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Chemical Pathology Rotations > Chenical Pathology Day 2 > Flashcards

Chenical Pathology Day 2 Flashcards

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1
Q

What are the various biochemical general chemistry tests done at KATH

A

Profile tests:
LFT
KFT
Cardiac profile
Lipid profile (called lipogram sometimes)
Glucose studies (diabetes test)
Basic metabolic panel (BMP)
Comprehensive metabolic panel (CMP)
Blood gases
Bone profile
Iron studies (for anemia)

Tests that can stand on their own:
Uric acid (U/A)
Magnesium
Phosphorus
Calcium
Pro-calcitonin test (PCT)
C-reactive protein (CRP)

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2
Q

What are the three general groupings of test

A

General chemistries
Hormones
Tumor markers

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3
Q

What are the three groupings of tests based per the need of the test

A
  1. Core test (test taken based on history). Eg. LFTs
  2. Specialized test. Eg. AFP
  3. Emergency test

Each core test might have its own further specialized test

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4
Q

When a group of tests are put together to determine a common cause, it is referred to as a ………

A

Profile (composite tests)

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5
Q

How many analytes come together to form LFTs

A

10 (3 proteins, 3 bilirubins, 4 enzymes)

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6
Q

LFTs are made of what three main analytes

A

Enzymes
Proteins
Bilirubins

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7
Q

What are the enzymes used in LFTs

A

AST
ALT
GGT
ALP

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8
Q

What are two types of enzymes as used in testing

A

Functional and non-functional enzymes

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9
Q

Which compartment are non-functional enzymes found

A

ICF

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10
Q

What is the range of ALT

A

0 - 42 IU/L

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11
Q

What is another name for direct bilirubin

A

Conjugated bilirubin

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12
Q

What are the bilirubins used in LFTs

A

Total bilirubin
Direct bilirubin
Indirect bilirubin

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13
Q

What are the proteins used in LFTs

A

Total protein
Albumin
Globulins

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14
Q

What is the common elective or specialized test for LFT

A

Alpha fetoprotein test (AFP)

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15
Q

How is globulins calculated for an protein section of an LFT

A

TP - albumin = globulins

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16
Q

How do you calculate for indirect bilirubin

A

Total BIL - direct BIL = indirect BIL

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17
Q

What are the core KFTs

A

Creatinine - elevated creatinine means there is a problem
Urea (blood urea nitrogen)
Electrolytes (Na, K, Cl)

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18
Q

What are some other tests (which are not core tests) to find out if kidney disease is being developed

A

UACR
UPCR
eGFR
Microalbumin

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19
Q

Protein is not allowed to pass through urine but creatinine does
True or false

A

True

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20
Q

Creatinine concentration is high in the urine while protein concentration is low in urine
True or false

A

True

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21
Q

What are the creatinine lab ranges

A

44-80 for women
44-106 for men

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22
Q

What test could you use to detect the earliest sign of kidney disease

A

Microalbumin test

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23
Q

What is creatine

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A

Creatine is the hydrated form of creatinine

24
Q

What are the core tests (enzyme) in a cardiac profile

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A

AST
CK (creatine kinase)
LDH

25
What are some specialized tests in a cardiac profile
Troponin I or T CK-MB Myoglobin
26
CK-MB is an isomer of ………….
Creatine kinase *CKMM (deals with muscle), CKMB (deals with heart), CKBB (deals with brain)*
27
List the lipid profile tests
TC TRG HDL LDL (calculated) VLDL (calculated) CR (coronary risk) (calculated)
28
What is the formula for LDL
TC - HDL - 0.2TRG
29
Why does eating before LDL testing affect results
LDL is directly proportional to TRG, thus if a patient eats LDL (increasing TRG) would also increase leading to false values
30
What is the formula for coronary risk
TC/HDL
31
What is the range of coronary risk
4.2 - 7.1 *Below the range means you’re safe. Outside the range, means there’s a problem. Within the range also means there’s a problem.*
32
What are the components of a BMP
KFT + glucose
33
What are the components of a CMP
BMP LFT Lipids
34
What are blood gases
A test used in measuring oxygen and other things in arterial blood (oxygenated blood) - an emergency test
35
What are the components of a blood gas
PCO2 PO2 pH SO2 iCa (ionized calcium) Na, K, Cl
36
What are the components of a bone profile
Creatinine Albumin Ca Phosphate (PO32-) ALP Mg
37
What are the components of iron studies
Total iron TIBC (total iron binding capacity) Ferritin
38
What is the use of procalcitonin test
Pro calcitonin is a marker to detect whether an infection is bacterial or not. It is normally requested alongside CRP test
39
What are the components of a diabetes study
FBS (fasting plasma glucose) RBS HBA1C Glucose profile OGTT
40
What test is the baseline test (reference point and cuts across all glucose tests) for diabetes studies
FBS
41
What is the test used to diagnose DM
FBS
42
What are the conditions necessary to consider to do an FBS
Time (patient should not eat after 6 am) Diet Medication (patient should not be on a drug that interferes glucose metabolism unless patient is a known diabetic) *Don’t take FBS after 11 because it is assumed that the free glucose to be measured in the blood is consumed and what the body is now relying on is glycogen being converted to glucose. Thus, after 11 everything is RBS*
43
Which of the glucose tests are tentative and used in emergency cases
RBS
44
What is the range of FBS
3.6 - 6.4 mmol/L
45
What is the range for RBS
3 - 7 mmol/L (no matter what food you take your sugar level should not be more than 7, no matter what drug you take, your sugar level should not go below 3)
46
What are the reasons for doing glycated hemoglobin test
1. To determine the efficacy of the drugs prescribed 2. To determine how faithful the patient has been in taking the drugs prescribed
47
What are the types of glucose profile
Food glucose profile Partial glucose profile
48
What are the components of a food glucose profile
Pre-breakfast (FBS) - say test starts at 7 am Post-breakfast (2 hrs later - 2 hr post-prandial) - 9 am Pre-lunch (should be taken about 5-10 mins to lunch) - 11:50 am (test), 12 pm (eat) Post-lunch (2 hrs later) - 2 pm Pre-supper - 3:50 pm (test) / 4:00 pm (eat) Post-supper - 6 pm
49
What is the use of a glucose profile
Glucose profile is done in pregnant individuals It is done to assess how the body system of the pregnant individual is responding to the diabetic drug administered
50
What are the components of a partial glucose profile
Pre-BF Post-BF Post-lunch Post-supper
51
Why do you an OGTT
It is a confirmatory test for diabetes. In the case where you have fluctuating upper limit sugar levels, you cannot classify the person as a diabetic till the upper limit sugar level is sustained and chronic (sustained at a high level for a long time). An OGTT is done to find out whether the patient is diabetic or not
52
What are the steps in conducting an OGTT
Patient preparation Items required Measurement of glucose Administration of glucose solution Measurement of glucose values Interpretation of results
53
What are some precautions in OGTT (patient preparation)
Time Diet Medication Should not smoke prior to testing Should not engage in strenuous exercise prior to the test Patient should not lie down during the test
54
What are some items required for an OGTT
1. Glucose (vitamin c type and anhydrous (plain one, anhydrous one is more preferable. Under certain circumstances, some patients vomit anhydrous glucose. Under those circumstances administer vitamin c glucose . However, ideally, anhydrous (white) glucose is used. 2. An unopened bottle of water (not sachet water) 3. Clean or neat spoon 4. Neat or clean cup (which can contain more than 300mls of water) 5. A sensitive weighing scale (should be sensitive)
55
How is glucose administered in a OGTT
Dissolve glucose in water and make sure everything is dissolved. You should have taken the FBS by now. Per the WHO guidelines, the value of the FBS should be known before glucose is administered. Patients should ingest the solutions within a few minutes (3 or 4 minutes). Don’t force patient to take it at a gulp (all at once). Note the time patient finishes taking the glucose solution. After patient takes glucose solution, take sample from patient 3x on a hourly basis (Eg. 9 (given glucose solution), 10 (first sample), 11 (second sample), 12 (third sample), patient should not eat in between sample taking). (FBS - 1 hr post prandial, 2 hr post prandial, 3 hr post prandial - if any of the post-prandial values goes above the value 8.5 mmol/L for 75g of glucose or 11.1mmol/L for 100g of glucose, patient is diabetic)
56
How are results interpreted in an OGTT
Measurement of glucose depends on the physiological condition of the patient (is the patient pregnant or not, an adult or a juvenile) Pregnant patient 1. 100 g of glucose in 300 ml of water (> or = 11.1 mmol/L) 2. 75 g of glucose in 300 ml of water (> or = 8.5 mmol/L (> or = 8.5 mmol/L) - WHO recommended - reason being that given more glucose (100g of glucose instead of the WHO recommended 75g of glucose) could result in fetal macrosomia Non-pregnant individuals 1. 75 g of glucose in 300 ml of water (range is > or = 11.1 mmol/L) 1.75 * body weight = amount of glucose to use in grams Volume of water depends on what the patient can take not necessary 300 ml of water

Chemical Pathology Rotations (5 decks)

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