Wednesday, August 23, 2017

ANSWERS TO CASE ANALYSIS in Clinical Chemistry

ANSWERS TO CASE ANALYSIS in Clinical Chemistry

Laboratory tests are performed on a 50-year old lean woman during an annual physical check-up. She has no family history of diabetes or any history of elevated glucose levels during pregnancy. Her laboratory results are the following:
FBS = 90 mg/dL
Cholesterol = 140 mg/dL
HDL = 40 mg/dL
TAG = 90 mg/Dl


1.    The probable diagnosis of the patient is:
    a. myocardial infarction
    b. gestational diabetes
    c. hypercholesterolemia
    d. hyperlipoproteinemia

2.    What are the risk factors that would indicate a potential risk of this patient developing diabetes?
    1. increased cholesterol value
    2. increased TAG value
    3. decreased HDL value
    4.  increased LDL value
    5. NIL

    a. 1         b. 1 & 2    c. 1,2 & 3 
   d. 1, 2, 3 & 4     e. NIL

3.    What would be the proper follow-up tests for this patient?
    a. Repeat FBS and OGTT
    b. Repeat TAG, Chole, HDL
    c. Repeat all tests
    d. Repeat all tests and OGTT
    e. NIL

4.    In this specific case, what would be the most significant test for DM?
    a. 2 HPPT
    b. FBS
    c. OGTT
    d. RBS
    e. NIL

5.    Using the Friedewald formula, the LDL value of a patient with the following results is:
TC = 150 mg/dL, TAG = 90 mg/dL, and HDL = 36 mg/dL:
a.    96 mg/dL
b.    102.69 mg/dL
c.    375 mg/dL
d.    24 mg/dL
e.    NIL

Friedewald formula: Explanation

The Friedewald formula (FF) is an estimation of LDL-c level. It utilizes the following values:

Total Cholesterol (TC), Triglycerides (TG), and high-density lipoprotein cholesterol (HDL-c)

The FF is:

LDL-c (mg/dL) = TC (mg/dL) − HDL-c (mg/dL) − TG (mg/dL)/5

Example is above:

Substituting the given data, you will get:

LDL-c = (150 - 36) - (90/5)

LDL-c = (150 -36) - 18

LDL-c = 96 mg/dL

6.    The reason why the value of glucose is 10-15% lower in whole blood than serum and plasma is:
    a. Glycolysis is more predominant in plasma
    b. Gluconeogenesis occurs only in serum and plasma
    c. Red blood cells consume glucose
    d. Glucose is contained mostly in serum
    e. NIL

7.    The value of 110 traditional units of cholesterol in SI units is:
    a. 1.10 mmol/L
    b. 220 mg/dL
    c. 11.0 mmol/L
    d. 6.105 mmol/L
    e. NIL  - 110 mg/dl  = 2.8446 mmol/l

To convert from mg/dL (Traditional units) to mmol/L (SI units)

For total, HDL, and LDL cholesterol divide mg/dL by 38.67

Example 110 mg/dL to SI units

110 mg/dL/38.67 = 2.8846 mmol/L

For triglycerides divide mg/dL by 88.57

Example 150 mg/dL to SI units

 150 mg/dL/88.57 = 1.69357 mmol/L

To convert from mmol/L to mg/dL

For total, HDL, and LDL cholesterol multiply mmol/L by 38.67

Example 2.0 mmol/L to traditional units (mg/dL)

2.0 mmol/L * 38.67 = 77.34 mg/dL

For triglycerides multiply mmol/L by 88.57

Example 3.2 mmol/L to traditional units (mg/dL)

3.2 mmol/L * 88.57 = 283.424 mg/dL
8.    The normal value of TP in SI units is:
    a. 3.2 – 8.5 g/dL
    b. 3.5 – 6.2 g/L
    c. 32 – 85 g/L OTHER BOOKS SAY IT’S 60 – 80 g/L
    d. 3.3 – 5.3 g/dL
    e. NIL

9.    In protein measurements, Nessler’s reagent is:
    a. double iodide of potassium and mercury
    b. double ions of mercury and iodine
    c. mercury, iodine and potassium
    d. bonds between an anion and a cation
    e. NIL

10.    The following are methods for cholesterol determination, except:
    a. Van Handel and Zilversmit
    b. Pearson McGavak
    c. Schoenheimer and Sperry
    d. Sperry and Webs
    e. NIL

11.    The serum proteins are the following, EXCEPT:
    a. albumin
    b. globulin
    c. fibrinogen
    d. immunoglobulin
    e. NIL

12.    When testing for OGTT, the following precautions should be observed, EXCEPT:
    a. The patient should not be ambulatory
    b. The patient should eat only 150 grams of carbohydrates daily for 3 days prior to the test
    c. The patient should fast for 8-12 hours
    d. Strenuous exercise should be avoided
    e. NIL

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