Clinical Chemistry (Exam 1) Flashcards
(109 cards)
1
Q
Clinical chemistry is the measurement of biologically important substances called ______________ in body fluids. The tests measure concentrations of biologically important ions (salts and minerals), small organic molecules and large macromolecules (primarily proteins)
A
analytes
2
Q
What is the most common fluid used in clinical lab testing?
A
blood (whole blood, plasma, or serum)
3
Q
What is the clinical test for strep infections like rheumatic fever, APSGN, or erythema nodosum?
matching test q
A
ASO titer
4
Q
What is the clinical test for infectious mono (epstein barr virus)?
matching test q
A
heterophile antibody
5
Q
What is the clinical test for acute phase reactant, inflammation, bacterial infections, and necrosis?
matching test q
A
c reactive protein
6
Q
What is the clinical test for early detection of CAD?
matching test q
A
hs-CRP
7
Q
What is the clinical test for generalized inflammation/necrosis?
matching test q
A
ESR
8
Q
What is the screening test for abs for hepatitis and HIV?
matching test q
A
ELISA
9
Q
What is the confirmatory test for Ab proteins on virus?
matching test q
A
western blot
10
Q
What is the clinical test screening for syphilis?
matching test q
A
RPR or VDRL
11
Q
What is the confirmatory test for syphilis?
matching test q
A
FTA-ABS (fluorescent treponemal Ab)
12
Q
What is the clinical test for collagen diseases like SLE?
matching test q
A
(F)ANA (fluorescent anti nuclear Ab)
13
Q
What is the clinical test for RA?
matching test q
A
RF or RA latex
14
Q
What is the clinical test for anti-citrullinated protein Abs found in RA?
matching test q
A
anti CCP (ACPS)
15
Q
What clinical test is most specific for SLE?
matching test q
A
anti ds-DNA
16
Q
What is the clinical test for prostate screening and BPH?
matching test q
A
PSA
17
Q
What is the clinical test for Abs produced by group A strep?
matching test q
A
anti DNase B Ab
18
Q
What is the clinical test for allergies?
matching test q
A
RAST test
19
Q
What is the clinical test for fetal abnormalities?
matching test q
A
TORCH
20
Q
What is the clinical test for alcohol abuse?
matching test q
A
CAGE
21
Q
What tests require a 12 hour fast or more?
A
lipids (cholesterol and TGs)
22
Q
Why does a lipid panel require a 12 hr fast?
test q
A
because they can be affected by hemolysis and falsely elevate potassium which is critical for the heart
23
Q
What clinical test is this?
-method used for many of the common analytes in blood
-measures light absorbed by a substance
A
spectrophotometry
24
Q
What clinical test is this?
-method that separates similar substances into individual components
-based on size, charge, or other properties
A
electrophoresis
25
Healthy plasma membranes and various organelles contain enzymes within them. If there is a functional or anatomical disruption in the plasma membrane, enzymes will be released into the
plasma
26
____________ exist with many enzymes; multiple forms of enzymes that differ in AA sequence but catalyze the same chemical reaction
Isoenzymes
27
What clinical test is this?
-used to separate and identify different types of hemoglobin in the blood
-helps diagnose hemoglobin disorders such as sickle cell disease and thalassemia
-Hb molecules have different electrical charges based on their AA sequence
Hb electrophoresis
28
What clinical test is this?
-fractionation of serum proteins can be used to diagnose, evaluate, and monitor the disease course in patients with lymphoma, myeloma, renal, and intestinal wasting pathologies, liver dysfunction, immune disorders, chromic edema, and impaired nutrition
-may have a monoclonal spike/ m spike
total protein electrophoresis also known as serum protein electrophoresis (SPE)
29
What is a monoclonal spike/m spike?
abnormal pattern in a patient with multiple myeloma bc of increased gamma globulins
30
What clinical test is this?
-primarily used to identify and characterize specific abnormal monoclonal proteins in the blood or urine
immunofixation electrophoresis
31
What clinical test is this?
-detects the presence of free monoclonal light chains (kappa or lambda) specifically in urine, often as an initial or follow up screening test for multiple myeloma
bence jones protein
32
What clinical test is this?
-used to test for the presence of a specific Ab or Ag in blood or other fluids
immunoassays
33
Which clinical test is this?
-type of immunoassay which tects and measures Abs in your blood
enzyme linked immunosorbent assay (ELISA)
34
Which lab test is a screening and confirmatory test for heptitis?
ELISA
35
Which clinical test is this?
-immunoassay test detects specific proteins in blood (antigens)
-confirms the presence of an Ab to help with diagnosis
-confirmatory procedure for viral Abs screened by other methods first
-highly specific confirmatory test method
western blot
36
Which lab test is confirmatory for HIV?
western blot
37
T/F: routine blood work measures the total calcium
true
38
What is the most abundant mineral in the body?
calcium
39
The amount of albumin affects the total __________ level because ~50% of this mineral is albumin bound. So, a decrease in albumin will result in a decrease of total serum ___________
calcium, calcium
note: this decrease does not alter the conc. of ionized calcium
40
Calcium levels are influenced by....
-PTH
-calcitonin
-vit D
-dietary calcium intake
41
Total calcium is often used as a screening test for what?
evaluate PTH function and calcium metabolism
42
What are the most common causes of increased total calcium?
hyperparathyroidism and cancer
43
What is the most common cause of decreased total calcium?
hypoalbuminemia
44
What are the most common causes of hypercalcemia?
1) primary hyperparathyroidism (most common) usually due to parathyroid adenoma
2) cancer usually due to bone resorption
3) vitamin D toxicity (causes excessive bone resorption)
45
increased calcium in otherwise healthy person=
hyperparathyroidism
46
increased calcium in hospitalized patients=
malignancy
47
What are the signs and symptoms of hypercalcemia?
-painful bones
-renal stones
-abdominal groans
-sitting on the throne (polyuria, constipation)
-psychiatric overtones
48
What are the most common causes of hypocalcemia?
1) hypoalbuminemia
2) hypoparathyroidism
3) vit D def
49
What are the signs and symptoms of hypocalcemia?
-tetany with trossesu's and chvostek signs
-muscle spasms
-paresthesia
50
What is trossesu's sign?
-flexion of the wrist
-flexion of the thumb and MCP joints
-hyperextension of the fingers
51
What is chvostek sign?
-abnormal twitching of muscles that are innervated by facial nerve
-cheek will muscle spasm
52
Renal osteodystrophy is defective bone development that occurs when kidneys fail to maintain proper levels of __________ in the blood. It is caused by chronically decreased ____________ in people with chronic kidney disease. Kidneys cannot make *vit D*
1st blank: calcium and phosphorus
2nd blank: calcium
53
define electrolytes
minerals that carry an electric charge
54
T/F: phosphorous levels are always elevated in relation to calcium because there is generally an inverse relationship between the two
true
55
What everyday things can alter phosphorous levels?
-eating will increase phosphorous levels
-laxatives/enemas with sodium phosphate can falsely increase levels
-antacids absorb in the small bowel and can bind to phosphorous and decreased absorption
56
What are the causes of hyperphosphatemia?
1) hypoparathyroidism
2) renal failure (most common cause)
3) vit D toxicity
57
What is the most common cause of hyperphosphatemia?
renal failure
58
What are the acute causes of hypophosphatemia?
-starvation
-DKA
-hypercalcemia
-severe alcoholism
-severe burns
59
What are the chronic causes of hypophosphatemia?
-hyperparathyroidism
-fanconi syndrome
-chronic diarrhea
-long term diuretic or antacid use
60
When tissues are damaged what enzyme is dumped into bloodstream?
ALP
61
Where are the highest concentrations of ALP?
-liver
-biliary tract
-bone
-epithelium
62
increased ALP but not liver enzymes= look at __________
bone
63
increased ALP with liver enzymes= look at _____________
liver
64
In bone disease, ALP rises in proportion to any new bone cell production resulting from _____________ activity and the deposit of calcium in the bones
osteoblastic
65
Young children will have __________ levels of ALP due to growth
higher
66
Where is creatine kinase (CK) found in high concentrations?
-heart
-skeletal muscles
(low concentration in the brain)
67
CKBB/ CK1 is found where?
brain
68
CKMB/CK2 is found where?
cardiac muscle
69
CKMM/ CK3 is found where?
skeletal muscle
70
What is the gold standard for diagnosing skeletal muscle disease like muscular dystrophy?
elevated CKMM/ CK3 and total CK
71
Uric acid is a waste product from the breakdown of
purines
72
Uric acid is influenced by what organ?
kidneys
73
When there is an excess of uric acid in the blood or if the kidneys are unable to efficiently eliminate it, ______________ can occur
hyperuricemia
74
When uric acid levels exceed the physiologic saturation threshold what happens?
monosodium urate crystals ( uric acid crystals) deposited in the joints and soft tissues (tophi) and cause pain
75
What are the 4 causes of hyperuricemia?
1) idiopathic (most common, reduced clearance from kidney with no kidney disease)
2) chronic kidney disease (decreased GFR)
3) increased ingestion of purines like beer
4) myeloproliferative disorders, metastatic cancers, multiple myeloma, leukemia, lymphoma, chemotherapy (increased destruction associated with rapidly growing cancers, and for chemo it causes cells to lyse and spill nucleic acids into bloodstream)
76
What is the most common cause of hyperuricemia?
idiopathic (reduced clearance from kidney with no kidney disease)
77
What are the 3 causes of hypouricemia?
test q
1) wilson's disease
2) fanconi syndrome
3) lead poisoning
all are associated with increased uric acid renal exertion due to decreased renal tubular reabsorption
78
Gout is an inflammatory arthritis caused by
hyperuricemia
79
What crystals are found in gout?
monosodium urate crystals
hardened deposits of the crystals is called tophi
80
What pathology is this?
-defect in purine metabolism resulting in overproduction of uric acid, retention of uric acid, or both
-most cases are idiopathic with unexplained impairment of renal uric acid excretion
gout
81
What are the secondary causes of gout (primary is idiopathic hyperucicemia)?
1) leukemia
2) multiple myeloma
3) myeloproliferative syndrome
4) alcoholism
5) hemolytic anemia
6) chronic kidney disease
82
What pathology would have these symptoms and lab findings?
-intense pain and tenderness
-joint may be swollen, warm, and red
-often awakens patient
-increase in serum uric acid levels
-increased ESR and CRP
-increased WBCs (neutrophils) in blood and in synovial fluid
-joint aspiration (arthrocentesis) would show monosodium urate crystals (tophi)
test q
gout
83
In primary hyperparathyroidism, increased PTH = increase ?
calcium
84
Primary hyperparathyroidism is usually caused by?
parathyroid adenoma
85
Is muscular dystrophy congenital or acquired?
congenital
86
What pathology is this?
-progressive symmetrical wasting of skeletal muscles with neural or sensory defects
muscular dystrophy
87
What is the most common and most severe muscular dystrophy?
duchenne's
88
A condition characterized by the softening of bones due to defective bone mineralization, primarily caused by a deficiency in vit D, calcium, or phosphate. It results in defective calcification of osteoid matrix and increases osteoblastic activity. Diffuse radiolucency can mimic osteoporosis
osteomalacia in adults, rickets in children
89
When secondary to renal disease, osteomalacia is called....
renal osteodystrophy
90
What are the lab findings for osteomalacia and rickets?
decreased vit D and calcium but increased ALP
91
Nutritional deficiency of vit D in children is known as?
rickets
92
What is another name for paget's disease?
osteitis deformans
93
What pathology is this?
-disorder of the bone remodeling process
-the body absorbs old bone and forms abnormal new bone
-enlarged, misshapen boned with structural problems
-pathological fractures
-leads to patchy areas of high density (sclerosis) and low density (lysis)
-most common in elderly men
paget's disease/osteitis deformans
94
What pathology would have these S&S and lab findings?
-localized bone pain (most common presenting symptom)
-bone deformities and fractures
-hearing loss if it affects bones in the ear
-neurological symptoms if spinal cord compression occurs
-INCREASED ALP
-typically normal calcium and phosphate
-urine hydroxyproline
paget's disease/osteitis deformans
95
What is the most important blood test for diagnosing paget's disease?
ALP
96
What pathology would have these imaging findings?
-bone enlargement and deformity
-cotton wool appearance of skull (disorganized bone formation)
-v shaped defects in long bones
-bowing deformities
paget's disease/osteitis deformans
97
What pathology is this?
-an acute or chronic bone infection with associated inflammation
-deep bone pain gradual in onset and erythema in affected area
-CRP and ESR is elevated
osteomyelitis
98
What pathology is this?
-caused by bacterial invasion of a joint resulting in inflammation
-s. aureus is the most common cause in adults
-n. gonorrhea is most common in young sexually active adults
-acute joint pain
-WBCs in synovial fluid
-bacterial culture
septic arthritis
99
What is the gold standard for diagnosing septic arthritis?
synovial fluid contains WBCs (arthrocentesis)
100
What pathology is this?
-characterized by decrease in bone mass
-deterioration of bone tissue
-disruption of bone architecture
-increased risk for fracture
-results from osteoclastic bone resorption not compensated by osteoblastic bone formation
-causes bones to become weak and fragile
-associated with post menopause (estrogen def), physical inactivity, cushing's, hyperthyroidism, primary hyperparathyroidism
osteoporosis
101
What is the most common metabolic bone disease?
osteoporosis
102
Is there a blood test for osteoporosis?
NO its diagnosed through dexa scan
103
What is another name for osteoarthritis (OA)?
DJD
104
What is the most common form of arthritis?
OA/ DJD
105
What pathology is this?
-non-inflammatory condition that will eventually become inflammatory
-progressive loss of articular cartilage with reactive changes at joint margins and in subchondral bone
-wear and tear in the joints
-primarily idiopathic
OA/ DJD
106
What pathology is this?
-autoimmune condition of the synovial lining of the joints, tendon sheaths, and bursa
-inflammatory arthritis = chronic inflammation
-symmetrical distal poly arthropathy
RA
107
What test is done to check for RA?
-serum RF, found in Fc portion of IgG
-anticyclic citrullinated peptide (anti CCP, more sensitive and specific)
108
What is the screening test for autoimmune disorders?
ANA/ FANA
109
Compare RA to OA in stiffness and lab findings
test q
RA
-worse stiffness after resting
-morning stiffness
-positive RF
-positive anti CCP Ab
-elevated ESR and CRP
OA
-stiffness is worse after moving, may be described as evening stiffness
-negative RF
-negative anti CCP Ab
-normal ESR and CRP
