Clinical Chemistry (part 3) Flashcards
(572 cards)
1
Q
EC numerical code for ALP
A
3.1.3.1
2
Q
Catalyze the hydrolysis of various phosphomonoesters at an alkaline pH (9.0 – 10.0) into alcohol and phosphate
A
ALP
3
Q
ALP requires __ as an activator
A
Magnesium
4
Q
Tissues sources of ALP
A
Liver, small intestine, kidney, bone, placenta
5
Q
Diet may induce elevation in ALP activity of blood groups __ and __ individuals who are secretors
A
B and O
6
Q
Not usually tackled ALP isoenzyme, but lectin may be used in electrophoresis to resolve it
A
Kidney ALP
7
Q
Origin of ALP isoforms: genetic loci
Chromosome 1:
Chromosome 2:
A
Chromosome 1: Kidney, Liver, Bone
Chromosome 2: Intestinal, Placental
8
Q
A
9
Q
Normal ALP isoenzymes
A
Intestinal, placental, bone, liver
10
Q
3 abnormal ALP isoenzymes (carcinoplacental ALPs)
A
Regan, Nagao, Kasahara
11
Q
Abnormal ALP isoenzyme with the highest incidences is found in ovarian and gynecological cancers
A
Regan ALP
12
Q
Abnormal ALP isoenzyme observed in pleural cancer and pancreatic and bile duct carcinomas
A
Nagao ALP
13
Q
Abnormal ALP isoenzyme observed in hepatoma and GIT tumors
A
Kasahara ALP
14
Q
Regan ALP is found in (4 carcinomas)
A
Lung cancer
Breast cancer
Ovarian cancer and gynecological
Colon cancer
15
Q
Most heat-stable (including normal and abnormal ALP); Resist heat up to 60 deg C for 30 minutes
A
Regan ALP
16
Q
Variant of Regan;
Found in metastatic carcinoma of pleural surfaces
A
Nagao
17
Q
Most anodal ALP isoenzyme
A
Liver ALP
18
Q
Least anodal ALP isoenzyme
A
Intestinal
19
Q
Electrophoretic mobility of ALP isoenzymes towards the anode
A
Intestinal > Placental > Bone > Liver
20
Q
3 methods to use to improve separation of bone and liver forms
A
- Neuraminidase
- Wheat germ lectin
- High resolution electrophoresis
21
Q
Removes sialic acid
A
Neuraminidase
22
Q
Bind other isoenzymes
A
Wheat germ lectin
23
Q
Uses polyacrylamide gel and isoelectric focusing to remove multiple bands of ALP isoenzymes
A
High resolution electrophoresis
24
Q
Heat stability is determined by heating serum at __
A
56 deg C for 10-15 minutes
25
Heat stability of ALP isoenzymes
Placental > Intestinal > Liver > Bone
26
Most heat-labile isoenzyme
Bone ALP
27
Most heat-stable of all normal ALP isoenzyme
Placental ALP
28
Regan ALP can resist heat up to ___
60 deg C for 30 minutes
29
After heat denaturation,
80% activity remains in: ___
20% activity remains in: ___
Placental
Bone
30
Inhibits placental, intestinal, Regan, and Nagao
L-phenylalanine
31
Inhibits liver and bone isoenzymes
Levamisol, L-homoarginine
32
Inhibits bone isoenzymes
2M urea
33
Inhibits Nagao isoenzyme
L-leucine
34
Denatures liver ALP rapidly than bone
20% ethanol
35
Enzyme often used in the evaluation of hepatobiliary disorders (obstructive conditions) and bone disorders
ALP
36
Highest elevation of Alp (5-10x ULN) is attributed to either __ or ___
Liver ALP or bone ALP
37
Biliary tract obstruction, biliary cirrhosis (type of ALP isoenzyme)
Liver ALP
38
Paget’s disease (Osteitis deformans), osteogenic sarcoma, hyperparathyroidism (type of ALP isoenzyme)
Bone ALP
39
Moderate ( up to 3x ULN) elevation of ALP is seen in:
Hepatocellular disorders – viral hepatitis and liver cirrhosis
40
ALP is elevated during pregnancy (3rd trimester until onset of labor) and normalizes after ___ of labor
6 days
41
ALP up to 3x ULN
Healing fractures and normal growth (children)
42
Decreased level of what enzyme is found in inherited condition of hypophosphatasia
ALP
43
Avoid hemolysis, ___ is 6 times more concentrated in RBCs than in serum
ALP
44
Run ALP asssays ASAP; ALP activity in serum increases __ at room temperature or refrigerated for several hours
3 – 10%
45
ALP values may be ___ higher following ingestion of a high-fat meal due to increase intestinal fraction
25%
46
Plasma should not be used - __, ___, ___ inhibit ALP activity
Citrate, oxalate, EDTA
47
Method of ALP determination
Bowers and Mc Comb
48
IFCC recommended method for ALP determination Szasz modification
Most specific method
Bowers and Mc Comb
49
Substrate used in the Bowers and Mc Comb of ALP determination
p-nitrophenyl phosphate
50
ALP isoenzyme found in extrahepatic biliary obstruction and intrahepatic cholestasis
Liver ALP
51
Optimum pH in Bowers and Mc Comb method for ALP determination
pH 10.5 at 30 deg C
52
Increased p-nitrophenol production is directly proportional to the activity of ALP in the sample; measured at ___
405 nm (yellow colored complex)
53
___ buffer is added to bind phosphorus in the sample (phosphorus inhibits ALP activity)
2-amino-2-methyl-1-propanol
54
Substrate and endproducts in Bessey, Lowry, Brock method of ALP determination
S: p-nitrophenyl phosphate
P: p-nitrophenol or yellow nitrophenoxide ion
“Bakit nahuli ng PNPP ang Bessey ko na nagnanakaw ng ALPo”
55
Substrate and endproducts in Huggins and Talalay (ALP determination)
S: Phenophthalein diphosphate
P: Phenolphthalein red
56
Substrate and endproducts in Moss (ALP determination)
S: Alpha naphthol phosphate
P: Alpha-naphthol
57
Substrate and endproducts in Klein, Babson, and Read (ALP determination)
S: Buffered phenolphthalein phosphate
P: Free phenolphthalein
58
Substrate and endproducts in Bodansky, Shinowara, Jones, Reinhart (ALP determination)
S: Beta-glycerophosphate
P: Inorganis phosphate + glycerol
59
Substrate and endproducts in King and Armstrong
S: Phenyl phosphate
P: Phenol
60
Gamma Glutamyl Transferase EC numerical code
2.3.2.2
61
Tissue sources of GGT
Kidneys, liver, prostate, pancreas
62
GGT present in the serum is predominantly derived from the __ tissue where it is concentrated in the lining of biliary ductules
Liver
63
Highest concentration of ALP and GGT
Biliary obstruction
64
In Myocardial infarction, the level of GGT is __
Normal
65
GGT in AMI
Occurs at 4th day
Peaks for another 4 days
66
If GGT is increased in MI, liver damage is secondary to __
Cardiac insufficiency
67
GGT is a sensitive indicator of hepatobilary disorders (biliary obstruction) ___ x ULN
5-30
68
69
Used to differentiate the source of ALP elevation
GGT
70
GGT is affected by enzyme-inducing drugs
Warfarin, phenobarbital, and phenytoin
71
GGT is slightly elevated in patients with ___
Diabetes mellitus
72
Hemolysis will not interfere with GGT
True
73
Preferred specimen for GGT
Serum
74
Anticoagulants that inhibit GGT activity
Citrate, oxalate, fluoride
75
Anticoagulant that causes turbidity in GGT determination
Heparin
76
GGT is stable with no loss of activity for ___ at ___
1 week at 4 deg C
77
Methodologies for GGT determination (3)
Szasz and Rosalki
Persijn and Van der Silk method
Goldberg method
78
IFCC recommended method for GGT determination
Optimum pH: 8.2
Subtrate: gamma-L-glutamyl-p-nitroanilide
Product: p-anilide (405-420 nm)
Szasz and Rosalki
79
Aka 5'-ribonucleotide phosphohydrolase
5' nucleotidase
80
a metalloprotein with zinc as its integral component
5' nucleotidase
81
More sensitive to metastatic liver disease than ALP
5' nucleotidase
82
levels of 5' NT after abdominal surgery
Increased
83
Similar to GGT, ___ is commonly used to determine the source of ALP elevation
5' NT
84
Highest elevation of 5'NT is observed in ____
hepatobiliary disorders
85
Increased ALP, Normal GGT, Normal 5'NT
Pregnancy
86
Increased ALP, Increased GGT, Increased 5'NT
Hepatobiliary disorders
87
Increased ALP, Normal GGT, Normal 5'NT
Bone disorders
88
2 enzymes that can be used to estimate the degree r severity of liver cell damage
AST and GLD
89
___ elevation is observed in patients with hepatocellular disorder since GLD is a mitochondrial enzyme
GLD
90
4-5 x ULN in GLD:
Chronic hepatitis
91
2 x ULN in GLD:
liver cirrhosis
92
pronounced elevation of GLD is seen in ___
Halothane toxicity
93
Potential hepatotoxic drugs can lead to notable rise in ___ level
GLD
94
Type of GST with the highest concentration in the liver
Alpha
95
Evenly distributed in the liver acinus making it useful in determining all types of hepatocyte damage
GST
96
___ was found more valuable than AST in detecting early rejection episodes after liver transplant procedure
GST
97
True cholinesterase/ choline esterase I
Acetyl choline esterase
98
True cholinesterase is found in ___
RBCs
99
Enzyme that inhibits neurotransmission, and detection of neural tube defects
Acetyl choline esterase
100
Pseudocholinesterase
Serum cholinesterase/ butyryl cholinesterase
101
Only enzyme that decreased during infection or disease states
Pseudocholinesterase
102
Sensitive indicator of liver synthetic capacity
Pseudocholinesterase
103
In hepatitis, pseudocholinesterase is decreased by how many percent?
30 - 50%
104
In metastatic carcinoma and cirrhosis, pseudocholinesterase is decreased by how many percent?
50 -70%
105
Maker of organophosphate poisoning
Pseudocholinesterase
106
In surgical procedures, muslce relaxants are used. ___ is normally present to hydrolyze them
cholinesterase
107
EC numerical code of glycogen phoshorylase
Glycogen phosphorylase
108
Other names of glycogen phosphorylase
1,4-alpha-D-glucan (orthophosphate)
alpha-D-glucosyltransferase
109
3 isoenzymes of glycogen phosphorylase
GP-LL
GP-MM
GP-BB
110
GP found in liver and all other human tissues, except the heart, smooth muscle, and brain
GP-LL
111
GP found in adult skeletal muscle
GP-MM
112
GP found in human brain
GP-BB
113
EC numerical code of creatinine kinase
2.7.3.2
114
Catalyzes the transfer of phosphate to creatine
Creatinine kinase
115
Creatine + ATP --> creatinine phosphate +
ADP
116
Creatinine kinase requires __ and ___
Magnesium and thiol source (cysteine)
117
CK is inhibited by ___ and ___
Zinc and manganese
(excess magnesium can also inhibit CK)
118
CK is highly seen in what tissue source
striated muscle and heart muscle
119
__ and __ are devoid of CK actiivty
Erythrocytes and Liver
120
B subunit of CK is found in chromosome
14
121
M subunit of CK is found in chromosome
19
122
___ is responsible for rephosphorylation of ADP to ATP at pH 6.7 or pH 9.0
CK
123
It activates CK but present in minimal concentration because it is inhibitory
Magnesium
124
other sulfhydryl-binding reagent sulfhydryl compounds
1. N-acetyl cysteine
2. Dithiothreitol
3. Glutathione
125
" The brain type " CK
CK-BB
126
"The hybrid type" CK
CK-MB"
127
"The muscle type" CK
CK-MM
128
Tumor associated marker-prostatic carcinoma and other carcinomas
CK-BB
129
CK-BB is ___ (usually within 10 - 50 U/L) in carcinomas
>5 U/L
130
Half-life of CK-BB
2-3 hours
131
CK type that is fastest to move to anode
CK-BB
132
CK type seen in acute myocardial infarction (1st to ride)
CK-MB
133
AMI in CK-MB
Rise within 4-8 hours
Peak at 12-24 hours
Returns to normal within 48-72 hours
134
CK-MB in the serum is derived only in __
myocardium
135
CK-MB that is >6% of the total CK is indicative of ___
myocardial damage
136
Half-life of CK-MB
12 hours
137
CK type seen in myocardial infarction and skeletal muscle disorders
CK-MM
138
Highest elevation of CK is seen in ___
Duchenne's muscular dystrophy
139
Major isoenzyme of CK found in serum
CK-MM
140
Half life of CK-MM
15 hours
141
AMI markers
"MyTROPICAL"
Myoglobin
Troponin I
CK-MB
AST
LDH
142
20% if CK-MB is found in ___
Cardiac tissue
143
CK-MB concentration in healthy serum
<5 ug/L
144
More specific during myocardial damage
Troponins
145
2 atypical forms of CK
CK-MI
Macro-CK
146
Chromosome 15
Constitutes up to 15% of the total CK
CK-MI
147
Largely comprises CK-BB complexed with IgG
Some comprises CK-MM complexed with a lipoprotein
Macro-CK
148
CK is not present in RBCs, but ___, which catalyzes a similar reaction as that of CK is present - False increase in CK
adenylate kinase
149
CK is stored in ___
Dark
(since recent studies show that CK is inactivated by direct light exposure)
150
Removes adenylate kinase
adenosine monophosphate
151
specimen of choice for CK
Serum
(heparinized plasma can be used; other anticoagulants inhibit CK activity)
152
2 methodologies in CK determination
Tanzer-Gilvarg
Oliver-Rosalki
153
ATP + creatine --> ADP + creatine phosphate
ADP formed is reacted with pyruvate kinase and lactate dehydrogenase
PK: ADP + phosphoenol pyruvate --> ATP + pyruvate
LDH: pyruvate + NADH --> lactate and NAD
NADH absorbs light at 340 nm (pH 9.)
Tanzer-Gilvarg method
154
ADP + creatine phosphate --> ATP + creatine
ATP formed from the reaction is reacted with Hexokinase and G6PD
pH: 6.7
Reverse reaction that is 6x faster than forward reaction
Addition of adenosine monophosphate inhibits adenylate kinase
Oliver-Rosalki (reverse reaction)
155
EC Numerical code for Lactate dehydrogenase
1.1.1.27
156
Catalyzes the reversible conversion of lactate and NAD into pyruvate and NADH
Lactate + NAD --> pyruvate + NADH
LDH
157
pH of the forward reaction in LDH determination
8.8 - 9.8
158
pH of the reverse reaction in LDH determination
7.4 - 7.8
159
One of the components of LDH determination methods
Zinc
160
LD-M is found in chromosome
11
161
LD-H is found in chromosome
12
162
Most abundant and most heat-stable LD
LD-2
163
Least anodal and most cold-labile LD (4 deg C loss of activity)
LD-5
164
Normal LD pattern
LD2> LD1 > LD3 > LD4 > LD5
165
Electrophoretic mobility of LD
(least anodal to most anodal)
LD5 - LD4 - LD3 - LD2 - LD1
166
LD isoenzyme present in post-pubertal human testes (not found in human serum but in seminal fluid)
LD-X or LD-C
(XXXX or CCCC)
167
LD observed in arteriosclerotic cardiovascular failure
LD6
168
3 clinical significance of LDH
Hemolytic anemia
Hepatic and non-hepatic metastases
Myocardial infarction
169
LD is ___ x ULN in megaloblastic anemia (pernicious anemia)
50 (highest elevation)
170
LD flipped pattern (LD1 > LD2) is seen in
myocardial infarction
171
AMI in LD
Rises within 12-24 hours
Peaks at 48-72 hours
remains elevated for long periods of time
Returns to normal within 10 days
172
Specimen of choice for LD
Serum
(anticoagulant may inhibit LD activity)
173
LD is present __ times in RBCs than in serum
100 - 150
174
Moderate elevations of LD
Acute viral hepatitis
Cirrhosis
175
Slight elevations of LD is seen in
Biliary tract disease
176
2 methods of LD determination
Wacker (forward reaction)
Wroblewski and La Due (reverse reaction)
177
Measure enzymatic activity as lactate is converted to pyruvate
UV kinetic or colorimetric
Wacker method (LD determination)
178
Measures increase in absorbance at 340 nm as NAD is converted to NADH (LD determination)
Colorimetric method (Wacker)
179
Colorimetric method (Wacker):
Addition of phenazine methosulfate and nitroblue tetrazolium which reacts with NADH to produce a positive ___
blue-purple color
180
Colorimetric method (Wacker):
Addition of p-nitrophenylhydrazine (or 2,4-dinitrophenylhydrazine) which reacts with pyruvate producing phenylhydrazone -- ___ color at alkaline pH measured at 440 or 525 nm
Golden brown
181
Measures enzymatic activity as pyruvate is converted to lactate
Measures the decrease in absorbance at 340 nm as NADH is converted to NAD
3 times faster than forward reaction of LD determination
Wroblewski and La Due (reverse reaction)
182
Catalyzes an early step in glycolysis for glucose
Aldolase
183
Highest level in skeletal muscle disease or injury, metastatic carcinoma of the liver, granulocytic leukemia
Aldolase
184
AMI in Aldolase
Rises 6-8 hours and stay elevated up to 3-4 days
185
RBC alsolase is __ times as high as the serum level
150
186
Specimen of choice of Aldolase determination
Plasma
(because of the possible release of platelet enzyme during clotting
187
3 tetramers of aldolase
ALD A - skeletal muscle
ALD B - WBC, Liver, Kidney
ALD C - Brain tissue
188
Acid orthophosphoric monoester phosphohydrolase
Acid phosphatase
189
factor conversion of ACP
860 - Total ACP
853 - Non-prostatic ACP
190
catalyze the hydrolysis of various phosphomonoesters at an optimal pH of below 7.0 (5.0 - 6.0)
acid phosphatase
191
Highest concentration in prostate and RBCs, mod amounts in bone, platelets, liver, and spleen
ACP
192
Isoenzymes of ACP and their location
Prostatic ACP - Chr 13
Bone ACP - Chr 19 (TRACP)
Lysosomal ACP - Chr 11
Erythrocytic ACP - Chr 2
Macrophage ACP - Chr 19
193
Metastatic carcinoma of the prostate
ACP
194
Enzyme used in the medico legal evaluation of rape (up to 4 days in vaginal washings)
ACP
195
TR-ACP is found in (3 conditions)
Bone diseases
Gaucher's disease
Hairy cell leukemia (leukemic reticuloendotheliosis)
196
ACP is labile at room temperature - acidification of sample is needed (___ is used to achieve a pH of 6.2 to 6.6)
Acetate buffer (20 uL : 1 ml serum)
197
Preferred sample for ACP determination
Plasma
198
Preferred anticoagulant for ACP determination
Citrate
199
Anticoagulant that inhibits ACP
Fluoride
200
Anticoagulant that false decrease ACP
Heparin and oxalate
201
ACP isoenzyme that remains in the origin
Erythrocytic ACP
202
ACP isoenzyme that migrates the fastest
Prostatic ACP
203
Inhibits the activity of the prostatic ACP and Lysosomal ACP
L-tartrate
204
Formula for prostatic ACP
Prostatic ACP = Total ACP - Nonprostatic ACP
205
2% formaldehyde and 1 mM cupric sulfate solutions inhibit the activity of ___
erythrocytic ACP
206
Other methods for total ACP activity
Thymolphthalein monophosphate
Alpha-naphthyl phosphate
207
The substrate of choice for most endpoint reactions of Total ACP activity
Thymolphthalein monophosphate
208
Substrate of choice for most continuous monitoring assays of Total ACP activity
Alpha-naphthyl phosphate
209
6 other methods of ACP determination
Bodansky
Gutman, King, Armstrong
Hudson
Babson and Reed
Roy
Reitz, Guilbault
210
Bodansky subtrate and product;
nonspecific to prostatic ACP; lengthy assay
S: Beta-glycerophosphate
P: Glycerol
211
Gutman, King, Armstrong substrate and product;
non-specific to prostatic ACP
S: phenyl phosphate
P: Phenol
212
Hudson substrate and product;
non-specific to prostatic ACP; rapid assay
S: p-nitrophenyl phosphate
P: p-nitrophenol
213
Babson and Reed substrate and product;
less sensitive to prostatic ACP
S: Alpha-naphthyl phosphate
P: Alpha-naphthol
214
Roy (most specific) substrate and product;
most specific method for prostatic ACP; less interferences from bilirubin and hemoglobin
S: THymolphthalein monophosphate
P: Thymolphthalein
(has a strong absorbance at 590 nm)
215
Reitz, Guilbault substrate and product;
fluorescence method
S: 4-methylumbeliferonephosphate
P: methylumberliferone
216
Catalyzes the breakdown of starch and glycogen
Amylase (diastase)
217
Enzyme that requires calcium and chloride for activation
Amylase (diastase)
218
Smalles enzyme; only enzyme present in urine
Amylase
219
Highest tissue concentration of amylase
acinar cells of the pancreas and salivary glands
220
2 isoenzymes of amylase
P-amylase
S-amylase
221
Other name of P-amylase
Amylopsin
222
Other name of S-amylase
Ptyalin
223
Tissue source of P-amylase
Predominantly from pancreatic tissue
224
Tissue source of S-amylase
salivary glands
225
Electrophoretic mobility of P-amylase
Slowest towards the anode
226
Electrophoretic mobility of S-amylase
Fastest towards the anode
227
Presence in sample of P-amylase
Found in urine
228
Presence in sample of S-amylase
Found in serum
229
Acute pancreatitis (Amylase)
Rises within 2-12 hours
Peaks at 24 hours
Returns to normal within 3-5 days
230
Amylase 5 or more x ULN
Pancreatic pseudocyts
Morphine administration
Lung and ovarian tumors
231
Amylase 3-5 x ULN
Pancreatic carcinoma
Mumps
Perforated peptic ulcer
Ionizing radiation
232
Amylase can be detected in serum, urine, and __
peritoneal fluid
233
Saliva contains ___ times more amylase than serum
700
234
Red cells do not contain amylase (T/F)
T
235
__ and ___ falsely elevate amylase
Morphine and opiates
236
Macroamylasemia, lipemia, bilirubin ___, and insulin falsely decrease amylase
>20 mg/dl
237
Urine samples for amylase determination
24-hour urine sample
adjusted to a pH of 7.0 (using either 0.1 N NaOH or 0.1 N HCl)
238
inhibits amylase activity
Calcium-binding anticoagulants
239
What is the level of amlase in patients with acute pancreatitis and hyperlipemia?
Normal
(since the excess AMY is inhibited by triglyceride)
nagcancel out kaya naging normal
240
4 methods of amylase determination
Saccharogenic
Amyloclastic
Coupled enzymatic reaction
Chromogenic
241
Amylase determination method
Sugar-generating;
Includes Folin-Wu and Somogyi-Nelson;
Measures reducing sugars produced by hydrolysis of starch;
"Sugar-cutting"
Saccharogenic
242
Amylase determination method;
Starch-cutting or iodometric method;
Includes method of Caraway;
Measures decrease in substrate concentration;
Starch + iodine --amylase--> dark blue colored compound;
endpoint: absence of blue starch-iodine complex
Reduction in the intensity of the blue colored compound is directly proportional to the activity of amylase
Amyloclastic
243
Amylase determination method;
Coupling of several enzyme systems;
Often used for automated procedures;
Substrate: matopentose or maltotetraose;
Optimal pH: 6.9;
Coupled enzymes used:
(1) amylase-glucosidase-glucoamylase
(2) amylase-glucosidase-hexokinase-G6PD
(most commonly used)
Coupled enzymatic reaction
244
Amylase determination method;
starch is bound to a chromogenic dye;
the complex is hydrolyzed by amylase releasing dye-substrate fragments;
increase in color intensity is proportional to the activity of amylase
Chromogenic
245
Hydrolyzes the ester linkages of fats to produce alcohol and fatty acids
Lipase
246
Primary tissue source of lipase
Pancreas
247
Clinical significance of lipase (2)
Acute pancreatitis
Chronic pancreatitis
248
Acute pancreatitis in Lipase
Rises within 4-8 hours
Peaks at 24 hours
Remains elevated for 5 days to 2 weeks
249
More sensitive enzyme in detecting acute pancreatitis
Lipase
250
Complete absence of lipase resulting to fat malabsorption and severe steatorrhea
Chronic pancreatitis
251
Result of hemolysis in lipase
False decrease
252
Cause of false increase lipase concentration
Bacterial contamination
253
3 methods of lipase determination
Cherrry and Crandall
Turbidimetric
Colorimetric
254
Substrate in Cherry and Crandall method that liberates fatty acids and measured by titration with NaOH after 24-hour incubation
Olive oil
255
Substrate in Cherry and Crandall that is used for a more pure form of triglycerides
Triolein
256
Used to determine the amount of acid released in Cherry and Crandall method of lipase determination
Copper salt
257
___ measurement of copper indicates the amount of fatty acids present corresponding to the level of enzyme activity
Colorimeteric
258
258
Simpler and more rapid of lipase determination;
measurement of rate of clearing as an estimate for lipase activity
Turbidimetric method
259
Coupled reactions with peroxidase or glycerol kinase of lipase determination
Colorimetric method
260
Tissue source of G6PD
RBC
261
For assessment of X-linked disorder of G6PD deficiency;
Decreased with hereditary disposition to hemolytic crises after ingestion of oxidant drugs
G6PD
262
In G6PD deficiency, ___ is used
Red cell hemolysate
263
G6PD excess uses this type of specimen
serum
264
Pseudocholinesterase is found in these tissue sources
Liver
Brain
Serum
265
Sensitive indicator of liver synthetic capacity;
insecticide poisoning;
organophosphate poisoning (Decrease in concentration)
Pseudocholinesterase
266
aka serum cholinesterase, butyrylcholinesterase;
used to hydrolyze muscle relaxants administered in surgical operations
Pseudocholinesterase
267
Enzymes used for pancreatic profile
LIpase, amylase
268
Enzymes used to assess hepatic disorders
AST, ALT, (GST, GGT)
269
Enzymes used to assess hepatobiliary disorders
ALT, GGT, 5'NT
270
Average water content of the human body
40% to 70% (45% to 75%)
(2/3 ICF, 1/3 ECF)
271
test measures the solute concentration of plasma
osmolality
272
In response to an increased plasma osmolality, ____ is secreted by the posterior pituitary gland stimulated by the hypothalamus
arginine vasopressin hormone (formerly ADH)
273
Normal plasma osmolality
275 - 295 mOsm/kg of plasma H2O
274
Determines state of hydration
Increased POV = dehydrated
Osmolality
275
Stimuli (increased BP and Plasma volume)
Prevents salt-induced hypertension and congestive heart failure
Natriuretic peptides
276
2 body water compartments
Extracellular compartment (1/3)
Intracellular compartment (2/3)
277
2 types of extracellular water compartment
Physiological
Transcellular
278
Plasma osmolality and __ are maintained within a narrow range
Sodium
279
Principal determinant of plasma osmolality
Sodium
280
Produced primarily in the atrium of the heart
Reduced venous pressure due to increase blood volume;
Increases vascular permeability;
Promotes natriuresis and diuresis;
Inhibits salt appetite, water intake, and ADH and cortisol secretion in the brain
Atrial Natriuretic peptide
281
More potent natriuretic and diuretic
Urodilatin
282
Produced primarily from the ventricles of the heart;
Has cardiovascular, natriuretic, and diuretic effects
Brain natriuretic peptide
283
Produced in the brain, vascular endothelial cells and renal tubules
Most potent vasodilator but has no natriuretic effect
C-type natriuretic peptide
284
Charged particles
Electrolytes
285
Electrolyte panel
Sodium
Potassium
Chloride
Bicarbonate
286
Anticoagulant of choice for electrolyte analysis
Heparin
287
Balance of charges (equal no. of cations and anions)
Electroneutrality
288
Major extracellular cation (90%)
largely determines the plasma osmolality
Sodium
289
sodium levels are mainly controlled by
Aldosterone
290
Sodium levels in blood is dependent on (4 factors)
1. sodium intake and excretion
2. renal regulation
3. arginine vasopressin hormone
4. aldosterone
291
PISO
Potassium In (2 molecules)
Sodium out (3 molecules)
292
Causes of hypernatremia
Increased water loss relative to sodium loss
Decreased water intake
Increased sodium intake or retention
Diabetes mellitus
Hyperaldosteronism
293
Causes of hyponatremia
Increased sodium loss
Increased water retention
Water imbalance
Hypoaldosteronism
Potassium deficiency
Ketonuria
Salt-losing nephropathy
Vomiting, diarrhea, SIADH
294
Primary intracellular cation
Potassium
295
NV or potassium
3.5 - 5.5 mmol/L
296
Only electrolyte clinically affected by hemolysis
Potassium
297
Involved in the proper transmission of nerve impulses
Potassium
298
Important for heart contraction - abnormal levels can lead to altered electrocardiographic patterns
Potassium
299
Causes of Hyperkalemia
Decreased renal excretion
Increased potassium intake
Hemolysis, thrombocytosis, prolonged tuorniquet applications, excessive fist clenching
300
Causes of hypokalemia
GI loss
Decreased potassium intake
Renal loss
Cellular shift (alkalosis, insulin overdose)
301
Major extracellular anion
Chloride
302
Counterion of sodium - to maintain electroneutrality
Chloride
303
Maintains water balance, osmotic pressure, and anion-cation balance in the ECF
Responsible for chloride shift
Chloride
304
Exchange mechanism between chloride and bicarbonate across RBC membrane
Chloride shift
305
Causes of hyperchloremia
Excess loss of bicarbonate
Renal tubular acidosis
Metabolic acidosis
306
Causes of hypochloremia
Prolonged vomiting
Diabetic ketoacidosis
Hypoaldosteronism
Salt-losing nephropathy
High serum bicarbonate
307
5th most abundant cation
Contributor to structure of bone and teeth;
Coagulation factor IV;
for proper contraction of heart muscles and a neurotransmission regulator
Calcium
308
Causes of hypercalcemia
Primary hyperparathyroidism
Familial hypocalciuric hypercalcemia
Ectopic secretion of PTH by neoplasms
Malignancy associated
Vitamin D intoxication
Thyrotoxicosis
Hypoadrenalism
309
Causes of hypocalcemia
Primary hypoparathyroidism
Severe hypomagenesemia
Pseudohypoparathyroidism
Vitamin D deficiency
Chronic renal failure
Fanconi's syndrome
Rhabdomyolysis
310
Most reabsorbed in kidneys as CO2
Bicarbonate
311
Increased in metabolic alkalosis
Decreased in metabolic acidosis
Bicarbonate
312
Second most abundant anion in ECF
Account for more than 90% of the total CO2;
Major component of the buffering system in blood
Diffuses out of the cell in exchange for chloride
Bicarbonate
313
Regulation controlled largely by kidneys
PTH increases renal reabsorption and intestinal reabsorption
Aldosterone and thyroxine increase renal excretion
Magnesium
314
Increased in renal failure, acute diabetic acidosis, dehydration;
decreased in chronic alcoholism, malabsorption, severe diarrhea, pancratitis
Magnesium
315
Second most abundant intracellular cation
Low levels cause tetany
Magnesium
316
Kidneys play major role in regulation;
PTH decreases it while Vitamin D and GH increase its levels
Phosphate
317
Hyperphosphatemia
Acute or chronic renal failure
Neonates with increased intake
Increased breakdown of cells
Lymphoblastic leukemia
318
Hypophophostemia
Diabetic ketoacidosis
COPD
Asthma
Malignancies
Inflammatory bowel disease
319
Only electrolyte affected by diurnal variation
Highest levels in the late morning and lowest in the evening
Phosphate
320
Concentration of inorganic and organic phosphates in adults
60 grams
321
Electrolyte that is not specifically regulated;
Liver is the major organ that removes it
Lactate
322
Lactate is increased in :
Hypoxic conditions
(shock, MI, CHF, pulmonary edema, blood loss)
Metabolic origin
(DM, severe infection, leukemia, liver and kidney diseases, and toxins)
323
By-product of an emergency mechanism that produces a small amount of ATP when oxygen is severely diminished
Lactate
324
Specimen considerations in sodium determination
Serum, plasma, 24 hr urine, sweat, CSF
325
Formula for sodium determination
Na = CO2 + Cl + 10 or
Na = CO2 + Cl + 12
326
3 methodologies for Sodium determination
Flame Emission Photometry
Atomic Absorption Spectrophotometry
Ion Selective Electrode (most common method)
- emits light at 590 nm
327
Method wherein sodium produces yellow color when exposed to flame
- sodium emits light at 590 nm
- serum is diluted with high purity water (1:100 or 1:200)
Flame emission photometry
328
NV of serum sodium
135 to 145 mmol/L
329
Normal value of 24-hour urine sample (sodium)
40 to 220 mmol/day
330
NV of CSF serum
138 to 150 mmol/L
331
Specimen considerations for potassium
Serum/Plasma
No to prolonged tourniquet application
332
3 methods of potassium determination
Flame Emission photometry
AAS
ISE (most common method)
- emits light at 768 nm
333
In sodium determination using ISE, what is the membrane used?
Valinomycin
334
NV of serum potassium
3.4 to 5.0 mmol/L
335
NV of potassium in 24 hour sample
25 to 125 mmol/day
336
Electrolyte that has the most narrow reference range and is most strictly regulated by the body
Potassium
337
Anticoagulant of choice for chloride measurements
lithium heparin
338
4 methods of chloride determination
ISE
Amperometric-Colorimetric titration
Mercurimetric titration
Colorimetric method
339
Most commonly used method of chloride measurement
ISE
340
Membrane used in ISE for the determination of chloride
Combination of silver wire coated with AgCl
341
Principle of Amperomeric-Colorimetric titration of chloride measurement
Cotlove Chloridometer
342
Principle of mercurimetric method of chloride determination
Sshales and Schales method
343
What leads to a positive error in mercurimetric titration in chloride determination
Bromide
344
Uses mercuric thiocyanate and ferric nitrate to form ferric thiocyanate (red colored complex with a peak absorbance at 480 nm)
- used in autoanalyzer (Technicon) in chloride measurement
Colorimetric method
345
NV serum chloride
98 to 107 mmol/L
346
NV of chloride in 24 hr urine
110 to 250 mmol/day
347
In 24 hr urine calcium, the sample is acidified using ___
6M HCl (1ml per 100 ml urine)
- to prevent precipitation of calcium
348
2 methodologies in calcium determination
Orthocresolphthalein complexone
Arsenzo III
349
Conversion factor of calcium
0.25
350
A calcium chelator
-produces reddish complex (570 to 578nm)
-used in autoanalyzer (Hitachi and Dimension)
Orthocresolphthalein complexone
351
Method used in calcium measurement
- used in autoanalyzer (Vitros and Synchron)
Arsenzo III
352
NV of Total Calcium
Child: 2.20 - 2.70 mmol/L
Adult: 2.15 - 2.50 mmol/L
353
NV of Ionized calcium
Child: 1.20 - 1.38 mmol/L
Adult: 1.16 - 1.32 mmol/L
354
NV of 24 hour urine calcium
2.50 - 7.50 mmol/day
355
24 hour urine ___ is acidified with __
6M HCl
356
5 methods of magnesium measurement
-Colorimetric method
-Dye lake method
-Fluorometry
-AAS: Reference method
-ISE: most common
357
Magnesium measurement wherein the titan yellow dye (clayton yellow/thiazole yello) forms a red lake with magnesium)
Dye-lake method
358
NV for serum magnesium
0.63 - 1.0 mmol/L
359
Method for phosphate measurement
Fiske-Subbarow Method
360
Reagent used in Fiske-Subbarow method
Molybdate
361
NV for serum magnesium
Neonate: 1.45 - 2.91 mmol/L
Child: 1.45 - 1.78 mmol/L
Adult: 0.87 - 1.45 mmol/L
362
NV or 24 hour urine phosphate
13 - 42 mmol/day
363
Difference between unmeasured anions and unmeasured cations;
-useful in indicating an increase in one or more of the unmeasured anions in the serum
-serves as a form of quality control for the analyzer used to measure these electrolytes
Anion gap
364
Formula for anion gap
AG = Na - (Cl + HCO3) or
AG = (Na + K) - (Cl + HCO3)
365
NV of anion gap
7 - 16 mmol/L or
10 - 20 mmol/L
366
Increased AG
Methanol
Uremia
Diabetic ketoacidosis
Iron, inhalants, isoniazid. ibuprofen
Lactic acidosis
Ethylene glycol poisoning, ethanol ketoacidosis
Salicylates, starvation
367
Decreased AG
Hypoalbuminemia
Severe hypercalcemia
Multiple Myeloma
Instrument error
368
Substance that can yield a hydrogen ion when dissolved in water
Acid
369
Substance that can yield hydroxyl ion when dissolved in water
Base
370
The relative strength and ability of acids and bases to dissociate in water
Dissociation constant or ionization constant K value
371
5 Buffer systems
Bicarbonate
Ammonia-Ammonium
Protein
Phosphate
Hemoglobin
"BAPPH"
372
Important buffer of H in red blood cells
-binds and release H to facilitate its buffering effect
Hemoglobin Buffer System
373
Most abundant buffer in the ICF and blood plasma
-most circulating proteins have a negative charge capable of binding H
Protein Buffer System
374
Important buffer system in the secretion of H via urination
Ammonia-ammonium buffer system
375
If pH is too high:
(what is the response of the carbonic acid-bicarbonate buffer system)
HCO3 is excreted while H is reabsorbed
376
if pH is too low
(what is the response of the carbonic acid-bicarbonate buffer system)
H will be excreted while HCO3 is reabsorbed
377
Normal ratio of bicarbonate to carbonic acid
20:1
378
2 organs that play important roles in regulating blood pH
Lungs, kidneys
379
The interrelationship of lungs and kidneys in maintaining pH is depicted by the ___
Henderson-Hasselbach equation
(recall)
380
Important regulator of pH in the cytosol
- buffers acid in urine
-secretes excess H in the kidney tubule
-combines with HPO4 to produce H2PO4
Phosphate buffer system
381
___ is expressed in concentration of dissolved carbon dioxide
H2CO3
382
Concentration is controlled by the kidneys; Non-respiratory or "metabolic" component
HCO3
383
Concentration is controlled by the lungs;
- respiratory component
H2CO3
384
___ is computed by multiplying partial pressure of carbon dioxide (mmHg) by alpha (solubility coefficient of carbon dioxide)
dCO2
385
Normal average of pCO2 is equal to __
40 mmHg
386
THe solubility coefficient of CO2 is ___
0.03 mmol/K/ mmHg
387
the Pka is equal to 6.1, with a bicarbonate concentration of ___
24 mmol/L
388
The normal ratio of bicarbonate to carbonic acid, which is expressed in dCO2 is ___
20:1
389
The normal blood pH is 7.4. the normal range is from
7.35 to 7.45
390
Blood pH <7.35
acidosis
391
Blood pH >7.45
alkalosis
392
Action of the body to restore acid-base homeostasis whenever an imbalance occurs
-alters the factor not primarily affected by the pathologic process
Compensation
393
In metabolic/nonrespiratory acidosis or alkalosis: ____ compenstation
- response is short-term and often incomplete
Respiratory
394
In respiratory acidosis or alkalosis: ___ compensation
-response is slower but long term and potentially complete
Renal
395
If the pH has returned to the normal range, meaning the 20:1 ratio has been restored, it is considered ____
Fully compensated
396
If the pH is approaching the normal range, it is considered
Partially compensated
397
Due to a decreased bicarbonate level
Metabolic acidosis
398
Metabolic acidosis is caused by:
1. Renal tubular acidosis
2. Direct administration of acid-producing substances (ammonium chloride, calcium chloride)
3. Excessive formation of organic acids (diabetic ketoacidosis, starvation)
4. Excessive loss of bicarbonate (diarrhea)
399
Primary compensation for metabolic acidosis
lungs blow off CO2 to raise pH
400
Significant laboratory findings of metabolic acidosis
Decreased pH, normal pCO2, decreased HCO3
401
Due to decreased alveolar ventilation (hypoventilation)
Respiratory acidosis
402
Respiratory acidosis results to ___
hypercapnia
403
Respiratory acidosis is caused by:
1. Lung diseases (COPD, bronchopneumonia)
2. Hypoventilation caused by drugs (barbituates, morphine, alcohol)
3. Mechanical obstruction or asphyxiation
4. Asthma
5. Severe pulmonary infection
404
Primary compensation of respiratory acidosis
Renal compensation (it takes days to weeks to complete)
405
Significant laboratory findings of respiratory acidosis
Decreased pH, increased pCO2, normal HCO3
406
Due to an increased bicarbonate level; ratio is greater than 20:1 because of increased HCO3
Metabolic alkalosis
407
Metabolic alkalosis is caused by:
1. Excessive loss of acid (vomiting and nasogastric suctioning)
2. Prolonged use of diuretics
3. Excessive sodium bicarbonate administration
4. Hyperaldosteronism and Cushing's syndrome
5. Ingestion of bicarbonate-producing salts (sodium, lactate, citrate, and acetate)
408
Primary compensation of metabolic alkalosis
lungs retain CO2 to lower pH
409
Significant laboratory findings of metabolic alkalosis
Increased pH, normal pCO2, Increased HCO3
410
Due to an increased alveolar ventilation (hyperventilation)
Respiratory alkalosis
411
Causes of respiratory alkalosis
1. Hysteria
2. Pulmonary emboli and pulmonary fibrosis
3. Fever
4. Increased in environmental temperature
5. Drugs that stimulates respiratory center (salicylates)
6. Congestive heart failure
412
Primary compensation of respiratory alkalosis
Renal compensation
413
Significant laboratory findings in respiratory alkalosis
Increased pH, decreased pCO2, normal HCO3
414
NV
Blood pH
pCO2
HCO3
pO2
Total CO2
Oxygen saturation
NV
Blood pH: 7.35 - 7.45
pCO2: 35 - 45 mmHg
HCO3: 22 - 26 mmol/L
pO2: 80 - 110 mmHg
Total CO2: 23 - 27 mmol/L
Oxygen saturation
415
3 methods for blood gas analysis
-Spectrophotometric (Co-oximeter)
-Blood Gas analyzers
-Stow-Severinghaus ISE method
-Enzymatic methods
416
Method for blood gas analysis that determines oxygen saturation and the actual percent of oxyhemoglobin
Spectrophotometric (Co-oximeter)
417
Method for blood gas analysis that use electrodes as sensing devices to measure pO2, pCO2, and pH
Blood Gas Analyzers
418
pO2 measurement is ___
amperometric
419
pCO2 measurement is ___
potentiometric
420
Method for blood gas analysis that measures total CO2 with the use of an acid reagent
Stow-Severinghaus ISE method
421
Method for blood gas analysis that use phosphoenolpyruvate carboxylase and malate dehydrogenase
Enzymatic methods
422
Preferred sample for blood gas analysis
Arterial blood
423
Air trapped in syringe for blood gas analysis leads to
increased pO2, decreased pCO2
424
Anticoagulant used in blood gas analysis and its corresponding concentration
Liquid heparin - 0.05 ml per ml of blood
425
If processing for blood gas analysis is delayed, what is the next course of action
Transport the specimen in chilling condition
426
Specialized organs capable of producing hormone
Endocrine system
427
3 structural classes of hormones
Steroid hormones
Protein hormones
Amine hormones
428
Site of production of steroid hormones
Adrenal glands, gonads, placenta
429
Chemical component of steroid hormones
Cholesterol
430
Carrier of steroid hormones
Protein
431
Examples of steroid hormones
Cortisol
Aldosterone
Testosterone
Estrogen
Progesterone
432
Site of production of protein hormones
Anterior pituitary, placenta, and parathyroid glands
433
Chemical component of protein hormones
Protein
434
Production and storage of protein hormones
Synthesized then stored in cell as secretory granules until needed
435
Examples of protein hormones
FSH
LH
TSH
hCG
Glucagon
Parathyroid hormone
GH
Prolactin
436
Site of production of amine hormones
Thyroid and adrenal glands
437
Chemical component of amine hormones
Amino acids
438
Examples of amine hormones
Epinephrine
Norepinephrine
Thyroxine
Triiodothyronine
439
Butterfly-shaped organ located on the posterior portion of the neck
Thyroid gland
440
ligament that separates the left and right lobes of the thyroid gland
isthmus
441
2 cell types of the thyroid gland
Follicular cells
Parafollicular cells
442
Produces metabolic hormones T3 and T4
Follicular cells
443
AKA perfollicular cells or C-cells; produces calcitonin
Parafollicular cells
444
T3 is composed of
MIT + DIT
-more biologically active
445
T4 is composed of
DIT + DIT
- greater concentration
446
Primary Hypothyroidism
(T3, T4, TSH levels)
Low T3 and T4 levels, Increased TSH levels
447
Secondary Hypothyroidism
Low T3, T4, and TSH levels
448
Primary hyperthyroidism
High T3 and T4 levels, low TSH levels
449
Secondary hyperthyroidism
High T3, T4, TSH levels
450
Basal metabolic rate and sympathetic response in hypothyroidism
Decreased
451
Hypothyroidism, weight ___
Gain
452
Temperature tolerance in hypothyroidism
Cold intolerance
Decreased sweating
453
GIT function in hypothyroidism
Constipation
Decreased appetite
454
Cardiovascular function in hypothyroidism
Decreased cardiac output
Bradycardia
455
Respiratory function in hypothyroidism
Hypoventilation
456
General appearance in hypothyroidism
Myxedema
Deep voice
Impaired growth (in children)
457
General behavior in hypothyroidism
Mental retardation (infant)
Mental and physical sluggishness
Somnolence
458
Basal metabolic rate and sympathetic response in hyperthyroidism
Increased
459
Weight in hyperthyroidism
Loss
460
Temperature tolerance in hyperthyroidism
Heat intolerance
Increased sweating
461
GIT function in hyperthyroidism
Diarrhea
Increased appetite
462
Cardiovascular function in hyperthyroidism
Increased cardiac output
Tachycardia and palpitation
463
Respiratory function in hyperthyroidism
Dyspnea
464
General appearance in hyperthyroidism
Exophthalmos
Decreased blinking
Enlarged thyroid
465
General behavior in hyperthyroidism
Restlessness
Irritability and anxiety
Hyperkinesis and wakefulness
466
-Decreased T3 and T4
-Decreased TSH
-Increased or Normal TRH
-TSH before administration is low
Secondary hypothyroidism
467
-Decreased T3 and T4
-Decreased TSH
-Decreased TRH
-TSH before administration is low
After administration is high
Tertiary hypothyroidism
468
Anti-microsomal antibodies (anti-thyroid peroxidase antibodies)
-Anti-thyroglobulin antibodies
-primary hypothyroidism
Hashimoto's thyroiditis
469
Anti-TSH receptor antibodies
-primary hyperthyroidism
Grave's disease
470
Major transport protein for T3 and T4 (approximately 70 - 75%)
Thyroid-Binding Globulin (TBG)
471
Percentage of T4 that is unbound
0.03 - 0.05%
472
Percentage of T3 that is free
0.5%
473
Which is more potent, T3 or T4?
T3
474
Other names of T4
Thyroxine
475
Methods for T4 measurement
RIA
Fluorometric enzyme immunoassay
Fluorescence polarization immunoassay (FPIA)
476
Other name of T3
Triiodothyronine
477
Methods for T3 determination
RIA
Microparticle enzyme immunoassay
Fluorometric enzyme immunoassay
478
THBR other names
Thyroid hormone binding ratio
T3 uptake test
T uptake test
479
Methods for THBR measurement
Resin uptake
RIA
480
Methods for FT4 determination
Equilibrium dialysis
Immunometric assay (chemiluminescence)
481
Methods for FT3 determination
RIA
482
FT4 index methods of measurement
Calculation from T4 and THBR
483
FT3 index method of measurement
Calculation from T3 and THBR
484
Methods for TSH measurement
RIA
Immunometric assay (IMA)
485
3 classes of steroid hormones
Mineralcorticoids
Glucocorticoids
Sex steroids
486
Function of mineralocorticoids
fluid and electrolyte balance
487
Function of glucocorticoids
glucose production and protein metabolism
488
Function of sex steroids
regulate sexual development and control many aspects of pregnancy
489
Hormone under mineralocorticoids
Aldosterone
490
3 hormones under glucocorticoids
Cortisol
Cortisone
11-deoxycortisol
491
3 hormones under sex steroids
Androgens
Estrogens
Progesterone
492
Most abundant hormone in post-menopausal women
Estrone (E1)
493
Most potent ; most abundant in pre-menopausal women
Estradiol (E2)
494
Metabolite of estradiol; estrogen found in maternal women; major estrogen secreted by placenta
Estriol (E3)
495
steroid transport protein that nonspecific and carries many steroids
albumin
496
Steroid transport protein that carries cortisol and derivatives; progesterone
Cortisol-binding globulin
497
Steroid transport protein for testosterone and estradiol
Sex hormone-binding globulin
498
3 colorimetric assays in steroid hormone analysis
Zimmerman reaction
Porter-Silber assay
Kober reaction
499
Measurement of 17-ketosteroids (metabolites of several precursors to cortisol) to assess androgen production by the adrenal glands
Zimmermann reaction
500
Primary reagent in Zimmermann reaction
m-dinitrobenzene in alcoholic KOH solution
501
Result of Zimmermann reaction
Purple color (520 nm)
502
For urine cortisol and derivatives (cortisone and 11-deoxycortisol)
Porter-Silber assay
503
Primary reagent in Porter-Silber assay
2,4-dinitrophenylhydrazine
504
Result of Porter-Silber assay
Yellow derivative (410 nm)
505
FOr urine estrogen determination: sufficiently sensitive to quantitate total urine estrogen during the middle and latter stages of pregnancy
Kober reaction
506
Primary reagent in Kober reaction
Strong aqueous sulfuric acid solution containing hydroquinone
507
Result of Kober reaction
Reddish-brown color (472 nm, 512 nm, and 556 nm)
508
Formed by the conversion of tyrosine
Catecholamines
509
2 best known catecholamines
epinephrine
norepinephrine
510
Catecholamines are synthesized and stored by the __
Chromaffin cells of the adrenal medulla
511
2 end products of catecholamine metabolism
Homovanillic acid
Vanillylmandelic acid
512
Method of determination of catecholamines
Pisano method
513
Colorimetric assay for total metanephrines
-involves extraction followed by colorimetric reaction
-conversion to vanillin (absorbance maximum at 360 nm) is accomplished through periodate oxidation
Pisano method
514
Increased levels of catecholamines are seen in
Pheochromocytoma
Neuroblastoma
Essential hypertension
Hypothyroidism
Diabetic acidosis
Cardiac disease
Burns
Septicemia
Depression
515
Decreased levels of catecholamines are seen in
Hyperthyroidism
long term diabetes mellitus
516
Involves analysis, assessment and evaluation of circulating concentrations of drugs in serum, plasma, or whole blood ;to ensure that a given dosage of drug produces maximal therapeutic benefit and minimal toxic side effects
Therapeutic Drug Monitoring (TDM)
517
Concerned with the application or administration of drugs to patients for the purpose of prevention and treatment of disease
Pharmacotherapeutics
518
Describe what the drug does to the body
Pharmacodynamics
519
Describe how drugs are received and handled by the body
Pharmacokinetics
520
The rate of administration is equal tot he rates of metabolism and excretion
Steady state
521
Refers to the serum concentration of drug established to achieve desired clinical effect
Therapeutic range
522
Drugs enter hepatic portal system first before entering the general circulation
First pass metabolism
523
Refers to the spread of drug from its point of entry throughout the systemic circulation and into various tissues
Drug distribution
524
Represents the time needed for the serum concentration of a drug to decrease by half
Half-life
525
preferred sample for TDM
Serum
526
Why are samples for TDM not collected in serum separator tubes
Drugs are reabsorbed in gel
527
Maximum specimen; collected 30 - 60 minutes after drug administration but may vary depending on the type of drug
Peak specimen
528
Minimum concentration; collected before administration of the next dose
Trough specimen
529
Laboratory results should contain 2 factors
Time of last dose
Time of extraction
530
Effective dose; predicted to be effective or have therapeutic benefit in 50% population
ED50
531
Toxic dose; predicted to produce toxic response in 50% population
TD50
532
Lethal dose; predict death in 50% of population
LD50
533
Refers to a constellation of clinical signs and symptoms that suggest a specific class of poisoning
Toxidromes
534
Most commonly abused chemical substance
Alcohol
535
Method of alcohol determination
Flame ionization gas chromatography
Headspace gas chromatography
536
Most ingested ethanol is converted to __
acetic acid
537
Alcohol is increased in __
GGT, AST, AST/ALT ratio (>2.0), increased HDL, MCV
538
Disinfectatn use for alcohol measurement
Benzalkonium chloride
539
Methods for cyanide determination
Photometric analysis
Headspace gas chromatography
540
Characteristic odor of cyanide
Bitter almonds
541
Cyanide binds to hemoglobin causing ___
hypoxia
542
Methods for carbon monoxide measurement
Gas chromatography
Spot test for CO exposure
Differential spectrophotometry
543
Colorless, tasteless, odorless gas;
common sources are car exhausts and cigarette
-Has 250 times greater affinity for hemoglobin compared to oxygen
-produces cherry red color of the blood
Carbon monoxide
544
Odor of garlic;
highly keratinophilic, carcinogenic;
specimen toxicity analysis include skin, hair, or nails
Arsenic
545
can cause toxic effects in brain and can lead to anemia
(measurement of blood level)
Lead
546
Previously used in sphygmomanometer, thermometers, and manometers
- toxicity: can alter proteins and cause severe kidney damage
Mercury
547
Found in pesticides and insecticides
Toxicity decreases cholinesterase
Organophosphatases
548
Sedative hypnotics drugs
Barbiturates
Benzodiazepines
549
Derived from the leaves of marijuana plant Cannabis sativa
Cannabinoids
550
Alkaloid found in a plant Erythroxylon coca
Cocaine
551
Structurally similar to serotonin; found in fungus Claviceps purpura
Lysergic Acid Drugs (LSD)
552
Stimulants and hallucinogen
Amphetamines
553
Produced directly by the tumor as an effect of the tumor in a healthy tissue
Tumor markers
554
Ideal characteristics of tumor markers
1. Tumor specific
2. Absent or present in very narrow range in healthy individuals
3. Readily detectable in body fluid
555
Tumor marker for hepatic and testicular cancers
AFP
556
Tumor marker for pancreatic cancer
Amylase
557
Tumor marker for breast or ovarian cancer
BRCA-1
558
Tumor marker for ovarian cancer (treatment and recurrence)
CA 125
559
Tumor marker for breast cancer
CA 15.3, Cathepsin-D, Estrogen receptor , HER-2/neu
560
Tumor marker for gastric, pancreatic, and colorectal cancers
CA 19.9
561
Tumor markers for gastric and pancreatic cancers (treatment and recurrence)
CA 50
562
Tumor marker for breast cancer (treatment and recurrence)
CA 27-29
563
Tumor marker for medullary thyroid cancer
Calcitonin
564
Tumor marker for colorectal, stomach, breast, lung cancer (treatment and recurrence)
CEA
565
Tumor marker for small cell lung cancer, prostate cancer
CK-1
566
TUmor cancer for hepatoma
GGT
567
Tumor marker for urinary bladder cancer
Nuclear matrix protein (NMP)
568
Tumor markers for monitoring breast cancer
CA 15-3, HER-2/neu, CA 27-29
569
Tumor marker for monitoring ovarian cancer
CA 125
570
Tumor marker for monitoring pancreatic cancer
CA 19-9
571
