Clinical Chemistry Ii Test 3 - Special Patients And Fluids

Front 1

What do physicians look for in infant lung maturity?

Back 1

Type 2 pneumocytes make the surfactant phospholipids, lecithin and sphingomyelin.
CO2 will be retained, causing respiratory acidosis

Front 2

Both glomerular and tubular function develop over the first year of life (T/F)

Back 2

False. First 2 years of life.

Front 3

What is the first thing you should suspect when hyperkalemia is present?

Back 3

poor capillary puncture technique.

Front 4

What is the enzyme that conjugates bilirubin?

Back 4

UDP glucagonal transferase

Front 5

What is neonatal jaundice?

Back 5

The developing liver is unable to conjugate bilirubin because of lack of enzyme, resulting in “neonatal jaundice.”
Bilirubin result will show increased total bilirubin, most of which is indirect or unconjugated bilirubin

Front 6

What pathological condition needs to be considered in neonatal physiologic jaundice?

Back 6

A pathological condition must be considered: Crigler-Najjar disease, a genetic disease in which the enzyme that conjugates bilirubin, UDP-glucuronoyltransferase, is not produced

Front 7

What genetic enzyme deficiency can result in the decreased synthesis of aldosterone and cortisol?

Back 7

steroid 21-hydroxylase

Front 8

Until what age do liver metabolizedrugs more slowly than adults?

Back 8

2 years old

Front 9

What increased lab results do geriatric patients exhibit?

Back 9

GGT
LD
AST
Lipids
ALP (women)
CK
BUN
pCO2Fasting glucose
Potassium
TSH
Uric acid

Front 10

What decreased lab results do geriatric patients exhibit?

Back 10

Albumin
pO2
Bilirubin
T3
Total protein
Growth hormone
Creatinine clearance

Front 11

What lab values do not change in geriatric patients?

Back 11

Chloride
Free T4
Sodium
Insulin
pH

Front 12

All aspects of Therapeutic Drug Monitoring may be affected in geriatric patients: absorption, distribution, metabolism and excretion. (T/F)

Back 12

True

Front 13

What is the most significant of the changes in TDM in geriatric patients?

Back 13

elimination.
Renal mass and renal blood flow diminish.
GFR decreases.
Drugs may easily be overdosed and become toxic.

Front 14

What are good nutrition markers in geriatric patients?

Back 14

protein - few days
albumin - weeks
weight loss

Front 15

What is CSF?

Back 15

CSF is the liquid that occupies the spaces of the CNS and surrounds all facets of brain and spinal cord

Front 16

What is the volume of CSF in adults?

Back 16

150 mL
Constantly produced and reabsorbed at the rate of 500 mL/day
Formation is the result of ultrafiltration of plasma and active secretion by the epithelial membranes

Front 17

What is the glucose ref range in CSF?

Back 17

40 – 70 mg/dL (~ 70 -80 % of serum glucose level)

Front 18

What is the protein ref range in CSF?

Back 18

0.02 to 0.04 g/dL (~ 0.5% of plasma level)

Front 19

What is the sodium ref range in CSF?

Back 19

Almost same as plasma (Osmolality ~ 280 mOsm/Kg)

Front 20

How are CSF specimens collected?

Back 20

Lumbar puncture

Front 21

What things are we interested in CSF as far as biochemical analysis?

Back 21

Glucose (decrease is significant)
increased lactate and normal to decreased glucose suggests bacterial infection

Protein - CSF electrophoresis
Increased prealbumin (compared to serum)
IgG-Albumin ratio is used in diagnosis of MS

Front 22

What are serous fluids?

Back 22

The pleural, peritoneal and pericardial cavities are all lined by two membranes.
The parietal membrane lines the cavity wall
The visceral membrane covers the organs within the cavity.
The fluid between the membranes which provides lubrication as the surface move against each other is called serous fluid

Front 23

Where is pleural fluid?

Back 23

surrounds lungs

Front 24

Where is peritoneal fluid?

Back 24

surround the intestines

Front 25

Where is pericardial fluid?

Back 25

Surrounds the heart

Front 26

How are serous fluids formed?

Back 26

Serous fluids are formed as ultrafiltrates of plasma with no additional material contributed by the membrane cells.
Normally, only a small amount of serous fluid is present, because production and reabsorption take place at a constant rate.
The spaces are subject to hydrostatic and colloidal (oncotic) pressures from the capillaries serving the cavities and capillary permeability.

Front 27

What is effusion?

Back 27

Disruption of the mechanisms of serous fluid formation and reabsorption causes an increase in fluid between the membranes.

Front 28

What are some causes of effusion?

Back 28

increased hydrostatic pressure (CHF), decrease oncotic pressure (hypoproteinemia), increased capillary permeability (inflammation and infection) and lymphatic obstruction (tumor)

Front 29

What is a transudate?

Back 29

Serous effusion that form as a result of a systemic disorder that disrupts the balance in the regulation of fluid filtration and reabsorption between the serous membranes

Front 30

What is an exudate?

Back 30

serous effusion produced by conditions that directly involve the membranes of the particular cavity including infections and malignancies.

Front 31

What are examples of sample preparation?

Back 31

Centrifugation
Cytocentrigugation
Direct smear
Cell block: prepared in Histology
Abundant fluid (greater than 100 ML) is usually collected; therefore ,suitable specimens are available for each section of the laboratory
EDTA tube is used for cell counts and differential. The remaining fluid can be heparinized for chemical, serologic, microbial and cytologic analysis

Front 32

Is pleural fluid transudative or exudative in origin?

Back 32

Pleural effusion may be of either transudative or Exudative in origin

Front 33

What ar ethe most common chemical tests performed on pleural fluid?

Back 33

are glucose, pH, and amylase

Front 34

What lab results are indicative that a pleural fluid is an exudate?

Back 34

pleural fluid:
cholesterol >60 mg/dL or
pleural fluid:serum cholesterol ratio >0.3 and fluid:serum bilirubin ratio of >0.6

Front 35

What is a clear, pale yellow pleural fluid indicative of?

Back 35

Normal and transudate

Front 36

What is a turbid, white pleural fluid indicative of?

Back 36

presence of WBCs and indicates bacterial infection, tuberculosis, or an immunologic disorder such as RA.

Front 37

Bloody pleural fluid?

Back 37

This signify a hemothorax (traumatic injury) and hemorrhagic effusion. To differentiate between the two is by comparing HCT of fluid to HCT of blood.

Front 38

Milky pleural fluid?

Back 38

Chylous material from thoracic duct leakage and Pseudochylous material from chronic inflammation.

Front 39

What is the accumulation of fluid in the peritoneal cavity?

Back 39

ascites

Front 40

What causes ascitic transudates?

Back 40

Hepatic disorder such as cirrhosis

Front 41

What causes exudative fluids?

Back 41

Bacterial infection (peritonitis) often as a result of intestinal perforation or a ruptured appendix and malignancy

Front 42

How can you detect transudates of hepatic origin?

Back 42

The serum-ascites albumin gradient of 1.1 or greater is recommended over the fluid to serum total protein and LD ratio

Front 43

Gross exam for peritoneal fluid

Back 43

bloody: ruptured spleen or liver
cloudy: appendicitis, pancreatitis
greenish: bile stained, perforated gallbladder, ulcer or cholecystitis
pseudochylous: greenish milky, cellular debris or cholesterol crystals
Peritoneal lavage - is a particularly sensitive test for the detection of intra-abdominal bleeding in blunt trauma cases, and results of the RBC count are used to aid in determining the need for surgery.

Front 44

How does normal and transudate pericardial fluid appear?

Back 44

clear and pale yellow

Front 45

Tell me about pericardial effusions

Back 45

Pericardial effusions are primarily the result of changes in the permeability of the membranes due to infection (pericarditis), malignancy, trauma, or metabolic disorders, such as uremia.
The presence of an effusion is suspected when cardaic compression is noted during the physician’s examination

Front 46

Gross exam of pericardial fluid.

Back 46

Gross exam
Exudates only
Effusion result of infection, malignancy or metabolic damage
clear- metabolic disorders
turbid - infection and malignancy
milky - lymphatic system damage
blood streaked - membrane damage
grossly bloody – cardiac puncture

Front 47

What is the calculation to determine transudates from exudates?

Back 47

Total Protein (TP) and Lactic Dehydrogenase (LD) ratios.
TP Ratio = TP (Fluid) / TP (Serum).
LD Ratio = LD (Fluid) / LD (Serum).
TP <0.5 and LD <0.6 is Transudate.
TP >0.5 and LD >0.6 is Exudate.