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CC 17 > Exam 1 (AA's, Proteins, Non-Protein Nitrogens) > Flashcards

Exam 1 (AA's, Proteins, Non-Protein Nitrogens) Flashcards

1
Q

20 amino acids are divided into two groups:

A

Essential

Non-essential

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2
Q

How are essential amino acid supplied:

A

through diet when we eat proteins

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3
Q

How are non-essential amino acids supplied:

A

They are made from the essential amino acids, converted by liver enzymes

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4
Q

This is the transfer of one amine group from 1 amino acid to another, done by liver enzymes to make new amino acids from recycled ones:

A

transamination

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5
Q

The removal of an amino group from an amino acid; produces ammonia which is converted to urea and excreted in urine:

A

Deamination

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6
Q

Amino acids consist of these parts:

A

Amino group
Carboxyl group
Hydrogen
R-group

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7
Q

Formation of a peptide involves the ___terminal end of one amino acid reacting with the ___terminal end of another through this type of reaction:

A 
C-terminal, N-terminal
hydrolysis reaction (H2O is released)
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8
Q

Define polypeptide:

A

chain of amino acids linked via peptide bonds

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9
Q

Why are amino acids zwitterions:

A

Amino has + charge
Carboxyl group has - charge
*net charge = 0
*makes them good buffers

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10
Q

Describe secondary peptide structure:

A

coiling into helix by h bonds of neighboring peptides

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11
Q

Describe tertiary peptide stucture:

A

Folding of peptide chain by many forces

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12
Q

The interaction of the polypeptides results in a :

A

protein

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13
Q

Proteins have ___ main stages of assembly:

A

Primary, Secondary, Tertiary, Quaternary

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14
Q

T/F All proteins contain all 20 amino acids:

A

False

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15
Q

When errors in metabolism occur, these can build up in blood and urine and be detected by the lab:

A

amino acids

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16
Q

T/F When certain amino acids accumulate in blood, they can be toxic and result in death:

A

True

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17
Q

What are the two categories of aminoacidopathies:

A

Primary

Secondary

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18
Q

Describe primary vs secondary aminoacidopathy:

A
  • Primary: inherited defect in enzymatic pathway

* Secondary: disease of a specific organ where amino acid is synthesized (liver, kidney)

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19
Q

List the 6 Primary (inherited) amioacidopathies:

A 
Alkaptonuria
Cystinuria ???
Homocystinuria
Maple Syrup Urine
Phenylketonuria
Tyrosinemia
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20
Q

In alkaptonuria, what enzyme is inhbitied, and what builds up:

A
  • enzyme: homogentisic acid oxidase

* builds up: homogentisic acid

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21
Q

Which aminoacidopathy creates a buildup of homogentisic acid, causing generalized pigmentation and arthritic-like degeneration:

A

Alkaptonuria

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22
Q

In alkaptonuria, this will happen to urine up standing, and is caused by a buildup of what:

A
  • urine will darken

* buildup of homogentisic acid

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23
Q

Cystinuria is not an enzymatic defect, but a defect in _____ _____:

A

renal absorption

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24
Q

Buildup of cysteine causes:

A

renal calculi (cysteine stones)

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25
Q

This aminoacidopathy is caused by a defect in Branched Chain Ketoacid Dehydrogenase:

A

Maple Syrup Urine Disease

MSUD

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26
Q

What builds up in MSUD:

A

Ketoacids (leucine, isoleucine, valine)

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27
Q

What signs/symptoms result from MSUD:

A
  • maple syrup smell in urine, skin, breath
  • mental retardation
  • convulsions
  • acidosis
  • death
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28
Q

What is the defect in MSUD:

A

the defect is in the Branched Chain Ketoacid Dehydrogenase

ketoacids then buildup

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29
Q

What is the defect in Type 1 Tyrosinemia:

A

FAA hydrolase (most severe)

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30
Q

Which type of Tyrosinema is most severe?

A

Type 1

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31
Q

What is the defect in Type 2 Tyrosinemia:

A

Tyrosine aminotransferase

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32
Q

What builds up in both types of Tyrosinemia?

A

Tyrosine

it needs to be broken down for complete amino acid metabolism

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33
Q

What does Type 1 tyrosinemia cause:

A

severe liver disease

death in infants

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34
Q

What does Type 2 Tyrosinemia cause:

A

eye involvement and skin lesions

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35
Q

What amino acid is not metabolized in Homocysteinuria:

A

Methionine

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36
Q

The enzyme Cystathionine B-synthase is blocked in _______, causing a buildup of this amino acid:

A
  • Homocysteinuria

* Methionine

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37
Q

This aminoacidopathy is similar to Marfan’s Syndrome:

A

Homocysteinuria

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38
Q

List some signs and symptoms of Homocysteinuria:

A
  • mild to severe cases
  • mental retardation
  • lens dislocation in eye= nearsightedness
  • chest deformities
  • long, spindly limbs
  • scoliosis
  • thrombosis (Increased homocysteine levels can lead to CVA)
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39
Q

Increased levels of this amino acid can lead to CVA:

A

Homocysteine

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40
Q

This causes a buildup of phenylalanine and causes severe mental retardation if not treated:

A

PKU

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41
Q

For mandated amino acid testing, is it required that an effective treatment must be available:

A

yes

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42
Q

List the requirements for state mandated amino acid testing:

A

1) high incidence disorder
2) must have effective treatment available
3) inexpensive screening for high volume
4) test has high sensitivity/specificity

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43
Q

T/F Blood sample for amino acid testing must be drawn after 6-8 hour fast and avoiding absorbed dietary proteins:

A

True

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44
Q

Why must you be careful to avoid WBC and PLT when aliquotting specimen for amino acid testing:

A

they contain amino acids

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45
Q

What do you do with an aliquotted blood specimen for amino acid testing:

A

de-proteinize (aliquot) and freeze immediately

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46
Q

T/F Random urine can be used for amino acid test screening:

A

True

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47
Q

When using urine to test for amino acids, this is required for confirmation:

A

24 hour urine

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48
Q

What is the card test used to screen newborns for aminoacidopathies/PKU:

A

Guthrie test

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49
Q

Describe the Guthrie test:

A

1) start with culture of Bacillus subtilis (requires phenylalanine to grow)
2) add inhibitor to media to prevent bacteria from growing
3) add blood sample
* positive = bacteria will grow (still need confirmation)
* negative = no bacterial growth

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50
Q

Why will the Bacillus subtilis grow in the Guthrie test if the patient has PKU:

A

If defect exists, blood will contain much phenylalanine, feeding B. subtilis

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51
Q

Amino acid testing requires ___-____ filtrate:

A

protein free

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52
Q

What other methods can be used to test for amino acids:

A
  • TLC
  • Ninhydrin (stains aa’s blue)
  • HPLC
  • Capillary electrophoresis
  • MS/MS
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53
Q

PKU is caused by a defect in the gene that helps create the enzyme _____:

A

phenylalanine hydroxylase

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54
Q

What type of test of albumin is run for short term blood sugars:

A

glycosylated albumins

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55
Q

Albumin is this type of reactant:

A

Negative phase reactant

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56
Q

Which blood sample has highest protein concentration:

A

plasma (contains the protein fibrinogen)

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57
Q

Which is preferred for protein testing, serum or plasma:

A

serum (does not contain the protein fibrinogen)

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58
Q

T/F Urine and CSF have protein in them:

A

True, but smaller quantities so need to concentrate samples if quantitating

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59
Q

Are proteins too large to pass through vessels?

A

Yes

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60
Q

The presence of protein draws water; distributing extracellular fluid between vascular bed and interstitial space, keeps water out of tissues, maintaining this:

A

oncotic pressure

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61
Q

The presence of ___ differentiates proteins from carbohydrates and lipids:

A

Nitrogen

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62
Q

Proteins denature when ____ and ____ structure bonds break:

A

Tertiary and Quaternary

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63
Q

List methods of denaturing proteins:

A
  • heat
  • pH
  • Enzymatic action
  • heave metals
  • urea exposure
  • UV light
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64
Q

The function of albumin:

A

maintain osmotic pressure

keep fluid in vessels and out of tissues

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65
Q

T/F Proteins can act as pH buffers:

A

True. They are amphiprotic zwitterions.

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66
Q

These can act as hormones/hormone receptors:

A

Proteins

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67
Q

List some functions of proteins:

A
  • Aid in coagulation
  • Transport mechanism (carries things insoluble in fluid- bili, lipids,etc)
  • Antibodies
68
Q

Proteins are classified into these two groups:

A
  • Simple proteins

* Conjugated proteins

69
Q

Albumin, immunoglobulins, hemoglobin are examples of this type of protein group:

A

Simple proteins

70
Q

Define conjugated proteins:

A

Protein + non-protein group

71
Q

Metalloproteins, lipoproteins, glycoproteins, mucoproteins, and nucleoproteins are examples of:

A

Conjugated proteins

72
Q

Give an example of the following:

  • metalloprotein:
  • lipoprotein:
  • glycoprotein:
  • nucleoprotein:
A
  • Ferritin
  • Cholesterol, Triglycerides
  • Haptoglobin, Alpha-1-Antitrypsin
  • Cellular chromatin
73
Q

_____ + _____ = Total Protein

A

Albumin + Globulin

74
Q

Total Protein ref. range:

75
Q

_____ makes up 60% of the total proteins

76
Q

Which are measured directly in lab, which are calculated values-

  • Albumin:
  • Total Protein:
  • Globulins:
A
  • Alb= direct
  • TP= direct
  • Globulins= calculated (TP-ALB= globulins)
77
Q

Ref range for Globulins:

A

2.5 - 4 g/dL

78
Q

How do you calculate Globulins:

A

TP - Alb = globulins

79
Q

There are how many main globulins:

A

4

alpha-1, alpha-22, beta, gamma

80
Q

Disruption of the A/G ratio can indicate this:

81
Q

TP < 3.0 g/dL, decrease on oncotic pressure:

A

Transudate

82
Q

TP > 3.0 g/dL, excreted by cells:

83
Q

T/F Individual Fractionation of proteins often more important than Total Protein alone:

84
Q

This test can replace the HgA1C:

A

Glycosylated Albumin

85
Q

This protein has many functions, including transporting bilirubin, steroids, thyroid hormones, fatty acids, iron:

86
Q

Albumin testing is quantitated by this method:

A

dye binding directly to albumin

color of dye changes once bound, color difference proportional to amount of albumin

87
Q

What dyes are used for albumin quantitation:

A

1) Bromcresol green (HgB binds well, must avoid hemolysis)

2) Bromcresol purple (bilirubin will bind)

88
Q

Which dye in Albumin quantitation will bind hemoglobin, and which will bind bilirubin:

A
  • bromcresol green: binds Hgb

* bromcresol purple: binds bilirubin

89
Q

Increased albumin levels indicate:

A

not typically significant. Can be seen in temporary dehydration.

90
Q

Decreased albumin levels indicated:

A
  • malnutrition
  • liver disease
  • nephrotic syndrome
  • chronic inflammation
91
Q

What are two methods for albumin quantitation:

A

1) Kjedahl

2) Biuret (most current)

92
Q

What is being tested for in Kjedalh method vs Biuret method for albumin quatitation:

A
  • Kjedahl: determining Nitrogen content (must denature protein first to release N)
  • Biuret: testing for peptide bonds in protein (no need to denature)
93
Q

This describes what method:

  • denature protein to release Nitrogen
  • N converted to NH4
  • NH4 reacts w/ Nessler’s reagent= color change
  • color product is measured via spectra
A

Kjedahl method for albumin quantitation

94
Q

These steps describe what method:

  • Copper sulfate solution binds to peptide bonds in alkaline solution = color change
  • intensity of color is proportional to protein concentration
  • must avoid hemolyzed blood, cannot use for urine or CSF
A

Biuret method for albumin quantitation

95
Q

Increased Total Protein indicates:

A
  • dehydration
  • multiple myelom
  • chronic inflammation
96
Q

Decreased Total Protein can indicate:

A
  • malnutrition/starvation
  • hepatic insufficiency
  • nephrotic syndrome
97
Q

Total Protein < 4.5 indicates what:

A 
peripheral edema
(less protein to control oncotic pressure; fluid gets into tissues)
98
Q

T/F The Biuret method can be used on urine and CSF:

A

False. Can only be used on blood.

Not enough protein in CSF for method to work

99
Q

Reasons for increased protein in CSF:

A
  • infection/inflammation of meninges
  • trauma
  • MS
  • bloody sample
100
Q

Reasons for decreased protein in CSF:

A

hyperthyroidism

101
Q

Is protein found in urine?

A

Only trace amounts, most is reabsorbed by kidneys

102
Q

Reasons for increased protein in urine:

A
  • Nephrotic syndrome
  • Multiple Myeloma
  • some benign conditions
103
Q

Normal value for globulins:

A

2.5 - 4.0 g/dL

104
Q

Normal value for A/G ratio:

105
Q

Globulins are divided into these 4 groups:

A

Alpha-1
Alpha-2
beta
gamma

106
Q

Normal protein value for CSF:

A

15 - 45 mg/dL

107
Q

What type of acute phase reactant is albumin:

108
Q

Albumin migrates the farthest and toward the ____:

109
Q

This is seen before albumin, is measured directly in lab, and can be used to monitor nutritional status:

A

Prealbumin

110
Q

List the proteins associated with Alpha-1:

A
  • antitrypsin
  • fetoprotein
  • lipoproteins
  • acid glycoprotein
111
Q

Increases in the Alpha-1 band are caused by:

A
  • acute phase reaction

* pregnancy

112
Q

Decreases in the Alpha-1 band are caused by:

A
  • Alpha-1 antitrypin deficiency

* lung disease (emphysema)

113
Q

Alpha-1 and Alpha-2 are ____ acute phase reactants:

114
Q

Albumin and Beta are ___ acute phase reactants:

115
Q

A decrease in the Beta region can be caused by:

A
  • acute phase reactions (negative)
  • liver or renal disease
  • malabsorption/malnutrition
116
Q

List some examples of acute phase reactants:

A
  • Alpha-1 antitrypsin
  • Alpha-1 glycoprotein
  • ceruloplasmin
  • haptoglobin
  • fibrinogen
  • CRP
  • Transferrin
  • Albumin
117
Q

Proteins associated with Alpha-2:

A
  • haptolobin
  • alpha-2 macroglubulin
  • ceruloplasmin
118
Q

Proteins associated with Beta:

A
  • transferrin
  • beta lipoprotein
  • C3 complement
119
Q

List the 4 non-protein Nitrogens:

A

Urea
Creatinine
Uric Acid
Ammonia

120
Q

Non-protein nitrogens are products of:

A

protein catabolism

121
Q

Why can we measure Urea in the blood if it is excreted in the urine:

A

A small amount is reabsorbed

122
Q

Plasma concentration of urea is dependent on these two factors:

A

1) Diet and rate of catabolism

2) Renal function/profusion

123
Q

Do we measure BUN or urea in the lab:

124
Q

How do you convert BUN to urea:

A

Bun x 2.14 = Urea

125
Q

This is defined as elevated plasma urea accompanied by renal failure:

126
Q

_____= elevated concentration of plasma urea:

127
Q

Cause(s) of prerenal azotemia:

A
  • CHF
  • shock, hemorrhage
  • dehydration
  • increased protein intake
128
Q

Cause(s) of renal azotemia:

A
  • acute and chronic renal failure
  • renal disease
  • Glomerulonephritis
  • Tubular necrosis
129
Q

Cause(s) of postrenal azotemia:

A

*urinary tract obstruction

130
Q

Cause(s) of decreased Urea:

A
  • Low protein intake
  • severe V/D
  • Liver disease
  • Pregancy
131
Q

What are the two enzymes used in the enzymatic reacted testing for Urea:

A

*Urease
*GLDH
(measures change in absorbance of NADH and NAD at 340nm)

132
Q

_____is filtered by the glomerulus, and 90-95% is excreted in urine:

A

Creatinine

133
Q

This is used to asses GFR and kidney function:

A

Creatinine

134
Q

Creatinine and GFR are _____ related:

A

Inversely
(Plasma creatinine not cleared by kidney= low GFR, high plasma creatine= creatinine not being excreted, and plasma levels will rise

135
Q

_____is produced at a constant rate under normal conditions, in relation to muscle mass, making it an ideal measurement for GFR and renal function:

A

Creatinine

136
Q

If you GFR is low, what would you expect to see in plasma creatinine level:

A

Increased

creatinine is not being cleared/excreted by kidney, causing plasma levels to rise

137
Q

Describe the Jaffe reaction, and what is it used to measure:

A

*Measures creatinine
*creatinine + picric acid in akaline solution= red/orange chromagen
(but many interferences)

138
Q

How does the Kinetic Jaffe method differ from the classic Jaffe reaction:

A

Same as Jaffe method, but is measured in time intervals to look for change in absorbance
(accounts for interferences)

139
Q

What can interfere with creatinine sample testing:

A
  • ascorbic acid
  • glucose
  • alpha-ketoacids
  • ammonia exposure
140
Q

What is the formula for estimating GFR:

A

Cockcroft-Gault
(140-age) x mass
—————————-
72 x serum creatinine

141
Q

When would the Cockcroft-Gault formula be used:

A

In situations where 24 hour urine is not collected, doctor may request this

142
Q

This can be used to determine cause of elevated BUN:

A

BUN/Creatinine ratio

143
Q

Normal ratio of BUN/creatinine:

A

10:1 - 20:1

144
Q

If BUN/creatinine ratio is >20:1:

A
  • BUN is elevated, crea is normal
  • Prob is is not renal or post renal, crea is being cleared
  • problem would be pre-renal
145
Q

If BUN/creatinine ratio is <10:1:

A

*The BUN is low, crea is normal

146
Q

If there is a problem with the kidney itself, what will the BUN and creatinine be:

A

Both elevated

147
Q

Uric acid is a product of:

A

purine catabolism

148
Q

What happens when uric acid levels build up in the blood:

A

it will precipitate out and form crystals, which accumulate in the joints (GOUT)

149
Q

Is high uric acid alone diagnostic of gout:

A

No. Other problems can cause high uric acid.

150
Q

What is diagnostic of Gout:

A

Identification of Monosodium Urate crystals

151
Q

Causes of hyperuricemia:

A
  • Gout
  • cytotoxic drugs
  • renal disease
  • Purine-rich diet
152
Q

Causes of hypouricemia:

A
  • liver disease

* over treatment with gout and kidney stone treatment

153
Q

What is the test methodology used for Uric Acid:

A

Caraway Method

*uricase enzyme, converts uric acid to allantoin

154
Q

What is it called when the liver converts the ammonia to urea (it is then soluble):

A

Ornithine cycle

155
Q

For urea (BUN), which occurs first, transamination or deamination:

A

transamination

156
Q

Which method does the Vitros use for Urea:

157
Q

T/F Test samples for Urea must avoid Sodium Fluoride and ammonia:

158
Q

Ammonia is a product of _____ in the liver:

A

deamination

159
Q

Ammonia is found in ____ concentrations in plasma:

160
Q

If liver is damaged, conversion of _____ to _____ can not occur:

A

ammonia

urea

161
Q

List the 4 steps of conversion of amino acids to urea:

A

1) transamination of AA’s
2) deamination, forms Ammonia
3) Ornithine cycle converts ammonia to urea
4) urea to blood to kidney, most excreted, some reabsorbed (why we can measure in blood)

162
Q

Test samples for ammonia must be handled carefully, such as:

A
  • collect on ice
  • avoid cigarette smoke
  • avoid ammonia cleaning products (floor wax)
  • avoid hemolysis (ammonia is still generated after draw)
163
Q

Which method for measuring ammonia is most common on automated instruments:

A

GLDH enzymatic

difference between NADH and NAD

164
Q

Why is it important to be aware of increased ammonia levels in children under 18:

A

Reye’s syndrome

165
Q

T/F Reye’s syndrome may occur after acute viral infections, ingestion of salicylates by children, and can lead to encephalopathy:

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