Quiz 2: Diabetes and Cardiac Flashcards
1
Q
Who secretes insulin in response to glucose intake?
A
pancreatic beta cells
2
Q
Type 1 diabetes:
A
acute onset of insulin deficiency, requires exogenous insulin administration
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
4
Q
Hemoglobin A is what percent of total Hgb?
A
98%
5
Q
Hemoglobin A1 is what percent of Hemoglobin A?
A
7%
6
Q
What are the three components of Hemoglobin A1:
A
A1a, A1b, A1c
7
Q
Hemoglobin A1c makes up what percent of A1?
A
80% of A1
8
Q
The average A1c is what?
A
5.6%
9
Q
If you measure TOTAL hemoglobin A1 it is generally x% higher than just the hemoglobin A1c component?
A
2-4%
10
Q
Hemoglobin A1c is the component of hemoglobin A1 that combines…
A
most easily and strongly with glucose
11
Q
Non diabetic adult or child A1c
A
4-5.6%
12
Q
Diagnosis of diabetes A1c:
A
> 6.5%
13
Q
Our goal in patient care is to keep the diabetic patient’s HbA1c under?
A
7.0%
14
Q
What is the average lifespan of a RBC?
A
100-120 days
15
Q
HgbA1c percentage can be used to determine the patient’s glucose level over what period?
A
3-4 month
16
Q
Mean plasma glucose:
A
(35.6 x HgbA1c) -77.3
17
Q
Mean plasma glucose shows what?
A
uses hemoglobin A1c to let our patients know what their average daily glucose reading is
18
Q
1% reduction in HbA1c reduces risk by what percent? Diabetes related deaths
A
21%
19
Q
1% reduction in HbA1c reduces risk by what percent? MI
A
14%
20
Q
1% reduction in HbA1c reduces risk by what percent? Microvascular complications
A
37%
21
Q
1% reduction in HbA1c reduces risk by what percent? amputations or deaths
A
43%
22
Q
Insulin is produced in?
A
pancreatic beta-cell
23
Q
Insulin release facilitates the moment of glucose from?
A
circulatory system to the cell
24
Q
When is insulin level helpful:
A
detection of an insulinoma or to find cause of hypoglycemia
25
Why is insulin level of the blood not always reflective of pancreatic beta-cell function?
it undergoes significant first pass metabolism by liver
26
Increased insulin:
insulinoma, obesity, early type 2 diabetes
27
Decreased insulin:
insulin-dependent diabetes (type 1 generally)
28
What is C-peptide?
a connecting protein
29
What does C-peptide connect?
the alpha and beta chains of proinsulin, which is the precursor of insulin
30
The chains of proinsulin separate in the?
beta cells of the Islet of lnagerhans within the pancreas
31
What is C-peptide useful for?
cause of hypoglycemia and distinguishing type 1 for type 2 diabetes
32
Does synthetic insulin contain c-peptide?
no
33
c-peptide in Type 1 diabetes:
low c-peptide
34
c-peptide in type 2 diabetes:
Normal or high c-peptide
35
Pancreatitis results from:
long term alcohol use or binge drinking, gallstones, trauma to pancreas, drug-induced
36
When is amylase ordered?
in the evaluation of abdominal pain and is specifically used to detect pancreatitis
37
Amylase is secreted from:
acinar cells of the pancreas
38
Amylase is involved in the catabolism of?
carbohydrates
39
When damage occurs to the acinar cells, amylase "pours out" into:
lymphatic system, free peritoneum, and circulatory system
40
Amylase level can return to normal within x hours of onset of illness or trauma, because it's rapidly cleared by kidneys
12 hours
41
What can cause persistently elevated levels of amylase?
persistent or severe disease
42
Amylase increased in:
acute pancreatitis, chronic pancreatitis, pancreatic cancer, bile duct obstruction by gallstone, cholecystitis, renal failure, ectopic pregnancy, mumps
43
Aside from the pancreas, amylase can be found in:
Fallopian tubes, salivary glands, gallbladder
44
Lipase is used to diagnose:
pancreatitis in the evaluation of abdominal pain
45
Lipase is secreted by the
pancreas into the duodenum
46
Lipase is involved in the catabolism of:
triglycerides into fatty acids
47
Lipase is excreted via
kidneys
48
Who is lipase's partner in crime?
amylase
49
Lipase often parallels rise in amylase, but may rise...
a little later and sticks around a little longer (5-7 days)
50
Lipase is useful to diagnose pancreatitis at:
a later stage
51
Uric acid is the end byproduct of:
purine nucleotide catabolism
52
Purines and pyrimidines are building blocks of?
DNA
53
Sources of purine include:
diet, degradation of nucleotides or endogenous synthesis of new purines
54
Uric acid that results from purine catabolism is primarily excreted by
kidneys but also by intestinal tract
55
Uric acid elevated in:
high purine diets, alcohol abuse, cancer, renal failure, dehydration caused by diuretics
56
Uric acid levels are frequently elevated in:
gout
57
High levels of uric acid is called
hyperuricemia
58
At levels >6.5 mg/dl, uric acid can be deposited into:
joint tissue in the form of monosodium urate crystals
59
Gout most frequently happens at what joint?
first metatarsal
60
Gout of the foot is called:
podagra
61
How to differentiate between gout and cellulitis?
Gout is very painful and doesn't have an origin
62
When does congestive heart failure occur?
when the heart is not able to pump blood adequately and perfuse all tissues sufficiently
63
Natriuretic peptides generally function to inhibit the:
reabsorption of sodium in the renal tubule so that sodium excretion into the urine is increased
64
The three major natriuretic peptides are:
ANP, BNP, C-type Natriuretic peptide (CNP)
65
ANP is synthesized in:
atrial cardiomyocytes
66
BNP primarily released from
ventricles of the heart
67
C-type natriuretic peptide (CNP) is found in?
the nervous system and endothelium
68
ANP and BNP are released when?
the atria and ventricles stretch
69
ANP and BNP cause:
vasorelaxation and increase the amount of sodium and water excreted
70
What's the indication for BNP?
to aid in diagnosis of congestive heart failure
71
BNP level has a strong correlation with:
left ventricular pressures
72
BNP can be used in the diagnosis of congestive heart failure with an accuracy of
83%
73
What # for BNP basically rules in CHF
500
74
Increased BNP:
congestive heart failure, MI, hypertension, cor pulmonale (right-sided heart failure)
75
When does an MI occur?
when one of the coronary arteries suffers critical blockage
76
where is creatine found?
mitochondria and cytoplasm of skeletal muscle
77
What is metabolized to generate more ATP?
creatine
78
Without the Creatine -> phosphocreatine + ADP reaction ATP stores would be depleted within?
10 seconds
79
Creatine goes to Phosphocreatine via
CK enzyme
80
Where is CK enzyme found?
cardiac, skeletal muscle, brain = high energy tissues
81
Creatine kinase exists in three different isoenzymes:
CK-MM, CK-BB, CK-MB
82
CK-MM is found in:
skeletal muscle
83
CK-BB is found in:
brain
84
CK-MB is found in:
predominately found in heart and is specific for cardiac cells, small amounts in skeletal muscles
85
What is the largest CK type?
CK-MM (94-99%)
86
Creatine kinase is elevated in:
disorders/injury to muscle (usually skeletal) or neurologic disease
87
What body type is associated with higher levels of CK?
people with larger muscle mass
88
Increased total creatine kinase:
strenuous exercise, recent surgery, rhabdomyolysis, myositis, recent convulsions, trauma/crush injuries, neuromuscular disorder, statin use/medications for cholesterol, excessive exercise
89
CK-MB tests specifically for injury to the
myocardium
90
CK-MB rises about x hours after MI
3-6 hours
91
CK-MB is not elevated in all patients until
12 hours after MI
92
CK-MB returns to baseline following MI in
36-48 hours
93
Why might CK not be the best for detecting MI?
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
Is CK-MB the preferred test to diagnose myocardial infarction?
No
95
Increased CK-MB:
acute myocardial infarction, cardiac ischemia, myocarditis, ventricular arrhythmias
96
Troponins are proteins that control the interaction of
actin and myosin in skeletal and cardiac muscle
97
What do troponins interact with during muscle contraction:
calcium ions and tropomyosin
98
When troponin is bound by calcium it allows exposure of:
the myosin binding sites on actin
99
What are the three subtypes of troponin:
I, T, and C
100
Troponin C contains the:
calcium binding site
101
Troponin I inhibits:
the interaction of actin and myosin
102
Troponin T binds:
troponin and tropomyosin
103
What is the cardiac specific subtype for troponin I?
cTnI
104
What is the cardiac specific subtype for troponin T?
CTnT
105
What troponin subtypes are useful in diagnosing an MI?
Troponin I and Tropinin T
106
How much troponin will a healthy individual have in their blood?
little to none
107
Troponin levels rise x hours after onset of MI
2-3 hours
108
Troponin levels stay elevated for x days after MI
7-14 days
109
Is cardiac troponin I or T used more frequently to diagnose MI? Why?
Cardiac Troponin I, because renal failure more frequently increases Cardiac Troponin T
110
Elevated troponin:
unstable angina, MI, congestive heart failure, myocarditis, severe PE, CPR, cardioversion or pacemaker firings
111
Myoglobin only occurs in:
skeletal or cardiac muscle tissue
112
Myglobin serves as:
short-term oxygen storage in muscle tissue
113
Myoglobin is only released into serum when there is a :
skeletal or cardiac muscle injury
114
Myoglobin increases in x hours after cardiac injury
3 hours
115
Myglobin is more sensitive but not as specific for MI than:
CK-MB
116
Elevated myglobin:
MI, myositis, skeletal muscle injury, seizures, muscular dystrophy, recent cocaine use, trauma/inflammation
117
What is left behind when a clot is dissolved?
fibrin degradation products (FDPs)
118
When is D-dimer formed?
during lysis of cross-linked fibrin through the action of plasmin
119
D-dimer is used to identify when a patient has:
intravascular clotting
120
D-dimer is used to diagnose a patient with a:
DVT or PE
121
Describe the sensitivity/specificity of D-dimer test
Highly sensitive, but not specific enough
122
Does D-dimer test have a better positive or negative predictive value?
Better negative value
123
D-dimer elevations:
DVT, PE, disseminated intravascular coagulation (DIC), sickle cell anemia, surgery, pregnancy, elderly patients
124
What is the leading cause of mortality worldwide?
Coronary heart disease
125
CHD causes what percent of deaths worldwide?
50%
126
There's a linear relationship between CHD and?
hyperlipidemia
127
Cholesterol is derived primarily from:
diet of animal origin
128
Cholesterol is metabolized in:
liver
129
Cholesterol is carried on:
lipoproteins
130
What carries 75% of cholesterol?
Low-density lipoprotein
131
What carries 25% of cholesterol?
High-density lipoprotein
132
If the initial lipid panel is normal, test every?
5 years
133
If the initial lipid panel is borderline, test every?
3 years
134
In patients over age 65 who have had more than 1 normal screening in past, it is reasonable to:
stop screening
135
Generally, lipid panel should be measured when:
fasting
136
How long should fasting occur?
12-14 hours prior to test is ideal
137
What is ok to ingest when fasting?
water and black coffee
138
Total cholesterol includes:
LDL + HDL + VLDL
139
Variation in total cholesterol form one test to the next can be:
15%
140
Total cholesterol can vary due to:
stress, minor illness, positional changes when drawing blood
141
Triglycerides are produced in:
the liver
142
Triglycerides are composed of
chain of fatty acids + glycerol
143
Triglycerides are supplied in diet and make up about x% of caloric intake
35-40%
144
Muscles prefer what as their energy source?
fatty acids
145
If blood levels of triglycerides are high, triglycerides are deposited into:
fatty tissues
146
Normal triglyceride levels:
less than 150 mg/dL
147
Borderline high triglyceride levels:
150-199 mg/dL
148
High triglyceride levels:
200-499 mg/dL
149
Very high triglyceride levels:
500 mg/dL or above
150
Factors that alter triglycerides: increase
familial hypertriglyceridemia, hyperlipidemia, high carbohydrate diet, poorly controlled diabetes
151
Factors that alter trigylcerides: decrease
malabsorption/malnutrition, thyroid disease
152
Which is the "good cholesterol"?
High-density lipoprotein (HDL)
153
The function of HDL is to transport:
cholesterol from tissues of the body and the vascular endothelium returning it to the liver
154
What is an inverse risk factor for CHD?
HDL
155
Acceptable HDL level for men?
>40 mg/dL
156
Desired HDL level for men?
>60 mg/dL
157
Acceptable HDL for women?
>50 mg/dL
158
Desired HDL for women?
>60 mg/dL
159
HDL increases:
genetics, exercise, moderate alcohol use, healthier eating choices, estrogen administration
160
HDL decreases:
metabolic syndrome, genetics, tobacco use
161
Which is the "bad cholesterol"
Low-density lipoprotein (LD)
162
LDL is deposited?
in the walls of arteries
163
LDL is most commonly calculated by:
Friedewald formula
164
Friedewald formula:
LDL = total cholesterol - (HDL + 1/5 Tg)
165
Friedeweld is only valid if triglyceride level is:
<400 mg/dL
166
LDL levels ideal for those at risk of heart disease
70-100 mg/dL
167
LDL levels near ideal
100-130 mg/dL
168
LDL levels borderline
130-159 mg/dL
169
LDL levels high
>160 mg/dL
170
Factors that impact LDL: Increase
Genetics, high staturated fat in diet, excessive alcohol consumption, chronic liver disease, hypothyroidism
171
Factors that impact LDL: decrease
genetics, exercise, low fat diet, hyperthyroidism
172
What is used to test LDL particles?
Gel electrophoresis
173
LDL particle types:
Pattern A and Pattern B and Pattern I
174
Pattern A (LDL)
large particle size
175
Pattern B (LDL)
small, dense particle size
176
What is the issue with pattern B?
higher ability to enter walls of blood vessel and increased risk of CHD
177
Pattern I:
Intermediate particle size
178
Small, dense LDL particles is associated with:
increased risk of CAD, promotion of atherosclerosis and thrombosis
179
Small LDL particles result in increased (three things)
-half-life in the circulation due to decreased receptor binding -oxidative stresses -penetrance of arterial walls
180
What are some LDL particle size testing?
Spectracell and LipoScience NMR Lipoprofile test
181
What's the issue (patient side) with particle size test?
Very costly test (167 and up) and insurance not always covered
