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Reviewers > Clinical Chemistry part 2 > Flashcards

Clinical Chemistry part 2 Flashcards

1
Q

Organic molecules that are water insoluble, fat-soluble

A

Lipids and lipoproteins

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2
Q

Building blocks of lipids; hydrocarbon chains with a terminal COO group

A

Fatty acids

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3
Q

3 fatty acid molecules attached to one molecule of glycerol by Ester bonds; serves as main storage form of energy, insulator, shock absorber and integral part of cell membrane

A

Triglycerides

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4
Q

Similar to triglycerides except that the third position on the glycerol backbone contains a phospholipid head group; contains polar and non-polar end; consitutent of cell membranes

A

Phospholipids

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5
Q

Serves as part of cell membranes and as parent chain for cholesterol-based hormones

A

Cholesterol

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6
Q

2 forms of cholesterol

A

Cholesterol esters and free cholesterol

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7
Q
A
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8
Q

approximately 70% of total cholesterol

A

Cholesterol esters

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9
Q

approximately 30% of total cholesterol

A

free cholesterol

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10
Q

Typically spherical in shape with sizes ranging from 10 to 1200 nm

A

Lipoprotein

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11
Q

Lipoproteins are composed of lipids and proteins called

A

apolipoproteins

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12
Q

The size of lipoproteins particle correlates with its lipid content

A

T

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13
Q

The various lipoproteins were separated through

A

Ultra centrifugation

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14
Q

Located on the surface of lipoproteins particles; maintain structural integrity of lipoproteins; serve as ligands for cell receptors

A

Apolipoproteins

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15
Q

Function of lipoproteins

A

Transport lipids

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16
Q

Apo A-I location

A

HDL

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17
Q

Apo A-II

A

HDL

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18
Q

Apo A-IV

A

Chylos, VLDL, HDL

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19
Q

Apo B-100

A

LDL, VLDL

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20
Q

Apo B-48

A

Chylos

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21
Q

Apo C-I

A

Chylos, VLDL, HDL

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22
Q

Apo C-II

A

Chylos, VLDL, HDL

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23
Q

Apo C-III

A

Chylos, VLDL, HDL

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24
Q

Apo-E

A

VLDL, HDL

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25
Q

Apo (a)

A

Lp(a)

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26
Q

Largest lipoprotein; least dense; highest TAG content; can block light: causes post-prandial turbidity

A

Chylomicrons

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27
Q

Transports exogenous or dietary TAG

A

Chylomicrons

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28
Q

2nd largest, 2nd least dense, 2nd highest TAG content

A

VLDL

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29
Q

Causes FASTING HYPERLIPIDEMIC TURBIDITY

A

VLDL

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30
Q

Transports endogenous or hepatic TAG

A

VLDL

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31
Q

Small; highest cholesterol content; transports cholesterol To peripheral tissues

A

LDLQ\

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32
Q

Target of cholesterol lowering therapy (statins)

A

LDL

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33
Q

Deposition of cholesterol

A

Atherosclerosis

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34
Q

Smallest, densest, highest protein content

A

HDL

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35
Q

Reverse transport of cholesterol

A

HDL

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36
Q

Triglycerides rich lipoproteins

A

CM, VLDL

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37
Q

Protein-rich lipoproteins

A

LDL, HDL

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38
Q

Highest TAG content

A

CM

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39
Q

Highest cholesterol content

A

LDL

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40
Q

Highest protein content

A

HDL

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41
Q

Apo B containing

A

CM, VLDL, LDL

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42
Q

Alpha lipoprotein

A

HDL

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43
Q

Pre-beta lipoprotein

A

VLDL

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44
Q

Beta lipoprotein

A

LDL

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45
Q

Target for station therapy

A

LDL

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46
Q

Floating beta lipoprotein

A

Beta-VLDL

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47
Q

Increased in familial dysbetalipoproteinemia

A

Beta-VLDL

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48
Q

Sinking Pre-beta lipoprotein

A

Lp(a)

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49
Q

LDL-like particule; increased risk of premature coronary heart disease and stroke

A

Lp(a)

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50
Q

Seen in patients with biliary cirrhosis or cholestasis and in patients with mutations in the enzyme LCAT

A

LpX

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51
Q

Triglyceride content of CM

A

85-95%

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52
Q

Triglyceride content of VLDL

A

45-65%

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53
Q

cholesterol content of LDL

A

6-8%

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54
Q

Protein content of HDL

A

45-55%

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55
Q

Optimal LDL cholesterol Reference range

A

<100

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56
Q

Near optimal LDL cholesterol Reference range

A

100-129

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57
Q

Borderline high LDL cholesterol Reference range

A

130-159

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58
Q

High LDL cholesterol Reference range

A

160-189

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59
Q

Very high LDL cholesterol Reference range

A

> /= 190

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60
Q

Desirable total cholesterol Reference range

A

<200

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61
Q

Borderline high total cholesterol Reference range

A

200-239

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62
Q

High total cholesterol Reference range

A

> /= 240

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63
Q

High HDL cholesterol Reference range

A

> /= 60

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64
Q

Low HLD cholesterol Reference range

A

< 40

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65
Q

Normal TAG reference range

A

< 150

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66
Q

Borderline high TAG reference range

A

150-199

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67
Q

HIigh TAG reference range

A

200-499

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68
Q

Very high TAG reference range

A

> /= 500

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69
Q

Used to characterize lipid disorders

A

Fredrickson Classification

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70
Q

The Fredrickson Classification used ___ and ___ for CM to correlate clinical disease syndromes with laboratory phenotypes.

A

Electrophoresis and standing plasma test

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71
Q

Type 1 Hyperchylomicronemia (Familiar LPL deficieny)

A

Increased TG and CM

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72
Q

Type 2a (Familial Hypercholeseterolemia

A

Increased cholesterol and LDL

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73
Q

Type 2b (Familial Combined Hyperlipidemia)

A

Increased TG, Cholesterol, LDL, VLDL

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74
Q

Type 3 (Familial Dysbetalipoproteinemia)

A

Increased TG, Cholesterol, and VLDL

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75
Q

Type 4 (Familial Hypertriglyceridemia)

A

Increased TG, VLDL

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76
Q

Type 5

A

Increased all except LDL

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77
Q

Fasting requirement for Lipid profile

A

12 hours

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78
Q

2 parameters that can be measured nonfasting

A

TC and HDL-C

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79
Q

Prolonged tourniquet application can cause ___

A

Hemoconcentration

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80
Q

Reclined patients causes ___ values

A

Decreased

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81
Q

Preferred sample for lipid profile

A

Serum or plasma

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82
Q

Preferred sample in electrophoresis and ultracentrifugation (lipid profile)

A

Plasma

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83
Q

Capillary blood samples have generally __ values

A

Lower

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84
Q

Lipemic samples are seen when triglyceride levels exceed ___

A

4.6 mmol/L (400 mg/dl)

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85
Q

Cholesterol measurement (3)

A
  1. Abell-Kendall method
  2. Enzymatic methods
  3. IDMS
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86
Q

Cholesterol measurement wherein the initial extraction with zeolite is used to remove sterols  redissolving of cholesterol  hydrolysis of cholesterol esters to cholesterol

A

Abell-Kendall method

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87
Q

3 components of the Liebermann-Burchard reagent

A

Glacial acetic acid, sulfuric acid, acetic anhydride

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88
Q

Absorbance of the Abell-Kendall method

A

410 nm

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89
Q

Reference method for Cholesterol measurement

A

GC-MS method

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90
Q

Gold standard for drug testing

A

GC-MS method

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91
Q

In the enzymatic method of cholesterol measurement, what is the first enzyme in the reaction

A

Cholesteryl esterase

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92
Q

Definitive method of cholesterol measurement

A

Isotope Dilution Mass Spectrometry (IDMS)

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93
Q

Triglyceride measurement (3)

A
  1. Enzymatic method
  2. Chemical methods
  3. GC-MS method
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94
Q

In the enzymatic method of triglyceride measurement, what is the first enzyme in the reaction?

A

Bacterial lipase

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95
Q

Hydrolysis of glycerol is accomplished using alcoholic KOH  Oxidation of glycerol by periodic acid, forming formaldehyde and formic acid  formaldehyde combines with a variety of reagents forming colored products and fluorescence

A

Chemical methods of triglyceride measurement

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96
Q

Colorimetric method of triglyceride measurement

A

Van Handel and Zilversmit

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97
Q

Fluorometric method of triglyceride measurement

A

Hantzsch

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98
Q

Reagent in Van Handel and Zilversmit (TG)

A

Chromotropic acid

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99
Q

Product formed in Van Handel and Zilversmit

A

Blue colored compound

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100
Q

Reagent in Hantzsch method (TG)

A

Acetylacetone (diacetyl acetone; reactant of choice)

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101
Q

Produce formed in Hantzsch method

A

Strong absorption maximum at 412 nm and has a good fluorescence

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102
Q

New reference method for triglyceride measurements; involve the hydrolysis of fatty acids on triglycerides and the measurement of glycerol

A

GC-MS method

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103
Q

Range in density observed among lipoprotein classes is a function of lipid and protein content and enables fractionation by density using ___

A

Ultracentrifugation

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104
Q

Takes advantage of differences in size and charge

A

Electrophoresis

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105
Q

___ can be performed using unfractionated plasma or in plasma fractions that contain other serum proteins.

A

Electrophoresis

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106
Q

Most anodal lipoprotein

A

HDL

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107
Q

Lipoprotein electrophoretograms are usually visualized with a lipid-staining dye such as ___

A

Oil Red O
Fat Red 7B
Sudan Black B
“OFS or Only Find Sun”

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108
Q

Depends on particle size, charge, and differences in the apolipoprotein content; primarily used in research labs only. It uses polyanions (heparin sulfate, dextran sulfate and phosphotungstate) and divalent cations such as magnesium, calcium and manganese)

A

Chemical precipitation

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109
Q

Uses antibodies specific to apolipoproteins to bind and separate lipoprotein classes

A

Immunoassays

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110
Q

Takes advantage of size differences in molecular sieving methods or composition in affinity methods

A

Chromatographic methods

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111
Q

Recall the Friedewald calculation

A

[Plasma TG/5] = mg/dl
[Plasma TG/2.175] = mmol/l
[Plasma TG/2.825] = gives more accurate estimate of VLDL-C , which is equivalent to [Plasma TG/6.5]

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112
Q

Involves large and medium sized arteries

A

Atherosclerosis

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113
Q

Increased risk of atherosclerosis

A

LDL

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114
Q

Decreased risk of atherosclerosis

A

HDL

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115
Q

Narrowing of blood vessels result in impaired blood flow and ischemia leading to
Peripheral vascular disease
Angina
Ischemic bowel disease

A

Complications of atherosclerosis

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116
Q

Plaque rupture  thrombosis  ___

A

Myocardial infarction and stroke

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117
Q

Plaque rupture  embolization  ___

A

Atherosclerotic emboli

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118
Q

Weakening of blood vessel wall results in ___

A

Aneurysm

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119
Q

An extreme form of hypoalphalipoproteinemia (isolated decrease in circulating HDL)

A

Tangier Disease

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120
Q

Tangier disease is associated with HDL cholesterol concentrations as low as ____ in homozygotes, accompanied by total cholesterol concentrations of ___

A

1-2 mg/dl (0.03 -0.05 mmol/l;
50 – 80 mg/dl (1.3 – 2.1 mmol/L)

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121
Q

Tangier disease is associated with increased risk of premature ____

A

Coronary heart disease (CHD)

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122
Q

Linear polymers of amino acids

A

Proteins

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123
Q

Regulate metabolism
Facilitate contraction in the muscle
Provide structural framework
Shuttle molecules in the bloodstream
Component of the immune system

A

Functions of proteins

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124
Q

Number and types of amino acids in the specific amino acid sequence

A

Primary

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125
Q

Regularly repeating structures stabilized by hydrogen bonds between the amino acid within the protein (local folding; geometrically structured levels)

A

Secondary

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126
Q

Overall shape, or conformation of the protein molecule

A

Tertiary

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127
Q

Shape or structure that results from the interaction or more than one protein molecule, or protein subunits held together by noncovalent forces

A

Quaternary

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128
Q

Number and types of polypeptide units of oligometric proteins and their spatial arrangement

A

Quaternary

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129
Q

Most plasma proteins are synthesized in the ___ and secreted by the hepatocyte into the circulation

A

Liver

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130
Q

___ are synthesized in plasma cells

A

Immunoglobulins

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131
Q

___ are produced by endothelial cells and megakaryocytes

A

vWF

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132
Q

In liver failure, all proteins are decreased except

A

Immunoglobulin and VWF

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133
Q

The nitrogen content of serum protein is approximately ___

A

16%

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134
Q

Site of protein synthesis within the cell

A

Ribosomes

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135
Q

Indicator of malnutrition; binds thyroid hormones and retinol-binding protein

A

Prealbumin (Transthyretin)

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136
Q

Binds bilirubin, steroids, fatty acids; major contributor to oncotic pressure

A

Albumin

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137
Q

Protease inhibitor

A

Alpha-1-antitrypsin

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138
Q

Principal fetal protein

A

Aplha-1-fetoprotein

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139
Q

May be related to immune response

A

Alpha-1-acid glycoprotein

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140
Q

Binds to hemoglobin

A

Haptoglobin

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141
Q

Transports copper; peroxidase activity

A

Ceruloplasmin

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142
Q

Binds heme

A

Hemopexin

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143
Q

Immune response

A

Complement

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144
Q

Precursor of fibrin

A

Fibrinogen

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145
Q

Opsonin

A

C-reactive protein

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146
Q

Migrates before albumin in the serum protein electrophoresis

A

Prealbumin

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147
Q

Transport protein for thyroid hormones; transports Vitamin A by forming a complex with retinol-binding protein

A

Prealbumin (Transthyretin)

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148
Q

Decreased in hepatic damage, acute-phase inflammatory response and tissue necrosis

A

Prealbumin

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149
Q

Sensitive marker of poor nutritional status

A

Low prealbumin

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150
Q

Increased in patients receiving steroids, in alcoholism, and in chronic renal failure

A

Prealbumin

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151
Q

Negative Acute Phase Reactant (decreased in inflammation)

A

Prealbumin, Albumin, Transferrin

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152
Q

Protein present in the highest concentration in serum (2/3 of total protein)

A

Albumin

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153
Q

Provide nearly 80% of colloid osmotic pressure (COP) of intravascular fluid

A

Albumin

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154
Q

Buffers pH

A

Albumin

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155
Q

Binds to various substances in blood (hormones, drugs, electrolytes, unconjugated bilirubin)

A

Albumin

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156
Q

50% of calcium is transported by ___

A

Albumin

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157
Q

Decreased in liver disease, malnutrition, malabsorption, kidney loss (nephrotic syndrome), hemodilution
Increased in hydration

A

Albumin

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158
Q

Most important function is the inhibition of the protease neutrophil elastase

A

Alpha-1-antitrypsin

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159
Q

Abnormal form of AAT can also accumulate in the liver and cause ___

A

Cirrhosis

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160
Q

Alpha-1-antitrypsin is a major component of a1-globulin band  deficiency of AAt seen as lack of an a1-globulin band on SPE

A

True

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161
Q

Excessive elastase breaks down elastin in alveoli leading to ___

A

Emphysema

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162
Q

Normal albumin-globulin ration

A

2:1

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163
Q

Hypoalbuminemia leads to

A

Edema (H20 goes out of the BV and enters the tissue)

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164
Q

One of the COPDs (chronic obstructive pulmonary diseases). Most common cause is smoking

A

Emphysema

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165
Q

Excessive inflammation or lack of AAT leads to destruction of alveolar air sacs  loss of elastic recoil and collapse of airways during exhalation  obstruction and air trapping

A

Emphysema

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166
Q

“Pink puffers” “barrel-chest”, hypoxemia

A

Emphysema

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167
Q

Synthesized by the developing embryo and fetus; thought to protect the fetus from immunologic attack by the mother. No known function in normal adults

A

Alpha-1-fetoprotein

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168
Q

Elevated AFP

A

Neural tube defects, presence of twins

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169
Q

Low AFP

A

Increased risk for Down syndrome

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170
Q

Tumor marker for hepatocellular carcinoma, some testicular carcinomas

A

Alpha-1-fetoprotein

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171
Q

Cooper-containing (contains >90% of total serum copper)

A

Ceruloplasmin

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172
Q

Used in diagnosis of Wilson’s disease

A

Ceruloplasmin (decreased)

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173
Q

Decreased levels of ceruloplasmin. Excess storage of copper in various organs.
Liver  hepatic cirrhosis
Brain  neurologic damage
Cornea  Kayser-Fleischer rings

A

Wilson’s disease

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174
Q

Total serum copper decreased
Free serum copper increased
Urinary copper increased

A

Wilson’s disease

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175
Q

Large protein that inhibits proteases such as trypsin, thrombin, kallikrein, and plasmin

A

Alpha-2-macroglobulin

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176
Q

Increased in nephrotic syndrome (large size aids in its retention)

A

Alpha-2-macroglobulin

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177
Q

Glomerular disorder characterized by proteinuria (>3.5 g/day)
Disruption of the electrical charges that produce the tightly fitting podocyte barrier resulting in massive loss of protein and lipids

A

Nephrotic syndrome

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178
Q

Manifestations of nephrotic syndrome

A

Hypoalbuminemia – pitting edemia
Hypogammaglobulinemia – increased risk of infection
Hypercoagulable state – due to loss of anti-thrombin III
Hyperlipidemia and hypercholesterolemia – may result in fatty casts in the urine

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179
Q

Marker for intravascular hemolysis

A

Haptoglobin

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180
Q

Bind free hemoglobin to prevent loss of hemoglobin and its constituent iron into the urine

A

Haptoglobin

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181
Q

Haptoglobin-hemoglobin complex is removed by

A

Reticuloendothelial system (mainly in the spleen)

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182
Q

Transports two molecules of ferric iron

A

Transferrin

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183
Q

Major component of the beta-globulin fraction

A

Transferrin

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184
Q

Tested to determine cause of anemia

A

Transferrin

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185
Q

Scavenge heme released or lost by the turnover of heme proteins such as hemoglobin  protect body from oxidative damage that free heme can cause

A

Hemopexin

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186
Q

Diagnostic of hemolytic anemia

A

Low hemopexin levels

187
Q

Precipitates with C substance, a polysaccharide of pneumococci

A

C-Reactive Protein

188
Q

Functions in opsonization

A

C-Reactive Protein

189
Q

One of the first acute-phase proteins to rise in inflammatory disease

A

C-Reactive Protein

190
Q

High or increasing amount of CRP suggests an ___

A

Acute infection or inflammation

191
Q

___ is the same protein but is named for the newer, monoclonal antibody-based test methodologies that can detect CRP at levels below 1 mg/L

A

High-sensitivity CRP

192
Q

The ___ test determines risk of cardiovascular disease

A

High-sensitivity CRP

193
Q

Glycoprotein produced by fetal membranes responsible for the cellular adhesiveness of placenta and membranes to the decidua

A

Fibronectin

194
Q

Fetal ___ is produced at the boundary between the amniotic sac and the decidua (the lining of the uterus) and functions to maintain the adherence of the placenta to the uterus

A

Fibronectin

195
Q

Fibronectin test for assessment of the risk for ___ in women between 24 to 35 weeks gestational age

A

Preterm delivery

196
Q

Proteolytic fragments of collagen I formed during bone resorption

A

Cross-Linked C-Telopeptides

197
Q

Biochemical marker of bone resorption that can be detected in serum and urine

A

Cross-linked C-telopeptides

198
Q

Gold standard for the detection of myocardial infarction

A

Troponin

199
Q

Govern excitation-contraction coupling in muscle

A

Troponin

200
Q

Used as an AMI indicator because of specificity and early rise in serum concentration

A

Troponin T or Troponin I

201
Q

Troponin T rises within ___
Peaks in ___
Returns to normal in ___

A

3-4 hours
10-24 hours
10-24 days

202
Q

Troponin I rises within ____
Peaks in ___
Returns to normal in ____

A

3-6 hours
14-20 hours
5-10 days

203
Q

Earliest protein marker for Myocardial infarction

A

Myoglobin

204
Q

Heme-containing protein that binds oxygen with cardiac and skeletal muscle. Levels are related to muscle mass and activity (reasonable sensitivity but poor specificity)

A

Myoglobin

205
Q

Increased in skeletal muscle injuries, muscular dystrophy, and AMI

A

Myoglobin

206
Q

Myoglobin rises in ___
Peaks in ___
Returns to normal in ___

A

1-3 hours
5-12 hours
18-30 hours

207
Q

Myoglobin is not tissue specific. It is better used as a negative predictor in the first 2-4 hours following chest pain

A

True

208
Q

Neurohormones that affect body fluid homeostasis (through natriuresis and diuresis) and blood pressure

A

Natriuretic peptides

209
Q

Found in largest concentration in the left ventricular myocardium but are also detectable in atrial tissue as well as in the myocardium of the right ventricle

A

NT-proBNP and BNP

210
Q

BNP has become a popular marker for ___

A

Congestive Heart failure

211
Q

A1- globulins

A

A1-antitrypsin
A1-fetoprotein
A1-acid glycoprotein
A1-lipoprotein
A1-antichymotrypsin
Inter-a-trypsin inhibitor
Gc globulin

212
Q

A2 globulins

A

Haptoglobin
Ceruloplasmin
A2-macroglobulin
“CHA”

213
Q

Beta globulins

A

Pre-b-lipoprotein
b-lipoprotein
Transferrin
Hemopexin
B2-microglobulin
Complement
Fibrinogen
CRP

214
Q

y-Globulins

A

IgA
IgD
IgE
IgG
IgM
CRP

215
Q

Share the property of showing elevations in concentrations in response to stressful or inflammatory states that occur with infection, injury, surgery, trauma, or other tissue necrosis.

A

Acute phase reactants

216
Q

CRP response time
Normal concentration (mg/dl)
Increase
Function

A

6-10 hours (preferred marker for inflammation)
0.5
1000x
Opsonization, complement activation

217
Q

Serum amyloid A response time
Normal concentration (mg/dl)
Increase
Function

A

3.0
1000x
Removal of cholesterol

218
Q

A-1-antitrypsin response time
Normal concentration (mg/dl)
Increase
Function

A

24 hours
200-400
2-5x
Protease inhibitor

219
Q

Fibrinogen response time
Normal concentration (mg/dl)
Increase
Function

A

24 hours
110-400
2-5x
Clot formation

220
Q

Haptoglobin response time
Normal concentration (mg/dl)
Increase
Function

A

24 hours
40-200
2-10x
Binds hemoglobin

221
Q

Ceruloplasmin response time
Normal concentration (mg/dl)
Increase
Function

A

48-72 hours
20-40
2x
Binds coppere, oxidizes iron

222
Q

C3 response time
Normal concentration (mg/dl)
Increase
Function

A

48-72 hours
60-140
2x
Opsonization, lysis

223
Q

Mannose-binding protein response time
Normal concentration (mg/dl)
Increase
Function

A

?
0.15-1.0
?
Complement activation

224
Q

Total protein level less than the reference interval

A

Hypoproteinemia

225
Q

Occurs in any condition where a negative nitrogen balance exists (excessive loss, decreased intake, decreased synthesis, accelerated catabolism)

A

Hypoproteinemia

226
Q

Increased in total plasma proteins

A

Hyperproteinemia

227
Q

Not an actual disease state, but is the result of dehydration

A

Hyperproteinemia

228
Q

Abnormal proliferation of plasma cells  produce many Ig (which are abnormal)

A

Multiple myeloma

229
Q

Total Protein analysis (4 methods)

A

Kjeldahl
Refractometry
Biuret
Dye binding

230
Q

Digestion of protein; measurement of nitrogen content
Reference method of total protein analysis; assume average nitrogen content of 16%

A

Kjeldahl

231
Q

Conversion factor in Kjeldahl method

A

6.25 or 6.54

232
Q

Measurement of refractive index due to solutes in serum
Rapid and simple; assume nonprotein solids are present in same concentration as in the calibrating serum

A

Refractometry

233
Q

Formation of violet-colored chelate between Cuprous ions and peptide bonds
Routine method; requires at least 2 peptide bonds and an alkaline medium

A

Biuret

234
Q

Protein binds to dye and causes a spectral shift in the absorbance maximum of the dye
For research use

A

Dye binding

235
Q

Globulins are precipitated in high salt concentrations; albumin in supernatant is quantitated by biuret reaction
Labor intensive

A

Salt-precipitation (Historical method)

236
Q

Albumin binds to dye; causes shift in absorption maximum;
Nonspecific for albumin

A

Methyl orange

237
Q

Albumin binds to dye; causes shift in absorption maximum;
Many interferences (salicylates, bilirubin)

A

HABA

238
Q

Albumin binds to dye; causes shift in absorption maximum;
Sensitive; overestimates low albumin levels; most commonly used dye

A

Bromcresol green

239
Q

Albumin binds to dye; causes shift in absorption maximum;
Specific, sensitive, precise

A

Bromcresol purple

240
Q

Protein separated based on electric charge; accurate, gives overview of relative changes in different protein fractions

A

Electrophoresis

241
Q

Performed when an abnormality in the total protein or albumin is found. Separation of proteins based on their charge density

A

Protein electrophoresis

242
Q

Regions in protein electrophoresis are stained using:

A

Coomassie Blue, Amido Black, Ponceau S

243
Q

Beta-gamma bridging electrophoretic pattern

A

Cirrhosis

244
Q

Monoclonal spike electrophoretic pattern

A

Multiple myeloma

245
Q

Increased a2, increased b2, decreased albumin electrophoretic pattern

A

Nephrotic syndrome

246
Q

Decreased a1-antitrypsin electrophoretic pattern

A

Emphysema

247
Q

Increased beta region electrophoretic pattern

A

Use of plasma instead of serum (fibrinogen)

248
Q

The most significant finding from an electrophoretic pattern is ___

A

Monoclonal immunoglobulin disease

249
Q

Non-protein nitrogen compounds

A

Urea
Amino acids
Uric acid
Creatinine
Creatine
Ammonia

250
Q

NPN present in the highest concentration in blood

A

Urea

251
Q

Major excretory product of protein metabolism

A

Urea

252
Q

Concentration of urea in the plasma is determined by

A

Renal function and perfusion,
Protein content of the diet
Rate of protein catabolism

253
Q

Most common cause of death or liver failure

A

Increased ammonia

254
Q

Evaluate renal function
Assess hydration status
Aid in diagnosis of renal disease
Verify frequency of dialysis

A

Clinical applications of urea

255
Q

Urea nitrogen concentration is converted to urea concentration by multiplying

A

2.14

256
Q

Most used method in determining urea concentration

A

Enzymatic methods

257
Q

Proposed reference method for the urea determination

A

IDMS

258
Q

Elevated concentration of urea in the blood

A

Azotemia

259
Q

Very high plasma urea concentration accompanied by renal failure is called

A

Uremia or the uremic syndrome

260
Q

Prerenal azotemia

A

Congestive heart failure
Shock, hemorrhage
Dehydration
Increased protein catabolism
High-protein diet

261
Q

Renal azotemia

A

Acute and chronic renal failure
Renal disease (glomerular nephritis, tubular necrosis)

262
Q

Postrenal azotemia

A

Urinary tract obstruction

263
Q

Decreased urea concentration

A

Low protein intake
Severe vomiting and diarrhea
Liver disease
Pregnancy

264
Q

Product of catabolism of purines (guanine and adenosine)

A

Uric acid

265
Q

Filtered by the glomerulus and secreted by the distal tubules into the urine, but mostly reabsorbed in the proximal tubules and reused

A

Uric acid

266
Q

Relatively insoluble in plasma, and a high concentrations, can be deposited in the joints and tissues, causing painful inflammation

A

Uric acid

267
Q

Uric acid is mostly present as ___ in plasma, wherein it is insoluble at around pH 7

A

Monosodium urate

268
Q

Increased uric acid in urine
“Orange sand” in diapers
UA crystals

A

Lesch-Nyhan syndrome

269
Q

Uric acid determination (phosphotungstic acid and tungsten blue)

A

Caraway method

270
Q

Proposed reference method for uric acid

A

IDMS

271
Q

Uric acid determination or method where there are problems with turbidity and several common drugs interference

A

Colorimetric

272
Q

Preferred marker for kidney function (glomerular filtration)

A

Creatinine or creatine

273
Q

Creatinine is formed from ___ (synthesized primarily in the liver from arginine, glycine, and methionine) and creatine phosphate in muscle

A

Creatine

274
Q

Excreted in plasma at a constant rate related to muscle mass

A

Creatinine

275
Q

Daily excretion is fairly stable thus it is commonly used to assess renal filtration function

A

Creatinine

276
Q

Determine sufficiency of kidney function and severity of disease
Monitor the progression of kidney disease
Measure of completeness of 24 hour collections

A

Creatinine

277
Q

Increased creatinine concentration

A

Abnormal renal function
Muscle disease

278
Q

Normal BUN/Creatinine ratio

A

10:1 – 20:1

279
Q

The BUN/Creatinine ratio rises in prerenal disease to

A

> 20:1

280
Q

In true renal disease, both BUN and creatinine rise together, maintaining BUN/Creatinine ratio at __

A

10-20:1

281
Q

__ performed directly on sample; detection of color formation times to avoid interference of noncreatinine chromogens

A

Jaffe-kinetic

282
Q

Creatinine in protein-free filtrate adsorbed onto Fuller’s earth (aluminum magnesium silicate); then reacted with alkaline picrate to form colored complex
Lloyd’s reagent (sodium aluminum silicate)

A

Jaffe with adsorbent

283
Q

Highly specific, accepted reference method for creatinine

A

IDMS

284
Q

Formed through the deamination of amino acids during protein metabolism

A

Ammonia

285
Q

Ammonia is removed from the circulation and converted to __ in the liver

A

Urea

286
Q

Provide useful information on clinical conditions such as hepatic failure, Reye’s syndrome and inherited deficiencies of the urea cycle enzymes

A

Ammonia

287
Q

Indicator in the spectrophotometric method of ammonia determination

A

Bromphenol blue

288
Q

Enzymatic method of ammonia determination

A

Glutamate dehydrogenase

289
Q

Specimen consideration for ammonia

A

Should be iced,
Avoid smoking prior to collection

290
Q

Increased BUN, Normal creatinine, Increased BUN/Crea ratio

A

Prerenal azotemia

291
Q

Increased BUN, increased creatinine, Normal Ratio

A

Renal, postrenal azotemia

292
Q

Largest and heaviest internal organ

A

Liver

293
Q

Weight of the liver

A

1.2 – 1.5 kg

294
Q

Ligament the divides the right and left lobe of the liver

A

Falciform ligament

295
Q

Functional units of the liver

A

Lobules/ acini

296
Q

Supplies oxygen-rick blood in the liver (main blood vessel)

A

Hepatic artery

297
Q

Supplies deoxygenated blood to the liver; delivers blood from the gallbladder, spleen, GIT to the liver

A

Hepatic portal vein

298
Q

Capillary-like blood vessel where blood from hepatic artery and hepatic vein miX

A

Sinusoids

299
Q

Small passages in the liver

A

Canaliculi

300
Q

Perform most of the liver function; contribute to the regenerative properties of the liver

A

Hepatocytes

301
Q

Derived from macrophages; found in sinusoids

A

Kupffer cells

302
Q
A
303
Q

Synthesize nitric oxide (regulate blood flow)

A

Stellate/Ito cells

304
Q

Liver stem cells (regeneration of hepatocytes and bile ducts)

A

Oval cells

305
Q

Carries bile

A

Common bile duct

306
Q

Layer of loose connective tissue in the liver

A

Glisson’s capsule

307
Q

Covers the exterior portion of the liver

A

Peritoneum

308
Q

Synthetic function of the liver

A

Produce substances such as proteins, bile salts, lipids, and carbohydrates

309
Q

Storage function of the liver

A

Glycogen, iron, amino acids, and some lipids

310
Q

Excretes bilirubin, bile acids, and ammonia

A

Excretes bilirubin, bile acids, and ammonia

311
Q

Detoxification function of the liver and drug metabolism

A

Convert toxic substances

312
Q

Bile acids are conjugated with amino acids (taurine, glycine) to form

A

Bile salts

313
Q

Aids in absorption and digestion of vitamins

A

Bile salts

314
Q

Major metabolite of heme; orange-yellow pigment derived from hemoglobin

A

Bilirubin

315
Q

Daily bilirubin production

A

250-300 mg

316
Q

Bilirubin is mainly transported by __

A

Albumin

317
Q

Bilirubin production is contributed by __

A

85% liver, spleen, BM (reticuloendothelial)
15% ineffective erythropoiesis, heme-containing proteins/hemoproteins

318
Q

3 heme-containing proteins/hemoproteins

A

Cytochromes
Peroxidases
Myoglobin

319
Q

How many grams of albumin is produced a day by the liver

A

12 g

320
Q

One of the synthetic functions of the liver is the metabolism of cholesterol into ___

A

Primary bile acids

321
Q

Promote fat absorption and emulsification

A

Primary bile acids

322
Q

2 types of primary bile acids

A

Deoxycholic acid and chenodeoxxycholic acid

323
Q

Unconjugated, nonpolar, water insoluble, indirect bilirubin, hemobilirubin

A

B1

324
Q

Conjugated bilirubin, polar, water soluble, direct bilirubin, cholebilirubin

A

B2

325
Q

First type of bilirubin formed

A

B1

326
Q

Type of bilirubin not normally present in the urine

A

B1

327
Q

Type of bilirubin that slowly reacts with diazo reagent

A

B1

328
Q

Bilirubin that is normally in the circulation

A

B1

329
Q

Type of bilirubin that needs an accelerator or solubilizer

A

B1

330
Q

Bilirubin that is freely filtered in plasma and present in the urine

A

B2

331
Q

Bilirubin that directly reacts with diazo reagent

A

B2

332
Q

Aka biliprotein; a bilirubin that is covalently bound to albumin thus contributes to the direct bilirubin

A

Delta bilirubin

333
Q

Formula for total bilirubin

A

Total bilirubin = unconjugated + conjugated + delta bilirubin

334
Q

“Jaune” = yellow
Yellow discoloration of the skin, eyes, and mucous membranes due to bilirubin retention

A

Jaundice

335
Q

Serum bilirubin in adults and neonates

A

2-3 mg/dl (adults)
5 mg/dl (neonates)

336
Q

Amount of bilirubin that becomes noticeable to the naked eye

A

> 3 mg/dl

337
Q

Unconjugated hyperbilirubinemia;
Mild type of jaundice that occurs prior to liver metabolism

A

Pre-hepatic jaundice

338
Q

Most common cause of pre-hepatic jaundice

A

Hemolytic anemia
Ineffective erythropoiesis

339
Q

Results from intrinsic liver disease due to defects in bilirubin metabolism and transport; due to diseases resulting to hepatocellular injury

A

Hepatic jaundice

340
Q

Inherited, autosomal recessive mild form of unconjugated hyperbilirubinemia
Serum bilirubin: 1.5 – 3 mg/dl
The gene responsible for the expression of the enzyme UDPGT is mutated or due to transport deficit across the hepatocyte membrane

A

Gilbert syndrome

341
Q

Problem in conjugation deficit

A

Criggler-Najjar syndrome

342
Q

UDPGT absent; serum bilirubin >20 mg/dl; kernicterus; therapy is liver transplant

A

Type 1 Crigler-Najjar syndrome

343
Q
A
344
Q

Partial UDPGT deficiency (25% activity); serum bilirubin 5-20 mg/dl; no kernicterus; patients responds to UV therapy

A

Type 2 Crigler-Najjar syndrome

345
Q

Transporter gene deficit

A

Dubin-Johnson syndrome

346
Q

Predominantly elevated conjugated bilirubin; excretion of bilirubin is impaired; liver biopsy shows dark brown pigment in hepatocytes due to accumulation of lipofuscin-like pigment; B2 cannot be transported out of the hepatocyte

A

Dubin-Johnson syndrome

347
Q

Conjugated hyperbilirubinemia similar to Dubin-Johnson syndrome but without liver pigmentation

A

Rotor syndrome

348
Q

Transient familiar neonatal hyperbilirubinemia; presence of UDPGT inhibitor (antibody); mild hyperbilirubinemia that lasts for the first 2-3 weeks of life; increased B2

A

Lucey-Driscoll syndrome

349
Q

3 types of unconjugated hyperbilirubinemia in the jaundice of the newborn

A

Physiologic jaundice of the newborn
Hemolytic disease (HDFN)
Breastmilk hyperbilirubinemia

350
Q

In breastmilk hyperbilirubinemia what inhibits the conjugation

A

Alpha glucoronidase

351
Q

Conjugated bilirubin is >1.5 mg/dl; most important causes are idiopathic neonatal hepatitis and biliary atresia

A

Conjugated hyperbilirubinemia in the jaundice of the newborn

352
Q

Results from biliary obstructive disease

A

Post hepatic jaundice

353
Q

Most common causes of post hepatic jaundice

A

Gall stones or tumors in the biliary tree

354
Q

Common cause of gallstones

A

Ketodiets (intermittent fasting)
High fat diet and steatorrhea

355
Q

Increased serum B1, Normal serum B2, increased serum total bilirubin

A

Pre-hepatic jaundice

356
Q

Increased serum B1, decreased serum B2, increased serum total bilirubin

A

Gilbert syndrome, Crigler-Najjar syndrome, jaundice of the newborn, Lucey-Driscoll syndrome

357
Q

Normal serum B1, increased serum B2, Increased serum total bilirubin

A

Dubin-Johnson syndrome, Rotor syndrome, Post-hepatic jaundice

358
Q

Viral hepatitis that causes hepatocellular injury

A

Hepatitis A,B,C,D,E,G

359
Q

Acute injury of hepatocytes caused by toxic drugs, ischemia, or immunologically mediated injury

A

Acute hepatitis

360
Q

Accumulation of fats as a consequence of insulin resistance

A

Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis

361
Q

Chronic liver inflammation that persists for at least 6 months

A

Chronic hepatitis

362
Q

Diffused fibrosis with nodular regeneration (end stage of scar formation)

A

Liver cirrhosis

363
Q

Causes mild hyperbilirubinemia with three fold rise in transaminases (AST and ALT); has a strong association with intake of aspirin; characterized by non-inflammatory encephalopathy and fatty degeneration of the liver; usually affects children 2-14 years old after a viral infection – flu and chickenpox
(most harmful in affecting brain and liver)

A

Reye Syndrome

364
Q

Methods of bilirubin determination

A

Ehrlich reaction
Van den Berg reaction
Jendrassik-Grof method
Evelyn-Malloy method
Bilirubinometry

365
Q

Bilirubin + diazotized sulfanilic acid  azobilirubin
Initially done on urine and stool samples (freshly collected 24 hour samples)

A

Ehrlich reaction

366
Q

Bilirubin + diazotized sulfanilic acid  azobilirubin
Done using serum samples;
Diazotized sulfanilic acid is formed by reacting sulfanilic acid with sodium nitrite and hydrochloric acid

A

Van den Berg reaction (and Muller reaction)

367
Q

Results of the Van den Berg reaction at neural pH and at high or low pH

A

At neutral pH  reddish purple
At low or high pH  blue

368
Q

Diazotized sulfanilic acid + accelerator/solubilizer (caffeine sodium benzoate) ;
Buffer: sodium acetate
Strong alkaline tartrate is added to convert original purple color into blue (measured spectrophotometrically at 600nm)

A

Jendrassik-Grof method

369
Q

Advantages of Jendrassik Grof method:
Insensitive to sample pH changes and variation in protein concentration of sample
Not affected by hemoglobin up to 750 mg/dl
Has adequate optical sensitivity even for low bilirubin concentrations

A

True

370
Q

Accelerator in Evelyn-Malloy method

A

50% methanol

371
Q

Azobilirubin: red to reddish purple color in acid pH (measured at 560 nm)

A

Evelyn-Malloy method

372
Q

Done in neonates
Transcutaneous bilirubin concentration device;
Measurement of reflected light from the skin using 2 wavelengths, providing a numerical index based on spectral reflectance;
Has a positive interference with carotenoid compounds thus cannot be done in adults

A

Bilirubinometry

373
Q

Diazo reagents

A

Diazo A: 0.1% Sulfanilic acid + HCl
Diazo B: 0.5% Sodium nitrite
Diazo Blank: 1.5% HCl

374
Q

Tests Measuring Hepatic Synthetic Ability

A

Total Protein determination
Prothrombin time – Vitamin K response test
Test for albumin
Albumin/Globulin ratio

375
Q

Total bilirubin

A

Up to 1.0 mg/dl

376
Q

Direct bilirubin

A

<0.5 mg/dl (other references 0 – 0.2 mg/dl)

377
Q

Indirect bilirubin

A

0.2 – 0.8 mg/dl (other references 0 – 1 mg/dl)

378
Q

Conversion factor of bilirubin

A

17.1

379
Q

Critical value of bilirubin

A

> 18 mg/dl (may cause kernicterus)

380
Q

Intamuscular injection of 10 mg Vitamin K everyday for 1 – 3 days

A

Vitamin K response test

381
Q

Results in vitamin K response test

A

Prolonged: Intrahepatic disorder
Normal: Extrahepatic disorder
Consistently prolonged: Loss of hepatic synthetic ability of liver

382
Q

Tests measuring conjugation and excretion function

A

Bilirubin assay
Bromosulfophthalein dye exretion test
Urobilinogen test

383
Q

2 methods under Bromosulfophthalein dye exretion test

A

Rosenthal White method
MacDonald

384
Q

Rosenthal White Method

A

Double collection method
After 5 mins: 50% dye retention
After 30 mins: 0%

385
Q

MacDonald (Reference method)

A

Single collection method
NV: After 45 mins +/- 5% retention of dye

386
Q

Ehrlich’s reagent

A

p-dimethyl aminobenzaldehyde

387
Q

Uses Ehrlich’s reagent
Specimen: 2-hour freshly collected urine or stool sample
Positive reaction: red color production

A

Urobilinogen Test

388
Q

Consists of binding site and catalytic site; a site where substrate interacts with the enzyme

A

Active site

389
Q

Site other than the active site; binds to regulator molecules

A

Allosteric site

390
Q

Non-protein substances needed for maximal activity of the enzyme

A

Cofactors

391
Q

Inorganic cofactors

A

Activators (anions and cations)

392
Q

Organic cofactors

A

Coenzymes (acts as co-substrate in enzyme reactions)

393
Q

Complete active enzyme system with full catalytic activity; apoenzyme + prosthetic group

A

Holoenzyme

394
Q

Inactive form of an enzyme

A

Proenzyme/ Zymogen

395
Q

Multiple forms of serum proteins that are functionally related; results from post translational modifications

A

Isoform

396
Q

Multiple forms of an enzyme that catalyzes the same biochemical reaction

A

Isoenzyme

397
Q

6 classes of enzymes

A

Oxidoreductases
Transferases
Hydrolases
Lyases
Isomerases
Ligases

398
Q

Catalyzes an electron transfer or oxidation-reduction reaction between 2 substrates

A

Oxidoreductasses

399
Q

Catalyzes the transfer of various chemical groups from one molecule to another

A

Transferases

400
Q

Catalyzes the hydrolysis of various bonds with the addition of water; involves splitting of molecules

A

Hydrolases

401
Q

Catalyzes the removal of groups from substrates without hydrolysis; formation of double bonds

A

Lyases

402
Q

Catalyzes the interconversion of geometric, optical or positional isomers within a molecule

A

Isomerases

403
Q

Catalyzes the joining of two substrate molecules coupled with breaking of the pyrophosphate bond in ATP

A

Ligases (synthetases)

404
Q

Rate of reaction is almost directly proportional to substrate concentration at a low level

A

First order kinetics

405
Q

Substrate concentration is high enough to saturate all available active sites of the enzymes;
Reaction is independent of substrate concentration
Reaction rate depends only on enzyme concentration

A

Zero-order kinetics

406
Q

Enzymes are affected by changes in ___ as it is a factor in their stability

A

pH

407
Q

Most favorable pH value at which enzyme is most active

A

Optimum pH (7.0 – 8.0)

408
Q

ALP optimum pH

A

9.0 – 10.0

409
Q

ACP optimum pH

A

5.0

410
Q

pH are controlled using ___

A

Buffer solutions

411
Q

Optimum temperature for most enzymes is ___

A

37 deg C

412
Q

Increased temperature = increased rate of ___

A

Chemical reaction

413
Q

For every ___ increase in temperature, rate of reaction is doubled until it is denatured

A

10 deg C

414
Q

Absence means enzyme activity may not occur.
In excess, may inhibit enzyme activity

A

Cofactors

415
Q

Substrate competes with active site

A

Competitive inhibitor

416
Q

Substrate competes other than the active site

A

Non-competitive inhibitor

417
Q

Substrate competes with the substrate-enzyme complex

A

Uncompetitive inhibitor

418
Q

Enzyme concentration is measured in fixed period of time; the reaction is stopped and a measurement is made

A

Fixed time assay (End point assay)

419
Q

Multiple measurements (absorbance change) are made at specific time interval

A

Continuous monitoring assay

420
Q

Amount of enzyme that will catalyze the reaction of 1 umol of substrate in 1 minute

A

1 International Unit

421
Q

Amount of enzyme that would catalyze the reaction of 1 mole substrate in one second

A

1 Katal

422
Q

EC numerical code of AST

A

2.6.1.1

423
Q

Tissue source of AST

A

Cardiac tissue, liver, skeletal muscle

424
Q

AST is previously known as

A

SGOT

425
Q

Aspartate + alpha-ketoglutarate ____ + ____

A

Oxaloacetate, glutamate

426
Q

Coenzyme of AST

A

Pyridoxal phosphate

427
Q

2 enzyme fractions of AST

A

Cytoplasmic AST
Mitochondrial AST

428
Q

Most predominant AST in the serum

A

Cytoplasmic AST

429
Q

Mitochondrial AST becomes highest than cytoplasmic AST in serum in ____

A

Cellular necrosis

430
Q

Normal  cAST > mAST
Necrosis 

A

cAST < mAST

431
Q

AST highest elevation: 5 or more x ULN

A

Acute hepatocellular disorder
Myocardial infarction
Circulatory collapse
Acute pancreatitis
Infectious mononucleosis

432
Q

AST 3 or more x ULN

A

Stop the medication (potential hepatotoxic drug)

433
Q

AST in AMI

A

Rise within 6-8 hours
Peaks at 24 hours
Returns to normal within 3-5 days

434
Q

Marked elevation of AST is observed in __

A

Viral hepatitis and AMI

435
Q

Hemolysis increases AST concentration (T/F)

A

T

436
Q

AST activity is stable in serum for ___ at refrigerated temperature

A

3-4 days

437
Q

Methodologies for AST

A

Karmen method
Reitman-Frankel method
Diazonium salt reaction

438
Q

Coupled enzymatic reaction
Basis for IFCC
Malate dehydrogenase is added: oxaloacetate + NADH  Malate + NAD

A

Karmen Method (AST)

439
Q

In the Karmen method, the rate of decrease in absorbance at __ due to the formation of NAD is directly proportional to the activity of AST in the sample

A

340 nm

440
Q

Optimal pH of Karmen method for AST determination

A

pH 7.3 – 7.8 (7.5)

441
Q

Colorimetric method of AST determination
Substrate: aspartic alpha-ketohlutarate
Color developer: 2,4-dinitrophenylhydrazone

A

Reitman-Frankel method

442
Q

Final reaction of Reitman-Frankel method of AST determination

A

Blue-colored complex, measured at 505 nm

443
Q

The Reitman-Frankel method lacks specificity because it reacts with any ___

A

Keto-compound

444
Q

Colorimetric method of AST determination
Stabilized diazonium salt + oxaloacetic acid  red colored compound
Formation of diazonium derivatives

A

Diazonium salt reaction

445
Q

EC numerical code for ALT

A

2.6.1.2

446
Q

Tissue sources of ALT

A

Highest concentration in liver and kidney, smaller amount in cardiac tissue and skeletal muscle

447
Q

ALT is formerly known as

A

SGPT

448
Q

More liver specific than AST

A

ALT
(ALT>AST)

449
Q

Involved in the reversible transfer of an amino group between alanine and alpha-ketoglutarate
Alanine + alpha-ketoglutarate  ___+ _____

A

Pyruvate; glutamate

450
Q

ALT has the highest elevation in __

A

Acute viral hepatitis

451
Q

De Ritis ration (AST/ALT quotient)
>1

A

Liver cirrhosis, metastatic carcinoma

452
Q

De Ritis ration (AST/ALT quotient)
3-4:1

A

Alcohol-induced liver disease

453
Q

ALT is stable in serum for ___ days at 4 deg C

A

3-4

454
Q

ALT is unaffected by hemolysis

A

True

455
Q

In liver disease, ALT > AST, except in __

A

Hepatic cirrhosis and liver neoplasia

456
Q

ALT is increased, HCV (-), accept or reject donor?

A

Defer (consider window period)

457
Q

Acute hepatocellular injury (AST/ALT ratio)

A

AST>ALT

458
Q

Methodologies for ALT determination (4)

A

Wroblewski and La Due
Reiman-Frankel method
Diazonium salt reaction

459
Q

Coupled enzymatic reaction (ALT determination)
Basis for the IFCC recommended method
Lactate dehydrogenase is added to convert endogenous pyruvate in the sample into lactate (excess pyruvate is inhibitory to ALT activity)
Pyruvate + NADH  lactate + NAD (340 nm)

A

Wroblewski and La Due

460
Q

Optimal pH in Wroblewski and La Due (ALT determination)

A

pH 7.3 – 7.8 (7.5)

461
Q

Substrate in Reiman-Frankel method (ALT determination)

A

Alpha-ketoglutarate

462
Q
A
463
Q

Anticoagulant of choice for TDM

A

Heparin

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