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Chemistry review (major)

  1. Increase with hemolysis?
    • KLAMP
    • K, LDH, AST, Mg, PO4
  2. Sugar to test intestinal vs pancreatic malabsorption?
    Xylose (no enzyme required for digestion)
  3. Cardiac risk values for HDL
    • <40 = positive risk factor
    • >60 = negative risk factor
  4. Apolipoproteins associated with lipid carrying molecules
    • B48: chylomicrons
    • B100: VLDL, LDL
    • A1: HDL
  5. Serum Protein vs UCSF Protein techniques - coomassie brilliant blue, kjeldahl, bromcresol green, HABA, biuret, turbidimetry
    • S: kjeldahl, biuret
    • UCSF: coomassie brilliant blue, bromcresol green, HABA, turbidimetry
  6. SPSP: pH, charge/migration, fractions, increase/decrease, common patterns in disease
    • pH 8.6, all proteins negatively charged, migrate to anode (+)
    • Albumin to Anode
    • Fractions: Albumin, a-1 globulin, a-2-globulins, B-globulins, Y-globulins
    • Albumin: albumin
    • ↑ dehydration
    • ↓ liver damage, malabsorption, nephrotic syndrome, burns
    • a-1-globulins: a-1-antitrypsin, a fetoprotein
    • ↑ acute phase, preggo, neural tube defect, liver cancer
    • ↓ emphysema, Down's pregnancy
    • a-2-globulins: haptoglobin, cerruloplasmin
    • ↑ acute phase, nephrotic syndrome, preggo
    • ↓ hemolysis, liver disease, tfxn rxn, Wilson's disease
    • B-globulins: transferrin, lipoproteins
    • ↑ iron def anemia, elevated B lipoproteins
    • Y-globulins: immunoglobulins
    • ↑ inflammation, cirrhosis, monoclonal gammopathies
    • ↓ immunodeficiency
    • ***B-Y bridge in cirrhosis
    • ***decrease alb increase a2 in nephrotic syn
  7. amt of U (IU)
    1 umol/min substrate used or product formed
  8. 5'NT vs ALP?
    • ALP increase in liver and bone activity/disease
    • 5'NP increased in liver NOT bone activity/disease
    • Use both to differentiate liver/bone disease
  9. LIVER ENZYME MARKERS (hep vs obstr)
    • HepATitis: AST, ALT
    • Obstruction: ALP, 5'NT
    • Both: GGT, ↑bili
  10. measured vitD vs more active vitD.  Hormone that stimulates? Why?
    • measure: 25-OHD
    • active: 1,25-(OH)2D AKA calcitrol
    • PTH stimulates this conversion to facilitate increase of serum Ca (increased absorp, bone resorp)
  11. Serum iron/Tferrin sat/TIBC/Serum tferrin
    storage depletion, iron def anemia, ACD (infl), Thalassemia, Hemochromatosis, Sideroblastic
    • Storage Depl: N,N,N,↓
    • Iron def: ↓,↓,↑,↓
    • ACD: ↓,↓,↓,↑
    • Thalassemia: ↑,↑,↓,↑
    • Hemochromatosis: ↑,↑,↓,↑
    • Sideroblastic: ↑,↑,N,↑
  12. Blood Gas/Acid Base rough references
    • pCO2: ~100 [80-100]
    • pO2: ~45 (~1/2 of pCO2) [35-45]
    • HCO3-: ~23 (~1/2 of pO2) [22-26]
    • pH: 7.35-7.45
  13. ↑/↓ for bili (unconj,conj,Ubili,urobil) in prehep, hep, post hep
    • pre hep: ↑,N,0,↑
    • hep: ↑,↑,0-↑,↑ (everything's up except Ubili)
    • post hep: N,↑,↑,↓
  14. FFN indicator of?
    • FFN is a negative predictor
    • neg FFN = no preterm delivery
    • pos FFN = not a predictive value
    • high specificity
  15. Also measure ____ with Theophylline? Procainamide? Primidone?
    • Theophylline: caffeine
    • Pocainamide: NAPA
    • Primidone: Pheobarbital
  16. Osmolality calculation
    2*Na + Glucose/18 +BUN/2.8
  17. Creat clearance calc
    • Ucreat/Pcreat*Uvol (mL)/Utime (min)
    • *1.73/area to factor in SA
  18. Normal BUN:creat
    10:1-20:1
  19. Graves disease
    • autoimmune (TRAb,TSI)
    • thyroid-stim Abs cause ↑T3/T4 ↓TSH
    • "Go getter Graves" everything ↑ except TSH
    • Primary hyperthyroidism, increased metab, bulging eyeballs, etc
  20. Myxedema
    • Thyroid deficiency (primary hypothyroidism)
    • "Morbid Myxedema" everything ↓ except TSH
  21. Hashimoto's
    • autoimmune (TPO Ab, TgAb)
    • anti-thyroid antibodies cause thyroid damage ↑TSH ↓T3/T4
    • Primary hypothyroidism, weight gain, etc
  22. Cushing's
    • Cushy Carl = Everything ↑ (Cortisol, glucose, Na, urinary steroids, aldosterone)
    • Obesity, hypertension, moon face, poor healing
    • Cushing's Disease (secondary Cushings)= ACTH-releasing tumors AKA secondary
    • Primary Cushings = cotrisol-releasing carcinoma
    • *no diurnal variation in this syndrome
  23. Addison's
    • Anemic Addison = Everything ↓ **ACTH can be ↑ (coristol, Na, Hb, Alodsterone, urinary steroids)
    • Primary adrenal insufficiency (destruction of adrenal cortex)
    • ACTH stimulation test NEGATIVE
  24. catecholamines?
    • "Adrenal Medusa guards the Lions D.E.N. in the catecombs"
    • Dopamine, Epinephrine, Norepinephrine
  25. Hypothalamus -> pituitary -> (target organ) axis -> resulting substance  (5)
    • TRH -> TSH -> (Thyroid) -> T3/T4
    • CRH -> ACTH -> (Adrenals) -> cortisol, aldosterone, catecholamines
    • GnRH -> LH/FSH -> (ovaries/testes) -> sex steroids
    • GHRH/GHIH -> GH -> (bones/cartilage) -> insulin-like growth factors
    • PIF/PRL -> PRL -> (mammary glands)
  26. aldosterone function
    Increase blood volume (increase Na reabs, decrease K reabs)
  27. Hormones increased at NIGHT?
    • GH (serotonin stims)
    • Prolactin
  28. Conn's
    • Primary hyperaldosteronism (aldosterone-releasingadrenal adenomas)
    • Increased BP, Na
    • Decreased renin, K
  29. Urea formation?
    • Major product of protein breakdown!!!
    • AA breakdown -> NH4+ -> urea (via urea cycle)
    • prevents NH4 toxicity
    • *note - freely filtered, but passively resabs (~50%)
  30. Calcium breakdown in blood
    • 1% in blood, of that...
    • 45% bound to protein
    • 10% complexed with anions
    • 45% free/ionized  *ACTIVE FORM
  31. Metabolic syndrome
    • 3/5
    • Waist >40in
    • Trig >150
    • HDL <40
    • BP >130/85
    • Fgluc >100
  32. Common bili "diseases" and their effect
    • Glibert's: decreased glucoronyl transferase activity
    • increased ubili
    • benign
    • common
    • Crigler-Najjar: severely decreased or no glucoronyl activity
    • very increased ubili
    • decreased cbili, urobil, fecal urobil
    • kernicterus, jaundace
    • very rare
    • Dublin-Johnson/Rotors: increased cbili, ubili
  33. Typical pathway of bili.
    • unconjugated (circ, spleen) --glucoronyl transferase (liver)--> conjugated (bile duct, intestines)
    • conjugated (bile duct, instestines) --bacteria (intestines)--> urobilinogens (intestines)
    • urobilinogens (intestines) --20% reabsorp (intestines)--> urine
    • urobilinogens (intestines) --oxidation (intestines)--> urobilin (brown feces)
  34. RAAS very basic
    • Angiotensinogen --(renin)--> angiotensin I --(ACE in lungs)--> angiotensin II -> vasoconstriction, aldosterone release
    • acts in increase BP, Na
  35. [HCO3-]:[H2CO3] normal
    20:1
  36. hypoventilation vs hyperventilation
    • Hypo: increased pCO2 (decreased pH)
    • Hyper: decreased pCO2 (increased ph)
  37. Methemoglobin change?
    Ferric in place of Ferrous ion
  38. TDM - steady state, first order kinetics
    • steady state after 5 1/2 half lives
    • 1st order k: clearance proportional to [drug], halflife = 0.693/K
    • *note- ethanol, theophylline, salicylates, phenytoin NOT 1st order
  39. Hormones that increase bone breakdown and decrease bone breakdown
    • increase: PTH, T4 (thyroxine), cortisol
    • decrease (increase formation): estrogen, testosterone, calcitrol (vit D), calcitonin, insulin
  40. hsCRP values
    • 0.5: low risk
    • 1.5: average risk
    • 3.5: high risk
    • 10: inappropriate test
Author
victimsofadown
ID
329004
Card Set
Chemistry review (major)
Description
Chemistry review (major)
Updated

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