Introduction to Clinical Pathology
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Introduction to Clinical Pathology

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Questions and Answers

What is the primary focus of clinical pathology?

  • Diagnosis of disease through surgical procedures.
  • Treatment of diseases through pharmacological means.
  • Diagnosis based on laboratory analysis of bodily fluids. (correct)
  • Development of new surgical techniques.

    • Which of the following is not considered a sub-specialty of chemical pathology?

  • General or routine chemistry
  • Clinical endocrinology
  • Toxicology
  • Clinical microbiology (correct)

    • What type of specimen is primarily used for clinical chemistry tests?

  • Red blood cells
  • Platelet rich plasma
  • Whole blood
  • Serum (correct)

    • Which of these best describes therapeutic drug monitoring?

    <p>Measurement of drug levels to optimize dosage.</p> Signup and view all the answers

    Which component is analyzed in urinalysis?

    <p>Chemical content of urine</p> Signup and view all the answers

    After centrifuging clotted blood, which part is collected as serum?

    <p>The yellow watery part of blood</p> Signup and view all the answers

    What is the primary analysis under special chemistry?

    <p>Electrophoresis techniques</p> Signup and view all the answers

    Which of the following accurately defines anatomical pathology?

    <p>The study of body tissues.</p> Signup and view all the answers

    What is the role of inulin clearance in clinical settings?

    <p>Assessing glomerular filtration rate (GFR)</p> Signup and view all the answers

    Which of the following is NOT a component of urinalysis?

    <p>Liver enzyme levels</p> Signup and view all the answers

    Which liver function test is primarily associated with cellular integrity?

    <p>Transaminases</p> Signup and view all the answers

    Liver function tests can be used for all the following purposes EXCEPT:

    <p>Measuring blood pressure</p> Signup and view all the answers

    What does urinalysis help reveal regarding the body?

    <p>Diabetes mellitus and renal disease</p> Signup and view all the answers

    Which substances are important to measure together when assessing calcium levels?

    <p>Serum albumin and total calcium</p> Signup and view all the answers

    What is a common cause of hypercalcemia?

    <p>Malignant disease</p> Signup and view all the answers

    Which condition is least likely associated with hypocalcemia?

    <p>Hyperparathyroidism</p> Signup and view all the answers

    Which marker is NOT suitable for use in clearance studies?

    <p>A substance that is secreted by the tubules</p> Signup and view all the answers

    What is the formula used to determine clearance in renal function tests?

    <p>C = (U x V) / P</p> Signup and view all the answers

    Which of the following is a requirement for a substance to be used in clearance tests?

    <p>It should not be reabsorbed by the tubules.</p> Signup and view all the answers

    Which statement best describes the relationship of GFR with renal impairment?

    <p>GFR provides an estimate of the degree of renal impairment.</p> Signup and view all the answers

    Which of the following statements about inulin is correct?

    <p>Inulin is completely filtered, but neither secreted nor reabsorbed.</p> Signup and view all the answers

    What is blood plasma primarily used to test for in chemical pathology?

    <p>Fibrinogen and glucose</p> Signup and view all the answers

    What process is used to prepare blood plasma from whole blood?

    <p>Centrifugation</p> Signup and view all the answers

    Which of the following is included in the Basic Metabolic Panel (BMP)?

    <p>Glucose</p> Signup and view all the answers

    What is the primary role of electrolytes in the body?

    <p>Dissociate into ions in water</p> Signup and view all the answers

    How much calcium in serum is typically ionized and physiologically active?

    <p>50%</p> Signup and view all the answers

    What is the reference range for serum total calcium levels?

    <p>2.25 – 2.75 mmol/L</p> Signup and view all the answers

    Which ions are considered medically significant electrolytes?

    <p>Sodium, potassium, chloride</p> Signup and view all the answers

    What can result from derangements in calcium metabolism?

    <p>Hypercalcemia or hypocalcemia</p> Signup and view all the answers

    Which condition is associated with increased activity of alkaline phosphatase due to a bone disease?

    <p>Osteomalacia</p> Signup and view all the answers

    What is a physiological cause for elevated alkaline phosphatase levels?

    <p>Pregnancy</p> Signup and view all the answers

    Which cardiac marker is specifically used to assist in diagnosing an acute myocardial infarction?

    <p>Creatinine Kinase - MB</p> Signup and view all the answers

    Which lipid component is classified as a type of cholesterol within the lipid profile?

    <p>Total Cholesterol</p> Signup and view all the answers

    Increased alkaline phosphatase levels can indicate which of the following conditions?

    <p>Paget’s disease of bone</p> Signup and view all the answers

    Study Notes

    Introduction - Clinical Pathology

    • Clinical pathology is a medical specialty that analyzes bodily fluids, tissues, and cells to diagnose disease.
    • The tools used in clinical pathology include clinical chemistry, haematology, and anatomical pathology.

    The Sections of Clinical Pathology

    • Anatomical Pathology
      • Histology and Cytology
    • Haematology
    • Blood Bank
    • Chemical Pathology

    Chemical Pathology

    • Chemical Pathology is the area of clinical pathology concerned with fluid analysis for diagnosis and treatment.
    • Sub-specialities include:
      • General or routine chemistry
      • Special chemistry
      • Clinical endocrinology
      • Toxicology
      • Therapeutic Drug Monitoring
      • Urinalysis
      • Fecal analysis

    Types of Specimens Used in Chemical Pathology Laboratory

    • Serum
      • Yellow watery portion left after blood clots and cells are removed
    • Plasma
      • Prepared by centrifuging whole blood collected with an anticoagulant
      • Used for parameters like fibrinogen, glucose, and clotting factors.
    • Urine
      • Analyzed for a wide range of diseases
    • Other body fluids

    Test Panels

    • Basic Metabolic Panel (BMP)
      • Includes 8 tests: sodium, potassium, chloride, bicarbonate, BUN, creatinine, glucose, calcium.
    • Comprehensive Metabolic Panel (CMP)
      • Includes 14 tests: all BMP tests plus total protein, albumin, ALP, ALT, AST, bilirubin.

    Electrolytes

    • Substances whose molecules dissociate into ions when dissolved in water.
    • Medically significant electrolytes include:
      • Sodium (Na)
      • Potassium (K)
      • Chloride (Cl)
      • CO2 (in its ion form HCO3-)

    Calcium Metabolism

    • Calcium is the most abundant mineral in the body.
    • The body maintains adequate calcium levels through a process called calcium homeostasis.
    • Disruptions to this mechanism can lead to hypercalcemia or hypocalcemia.

    Calcium Fractions

    • Calcium in serum exists in three forms:
      • Ionized (Ca2+) – physiologically active (50%)
      • Protein-bound (approximately 80% to albumin) – 40%
      • Complexed (citrates, phosphates etc) – 10%

    Calcium Reference Intervals

    • Serum total calcium reference range is 2.25 – 2.75 mmol/L.
    • Serum ionized calcium reference range is 1.1 – 1.4 mmol/L.
    • Serum albumin concentration should be measured alongside serum total calcium.

    Causes of Hypercalcemia

    • Common
      • Malignant disease (e.g., some lung cancers)
      • Hyperparathyroidism
      • Vitamin D toxicity (excessive intake)
    • Uncommon
      • Renal failure
      • Sarcoidosis
      • Multiple myeloma

    Causes of Hypocalcemia

    • Hypoparathyroid
      • Postoperative
      • Idiopathic
      • Post radiation
    • Nonparathyroid
      • Vitamin D deficiency
      • Malabsorption
      • Liver disease
      • Kidney disease
      • Vitamin D resistance
    • PTH Resistance
      • Pseudo-hypoparathyroidism

    Renal Function Tests

    • Used to evaluate kidney function and identify potential problems.

    Biochemical Tests of Renal Function

    • Glomerular Function Tests
      • Measurement of GFR (clearance tests)
        • Creatinine clearance
        • Serum creatinine
        • Serum blood urea nitrogen (BUN)

    Glomerular Filtration Rate (GFR)

    • Provides an index of functioning glomeruli.
    • Estimates the degree of renal impairment.
    • The rate in millilitres per minute that substances are cleared from the circulation through the kidney’s glomeruli.

    GFR via Clearance Studies: Criteria for Substances

    • Criteria for a suitable marker for clearance studies:
      • Freely filterable at the glomerular barrier
      • Not reabsorbed by the tubules
      • Not secreted by the tubules
      • Present at a stable plasma concentration
      • If exogenous - nontoxic
      • Reliable assay procedure

    Determination of Clearance

    • Involves accurately timed urine sample plus representative blood sample(s).
    • Clearance (C) = (U x V) / P
      • Units: mL/min
      • U: urinary concentration of substance
      • V: rate of urine formation (mL/min)
      • P: serum concentration of substance

    GFR Determination Using Inulin

    • Inulin is completely filtered at the glomerulus, but neither secreted nor reabsorbed by the tubules.
    • This property makes inulin clearance a highly accurate measure of GFR.
    • Inulin Clearance - potentially most accurate approach - Gold Standard.

    Tubular Function Tests

    • Include:
      • Urinalysis
        • Appearance
        • Specific gravity and osmolality
        • pH
        • Glucose
        • Protein

    Urinalysis

    • A physical and/or chemical examination of urine.
    • Consists of various chemical and microscopic tests to screen for:
      • Urinary tract infections
      • Renal disease
      • Diseases of other organs that result in abnormal metabolites in the urine.
    • Can reveal diseases like diabetes mellitus, glomerulonephritis, and urinary tract infections.

    Types of Urinalysis

    • Macroscopic Examination
    • Chemical Analysis (Urine Dipstick)

    Liver Function Tests

    • Used to:
      • Detect the presence of liver disease
      • Distinguish between types of liver disorders
      • Gauge the extent of known liver damage
      • Monitor response to treatment

    Routine Liver Function Tests (LFTs)

    • Some liver function tests are associated with:

      • Functionality (e.g., albumin)
      • Cellular integrity (e.g., transaminase)
      • Conditions linked to the biliary tract (e.g., gamma-glutamyl transferase and alkaline phosphatase)

    • Include:

      • Transaminases (Alanine and Aspartate aminotransferase (ALT & AST))
      • Alkaline phosphatase (ALP)
      • Bilirubin (direct and total)
      • Gamma glutamy transferase (GGT)
      • Albumin

    Alkaline Phosphatase (ALP)

    • Increased activity can be caused by:
      • Physiological:
        • Infancy
        • Puberty
        • Pregnancy
        • Intestinal isoenzymes
      • Bone disease:
        • Hyperparathyroidism
        • Osteomalacia, rickets
        • Paget’s disease of bone
        • Osteomyelitis
      • Hepatobiliary disease:
        • Hepatitis
        • Cholestasis
        • Cirrhosis
      • Others:
        • Carcinoma of the bronchus

    Cardiac Markers Panel

    • Used to diagnose myocardial infarction (heart attack).
    • Includes:
      • Troponin I (or T)
      • Creatinine kinase (Total)
      • Creatnine Kinase – MB
      • Lactate dehydrogenase (LDH-1)
      • Myoglobin
      • Brain natriuretic peptide.

    Cardiac Markers: CK-MB

    • Used to assist in diagnosing acute myocardial infarction.
    • Measures the blood level of CK-MB, a bound combination of two variants of the enzyme phosphocreatine kinase.

    Lipid Profile

    • Includes:
      • Total Cholesterol
      • Triglycerides
      • Low Density Lipoprotein - Cholesterol (LDL-C)
      • High Density Lipoprotein- Cholesterol (HDL-C)

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    Chemical Pathology - General Aspects - September 12, 2022 PDF

    Description

    This quiz covers key aspects of clinical pathology, including its definition, the various sections such as anatomical pathology and haematology, and the significance of chemical pathology in fluid analysis. Test your knowledge on the types of specimens and sub-specialties involved in this medical field.

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