Clinical Chemistry Final

What is the difference between an "α- hydroxyl" and a "β- hydroxyl" pyranose ring?

"α-" means that the -OH on C-1 of the ring is positioned below the ring, and a "β-" means that the -OH on C-1 of the ring is positioned above the ring.

What units does coefficient of variation use

%

What is the formula for converting F to C

(5/9-32 from F)

What is the equation for creatinine clearance?

(U*V/P) * (1.73/BSA)

What is the 68-95-99 Rule?

+/- 1 SD = 68.3% +/- 2 SD = 95.4% +/- 3 SD = 99.7%

Discuss the function or importance of haptoglobin (Hp)

-An APR that binds to free hemoglobin in plasma -Hp prevents loss of hemoglobin and its iron through renal glomeruli -Another important role of Hp is the control of local inflammatory response through a number of processes.

What is the most common methodology for measuring Urea/BUN? What does it measure?

-Glutamate dehydrogenase (GLDH) - Measures NAD+

Ammonia is measured by what method? What does it measure?

-Glutamate dehydrogenase method -Indirectly proportional to NADPH+

enzymes end in:

-ase

Describe the GFR

proportional to body size and varies with age and sex. GFR is a key indicator of kidney function and is used to monitor kidney disease progression.

To convert urea to BUN, multiply the urea by ____

.467

Haptoglobin

protein that is synthesized in the liver which functions to bind free hemoglobin for recycling by the spleen used as a marker for hemolytic anemias (levels will decrease bc there is more haptoglobin being used) migrates to alpha 2 region in serum protein electrophoresis

What amount of blood can be used to measure the pts acid-base status in the analyzer

0.1-0.3 mL

What is alpha thalassemia silent carrier

1 gene deletion Normal Hb synthesis levels 27% of African American population

Describe the structure of the renal system

1 million nephrons/kidney Contains the glomerulus which has 3 parts: Proximal convoluted tubule Loop of Henle Distal convoluted tubule Bowman's capsule surrounds glomerulus

Medicare was designed for what percentage of the population?

1%, its covering 15%

What are some things that cause an increased plasma level (albumin)

protein wasting diseases such as a starvation diet or uncontrolled Diabetes Mellitus

all enzymes are:

proteins

What is a protein error indicator

proteins will alter the color of a pH indicator without actually changing the pH Tetrabromthymol blue turns green then blue depending on concentration of protein Most sensitive to albumin

What are the three types of enzyme inhibitors?

1. Competitive 2. noncompetitive 2. Uncompetitive

What are five things that affect the measurement of enzyme reaction?

1. Concentration of reactants 2. pH 3. Temperature 4. Ionic strength 5. Cofactors and coenzymes

what are the functions of carbohydrates?

provide energy through oxidation; supply carbon for synthesis of cell components; store chemical energy; form parts of cell and tissue structures

In which tubules are Hydrogen ions exchanged for sodium ions of sodium bicarbonate

proximal and distal tubules

There are ___ million nephrons in each kidney

1.5

Describe the metabolism of amino acids

10 amino acids needed by humans can be synthesized by the body (non-essential, can be made from EAA through a.a. metabolic pathway), 10 others (essential) must be supplied by proteins in food.

What is the reference range for the anion gap

10-20 mmol/L

What is the normal BUN/Cr ratio?

10:1 - 20:1

What are the chains that make up hemoglobin A1

2 alpha and 2 beta

What are the chains that make up hemoglobin A2

2 alpha and 2 delta

What makes up Hemoglobin F

2 alpha and 2 gamma

What are Phosphoipids

2 fatty acids attached to 1 molecule of glycerol solid or liquid depending on fatty acid content Third position on glycerol backbone contains phospholipid group Types of head groups: choline, inositol, serine, ethanolamine

What is alpha thalassemia minor

2 gene deletions Mild, microcytic, hypochromic anemia May see HbH (4 beta chains) inclusions and some hemolytic anemia Higher incidence in African Americans

When converting BUN to urea, multiply by ___

2.14

The concentration of Potassium is how many times greater inside the cells than outside the cells

20x

What is the reference range for osmolality

295 mmol/L

What are triglycerides

3 fatty acid molecules attached to 1 molecule of glycerol Are either solid or liquid depending on fatty acid content

What is hemoglobin H disease

3 gene deletions—1/3 of alpha chain synthesis occurs, resulting in accumulation of beta chains and formation of beta chain tetramers (HbH) Shortened RBC lifespan due to deformity Moderate hemolytic anemia

what is an oligosaccharide?

3-10 monosaccharide units (less common)

What are some basic celcius temperatures to know

37 degrees body temperature 25 degrees room temperature 4 degrees fridge temperature

Describe the stucture of a porphyrin ring

4 pyrrole groups bonded by methene bridges Hemoglobin has 4 porphyrin rings and each can bind an iron atom

Water makes up what percent of human body weight

40-75%

A creatinine clearance of ___-___ indicates mild renal impairment, ___-___ indicates moderate impairment, and < __ indicates severe impairment

50-79; 10-49; 10

How much do newborns gain per day

6 grams

What PH must a citriate agar electrophoresis test be performed at

6.0-6.2

In chronic kidney disease, the GFR is < ____ ml/min for ___ months or more

60; 3

Where does normal hemoglobin synthesis occur

65% in nucleated cells 35% in reticulocytes

The glomerulus has a molecular weight cut off filter of ___ kDa, which is the size of ____

66; albumin

optimum pH for enzyme activity is:

7 (neutral)

What is the use of glycosylated hemoglobin? What is it also known as? What levels are in normal pts/diabetics?

8% in normal persons and 25% in diabetics Measures glucose levels over several weeks Helps monitor diabetics with hemoglobinopathies. Also known as fructosamine

How is phosphate distributed throughout the body

80% in bone, 20% soft tissues, <1% serum/plasma

The PCT reabsorbs __% of glomerular filtrate, including ___, ___ and ____

80%; water; Na; Cl

How is calcium distributed throughout the body

99% of body calcium is in bone \1% is in blood & other ECF Of total amount in blood, 45% circulates as free calcium ions, 40% is bound to protein, & 15% is bound to anions

In the normal range of LD, will LD1 be greater than or less than LD2

<

In a MI LD1 will be greater than or less than LD2?

>

What is the reference range for proteinuria

>300mg/24 hour urine

What are porphyrogens

reduced, functional forms that must be used in heme synthesis; unstable; colorless, do not fluoresce

What is the function of renal tubules and collecting duct

regulate electrolytes and water under the influence of hormones

What are some effects of hyperphosphatemeia

renal failure

What do the test in the metabolic panel measure

renal function, liver function, electrolyte and acid/base balance glucose, & proteins

What is the function of surfactant

required for lungs to expand & transfer of blood gases (oxygen & carbon dioxide) after delivery

what is NAD+ involved in?

respiration

What is Mass Spectrometry used as

A detector to identify samples eluting form gas chromatographic/HPLC column

What is osteoporosis

A gradual loss of bone mass due to increased bone resorption relative to bone formation Osteoclasts remove bone matrix Osteoblasts refill bone matrix Affects 30% of elderly women & 20% of elderly men

What is Diabetes Mellitus

A group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both Patient symptoms: Polydipsia, polyphagia Polyuria Fatigue Pallor Fruity breath

What is the structure of hemoglobin

A large, spherical, complex protein molecule (molecular weight is 64,000) Heme (3%) & globin proteins (97%) Contains 4 heme groups attached to 4 globin chains Each heme group can bind one iron atom Each globin chain consists of 141 or more amino acids & has 4-fold structure Majority of hemoglobin in normal adults is hemoglobin A (or A1).

enzymes form in:

ribosomes

What is the effect of a dietary deficiency of calcium

rickets or osteomalacia

What is growth hormone

roduced by anterior pituitary Decreases uptake of glucose by cells, increases gluconeogenesis increases blood glucose levels

Describe and compare methodologies used in the analysis of albumin

runs from negative to positive side because ph is 7.4 and proteins are negatively charged (more alkaline and will be attracted to the anode which attracts anions) pI range for proteins in human body = 5.5-5.8 From black (cathode which attracts cations) to red (anode which attracts anions)

What is the Reference interval/range

A pair of medical decision points that span limits of results expected for the patent population with regard to the analyte of interest Not normal range

What is osmolality

A physical property of a solution- measured in molality (solute concentration/kg solvent)

What are some causes of metabolic acidosis

salicylate ingestion, lactic acidosis, or ketoacidosis

What is the solubility test

A screening test for sickling hemoglobin, this test sees if sickling hemoglobin forms a precipitate in concentrated phosphate buffer solution

What is the structure of myoglobin

A simple heme protein found in skeletal & cardiac muscle Has 1 polypeptide chain (153 amino acids) & 1 heme group per molecule Slightly larger than 1/4th of a hemoglobin molecule, with molecular weight of 17,000

What is the function of the hypothalamus

secretes antidiuretic hormone (reabsorption of water by kidneys)

What is spectrophotometry

A way of measuring light intensity transmitted (%T) or absorbed (%Abs) by a solution at a particular wavelength. The wavelength is selected by a filter

What are the components of beers law

A=abc via graph A = absorbance "a" = absorptivity constant for the analyte at standard wavelength, temp, & pH "b" = length of light path in the spec "c" = concentration of the analyte

What can a alpha-1 antitrypsin (AAT) deficiency result in? What will it look like on electrophoresis?

AAT deficiency is one of the most common genetically lethal diseases in caucasians. Occurs in patients with pulmonary emphysema (can be brought on by age or smoking). A congenital deficiency can also result in juvenile hepatic cirrhosis, where AAT

What is a disorder if you cant synthesise Aminolevulinic acid

ALA Dehydratase (Plumboporphyria (PP))

What enzymes are associated with bone disorders?

ALP

In a liver obstruction, what liver markers will be increased?

ALP and 5'NT

What enzymes are associated with a biliary tract obstruction?

ALP and GGT

Which liver enzyme is the most specific for liver disease

ALT ALT>AST is specific for liver disease

Which chemicals are the best for labs

AR (Analytic Reagent Grade) and ultrapure are best for the lab

In hepatitis which liver markers will be increased?

AST and ALT

What enzymes are associated with a hepatocellular disorder?

AST, ALT, LD

What are the 6 liver markers?

AST, ALT, LD, ALP, 5'NT, and GGT

What are some enzymatic changes that occur as you age

AST, GGT, lactate dehydrogenase, amylase: increase with age ALP: increase in women >60 and men >90 CK: increase slightly between 60-70 years, decrease after age 70 Lipase: decrease after age 90

How would you read a pipette

AT THE BOTTOM OF THE MENISCUS

What is the mean

AVERAGE

What are the neurological symptoms of Hepatic (acute) porphyrias

Abdominal pain, constipation, vomiting Hypertension, tachycardia Fever, leukocytosis, paresthesia (tingling sensation on skin)

What is Analytical specificity

Ability of a method to identify only the analyte of interest in a sample with many potential interfering substances

What is clinical sensitivity

Ability to correctly identify patients with a disease

What is clinical specifity?

Ability to correctly identify patients without a disease

What are somethings that need to be looked for in POC testing

Ability to lock out untrained users Required quality assurance procedures before sample analysis Ability to download data to hospital lab information system

What are the different enzyme specificity types

Absolute: specific to only one substrate Group: specific to all substrates of a chemical group Bond: specific to chemical bonds Stereoisometric: specific to one optical isomer of a compound (L or D isomers)

What does turbidity measure

Absorbance of light by matter in the sample Absorbance is directly proportional to concentration

What are the effects of porphyras on the body?

Accumulation of heme precursors in blood, overflow into urine

What are the three ways to measure Spectrophotometer Quality assurance

Accuracy of wavelength selection Whether or not there is stray light or light scatter by interfering solutes linearity of the test

How does porphyrin function in the body

Act as chemical precursors in synthesis of hemoglobin, myoglobin, & other respiratory pigments called cytochromes Form part of peroxidase & catalase enzymes, which contribute to efficiency of internal respiration Chelate iron to form heme Used to diagnose porphyrias

What is albumin's function?

Action/role = provides 80% of oncotic pressure; amino acid reservoir; binds/carries small molecules and electrolytes, helps buffer the pH of the blood

What is the function of hemopexin?

Action: Removes heme from circulation When RBCs are destroyed, hemopexin transports heme to the liver, where it is catabolized by the reticuloendothelial system

What does the size of a lipoprotein depend on

Actual size of lipoprotein depends on lipid content

What is the function of the DCT?

Adjusts for electrolyte and acid base homeostasis through hormonal control of ADH and aldosterone

What is the treatment for alkaptonuria

Administering vitamin C which decreases oxidation of HGA

What is the function of the adrenals

Adrenals: produce and secrete aldosterone (reabsorption of Cl-)

What are the reference intervals of Uric Acid

Adult, plasma/serum (mg/dL): male, 3.5-7.2; female, 2.6-6.0 Adult, urine, 24-hr (mg/day): 250-750 Child, plasma/serum (mg/dL): 2.0-5.5

What are some reference intervals for Ammonia

Adult: plasma, 19-60 g/dL Child (10 days-2 years): plasma, 68-136 g/dL

What are some advantages of Flurorometry? Disadvantages?

Advantages- greater specificity and sensitivity Disadvantages- very sensitive to environmental changes- needs FREQUENT CALIBRATION

What are the 10 non essential amino acids

Alanine (ala), asparagine (asn), aspartic acid (asp), cysteine (cys), glutamic acid (glu), glutamine (gln), glycine (gly), proline (pro), serine (ser), tyrosine (tyr)

Discuss the albumin to globulin ratio. (When is albumin suppresed/globulins elevated?)

Albumin can be suppressed due to decreased production in malnutrition, malabsorption, liver failure, or amino acid diversion to other proteins. Globulins (alpha 1 and 2, beta and gamma) may be elevated due to increased synthesis or many different proteins in acute and chronic disease states, such as CRP increases in inflammation and complement proteins during infection

What is the most abundant serum protein

Albumin:

____ is the protein that is in highest concentrations in the blood, and is a ____ APR

Albumin; negative

What are some liver enzymes

Alkaline phosphatase (ALP) Alanine aminotransferase (ALT) Aspartate aminotransferase (AST) Transferases which catalyze conversion of amino acids to oxo-acids

What are some chemical properties of carbohydrates

All ketoses and aldoses are reducing sugars (All monosaccharides & many disaccharides) Nonreducing carbohydrates do not have an active ketone or aldehyde group Sugar is oxidized and the other reactant is reduced

What is the purpose of using beers law

Allows determination of concentration when absorbance is known Basis for photometric assays

Discuss the importance of electrophoresis

Allows us to find a spike in someones Immunoglobulin Band. We can quantitate the band using a densitometer to see if the band is significant or report out numbers for a patient.

What is cPSA, and what is it used for?

Alpha1-macroglobulin (AMG) can form a complex with prostate specific antigen (PSA, used to diagnose prostate cancer) = cPSA which can escape detection by commercial PSA immunoassays

How much of the amino acids and glucose is reabsorbed

Amino acids and glucose almost completely reabsorbed

Describe the basic structure of amino acids

Amino acids contain an amino group (NH2), carboxyl group (COOH), hydrogen and an R group (radical or side chain) with the formula RCH(NH2)COOH L-form is naturally occurring They will have at least one of both amino and carboxylic acid functional groups A chain of amino acids is a polypeptide, a large polypeptide is protein

What are the early precursors of Hepatic (Acute) porphyrias

Aminolevulinic acid (ALA) Porphobilinogen (PBG)

Which steps for making heme are in the cytoplasm

Aminolevuninic acid-> Porphobilinogen-> Hydroxymethylbilane-> Uroporphyrinogen III-> Coporophyrinogen III ->

Discuss the general characteristics of the aminoacidopathies, including the metabolic defect in each and the procedure used for detection

Aminopathies are Inherited enzyme defects that inhibit metabolism of certain amino acids some metabolic defects that can happen with a person with a aminopathy is their membrane transport system could block entry of certain amino acids and preventing their use in synthetic pathways could cause medical complications because of toxic amino acid build up. The procedure that is used to detect aminopathies are newborn screening tests.

When will Ammonia be elevated

Ammonia will be elevated in liver disease, Reye's syndrome, deficiency of urea cycle enzymes Can be elevated in patients on parenteral nutrition-- need to monitor ammonia levels especially in infants whose livers are immature and can't handle too much protein.

___ is usually not involved in kidney function tests, and is normally converted into ____

Ammonia; urea

How does a Ion-selective Electrode compare voltage generated

And ISE compares voltage generated by reference and test electrodes

What are some acid-base disorders that can occur in an infant

Anoxia during delivery- lactic (metabolic) acidosis Respiratory distress- respiratory acidosis Liver immaturity or inborn error of metabolism—hyperammonemia (metabolic alkalosis)

What are the different types of thalassemias

Aplha Thalassemias Beta Thalassemias Minor = heterozygous Major = homozygou

What are some ways of measuring Apolipoproteins

Apo B is measured directly in serum by immunoassay Apo A-I is measured by separation & analysis of HDL cholesterol Lp(a) is commonly measured by immunoassays

how much of the renal plasma is filtered through the glomeruli

Approximately 120 ml/min, or one-fifth of the renal plasma

What are the 10 essential amino acids

Arginine (arg), histidine (his), isoleucine (ile), leucine (leu), lysine (lys), methionine (met), phenylalanine (phe), threonine (thr), tryptophan (trp), valine (val)

What are some aging issues that make phlebotomy difficult

Arthritis, malnutrition, dehydration Decrease in muscle tone & skin elasticity Vein issues (rolling veins)

What are symptoms of gout? (3)

Arthritis, nephropathy, and nephrolithiasis

Which race has lower levels of LDL cholesterol and Heart disease

Asians

How is quality control accomplished

Assaying stable control materials and comparing determined vs. expected values

What is the clinical application of Creatinine

Assess renal function, diagnose and monitor renal disease Renal damage: elevated creatinine and decreased GFR Insensitive: loss of 50% renal function before creatinine levels are significantly increased

What are some clinical applications of Uric Acid

Assessment of inherited disorders of purine metabolism Diagnosis and monitoring of gout and associated renal calculi Prevention of uric acid nephropathy in chemotherapy patients Detection of kidney dysfunction

Describe the structures and general properties of amino acids and proteins

At least 1 of both amino & carboxyl functional groups polypeptide- chain of amino acids protein-large polypeptide

___ gives a definitive diagnosis for gout, with ___ ___ ___ and a high ____ count

Athrocentesis; uric acid crytals; WBC

Describe the major pathologic conditions associated with increased and decreased plasma concentrations of urea

Azotemia: elevated concentration of urea (or other nitrogenous substances) in blood Prerenal azotemia: due to reduced renal blood flow Renal azotemia: due to decreased renal function (i.e., renal failure) Postrenal azotemia: due to obstruction of urine flow Uremia: very high plasma urea concentration with renal failure (aka uremic syndrome)

What are the specimans for lipid analysis

serum (prefered) and plasma

How can you measure phosphate

serum, lithium heparin plasma methods used to measure phosphate: formation of an ammonium phosphomolybdate complex

What specimans are used for determining bicarbonate

serum, plasma methods: ISE or using an enzymatic method

What specimans can you use to determine chloride

serum, plasma, urine, sweat this can be analyzed by ISE

What specimans and methods can be used to measure sodium in the body

serum, plasma, whole blood, urine, sweat Ion-selective electrode method is most common

What species can you use to determine calcium? How?

serum, plasma; you can determine calcium by dye binding

What are some things that cause a decreased plasma level (albumin)

severe burns, inflammation, or gastrointestinal malabsorption /maldigestion

What is a isoform

similar to isoenzyme except differences occur posttranslationally

what is a monosaccharide?

single polyhydroxy aldehyde/ ketone unit

What is microalbuminuria

small amounts of albumin in urine

When CO2 diffuses out of the tubule, what is reabsorbed

sodium and bicarbonate

Solution

solute plus solvent

What are syringes

sometimes used for transfer of small volumes in blood gas analysis or separation techniques

all enzymes are:

specific

How can you detect porphyrins

stable & violet to red-brown in color; fluoresce red when excited by light near 400 nm via spectrophotometry

When does the renal system began to decline

starting at 30 years and decline by 1/2 starting at 60

catalyst

starts or speeds up reaction

What is required to stimulate a babies first breath

stimuli caused by surfactant

What is the function of the Posterior pituatiary

stores antidiuretic hormone

What is an acid

substance that can yield a hydrogen ion (H+) when in solution

enzymes only work with one:

substrate

enzymes that works with sucrose substrate:

sucrase

What is the glycation theory

sugars binding to lipids or proteins (causes browning of toast/ cookies!)—results in cross linking and denaturation of the proteins (renal damage, heart disease, diabetic complications, Alzheimer's, etc.)

How can you calculate the anion gap

sum of cations minus the sum of anions

What converts cholesterol to vitamin D3

sunlight converts cholesterol to vitamin D in the skin

3 factors that affect enzyme activity

temperature, pH, concentration

what is benedict's test?

test to indicate reducing sugars. reduces all monosaccharides and some disaccharides.

what geometric shape does an L- or D- Glyceraldehyde molecule take?

tetrahedral

what does the "L-" and "D-" label apply to on the enantiomer itself?

the "L-" and "D-" label applies to the side of the molecule which contains the -OH farthest from the first chiral carbon.

what is another name for a the C-1 carbon on a Pyranose or Furanose ring?

the "anomeric" carbon

How can you measure the actual percent of Oxyhemoglobin?

the actual percent of oxyhemoglobin can be determined using cooximeter which is designed to measure various hemoglobin species.

enzyme activity increases and then becomes constant as:

the amount of enzymes increases

When is beta2-microglobulin (BMG) increased?

BMG increased in renal failure, inflammation, and neoplasms especially those associated with B-lymphs

What screening tests exist for CKD? (4)

BMP(basic metabolic panel), eGFR, UA, albumin:Cr or protein: Cr ratio on random urine sample

Which cardiac marker is used to measure severity and distinguish dyspenia from cardiac origins or not?

BNP

Describe the diseases associated with alteration in CSF protein

Bacterial, viral, & fungal meningitis; traumatic tap; multiple sclerosis; neoplasm; disk herniation; & cerebral infarction usually levels are increased when there is a disruption of the blood brain barrier

Transferrin migrates to the ____ region

Beta

What region does CRP migrate to?

Beta

Where does complement migrate to?

Beta region

What are some methods of measuing LDL

Beta-quantification: most common; combines ultracentrifugation & chemical precipitation Friedwald calculation: bypasses centrifugation; commonly used in routine & sometimes research labs

Cys C is ___ than creatinine at detecting ___ impairment of a person's ___ function

Better; early; kidney

Which anion is the second most abundant antion in ECF

Bicarbonate

How does the body regulate the amount of bicarbonate in the blood

Bicarbonate is reabsorbed by proximal & distal tubules in kidneys Respiration as CO2

What does abnormal urine contain

Bilirubin, Blood, Glucose Ketone bodies, Porphyrins, Protein

Define the term enzyme

Biologic proteins that catalyze biochemical reactions without altering equilibrium point of reaction or being consumed or altered during the reaction

enzyme activity increases and then becomes constant as:

the amount of substrates increases

What does first order kinetics mean?

the enzyme concentration is greater than the substrate concentration

Describe and compare methodologies used in the analysis of total protein

Biuret: copper binds peptide bond forming a purple complex which absorbs at 540nm Electrophoresis Most often measured in serum Reference interval: 6.5-8.3 g/dL (65-83 g/L) in ambulatory adults

What is the glomerulus?

Blood filter

What is hypoglycemia

Blood glucose <50-55 mg/dL Can be transient & relatively insignificant or life-threatening Most often due to: Hyperinsulinemia (over-medication) Starvation due to illness or malnutrition Addison's disease Patient symptoms Polyphagia, sweating, nausea & vomiting, dizziness, nervousness & shaking, blurred speech & sight, mental confusion

Azotemia is increased ___ ____

Blood urea

Tubular reabsorption returns substances to ___ via ____ and ___ transport

Blood; active; passive

Draw out the path of the urinary filtrate flow

Bowman's capsule → PCT → Descending loop of Henle → Ascending loop of Henle → DCT → Collecting duct → Renal calyces → Ureter → Bladder → Urethra

How does the body regulate the amount of magnesium in the body

the kidneys can absorb it when the body is deficient or secrete it when there is excess

Cholesterol is considered to be the building block for what? Where is this produced

Building block for steroid hormones (which are produced in gonads and adrenal glands)

How would you classify proteins by function

By function: enzyme, hormone, transport, immunoglobulin, structural, storage, energy source, osmotic force

How would you classify proteins by structure

By structure: database (manual & automated), simple, conjugated

How does a medical technologist measure trends in oxygen saturation

the med tech measures the trends in oxygen saturation using pulse oximetry (SpO2)

what is cellulose?

the most important polysaccharide and most abundant compound in nature; provides rigidity and strength to plant cell walls; consists of D-glucose units linked by "β-" (1-->4) linkage

when drawing the D-aldoses (example, d-glucose), how do you determine which side of the polyhydroxide rungs will cycle to the above side of the cyclic formation ring?

the oxygen of the carbonyl group at the top will point to the side which goes above.

What can be done to assess the elderly's nutritional status

the pt could have a nutritional assessment

Why must we monitor drugs that are taken by the elderly

the pt could overdose or have adverse drug reactions Prolonged gastric emptying time: delay in drug absorption Impaired absorption of injected drugs due to decreased blood flow Elimination of drugs through kidneys is decreased Decreased liver function: greater risk for toxicity

enzymes are named after:

the substrate

What does zero-order kinetics mean?

the substrate concentration is greater than the enzyme concentration

What are some theories to why we age?

there are genetic factors and enviormental factors that are associated with change in tissue structure and cell damage

What do Porphyrins, hemoglobin, & myoglobin all have in common

they all contain a porphyrin ring

What are reference materials derived from? Who certifies them?

they are derived from biohazard samples NIST certified

Why is triglycerides useful to measure

they are useful in detecting metabolic disorders & CVD risk

How were lipoproteins originally classified

they were centrifuged and separated based on density

True or false Bicarbonate is the major component of the buffering system in blood

this is true

What is hyperchloremia

too much chloride, can be found in patients with metabolic acidosis

List the reference intervals for total protein and albumin and discuss and nonpathologic factors that influence these levels

total protein (67.54 ± 11.53 g/l) albumin (31.86 ± 4.60 g/l), α(1)-globulin (5.77 ± 2.20 g/l) , α(2)-globulin (5.84 ± 1.90 g/l), β-globulin (7.46 ± 1.94 g/l), and γ-globulin (16.73 ± 4.54 g/l) (A/G) ratio (0.88 ± 0.43)

How is oxygen and co2 measured in an infant

transcutaneous monitoring

What is the role of hemoglobin in the body

transports oxygen to tissue & CO2 to lungs

what are sugars called when they contain 3, 4, 5, and 6 carbons?

trioses, tetroses, pentoses, and hexoses (note, sugars have the "-ose" suffix)

what is a disaccharide?

two monosaccharide units linked together by the acetal or ketal linkages

What is the most common type of diabetes that is found in pediatrics

type 1

What are some methods of measuring lipoproteins

ultracentrifugation, electrophoretic separation, chemical precipitation, chromatographic, immunochemical

What compostition is similar to blood plasma

ultrafiltrate

What are some tests that test the renal system's function

urine volume, constituents/concentration, BUN, uric acid, clearance (creatinine, glomerular filtration rate, plasma flow)

How would you measure Phospholipids

using an Enzymatic reaction sequence

what is a polysaccharide?

very large chain of linked monosaccharide units; polymer consisting entirely of D-glucose units

How is hemoglobin regulation maintained

via gamma-aminolevulinic acid synthase enzyme

How is IgG transfered from the mother to the fetus

via placenta or breast milk

example of a co-enzyme:

vitamins, NAD+

What is the most used reagent

water

What are some filtered productions of urine production

water, glucose, electrolytes, amino acids, urea, uric acid, creatinine, and ammonia.

All buffers consist of what

weak acid and its conjugate base

What is the difference between Weak acids and strong acids

weak acids do not completely dissociate into H+ in solution Strong acids do

Buffers

weak acids or bases and their related salts that minimize changes in hydrogen ion concentration

what makes a compound chiral?

when two compounds have the same molecular and structural formulas but cannot be superimposed on each other

what is a glycosidic bond?

when two monosaccharide rings are bonded using a C-O-C bond

active site

where enzyme and substrate meet

What are burets

wide, long, graduated pipettes with a stopcock at one end

How would you measure Fatty Acids

you would use gas-liquid chromatography

What happens to your ability to deal with stress as you age? What does this depend on?

your ability to deal with stress declines as you age heredity, lifestyle, nutrition

Which order of kinetics is the best for reactions

zero order due to an excess substrate

What component of complement is pick up on electrophoresis?

C3

Why can't C3 and C4 be used to asses rheumatic disorder in regular serum electrophoresis?

C3 and C4 are used to assess rheumatic disorders (SLE and rhematoid arthritis), but C4 is too low in concentration to be detected by serum protein electrophoresis

What does lactate acid differentiate into

CH3CH(OH)COO−

What is the number 1 cause of death in the united states

CHD

What enzymes are associated with cardiac disorders?

CK (MB), LD, AST

What enzymes are associated with Skeletal muscle disorders?

CK (MM), AST, LD, adolase

What are the 5 or 6 cardiac markers?

CK, LD, Troponins, myoglobin, AST, and BNP

What are the different Creatine Kinase Isoenzymes

CK-MM (CK 3) Concentrated in skeletal and heart muscle CK-MB (CK 2) Concentrated in heart and skeletal muscle CK-BB (CK 1) Concentrated in brain Also in many other organs

What is the equilibrium equasion for bicarbonate

CO2 + H2O<---->H2CO3<----> H+ +HCO3-

Describe the relationship between bicarbonate and renal buffering

CO2 from tissues enters blood and travels to kidney In proximal convoluted tubule cells, CO2 + H2O form carbonic acid (H2CO3 ) Carbonic acid readily dissociates into H+ and bicarbonate H+ moves into urine filtrate in exchange for Na+ (sodium/hydrogen antiport system) Sodium moves into the blood in exchange for potassium In urine filtrate, H+ combines with bicarbonate to form carbonic acid Carbonic anhydrase splits carbonic acid into water and CO2 CO2 diffuses back into the renal tubular cell where it can enter the plasma as bicarbonate (blood & respiratory buffering systems)

What is the function of CRP? What is it a non-specific indicator of?

CRP is an APR and a non specific indicator of bacterial or viral infection, inflammation, and tissue injury or necrosis CRP reacts with proteins present in many bacteria, fungi and protozoal parasites One of the first APRs to be discovered and one of the most sensitive

What CV indicates high precision

CV greater than 1%

Which enzymes help with blood coagulation

Ca, Mg

How can Wilson's disease be treated?

Can be treated when a copper chelator (binds to copper and lets it be released from the body), such as penicillamine or trientine.

What is the function of myoglobin

Can reversibly bind oxygen, similar to hemoglobin molecule Unable to release oxygen, except under low oxygen tension Acts as oxygen carrier in cytoplasm of muscle cell Serves as an extra reserve of oxygen to sustain activity in exercising muscle

What is albumin used for

Carrier protein for bilirubin and many hormones, thus levels affect many physiologic functions

Active transport requires ___ ____ and ATP, and passive transport flows with the ___ gradient

Carrier proteins; concentration

What are the two types of electrolytes

Cations-positively charged ions that move towards the cathode Anions-negatively charged ions that move towards the anion

What, in the urine, can be normal or abnormal

Cells, casts, and crystals

What is centrifugation

Centrifugation force is used to separate solids from liquid matter

What are toxicologic issues in pediatric clinical cheimstry

Children who unknowingly consume pharmacologic & other chemical agents in home Self-ingestion of street drugs of abuse in older children Munchausen syndrome

What is the major extracellular anion

Chloride

What part of a lipoprotein is uncharged? Where is this found?

Cholesterol esters and triglycerides are uncharged and inside the lipoprotein

What is cholesterol converted to in the liver? What does this help with

Cholesterol is converted to bile salts in the liver. This assists in absorption of fats from diet in intestine by acting as a detergent

A normal ratio with elevated levels of all NPN (Bun and Cr) indicates ___ ____ _____

Chronic renal failure

What is the exogenous pathway

Chylomicrons interact with proteoglycans on surface of capillaries in various tissues Free fatty acids & glycerol from hydrolysis of triglycerides by lipoprotein lipase can then be taken up by cells

What is the difference between cis and trans fats

Cis same side- naturally occurring liquid fats, plant oils. Causes a bent structure Trans-unnatural fats that are formed from chemical hydrogenation (like margarine) formed from polyunsaturated vegetable oils

What are some ways to measure the glomular filtration rate

Clearance: rate at which creatinine & urine are removed from blood into urine Creatinine: endogenous metabolic product synthesized at a constant rate & cleared only by glomerular filtration Creatinine clearance rate: standard lab method to determine glomerular filtration rate (GFR) Insulin is also used for GFR measurements

What are colligative properties

Colligative properties (properties of a solution relative to pure water) As osmolality increases, freezing point & vapor pressure decrease

What are some physical characteristics of a urinalysis

Color Clarity (turbidity) Odor Specific gravity Volume

What are the basic components of chromatography

Column containing stationary phase, mobile phase, detection method

What are Neurocutaneous porphrias

Combination of neurological and cutaneous symptoms and triggers Buildup of early and late precursors to heme synthesis in blood

What is the complete or basic metabolic panel

Commonly ordered panel of tests that gives an overview of the patient's health status—standard across US

What composes a Lipoprotein

Composed of lipids and proteins Hydrophobic part of phospholipids and cholesterol on inner surface of cell Hydrophilic parts outside

Concentration in intracellular and extracellular spaces is directly related to what

Concentration in extracellular and intracellular spaces is directly related to water volume

Concentration is related to what and inversely related to what

Concentration is related to sodium and inversely related to bicarbonate

What Is Beer's law

Concentration of an analyte in a solution is directly proportional to amount of light absorbed or inversely proportional to amount of transmitted light

The collection duct is the final site for ___ or ____ of urine. Controls the ___ of ___, ___, ___ and ____

Concentration; dilution; water; Na; Cl; urea

What is pediatric diabetes

Condition in which endocrine control of glucose metabolism is abnormal

what is lactose intolerance?

Congenital disorder consisting of an inability to digest milk and milk products; absence or deficiency of lactase results in an inability to hydrolyse lactose

What is a disorder if you cant synthesise Hydromethbilane

Congenital erythropoietic porphyria (CEP))

What are the different components of a centrifuge

Consists of head/rotor, Carriers/shields attached to the verticle shaft of motor, caps/lids, metal enclosure

What is type I diabetes Mellitus

Constitutes 10-20% of all diabetes cases Results from autoimmune destruction of cells of pancreas, causing absolute deficiency of insulin Diagnosed in childhood & adolescents Genetic Patient symptoms as for general DM, including: Hyperglycemia even when fasting Ketonemia, ketonuria, fruity breath Metabolic acidosis (electrolyte imbalance) Kussmaul-Kien respiration Elevated triglycerides (lipemic blood sample) Very low or absent insulin even after a meal Patients are often thin, complain of fatigue, cannot gain weight Complications if not properly controlled: renal disease, retinopathy, poor wound healing, lower life expectancy

What is type II diabetes

Constitutes 80-90% of all diabetes cases Due to insulin resistance, not absence of insulin production Constitutes majority of diabetes cases Typically presents in adults, but this is changing Risk factors include poor diet, lack of exercise, age, obesity, genetic predisposition Less acute symptoms than type 1 Some symptoms of DMII are No ketoacidosis Often hyperinsulinemia or within reference range Hypertriglyceridemia, hypercholesterolemia Dehydration, elevated blood glucose (can be very high and life threatening because lipolysis is also inhibited)

What is a disorder if you cant synthesise Protophyrogen IX

Coproporphyrinogen oxidase (Hereditary coproporphyria (HCP)

What are the top 10 causes of death in patients over 65 years old

Coronary heart disease Cancer Stroke COPD Pneumonia Diabetes Accidents Septicemia Nephritis Alzheimer's disease

What are the steps for sample processing

Correct processing of collection tube/ patient ID label Centrifugation Noting presence of any serum/plasma characteristics (hemolysis/icterus) or turbidity (shows lipemia) Analysis within 4 hours Proper protection Refrigeration at 4 C for 8 Hours or freezing at -20C for longer periods, if later testing is required

Discuss the importance of ceruloplasmin?

Cp is principal copper containing protein in plasma containing 95% of the total serum protein Although it is an essential nutrient, can be toxic to cells in high concentrations The primary storage site is the liver and primary site of excretion is the biliary tract

Which serum protein is involved in Wilson's disease, and what pathologies does it cause?

Cp levels are reduced which decreases reabsorption of copper into the liver, and copper concentration is increased in tissues. Excessive accumulation in the liver, kidney, and brain and lead to degenerative cirrhosis, chronic active hepatitis, renal tubular acidosis, and neurological damage.

What is creatinine clearance

CrCl (mL/min) = (Ucr(Vu)/ Pcr) Ucr: creatinine concentration in 24 hour urine collection Vu: urine volume Pcr: creatinine concentration in plasma collected during the 24 hour urine collection period Can be modified to correct for body surface area Same formula can also be used with inert substance such as inulin to calculate glomerular filtration rate (GFR)

Describe the biosynthesis and excretion of creatine

Creatine is synthesized mainly in liver from arginine, glycine, & methionine. It is then transported to other tissues & converted to creatine phosphate, which serves as a high-energy source

What is Creatine Kinase

Creatine kinase (CK) catalyzes the breakdown of creatine to creatine phosphate

___ is an index or renal function and measures the GFR

Creatinine

Describe how the creatinine test can measure renal function

Creatinine is a waste produce that is sythesyzed and used in muscle contraction levels are held steady by glomerular filtration decreased amount of clearancy indicates glomerular/renal disease

Describe the biosynthesis and excretion of creatinine

Creatinine is a waste product formed from creatine & creatine phosphate in muscle Creatinine is excreted in urine Concentration of creatinine in plasma is directly related to muscle mass Plasma creatinine level is inversely related to glomerular filtration rate (GFR)

What waste products are removed by glomular filtration

Creatinine, urea, uric acid

___ and ___ are used to identify fluid as urine

Creatinine; BUN

What is the decision level

Critical value Level at which the physician will decide to change the patients course of treatment Lab methods must be sensitive af around this value

How is MSUD cured?

Cured with dietary restriction.

what is an example of a furanose ring?

D-fructose

what is the smallest monosaccharide?

D-glyceraldehyde.

What are some physiological things that happen to you as you age?

Decline in total body fluid volume Decreased muscle mass Decreased bone density (increased re-modeling) Increased lipids Decline in respiratory, cardiovascular, renal, hepatic, GI, immune, neurologic, and endocrine functions

What is respiratory acidosis

Decrease in alveolar ventilation, which causes decreased elimination of CO2 by lungs and increasing H (acid)

What is metavolic acidosis

Decrease in bicarbonate resulting in decreased pH

What are symptoms of acute renal failure?

Decreased urine production such as oliguria (<400 ml/day) or anuria

A low BUN/Cr ratio can be due to ____ urea, which can be caused by....

Decreased; low protein intake, severe liver disease or tubular necrosis

What causes Hereditary Variegate porphyria (VP) and Hereditary corproporphyria (HCP)

Defective genes that are further down the synthetic pathway leading to accumulation of protophyrinogens and porphobilinogens

What is AIP (Acute intermittent porphyria)

Deficiency of PBG deaminase Affects 2:100,000 people (only 10% have attacks) Attacks precipitated by drugs (barbiturates & sulfonamids) High urinary ALA and PBG during attack Urine turns red/brown upon exposure to light at room temperature Deficiency of hydroxymethylbilane synthase and accumulation of porphobilinogen

What is Hereditary coproporphyria (HCP)

Deficiency of coproporphyrinogen oxidase Mild with mostly neurologic symptoms Photosensitivity in 30% of patients Attacks precipitated by drugs, hormones, changes in nutritional status High elevation of urinary and fecal coproporphyrinogen (also urinary ALA and PBG)

When is albumin increased?

Dehydration

When is C3 increased? When is it decreased?

Depression of C3 band occurs in autoimmune disorders when the complement system is activated and C3 becomes bound to immune complexes deposited in tissues, thereby removing them from plasma (No particular diagnostic significance is ascribed to higher than normal)

Explain the secondary structure of proteins

Determined by the interaction of adjacent amino acids. Hydrogen bonds are used between adjacent amino acids in order to stabilize structure The three possible conformations are the alpha helix, beta pleated sheets, and random coils To prevent random coils, enzymes called "chaperones" help by "re-folding" proteins

How can you diagnose porphyras

Diagnosis is made by combination of patient/ family history, physical exam, and laboratory findings

How could you diagnose PKU

Diagnosis: phenylketones in urine/serum Newborn screening in all states—blood test chromatographic Urine: monitor PHE status Guthrie test on patient blood Ferric chloride reaction for urine testing

How is phosphate regulated

Dietary sources, release from cells into blood, bone formation and resorption (calcitonin and parathyroid hormone)

What is the anion gap

Difference between anions & cations

Why is electrophoresis performed on CSF?

Differentiate between multiple myeloma and MS

What are some ammonia assay methods

Difficult due to low concentration, risk for contamination, instability Detect both ammonia and ammonium ion Direct measurement of ammonia by enzymatic method Glutamate dehydrogenase with NADPH coenzyme Decrease in absorbance at 340nm

describe sucrose

Disaccharide common sugar; composed of glucose and fructose joined by an "α-" linkage from C-1 of glucose and a "β-" linkage from C-2 of fructose

describe lactose

Disaccharide composed of one molecule of D-galactose and one of D-glucose; linkage between units is "β-" (1--->4)

describe maltose

Disaccharide two glucose units joined by a glycoside (C-O-C) linkage between C-1 on the first glucose and C-4 on the second unit; has an "α-" gylcosidic linkage between glucose units (linkage points below).

Disaccharides are converted to monosaccharides in intestine. What happens next

Disaccharides are converted to monosaccharides in intestine Monosaccharides are absorbed from intestine & transported to liver Hepatic portal circulation Once glucose enters cell, it is shunted into 1 of 3 metabolic pathways to produce energy or be processed for storage: Glycolysis (aerobic or anaerobic) Gluconeogenesis Glycogenesis

What is Hyperlipoproteinemia

Diseases associated with elevated lipoprotein levels Includes hypercholesterolemia, hypertriglyceridemia, & combined hyperlipidemia

What is the definition of hemoglobinopathies

Diseases related to defects in hemoglobin structure

What is the hallmark symptom of homocystinuria?

Dislocation of optic lens is the hallmark of homocystinuria

What are some questions that need to be addressed in POC testing

Does analyte really require immediate turnaround? Who chooses POCT device?

What is Duchenne Form

Duchenne form: X-linked autosomal recessive inherited disorder (almost exclusively in males since they have only one copy of the x genes—females would have to inherit two defective x genes in order to have the disease) Symptoms of muscle weakness/ wasting before age 6, often at birth Lead to death in late teens to 30s due to heart and breathing muscle degeneration There is no cure, no treatment, and no survivors. Approx. 1 in every 2,400 boys worldwide is born with DMD; they die, on average, at about 16 years old. In about 60% of the cases, DMD is inherited from the mother; in about 40% of the cases the disease is the result of spontaneous gene mutation, meaning anyone's son could be born with DMD.

What are the 5 components of electrophoresis

Electric current, support medium, buffer, sample, detecting system

How does mass spectrometry use sample introduction and ionization

Electron Ionization is used to break analytes into predictable (size/quantity) fragments with are unique to the analyte

What can cause Pre, renal, and post renal disease

Elevated BUN means that urea concentration in the blood is too high due to decreased renal perfusion or increased protein breakdown Prerenal: congestive heart failure, dehydration, hemorrhage, increased protein breakdown, high protein diet Renal: renal disease/ failure, glomerular disease Small amounts of urea are normally reabsorbed along with water in the renal tubules Postrenal: urinary tract obstruction (tumor, stones) Other causes for low BUN : creatinine Protein malnutrition, liver disease

When are elevated levels of alpha-1-acid glycoprotein found?

Elevated levels found in rheumatoid arthritis, cancer, pneumonia, and other conditions resulting in an APR

What is the clinical significance of myoglobin

Elevated levels in serum & urine indicate muscle damage Combination of high serum myoglobin & low creatinine clearance rate indicates high risk for acute renal failure Primary use of serum myoglobin is investigation of chest pain to rule out acute myocardial infarction Also has been investigated to aid in diagnosis & differentiation of types of hereditary progressive muscular dystrophy

What is combined Hyperlipoproteinemia

Elevated levels of serum total cholesterol & triglycerides Increased risk for coronary heart disease (CHD)

What plasma tests would you use to diagnose alkaptonuria

Elevated liver enzymes Elevated total CK and CK-MB Spectrophotometric or chromatographic detection of homogentisic acid

What is Hypertriglycemia

Elevated triglyceride levels: high, 200-500 mg/dL; very high, >500 mg/dL Due to either genetic abnormalities or hormonal abnormalities

What are some sources of Error for Ammonia

Eliminate sources of contamination: tobacco smoke, urine, & ammonia in detergents, glassware, reagents, & water

What is ESRD?

End-stage renal disease; renal failure treated by dialysis and/or transplantation

What are some tests for porphyrins

Enhanced fluorescence of compounds in acidic solution Chromatic separation & quantitation with spectrophotometry or fluorometry Molecular diagnostics

The Jaffe is a ____ method measures ___ using ___ ____

Enzymatic; creatinine; alkaline picrate

What happens during Erythropoietic (cutaneous) porphyrias?Hepatic (acute) porphyrias?

Erythropoietic (cutaneous) porphyrias: heme precursors accumulate in the bone marrow Hepatic (acute) porphyrias: heme precursors accumulate in the liver

What is the physiology of calcium

Essential for myocardial contraction Blood-ionized calcium is closely regulated & has mean concentration in humans of about 1.18 mmol/L Important to maintain normal ionized levels during surgery & in critically ill patients

What makes proteins so important

Every function in living cell depends on proteins: motion, biochemical reactions, cell structure, transport, antibodies.

What are some triggers for porphyras

Exposure to sunlight Inflammation/ infection Physical stress Emotional stress

What is ALA dehydratase deficiency porphyria (ADP)

Extremely rare, autosomal recessive Only 7 known cases High urinary ALA & coproporphyrin III, normal PBG Lead poisoning is a more common cause for deficiency of ALA dehydratase

True or false Thermometers do not have to be calibrated

False, Thermometers must be calibrated, It controls QC and temperatures for certain reactions

True or false By itself, Mass Spectrometry has powerful analytical capabilities with widespread clinical applications

False, When coupled

True or false both patient data and controls should fit the 68-95-99 rule.

False, only controls should fit the 68-95-99 rule, if the controls do not there is a qc problem

True or false, In Hepatic (Acute) porphyrias all the attacks are different, are more common in women than men and usually first occur between ages 15-40

False, while this porphyria is most common in woman and usually occurs between the ages of 15-40 the attacks are all THE SAME

What are some genetic forms of Hyperlipoproteinemia

Familial CH: some in family have only elevated cholesterol, others only elevated triglycerides, others both Familial dysbetalipoproteinemia: very rare

What are the four types of Lipids

Fatty acids Triglycerides Phospholipids Cholesterol

What Urinalysis tests would you use to diagnose Alkaptonuria

Ferric chloride test: transient dark blue color Darkening of urine upon alkalinization or treatment with sodium nitrate and ammonium hydroxide Clinitest: yellow precipitate forms indicating a reducing substance Spectrophotometric test for homogentisic acid in urine or plasma

What is a disorder that occurs when you cannot put the protorphyrin IX into heme

Ferrochelatase Erythropoietic porphyria (EP)

Proteomics is made by modifying protein electrophoresis (via crossing immunoelectrophoriseis). What are the two dimentions that are used?

First dimension: separation of patient sample proteins based on size Second dimention: perpendicular to first dimension—new gel contains antibody that can bind to the separated proteins

Explain enzyme kinetics, including zero-order and first-order kinetics

First order: Enzyme excess Reaction rate is directly proportional to substrate concentration are used when the enzyme is merely the reagent and you are detecting the concentration of a hormone or other analyte in the serum) Glucose (oxidase or hexokinase methods) Lactate (lactate dehydrogenase) Uric acid (uricase) Zero order: Substrate excess Reaction rate is directly proportional to enzyme concentration Zero order is used because you are looking for patient enzyme activity as an estimate of concentration

What are some Misc Facts about G-6-PD

First step in pentose-phosphate shunt Found more often in males In RBC maintains NADPH in reduced state to protect hemoglobin from oxidation by other intracellular agents When G6PD is deficient, hemoglobin will be oxidized too easily resulting in a hemolytic anemia Especially with antimalarial drugs (Quinones), Most common in African americans, but found in all races

Analytes must be bound to a ______ for _______

Fluorophore; detection

What is the difference between Flurorometery and Spectrophotometry

Flurometery uses 2 filters instead of 1 for wavelength selection

List the common procedures used for detection, and the specific amino acid detected

For PKU, homocystinuria and MSUD, tandem mass spectrometry (MS/MS) is used to test newborns for elevations of their respective amino acids

What does the force of a centrifuge depend on

Force depends on mass, speed and radius

Describe the biosynthesis and excretion of ammonia

Formed during deamination of amino acids during protein metabolism At pH 7.4, most is ammonium ion (NH4+) Converted to urea in liver (urea cycle) Excreted as ammonium ion by kidney & acts to buffer urine

What is the physiology of phosphate

Found everywhere in living cells; participates in nearly all biochemical processes (higher intracellular concentration)

What is CRP valuable in diagnosing?

Found valuable in diagnosis of bacterial infections vs viral infections

What is the function of lipoproteins

Function is to deliver fuel to the peripherial cells (Core is the energy source)

What do we call monosaccharides which form 5-membered rings?

Furanose ring

eGFR estimates ___ from the serum creatinine levels in pts with ___ ____ ____ or at risk for ___

GFR; chronic renal disease; CKD

What is metabolic alkalosis

Gain in HCO3-, causing increase in pH

Where do immunoglobulins migrate to in electrophoresis?

Gamma region

What is the equation for the A/G ratio?

Globulin= Total protein (g/dl)- albumin A/G ratio is then determined by dividing the albumin concentration by the calculated globulin

What are the three functions of the kidney? (3)

Glomerular filtration, tubular reabsorption and tubular secretion

What is Chronic glomerulonephritis

Glomerular scarring & eventual loss of functioning nephrons Gradual development of uremia

What are the 5 different parts of the nephron?

Glomerulus, PCT, Loop of Henle, DCT, Collection Duct

Uric acid is filtered by the ____, but most is reabsorbed in ___

Glomerulus; PCT

What tests can be included in the Chem 12 or 14

Glucose Calcium Albumin Total protein Sodium Potassium CO2 Chloride Blood Urea Nitrogen (BUN) Creatinine Alkaline phosphatase Alanine aminotransferase Aspartate aminotransferase Bilirubin

What test are included in the Chem 7

Glucose Calcium Sodium Potassium CO2 Chloride Blood urea nitrogen (BUN) Creatinine

What are some things that a chemical urinalysis measures

Glucose Ketones Protein Nitrite Leukocyte esterase Bilirubin Urobilinogen Hemoglobin/blood pH

What is Glycosylated Hemoglobin/ Hemoglobin A1c

Glucose bound to an amino group of hemoglobin molecule forming a ketoamine Rate of formation of HbA1c is directly proportional to blood glucose level Indicator of long term glucose status (2-3 months based on lifespan of an erythrocyte—120 days) Good for monitoring control of diabetes Affinity chromatography is preferred method of measurement, but also immunoassay point of care test Reference range: <7%

What is gestational diabetes

Glucose intolerance with onset during pregnancy May resolve after delivery or persist Carries increased risk for developing diabetes mellitus type 2 later in life Infant is at risk for perinatal complications, respiratory distress, cesarean section, transient hypoglycemia immediately after birth

Describe Glucose Metabolism

Glucose is only carbohydrate directly used for energy Primary source of energy for humans; nervous system completely dependant on glucose supply from extracellular fluid

What is hemoglobin S

Glutamic acid at 6th position on beta-chain is replaced by valine Most common hemoglobinopathy in U.S Trait: heterozygous (HbAS) Disease: homozygous (HbSS) Highest incidence in black Africans/African Americans, and Mediterranean countries High mortality and morbidity with HbSS HbAS has selective advantage in malaria endemic areas Sickled cells are preferentially infected and then destroyed by immune system

What is Hemoglobin C

Glutamic acid in 6th position of beta-chain is replaced by lysine Found in West Africa (North Ghana) in 17-28% of population & in 2-3% of African Americans Heterozygous: asymptomatic Homozygous: mild, compensated anemia, abdominal pain, splenomegaly, target cells

What are some enzyme co-factor functions of magnesium

Glycolysis Transcellular ion transport Neuromuscular transmission Synthesis of carbohydrates, proteins, lipids, nucleic acids Release of & response to certain hormones

What is the renal decline caused by

Gradual loss of nephrons Decreased enzymatic & metabolic activity of tubular cells Increased incidences of pathologic processes (atherosclerosis)

Describe the serologic pipette

Graduated to the tip Blow out pipette Called this because people used to blow out stuff from it Has 2 etched rings

How is quality control represented

Graphically and referencing standard deviations

What is chromatography

Group of techniques used to separate complex mixtures on basis of different physical interactions with reagents in liquid or solid phase

What is Congenital erythropoietic porphyria (CEP)

Gunther's disease Deficiency of uroprophyrinogen III cosynthase Rare (<200 known cases) Appears shortly after birth Patients may have hemolytic anemia which further increases the amount of heme precursors in bone marrow Red/brown urine in diaper Cutaneous photosensitivity—lesions, scarring, infection, mutilation of fingers, ears, nose Teeth will fluoresce red with UV light and appear red/brown in daylight due to porphyrin deposits Elevation of urine and fecal uroporphyrinogen and coproporphyrinogen

How does phosphate buffer in the kidney

H+ can also combine with hydrogen phosphate forming dihydrogen phosphate which is excreted in the urine

Why is the bicarbonate-carbonic acid system an important buffer

H2CO3 dissociates into CO2 and H2O, allowing CO2 to be eliminated by lungs and H+ as water. Changes in CO2 concentration modify respiration rate. HCO3- concentration is regulated by kidneys

What is the Reverse cholesterol transport pathway

HDL removes excess cholesterol from cells

What are the 4 most common Hemoglobin species

HHb, O2Hb, COHb, MetHb

Fibrinogen

Helps make blood clots. Its in the serum.

What is Intravascular degradation

Hemoglobin in circulation dissociates into alpha and beta dimers which are bound by haptaglobin and carried to liver to enter the extravascular pathway

Low levels of albumin is an early warning of ____, and can cause ____

Hepatic damage, edema

What are high ammonia levels caused by

High ammonia levels are common in newborn due to immaturity of urea cycle enzymes & portal circulation

What is cooley aneima

Homozygous, no beta chain synthesis 1-6% HbA2 and 95% HbF Severe anemia Bone marrow responds by expanding in size—enlargement of flat bones Crippling disease diagnosed in childhood Requires regular transfusions, and iron chelation

What is accuracy

How close is that result to the value/target

Discuss the tissue sources, diagnostic significance, assays, and sources of error for amylase

Hydrolase Tissue source: acinar cells of pancreas, salivary glands Diagnostic significance: acute pancreatitis, disorders causing salivary gland lesions (mumps, parotitis) Assay for enzyme activity: saccharogenic method using AMY to hydrolyze a starch to reducing sugars and para nitrophenol which is detected spectrophotometrically Source of error: plasma triglycerides inhibit AMY (hyperlipidemia is common in acute pancreatitis) Reference range: serum: 25-130 U/L; urine: 1-15 U/hour

Discuss the tissue sources, diagnostic significance, assays, and sources of error for ALP

Hydrolase Tissue source: intestine, liver, bone, others Diagnostic significance: Hepatobiliary: biliary tract obstruction Bone: Paget's disease, osteomalacia, rickets, hyperparathyroidism Assay for enzyme activity: Bowers & Macomb ρ-NPP + H2O ρ-Nitrophenol + H3PO4 Source of error: hemolysis; assays should be run as soon as possible after collection; high-fat meal Reference range: 30-90 U/L (30C)

Discuss the tissue sources, diagnostic significance, assays, and sources of error for LPS

Hydrolase Tissue source: primarily in pancreas; also in stomach & small intestine Diagnostic significance: acute pancreatitis Evaluate along with amylase for increased specificity Assay for enzyme activity: colorimetric method with reactions coupled to LPS hydrolysis of a diglyceride, formation of a quinone dye is detected spectrophotometrically (Pointe Scientific method) Source of error: hemolysis Reference range: 0-1.0 U/mL

Discuss the tissue sources, diagnostic significance, assays, and sources of error for ACP

Hydrolase Tissue source: prostate, (highest concentration) bone, erythrocytes, platelets Diagnostic significance: prostatic carcinoma, hyperplasia of prostrate, prostatic surgery, bone metastatic cancer Prostate specific antigen has largely replaced ACP Assay for enzyme activity: same techniques as in alkaline phosphatase, except performed in an acid pH Source of error: Serum should be separated from red cells as soon as blood has clotted Reference range: ACP: 0-3.5 ng/mL

Which part of cholesterol is hydrophilic

Hydrophilic: hydroxyl group on A steroid ring

Which part of cholesterol is hydrophobic

Hydrophobic: rests of fatty acid tail and other 3 steroid rings

CKD is associated with the following conditions (7):

Hypertension, diabetes, autoimmune diseases, urinary tract infections, systemic infections, nephrolithiasis, and some medications

Differentiate types of proteinuria

Hypoproteinemia Total protein level less than reference interval Can be caused by excessive loss, decreased intake, decreased synthesis, or accelerated breakdown of proteins Renal disease, burns, malnutrition, liver disease Hyperproteinemia An increase in total plasma proteins Occurs in dehydration, when concentration of proteins is elevated due to decreased volume of solvent water Sweating, vomiting, diarrhea, hypoaldosteronism Also results from excessive production of proteins Multiple myeloma

___ is a highly specific method for measuring creatinine

IDMS (Isotope dilution mass spec)

What immunoglobulins are found it what percentage?

IgM is largest Ig, produced during immune primary response IgG most abundant Ig in serum (70-75%) produced in response to Ags of most bacteria or viruses IgA comprises 10-15% of Ig, found in secretions IgE, very low concentrations, produced in allergic reactions, asthma, urticaria.

Why is microalbumin important

Important in management of patients with diabetes mellitus because of risk for nephropathy In later phase of nephropathy, increased glomerular capillary permeability allows small amounts of albumin to pass into urine. If detected in early phase by microalbumin measurement, progression to end-stage renal disease can be delayed.

Why would you measure lipids

Important measures of CHD risk Standardized decision cut-points for CHD risk developed by National cholesterol education program (NCEP)

What are some benefits of exercise

Improves overall health & cerebral function, increases social contacts Reduces cardiovascular risk, controls weight, increases functional capacity, improves nutrient intake & sleep

When is haptoglobin (Hp) elevated?

In conditions involving inflammation, infection, tissue necrosis, or malignancy

What is the Lipid Absorbtion pathway

In digestion, dietary lipids are converted to amphipathic lipids Amphipathic lipids form micelles in intestinal lumen Micelles come into contact with microvillus membranes of intestinal mucosal cells & are absorbed

What are some ways of measuring HDL

In past, 2-step separation by chemical precipitation was used Precipitation methods are falsely elevated by high triglyceride levels Homogeneous process: ultracentrifugation to remove VLDL, heparin manganese precipitation to remove LDL, & analysis of supernatant cholesterol by Abell-Kendall assay

What are the reference intervals for urea nitrogen in adults

In plasma or serum (BUN): 6-20 mg/dL In urine, 24-hour: 12-20 g/day

How do the kidneys regulate potassium

In the kidneys there is an exchange for Na+ in distal tubules and collecting ducts

What is the body's natural defense against low levels of albumin levels that cause edema?

Increase globulins to maintain oncotic pressure

What is respiratory alkalosis

Increase in alveolar ventilation, causing excessive elimination of CO2 by lungs and reducing H+

Acute renal failure occurs when there is a short time ___ in serum ___ of __% or more, and a GFR of < __ ml/min

Increase; creatinine; 25; 15

What are some effects of acute tubular diseases

Increased BUN, creatinine, high urine sodium, loss of renal concentrating ability Common causes: ischemia, renal toxins

What is hyperuricemia caused by?

Increased dietary intake, over production of uric acid (10%), underexcretion of uric acid (90%), and specific enzyme deficits

What are some thyroid changes that occur

Increased fibrosis & nodularity of gland Incidences of hypothyroidism & hyperthyroidism increase

When is transferrin increased?

Increased in hepatitis, pregnancy, and women on oral contraceptives or HRT

What does an increase in Lp(a) cause

Increased risk of CHD & cerebrovascular disease

What is the anion gap used for

Indicating an increase in one or more unmeasured cations in serum Renal failure (due to retention of phosphate and sulfate—alkalosis) Ketoacidosis Alcohol or salicylate poisoning (acidosis) Quality control for analyzer used to measure electrolytes Indicated when an anion gap is observed in healthy patients

What are less common methods for measuring urea/BUN?

Indicator dye, conductimetric, isotope dilution mass spec

What is hyperuricemia

Inherited disorders of purine metabolism Lesch-Nyhan syndrome Gout Increased catabolism of nucleic acids Chemotherapy Chronic renal disease Hemolytic anemia Starvation (malnutrition, prolonged vomiting, diabetes mellitus)

Discuss the general characteristics of aminoacidopathies

Inherited enzyme defects that inhibit metabolism of certain amino acids. Exist either in activity of specific enzyme in metabolic pathway or in membrane transport system for amino acids Cause severe medical complications due to build up of toxic amino acids and biproducts of amino acid metabolism in blood

What are some physiological changes of a baby that was just born

Initiation of active respiration at birth requires stimuli, surfactant. Pulmonary blood flow increases & blood pressure decreases at birth; ductus arteriosus closes.

What are some hormones that control glucose levels

Insulin Glucagon Epinephrine Growth hormone Cortisol Thyroxine (T4)

What are some other factors that influence plasma potassium concentration

Insulin promotes uptake of K+ by muscle & liver Exchange for H+ or Na+ Aldosterone levels Metabolic acid/base imbalance Loss due to vomiting, diarrhea, diuretic medication Hemolysis/ cell breakdown

How does the body regulate sodium

Intake of water in response to thirst ADH causes reabsorbtion of water by kidneys Na+, K+, ATPase pump regulates intracellular levels Aldosterone causes retention of chloride A & B natriuretic peptides causes excretion of sodium)

the amount of enzym that will cause utilization of substrate or production of product at the rate of 1uM/min

International unit

Water makes up what % of the intracellular space? Extracellular space?

Intra cellular space 2/3 Extracellular space 1/3 (intravascular space and interstitial fluid)

What are electrolytes

Ions capable of carrying electric charge

What would transferrin/ percent saturation levels look like in IDA? Hemochromotosis?

Iron deficiency: Transferrin levels will be elevated but % saturation will be lower than the normal 20-50% Hemochromotosis: % saturation will be very high

What happens during extravascular degredation

Iron is recycled via transferrin Carbon is exhaled as CO2 Globin chains are recycled as amino acids Remainder is waste bilirubin

Charge & Isoelectric Point (pI)

Isoelectric point (pI): pH at which protein has no net charge If pH > pI, charge is negative; if pH < pI, charge is positive At physiologic pH, serum proteins are negatively charged because the pI range from 5,5-5.8 The farther the pI is from the pH of the buffer, the farther the migration, assuming pore size is large enough to accommodate the protein Important for serum protein electrophoresis (SPE) Solubility: > charge = > solubility in water

What is Hypoalphalipoproteinemia

Isolated decrease in circulating HDL (concentration <40 mg/dL), without presence of hypertriglyceridemia Alpha denotes region in which HDL migrates on agarose electrophoresis. Associated with several defects, often genetic, most of which are linked to increased risk of premature CHD

Discuss the function of α1-antitrypsin (AAT)

It is an APR with antiprotease (trypsin) activity, also resulting in the neutralization of neutrophil esterase (normal for fighting infections, but can destroy alveoli) and collagenase.

What is the major metabolic defect for homocystinuria?

It results from a deficiency in cystathionine beta-synthetase, which converts homocysteine to cystathionine.

Which electrolytes are essential in Myocardial rhythm and contractility

K, Mg, Ca

How would you dispense the mohr and serologic pipette

Keeping vertical and not touching container

Cystatin C is a ___ function marker and a ___ protease inhibitor

Kidney; cysteine

What is the Jaffe Methoid

Kinetic Jaffe method (rapid, inexpensive, easy to perform—most commonly used) Serum is mixed with alkaline picrate & rate of change in absorbance is measured May be measured in plasma, serum, or urine Hemolyzed & icteric samples should be avoided Cephalosporins, dopamine, lidocaine, elevated glucose, ketones, and uric acid interfere May be refrigerated for 4 days, frozen for longer storage

Which cardiac marker can be used to detect if an MI has occurred more than five days ago?

LD

Which cardiac marker takes the longest to peak, and first increase?

LD

Which cardiac marker has the longest duration?

LD and Troponins

What is included in a cholesterol measurement

LDL, HDL, total cholesterol panel found using an enzymatic test method

What is Lipoprotein A

LDL-like particles and area heterogenous in size and density Plasma levels of Lp(a) vary widely amound individuals in population but remain relatively constant within an individual Similar to plasminogen; elevated levels may promote clot formation-risk factor for coronary heart disease

What is the function of Beta2-microglobulin (BMG)?

LMW protein that comprises the common light chain of class one MHC antigens found on all nucleated cells

What is " Chain of custody"

Lab tests related to crime are forensic/legal cases Need documentation at each stage of the process Tamper proof seal

Who verifies a reference interval? Why?

Lab to ensure the stated interval applies to the patient population

How many times does lab water need to be purified

Lab used water needs to purified at least 2x

What do the chemical labels show

Labels show grade and percentage of impurities

What are some lab results of Diabetes Mellitus

Laboratory results: Hyperglycemia (random glucose > 200mg/dL, fasting >100mg/dL) Glucosuria Ketonemia/ ketonuria (typically only in type 1DM) Hormone abnormalities

Who establishes a reference interval?

Laboratory, health care community, or reagent manufacturer

What is used in energy metabolism

Lactose glucose and galactose

What is Acute Glomerulonephritis

Large, inflamed glomeruli with a decreased capillary lumen Rapid onset of hematuria & proteinuria

What are Chylomicrons

Largest and least dense; diameters as large as 1,200 nm Produced by the intestine Deliver dietary triglycerides to hepatic and peripheral cells

Haptoglobin (Hp) is synthesized ___ and is ___ reacting

Late; weak

What is hyponatremia

Less than 135 mmol/L sodium in serum can be caused by Hypoaldosteronism Hypokalemia or Hypervolemia

MSUD has high serum levels of...

Leucine, isoleucine and valine.

When is CRP elevated?

Levels may rise dramatically following myocardial infarction, trauma, psychological or physiological stress, infection, inflammation (rheumatoid stuff), surgery, various cancers

What are some dermatological sympoms of Cutaneous porphyras

Light sensitivity, hyperpigmentation Rash/ blisters/skin fragility/sun burn Necrosis of skin Excess hair growth NO abdominal pain or constipation

What are the 4 components of a spectrophotometer

Light source Monochromators Sample cell Photo detectors

What is the predictive value

Likelihood that the result is true, can be a positive or negative predicative value.

What are the Four major pathways for Lipoprotein metabolism

Lipid Absorption, Exogenous Pathway, Endogenous pathway, Reverse Cholesterol transport pathway

What is Hypercholesterolemia

Lipid abnormality most closely linked to heart disease Familial hypercholesterolemia (FH): genetic abnormality predisposing people to elevated cholesterol levels Can be Homozygous (rare 1:1 million and have their first heart attack in teens) or Heterozygous (more common 1:500)

Hypoalbuminemia can cause falsely ___ values for certain measured ions

Low

What is Hypolipoproteinemia

Low levels of lipoproteins Hypobetalipoproteinemia—not associated with CHD risk

What is analytical sensitivity

Lower limit of detection for a method

What are some different buffering systems

Lungs: bicarbonate Renal: bicarbonate, phosphate, ammonium ion Blood

What is the function of chloride

Maintain osmolality, blood volume, & electric neutrality

What is the importance of alpha-1-acid glycoprotein?

Major glycoprotein increased during inflammation, and APR

What band does α1-antitrypsin (AAT) migrate to?

Makes up 90% of the alpha 1 protein area of electrophoresis

Gout occurs in ___ patients, age ___-___

Male; 30-50

What would the urinalysis look like for someone with Maple syrup urine disease

Maple syrup odor of urine Positive ketone on dipstick 2,4 dinitrophenylhydrazine (DNPH) reaction Yellow precipitate with keto acids

What is nephrotic syndrome

Massive proteinuria & lipiduria, hypoalbuminemia, edema, and hyperlipidemia Due to renal degeneration as a result of chronic disease

What are reference materials

Materials that are used to calibrate instruments or find out the standard "calibration mode"

What are some speciman requirements and interfering substances

May be measured in plasma, serum, or urine In plasma, avoid ammonium ions & high citrate & fluoride. No light blue top or gray top tubes Susceptible to bacterial decomposition—must assay promptly in urine or refrigerate

What is the purpose of measuring lipoproteins

Measure physical properties: density, size, charge, apolipoprotein content

What are the speciman requirements and interfering substances in a uric acid test

Measured in heparinized plasma, serum, or urine Remove serum from cells quickly to prevent false elevation due to higher intracellular content Diet affects concentration overall, but fasting not necessary

What is Ion-Selective Electrodes (ISE)

Measurement of electrical potential difference between two electrodes (in Volts)

What does Osmometry Measure

Measures concentration of solute particles in a solution

What does the comparison of methods experiment involve?

Measuring patient specimens by both existing and new methods Reference and test methods

Gout is an ____ problem, resulting in the ____ and ____ of ___ ___ in the joints

Metabolic; supersaturation; crysalization; uric acid

Tubular secretion secretes products of ____

Metabolism

What are conjugated proteins?

Metalloproteins (protein + heavy metal), Lipoproteins, Glycoproteins (Protein + carbohydrate), Mucoproteins, Phosphoproteins, Nucleoproteins

Homocystinuria has high levels of...

Methionine

Why is methionine tested instead of homocysteine in homocystinuria?

Methionine is tested due to difficulty measuring homocysteine directly

Which enzymes are cofactors in enzyme activation

Mg, Ca, Zn

Prealbumin

Migrates ahead of albumin in classic electrophoresis of proteins Functions: transport protein for thyroxine & triiodothyronine

What is the mobile phase in Gas Chromatography? The stationary Phase?

Mobile phase is gas Stationary phase is liquid or solid

What are compact analyzers

Mobile point-of-care testing systems Can measure cholesterol, triglycerides, HDL cholesterol, & glucose from a finger stick sample

What is the mobile phase in High-Performance Liquid Chromatography (HPLC)? Stationary Phase?

Mobile- solvent Stationary- solid within column

What is quality control

Monitoring of analytic processes to detect errors

Describe Urine Protein Electrophoresis

Monoclonal or polyclonal immunoglobulins Lambda or kappa light chains in multiple myeloma Due to small size, may not accumulate in serum but can be found in urine

Does clinical specificity have more false positives or false negatives? What is this is this desirable for?

More false negatives, desirable for confirmatory methods.

Does clinical sensitivity have more false positives or false negatives? What is this desirable for?

More false positives, and this is desirable for screening methods

Describe Porphyria cutanea tarda (PCT)

Most common porphyria Severe deficiency of uroporphyrinogen decarboxylase Autosomal dominant or idiopathic and sporadic Presents in adulthood Blistering of skin when exposed to light Increased hair growth Excretion of uroporphyrin in urine Remission after low dose chloroquine or iron depletion Hepatocyte damage (hemosiderosis, fibrosis) Induced by alcohol, estrogen, benzenes, viral hepatitis, other diseases

What is Hydrops fetalis

Most severe, 4 gene deletions—no alpha Hb chains are formed (4 gamma chains) Incompatible with life due to extremely high affinity for O2 and lack of delivery to tissues

Discuss serum protein electrophoresis.

Most significant is monocloncal immunoglobulin

What are some tests for urinary porphobilinogen (PBG) and aminolevulinic acid (ALA)

Must be separated by ion exchange column PBG turns red/orange when mixed with Erlich's reagent (para-dimethylaminobenzaldehyde) ALA first reacts with acetylacetone to form a pyrrole, then Erlich's reagent Watson-Schwartz method: extraction step to prevent interference from other colored compounds such as urobilinogen Hoesch method: reagent is not subject to interference by urobilinogen

Which cardiac marker can be used to rule out an MI by lack of it's presence within 4 hours?

Myoglobin

Which electrolytes are essential in volume and osmotic regulation

Na,Cl, K

Transferrin is a ____ APR

Negative

What is the effect of negative feedback on hepatic heme? When is this needed

Negative feedback from high levels of hepatic heme stops production of ALA enzyme and limits new synthesis of heme needed when liver heme levels are low

When pH of a solution is greater than pKa, there is a net ___ charge, because...

Negative, b/c excess OH- ions, H+ ions will form water

What is the difference between Nephelometry and Turbidity

Nephelometry measures the light scatter by particulate matter in the sample Concentration is directly proportional to light scatter

C3 and C4 are now easily quantified by _____ for monitoring _____ disease

Nephelomtry; rheumatic

When is alpha2-macroglobulin (AMG) increased?

Nephrotic syndrome = AMG is characteristically increased up to 10 times normal because it is retained while smaller proteins are excreted in the urine. AMG can reach serum levels equivalent to albumin (2-3 g/dL) AMG is also elevated in liver disease, estrogen (oral contraceptive / hormone replacement therapy), and slightly in DM

Describe the biosynthesis and excretion of urea

Nitrogen is released as a result of protein metabolism, converted to urea in liver & excreted by kidneys as a waste product Most urea in glomerular filtrate is excreted in urine, but some is reabsorbed in renal tubules.

Do all proteins have quaternary structure?

No

Describe the Mohr Pipette

Not graduated to the tip Self draining

Classify carbohydrates into their respective groups.

Number of carbon atoms: Triose (3) Tetrose (4) Pentose (5) Hexose (6) Location of carbonyl group Aldose: terminal carbonyl group (aldehyde group) Ketose: carbonyl group in middle, linked to 2 other carbon atoms (ketone group) Stereochemistry of compound Carbons in a carbohydrate are chiral (asymmetric) D and L stereoisomers Determined by lowest numbered OH (double bond is #1) Most natural carbohydrates are D-form Number of sugar units in chain Monosaccharides: 1 unit (glucose, fructose, galactose) Disaccharides: 2 units (maltose, lactose, sucrose, trehalose) Polysaccharides: >10 units (starch [glucose molecules], glycogen)

How does the respiration system regulate the acid base balance

O2 is inspired & diffuses from alveoli into blood CO2 diffuses into alveoli from blood & is eliminated Result is minimal change in H+ concentration between venous & arterial circulations.

What is Oxyhemoglobin

O2 reversibly bound to hemoglobin

what is the general structure of a hemiacetal?

OR | R-- C --OH | R

What are some other diabetes tests

Oral glucose tolerance test (OGTT) 75-g glucose is taken by patient 2-hour blood glucose ≥200 mg/dL is diagnostic for DM >140 mg/dL is pre-diabetic

The cortex is the ___ layer of the kidney, and the medulla is the ___ layer of the kidney

Outer; inner

Discuss the tissue sources, diagnostic significance, assays, and sources of error for (G-6-PD)

Oxidoreductase Tissue source: erythrocytes, adrenal cortex, spleen, thymus, lymph nodes, lactating mammary gland Diagnostic significance: G-6-PD deficiency Inherited sex-linked trait Manifested in drug-induced hemolytic anemia Assay for enzyme activity: Patient red cell hemolysate is used to assay for deficiency of enzyme If present in hemolysate, G6PD reduces G-6-phosphate and NADPH to 6-phosphogluconate and NADP Reference range: 10-15 U/g Hgb

What are the 6 ways to classify an enzyme

Oxidoreductases Transferases Hydrolases Lyases Isomerases Ligases

What is a disorder if you cant synthesise Porphobilinogen

PBG deaminase (Acute intermittent porphyria (AIP))

Describe the major metabolic defect of PKU, the way it is tested for, and the "cure"

PKU has an abnormally high level of phenylalanine in serum, and mother will have elevated Phe levels during pregnancy. Dietary restriction is the "cure".

How do hormones regulate calcium in the body

Parathyroid hormone (PTH)—increases levels Vitamin D—increases levels Calcitonin—decreases levels

What is Chemiluminescence

Part of chemical energy generated produces excited intermediates that decay to a ground state with emission of photons

What is proficiency testing

Part of quality control and is required to maintain lab accreditation, provided by the College of American Pathologists (CAP)

What does the reference interval/ range depend on

Patient age, race, weight, sex, disease state etc.

What are some patient requirements/interfering substances for Ammonia assays

Patient should not smoke for several hours before collection Venous blood should be obtained without trauma & placed on ice immediately Heparin & EDTA are suitable anticoagulants Samples should be centrifuged at 0-4C within 20 minutes of collection & plasma or serum removed

What is a key characteristic of Wilson's disease?

Patients show copper deposits in the eye, resulting in a Kayser Fleischer rings (pigmented rings at the outer margins of the cornea and sclera)

What are some pediatric preanalytic concerns

Pediatric sample tubes: cannot be handled by automated systems & are subject to greater evaporation when opened

What is the bell curve standard deviation used for

Perform method quality control using control substances

What is the purpose of urinalysis

Permits a detailed, in-depth assessment of renal status with an easily obtained specimen Serves as a quick indicator of glucose status, hepatic-biliary function, hydration, urinary tract infection, renal health and function

The three aminoacidopathies tested for in NYS are...

Phenylketonuria, Maple Syrup Urine Disease, and homocystinuria

What is the chemical method for measuring uric acid?

Phosphotungstic acid

What dectector is used in HPLC

Photometery, MS

What does a routine urinalysis assess

Physical characteristics Chemical analyses Microscopic examination of sediment from a urine sample

What are some preanalytical variables of sample processing

Physiologic considerations Proper patient preparation Problems in storage, collection, transporting, or processing

What is bilirubin

Pigment resulting from hemoglobin catabolism in the liver—normally excreted in bile

What are some reference intervals for creatinine

Plasma or serum (mg/dL) Adult (M): Jaffe method, 0.9-1.3 Adult (F): Jaffe method, 0.6-1.1 Child: Jaffe method, 0.3-0.7 Urine, 24-hour (mg/day) Adult (M): 800-2000 Adult (F): 600-1800

Uremia is increased ___ ____, and is usually accompanied by ___ failure

Plasma urea; renal

What is another name for ALA dehydratase deficiency porphyria

Plumboporphyria (PP)

What is a disorder if you cant synthesise Coproporphyrinogen III

Porphyria cutanea tarda (PCT) Hepatoerythropoietic porphyria (HEP)

How does Porphyrins get metals to participate in oxidative metabolism

Porphyrins can chelate metals to form functional groups that participate in oxidative metabolism

What is the chemistry of porphyrins

Porphyrins found in nature are compounds in which side chains substitute for 8 hydrogen atoms found in 4 pyrrole rings Four basic isomers may exist for every porphyrin compound (I-IV) Only types I & III, which differ in side chain arrangement, occur in nature

When pH of solution is less than pKa, there is a net ___ charge, because....

Positive, b/c greater [H+]

What is the major intracellular cation in the body

Potassium

What are the three types of errors in a laboratory setting

Pre analytic Analytic Post analytic

Which APR has a role as a sensitive marker of poor nutritional status such as protein-energy nutrition (PEM)

Pre-albumin (TTR)

What kind of chemicals do labs buy?

Pre-prepared chemicals with varying purity

A high BUN/Cr ratio with an increase BUN but a slightly increased Cr indicates ____ _____, while a high ratio with increased BUN and Cr indicates ____ ____

Prerenal azotemia; postrenal azotemia

What are the pre, during, and post renal disease ranges of creatinine

Prerenal disease- Elevated BUN and normal creatinine Renal disease- less than 10:1 Post-renal disease-ratio within reference range

Increased levels of creatinine are caused by ___, ___, or ___ causes that impair the ___/___ of urine

Prerenal; renal; post renal; formation/excretion

Islet Autoantibody and Insulin Testing

Presence of autoantibodies to -islet cells of pancreas is characteristic of type 1 diabetes Neither test is commonly done currently

What is the goal of quality control

Prevent reporting incorrect patient test results

How does the renal system regulate the acid base balance

Primary function is to reabsorb bicarbonate because we produce more acids than bases from metabolism Also provide ammonia and phosphate buffering systems

What does the primary filter select? Secondary Filter?

Primary- selects short-wavelength high-energy excitation light Secondary-selects longer wavelength lower energy emission light

What is the importance of alpha-1-fetaprotein?

Principal fetal protein in maternal serum used to screen for diagnosis of neural tube defects, and is decreased in down syndrome Also used as a tumor markers, with increased levels found in patients with hepatocellular cancer, germ cell tumors, and all children with hepatoblastoma

What is the Principle for BUN

Principle: creatinine is excreted (not reabsorbed) at a constant rate dependant on muscle mass while urea excretion can be regulated by the kidneys Reference range: 10:1 - 20:1

What is cortisol

Produced by adrenal cortex Stimulates gluconeogenesis, lypolysis Addison's disease: decreased cortisol = hypoglycemia Cushing syndrome: increased cortisol = hyperglycemia

What is epinephrine

Produced by adrenal medulla Inhibits insulin secretion, increases glycogenolysis and lipolysis increases blood glucose levels

What are Very-Low-Density Lipoproteins

Produced by liver Primary carriers of triglycerides assembled in liver (endogeneous)

Immunoglobulin

Produced by lymphocytes and there are 5 different types IgGAMED, They can be released on plasma cell

What is Thyroxine (T4)

Produced by thyroid gland Stimulates glycogenolysis, gluconeogenesis, and absorption of glucose from intestines

What is the function of aldosterone

Produced in adrenal glands Causes renal retention of Cl-

What is the function of ADH (vasopressin)

Produced in hypothalamus, released from posterior pituitary Causes renal retention of water

What is the function of renin

Produced in juxtaglomerular kidney cells Released in response to low blood pressure Stimulates angiotensin release from liver Stimulates release of aldosterone from adrenal glands

What is the function of angiotensin

Produced in liver Stimulates vasoconstriction to increase blood pressure

What is glucagon

Produced in pancreatic alpha islet cells Stimulates glycogenolysis and gluconeogenesis increases blood glucose levels

What is insulin

Produced in pancreatic beta islet cells Stimulates uptake of glucose by cells; glycolysis, glycogenesis, lipogenesis, decreases blood Glucose levels

What is the clinical application of Ammonia

Prognostic indicator for severe liver disease Determine severity & prognosis of Reye's syndrome Diagnose inherited deficiency of urea cycle enzymes Monitoring of hyperalimentation therapy (parenteral feeding) Sympotoms urea cycle enzyme deficiency (diagnosed in infants): failure to thrive, neurological symptoms

Discuss the function α2-macroglobulin (AMG)

Protease inhibitor and a major binding protein for other molecules and proteins

Albumin

Protein present in highest concentration in plasma Functions: Maintain osmotic pressure in blood Negative acute phase reactant protein Major transport protein in body

Interfering substances of the Jaffe method include ___, ___, ___, ____, and ____. These cause a ___ bias. Using a ___ method rather than a ____ method can reduce the effect of interfering substances.

Protein; albumin; ketones; glucose; bilirubin; positive (0.1-0.3); kinetic; enzymatic

In glomerular filtration, small ___ is filtered by the glomerulus and follows ___ ____ flow. The ____ ____ is negatively charged so __ __ proteins/molecules are repelled

Protein; urinary filtrate; basement membrane; negatively charged

Which steps for making heme are in the mitochondria

Protoporphyrinogen IX-> Protoporphyin IX-> Heme

What is a disorder if you cant synthesise protorphyrin IX

Protoporphyrinogen oxidase (Variegate Porphyria VP)

How does ammonium buffer in the kidney

Proximal convoluted tubule cells Ammonia and bicarbonate are produced from glutamine metabolism in proximal convoluted tubule cells combines with H+ to form ammonium ion (NH4+) Ammonium is excreted into the urine filtrate in exchange for Na+ (antiport system) Na+ is transported into the blood in exchange for potassium (same as in bicarbonate system) Bicarbonate enters blood in exchange for Cl- and enters the respiratory buffering system THIS ONLY OCCURS DURING EXTREME ACIDOSIS

Lesh Nyhan Syndrome is an X-linked disorder that effects ___ metabolism, resulting from a complete deficiency of the enzyme ______

Purine; HGPRT (hypoanthine-guanine phosphoribosyltransferase)

What is the physiology of Uric Acid

Purines are converted to uric acid in liver Transported in plasma from liver to kidney & filtered by glomerulus Elimination by renal excretion or (small amounts) GI tract degradation by normal flora

previous review: generally describe a carbonyl group with R functional groups

R1 | C=O | R2

What are the two types of error when in a clinical setting?

Random and systemic

What are some glucose reference ranges

Random blood glucose: 70-125mg/dL Fasting: <100mg/dL

What factors are believed to be related to aging

Random genetic damage Glycation- formation of advanced glycosylation end products (AGEs) Developmental processes involving immune & neuroendocrine systems Genetic programming (apoptosis) Free radical damage

What are the two types of errors that can happen in quality control

Random or systemic

What is oxygen saturation

Ratio of O2 bound to carrier protein, hemoglobin, compared with total amount of hemoglobin capable of binding to O2

What is Fractional oxyhemoglobin

Ratio of concentration of oxyhemoglobin to concentration of total hemoglobin (ctHb)

What is the coefficient of variation

Ratio of the SD to the mean

The loop of Henle aids in ____ of ____, ___ and ____

Reabsorption; water; Na; Cl

What are some things that a microscopic urinalysis measures

Red blood cells White blood cells Epithelial cells (squamous, renal, transitional/bladder) Bacteria Hyaline casts Granular casts Cellular casts Crystals Fibers and miscellaneous formed elements

What is the clinical significance of osmolality

Regulated by hypothalamus, posterior pituitary, and adrenals Regulation of osmolality affects plasma sodium concentration Regulation of sodium & water controls blood volume

What is Hypothalamic-Pituitary-Adrenal Cortex System

Regulates glucose metabolism (growth hormone) Suppression of gonadotropin releasing hormone pre-puberty Diseases result in hypofunction or hyperfunction of this system

What are some functions of Potassium

Regulation of neuromuscular excitability Contraction of heart ICF volume Regulation of hydrogen ion and sodium concentration

Draw out the path of renal blood flow

Renal artery → Afferent arteriole → Glomerulus → Efferent arteriole → Peritubular capillaries → Vasa Recta → Renal Vein

When would renal buffering systems kick in

Renal buffering systems are used to compensate for respiratory acidosis and alkalosis

What are some outcomes of the dilution effect

Renal failure, syndrome of inappropriate antidiuretic hormone (SIADH)

How does Diabetes Mellitus/Insulin resistance effect the elderly

Renal threshold increases & insulin response to glucose is decreased suspected to be more of a chronic inflammartory disease than pancreatic endoctrine function

___ flow and ___ flow are essential for proper nephron function

Renal; urine

What must you do if a control value is out of range

Repeat the control to rule out random error

What does PCO2,pH change in voltage depend on?

Requires test cell and calibration cell and a voltmeter to measure change in voltage between the two cells change in voltage is related to analyte concentration by the Nernst equation

When will respiratory buffering systems kick in

Respiratory buffering system is used to compensate for metabolic acidosis and alkalosis

What are some problems that can occur in premature/immature babies

Respiratory distress, electrolyte & water imbalance, jaundice

What is physiologic jaundice

Results from inability of newborn liver to adequately metabolize bilirubin Causes serum bilirubin level of up to 15 mg/dL Can lead to kernicterus & severe brain damage

What are some methods of purification

Reverse osmosis, filtration, distillation, deionization, UV light

What is a Freezing-point Osmometer

Sample in a small tube is lowered into a chamber with cold refrigerant circulating from cooling unit. Thermistor is immersed in sample. Wire is used to stir sample until it is cooled to several degrees below its freezing point.

What are some methods of glucose measurement

Sample: serum, plasma, whole blood, urine Serum or plasma must be separated from cells within 1 hour & refrigerated to prevent loss of glucose (5% decrease per hour) Fasting blood glucose should be obtained in morning after 8- to 10-hour fast Most common methods of glucose analysis are enzymatic: Glucose oxidase or hexokinase Nonspecific method is used in urinalysis section of lab to detect reducing substances Clinitest—Benedict's reagent (copper reduction)

Which types of fats are solid? Liquid?

Saturated fats are solid Unsaturated fats are liquid

What is the purpose of using Gas Chromatography

Separate mixtures of compounds that are volatile or can be made volatile (by heating)

What are some common applications of a centrifuge

Separating serum/plasma from Blood Cells Separating supernatant from a precipitate in an analytic reaction Separating 2 immiscible liquids Expelling air

What is High-Performance Liquid Chromatography

Seperation of solutes based on interaction with the mobile and stationary phase-solutes elute at different times and can be removed for further study

What are the different types of pipettes

Serologic Mohr Volumetric Transfer (Pasteur) pipette Usually plastic or glass Micropipette Automatic or multichannel

What are some liver function tests that can be performed on a pediatric patient

Serum albumin Total & conjugated bilirubin Liver enzymes (AST, ALT, ALP)

What samples are used to determine osmolality

Serum and urine

___ ____ is better than Cystatin C for monitoring a person's renal function

Serum creatinine

What would you use electrophoresis for

Serum proteins, hemoglobin variants, detection of immunoglobulin's

What are some ways of measuring myoglobin

Several immunoassay methods: fluorescence, chemiluminescence, immunochromic Procedures incorporate binding of specific antibodies to myoglobin Resulting chemical or physical change can be measured & correlated to myoglobin concentration Methods have been adapted to point-of-care devices for rapid assessment of chest pain

What are some lab calculations that may be used

Significant Figures (keeping all until the end) Unit conversions Molality/Molarity Simple/Serial Dilutions

What is Arteriosclerosis

Single leading cause of death & disability in U.S. Caused by lipids, in form of esterified cholesterol, being deposited in artery walls, resulting in fatty streaks Fatty streaks develop into plaques that can block blood flow and start an inflammatory process

In electrophoresis, migration of charged solutes/particles in an electric field are based on what

Size and charge

Components of the immune system

Skin: barrier to microorganisms Phagocytes: cells that engulf & digest foreign particles B cells: lymphocytes that produce neutralizing antibodies Natural killer cells: leukocytes that bind to & kill virus-infected cells Acute-phase proteins: defense proteins produced in response to infection Antibody production: immunoglobulins recognize foreign antigens & produce unique antibody to cover antigen

Microalbuminuria

Small quantity of albumin in the urine (does not refer to the size of the molecule) Increase in urinary albumin is early sign of renal nephropathy Annual assessment of kidney function is recommended for diabetic patients Defined as persistent albuminuria in range of 30-299 mg/24 hr or albumin-creatinine ratio of 30-300 ug/mg Protein error of indicator methodology

What are some things you need to keep in mind when performing phlebotomy on pediatric patients

Smaller blood volume limits amount that can be drawn. Small veins need small needles; risk of hemolysis, hyperkalemia Capillary samples collected when suitable veins not available

What are High-Density Lipoproteins

Smallest and most dense; synthesized by liver and intestine Capable of removing excess cholesterol from peripheral cells Highly heterogenous and can be separated into 13 or 14 subfractions

What is the most abundant extracellular cation which largely determines the osmolality of plasma

Sodium

How much of the NaCl is reabsorbed

Sodium chloride is only partly reabsorbed

What are some pancreatic changes that occur

Some atrophy & increased incidence of tumors Aldosterone & DHEA production declines

What is proteomics

Study of proteins

Discuss the factors which affect the rate of an enzymatic reaction

Substrate concentration Enzyme concentration pH Temperature Cofactors Inhibitors Competitive Noncompetitive

C-reactive protein

Synthesized in liver Acute phase reactant Marker of inflammation and cell death (necrosis) Used as a marker for cardiovascular disease, diabetes, rheumatoid arthritis, Promotes complement binding and phagocytosis Migrates in gamma region

What are apoproteins?

Term used for the protein when not in complex with other molecule (ex. apo-lipoprotein)

What are the processes that the body goes through when there is hypovolemia

The Brain stimulates thirst The kidneys decrease renal perfusion pressure, secretes renin which converts angiotensinogen to angiotensin I which is then converted by ACE in the lungs to angiotensin II. Angiotensin II stimulates vasoconstriction and Stimulates kidneys to retain water/sodium/chloride and excrete potassium Stimulates aldosterone release from adrenals Retention of Chloride (sodium and water)

Does the HDL level in adult males increase or decrease 20% when compared to their childhood levels

The HDL levels in adult males decrease about 20% when compared to their childhood levels

What is precision

The ability of a method to consistently produce the same result even when circumstances are changed

What does the 68-95-99 Rule Apply to?

The bell curve data distribution

Describe how the BUN measures renal function

The blood urea nitrogen measures the amount of urea (which is filtered by the renal glomeruli and excreted as waste) Urea should not be present in the plasma

What is the process that the body goes through when there is hyper volemia

The heart secretes ANP which causes renal Na and water excretion and vasodilation

what represents a chiral carbon?

The intersection of two lines

What is the functional unit of the kidney?

The nephron

Define renal threshold

The point of concentration where a substance cannot be totally reabsorbed and is excreted in the urine

How are the reference intervals for elderly patients? Does this need to change?

The reference intervals right not are not that good and this needs to change in the future to have a better baseline for what is

Explain the primary structure of proteins

The sequence of amino acids in the polypeptide chain-the identity and specific order of amino acids

Explain the tertiary structure of proteins

The way in which the chain folds back on itself to form a 3D structure. These are mainly interactions of amino acids with the R-groups of more distant amino acids TS determines the chemical and physical properties of a protein

Outline protein synthesis and metabolism

There are 10 amino acids that can be synthesized by the body and 10 that must be supplied from proteins in food.

How is chemiluminescence different from fluorescence

There is no excitation radiation or monochromators required

What is the difference in cholesterol levels between men and women after menopause

There would be no difference in cholesterol after menopause

What are charicteristics of lipids

They are a rich source of energy and a efficient way for the body to store calories They are hydrophobic They are an integral part of cell membranes and structure

What are some charicteristics of Fatty acids

They are bound to albumin and have low concentration in plasma Found as part of triglycerides or phospholipids Saturated have no double bonds and all carbons are bound to hydrogen (usually solid fats like animal fats think of the marbling meat) Unsaturated fats contain double bonds and can be cis or trans

What is the process of doing a thin layer chromatography test

Thin layer of sorbent is coated on glass/plastic plate Samples are applied as spots near the edge One edge of plate is placed in solvent Solvent migrates up thin layer by capillary action After solvent reaches predetermined height, plate is removed and dried

What are the processes the body goes through when there is hyperosmolality /hypernatremia

Thirst Antidiuretic hormone release from posterior pituitary Stimulates kidneys to retain water/sodium/chloride and excrete potassium Stimulates aldosterone release from adrenals Retention of Chloride (sodium and water)

What is the major cause of death of patients with homocystinuria, and at what age do they die?

Thromboembolism is the major cause of death with half of patients dying by the age of 20 and 75% dying by the age of 30.

How would you dispense the Volumetric Pipette

Tipping the container Holding pipette vertically Tip of pipette touching receptacle DO NOT REUSE A PIPETTE/TIP

Which troponin is the most specific?

TnI

What is the coefficient of variation used for

To compare standard deviations for test methods when the unites of measure are different and to summarize QC data

When is the total cholesterol, LDL and triglycerides the lowest level? When do they increase

Total & LDL cholesterol & triglycerides are much lower in young children than adults Total & LDL cholesterol & triglyceride levels all increase with age, in both men & women

What is the oxygen content

Total O2 in blood; sum of O2 bound to hemoglobin (O2Hb) & amount dissolved in plasma (PO2)

What are the reference levels for total protein/albumin for UH? What about from the textbook?

Total protein: 6.5-8.3 g/dl (65-83 g/L) Albumin: 53-65% (3.5-5.0 g/dl) Albumin (Upstate): 56%-71% (3.6-5.9 g/dl)

Discuss the tissue sources, diagnostic significance, assays, and sources of error for GGT

Transferase Tissue source: liver and others Diagnostic significance: hepatobiliary disorders (biliary tract obstruction), alcoholism Assay for enzyme activity: γ-glutamyl-p-nitroanilide is most widely accepted substrate used in GGT analysis with p-nitroaniline as detected product Source of error: stable for 1 week at 4C; hemolysis not a concern Reference range: male: 6-45 U/L (37C); female: 5-30 U/L (37C) Useful in discerning reason for elevated ALP / ACP in children and pregnant women because GGT will be normal in these people

Discuss the tissue sources, diagnostic significance, assays, and sources of error for CK

Transferase Catalyzes reversible conversion of creatine to creatine phosphate to generate ATP for muscle contraction or cell membrane transport Tissue source: found in almost every tissue, highest concentrations in Skeletal muscle Heart muscle Brain tissue Primary diagnostic significance: Acute myocardial infarction Muscular dystrophy (Duchenne) Cerebral vascular accident Seizures Enzyme activity Catalyzes both forward & reverse reactions involving phosphorylation of creatine or ADP See eq. 13-6 Increase in absorbance due to formation of NADH or NADPH Source of error Hemolysis of serum samples may elevate CK activity Serum should be stored in a dark place, because CK is inactivated by light Reference range Male: 15-160 U/L (37C); Female: 15-130 U/L (37C)

Discuss the tissue sources, diagnostic significance, assays, and sources of error for AST

Transferase Tissue source: cardiac tissue, liver, skeletal muscle Diagnostic significance: hepatocellular disorders Viral hepatitis, cirrhosis Not specific as AST is found in smaller amounts in other tissues (skeletal muscle, cardiac muscle, kidney, RBC) Assay for enzyme activity: based on Karmen method Decrease in absorbance due to oxidation of NADH to NAD+ Source of error: hemolysis; stable in serum for 3-4 days at refrigerated temperatures Reference range: 5-30 U/L (37C)

Discuss the tissue sources, diagnostic significance, assays, and sources of error for ALT

Transferase Tissue source: liver (more specific than AST due to high concentration in liver and lower concentrations in other tissues) Diagnostic significance: hepatic disorders Assay for enzyme activity: coupled enzymatic reaction using lactate dehydrogenase as indicator enzyme, which catalyzes reduction of pyruvate to lactate with simultaneous oxidation of NADH Source of error: stable for 3-4 days at 4C; relatively unaffected by hemolysis Reference range: 6-37 U/L (37C)

What are some immune disorders

Transient hypogammaglobulinemia of infancy Agammaglobulinemia (Bruton's disease) Severe combined immune deficiency (SCID

What is another site for disrupting the heme pathway

Transport of precursors into mitochondrion

What are low-density lipoproteins

Transports cholesterol Form as a result of lipolysis of VLDL Readily taken up by cells via LDL receptors in liver and peripheral cells Signaifically smaller VLDL, and can infiltrate extracellular space

Discuss the function of transferrin

Transports ferric ions of intracellular stores to bone marrow. RBCs contain TRF receptors for uptake and of TRF ion

Water is a solvent for all processes in the human body. What are some examples

Transports nutrients to cells Determines cell isotonicity Removes waste products via urine Acts as body's coolant via sweating

Which of the cardiac markers are most sensitive and specific?

Troponins

True or False Solutes with a lower boiling point pass more quickly to the detector than those with a higher boiling point?

True

True or false Nephelometry has increased sensitivity over spectrophotometry

True

What is the function of the PCT?

Tubular reabsorption and secretion

The urinary system is made up of...

Two kidneys, two ureters, a bladder and a urethra

How big is a lipoprotein structure?

Typically spherical diameters of 10-1200 nm

What is the ultimate goal of the cell

Ultimate goal of cell is to convert glucose to carbon dioxide and water wastes

Which pure chemicals are used for chromatography assays

Ultrapure is used in chromatography assays

What is hypouricemia

Uncommon Liver disease Defective renal tubular resorption Chemotherapy agents which inhibit cell synthesis

What is cholesterol

Unsaturated amphipathic steroid alcohol Synthesized nearly exclusively by animals, not readily catabolized by most cells or a source of energy

List the nonprotein nitrogen components of the blood and recognize their relative physiologic concentrations.

Urea-highest concentration in blood Uric acid Creatine Creatinine Ammonia

Urea/BUN is dependent on ___ concentration, ___, and ____

Urea; GFR; hydration

___ ___ is a major product of ___ catabolism from exogenous and endogenous ___

Uric acid; purine; nucleotides

What are the enzymatic methods for measuring uric acid?

Uricase, peroxidase (automated), or spectrophotometric

How is microalbumin related to the urinary system

Urinary albumin concentrations of 30-300 mg/24 hours are predictive of diabetic nephropathy.

Alkaptonuria

Urine darkens because it becomes more alkaline when it is at room temperature 1 out of 250000 births Absence of homogentisic acid oxidase leads to incomplete metabolism of phenylalanine and accumulation of homogentisic acid (HGA) in the blood with overflow into urine Deposition of homogentisic acid in cartilage, and soft tissues (ochronosis)

What late precursors are built up in the blood

Uroporphyrinogen Coproporphyrinogen Protoporphyrinogen

What are some clinical applications of Urea

Used primarily to evaluate renal function or monitor renal dialysis patients Method Coupled enzymatic assay using urease reagent

What is beers law

Used to establish a relationship between concentration and absorbance in photometric determinations

What is thin layer chromatography used for

Used to separate analytes that are colored or can be colored

Describe the Volumetric Pipette

Used with viscous fluids Ex synovial joint fluid/effusions Blow out (TC) and has 2 etched rings

What is Proteomics used for

Useful for identifying new markers of disease

What is haptoglobin (Hp) a sensitive indicator of?

Useful marker of in vivo hemolysis due to short half life (3-5 minutes); indicates this when there is Hp depletion. Most sensitive indicator of intravascular hemolysis, transfusion reactions, and certain hemolytic disorders (hemolytic anemias)

What are the speeds and times that are used in a centrifuge

Uses 300-3400 rpm/RCF or 500-2000 x g for 10-15 min

What liquids are used in thermometers

Uses red alcohol (previous mercury)

What is the endogenous pathway

VLDL loses core lipids, causing dissociation & transfer of apolipoproteins & phospholipids to other lipoprotein particles VLDL is converted to VLDL remnants, which can be further transformed by lipolysis into LDL Half of VLDL is converted to LDL; remainder is taken up as VLDL remnants by liver remnant receptors

Which colligative properties are depressed as concentration of solute is added

VP and FP

What is the Glycogen storage disease Autosomal recessive

VonGierke disease: Glucose-6-phosphatase deficiency Glycogen can not be converted back to glucose for energy production in the liver Hepatomegaly results from buildup of glycogen in liver Laboratory results: hypoglycemia, ketonemia, metabolic acidosis, hyperlipidemia, uricemia, Symptoms: typical presentation at 6 months when infant sleeps through the night, crying in hunger between prolonged feeding intervals, failure to thrive Treatment: avoid hypoglycemic states or liver transplant

Describe the biosynthesis and excretion of uric acid

Waste product of catabolism of purine nucleic acid insoluable in plasma and can cause gout 98-100% is reabsorbed in proximal tubules of kidneys Potent antioxidant High intracellular concentration—amplifies T cell response to pathogens that have damaged host cells

What are Ketones

Waste product of fatty acid metabolism in liver Increased in type 1 diabetes mellitus, starvation, low carbohydrate diet Three ketoacids: Acetone (2%) Acetoacetic acid (20%) 3--hydroxybutyric acid (78%) Specimen requirement is fresh serum or urine Method: sodium nitroprusside reaction Detects acetoacetic acid only Urine strip test & Acetest tablets

What is the 1-3 water designation? Which designation does the lab use?

Water has a 1-3 designation where 1 is the most pure and 3 is the least LAB USES I

What is normally in urinary filtrate?

Water, electrolytes, glucose, amino acids, urea, creatinine

What does normal urine contain

Water, urea, uric acid, creatinine, sodium, potassium, chloride, calcium, magnesium, phosphates, sulfates, urobilin (from breakdown of bilirubin), and ammonia.

How does the bicarbonate system buffer

When in an acidic solution, bicarbonate can bind H+ forming carbonic acid When in an alkaline solution, carbonic acid can bind OH-, forming H2O and bicarbonate

What happens when the pH of the solution and the pKa are the same?

When net charge is zero, resulting in no migration. This occurs when pH is between two pKa's, and can be calculated as an average of pKa

Describe Threshold Substances

When plasma concentration exceeds reference range (or threshold), the substance is no longer reabsorbed--"overflows" into urine

When will you use the comparison of methods experiment

When you are validating a new instrument or method

How does bicarbonate effect the buffering capacity of blood

Whenever bicarbonate enters the blood, this renews (increases) the buffering capability of the blood

What are some sample types that are used in clinical chemistry

Whole blood Plasma Serum Arterial Blood Urine CSF/Paracentesis Fluid Amniotic Fluid Semen, saliva, sweat, hair, nails, feces...

Why do women have a lower percentage of water than men

Women have a higher percentage of body fat

Women have higher _________ levels than men but lower ____________ __________ and ____________ levels

Women have higher HDL cholesterol levels but lower total cholesterol & triglyceride levels than men

Uric acid is produced in the liver from ___ via ____ ____

Xathine; xanthine oxidase

what is the general name of the ring formed during monosaccharide cyclization?

a "Pyranose" (pi-ran-ose) ring (a cyclic hemiacetal or hemiketal)

What blood test would you use to diagnose someone with MSUD

a blood test that detects alloisoleucine amino acid

what is a chiral carbon?

a carbon atom with four different groups attached

what is an ester? what is its general structure?

a carbonyl adjacent to an ether linkage. General formula: R-C=O | OR

what is a glycoside?

a glycoside is an acetal or ketal formed from the reaction of cyclic monosaccharides with alcohols in the presence of acid

What is Hemoglobin SC

a mixture between Hemoglobin S and Hemoglobin C. It presents itself like homozygous sickle celled anemia

What is an amphipathic molicule

a molecule that is both hydrophobic and hydrophilic Hydrophobic-tail fatty acid Hydrophilic- head phospholipid

What is alkalosis

a pH level above reference range (>7.44)

What is acidosis

a pH level below reference range (<7.34)

There are two kinds of enantiomers; how do we distinguish between the two?

a prefix label of: L- or "levo" meaning "left" and D- or "dextro" meaning "right" (for example: D-glucose and L-glucose)

α1-fetoprotein

a protein that is synthesised in the liver used as a tumor marker in adults and binds estradiol and may protect fetus from mother's immune system in fetus. used as a marker for congenial diseases such as Spina bifida Neural tube defects Anencephaly Fetal distress syndrome Down syndrome (decreased levels) on serum protein electrophoresis AFP will migrate between albumin and alpha I region

Transferrin

a protein that is synthesized by the liver negative acute phase reactant transports iron to bone marrow and storage sites which prevents toxic accumulation of free iron in tissues/kidney loss Identifies IDA and hemochromatosis migrates in beta region

solute

a substance dissolved in a liquid

Enzyme inhibition is described as?

a substance that can reduce the rate of the enzyme reaction

What is a base

a substance that can yield hydroxyl ions (OH-) in solution

what do hemiacetals and hemiketals react with alcohol to form?

acetals and ketals

What are some clinical applications of bicarbonate

acidosis-> increase bicarbonate Reabsorb from urine filtrate hyperventilation excess CO2 in order to remove excess acid alkalosis-> decrease bicarbonate Excrete into urine filtrate Hypoventilation to retain more H+

What are some functions of proteins

act as enzymes, hormones, transport molecules, can be antibodies, Makeup structures, store energy or iron, and maintain osmotic pressure in blood

enzymes lower:

activation energy

What are the two divisions of the immune system

adaptive and innate

CHD increases with what

age

Percentage of water in the body declines with

age and obesity

What are some risk factors of CHD

age, gender, genetic predisposition, obesity, hypertension, poor fitness, diabetes mellitus, smoking, hyperlipidemia

Discuss the albumin method (bromocresol green)

albumin binds to dye; causes shift in absorption maximum.

how does benedict's test work?

aldehydes and ketones having adjacent -OH groups are readily oxidized; open chain and cyclic forms of monosaccharides are readily oxidized

how do we indicate the presence of an aldehyde or ketone group in a sugar?

aldehydes in a sugar contain prefix "aldo-" ketones in a sugar contain prefix "keto-" (for example: glucose, a six carbon sugar which contains an R-CHO, or aldehyde, group, is an "aldohexose"; ribulose, a five carbon sugar contains an R1-C=O \ R2, a ketone, is a "ketopentose")

Discuss the importance of IFE (immunofixation electrophoresis)

allows us to type and classify the antibody that is increased when a dark Immunoglobulin Band is found on a patient. It uses more sensitive dyes with specific antibodies that target IgG, IgA IgM, Kappa or Lambda light chains.

building blocks of an enzymes

amino acids

What is the creteria that is followed when deciding to chose an analyzer to analyze the speciman

amount of dead volume, salvage of sample when clot or bubble is detected, true random access

What is the international unit

amount of enzyme that will catalyze reaction of 1 μmol of substrate/min under specified conditions Enzyme concentration usually expressed in IU or U per liter (IU/L)

What enzymes are associated with pancreatitis?

amylase and lipase

what are two starch fractions?

amylose and amylopectin

what is glycogen?

animal starch; similar to amylopectin

What is the free radical damage theory

any atom or molecule with unparied (odd number of) electrons-- incomplete removal of oxygen free radicals produced by metabolism ( oxidative phosphorylation) within cells, release of inflammatory cytokines

What is the genetic programming (apoptosis) theory

apoptosis (pre-programmed cell death)—we are pre-programed to live a certain number of years (caspase = protease)

heat and pressure

are catalysts for chemical reactions

Explain the quaternary structure of proteins

arrangement of two or more polypeptide chains to form a protein. Only proteins with more than one polypeptide chain have QS Examples: CK-MB (heterodimer), hemoglobin tetramer (A2B2)

co-factor

assist enzyme, non-organic

where is the carbonyl carbon placed in carbohydrates?

at or near the top

describe the similar structure of D-aldoses

at the top, H-C=O. at the bottom, CH2OH. Differences are in carbons rungs in between.

What can cause hypoglycemia in pediatric patients

babies that are born to mothers with gestational diabetes

Why does Plasma need to be multiplied by 1.03

because the anticoagulant EDTA draws water from RBC and dilutes the lipids

What are the steps to drawing monosaccharides forming Pyranose and Furanose rings (Halworth Structures)?

beginning with a properly drawn monosaccharide chain... 1. draw the ring with its oxygen to the back 2. put the anomeric carbon (C-1) on the right side 3. the terminal -CH2OH group (C-6) is always shown above the ring for D-monosaccharides

What is the gaussian curve

bell curve

What does a noncompetitive inhibitor do?

binds at a site other than the active site

What does a competitive inhibitor do?

binds free enzyme at the active site

What does an uncompetitive inhibitor do?

binds only to the enzyme-substrate complex

Analytes

biologic solutes

optimum temperature for enzyme activity:

body temperature (37-38 C)

reactions take place at normal:

body temperature (98.6 F=37 C)

What is the function of the buffering system

body's defense against extreme changes in pH

What is geriatrics

branch of health care thats concerned with old people

What are some sources of error for PO2 (Clarke) electrodes

buildup of protein material on surface of membrane, bacterial contamination within measuring chamber

how does a straight monosaccharide cyclize into a ring (which carbons are active)?

carbon 5 adds to the aldehyde group of carbon 1; predominantly cyclic hemiacetals/hemiketals

elements:

carbon, hydrogen, oxygen, nitrogen, (sulfur)

Hydrogen ions combine with bicarbonate to form what

carbonic acid

Describe the relationship between bicarbonate and hemoglobin buffering

carbonic acid rapidly dissociates into bicarbonate (enzyme carbonic anhydrase) which then diffuses out of the cell along concentration gradient Bicarbonate in circulation allows the blood to act as a buffer To balance efflux of bicarbonate, chloride moves into the RBC

Carbonic acid, in the presence of what breaks down to water and carbon dioxide.

carbonic anhydrase

What do enzymes do?

catalysts responsible for most reactions in the body

Oxidoreductases

catalyze an oxidation-reduction reaction between two substrates

Hydrolases

catalyze hydrolysis of various bonds

Isomerases

catalyze interconversion of geometric, optical, or positional isomers

Ligases

catalyze joining of two substrate molecules, coupled with breaking of pyrophosphate bond in ATP

Lyases

catalyze removal of groups from substrates without hydrolysis; product contains double bonds

What is a isoenzyme

catalyze same reaction but differ slightly in amino acid sequence

Transferases

catalyze transfer of a group other than hydrogen from one substrate to another

What can cause hyperglycemia in pediatric patients

caused by diabetes

what are carbohydrates?

cellulose, sugars, starch

How is chemiluminescence like fluorescence?

chemiluminescent tag must be bound to the analyte to be detected

What is renal tubular acidosis

chronic inability to secrete H+ into urine filtrate Metabolic acidosis, low blood potassium and calcium

What are some methods in which magnesium can be measured

colorimetric spectrophotometry

What is a buffer

combination of weak acid or weak base & its salt a system that resists changes in pH

What are simple proteins?

composed only of its unique acid sequence (ex. albumin)

What is Primary hypothyroidism

congenital hypothyroidism: 1 in 4,000 births Mental retardation Requires thyroid hormone replacement Measure serum TSH levels which will be elevated

What can be impared causing energy content of milk to be reduced by 50%

conversion of galactose to glucose

Why is it absolutely important for the kidneys to stay balanced at all times in an infant

critical for maintenance of electrolyte & water homeostasis Glomeruli & renal tubules do not function at normal rate in neonate Inicreased risk for dehydration and electrolyte imbalance

What are some dietary sources of phosphate

dairy and meats

What are some lung and changes that happen as you age

decrease in pulmonary function, vital lung capasity, Respiratory Diseases such as Chronic bronchitis, COPD, neoplasia and lung diseases cause a quarter of deaths over age 85

How does liver disease effect bilirubin catabolism

decreased ability to catabolize bilirubin which builds up in blood and is deposited in tissues and overflows into urine

What are some effects of the decline in endocrine function as you age

decreased estrogen Osteoporosis Thyroid changes Pancreatic changes Hypertension

What is the result of tubular diseases

decreased excretion or reabsorption of certain substances, or reduced concentrating capability due to damage to renal tubule cells

What are some ways that the liver declines when you age

decreases in total proteins, albumin, and transferrin, urea synthesis, bilirubin metabolism, increase in toxicity,

what color is the reaction between a polysaccharide and iodine?

deep blue

What is Nephrosis

degeneration of the kidney without inflammation

What are some diseases in which electrolytes are out of balance

dehydration, renal disease, malnutrition, vomiting, severe asthma, COPD, cardiac/brain ischemia

excessive acids or excessive bases will

denature enzymes

What does normal hemoglobin synthesis rely on

depends on adequate iron supply & heme & protein synthesis to form globin portion

Anuria

designates the complete suppression of urine formation, although in the wider sense of the term it is sometimes defined as being < 100 ml/24 h

denature

destroy shape of enzyme

excessive heat will:

destroy the shape of the enzymes

What is the treatment for PKU

diet that is low in phenylalanine with supplemental amino acids

What are some preanalytic variables that effect lab tests

diet, gender, posture, smoking, alcohol consumption, body composition, physical activity, prescribed medications

What are some risk factors of osteoporosis

diet, inactive lifestyle, genetic predisposition, smoking, endocrine disturbances, medications

what is the main difference between glucose and galactose?

differs in the orientation of -OH group attached to C-4

enzymes are needed for:

digestion, dehydration synthesis, hydrolysis, respiration, photosynthesis

what are Porphyrias

disorders associated with heme synthesis which result in an inability to form heme and a build up of precursor molecules primarily autosomal dominant or acquired enzyme deficiencies

What are hemoglobinopathies

disorders of QUALITATIVE defects in hemoglobin molecule

What are thalassemias

disorders of QUANTITATIVE defects in production of normal hemoglobin molecules Group of diseases in which defect causes reduced synthesis of 1 or more of hemoglobin chains Autosomal dominant

during the enzyme-substrate complex enzymes:

do NOT change

When do the organs develop the most

during the 1st year of life

what is an enantiomer?

each of a pair of molecules that are mirror images of each other.

What does PO2 (Clarke) electrodes measure?

electrodes measure amount of current flow in circuit related to amount of O2 being reduced at cathode

activation energy

energy needed for reactions to take place

What is activation energy

energy required to raise all molecules in 1 mole of a compound at certain temperature to transition state

as temperature increases:

enzyme activity increases and peaks at 37-38 C

all reactions in living things require:

enzymes

enzyme-substrate complex

enzymes+substrate+water=substrate broken down

What is acidemia

excess acid or H concentration (pH < 7.34)

What is Alkalemia

excess base (pH > 7.44)

What is the random genetic damage theory

exposure to radiation/ mutagens, random errors in DNA replication

What is atherosclerosis

fatty accumulations in vascular walls

What are some sources of error for measuring oxygen saturation

faulty instrument calibration & spectral-interfering substances

What do the proximal tubules reabsorb

filtered water, sodium chloride, bicarbonate, potassium, calcium, amino acids, phosphate, glucose, and other substances.

What is the function of the glomerulus

filters out large proteins & protein-bound particles to retain in plasma

What are some lab vessels

flasks, beakers, graduated cylinders

What are some samples and the method used to determine potassium

for Potassium, you can use either serum, plasma, urine The method of choice is ISE

Discuss the total protein method (biuret)

formation of violet-colored chelate between Cu2+ ions and peptide bonds; Requires at least two peptide bonds and an alkaline medium.

When is an electrochemical cell formed

formed when two opposite electrodes are immersed in a liquid that will conduct current

what is galactosemia?

genetic disease (autosomal recessive) in which an enzyme needed to metabolize galactose is deficient or absent; typically develops shortly after birth

What are pipettes

glass or plastic utensils used to transfer liquids

What is the primary energy source used by tissues

glucose

what are the different types of monosaccharides?

glucose, fructose, galactose

What are the building blocks for heme

glycine+ succinyl-CoA

What is the steps for making heme

glycine+ succinyl-CoA reacts with ALA synthase to produce Aminolevuninic acid-> Porphobilinogen-> Hydroxymethylbilane-> Uroporphyrinogen III-> Coporophyrinogen III -> Protoporphyrinogen IX-> Protoporphyin IX-> HEME

What is needed now more than ever since people are living longer?

greater need for age related criteria (normal ranges) and interpretation (do the old people fit that range)

What is hypernatremia

greater than 145 mmol/L sodium in serum can be caused by Hypovolemia that can be found in Diabetes insipidus, dehydration, and burn patients

Describe the geriatric population in the united states

growing, went from 47-77 years old within 100 years. 20% of the US will be old people by 2030

co-enzyme

help enzyme, an organic non-protein

generally describe glycoside formation

hemiacetal sugar + alcohol ---> acetal ring + H2O

What do aldehydes and ketones with alcohols react to form?

hemiacetals and hemiketals

What does respiratory buffering depend on

hemoglobin being able to transport oxygen effectively

What is Carboxyhemoglobin

hemoglobin bound to carbon monoxide

What is Deoxyhemoglobin

hemoglobin not bound to O2 but capable of forming a bond when O2 is available

What are some other factors of respiratory buffering

hemoglobin present, pH, temperature, oxygen saturation, level of 2,3 diphosphoglycerate

What is Methemoglobin

hemoglobin unable to bind O2 because iron is in an oxidized (Fe3+ ) rather than reduced (Fe2+ ) state

What is hyperkalemia

higher-than-normal plasma potassium this can also cause muscle weakness, arrhythmia, paralysis

What are some effects of hypophospgatemia

hormonal imbalance, malnutrition

what does the hydrolysis of disaccharides in presence of dilute acid (or specific enzymes) yield?

hydrolysis of disaccharides yields monosaccharide units

carbohydrates have a large number of what kind of functional groups?

hydroxy- aldehydes/ketones (aka, polyhodroxy aldehydes and polyhydroxy ketones)

What are some results that happen when a pt has atherosclerosis

hypertension, hemorrhage, thrombosis, stroke, coronary heart disease

What can happen if the glucogenesis pathway is impared at birth

hypoglycemia if glycogen storages are depleted

What are some causes of metabolic alkalosis

hypokalemia or using too many antacids

What is hypomagnesemia? hypermagnesemia?

hypomagnesemia- not enough magnesium hypermagnesemia-too much magnesemia

What is the development process involcing immune and neuroendocrine systems theory

immune system decline (decreased T and B cell populations), loss of hormone function (estrogen in women, testosterone in men, antidiuretic hormone in both, etc.)

Sodium concentration is highest where?

in the extracellular fluid

What is a zymogen

inactive form of an enzyme

Maple syrup urine disease (MSUD)

inborn metabolism defect does not have the enzyme to metabolize leucine, isoleucine and valine in the liver accumulates ketoacids in blood and urine presents in newborns with failure to thrive, mental development and death

Do HDL, LDL, & total cholesterol, and trigycerides increase or decrease with age

increase

Will the need for Geriatric care increase or decrease in the future

increase

When is hemopexin increased?

increased levels are found in pregnancy and in diabetes mellitus

What is Cystitits

inflammation of the bladder

What is Nephritis

inflammation of the kidney and can either be present with bacterial infection (pyelonephritis), or without infection (glomerulonephritis)

Magnesium is higher intracellularly or extracellularly

intracellularly

pH

inverse log of the hydrogen ion concentration

What is the dissociation constant

ionization constant K value which describes relative strengths of acids & bases

What is/is the effect of hypocalcemia

irritability, twitching, seizures, rickets

Oliguria

is a decrease in urinary volume, such as occurs in shock and acute nephritis. In an adult it is frequently defined as being <500 ml/24 hr.

Almost all dietary chloride goes where

is absorbed by the intestinal tract

Polyuria

is an abnormal increase in the volume of urine (> 2500 ml), as in diabetes insipidus and diabetes mellitus.

What is Renal Calculi

kidney stones

What is the effect of excess plasma levels of calcium

kidney stones

What are some ways that children's drug metabolism is different than adults

lesss acidic gastric secretions in infants that effect absorbtion Less adapose tissue that effects the circulation and distribution of lipid-soluble drugs immature hepatic metabolism which effects clearance of drugs

Solvent

liquid in which solute is dissolved

All cells can synthesize hemoglobin, but where are the main sites

liver and bone marrow

Do liver diseases have high levels of liver enzymes in the blood or low levels of liver enzymes in the blood?

liver diseases have high amounts of enzymes

what are Porphyrias called when they are in the liver? Bone marrow

liver-hepatic porphyrias bone marrow-erythropoietic porphyrias

describe amylose

long unbraced chain of D-glucose units connected by an "α-" (1--->4) linkages

hypocalcemia can be caused by

low vitamin D, dietary deficiency, malapsorption, renal loss, hypoparathyroidism can cause rickets and osteomalacia

What is hypokalemia

lower-than-normal plasma potassium can cause muscle weakness, arrhythmia, paralysis

Are proteins macro or micro molecules

macromolecules made up of 200-300 amino acids

What is the function of electrolytes

maintain water homeostasis and physiologic pH, promote cardiac and skeletal muscle contraction, act as enzyme cofactors, maintain blood pressure

What is the function of the Lecithin-sphingomyelin ration

measure lung development

Conductivity

measure of how well electricity passes through a solution

Redox potential

measure of the ability of solution to accept or donate electrons

Explain why the measurement of serum enzyme levels is clinically useful

measurement of serum enzymes are clinically useful because they can detect when there is a: Increase in product concentration Decrease in substrate concentration Decrease in coenzyme concentration Increase in concentration of altered coenzyme

example of a co-factor:

metals such as zinc

What are some parameters that lab water need to fit

microbiologic count, pH, resistivity, silicate, particulate matter, organics

What is the median

middle point

Discuss the function and clinical significance of pre-albumin

migrates ahead of albumin in classic electrophoresis of proteins transport protein for thyroxine and triiodothyronine Action/role: binds thyroxine; transports Vitamin A

What happens to the bones of children that are near or reaching puberty

mineral absorption, transport, & endocrine-controlled incorporation of minerals are being added into growing bone

What is the advantage of using Nephelometry

minimizes interference from colored solutes

Molarity

moles/L solvent

Molality

moles/kg solvent

Are monosaccharides soluble or insoluble in water? What makes them this way? Why is it important in living organisms?

monosaccharides are extremely soluble in water; this is because of the multiple -OH groups; it is important in living organisms because their solubility allows them to be transported rapidly in the circulatory system.

How does geriatric health care need differ from a younger pt?

more physician office visits, hospital stays, lab tests, and more lab volume

Phenylketonuria (PKU)

most common (1 in 10000 to 20000) aminoaciduria that causes the person to have an inability to metabolize phenylalnine to tyrosine accumulation of Phenylalanine saturates the amino acid transporters into the brain, leading to decreased concentration of other amino acids required for protein synthesis in the brain Pheneylalanie is converted into phenylketone which accumulates in blood and into urine If untreated, severe mental retardation can occur Children have mousy odor to urine and fair skin because melanin production is decreased in PKU

What is the mode

most frequently occurring value

are most monosaccharides aldoses or ketoses? which series do most natural monosaccharides belong to (D- or L-)?

most monosaccharides are aldoses. most monosaccharides belong to the D- series.

What are some symptoms of hypoglycemia

nausea, trembling, rapid pulse, lightheadedness

describe a cathode

negative electrode; site to which cations tend to travel; site at which reduction occurs

What is pK (A or B)

negative log of ionization constant & pH in which protonated & unprotonated forms are present in equal concentrations

chemical reactions take place in:

non-living things

How much of the creatinine is reabsorbed

none

What are the speciman requirements for magnesium

nonhemolyzed serum or lithium heparin plasma

What is a cofactor

nonprotein molecule required for activity of some enzymes (often metal ions) Activator: inorganic cofactor Coenzyme: organic cofactor Prosthetic group: a cofactor bound to its enzyme Holoenzyme = apoenzyme + coenzyme Apoenzyme: enzyme portion

What is hypochloremia

not enough chloride, can be caused by loss of volume due to vomiting, diarrhea, and an aldosterone deficiency

How much IgM can be synthesized in fetuses

not much

The number of wavelengths incomperated into the instrument determines what?

number of species that can be measured

Where does protein synthesis occur

occurs in liver or plasma cells if they're immunoglobulins

Where does extravascular hemoglobin degredation occur

occurs outside circulatory system within phagocytic cells of spleen, liver, & bone marrow

indused fit

one enzymes can work with more than one substrate

lock and key hypothesis

one enzymes, one substrate

What main change occurs during the cyclization of a monosaccharide into a Pyranose ring?

only the Carbons at positions 1 and 5 change, the rest of the molecule is simply along for the ride.

enzymes

organic catalysts

Colligative properties

osmotic pressure, vapor pressure, freezing point, boiling point

Why is calibrating blood gas analyzers so important

pH & blood gas measurements are extremely sensitive to temperature Electrode sample chamber must be maintained at constant temperature

Hwo does the body maintain Hydrogen Ion

pH homeostasis is maintained via lungs & kidneys to eliminate excess H+

What does Ion-selective Electrodes use to perform a test

pH, electrolytes (Cl, K, Na, Ca), Indicator/test electrode with selectively permeable membrane, and Reference electrode.

bond:

peptide bonds

When would you see increased plasma levels of calcium

periods of bone growth or in pathologic bone resorption (osteoporosis) or renal disease

What is Secondary hypothyroidis

pituitary defect resulting in low TSH probably other hormone levels are low also (panhypopituitarism) Hypoglycemia, failure to thrive, failure of secondary sex characteristics FSH and LH are low in pediatrics due to gonadotropin releasing hormone supression which is removed at puberty

what type of sugar the major storage form of D-glucose in plants?

polysaccharide

What are the most ingested carbohydrates

polysaccharides

describe a anode

positive electrode; site to which anions tend to travel; site at which oxidation occurs

What is the function of the fetal fibronectin test

predicts risk of premature delivery

What disease can be caused by hypercalcemia

primary hyperparathyroidism

What are the 4 structures of proteins

primary, secondary, tertiary, quaternary