Exam 2 Study Questions

What is the primary dietary source of glucose for humans?
Starch
What is the primary storage form of glucose for humans?
Glycogen
What salivary and pancreatic enzyme is responsible for initial digestion of carbohydrates?
AMS
lipolysis
Breakdown of fats with the production of ketones through the TCA cycle
aerobic oxidation
Acetyl CoA enters the TCA cycle and ATP, CO2 and water are made
HMP shunt
Endproduct is NADPH; important energy source in RBCs
glycogenesis
Conversion of glucose into the storage form
glycolysis
Production of pyruvate / lactate during oxygen depletion
glycogenolysis
Breakdown of glycogen back into glucose
What is the only hormone that will lower blood glucose levels, and where is it produced?
Insulin, made in the pancreas
What primary hormone raises glucose levels, and where is it produced?
Glucagon, made in the pancreas
Which hormone is capable of raising glucose levels most rapidly, and where is it produced?
Adrenaline (epinephrine), adrenal gland
The ingestion of excess carbohydrate will lead to the production and storage of what type of compound?
Fat
List the reference range for fasting serum glucose.
Approx 70-110 mg/dL
How will ranges be affected if whole blood is tested?
10% lower
What is the preferred anticoagulant for testing whole blood and color of collection tube?
NaFl, gray top
What is the preferred anticoagulant for plasma testing and color of collection tube?
Heparin, green top
What happens to glucose levels after one hour if unpreserved whole blood is left to sit?
Levels may decrease 10-12% per hour
Gestational
May be transient
Interference from lactogen
Type 2
Obesity and sedentary lifestyle
Adult onset
Strongest genetic connection
Includes most cases of diabetes
Type 1
Autoimmune
Insulin dependent
Acute onset of polydipsia and polyuria
What causes excess ketone production in diabetes?
Increased fat metabolism
List several metabolic complications seen in diabetes
Renal and heart dz, vascular dz, blindness
What constitutes “hypoglycemia”?
glucose <50 mg/dL
List the primary causes of hypoglycemia.
Insulin shock due to overdose or insulin-producing tumor
According to the ADA, what criteria is diagnostic for diabetes when testing:
A fasting serum or plasma
>126
According to the ADA, what criteria is diagnostic for diabetes when testing:
A random serum or plasma
>200 with symptoms
According to the ADA, what criteria is diagnostic for diabetes when testing:
A 2-hour postprandial sample
>200
HbA1C is an indicator of glucose control for what preceding time period?
2-3 months
What is the specimen requirement for HbA1C testing?
EDTA
What conditions can cause a falsely decreased HbA1C?
hemolytic anemias, blood loss, alcohol, lead and some drugs
What is microalbumin and what is the purpose of performing this test?
Small levels of albumin not detected by urine dipstick; may indicate early renal dz
List the two primary methodologies used to measure serum glucose.
Include those substances known to cause interference.
Glucose oxidase; BUN, uric acid and bilirubin interfere
Hexokinase; bilirubin
Exogenous fats are those derived from what source?
Diet
Endogenous fats are those derived from what source?
Liver
A fatty acid that contains NO double bonds is classified as saturated or unsaturated?
Saturated
Which type of fat is more easily excreted?
Unsaturated
What class of fats has a steroid alcohol base?
Cholesterol
What class of fats is composed of fatty acids plus glycerol?
Triglyceride
What type of fats are products of man-made manipulation of oils to solids?
Trans fats
Lung surfactants
Principle component of most cell membranes
phospholipids
Cell membranes of brain and CNS
glycolipids
Steroid hormone and vitamin D precursor
Component of bile acids
cholesterol
Regulates renin secretion
prostaglandins
Primary storage form of fat
Broken down under the influence of lipase enzyme
triglycerides
No good function that we know of
trans fatty acids
Building blocks that contribute to production of acetyl CoA
fatty acids
What is the protein portion of the lipoprotein molecule called?
apoprotein
What abnormal lipoprotein is associated with CHD at an early age?
Lp(a)
Made in the intestines in response to food ingestion
Causes a milky layer on serum after meals
Carries exogenous Tg to tissues
Chylomicrons
Excess leads to plaques and clogged arteries
“Bad” cholesterol
LDL
Contains the highest percentage of protein
Transports cholesterol to liver for excretion
HDL
Transports Tg from liver to tissues
VLDL
Foam cells–>fatty streaks–>plaques
Leading cause of death in U.S.
Arteriosclerosis
Major cause of pancreatitis
Increase of glycerol-based lipids
GGT and beta-gamma bridging
Alcoholism
Inc TG, chol, and LDL
Microalbuminuria
Diabetes
Inc. TG and chol,
Dec. albumin
Massive proteinuria and oval fat bodies
Nephrotic syndrome
Supersaturated bile
Gallstones
LDL receptor problem
Cause of early onset heart disease
Familial hypercholesterolemia
Name the enzyme needed to break cholesterol esters into free cholesterol particles.
cholesteryl esterase
List the most common interfering factors in the cholesterol test.
Bilirubin, ascorbic acid
List specimen requirements for TG and chol.
Fasting preferred
Name the enzyme needed to break TG into fatty acids and glycerol.
Lipase
Describe the homogeneous method of HDL quantitation.
Selective enzymes block non-HDL lipids; reagent reacts with free HDL
Which of the NPNs is the best indicator of liver dysfunction?
Ammonia
What test is commonly used as an indicator of GFR?
Creatinine clearance
List the 3 most common causes of an elevated uric acid.
Gout, chemo/irradiation, renal dz
Which NPN is elevated in Reye’s syndrome?
Ammonia
Define azotemia.
Increased BUN
Define uremia.
Increased BUN with renal failure
For each of the following, identify it as a prerenal, renal, or postrenal cause of an elevated BUN:
Kidney stone
post
For each of the following, identify it as a prerenal, renal, or postrenal cause of an elevated BUN:
Glomerular disease
renal
For each of the following, identify it as a prerenal, renal, or postrenal cause of an elevated BUN:
Congestive heart failure
pre
For each of the following, identify it as a prerenal, renal, or postrenal cause of an elevated BUN:
Bladder tumor
post
For each of the following, identify it as a prerenal, renal, or postrenal cause of an elevated BUN:
High protein diet
pre
Match the NPN with the source:
Muscle metabolism
Creatinine
Match the NPN with the source:
Purine metabolism
Uric acid
Match the NPN with the source:
Protein metabolism
BUN
Which NPN is adversely affected by fluoride and citrate in the sample?
BUN
Picric acid in an alkaline environment. Name the reaction and the analyte being measured.
Jaffe reaction for creatinine
List special handling requirements for ammonia analysis.
Put tube on ice immediately after collecting; spin @ 4 C, test ASAP or keep on ice.
Match the function with its primary site or action:
Initial filtration of blood
Blood retention of proteins and cells
Glomerulus
Match the function with its primary site or action:
Reabsorption of most water, glucose and amino acids
Secretion of non-filterable wastes
Proximal tubule
Match the function with its primary site or action:
Na reabsorbed under the influence of aldosterone
Water reabsorption under the influence of ADH
Distal tubule
Na reabsorbed under the influence of?
aldosterone
Water reabsorption under the influence of?
ADH
In order to maintain electrical neutrality, what 2 analytes will be excreted when Na is reabsorbed?
K and H
What two analytes are excreted or reabsorbed to help maintain blood pH?
H & HCO3
In response to a decrease in blood pressure or volume, the kidneys secrete the hormone ____, which stimulates the production of angiotensin.
Renin
Angiotensin stimulates the adrenal gland to secrete the hormone
aldosterone.
Aldosterone then causes the renal tubules to reabsorb the analyte
sodium
An increase in sodium causes the plasma osmolality to:
Rise
In response to an increased osmolality, the pituitary gland secretes
ADH (vasopressin).
ADH in turn causes the tubules to reabsorb
water.
After ADH causes reabsorption of water, the blood volume/pressure will then
Fall
U Cr = 105mg/dL
U vol = 950 mL
S Cr = 1.5mg/dL
Time = 24 hours
BSA = 1.95 m2
What is the Creatinine Clearance?
46 mL/min
U Cr = 105mg/dL
U vol = 950 mL
S Cr = 1.5mg/dL
Time = 24 hours
BSA = 1.95 m2
What is the Corrected Creatinine Clearance?
41 mL/min
What is a normal average GFR for adults?
120 ml/min
What are advantages of the eGFR and cystatin C as compared to a traditional creatinine clearance?
No urine needed
What urine dipstick result is considered the best indicator of renal disease?
Protein
What cell and cast type is consistent with:
Renal failure
waxy/broad casts
What cell and cast type is consistent with:
Acute glomerulonephritis
red cells and RBC casts
What cell and cast type is consistent with:
Pyelonephritis
WBC and WBC casts
What cell and cast type is consistent with:
Nephrotic syndrome
RTE, oval fat bodies, fatty casts and cholesterol crystals
What substance in plasma contributes the most to osmolality?
sodium
Would the urine of someone with diabetes mellitus have a dipstick SG that is increased, decreased or normal?
Normal
Would the urine of someone with diabetes mellitus have a refractometer SG that is increased, decreased or normal?
Increased
What test is used as an early indicator of renal disease in diabetics?
microalbumin
In someone who is deficient in ADH (diabetes insipidus), would the SG of the urine be increased, decreased or normal?
Decreased
In someone who is deficient in ADH (diabetes insipidus), would the Urine Volume be increased, decreased or normal?
Increased