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Wednesday, August 22, 2012

Clinical Chemistry 3 Answers to Case Analysis, Problem Solving in Endocrinology and Toxicology

IV. CASE ANALYSIS: (10 pts.)

A 32 YR. OLD FEMALE PATIENT COMPLAINED OF DIZZINESS, DYSPNEA AND NAUSEA. SHE HAD RED RASHES ALL OVER HER BODY, AND HER BREATH WAS FRUITY.

THE LAB RESULTS WERE:
:
•    FT3 - 30 ng/dL
•    FT4 - 2 ng/dL
•    TSH - normal
•    WCC – 5,100/ mm3
•    RCC – 5, 113, 100/ mm3
•    Total cholesterol – 1.87 mmol/L
•    Triglycerides – 1.3 mmol/L
•    Glucose = 3.8 mmol/L
•    Hemoglobin = 150 mg/dL
•    Hematocrit 52 vol%

QUESTIONS FOR CASE ANALYSIS: (10 pts.)

1. WHAT FURTHER TESTS WOULD YOU RECOMMEND? DEFEND YOUR ANSWER.

ANSWER:


All of the values given are within normal concentrations, so thyroid dysfuntction could be discounted, if other diagnostic tests and physical symptoms are not evident.  

Alcohol testing should be done, like Gas Chromatography or Enzymatic. A breath analyzer test for alcohol, or QED test for alcohol in saliva could also be performed. GGT could also be tested for alcohol long term abuse.


2. WHAT WOULD BE THE MOST LIKELY DIAGNOSIS? DEFEND YOUR ANSWER.

Red rashes without any occurrence of fever and a normal WBC most likely indicates allergy. Since it is coupled with dyspnea and dizziness, allergy is further emphasized.

The fruity odor could not be because of hyperglycemia beause of diabetes mellitus, so there’s one reason, which is alcohol consumption.

These all point out to alcohol allergy and intoxication.


V. PROBLEM (5 PTS. EACH)

1. WHAT IS THE HALF OF A DRUG WITH AN ORIGINAL CONCENTRATION OF 500 mg/dL, AND IS REDUCED 50 mg/dL FOR EVERY 30 MINUTES.

ANSWER =150 minutes or 2.5 hours

500 mg/dL - 30 minutes = 450 mg/dL
450 mg/dL – 60 minutes = 400 mg/dL
400 mg/dL -  90 minutes = 350 mg/dL
350 mg/dL – 120 minutes = 300 mg/dL
300 mg/dL – 150 minutes = 250 mg/Dl

Or 450 mg/dL minus 400 = 50 mg/Dl

50 / 30 = 250/X;
   
    50X = 250 x 30

    250 x 30
X = _____________
           50
   
X = 150 minutes or 2.5 hours


2. SOLVE FOR THE HALF-LIFE OF PARACETAMOL WITH AN ORIGINAL CONCENTRATION OF 600 mg/dL, AND WHICH HAS BEEN REDUCED TO 400 mmol/L AFTER 120 MINUTES.

Before you start solving the problem, you can convert either the mg/dL to mmol/L or vice versa. (If you have tried converting the units, you get 3 points. Since the atomic weight of paracetamol is not given. You should have shown conversion formula, anyhow, to get full points. That’s why it helps to keep reading. Board Topnotchers are those who research and read.)

Use the following conversion units:

1 g = 1,000 mg
100 ml= 1 dL
10 dL = 1 L
1 mole = 1,000 mmol

You can convert from mmol/L to mg/dL by:

400 mmol/L  x  1 mole     x   MW paracetamol (in grams)  x  1,000 mg x 1 L_= P in mg/dL
                      1,000 mmol          1 mole                                      1 g             10 dL

You can also convert mg/dL to mmol/L by:

600 mg/dL  x  1 g      x   1 mole                                x   1,000 mmol x 10 dL_= P in mg/dL
                   1,000 mg  MW paracetamol (in grams)        1mole            1L

MW OF PARACETAMOL = 151.16

(C8H9NO2)

C = 12, H=2, N= 14, O = 16

SINCE THE VALUE IS EXTREMELY HIGH, IT IS ENOUGH THAT YOU HAVE SHOWN THE CORRECT STEPS.

VI. TRANSCRIPTION: (1 pt.)

DASDRUG ABUSE SCREENING
ETEMERGENCY TOXICOLOGY
TDMTHERAPEUTIC DRUG MONITORING
D-9THCDELTA-9-TETRAHYDROCANNABINOL
NSAIDNON-STEROIDAL ANTI-INFLAMMATORY DRUGS
HLHALF LIFE
NADHNICOTINAMIDE ADENINE DINUCLEOTIDE REDUCED FORM
EMIT ENZYME MULTIPLIED IMUNOASSAY TECHNIQUE
ELISAENZYME LINKED-IMMUNOSORBENT ASSAY
ANS 8 –ANILINO-1 NAPHTHALENE  SULFONIC ACID

Clinical Chemistry 3 - Endocrinology -Toxicoloy Exam Questions


ANSWERS TO CLINICAL CHEMISTRY 03 MIDTERM EXAMS 2012-2013
IDENTIFICATION
1.__half-life__________________________________
2.__pituitary gland_____________________________
3.__cortisol binding protein______________________
4.__T3 or triiodothyronine_______________________
5.__RT3U, THBR_ ______________________________
6._Thyroid Binding Globulin_or Thyroxine Binding Globulin
7.__anterior pituitary___________________________
8.__ultrasound________________________________
9.__8-anilino-1 naphthalene sulfonic acid____________
10.__acetaldehyde______________________________

MULTIPLE CHOICE
1.       C             26. E       51. B      76. G
2.       A             27. A      52. D      77. F
3.       B             28. A      53. D      78. F
4.       C             29. D      54. C      79. BONUS
5.       D             30. A      55. B      80. BONUS
6.       C             31. D      56. A      81. F
7.       B             32. A      57. B      82. F
8.       D             33. B      58. B      83. F
9.       C             34. D      59. B      84. G
10.   D             35. D      60. C      85. F
11.   A             36. A      61. B      86. E
12.   A             37. A      62. D      87. F
13.   E              38. A      63. BONUS 88. A
14.   A             39. D      64. D      89. A
15.   D             40. A      65. B      90. B
16.   B             41. C      66. D      91. C
17.   D             42. B      67. C      92. A
18.   B             43. A      68. B      93. E
19.   D             44. A      69. C      94. F
20.   D             45. D      70. D      95. A
21.   D             46. D      71. D      96. A
22.   A             47. C      72. B      97. B
23.   D             48. A      73. D      98. H
24.   E              49. A      74. A      99. F
25.   B             50. D      75. A      100. C
MATCHING TYPE

1.      FT3         =          A                                             A. 10-40 ng/dL
2.      FT4        =          G                                             B. 60-220 ng/dL
3.      TT4        =          D                                             C. 0.02-0.03%
4.      TT3        =          B                                             D. 4.5 – 13 ug/dL
5.      TSH       =          E                                              E. 0.5 – 5.0 u U/mL                                       
6.      ETHANOL DETECTION        = C                  F. 0.2-0.3%
7.      TBG     =           I                                               G. 1.2 –2.5 ng/dL
8.      THBR    =          K                                             H. 15-24 ug/mL
9.      FT3I       =          H                                             I. LESS THAN 10 ng/mL
10.  FT4I       =          L                                             J. 0.8-1.35
K. 25 % -30 %
L. 4.5 – 12 ug/Dl

Thursday, August 2, 2012

MIDTERM EXAMINATIONS IN CLINICAL CHEMISTRY 3 LABORATORY

MIDTERM EXAMINATIONS IN CLINICAL CHEMISTRY 3 LABORATORY


1.    The process called when the unbound portion of medication moved from higher drug concentration(blood stream) to lower drug concentration( tissues)  until the balance reach between two areas is called ________DIFFUSION___________________

2.     When the patent on a specific pharmacologic agent expires, other companies are free to manufacture the drug and market it under their own name called  GENERIC NAME/GENERIC DRUG

3.     The time required for the concentration of the drug to decrease by 50% is called HALF LIFE_

4.    Prolong use of one or more drugs may stimulate the formation of more of  particular enzyme systems by the liver is a process known as _ENZYME INDUCTION

5.    The action of (chemical  drug) _AMINOGLYCOSIDES___ are to blocked the amino acid incorporation into the growing protein chain thereby lowering the amount of protein manufactured and causing the bacteria to misread the genetic code, resulting in the production of “incorrect proteins”.

6.    The action of  ( drug) _QUINIDINE___ is to lower the heart’s ability to conduct an electric current and its contraction decreases resulting to cardiac rhythm stabilizes.

7.    ___TRICYLIC  ANTIDEPRESSANTS______(class of drug) act by blocking the uptake of norepinephrine and serotonin by the presynaptic nerve endings.

8.    The active ingredients of aspirin is _____SALICYLATE__

9.    The response of any patient to drug treatment is highly __INDIVIDUALIZED__ and variable one depending on age, physical condition, genetic makeup, patients differ in response  to the same medication.

10.    __ENDOGENOUS DIGOXIN LIKE _SUBSTANCES___ are substances  in the blood that cross react with antibody  to digoxin due to expansion of the blood volume ,increase in blood pressure, acromegaly, renal impairment ,liver disease,  pregnancy which disappear from circulation 24 h after delivery.

11.    The net effect of the high protein binding and the uptake of tissues is a low level of __FREE FACTION/UNBOUND___  in the circulation

12.     ______LITHIUM__________ is a salt which is quickly absorbed into the circulation after oral admin that is used for the treatment of the of manic-depressive (bipolar illness).

13.     _______CHROMATOGRAPHY______________is an assay technique that has the ability to measure amount of parent drug and metabolites simultaneously, allowing quantitation of all significant contributors to the therapeutic effect.

14.     _______ALKALINIZATION________________ of urine is often utilized for emergency treatment of salicylate toxicity.

15.     ___CAFFEINE_________  is a significant metabolite of the drug theophylline in newborns and small children, monitoring for the presence and amount of this metabolite can be useful.

16.     As with all TDM, sampling time must be consistent and the most preferred specimen is the ______TROUGH SAMPLE_____, collected at the end of the dosing interval.

17.    One of the most prominent gene families that affect drug metabolism is the _____CYP 450 or CYTOCHROME P450___   family. It is an enzyme within the mixed function oxidase  system . It encodes a family of liver enzymes that metabolizes many drugs.

18.    The biochemical pathway responsible for a large portion of drug metabolism is the ___HEPATIC MIXED FUNCTION OX IDASE system. The basic function of this system involves taking hydrophobic substances and, through a series of enzymatic reactions, converting them into   

19.     ___WATER SOLUBLE______________substances facilitating easier absorption into the tissues and elimination by the kidneys

20.    ____TDM_______________ involves the analysis, assessment, and evaluation of circulating concentrations of drugs in serum, plasma, or whole blood. The purpose of these actions is to ensure that a given drug dosage produces maximal therapeutic benefit and minimal toxic adverse effects.

ESSAY –REFER TO NOTES

1.     Explain principles supporting TDM

a.     multiple dosing,  steady state of drug level
b.    Sub therapeutic, therapeutic, toxic level

2.    Enumerate 3 precautions needed in interpretation of TDM result