Clinical Chemistry Flashcards by Danielle Marco

Random errors

12S, 13S, R4S

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1 control value exceeds the mean +/- 2s

12S / Warning rule

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1 control value exceeds the mean +/- 3s

13S

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1 control value exceeds +2s and ANOTHER value exceeds -2s

R4S

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2 CONSECUTIVE control values exceeds the same mean +/- 2s

22S

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8 consecutive values fall on 1 SIDE of the mean

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Errors that occurs BY CHANCE

Random errors

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Errors that are consistent in ONE DIRECTION

Systematic

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RANDOM OR SYSTEMATIC:
Pipetting errors, mixing, timing (variation in handling techniques)

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Variation in operators

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RANDOM OR SYSTEMATIC:
Environmental conditions

Random

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Fluctuations in line voltage

Systematic

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Technologist interactions

Systematic

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Dispensing of reagents

Random

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Aging reagents

Systematic

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Aging calibrators

Systematic

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Calibrator reconstitution

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Temperature analyzer

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Instability of instrument

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Wear and tear of instruments and instrument components

Systematic

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ABRUPT change in the mean

Shift

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Main cause of shift

Improper calibration of instrument

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Drift of values to ONE SIDE of the mean

Trend

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Main cause of trend

Deterioration of reagents

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Variables: CHAXI

Concentration Horizontal Abscissa X-Axis Imdependent

Variables: AVOYD

Absorbance Vertical Ordinate Y-Axis Dependent

F-test

SD and Precision

T-test

Mean and Accuracy

Interlab QC; long-term monitoring; monthly or quarterly

External QC

Intralab QC; short-term monitoring; daily

Internal QC

Solution that uses 1 ANALYTE for CALIBRATION or REFERENCE

Standard

Solution that uses 2 ANALYTES to ENSURE CORRECT RESULTS

Control

Isolates specific or individual wavelength of light

Monochromator

Measures LIGHT TRANSMITTED by a solution to determine the concentration

Spectrophotometer

Determines the amount of LIGHT BLOCKED by a particulate matter in a turbid solution

Turbidimetry

Determines the amount of LIGHT SCATTERED by a particulate matter in a turbid solution

Nephelometry

Measure the amount of LIGHT EMITTED by a molecule AFTER EXCITATION by EMR, over a zero background

Fluorometry

Measures the electrical potential / DIFFERENCES BETWEEN 2 ELECTRODES in terms of voltage at constant current

Potentiometry

Samples flow through a COMMON vessel or pathway

Continuous Flow Analysis

Each sample-reagent mixture is handled SEPARATELY in its own reaction vessel

Discrete Analysis

Multiple tests one sample at a time; most popular and versatile type of automation

Discrete analysis

Uses acceleration and deceleration of ROTOR to transfer the reagents and sample

Centrifugal Analysis

Vertical when not spinning horizontal when spinning

Horizontal Head centrifuge / Swinging bucket centrifuge

Speed of swinging bucket centrifuge

1,650 g

Fixed angle centrifuge with speed of 9000

Angle-head centrifuge

Has continuous ETCHED RINGS on top; exact volume obtained when LAST DROP IS BLOWN OUT

Blowout pipet

The simplest pipet

Pasteur pipet

Relies on PISTON FOR SUCTION creation to draw sample into a DISPOSABLE TIP

Air displacement pipet

Reagent water for preparation of STANDARD SOLUTIONS

Type 1

GENERALLY USED reagent water for chemistry, microbiology, hematology, and immunology; also used for WASHING GLASSWARES

Type 2

Reagent water for urinalysis, parasitology, and histology

Type 3

Bleach inactivates HBV for how many minutes?

Bleach inactivates HIV for how many minutes?

Diurnal variation: Increase in the MORNING (AM)

🌞*ACIA ACTC Cortisol Iron Aldosterone

Diurnal variation: Increase in the AFTERNOON (PM)

🌛*GAPT Growth hormone ACP PTH TSH

Affected by posture; increases from supine to sitting / standing

Albumin Calcium Enzymes

*I CLAAAAAMPP Iron, Catecholamines, CK, LD, ALT, AST, ALP, ACP, Ammonia, Magnesium, Potassium, Phosphate _____ when sample is HEMOLYZED

Increases

If antecubital veins are unsuitable for venipuncture, what are the alternative sites?

Wrist and hand

When BP cuff is used as a tourniquet, it should be inflated at ___ mmHg

60 mmHg

Blood specimens on serum separator gel tubes must be processed within _____

30 minutes

Normal BMI

18.5 - 24.9

BMI of underweight / malnourished

< 18.5

BMI of obese

30 and above

SI unit for length

Meter (m)

SI unit for mass

Kilogram (kg)

SI unit for Themodynamic temperature

Kelvin (K)

SI unit for amount of substance

Mole (mol)

10^6

Mega

10^3

Kilo

10^9

Giga

10^12

Tera

10^-3

Milli

10^-6

Micro

10^-9

Nano

10^-12

Pico

Celsius to Farenheit

F = (C x 1.8) + 32

Farenheit to Celsius

C = (F - 32) x 5/9

Conversion factor of glucose

0.0555

BUN to Urea

2.14

Conversion factor of BUN

0.357

Conversion factor of creatinine

88.4 umol/L

Conversion factor of uric acid

0.0595

Conversion factor of triglycerides

0.0113

Conversion factor of sodium, potassium, chloride

Conversion factor of cholesterol

0.026

Conversion factor of TPAG

10 (g/dL) 0.01 (mg/dL)

Conversion factor of bilirubin

17.1 umol/L

Conversion factor of thyroxine

12.9 nmol/L

Effect of high WBC count on blood glucose determination

Decreased

Uses arsenomolybdate reagent

Nelson-Somogyi

Uses phosphomolybdate reagent

Folin-Wu

Results produced by REDUCTION methods for glucose are _____ higher than those of ENZYMATIC methods

5-15 mg/dL

To establish Diabetes Mellitus, symptoms (3P's) should be accompanied by RBS level of:

200 mg/dL

Beta-cells destruction

Type 1 DM

Insulin resistance

Type 2 DM

Detectable C-peptide levels

Type 1 DM

DM with Autoantibodies

Type 1 DM

Common DM

Type 1 DM

Uses oral agents as medication

Type 2 DM

Uses insulin absolute as medication

Type 1 DM

Glycogen storage disease with G6PD deficiency

Von Gierke

Most common phospholipid found in cell membranes

Lecithin

Apo A1

HDL

Apo B100

LDL, VLDL

Apo B48

Chylomicrons

Reverse cholesterol transport

HDL

Endogenous triglycerides

VLDL

Exogenous triglycerides

Chylomicrons

Least dense

Chylomicrons

Most dense

HDL

Lipoprotein that carries TRIGLYCERIDES

CM, VLDL

Lipoprotein that carries CHOLESTEROL

LDL

Lipoprotein that carries PROTEIN and PHOPHOLIPIDS

HDL

Bad cholesterol

LDL

Good cholesterol

HDL

SPE Migration Pattern of lipoproteins

Chylomicrons (origin) LDL VLDL HDL (anode)

Lipoprotein ultracentrifugation pattern

Chylomicrons (top) VLDL LDL HDL (bottom)

Floating B-lipoprotein

B-VLDL

Sinking Pre-B-lipoprotein

Lp(a)

Borderline value for total cholesterol

200-239 mg/dL

>240 value of TOTAL cholesterol

Higher risk for CHD

SERUM cholesterol value with MODERATE RISK for age 20-29

>200 mg/dL

SERUM cholesterol value with HIGH RISK for age 20-29

>220 mg/dL

<40 HDL

High risk for cardiovascular disease

>60 HDL

Low risk for cardiovascular disease

Borderline value for LDL Cholesterol

130-159 mg/dL

Cholesterol determination 1-STEP method

Liebermann-Burchard (Pearson/Stern/Mac-Gavack)

Cholesterol determination 2-STEP method

Bloors

< 3% CV

Cholesterol

< 5% CV

Triglycerides

< 4% CV

LDL, HDL

Fredrickson classification: high CHYLOMICRONS

Type 1 (Familial LPL Deficiency)

Fredrickson classification: high VLDL

Type 4 (Familial hypertriglyceridemia)

Fredrickson classification: high CM & VLDL

Type 5

Fredrickson classification: high LDL, abnormal LDL receptor gene

Type 2 (Familial hypercholesterolemia)

Negative APRs

Prealbumin Albumin Transferrin

Indicator of nutrition; binds thyroid hormone and retinol-binding protein

Prealbumin

Major contributor to oncotic (osmotic pressure)

Albumin

Binds copper

Ceruloplasmin

Protease inhibitor

Alpha 1 antitrypsin

The principal use of serum protein electrophoresis is to detect

Monoclonal spike

Beta-gamma bridging

Liver cirrhosis

Monoclonal spike

Multiple myeloma

Alpha 1 globulin flat curve

AAT (alpha 1 antitrypsin deficiency)

Alpha 2 globulin spike

Nephrotic syndrome

Alpha 1, Alpha 2 globulin spikes

Acute inflammation

Polyclonal gammopathy

Chronic inflammation

Low albumin, very high alpha2-macroglobulin (10-fold or more)

Nephrotic syndrome

Protein based on phenolic amino acid oxidation with the HIGHEST SENSITIVITY

Folin-Ciocalteu

Biochemical marker for bone resorption

Cross-linked C Telopeptide

Useful marker of nutrition

Fibronectin

Most concentrated NPN

Urea

2nd most concentrated NPN

Amino acid

Least concentrated NPN

Ammonia

Ammonia is associated with what kidney function

Excretion

Osmolarity is associated with what kidney function test

Tubular function

Inexpensive urea assay, LACKS specificity

Colorimetric: diacetyl

More expensive urea assay; GREATER specificity

Enzymatic: NH3 formation

Simple and nonspecific creatinine assay

Colorimetric: end point

Uric acid assay that assess problems with turbidity

Colorimetric

SPECIFIC uric acid assay which requires mercury arc vapor lamp

Enzymatic UV

Azotemia caused by renal diseases, acute and chronic renal failure

Renal azotemia

Azotemia caused by urinary tract obstruction, renal calculi, bladder or prostate tumors, severe UTI

Post-renal azotemia

_____ is the single marker to diagnose renal failure; _____ test is used to assess the renal tubular integrity

Creatinine; B2-microglobulin

Exogenous substance used as ALTERNATIVE test for creatinine clearance to screen for kidney dysfunction

Cystatin C

Proteins such as albumin, cholinesterase, coagulation proteins, cholesterol, bile salts and glycogen are associated with what liver function

Synthetic

Bilirubin, ammonia, and drugs are associated with what liver function *BAD

Detoxification

Bile acids and bilirubin are associated with what liver function

Excretion

Test for PATENCY of billiary ducts and hepatocellular metabolism of bilirubin

Direct and total bilirubin ratio

Test for OVERALL patency of billiary ducts

Serum bile acid

Test for abnormality of bile-duct epithelium

ALP "obstructive" enzymes

Test for capacity to conjugate bilirubin and secrete bile

Serum bilirubin level

Test for hepatocellular damage and necrosis

Serum AST levels

Bilirubin fraction covalently attached to albumin; also known as "Biliprotein"

Delta bilirubin

Characterized by PARTIAL deficiency of UDPGT

Criggler-Najar syndrome Type II / Arias syndrome

Principle of Malloy and Evelyn method & Jendrassik and Grof method

Van den Berg reaction

Accelerator for Malloy and Evelyn method

Methanol

Accelerator for Jendrassik and Grof method

Caffeine-Sodium benzoate

Enzyme activity: Substrate and coenzyme _____, product and altered coenzyme _____

Decreases; increases

Enzyme classifications *OTHLIL

Oxydoreductase Transferase Hydrolase Lyase Isomerase Ligase

LDH and G6PD are under what category of enzymes

Oxidoreductase

AST, ALT, GGT are under what category of enzymes

Transferase

Kinases (CK and HK) are under what category of enzyme

Transferase

Esterases (ACP, ALP, CHS, 5-NT, LP) are under what category of enzyme

Hydrolase

Trypsin and pepsin are under what category of enzyme

Hydrolase

Amylase and Galactosidase are under what category of enzyme classification

Hydrolase

ALDOLASE and DECARBOXYLASE are under what enzyme classification

Lyase

Enzymes involved in INTRAMOLECULAR ARRANGEMENT are called

Isomerases

Synthases / joining of two molecules

Ligase

CK-MB onset of elevation

4-6 hours

1st to elevate in AMI, but NOT cardiac-specific

Myoglobin

CARDIAC-specific marker of AMI

Troponin

1st to elevate in acute pancreatitis, but NOT pancreas-specific

Amylase

Late marker, but PANCREAS-SPECIFIC

Lipase

P-nitrophenylphosphate (PNPP) is the MOST SPECIFIC substrate used in what ALP method

Bowers and McComb

Thymolphthalein monophosphate is a substrate used in what ACP method

Roy and Hillman

End product of AST enzymatic method

Oxaloacetate

The formation of MALTOSE is observed in what enzymatic method of AMS

Coupled-enzyme

Reference method of LPS (lipase) that measures the titration of fatty acids with NaOH

Cherry Crandal

Forward/direct reaction of LDH (*FLP = lactate to pyruvate)

Wacker

Reverse/indirect reaction of LDH

Wrobkeuski La Due

Forward/direct method for CK

Tanzer-Gilvarg

Reverse/indirect method for CK

Oliver-Rosalki

Bile duct obstruction, Osteitis deformans, Billiary cirrhosis, Osteogenic sarcoma (*BOBO) is _____ elevation of _____

Pronounced (5x); ALP

Pregnancy. _____ elevation of _____

Slight (3x) ALP

Megaloblastic anemia and renal infaction. _____ elevation of _____

Pronounced (5x); LDH

Myocardial infarction, pulmonary infarction, and hemolytic conditions. _____ elevation of _____

Moderate (3-5x); AST

Cholangitis. _____ elevation of _____

Slight (3x); LDH

Acute hepatocellular damage, myocardial infarction, and acute pancreatitis (*AMA) indicates _____ elevation of _____

Pronounced; AST

Duchenne's muscular dystrophy is _____ elevation of _____

Pronounced; CK

Major extracellular cation

Sodium

Major regulator of water balance, osmolality, and osmotic pressure for electrolytes

Sodium

Major intracellular cation

Potassium

Countercurrent ion of sodium

Potassium

Major extracellular anion

Chloride

Counterion of sodium that maintains electroneutrality

Chloride

Electrolytes involved in MYOCARDIAL rhythm and contractility

*PoMaCa Potassium (K) Magnesium (Mg) Calcium (Ca)

Electrolytes involved in volume and OSMOTIC REGULATION

Sodium (Na) Potassium (K) Chloride (Cl)

Electrolytes that serves as COFACTORS in enzyme activation

*ZiMaCa Magnesium Calcium Zinc

Electrolytes involved in ACID-BASE balance

Chloride (Cl) Bicarbonate (HCO3) Potassium (K)

Electrolytes involved in BLOOD COAGULATION

Calcium (Ca) Magnesium (Mg)

Electrolytes involved in NEUROMUSCULAR excitability

*PoMaCa Potassium (K) Magnesium (Mg) Calcium (Ca)

Included in the electrolyte profile

Na, K, Cl, HCO3

Increased Anion Gap

*SEDULA & MUDPILES Starvation Exogenous poisons (sallicylates) Diabetic ketoacidosis Uremic acidosis Lactic acidosis Alcoholic ketosis

Normal Anion Gap

*HERD Hyperalimentation Early renal failure Renal tubular acidosis Diarrhea

Decreased Anion Gap

*CHEE Cationic myeloma patients Hypercalcemia Hyperlipidimia Erroneous report

Diabetes insipidus causes _____ (hypernatremia/hyponatremia) due to _____

Hypernatremia; increased water loss

Potassium deficiency, diuretics, and severe burns causes _____ (hypernatremia/hyponatremia) due to _____

Hyponatremia; increased sodium loss

Renal failure causes _____ (hypernatremia/hyponatremia) due to _____

Hyponatremia; increased water retention

Excess water intake, SIADH, and pseudohyponatremia causes _____ (hypernatremia/hyponatremia) due to _____

Hyponatremia; water imbalance

Most common cause of hyperkalemia

Decreased renal excretion

Addison's disease (hyperkalemia/hypokalemia)

Hyperkalemia

Sample hemolysis, thrombocytosis, prolonged tourniquet use or excessive fist clenching causes _____ hyperkalemia

Artifactual

Henderson Hasselbach Equation

pH = pKa + log (HCO3/H2CO3)

Method for measurement of pH and pCO2

Potentiometry

Method for measurement of pO2

Amperometry

Determine the acid-base balance disorder: Alcoholism

Metabolic acidosis

Determine the acid-base balance disorder: Vomiting

Metabolic alkalosis

Determine the acid-base balance disorder: Diarrhea

Metabolic Acidosis

Determine the acid-base balance disorder: Hyperkalemia

Metabolic acidosis

Determine the acid-base balance disorder: Emphysema

Respiratory acidosis

Determine the acid-base balance disorder: Hyperventilation

Respiratory acidosis (⬆️ CO2 loss)

Compensatory mechanism in metabolic acidosis

Hyperventilation

Compensatory mechanism in metabolic alkalosis

Hypoventilation

Compensatory mechanism in respiratory acidosis

Increased HCO3 reabsorpion

Compensatory mechanism in respiratory alkalosis

Decreased HCO3 reabsorption

Acidemia occurs when the blood pH is

<7.35

Alkalemia occurs when blood pH is

>7.45

Amino acids (stimulate/inhibit) growth hormone secretion

Stimulate

Glucose loading (stimulate/inhibit) growth hormone secretion

Inhibit

Insulin deficiency (stimulate/inhibit) growth hormone secretion

Inhibit

Thyroxine deficiency (stimulate/inhibit) growth hormone secretion

Inhibit

Screening test for Acromegaly

Somatomedin-C

Confirmatory test for Acromegaly

Glucose suppression test (OGTT)

Increased T3 and T4 Increased T3 uptake Decreased TSH

Primary hyperthyroidism

Decreased T3 and T4 Decreased T3 uptake Decreased TSH

Secondary hypothyroidism

Increased T3 and T4 Increased T3 uptake Increased TSH

Secondary hyperthyroidism

Decreased T3 and T4 Decreased T3 uptake Increased TSH

Primary hypothyroisism

Fluorophore-labeled thyroxine; polarized light

Fluorescent polarization immunoassay (FPIA)

Fluorogenic substrate-labeled thyroxine

Fluorescent substrate-labeled inhibition immunoassay

Addition of luminol; measured by luminometer

Chemiluminescence

Similar to ELISA

Microparticle enzyme immunoassay (MEIA)

Mineralocorticoids, aldosterone. What adrenal cortex layer

Zona glomerulosa

First responder to stress by acting within seconds

Catecholamines

Increased cortisol, increased ACTH

Cushing's disease

Screening tests for Cushing's syndrome

Midnight salivary cortisol test Overnight dexamethasone suppression test 24-hour urinary free cortisol test

Confirmatory test for Cushing's syndrome

LOW-dose dexamethasone suppression test

Low testosterone, high LH and FSH

Primary hypogonadism / Klinefelter's syndrome

Low testosterone, low LH and FSH

Secondary hypogonadism

TRANSPORT of drug from the site of administration to the blood

Absorption

DELIVERY of the drug to the tissues

Distribution

HIGHEST CONCENTRATION of a drug obtained in the dosing interval

Peak concentration

Time required to reduce drug level to HALF of its initial value

Half-life

Procainamide is an example of _____ drug

Cardioactive

Phenobarbital (barbiturate) is an example of _____ drug

Anti-epileptic

Cyclosporine, tacrolimus, rapamycin are examples of _____ drug

Immunosuppresive

Aspirin, acetaminophen, ibuprofen and salicylates are examples of _____ drug

Anti-inflammatory / analgesic

Methotrexate is an example of _____ drug

Chemotherapeutic

Theophyline and theobromine are what type of drug

Bronchodilator

Lithium is an example of _____ drug

Psychoactive / antidepressant

Treatment for petit mal (absence) and grand mal seizures

Valproic acid / valium

Treatment for various seizure disorders

Carbamazepine

Most commonly abused substance in the entire world

Alcohol

Mental confusion, dizziness, strongly impaired motor skills (staggering, slurred speech)

0.18-0.30

Unable to stand of walk, vomiting, impaired consciousness

0.27-0.40

Coma and possible death

0.35-0.50

Symptoms of alcohol intoxication begin

>0.05%

Legally intoxicated

>100 mg/dL

Presumptive evidence of driving under influence of alcohol

>0.10%

Not a natural opiate

Pentazocine

Vitamin B9

Folic acid

Vitamin C

Ascorbic acid

Beri-beri is deficiency of what vitamin

Vitamin B1 / Thiamine

Pellagra is deficiency of what vitamin

Vitamin B3 / Niacin

Megaloblastic anemia is associated with what vitamin deficiency

Vitamin B9 / Folic acid

Scurvy is associated with what vitamin deficiency

Vitamin C

Serum potassium critical value

>6.5 mEq/L

Serum bicarbonate critical value

<10 or >40 mEq/L

Cholesterol determination 3-STEP method

Abell-Kendall

Clinical Chemistry Flashcards

(299 cards)