Chemistry 2 (Hepatic)

Question 1

AST is present in

Answer 1

Cardiac>liver>sk. musc>kidney>brain>lung>panc

Question 2

which is more specific for liver (AST or ALT)

Answer 2

ALT (in liver and kindey)

Question 3

which is 80% mitochondrial and 20% cytoplasmic

Answer 3

AST

Question 4

which has marked diurnal variation

Answer 4

ALT

Question 5

Fast LDH isoenzymes are, and are seen in

Answer 5

LD1>2

heart, RBC, kidney

Question 6

In adults, ___ tends to be slightly higher than ___

Answer 6

ALT>AST

Question 7

Slow LDH isoenzymes are, and are found in

Answer 7

LD4&5

liver and skeletal muscle

Question 8

LDH isoenzymes that is “dire finding”

Answer 8

LD6

hepatic vascular insufficiency

Question 9

order of normal [LDH] by isotype

Answer 9

2>1>3>4>5

Question 10

what is “flipped LD ratio” and when is it seen

Answer 10

LD1>LD2

acute MI, hemolysis, renal infarct

Question 11

[LDH] order in normal CSF

Answer 11

1>2>3>4>5

Question 12

where is acid phosphatase found

Answer 12

prostate
RBCs
bone

Question 13

What separates RBC acid phosphatase from others

Answer 13

susceptible to inhibition by 2% formaldehyde

resistant to inhibition by tartrate (TRAP of hairy cell)

Question 14

Sources of Alkaline phosphatase

Answer 14

bone, bile ducts, intestine, placenta

Question 15

Alk phos decreased in

Answer 15

hypophosphatemia

malnutrition

Question 16

alk phos isoenzyme that is inactivated by hear or urea

Answer 16

bone (100%)

biliary (50%)

Question 17

most sensitive marker of hepatic metastases

Answer 17

biliary alk phos

Question 18

bone alk phos produced by osto___

Answer 18

osteoblasts (during bone formation)

Question 19

Regan isoenzyme

Answer 19

seen in 5% of pts with CA

identical to placental alk phos

Question 20

blood groups that are particularly susceptible to false increase in alk phos when not fasting

Answer 20

Lewis+ B or O secretors

Question 21

mild alk phos increase

Answer 21

pregnancy
CHF
hyperthryroidsm
NSAIDs

Question 22

most sentitive marker to biliary injury

Answer 22

GGT

Question 23

Toxins that increase GGT

Answer 23

warfarin, barbiturates, Dilantin, valproate, methotrexate, EtOH

Question 24

5’-nucleotidase found in, and increased in

Answer 24

biliary epithelium

cholestasis

Question 25

transport requirements for ammonia

Answer 25

fresh sample, chilled during transport, no hemolysis

Question 26

which bilirubin type appears in urine

Answer 26

conjugated only

Question 27

Unconjugated hyperbilirubinemia seen n

Answer 27

Crigler-Najjar Gilbert Hemolysis cirrhosis

Question 28

Conjugated hyperbilirubinemia seen in

Answer 28

``` Dubin-Johnson hepatitis estrogen obstruction Rotor ```

Question 29

what is delta-bilirubin

Answer 29

conjugated bilirubin attached to albumin | can't be excreted so lasts a long time

Question 30

T1/2 of Factor 7

Answer 30

12 hr

Question 31

Vit K deficiency can be caused by

Answer 31

impaired bile secretion (bile salts needed for K+ absorption

Question 32

Immunoglobulins in autoimmune hepatitis

Answer 32

polyclonal IgG

Question 33

Immunoglobulins in primary biliary cirrhosis

Answer 33

polyclonal IgM

Question 34

A/G ratio in liver disease

Answer 34

<1.0

Question 35

physiologic and breast milk jaundice are both___

Answer 35

unconjugated

Question 36

2 inherited unconjugated bilirubinemias

Answer 36

Crigler-Najjar | Gilbert

Question 37

2 inherited conjugated bilirubinemias

Answer 37

Dubin-Johnson | Rotor

Question 38

Physiologic jaundice seen at ____ days of life, rises at ____

Answer 38

2-3days | 5-6mg/dL

Question 39

Concerning signs in neonatal jaundice | appears within ___, rising beyond ____, persisting beyond___, total >____, single day increase>___, conjugated >___

Answer 39

``` appear within 24hr rising beyond 1 wk persisting beyond 10d total > 12mg/dL single day increase >5mg/dL conjugated >2 mg/dL ```

Question 40

exchange transfusion when bili

Answer 40

>20mg/dL

Question 41

phototherapy not useful for ___

Answer 41

conjugated hyperbili

Question 42

Jaundice in 1st 24hr ddx

Answer 42

HDFN, hemorrhage, sepsis, TORCH

Question 43

Jaundice after 1st week ddx

Answer 43

breast milk jaundice, extrahepatic biliary atresia, CF, Alagille

Question 44

AST/ALT ratio in toxic/ischemic/Etoh vs Viral

Answer 44

toxic >2 | viral <1

Question 45

best indicator of prognosis in acute hepatic injury

Answer 45

PT longer than 4s