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Clinical Chem > Chem Unit 4 > Flashcards

Chem Unit 4 Flashcards

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1
Q

What is the definition of hormone?

A

A regulatory substance produced and transported in the body to stimulate specific cells or tissues.

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2
Q

What is the definition of Endocrine?

A

An enzyme or hormone that acts inside the body.

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3
Q

What is the definition of Exocrine?

A

An enzyme or hormone that acts outside of the body.

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4
Q

What is the definition of Tropic Hormone?

A

Hormone which causes the cell to secrete another hormone.

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5
Q

What is the definition of Trophic Hormone?

A

Hormone which causes a direct effect on the cell.

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6
Q

What is a hormone with Diurnal variation?

A

The concentration of hormone varies throughout the day.

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7
Q

What is a hormone bound to that makes it inacitve?

A

A protein

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8
Q

What are steroid hormones derived from?

A

Cholesterol

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9
Q

What hormones are hydrophobic?

A

Steroid hormones

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10
Q

Where do steroid hormones bind to elicit a response?

A

Nucleus of the cell

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11
Q

How do Polypeptide hormones elicit a response?

A

They bind to a membrane-bound receptor and then use a second messenger system.

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12
Q

What hormones are hydrophilic

A

Polypeptide and Amino Acid hormones

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13
Q

Thyroxine is what type of hormone?

A

Amino Acid

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14
Q

Cortisol is what type of hormone?

A

Steroid

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15
Q

PTH is what type of hormone?

A

Polypeptide

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16
Q

Epinephrine is what type of hormone?

A

Amino Acid

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17
Q

Estrogen is what type of hormone?

A

Steroid

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18
Q

Serotonin is what type of hormone?

A

Amino Acid

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19
Q

What are the 2 ways hormones are regulated?

A

Positive or Negative feedback loop

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20
Q

What does the positive feedback loop do?

A

Tells the body to accentuate the process, which, in turn, creates more of the message.

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21
Q

What are 2 most common processes that use the positive feedback loop?

A

Childbirth
Clotting

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22
Q

What are the steps in negative feedback loop?

A

Homeostasis
Abnormal variable
Detected by a sensor
Activates an effector
Homeostasis is regained

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23
Q

What produces Thyroglobulin?

A

Follicular cells in the thyroid

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24
Q

What happens to Thyroglobulin in the colloid matrix?

A

Iodinated and conjugated into T3 and T4

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25
Q

What is the predominant form of thyroid hormone secreted by follicular cells?

A

T4

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26
Q

What are test results for Primary Hypothyroidism?

A

TSH: High
T4: Low
T3: Low

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27
Q

What are test results for Secondary Hypothyroidism?

A

TSH: Low
T4: Low
T3: Low

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28
Q

Primary Hypothyroidism is a problem with what?

A

Thyroid

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29
Q

Secondary Hypothyroidism is a problem with what?

A

Pituitary gland

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30
Q

Hashimoto is what Thyroid Pathology?

A

Primary Hypothyroidism

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31
Q

What are the test results for Primary Hyperthyroidism?

A

TSH: Low
T4: High
T3: High

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32
Q

What are the test results for Secondary Hyperthyroidism?

A

TSH: High
T4: High
T3: High

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33
Q

Graves Disease is what Thyroid pathology?

A

Thyroid

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34
Q

Pituitary adenoma can cause?

A

Secondary Hyper and Hypo Thyroidism

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35
Q

Thyroid hormone is primary bound to what?

A

Transthyretin
TBG
Albumin

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36
Q

What does the thyroid gland primarily produce?

A

T4

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37
Q

How is T3 produced

A

Deiodination in the peripheral tissues

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38
Q

Metabolically active T3 and T4 are what?

A

Free fraction (not protein bound)

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39
Q

What happens in Graves Disease?

A

Thyroid Stimulating Immunoglobulins which bind and activate the TSH Receptor —-> Increases T4 secretion

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40
Q

What causes Hashimoto Thyroiditis

A

Thyroglobulin and TPO antibodies

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41
Q

What can cause Non-thyroidal Illness

A

Stress on the body
Trauma
Surgery
Malignancy

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42
Q

What is the result from Non-thyroidal Illness

A

Decrease in TSH secretion and subsequently low T3 and T4 without any antibodies

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43
Q

When do we see Non-Thryroidal Illness (NTI)

A

Chronic disease states where the body is either repairing itself or fighting something

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44
Q

Symptoms of Hyperthyroidism

A

Anxiety/Nervousness
Tremors
Sweating
Heat Intolerance
Hyperactivity
Palpitations

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45
Q

Symptoms of Hypothyroidism

A

Lethargy/Stupor
Weight gain
Dry Skin
Cold Intolerance
Hair loss
Bradycardia

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46
Q

What controls Cortisol?

A

Hypothalamic-Pituitary-Adrenal Axis

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47
Q

What are the Cortisol pathologies?

A

Addison Disease
Cushing Syndrome

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48
Q

What disease state has ACTH present but the adrenal glands don’t secrete enough Cortisol

A

Addison Disease

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49
Q

What is the Primary Adrenal Insufficiency

A

Addison Disease

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50
Q

What disease state hyper secretes cortisol but ACTH is low

A

Cushing Syndrome

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51
Q

Cholesterol is the precursor to?

A

Testosterone
Aldosterone
Cortisol

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52
Q

How is Cushing Disease different than Cushing Syndrome?

A

Disease has a pituitary tumor that produces ACTH while syndrome refers to the symptoms caused by an increase in Cortisol.

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53
Q

Hypercortisolism symptoms

A

Buffalo hump
hypertension
poor wound healing
Striae (reddish-looking stretch marks)

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54
Q

What is Conn Syndrome

A

Primary Hyperaldosteronism

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55
Q

What causes Conn Syndrome

A

Primary adrenal tumor hypersecreting unregulated aldosterone.
*causes salt and fluid retention in the kidneys —> hypertension

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56
Q

What is Pheochromocytoma

A

Tissue that over produces catecholamines which increases the levels of dopamine, epinephrine, and norepinephrine

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57
Q

Where is Pheochromocytoma found

A

Neurochromaffin cells of the adrenal medulla
**low rate of malignancy

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58
Q

What is Neuroblastoma

A

tissue that over produces catecholamines

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59
Q

How is Neuroblastoma different than Pheochromocytoma

A

It is a malignant neoplasm that is found in the neural crest tissue anywhere in the body

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60
Q

How many hormones are deficient in hypopituitarism

A

Only one

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61
Q

How many hormones are deficient in panhypopituitarism

A

All pituitary hormones are low

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62
Q

Trophic hormones from the Anterior Pituitary gland

A

Gh
Prolactin

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63
Q

Tropic hormones from the Anterior Pituitary gland

A

TSH
ACTH
LH
FSH

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64
Q

Hormones released from the Posterior Pituitary gland

A

Oxytocin
ADH

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65
Q

What is Diabetes Insipidus

A

ADH deficiency causes an increased loss of free water resulting in an extremely high plasma osmolarity.

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66
Q

What is Nephrogenic Diabetes Insipidus

A

Adequate ADH present, but the kidney does not respond

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67
Q

What is Central Diabetes Insipidus

A

Complete lack of ADH production

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68
Q

What hormones are secreted in stress

A

Cortisol
Catecholamines
Vasopressin
Prolactin

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69
Q

What detects all Thyroid Hormone, Bound and unbound

A

TT3
TT4

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70
Q

What only detects unbound Thyroid Hormone

A

FT3
FT4

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71
Q

What detects the protein that primarily binds to Thyroid Hormone

A

TBG

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72
Q

What is the cortisol test for?

A

Evaluate the total cortisol in the blood, bound and unbound

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73
Q

What is the Free cortisol test for?

A

Evaluates only the unbound fraction of cortisol in the blood

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74
Q

What is the DHEA-S test for?

A

Evaluates the natural byproduct of adrenal testosterone production

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75
Q

What is the ACTH test for?

A

Evaluates the concentration of the corticotropic hormone ACTH

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76
Q

What is the Dexamethasone Suppression test used for?

A

Evaluate the negative feedback loop to ensure there is no unregulated secretion of cortisol.

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77
Q

What is the Metyrapone test for?

A

Metyrapone blocks the conversion of 11-deoxycortisol to cortisol by inhibiting 11-Beta-hydroxylase.
*results in elevated 11-beta-hydroxylase and decreased cortisol levels overnight.

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78
Q

What is Vanillylmandelic acid (VMA) test used for?

A

To diagnose pheochromocytoma

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79
Q

What is the Catecholamines test used for?

A

Dopamine, Epinephrine, and norepinephrine are used to diagnose phoechromocytoma

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80
Q

What are the 2 markers used to diagnose carcinoid tumors

A

5-hydroxy-indole-acetic acid (5-HIAA)
Chromogranin A (CgA)

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81
Q

What is 5-HIAA derived from?

A

Serotonin

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82
Q

What does the LH spike correlate with?

A

Ovulation and a spike of estrogen

83
Q

After menopause, what does the hypothalamus release to replace estrogen and progesterone?

A

GnRH

84
Q

What does GnRH do?

A

tells anterior pituitary to secrete FSH and LH

85
Q

What is competitive Ab binding assay

A

labeled Ag competes with a patient Ag for Ab binding sites

86
Q

What is Direct ELISA

A

1 Ab
1st Ab bound to solid phase and 1 epitope of the Ag of interest. Ab is labeled. DIRECTLY assessing the Ag

87
Q

What is Indirect ELISA

A

2 Ab
1st Ab is what we are interested in.
INDIRECTLY assesses Ag

88
Q

How does Sandwich Assay work

A
  1. primary Ab bind to target substrate and a solid phase
  2. wash
  3. Labeled 2nd Ab
  4. detection of signal in sample
89
Q

What is the posterior pituitary gland made up of

A

Neural tissue
*extension of neurons from hypothalamus

90
Q

What are the gonadotropins?

A

FSH
LH

91
Q

What happens during the follicular phase?

A

-FSH stimulates growth of several follicles
-Dominant follicle secretes estrogen
-Estrogen inhibits growth of other follicles (&FSH)
-Estrogen stimulates development of endometrium

92
Q

What happens during ovulation

A

-A surge in LH causes egg to release
- rupturing of follicle creates corpus luteum

93
Q

What happens in Luteal phase

A

-Corpus luteum secretes progesterone
-progesterone stimulates development of endometrium
-estrogen and progesterone inhibit FSH and LH
-Corpus luteum degrades which drops progesterone
-Without progesterone endometrium is sloughed away

94
Q

What happens in tertiary hypothyroidism

A

Problem is in the hypothalamus so TRH is not being secreted resulting in low TSH, T3, T4

95
Q

In Grave’s disease what is the result for TSH Receptor Ab?

A

Hallmark Posititve

96
Q

In Grave’s disease what is the result for TPO Ab?

A

Usually positive

97
Q

In Grave’s disease what is the result for Tg Ab?

A

usually negative

98
Q

In Hashimoto’s disease what is the result for TSH Receptor Ab

A

usually negative

99
Q

In Hashimoto’s disease what is the result for TPO Ab

A

hallmark Positive

100
Q

In Hashimoto’s disease what is the result for TG Ab

A

usually positive

101
Q

What does an enzyme bind to and changes it

A

A substrate

102
Q

What is the definition of an enzyme

A

A protein that decreases the activation energy of a reaction

103
Q

What is the definition of a catalyst

A

any substance that increases the reaction rate without being permanently changed

104
Q

what is an apoenzyme

A

an inactive enzyme without its cofactor

105
Q

what is an active site

A

the specific location on an enzyme where the reaction takes place

106
Q

What is a substrate

A

the substance that is used up in the reaction

107
Q

what is a product

A

the substance that is formed in the reaction

108
Q

What is an inhibitor

A

a substance that prevents tor inhibits a reaction taking place

109
Q

what is kinetic assay

A

the change of absorbance is measured on a spectrophotometer to assess the reaction rate

110
Q

What is endpoint assay

A

the change in absorbance is measured at the end of the reaction

111
Q

What is international unit

A

a unit of activity or potency for many substances defined individually in terms of the activity of a standard solution

112
Q

What is Vmax

A

the maximum velocity of an enzymatic reaction

113
Q

what is Km

A

the concentration of substrate which allows the enzyme to achieve half Vmax

114
Q

What is activation energy

A

the energy required to get the reaction started.

115
Q

What is first order reaction

A

the reaction rate is dependent upon substrate and enzyme concentration

116
Q

what is zero order reaction

A

the reaction rate is constant and dependent upon only the enzyme concentration

117
Q

What are cofactors

A

inorganic and organic compounds that are required for full enzyme function

118
Q

What is Coenzyme

A

Organic cofactors that commonly have a structure similar to vitamins

119
Q

What is Prosthetic groups

A

coenzymes covalently bound to an enzyme

120
Q

What is holoenzyme

A

is the apoenzyme and coenzyme in one catalytically active unit

121
Q

what is metalloenzyme

A

enzymes that have a metallic ion in them

122
Q

What is a 1:1 relationship between substrate an velocity

A

First Order Kinetics

123
Q

What is the Michaelis constant

A

the substrate concentration at which the reaction rate is half of Vmax

124
Q

What is the reaction equation.

A

V =
Vmax [S] /
[S] + Km

125
Q

What is happening in zero order reactions

A

All active sites are occupied so the speed of the reaction can not increase any further with more substrate

126
Q

Where does LD-1 have an effect

A

Heart
RBCs
Kidney

127
Q

Where does LD-2 have an effect

A

Lungs
RBCs

128
Q

Where does LD-3 have an effect

A

Spleen
Lung
many tissues

129
Q

Where does LD-4 have an effect

A

Liver
Skeleton

130
Q

Where does LD-5 have an effect

A

Liver
Skeleton

131
Q

What is the Order of the 5 LD isoenzymes

A

LD2>LD1>LD3>LD4>LD5

132
Q

What does lactate dehydrogenase do

A

Catalyzes the conversion of L-lactate to pyruvate and NADH

133
Q

What are the 2 methodologies for LD

A

Wacker
Wroblewski and LaDue

134
Q

If LD1>LD2 what does that indicate

A

MI
Shock
Myocarditis
CHF

135
Q

When does LD peak

A

48-72 hours

136
Q

How long does LD stay elevated

A

7-14 days

137
Q

What does LD5>LD4 indicate

A

Liver disease

138
Q

How does hemolysis effect LD

A

Causes a gigantic spike

139
Q

What does freezing do to LD

A

All activity is lost

140
Q

What is the reference range for CK

A

Male: 52-236
Female: 38-176

141
Q

What is the stability of CK

A

Light sensitive
RT for 4 hours
48 hours fridge
1 month frozen

142
Q

Where is CK found

A

Brain
Heart
muscles

143
Q

When does CK-MB peak

A

24 hours

144
Q

CK-MM is elevated in what conditions

A

Duchenne muscular dystrophy
seizures
trauma
extreme exercise

145
Q

When is CK-BB elevated

A

Brain injury

146
Q

What are the CK isoenzyme methodologies

A

Immunoinhibition
Mass assay

147
Q

If CK-MB is >6% of the total CK what does that indicate

A

Myocardial Infarction

148
Q

How do we measure AST

A

Karmen Method

149
Q

Where is AST primarily found

A

Cytoplasm of cells

150
Q

Where is AST present

A

RBC
Heart
Liver
Skeletal muscle
Kidney

151
Q

What enzyme is the most sensitive to alcoholic injury

A

AST

152
Q

What does AST stand for

A

Asparate Aminotransferase

153
Q

What is the reference range for AST

A

5-30

154
Q

What does ALT stand for

A

Alanine Aminotransferase

155
Q

How do we measure ALT

A

Wroblewski and LaDue method

156
Q

What is used in ALT methodology to indicate the reaction

A

Lactate Dehydrogenase

157
Q

Where is ALT primarily found

A

Cytoplasm of cells

158
Q

What is ALT most specific for

A

Liver

159
Q

What is the reference range for ALT

A

6-37

160
Q

What is the DeRitis Ratio

A

AST/ALT ratio

161
Q

DeRitis Ratio >2 means

A

Alcoholic liver disease

162
Q

DeRitis Ratio <1 means

A

Other hepatitides

163
Q

What enzyme is used to differentiate hepatobilliary tract disorders

A

GGT

164
Q

Where is GGT primarily found

A

Biliary tract
Liver
Kidney
Pancreas
Large and Small intestine

165
Q

What does GGT stand for

A

Gamma Glutamyl Transferase

166
Q

What tissue has the highest concentration of ACP

A

Prostate

167
Q

ACP has a very high intracellular concentration in what?

A

RBCs

168
Q

What is used in forensic rape testing

A

ACP

169
Q

What will inhibit Prostate ACP

A

Tartrate

170
Q

Most ACP in serum is from what?

A

Osteoclasts

171
Q

What does amylase do

A

catalyzes the hydrolysis of starches

172
Q

What are the 2 types of amylase in humans

A

Salivary
Pancreatic

173
Q

What is amylase increased in?

A

Pancreatitis
Alcoholism
Parotitis

174
Q

What is a very sensitive marker for pancreatitis

A

Amylase

175
Q

What activates pancreatic amylase in gastric acid

A

chloride

176
Q

What is the role of Lipase

A

Hydrolyzes glycerol esters

177
Q

What stabilizes droplets of fat while they are being digested by pancreatic lipase

A

Bile salts

178
Q

What is lipase a specific marker for?

A

Pancreatitis

179
Q

What cells produce lipase

A

Pancreatic acinar cells

180
Q

When does lipase peak

A

after 24 hours then stays elevated for 8-14 days

181
Q

What are the lipase methodologies

A

Turbimetric assay
Enzymatic assay

182
Q

What is the stability for lipase

A

RT for 1 week
Fridge 3 weeks
Frozen for years

183
Q

Where is Cholinesterase primarily located

A

RBC
Lungs
Spleen
CNS

184
Q

What deficiency can cause a patient under anesthesia to stay paralyzed for longer than intended

A

CHE (Cholinesterase)

185
Q

What is the reference range for CHE

A

Men 40-78
Women 33-76

186
Q

How is CHE measured

A

5-MNBA at 410 nm

187
Q

Test that measure hepatocyte integrity

A

AST
ALT

188
Q

Tests that measure hepatocyte function

A

PT/PTT
Serum Albumin

189
Q

Tests that access biliary tract

A

GGT
ALP
5-‘NT

190
Q

What is the methodology for Alkaline Phosphatase

A

Bowers and McComb Reaction

191
Q

Reference range for ALP

A

44-147

191
Q

Where is ALP found

A

Bone
Biliary tract
placenta

192
Q

What is the optimal Ph for ALP

A

9-10

193
Q

What enzyme is associated with gallstones

A

ALP

194
Q

If ALP is refrigerated what happens to it

A

activity is decreased

195
Q

ACP + ALP =

A

hepatobiliary disorder

196
Q

When is 5-‘NT useful

A

When ALP is elevated to determine the source of elevation

197
Q

What is ALP associated with

A

Lung
Colon
Ovarian
Breast
Uterine cancers
lymphomas

198
Q

What is ACP associated with?

A

Prostate cancer

199
Q

Enzymes useful in diagnosis of pancreatitis

A

Amylase
Lipase

200
Q

Fecal chymotrypsin is a diagnostic tool for what?

A

Exocrine pancreatic insufficiency

201
Q

As Chymotrypsin levels increase, what decreases

A

Pancreatic enzymes

202
Q

Enzymes that are skewed by hemolysis

A

ACP
AST
LD

Clinical Chem (5 decks)

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