hsd sept21 clin chem saqs essay and case OmpathStudy

Clinical Chemistry — September 2021 Specialist Examination Complete transcription of all 12 main questions from all 11 source pages. Subquestions and laboratory-result tables are preserved. The source contains no answer key, so answers have not been invented. Short-answer paper 1 1. Your laboratory receives an external quality assurance report for the ‘Serum Rhubarb’ test, for which two samples were processed: Sample A: Your result 4.6mg/L n Mean SD CV All method 198 3.3 0.3 9.1% Your method 58 2.9 0.2 6.9% Sample B: Your result 2.9mg/L n Mean SD CV All method 198 5 0.3 6.0% Your method 58 4.6 0.2 4.3% Based on the data observed in this distribution: a. Please comment on the performance of the method that your laboratory uses against other methods. (5 marks) b. Please comment on your laboratory’s performance in comparison to your own method and other methods. (5 marks) c. How would you investigate your laboratory’s performance in this distribution? What corrective action would you take? (15 marks) 2 2. You are asked by your trainee to help them understand some of the terminology used in the validation and verification process. Provide a brief explanation of the following terms and how they are assessed: a. Linearity (5 marks) b. Specificity/Interference (10 marks) c. Limit of Detection (LoD) (10 marks) 3 3a. A newly registered biomedical scientist comes to you with some abnormal results which include a significant drop in creatinine and TP. What is the possible cause of this change in results and what other abnormal results would you expect to see? (15 marks) 3b. What are the other typical causes of spurious results and what effects would this have? (10 marks) 4 4. You are required to put together a tutorial on therapeutic drug monitoring. Provide a brief description of the key learning outcomes and terminology you consider important to include in a tutorial on pharmacokinetics and therapeutic drug monitoring. Higher Specialist Diploma Clinical Chemistry Examination – September 2021 Essay Paper 120 minutes Attempt 2 out of 5 questions Instructions to candidates 1. Record your candidate number and HSD discipline on the front sheet of the answer booklet 2. Record your candidate number, the question number and the page number in the spaces provided on the answer sheets 3. Begin each new answer on a new page 4. Each question is worth 100 marks Essay paper 1 1a. Describe the role creatinine plays in chronic and acute renal disease diagnosis and monitoring. (50 marks) 1b. Critically discuss the different laboratory methods for its measurement. (50 marks) 2 2. Critically discuss the role of the laboratory in the diagnosis, monitoring and treatment of GI health conditions. 3 3. Using named examples, describe and evaluate the ‘Westgard’ rules and discuss laboratory application and strategy requirements with regards to UKAS accreditation. 4 4. Critically evaluate the role of clinical chemistry and POCT in Covid-19 patient monitoring. 5 5. Provide detailed accounts of acute diabetic conditions and critically evaluate the role of the laboratory in the diagnosis and monitoring of these. Higher Specialist Diploma Clinical Chemistry Examination – September 2021 Case studies 120 minutes Attempt all case studies Instructions to candidates 1. Record your candidate number and HSD discipline on the front sheet of the answer booklet 2. Record your candidate number, the question number and the page number in the spaces provided on the answer sheets 3. Begin each new answer on a new page 4. Each question is worth 100 marks 5. For these case study questions you are strongly advised to answer the questions as they arise during the case study to avoid later information impacting adversely on your answers to the earlier questions by presuming an “outcome”. Case studies 1 1. A 67 year old man attended his GP with the clinical details of tiredness and back pain. He previously saw a colleague with the same problem 6 weeks ago, He was advised to take ibuprofen and return if symptoms did not settle. He has taken ibuprofen and paracetamol in combination with some relief but the pain is increasing. The following results were obtained: Sodium 133 132-144 mmol/L Potassium 4.5 3.2-4.8 mmol/L Chloride 93 95-108 mmol/L Bicarbonate 26 22-29 mmol/L Urea 10.1 3.0-8.0 mmol/L Creatinine 211 60-120 µmol/L Albumin 39 34-50 g/L Bilirubin 18 <17 µmol/L Alk phos 74 35-120 IU/L ALT 7 <45 IU/L Total protein 87 60-80 g/L Globulin 48 g/L Calcium 2.74 2.12-2.60 mmol/L Corrected calcium 2.82 2.12-2.60 mmol/L Phosphate 1.35 0.80-1.50 mmol/L Magnesium 0.71 0.70-1.00 mmol/L CRP 180 <5 mg/L Glucose 5.1 mmol/L His haemoglobin is found to be 106g/L, (130-160g/L) with an MCV of 92 (80-100fl) a. Comment on these results, provide some possible diagnosis and discuss what further tests might be requested. (20 marks) At follow-up the following obtained: Sodium 132 132-144 mmol/L Potassium 4.0 3.2-4.8 mmol/L Urea 8.9 3.0-8.0 mmol/L Creatinine 147 60-120 µmol/L Albumin 32 34