Chemistry Internship Study Questions Section 2

Why should GRAY top and PURPLE top tubes be AVOIDED when doing electrolyte testing?
They interfere with Calcium and also Contain Potassium
Which electrolytes are most affected by hemolysis?
Potassium & Phosphate
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
A
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Extra
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
B
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Intra
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
C
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Extra
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
D
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Cation
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
E
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Cation
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
F
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Anion
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
G
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Dehydration, Cushing’s, Diabetes insipidus
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
H
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Hemolysis, Tissue trauma, Renal failure, Burns, Diabetes
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
I
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Dehydration, Metabolic acidosis
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
J
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Addison’s Disease, Diuretics, Diarrhea, Kidney Disease, Heart Failure
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
K
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Alkalosis, Insulin Excess
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
L
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Vomiting, Renal Failure
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
M
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135-145 mEq/L
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
N
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3.5-5.0 mEq/L
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
O
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100-109
(Mayo Clinic >/= 18 years:98-107, <18 years: 102-112)
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
P
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<120
>155
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
Q
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<3
>6
Fill in the chart. For “highest” and “lowest” levels, list only the most common conditions:
R (UAMS neonates)
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<90 mmol/L
>120 mmol/L
Define osmolality
Number of particles present per unit of solution;
Proportional to concentration
What are accepted normal ranges for osmolality for plasma?
280-300 m Osm/kg
What are accepted normal ranges for osmolality for urine?
300-900 m Osm/kg
How will an increased osmolality affect each of the following colligative properties:

Freezing Point

Decreased value
How will an increased osmolality affect each of the following colligative properties:

Vapor Pressure

Decreased value
How will an increased osmolality affect each of the following colligative properties:

Boiling Point

Increased value
How will an increased osmolality affect each of the following colligative properties:

Osmotic Pressure

Increased value
What is the formula from class that is used to calculate osmolality?
2(Na) + Glucose/20 + BUN/3
Calculate an osmolality from the following data (use the formula from class):
BUN 20 mg/dL
Glucose 100 mg/dL
Sodium 140 mEq/L
292 mOsm/kg
What are the most common conditions responsible for hyperosmolality of serum?
Diabetes mellitus, Dehydration, Renal Failure, and Hyperproteinemia
What is the formula for delta osmolality?
Measured-Calculated
What is the normal range for delta osmolality?
0-10
What 3 major substances are most commonly associated with an elevated delta osmolality?
Methanol, isopropanol, ethylene glycol. Increased lipids, protein, or glucose
What is the most common cause of a delta osmolality <0?
Error
What is meant by “anion gap”?
Estimate of unmeasured electrolyte
Why is an “anion gap” measured?
Used to assess acid-base disorders and lab QC
Give the formula for the anion gap
(Na + K) – (Cl + HCO3)
What is the normal range for the “anion gap”?
12-20 mmol/L
How will the “anion gap” be affected in the following conditions? (increased, decreased, or unaffected)
Salicylate Poisoning
Increased
How will the “anion gap” be affected in the following conditions? (increased, decreased, or unaffected)
Ketosis
Increased
How will the “anion gap” be affected in the following conditions? (increased, decreased, or unaffected)
Dehydration
Increased
How will the “anion gap” be affected in the following conditions? (increased, decreased, or unaffected)
Ethylene Glycol Poisoning
Increased
What is the most likely cause of an AG<5?
Lab Error OR Significant Increase in Na, K, Cl, or HCO3
What is the difference between a direct and indirect ISE analysis?
Direct – NO Sample Dilution required
Indirect – Requires Sample Dilution
What are the main sources of interference in the indirect ISE test?
Increased Lipids & Proteins
What is the clinical significance of an elevated sweat chloride test?
Cystic Fibrosis
What is the name of the procedure/technique used to collect sweat for analysis?
Pilocarpine iontophoresis
Which 2 analytes, when markedly decreased in serum, can cause tetany?
Calcium & Magnesium
Why are oxalate & EDTA unacceptable anticoagulants for calcium analysis?
Both chelate Calcium, causing falsely Decreased results
Why is the determination of ionized Calcium important?
This form is NOT bound to protein and is a better reflection of Calcium levels in patients that may have protein abnormalities or liver disease
What effect does each of the following have on serum Calcium levels:
PTH
Increased
What effect does each of the following have on serum Calcium levels:
Calcitonin
Decreased
What effect does each of the following have on serum Calcium levels:
Vitamin D
Increased
What is the most common cause of elevated plasma Calcium?
Hyperparathyroidism
What common plasma cell disease is also associated with elevated Calcium?
Multiple Myeloma (MM)
How does the Albumin concentration influence the level of Calcium?
Most Calcium is Albumin bound so when there are Increased levels of Albumin there will likely be Increased levels of Calcium
Where is most body Iron found?
Blood / RBCs (Hemoglobin)
What is the carrier protein for Iron?
Transferrin
What is the storage form of Iron?
Ferritin
Where is the storage form of Iron stored?
Liver & Bone Marrow
What are the most common causes of Iron Deficiency Anemia (IDA)?
Chronic Blood Loss, Pregnancy, Childhood, & Dietary Insufficiency
Describe the typical RBC morphology in Iron Deficiency Anemia (IDA)
Microcytic, Hypochromic
What is the purpose of the TIBC test?
Indirect measure of Transferrin. Used to differentiate causes of Iron deficiency.
How is TIBC calculated / What is the formula for TIBC?
TIBC = Transferrin * 1.4
What is %Tf Saturation?
Measures the degree to which the binding sites are saturated with Iron
What is the formula for %Tf Saturation?
(Fe/TIBC)x100
Under what conditions (test results) can the TIBC & %Tf Saturation NOT be calculated?
Fe <5 OR Transferrin <70
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
A
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Decreased
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
B
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Increased
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
C
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Decreased
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
D
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Decreased
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
E
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Decreased
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
F
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Decreased
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
G
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Decreased
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
H
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Normal / Increased
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
I
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Increased
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
J
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Normal / Decreased
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
K
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Increased
Complete the chart below. Indicate whether the following conditions are typically associated with Increased, Normal, or Decreased test results:
L
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Increased
x

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