Mls 309L Exam 2

Front 1

Intracellular fluid represents 66% of the total body water. K+ is the major intracellular electrolyte and Na+ is the major extracellular electrolyte

Osmolality is the measure of the number of dissolved particles in a solution. Na+ and Cl- are the major serum osmolality contributors.

Back 1

Intracellular fluid represents ____ of the total body water. ____ is the major intracellular electrolyte and ____ is the major extracellular electrolyte

Osmolality is the measure of the number of ____ in a ____. Na+ and Cl- are the major serum ____ contributors.

Front 2

Plasma Osmolality formula:
Posm = 1.86[Na+] + ([Glucose]/18) + ([BUN]/2.8)

Back 2

Plasma Osmolality formula:
Posm = ____

Front 3

A solution with higher osmolality will have more particles and less water per unit volume than a solution of lesser osmolality.

A decrease in the electrolyte concentration of Na+ or Cl- will produce a lower than normal osmolality and result in water shift from extracellular fluid to intracellular to reestabilish equilibrium.

Often there are decreases in the measured and the calculated osmolality which is referred to as the osmol gap. Abnormal high values are attributed to osmotically active compounds other than those mentioned above.

The higher the osmol gap, the poorer the prognosis.

Normal values is less than 10 Osm/kg.

Back 3

A solution with ____ osmolality will have more particles and less ____ per unit volume than a solution of ____.

A decrease in the ____ concentration of ____ or ____ will produce a ____ osmolality and result in ____ from extracellular fluid to intracellular to ____.

Often there are ____ in the measured and the calculated ____ which is referred to as the ____. ____ values are attributed to____ other than those mentioned above.

The higher the osmol gap, the ____.

Normal values is less than ____.

Front 4

Anion Gap
Na+ - (Cl- + HCO-) = 8-16 mmol/L
(Na+ + K+) - (Cl- + HCO-) = 12-20 mmol/L

Any change from normal must involve a change in unmeasured cations or anions.

Back 4

Anion Gap
____ = ____
____ = ____

Any change from ____ must involve a change in ____.

Front 5

Iron is released from its transport protein using an acid pH. Transferrin transport iron in its ferric form and its reduced to ferrous state by using hydroxylamine.

About one-third of the serum iron is normally bound to the transferrin

Neocuproine is used to prevent copper interference since copper is the only other trace element found in serum to form a violet colored complex with ferrozine.

Back 5

____ is released from its transport protein using an ____. ____ transport iron in its ____ form and its reduced to ____ state by using ____ .

About ____ of the serum iron is normally bound to the ____.

____ is used to prevent ____ since copper is the only other trace element found in serum to form a ____ colored complex with ____.

Front 6

Unhemolyzed serum, that has been separated from the cells after collection, should be used in iron testing. Samples should be drawn in the morning and in the fasting state since iron values can decrease by 30% during the course of a day.

EDTA falsely depresses serum iron values, while sodium heparin, sodium fluoride with potassium oxalate, and sodium oxalate with ascorbic acid falsely elevate iron levels. Hemolysis falsely elevates serum iron and UIBC values.

Back 6

____, that has been separated from the cells after collection, should be used in ____. Samples should be drawn in the ____ and in the ____ since iron values can decrease by ____ during the course of a day.

____ falsely depresses serum iron values, while ____, ____ with ____, and ____ with ____ falsely elevate iron levels. ____ falsely elevates serum iron and UIBC values.

Front 7

UIBC = 500 ug/dL - excess iron
TIBC = UIBC + serum iron
% transferrin saturation = total Fe / TIBC * 100

serum iron = delta test / delta standard * 500 ug/dL
delta test = tests specifically for iron

Back 7

UIBC = ____
TIBC = ____
% transferrin saturation = ____

serum iron = ____
delta test = ____

Front 8

Ferritin normal values:
10-120 ng/mL (female)
20-300 ng/mL (male)

Serum concentrations of ferritin can be measured by a variety of immunoassay techniques including ELISA, CLIA, IRMA, and FIA

ELISA uses an enzyme label to measure the formation of antigen-antibody complexes.

CLIA uses chemical labels to measure the formation of antigen-antibody complexes.

IRMA is a radiolabeled antibody used to determine the presence of an antigen in biological fluids.

FIA uses a fluorescent label to measure the formation of antigen-antibody complexes.

Back 8

Ferritin normal values:
____ (female)
____ (male)

Serum concentrations of ____ can be measured by a variety of immunoassay techniques including ____, ____, ____, and ____.

____ uses an enzyme label to measure the formation of antigen-antibody complexes.

____ uses chemical labels to measure the formation of antigen-antibody complexes.

____ is a radiolabeled antibody used to determine the presence of an antigen in biological fluids.

____ uses a fluorescent label to measure the formation of antigen-antibody complexes.

Front 9

Calcium is a divalent predominantly extracellular ion that is essential to many physiological functions. Ninety-nine percent of total body calcium is bound in the skeleton. The remaining one percent is found in the extracellular fluid and in skeletal muscle.

Back 9

____ is a divalent predominantly extracellular ion that is essential to many physiological functions. ____ of total body calcium is bound in the ____. The remaining ____ is found in the extracellular fluid and in ____.

Front 10

Calcium in the blood is found almost exclusively in the plasma. It exists in three forms, free or ionized, complexed with anions such as lactate, citrate, or phosphate, and finally bound to proteins.

Albumin accounts for 80% of protein bound calcium while globulins account for approximately 20% of the calcium bound.

Back 10

Calcium in the blood is found almost exclusively in the ____. It exists in three forms, ____ or ____, ____ with anions such as ____ , ____ , or ____, and finally ____.

Albumin accounts for ____ of protein bound ____ while globulins account for approximately ____ of the calcium bound.

Front 11

Adjusted calcium (mg/dL) = Calcium total (mg/dL) - Albumin (g/dL) + 4.0

Back 11

Adjusted calcium (mg/dL) =____

Front 12

Ionized calcium concentrations in plasma or serum is sensitive to both pH and temperature. Samples collection should be done under anaerobic conditions that would minimize loss of CO2. The resultant increase in pH would contribute to lower ionized calcium levels.

Heparin is suitable for measuring calcium but excessive amounts can lower the ionized fraction 3% to 5%.

Recumbent position can decrease calcium by 4%.

Back 12

____ calcium concentrations in plasma or ____ is sensitive to both ____ and ____. Samples collection should be done under ____ that would minimize loss of ____. The resultant increase in ____ would contribute to ____ ionized calcium levels.

____ is suitable for measuring calcium but ____ amounts can lower the ionized fraction____.

____ position can decrease calcium by____.

Front 13

Ionized calcium in heparinized whole blood is stable for 6 hours at refrigerator temperatures.

Serum or urine specimens are stable at refrigerated temperatures for several months.

Back 13

____ calcium in ____ whole blood is stable for ____ hours at ____ temperatures.

Serum or urine specimens are stable at ____ temperatures for ____ months.

Front 14

Methods for analyzing calcium:
atomic absorption
ion selective electrodes
colorimetric

Back 14

Methods for analyzing calcium:
____
____
____

Front 15

Phosphorus exists as organic phosphate in combination with lipids and proteins. As phospholipids and phosphoproteins, it is essential for the structural integrity of the cell membrane and is an important component in DNA and ATP. The majority of extracellular phosphorus is found bound to calcium in bone.

Back 15

Phosphorus exists as ____ in combination with ____ and ____. As ____ and ____, it is essential for the structural integrity of the ____ and is an important component in ____ and ____. The ____ of extracellular phosphorus is found bound to calcium in ____.

Front 16

Phosphorus in serum exists in two forms
85% as inorganic mono or dihydrogen phosphate
12-15% found bound to protein.

Back 16

Phosphorus in serum exists in two forms:
____ as ____ phosphate
____ as ____.

Front 17

Phosphorus sample should be serum or heparinized plasma after fasting because phosphorus levels are lower following meals. Serum should be separated immediately after collection in order to prevent leakage of phosphorus from the RBC. Urine specimens must be acidified with HCl

Analyzing method for phosphorus: Fiske and Subbarrow

Back 17

Phosphorus sample should be ____ or ____ after ____ because phosphorus levels are ____ following meals. Serum should be ____ immediately after collection in order to prevent leakage of ____ from the ____. Urine specimens must be ____ with ____.

Analyzing method for phosphorus: ____

Front 18

As the pH increases, ionized magnesium decreases. As the pH decreases, ionized magnesium increases.

Methods for analyzing magnesium:
colormetric (most common, metallochromic indicators or dyes used that change color upon selective binding to magnesium)
atomic absorption spectrometry
flame emission spectrometry
flurometry

Back 18

As the pH ____ , ionized magnesium decreases. As the pH ____ , ionized magnesium increases.

Methods for analyzing magnesium:
____ (most common, ____ or ____ used that change ____ upon ____ to magnesium)
____
____
____

Front 19

The specimen for blood gases and pH should be arterial or arterialized capillary blood collected in heparinized plastic containers including syringes and capillary tubes. All air bubbles should be removed and the specimen should be placed in ice water until analysis. Air bubbles falsely increase pH and PO2 and decrease PCO2.

Temperatures above 4C allow cell glycolysis to continue in the whole blood specimen resulting in falsely decreased pH and partial pressure of oxygen and falsely increased partial pressure of carbon dioxide.

Arterial blood generally fills automatically into the syringe since higher blood pressure is found in the arteries.

Back 19

The specimen for blood gases and pH should be ____ or ____ collected in ____ plastic containers including syringes and capillary tubes. All ____ should be removed and the specimen should be placed in ____ until analysis. ____ falsely increase pH and ____ and decrease ____.

Temperatures above ____ allow cell ____ to continue in the whole blood specimen resulting in falsely ____ pH and ____ and falsely increased ____.

Arterial blood generally fills ____ into the syringe since higher blood pressure is found in the ____.

Front 20

Test methodology for arterial blood gases.

A blood gas analyzer measures multiple parameters using a series of electrodes and spectrophotometric measurements.

Earlier models used carbon dioxide, or Pco2, but newer instruments use tonometered aqueous gas solutions.

Oxyhemoglobin and other hemoglobin forms are determined from a standardized spectrophotometer, calibrated with a total hemoglobin standard.

Back 20

Test methodology for arterial blood gases.

A blood gas analyzer measures multiple parameters using a ____ and ____.

Earlier models used ____, or ____, but newer instruments use ____.

____ and other hemoglobin forms are determined from a ____, calibrated with a ____ standard.

Front 21

Arterial Blood Gases Reaction Principles

pH - Potentiometric reaction of an indicator electrode that selects for H+ with a specific glass membrane and measures potential versus reference electrode of calomel or Ag/AgCl with a saturated AgCl salt bridge; voltage change due to H+ is measured.

Back 21

Arterial Blood Gases Reaction Principles

pH - ____ of an indicator electrode that selects for H+ with a specific ____ and measures ____ versus reference electrode of ____ or ____ with a saturated ____ salt bridge; voltage change due to H+ is measured.

Front 22

Arterial Blood Gases Reaction Principles

Pco2 - Modified pH electrode using potentiometer with Teflon or silicon semipermeable membrane that selects for CO2 gas and containing H2O/bicarbonate buffer that produces H+ as a result of carbon dioxide reacting with water to form carbonic acid, bicarbonate ions, and H+; voltage change due to H+ is measured.

Back 22

Arterial Blood Gases Reaction Principles

Pco2 - Modified ____ using potentiometer with Teflon or ____ membrane that selects for ____ gas and containing ____ buffer that produces H+ as a result of ____ reacting with water to form ____, ____, and ____; voltage change due to H+ is measured.

Front 23

Arterial Blood Gases Reaction Principles

Po2 - Polargraphic Clarke electrode with polypropylene selective semipermeable membrane that allows O2 to diffuse through and be reduced at the platinum cathode in a KCl/phosphate buffer solution, with oxidation occurring at the Ag anode; change in current is measured.

Back 23

Arterial Blood Gases Reaction Principles

Po2 - Polargraphic Clarke electrode with ____ selective ____ membrane that allows ____ to diffuse through and be reduced at the ____ in a ____ solution, with oxidation occurring at the ____; change in current is measured.

Front 24

Arterial Blood Gases Reaction Principles

So2 - Saturated O2 is measured as oxyhemoglobin versus total hemoglobin by spectrophotometer taking multiple absorbance readings at various wavelengths; O2 hemoglobin/total hemoglobin is measured

Back 24

Arterial Blood Gases Reaction Principles

So2 - Saturated O2 is measured as ____ versus ____ by ____ taking multiple absorbance readings at ____; O2 ____is measured

Front 25

pH = pKa + log (HCO3 / H2CO3)

H2CO3 = Pco2 x 0.03

Back 25

Henderson-Hasselback Equation

Front 26

Metabolic acidosis is the loss of HCO3 or the addition of H+.

Metabolic alkalosis is the loss of H+ or the addition of HCO3.

Respiratory acidosis is an increase in Pco2.

Respiratory alkalosis is a decrease in Pco2.

Back 26

Metabolic acidosis is the loss of ____ or the addition of ____.

Metabolic alkalosis is the loss of ____ or the addition of ____.

Respiratory acidosis is an ____ in Pco2.

Respiratory alkalosis is a ____ in Pco2.

Front 27

In metabolic acidosis and mixed acid-base disorders, the anion gap is significantly elevated.

Metabolic acidosis with a normal anion gap is associated with renal diseases such as proximal or distal renal tubular acidosis, renal insufficiency with HCO3 loss and hypoaldosteronism with potassium-sparing dostomy or ingestion of medications used to treat glaucoma.

Metabolic acidosis with a high anion gap is generally due to addition of acid from ketoacidosis; lactic acidosis or decreased circulation; toxic ingestion of aspirin, ethylene glycol, or methanol; or renal insufficiency.

Back 27

In metabolic acidosis and mixed acid-base disorders, the anion gap is significantly ____.

Metabolic acidosis with a ____ is associated with renal diseases such as ____ or ____, renal insufficiency with ____ and ____ with potassium-sparing ____ or ingestion of medications used to treat ____.

Metabolic acidosis with a ____ is generally due to addition of ____ from ____; ____ or ____; toxic ingestion of ____, ____, or ____; or ____.

Front 28

pCO2
Low - respiratory alkalosis
High - respiratory acidosis

Back 28

pCO2
Low - ____
High - ____

Front 29

HCO3
Low - metabolic acidosis
High - respiratory alkalosis

Back 29

HCO3
Low - ____
High - ____

Front 30

decreased pH
decreased HCO3

Back 30

metabolic

Front 31

decreased pH
increased pCO2

Back 31

respiratory