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Clinical Chemistry quick review all area for ASCP or AMT exa
Quick Review Q&A for CLS
99
Chemistry
Undergraduate 2
06/23/2015

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Cards

Term
Glucose is (higher/lower) in newborns that adults
Definition
lower
Term
Why is the A1C test invalid in a patient with hemoglobin S or C?
Definition
because of the shortened life span of the RBCs
Term
Describe the solubility properties of lipids in the blood.
Definition
In the blood, liids are soluble due to their combination with protein (lipoprotein
Term
What is the main storage form of lipid storage in the body?
Definition
Triglycerides in adipose tissue
Term
What is the major site of cholesterol synthesis
Definition
liver
Term
What is the most common method for cholesterol determination?
Definition
enzymatic using cholesterol esterase and cholesterol oxidase
Term
How is LDL cholesterol determined
Definition
Friedwald formula
(Total cholester - HDL cholesterol)- (triglycerides/5)

This formula is not valid if triglycerides > 500 mg/dL
Term
What is the main storage form of lipid storage in the body?
Definition
Triglycerides in adipose tissue
Term
What is the major site of cholesterol synthesis
Definition
liver
Term
What is the most common method for cholesterol determination?
Definition
enzymatic using cholesterol esterase and cholesterol oxidase
Term
How is LDL cholesterol determined
Definition
Friedwald formula
(Total cholester - HDL cholesterol)- (triglycerides/5)

This formula is not valid if triglycerides > 500 mg/dL
Term
What are chlylomicrons?
Definition
Largest and least dense of lipoproteins. They transport EXOgenous triglycerides and account for the turbidity of serum following a meal
Term
What is the major waste product of protein catabolism?
Definition
urea
Term
Which element if found in protein but not in carbohydrates or lipids
Definition
nitrogen
Term
What is the most common method for measuring serum total protein?
Definition
biuret method
Cuprous ions react with peptide bonds at al alkaline pH to produce a colored complex
Term
Why is biuret method of protein analysis not used for urine or CSF
Definition
It is not sensitive enough
Trichloracetic acid can be used to precipitate protein in urine and CSF
Term
How does hemolysis affect serum total protein
Definition
It would increase it
Term
How is the concentration of globulins determined in a chemistry profile?
Definition
Total protein minus albumin
Term
In the body, what charge do most proteins carry
Definition
at pH 7.4 proteins are negatively charged
Term
What is electroendosmosis
Definition
The flow of bufferr toward the cathode due to the negative surface charge present in the support medium. On cellulose acetate, this results in gamma globulins being swept toward the cathode
Term
What stains are used in serum protein electrophoresis
Definition
Coomassie brilliant blue (CBB), amido black, Ponceau S, and bromphenol blue. CBB is more widely used because it is more sensitive
Term
What is the name of the instrument used to quantitate rotein fractions following serum protein electrophoresis
Definition
densitometer
Term
What causes increased albumin concentrations
Definition
dehydration
Term
What causes decreased alpha-1 globulin
Definition
alpha 1 antitrypsin deficiency. this is seen in emphysema
Term
What causes a decreased gamma globulin fraction
Definition
hypogammaglobuliemia
Term
Describe the acute phase reactant or inflammatory pattern
Definition
Albumin is decreased
alpha 1, alpha 2, and BETA globulins are increased
Term
Describe the chronic response pattern
Definition
Albumin is decreased
alpha 1, alpha 2, and GAMMA globulins are increased
Term
What is the name of the instrument used to quantitate rotein fractions following serum protein electrophoresis
Definition
densitometer
Term
What causes increased albumin concentrations
Definition
dehydration
Term
What causes decreased alpha-1 globulin
Definition
alpha 1 antitrypsin deficiency. this is seen in emphysema
Term
What causes a decreased gamma globulin fraction
Definition
hypogammaglobuliemia
Term
Describe the acute phase reactant or inflammatory pattern
Definition
Albumin is decreased
alpha 1, alpha 2, and BETA globulins are increased
Term
Describe the chronic response pattern
Definition
Albumin is decreased
alpha 1, alpha 2, and GAMMA globulins are increased
Term
When is beta-gamma bridging seen
Definition
cirrhosis
Term
Describe pattern for monoclonal gammopathy
Definition
Sharp peak in the gamma region
Term
When is beta-gamma bridging seen
Definition
cirrhosis
Term
Describe pattern for monoclonal gammopathy
Definition
Sharp peak in the gamma region
Term
What causes the hyperproteinemia seen in multiple myeloma
Definition
An increase in one of the immunoglobulins or free light chains
Term
Which immunoglobulin is increased in waldenstroms macroglobulinemia
Definition
IgM
Term
A patient has a monoclonal gammopathy on serum protein electrophoresis. What test can be done to determine which immunoglobulin is increased
Definition
immunofixation
Term
What is the substrate for starch
Definition
amylase
Term
Why shouldn't EDTA plasma be used for an amylase determination?
Definition
Ca++ is needed for the reaction and EDTA chelates Ca++
Term
Which enzyme is most specific for acute pancreatitis
Definition
Lipase
Term
In which disease does the highest elevations of alkaline phospatase (ALP) occur?
Definition
Paget's disease (bone disease characterized by excessive bone destruction and unorganized bone repair
Term
What is the clinical significance of ACP (acid phosphatase)
Definition
Highest levels of ACP are seen in the prostate. It is most significant use is in rape cases
Term
In which condition is the highest levels of CK seen
Definition
muscular dystrophy
Term
Which cardiac enzyme is most specific
Definition
CKMB is the most specific cardiac enzyme but not the most specific cardiac biomarker. Cardiac troponins are more specific for AMI
Term
How is cardiac troponin measured
Definition
immunoassays using monoclonal antibodies
Term
Which cardiac marker is most likely to be elevated 4 days after a suspect myocardial infarction?
Definition
Cardiac troponins. CK-MB would have returned to normal
Term
What is the clinical significance of B-type natriuretic peptide
Definition
It is a cardiac hormone produced by the heart ventricles in response to ventricular volume expansion. It is a predictor of congestive heart failure. The test is an immunoassay tha can be performed at point of care
Term
What is significance of highly sensitive C-reactive protein (hs-CRP)
Definition
CRP is a marker of inflammation and appears to be assoicated with increased risk for coronary heart disease, sudden death, and peripheral artery disease
Term
Which enzymes are most useful for assessment of liver function
Definition
ALT AST ALP GGT and LD

Other liver tests include total protein, albumin, and total and conjugated bilirubin
Term
Which enzyme is most sensitive for all types of liver disease
Definition
GGT

Levels are highest with biliary obstruction
Term
Which disease has the highest elevation of AST and ALT
Definition
acute hepatitis
Term
Where is LD found
Definition
In all cells of body. In liver disease, LD does not increase as much as AST and ALT
Term
What effect does hemolysis have on LD
Definition
Increasedd
LD is 100 to 150 times more concentrated i the RBCs
Term
How should specimens for LD be stored
Definition
25C and analyzed with in 48 hours
They should not be refrigerated because LD decreases more rapidly at 4C
Term
What clinical condition results in the highest level of LD
Definition
pernicious anemia
Term
Bone disease enzyme
Definition
ALP
Term
Muscle disorder enzymes
Definition
CK, AST, LD, and aldolase
Term
What is clinical significance of low pseudocholinesterase levels
Definition
Low levels are seen following exposure to insecticides and nerve gases
Term
Name 3 substances that are elevated in renal disesase
Definition
BUN, creatinine, and uric acid
Term
What is urea
Definition
End product of protein metabolism
Term
Where is 98% of the body's creatinine located?
Definition
the muscles
Term
Where is 98% of the body's creatinine located?
Definition
the muscles
Term
what is uric acid
Definition
end product of purine metabolism
The purines are adenosine and guanine.
Uric acid is increased with gout and renal disease
Term
what is uric acid
Definition
end product of purine metabolism
The purines are adenosine and guanine.
Uric acid is increased with gout and renal disease
Term
What reagent is commonly used to mearure uric acid
Definition
uricase
Term
Where is ammonia formed
Definition
mainly in the intestines from deamination of amino acids. it is converted to urea by the liver
Term
When is ammonia elevated
Definition
with Reye's syndrome and hepatic failure
Term
Which protein transports bilirubin
Definition
albumin
Term
Name the 3 type of bilirubin
Definition
unconjugated, conjugated, and delta
Term
Which type of bilirubin is bound to albumin
Definition
delta bilirubin

It is ONLY present with hepatic obstruction
Term
What is the significance of clay colored stools
Definition
obstruction of the bile duct

Urobilin is not being produced because bilirubin is not reaching the intestines
Term
Which form of bilirubin can only be excreted in teh urine
Definition
conjugated bilirubin
Term
Which form of bilirubin can only be excreted in teh urine
Definition
conjugated bilirubin
Term
Which methods are used to determine bilirubin levels
Definition
jendrassik grof and malloy-evelyn

Both use a diazo reagent to react with bilirubin and produce a colored azobilirubin. Malloy-Evelyn is carried out at an acid pH. Jendrassik Grof at an alkaline pH.
Term
Name the accelators for the two methods of bilirubins
Definition
Malloy-Evelyn - methanol
Jendrassik-Grof - caffeine
Term
What is the precursor in the iosynthesis of all steroid hormones
Definition
cholesterol
Term
What is main action of FSH (follicle stimulating hormone)
Definition
stimulates production of egg and sperm
produced in anterior pituitary
Term
What is function of growth hormone
Definition
Stimulates protein and cell growth and division
produced in anterior pituitary
Term
Where is TSH produced
Definition
anterior pituitary. stimulates thyroid to produce t3 and t4
Term
What is main action of ADH (anti diuretic hormone)
Definition
Produced in hypothalamus and stored in posterior pituitary
Regulates reabsorptio of water from teh distal convoluted tubules. Increased in diabetes insipidus
Term
What is addisons disease
Definition
adrenal insufficiency
decreased cortisol and increased ACTH
The adrenal gland is unable to respond appropriatey to ACTH
Term
Cushing syndrome
Definition
ELevated levels of cortisol. May be due to tumors
Term
What does aldosterone do
Definition
It increases the retention of Na and excretions of K and H+
Term
What does aldosterone do
Definition
It increases the retention of Na and excretions of K and H+
Term
What is main action of parathyroid hormone (PTH)
Definition
increases calcium and decreases phosphorus
Term
What is major intracellular ANION
Definition
phosphate
Term
What is major intracellular ANION
Definition
phosphate
Term
What is major extracellular ANION
Definition
chloride
Term
What is major extracellular ANION
Definition
chloride
Term
Which hormone regulates the concentration of sodium
Definition
aldosterone
Term
What is the approximate ration of potassium between RBCs and serum
Definition
20:1
Term
Wht clinical condition results from potassium that is very high or very low
Definition
cardiac arrhythmmias
Term
What is chloride's role in the body
Definition
maitains hydration, osmotic pressure, and electrolyte balance
Term
What happens to lactate in the blood following collection
Definition
it increases due to glycolysis
Term
Which substance contributes most to serum osmolality
Definition
sodium
Term
What is a buffer
Definition
a weak acid and its salt
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