Clinical Chemistry Flashcards
(147 cards)
1
Q
Main hyperglycemic hormone
A
Glucagon
2
Q
Most specific enzyme for glucose
A
GLUCOSE OXIDASE
NOTE: Most specific enzyme but not reference because of uric cid and ascorbic acid (reducing agents) that causes falsely decreased results.
3
Q
Most specific method for glucose determination
A
HEXOKINASE METHOD
NOTE: Hemolysis and bilirubin causes falsely decreased results.
4
Q
Responsible for the specificity of the Hexokinase method
A
G6PD
5
Q
Trisonomy 21is also known as
A
DOWN SYNDROME
6
Q
When does hemoglobinuria happen?
A
WHEN HAPTOGLOBIN IS DEPLETED
7
Q
Increase ammonia, decrease urea
A
LIVER DISEASE
8
Q
a. beta cells produces
b. alpha cells produces
A
A. INSULIN
B. GLUCAGON
9
Q
What lowers the HbA1c level?
A
HEMOLYSIS, ACUTE BLOOD LOSS, BLOOD TRANSFUSION, SPLENECTOMY, DECREASE RBC LIFESPAN
10
Q
It monitors kidney function of people with DM
A
MICROALBUMINURIA
11
Q
C-peptide level in insulin overdose hypglycemia
A
DECREASED/UNDETECTABLE
NOTE: low insulin = low c-peptide
12
Q
Compliance to therapy or medication of DM
A
KETONES
13
Q
Kidney function by the determination of urinary albumin excretion of diabetic patients should be done…
A
ANNUALLY
14
Q
Increased insulin and detectable c-peptide
A
INSULINOMA
15
Q
Whole blood glucose in 100mg/dL, what is the plasma glucose?
A
115md/dL
NOTe: 100 x 1.15
16
Q
a. Binds retinol (vitamin A) and tyroxine, sensitive marker of poor nutritional status
b. Most abundant protein in blood, highest dye binding capacity**, major contributor to oncotic pressure, assessment of nutritional status
A
A. PREALBUMIN
B. ALBUMIN
17
Q
Neutralizes trypsin and elastase; deficiency results to pulmonary emphysema and juvenile cirrhosis
A
ALPHA1 ANTITRYPSIN
18
Q
Binds free hemoglobin, conserve the iron, decreases in intravascular hemolysis
A
HAPTOGLOBIN
19
Q
Transports iron, also known as siderophilin
A
TRANSFERIN
20
Q
Binds heme, decreased in intravascular and extravascular hemolysis
A
HEMOPEXIN
21
Q
Essential role in immune response
A
COMPLEMENT PROTEIN
NOTE:C3 is the most abundant complement protein
22
Q
Precursor of fibrin clot, present in plasma but not in serum
A
FIBRINOGEN
23
Q
Antibodies, protection against foreign antigens
A
IMMUNOGLOBULIN/ GAMMA GLOBULINS
24
Q
A. Most abundant immunoglobulin, can pass the placenta
B. Biggest immunoglobulins
A
A. IgG
B. IgM
25
Protein Determination
a. Routine method
b. Reference method
A. Biuret method
B. Kjeldahl Method
NOTE: kheldahl method principle: measures nitrogen content
26
Used for albumin determination; binds to the dye causing a shift in the absorption maximum **
DYE-BINDING TECHNIQUES **
NOTE: Bromcresol green= common;Bromcresol purple= sensitive, specific & precise
27
A.high AFP
B. Low AFP
A. Neural Tube Defects
B. Down syndrome (trisonomy 21)
28
Capable of detecting as low as 0.05 mg/dL of risk for Cardiovascular Disease **
hs-CRP **
29
CERULOPLASMIN
a. Ceruloplasmin deficiency, decrease production
B. Severe copper deficiency, decrease absorption
A. Wilson's Disease
B. Menke's Disease
NOTE: Copper deposits is present in Wilson's disease, and absent in Menke's Disease **
30
SERUM PROTEIN ELECTROPHORESIS
A.H A1, A2 and B regions
B. H Y region
C. A1 flat curve
D. B and Y bridging **
E. A2 spike, H A2 and B regions
F.Y spike
A.Acute Inflammation
B. Chronic Inflammation
C. A1 antitrypsin deficiency
D. Hepatic Cirrhosis**
E. Neprotic Syndrome
F. Monoclonal Gammopathy
- follow up: Immunofixation electropheresis **
31
CSF ELECTROPHORESIS
A. Oligoclonal bands in CSF **
B.Oligoclonal bands in both CSF and serum
A. Multiple sclerosis, Guillian-Barre Syndrom, "MEN" malignancies, encephalitis, neurosyphilis **
B. HIV infection, systemic infection
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A. Oligoclonal bands in CSF **
B.Oligoclonal bands in both CSF and serum
A. Multiple sclerosis, Guillian-Barre Syndrom, "MEN" malignancies, encephalitis, neurosyphilis **
B. HIV infection, systemic infection
33
Cylomicron and lipoprotein are responsible
POSTPRANDIAL LIPEMIA **
34
Cylomicron but least dense lipoprotein
B. Smallest but most dense lipoprotein
A. Chylomicron
B. HDL
35
A. Minor lipoprotein, sinking pre-B lipoprotein
B. Abnormal lipoprotein, floating B lipoprotein
A. Lp(a)
B. B-VLDL
36
Method of choice for the precipitating reagents of HDL
Heparin-manganese-chloride
37
Indirect measure of TAG
Glycerol
38
URINE ELECTROPHORESIS
A. Strong albumin, A1 and B bands
B. Weak albumin, strong A1, A1 and B bands
C. Strong Y bands
A. Glomerular proteinuria
B. Tubular proteinuria
C. Overflow proteinuria, hemoglobinuria, myoglobinuria
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Migrating in Y region (Bence-Jones Protein)
Monoclonal Light Chains
40
A. Main cation in the ECF
B. Main cation in the ICF
A. Sodium
B. Potassium
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A. Most abundant anion in the ECF
B. Second most abundant anion in the ECF
C. most abundant cation in the body
D. Main anion in the intracellular compartment
A. Chloride
B. Bicarbonate
c. Calcium
D. Phosphate
42
Main hypernatremic hormone
ALDOSTERONE
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A. Chief countercurrent of sodium
B. Chief counterion/counterbalance of sodium
A. potassium
B. Chloride
44
Essential cofactor/ activator of more than 300 enzymes **
MAGNESIUM **
45
Increase the activity of sodium/potassium ATPase pump **
INSULIN OVERDOSE (hypokalemia) **
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Aldosterone, Na+ an d K+ level of Cushing's syndrome and Conn's disease
H aldosterone = H NA+ and L K+
47
H lipids and H protein
PSEUDOHYPONATREMIA
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Na+ is low, other electrolytes are nomal ***
A. Measure serum glucose
B. Measure sodium using indirect ISE
A
49
Na+ is low, serum/plasma osmolality normal, other electrolytes are normal ***
A. Measure serum glucose
B. Measure sodium using direct ISE
B
50
Most common cause of primary hyperparathyroidism ***
PARATHYROID ADENOMA/ CARCINOMA ***
NOTE: H iCa, H PTH
51
Hyperthyroidism, multiple myeloma, sarcoidosis, iathrogenic causes ***
METASTATIC CARCINOMA ***
NOTE:H iCa, N PTH
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A. increase in blood urea ***
B. Increase in blood urea due to renal failure ***
A.AZOTEMIA
B. UREMIA
53
Indicators of GFR, better indication of the source of BUN and creatinine elevation
BUN:CREA RATIO
54
What is seen in the true renal disease?
NORMAL RATIO WITH ELEVATED BUN AND CREA LEVELS
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pCO2 and HCO3 ratio if the kidneys and lungs are properly functioning
20:1
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A. Categorized by presence and absence of anion gap and osmolal gap.
B. Categorized by chloride responsiveness or resistance.
A. METABOLIC ACIDOSIS
B. METABOLIC ALKALOSIS
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a. Osmolal gap NV
B. Anion gap NV
A. <10
B. <20
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pCO2 is sensitive to what? ***
pH ***
59
1. Specimen exposed to room air (HpO2= LpCO2, HpH)
2. Sealed specimen left at room temperature (LpO2= HpCO2, LpH)
3. Excess heparin (acid mucopolysaccharide= LpH)
60
ENZYME KENETICS
A. The rate of reaction is dependent on substrate concentration.
B. The rate of reaction is dependent on enzyme concentration.
A. E > S (glucose oxidase, hexokinase method)
B. E < S (enzyme determination method)
61
Norma Values
A. pH
B. pCO2
C. HCO3
A. 7.35-7.45
B. 35-45 (35-44 BOC)
C. 22-26 (23-29)
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A. Metabolic Acidosis; for each _____ mEq decreased in HCO3, the pCO2 decreases by ____.
A. Metabolic Alkalosis; for each _____ mEq increasaed in HCO3, the pCO2 increased by ____.
A. 1.3 mEq; 1.0mmHg
B. 0.6 mEq; 1.0 mmHg
63
Respiratory Acidosis and Alkalosis
A. ACUTE: for each 1mmHg change in pCO2, there is ____ change in HCO3 in the same direction.
B. CHRONIC: for each 1mmHg change in pCO2, there is ____ change in HCO3 in the same direction.
A. 0.1 mEq
B. 0.4 mEq
64
OSMOLAL GAP FORMULA
A. Mg/dL
B. Mmol/L
A. Osm= 2Na + glucose/18 + BUN/2.8 mg/dL
B. Osm= 2Na + glucose + bUN mmol/L
NOTE: NV: <10
65
ANION GAP CALCULATION
AG= (Na +K) - (Cl + HCO3)
66
Considered as least specific enzyme
Lactate Dehydrogenase (LDH)
67
LDH under normal conditions
LD2> LD1> LD3> LD4> LD5> LD6
68
MAJOR ISOENZYMES FROM LD1 TO LD6
LD1- heart, RBCs
LD2- heart, RBCs
LD3- intestines ,lungs pancreas
LD4- liver, skeletal muscles
LD5- liver, skeletal muscles
LD6- alcohol dehydrogenase; heart disease with liver disease
69
Highest elevation of isoenzymes is often seen in
MEGALOBLASTIC ANEMIA
PERNICIOUS ANEMIA
70
Alkaline phosphatase (ALP) in normal condition
BONE> LIVER> INTESTINAL> PLACENTAL
71
a. Highest elevation in alkaline phosphatase is seen in
b. Physiologic elevation can be seen in
a. PAGET'S DISEASE, OSTATIS DEFORMANS
b. PREGNANCY, BONE GROWTH (children)
72
Enzyme that best correlates with ALP ***
GGT***
73
A. High GGT
B. Normal GGT
A. Liver disease, hepatobiliary
B. bone disease
74
MAJOR ALP ISOENZYMES
A. Electrophoresis (anode to cathode)
B. Heat denaturation (stable to labile)
A. LIVER - BONE - PLACENTAL - INTESTINAL
B. PLACENTAL - INTESTINAL - LIVER - BONE (heat labile)
75
A cardiac marker that requires pyridoxal phosphate as coenzyme (vitamin b6), highly affected by hemolysis
AST/ SGOT
76
Most liver specific amonitransferase, not affected by hemolysis
ALT/ SGPT
77
Inhibited by lipids, triglycerrides, cholesterol ***
AMYLASE ***
78
TWO ISOENZYMES
A. Ptyalin
B. amylopsin
A. Salivary amylase
B. Pancreatic amylase
79
Most specific marker for acute pancreatitis ***
LIPASE ***
80
High amylase, normal lipase (parotitis) ****
MUMPS ***
81
Low amylase, low lipase, depletion of organ source ****
CHRONIC PANCREATITIS ***
82
a. Bilirubin + Diazo reagent =
B. Bilirubin + accelerator + Diazo reagent =
A. Azobilirubin that measure B2
B. Azobilirubin that measure B1 and B2 (total bilirubin)
83
Evelyn-Malloy vs Jendrassik-Grof
A. pH
B. Dissociating agent
c. Diazo product
D. Wavelength used
A. Acid; alkaline
B. 50% methanol; caffeine sodium bonnzoate
c. Red; blue
D. 560 nm; 600nm
84
Differentiate B1 and B2
B1= unconjugated bilirubin, indirect bilirubin, pre-hepatic bilirubin, water insoluble, non-polar
B2= conjugated bilirubin, direct bilirubin, post-hepatic bilirubin, water soluble, polar
85
Common manifestation of bilirubin dearrangements
JAUNDICE
86
Test performed if patient has jaundice and pancreatic enlargement
CA19-9
87
UNCONJUGATED (B1)
A. Transport defect with UDPGT deficiency
B. Conjugation defect due to UDPGT deficiency
C. Presence of antibodies against UDPGT
A. Gilbert's Syndrome
B. Crigler-Nejjar Syndrome
C. Lucey-Driscoll Syndrome
88
CONJUGATED (B2)
A. Impaired transport of conjugated bilirubin into the canaliculi
A.reduction in the concentration or activity of ligandin
A. DUBIN-JOHNSON SYNDROME
B.ROTOR SYNDROME
89
A. High B1, normal B2, high urobilinogen, (-) urine bilirubin
B. High B1, high B2, high urobilinogen, (+) urine bilirubin
C. High B1, high B2, low urobilinogen, (+) urine bilirubin
A. PRE-HEPATIC
B. HEPATIC
C. POST-HEPATIC
90
Bilirubin cannot pass through, no stool color (gray-colored stool)
BILIARY OBSTRUCTION, PANCREATIC CANCER, CHOLESTASIS, CHOLELITHIASIS
91
A. Earliest enzymatic cardiac marker
B. Earliest cardiac marker
A. CK-MB
B. Myoglobin
NOTE: "MiCAL" Myoglobin, Trop I are PROTEINS. CK-MB, AST and LDH are enzymes
92
a. Main hormone released from the thyroid gland, most abundant thyroid hormone
B. Most active thyroid hormone, majority comes from peripheral deiodinization of T4
A. T4/ THYROXINE/ TETRAIODOTHYRONINE
B. T3/ TRIIODOTHYRONINE
93
A. Primary hypothyroidism
B. Primary hyperthyroidism
A. Hashimoto's throiditis
B. Grave's disease
94
Normal thyroid but unusually low T3 and T4
EUTHYROID SICK SYNDROME
95
A . Cold intolerance, weight gain, decreased basal metabolic rate and sympathetic response
B. Heat intolerance, weight loss, increased basal metabolic rate and sympathetic response
A. Hashimoto's thyroiditis (primary hypothyroidism)
B. Grave's disease (primary hyperthyroidism)
96
SUBLINICAL
A. Subclinical hypothyroidism
B. subclinical hyperthyroidism
A. NT3, NT4, high TSH
B. NT3, NT4, low TSH
97
Promote sodium and water reabsorption by the kidney to help maintain blood pressure and tonicity, regulated by the renin-angiotensin-aldosterone system (RAAS)
ALDOSTERONE
98
Plasma cortisol values normally display diurnal variation,with the ______________ occuring in the morning and the ______________________ in the early evening. ****
Highest levels; lowest levels ****
99
Exhibits diurnal variation;regulated by ACTH production through the HPA axis
CORTISOL
100
First responders to stress****
Catecholamine ****
101
high thyroid hormones= _____ lipid = ____ metabolism****
High thyroid hormones = low lipids = high metabolism***
NOTE: HYPOTHYROIDISM causes weight gain while HYPERTHYROIDISM causes weight loss.
102
HYPOTHYROIDISM (hashimoto's throiditis) ***
A. Primary= __ TRH, __ TSH, __ T3, T4
B. Secondary = __ TRH, __ TSH, __ T3, T4
C.Tertiary = __ TRH, __ TSH, __ T3, T4
A. Primary= high TRH, high TSH, low T3, T4
B. Secondary = high TRH, low TSH, low T3, T4
C.Tertiary = low TRH, low TSH, low T3, T4
103
HYPERTHYROIDISM (grave's disease) ****
A. Primary= __ TRH, __ TSH, __ T3, T4
B. Secondary = __ TRH, __ TSH, __ T3, T4
C.Tertiary = __ TRH, __ TSH, __ T3, T4
A. Primary= low TRH, low TSH, high T3, T4
B. Secondary = low TRH, high TSH, high T3, T4
C.Tertiary = high TRH, high TSH, high T3, T4
104
Hormone that is highest concentration in the brain
DOPAMINE
105
Hormone that is highest concentration in the CNS
NOREPINEPHRINE / NORADRENALINE
106
Group of clinical and metabolic disorders characterized by adrenocortical hyperfunction. Clinical findings includes hirutism, obesity, hypertension, buffalo hump, moon-shaped face.
CUSHING'S SYNDROME ****
NOTE: high cortisol and aldosterone
107
A. Primary cushing's syndrome
B. secondary cushing's syndrome
A. Adrenal cushing's (high cortisol, normal pituitary, low ACTH)
B. Pituitary cushing's (high cortisol, high pituitary, high ACTH)
108
It is the true cushing's disease
PITUITARY CUSHING'S
High cortisol, high pituitary, high ACTH
109
Decreased aldosterone, cortisol and other steroids. Can be due to defect in hypothalamus, pituitary or adrenal gland.
ADDISON'S DISEASE (hypoadrenalism)
110
Aldosterone-secreting adrenal adenoma. It is the primary aldosteronism.
CONN'S DISEASE
111
Tumor of the adrenal medulla resulting to overproduction of catecholamines.
PHEOCHOMOCYTOMA
NOTE: high catecholamines = hyperglycemia***
112
Fatal malignant condition in children results to excessive neropinephrine production.
NEUROBLASTOMA
113
DRUG DISPOSISTION
A. Release of drug
B. Drug leaves the administration site, transport of drug
C. Equilibrium of drug with body issue and plasma protein, delivery of drug tissues
D. Chemical modification of drug by cells, usually occurs in the liver
E. Drugs and its motabolites are excreted from the body, occurs in the liver
A. LIBERATION
B. ABSORPTION
C. DISTRIBUTION
D. METABOLISM
E. EXCRETION
"LADME"
114
a. Specimen collection for the peak levels of drug
B.specimen collection for the trough level
A. 1 hour after the dosage
B. Right before the next dose
115
a. Time required to reduce a drug level to half of its initial value
B. Time during which the concentration of the drug in the body stays consistent
A. HALF-LIFE (ex. 4 hr interval)
B. STEADY LIFE (ex. 4-7 doses)
116
The half-life of the drug is 2 hrs. When can you achieve the steady state? ****
2hrs x 4doses = 8 HRS***
117
Hepatotoxic that is responsible for coma. AST/ALT enzymes evaluates the toxic effect of ____________. ****
ACETOMINOPHREN ***
118
Orally administered drugs. Low bioavailability.
FIRST-PASS METABOLISM
119
Decease production of ceroluplasmin.
Wilson's disease
120
Present copper deposits
Choices
A. Wilson's disease (kayser-fleischer ring)
B. Menke's disease (kingky hair)
A.
121
High protein, high lipid (hypercholesterolemia, hypertriglyceridemia)
PSEUDOHYPONATREMIA
122
A. Major protein of HDL
b. Major protein of LDL
c. Major protein of VLDL
A. Apolipoprotein A
B. Apolipoprotein B
C. Apolipoprotein C
123
A. Exogenous (dietary) TAG
B. Endogenous TAG
C. Cholesterol to cells (heart)
D. Cholesterol out of cells (heart)
A. Chylomicrons
B. VLDL
C. LDL
D. HDL
NOTE:
• HDL is helpful; takes cholesterol from the cells
• LDL is lethal; brings cholesterol to the cells
• VLDL has longest initials; pre-beta and endogenous TAG
124
Method used for the calculation of LDLc and VLDLc
Friedewald method
NOTE: cannot use when TAG is more than 400mg/dL
125
What disease is a branched chain ketoaciduria?
Maple syrup urine disease
126
Protein breakdown in the body produces
Urea and ammonia
127
ALPHA 2 GLOBULINS
a. High in acute phase and nephrotic syndrome, low in hemolysis and liver disease
B. High acute phase and pregnancy, low in Wilson's disease
A. Haptoglobin ; binds free hemoglobin
C. Ceruloplasmin; transports copper
128
Produced in muscles including heart, high in muscle damage including AMI
Myoglobin
129
Mass CK2 assays measures concentration rather than activity.
CKMB
130
Out of three forms of troponin, these two are mose specific for AMI identification.
Trop I and Trop T
131
A. Rises within 3O mins, peaks within 4-10 hrs and returns to normal within 24 hrs.
B. Rise within 6-10hrs, peaks within 24hrs and returns to normal within 2-3 days.
C. Rise within 4-8 hrs, peaks within 12-24 hrs and returns to normal within 10 days.
A. Myoglobin
B. CKMB
C. Troponin
132
Early marker of AMI
IMA (ischemia modified albumin)
133
_____ causes ACTH and cortisol levels to be highest in the early morning and lowest at night.
Diurnal variation
134
Liver specific, highest from biliary obstruction or after alcohol ingestion.
GGT
135
Elevated liver enzymes are as easy as ABC
Alcoholism
Biliary obstruction
Cirrhosis
136
CUSHING'S SYNDROME
A. Pituitary Cushing
B. Adrenal Cushing
A. high cortisol, high pituitary, high ACTH
B. High cortisol, normal pituitary, low ACTH ***
137
Enzymes indicating muscle disorders
ALT, CKMB, aldolase
138
Clinical findings:
Hirsutism, obesity, hypertension, buffalo hump, moon-shaped face
Cushing's Syndrome
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142
143
Decreased cortisol, aldosterone and other steroids
Addison's Disease
144
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