Exam 9 (Vitamins, Minerals, Body Fluids, Enzymes) Flashcards
1
Q
What are the major hormones involved in pancreatic endocrine function?
A
Glucagon and insulin
2
Q
What are the major enzymes involved in pancreatic exocrine function?
A
Amylase, lipase, and HCO3
3
Q
What cells in the pancreas secrete insulin?
A
Beta cells
4
Q
What cells in the pancreas secrete glucagon?
A
Alpha cells
5
Q
What cells in the pancreas secrete ghrelin?
A
Epsilon
6
Q
What cells in the pancreas secrete somatostatin?
A
Delta
7
Q
What cells in the pancreas secrete pancreatic polypeptide?
A
Gamma
8
Q
What has more function in the pancreas; endocrine or exocrine?
A
Exocrine function (98% of pancreatic tissue)
9
Q
How does HCO3 play a role in exocrine function of the pancreas?
A
Sodium bicarb in secretions helps to neutralize stomach acid as it enters through the duodenum
10
Q
What are the two important proteins that the pancreas secretes to help digest?
A
Trypsin and chymotrypsin
11
Q
What are the lipids that the pancreas secretes to help digest?
A
Lipase and lecithinase
12
Q
What is the carbohydrate that the pancreas secretes to help digest?
A
Amylase
13
Q
What is the nuclease that the pancreas secretes to help digest?
A
Ribonuclease
14
Q
What is secreted to help regulate the digestion of increased lipids and fats?
A
Cholecystokinin (CCK)
15
Q
What is secreted to stimulate NaCO3 while stomach is forming food bolus to neutralize stomach acid?
A
Secretin and gastrin
16
Q
All exocrine diseases decrease pancreas activity and are associated with ___________.
A
Steatorrhea
17
Q
Exocrine pancreatic diseases
A
Cystic fibrosis, pancreatitis, pancreatic carcinoma
18
Q
Endocrine pancreatic diseases
A
Diabetes mellitus
19
Q
Steatorrhea
A
Inability to properly digest and absorb fats so they accumulate inside GI lumen and fats are present in stool
20
Q
What mutation causes CF?
A
CFTR gene on chromosome 7 (autosomal recessive)
21
Q
How does CF relate to pancreas?
A
Dysfunction of mucosal ducts of exocrine glands throughout the body - blockages of mucosal surfaces occur in lungs and bowel
22
Q
What is ZE syndrome?
A
Gastrinoma that results in the overproduction of gastrin, stimulating the stomach to increase stomach acid production. Results in peptic ulcers and stomach cancer due to very decreased stomach pH
23
Q
What are the lab findings associated with acute pancreatitis?
A
Increased amylase
Increased lipase
Increased triglycerides
Hypercalcemia
24
Q
What is pancreatitis often associated with?
A
Alcoholism, gallstone formation, hyperparathyroidism
25
What is pancreatitis?
Inflammation of the pancreas as a result of reflux of pancreatic fluid from the common bile duct back into pancreatic tissue --> autodigestion and tissue breakdown
26
What is measured during the CCK test?
pH, bile flow rate, enzyme function, NaCO3 levels
27
What lab values with the CCK test are associated with pancreatic/bile duct obstruction?
Decreased flow rate
Increased enzyme concentrations
28
What lab values with the CCK test are associated with cystic fibrosis or pancreatitis?
Low NaCO3 and low enzymes
29
What lab value indicates steatorrhea?
>7g of fecal fat in 24 hours
30
In exocrine pancreatic insufficiency, fecal fats are _______, fecal enzymes are _______.
increased; decreased
31
What lab value for the sweat test are diagnostic for CF?
>60 mmol/L
32
What is the most sensitive lab test to assess pancreatitis?
Lipase
33
What lab values are measured for the serum enzyme test to determine if patient is suffering from pancreatitis vs biliary obstruction vs liver disease vs bone disorders/fractures?
AST, ALT, Amylase, Lipase, and GGT
34
What lab values from the serum enzyme test will be increased during a liver disorder?
AST and ALT
35
What lab values from the serum enzyme test will be increased during pancreatic issues?
Lipase and Amylase
36
What lab values from the serum enzyme test will be increased for bone diseases?
GGT only
37
What lab values from the serum enzyme test will be increased for biliary obstruction?
GGT with normal ALP
38
What can the serum enzyme test values be compared with for improved sensitivity with disease/morbidity assessment?
Haptoglobin, direct/indirect bilirubin, and hemoglobin
39
Order of the 3 protective layers of the brain and spinal cord
Dura mater (outermost)
Arachnoid mater
Pia mater (inner most)
40
During the collection of CSF, tube 1 goes where and is stored how?
Chemistry, may be frozen
41
During the collection of CSF, tube 2 goes where and is stored how?
Microbiology at RT
42
During the collection of CSF, tube 3 goes where and is stored how?
Hematology, refrigerated
43
During the collection of CSF, tube 4 goes where and is stored how?
Spare/extra kept at RT
44
Cloudy CSF is indicative of
increased protein or cells
45
Red CSF is indicative of
Erythrocyte contamination
46
Yellow CSF is indicative of
Xanthochromia; accumulation of bilirubin
47
Clotted CSF is indicative of
blood contamination during collection process
48
Traumatic tap vs intracranial hemorrhage: comparing tubes 1 through 4 colors
If color is fading/diluted from tube 1 to tube 4 = traumatic tap
If color is constant from tube 1 to tube 4 = intracranial hemorrhage
49
Traumatic tap vs intracranial hemorrhage: appearance before and after centrifugation
If pre centrifuge is red and post centrifuge is clear = traumatic tap
If pre centrifuge is red and post centrifuge is red = intracranial hemorrhage
If pre centrifuge is yellow/red and post centrifuge is yellow/pink/red = hemorrhage
50
Traumatic tap vs intracranial hemorrhage: presence of fibrinogen and clotting factors
If CSF sample is clotted = traumatic tap
If CSF sample is red but not clotted = might be hemorrhage and could contain hemosiderin and hematoidin crystals; evaluate with supernatant and color assessments
51
Normal CSF glucose is ________ % less than the value of blood glucose levels.
60-70%
52
Increase in CSF glucose =
clinically insignificant
53
Decrease in CSF glucose =
bacterial or fungal meningitis, hypoglycemia, or hypoglycorrhachia
54
Decreased CSF protein =
hypoproteinemia, CSF leakage or tear (detect by loss of CSF B-transferring which will be decreased B globulin region on electrophoresis)
55
Increased CSF protein =
traumatic tap, disrupted BBB, monoclonal gammopathy, multiple sclerosis, or cancer
56
________ and _________ are the dominating proteins under normal circumstances in CSF.
Albumin and prealbumin
57
What lab test would you evaluate to determine if the BBB is intact? What do these values mean?
CSF/Serum Albumin Index
If the index is >9, the BBB is disrupted (more albumin in CSF than serum)
If the index is <9, the BBB is intact (more albumin in serum)
58
What is the formula for CSF/Serum Albumin Index?
CSF albumin/Serum albumin
59
If IgG is increased in CSF, the IgG index is used. What is the formula?
(CSF IgG/serum IgG)/(CSF albumin/serum albumin)
60
Describe the lab values associated with IgG index
IgG index >0.73 = IgG being made within the CNS like with multiple sclerosis or SSPE or bacterial meningitis
IgG index <0.73 = normal
61
What will multiple sclerosis patients look like with electrophoresis?
Increased gamma globulin (oligoclonal banding)
62
What protein is present in those with neurogenerative disorders such as alzheimer's and dementia?
Tau protein
63
Increased lactate and decreased glucose is highly suggestive of __________.
bacterial meningitis
64
Increased lactate and normal glucose is highly suggestive of __________.
viral meningitis
65
Glutamine is an indirect measure of _____ levels in CSF. Increased gluatmine is associated with?
NH3; hepatic encephalopathy
66
Transudate
Type of effusion due to systemic disorders that disrupt capillary blood flow and osmotic pressures (congestive heart failure, hepatic cirrhosis, and nephrotic syndrome, hypoproteinemia)
67
Transudative fluids tend to have _______ cells and ____ specific gravity.
decreased, low
68
Exudate
Type of effusion characterized by direct inflammatory or disease processes that affect the heart, lungs, or peritoneal cavity
69
Exudative fluids have _____ cell counts, ____ protein, and _____ specific gravity.
high, high, high
70
Thoracentesis is the removal of pleural fluid if an effusion is suspected. What is used to remove the pleural fluid for microbiology, cellular microscopy, and metabolism?
Microbiology: heparinized synringes
Cellular microscopy: EDTA
Metabolism: NaF (glucose and lactate)
71
Transudates are associated with
CHF, hypoproteinemia
72
Exudates are associated with
Infections/cancer/COPD
73
Formula for SAAG
Serum albumin - Ascites albumin
74
SAAG values interpreted
SAAG of 1.1 or up = transudative
SAAG <1.1 = exudative
75
Values of the L/S ratio to determine FLM
L/S ratio >2 = mature lungs
L/S ratio <2 = immature lungs
76
When is phosphatidylglycerol test used to assess FLM?
With gestational diabetic mothers
77
If a mother has gestational diabetes and her L/S ratio is >2, but she has decreased phosphatidylglycerol, does the fetus have matured lungs?
No
78
Lamellar body test to assess FLM
>50,000 lamellar bodies = suggestive of mature lungs
<15,000 lamellar bodies = suggestive of immature lungs
79
What is the gold standard for FLM assessment for surfactant levels?
L/S ratio (lecithin and sphingomyelin levels)
80
Important lab values for group I, noninflammatory synovial fluid disorder
yellow/slightly cloudy
decreased viscosity
fair mucin clot
<1000 WBCs, <30% neutrophils
81
Important lab values for group II, inflammatory synovial fluid disorders
white/gray/yellow/turbid
no viscosity
poor mucin clot
<100,000 WBCs, >50% neutrophils
82
Important lab values for group III, septic synovial fluid disorders
yellow/green/cloudy/purulent
no viscosity
poor mucin clot
50,000-200,000 WBCs >90% neutrophils
20-100 glucose blood
positive cultures
83
Important lab values for group IV, crystal induced synovial fluid disorders
white/cloudy/turbid/milky
no viscosity
poor mucin clot
500-200,000 WBCs <90% neutrophils
crystals present
84
Important lab values for group V, hemorrhagic synovial fluid disorders
xanthochromic, red, brown, cloudy
no viscosity
poor mucin clot
50-10,000 WBCs <50% neutrophils
RBCs present
85
MSU crystals in synovial fluid are useful to identify _____.
Gout
86
CPPD crystals in synovial fluid are useful to identify _______.
pseudogout
87
Synovial fluid testing and acceptability
Total protein should be 1-3 g/dL
Normal glucose levels are 10% less than fasting glucose levels
Uric acid crystals present
Lactic acid <25
88
What is aluminum toxicity associated with?
Encephalopathy and alzheimer's
89
Organic vs methylated/inorganic arsenic
organic arsenic = OK, ingested in food
inorganic arsenic = acutely toxic
90
Arsenic toxicity presents as
N/V/D, CNS impairment leading to "sock and glove" neuropathy, anemia, BM failure
91
Highest source of cadmium
Fossil fuels and municipal waste
92
Highest exposure risks for chromium
Steel plants, wood treatment, chrome plants, leather tanning
93
Cr3+ vs Cr6+
Cr3+ = essential dietary element to increase insulin activity
Cr6+ = associated with cancer
94
Copper is essential T/F
True
95
Chromium is essential T/F
Cr3+ is essential not Cr6+
96
What is the Cu transporter?
Ceruloplasmin
97
Menke's disease
Copper deficiency with high fatality rates for neonates with steely/kinky hair
98
Wilson's disease
Genetic mutation of overaccumulation of copper that deposits in eyes, CNS, skin, liver, heart, due to loss of ceruloplasmin
99
What disease is associated with Kayser-Fleischer rings of the iris?
Wilson's disease
100
Wilson's disease serum copper vs urine copper
Serum copper = normal or decreased
Urine copper = increased
101
Menke's disease serum copper vs urine copper
Serum copper = decreased
Urine copper = increased
102
Increased hepcidin levels = ______ serum iron
Decreased
103
Decreased hepcidin levels = _______ serum iron
Increased
104
The majority of iron is used for ________
hemoglobin
105
Iron is stored as ______ and ________ within the BM, spleen, and liver
Ferritin and hemosiderin
106
Primary transport protein for iron in the blood
Transferrin
107
Iron study values for IDA patients
Decreased ferritin
Decreased TSAT
Increased TIBC
Increased transferrin
Decreased serum iron
108
Iron study values for HH patients
Increased ferritin
Increased TSAT
Decreased TIBC
Decreased transferrin
Increased serum iron
109
What happens when lead gets inside the body?
90% goes inside RBCs and interferes with heme synthesis, increase in protoporphyrin levels
110
Lead toxicity
CNS involvement
111
Manganese is essential T/F
True
112
Lead is essential T/F
False
113
Manganese toxicity is associated with
Compulsive laughing/crying (manganese madness)
Memory loss
Disorientation
114
Low manganese is associated with
Blood clotting disorders
Dermatitis
Affects organs like heart, bone, joints
115
Mercury is essential T/F
False - it should not be present
116
What was mercury historically used for? What can it still be found in today?
Historically - treat syphilis, used in eye cosmetics
Still found today in OTC drugs, diaper rash creams, tattoo pigments
117
T/F liquid mercury is more toxic than vaporized mercury
False
118
T/F Molybdenum is essential
Tru
119
Molybdenum toxicity
Arthritis symptoms with increased uric acid crystals and higher incidence of gout
120
Selenium is essential T/F
True
121
Role of selenium discovered recently
Can be anticarcinogenic
122
Keshan disease
Deficiency of selenium; cardiomyopathy
123
Kashin-Beck disease
Deficiency of selenium; osteoarthritis
124
Selenium toxicity
Tachycardia; hair skin and nail changes
125
What is used to treat wilsons disease?
Zinc
126
What is the first and second most abundant trace metal?
Iron and zinc respectively
127
Most zinc is found where?
Muscle and skeletal bone
128
Zinc is essential T/F
True
129
Zinc deficiency
Growth retardation
130
Water soluble vitamins
Vitamins B and C (excreted in urine when saturated)
131
Fat soluble vitamins
D, E, A, K (can become toxic at increased levels)
132
Deficiency of Vitamin A can lead to:
Night blindness
133
Deficiency of Vitamin D can lead to:
Rickets (children)
Osteomalacia (adults)
134
Deficiency of Vitamin E can lead to:
Hemolytic anemia, chronic cholestasis
135
Deficiency of Vitamin K can lead to:
Decreased ability to form blood clots
136
Deficiency of Vitamin B7 (Biotin) can lead to:
Damage and loss of hair, skin, nail health
137
Deficiency of Vitamin B3 (niacin) can lead to:
Pellagra
138
Deficiency of Vitamin B9 (folic acid) can lead to:
Megaloblastic anemia, neural tube defects
139
Deficiency of Vitamin B12 (cobalamin) can lead to:
Pernicious and megaloblastic anemia
140
Deficiency of Vitamin C can lead to:
Scurvy
141
What is considered to be an anti-aging vitamin?
Vitamin E
142
Vitamin E toxicity
Neonates can get necrotizing enterocolitis
143
Deficiency of Vitamin B1 (thiamine) can lead to:
Beriberi (can be due to chronic alcoholism)
144
What is a specialized transporter protein necessary for B12 uptake in the intestines?
Intrinsic factor
145
What is an essential coenzyme for hematopoiesis?
Vitamin B12 (cobalamin)
146
5 characteristics of ALL enzymes
- Increase rate of reaction
- Do not increase/decrease amount of product
- Dependent upon temp, saturation, and affinity of its substrate
- Not consumed or destroyed
- Drive irreversible reactions
147
Enzymes are mostly ________
Catabolic
148
Cofactors
Non-proteins, metals, and minerals to help enhance enzyme activity (ex. Iron)
149
Coenzymes
Tend to be organic compounds derived from vitamins (ex. NADH)
150
Apoenzymes
Protein-only component of an enzyme without cofactors or coenzymes
151
Holoenzyme
An enzyme with a protein component and cofactors/coenzymes
152
Cofactors are _______ bound, while coenzymes are ________ bound.
Ionically/Covalently
153
Zymogen
Inactive version of an enzyme that must be cleaved to become active
154
Enzymes help with ______________ reactions to _________ efficiency in biological systems by ________ the activation energy.
Non-spontaneous, increase, decrease
155
First order kinetics
In low concentrations, the reaction is dependent upon substrate concentrations and is directly correlated with enzyme activity. (Decrease substrate = decrease enzyme activity)
156
Zero order kinetics
In high concentrations, the reaction rate is solely dependent upon the enzyme concentration as all enzymes are fully saturated and cannot work any faster unless more enzymes were added.
157
What is Km?
50% of max velocity achieved for specific enzyme
(Km is a constant for specific enzyme)
158
Second order kinetics
Depends on concentrations of two different substrates to produce a product
159
Vmax
Maximum velocity
160
On a graph, where does first order take place?
At Km (1/2 vmax)
161
On a graph, where does zero order take place?
At vmax
162
How does temperature affect enzymatic reactions?
Increasing temperature doubles the chemical reaction rate
Cold temperatures reversibly inactivate enzymes
163
Competitive inhibitors
Reversibly bind to the active site and stops enzyme activity
164
Uncompetitive inhibitors
Bind to the enzyme substrate complex but prevent release of finished product
165
Noncompetitive inhibitors
Reversibly bind to the allosteric site on enzyme and stop product formation, but substrate can still bind to the active site
166
Where does the inhibitor bind during competitive binding? How is Km and Vmax affected? Why?
Active Site
Km is increased; substrate is inhibited from binding to enzyme so we need more substrate
Vmax is unchanged; available enzyme is not changed
167
How is Km and Vmax affected during noncompetitive binding?
Allosteric Site
Km is unchanged; substrate is not inhibited from binding to enzyme
Vmax is decreased; less available enzyme
168
How are Km and Vmax affected during uncompetitive binding?
Enzyme/Substrate Complex
Km is decreased; need more substrate
Vmax is decreased; less available enzyme
169
What makes an ideal cardiac biomarker?
Released rapidly for earlier detection
Specific and sensitive
Rapid assay with low limit of detection to measure low concentrations
Persists in circulation for several data for late diagnostic time window
170
What 2 cardiac markers are most specific for MI (heart attack)?
Troponin and CK-MB
171
Isomers of CK and what part of the body they affect
CK-MB: heart muscles
CK-BB: brain
CK-MM: skeletal muscle
172
What is the earliest marker of AMI, but is not cardiac specific?
Myoglobin
173
Myoglobin sensitivity and specificity for AMI
high sensitivity, low specificity (not cardiac specific)
174
What is the most specific cardiac marker for a heart attack?
Troponin
175
What is the earliest cardiac specific marker of AMI?
Troponin
176
What cardiac marker stays elevated the longest during AMI?
Troponin
177
T/F any value of troponin in the body is abnormal
true
178
What is elevated in patients with CHF?
BNP
179
BNP hormone mainly released from __________ __________.
myocardial ventricles
180
More bnp = ______
worse condition of CHF
181
How to differentiate CHF from COPD?
Normal BNP in COPD, elevated BNP in CHF
182
CRP
acute phase reactant that may be elevated in cardiovascular diseases, but is not specific
183
Why is troponin a better cardio marker than CK-MB, AST, myoglobin, or LDH?
Specific to cardiac muscles, stays elevated the longest, should never be present unless heart damage
184
In what order (fastest to slowest) do the enzymes AST, CK, and LDH become elevated when an AMI occurs?
(MICTAL)
MI = CK, Troponin, AST, LDH
185
What does an increase of CK-MM associate with?
Heart (myocardial infarction)
Skeletal muscle (muscular dystrophy, muscle disorders)
186
What does an increase of CK-MB associate with?
Myocardial infarction
Skeletal muscle disorders such as duchenne type muscular dystrophy and Reye's syndrome
187
What does an increase of CK-BB associate with?
Brain CNS damage
188
Isomers of lactate dehydrogenase and what they are associated with
LD-1: heart and RBCs
LD-2: Heart and RBCs (normal LD present in plasma)
LD-3: lungs
LD-5: liver and skeletal muscle
189
What situations would AST be elevated?
100x elevated for cirrhosis and viral hepatitis
4x elevated by skeletal muscle damage/disorders
190
What situations would ALT be elevated?
Liver disorders - more sensitive marker for this than AST
191
What is the De Ritis Ratio and normal values
AST:ALT
Levels between 1 and 1.5 are ok.
>2 higher risk for liver disorder
192
What are increased ALP levels most associated with?
Liver disorders
Mostly biliary obstructions**
Bone disorders
193
What are increased levels of ACP most associated with?
Prostate cancers
194
When is GGT increased?
All cases of hepatobiliary obstruction
Liver disorders
195
What organ has the highest concentration of GGT?
Kidney
196
What color is positive for laboratory testing for AST/ALP/ALT?
Yellow is positive
Colorless is negative
197
What wavelength is measured for ALP testing?
405 nm
198
What wavelength is measured for ALT testing?
340 nm
