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CLINICAL ENZYMOLOGY Flashcards

(103 cards)

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1
Q

Sources of creatine kinase

A

Brain, myocardium, skeletal muscle

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2
Q

CK pronounced elevation (5 or more times)

A

Duchenne’s muscular dystrophy
Polymyolitis
Dermatomyositis
Myocardial infarction

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3
Q

CK isoenzyme - elevated in CNS damage, tumors, presence of macro-CK

A

CK-BB (CK1)

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4
Q

CK Isoenzyme : present in significant amounts in the cardiac tissue ; <6% of total CK in serum

A

CK-MB (CK2)

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5
Q

CK Isoenzyme : major isoenzyme found in striated muscle and normal serum (94-100%)

A

CK-MM (CK3)

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6
Q

CK isoenzyme from anode to cathode

A

CK MM
CK MB
MACRO CK
CK-IM

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7
Q

CK-BB bound to IgG ; migrates between CK MB and CK MM

A

CK-IM

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8
Q

CK determination : forward reaction / direct method ; creatine —> creatine PO4

A

Tanzer-Gilvarg

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9
Q

CK determination : reverse reaction / indirect method ; creatine PO4 —> creatine

A

Oliver-Rosalki

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10
Q

Total CK reference value (MALE)

A

15-160 U/L

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11
Q

Total CK reference value (FEMALE)

A

15-130 U/L

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12
Q

LD1 & LD2 tissue sources

A

Heart, RBCs, renal cortex

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13
Q

LD Isoenzyme found in lungs, lymphocytes, spleen, and pancreases

A

LD 3

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14
Q

LD Isoenzyme found in liver, skeletal muscle

A

LD4 and LD5

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15
Q

LD ISOENZYME : HHHH

A

LD1

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16
Q

LD ISOENZYME : HHHM

A

LD2

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17
Q

LD ISOENZYME : HHMM

A

LD3

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18
Q

LD ISOENZYME : HMMM

A

LD4

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19
Q

LD ISOENZYME : MMMM

A

LD5

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20
Q

LD1 and LD2 ratio in normal serum

A

LD2 > LD1

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21
Q

Flipped ratio ; seen in MI, hemolytic disorder, megaloblastic anemia, renal infarction

A

LD1 > LD2

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22
Q

LD Isoenzyme associated with arteriosclerotic cardiovascular failure signifying grave prognosis and impending death

A

LD6

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23
Q

LDH Pronounced elevation (5 or more times)

A

Megaloblastic anemia
Renal infarction

Septic shock & hypoxia
Hepatitis, thrombotic thrombocytopenic purpura
Widespread carcinomas, especially hepatic metastases

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24
Q

LDH moderate elevation (3-5 or more times)

A

Myocardial infarction
Pulmonary infarction
Hemolytic conditions, leukemias

Infectious mononucleosis
Delirium tremendous
Muscular dystrophy

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25
LDH determination : forward reaction / direct reaction ;
Wacker method (lactate —> pyruvate) FL(i)P
26
LDH determination : reverse method / indirect reaction
Wrobleuski-Ladue (pyruvate —> lactate) RPL
27
Onset of elevation of CK-MB
4-6 hours
28
LD reference value
100-225 U/L (37C)
29
LD Isoenzyme most abundant in serum
LD2
30
AST/SGOT tissue sources
Liver, heart, skeletal muscle
31
ALT/SGPT tissue source
Liver
32
AST Pronounced elevation (5 or more times)
Acute hepatocellular damage Myocardial infarction Acute pancreatitis Circulatory collapse (shock) Infectious mononucleosis
33
Liver-specific ; higher and more sustained elevation
ALT/SGPT
34
AST isoenzyme that is first released
Cytoplasmic AST
35
AST Isoenzyme that is increased in hepatocellular disorder
Mitochondrial AST
36
In most acute hepatocellular disorders, the De Ritis ratio is ___
<1
37
AST/ALT ratio
De Ritis ratio
38
Rietman & Frankel method (AST) Substrate : End product :
SS: Aspartate + alpha-keto glutarate EP: Glutamate + oxaloacetate
39
Rietman & Frankel method (ALT) Substrate : End product :
SS: Alanine + alpha-keto glutarate EP: Glutamate + Pyruvate
40
AST Method : coupled-enzymatic method that uses Malate dehydrogenase
Karmen method
41
AST reference values
5-35 U/L
42
ALT reference values
7-45 U/L
43
ALP tissues sources
Liver, bone, placenta, intestine
44
ALP pronounced elevation (5 or more times normal)
Bile duct obstruction (intrahepatic or extra hepatic) Osteitis deformas (PAGET’S DISEASE) Biliary cirrhosis Osteogenic sarcoma (bone tumor) Hyperparathyroidism
45
ALP slight elevation (up to 3 times normal)
Pregnancy Viral hepatitis Cirrhosis Healing fractures Normal growth patterns in children
46
Highest ALP elevation is in what condition
PAGET’S DISEASE
47
ALP isoenzyme electrophoretic pattern:
(+) L > B > P > I (-)
48
ALP isoenzyme heat stability:
P > I > L > B “Promise ikaw lang baby” yiee sanaol mwehehehe
49
Placental ALP resists heating at __C for __ mins
65C for 30mins
50
Bone ALP <20% activity at __C for __ mins
56C for 10 mins
51
Bone is inhibited by
3M urea
52
Liver and bone are inhibited by
Levamisole
53
Placental, intestinal, carcinoplacental are inhibited by
Phenylalanine
54
ALP Isoenzyme that is more likely to be found in B or O secretor individuals ; bound by group A erythrocytes; level increases after consumption of a fatty meal
Intestinal ALP
55
Carcinoplacental Isoenzymes
Regan Nagao Kasahara
56
Carcinoplacental Isoenzymes : detected in lung, breast, ovarian, and gynecologic cancers ; MOST HEAT STABLE ; inhibited by phenylalanine
Regan
57
Carcinoplacental Isoenzymes : detected in carcinoma of pleural surfaces, pancreas, and bile duct ; inhibited by leucine
Nagao
58
Carcinoplacental Isoenzymes : associated with GI and hepatic tumors
KASAHARA
59
Reference method for ALP determination ; most specific
Bowers and McComb
60
Bowers & McComb substrate
P-nitrophenylphosphate (PNPP)
61
ALP reference value
30-90 U/L
62
Small pancreatic enzyme ; easily to excrete ; found in pancreas and salivary glands
Amylase
63
Diagnostic significance of amylase
Acute pancreatitis (pancreas) Mumps, parotitis, macroamylasemia (salivary glands)
64
Large pancreatic enzyme ; late marker but pancreas-specific ; marker of acute pancreatitis ; produces higher and more sustained elevation
Lipase
65
Amylase onset of elevation
2-12 hours
66
Amylase peak activity
24 hours
67
Amylase duration of elevation
3-5 days
68
Lipase onset of elevation
6 hours
69
Lipase peak activity
24 hours
70
Lipase duration of elevation
7 days
71
Amylase determination method : decrease in color of starch-iodine complex
Amyloclastic method
72
Amylase determination method : increased reducing sugars as STARCH is hydrolyzed by amylase
Saccharogenic method
73
Amylase determination method : increased COLOR intensity of soluble dye-substrate solution
Chromogenic method
74
Amylase determination method : increased absorbance of NADH at 340 nm
Coupled-enzymatic / continuous-monitoring method
75
Amylase reference values (SERUM)
25 - 130 U/L
76
Amylase reference values (URINE)
1-15 U/h
77
Reference method for amylase
Saccharogenic method
78
Amylase Isoenzyme inhibited by wheat germ lectin
Salivary amylase
79
Lipase determination method : uses olive oil (trioleine-new) as substrate ; REFERENCE METHOD
Cherry-Crandall method
80
Lipase determination method : Measures the rate of CLEARING as fats are hydrolyzed by LPS
Turbidimetric method
81
Lipase determination method : based on coupled reactions with glycerol kinase and Peroxidase
Colorimetric method
82
Lipase reference value
<38 U/L
83
Miscellaneous enzymes : hepatobiliary disorders, alcoholic liver disease, microsomal induction by drugs and alcohol ; used to identify the source of increase ALP level
GGT (Gamma glutamyl transferase)
84
Miscellaneous enzymes : intrahepatic cholestasis : used to identify the source of high ALP level
5’Nucleotidase
85
HIGH ALP in conjunction with HIGH GGT and 5’Nucleotidase, the condition source must be from the ____
Liver (Hepatobiliary)
86
HIGH ALP in conjunction with NORMAL GGT and 5’Nucleotidase, the condition source must be from the ____
Bone (bone lesion)
87
Szasz substrate
Gamma-glutamyl-p-nitroanilide
88
Szasz method end product : color
P-nitroaniline (yellow)
89
Major sources of ACP
Prostate and RBCs
90
ACP clinical significance
Prostatic carcinoma/hyperplasia, rape (vaginal washings)
91
Roy and Hillman substrate
Thymolphthalein monophosphate (endpoint)
92
RBC ACP is inhibited by
Copper and formaldehyde
93
Prostatic ACP is inhibited by
Tartrate
94
Prostatic ACP formula
Total ACP - ACP after tartrate inhibition
95
Miscellaneous enzymes : skeletal muscle disorders
Aldolase
96
Miscellaneous enzymes : hepatocellular disorder
Glutamate dehydrogenase and Glutathione-S-transferase
97
Miscellaneous enzymes : blood pressure regulation
Angiotensin-converting enzyme (ACE)
98
Miscellaneous enzymes : Acute myocardial infarction
Acute myocardial infarction
99
Miscellaneous enzymes : pancreatic insufficiency
Trypsin Chymotrypsin/elastase 1
100
Miscellaneous enzymes : when low in RBC, its manifestation is drug-induced hemolytic anemia
G-6-PD
101
Miscellaneous enzymes : When low in RBC, its manifestation is hemolytic anemia secondary to membrane abnormality
Pyruvate kinase
102
Miscellaneous enzymes : low in serum due PESTICIDE POISONING, liver disease, genetic variants (abnormal response to muscle relaxants)
Pseudocholinesterase
103
Miscellaneous enzymes : low in serum due PESTICIDE POISONING, liver disease, genetic variants (abnormal response to muscle relaxants)
Pseudocholinesterase

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