HCG is produced by the synctiotrophoblast cells of the fetal placenta. levels begin rising about 1 week after conception; serum levels are detectable 1-2 days after implantation and urine levels are detectable 3-4 days afterwards. HCG levels are useful for monitoring the viability of a pregnancy; normally, levels should double every 48 hours. if the rate of increase is less than 66% / 48 hours, ectopic pregnancy is suspected. false positives can be caused by hematuria / proteinuria while false negatives can be caused by dilute urine or early timing of testing.
other tests: if gestational diabetes is suspected, a glucose challenge screening test is performed at 24-28 weeks. if this test is above 140mg/dl, an OGTT is then administered.
[didn't have a chance to write up the rest of the summaries, my apologies]
questions
1. HCG is produced by...√
2. when does HCG production begin?√
3. when is serum and urinary HCG present in detectable amounts? √√
4. what are factors that could produce false negative results in urine pregnancy tests?†
5. what are factors that could produce false positives in urine pregnancy tests?†
6. what is the normal rate of increase for serum quantitative HCG tests?√
7. how might ectopic pregnancy be detected by serum quantitative HCG test?†
8. what is the significance of decreased HCG levels?†
9. how long after an ectopic pregnancy is removed would HCG levels return to normal? √√√
10. what are other reasons why HCG levels might be elevated? √√√
11. how do HgB, HcT, and CMP values change during pregnancy?√
12. what is the test for gestational diabetes and when is it performed? √√√√√
13. what is the indication for performing a full OGTT test when gestational diabetes is suspected?
14. at what point during a pregnancy are group B strep cultures collected? √√XX√
15. what is the purpose of collecting triple screens and quad screens? √√√
16. when are triple and quad screens collected? √√X†
17. what is the most common reason for increased AFP levels? √√√
18. what is the pH of vaginal secretions vs. amniotic fluid? √√√
19. why would the ABO or Rh test be administered to neonates? √√√
20. why would the direct coombs test be administered to neonates? √√√
21. what bilirubin values are associated with kernicterus and jaundice? √√√
22. when and how are thyroid tests performed on neonates? √√√
23. what is the PKU test and how is it administered? √√√
24. describe what happens with a phenylalanine hydroxylase deficiency. √√√
25. what can cause a false positive PKU test? Xà
26. what is the LD50? √√√
27. what are the best testing choices for short term vs. long term toxic material exposure? √√√
28. what are some routes of absorption for heavy metals? √√√
29. what are some ways in which heavy metals impair proper metabolic functioning? XX√√√
30. what are the effects of lead toxicity? XX√√
31. how would lead toxicity show up on a CBC? XX√√√
32. what are normal lead blood levels in children and adults? X√√√
33. what is the principle behind the "provocative challenge test" of heavy metals? √√
34. which tests should be performed before administration of DMSA? √√
35. what is the order of heavy metals that are bound by DMSA? √√
36. what is the method for assessing the "natural method of heavy metal elimination"? √√
37. what are the symptoms of cholinesterase pesticide toxicity? √√√
38. how is glyphosphate exposure monitored? √√
39. how is exposure to agent orange (chlorophenoxy) monitored? √X
40. what is the metabolite of benzene in the body? XX
41. what about toluene? √√
42. and what about ketones? √√
43. where are solvents generally stored in the body? √√
44. when is nitrite/nitrate toxicity suspected? √√
45. what occurs with nitrate/nitrite toxicity? √X
46. what is the therapeutic index? √
47. how many "half lives" are required after starting drug therapy to achieve "steady state" generally? √
48. what are peak and trough levels? √
49. what are the active ingredients in cocaine and opiates? X
answers
1. synctiotrophoblast cells of fetal placenta.
2. 7 days after conception, 1 day after implantation.
3. serum: 1-2 days after implantation, urine: 3-4 days after implantation.
4. dilute urine, early timing in pregnancy.
5. proteinuria, hematuria, excess pituitary gonadotropin production, HCG containing drugs.
6. doubles every 48 hours.
7. 66% rate of increase every 48 hours.
8. increased chance of miscarraige, non-viable pregnancy.
9. 4 weeks.
10. multiple embryos
tumors
gestational trophoblastic diseases
hydatidiform moles
choriocarcinomas
11. all get lower due to higher blood volume.
12. glucose challenge screen at 24-28 weeks
13. when the initial screening test is >140mg/dl.
14. 35-37 weeks.
15. to assess for risks of neural tube defects, trisomy 21, trisomy 18.
16. 16-18 weeks gestation.
17. neural tube defects.
18. vaginal: 4.5-5.5. amniotic fluid: 7.0-7.5.
19. ABO: when the mother is type O. Rh: when the mother is Rh-.
20. when the mother is type O, Rh-, or if the baby has jaundice.
21. >2.5 mg/dl jaundice, >15 mg/dl kernicterus.
22. heel stick at 3 days.
23. test for deficiency of phenylalanine hydroxylase, via heel stick at 3 days.
24. buildup of phenylalanine in the brain causes brain damage.
25. prematurity, lack of proper nutrition, phenylpyruvic acid buildup and spillage into urine.
26. lowest dose for a toxic substance which will kill 50% of people.
27. short term is best tested through blood, long term through urine or hair.
28. skin, ingestion, inhalation, eyes.
29. disruption of enzymes, cell membrane transport processes, mitochondrial function, neuronal function. [membrane, energy, nerves]
30. inhibition of heme synthesis, globin synthesis, and porphobilinogen synthesis.
31. basophilic stippling, microcytic hypochromic anemia, accumulation of delta ALA
32. <10>Fe3+)
46. ratio of median toxic dose (MD50) over median effective dose (ED50).
47. 4-5 half lives.
48. peak levels achieved 1-2 hours after oral intake or 1/2 hour after IV, and is used to monitor toxicity levels. trough levels achieved 15-30 minutes before next dose, and used to monitor therapeutic levels.
49. cocaine: benzoylecgoin
opiates: conguated glucuronide.
50.
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