Chem Theo
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| Four things an accurate chemical analysis depend on | Proper collection, Preservatives, Processing, Method of Analysis
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| What is the ideal time for lab measurements to be performed | One hour- Quest centrifuge within one hour of collection- test within 2 hours: VARIES
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| Hemolyzed serum | Serum or plama clear red; interfere with test
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| What sample is most often used for chemical analysis | Serum- Fasting serum
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| The difference between plasma and serum | Plasma liquid portion of circulating blood with fibrinogen and clotting factors- Serum only exist on top of blood
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| What methods are used to preserve specimens | Part of specimen collection, Sodium flouride preservative: gray topped tube- refrigeration, must be RT before testing-Separate cells from plasma or serum- protect from light for bilirubin- freeze plasma or serum, must mix before testing
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| What is thixotropic gel used for | To separate serum or plasma from cells, prevent shift of substance, prevent glycolysis
T
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| What vacutainer is used to collect serum and why |
Gold and Red, no anticoagulants
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| How is a gold top tube processed | Invert 5x, do not remove stopper, do not centrifuge immediately after drawing, clot upwright @ least 30 min no more than 60 @ RT so clot not connected to stopper, centrifuge @ least 15 min within one hour of collection
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| Precaution when handling blood | Gloves, PPE, biohazard sharp container for blood and needle, immediately disinfect blood spill, open stopper carefully and away
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| What are fats called when they are combined with proteins | lipoproteins- insoluble in water
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| VLDL | very low density lipoprotein- carry lipid to tissue
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| HDL | High density Lipoprotein- return stuck pieces back to liver; heart helping
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| LDL | Low density lipoprotein- pieces stuck on blood vessel walls- artert clogging
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| VFR | Very fast rising- Chylomicrons
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| What kind of cholesterol is desirable to have | HDL
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| How does the body rid itself of cholesterol | Through the bile
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| What does the precipitation of cholesterol in the gall bladder cause | Gallstone; 60- 80% cholesterol by weight
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| Name 4 lipids | Cholesterol, phospholipids, triglycrerides, fatty acids
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| Desirable cholesterol level | Below 200 mg/dL
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| Borderline cholesterol level | 200- 239 mg/dL
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| High risk cholesterol level for CAD | Greater than 240
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| What ratio is used to predict the risk of a person getting clogged arteries | Total/ HDL; less than or equal 4.5
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| What function do enzymes play in the body | Catalyst; increase the rate of chemical reaction
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| Enzymes are which type od substance | Proteins
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| What things can denature enzymes | Heat, strong acid base, uv sunlight
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| What is substrate | Material acted upon by enzyme
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| How are enzymes named | First part, name of substrate. Ends in -ase and tell what type of reaction
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| Where are enzymes normally found | intact cell; serum level usually very low
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| What does Amylase/ Hydrolase do | Digestive enzyme that break down starch
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| What tissue is Amylase found | Pancrease, salivary glands
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| What diseases are Amylase increased in | acute, chronic pancreasitis
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| What does lipase do | break down fats
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| What tissue is lipase found in | Pancrease
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| What disease are lipase found in | acute, chronic pancreitis
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| What pH is Alkaline phospahatase active in | high pH, optimum ph 10
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| What disease is alkaline phosphatase increased in | Bone, liver
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| What pH is acid phosphatase active in | low pH, optimum pH 5 4.8- 5.1
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| Acid phosphatase is increased in what kind of cancer | prostatic with metastasis
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| SGOT/ AST increased in what diseases | Heart, muscle and liver- heart cell destruction and mono-
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| SGPT/ ALT increased in what disease | liver
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| GGTP increased in what diseases | liver, pancrease- sensitive to alcohol consumption
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| CPK found in what tissue | heart, muscle, brain and lung- Fastest rising in an MI
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| 3 iso enzymes and which tissue is from each | CK1- BB chain- brain and lung, CK2- MB- heart, CK3- MM- muscle
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| Present in almost all tissues, remains elevated longest in MI | LDH
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| How are isoenzymes separated | Electroporiesis
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| Why are hemolyzed specimens not acceptable | high concentration in RBC, 200x plasma limit
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| Which two enzymes are ordered together to evaluate pancreatic function | emylase, lipase
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| Which test are in a cardiac profile | CPK, Troponin I, Trooponin T
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| Which test are in a liver profile | ALKP, GGTP, AST, ALT, LDH
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| Which is the most sensitive of the liver enzymes | GGTP
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| What is a gold topped tube used for | Serum, chemistry
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| Icteric | hyperbilirubinemia/ jaundiced serum or plasma, brownish yellow from bilirubin- liver disease, hepatitis
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| Lipemic | Serum or plasma milky white, may have been too soon after a meal
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| Accuracy | True and actual value
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| Precision | Repeat ability
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| Normal value | Average result of healthy individual
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| Batch or run | specimen analyzed @ same time
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| Calibrator | Used to set machine values
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| Control | Must fall within acceptable range before patient samples reported, check accuracy
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| What four things does control check for | Meter, control/ reagent, technique, enviornmental, g
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| What steps should you follow if a control falls outside of the acceptable range | Document, check expiration date, clean meter, retest same control vial
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| Define duplicate determination | One specimen measured twice- check precision
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| What does a quality control program include | Waived- QC as specified by kit manuf. Easy not lot of training. Moderate- complexity- Keep results two years.
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| glycogen | storage form of glucose
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| glycogenesis | formation of glycogen from glucose
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| glycolysis | glucose changed to give energy
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| glycogenolysis | breakdown of glycogen to glucose
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| gluconeogenesis | glucose from fat or protein
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| Where is glycogen made and stored | made in liver; stored in liver and muscle
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| Where is insulin made | Beta cell of Ishlets of Langerhans in pancrease
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| What does insulin do | Stimulates the transport of glucose thru cell membrane, must be present for glucose to enter cell
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| Where are ketone bodies made | In the liver
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| What are ketone bodies made from | Excess fatty acids; partially metabolized into ketone bodies by the liver
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| ketonuria | ketone bodies in the urine
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| ketonemia | ketone bodies in the blood
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| ketoacidosis | Ketone blood pH (acid)> 7.35 due to ketone bodies in the blood
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| hyperglycemia | high glucose in the blood
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| hypoglycemia | low glucose in the blood
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| glucosouria/ glycosuria | glucose in the urine
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| renal threshold | blood level above which glucose spill in the urine; 160- 180 mg/dL- over maximum reabsorptive level
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| IDDM aka as | Insulin Dependent DM- Type 1 juvenile
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| IDDM age of onset | any age youth > than 20
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| IDDM type of onset | abrupt
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| IDDM sypmtoms | weight loss
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| Do IDDM have endogenous insulin | None
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| Is oral agents used for IDDM | No
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| NIDDM aka | Non- insulin dependent DM- Type 2 adult
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| NIDDM age of onset | any age common in adults over 30
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| NIDDM Type of onset | Gradual
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| NIDDM Symptoms | wounds heal slowly, drowsy after meal, vision
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| DO NIDDM have endogenous insulin | some
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| Is oral agents used for NIDDM | yes, 1/3 oral agent, 1/3 diet, 1/3 insulin
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| What is the cause of IDDM | Genetic susceptible, auto-immune destruction of beta cells
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| What is the cause of NIDDM | Beta cell exhaustion, target cell resistant
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| Which type of diabetes has a tendency to get ketoacidosis | Ty 1 juvenile no insulin of own
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| IDDM type of onset | abrupt
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| IDDM sypmtoms | weight loss
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| Do IDDM have endogenous insulin | None
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| Is oral agents used for IDDM | No
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| NIDDM aka | Non- insulin dependent DM- Type 2 adult
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| NIDDM age of onset | any age common in adults over 30
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| NIDDM Type of onset | Gradual
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| NIDDM Symptoms | wounds heal slowly, drowsy after meal, vision
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| DO NIDDM have endogenous insulin | some
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| Is oral agents used for NIDDM | yes, 1/3 oral agent, 1/3 diet, 1/3 insulin
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| What is the cause of IDDM | Genetic susceptible, auto-immune destruction of beta cells
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| What is the cause of NIDDM | Beta cell exhaustion, target cell resistant
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| Which type of diabetes has a tendency to get ketoacidosis | Type 1 juvenile, no insulin of own
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| Which diabetes may be controlled by diet alone | Type 2
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| What do diabetics metabolize instead of glucose | lipids, fats, triglycerides, fatty acids
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| Complications of diabetes of diabetes | Atherosclerosis, CAD, peripheeral vascular disease, poor wound healing, susceptible frequent infection, nephropathy, neuropathy
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| Diabetic coma insulin level | none/low
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| Diabetic coma blood glucose level | high
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| Do diabetic coma have urine glucose | yes/present
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| Diabetic coma onset | hours/ days
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| Symptoms of diabetic coma | deep breathing, dry tongue/skin, fruity breath, drowsy, lethargic, coma
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| How do you treat patient with diabetic coma | insulin
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| Insulin shock insulin level | none
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| Insulin shock blood glucose level | too low
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| Insulin shock urine glucose | negative
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| Insulin shock onset | sudden/ matter of minutes
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| Insulin shock symptoms | shallow breathing, perspiration, shaky, light headed, faint, drunk acting
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| How do you treat patient with insulin shock | 15 grams of readily available carbs, small box of rasins, tbs of honey, 7-8 lifesavers
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| What samples are taken for OGTT | fasting 1, 2, 3, hours after glucose
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| What does Hb-A1c test measure | glysolated hemoglobin
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| What is the advantage of the Hb-A1c/ glycosylated hemoglobin test | reflect the blood glucose over a 3 month period
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| What are NPN Compounds | urea, creatinine, uric acid, ammonia, creatine, amino acid
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| What is urea the breakdown product of | Protein
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| What does BUN stand for | Blood urea nitrogen
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| What two things affect serum BUN | Protein in diet, urine volume
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| What causes increased BUN | Pre-renal dehydration, DM, - Renal cause- glomerulonephritis, polycystic kidney disease- Post renal- kidney stones enlarged prostate
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| What is azotemia | increase in NPN in the blood
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| What does creatine and phosphocreatine break down into | creatinine- waste
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| What are two test to assess kidney function | BUN, Creatinine
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| What is uric acid the break down product of | purines- protiens
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| Where is uric acid formed | in the liver
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| Which foods are high in purines | meat, fish, poultry, organ meat, anchoves, beef broth,
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| When is uric acid increaded in the serum | gout, cell turnover- leukemia, polycythemia
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| Where is ammonia made | bacteria in intestines, breakdown of protein, kidney tubules
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| What are amino acids | building blocks of proteins
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| What are the different plasma proteins and where are each made | albumin, fribrinogen, alpha globulin, beta- made in the liver- gamma globulin, made in reticuloendothelial system including lymph nodes- B lymphocytes
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| Important function of protein | transport of metals, iron, hormones and lipids
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| What does TSP stand for | Total serum protein
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| What is the normal A/G ratio | 1.0/ 2.5
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