1. A normal kidney function study shows a
a. BUN to creatinine ratio between 15:1 and 20:1
b. Alkaline phosphatase 30 to 85 international milliunits/mL
c. Serum aspartate aminotransferase 5 to 40 international units/L
d. Amylase 56 to 190 international units/L
2. When serum proteins indicate disease, the doctor usually follows up with
a. Total protein, albumin, and globulin
c. Protein electrophoresis
3. Elevated creatine phosphokinase (CPK) could mean myocardial infarction, but could also mean
a. Alcoholism, hypothyroidism, cardioversion, or clofibrate use
b. Aspirin, burns, warfarin, or sickle cell anemia
c. Lung disease or congestive heart failure
d. Crushing injury, bowel infarction, or opiate use
4. If the doctor suspects the patient has Hodgkin disease, then the correct stain for the smear is
a. Periodic acid-Schiff (PAS)
b. Sudan black B (SBB)
c. Leukocyte alkaline phosphatase (LAP)
d. Lactophenol cotton blue (LPCB)
5. A bleeding patient with a coagulation deficiency needs
a. 225 mL of fresh frozen plasma at +18�°C
b. 15 mL of cryoprecipitate at +18�°C
c. 300 mL of platelet pheresis at +20�°C
d. 520 mL of whole blood at +4�°C
Answers and Explanations
1. A: Blood urea nitrogen (BUN) and creatinine are waste products of protein metabolism, measured in kidney function tests performed with a 24-hour urine. If the kidneys do not filter properly, creatinine output in the urine decreases, and creatine blood levels increase. High creatinine (more than 1.5 mg/dL) and BUN (more than 20 mg/dL) means the patient has a kidney disease (e.g., glomerulonephritis, pyelonephritis, stones, tubular necrosis, tumors). BUN and creatinine must be in correct proportion for optimal health. ALP and AST are liver function tests. Amylase is a pancreas test.
2. C: The serum proteins test includes total protein, albumin, and globulin. Ascites is swelling of the abdomen from extra fluid in the peritoneum, resulting from end-stage diseases of the heart, kidney, liver, ovary, and pancreas. When serum proteins make the doctor suspect one of these diseases, the doctor follows up with protein electrophoresis. Four globulin fractionations are added to the total protein and albumin alpha-1 globulin, alpha-2 globulin, beta globulin, and gamma globulin. Electrophoresis patterns and the patient's history of drug use help pinpoint the diagnosis, which may extend to rheumatoid arthritis, muscle tumors, and immune deficiencies. Bilirubin is the brownish-red bile pigment from broken down blood cells in the liver.
3. A: Cardiac enzymes elevate soon after a heart attack, but that is not the only possible root cause. CPK elevates in alcoholism; cardiac catheterization; stroke; clofibrate use; electric shock applied during resuscitation; low thyroid hormone and high thyroid stimulating hormone; and after surgery. B and D refer to situations that cause AST enzyme to rise. C refers to situations that cause LDH enzyme to rise.
4. C: Hematologists use LAP stain to highlight neutrophils when the patient has many white blood cells but not leukemia (leukemic reaction). Microbiologists use periodic acid-Schiff (PAS) to stain carbohydrates, collagen, fibrin, and mucin purple. Sudan black B (SBB) is specifically for acute leukemia patients; it helps to differentiate between immature cells by staining lipids in myeloid leukemia that are absent in lymphoid leukemia. LPCB is mixed with 10% potassium hydroxide (KOH) to identify fungus.
5. A: Fresh frozen plasma can be used for a bleeding patient with a coagulation deficiency, or a trauma patient who needs additional red blood cells. Reserve whole blood for the resuscitation of trauma victims. Cryoprecipitate is appropriate for hemophiliacs, von Willebrand disease, and hypofibrinogenemia. Platelet pheresis is useful for patients with thrombocytopenia or platelet dysfunction.
Short notes about interesting topics
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