Essay Questions

Area1

1.      What is quality assurance? How does quality control fit into the model? Describe a typical quality control model utilizing the terms: controls, standard deviation, Levey- Jennings plots, and Westgard rules. Give specific examples using Westgard rules to determine if patient results should be reported or not.

            I development and production of products and services, quality assurance is a systematic process of determining whether a product or service under development meets the specified requirements. A typical quality control model is the Donabedian Model. Donabedian model is a quality control model that has a framework for the examination of health services and evaluation of the quality of the healthcare. According to the model, it draws information about quality healthcare from the structure, process, and outcomes. Westgard 2_2s rule state that both controls that are in the same run exceed the + 2SD. Therefore, the results of the patient cannot be reported, and they need to be corrected.

Area 2

2.      What are total bilirubin and conjugated bilirubin?  What are the normal ranges for both? How are these affected by physiological jaundice, biliary obstruction, and hemolytic anemia? Describe test methodologies for measuring bilirubin.

            Total Bilirubin is a yellow substance in the bile. Bilirubin is produced due to the breakdown of the red blood cells by the liver. Bilirubin then comes out of the body through feces thereby giving feces its normal color. Conjugated bilirubin is formed in the liver due to the attachment of sugars to the bilirubin. It mixes with the bile when it passes from the liver to the intestines. After that, it is removed from the body through the feces. There is no presence of conjugated bilirubin in the blood. Bilirubin is a breakdown product of heme catabolism. Bilirubin should be measured as both total bilirubin and conjugated bilirubin. The range of total bilirubin is 0.2 – 1.2 mg/dL while, on the other hand, the reference range of conjugated bilirubin is 0.1 – 0.4 mg/dL. When the range of bilirubin increase, then skin and the white part of the eye may be yellow (jaundice). Jaundice may be as a result of hemolytic anemia or biliary obstructions. A blood sample is required to measure bilirubin. The patient should not eat or drink for four hours before the test. Additionally, the health care provider may give instructions of not taking any medication that would affect the test.

Area 3

3.      What is normal thyroid physiology? Diagram the feedback loop for thyroid function. What are the symptoms of hyperthyroidism and hypothyroidism and respective laboratory values of each thyroid hormone in each of these diseases? What are the possible causes?

            Normal thyroid physiology is the production of the hormones L-thyroxine (T₄) and L-triiodothyronine (T₃) by the thyroid gland. The two hormones help in regulation of body metabolic processes, expenditure of total energy, tissue growth and maturation, respiration of cells, and turnover of vitamins, substrates, and hormones. Hyperthyroidism is caused by the production of excessive T₄ and T₃ hormones while hypothyroidism is caused by the less production of the hormones

Figure 1: Feedback Loop for Thyroid Function 

Symptoms of Hyperthyroidism and Hypothyroidism
Hyperthyroidism	Hypothyroidism
·         Feeling hot ·         Sweating ·         Forgetfulness ·         Weight loss ·         Anxiety ·         Fatigue	·         Fatigue ·         Dry skin ·         Muscle cramps ·         Weight gain ·         Constipation ·         Dry hair

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