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Chemistry Flashcards

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1
Q

What are the levels for the following

         AFP   uE   hCG    DIA  Downs 18 NTD
A

AFP uE hCG DIA
Downs L. L. H. H
18. L. L. L. L
NTD. H. L. N N

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2
Q

Name 2 causes of pseudo M spikes in the b2 regions

A

Fibrinogen
C3 - APR

IgA runs in this area

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3
Q

Where are they found?

LD1 and 2
LD4 and 5
LD3

A

LD1 and 2 in heart, RBC, kidney
LD4 and 5 in liver and skeletal muscle
LD3 in lung, spleen, lymphocytes and pancreas

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4
Q

When is LD1> LD2

A

Acute MI, hemolysis, renal infxn

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5
Q

Where is alk phos found?

A

Bone liver intestines placenta

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6
Q 
Fill in the following
                      Borderline         Hyperglycemia
FPG                  
2hr OGTT     
A1c
A

Borderline Hyperglycemia
FPG 100-125 >=126
2hr OGTT 140-199 >=200
A1c 5.7-6.4 % >=6.5

Need two

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7
Q

CrCl =

A

Urine volume X Urine creatine / Plasma creatine

Expressed in ml/min or mL/min/1.73M^2
80-120 ml/min is the typical range

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8
Q

What is NH4? NH3?

A

NH4 : Ammonium

NH3 : Ammonia

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9
Q

What enzyme in the Urea cycle is x-linked and leads to increase level of Ammonia?

A

Ornithine transcarbamoylase

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10
Q

BUN=

A

UREA/ 2.14

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11
Q

Fractional excretion of Na =

A

Una x Pcr / Pna x Ucr x 100

If >1, consider acute tubular necrosis

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12
Q

Name 3 things that runs in the alpha 1 and 2 lanes

A

Alpha 1: Anti-trysin, anti-chymotrypsin, acid glycoprotein

Alpha 2: macroglobulin, haptoglobin, ceruloplasmin

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13
Q

What runs in the B1 and B2?

A

B1- transferrin

B2- IgA and C3

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14
Q

Where are these found?
CK1
CK2
CK3

A

CK1 : BB Brain
CK2/MB Skeletal 1% and Cardiac 30%
CK3 MM : Skeletal 99% and cardiac 70%

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15
Q

When is macro CK 1 and CK2 seen?

A 
Macro CK1 (cytoplasmic)  in elderly women and autoimmune disease
Macro Ck2 (mitochondrial) , associated with malignancy
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16
Q

What is the reference interval for Tn?

A

99%

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17
Q

LD1 and 2 are found in?
LD4 and 5 are found in?
LD3 found in?

A

LD1/2 : Heart RBC Kidney
LD4/5 : Liver, skeletal
LD3 : lung, spleen, lymphocytes, pancreas

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18
Q

When is LD1>LD2? “Flipped”

A

Acute MI, hemolysis, renal infarction

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19
Q

How is delta bilirubin formed?

A

bilirubin bound to albumin

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20
Q

Name the sydrome

Poor uptake of unconjugated bili
Impaired conjugation
Impaired transmembrane secretion of conjugated bili

A

Poor uptake of unconjugated bili : Gilbert
Impaired conjugation : Crigler Najjar
Impaired transmembrane secretion of conjugated bili : Dubin johnson and Rotor

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21
Q

Anion gap =

A

Anion gap = Na- Cl- HCO3

Normal is <12

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22
Q

Osmolal gap =

A

Osmolal gap = Osm (measured) - (2NA + glucose/18 + BUN/2.8)

Normal is <10

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23
Q

Whats the ratio of Lecithin/sphingomyelin for fetal lung maturity?

A

> = to 2.5:1

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24
Q

Name the apolipoproteins

Chylo
VLDL
IDL
LDL
HDL
A

Chylo ApoCII ApoE ApoB48
VLDL ApoCII ApoE ApoB100
IDL ApoE ApoB100
LDL ApoB100
HDL ApoA1

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25
Whats the major cholesterol carrier? TG carrier?
Cholesterol: LDL TG: VLDL
26
Increase TG seen in?
I Chylo IV VLDL V Chylo and VLDL
27
Increase of LDL seen in?
IIa LDL aka Familial hypercholesterolemia AD
28
Incease in TG and LDL seen in?
IIb LDL and VLDL | III IDL aka dysbetalipoproteinemia
29
Gilbert and Crigler Najjar is associated with?
Unconjugated/Indirect bili
30
Dubin-Johnson and Rotor is associated with? How can you grossly tell them apart?
Conjugated/Direct bili | Dubin Johnson is Black
31
What do these drugs raise? ( Uncojugate or Direct) | Rifampin, probenacid, estrogen, cyclosporine
Elevated Unconjugated bili : Rifampin and probenaicd | Elevated Conjuagated bili: Estrogen, cyclosporine
32
In neonatal jaundice, total bili exceeds __ mg/dl with a daily increase of __ mg/dl and a conjugated bilirubin that exceeds __ mg/dl
In neonatal jaundice, total bili exceeds 12 mg/dl with a daily increase of 5mg/dl and a conjugated bilirubin that exceeds 2 mg/dl
33
``` Pancreas Amylase CEA Pseudocyst IPMN Serous cystadenoma Solid Pseudopapillary Mucinous ```
Amylase CEA Pseudocyst H - IPMN H H Serous cystadenoma L L Solid Pseudopapillary L L Mucinous - H
34
Name 3 major alpha 1 globulin
anti-trypsin anti-chymotrypsin anti-acid glycoprotein
35
Name 3 major alpha 2 globulins
macroglobulin ceruloplasmin haptoglobin
36
Name the major B globulin
Transferrin
37
Name 3 Neg acute phase reactants
Albumin, prealbumin, transferrin
38
type 1 cryoglobulin is a
monoclonal Immunoglobulin
39
Type 2 cryoglobulin is a
Mix of monoclonal IgM and polyclonal IgG
40
Type 3 cryoglobulin is a
2 polyclonal immunoglobulin
41
Name causes of metabolic acidosis with Anion gap Non anion gap
``` Anion Gap (>=12) MUDPILES Cyanide Lactic Acid Uremia Methanol - O Paraaldehyde --O Salicylate Ethylene glycol --O Ketoacidosis ``` Non Anion gap Renal tubular acidosis Diarrhea
42
Elimination of most drugs follows ___ kinetics
1st order, except for ethano which is 0 order
43
Steady state reaches after?
5 doses
44
``` For alcohol what are the clinical effects for the % <0.05 0.05-0.1 0.1-0.2 0.2-0.3 0.3-0.4 >0.4 ```
``` <0.05 Sobriety 0.05-0.1 Euphoria 0.1-0.2 Excitement 0.2-0.3 Confusion 0.3-0.4 Stupor >0.4 Coma and death ```
45
Signs of Anticholinergic effect? Agents?
Hyperthermia, dry skin, flushing, altered mental status, psychosis Atropine, anti-histamine, TCA, scopolamine
46
Signs of Cholinergic effect? Agents?
Salivation, lacrimation, urination, diarrhea, GI cramps, ememsis, diaphoresis , miosis, wheezing Organophosphates, pilocarpine
47
Signs of Adrenergic?
HTN, tachy, mydriasis, anxiety, hyperthermia amphetamines, cocaine, PCP
48
Tangier's disease?
AR characterized by low cholesterol, increased TG absent HDL, and absence of ApoA1. Cholesterol deposits on tonsils (orange) and others.
49
Abetaliproproteinemia
AR, Fat metabolism disorder, Normal HDL, but low LDL, IDL, TG Acanthocytes
50
In diabetes, what are some autoantibodies? What is DM1 assoc with?
Islet cell antibody Insulin antibody Antibodies to glutamic acid decarboxylase insulinoma associated protein Strong association with HLA DR and DQ
51
Graves associated with which antibodies?
Anti-microsomal 60% | Anti-thyroglobulin 30%
52
Hashimotos associated with which antibodies?
Anti tissue peroxidase | anti-thyroglobulin 90%
53
What happens in vitreous and body? Glucose Na Cl K
Vitreous: Glucose drops, K increases linearly, Na and Cl remain stable Body: Glucose Increase, K double increase, Na and Cl drops
54
Urine dipstick is sensitive to what protein? Sugar? Ketone?
albumin Glucose acetoacetic acid
55
Name nitrite producing organisms and infections that doesn't produce it
E.coli produce nitrite | Enterococci, gonorrhea, and TB does not
56
Normal urine pH? In Renal tubular acidosis?
pH6 | In RTA, pH>6.5
57
The most common kidney stone is?
Calcium oxalate
58
Calcium oxalate stones are promoted by?
Low urine volumes low urinary citrate hypercalciuria oxaluria pH does NOT effect it
59
Who gets oxaluria?
Crohns patient with small bowel resection | increased ingestion of oxalate (spinach, nut, rhubarbs)
60
Calcium stones are formed where?
in the pelvis, attached to papillae
61
Whats the main component of the struvite stone?
Magnesium ammonium phosphate | aka triple phosphate
62
How is struvite stones made?
by UTI, proteus mirablilus and other urea spillite organism | Alkaline pH
63
Name two stones associated with alkaline pH, and acidic pH
Alkaline: Calcium phosphate and Struvite stones Acidic: Urate stones
64
Name stone associated with inherited disease, AR, characterized by defective renal and intestinal dibasic amino acid transport affecting cystine, ornitine, lysine, and arginine (COLA)
Cystine stones
65
Low levels of anti-mullerian hormones suggest?
menopause, premature ovarian failuire
66
High levels of anti-mullerian hormones suggest?
PCOS
67
``` Name the associated disease anti-actin antibody : anti-Liver Kidney Microsome antibody : anti-mitochondiral (M2) antibody : anti-neutrophil cytoplasmic antibody : anti-soluble liver antigen antibody : ```
anti-actin antibody : AIH type 1 anti-Liver Kidney Microsome antibody : AIH type 2 anti-mitochondiral (M2) antibody : Primary biliary cirrhosis anti-neutrophil cytoplasmic antibody : Primary sclerosing colangitis anti-soluble liver antigen antibody : AIH type 1
68
Whats in the blue top tube?
Blue : Citrate
69
Whats in the Purple top tube?
Purple : EDTA irreversibly binds Ca+
70
Whats in the Green top tube?
Green : Heparin (Heparin interferes with PCR also if its Lithium heparin- interferes with lithium levels)
71
Whats in the Red top tube?
Glass: None | Plastic : silica clot activator
72
Whats in the Grey top tube?
Sodium fluoride (inhibits glycolysis)
73
What tube is best for coag studies?
Blue - citrate binds Ca+ REVERSIBLE
74
What tube is best for glucose/lactate studies?
grey top - sodium fluoride inhibits glycolysis
75
What tube is best for serum chem, serology , immunology, blood bank (crossmatch) studies?
Red
76
What tube is best for plasma chem studies?
Green
77
What tube is best for hematology and blood bank (crossmatch) studies?
Purple - EDTA like citrate binds Ca+, unlike citrate is NOT reversible
78
What tube is best for flow/fish?
Green top (sodium heparin)> Purple (EDTA)
79
What tube is best for HLA and DNA studies studies?
Yellow
80
Whats in a yellow top tube?
Citrate and dextrose (ACD): best for blood bank/genetic testing
81
Name that cast! | Glomerulonephritis
Red cell cast
82
Name that cast! | pyelonephritis
White cell cast
83
Name that cast! | Tubular necrosis
Tubular cast
84
Name that cast! | Severe renal disease
Waxy casts
85
Name that cast! | nephrotic syndrome
fatty casts
86
Name that cast! | nonspecific, renal disease, dehydration, exercise
granular and hyaline casts
87
Name that cast! | ESRD
Broad casts - these are hyaline, granular or waxy thats unusually broad
88
Name that crystal! | coffin lid
triple phosphate aka MAP
89
Name that cast! | envelope
calcium oxalate
90
Postmortem chem pattern: | Dehydration
High Na, Cl, BUN, Cr
91
Postmortem chem pattern: | Uremia
high Bun, Cr
92
Postmortem chem pattern: | Decomp
High K
93
AST highest in?
Heart
94
Decreased stool elastase and chymotrypsin is indicatie of?
Pancreatic exocrine insufficiency
95
A pseudo M spike at alpha2 and beta interface
Hemoglobin
96
In urine protein electrophoresis: | strong albumin, a1, and b
glomerular
97
In urine protein electrophoresis: | weak albumin, strong a1 and b
tubular
98
Name two causes of acidosis with hypokalemia
RTA 1 and 2
99
Cyanide inhibits? Treatment?
Cytochrome a3; sodium nitrite, amyl nitrite, and thiosulfate
100
Arsenic inhibits? Test?
oxidate phosphorylation, 24hr urine or nail/fingernail
101
Lead inhibits?
delta-ALA-dehydratase and ferrochelatase ( FEP, ZPP increased) 5'nucleotidase mitochondria
102
N-acetyle-P-benzoquinone imine causes?
Zone 3 necrosis | formed when acetominophen is metabolized by p450
103
Feer and Ertheism is asociated with?
mercury- 24 hr ur Feer- or Acrodynia: autonomic manifestation with desquamative rash of palms/sole Erethism: Personality change
104
In the Third adult Treatment panel, whats the target LDL if 0-1 risk factors?
<160
105
In the Third adult Treatment panel, whats the target LDL if 2 or more risk factors?
<130
106
In the Third adult Treatment panel, whats the target LDL if CHD or equivalent?
<100
107
Whats a CHD equivalent?
DM, vascular disease, framingham risk of MI within 10 years >20%
108
Risk factors according to the TAT?
``` Smoking HTN >140/90 <40 HDL family history of CHD, Age (M>45, F>55) ```
109
CA27.29 or CA15-3 is seen in?
Breast CA, protein product of MUC1 gene
110
For carcinoides, what do they produce? Foregut Midgut Hindgut
Foregut - histamine, catecholamines, 5HTP Midgut - serotonin Hindgut - nothing
111
NMP22 is a marker of what carcinoma?
Urothelial
112
BTA (Bladder tumor antigen) test detects?
Complement factor H (CFH) and related proteins
113
Light criteria is used for?
classify effusions Pleural fluid: Serum protein ratio > 0.5 Pleural fluid: Serum LD ratio >0.6 Pleural fluid LD>2/3 of the upper limit of normal for serum LD
114
Rumack-Matthew nomogram is for?
Acetaminophen toxicity
115
In portal hypertension, the serum ascited albumin gradient is?
>1.1 g/dl
116
In Ranson criteria, what are the values checked at admission/
``` Age >55 WBC >16 Glucose >200 AST>250 LD>350 ```

Pathology (16 decks)

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