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Leila's Yr 5 Pathology (COPY) > Chem path 16 - Enzymes and cardiac markers > Flashcards

Chem path 16 - Enzymes and cardiac markers Flashcards

1
Q

Which type of enzyme is released first from a necrosed cell?

A

Cytosolic enzymes are released before subcellular enzyme

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2
Q

In which two places can enzymes be measured?

A

In the serum (injury) and in the tissue (abnormalities)

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3
Q

How can iso-enzymes be separated out?

A

Electrophoresis (isoenzymes have different Kms)

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4
Q

What is Km (Michaelis-Menten constant)

A

=[substrate] at which reaction velocity is 50% of the maximum

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5
Q

What do high and low Kms indicate?

A

High Km = weak binding

Low Km = strong binding

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6
Q

Where is ALP found?

A

BLIP (bone liver intestines placenta)

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7
Q

When is an elevated ALP physiological?

A

During pregnancy (third trimester) and childhood

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8
Q

ALP is high in bone diseases associated with which type of activity?

A

Osteoblastic activity

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9
Q

What is the clinical approach to unexplained ALP/

A
  1. LFTs (GGT and ALT)
  2. Check vitD
  3. ALP isoenzymes - performed by electrophoresis test
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10
Q

Which 3 ways can bone and liver ALP be differentiates?

A

GGT measurement
Electrophoresis separation
Bone ALP immunoassay

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11
Q

Pathological causes of raised ALP <5x upper limit

A

Bone - tumours, fractures, osteomyelitis

Liver - Infiltrative disease, hepatitis

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12
Q

Pathological causes of raised ALP >5x upper limit

A

Bone - Paget’s disease, osteomalacia

Liver - Cholestasis, cirrhosis

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13
Q

Is ALT or AST more speciifc to the liver?

A

ALT

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14
Q

What numerical cut off of ALT is highly suggestive of paracetamol OD?

A

ALT >1000 (ULN 45)

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15
Q

In which conditions does an elevated LDH carry a poor prognosis?

A

Germ cell testicular cancer or lymphoma

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16
Q

What is amylase a marker of?

A

Acute pancreatitis

17
Q

What else is often measured as a marker of acute pancreatitis?

A

Pancreatic lipase

18
Q

Which other gland produces an amylase isoenzyme?

A

Salivary glands - amylase can be raised in parotitis (mumps)

19
Q

What do you measure in chronic pancreatitis?

A

Foecal elastase

20
Q

What is a common SE of statins?

A

Statin-related myopathy

21
Q

Which creatine kinase isoenzyme can help make the diagnosis of statin-related myopathy?

A

CK-MM (>10X UL)

22
Q

What are the clinical syndromes of statin-related myopathy

A

Myalgia –> rhabdomyolysis

23
Q

Name some risk factors for statin-related myopathy

A 
Polypharmacy (other drugs metabolised by CYP3A4 e.g. clarithromycin, fibrates, cyclosporin)
High doses
genetic predisposition
previous myopathy with statins  
vitamin D deficiency
24
Q

Other than statins, what are some other causes of raised CK?

A

MI, Myositis, myopathy e.g. Duchenne’s, severe exercise, physiological (AFC)

25
Q

Which enzyme MUST be measured before starting thiopurine drugs such as azathioprine

A

TPMT

26
Q

Which cardiac enzyme rises fastest folllowing MI and why?

A

Myoglobin (Cytosolic)

27
Q

Which is the best enzyme marker following MI?

A

Troponin

28
Q

Which enzyme is best to detect a re-infarction following an MI?

A

CK-MB

29
Q

What are the three types of troponin called?

A

I,T,C

30
Q

What is needed to make a diagnosis of MI?

A

History, exam, ECG, troponin

31
Q

Name 3 factors which affect troponin levels

A

Age, gender (Women have less), pts with renal impairment clear less troponin

32
Q

When do troponin levels rise, peak and fall?

A

Rise 4-6 hrs
Peak 12-24 hrs
Fall 3-10 days

33
Q

When should troponin levels be measured following MI?

A

First at 6 hours and again 12 hours after

34
Q

What are the sensitivities and specificities of troponin at 12 hours?

A

100% sensitive

98% specific

35
Q

What can be seen on the ECG of someone with MI?

A

Pathological Q waves

ST elevation

36
Q

Name 2 markers of heart failure

A

ANP (Atria)

BNP (ventricles)

37
Q

What is IU a measure of?

A

IU is a measure of enzyme mass/concentration NOT ACTIVITY

38
Q

What is one IU of enzyme activity equivalent to?

A

quantity of enzyme that catalyses 1 umol of substrate per minute

Leila's Yr 5 Pathology (COPY) (100 decks)

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