I need help here please

Cancer and Tumor Markers Name: Date:

Supervisor: Section:

General/Clinical:

1. What is cancer?

2. What are the most common signs and symptoms of cancer?

3. What are the most common metabolic effects of cancer?

4. What is the definition of tumour markers?

5. What are the attributes of the perfect tumour marker?

6. What are the most common tumour markers currently in routine use?

7. What is the appropriate use of tumour markers?

8. What are the main screening cancer programmes currently in place?

Analytical:

1. What methods are routinely used to measure tumour markers?

2. What is the linear range for the PSA method? At what levels should the result be repeated on manual dilution?

Post analytical:

1. What are the units and normal reference ranges for PSA and CA125?

Proteins Name: Date:

Supervisor: Jenna Waldron Section:

1. Describe the properties of proteins that influence their separation.

2. Describe the acute phase response, including the changes in acute phase proteins observed.

3. (a) What is the role of Alpha-1-Antitrypin (A1AT)?

(b) What are causes and clinical implications of a low A1AT?

(c) What further investigations are required in a patient with a low A1AT?

4. What is cryoglobulin and how is it determined?

5. What is a paraprotein and what clinical conditions can this be seen in?

6. What is the difference between MGUS and Myeloma?

7. How would you investigate a patient with suspected myeloma in the laboratory?

8. What are the 6 major groups of proteins seen in serum electrophoresis?

9. Describe the principles of capillary of electrophoresis.

10. What advantages does capillary electrophoresis have over conventional gel

electrophoresis?

11. Describe the rationale behind immunofixation and how it is used to identify monoclonal proteins.

12. Explain the differences between turbidimetry and nephlometry.

13. Describe the principles of the laboratory methods used to measure:

(a) Urine/CSF total protein

(b) C-reactive protein

(c) CSF oligoclonal bands

14. What can cause an increase in CSF total protein?

15. Why is it important to have a paired serum sample with CSF when looking for

oligoclonal bands?

Liver Function

Name: Date:

Supervisor: Jenna Waldron Section:

1. What are the key functions of the liver?

2. What is the role of the aminotransferases and how are they measured? Include details of the methodology for each of these tests.

3. Describe the metabolism and breakdown of haemoglobin and the formation of both unconjugated and conjugated bilirubin.

4. What type hyperbilirubinaemia and other biochemical abnormalities can be found in the following:

(a) Pre-hepatic jaundice/Haemolysis

(b) Hepatic Jaundice

(c) Post-hepatic Jaundice/Cholestasis

5. Name the most common type of inherited abnormality of bilirubin metabolism and describe (a) its aetiology and (b) the associated biochemical features.

6. Describe in detail the methods used to measure:

(a) Total Bilirubin

(b) Direct Bilirubin

(c) ALP

(d) ALP Isoenzymes

(e) Total Protein

7. Name two markers of synthetic capacity/true function of the liver.

8. How is globulin determined?

9. Define the following terms and describe any associated clinical and/or biochemical features:

(a) Cholestasis

(b) Cirrhosis

(c) HELLP Syndrome

(d) Acute Pancreatitis

10.Name two metabolic liver diseases and, for each, describe the

(a) aetiology of the disease

(b) key biochemical markers/diagnostic tests for the disease

Calcium & Magnesium Name: Date:

Supervisor: Section:

1. What is the reference range for calcium, phosphate and magnesium?

2. What are the main functions of calcium, phosphate and magnesium

3. What do you understand by the term ‘adjusted calcium’? Why is it important to measure it?

4. Briefly explain the role of PTH and Vitamin D in Ca and phosphate homeostasis

5. List 3 causes of hypocalcaemia and 3 causes of hypercalcaemia.

6. List 2 common clinical signs of hypocalcaemia.

7. List 2 causes of hyperphosphateamia

8. List 3 causes of hypomagnasemia

9. How is hypercalcaemia treated?

10.How is hyperphosphateamia treated

GIT Name: Date:

Supervisor: Section:

Briefly described the functions of: • Oral cavity • Oesophagus • Stomach • Liver and biliary system • Pancreas • Small intestine • Colon • Rectum

2. Described the digestion and absorption of • Proteins • Carbohydrates • Fat • Vitamins • Water and electrolytes

3. What are the main causes of malabsorption?

4. What are the signs and symptoms of malabsorption?

5. What are the differences between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS)?

6. Describe the tests used in the laboratory to assess GI disorders and malabsorption, including sample requirement and method used hormones are rarely (if ever) indicated for testing?

Kidney Disease Name: Date:

Supervisor: Section:

General/Clinical:

1. What are the main functions of the kidney?

2. What is GFR? What is it a measure of?

3. What is acute kidney injury (AKI)?

4. What are the 3 main categories of AKI. Give 2 examples of pathological conditions which give rise to each one.

5. How is chronic kidney disease (CKD) defined? Give 3 examples of pathological conditions that give can lead to CKD.

6. What samples are required to calculate a creatinine clearance? What are the shortcomings of this test?

7. Aside from renal impairment, what other pathological conditions may give rise to a raised urea?

8. What is microalbuminuria? In which group of patients is it routinely screened for and how?

9. Why is protein:creatinine ratio usually performed rather than a 24h collection for urine protein?

Analytical:

1. What method is used to measure creatinine in our laboratory?

2. What is the principle behind this method?

3. What are the common problems with this method?

4. What is an alternative (and more ideal) method for creatinine?

5. What pre-analytical variables can affect creatinine results?

6. What is the name of the equation used to estimate GFR in our laboratory?

7. Give examples of patient groups/situations where this equation may not be used.

8. Under what circumstances may low creatinine results be seen?

9. What are the differences between the methods for urine total protein and urine albumin? What is the advantage of the urine albumin method over the urine total protein method?

Post analytical:

1. What are the units and normal reference ranges for serum urea and creatinine?

2. When should urea and/or creatinine results be urgently phoned out?

Endocrinology Name: Date:

Supervisor: Section:

1)What are possible causes of a raised prolactin?

2) Use of TSH alone has been proposed as a first line screening test for suspected thyroid dysfunction. What is the disadvantage of this approach?

3) (a) What is Diabetes Insipidus? (b) How is it diagnosed? (c) How are the cranial and renal types differentiated?

4) A patient is investigated for suspected Cushing’s syndrome: • A 24 hour urine free cortisol is elevated • ACTH is measured and found to be high (a)What are the likely causes? (b)What further investigations might be carried out?

5) A patient presents to their GP as “tired all the time”. They have no history of thyroid or other disease and are not on medication. Thyroid tests show: free T4: 7 pmol/L (9 – 20) TSH: 0.05 mU/L (0.35 – 4.94) What might this indicate? What additional tests might be appropriate?

6) How can prolactinomas be managed medically? Why does this work?

7) (a) What is macroprolactin? (b) Describe the principle behind the identification of macroprolactin NHS

8) Why is GH not generally a useful test? What other hormone should be measured instead?

9) Consider all pituitary hormones. (a) Which pituitary hormones do we analyse at SWBH and by what type of assay?

(b) Which pituitary hormones are sent to referral laboratories for analysis? What type of assay is used?

(c) Which pituitary hormones are rarely (if ever) indicated for testing?

10) What are the reasons for failure of cortisol synthesis?

11) What is the most common defect in Congenital Adrenal Hyperplasia?

12) Describe Congenital Adrenal Hyperplasia.

13) How can gene deletions be detected?

14) What are the symptoms of Addisons Disease?

15) What is the concentration of cortisol suggestive of adrenal insufficiency?

16) Describe Cushings Syndrome?

17) What are the lab tests for Cushings?

18) Describe the methods for catecholamine measurement

Lipids, Lipoproteins and CVD Name: Date:

Supervisor: Section:

General/Clinical:

1. List the main types of lipids and their purpose.

2. List the main types of lipoprotein and their purpose. How are lipoproteins classified?

3. List the main causes of hyperlipidaemia. What tests can we use to determine the secondary causes of hyperlipidaemia?

4. Explain the pathogenesis of Cardio-vascular Disease and list the risk factors for developing CVD.

5. What are the 3 forms of Acute Coronary Syndrome and what is the common cause behind all three?

6. List some of the causes of a raised Total Creatine Kinase.

7. How do we calculate CVD risk? Give examples of patient groups/situations where this may not be used.

8. How is heart failure diagnosed?

9. How would the diagnosis of heart failure differ for patients at SWBH compared to hospitals that do offer BNP?

Analytical:

1. What is the principle behind the methods for cholesterol, triglycerides and HDL?

2. How can we calculate LDL-cholesterol and give examples of patient groups/situations where this equation may not be used.

3. What pre-analytical variables can affect triglyceride results?

4. When dealing with a lipaemic sample, what other biochemistry tests can be affected?

5. What are the characteristics of the ideal bio-marker for the detection of a myocardial infarction?

6. What biochemical tests do we use at SWBH to aid in the diagnosis of myocardial infarction?

7. What method do we use for Total CK? Why do we have sex-specific reference ranges?

8. Why do we use Troponin T instead of Troponin I? What are the common issues with the hs Troponin T method?

9. What is the clinical utility of the measurement of BNP or NT-ProBNP?

Post analytical:

1. What are the units and normal reference ranges for serum cholesterol, triglycerides and HDL?

2. When should triglycerides be urgently phoned out and why?

3. What are the units and normal reference ranges for CK?

4. When do we measure Troponin T? What units and guidance do we use for Troponin T?

5. What are the normal ranges for BNP and NT-ProBNP? What are the issues with these two tests?

Reproductive Endocrinology Name: Date:

Supervisor: Section:

1. What cells do FSH and LH act on in (a) males and (b) females? What are the effects of this action? (a) males

(b) females

2. (a) What stage of the menstrual cycle should the following tests be performed?  FSH

 LH

 Progesterone

(b) In what clinical scenario can it be difficult to ascertain the stage of menstrual cycle?

3. What functions does testosterone perform in the male?

4. (a) What biochemical test(s) (if any) are required to investigate the menopause in the following scenarios? • Female age 30

• Female age 55

(b) What pattern of these hormones would you expect to see in the menopause?

(c) What is the age below which menopause would be considered premature?

5. What pattern of hormones (FSH, LH, progesterone, oestradiol) would you expect to see in (a) pregnancy

(b) OCP

6. (a) Describe the criteria for diagnosis of PCOS

(b) What disorder(s) can present similarly? How can this be excluded?

7. What further action might be taken in the following scenarios? (a). Female age 18y. Clinical details ?PCOS. Testosterone (immunoassay) = 4.5

(b). Female age 50y. Clinical details: virilisation. Testosterone (LC-MS/MS) = 7

(c). Male age 50y. No clinical details. Testosterone = 7

(d). Male age 50y. Clinical details: Testosterone = 3

8. (a) What analytical method is most commonly used for hormonal analysis?

(b) What are the advantages and disadvantages of this method?

(d) What alternative methodology is used for some steroid hormones and why?

(c) Briefly describe how the assay in use at SWBH detects one of the following analytes: • LH • FSH • Prolactin

9. Find a recent EQA return for testosterone. Comment on which analytical methods are in use? Are any differences in method choice for male and female testosterone analysis apparent? Briefly comment on the performance of the assay at SWBH.

Fluid and Electrolytes Name: ID:

Hospital: Date:

General/Clinical:

1. What is the clinical use of the water deprivation test?

2. What samples will be received by the lab and which tests will be requested as part of a water deprivation test and why is the analysis urgent?

3. What is the recommended sample type for electrolyte analysis?

4. What pathological conditions would give an abnormal potassium result?

5. How stable is a sample for potassium at room temperature prior to separation?

6. What are the ideal storage conditions for a sample for electrolytes?

7. What additional tests may be requested to investigate a patient with hyponatraemia?

8. When do abnormal electrolyte results require immediate action?

Analytical:

1. What method is used to measure serum or urine osmolality?

2. What is the principle behind the method?

3. What is the difference between direct and indirect ISE methods? What sample types may be analysed with each method?

4. What is the on board stability of the sodium / potassium electrodes?

5. How frequently should calibration and QC be performed for ISE’s?

6. What pre-analytical variables can affect potassium results?

7. In what circumstances may spurious hyponatraemia be seen?

8. What is the linear range for the sodium method? At what levels should the result be repeated?

Post analytical:

1. What are the units and normal reference ranges for serum sodium and potassium?

Acid-Base Name: Date:

Supervisor: Section:

General/Clinical:

1. What limits is blood pH maintained between in health?

2. Briefly describe the main buffering system in plasma.

3. State and briefly describe the two main control mechanisms for maintaining acid-base homeostasis.

4. What are the 4 main categories of acid-base disturbance? For each one indicate whether pH, [H+], [HCO3], pCO2 are expected to be high or low. Give 2 examples of pathological conditions which give rise to each one.

A.

B.

C.

D.

5. What equation is used to calculate “anion gap”? What is this used for?

6. What is the most important urinary buffer?

7. Briefly describe how the compensatory mechanisms work and indicate which is associated with a fast response and which with a slower response.

8. What is the mathematical relationship between pH and [H+]?

(a) Convert the following pH values into [H+] (nmol/L): 6.95, 7.35, 7.80

(b) Convert the following [H+] into pH values: 30 nmol/L, 41 nmol/L, 48 nmol/L

Analytical:

1. What are the sample requirements for blood gas analysis?

2. What is the method principle behind the measurement of pH?

3. What is the difference between “total bicarbonate and actual bicarbonate?

4. What might a very low pO2 indicate about a sample for blood gases?

5. What pre-analytical factors may lead to erroneous blood gas results?

6. What is the approximate stability of bicarbonate in a serum sample?

Post analytical:

1. What are the units and normal reference ranges for pH, [H+], [HCO3], pCO2 and pO2 ?

2. At what concentration of serum bicarbonate would you consider phoning out? What would you check first?