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Enzymes Flashcards

1
Q

A substance that increases the rate of reaction without itself being consumed or altered

A

Enzyme

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2
Q

As long as the cell membrane is intact, enzymes are contained within the cell walls. Increased levels of enzymes in the PLASMA are due to what 4 things?

A
  1. Cell leakage
  2. Increased synthesis
  3. Multiplication of cells which produce the enzyme
  4. Duct obstruction
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3
Q

The greatest concentration of _____ is in the liver, spleen, milk, rbc’s, platelets, bone marrow and at HIGHEST concentrations in the prostate gland.

A

Acid Phosphatase (ACP)

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4
Q

Acid phosphatase (ACP) levels may be tested on vaginal secretions to investigate alleged acts of rape due to it’s high concentration in _____

A

Seminal fluid (semen)

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5
Q

____ might be elevated after a rectal exam

A

Acid phosphatase (ACP)

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6
Q

Would alcohol potentially increase or decrease ACP levels?

A

Decrease

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7
Q

On an ACP test, serum left at room temp after exposure to air may show significantly ___ activity after as little as 1 hour.

A

Decreased

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8
Q

Increased values of ___ are found in prostatic carcinoma, multiple myeloma, Paget’s disease, sickle cell crisis, Gaucher’s disease, renal impairment, cancer of the breast and bone, cirrhosis, hyperparathyroidism, thrombocytosis, cancer metastasis to the bone. PROSTATE CA is what’s important here. The others are basically false positives.

A

ACP

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9
Q

Measurement of prostatic ACP for the diagnosis and management of prostate cancer is rapidly being replaced by assaying ___. Although measuring ACP levels is still important.

A

Prostate-Specific Antigen (PSA) (blood test)

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10
Q

Elevations of prostatic ACP are found in the serum of males who have prostate cancer with ____. Normal or only slightly elevated levels are found if the cancer stays localized to the prostate.

A

Metastasis

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11
Q

A group of closely related enzymes with maximal activity when the pH is about 10.

A

Alkaline Phosphatase (ALP)

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12
Q

ALP is principally measured to evaluate diseases of ___ and ___

A

Liver, bone

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13
Q

ALP is present in practically all tissues of the body, but it’s highest concentrations are in what three tissues?

A
  1. Liver
  2. Biliary tract epithelium
  3. Bone
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14
Q

Within the liver, ALP is present in the ___ cells. These cells line the biliary collecting system.

A

Kupffer’s

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15
Q

Enzyme levels of ALP are greatly increased in both extrahepatic and intrahepatic _____

A

Obstructive biliary disease

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16
Q

____ is the most frequent extrahepatic source of ALP

A

Bone

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17
Q

____ of ALP are used to distinguish between liver and bone diseases.

A

Isoenzymes

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18
Q

ALP isoenzymes are most easily differentiated by the ____ test

A

Heat stability

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19
Q

The isoenzyme of liver origin

A

ALP1

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20
Q

The isoenzyme of bone origin

A

ALP2

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21
Q

___ is heat stable, while ___ is inactivated by heat (ALP isoenzymes)

A

ALP1, ALP2

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22
Q

Pronounced heat stability is also shown by the “____ isoenzyme”

A

Regan

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23
Q

The highest level of ALP would be in ____ disease

A

Paget’s

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24
Q

Macronutrient that increases ALP

A

Fat

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25
Increased levels of ___ occur in cirrhosis, Paget’s disease, rheumatoid arthritis, intrahepatic or extrahepatic biliary obstruction, primary and metastatic liver tumors, normal pregnancy (3rd trimester, early postpartum), normal bones of growing children, intestinal ischemia or infarction, metastatic tumor to the bone, healing fractures, hyperparathyroidism
ALP
26
____ levels of ALP might occur in hypothyroidism, malnutrition, Milk-alkali syndrome, pernicious anemia, hypophosphatemia, scurvy, celiac disease, excess vitamin B ingestion
Decreased
27
Elevation of ALP tends to be more marked in ____ than in ____ obstruction
Extrahepatic, intrahepatic
28
Bone disease with normal ALP
Osteoporosis
29
This enzyme splits creatine phosphate in the presence of ADP to yield creatine and ATP
Creatine Phosphokinase (CPK)
30
CPK is found primarily in what three tissues?
1. Heart muscle 2. Skeletal muscle 3. Brain
31
This isoenzyme of CPK is found in skeletal muscle
CK3 (MM)
32
This isoenzyme of CPK is found in nervous tissues, thyroid, kidney and intestines
CK1 (BB)
33
This isoenzyme of CPK is found in heart muscle, diaphragm, and esophagus
CK2 (MB)
34
Isoenzyme elevated in patients with muscular dystrophy
CPKMM
35
Isoenzyme elevated in patients with cerebral vascular accident
CPKBB
36
The number of CPK isoenzyme elevated in CVA
One
37
Neurogenic muscle disease with normal CPK
Poliomyelitis
38
To test specifically for for myocardial muscle injury, _____ on the total CPK is performed to detect the three CPK isoenzymes.
Electrophoresis
39
CPK-BB is found predominantly in the ___ and ___
Brain, lung
40
Elevated CPK-MB, LDH-1, and AST (aspartate aminotransferase)
Acute MI
41
Strenuous exercise and recent surgery may cause increased levels
CPK
42
Normal CPK values for black males are ____ those for white males. Values for black and white females are nearly equal.
Double
43
Isoenzyme elevated in acute MI
CPK-MB
44
Isoenzyme elevated in pulmonary infarction
CPK-BB
45
Patients with primary liver disease and cirrhosis have ___ CPK activity in their serum
Normal
46
____ levels of CPK are found in patients with hyperthyroidism
Decreased
47
The average maximum elevation of CPK in individuals with a myocardial infarction is __-__ times the upper limit of normal
7-12
48
About 50-80% of asymptomatic female carriers of _____ show 3-6 fold increases of CPK activity in the serum.
Duchenne
49
In progressive muscular dystrophy enzyme activity in serum is highest in ____ and ____ and may be elevated long before the disease is clinically apparent.
Infancy, childhood
50
GGT stands for what enzyme?
Gamma Glutamyltransferase
51
____ is a biliary enzyme used to detect liver cell dysfunction. It very accurately reveals evidence of cholestasis.
GGT
52
The elevation of GGT generally parallels that of _____ (another enzyme)
Alkaline Phosphatase (ALP)
53
Although GGT usually parallels ALP, it is NOT elevated in ____ diseases.
Bone
54
A normal GGT level with an elevated ALP level would imply ____ disease
Skeletal
55
An elevated GGT AND ALP level would imply ___ disease
Hepatic (liver)
56
Another important clinical aspect of GGT is that it can detect ____ ingestion
Alcohol
57
Why GGT is elevated 4-10 days after an acute ____ is not clear.
Myocardial Infarction
58
GGT is decreased in late pregnancy and ____
Hypothyroidism
59
By far the most common cause of serum GGT elevation is _____
Active liver disease
60
GGT is highest in cases of intra or posthepatic ______
Biliary obstruction
61
GGT levels are increased in about 90% of patients with _____ and about 75% with cytomegalovirus infection.
Infectious mononucleosis
62
This enzyme splits complex carbohydrates
Amylase
63
The greatest concentration of amylase occurs in the ____ and salivary glands
Pancreas
64
What serum test is most specific for acute pancreatitis?
Lipase
65
Amylase and Lipase are normally secreted from the pancreatic ____ cell
Acinar
66
What commonly causes an obstruction of the pancreatic duct flow?
Pancreatic carcinoma
67
In a patient with mumps, ____ will be elevated while ____ will not be. (Enzymes)
Amylase, Lipase
68
Other than pancreas pathology, bowel perforation, peptic ulcers, and mumps can cause increases in this enzyme.
Amylase
69
Patients with chronic pancreatic disorders (e.g. chronic pancreatitis) that have resulted in pancreatic cell destruction often have ____ amylase levels.
Normal
70
A possibly critical value for amylase would be more than ___ times the upper limit of normal (depending on the method)
Three
71
This enzyme hydrolyzes the glycerol esters of long chain fatty acids (breaks triglycerides into fatty acids and glycerol)
Lipase
72
Lipase is present in significant quantities only in the _____
Pancreas
73
What is sort of unique about lipase (as compared to amylase) is that after acute injury to the pancreas it’s levels stay elevated for __-__ days
5-7
74
The most common cause of an elevated serum lipase level is ______
Acute pancreatitis
75
____ is a little less sensitive for pancreatitis, but is more specific than ____
Lipase, amylase
76
This enzyme is present in nearly all tissues of the body. It catalyses the oxidation of L-lactate to pyruvate in the presence of NAD/NADH.
Lactate dehydrogenase (LDH)
77
Name the 5 tissues where LDH is found at high levels in the body:
1. Liver 2. Heart 3. Lung 4. Skeletal muscle 5. RBC’s
78
How many isoenzymes are there for LDH?
5
79
LDH-1 comes mainly from the ___ and ___
Heart, blood vessels
80
LDH-2 is primarily from the _____ system. Normally, it’s serum levels are higher than the other 4 isoenzymes
Reticuloendothelial
81
LDH-3 is from the ____
Lungs
82
LDH-4 is from what 3 tissues?
1. Kidney 2. Placenta 3. Pancreas
83
LDH-5 is mainly from the ___ and ____
Liver, striated muscle
84
Which isoenzyme of LDH is sensitive and specific for a myocardial infarction?
LDH-1
85
An elevated LDH level with greater than ___% LDH-1 is considered diagnostic of myocardial damage.
40%
86
LDH’s main diagnostic use is in an acute MI when the ____ (isoenzyme) fraction elevation has passed
CPK-MB
87
LDH will remain elevated for __-__ days after a MI
7-12
88
Elevations of LDH are especially high in this liver disease
Toxic jaundice
89
Marked elevations of LDH are seen in untreated pernicious anemia, as well as anemia from ____ deficiency
Folate
90
LDH isoenzymes should not be done if total LDH is less than ___ IU/L
500
91
You would see an elevated of this LDH isoenzyme in an acute MI, hemolytic anemia, or megaloblastic anemia
LDH-1
92
Hepatic congestion, hepatitis, or skeletal muscle injury would show an elevation of this LDH isoenzyme
LDH-5
93
Damage to the lungs (such as acute pulmonary infarction, or pneumonia) would show an elevation of this LDH isoenzyme
LDH-3
94
ALT stands for?
Alanine aminotransferase
95
This enzyme is found PREDOMINANTLY IN THE LIVER with moderate amounts in the kidney and small amounts in the heart and skeletal muscle.
ALT
96
ALT is sensitive and specific in indicating ____ disease
Hepatocellular (liver)
97
In this liver disease ALT>AST
Acute VIRAL hepatitis
98
In cirrhosis, alcoholic hepatitis, and cholestasis, ___>___ (transaminases)
AST>ALT
99
ALT levels would be decreased in vitamin ____ deficiency
B6
100
AST stands for?
Aspartate aminotransferase
101
AST is more ____, but less ____ than ALT in detecting liver disease.
Sensitive, specific
102
What three enzymes are usually observed in high quantities after a recent MI?
1. CPK 2. LDH 3. AST
103
The AST:ALT ratio is usually greater than ___ in patients with alcoholic cirrhosis, liver congestion, and metastatic tumor of the liver.
1.0
104
The AST:ALT ratio would be less than ____ in patients with acute hepatitis, viral hepatitis, or infectious mononucleosis.
1.0
105
Elevation of both AST and ALT is highly suggestive of ____
Liver disease
106
In normal individuals, the AST:ALT ratio is ____
1.15
107
In general, an elevated AST:ALT ratio to 2.0-6.0 (or greater) is most commonly associated with ____
Alcoholic liver disease
108
Acute viral hepatitis is usually associated with ___ AST:ALT ratios
Low (ALT>AST)
109
Which enzyme is increased after an acute MI, AST or ALT?
AST
110
First enzyme to rise in an acute MI?
CPK
111
Second enzyme to rise in acute MI?
AST
112
Third enzyme to rise in acute MI?
LDH (1 specifically)
113
Obstructive liver disease is called ____
Cholestasis
114
What might you be thinking with the following lab findings?: 1. Elevated ALP and GGT 2. NL or slightly elevated transaminase 3. Possibly elevated LDH
Obstructive liver disease (cholestasis)
115
Patient has severe abdominal pain radiating to the back, increasing, fever, nausea, and vomiting. Lab findings: 1. Serum Amylase rises very quickly 2. Urine amylase stays elevated longer 3. Elevated lipase 4. Leukocytosis
Acute pancreatitis
116
Lab findings: 1. Hematuria 2. Pyuria 3. Elevated acid phosphatase (ACP) 4. Possible elevated alkaline phosphatase (ALP) 5. PSA positive
Prostate cancer
117
50% elevated total LDH, with an elevated LDH-3 isoenzyme would indicate?
Malignancy
118
Hematopoietic disease (such as megaloblastic anemia) shows elevated _____ (isoenzyme)
LDH-1
119
The best test for detection and management of a muscle disease?
CPK
120
The increase of LDH in progressive muscular dystrophy is confined to LDH-__ (isoenzyme)
5 (specific to striated muscle)

Clinical Pathology (12 decks)

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