

Back 416

insulin is primarily stored where?

Front 417

High glucose levels in blood

Back 417

Trigger of insulin release?

Front 418

TLC followed by densitometric quantitation

Back 418

What instrumentation is used to measure L/S ratio?

Front 419

Increase

Glycogenesis

Lipogenesis

Glycolysis

Decrease

Glycogenolysis

Back 419

Functions of Insulin?

Front 420

25-50 pg/mL

Back 420

Fasting plasma glucagon are normally ?

Front 421

A1-Antitrypsin

Back 421

Plasma protein that neutralizes trypsin like enzymes

Major inhibitor of protease activity : Prevents self destruction of tissues

90% of the A1-globulin band

Front 422

Hydroxyl group of the A-ring

Back 422

Cholesterol is amphipathic what is its hydrophilic part?

Front 423

Estrogen

Back 423

Transport and excretion if cholesterol is facilitated by?

Front 424

Back 424

Reference value of cholesterol?

Front 425

A1 Fetoprotein

Back 425

Most abundant protein in fetal serum?

Front 426

13th wk of Gestation

Back 426

Peak period of A1-Fetoprotein?

Front 427

7th to 8th month of pregnancy

Back 427

A1-Fetoprotein is detectable in serum of mothers during?

Front 428

Progestin,Estrogen,Aldosterone

Glucocorticoids, mineralocorticoids

Back 428

Cholesterol is the precursor of the 5 major steroids:

Front 429

Neural tube disorders

Down syndrome

Back 429

Diagnostic significance of AFP? it could detect?

Front 430

Hemopexin

Back 430

Binds heme?

Front 431

Cholesteryl ester- 70%

Free cholesterol- 30%

Back 431

How much of the cholesterol is a Cholesterol ester and how much is a free cholesterol?

Front 432

Haptoglobin

Back 432

Binds hemoglobin and prevents its loss together with iron in the urine

Front 433

Ceruloplasmin

Back 433

Binds copper? Imparts blue color to protein?

Front 434

Esterified by: LCAT (Lecithin Cholesterol Acyl Transferase)

-transfer if fatty acids from lecithin to cholesterol which results in the formation of lysolecithin and cholesterol ester

Re-esterified by: ACAT

Back 434

Cholesterol ester undergoes esterification by ____ Excess cholesterol is re esterified by ___

Front 435

Wilson's Disease

Back 435

Kayser Fleisher rings is found where?

Front 436

A2-Macroglobulin

Back 436

Largest major non imunoglobulin protein in plasma?

Front 437

Apo-A1

Back 437

What is the activator of LCAT?

Front 438

Hydrophobic & Hydrophilic (Phospholipid, Free Cholesterol) - Are located at the surface of lipoprotein

Hydrophobic (Cholesterol ester) - Are located inside the lipoprotein

Back 438

Principle of the arrangement of lipids in the lipoproteins?

Front 439

True

Back 439

Total cholesterol is rather measured than its forms true or false?

Front 440

Cholesterol & HDL

Back 440

Only lipid component not affected by fasting state is?

Front 441

Dehydration and Oxidation of cholesterol to form a colored compound

Back 441

Principle of the Chemical method of measuring cholesterol?

Front 442

Liebermann buchard

¤ End product: GREEN color

¤Rgt: MONOsulfonic acid

Salkowski Reaction

¤ End Product: RED color

¤Rgt: DIsulfonic acid

Back 442

2 chemical methods of measuring cholesterol?

Front 443

SHOULD NOT BE:

Hemolyzed: Falsely increase

Icteric: 5-6%mg Increase (Biliribin absorbs light at 500 nm)

Back 443

Precautions in Total cholesterol measurement? Specimen should not be ___ & ___

Front 444

Ascorbic acid = FALSE DECREASE

Back 444

Ascorbic acid usually causes false ___ in Enzymatic methods of measurement for glucose & cholesterol

Front 445

Measure the amount of HYDROGEN PEROXIDE produced

Back 445

Currently the most common method of quantifying cholesterol oxidase is measuring the amount of ____ produced

Front 446

Abell-Kendall , Levy, and Brodie Method

1.)Hydrolysis w/ alcoholic KOH

2.)Hexane extraction

3.)Liebermann-Burchardt color reagent

Back 446

reference method for enzymatic measurement of cholesterol is?

Front 447

LPL - Lipoprotein lipase

Epinephrine & Cortisol

Back 447

Breakdown of TAG is facilitated by?

Front 448

Glomerular proteinuria / Albuminuria

Back 448

most common type and serious type of proteinuria?

Front 449

12-14 hours

Back 449

Fasting requirement of TAG?

Front 450

Back 450

Reference value of Triglyceride?

Front 451

Glomerular proteinuria

- albuminuria

Tubular proteinuria

-low molecular mass proteins due to defective reabsorption

Overload proteinuria

-hemoglobinuria, myoglobinuria, BJP

Post renal proteinuria

-Potein from UTI caused by infxn, bleeding or malignancy

Back 451

Types of proteinuria?

Front 452

Triglycerides & Colesterol

-Fasting TAG > or = 200 mg/dL is indicative of risk for coronary heart disease because of atherogenic VLDL remnants

Back 452

___ & ____ are the most important lipids in the management of coronary heart disease

Front 453

B-VLDL

-Has Density of VLDL but migrates to LDL (B region) in electrophoresis

-There is accumulation of IDL because of failure to fully convert VLDL to LDL

Back 453

"abnormally migrating B-VLDL"

"Floating B lipoprotein"

"VLDL Rich in Cholesterol"

Are all descriptions of?

Front 454

B-VLDL

Back 454

Found in Type 3 htperlipoproteinemia or dysbetalipoproteinemia?

Front 455

LDL

-It is only estimated through FRIEDEWALD EQUATION

Back 455

Between TC, TAG, HDL & LDL what IS NOT directly measured?

Front 456

Microalbuminuria

Back 456

An early indicator of glomerular dysfunction and precedes nephropaty assctd w/ DM type 1?

Front 457

ALBUMIN: CREATININE

30:300 ug/mg

-2 out of 3 spx w/in a 3-6 month period with abnormal findings

Back 457

A patient is said to have a microalbuminuria if he/she has an albumin: crea ratio of?

Front 458

Ultracentrifugation & Enzymatic cleavage

Back 458

Lipemic samples could be pretreated by?

Front 459

Total Cholesterol - HDL = Non HDL

Back 459

Formula for lipoproteins?

Front 460

Colorimetric method (Van Handel & Zilversmith)

Fluirometric method (Hantzsch Condensation)

Back 460

chemical methods of measuring triglyceride?

Front 461

Glycerol Kinase method

-Hydrolysis of TAG to free fatty acids and glycerol

-Phosphorylation of glycerol to glycerolphosphate

-Disappearance of NADH is measured at 340 nm

Back 461

enzymatic method of measuring triglyceride?

Front 462

Back 462

Reference value of microalbuminuria?

Front 463

10 to 30 mg/dL (2/3 of the CSF total protein)

Back 463

CSF Albumin is how much of the CSF total protein?

Front 464

Coomassie Brilliant Blue dye

Back 464

What dye is used to measure CSF protein?

Front 465

Oligoclonal Banding: Presence of 2 or more IgG bands in the y region

Condition: Multiple Sclerosis

Indication: Inflammation w/in the CNS

Back 465

What is CSF oligoclonal banding? what condition is it seen? It indicates what?

Front 466

Supporting medium: Agarose Gel

Stain: Coomassie Brilliant Blue

Back 466

Supporting medium of electrophoresis abd stain for oligoclonal binding

Front 467

Elevated levels of homocysteine & methionine in blood and urine

Cystathionine B-Synthetase is impaired

Back 467

What is homocystinuria?

Front 468

Modified Guthrie Test

Back 468

Screening test for homocysteinuria?

Front 469

Deficient: A-ketoacid Decarboxylase

Screening test: Modified Guthrie Test

Accumulation of: Branched Amino Acid (Leucine, Isoleucine, Valine)

Diagnostic test: Amino Acid Analysis (HPLC)

Back 469

What is maple syrup urine disease?

Deficient?

Screening test?

Accumulation of?

Diagnostic test?

Front 470

Deficient: Phenylalanine Hydrolase (Phenylalanine hydrolase converts phenylalanine to tyrosine)

Clinical features: Severe mental retardation

Screening test: Guthrie Bacterial Inhibition Assay (B.subtilis spores)

+ Result: Bacterial growth if phenylalanine is >4mg/dL

Back 470

Phenylketonuria

Deficient:

Clinical Feautures:

Screening test:

Front 471

potassium

phosphate

lactate

Back 471

factors affected by vigorous hand exercise during veni?

Front 472

Glucose

cholesterol

electrolytes

TAG

Back 472

analytes that needed basal state collection?

Front 473

Glucose, BUN, Creatinine

Na, K, Cl

CO2

Calcium

Back 473

Basic metabolic panel

Front 474

Collecting duct

Back 474

The final site of either concentrating or diluting urine?

Front 475

Nephron

Back 475

Functional unit of kidney?

Front 476

Ascending loop of Henle

Back 476

Part of Kidney that is impermeable to water?

Front 477

Ascending loop of Henle

Back 477

Part of Kidney that is impermeable to water?

Front 478

Basic Metabolic Panel + Phosphorus & albumin

Back 478

Renal Function panel?

Front 479

Hgb = Increased by 1g/dL

Hct= Increased by 3.5%

Back 479

1 Unit of Whole Blood or PRBC increases Hgb by? Hct by?

Front 480

Random Donor

-From different donors pooled

-Takes 4-6 units before it has therapeutic effects

-Adv: Cheap

-Disadv: From different donors has antigens

-QC: 5.5×10^14

Single Donor Platelet

-1 unit for therapeutic effect

-Less Antigenic

-Expensive (12-25k)

-QC: 3.0×10^11

Back 480

Differentiate Single from random donor platelet conc

Front 481

Whole --> Soft --->PRBC (For RBC

Blood Spin loss)

\

--> PRP-->Hard

Spin

/ \

/ \

<---FFP<--Freeze <--PPP Platelet

| @ -18¤C conc.

|

--->Thaw @1-6-->Centrifuge

degrees / \

/ \

Cryo Cryo

preci super

pitate nate

*Cryoprecipitate- For Factor I,XIII, VIII

Back 481

How to prepare blood components?