Clinical Chemistry: Final Coaching by Sir Steven Joseph Gambito Flashcards by Haina Balneg

Enumerate the Basic Units and their respective symbol names

“LTM TALE”

Length - meter
Time - seconds
Mass - kilogram
Temperature - kelvin
Amount of substance - mole
Luminosity - candela
Electric current - ampere

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Enumerate the analytes with 1 as their Conversion Factor

“Bi CLOPS 1”

Bicarbonate
Chloride
Lithium
Osmolality
Potassium
Sodium

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Enumerate the analytes with 10 as their Conversion Factor

“HAT 10”

Hemoglobin
Albumin
Total Protein

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What is the Conversion Factor of :
Thyroxine (T4):
Bilirubin:
Folic Acid
Creatinine

“The Big Fat Cock”

Thyroxine (T4) : 12.9
Bilirubin: 17.1
Folic Acid: 2.27
Creatinine: 88.4

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What is the Conversion Factor of:
Glucose:
Uric Acid:
Ammonia:
Magnesium:

“GUAM .5”

Glucose: 0.0555
Uric Acid: 0.0595
Ammonia: 0.587
Magnesium: 0.5

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What is the Conversion Factor of:
Cholesterol:
Triglycerides:
BUN:

“Ci-Ty of Baguio”

Cholesterol: 0.026
Triglycerides: 0.0113
BUN: .357

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Enumerate the prefixes from factor 10^18 to 10^1

exa
peta
tera
giga
mega
kilo
hecta
deka

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Enumerate the prefixes from factor 10^-1 to 10^-18

deci
centi
milli
micro
nano
pico
femto
atto

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Temperature Conversion of Centigrade to Kelvin

Kelvin = C + 273.15

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Temperature Conversion of Centigrade to Fahrenheit

F = (C x 9/5) +32

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Temperature Conversion of Fahrenheit to Centigrade

C = (F - 32) x 5/9

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It is objective and is based on the perception of the practitioner

Signs

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It is subjective and is based on the perception of the patient

Symptoms

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It connects all wards, surgical rooms, and departments of the hospital laboratory and pharmacy, and it greatly decreases transport time and TAT for test results

Pneumatic Tube Transport System

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It is the measurement of an organization’s products or services against specific standards for comparison and improvement

Benchmarking

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Trends an organization’s productivity over time, and is usually expressed as a ratio of the products or services to the various inputs used

Internal Benchmarking

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Compares a laboratory’s productivity with that of the other laboratories

External Benchmarking

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Time from ordering a test through analysis in the laboratory to the charting of the report

Turnaround Time (TAT)

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Comparison of current analyte result with the result from the most recent previous analysis or the same patient

Delta Check

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Failed delta check happens when the deviation is ______ %

> or = 20 %

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Too low or too high values that represent life-threatening situations and should be reported immediately

Panic Value or Critical Value

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It is a pair of medical decision points that extend the limits of the test results for a certain healthy population

Reference Interval or Reference Value

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How many individuals are needed to VERIFY existing and established reference intervals

20 individuals

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How many individuals are needed to ESTABLISH reliable estimates of reference intervals

120 individuals

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CLSI Order of Draw

“BB Real Girl Love Gray” (SCSHEG) Blood Culture (sterile tube) Blue (coagulation) Red (serum) Green (heparin) Lavender/Pink/Pearl (EDTA) Gray (Glycolytic inhibitors)

Anticoagulant suitable for most drug analysis

Heparin

Needle gauge and bore size relationship

Needle gauge is INVERSELY PROPORTIONAL to the bore size. “Life is Good in Star Bucks” The LARGER the GAUGE , the SMALLER the BORE size

Commonly used gauge for adult patients

21G

Commonly used gauge pediatric patients

23G

What is the purpose of the 1 - 1.5 length of the needle?

For better control

It is a portable device to easily locate veins that are difficult to locate

AccuVein

AccuVein shines what type of light?

Infrared Light

AccuVein held how many inches above the site?

7 inches

Tourniquet application and tourniquet dimension

Tourniquet should be applied to the venipuncture site for about 3-4 inches above, and should not be more than 1 minute application. Tourniquet dimension are 15 x 1 inch

Serum sample should be allowed to clot before being centrifuged, stand for how many minutes?

20 minutes

Centrifugation of whole blood and its components should be for approximately _____ minutes at an RCF or _________ x g.

10 minutes; 1000 - 2000 RCF x g

Pipettes should be calibrated by ________ and ___________.

Gravimetric and Photometric

Pipettes calibration should be done _________.

Every 3 months or quarterly

A pipette that contain and hold particular volume but does not dispense exact volume or exact amount

TC Pipette

A pipette that dispenses the volume indicated in the pipette

TD Pipette

Has continuous etched ring at the top of the pipette

Blowout Pipette

Blow-out pipette with graduations up to the tip

Serologic Pipette

Pipette with no or do not have etched rings

Self-draining pipette

Self-draining pipette and does not have graduations up to the tip

Mohr Pipette

An analytic testing of patient specimens performed outside the laboratory

POCT (Point Of Care Testing)

Most common sample for POCT

Capillary Blood

Most common test for POCT

Blood Glucose

Quality Control for POCT

Each day of use

Expel noxious and hazardous fumes from chemical reagents; and its face velocity

Fume Hoods; 100 - 120 feet per minute

Remove particles that may be harmful to the employee who is working with infective biologic specimen

Biosafety Cabinet

Total system or process that encompasses pre-analytic, analytic, post-analytic factors and ensuring quality results

Quality Assurance

It is a system for recognizing and minimizing analytical errors and ensuring accuracy and precision

Quality Control

Nearness of the assayed value to the true value

Accuracy

Nearness of the assayed value to each other

Precision or Reproducibility

The most widely used QC chart

Levey-Jennings Chart

This will give the earliest identification of a shift or a trend

CuSum

A gradual change; six consecutive values in either increasing or decreasing pattern; and its main cause is _______.

Trend; Reagent deterioration

Abrupt or sudden change; six consecutive values on the same side of the mean, and its main cause is ______.

Shift; instrument or improper calibration

Enumerate the random errors and systematic errors in the Westgard Rules

Random errors: 12s, 13s, R4s Systematic errors: 22s, 41s, 10x

It occurs when a data set can be described by the standard deviation and mean

Gaussian or Normal Distribution

For a Normal Distribution, Mean ___ Median ___ Mode

Mean = Median = Mode

Shape of the Gaussian Curve, exactly ____ or ____ under the gaussian curve

Symmetric and Bell shaped, exactly 1.0 or 100% nuder the Gaussian curve

The most commonly used interval

+/- 2 SD

+/- 1 SD = ___ +/- 2 SD = ___ +/- 3 SD= ___

+/- 1 SD = 68.3 % +/- 2 SD = 95.5% +/- 3 SD = 99.7 %

Too high or too low values that are typically removed; control results outside the established limits

Outlier

Reduces or eliminates WASTES (non-valued activities)

Lean

2 strategies used in Lean

5S and PDCA 5S “SoseShStSu” Sort Set in order Shine Standardize Sustain PDCA Plan Do Check Act

Eliminates DEFECTS (process variations)

Six Sigma

Steps in Six Sigma

DMAIC Define Measure Analyze Improve Control

Unit used in Six Sigma

DPMO (defects per million opportunities)

Calibration of the speed of centrifuge is done ______, and uses ______ or _______.

Every 3 months or quarterly, uses tachometer or strobe light

Calibration of the timer of centrifuge is done ______ ; and uses ______.

Monthly; stopwatch

Disinfection of Centrifuge is done ______.

Weekly

Beer’s law states that concentration is _________ proportional to absorbance and ________ proportional to transmittance

Concentration is DIRECTLY PROPORTIONAL to Absorbance Concentration s INDIRECTLY PROPORTIONAL to Transmittance

Determine analyte concentration substance in solution by measuring amount of light absorbed

Spectrophotometry

Measures light absorbed by atoms in ground state

Atomic Absorption Spectrophotometry (AAS)

Measures light emitted by a single atom excited by a flame

Flame emission photometry

It uses two monochromators, and it measures light emitted by a molecule excited by electromagnetic radiation; used for drug and hormone analysis

Fluorometry

Unknown sample react with known substance with the presence of indicator dye

Volumetric or Titrimetric

Measures light blocked

Turbidimetry

Measures light scattered

Nephelometry

Migration of charged particles in an electrical field

Electrophoresis

Separation of components according to their physical and chemical characteristics

Chromatography

Separation based on fragmentation and ionization

Mass Spectroscopy

Measures electrical current

Amperometry

It is used to quantitate pH, pO2, pCO2 in a patient

Ion Selective Electrode

All samples, in one test

Batch Testing

One clinical specimen, multiple tests

Parallel Testing

Multiple tests analyzed one after the other

Sequential Testing

It produces roaring blue flame

Bunsen Burner

Colors in bunsen burner: ____ - high temperature flame ____ - incomplete combustion ____ - insufficient oxygen ____ - not produce

Blue - high temperature flame Orange - incomplete combustion Yellow - insufficient oxygen Red - not produce

Used to zero instrument BEFORE measuring a test sample

Reagent Blank

Used to zero instrument DURING a test procedure

Sample Blank

Glucose metabolism will yield:

Lactate, pyruvate, and Acetyl Coenzyme A (Acetyl CoA)

Complete oxidation will yield:

Carbon dioxide and water

Causes increase in blood glucose

Gluconeogenesis Glycogenolysis Lipolysis

Causes decrease in blood glucose

Glycolysis Glycogenesis Lipogenesis

Metabolism or breakdown of glucose to pyruvate and lactate to produce energy

Glycolysis

Conversion of glucose to glycogen for storage in liver and/or in muscles

Glycogenesis

Formation of glucose-6-phosphate from non-carbohydrate sources

Gluconeogenesis

Conversion carbohydrates to fatty acids

Lipogenesis

Breakdown of glycogen to produce glucose for energy

Glycogenolysis

Breakdown of fats

Lipolysis

FBS Normal: Pre-diabetic/Impaired: Diabetes mellitus:

FBS Normal: <100 mg/dL Pre-diabetic/Impaired: 101-125 mg/dL Diabetes mellitus: > or = 126 mg/dL

2h PPG Normal: Pre-diabetic/Impaired: Diabetes mellitus:

2h PPG Normal: <140 mg/dL Pre-diabetic/Impaired: 140-200 mg/dL Diabetes mellitus: > or = 200 mg /dL

HBa1c Normal: Diabetes mellitus:

HBa1c Normal: 5.7 - 6.4 % Diabetes mellitus: > or = 6.5 %

Hypoglycemia blood glucose:

<70 mg/dL

_____ mg/dL hypoglycemia observable symptoms appear, other hyperglycemic agents are released

Condition associated with hypoglycemia; diagnostic tests are: ____ and ____

Whipple’s triad; 5h Glucose Tolerance Test and 72 hr fasting

Hyperglycemia blood glucose ____ mg/dL ; renal threshold for glucose is ____.

> 126 mg/dL ; 160 - 180 mg/dL

Characteristics of Type I DM Other name: Onset: Pathogenesis: Frequency: Ketoacidosis: C peptide level: Medication:

Characteristics of Type I DM Insulin Dependent Juvenile onset Autoimmune 5-10 % Ketoacidosis prone C peptide level is low / undetectable Insulin injection

Characteristics of Type II DM Other name: Onset: Pathogenesis: Frequency: Ketoacidosis: C peptide level: Medication:

Characteristics of Type II DM Insulin Independent Adult onset Lifestyle 90-95 % Ketoacidosis not prone C peptide level is normal / detectable Oral hypoglycemic agents

Type of diabetes that is acquired, and develops due to pancreatic disease such as pancreatic cancer or pancreatitis

Type 3C Diabetes Mellitus

Standard sample for glucose

Fasting venous plasma

Fasting hours for glucose

8 - 10 hrs fasting

Fasting for lipid profile

12 hrs of fasting

Whole blood blood glucose level is ______ % lower than plasma glucose

10-15%

Glucose is metabolized at a rate of _____at room temperature and ____ at refrigerator temperature (4 C)

7 mg/dL/hr - Room Temperature 2 mg/dL/hr - Ref Temp (4 C)

Glucose CSF is ____ % of plasma glucose

60-70 %

Normally, glucose should return near or within normal range after ____ after carbohydrate load.Blood glucose of healthy individuals should return in?

2 hours

Standard screening test for glucose test

Fasting Plasma Glucose

Used for long term monitoring glucose control (2-3 months or 2-4 months or 8-16 weeks (reflecting the lifespan of RBCs) )

HBa1c or Glycosylated hemoglobin or Ketoamine

For every 1 % increase in HBa1c, there is a _____ change in plasma glucose

35 mg/dL

Ideal value or HBa1c is ____.

< 7 %

Used for short term monitoring of glucose control (3-6 weeks or 19 days (reflecting the lifespan of albumin) )

Fructosamine or Glycated albumin

Reduction methods are ______ higher than enzymatic techniques

5-15 mg/dL

Most specific for beta-D glucose

Glucose oxidase

Most specific, reference method

Hexokinase

Used to measure the amount of glucose present in the sample; glucose is converted into ____ and ____, followed by subsequent reaction wherein H202 is used to oxidized dye creating a ____ tautomer measured at ____ nm

Peroxidase Test (Trinder Method); gluconic acid and H2O2, RED; 540 nm

Color produced in GOD-POD method?

Red

Most common glycogen storage disease, described by the deficiency of Glucose-6-phosphate

Von Gierke’s Disease

Lacks glycogen synthase

Type 0 GSD

It used to establish fasting hypoglycemia and insulin hypersecretion syndrome; administered as ______ over two minutes

Tolbutamide Tolerance test; IV bolus

Are important for body function and serve as precursors of steroid hormones, cell membrane structure, fuel and energy storage

Lipids

Steroid hormones are derived from

Non-glyceride

Building blocks of lipids

Fatty acids

Serves as the main storage form of lipid in man

Triglycerides

Unsaturated steroid hormone alcohol containing 4 rings with single side chain tail, and not catabolized by most cells

Cholesterol

Total Cholesterol Desirable: Borderline: High:

Cholesterol Desirable: <200 mg/dL Borderline: 200-240 mg/dL High: >240 mg/dL

Recommended cut-off for Serum Cholesterol Ages 2-19 y/o Moderate: High:

Ages 2-19 y/o Moderate: >170 mg/dL High: >185 mg/dL

Recommended cut-off for Serum Cholesterol Ages 20-29 y/o Moderate: High:

Ages 20-29 y/o Moderate: > 200 mg/dL High: > 220 mg/dL

Recommended cut-off for Serum Cholesterol Ages 30-39 y/o Moderate: High:

Ages 30-39 y/o Moderate: > 220 mg/dL High: > 240 g/dL

Recommended cut-off for Serum Cholesterol Ages 40 and above Moderate: High:

Ages 40 and above Moderate: > 240 mg/dL High: > 260 mg/dL

Composed of 3 molecules of fatty acids and one mole of glycerol connected by ______ bond

Triglyceride; ester bond

Triglycerides Normal: Borderline high: High: Very high:

Triglycerides Normal: < 150 mg/dL Borderline high: 150 - 199 mg/dL High: 200 - 499 mg/dL Very high: > 500 mg/dL

Old reference method for measurement of Triglycerides

Van Handel & Zilversmith

New reference method for Triglycrides

GC-MS

A patient sample is assayed for fasting triglycerides and a triglyceride value of 1036 mg/dL. This value is of immediate concern because of its association with which of the following conditions?

Pancreatitis

They are large macromolecules that transport triglyceride and cholesterol to the sites of energy storage and utilization

Lipoproteins

Largest, lightest, and least dense; causes nonfasting turbidity; apolipoprotein B48

Chylomicrons

Also known as pre-beta lipoprotein, causes sting turbidity; apolipoprotein B100

VLDL

Also known as beta lipoprotein / bad cholesterol; is directly proportional to the risk of atherosclerosis and CHD; apolipoprotein B100

LDL

Deficiency or lack of LDL causes ___.

Abetalipoproteinemia or Bassen-Kornzweig syndrome

Also known as alpha lipoprotein / good cholesterol; most anodal lipoprotein; apolipoprotein A1

HDL

Deficiency of HDL causes ____.

Tangier’s disease

Reference method for lipoprotein tests; based on he density of lipoproteins

Ultracentrifugation

For standing plasma test, sample is stored at ____ for _____.

Stored at 4 C for 24 hours

Chylomicron is seen as _______ ,while VLDL causes the sample to be _____.

Chylomicron is seen as floating creamy layer ,while VLDL causes the sample to be turbid

Friedwald formula if mmol/L and if mg/dL

LDL = TC - HDL - (TAG / 2.175) if mmol/L LDL = TC - DL - (TAG / 5) if mg/dL

Lipid profile fasting hours ; and lipid profile / panel

10-12 hours; HDL, TC, LDL, TAG

Require fasting samples among the lipid profile or panel

LDL and TAG

Require non-fasting samples among the lipid profile or panel

HDL and TC

Lipoprotein assay required or preferred sample

EDTA plasma

LDL values Optimal: Near or above optimal: Borderline: High: Very high:

LDL values Optimal: < 100 mg/dL Near or above optimal: 100 - 129 mg/dL Borderline: 130 - 159 mg/dL High: 160 - 189 mg/dL Very high: > 190 mg/dL

HDL values Cut-off level: High risk: Low risk:

HDL values Cut-off level: 40 mg/dL High risk: < 35 mg/dL Low risk: > 60 mg/dL

Fredrickson Classification of Lipid Disorders Type 1 Hyperchylomicronemia; Familial LPL

High TAG ; High CM

Fredrickson Classification of Lipid Disorders Type IIa Familial Hypercholesterolemia

High Cholesterol ; High LDL

Fredrickson Classification of Lipid Disorders Type IIb Familial Combined Hyperlipidemia

Only CM is Normal; the rest is High

Fredrickson Classification of Lipid Disorders Type III Familial Dysbetalipoproteinemia

High TAG, High Chole, High VLDL

Fredrickson Classification of Lipid Disorders Type IV Familial Hypertriglyceridemia

High TAG; High VLDL

Fredrickson Classification of Lipid Disorders Type V

Only LDL is Normal; the rest is High

These are macromolecules composed of various amino acids and are connected by ______ bonds

Proteins; Peptide bonds

Most proteins are produces by the ______, with the exception of immunoglobulins which are produced by _____.

Liver; Plasma cells

Negative acute phase reactant, also known as transthyretin, marker for poor nutritional status or malnutrition, and transport T4 and retinol; migrates ahead of albumin

Prealbumin

Negative acute phase reactant, maintains oncotic pressure, highest protein concentration; lowest level seen in nephrotic syndrome

Albumin

Neutralizes trypsin-like enzymes(neutrophil elastase) deficiency will lead to emphysema

Alpha 1-antitrypsin

Produced by fetal liver; increased in hepatoma ,testicular cancer, neural tube defects (spina bifida), presence of twins; decreased in trisomy 21 or down syndrome

Alpha 1-Fetoprotein

Also known as orosomucoid; useful for neonatal immune system

Alpha 1 Acid Glycoprotein

Associated with Alzheimer’s disease

Alpha 1-antichymotrypsin

Increase affinity with vitamin D and actin

Group specific globulin

Inhibits proteases such as trypsin, pepsin, plasmin; largest major non-immunoglobulin protein in plasma

Alpha 2-macroglobulin

Binds hemoglobin, and prevents loss of hemoglobin and iron in urine during intravascular hemolysis

Haptoglobin

Binds and transports copper in the body, has peroxidase activity; deficiency would lead to ______ disease.

Ceruloplasmin; Wilson’s disease

Binds heme and indicator of intravascular hemolysis

Hemopexin

Negative acute phase reactant, also known as siderophilin; transport iron to its storage sites

Transferrin

Found on the surface of all nucleic cells; needed for antigen presentation

Beta 2-microglobulin

Reacts to C-polysaccharide of Pnemococcus; serves as a marker of coronary artery disease and acute inflammation

CRP

Produced in plasma cells and acts in humoral immunity

Immunoglobulin

Transports and stores oxygen from hemoglobin to contractile cells; the first protein to increase in Myocardial Infarction and a nephrotoxic protein

Myoglobin

Three proteins that bind the thin filaments of cardiac muscle; most important marker and gold standard for diagnosis of Acute Myocardial Infarction (AMI)

Troponin

Most specific for AMI

Troponin I

Cardiac marker and is diagnostic to CHD

B type natriuretic peptide

Biochemical marker of bone resorption

Cross linked C-telopeptide

Used to predict short term risk of premature delivery

Fetal fibronectin

Used as a marker for bacterial infection

Procalcitonin

Marker for CSF leakage

B trace protein

Electrophoretic Pattern

Albumin Alpha 1 Alpha 2 Beta Gamma

Sample of choice for electrophoretic pattern

Serum

Alpha 2 band spike; Increase Alpha 2; decrease Alpha 1, beta , gamma, and albumin

Nephrotic Syndrome

Increase IgA; beta-gamma bridging effect, decrease alpha 1 ,alpha 2 and albumin

Liver Cirrhosis

Alpha 1 flat curve; decrease or deficiency of alpha 1-antitrypsin

Emphysema

Gamma spike; monoclonal spike; bence jones protein

Multiple myeloma

Polyclonal gammopathy; All increased, increase A1, A2, gamma; Diffused increase

Chronic Inflammation

Decreased albumin, All increased; increase A1, A2

Acute Inflammation

Small spikes in beta region

IDA

Narrow / extra band in beta region

Use of plasma instead of serum

Unusual band between A2 and beta region

Hemolyzed Sample

Reference method for protein determination, based on the measurement of the ______ content of proteins; utilized ____ as reagent, and measures _______ (end product)

Kjedahl Method; nitrogen content; H2O2; ammonia

Most widely used method for protein determination ,based on _____ ions forming a complex with substances connected by peptide bonds forming ______ color.

Biuret; cupric ions; violet

Protein determination method with highest analytical sensitivity ,based on the oxidation of ________ to give ____ color

Folin-ciocalteu/Lowry Method; phenolic compounds; deep blue

Major end product of protein catabolism

Blood Urea Nitrogen

Urea = BUN x ______

2.14

A condition with elevated concentration of nitrogenous substances like BUN and Creatinine in blood

Azotemia

A syndrome with marked elevation of urea, acidemia, electrolyte imbalance, and renal failure

Uremia or Uremic Syndrome

End product of muscle metabolism derived from Creatine; not affected by diet but directly proportional with mass or skeletal muscle

Creatinine

Synthesized primarily in the liver from amino acid; glycine, arginine and methionine

Creatine

Provides an estimate of the amount of plasma that must flow through kidney glomerular per minute; it is a test for _______________. ______is used to convert 24 hrs to minutes and serves as constant. _____ represents the average body surface.

Creatinine clearance; glomerular filtration rate; 1440; 1.73

The final breakdown of purine catabolism

Uric Acid

Product of amino acid deamination; increase in cirrhosis, Reye’s syndrome, acetaminophen poisoning and chronic renal disease

Ammonia

BUN Normal Value and Reference method

6-20 mg/dL ; IDMS (Isotope Dilution Mass Spectrometry)

Creatinine Normal Value and Reference method

Male - 0.9 - 1.3 mg/dL Female- 0.6 - 1.1 mg/dL ; IDMS

Uric Acid Normal Value and Reference Method

Male - 3.5 - 7. 2 mg/dL Female - 2.6 - 6.0 mg/dL ; IDMS

Liver function test: Synthetic function

Total protein, prothrombin time, albumin level and A/G ratio

Conjugation and Excretion Test

Bilirubin, bromsulphthalein dye excretion test

Detoxification function

Ammonia and Liver enzyme test

This assay is based on Van den Berg reaction where there is diazotization of bilirubin forming _____.

Bilirubin; azobilirubin

Used as accelerator in Evelyn -Malloy method; color of the end product

Methanol; pink to purple

Most commonly used method for bilirubin assay; _____ accelerator used ; ____ color end product

Jendrassik-Grof Method; caffeine sodium benzoate; blue to violet

Also known as Bilirubin 1, B1, Pre-hepatic bilirubin, unconjugated bilirubin, hemobilirubin Water insoluble, indirect reacting, slow reacting

Indirect Bilirubin

Also known as Bilirubin 2, B2,Post-hepatic/Hepatic/Obstructive/Regurgitive Bilirubin Water soluble, direct reacting, prompt/one minute

Direct Bilirubin

Enzyme-Organ Associations Heart

“CASL” CK-MB AST LD1>LD2

Enzyme-Organ Associations Liver Hepatocellular disorder: Biliary tract obstruction:

Hepatocellular disorder: “ASAL” AST ALT LD5 Biliary tract obstruction: “ALaGAT” ALP GGT

Enzyme-Organ Associations Skeletal Muscle

“CALA” CK-MM AST LD Aldolase

Enzyme-Organ Associations Bone

ALP

Enzyme-Organ Associations Pancreas

Amylase Lipase

Enzyme-Organ Associations Brain

CK-BB

Enzyme-Organ Associations Prostate

ACP

Enzymes are expressed as _______ .

SI unit or KU (mols)

Enzymes with high specificity

ACP ALT GGT Amylase Lipase

Enzymes with moderate specificity

AST ALP CK

Enzyme with low specificity

LDH

These are normally resent in plasma at higher concentrations than in most tissues and typically produced by liver and constantly liberated into the plasma to maintain a steady-state concentration

Plasma Enzymes

Disease associated with high levels of enzyme LD

Megaloblastic or Pernicious anemia

Disease associated with high levels of enzyme CK

Duchennne Muscular Dystrophy

Disease associated with high levels of enzyme ALP

Paget’s Disease or Osteitis Deformans

It is an enzyme that catalyzes the interconversion of lactic acid and pyruvic acid using the coenzyme NAD+. The reaction can proceed in either a _________ (lactate to pyruvate) or ________ (pyruvate to lactate) direction

Lactate dehydrogenase; forward ; reverse

This reaction preferred if LD1 is being measured, more specific but slower; optimal pH is ______

Forward Reaction; 8.3 - 8.9

This reaction is three times faster, requires smaller sample and shorter reaction times but susceptible to substrate exhaustion and loss of linearity; optimal pH is ______.

Reverse Reaction; 7.1 - 7.4

Isoenzyme most abundant in cardiac muscle and RBCs

LD 1 ( HHHH )

Isoenzyme most abundant in serum of healthy individual

LD 2 ( HHHM )

Isoenzyme seen in organs lungs, kidney, pancreas, spleen, adrenal, platelets

LD 3 ( HHMM )

Isoenzyme seen in skeletal muscle and liver

LD 4 ( HMMM )

Isoenzyme most abundant in skeletal muscle and liver

LD 5 ( MMMM )

Isoenzyme also known as alcohol dehydrogenase

LD 6

Isoenzyme seen in spermatozoa

LD-c ( CCCC )

It is a hydrolase that catalyzes the hydrolysis of phosphomonoesters at an alkaline pH

ALP ( Alkaline phosphatase )

Elevations of ALP are of most diagnostic significance in the evaluation of ________ and ________ disorders.

Hepatobiliary and bone disorders

Buffer utilized by Bessy-Lowry-Brock method

Glycine

Buffer utilized by Bowers-McComb method

2-amino-2-methyl-1-propanol or diethanolamine

Substrate utilized by Bessy-Lowry-Brock method and Bowers McComb method

p-nitro-phenylphostate

Also known as SGOT

Aspartate aminotransferase

Also known as SGPT

Alanine aminotransfearse

An enzyme that catalyze the transfer of amino group between aspartate and a-keto acid with the subsequent formation of oxaloacetate and glutamate

AST / SGOT

A method utilized to measure the activity of AST; which incorporates a coupled enzymatic reaction sing ___________ as the indicator reaction and monitors the change in absorbance at 340 nm continuously as NADH is oxidized to NAD

Karmen Method; MD ( malate dehydrogenase )

A hydrolase that catalyzes the breakdown of starch and glycogen ; it is the smallest enzyme d readily filtered by the renal glomerulus ; _______ and _______ acts as enzyme cofactors

Amylase; Calcium and Chloride

Also known as butyrylcholinesterase / acetylcholine thyldrolase, it is used as a marker of pesticide / organophospahte poisoning when decreased

Pseudocholinesterase

An enzyme marker for skeletal muscle injury

Aldolase

Gastric proteolytic enzyme which cleaved ingested proteins, it is produced by the pancreas and is more specific marker for acute pancreatitis than amylase

Trypsin

In AMI, what is the first marker to elavate

Myoglobin

In AMI, what is the first enzyme to elavate

CK-MB

Electrolytes that functions in volume and osmotic regulation

Sodium, potassium, chloride

Electrolytes that functions in myocardial rhythm and contractility, euromuscular excitability

Potassium, calcium, magnesium

Electrolytes that functions in production and use of ATP from glucose

Magnesium, phosphate

Electrolytes that functions in blood coagulation

calcium, magnesium

Electrolytes that functions in acid-base balance

Bicarbonate, potassium, chloride

Electrolyte that functions in he regulation of ATPase ion pumps

Magnesium

Electrolytes that serves as cofactors in enzyme activation

Magnesium, zinc, calcium

_______ is a threshold substance, meaning that no sodium will be excreted in the urine until the renal threshold (120 mmol/L) is exceeded. ____ is not a threshold substance and will be secreted by the tubules even when plasma potassium levels are low.

Sodium; Potassium

Major extracellular cation

Sodium

Determines the osmolality of the plasma, and maintaining osmotic pressure

Sodium

When serum/plasma sodium is <135 mmol/L

Hyponatremia

When serum/plasma sodium is >145 mmol/L

Hypernatremia

Major intracellular cation

Potassium

It is the plasma electrolyte that has the narrowest reference range and is most strictly regulated by the body

Potassium

When serum/plasma potassium > 5 mmoml/L

Hyperkalemia

How many percent of calcium are found in the bone and how many percent are found in the ECF and soft tissues?

99 % in the bone and 1 % in ECF and soft tissues

Associated with hypercalcemia

“CHIMPSA” Cancer Hyperthyroidism Iatrogenic Multiple myeloma Hyperparathyroidism Sarcoidosis Acidosis

Associated with hypocalcemia

“CHARD” Calcitonin Hypoparathyroidism Alkalosis Renal Failure Vit D deficiency

Specimen for electrolyte analysis

Heparinized

It is the difference between unmeasured anions and cations, also serve as form of quantity control for the analyzer used to measure these electrolytes

Anion Gap

AG = Na - (Cl + HCO3) : _____ AG = (Na + K) - (Cl + HCO3) : _______

7 - 16 mmol/L 10 - 20 mmol/L

Decrease anion gap can be seen in cases of

Hypoalbuminemia Hypercalcemia Multiple Myeloma Instrument error

Increase anion gap can be seen in :

“MUDPHILES” Methanol poisoning Uremia Diabetic acidosis Paraldehyde ingestion Hypernatremia Isoniazid / Iron poisoning Lactic acidosis Ethylene glycol / ethanol poisoning Salicylate poisoning

A physical property f a solution that is based on the concentration of solutes (expressed as millimoles) per kilogram of solvent

Osmolality

Sample of choice for measuring osmolality

Serum and urine

Concentration of osmotically active particles in solution reported in millimoles per liter; not routinely used

Osmolarity

Expressed as moles of solute per liter of solution

Molarity

Hormones produced by the hypothalamus

“TGCGSPP” Thyrotropin-Releasing Hormone Gonadotropin-Releasing Hormone Corticotropin-Releasing Hormone Growth Hormone, RH Somatostatin Prolactin Releasing Hormone Prolactin Inhibiting Hormone

Hormones produced by the Anterior Pituitary / Adenohypophysis

TSH / Thyroid Stimulating Hormone FSH / Follicle Stimulating Hormone Luteinizing Hormone Prolactin Growth Hormone / Somatotropin ACTH

Hormones in the Posterior Pituitary

Oxytocin ADH (Antidiuretic Hormone) / Vasopressin

Hormone in Pineal Gland

Melatonin

Hormones in the Thyroid Gland

Thyroxine and Triiodothyronine (T3 T4) Calcitonin

Hormone in the Parathyroid Gland

Parathyroid Hormone

Hormones in the Adrenal

“ACDNE” Aldosterone Cortisol DHEA (dehydroepiandrosterone) Norepnephrine Epinephrine

Hormone in the Kidney

Renin

Hormone that stimulate TSH and Prolactin release

Thyrotropin Releasing Hormone

Hormone that inhibit release of GH ,TSH , insulin, and glucagon

Somatostatin

Hormone that stimulates growth of follicles with LH, and stimulates spermatogenesis

Follicle Stimulating Hormone

Stimulates follicle maturation, ovulation and production of testosterone, estrogen and progesterone

Luteinizing Hormone

Hormone for initiation and maintenance of lactation, inhibited by dopamine

Prolactin

Hormone for water and salt balance

Aldosterone

Hormone for metabolism of carbohydrates

Cortisol

Convert angiotensinogen o angiotensin I, and acts both n enzyme and hormone

Renin

It is found in the lower anterior neck and shaped like a butterfly

Thyroid Gland

Thyroid cells are organized into ____ which are spheres of thyroid cells surrounding a core f a viscous substance termed _____, also it is the center of thyroid hormone production

Follicles; Colloid

It is critical in regulating body metabolism, production of proteins, neurologic development, brain maturation of fetus and numerous other body functions

Thyroid Hormone

Is most abundant, approximately 80% of thyroid hormone

Thyroxine (T4)

Mostly derived from deiodination of T4 but 3–8 times more active than T4

Triiodothyronine (T3)

Secreted by parafollicular C cells and is involved in calcium homeostasis

Calcitonin

Transport majority of T3 and 70-75 % of T4

Thyroxine Binding Globulin (TBG)

Transport T3 and 10% T4

Albumin

Transport 15-20 % of T4 but no affinity to T3, also transports retinol / vitamin A

Pre-albumin / Transthyretin

0.04 % T4 and 0.4 % T3 are _____

Unbound

Thyroid panel is composed of:

TSH (main test), FT4, FT3, or Total T3

It is primarily dependent on the specificity of the antibody used and the absence of antithyroglobulin autoantibodies

Thyroglobulin assay

Helps regulate water, electrolyte balance, and blood pressure, and also important in reabsorption of sodium (Na)

Mineralocorticoids (Aldosterone)

This leads to increased sodium (hypernatremia), and water reabsorption > increase of blood volume > hypertension. Also stimulates tassium secretion (in exchange of Na in PCT) > hypokalemia. Lastly it results in secretion f H (in exchange of Na in DCT) leading to alkalosis

Hyperaldosteronism

Disease associated with hyperaldosteronism

Conn’s disease

It is due to bilateral ; adrenal hyperplasia or adreanl adenoma

Primary Hyperaldosteronism

Activation of RAAS

Secondary hyperaldosteronism

It stimulates gluconeogenesis in the liver resulting in increased blood glucose level

Glucocorticoids (Cortisol)

Syndrome associated with hypercortisolism

Cushing’s syndrome

Syndrome associated with hypercortisolism

Addison’s Syndrome

Naturally synthesized estrogen are carbon-18 compounds

Estrogen

Metabolite of estradiol, most abundant in post-menopausal women

Estrone

Most potent and most abundant in pre-menopausal women, also produced by males

Estrogen

Metabolite of estradiol, seen in pregnant women

Estriol

A tumor in adrenal medulla

Pheochromocytoma

Best test r diagnosing pheochromocytoma is measurement of ________ and______ in a 24 hr collection

Fractionated metanephrines and catecholamines

The most sensitive screening profile for pheochromocytoma

Measuring both total plasma catecholamines and urine metanephrines

The most specific and sensitive diagnostic test for pheochromocytoma

Plasma metanephrines measured by HPLC

Has the highest false negative e (up to 41% ) of the urine catecholamine tests

Urine VMA by HPLC or Fluorometric assay

Screening test for Cushing’s syndrome

24 hr urinary free cortisol test, overnight dexamethasone suppression test (most widely used), midnight salivary cortisol test

Confirmatory test for Cushing’s syndrome

Low dose dexamethasone suppression test, midnight plasma cortisol, corticotropin releasing hormone stimulation test

Test for Cushing’s disease

High dose dexamethasone (suppress if CD)

Normal value for pH

7.35 - 7.45

Normal value of pCO2

35 - 45

Normal value of pO2

80 - 100

Normal value of HCO3

22 - 26 mmol/L

Normal value of H2CO3

1.05 - 1.035 mmol/L

Normal value f Total CO2

23 - 27 mmol/L

Normal value of O2 sat

> = 95 %

It is an important buffer system of the body

Bicarbonate-Carbonic Acid System

The ratio of bicarbonate-carbonic acid is ____

20:1

It is the driving force of the bicarbonate-carbonic id system

Carbon dioxide

Increase in CO2 concentration, from cellular metabolism , will shift the equilibrium to the _______ forming more bicarbonate and hydrogen ions

Right

Causes of Metabolic alkalosis

Vomiting

Compensation f Metabolic alkalosis

Hypoventilation

Causes of Metabolic acidosis

Diabetic ketoacidosis Lactic acidosis Renal failure Diarrhea Inorganic acids

Compensation of Metabolic acidosis

Hyperventilation

Causes of Respiratory alkalosis

Anxiety Severe pain Aspirin / Salicylate overdose

Compensation of Respiratory alkalosis

HCO3 is excreted

Causes of Respiratory acidosis

COPD MG Drug overdose Botulism Stroke Myxedema Pneumonia

Compensation of Respiratory acidosis

Kidney retain HCO3

The most important factor affecting blood gasses and pH measurement

Temperature

pH decreases by _______, pO2 will fall by ______ and pCO2 will rise by _____ each Celsius above 37 C

Ph decreases by 0.015, pO2 will fall by 7 % and pCO2 will ise by 3 % each Celcius above 37 C

Specimen of choice for blood gas analysis

Arterial Blood collected on syringe with 0.05 mL/mL dried heparin as anticoagulant

Confirmatory testing for drug testing

GC - MS

Gas chromatography is for ________ while mass spectrometry is for _______.,

Quantitation ; Identification

Standard screening test for drug analysis

TLC

In screening or the presence of cocaine, _______ is measured.

Benzoylecgonine

Most common drug of abuse

Alcohol

It is acquired by ingestion which occurs mainly in children less than 6 years old, inhalation, and occasionally skin contact

Lead poisoning / Plumbism

CDC cut off level for children is

< 10 ug / L

Toxic blood level

> 70 ug / dL

An environmental pollutant which can be highly toxic to humans affecting several organ system. It is an industrial by product especially by manufacturing, smelting, chlorine bleaching and incineration

Dioxins or also known as 2,3,7,8 - tetrachlorodibenzo-p-dioxin

Clinical Chemistry: Final Coaching by Sir Steven Joseph Gambito Flashcards

(376 cards)