Chemistry

Talk about important. This is THE most tested subject on the ASCP MT exam - at least based on an unscientific poll of one person. It’s packed full of different topics: Endocrinology? check. Pharmacology? check. Enzymology, Diabetes and Blood gases? check check and check. This subject is essentially a catch-all with a whole variety of different topics - they’re all important!

Tumor markers

Tumor markers are used to monitor response to treatment. Think silly when you need to memorize very plain facts: AFP may not mean anything, but “Aaah! That’s F’in Painful!” might suggest which parts of the body it’s related to.

Rise of this marker	Is associated with this cancer	Memory hook
CEA	Colon	“C’ya on the flipside”
CA 19-9	GI, pancreas
AFP	Hepatic, testicular	“Aaah! That’s F’in Painful!”
CA-125	Ovarian	“The ovaries are full of hundreds of eggs”
hCG	Testes, ovaries (normally just indicates pregnancy)
PSA	Prostate (< 25% free PSA associated with cancer)

Diagnostic enzymology

Which enzymes diagnose which diseases: brackets group ALP, GGT, ALT, AST, LD, CK and cardiac troponin by disorder — Turn pages of text into a single diagram by just scribbling some notes and seeing what you come up with

Diagnosing diabetes mellitus

Cardiac markers

How to tell if someone had an MI and how long ago: serial blood draws checking CK-MB, LD1 > LD2, myoglobin and cardiac troponins — "As serious as a heart attack" is a phrase important enough to have made its way into common usage - it's going to be on the exam

Lipoproteins

Metabolic syndrome

Questions concerning the diagnosis of metabolic syndrome come up fairly regularly during practice exams. These are the NCEP ATP III diagnostic criteria: 3 or more means you’ve got it.

Criterion	Cutoff
Abdominal obesity (increased waist size)	> 40 inches in men; > 35 inches in women
Elevated triglycerides	≥ 150 mg/dL, or drug treatment ongoing
Low HDL cholesterol	< 40 mg/dL in men; < 50 mg/dL in women
Elevated blood pressure	≥ 130/85 mmHg, or drug treatment ongoing
Elevated fasting glucose	≥ 100 mg/dL, or drug treatment ongoing

NCEP ATP III = National Cholesterol Education Program, Adult Treatment Panel III

Acid-base disorders

The pH of plasma depends on pCO₂ regulated by the lungs and the bicarbonate concentration regulated by the kidneys

Essentially, an acid-base disorder is when the 201 ratio of HCO₃⁻0.03 × pCO₂ changes.

If this is the problem	Then this is the name of the condition	And your body resolves the problem by doing this
HCO₃⁻ low	Metabolic acidosis	Hyperventilation (blow off CO₂)
HCO₃⁻ high	Metabolic alkalosis	Hypoventilation (retain CO₂)
pCO₂ high	Respiratory acidosis	Kidneys retain HCO₃⁻, excrete H⁺
pCO₂ low	Respiratory alkalosis	Kidneys excrete HCO₃⁻, retain H⁺

Know the reference ranges: pH 7.35–7.45 · pCO₂ 35–45 mmHg · HCO₃⁻ 22–26 mEq/L

I had one very easy acid-base disorder question which I can no longer remember. Don’t go too crazy learning how the Henderson-Hasselbalch equation is derived - it’s only taught in school to fill time. DO know the reference ranges for the blood gases, as well as pH. It might be on your exam!

What else will be on the exam?

It’s very important to know the differences between Prehepatic, Hepatic and Posthepatic Jaundice. Know which type of jaundice results when you have problems like excessive RBC destruction (as during hemolytic disease of the newborn), Criggler-Najar, Dubin-Johnson Syndrome and when an obstruction (like a carcinoma or gallstone) blocks bile flow into the intestines.