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Clin Lab Exam II
Clin Lab Exam II
176
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Graduate
01/25/2010

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Term
Where are all proteins synthesized?
Definition
All in the liver except gamma globulins (B cells)
Term
: separates proteins based on their electric charge properties; Cations [(+) net charge] migrate toward the cathode (negative terminal) while anions [(-) net charge] migrate toward the anode (positive terminal)
Definition
Serum protein electrophoresis
Term
MC screening test for protein abnormalities? Next most common?
Definition
specific total protein and albumin measurements. Next is serum protein electrophoresis.
Term
What 5 proteins can be identified on serum protein electrophoresis?
Definition
Albumin, Alpha-1 globulin, Alpha-2 globulin, Beta, Gamma
Term
What percentage of colloid osmotic pressure and total serum protein level are caused by albumin?
Definition
80% of colloid osmotic and 60% of total serum protein level.
Term
What causes a decreased albumin? Increased?
Definition
Decreased = liver dz, renal dz, malnutrition, malabsorption syndromes, muscle wasting dz.
Increased = dehydration.
Term
What is a sensitive marker of inadequate dietary protein intake?
Definition
Pre-albumin levels
Term
What protein carries T3/T4 when complexed with retinol binding protein and also carries vit A?
Definition
Pre-albumin
Term
What condition is associated with degenerative emphysema in young patients that do not smoke?
Definition
Alpha-1 Antitrypsin deficiency
Term
:it is speculated that this protein protects the fetus from “attack” by the mother’s immune system.
Definition
Alpha-1 Fetoprotein
Term
What is used as a marker for prostate and liver cancer?
Definition
AFP
Term
What can result from elevated AFP?
Definition
neural tube defects in the fetus, atresia of the GI tract and fetal distress.
Term
What can result from low AFP?
Definition
Down's syndrome and trisomy 18
Term
:acute-phase reactant; it binds to free Hgb to prevent the loss of Hgb and iron from the kidneys; made by liver and RES
Definition
Haptoglobin
Term
:acute-phase reactant; contains > 90% of the total serum copper
Definition
Ceruloplasmin
Term
:inhibits a variety of protease enzymes (trypsin, pepsin, plasmin); made by liver
Definition
Alpha-2 Macroglobulin
Term
What results from a low ceruloplasmin?
Definition
Wilson's disease - copper is deposited in brain, liver and skin).
Term
:transports iron and prevents loss of iron through the kidneys; made by liver
Definition
Transferrin
Term
:removes circulating heme and porphyrins; made by liver
Definition
Hemopexin
Term
What condition could lead to an increased hemopexin?
Definition
Malignant melanoma
Term
What condition leads to increased compliment? Decreased?
Definition
Increased = inflammation.
Decreased = SLE.
Term
:acute-phase reactant; forms fibrin clot; one of the largest proteins in plasma
Definition
Fibrinogen
Term
What condition will cause a decreased fibrinogen?
Definition
DIC
Term
:acute-phase reactant; facilitates complement coating (opsonization); Can be used in place of a sed rate; commonly assayed as part of the risk assessment for CV dz
Definition
CRP
Term
What percentage of plasma proteins are immunoglobulins?
Definition
25%
Term
Which immunoglobulin is increased with liver dz, autoimmune dz and infection?
Definition
IgA
Term
Which immunoglobulin is increased with liver dz, infxns, conn. tissue disorders, and multiple myeloma?
Definition
IgD
Term
Which immunoglobulin is increased with asthma, allergic rhinitis, parasitic infxns?
Definition
IgE
Term
Which immunoglobulin is increased with increased in liver dz, infxns, and collagen dz; and is the most abundant?
Definition
IgG
Term
Which immunoglobulin is the first to appear in the immune response to a foreign Ag?
Definition
IgM
Term
:An inhibitory protein found in cardiac muscle only; binds calcium permitting contraction of the heart muscle; increased in acute MI
Definition
Troponin T
Term
How will  dehydration, vomiting, diarrhea, excessive sweating, Diabetes Insipidus, and DKA affect protein levels?
Definition
They cause increased protein.
Term
How do renal dz, liver dz, burns, bleeding, GI dz, fever, malignancy, chronic dz, chronic inflammation, and hyperthyroidism affect protein levels?
Definition
They decrease protein levels
Term
What is the most common total protein measuring procedure?
Definition
Biuret method
Term
What 2 hormones are responsible for monitoring sodium?
Definition
ADH and aldosterone
Term
What are some S&S of hypernatremia?
Definition
tremors, irritability, ataxia, confusion and coma.
Term
What is the cause of hypovolemic hypernatremia?
Definition
Dehydration
Term
What are some causes of euvolemic hypernatremia?
Definition
skin/lung loss and DI.
Term
What are some causes of hypervolemic hypernatremia?
Definition
Hypertonic saline tx, sodium bicarbonate tx, hyperaldosteronism and Cushing's syndrome.
Term
What are the S&S of hyponatremia?
Definition
nausea,weakeness and mental confusion.
Term
What are the causes of hypovolemic hyponatremia?
Definition
fluid loss, thiazide diuretics, K-depletion in cells and aldosterone deficiency.
Term
What are the causes of euvolemic hyponatremia?
Definition
SIADH, severe hyperglycemia, polydipsia, diuretics and hypothyroidism.
Term
What are the causes of hypervolemic hyponatremia?
Definition
SIADH, CHF, cirrhosis, overhydration, and renal failure.
Term
How is potassium regulated?
Definition
Kidneys and aldosterone
Term
What is the most common drug that causes hyperkalemia?
Definition
ACEi's
Term
What are the S&S of hyperkalemia?
Definition
muscle weakness and cardiac arrhythmias
Term
What is the most common cause of hypokalemia? What else can commonly cause it?
Definition
diuretics, also caused by insulin.
Term
What is the major cause of a low anion gap?
Definition
Multiple myeloma
Term
What are the major causes of a high anion gap?
Definition
MUDPILES:
Methanol
Uremia
DKA
Paraldehyde
Iron
Lactic acidosis
Ethanol
Salicylates/Starvation
Term
How do GH, ACTH, Cortison and Thyroid hormones affect plasma glucose levels?
Definition
They increase it
Term
How are urine ketones detected in urine?
Definition
Detected by serum acetone test
Term
:> 50% mortality; profound dehydration (loss of 10-11 L) and marked hyperglycemia (1000-1500)
Definition
Hyperosmolar coma
Term
Which test reveals the earliest sign of reversible renal disease?
Definition
Urine microalbumin test
Term
What is the best way to test for microalbunuria? Most convenient way?
Definition
Best = 24 hour urine microalbumin testing.
Convenient = random urine void (preferably first morning void).
Term
:nitrogen-containing metabolite of protein catabolism; made in liver, excreted in kidney
Definition
BUN
Term
What is azotemia?
Definition
elevated urea
Term
What is Prerenal azotemia?
Definition
decreased renal blood flow; CHF, shock, dehydration, increased protein breakdown, high protein diet, GI hemorrhage
Term
What is renal azotemia?
Definition
Renal failure
Term
What is postrenal azotemia?
Definition
Obstruction
Term
:toxic condition; high serum urea accompanied w/renal failure; You don’t see BUN early on; a high BUN means there is severe kidney dz; whereas the creatinine shows up earlier
Definition
Uremia
Term
What are some causes of a high BUN/Creatinine ratio?
Definition
pre-renal conditions
Term
What are some causes of low BUN/creatinine ratios?
Definition
acute tubular necrosis, low protein intake, starvation, liver dz
Term
What could cause both the BUN and Creatinine to be elevated?
Definition
post-renal obstruction or pre-renal azotemia superimposed on kidney dz
Term
:Genetic defect of low LDL/HDL; Absent LDL w/low cholesterol will be detected in infancy (failure to thrive), steatorrhea, CNS degeneration, malabsorption of fats and vitamins
Definition
Hypolipoproteinemia
Term
:increased accumulation of cholesterol in tonsils, adenoids, and spleen
Definition
Absent HDL (Tangier's Dz).
Term
Where is cholesterol made? What transports it?
Definition
Made in liver and intestine and transported by LDL and HDL.
Term
Where are triglycerides made? What transports them?
Definition
Made in the liver, transported by chylomicrons and VLDL.
Term
What binds to bilirubin to make it conjugated?
Definition
Glucuronide
Term
:positive test indicates presence of disease being investigated
Definition
Sensitivity
Term
:negative test indicates absence of disease being investigated
Definition
Specificity
Term
What biomarker is elevated in Reye's syndrome, brain disorders, bladder, stroke, lung, prostate, colon, seizure or shock conditions and is the fastest CK?
Definition
CK-BB
Term
Which biomarker is the 2nd fastest CK and is seen with cardiac conditions, and increases in 4-6 hours, peaks after 12-24 hours and normalizes at 2-3 days?
Definition
CK-MB
Term
Which CK makes up 98-100% of total CK and is the 3rd fastest CK and is elevated with any muscle disorder, malignant hyperthermia, post-physical activity, post-intramuscular injection?
Definition
CK-MM
Term
Which form of LDH is in mitochondria (heart, RBCs, kidneys), 24-40% of total serum LDH?
Definition
LD-1
Term
Which form of LDH is the major form in serum, 35-46% of total serum LDH?
Definition
LD-2
Term
Which form of LDH is in the platelets, lymph nodes, 17-33% of total serum LDH?
Definition
LD-3
Term
Which form of LDH is major fraction in skeletal muscle and liver (6-17%) of total serum LDH?
Definition
LD-5
Term
How can you tell if the heart, RBCs or kidneys are damaged by looking at LDH?
Definition
LD-1 will be greater than LD-2.
Term
How can you tell if the skeletal muscle or liver is damaged by looking at LDH levels?
Definition
LD-5 will be greater than LD-4
Term
What do high LDH levels in CSF indicate?
Definition
It is high in 90% of bacterial infections and 10% of viral.
Term
What are the LDH abnormalities seen with Megaloblastic anemia?
Definition
LD 1 & 2 are elevated
Term
What LDH abnormalities are seen with Germ cell tumors?
Definition
elevated LD-1
Term
What LDH abnormalities are seen with malignant diseases, liver disease, hypoxia, hyperthermia, CHF and renal disease?
Definition
Elevated total LD
Term
What are the LDH abnormalities seen with ITP, mononucleosis, lymphomas and leukemias?
Definition
Elevated LD 2-4
Term
:works at an alkaline pH; moves substances across cell membrane, lipid transport in GI, calcifying process in bone; isoenzymes found in liver, bone, kidney, spleen, intestine, placenta.
Definition
Alkaline phosphatase
Term
Where is heat stable alk phos and non-heat stable alk phos found?
Definition
Heat stable = liver.
Non-heat stable = bone.
"Bone burns and liver lasts"
Term
When is alk phos levels highest? What else can cause it to be high?
Definition
When there is osteoblast involvement (Paget's disease, bone cancer). Can also be high with hepatic obstruction.
Term
:catalyzes the breakdown of glycogen and starch to sugar; Requires Ca and Cl; Readily filtered by kidneys; mostly found in salivary glands, then pancreas, ovaries, testes, tears, colostrum, lungs, adipose tissue
Definition
Amylase
Term
What kind of amylase is made by acinar cells; major digestion of starches?
Definition
Pancreatic amylase (p-type)
Term
What type of amylase is made by salivary glands in the mouth; neutralized by stomach pH?
Definition
Salivary amylase (s-type)
Term
What are some common causes of hyperamylasemia?
Definition
Acute pancreatitis, cholecystitis, mumps, bowel obstruction, salivary gland inflmmation, and carcinomas (lung and ovary).
Term
:Hydrolyzes ester linkage of triglycerides to produce glycerol and fatty acids; bile salts assist in emulsification (break down of fat); found in pancreas, tongue; Lipase and amylase are commonly ordered together for suspected pancreatitis, but lipase is more specific for pancreatic dz
Definition
Lipase
Term
What is the most common cause of hyperlipasemia?
Definition
Acute pancreatitis
Term
:helps in amino acid synthesis and breakdown
Definition
Transaminases
Term
What is an elevated ALT (Alanine aminotransferase) indicative of?
Definition
Liver cell damage
Term
What is a decreased ALT indicative of?
Definition
Hepatic obstruction disorders
Term
What conditions can lead to an increased level of AST (Aspartate aminotransferase)?
Definition
acute MI, muscular dystrophy and hepatic disorders
Term
:transports amino acids through cell membrane; found in all cells except muscle; primarily ordered to evaluate liver, biliary system, kidneys
Definition
GGT (Gamma glutamyltransferase)
Term
What is a normal Gamma glutamyltransferase (GGT) and elevated ALP indicative of?
Definition
Bone disease
Term
What is an elevated Gamma glutamyltransferase (GGT) and elevated ALP indicative of?
Definition
liver or bile duct disease
Term
What is a more sensitive of an indicator than ALP, ALT, AST for obstructive jaundice, cholecystitis & cholangitis (occurs earlier and persists longer)?
Definition
Gamma glutamyltransferase (GGT)
Term
What conditions can cause an elevated gamma glutamyltransferase (GGT)? False positive?
Definition
Elevated with liver disease, pancreatitis, prostate malignancy and highest with hepat/biliary obstruction. Falsely elevated with anticonvulsant drugs.
Term
:This panel assesses renal function as well as the serum glucose level. (glucose, BUN, Creatinine, Na+, K+, Cl-, CO2, anion gap)
Definition
Chem 7 (BMP)
Term
:this panel assesses renal and liver function and provides a glucose level (glucose, BUN, Creatinine, GFR-nonblack, GFR-black, Na+, K+, Cl-, CO2, anion gap, Ca+, protein total, albumin, alk phos, AST, total bilirubin, ALT)
Definition
Chem 12 panel (CMP)
Term
What does a lipid panel consist of?
Definition
Cholesterol, Trigs, HDL, LDL and Chol/HDL ratio.
Term
What does an electrolyte panel consist of?
Definition
Na, K, Cl, CO2 and anion gap
Term
What type of panel is this? (Albumin, total bilirubin, alk phos, AST, ALT, bilirubin direct and protein total. (GGT is not routinely included).)
Definition
Hepatic panel
Term
What type of panel is this? (o albumin, Ca+, CO2, Cl-, Creatinine, glucose, phosphorus, K+, Na+, BUN, GFR-nonblack, GFR-black)
Definition
Renal function panel
Term
What kind of panel is this? (amylase (50-120 IU/L), lipase (10-150 IU/L), Ca+ (8.5-10.5 mg/dL), TGs (50-150 mg/dL), glucose (70-110 mg/dL))
Definition
Pancreatic panel
Term
What kind of panel is this? (ALT (5-35 IU/L), AST (10-34 IU/L), GGT (0-50 IU/L), albumin/total protein (3.4-5.5 and 6.0-8.5 mg/dL), total bilirubin and direct bilirubin (0.3-1.5 and 0-0.3 mg/dL), PT (11-14 sec), ALP 920-140 IU/L))
Definition
Liver Function tests
Term
What kind of panel is this? (troponin T/I (0-0.2 mcg/L), CK-MB (< 6% of total CK), total CK (30-150 IU/L), myoglobin (10-95 mcg/L for males; 10-65 mcg/L for females), LDH (70-180 IU/L)(flipped pattern: LD-1 > LD-2), AST (10-34 IU/L))
Definition
Cardiac panel
Term
:enzyme found in the prostate gland, bone, liver, spleen, kidney, RBCs, and platelets; Historically used as an aid in the dx of metastatic prostate Ca but PSA is now used, elevated with prostate cancer, BPH and post prostate surgery
Definition
Acid phosphatase
Term
Why does albumin not go through the glomerulus?
Definition
It is small enough but its negative charge prevents it from going through.
Term
What is the average daily urine output?
Definition
1200-1500 mL
Term
:Greatly reduced volume of urine; Commonly seen in states of dehydration resulting from water loss due to excessive vomiting, diarrhea, perspiration, or from severe burns
Definition
Oliguria
Term
:can result from serious damage to kidneys or dec. in blood flow to the kidneys, lack of urine output
Definition
Anuria
Term
:Increase in daily output of urine; output >3L/day; Urine looks dilute but has a high osmolality
Definition
Polyuria
Term
What does dark amber (beer brown) urine indicate?
Definition
Presence of conjugated bilirubin
Term
What does pink or red urine indicate?
Definition
RBCs, Hgb, myoglobin, porphyrins; Intact cells give the specimen a CLOUDY appearance
Term
What does black or brown urine indicate?
Definition
Methemoglobin, Homogentisic acid or melanin (malignant melanoma)
Term
What does dark orange urine indicate?
Definition
can be caused by the cystitis drug Pyridium (phenazopyridine) or by rifampin
Term
What is the normal urine chemstrip (dipstick) pH?
Definition
5.0-6.0
Term
What is the best test to check for albumin in urine?
Definition
Chemstrip or "dipstick"
Term
Which test is used to retest all specimens with a positive chemstrip result? What do they order if that test is positive?
Definition
Sulfosalicylic acid (SSA) confirmatory test. If that test is positive then they order a 24 hour urine test to quantify the amount of protein being secreted per day.
Term
What is ordered if a 24 hour urine test protein specimen is over 150 mg/day?
Definition
A urine protein electrophoresis to detect proportions of albumin and other proteins.
Term
What is the "spot" method of urinalysis useful for?
Definition
Useful for detecting the albumin to creatinine ratio (which corrects for variations in concentration w/o doing a 24-hour collection) for a diabetic pt; used to detect microalbumin (a protein present in the urine but is not detectable by routine Chemstrip testing) in the urine to dx and follow diabetic nephropathy
Term
What level of proteinuria is considered pathologic? What level is indicative of nephrotic syndrome?
Definition
Pathologic = greater than 150 mg/day.
Nephrotic syndrome = greater than 3.5g/day.
Term
How are glucose test results reported?
Definition
Negative, trace, 1 or greater than/equal to 2g/dL. Negative is normal.
Term
:confirmatory test that’s performed if the glucose test is > Trace on the chemstrip; it detects all sugars (not just glucose); since it also detects galactose, it picks up inherited defect of galactosemia
Definition
Clinitest Tablet
Term
How are ketones reported on urinalysis testing?
Definition
Negative, trace, small, moderate or large
Term
:confirmatory test for ketones in the urine if the chemstrip is > Trace.
Definition
Acetest Tablet Test
Term
:formed by the breakdown of Hgb in the spleen and RE cells and this Hgb is then attached to albumin and now called______?
Definition
Indirect bilirubin
Term
When bilirubin is in the liver and it is conjugated with glucuronic acid, making it soluble in water it is called_______?
Definition
Direct bilirubin
Term
Much of the bilirubin goes into the bile and thus out into the small intestine; Some of the direct bilirubin remains in the large intestine and is metabolized by colonic bacteria to_______?
Definition
Urobilinogen
Term
What gives urine its brown color?
Definition
Urobilinogen
Term
What gives feces its brown color?
Definition
Stercobilin
Term
:kind of bilirubin formed from Hgb breakdown; never found in urine since it’s insoluble
Definition
Unconjugated (indirect) bilirubin
Term
:confirmatory test that detects direct bilirubin in urine; shake test is first test performed by lab techs to detect direct bilirubin in urine, where the specimen is shaken vigorously and yellow foam (like beer head) forms if present
Definition
Ictotest tablet test
Term
What are the 3 most common causes of bilirubinuria?
Definition
liver dz, hepatic obstruction, and hemolysis.
Term
:Results reported as Normal (0.2-1), 2, 4, or 8 Ehrlich Units (EU); formed in the intestinal tract by bacterial breakdown of conjugated bilirubin; majority is excreted in feces and some is excreted in urine
Definition
Urobilinogen
Term
What are the confirmatory tests for increased and decreased urobilinogen?
Definition
Decreased levels = check stool sample.
Increased = check chemstrip.
Term
What conditions cause increased urobilinogen? Decreased?
Definition
Increased = hepatic dz.
Decreased = hepatic obstruction.
Term
What kind of urine specimen is preferred for detection of urinary tract pathogens that can convert nitrate to nitite?
Definition
First morning specimen
Term
What does a positive urine nitrite result indicate?
Definition
Bacteria are present in the specimen in significant numbers.
Term
What is the confirmatory test for a positive urine nitrite result?
Definition
Microscopic examination and a bacterial culture.
Term
What conditions commonly lead to pyuria (increased WBCs in urine)? What is the confirmatory test for pyuria?
Definition
Infection/inflammation of GU system. Confirmatory test is microscopic examination of the urine for WBCs.
Term
:Ratio of density of substance (urine) to water; it reflects relative degree of concentration; Normal is 1.005-1.030; tested with a refractometer
Definition
Specific Gravity (SG)
Term
What is the most common cause of an increased specific gravity?
Definition
dehydration
Term
What is the most common cause of a decreased specific gravity?
Definition
DI
Term
What condition is characterized by a constant specific gravity of 1.010 (normal) regardless of conditions?
Definition
Isothenuria
Term
:most commonly used for dx of polyuria when DM has been ruled out (disorders include DI and psychogenic water drinking)
Definition
Osmolality
Term
What should be suspected if transitional epithelial cells are found in urine and there has not been any recent procedures regarding an instrument?
Definition
Pathologic processes
Term
What does an increase in renal tubular epithelial cells in urine indicate?
Definition
Tubular necrosis/damage or nephrotic syndrome.
Term
Where are casts made?
Definition
DCT and collecting duct
Term
What factors increase cast formation?
Definition
acid pH, high SG, proteinuria and stasis of urine.
Term
What is the major constituent of casts?
Definition
Tamm-Horsfall protein
Term
What do hyaline casts indicate?
Definition
Could be just due to exercise, dehydration, fever or stress. But could also be due to renal dz.
Term
What do cellular casts indicate?
Definition
Indicate serious renal disease
Term
What do WBC casts indicate?
Definition
Nephronal infection or inflammation
Term
What do RTE cell casts indicate?
Definition
Renal tubular damage
Term
What are the causes of granular casts?
Definition
Could be a by-product of metabolism or it could be any other dz causing cellular cast formation.
Term
What do waxy casts indicate?
Definition
Severe urine stasis and often chronic renal failure.
Term
What do fatty casts indicate?
Definition
Nephrotic syndrome
Term
What do broad casts indicate?
Definition
End Stage Renal Failure
Term
When are uric acid crystals (Yellow to reddish-brown with irregular shapes) found on microscopic urine exam?
Definition
Dz causing hyperuricemia (Gout).
Term
When are calcium oxalate crystals (Colorless octahedrons that resemble envelopes) found on microscopic urine analysis?
Definition
Seen in antifreeze poisoning
Term
When are cystine crystals (colorless hexagonal plates) seen in microscopic urine examination?
Definition
Seen with cystinuria
Term
When are cholesterol crystals seen in microscopic urine examination?
Definition
Nephrotic syndrome
Term
When are leucine crystals (Yellowish-brown spheres that contain concentric circles with radial striations) seen in microscopic urine examination?
Definition
Severe liver disease
Term
When are tyrosine crystals (Fine, delicate colorless to yellow needles in clusters or sheaths) seen on microscopic urine evaluation?
Definition
Severe liver disease
Term
When will bilirubin crystals (Yellow-brown colored clumped needles or granules) been seen on microscopic urine examination?
Definition
Liver disease
Term
Which crystals are found in alkaline pH? Are they typically clinically significant?
Definition
Triple phosphate, calcium phosphate, ammonium biurate and calcium carbonate. None are clinically significant.
Term
What is the most common yeast in urine?
Definition
Candida albicans
Term
What is the most common parasite in urine?
Definition
Trichomonas vaginalis
Term
What does the presence of several starch granules along with a large # of squamous epithelial cells and bacteria suggests in a urine sample?
Definition
Contamination
Term
When will hCG be produced in a pregnant women? When will it be noticeable in urine?
Definition
It will be produced in 8-11 days after conception but will not be noticeable in urine until 1-2 days after a missed menstrual cycle.
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