[CLINICAL CHEM1 FINAL] Fall2012

Part 1 Ch4,5,7,8,9 Know shifts and trends Shift a sudden change in data and the mean Trend gradual change in the data an mean

Shift is circled; notice the dots are all on one side of the mean very suddenly

tREND
Goes in a direction gradually

Know the rules for acceptable and unacceptable deviations

Be able to calculate standard deviation

Be able to calculate CV 1

[CLINICAL CHEM1 FINAL] Fall2012

Supercooling

the process of lowering the temperature of a liquid or a gas below its freezing point without it becoming a solid.

test Q#4 I may have copied down wrong : analytical error indicates what when it goes in which direction systemic error influences observations constantly in one direction (higher or lower) , by measuring slope and y intercept you can estimate systemic error RANDOM ANALYTICAL ERR
Random error: Error varies from sample to sample.Causes include instrument instability, temperature variations, reagent variation, handling techniques, and operator variables.

. Random error is present in all measurements and can be either positive or negative. Random error is calculated as the SD of the points about the regression line (Sy/x). Sy/x essentially refers to average distance of the data from the regression line (Fig. 4-7). The higher the Sy/x, the wider is the scatter and

Define Specificity

proportion without disease who test negative/ruling out disease. Ability of analytic method to quantitate one analyte in the presence of others in a mixture like sruem

sPecificity the P means start with the negatives

sensitivity proportion of patients with disease who test positive for a test of the disorder seNsitivity the N means start with Positives

[CLINICAL CHEM1 FINAL] Fall2012

Efficiency

how good a test is at detection and predicting the presence of disease or physiologic condition Accuracy closest to actual value Predictability the predictive value of a test can be expressed as a function of sensitivity, specificity and disease prevalence PPV all the positives NPV all negatives Nonparametric methods of normal range determination Parametric tests Gaussian data Nonparametric analysis is used to analyze data that is abnormal distribution, like a skewed population data for interval studies. Analyze wih percentages Normal distribution contains 68% within 1 SD 95% within 2 SD 99% within 3 SD

pregnancy tests and specificity , improving sensitivity high sensitivity= screening high specificity is confirmation by changing cutoff/medical decision limit you determine percet of positive and negative tests

Notice test cutoff value for + test result is at 5units. 8 8 8 2 7 7 7 3

New test cutoff is 8units

4 4 8 8 6 2

4
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[CLINICAL CHEM1 FINAL] Fall2012

New test cutoff is 2units , less false negatives= better cut off value 9 9 9 4 4 4 6

be able to calculate sensitivity and specificity see above, be able to calculate each given Tp TN FP FN of a pregnancy test know the pieces of spectrometer eg monochromator Components of a Spectrophotometer Light source (most commonly used is UV)

Monochromators (isolate individual wavelengths of light)

Sample cell (usually square to decrease error) Photodetectors (converts transmitted energy to electrical energy, most common is a photomultiplier tube) A/D (analog to digital converter, converts voltage to digital signals and processed to produce absorbance readings on a display) formula for calculating the abosorbancy of a solution A = 2 log %T A=aXbXc o a is absorptivity o b is light path o c is conentration define different instruments and how they are used in the lab , refer to ppt

[CLINICAL CHEM1 FINAL] Fall2012

define immunoassays like FPIA MEIA and RID RID radial immunodeficiency , immune precipitation method to quantitate protein (Ag)(immunodiffusion, ouchterloney circles ) MEIA solid phase microparticles, with glass fiber matrix support Ag sandwhiched between Ab and enzyme labeled Ab fluorescence detection and quantitation by interaction of enzyme and substrate. FPIA fluid phase antigen antibody complexes ,homogeneous immunoassay uzes polarized light to excite the fluorescent label. quantitation Ag-Ab complexes by using tubidimetry(light transmitted) and nephelometry(light scattered) to measure the way it interacts with light antigen and antibody EPITOPE the antigenic determinant on the Ag, the antigenic site to which an F(ab) can bind antigen antibody comples and increased affinity stronger the affinity and avidity the greater possibility of cross-reactivity competitive inhibition enzyme reaction is what?

[CLINICAL CHEM1 FINAL] Fall2012

Competitive immunoassay. The labeled Ag(*) aka tracer competes with the same unlabeled Ag to bind to a limited number of binding sites. This is done with known and constant amt of Ab binding sites and Ag* to determine unknown amount of Ag that isnt labeled. More flouresence = more Ag* to Ag ratio. Low fluorescence= more Ag to Ag* ratio

Define EIA

enzyme immunoassay uses enzyme bound antibody to detect angtigen, substrate produces colorogenic reaction Why is chemiluminescence better The detection limits are very small , up to 1 zmol and its specificity is the alkaline phosphatase is the most sensitive chemiluminescent assay Why are EMIT assays different? Think preparation, dont have to separate first, skip a whole step.Its unique feature is the ability to detect this binding without resorting to a cumbersome separation of the bound component. This is accomplished by including in the mixture of antibodies and sample an
enzyme that is attached to the drug. Antibodies that do not become bound to drug in the sample bind instead to this enzyme-drug "conjugate". The conjugate is designed in such a way that when antibodies bind to its drug portion, the enzyme is deactivated. The more drug there is in the sample, the more of the antibody is bound to it and less is available to deactivate the conjugate. If an enzyme substrate is present that is converted to a colored or fluorescent product, the presence of drug will inhibit the formation of the detectible product to a degree related to the concentration of the drug.

Define southern blot western and northern Southern DNA extracted from sample, enzymatically digested, separation by electrophoresis, denatured, transferred to a membrane, and finally probed to produce a band. Northern same as southern but RNA instead of DNA Western protein separation ELISA direct and indirect tesing for antigen or antibody. Specificity confirmed with Western blot protein separation technique to isolate specific protein you are looking for Western blot technique used to detect antibodies to specific epitopes of electrophoretically separated substrates of antigens. A technique where electrophoresis of antigenic material yields separation of the antigenic components by molecular weight. Blotting the separated antigen to nitrocellulose retains the electrophoretic position and will have a reaction with specific antibodies, if present, in the different antigenic bands. EIA reactions then detects the antibodies that have been bound to the antigens on the nitrocellulose membrane, the EIA reaction characterizes the antibody specificity. This is done to confirm specificity of antibodies detected by ELISA EMIT capture method . detects very small concentrations of antigen with multiple epitopes, no separation step Common polymorphisms seen in genes SNP single nucleiotide polymorphisms PCR steps 6

[CLINICAL CHEM1 FINAL] Fall2012

denaturing anneling and extention fluorescent in suitu hybridization technique solution hybridizations performed on cells, tissue or chromosomes fixed on a slide, allows morphologic viewing of target DNA and specific probe Pro cons of clinical POC tests Higher turnaround time Able to do at bedside FISH

Higher Cost of equipment due to individually run tests and disposable 1 use equipment POCT LAB Turn around time fast turn around time slower Infrequent calibration Frequent calibration High consumables Low consumables Cost high Cost low
Why is POCT difficult to immpliment in hopspitals primary difficulties in the implementation of POCT in a health care facility is instilling the importance of quality control in nonlaboratorians performing POCT! Ionized calcium tests for POCT different why? My notes say are for a different government agency What regulations does POCT have to comply with (check?) CLIA regulation , need ClIA licence to level of complexicity Proficiency testing of POCt is why? Think errors in kits Monitor quality control, competency of personnel, correct patient identification(barcoded), instrument maintenance. So many users and meters, software used to control quality control, use lock out method. What is included in the written procedures for the test systems? Eg critical patient values, procedure, reagents , equipment, interferances What are waived test in lab and what do they include hematocrit Where can POCT be used At bedside, physician offices, at home fingerstick, lab Part2 Ch 10,11,12 Electrophoresis patterns and commonalities

[CLINICAL CHEM1 FINAL] Fall2012

normal

Monoclonal increase in gamma region Sharp increase in immunoglobulins

Alpha 1 antitrypsin deficiency Decrease alpha 1

1
Nephrotic syndrome , crown, princess nephriti,decrease relative albumin, increase alpha 2 and beta

albumin 2
Inflammation Increased alpha 1 2 and beta

2 1

Cirrhosis BETA GAMMA BRIDGE OF CIRROSIS

[CLINICAL CHEM1 FINAL] Fall2012

What are the different fractions see above Immunoglobulins igM Synthesized by neonate, pentamere igA In secrections, Dimer igG Crosses the placenta, most in blood igE Allergies increase igD No one cares Nephrotic syndrome and what happens at alpha and beta fractions Alpha 2 and beta increase Congestive heart failure causes prerenal hyperazotemia , a high level of nitrogen waste in blood, a common form of renal failure caused by decreased blood flow to kidneys Troponin doesnt increase with skeletal muscle damage but is specific marker for what? Specifc marker for myocardial damage, gold standard for acure myocardial syndrome Nitrogen is excreted as what?

urea
Enzymes decrease what in in a reaction Activation energy pancreatic enzymes pancreatic amalase and pancreatic lipase Causes of hemoproteniemia Edema
Osmotic force plasma proteins function in the distribution of water throughout the compartments of the body. Their colloid osmotic force, due to their size, does not allow protein to cross the capillary membranes. As a result, water is absorbed from the tissue into the venous portion of the capillary. When the concentration of plasma proteins is significantly decreased, the concomitant decrease in the plasma colloidal osmotic (oncotic) pressure results in increased levels of interstitial fluid and edema. This is often seen in renal disease when proteinuria results in a decreased plasma protein concentration and swelling of the hands and feet.

Nonprotein nitrogen compounds ammonia What is onciotic pressure and what does it do Maintains colloid osmotic pressure in intravascular fluid and fluid balance in tissue, albumin Hepatic encephalophathy measured by what concentrations Ammonia pp277 Amminoacidopathies and charachteristic smells Sweaty feet and isovaleric acidemia Liver is major organ to produx what enzyme activity in serum acid phosphotase activity liver enzymes are ALT AST ALP GGT Positive and negative nitrogen balabnce in the body Positive =eating food produces nitrogen Negative nitrogen blance= hypoprotenemia , malnutrition, malabsobrion, or excessive plasma protein loss Define apopenzyme protein portion of enzyme 9

[CLINICAL CHEM1 FINAL] Fall2012

Serum lactate dehydrogenase can be elvated in serum during Pernicious anemia, and megaloblastic anemia due to hemolysisi and release of LD in cells Multiple sclerosis gives what diagnostic bands? oligoclonal bands Seum BUN increased in what condition Glomerularnephritis Lactate dehydrogenase in normal limits during what condition eg acute appendicitis no intravascular hemolysisi PKU is caused by what amino acid deficiency phenylalanine hydroxylase Most abundant immunoglobulin in blood igG Hyperuricemia associated with what conditions Normal gout Branched chain amino aids Leucine, isoleucine, valine Creatinine mainly in skeletal muscle heart and brain, grossly elevated condition is ______ muscular dystropy & fisrt early to rise as a marker for acute myeocardial infarction ckmm Cardiac marker used to diagnose congestive heart failure BNP Immunofixation electrophresisi in book Top chart is IgA lambda monoclonal band Bottom chart is IgM kappa monoclonal band Maple syrup urine disease is due to overflow of what aminoacid? Normal The BCAA leucine, isoleucine, and valine.
Lack of branched-chain alpha-ketoacid decarboxylase,

Transferrin deficiency causes heavy metals in Atransferrinemia , absence of transferrin, hemosiderosis / iron deposits in the heart and the liver pp244 LD measurement is interference when? hemolysis Viral hep has what elelvated enzymes AST ALT Excreacelular enzyme that is clinicaly measured amylase Guthrie test Bacillus subtilis Haptoglobin Binds hemoglobin Toxic condition high serum urea, cratinein and renal failue uremia 10

[CLINICAL CHEM1 FINAL] Fall2012

Alkaptinuria black urine Liver damage due to ethanol determined by measuring what liver enzyme GGT Breakdown of amino acids produces urea Highest occurin acute phase reactant protein inhibits proteolysis alpha 1 anti trypsin Define reactant order kinetics First order kinetics where the reaction rate is directly proportional to the substrate concentration. Substrate binds readily to free enzyme at a low substrate concentration. If the amount of enzyme exceeds the amount of substrate, the reaction rate steadily increases as more substrate is added. Maximum reaction velocity is reached when the substrate concentration is high enough to saturate all available enzyme. Zero order kinetics where the reaction rate depends on the enzyme concentration. Where after product is formed the resulting free enzyme immidiatly combines with excess free substrate Increase alpha 1 fetoprotein in amniotic fluid spina bifida predicts short term premature birth risk Glycoprotein fibronectin Dehydration is seen with increased serum Albumin. hyperprotenemia Cirrosisi electropattern Beta gamma bridge Metabolism of purine leads to final product of uric acid Serum urea levels is more affected by diet and metabolism than serum creatine Glomerular filtration rate estimate what? Creatinine clearance nonprotien nitrogen compound not synthesized by the liver ammonia Hepatitis is seen whit a normal level of CK Primary The primary structure refers to amino acid linear sequence of the polypeptide chain. The primary structure is held together by covalent or peptide bonds Secondary Two main types of secondary structure, the alpha helix and the beta strand or beta sheets, These secondary structures are defined by patterns of hydrogen bonds between the main-chain peptide groups. Tertiary structure Tertiary structure refers to three-dimensional structure of a single protein molecule. The alpha-helices and beta-sheets are folded into a compact globule. non-specific hydrophobic interactions lock into place specific tertiary interactions, such as salt bridges, hydrogen bonds, and the tight packing of side chains and disulfide bonds. Quaternary structure Quaternary structure is the three-dimensional structure of a multi-subunit protein
and how the subunits fit together

Tryrosinemia and enzyme decificencie 11

[CLINICAL CHEM1 FINAL] Fall2012

Disorder of tyrosine catabolism, excretion of tyrosine in urine or its metabloites Protein fractions not produced in the liver gamma globulins High sensitivity CRP A marker for risk of cardiovascular disease Isoenzymes clinically significant LD CK alkaline phosphtase LD and alkaline phosphatase are both elevated in hemolysis due to high concentrations in RBC. Adenylate kinas pp 293 is an enzyme released from erythrocytes during hemolysisi that can be confused for CK. Hepatic failure will have what abnormal levels of ammonia? increased ammonia Isoenzyme indicates brain damage ckbb Kidney stones aminoacidopahthy cystinuria Chemotherapy patients would be seen with what increased levels Uric acid due to chemotherapys increased cell turnover rate Decreased Serum albumin levels Can reflect malabsorbtion or malnutrition levels of the patient

AA, nonessential & most abundant? Glutamine pp227

Ammonia testing Special procedure for ammonia, whole blood ammonia increased after collection so must place on ice immidiatly following collection in heparin or edta tube. Spin down within 20 minutes of collection at 0-4degrees and assay ASAP if not freeze the sample Decreased ceruloplasmin in serum indicates less able to transport copper will lead up to copper buildup in tissues also known as _______ and may have _________ wilsons and kayser-fleisher rings Fibrinogen is where not in serum in plasma Part3 13.14.15

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[CLINICAL CHEM1 FINAL] Fall2012

Familial hypercholesterolemia is A disease where heterozygous have LDL receptors on cells so LDL isnt able to enter the cell and leads to buildup of LDL in abnormally high levels in the plasma elevated LDL pp335 A patient with a 2hr post prandial glucose of 220 and serum insulin 15 Would be diagnosed as NIDDM non insulin depedenent diabeites mellitis Hyperkalemia is seen in whatpaient condiions? is not seen in vomiting and diarrhea, seen in acute renal failure, intravascular hemolysis, and oral potassium replacement therapy Higher risk of coronary hear t disease is seen wih wha liporoein levels? decreased hdl and increased total cholesterol (because of increased LDL) What is the main contributor to serum osmolality Sodium contributes most to total serum osmolality The Glucose of a normal person will be at what comparable levels for the 2hour post prandial test and the fasting glucose test ? equal levels during a 2hr post prandial and a fasting glucose test due to a normal pesons blood sugar should be at fasting levels 2hours afte eating True or False? an Indicaor of the severity of CO2 deprivation is excess lactate False Is Increased lactate is acidic?? Which reducing sugar is associated with accumulation in the plasma due to a genetic deficiency in carbohydrate metabolism? Redux sugar galactose accumulated of due to genetic deficiency in carb metabolism , galactosemia pp321 , increased levels in the plasma, and glactose accumulation in the blood. most common deficiencygalactose-1-phosphate uridyl transferase. And can be ID by measureing
erythrocyte galactose-1-phosphate uridyltransferase activity

Respiratory acidosis is compensated with? plasma bicarbonate , think bicarbonate is synthesized by the Kidneys in compensation to acidosis If total cholesterol is 400 triglycerides is 300 HDL 100 calculate LDL

4 3 Look at the patients Total Cholesterol, it is very out of range. Answer is LDL increases
Calculate anion gap without potassium Sodium 150 Poassium 5 Irrelevant Chloride 110 Bicarbonate 30

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[CLINICAL CHEM1 FINAL] Fall2012

What hormone inhibits glycolysis and glucose uptake by the muscle cells and raises blood glucose concentration? Growth hormone a pituitary hmone that promotes increased plasma glucose by decreasing the entry of glucose ino cells (inhibits glucose uptake by cells) and increases glycolsis True or False? Alkalosisi is caused by hyperkalemia? Hyperkalemia NOT caused by alkalosisi HyperKalemia can be caused by hypoaldosterone, hemolysis,or acute renal failure

What is the main extracellular cation sodium In the Reverse cholesterol transport pathway the primary apoproein is what ? what is it doing? HDL removes cholesterol What fatty acid is not associated with increased LDL-cholesterol Monosaturated-cis-fatty acids Hypernatremia commonly seen with Excess sweating and no water replacement Water leaves the cell and sodium follows What is the most important buffer in plasma? Bircarbonic and carbonic acid HDL gathers excess cholesterol and transports back to where? Liver A A1c panel on he red blood cells can be falsely reported due to a decreased patient ________ Rbc lilfe span A1C is assumed to be an assessment of normal RBC and glucose over a 3mo period due to 120 assumed in circulation Review definitions

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[CLINICAL CHEM1 FINAL] Fall2012

Which lipoprotein is transports 60-75% of the plasma cholesterol? LDL is the major lipoprotein responsisble for the delivery of exogenous cholesterol to peripeal cells b/c efficien LL recepors on cell membrane pp335 Premature sign of arteriosclerosis can be indicated by increased values of what? Elevated LDL is associated with premature arteriosclerosis due to its promotion of plaque formaion Preferred screening for diabetic and nonpregnant person is? a fasting plasma glucose If a Potassium level of 6.8 is seen in the patientserum, what would you do before reporting out ? (Normal K serum is 3.5-5.1mmol/L pp4.28 check first for hemolysis True or false? A Patient with lactic acidosis with have increased anionic gap true Given A Total cholesterol 400, HDL 100 and Triglycerides of300 calculate the LDL 3 4 24 5 Calcium concentration regulated by?Parathyroid hormone in serum could be calciums affect on parathyroid hormone PTH regulated Ca levels pp374 , PTH promotes abosorbtion of Calcium at the kidney and stimulates ca relaes into seuma t the BM. Decreased serum levels of ionized free calcium stimulates PTH production which works to increase Calcium levels by breaking down bone or retaining more Calcium at the renal system A Patient is seen with a Fasting glucose 130 1hr 225, and 2hrpost prandial 205 What is the idagnosisi? diabeties What is a Major intacellular cation(think hemolysis) Potassium Chief electrolyte to maintain osmotic pressure sodium what is the preferred glucose reference method? Hexokinase reaction due to less interference pp323

Unseparated glucose and levels of glucose decreased 15

[CLINICAL CHEM1 FINAL] Fall2012

Vitamin D deficiency would do what to phosphate? inorganic phosphate levels decline to determine a diabetic patients glucose control over 2 months what test would you run? glucoslysated hemoglobin a1c Chylomychrons true statements largest, least dense , float up and form creamy layer, produced by intestine. Deliver dietary lipids to hepatic and peripheral cells APO B48 Type1 diabetes is associated with what conditions? Ketoacidosis beta cells and inappropriate hyper glycemia Type2 Hyperglycemia as a result of insulin resistance with an insulin secretory defect A Hyperglucemic patient is seen with what type of specific gravity in urine and urine osmolality and levels of serum and urine glucose? Elevated SG osmolality and serum and urine glucose

True False Hypokaliemia caused by acidosis False hyperkalemia is caused by acidosis Define osmolality Concentration of solutes of a solution mmol/Kg SIADH syndrome of inappropriate antidiuretic hormone low plasma osmolality and low serum NA. SIADH is seen with hyponatreima decreased sodium For glucose determinations which tube would you use? sodium fluoride Chloride is maJor what Extracellular anion Lipemic specimen is being tested for total cholesterol what would you do ? dilute and report using friend equation if total cholesterol is too much Chylomychrons make the sample milky Serum tryglyceride estimate Vldl cystic fibrosis is done with a sweat test True or false? A decreased serum potassium will be observed in a blood sample allwed to sit and clot False Hemolyzed sample and ion levels of the sample compared to non hemolyzed Increased K An OGTT on a nonpregnant plasma glucose Fasting& 2hour Normal <140, prediabeties 140-200, diabties >200 Serum irion calcium is measured with Ion selective electrode The majority of CO2 present in blood is in the form of 16

[CLINICAL CHEM1 FINAL] Fall2012

bicarbonate Anion gap QC for lab Na K Cl CO2 total Hemolyzed sample electrode that is increased potassium Disease from familial absence of high lipoprotein Tangier disease is hypoalphalipoproeinemia pp344 Glucose oxidase reaction is most specific for beta d glucose Insulin Makes glucose enter the cell and depletes extracellular blood sugar A significant increase of Lp(a) in plasma marks for what? CHD Define type 2 diabeties Insulin resistant ,polydipsia polyphagia Which lipoprotein has the most protein % HDL most with protein VLDL transports endogenos triglycerides Buffering capacity of the blood is severly limited by the reverse exchange process between bicarbonate and hyper glycemic factor produced by the pancrease Hyperparathyroidism is seen with increased calcium and increased ph dehydration will have Plasma concentration and distribution to the tissue with increased osmolal of 400 Decreased risk of coronary artery disease is apo A1 Carries ccholesterol to peripheral tissue is LDL Part4 16.17 Which of the following elements can be measured usoing spectrophotometry methods? Iron Majority of iron in whole blood is bound to ? Hemoglobin Patient with iron overload has what levels? Serum iron Transferrin TIBC %sat Ferritin Iron deficient Iron overload Hendersson haselbach equation Respiratory acidosisi Basophilic stippling, anorexia, and low hemoglobin indicate what Iead Why combine liqud chromatography and ICP-MS to separate different arsenic Blood PH and calculations Hyperventilation gets rid of acid to compensate for metabolic acidosis or extreme bicarb loss 17

[CLINICAL CHEM1 FINAL] Fall2012

Hypoventilation compensates for metabolic alkalosis . hypoventilation casues holing in of CO2 increases acididty , a respiratory mechanism Calculate serum pH 3 3 7 2 Low serum copper and increased urine copper indicates what? Wilsons disease What are trace elements mostly measured with? ICPMS Essential and nonessential trace elements ?? cadmium non essential essential trace iron copper zinc nonessential trace: selenium, chromium, manganese Compensation kidneys compensate for the lungs and vice versa NL values in uncompensated metabolic acidosis would be? CO2 In which condition would hypochloremia be expected hypercholremia may occur when increase in HCO3-, hyperchloremia occurs at excessive losss of Cl- Pp367 Chloride shift leads to metabolic alkalosisi An acidic ph is seen with low O2 percent and saturation, and a high PCO2 and normal HCO3Emphysema seen with low oxygen and high co2 Bicarbonate to carbonic acid ratio is for Henderson hasselbach equation 20:1 Transferrin transports and iron and is decreased in iron deficienc Early morning blood test for serum irson and TIBC due to diphasic urine cyclic A low pH, increased glucose and presence of ketones Diabetic keto acidosis, patient should be metabolic acidosis 2x in smokers cadmium 3 techniques for analysis fo stuff AAS ICP-MS AES Define cofactor is a non-protein chemical compound that is bound to a protein and is required for the protein's biological activity Manganese chronic toxicity resembles parkinsons Menkes copper deficiency Lead is measured in Whole venous blood 18

[CLINICAL CHEM1 FINAL] Fall2012

hyperventilation breathing too fast, getting rid of CO2 acid or compensating for high acidity due to less bicarb sectretion by kindeys, or over loss of bicarbonate in kidneys due to improper filtration Reference range for arterial blod pH Arterial circulation Vein PO2 90mmHg 40mmhg PCO2 40mmHg 46mmhg pH 7.40 7.35 True False?Hypoventilation causes Partially compensated respiratory alkalosis False Solubility coefficient of carbon dioxide in plasma .0307 Metabolic acidosis can be caused by severe diaharrea Anxiety crazy breathing can cause respiratory alkalois Hyperkeratosisi and stomatis are symtoms of what trace elemtn poisoning? Arsenic ppt slide 8 Trace element deficiency causes acrodermatitias and enteropathica zinc ppt slide44 is increased in iron overload and and binds and stores iron Ferritin What would the PCO2 value be represented as in MAXIMALLY compensated metabolic acidosis? Choices: 60, 45, 35,15 PCO2 would be seen in maximally compensated metabolic acidosis as 15mmhg!!! Due to extreme loss of bicarbonate by kidneys, body tries to reduce acid as much as it can to match the lowered base Bicarbonate deficiency = metabolic acidosisi Dermatititis sklin disorder and eczema Chromium Toxcicity can dcrease IQ and development lead Buffer causes changes of fluctuations in ph and co2 Bicarbonate buffer Which iron is measured with an immunoassay Ferritin is the option no the test, can also be transferrin. Ppt slide35 book pp417 Oxygen contamination of a sample Oxygen contaminates a blood gas sample, the O would falsely increase Co2 would decrease Wilsons disease treatment With zinc due to competitive uptake ,and Wilson is overload of copper True or False:Base excess can be something about positive and negative blood proteins true Chronic renal falure Acidosis

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