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Clinical Pathology > Enzymes > Flashcards

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
Q

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

A

ALP

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26
Q

____ levels of ALP might occur in hypothyroidism, malnutrition, Milk-alkali syndrome, pernicious anemia, hypophosphatemia, scurvy, celiac disease, excess vitamin B ingestion

A

Decreased

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27
Q

Elevation of ALP tends to be more marked in ____ than in ____ obstruction

A

Extrahepatic, intrahepatic

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28
Q

Bone disease with normal ALP

A

Osteoporosis

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29
Q

This enzyme splits creatine phosphate in the presence of ADP to yield creatine and ATP

A

Creatine Phosphokinase (CPK)

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30
Q

CPK is found primarily in what three tissues?

A
  1. Heart muscle
  2. Skeletal muscle
  3. Brain
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31
Q

This isoenzyme of CPK is found in skeletal muscle

A

CK3 (MM)

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32
Q

This isoenzyme of CPK is found in nervous tissues, thyroid, kidney and intestines

A

CK1 (BB)

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33
Q

This isoenzyme of CPK is found in heart muscle, diaphragm, and esophagus

A

CK2 (MB)

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34
Q

Isoenzyme elevated in patients with muscular dystrophy

A

CPKMM

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35
Q

Isoenzyme elevated in patients with cerebral vascular accident

A

CPKBB

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36
Q

The number of CPK isoenzyme elevated in CVA

A

One

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37
Q

Neurogenic muscle disease with normal CPK

A

Poliomyelitis

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38
Q

To test specifically for for myocardial muscle injury, _____ on the total CPK is performed to detect the three CPK isoenzymes.

A

Electrophoresis

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39
Q

CPK-BB is found predominantly in the ___ and ___

A

Brain, lung

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40
Q

Elevated CPK-MB, LDH-1, and AST (aspartate aminotransferase)

A

Acute MI

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41
Q

Strenuous exercise and recent surgery may cause increased levels

A

CPK

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42
Q

Normal CPK values for black males are ____ those for white males. Values for black and white females are nearly equal.

A

Double

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43
Q

Isoenzyme elevated in acute MI

A

CPK-MB

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44
Q

Isoenzyme elevated in pulmonary infarction

A

CPK-BB

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45
Q

Patients with primary liver disease and cirrhosis have ___ CPK activity in their serum

A

Normal

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46
Q

____ levels of CPK are found in patients with hyperthyroidism

A

Decreased

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47
Q

The average maximum elevation of CPK in individuals with a myocardial infarction is __-__ times the upper limit of normal

A

7-12

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48
Q

About 50-80% of asymptomatic female carriers of _____ show 3-6 fold increases of CPK activity in the serum.

A

Duchenne

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49
Q

In progressive muscular dystrophy enzyme activity in serum is highest in ____ and ____ and may be elevated long before the disease is clinically apparent.

A

Infancy, childhood

50
Q

GGT stands for what enzyme?

A

Gamma Glutamyltransferase

51
Q

____ is a biliary enzyme used to detect liver cell dysfunction. It very accurately reveals evidence of cholestasis.

A

GGT

52
Q

The elevation of GGT generally parallels that of _____ (another enzyme)

A

Alkaline Phosphatase (ALP)

53
Q

Although GGT usually parallels ALP, it is NOT elevated in ____ diseases.

A

Bone

54
Q

A normal GGT level with an elevated ALP level would imply ____ disease

A

Skeletal

55
Q

An elevated GGT AND ALP level would imply ___ disease

A

Hepatic (liver)

56
Q

Another important clinical aspect of GGT is that it can detect ____ ingestion

A

Alcohol

57
Q

Why GGT is elevated 4-10 days after an acute ____ is not clear.

A

Myocardial Infarction

58
Q

GGT is decreased in late pregnancy and ____

A

Hypothyroidism

59
Q

By far the most common cause of serum GGT elevation is _____

A

Active liver disease

60
Q

GGT is highest in cases of intra or posthepatic ______

A

Biliary obstruction

61
Q

GGT levels are increased in about 90% of patients with _____ and about 75% with cytomegalovirus infection.

A

Infectious mononucleosis

62
Q

This enzyme splits complex carbohydrates

A

Amylase

63
Q

The greatest concentration of amylase occurs in the ____ and salivary glands

A

Pancreas

64
Q

What serum test is most specific for acute pancreatitis?

A

Lipase

65
Q

Amylase and Lipase are normally secreted from the pancreatic ____ cell

A

Acinar

66
Q

What commonly causes an obstruction of the pancreatic duct flow?

A

Pancreatic carcinoma

67
Q

In a patient with mumps, ____ will be elevated while ____ will not be. (Enzymes)

A

Amylase, Lipase

68
Q

Other than pancreas pathology, bowel perforation, peptic ulcers, and mumps can cause increases in this enzyme.

A

Amylase

69
Q

Patients with chronic pancreatic disorders (e.g. chronic pancreatitis) that have resulted in pancreatic cell destruction often have ____ amylase levels.

A

Normal

70
Q

A possibly critical value for amylase would be more than ___ times the upper limit of normal (depending on the method)

A

Three

71
Q

This enzyme hydrolyzes the glycerol esters of long chain fatty acids (breaks triglycerides into fatty acids and glycerol)

A

Lipase

72
Q

Lipase is present in significant quantities only in the _____

A

Pancreas

73
Q

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

A

5-7

74
Q

The most common cause of an elevated serum lipase level is ______

A

Acute pancreatitis

75
Q

____ is a little less sensitive for pancreatitis, but is more specific than ____

A

Lipase, amylase

76
Q

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.

A

Lactate dehydrogenase (LDH)

77
Q

Name the 5 tissues where LDH is found at high levels in the body:

A
  1. Liver
  2. Heart
  3. Lung
  4. Skeletal muscle
  5. RBC’s
78
Q

How many isoenzymes are there for LDH?

A

5

79
Q

LDH-1 comes mainly from the ___ and ___

A

Heart, blood vessels

80
Q

LDH-2 is primarily from the _____ system. Normally, it’s serum levels are higher than the other 4 isoenzymes

A

Reticuloendothelial

81
Q

LDH-3 is from the ____

A

Lungs

82
Q

LDH-4 is from what 3 tissues?

A
  1. Kidney
  2. Placenta
  3. Pancreas
83
Q

LDH-5 is mainly from the ___ and ____

A

Liver, striated muscle

84
Q

Which isoenzyme of LDH is sensitive and specific for a myocardial infarction?

A

LDH-1

85
Q

An elevated LDH level with greater than ___% LDH-1 is considered diagnostic of myocardial damage.

A

40%

86
Q

LDH’s main diagnostic use is in an acute MI when the ____ (isoenzyme) fraction elevation has passed

A

CPK-MB

87
Q

LDH will remain elevated for __-__ days after a MI

A

7-12

88
Q

Elevations of LDH are especially high in this liver disease

A

Toxic jaundice

89
Q

Marked elevations of LDH are seen in untreated pernicious anemia, as well as anemia from ____ deficiency

A

Folate

90
Q

LDH isoenzymes should not be done if total LDH is less than ___ IU/L

A

500

91
Q

You would see an elevated of this LDH isoenzyme in an acute MI, hemolytic anemia, or megaloblastic anemia

A

LDH-1

92
Q

Hepatic congestion, hepatitis, or skeletal muscle injury would show an elevation of this LDH isoenzyme

A

LDH-5

93
Q

Damage to the lungs (such as acute pulmonary infarction, or pneumonia) would show an elevation of this LDH isoenzyme

A

LDH-3

94
Q

ALT stands for?

A

Alanine aminotransferase

95
Q

This enzyme is found PREDOMINANTLY IN THE LIVER with moderate amounts in the kidney and small amounts in the heart and skeletal muscle.

A

ALT

96
Q

ALT is sensitive and specific in indicating ____ disease

A

Hepatocellular (liver)

97
Q

In this liver disease ALT>AST

A

Acute VIRAL hepatitis

98
Q

In cirrhosis, alcoholic hepatitis, and cholestasis, ___>___ (transaminases)

A

AST>ALT

99
Q

ALT levels would be decreased in vitamin ____ deficiency

A

B6

100
Q

AST stands for?

A

Aspartate aminotransferase

101
Q

AST is more ____, but less ____ than ALT in detecting liver disease.

A

Sensitive, specific

102
Q

What three enzymes are usually observed in high quantities after a recent MI?

A
  1. CPK
  2. LDH
  3. AST
103
Q

The AST:ALT ratio is usually greater than ___ in patients with alcoholic cirrhosis, liver congestion, and metastatic tumor of the liver.

A

1.0

104
Q

The AST:ALT ratio would be less than ____ in patients with acute hepatitis, viral hepatitis, or infectious mononucleosis.

A

1.0

105
Q

Elevation of both AST and ALT is highly suggestive of ____

A

Liver disease

106
Q

In normal individuals, the AST:ALT ratio is ____

A

1.15

107
Q

In general, an elevated AST:ALT ratio to 2.0-6.0 (or greater) is most commonly associated with ____

A

Alcoholic liver disease

108
Q

Acute viral hepatitis is usually associated with ___ AST:ALT ratios

A

Low (ALT>AST)

109
Q

Which enzyme is increased after an acute MI, AST or ALT?

A

AST

110
Q

First enzyme to rise in an acute MI?

A

CPK

111
Q

Second enzyme to rise in acute MI?

A

AST

112
Q

Third enzyme to rise in acute MI?

A

LDH (1 specifically)

113
Q

Obstructive liver disease is called ____

A

Cholestasis

114
Q

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
A

Obstructive liver disease (cholestasis)

115
Q

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
A

Acute pancreatitis

116
Q

Lab findings:

  1. Hematuria
  2. Pyuria
  3. Elevated acid phosphatase (ACP)
  4. Possible elevated alkaline phosphatase (ALP)
  5. PSA positive
A

Prostate cancer

117
Q

50% elevated total LDH, with an elevated LDH-3 isoenzyme would indicate?

A

Malignancy

118
Q

Hematopoietic disease (such as megaloblastic anemia) shows elevated _____ (isoenzyme)

A

LDH-1

119
Q

The best test for detection and management of a muscle disease?

A

CPK

120
Q

The increase of LDH in progressive muscular dystrophy is confined to LDH-__ (isoenzyme)

A

5 (specific to striated muscle)

Clinical Pathology (12 decks)

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