Clinical Chemistry Ii Test 1

Front 1

Confidence Intervals

Back 1

68.2% CI= ±1sd
95.5% CI =± 2sd
99.7% CI = ± 3sd

Front 2

Precision

Back 2

Reproducibility, Evaluated by random error, Estimated by running a sample of known concentration repeatedly. Calculate within run precision and day to day precision— acceptable CV <2-5%

Front 3

Accuracy

Back 3

True value
Estimated by systematic error (constant or proportional)
Method comparison study usually verifies accuracy. So does linearity

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Random Error

Back 4

Present in all measurements (no pattern)
Can be positive or negative
Due to instrument, operator or environment

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Systematic Error or Bias

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Consistent error in one direction
Should not be present in a method
Can be constant or proportional

Front 6

Glucose Ref Range

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Fasting: 70 – 99 mg/dL, 126 mg/dL Diabetic
Non Fasting: 70-140 mg/dL, 200 mg/dL Diabetes
Diabetes: Confirmed by casual, fasting, 2hr glucose tolerance, Hgb A1C ( 4.1 – 6.5)

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Type 1 DM

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Juvenile or Insulin dependent
Entirely insulin dependent
Keto Acidosis

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Type 2 DM

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Hyperosmolar coma
Functional insulin deficency

Front 9

Which lipoprotein has the most triglyceride? Second most? Least?

Back 9

Chylomicrons, VLDL, HDL (protein rich)

Front 10

Which lipoprotein has the most Cholesterol?

Back 10

LDL

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Risk factors for Atherosclerosis

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> 45 years old for men, > 55 years old for women
Family history of early coronary heart disease (CHD)
Cigarette smoking
Hypertension (BP >140/90 mm Hg)
Diabetes mellitus
Low HDL-cholesterol level -- <40 mg/dL
High LDL-cholesterol level -- >100 mg/dL
High Total cholesterol level -- >200 mg/dL
Severe obesity (>30% over weight)
Physical inactivity
Stress

Front 12

How do you calculate total cholesterol?

Back 12

Friedewald Formula = Calculation Method

total chol = HDL-cholesterol + LDL-cholesterol + VLDL-chol
(measure) (measure) (calculate) (calculate from trig/5)

Front 13

Where will free hemoglobin peak on a SPE?
Hemoglobin-haptoglobin complexes?

Back 13

Between alpha2 and beta region, Alpha2 region

Front 14

What is international unit/liter for enzyme concentration?

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IU/L= moles of substrate used up/minute of incubation/ liter

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BNP

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B-type naturetic peptide; Congestive heart failure

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IMA

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Ischemia modified Albumin; increased before MI

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CRP

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marker for imflamation

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Homocysteine

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amino acid pathway, marker for further heart problems, Low homocysteine = eat more B12

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Freely Filtered glomerular filtrate

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H2O
Na+, K+, Cl-, HCO3-, Ca++, Mg+, PO4, etc.
Glucose
Urea
Creatinine
Inulin – not physiologic

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Not filtered glomerular filtrate

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Immunoglobulins
Cells
Protein bound lipids and bilirubin
Large molecules
Negatively charged plasma proteins

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Creatinine Clearance

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GFR = U V x 1.73m2 = mL/min per 1.73m2
P BSA

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Uremia

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very high plasma urea concentration accompanied by renal failure

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prerenal azotemia

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decreased renal blood flow (CHF, dehydration)

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Renal azotemia

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intrinsic renal failure (acute or chronic)

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Post renal azotemia

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obstruction in the urinary system

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Decreased urea concentration

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Decreased protein intake
Liver disease
severe diarrhea and vomitting
Pregnancy

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Hyperuricemia

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Caused by overproduction or under excretion
incresed catabolism of nucleic acid, purine rich diet = overproduction of uric acid, renal disease = under excretion

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Hyperammonemia

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severe liver disease
reye's syndrome

Front 29

Kidney function tests

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Creatinine – not 100% accurate; 10% overestimated
BUN
Creatinine clearance
Total Protein
Uric acid
Cystatin C – more accurate
Osmolality - # of solutes
Electrolytes

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Acute renal failure

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Sudden, sharp decline in renal function as a result of acute toxic or hypoxic insult to the kidneys.
GFR is reduced to <10 mL/min.

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Chronic renal failure or kidney disease

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Gradual decline in renal function over time.
Occurs in 5 stages (table 26-3, pg. 574).

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Acute glomerulonephritis (acute nephritic syn.)

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Injury to glomerular tissue by immune complexes formed with beta-hemolytic strep.
Lab findings: hematuria, proteinuria, reduced GFR, increased sodium and hypertension.

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Chronic Glomerulonephritis

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Loss of nephron mass over a prolonged period of time
Lab findings: same as acute except - slight hematuria and proteinuria

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Nephrotic Syndrome

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Increased permeability of the glomerular basement membrane induced by disorders like diabetes mellitus, lupus, etc.
Lab findings: hyperprotinuria, hypoproteinemia (hypoalbuminemia), azotemia, hyperlipidemia, lipiduria
Symptoms: edema

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Tubular disease

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Acute and noninfectious pyelonephritis
(pyelo = pertaining to the pelvis)
Decreased excretion/reabsorption of certain substances or reduced urinary concentrating ability
Caused by drug toxicity, gram negative bacteria, etc.
Lab findings: decreased GFR, acidosis (decreased H+ secretion)

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Anion Gap

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[Na + K] - [Cl + HCO3-] = anion gap (AG)
Reference range: 10 – 20 mmol/L

Front 37

Osmolality

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Measure of the number of dissolved particles (molecules or ions) in a solution
Normal = 275 - 300 mOsm/Kg

Front 38

Calculated Osmolality

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2[Na+] + [glucose ]/20 + [BUN ]/3

Each 1000 mOsm./Kg of solute depresses the freezing point of H2O by 1.86oC

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Osmolal Gap

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measured osmo - calculated osmo = osmolal gap
normal value (included in the calculated osmo) = 9 mOsm/Kg

Front 40

Trace Elements

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Elements found in very small amounts in body; 1ug/gram tissue.

Front 41

% Saturation

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(Total Iron/TIBC) * 100

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Copper

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ESSENTIAL?
travels through blood bound to albumin or histidine for transport to the liver, brain, heart and kidneys. Incorporated as ceruloplasmin, an acute phase reactant. Deficiency results in decreased hemoglobin and collagen production

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Menkes syndrome

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Decreased serum copper, uncreased urine copperinherited; impaired copper absorption, serum copper extremely low

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Wilson's disease

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Norm-decreased serum copper, Increased urine copper. Inherited disorder of copper metabolism. Copper accumulates in liver, brain cornia, kidneys. Gold/green cashun-flavor rings around eyes

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Zinc

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ESSENTIAL
Absorbed through the intestine from the dietary nutrients. Transported in blood with albumin or alpha 2 macroglobulin carriers and finally excreted in feces or pancreatic secretions.

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Lead

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Exposure primarily respiratory or gastrointestinal. Tranported in blood, 94% transferred to erythrocytes, 6% in plasma.

Front 47

Half life of lead

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2-3 weeks

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Lead is stored in ______________

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Soft tissue 5% and Bones 95%

Front 49

Whole blood lead levels

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Whole Blood Lead
Children = > 10 ug/dL is toxic
Adults = >30 ug/dL is toxic

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Arsenic

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Used in wood preservative.
Ingestion.

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Selenium

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Enters food chain via plants.
In organ meats, etc.

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Trace metal analysis

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Royal blue tube free of all contaminants. Atomic absorption spectroscopy most sensitive and precise method

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Macronutrient

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jh

Front 54

Registered Dietitian preforms nurtitional assessment by looking at which data?

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anthropometric measures (height, weight, BMI)
biochemical analyses (Nutritional markers)
clinical history and physical exam
dietary profile
environmental information

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Macronutrient assessment

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ID and analysis of concentration of proteins, lipids, and carbs

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Micronutrient assessment

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testing of plasma levels of vitamins and minerals

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Functional lab testing

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Kidney = Creatinine, BUN, electrolites
Heart = Lipids, risk factors, AST, ALT
Bone = Calcium, Phosphorus, Parathyroid

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Albumin

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Protein in highest concentration
Half life of 18-20 days
Indicator of protein deficiency

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Retinol binding protein

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Correlates protein energy status of the patient

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Transferrin

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acts as a carrier protein for iron
8 day half life
marker of recent protein-energy nutritional status

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Transthyretin (thyroxin-binding pre-albumin)

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Carrier to thyroid hormones
1-2 day half life
marker for protein-energy nutritional status

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Nitrogen balance

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Difference between nitrogen intake and excretion.
positive wanted for therapy patients

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Vitamins

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Obtained by diet or intestinal bacteria.

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Fat soluble vitamins

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Absorbed, transported, stored for long periods
A, D, E, K
Must have carrier molecule to transport through blood. Stored in fat for long periods of time

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Water soluble vitamins

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retained less and excreted more in urine

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Vitamin A

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retinal, retinol, and retinoic acid.
Liver, organ meats, fish oils
Careteniods found in yellow-orange fruits; green veggies are precursors of vitamin A
Deficiency leads to night blindness and abnormal growth

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Vitamin D

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cholecalciferol
Produced by sunlight exposure
deficiency: rickets (children) or osteomalacia (adults)

Front 68

Vitamin E

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Alpha-tocopherol
Accumulates in liver, fat, muscle
antioxidant, protects RBCs
deficiency produces hemolytic anemia

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Vitamin K

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phylloquinone
diet and bacteria
forms coag factors 7,9,10, protein c and s
Deficiency: hemorrhage (easy bruising)

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Vitamin C

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Ascorbic acid
Reducing agent
helps synthesize collagen and neurotransmitters
Reduces risk of Cancer and Cold
Def: Scurvy

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B complex

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Enzyme cofactors
Deficiency: Pernicious anemia
B12 and folate Def: megaloblastic anemia

Front 72

Folate reference range
(Serum and RBC)

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Serum Folate: 2.6 - 12.2 ug/L
RBC Folate: 103 - 411 ug/L

Front 73

Schilling Test

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test for B12 absorption

Front 74

What cells secrete pepsinogen in the stomach?

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Chief Cells

Front 75

What converts pepsinogen to pepsin?

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HCL

Front 76

What cells secrete HCl into the stomach? What causes the cell to release HCl?

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Parietal cells
Sight and smell of food hits vagus nerve
Parietal cells produce HCL and intrinsic factor. H+ transported by H+ATPase across parietal cell barrier stimulated by gastrin.

Front 77

What compound acts on the pancreas and cause the release of pancreatic enzymes?

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Secretin

Front 78

What does pepsin do?

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Breaks down protein

Front 79

Intrinsic factor

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protein that binds and helps transport vitamin B12 throughout the lining of the intestine to blood.

Front 80

what hormone stimulates the release of bile from the gall bladder?

Back 80

Cholecystokinin

Front 81

The pancreas has the islets of langerhans which produces what endocrine hormones?

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glucagon, insulin, somatostatin

Front 82

Pancreatic fluid contains ______________ which neutralizes gastric fluid.

Back 82

sodium bicarbonate

Front 83

Gastric fluid contains which pancreatic proteolytic enzymes?

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Trysin, Chymotrypsin, Elastase, Carboxypeptidase, nuclease, secretin

These enzymes are in pancreatic fluid.
Nucleic acids largest molecule in body.

Front 84

Which pancreatic hormones produced in the Islets of Langerhans contribute to nutrient degradation?

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Amylase, lipase, pepttidases, disaccharidases

Front 85

What is the role of the large intestine?

Back 85

reabsorb water from undigested material

Front 86

What is Steatorrhea?

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Greasy, pale stools that have an abnormal appearance.

Front 87

Non-Tropical sprue, Celiac disease, gluten sensitive enteropathy

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An inherited autoimmune intolerance to gluten (in flour) ---> Ag-Ab complex deposits in intestinal mucosa causes a specific lesion ----> poor absorption and irritation in the stomach

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Tropical sprue

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Acquired, Abnormalities of small bowel structure and function ----> nutritional deficiency

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Ulcerative Colitis

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Chronic inflammatory disorder of the intestine
Mucosa of rectum and left colon are most commonly affected
Toxic megacolon can occur

Front 90

Regional enteritis (Crohn’s disease)

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Chronic inflammation of intestine of unknown etiology that can lead to intestinal obstruction
Ileum and colon are most often affected

Front 91

Vomiting that causes excessive fluid loss may produce __________________.

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Metabolic alkalosis with hypochloremia

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Zollinger-Ellison syndrome

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caused by a gastrin-producing tumor, or gastrinoma. High levels of gastrin cause overproduction of stomach acid and the high acid levels lead to multiple ulcers in the stomach and small bowel. The gastrinoma may occur in the stomach, pancreas, lymph node or mesentery.

Front 93

What is the most common carbohydrate malabsorption disorder?

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Lactose intolerance

Intestinal enzyme Lactase breaks down lactose into glucose and galactose.
70% of people show diminished lactase activity after the first few years of life

Front 94

Qualitative analysis for fecal fat employs which fat-soluble stains?

Back 94

Sudan III and IV

Front 95

What is the reference range for a fecal fat specimen?

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Qualitative reference range: 40-50 droplets per high powered fieldQuantitative reference range: less than or equal to 6 grams/day (fecal fat may also be reported as percentage of total fecal weight)

Front 96

What is the D-xylose absorption test?

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an indirect but specific method for assessing mucosal absorption of the small intestine.
Normal: 60% passed in urine

Front 97

How is Xylose measured?

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Spectrophotometrically;Xylose is measured by heating the protein-free specimen to convert xylose to a furfural, then combining the product to a chromagen for measurement by spectrophotometry.
An o-toluidene procedure is also available for xylose with differential absorbance at 630 nm.

Front 98

D-Xylose Reference range

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Patient fasts overnight.
Reference 1.4 g
Borderline 1.2-1.4 g
Abnormal: <1.2 g

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Lactose breath test

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Increased H2 caused by increased bacteria breaking down increased amounts of lactose in large intestine

Measured at 1, 2 and 3 hr post-ingestion
an increase greater than or equal to 20 ppm

Front 100

What are four disorders of pancreatic function?

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Acute Pancreatitis
Cystic Fibrosis
Diabetes mellitus
Tumors of Pancreas

Front 101

What lab results signify acute pancreatitis?

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Increased serum amylase, urine amylase, and serum lipase

Front 102

What is the most common single-gene inherited disease in americans of Northern European heritage?

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Cystic Fibrosis

Front 103

What chromosome is the CF mutant gene located?

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Chromosome 7; Mutation causes all exocrine secretions to have less H2O which causes salty sweat and malabsorption

Front 104

Lab test for CF

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sweat chloride level--screening test
RFLP detection of mutant gene--confirmatory test

Front 105

Sweat chloride test

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stimulate sweat by iontophoresis of pilocarpine
collect sweat and measure Cl- content
normal < 35 mmol/L
CF > 60 mmol/L

Front 106

Amylase requires _____ and ______ for full activity

Back 106

Chloride and Calcuim

Front 107

Amyloclastic method for Amylase

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measures rate of hydrolysis of starch by Amylase
Usually turbidimetric method (turbidity as starch is used up) or nephelometry (increase in light scatter)

Front 108

Saccharogenic Method for amylase

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measures rate of production of monosaccharides or
disaccharides such as maltose is produced in the
reaction when Amylase reacts with substrate

Front 109

What is a tumor/neoplasm?

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Abnormal/uncontrolled proliferation of cells

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What is a benign tumor?

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Tumor that remains confined to its primary site

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What is a malignant tumor?

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Tumor that is capable of invading surrounding normal tissue and metastasizing (spreading) through the circulatory and lymphatic systems to distant body sites—also called “Cancer”

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What is cancer?

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a malignant neoplasm or tumor that must be dealt with

Front 113

Tumor marker

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a substance synthesized by the tumor or by the host in response to a tumor that can be used to detect the presence of the tumor

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Anaplasia

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Loss fo cell differentiation and change in cell and tissue structure from typical or normal

Front 115

Carcinoma

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Malignant growth arising from skin or organ tissue epithelium

Front 116

Adenoma

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benign growth arising from glandular epithelium

Front 117

What are the desirable characteristics of a tumor marker?

Back 117

Specific for cancer
Always present with tumor
Amount of marker produced should correlate well with the tumor load
The half-life of the marker should be short so serum levels must drop producing undetectable concentrations when patient is in remission.
Levels of marker should have prognostic value

Front 118

Screening test should have high_______________ ; that is low rate of _________________

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sensitivity, false negative

Front 119

Confirmatory tests to the positive screening tests should have high _____________ ; that is low rate of ________________

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specificity, false positive

Front 120

What are the 7 uses for tumor markers?

Back 120

Screening for disease
Diagnosis for symptomatic patients
Aid in clinical staging
Measurement of tumor burden
Monitoring response to therapy
Detecting recurrence of disease
Prognostic indicator

Front 121

What are the types of tumor markers?

Back 121

Enzymes and isoenzymes
Hormones, neurotransmitters and their metabolites
Receptors (estrogen, progesterone, androgens, corticosteroids)
Proteins (immunoglobulins, glycoproteins, carcinoembryonic proteins or oncofetal antigens)
Genetic markers (Oncogens and supressor genes)
Other markers (amino acids)

Front 122

CEA is elevated in which cancers?

Back 122

Colon cancer
Lung cancer
Gastric cancer
Breast cancer
Pancreatic cancer
Ovarian cancer
Uterine cancer
Prostate cancer

Front 123

What are some problems with using CEA as a marker?

Back 123

Elevated in non malignant conditions; not specific
Most useful in establishing prognosis and monitoring therapy and reoccurrence of disease

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What is PSA?

Back 124

Prostate Specific Antigen; Serine protease produced exclusively by the epithelial cells in the prostate

Only tissue specific marker identified so far; also elevated in Benign Prostatic Hyperplasia

Only tumor marker approved for screening for prostate cancer.

Front 125

What are the two forms of PSA?

Back 125

Free and Complex (alpha1-antichymotrypsin)

Front 126

Increase in % free to total PSA means

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Benign prostatic hyperplasia (BHP)

Front 127

Increase in % complex to total PSA means

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Prostate cancer

Front 128

Human Chorionic Gondotropin (HCG)

Back 128

secreted by the synctiotrophoblastic cells of the placenta

Dimer composed of alpha and beta subunits
Alpha subunit is found in FSH, LH, and TSH
Beta subunit is specific to HCG

Front 129

Where is Alpha-fetoprotein located?

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Synthesized int he yolk sac, fetal liver, GI tract and kidney
Related to albumin
Marker for neural tube defects and screens for down syndrome

Front 130

Cancer antigen 15-3

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Glycoprotein on mammary epithelium
increased in breast cancer but not specific
Used in combo with CA 27-29

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CA 125

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Glycoprotein defined by monoclonal antibody OC125
Good marker for ovarian cancer but not specific

Front 132

CA 19-9

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Blood group antigen
Specific for pancreatic cancer but present in GI cancer
May be increased in diseases associated with biliary tract obstruction and CF

Front 133

Prostatic acid Phospatase (PAP)

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Tumor marker for prostate cancer

Front 134

CK-BB

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Tumor marker for prostate and stomach cancer

Front 135

ALP

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Tumor marker for bone and liver

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Amylase and lipase

Back 136

tumor markers for pancreatic cancer