Practical Exam Flashcards
What are the causes of hypoproteinaemia?
(5)
Salt retention syndromes - increased water retention and apparent decrease in concentration
Liver disease - decreased production of proteins
Renal disease - increased loss in urine
Burns - increased loss of proteins in exudate
Malabsorption - decreased production through lack of essential amino acids
What are the causes of hyperproteinaemia
(3)
Dehydration - reduced water volume results in an apparent increase in protein concentration
Immune response -> increased production of all Ig due to an infection/inflammation
Multiple myeloma -> increased production of a single clone of Ig due to a neoplastic increase in plasma cells
List some diseases that may cause an increase in total protein
(8)
Chronic infection e.g. TB
Liver dysfunction
Dehydration (chronic diarrhea, diabetic acidosis)
Respiratory distress
Haemolysis
Cryoglobulinaemia
Alcoholism
Leukaemia
List some diseases that cause a decrease in total protein
(8)
Malnutrition and malabsorption
Liver disease
Diarrhea
Severe burns
Loss through urine in severe kidney disease
Low albumin
Low globulins
Pregnancy
What are the causes of decreased albumin
(9)
Decreased synthesis
- analbuminaemia
-hypoalbuminaemia
Increased catabolism
Increased loss
- Nephrotic syndrome
- Exudate loss in burns
- Haemorrhage
- Gut loss
Redistribution
- Haemodilution
- increased capillary permeability
- Decreased lymph clearance
List three abnormalities of albumin synthesis
Bisalbuminaemia -> genetic variant of albumin - no clinical consequences
Analbuminaemia -> low synthesis -> slight consequences e.g mild oedmea
Hyperalbuminaemia -> high albumin found only artefactually i.e. prolonged venous stasis, loss of protein free fluid - dehydration
Why measure albumin?
To find out if hyperproteinaemia is due to dehydration, hypergammaglobulinaemia, or high albumin
What are the diagnostic differences between dehydration and hypergammaglobulinaemia
Dehydration = high total protein and high albumin
Hypergammaglobulinaemia = high total protein and normal/low albumin
What does high total proteins, albumin and globulins indicate?
Dehydration
What does high total proteins, normal/low albumin and high globulins indicate
Immune response
What does very high total proteins, normal/low albumin and very high globulins indicate?
Multiple myeloma
What does low total proteins, albumin and globulins indicate
(5)
Liver disease (globulins might be normal)
Renal disease
Salt retention syndrome
Intestinal malabsorption
Burns
What does low total protein, normal albumin and low globulin indicate
Immune deficiency
Write a note on some of the important pieces of information on diabetes
(3)
GLUT4 = insulin responsive glucose transporter -> found in skeletal muscle, cardiac muscle, adipose tissue
Preproinsulin, proinsulin, insulin + C peptide
Insulin signalling promotes externalisation of preformed GLUT) -> receptor formed inside the cell but in diabetes no insulin produced so the receptor never gets the signal to be expressed on cell surface -> therefore glucose can not be transported into the cell
Write a note on some of the important pieces of information on diabetes
(3)
GLUT4 = insulin responsive glucose transporter -> found in skeletal muscle, cardiac muscle, adipose tissue
Preproinsulin, proinsulin, insulin + C peptide
Insulin signalling promotes externalisation of preformed GLUT) -> receptor formed inside the cell but in diabetes no insulin produced so the receptor never gets the signal to be expressed on cell surface -> therefore glucose can not be transported into the cell
Write a note on some of the important pieces of information on diabetes
(3)
GLUT4 = insulin responsive glucose transporter -> found in skeletal muscle, cardiac muscle, adipose tissue
Preproinsulin, proinsulin, insulin + C peptide
Insulin signalling promotes externalisation of preformed GLUT) -> receptor formed inside the cell but in diabetes no insulin produced so the receptor never gets the signal to be expressed on cell surface -> therefore glucose can not be transported into the cell
What is produced by the endocrine and exocrine parts of the pancrease
Endocrine = alpha cells = glucagon, beta cells = insulin of islets of Langerhans
Exocrine = digestive enzymes to duodenum through ducts
What hormones can raise blood glucose
Glucagon
Cortisol
Epinephrine
Growth hormone
What can be seen in increased blood glucose
Increased insulin
Decreased glucagon
Increased glycogenesis
Increased fatty acid synthesis
Decreased glycogenolysis
Decreased gluconeogenesis
What can be seen in starvation
(5)
Insulin down
Glucagon up
Glycogen depletion
Triglyceride catabolism and ketone formation
Protein breakdown and gluconeogenesis
List some causes of atypica/non immune diabetes
(6)
Genetic defects of beta-cell function
Genetic defects in insulin action
Diseases of the exocrine pancreas -> endocrinopathies
Drug/chemical induced
Infections
List some causes of atypica/non immune diabetes
(6)
Genetic defects of beta-cell function
Genetic defects in insulin action
Diseases of the exocrine pancreas -> endocrinopathies
Drug/chemical induced
Infections
List some causes of atypica/non immune diabetes
(6)
Genetic defects of beta-cell function
Genetic defects in insulin action
Diseases of the exocrine pancreas -> endocrinopathies
Drug/chemical induced
Infections
What are the main causes of renal failure
Pre- renal e.g. decreased ECFV or MI
Renal e.g. acute tubular necrosis
Postrenal e.g. ureteral obstruction (stones)
What are the main causes of renal failure
Pre- renal e.g. decreased ECFV or MI
Renal e.g. acute tubular necrosis
Postrenal e.g. ureteral obstruction (stones)
What is renal failure
A deterioration in renal function leading to a complex of symptoms and signs
Why is bilirubin measured
(2)
Determining jaundice
Distinguishing conjugated from unconjugated hyperbilirubinaemia -> if unconjugated is high then there is a problem with conjugation in the liver -> high conjugated bilirubin indicated cholestasis
Why is ALP measured
To diagnose cholestasis
Why is ALP measured
To diagnose cholestasis
Why is AST measured
Diagnosing hepatocellular damage
AST>ALT in alcoholic disease, cirrhosis
Why is ALT measured
Diagnosing hepatocellular disease
Why is albumin measured in a liver profile
As an indication of how chronic, severe the condition
Why is prothrombin time measured in a liver profile
Indication of severity -> lack of coagulation factors
Write a note on dyslipidemia
(4)
A consequence of abnormal liporoprotein metabolism - high lipid levels
Elevated total cholesterol, elevated LDL, elevated triglycerides, decreased HDL
Primary - Caused by gene mutations -> problems with production or clearance of lipids
Secondary - caused by sedentary life and poor diet
What are the affects of hypercholesterolemia
Major risk factor for coronary heart disease
- cholesterol deposited along walls of blood vessels -> LDL is a key player
- impedes blood flow -> tissues starved of oxygen start to die -> angina/heart attack
What increases your chances of coronary heart disease
Smoking
High blood pressure
High blood cholesterol
Physical inactivity
Write a note on primary hyperlipidaemias
e.g. chylomicron syndrome
inability to clear chylomicrons from circulation -> CMs are high in TAGs which leads to profound hypertriglyceridaemia
-> leads to xanthomata -> lipids bursting out
-> treated with low fat diet
