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Chemistry > Exam 9 (Vitamins, Minerals, Body Fluids, Enzymes) > Flashcards

Exam 9 (Vitamins, Minerals, Body Fluids, Enzymes) Flashcards

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1
Q

What are the major hormones involved in pancreatic endocrine function?

A

Glucagon and insulin

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2
Q

What are the major enzymes involved in pancreatic exocrine function?

A

Amylase, lipase, and HCO3

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3
Q

What cells in the pancreas secrete insulin?

A

Beta cells

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4
Q

What cells in the pancreas secrete glucagon?

A

Alpha cells

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5
Q

What cells in the pancreas secrete ghrelin?

A

Epsilon

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6
Q

What cells in the pancreas secrete somatostatin?

A

Delta

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7
Q

What cells in the pancreas secrete pancreatic polypeptide?

A

Gamma

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8
Q

What has more function in the pancreas; endocrine or exocrine?

A

Exocrine function (98% of pancreatic tissue)

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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

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10
Q

What are the two important proteins that the pancreas secretes to help digest?

A

Trypsin and chymotrypsin

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11
Q

What are the lipids that the pancreas secretes to help digest?

A

Lipase and lecithinase

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12
Q

What is the carbohydrate that the pancreas secretes to help digest?

A

Amylase

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13
Q

What is the nuclease that the pancreas secretes to help digest?

A

Ribonuclease

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14
Q

What is secreted to help regulate the digestion of increased lipids and fats?

A

Cholecystokinin (CCK)

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15
Q

What is secreted to stimulate NaCO3 while stomach is forming food bolus to neutralize stomach acid?

A

Secretin and gastrin

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16
Q

All exocrine diseases decrease pancreas activity and are associated with ___________.

A

Steatorrhea

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17
Q

Exocrine pancreatic diseases

A

Cystic fibrosis, pancreatitis, pancreatic carcinoma

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18
Q

Endocrine pancreatic diseases

A

Diabetes mellitus

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19
Q

Steatorrhea

A

Inability to properly digest and absorb fats so they accumulate inside GI lumen and fats are present in stool

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20
Q

What mutation causes CF?

A

CFTR gene on chromosome 7 (autosomal recessive)

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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

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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

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23
Q

What are the lab findings associated with acute pancreatitis?

A

Increased amylase
Increased lipase
Increased triglycerides
Hypercalcemia

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24
Q

What is pancreatitis often associated with?

A

Alcoholism, gallstone formation, hyperparathyroidism

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25
Q

What is pancreatitis?

A

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

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26
Q

What is measured during the CCK test?

A

pH, bile flow rate, enzyme function, NaCO3 levels

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27
Q

What lab values with the CCK test are associated with pancreatic/bile duct obstruction?

A

Decreased flow rate
Increased enzyme concentrations

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28
Q

What lab values with the CCK test are associated with cystic fibrosis or pancreatitis?

A

Low NaCO3 and low enzymes

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29
Q

What lab value indicates steatorrhea?

A

> 7g of fecal fat in 24 hours

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30
Q

In exocrine pancreatic insufficiency, fecal fats are _______, fecal enzymes are _______.

A

increased; decreased

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31
Q

What lab value for the sweat test are diagnostic for CF?

A

> 60 mmol/L

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32
Q

What is the most sensitive lab test to assess pancreatitis?

A

Lipase

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33
Q

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?

A

AST, ALT, Amylase, Lipase, and GGT

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34
Q

What lab values from the serum enzyme test will be increased during a liver disorder?

A

AST and ALT

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35
Q

What lab values from the serum enzyme test will be increased during pancreatic issues?

A

Lipase and Amylase

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36
Q

What lab values from the serum enzyme test will be increased for bone diseases?

A

GGT only

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37
Q

What lab values from the serum enzyme test will be increased for biliary obstruction?

A

GGT with normal ALP

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38
Q

What can the serum enzyme test values be compared with for improved sensitivity with disease/morbidity assessment?

A

Haptoglobin, direct/indirect bilirubin, and hemoglobin

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39
Q

Order of the 3 protective layers of the brain and spinal cord

A

Dura mater (outermost)
Arachnoid mater
Pia mater (inner most)

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40
Q

During the collection of CSF, tube 1 goes where and is stored how?

A

Chemistry, may be frozen

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41
Q

During the collection of CSF, tube 2 goes where and is stored how?

A

Microbiology at RT

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42
Q

During the collection of CSF, tube 3 goes where and is stored how?

A

Hematology, refrigerated

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43
Q

During the collection of CSF, tube 4 goes where and is stored how?

A

Spare/extra kept at RT

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44
Q

Cloudy CSF is indicative of

A

increased protein or cells

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45
Q

Red CSF is indicative of

A

Erythrocyte contamination

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46
Q

Yellow CSF is indicative of

A

Xanthochromia; accumulation of bilirubin

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47
Q

Clotted CSF is indicative of

A

blood contamination during collection process

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48
Q

Traumatic tap vs intracranial hemorrhage: comparing tubes 1 through 4 colors

A

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

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49
Q

Traumatic tap vs intracranial hemorrhage: appearance before and after centrifugation

A

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

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50
Q

Traumatic tap vs intracranial hemorrhage: presence of fibrinogen and clotting factors

A

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

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51
Q

Normal CSF glucose is ________ % less than the value of blood glucose levels.

A

60-70%

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52
Q

Increase in CSF glucose =

A

clinically insignificant

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53
Q

Decrease in CSF glucose =

A

bacterial or fungal meningitis, hypoglycemia, or hypoglycorrhachia

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54
Q

Decreased CSF protein =

A

hypoproteinemia, CSF leakage or tear (detect by loss of CSF B-transferring which will be decreased B globulin region on electrophoresis)

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55
Q

Increased CSF protein =

A

traumatic tap, disrupted BBB, monoclonal gammopathy, multiple sclerosis, or cancer

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56
Q

________ and _________ are the dominating proteins under normal circumstances in CSF.

A

Albumin and prealbumin

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57
Q

What lab test would you evaluate to determine if the BBB is intact? What do these values mean?

A

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)

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58
Q

What is the formula for CSF/Serum Albumin Index?

A

CSF albumin/Serum albumin

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59
Q

If IgG is increased in CSF, the IgG index is used. What is the formula?

A

(CSF IgG/serum IgG)/(CSF albumin/serum albumin)

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60
Q

Describe the lab values associated with IgG index

A

IgG index >0.73 = IgG being made within the CNS like with multiple sclerosis or SSPE or bacterial meningitis

IgG index <0.73 = normal

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61
Q

What will multiple sclerosis patients look like with electrophoresis?

A

Increased gamma globulin (oligoclonal banding)

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62
Q

What protein is present in those with neurogenerative disorders such as alzheimer’s and dementia?

A

Tau protein

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63
Q

Increased lactate and decreased glucose is highly suggestive of __________.

A

bacterial meningitis

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64
Q

Increased lactate and normal glucose is highly suggestive of __________.

A

viral meningitis

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65
Q

Glutamine is an indirect measure of _____ levels in CSF. Increased gluatmine is associated with?

A

NH3; hepatic encephalopathy

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66
Q

Transudate

A

Type of effusion due to systemic disorders that disrupt capillary blood flow and osmotic pressures (congestive heart failure, hepatic cirrhosis, and nephrotic syndrome, hypoproteinemia)

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67
Q

Transudative fluids tend to have _______ cells and ____ specific gravity.

A

decreased, low

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68
Q

Exudate

A

Type of effusion characterized by direct inflammatory or disease processes that affect the heart, lungs, or peritoneal cavity

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69
Q

Exudative fluids have _____ cell counts, ____ protein, and _____ specific gravity.

A

high, high, high

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70
Q

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?

A

Microbiology: heparinized synringes
Cellular microscopy: EDTA
Metabolism: NaF (glucose and lactate)

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71
Q

Transudates are associated with

A

CHF, hypoproteinemia

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72
Q

Exudates are associated with

A

Infections/cancer/COPD

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73
Q

Formula for SAAG

A

Serum albumin - Ascites albumin

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74
Q

SAAG values interpreted

A

SAAG of 1.1 or up = transudative
SAAG <1.1 = exudative

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75
Q

Values of the L/S ratio to determine FLM

A

L/S ratio >2 = mature lungs
L/S ratio <2 = immature lungs

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76
Q

When is phosphatidylglycerol test used to assess FLM?

A

With gestational diabetic mothers

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77
Q

If a mother has gestational diabetes and her L/S ratio is >2, but she has decreased phosphatidylglycerol, does the fetus have matured lungs?

A

No

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78
Q

Lamellar body test to assess FLM

A

> 50,000 lamellar bodies = suggestive of mature lungs
<15,000 lamellar bodies = suggestive of immature lungs

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79
Q

What is the gold standard for FLM assessment for surfactant levels?

A

L/S ratio (lecithin and sphingomyelin levels)

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80
Q

Important lab values for group I, noninflammatory synovial fluid disorder

A

yellow/slightly cloudy
decreased viscosity
fair mucin clot
<1000 WBCs, <30% neutrophils

81
Q

Important lab values for group II, inflammatory synovial fluid disorders

A

white/gray/yellow/turbid
no viscosity
poor mucin clot
<100,000 WBCs, >50% neutrophils

82
Q

Important lab values for group III, septic synovial fluid disorders

A

yellow/green/cloudy/purulent
no viscosity
poor mucin clot
50,000-200,000 WBCs >90% neutrophils
20-100 glucose blood
positive cultures

83
Q

Important lab values for group IV, crystal induced synovial fluid disorders

A

white/cloudy/turbid/milky
no viscosity
poor mucin clot
500-200,000 WBCs <90% neutrophils
crystals present

84
Q

Important lab values for group V, hemorrhagic synovial fluid disorders

A

xanthochromic, red, brown, cloudy
no viscosity
poor mucin clot
50-10,000 WBCs <50% neutrophils
RBCs present

85
Q

MSU crystals in synovial fluid are useful to identify _____.

A

Gout

86
Q

CPPD crystals in synovial fluid are useful to identify _______.

A

pseudogout

87
Q

Synovial fluid testing and acceptability

A

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
Q

What is aluminum toxicity associated with?

A

Encephalopathy and alzheimer’s

89
Q

Organic vs methylated/inorganic arsenic

A

organic arsenic = OK, ingested in food
inorganic arsenic = acutely toxic

90
Q

Arsenic toxicity presents as

A

N/V/D, CNS impairment leading to “sock and glove” neuropathy, anemia, BM failure

91
Q

Highest source of cadmium

A

Fossil fuels and municipal waste

92
Q

Highest exposure risks for chromium

A

Steel plants, wood treatment, chrome plants, leather tanning

93
Q

Cr3+ vs Cr6+

A

Cr3+ = essential dietary element to increase insulin activity
Cr6+ = associated with cancer

94
Q

Copper is essential T/F

A

True

95
Q

Chromium is essential T/F

A

Cr3+ is essential not Cr6+

96
Q

What is the Cu transporter?

A

Ceruloplasmin

97
Q

Menke’s disease

A

Copper deficiency with high fatality rates for neonates with steely/kinky hair

98
Q

Wilson’s disease

A

Genetic mutation of overaccumulation of copper that deposits in eyes, CNS, skin, liver, heart, due to loss of ceruloplasmin

99
Q

What disease is associated with Kayser-Fleischer rings of the iris?

A

Wilson’s disease

100
Q

Wilson’s disease serum copper vs urine copper

A

Serum copper = normal or decreased
Urine copper = increased

101
Q

Menke’s disease serum copper vs urine copper

A

Serum copper = decreased
Urine copper = increased

102
Q

Increased hepcidin levels = ______ serum iron

A

Decreased

103
Q

Decreased hepcidin levels = _______ serum iron

A

Increased

104
Q

The majority of iron is used for ________

A

hemoglobin

105
Q

Iron is stored as ______ and ________ within the BM, spleen, and liver

A

Ferritin and hemosiderin

106
Q

Primary transport protein for iron in the blood

A

Transferrin

107
Q

Iron study values for IDA patients

A

Decreased ferritin
Decreased TSAT
Increased TIBC
Increased transferrin
Decreased serum iron

108
Q

Iron study values for HH patients

A

Increased ferritin
Increased TSAT
Decreased TIBC
Decreased transferrin
Increased serum iron

109
Q

What happens when lead gets inside the body?

A

90% goes inside RBCs and interferes with heme synthesis, increase in protoporphyrin levels

110
Q

Lead toxicity

A

CNS involvement

111
Q

Manganese is essential T/F

A

True

112
Q

Lead is essential T/F

A

False

113
Q

Manganese toxicity is associated with

A

Compulsive laughing/crying (manganese madness)
Memory loss
Disorientation

114
Q

Low manganese is associated with

A

Blood clotting disorders
Dermatitis
Affects organs like heart, bone, joints

115
Q

Mercury is essential T/F

A

False - it should not be present

116
Q

What was mercury historically used for? What can it still be found in today?

A

Historically - treat syphilis, used in eye cosmetics
Still found today in OTC drugs, diaper rash creams, tattoo pigments

117
Q

T/F liquid mercury is more toxic than vaporized mercury

A

False

118
Q

T/F Molybdenum is essential

A

Tru

119
Q

Molybdenum toxicity

A

Arthritis symptoms with increased uric acid crystals and higher incidence of gout

120
Q

Selenium is essential T/F

A

True

121
Q

Role of selenium discovered recently

A

Can be anticarcinogenic

122
Q

Keshan disease

A

Deficiency of selenium; cardiomyopathy

123
Q

Kashin-Beck disease

A

Deficiency of selenium; osteoarthritis

124
Q

Selenium toxicity

A

Tachycardia; hair skin and nail changes

125
Q

What is used to treat wilsons disease?

A

Zinc

126
Q

What is the first and second most abundant trace metal?

A

Iron and zinc respectively

127
Q

Most zinc is found where?

A

Muscle and skeletal bone

128
Q

Zinc is essential T/F

A

True

129
Q

Zinc deficiency

A

Growth retardation

130
Q

Water soluble vitamins

A

Vitamins B and C (excreted in urine when saturated)

131
Q

Fat soluble vitamins

A

D, E, A, K (can become toxic at increased levels)

132
Q

Deficiency of Vitamin A can lead to:

A

Night blindness

133
Q

Deficiency of Vitamin D can lead to:

A

Rickets (children)
Osteomalacia (adults)

134
Q

Deficiency of Vitamin E can lead to:

A

Hemolytic anemia, chronic cholestasis

135
Q

Deficiency of Vitamin K can lead to:

A

Decreased ability to form blood clots

136
Q

Deficiency of Vitamin B7 (Biotin) can lead to:

A

Damage and loss of hair, skin, nail health

137
Q

Deficiency of Vitamin B3 (niacin) can lead to:

A

Pellagra

138
Q

Deficiency of Vitamin B9 (folic acid) can lead to:

A

Megaloblastic anemia, neural tube defects

139
Q

Deficiency of Vitamin B12 (cobalamin) can lead to:

A

Pernicious and megaloblastic anemia

140
Q

Deficiency of Vitamin C can lead to:

A

Scurvy

141
Q

What is considered to be an anti-aging vitamin?

A

Vitamin E

142
Q

Vitamin E toxicity

A

Neonates can get necrotizing enterocolitis

143
Q

Deficiency of Vitamin B1 (thiamine) can lead to:

A

Beriberi (can be due to chronic alcoholism)

144
Q

What is a specialized transporter protein necessary for B12 uptake in the intestines?

A

Intrinsic factor

145
Q

What is an essential coenzyme for hematopoiesis?

A

Vitamin B12 (cobalamin)

146
Q

5 characteristics of ALL enzymes

A
  • 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
Q

Enzymes are mostly ________

A

Catabolic

148
Q

Cofactors

A

Non-proteins, metals, and minerals to help enhance enzyme activity (ex. Iron)

149
Q

Coenzymes

A

Tend to be organic compounds derived from vitamins (ex. NADH)

150
Q

Apoenzymes

A

Protein-only component of an enzyme without cofactors or coenzymes

151
Q

Holoenzyme

A

An enzyme with a protein component and cofactors/coenzymes

152
Q

Cofactors are _______ bound, while coenzymes are ________ bound.

A

Ionically/Covalently

153
Q

Zymogen

A

Inactive version of an enzyme that must be cleaved to become active

154
Q

Enzymes help with ______________ reactions to _________ efficiency in biological systems by ________ the activation energy.

A

Non-spontaneous, increase, decrease

155
Q

First order kinetics

A

In low concentrations, the reaction is dependent upon substrate concentrations and is directly correlated with enzyme activity. (Decrease substrate = decrease enzyme activity)

156
Q

Zero order kinetics

A

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
Q

What is Km?

A

50% of max velocity achieved for specific enzyme
(Km is a constant for specific enzyme)

158
Q

Second order kinetics

A

Depends on concentrations of two different substrates to produce a product

159
Q

Vmax

A

Maximum velocity

160
Q

On a graph, where does first order take place?

A

At Km (1/2 vmax)

161
Q

On a graph, where does zero order take place?

A

At vmax

162
Q

How does temperature affect enzymatic reactions?

A

Increasing temperature doubles the chemical reaction rate
Cold temperatures reversibly inactivate enzymes

163
Q

Competitive inhibitors

A

Reversibly bind to the active site and stops enzyme activity

164
Q

Uncompetitive inhibitors

A

Bind to the enzyme substrate complex but prevent release of finished product

165
Q

Noncompetitive inhibitors

A

Reversibly bind to the allosteric site on enzyme and stop product formation, but substrate can still bind to the active site

166
Q

Where does the inhibitor bind during competitive binding? How is Km and Vmax affected? Why?

A

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
Q

How is Km and Vmax affected during noncompetitive binding?

A

Allosteric Site

Km is unchanged; substrate is not inhibited from binding to enzyme

Vmax is decreased; less available enzyme

168
Q

How are Km and Vmax affected during uncompetitive binding?

A

Enzyme/Substrate Complex

Km is decreased; need more substrate

Vmax is decreased; less available enzyme

169
Q

What makes an ideal cardiac biomarker?

A

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
Q

What 2 cardiac markers are most specific for MI (heart attack)?

A

Troponin and CK-MB

171
Q

Isomers of CK and what part of the body they affect

A

CK-MB: heart muscles
CK-BB: brain
CK-MM: skeletal muscle

172
Q

What is the earliest marker of AMI, but is not cardiac specific?

A

Myoglobin

173
Q

Myoglobin sensitivity and specificity for AMI

A

high sensitivity, low specificity (not cardiac specific)

174
Q

What is the most specific cardiac marker for a heart attack?

A

Troponin

175
Q

What is the earliest cardiac specific marker of AMI?

A

Troponin

176
Q

What cardiac marker stays elevated the longest during AMI?

A

Troponin

177
Q

T/F any value of troponin in the body is abnormal

A

true

178
Q

What is elevated in patients with CHF?

A

BNP

179
Q

BNP hormone mainly released from __________ __________.

A

myocardial ventricles

180
Q

More bnp = ______

A

worse condition of CHF

181
Q

How to differentiate CHF from COPD?

A

Normal BNP in COPD, elevated BNP in CHF

182
Q

CRP

A

acute phase reactant that may be elevated in cardiovascular diseases, but is not specific

183
Q

Why is troponin a better cardio marker than CK-MB, AST, myoglobin, or LDH?

A

Specific to cardiac muscles, stays elevated the longest, should never be present unless heart damage

184
Q

In what order (fastest to slowest) do the enzymes AST, CK, and LDH become elevated when an AMI occurs?

A

(MICTAL)
MI = CK, Troponin, AST, LDH

185
Q

What does an increase of CK-MM associate with?

A

Heart (myocardial infarction)
Skeletal muscle (muscular dystrophy, muscle disorders)

186
Q

What does an increase of CK-MB associate with?

A

Myocardial infarction
Skeletal muscle disorders such as duchenne type muscular dystrophy and Reye’s syndrome

187
Q

What does an increase of CK-BB associate with?

A

Brain CNS damage

188
Q

Isomers of lactate dehydrogenase and what they are associated with

A

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
Q

What situations would AST be elevated?

A

100x elevated for cirrhosis and viral hepatitis
4x elevated by skeletal muscle damage/disorders

190
Q

What situations would ALT be elevated?

A

Liver disorders - more sensitive marker for this than AST

191
Q

What is the De Ritis Ratio and normal values

A

AST:ALT
Levels between 1 and 1.5 are ok.
>2 higher risk for liver disorder

192
Q

What are increased ALP levels most associated with?

A

Liver disorders
Mostly biliary obstructions**
Bone disorders

193
Q

What are increased levels of ACP most associated with?

A

Prostate cancers

194
Q

When is GGT increased?

A

All cases of hepatobiliary obstruction
Liver disorders

195
Q

What organ has the highest concentration of GGT?

A

Kidney

196
Q

What color is positive for laboratory testing for AST/ALP/ALT?

A

Yellow is positive
Colorless is negative

197
Q

What wavelength is measured for ALP testing?

A

405 nm

198
Q

What wavelength is measured for ALT testing?

A

340 nm

Chemistry (12 decks)

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