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clinical chemistry > Exam 4 > Flashcards

Exam 4 Flashcards

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1
Q

What is the substrate for the enzyme aspartate amino transferase (AST)?

A

aspartate and alpha ketoglutamic acid

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2
Q

creatinine is formed from the breakdown of what?

A

creatine

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3
Q

PSP is removed from the blood by what organ?

A

kidney

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4
Q

what is the principle of the Berthelot reaction and what substances can cause falsely elevated values in the reaction?

A

hydrolysis of urea to ammonium carbonate by enzyme urease ammonia, lipemia, and icteric specimens (blue endophenol compound) is formed.

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5
Q

what is the normal value for serum AST at 37 C?

A

5-35 IU/L

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6
Q

which anitcoagulant should NOT be used for urease testing?

A

sodium fluoride

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7
Q

what is the normal percentage for the CK-MB isoenzyme?

A
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8
Q

what reagent is used in the measurement of uric acid?

A

phosphotungstic acid

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9
Q

creatinine clearance is used to assess the rate of what?

A

glomerular filtration

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10
Q

calculation for creatinine clearance if given urine volume and values for plasma

A

CrCl=UcrVu

PcrT

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11
Q

what additional information must be known for the calculation if the pt is an infant, young child, or adolescent?

A

body surface area

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12
Q

what is the most common endogenous substance used to assess the glomerular filtration rate?

A

creatinine

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13
Q

what is the most common exogenous substance used to assess the glomerular filtration rate?

A

inulin

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14
Q

serum creatine kinase is most often elevated in disease of what tissue?

A

muscle

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15
Q

serum lipase levels are elevated to diseases of what organ?

A

pancreas

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16
Q

what is uremia?

A

abnormal substances in the blood retention of urea in the blood

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17
Q

what is the principle of the Berthelot reaction and what substances can cause falsely elevated values in the reaction?

A

hydrolysis of urea to annonium carbonate by enzyme urease ammonia, lipemia, and icteric specimens

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18
Q

increased ALT values are associated with disease of what organ?

A

liver

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19
Q

what is the normal value for serum AST at 37 C?

A

5-35 IU/L

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20
Q

which anitcoagulant should NOT be used for urease testing?

A

sodium fluoride

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21
Q

Gout is caused by the deposition of _____ in joints and other tissues?

A

uric acid

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22
Q

Diacetyl monoxime reacts with what to produce yellow product?

A

urea

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23
Q

what is the normal value for CK in males at 37 C?

A

15-160 IU/I

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24
Q

name 3 ways that can not be used in the lab to measure the rate of an enzymatic reaction?

A

multiple point assay
kinetic
contiunous monitoring point

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25
Q

Define IU (international unit)

A

catalyzes one micromole (mmol) per min

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26
Q

what is the peak absorband of reduced NAD (NADH)?

A

340 nm

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27
Q

the Jaffee reaction is used to measure what?

A

creatinine

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28
Q

which non protein nitrogen component comprises the largest fraction of NPN in the blood?

A

urea

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29
Q

which enzyme is useful in the detection of insecticide poisoning?

A

pseudocholinesterase

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30
Q

low levels of which enzyme can cause a pt to be susceptible to prolonged apnea when exposed to certain types of anesthesia?

A

pseudocholinesterase (most clinically significant)

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31
Q

increased levels of LD-4 and LD-5 are associated with what?

A

liver/acute hepatic disease

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32
Q

what is the clinical significance of a mildly elevated ALP in a teenager?

A

they are still growing so there is no significance

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33
Q

what is the normal ratio of BUN to creatine?

A

10:1 - 15:1

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34
Q

what enzyme is normally elevated during pregnancy?

A

alkaline phosphatase

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35
Q

L-tartrate is used in the specific assay of which enzyme?

A

prostatic acid phosphatase

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36
Q

which isoenzyme is detectable with-in 4-6 hrs after a MI?

A

CK-2 or CK-MB

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37
Q

what precaution must be taken with specimens to be used for blood ammonia determinations?

A

avoid ammonia forming in vitro (outside the body)

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38
Q

what substrate and coenzyme are required to measure ammonia?

A

alpha-ketoglutarate

NADH is coenzyme

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39
Q

what is the main way that ammonia levels are kept within normal limits?

A

liver takes ammonia and makes urea

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40
Q

amylase is an enzyme that breaks down what?

A

starch and glycogen

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41
Q

why should hemolyzed specimens NOT be used for acid phophatase?

A

RBC contain acid phophatase and it could cause an increase in levels

42
Q

acid phosphatase is primarily associated with diseases of what?

A

prostate

43
Q

what is the proper treatment of serum to be assayed for ACP?

A

acidified to a pH below 6

44
Q

what is the substrate for alkaline phosphatase methods for analysis?

A

para-nitrophenolphosphase

45
Q

in the urease method urea is converted to what?

A

ammonium carbonate

46
Q

increased levels of serum alkaline phophatase can indicate disease of what?

A

bone and liver

47
Q

the enzyme responsible for the reversible oxidation of lactic acid to pyruvic acid is what?

A

LD

48
Q

in the creatine kinase reaction ___ is converted to ______.

A

ATP to ADP

49
Q

what is the endpoint of purine metabolism in man?

A

uric acid

50
Q

serum amylase might be expected to be increased in diseases of the ______

A

pancreas

51
Q

which enzyme can be used to establish the resence of semen?

A

acid phophatase

52
Q

phynylketonuria (PKU) results from a deficiency in which enzyme?

A

phenylalanine hydroxylase

53
Q

what is the substrate for the enzyme alanine aminotransferase (ALT)?

A

alanine and alpha ketoglutamic acid

54
Q

what is the source of urease used in enzymatic methods for the determination of BUN?

A

jack bean meal

55
Q

what precaution must be taken with specimens to be used for blood ammonia determinations?

A

avoid ammonia forming in vitro (outside the body)
kept closed
on ice

56
Q

what is the correct order of migration of the creatine kinase (CK) isoenzymes starting with the slowest?

A

CK-MM (muscle)
CK-MB
CK-BB (brain)

57
Q

what are the substrates for amylase in the dye-labeled substrate method?

A

starch and dye

58
Q

in the creatinine method, a color develops when creatinine combines with what?

A

alkaline picrate

59
Q

the major isoenzymes of lactate dehydrogenase comes from the ______ and the ______.

A

heart

liver

60
Q

what is the principle of the enyzmatic method for measurement of ammonia?

A

uses enzyme glutamate dehydrogenase and the substrate alpha ketogluturate reaction followed by decrease in absorbance at 340 nm as NADPH is converted to NADP

61
Q

streunous exercise can cause and elevate what?

A

CK

62
Q

what causes the BSP dye to turn from colorless to colored?

A

alkaline medium

63
Q

what would hemolysis do to the results of a lactate dehydrogenase (LD) measurement?

A

elevated results

64
Q

what would the results of a lactate dehydrogenase if frozen?

A

falsely decreased

65
Q

what test can differentiate between liver and bone origin of an elevated alkaline phosphatatse?

A

GGT

66
Q

what is the order of migration for the isoenzymes of alkaline phohatase (ALP)?

A

liver fastest, bone, placenta, intestinal

67
Q

what is the best anticoagulant to use for plasma specimens to be tested for lactate dehydrogenase?

A

heparin

68
Q

what is the characteristic change in the isoenzyme of lactate dehydrogenase (LD) that is seen in a myocardial infarction (MI)?

A

1 is greater than 2 in LD

2 is greater than 1 in MI

69
Q

creatinine excretion correaltes best with the _______

A

muscle mass

70
Q

which enzyme is the first to become elevated following a MI?

A

CK

71
Q

aspartate aminotransferase (AST) is elevated in diseases of the ______

A

heart

72
Q

in the performance of a creatinine clearance, when should the specimen for serum creatinine be collected in relation to the collection of the urine?

A

midway thru urine collection and no longer than 24 hrs before or after collection

73
Q

what enzyme can be used in the detection of alcholism and in the monitoring of patients in alcohol treatment centers?

A

GGT

74
Q

what is the normal value for prostatic acid phosphatase (ACP)?

A
75
Q

why are creatinine levels in the serum not a good indicatior of early renal damage?

A

values are not above normal until 1/2-3/4 renal function is abnormal

76
Q

what is the composition of Nessler’s reagent and for what test is it used?

A

double iodide of potassium /mercury BUN

77
Q

which has more liver specificity, alanine aminotrasferase (ALT) or aspartate aminoransferase (AST)

A

ALT is more specific

AST for heart

78
Q

in which organs is the activity of creatine kinase (CK) the greatest?

A

brain heart and skeletal muscle

79
Q

what is the main factor that determines how much the level of an enzyme in serum increases?

A

severity of damage to its tissues and cells of origin

80
Q

what is the most likely cause of prehepatic bilirubin?

A

increased amount of bilirubin being presented to the liver, such as in acute or chronic hemolytic anemias

81
Q

how does progressive muscular dystrophy affect AST and ALT levels?

A

increases both AST and ALT levels

82
Q

what is the normal value for serum amylase at 37 degrees

A

95-290 IU/L

83
Q

what is the major creatine kinase (CK) isoenzyme of normal serum?

A

CK-MM

84
Q

at what temp should serum specimens be stored?

A

4 degrees C refrigerated

85
Q

what is the purpose of the PSP test and the p-aminohippurate test?

A

measure excretory capacity of the kidneys

86
Q

to what class of enzymes do amylase and lipase belong?

A

hydrolase

87
Q

what is the normal value for serum BUN?

A

8-26 mg/dl

88
Q

what is the old name for AST?

A

SGOT

89
Q

what is the old name for CK?

A

CPK

90
Q

what two isoforms of CK are used for the early detection of MI?

A

CK-MM

CK-MB

91
Q

what is the main use of ammonia measurements?

A

diagnose reyes syndrome, diagnose pending or existing hepatic comma

92
Q

what happens to the creatinine clearance value in renal disease?

A

decreases

93
Q

risk factors for CHD

A

smoking

obesity

94
Q

which marker is recognized as the earlist chemical marker of an AMI?

A

myoglobin

95
Q

Total bilirubin, unconjugated bilirubin, conjugated values

A

0.2-1.0 mg/dl

96
Q

biochemical markers for CHD

A

triglycerides
homocysteine
high sensitivity CRP
LPA

97
Q

what makes an ideal cardiac marker?

A
  • cardiac specific
  • rises soon after infarction occurs
  • elevated over a sustained period of time
  • easy to measure analytically
  • broad dynamic range for measurements
98
Q

what is the biggest diadvantage of the troponin cardiac marker?

A

remains in blood 7-10 days (can not detect new infarction within that time frame)

99
Q

causes of prehepatic, hepatic and post hepatic bilirubin

A

increased amount of bilirubin being presented to the liver, such as in acute of chronic hemolytic anemias

100
Q

why are high levels of bilirubin seen in newborns?

A

they lack of enzyme that processes bilirubin

101
Q

what precautions should be taken with bilirubin speic

A
  • serum or plasma
  • fasting sample
  • hemolysis not acceptable
  • keep away from light
  • stable 2 days at RT, 1 week at 4 C, indefinietely at -20C

clinical chemistry (4 decks)

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