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CC 17 > Exam 1 (Enzymes, Carbohydrates, Lipids) > Flashcards

Exam 1 (Enzymes, Carbohydrates, Lipids) Flashcards

1
Q

What are the two uses of enzymes in the clinical lab:

A
  • aid in dx

* used as reagents

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2
Q

Enzymes are usually only released when tissue is ______:

A

damaged

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3
Q

List the 6 categories of enzymes based on function:

A

*Oxidoreductases
*Transferases
*Hydrolases
*Lipases
*Isomerases
*Ligases
(Oh to have lived in Lisbon)

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4
Q

Many of the pathological conditions seen in the lab occur in what categories of enzymes:

A

the first 3

  • oxidoreductases
  • transferases
  • hydrolases
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5
Q

Enzymes are measured in ____, which means:

A

IU

*one IU = amount of enzyme that will catalyze the transformation of 1 umol of substrate/min

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6
Q

What type of reaction is used for LDH and what is being measured:

A
  • Coupled enzymatic (Urease, GLDH)
  • Measures amount of conversion of NADH to NAD (340nm)
  • -so actually measuring the enzyme activity of LDH, its ability to convert nadh to nad–
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7
Q

Since ALKP can be increased in both bone or liver/biliary disease, what test can be used to distinguish:

A

5’-Nucleotidase

*will NOT be increased in bone disease

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8
Q

5’-Nucleotidase can distinguish bone from liver disease, it would be increased in which one:

A

Increased in liver disease

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9
Q

This enzyme is found in liver, intestine, bone, spleen, placenta, kidney:

A

Alk Phos

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10
Q

This enzyme would be present in higher values in children, adolescents, and pregant women:

A

Alk Phos

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11
Q

Very high values of Alk Phos would likely indicate:

A

Extrahepatic obstruction

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12
Q

This enzyme would be elevated in biliary tract obstruction, hepatocellular disease, bone disease, and hyperparathyroidism:

A

Alk Phos

also ACP

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13
Q

Alk Phos has isoenzymes that are specific to these:

A

Bone
Liver
Intestine
Placenta

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14
Q

Alk Phos isoenzymes are sensitive to these factors:

A

Storage temp

pH

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15
Q

Which ALKP isoenzyme is the only heat stable form:

A

Placenta

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16
Q

Which ALKP isoenzyme is heat labile:

A

Bone

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17
Q

How do you differentiate bone vs liver ALKP isoenzymes in the lab:

A
  • heat inactivation (56 degrees for 10mins)
  • If <20% activity = bone
  • *incubate with Nuraminidase
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18
Q

ALKP enzyme activity is highest in this pH:

A

alkaline

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19
Q

This enzyme is present in prostate, RBC, Liver, Kidney, Plts:

A

ACP

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20
Q

Optimal pH for ACP:

A

acidic

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21
Q

Is ACP as sensitive as PSA as a marker for prostate cancer:

A

No. It is not specific to just prostate.

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22
Q

T/F GGT can help differentiate between bone and liver dysfunction when ALKP is elevated:

A

True

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23
Q

In bone disease, ALKP will be ____, and GGT will be ____:

A

ALKP high

GGT normal

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24
Q

In obstruction, ALKP will be _____, and GGT will be __:

A

ALKP high

GGT high

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25
Q

In liver disease, ALKP will be ___, and GGT will be ____:

A

ALKP normal or slightly elevated

GGT elevated

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26
Q

Associate the alternative test method, Bowers-McComb, with this enzyme:

A

ALKP

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27
Q

This enzyme is most specific to liver:

A

ALT

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28
Q

ALT > AST =

A

viral hepatic disorders

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29
Q

When is the enzymatic kinetic method for ALT and AST called:

A

Method of Henry

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30
Q

What is the ALT:AST ratio called:

A

DeRritis Ratio

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31
Q

ALT is synonymous with this name:

A

SGPT

serum glutamic-pyruvate transferase

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32
Q

AST is synoymous with this name:

A

SGOT

serum glutamic-oxaloacetic transferase

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33
Q

This was an ‘old school’ marker for MI:

A

AST

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34
Q

What is Method of Henry:

A

Enzymatic kinetic method for measuring ALT and AST

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35
Q

AST > ALT =

A

alcohol or drug related hepatic disorder

*also possible in carcinoma or cirrhosis

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36
Q

This enzyme can be elevated in hepatoceullar disorders, muscular dystrophy, MI, pulmonary embolism, CHF:

A

AST

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37
Q

This enzyme is elevated in pernicious/megaloblastic/hemolytic anemias:

A

LDH

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38
Q

What are the forward and reverse methods to measure LDH, and which is most popular:

A

Forward: lactate–>pyruvate (most popular)
Reverse: pyruvate–>lactate

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39
Q

Why is the Forward method (lactate to pyruvate) the most popular for measuring LDH:

A

It’s not subject to inhibitors and is more linear

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40
Q

T/F LDH can also be measured in body fluids:

A

True

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41
Q

What is the normal body fluid: serum ratio:

A

1:2

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42
Q

LDH is normally higher or lower in body fluid than serum:

A

lower in body fluid

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43
Q

LDH ratio of 1:2 or less =

A

transudate

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44
Q

LDH ratio greater than 1:2 =

A

exudate

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45
Q

Which is seen in carcinoma, hodgkins, leukemia – transudate or exudate:

A

Exudate

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46
Q

Which LDH isoenzyme is most specific for the heart:

A

LD1

LD1 higher than LD2 indicates an LD flip, significant for MI

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47
Q

List the organs associated with the LDH enzymes:

A 
LD1:  heart, RBC
LD2:  kidney, renal cortex
LD3:  lung, spleen, pancreas, lymphs
LD4:   liver, skeletal muscle 
LD5:   skeletal muscle
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48
Q

List the normal height pattern of LDH isoenzymes in order from highest to lowest:

A 
LD2
LD1
LD3
LD5
LD4
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49
Q

When would you see an increase in both LD4 and LD5:

A

liver disease

skeletal muscle disease

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50
Q

What would happen to the LD peaks in Mono:

A

LD3 would be significantly increased

LD4/5 moderately increased

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51
Q

An LDH isoenzyme pattern in circulatory shock would look like:

A

LD1-4 very decreased

LD5 significantly increased

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52
Q

In liver or skeletal muscle disease, which LD peaks would you expect to be increased:

A

LD4 and 5

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53
Q

This enzyme would be elevated in MI, CVA, muscle trauma, inflammation or damage:

A

CK

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54
Q

This is the first enzyme to increase after an MI:

A

CK

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55
Q

This enzyme is the most sensitive to muscle damage, with highest elevations seen in skeletal muscle disease:

A

CK

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56
Q

What are the 3 CK isoenyzmes and what are they specific for:

A

CKMM - muscle
CKMB - heart
CKBB - brain

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57
Q

What is another method, besides using CK isoenzymes, for distinguishing if elevated CK is due to MI or skeletal muscle disease or damage:

A

Oliver-Rosalski method

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58
Q

This CK isoenzyme is most sensisitive for muscle disease/damage:

A

CKMM

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59
Q

What is the CK Index:

A

(CKMB/CK) x 100

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60
Q

CK index >6 =

A

cardiac origin

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61
Q

CK index <3 =

A

skeletal muscle

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62
Q

What disorders will all have very high CK and CKMB, but not be a cardiac problem:

A
  • Muscular dystrophy
  • Rhabdomyolysis
  • Traumas
  • CK Index will help distinguish
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63
Q

List the 3 enzyme markers used for MI:

A

CK
AST
LDH

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64
Q

Which enzyme elevates first and highest with MI:

A

CK

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65
Q

Which enzymes elevate 2nd and 3rd in MI:

A

2nd- AST

3rd - LDH

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66
Q

Which enzyme stays elevated longest as MI marker:

A

LDH

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67
Q

Which MI marker enzyme is the first to return to normal after MI:

A

CK

first to rise, first to fall

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68
Q

These two enzymes are often used to assess pancreatic conditions:

A

AMY

LIP

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69
Q

Will both AMY and LIP be increased in chronic pancreatitis?

A

No. only LIP will be increased.

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70
Q

Will both AMY and LIP be increased in acute pancreatitis:

A

Yes.

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71
Q

T/F Increase in AMY alone is non-specific:

A

true, must run with LIP and both be elevated to dx acute pancreatitis

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72
Q

This enzyme breaks down starch/glycogen in pancreas/salivary glands:

A

Amylase (AMY)

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73
Q

This enzyme breaks down triglycerides in pancreas (also stomach and small intestine):

A

Lipase (LIP)

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74
Q

This enzyme would be elevated in acute pancreatitis, duodenal/peptic ulcers, intestinal obstructions, and acute choecystitis:

A

LIP

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75
Q

This enzyme would be elevated in acute pancreatitis, mumps, and salivary gland irritation:

A

AMY

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76
Q

You can see false elevations in this enzyme due to opiates, and false decreases due to elevated trigs:

A

AMY

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77
Q

Cherry and Crandall method associated with this enzyme:

A

LIP

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78
Q

Elevated ALKP with normal 5’ nucleotidase indicates problem with:

A

bone

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79
Q

Elevated CK, with CK index value <3 indicates this:

A

muscle disease

80
Q

What would the AST:ALT ratio be in cirrhosis:

A

AST > ALT

81
Q

What enzyme is increased during pregnancy?

A

ALKP

Due to placenta

82
Q

Liver cancer would show increases in these 3 enzymes:

A
  • ALT
  • AST
  • ALKP
83
Q

What would be significantly elevated in obstruction:

A

*ALP
*GGT
(slight increases in ALT and AST)

84
Q

Glycogenesis/genolysis/lysis all take place here:

A

Liver

85
Q

Carbs must be broken down into this form before it can be absorbed in blood stream:

A

monosaccharide

86
Q

Which two monosaccharides get further broken down into glucose:

A

Fructose

Galactose

87
Q

Metabolism of glucose molecule to pyruvate or lactate for production of energy:

A

Glycolysis

88
Q

Formation of glucose-6-phosphate from noncarbohydrate sources:

A

Gluconeogenesis

89
Q

Breakdown of glycogen to glucose for use as energy (Glycogen–>G-6-P):

A

Glycogenolysis

90
Q

Conversion of glucose to glycogen for storage:

A

Glycogenesis

91
Q

Conversion of carbohydrates to fatty acids:

A

Lipogenesis

92
Q

Decomposition of fat:

A

Lipolysis

93
Q

What enzyme converts glucose to G6P:

A

Hexokinase

94
Q

After glucose enters cells, it follows one of 3 pathways, name them:

A

1) Embden-Meyerhof
2) Hexose-Monophosphate
3) Glycogenesis

95
Q

Which pathway stores glucose for future energy needs:

A

glycogenesis

96
Q

This pathway breaks down glucose into pyruvate/lactate–>acetyl coA–>TCA cycle:

A

Embden Meyerhof

97
Q

In which pathway is NADPH formed:

A

Hexose-Monophosphate

98
Q

What is the end product of anaerobic pathway:

A

Lactate

99
Q

Hormone that decreases plasma glucose, promotes uptake by cells, storage and conversion to lipids of excess glucose (beta cells in pancreas):

A

Insulin

100
Q

Hormone responsible for increasing plasma glucose (alpha cells in pancreas):

A

Glucagon

101
Q

What is released from the alpha cells in the pancreas when blood glucose is LOW:

A

Glucagon

102
Q

This increases glycogenolysis and gluconeogenesis:

A

Glucagon

103
Q

This decreases glycogenolysis:

A

Insulin

104
Q

What are some causes of hypoglycemia:

A

overhydration
hepatic dysfunction
insulinoma
G6PD

105
Q

What are some causes of hyperglycemia:

A

lack of insulin
insulin resistance
loss of insulin release control

106
Q

Diabetes affects ___% of the puplation, ___% of these are >65 years old:

A

3%

10%

107
Q

____ takes up ~10-12% of total annual health care budget:

A

Diabetes

108
Q

This disease is not a ‘true’ diabetes, but is caused by trauma or injury to pineal gland:

A

Diabetes insipidus

109
Q

List the 4 types of Diabetes:

A

Type 1
Type 2
Gestational
Insipidus

110
Q

Carbohydrates–>glucose–> :

A

pyruvate–>acetyl CoA–>TCA cycle

111
Q

Lipids–>fatty acids–> :

A

Acetyl CoA

not as efficient as carbs though

112
Q

Proteins–>amino acids–> :

A

pyruvate–>acetyl CoA

113
Q

In diabetes, glucose cannot enter cells, so what happens:

A

Cells turn to fatty acids and proteins for enerrgy, leads to further increase of blood glucose.
(cholesterol and ketone bodies also increase)

114
Q

In ketoacidosis, which ketone body is in highest concentration:

A

Beta hydroxybuterate

115
Q

What is used to test for ketoacidosis:

A

Nitroprusside test

116
Q

What does the Nitroprusside test for and how:

A
  • positive indicates ketoacidosis

* tests for acetoacetic acid, will react with nitroprusside and turn purple if present

117
Q

Describe how ketoacidosis causes vision and renal problems and increase risk of CVD:

A

glucose binds to proteins, enhancing lipoprotein deposits increase CVD risk— capillaries thicken and occlude microvessels

118
Q

In ketoacidosis, increase in glucose will increase sorbitol, which increases osmotic pressure in cells, drawing water to them, resulting in :

A

nerve damage

diabetic neuropathy

119
Q

Decreased blood pH from ketoacidosis results in:

A

oxidative damage

120
Q

List the 3 methods for testing fasting glucose:

A

1) Glucosoxidase
2) Hexokinase
3) Copper reduction

121
Q

Which fasting glucose testing method is used for urine samples:

A

Copper reduction

122
Q

This testing method for fasting glucose is a highly specific coupled rxn that measures rate of NADPH produced (340nm):

A

hexokinase

123
Q

This testing method for fasting glucose is subject to pos and neg interference:

A

Glucosoxidase

124
Q

This testing method for fasting glucose can be falsely decreased due to increased bili/uric acid/ascorbic acid—- can be falsely increased due to bleach interferences (oxidizers):

A

Glucosoxidase

125
Q

In Hexokinase test for fasting glucose, amount of NADPH produced is ______ to glucose present in sample:

A

proportional

126
Q

Venous samples in Heparin, EDTA, Fluroide, Oxalate, and Citrate may be used for this test:

A

Fasting glucose

127
Q

What is important to note if testing whole blood (finger stick) for fasting glucose:

A

values will ~11% lower than venous blood

128
Q

T/F Bacterial infections will cause a greater decrease in blood glucose levels in venous blood samples (post draw):

A

True

Normal decrease is 5-7%/hour if not separated. greater w/ bacterial infection.

129
Q

Will capillary blood sample have higher glucose level right after a meal?

A

Yes

Important to remember if comparing capillary sample to venous sample.

130
Q

Diabetes dx may be missed if fasting sample tested in the ___:

A

PM.

Fasting glucose has diurnal variation- highest levels in the AM.

131
Q

When will glucose appear in urine and why:

A

Will appear in urine when renal threshold is exceeded . (~200mg/dL)

132
Q

What is the difference between glycated and glycosylated Hgb:

A

Glycated: permanently bound
Glycosylated: Not permanent, is reversible

133
Q

This test can monitor blood glucose over a 3 month window:

A

HgbA1C

134
Q

Optimal HgbA1C level is:

A

<6.5

135
Q

When glucose is permanently bound to heme A1C protein, and rxn is not reversible:

A

Glycated

136
Q 
List the criteria for diabetes dx for the following tests-
A1C:
FPG:
OGTT:
Random PG:
A

A1C >/= 6.5%
FPG >/= 126 mg/dL
OGTT >/= 200 mg/dL
RPG >/= 200 mg/dL

137
Q

Glucose + hemoglobin =

A

HgbA1C

glycated/glycosylated hgb

138
Q

This is an early indicator of nephropathy, and testing for it is recommended yearly on known diabetics:

A

Microalbumin

139
Q

How is microalbumin measured:

A

Directly or dipstick

140
Q

What must be done with venous blood right away when being used to test fasting glucose:

A

separate or test right away

glycolysis will continue in tube after draw, reducing glucose levels 5-7% per hour if not separated

141
Q

What is the significance of testing CSF for glucose:

A

It may be decreased in infection

normal 40-80 mg/dL

142
Q

Test where glucose reduces cupric ion to cuprous ions to cuprous oxide– color changes occur in this exothermic rxn:

A

Copper reduction

fasting glucose for urine test

143
Q

T/F Sleep deprivation affects insulin sensitivity:

A

True.. Leads to metabolic disorders such as metabolic syndrome, diabetes..

144
Q

Lipids are composed of ___, ___, and ___. May also contain ____ and ____:

A

Carbon, Hydrogen, Oxygen

Nitrogen, Phosphorous

145
Q

Lipids must bind to _____ for transport in body:

A

lipoproteins

146
Q

These types of lipids provide energy:

A

Trigs

Fatty acids

147
Q

These types of lipids provide structure:

A

Phospholipids and cholesterol present in cell membranes

148
Q

List the 3 main functions of lipids:

A

1) energy
2) structure
3) insulation

149
Q

List the 4 lipids present in plasma:

A

1) triglycerides
2) cholesterol
3) phospholipids
4) fatty acids

150
Q

What are the main lipids, usually the only ones tested for in the lab:

A

trigs and cholesterol

151
Q

This is a precursor to hormones, bile salt, and vitamin D:

A

cholesterol

152
Q

Two types of cholesterol and percentage they provide to total cholesterol level:

A
  • Exogenous (diet), animal fats, only 1/3 to 1/2 is absorbed, the rest is excreted
  • Endogenous (synthesized by liver), supplies 70% of total cholesterol
153
Q

How much of our total cholesterol is endogenous:

A

70% (synthesized by liver)

154
Q

Cholesterol reference range:

A

150-250 mg/dL

155
Q

Females typically have lower cholestTwo typeserol than men until this stage:

A

menopause

156
Q

How is cholesterol related to T4, insulin, and estrogens:

A

Inversely

157
Q

Two types of trigs:

A
  • endogenous (synthesized in liver and adipose tissue)

* exogenous (diet)

158
Q

What are the two functions of lipids:

A

1) Storage

2) Energy

159
Q

How are lipids converted from storage to be used for energy:

A

Hydrolyzed by lipase to make fatty acids, which will bind to albumin for transport to cells that need energy

160
Q

Optimal triglyceride levels:

Reference range for trigs:

A

<100 mg/dL
100-200 mg/dL

(just because its a reference range doesnt mean its optimal/healthy)

161
Q

What can be a complication of severe hypertriglylceridemia:

A

pancreatitis

162
Q

Increased fatty acids and triglycerides are associated with:

A

hyperglycemia

163
Q

Fatty acids are mainly provided by ___, and do/do not greatly contribute to plasma lipid level:

A
  • diet

* do not

164
Q

These act as lung surfactants, are important in coagulation, part of myelin sheath,and regulate cell permeability:

A

phospholipids

165
Q

These are major components of lipoprotein outer shell, and hold apoprotein to lipoprotein:

A

phospholipids

166
Q

T/F Phospholipids are quantified in the lab:

A

False

167
Q

Phospholipids as surfactant (Lecithin) can be measured via:

A

L/S ratio in amniotic fluid

lung maturity

168
Q

This coats embryonic alveolar sac lining in lungs, keeps them from collapsing, and is measured how:

A
  • Lecithin (phospholipid)

* L/S ratio in amniotic fluid

169
Q

T/F Phospholipids mostly come from diet:

A

False.

They are mostly synthesized in liver.

170
Q

List the 5 classes of lipoproteins, from least to most dense:

A
  • Chylomicrons
  • VLDL
  • LDL
  • HDL
  • Lipoprotein A
171
Q

These are found on the surface of lipoproteins, help maintain structure and play a role in cell receptors and inhibitors to enzymes that modify the lipoprotein structure:

A

apolipoproteins

172
Q

Apolipoprotein A1 is the major protein in ____:

A

HDL

173
Q

What are the two kinds of Apolipoprotein B:

A
  • B100 (LDL and VLDL)

* B48 (chylomicrons)

174
Q

B100 is found here:

A

LDLD and VLDL

175
Q

B48 is found here:

A

chylomicrons

176
Q

Apo-E found in many lipoproteins:

A

LDL, VLDL, HDL

177
Q

These transport exogenous trigs and dietary lipids to hepatic and peripheral cells:

A

chylomycroms

178
Q

This is formed by lypolysis of VLDL, and primary apolipoprotein is B100:

A

LDL

179
Q

Which is larger, LDL or VLDL:

A

VLDL

180
Q

When LDL infiltrates extracellular space of vessels, is oxidized and taken up by macrophages–>

A

Foam cells

181
Q

High levels of this lipoprotein is associated with increased risk of stroke, rather than heart disease:

A

LP-A

182
Q

Which is synthesized by liver and intestine, LDL or HDL:

A

HDL

DLD formed by lypolysis of VLDL

183
Q

What two things contribute to the milky appearance of a lipemic sample:

A

VLDL

Chylomicrons

184
Q

After refrigeration, which lipoprotein would float to the top in a lipemic sample:

A

Chylomycrons

largest and least dense

185
Q

Which lipoprotein is responsible for most turbidity in fasting hyperlipidemia samples:

A

VLDL

large particles scatter light and cause turbidity

186
Q

Which lipid panel value is calculated, and what is the equation named/used:

A

LDL
Friedewald equation
LDL= total chol - HDL - (trigs/5)

187
Q

What was the historical measurement for cholesterol/trigs:

A

Liebermann-Burchard rxn
(2 step precipitation)
(uses acetic anhydride, colorimetric)

188
Q

Can you use the Friedewald equation if trigs >400?

A

No

189
Q

What is the current method for cholesterol/trig measurement:

A

Enzymatic (and colorimetric)

better specificity, less interference

190
Q

Measuring these involves essentially an assay of glycerol:

A

Trigs

191
Q

Appearance of serum can predict trig level-
Clear:
Hazy:
Milky:

A

Clear <200
Hazy >300
Milky >600

192
Q

Is the current method of cholesterol/trig measurement recommended for research purposes?

A

No. Lacks specificity in liver/renal patients. Frequent modifications to reagents by manufacturer.

193
Q 
What are the optimal levels for the following-
LDL:
HDL:
Trigs:
Total Chol:
Total chol/HDL ratio:
A 
LDL:  <100
HDL:  >60 
Trigs:   <150
Total Chol:  <200
Total chol/HDL ratio:  <4
194
Q

Why could a lipid panel sample appear orange:

A

Increased LDL

195
Q

List some important specifics regarding testing for lipid panels:

A
  • Maintain normal diet for 3 days prior
  • Do not test during illness
  • Fast at least 12 hrs, no alcohol 24 hrs
  • Avoid hemoconcentration
  • EDTA will be 4-5% lower than serum
196
Q

If you have a lipemic sample to be tested for lipids, would you dilute or ultracentrifuge:

A

Dilute.

Ultracentifuge will spin out the trigs

CC 17 (5 decks)

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