Enzymes and Cardiac Assessment

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ncrook
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206559
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Enzymes and Cardiac Assessment
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2013-05-04 21:16:06
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Measuring Enzyme Activity Specific Enzymes Clinical Interest
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Measuring Enzyme Activity and Specific Enzymes of Clinical Interest
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  1. How are enzyme reactions performed (with substrate in excess)?
    Zero-order kinetics
  2. What are the 2 test methods used to measure enzyme reactions?
    • Endpoint
    • Kinetic
  3. What test methodology is a type of reaction that combines reactants, stops the reaction at a fixed time, then measures the product formed?
    Endpoint
  4. What test methodology is a type of reaction that combines reactants, then measures the change in absorbance at specific interfals over a specific time period?
    Kinetic
  5. How are enzymes reported and why are they reported that way?
    Reported in activity units (because they are measured based on their activity instead of their concentration)
  6. What is the quantity of enzyme that catalyzes the reaction of one micromole of substrate per minute under specified conditions?
    International units (IU or U)
  7. Where are the highest concentrations of lactate dehydrongenase (LD) located?
    • Liver
    • Heart
    • Skeletal muscle
    • Kidney
    • Erythrocytes
    • Lesser amounts in other tissues
  8. What do LD isoenzymes consist of?
    Four subunits (polypeptide chains) - derived from 2 types of polypeptides designated M (muscle/liver) and H (heart)
  9. What clinical conditions is associated with elevated LD values?
    • Cardiac disorders (acute myocardial infarction)
    • Hepatic disease (viral hepatitis, cirrhosis, infectious mononucleosis)
    • Skeletal muscle diseases
    • Hemolytic and hematologic disorders (pernicious anemia exhibits extreme elvations of LD)
    • Neoplastic disorders (acute lymphoblastic leukemia)
  10. In AMI, how do the levels of LD rise and fall?
    • Rise within 8-12 hours
    • Peak at 24-48 hours
    • Return to normal in 7-10 days
    • Not used to diagnose AMI
    • Useful when assessing concurrent liver damage
  11. What is the reference rang of LD?
    100-225 U/L at 37 degrees celcius
  12. Where are the highest concentrations of Creatine kinase (CK) and CK Isoenzymes located?
    • Skeletal muscle
    • Heart muscle
    • Brain tissue
  13. What do the CK isoenzymes consist of?
    2 subunits: M (muscle) and B (brain)
  14. What is the clinical significance of an increase in CK-MB?
    • Heart muscle damage
    • Indicative of AMI (when used in conjunction with other markers)
    • Skeletal muscle damage
  15. What is the clinical significance of an increase of CK-MM?
    • Skeletal muscle disorder
    • Heart muscle disorder
  16. What is the clinical significance of and increase in CK-BB?
    • CNS disorders
    • Tumors of various organs, including the prostate gland
  17. What is the clinical significance of an increase of CK?
    • Cardiac disorders (AMI)
    • Skeletal muscle disorders (muscular dystrophy)
    • CNS disorders (seizures and cerebral vascular accidents)
  18. When do the CK-MB values rise and fall following AMI?
    • Rise within 4-6 hours
    • Peak 12-24 hours
    • Return to normal at 2-3 days
  19. What is the reference range of CK?
    • Male: 15-160 U/L
    • Female: 15-130 U/L
  20. What is the reference range of CK-MB?
    • <6% of CK value
    • Mass assay: 0-5 ng/mL
  21. Where are the highest concentrations of Aspartate aminotransferase (AST) located?
    • Heart
    • Liver
    • Skeletal muscle
    • Lesser ammounts in kidney and other tissues (including erythrocytes)
  22. What clinical conditions are associated with AST?
    • Hepatocellular disorders
    • Skeletal muscle disorders
    • Pulmonary emboli
    • Acute pancreatitis
  23. What is the reference range for AST?
    5-30 U/L
  24. Where are the highest concentrations of alanine aminotransferase (ALT) located?
    • Liver
    • Lesser amounts in other tissues (kidneys and erythrocytes)
  25. What clinical conditions are associated with ALT?
    Hepatocellular disorders
  26. What is more specific indicator of liver disease, AST or ALT?
    ALT
  27. What is the reference range for ALT?
    6-37 U/L
  28. Where are the highest concentrations of alkaline phophatase (ALP) located?
    • Liver
    • Bone
    • Intestines
    • Spleen
    • Kidney
    • Placenta
  29. What is the clinical significance of increased ALP?
    • Hepatobiliary disease
    • Bone disorders
    • Paget disease
    • Healing bone fractures
  30. In hepatobiliary disorders that are caused by obstructive diseases, what lab would be more increased, AST, ALT, or ALP?
    ALP
  31. What causes a decrease of ALP levels?
    Hypophophatasia (lack of ALP bone isoenzyme) - characterized by insufficient bone calcification
  32. What is the reference range of ALP?
    • Adults: 50-115 U/L
    • Children (4-15 yrs): 54-369 U/L
  33. Where are the highest concentrations of Acid phosphatase (ACP) located?
    • Prostate gland
    • Lesser amounts in bone, liver, spleen, erythrocytes, plts
  34. What causes an increase of acid phosphatase (ACP)?
    • Prostate cancer
    • Benign prostatic hypertrophy
    • Bone disease
    • Paget disease
    • Breast cancer with bone metastases
    • Gaucher disease
    • Plt damage
    • Idiopathic thrombocytopenic purpura
  35. What are the reference ranges of acid phosphatase (ACP)?
    • Total ACP Male: 2.5-11.7 U/L
    • Total ACP Female: 0.3-9.2 U/L
    • Prostatic ACP Male: 0.2-5.0 U/L
    • Prostatic ACP Female: 0.0-0.8 U/L
  36. Where are the highest concentrations of gamma-glutamyltransferase (GGT) located?
    • Liver
    • Kidneys
    • Pancreas
    • Intestine
    • NOT found in Skeletal muscle or bone
  37. What causes an increase of GGT?
    • Hepatobiliary diseases
    • Intra- and posthepatic biliary tract obstruction
    • Induced by drugs and alcohol
  38. What is the reference range of GGT?
    • Male: up to 55 U/L
    • Female: up to 38 U/L
  39. Where is amylase found?
    • Pancreas
    • Salivary glands
    • Small intestine
    • Fallopian tubes
    • Other tissues
  40. What causes an increase of amylase?
    • Acute pancreatitis
    • Mumps
    • Perforated peptic ulcer
    • Intestinal obstruction
    • Cholecystitis
    • Ruptured ectopic pregnancy
    • mesenteric infarction
    • Acute appendicitis
  41. Where is lipase found?
    • Pancreas
    • Lesser amounts in gastric mucosa, intestinal mucosa, adipose tissue
  42. What causes an increase of lipase?
    • Acute pancreatitis
    • Perforated peptic ulcer
    • Duodenal ulcer
    • Intestinal obstruction
    • Cholecystitis
  43. What is the reference range for lipase?
    Up to 38 U/L
  44. Where is True cholinesterase found?
    • RBCs
    • Lungs
    • Spleen
    • Nerve endings
    • Gray matter of the brain
  45. Where is pseudocholinesterase found?
    • Liver
    • Pancreas
    • Heart
    • White matter of brain
    • Serum
  46. What causes a decrease in pseudocholinesterase?
    • Hepatocellular disease (due to decreased synthesis)
    • Insecticide poisonings
  47. What is the reference range for psuedocholinesterase?
    • Male: 40-78 U/L
    • Female: 33-76 U/L
  48. Where s glucose-6-phosphate dehydrogenase (G6PD) found?
    • Erythrocytes
    • Adrenal glands
    • Thymus
    • Lymph nodes
    • Spleen
  49. What causes a decrease in G6PD?
    • Inherited as a sex-linked trait
    • Drug induced hemolytic anemia
  50. What causes an increase of G6PD?
    • Megaloblastic anemia
    • AMI
  51. G6PD requires the analysis of a ___ ____ ____ ______
    Red blood cell hemolysate
  52. What is the reference range for G6PD?
    8-14 U/g Hgb

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