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Clinical Science > Quiz 2: Diabetes and Cardiac > Flashcards

Quiz 2: Diabetes and Cardiac Flashcards

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1
Q

Who secretes insulin in response to glucose intake?

A

pancreatic beta cells

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2
Q

Type 1 diabetes:

A

acute onset of insulin deficiency, requires exogenous insulin administration

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3
Q

Type 2 diabetes:

A

more gradual onset which causes insulin uptake in cells to be impaired and slower destruction of beta cells in pancreas

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4
Q

Hemoglobin A is what percent of total Hgb?

A

98%

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5
Q

Hemoglobin A1 is what percent of Hemoglobin A?

A

7%

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6
Q

What are the three components of Hemoglobin A1:

A

A1a, A1b, A1c

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7
Q

Hemoglobin A1c makes up what percent of A1?

A

80% of A1

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8
Q

The average A1c is what?

A

5.6%

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9
Q

If you measure TOTAL hemoglobin A1 it is generally x% higher than just the hemoglobin A1c component?

A

2-4%

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10
Q

Hemoglobin A1c is the component of hemoglobin A1 that combines…

A

most easily and strongly with glucose

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11
Q

Non diabetic adult or child A1c

A

4-5.6%

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12
Q

Diagnosis of diabetes A1c:

A

> 6.5%

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13
Q

Our goal in patient care is to keep the diabetic patient’s HbA1c under?

A

7.0%

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14
Q

What is the average lifespan of a RBC?

A

100-120 days

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15
Q

HgbA1c percentage can be used to determine the patient’s glucose level over what period?

A

3-4 month

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16
Q

Mean plasma glucose:

A

(35.6 x HgbA1c) -77.3

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17
Q

Mean plasma glucose shows what?

A

uses hemoglobin A1c to let our patients know what their average daily glucose reading is

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18
Q

1% reduction in HbA1c reduces risk by what percent? Diabetes related deaths

A

21%

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19
Q

1% reduction in HbA1c reduces risk by what percent? MI

A

14%

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20
Q

1% reduction in HbA1c reduces risk by what percent? Microvascular complications

A

37%

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21
Q

1% reduction in HbA1c reduces risk by what percent? amputations or deaths

A

43%

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22
Q

Insulin is produced in?

A

pancreatic beta-cell

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23
Q

Insulin release facilitates the moment of glucose from?

A

circulatory system to the cell

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24
Q

When is insulin level helpful:

A

detection of an insulinoma or to find cause of hypoglycemia

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25
Q

Why is insulin level of the blood not always reflective of pancreatic beta-cell function?

A

it undergoes significant first pass metabolism by liver

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26
Q

Increased insulin:

A

insulinoma, obesity, early type 2 diabetes

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27
Q

Decreased insulin:

A

insulin-dependent diabetes (type 1 generally)

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28
Q

What is C-peptide?

A

a connecting protein

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29
Q

What does C-peptide connect?

A

the alpha and beta chains of proinsulin, which is the precursor of insulin

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30
Q

The chains of proinsulin separate in the?

A

beta cells of the Islet of lnagerhans within the pancreas

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31
Q

What is C-peptide useful for?

A

cause of hypoglycemia and distinguishing type 1 for type 2 diabetes

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32
Q

Does synthetic insulin contain c-peptide?

A

no

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33
Q

c-peptide in Type 1 diabetes:

A

low c-peptide

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34
Q

c-peptide in type 2 diabetes:

A

Normal or high c-peptide

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35
Q

Pancreatitis results from:

A

long term alcohol use or binge drinking, gallstones, trauma to pancreas, drug-induced

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36
Q

When is amylase ordered?

A

in the evaluation of abdominal pain and is specifically used to detect pancreatitis

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37
Q

Amylase is secreted from:

A

acinar cells of the pancreas

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38
Q

Amylase is involved in the catabolism of?

A

carbohydrates

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39
Q

When damage occurs to the acinar cells, amylase “pours out” into:

A

lymphatic system, free peritoneum, and circulatory system

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40
Q

Amylase level can return to normal within x hours of onset of illness or trauma, because it’s rapidly cleared by kidneys

A

12 hours

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41
Q

What can cause persistently elevated levels of amylase?

A

persistent or severe disease

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42
Q

Amylase increased in:

A

acute pancreatitis, chronic pancreatitis, pancreatic cancer, bile duct obstruction by gallstone, cholecystitis, renal failure, ectopic pregnancy, mumps

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43
Q

Aside from the pancreas, amylase can be found in:

A

Fallopian tubes, salivary glands, gallbladder

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44
Q

Lipase is used to diagnose:

A

pancreatitis in the evaluation of abdominal pain

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45
Q

Lipase is secreted by the

A

pancreas into the duodenum

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46
Q

Lipase is involved in the catabolism of:

A

triglycerides into fatty acids

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47
Q

Lipase is excreted via

A

kidneys

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48
Q

Who is lipase’s partner in crime?

A

amylase

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49
Q

Lipase often parallels rise in amylase, but may rise…

A

a little later and sticks around a little longer (5-7 days)

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50
Q

Lipase is useful to diagnose pancreatitis at:

A

a later stage

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51
Q

Uric acid is the end byproduct of:

A

purine nucleotide catabolism

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52
Q

Purines and pyrimidines are building blocks of?

A

DNA

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53
Q

Sources of purine include:

A

diet, degradation of nucleotides or endogenous synthesis of new purines

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54
Q

Uric acid that results from purine catabolism is primarily excreted by

A

kidneys but also by intestinal tract

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55
Q

Uric acid elevated in:

A

high purine diets, alcohol abuse, cancer, renal failure, dehydration caused by diuretics

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56
Q

Uric acid levels are frequently elevated in:

A

gout

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57
Q

High levels of uric acid is called

A

hyperuricemia

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58
Q

At levels >6.5 mg/dl, uric acid can be deposited into:

A

joint tissue in the form of monosodium urate crystals

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59
Q

Gout most frequently happens at what joint?

A

first metatarsal

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60
Q

Gout of the foot is called:

A

podagra

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61
Q

How to differentiate between gout and cellulitis?

A

Gout is very painful and doesn’t have an origin

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62
Q

When does congestive heart failure occur?

A

when the heart is not able to pump blood adequately and perfuse all tissues sufficiently

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63
Q

Natriuretic peptides generally function to inhibit the:

A

reabsorption of sodium in the renal tubule so that sodium excretion into the urine is increased

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64
Q

The three major natriuretic peptides are:

A

ANP, BNP, C-type Natriuretic peptide (CNP)

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65
Q

ANP is synthesized in:

A

atrial cardiomyocytes

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66
Q

BNP primarily released from

A

ventricles of the heart

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67
Q

C-type natriuretic peptide (CNP) is found in?

A

the nervous system and endothelium

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68
Q

ANP and BNP are released when?

A

the atria and ventricles stretch

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69
Q

ANP and BNP cause:

A

vasorelaxation and increase the amount of sodium and water excreted

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70
Q

What’s the indication for BNP?

A

to aid in diagnosis of congestive heart failure

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71
Q

BNP level has a strong correlation with:

A

left ventricular pressures

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72
Q

BNP can be used in the diagnosis of congestive heart failure with an accuracy of

A

83%

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73
Q

What # for BNP basically rules in CHF

A

500

74
Q

Increased BNP:

A

congestive heart failure, MI, hypertension, cor pulmonale (right-sided heart failure)

75
Q

When does an MI occur?

A

when one of the coronary arteries suffers critical blockage

76
Q

where is creatine found?

A

mitochondria and cytoplasm of skeletal muscle

77
Q

What is metabolized to generate more ATP?

A

creatine

78
Q

Without the Creatine -> phosphocreatine + ADP reaction ATP stores would be depleted within?

A

10 seconds

79
Q

Creatine goes to Phosphocreatine via

A

CK enzyme

80
Q

Where is CK enzyme found?

A

cardiac, skeletal muscle, brain = high energy tissues

81
Q

Creatine kinase exists in three different isoenzymes:

A

CK-MM, CK-BB, CK-MB

82
Q

CK-MM is found in:

A

skeletal muscle

83
Q

CK-BB is found in:

A

brain

84
Q

CK-MB is found in:

A

predominately found in heart and is specific for cardiac cells, small amounts in skeletal muscles

85
Q

What is the largest CK type?

A

CK-MM (94-99%)

86
Q

Creatine kinase is elevated in:

A

disorders/injury to muscle (usually skeletal) or neurologic disease

87
Q

What body type is associated with higher levels of CK?

A

people with larger muscle mass

88
Q

Increased total creatine kinase:

A

strenuous exercise, recent surgery, rhabdomyolysis, myositis, recent convulsions, trauma/crush injuries, neuromuscular disorder, statin use/medications for cholesterol, excessive exercise

89
Q

CK-MB tests specifically for injury to the

A

myocardium

90
Q

CK-MB rises about x hours after MI

A

3-6 hours

91
Q

CK-MB is not elevated in all patients until

A

12 hours after MI

92
Q

CK-MB returns to baseline following MI in

A

36-48 hours

93
Q

Why might CK not be the best for detecting MI?

A

If you are having an MI, you might not know for 12 hours. Also, it can be released from skeletal muscles (maybe falsely elevated in pt with muscle disorder/injury)

94
Q

Is CK-MB the preferred test to diagnose myocardial infarction?

A

No

95
Q

Increased CK-MB:

A

acute myocardial infarction, cardiac ischemia, myocarditis, ventricular arrhythmias

96
Q

Troponins are proteins that control the interaction of

A

actin and myosin in skeletal and cardiac muscle

97
Q

What do troponins interact with during muscle contraction:

A

calcium ions and tropomyosin

98
Q

When troponin is bound by calcium it allows exposure of:

A

the myosin binding sites on actin

99
Q

What are the three subtypes of troponin:

A

I, T, and C

100
Q

Troponin C contains the:

A

calcium binding site

101
Q

Troponin I inhibits:

A

the interaction of actin and myosin

102
Q

Troponin T binds:

A

troponin and tropomyosin

103
Q

What is the cardiac specific subtype for troponin I?

A

cTnI

104
Q

What is the cardiac specific subtype for troponin T?

A

CTnT

105
Q

What troponin subtypes are useful in diagnosing an MI?

A

Troponin I and Tropinin T

106
Q

How much troponin will a healthy individual have in their blood?

A

little to none

107
Q

Troponin levels rise x hours after onset of MI

A

2-3 hours

108
Q

Troponin levels stay elevated for x days after MI

A

7-14 days

109
Q

Is cardiac troponin I or T used more frequently to diagnose MI? Why?

A

Cardiac Troponin I, because renal failure more frequently increases Cardiac Troponin T

110
Q

Elevated troponin:

A

unstable angina, MI, congestive heart failure, myocarditis, severe PE, CPR, cardioversion or pacemaker firings

111
Q

Myoglobin only occurs in:

A

skeletal or cardiac muscle tissue

112
Q

Myglobin serves as:

A

short-term oxygen storage in muscle tissue

113
Q

Myoglobin is only released into serum when there is a :

A

skeletal or cardiac muscle injury

114
Q

Myoglobin increases in x hours after cardiac injury

A

3 hours

115
Q

Myglobin is more sensitive but not as specific for MI than:

A

CK-MB

116
Q

Elevated myglobin:

A

MI, myositis, skeletal muscle injury, seizures, muscular dystrophy, recent cocaine use, trauma/inflammation

117
Q

What is left behind when a clot is dissolved?

A

fibrin degradation products (FDPs)

118
Q

When is D-dimer formed?

A

during lysis of cross-linked fibrin through the action of plasmin

119
Q

D-dimer is used to identify when a patient has:

A

intravascular clotting

120
Q

D-dimer is used to diagnose a patient with a:

A

DVT or PE

121
Q

Describe the sensitivity/specificity of D-dimer test

A

Highly sensitive, but not specific enough

122
Q

Does D-dimer test have a better positive or negative predictive value?

A

Better negative value

123
Q

D-dimer elevations:

A

DVT, PE, disseminated intravascular coagulation (DIC), sickle cell anemia, surgery, pregnancy, elderly patients

124
Q

What is the leading cause of mortality worldwide?

A

Coronary heart disease

125
Q

CHD causes what percent of deaths worldwide?

A

50%

126
Q

There’s a linear relationship between CHD and?

A

hyperlipidemia

127
Q

Cholesterol is derived primarily from:

A

diet of animal origin

128
Q

Cholesterol is metabolized in:

A

liver

129
Q

Cholesterol is carried on:

A

lipoproteins

130
Q

What carries 75% of cholesterol?

A

Low-density lipoprotein

131
Q

What carries 25% of cholesterol?

A

High-density lipoprotein

132
Q

If the initial lipid panel is normal, test every?

A

5 years

133
Q

If the initial lipid panel is borderline, test every?

A

3 years

134
Q

In patients over age 65 who have had more than 1 normal screening in past, it is reasonable to:

A

stop screening

135
Q

Generally, lipid panel should be measured when:

A

fasting

136
Q

How long should fasting occur?

A

12-14 hours prior to test is ideal

137
Q

What is ok to ingest when fasting?

A

water and black coffee

138
Q

Total cholesterol includes:

A

LDL + HDL + VLDL

139
Q

Variation in total cholesterol form one test to the next can be:

A

15%

140
Q

Total cholesterol can vary due to:

A

stress, minor illness, positional changes when drawing blood

141
Q

Triglycerides are produced in:

A

the liver

142
Q

Triglycerides are composed of

A

chain of fatty acids + glycerol

143
Q

Triglycerides are supplied in diet and make up about x% of caloric intake

A

35-40%

144
Q

Muscles prefer what as their energy source?

A

fatty acids

145
Q

If blood levels of triglycerides are high, triglycerides are deposited into:

A

fatty tissues

146
Q

Normal triglyceride levels:

A

less than 150 mg/dL

147
Q

Borderline high triglyceride levels:

A

150-199 mg/dL

148
Q

High triglyceride levels:

A

200-499 mg/dL

149
Q

Very high triglyceride levels:

A

500 mg/dL or above

150
Q

Factors that alter triglycerides: increase

A

familial hypertriglyceridemia, hyperlipidemia, high carbohydrate diet, poorly controlled diabetes

151
Q

Factors that alter trigylcerides: decrease

A

malabsorption/malnutrition, thyroid disease

152
Q

Which is the “good cholesterol”?

A

High-density lipoprotein (HDL)

153
Q

The function of HDL is to transport:

A

cholesterol from tissues of the body and the vascular endothelium returning it to the liver

154
Q

What is an inverse risk factor for CHD?

A

HDL

155
Q

Acceptable HDL level for men?

A

> 40 mg/dL

156
Q

Desired HDL level for men?

A

> 60 mg/dL

157
Q

Acceptable HDL for women?

A

> 50 mg/dL

158
Q

Desired HDL for women?

A

> 60 mg/dL

159
Q

HDL increases:

A

genetics, exercise, moderate alcohol use, healthier eating choices, estrogen administration

160
Q

HDL decreases:

A

metabolic syndrome, genetics, tobacco use

161
Q

Which is the “bad cholesterol”

A

Low-density lipoprotein (LD)

162
Q

LDL is deposited?

A

in the walls of arteries

163
Q

LDL is most commonly calculated by:

A

Friedewald formula

164
Q

Friedewald formula:

A

LDL = total cholesterol - (HDL + 1/5 Tg)

165
Q

Friedeweld is only valid if triglyceride level is:

A

<400 mg/dL

166
Q

LDL levels ideal for those at risk of heart disease

A

70-100 mg/dL

167
Q

LDL levels near ideal

A

100-130 mg/dL

168
Q

LDL levels borderline

A

130-159 mg/dL

169
Q

LDL levels high

A

> 160 mg/dL

170
Q

Factors that impact LDL: Increase

A

Genetics, high staturated fat in diet, excessive alcohol consumption, chronic liver disease, hypothyroidism

171
Q

Factors that impact LDL: decrease

A

genetics, exercise, low fat diet, hyperthyroidism

172
Q

What is used to test LDL particles?

A

Gel electrophoresis

173
Q

LDL particle types:

A

Pattern A and Pattern B and Pattern I

174
Q

Pattern A (LDL)

A

large particle size

175
Q

Pattern B (LDL)

A

small, dense particle size

176
Q

What is the issue with pattern B?

A

higher ability to enter walls of blood vessel and increased risk of CHD

177
Q

Pattern I:

A

Intermediate particle size

178
Q

Small, dense LDL particles is associated with:

A

increased risk of CAD, promotion of atherosclerosis and thrombosis

179
Q

Small LDL particles result in increased (three things)

A

-half-life in the circulation due to decreased receptor binding -oxidative stresses -penetrance of arterial walls

180
Q

What are some LDL particle size testing?

A

Spectracell and LipoScience NMR Lipoprofile test

181
Q

What’s the issue (patient side) with particle size test?

A

Very costly test (167 and up) and insurance not always covered

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