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chem test 3
n/a
165
Chemistry
Not Applicable
10/24/2012

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Term
folate
Definition
functions as coenzyme in metabolic reactions involving transfer of single-carbon units from donor to reciepiant compound
Term
What is essential for DNA synthesis and normal rbc maturations?
Definition
folate with Vitamin B12
Term
what are the dietary sources of Folate?
Definition
fruits, green leafy vegetables, yeasts, and organ meats
Term
where is folate stored?
Definition
in the liver
Term
what are some causes of folate deficiency?
Definition

low folate intake, malabsorption as a result of gastrointestinal disease, pregnancy and drugs such as phenytoin.

also associated with chronic alcoholism

Term
which type of anemia does folate deficiency cause
Definition
macrocytic anemia
Term
which principle does the cobas 6000 use to test folate
Definition
competitive principle
Term
what is Vitamin B 12?
Definition
a complex corrinoid compound that contains 4 pyrrole rings surrounded by a single carbon atom
Term
what are the dietary sources of Vitamin B12?
Definition
meats, eggs, and milk
Term
where is B12 stored?
Definition
stored mostly in the liver but found in the bone marrow and other tissues
Term
what roles does B12 play in dna synthesis?
Definition
vitamin B12 along with Folate are critical to DNA synthesis which in turn effects RBC maturation
Term
what is myelin sheath and how does B12 effect it?
Definition

B12 is essential to myelin sheath.

Myelin sheath is: the insulating enevelope that surrounds the core of nerve fibers or the axon and facilitates the transmission of nerve impulses

Term
what does B12 deficiency cause?
Definition
neurological abnormalities, decreased serum B12 levels, and increased excretion of methylmalonic acid
Term
what causes pernicious anemia?
Definition
B12 deficiency due to lack of intrinsic factor
Term
what causes B12 deficiency?
Definition
low vitamin B intake, gastroectomy and disesases of the small intestine, malabsorption and trans-cobalamin deficiency
Term
which principle does the COBAS 6000 use to test Vitamin B12
Definition
competitive principle
Term
what is Creatine Kinase (CK)?
Definition
an enzyme that is involved in the transfer of energy in muscle metabolism
Term
what are the 2 subunits of CK?
Definition

B- brain form

M-muscle form

Term
What are the 3 CK isoenzymes?
Definition

CK-BB: CK1

CK-MM: CK3

CK-MB: CK2

Term
What is CK1?
Definition
isoenzyme of the brain that is only found in the blood when the blood brain barrier has been breached
Term
what is CK3?
Definition
isoenzyme that accounts for almost all the CK activity in the skeletal muscle
Term
what is CK2?
Definition
has the most specificity for the heart
Term
what are elevated CK-MB levels associated with?
Definition
myocardial cell death and damage due to acute myocardial infarction (AMI)
Term
Describe the rise and fall pattern of CKMB levels
Definition
levels can be detected 4-6 hrs after onset of chest pain; levels peak at 12-24 hrs; levels return to normal after 24-48hrs
Term
what are other causes of elevated CKMB? What is the difference between them and an AMI?
Definition

cardiac surgery after coronary bypass, and valve replacement or repair of congenital defects.

in these cases CKMB doesnt exhibit the rise/fall pattern indicative of an AMI

Term
what most the CKMB to total CK ratio be to indicate heart damage?
Definition
more than 2.5-3
Term
what is the relative index
Definition
(ckmb/total ck) x 100
Term
what are some other causes of CKMB elevation?
Definition
skeletal muscle trauma, dermatomyositis, duschenne's muscular dystrophy, Reye's syndrome, rhabdomyolysis, drug overdose, delirium tremens, or chronic alcohol poisoning
Term
which principle does the COBAS 6000 use to test CKMB?
Definition
sandwich principle
Term
what are the 2 types of cardiac troponin?
Definition
troponin I (TnI) and troponin T (TnT)
Term
what is the difference between TnI and TnT?
Definition
TnI measures only cardiac troponin, TnT may be increased in the absence of heart damage
Term
what is TnT's correlation with acute coronary syndrome (ACS)
Definition
TnT is an independant prognosis- marker that can predict the near, mid, and even long term outcome of patients with ACS
Term
what causes elevated TnT levels?
Definition
congestive heart failure (CHF), cardiomyopathy, myocarditis, heart contusion, renal failure, lung embolism, stroke or after cardiac surgery
Term
are elevated TnT levels synonomous with the cause of myocardial injury?
Definition
No, elevated levels are indicative of myocardial injury but not synonomous with the cause
Term
which principle does the COBAS 6000 use to test TnT?
Definition
sandwich principle
Term
What is Myoglobin
Definition
a cytoplasmic protein in striated cardiac and skeletal muscleculature
Term
what is the importance of the determination of myoglobin in the serum
Definition
determination of myoglobin in the serum is an important factor in the diagnosis of AMI and successful reperfusion following lysis therapy
Term
Describe the rise/fall pattern of myoglobin
Definition
in an AMI levels are elevated 1-3hrs after onset of chest pain; levels peak btwn 5-12hrs; levels return to normal after 18-30hrs
Term
what is important about the degree of elevation of myoglobin levels?
Definition
the degree of elevation indicates the size of the infarction
Term
which principle does the COBAS 6000 use to test myoglobin
Definition
sandwich principle
Term
what is proBNP and what is it used for
Definition

-prohormone brain natrieutic peptide

-is used as an aid in the diagnosis of individuals suspected of having CHF

Term
what is proBNP further indicated for
Definition

-it is further indicated for the risk of straitifications of patients with AMI and CHF

- it is also suitable for assessing vascular remodeling and contributes to the establishment of individualized rehabilitation

 

Term
what does the concentration of proBNP in the serum/plasma indicate
Definition
the prognosis of left ventricular dysfunction
Term
which principle does the COBAS 6000 use to test proBNP
Definition
sandwich principle
Term
what are hormones
Definition
chemical signals produced by specialized cells, secreted into the blood stream, and carried to targeted tissues
Term
how is cellular function regulated
Definition
hormonal interaction
Term
are homones capable of responding to emergency situations
Definition
yes hormones can be secreted through specialized nerve cells and are capable of responding to emergency situations as well as maintaining internal chemal environments
Term
what are the 3 types of chemical hormones
Definition

-steroids

-polypeptides or proteins

- substances derived from amino acids (amines)

Term
what are steroids
Definition
lipid molecules that have cholestorl as a precursor
Term
where are steroids produced
Definition
adrenal glands, ovaries, testes, and placenta
Term
what controls the steroid rate of secretion
Definition
the rate of synthesis and the amount of cholesterol stored control the steroid rate of secretion
Term
what are the 2 forms of proteins
Definition
proteins may be peptides or glycoproteins
Term
what are the peptides
Definition
insulin, glucagon, parathyroid hormone (PTH), GH,and prolactin (PRL)
Term
what are proteins stored and synthesized as
Definition
secretory granules that are released as needed
Term
what are the glycoproteins
Definition

follicle stimulating hormone (FSH), leutenizing hormone (LH) and HGC

- they are all comprised of alpha/beta subunits

Term
what are the amines
Definition
epinephrine, norepinephrine, thyroxine, and triiodothyroxine
Term
which amines behave like protein hormones
Definition
epinephrine and norepinephrine
Term
which amines behave like steroids
Definition
thyroxine and triiodothyroxine
Term
how is the endocrine system regulated
Definition

primarily by means of control of hormone synthesis rather than by rate hormone degradation

(mechanisms of control)

Term
how is the production of hormones regulated
Definition

by a set of feedback relationships

- if concentrations of hormones rise within a desired level the system will take steps to cause the level to fall and vice/versa if the concentration is decreased

Term
what does the fertility assay test for
Definition
FSH, LH, progesterone, PRL, and quantitative HCG
Term
how much destruction of a functioning mass of a gland is necessary before clinical evidence of deficiency occurs
Definition
- as much as 90%

-serial dilutions are made to catch a disruption early

Term
where is pth formed
Definition
formed in the parathyroid gland and secreted into the blood stream
Term
how is the secretory activity of the parathyroid gland ascertained?
Definition
selective measurement of intake pth
Term
what does pth with vitamin D and calcatonin do
Definition
bring about the mobilization of calcium and phosphate from the skeletal system and increase uptake of calcium in the intestine and the excretion of phosphate via the kidneys
Term
how is the secretion of pth inhibited and promoted
Definition
pth is inhibited by high calcium concentrations and promoted by low calcium concentrations
Term
what does parathyroid gland disorders lead to
Definition
elevated/ depressed blood calcium levels (hypocalcemia/hypercalcemia) brought about by a change in the secretion of PTH
Term
what is hypoparathyroidism
Definition
subfunctioning of the parathyroid glands
Term
what is hyperparathyroidism
Definition
hyperfunctioning of the parathyroid gland resulting in increased secretion of pth
Term
what are the primary and secondary causes of hyperparathyroidism
Definition

-primary: adenomas of the parathyroid gland

-secondary: the blood calcium levels are low as a result of other pathological states

Term
what is FSH
Definition
a glycoprotein with 2 subunits
Term
what is FSh secreted by
Definition
secreted by the anterior pituitary gland in response to gonadotropin-releasing hormone secreted by the hypothalamus
Term
what does fsh play a critical role in
Definition

FSH and LH play a critical role in maintianing normal function of the male/female reproductive system

 

Term
describe fsh reaction in the female
Definition
the targeted tissue is the ovarian follicle; fsh stimulates follicle development and production of estradiol and other estrogens during the follicular phase of the menstrual cycle
Term
describe fsh action in males
Definition
the targeted tissue is the steroli cells in the seminiferous tubules of the testes; fsh stimulates spermatogenesis
Term
what increased fsh levels associated with
Definition
menopause and primary ovarian hypofunction in females and primary hypogonadism in males
Term
what are decreased fsh levels associated with
Definition
primary ovarian hyperfunction in females and hypergonadism i males
Term
what fsh levels are associated with polycystic ovary disease in females
Definition
normal or decreased fsh levels
Term
which principle does the COBAS 6000 use to test FSH
Definition
sandwich principle
Term
how does LH secretion come about
Definition
the hypothalamus secretes gonadotropin-releasing hormone (GnRH), a single peptide releasing hormone that controls the secretion of gonadotropins, LH, and FSH from the anterior pituitary gland
Term
what are the targeted tissues of LH in females
Definition
the targeted tissues are ca cells of the ovarian follicles, grafian follicle, and corpus luteum
Term
what does LH do in the female
Definition
stimulates production of androgens that FSH converts to estradiol during the follicular phase; LH acts synergistically with FSH to cause ovulation during the mid cycle peak; LH stimulates progesterone during the luteul phase of the menstraul cycle.
Term
what does LH do in males
Definition

in males the targeted tissue is the Leydig cells in the interstitial tissues of the testes

-LH stimulates testosterone secretion

Term
what are increased LH levels associated with
Definition

menopause, primary ovarian hypofunction, and polycystic ovarian disease in females

primary hypogonadism in males

Term
what are decreased levels of LH associated with
Definition
primary ovarian hyperfunction in females and primary hypergonadism in males
Term
which principle does the COBAS 6000 use to test LH
Definition
sandwich principle
Term
what secretes progesterone in women
Definition
in menstruating women progesterone is secreted mainly by the corpus luteum of the ovary
Term
what does progesterone do
Definition
it is partially responsible for cyclic changes in the endometrium that are necessary for attachment and growth of an embryo
Term
what are the major sources of progesterone in females
Definition
corpus luteum and the placenta
Term
what are minor sources of progesterone
Definition
adrenal cortex in men and women and the testes in men
Term
when do progesterone levels reach there peak
Definition
in the middle of the luteal phase
Term
why do we perform clinical evaluations of progesterone
Definition
clinical evaluation of progesterone confirms ovulation and normal luteul phase in non-pregnant woman
Term
what does inadequate production of progesterone indicate
Definition
inadequate production of progesterone by the corpus luteum may indicate luteul phase deficiency which is associated with infertility and early miscarriage
Term
what effects do oral contraceptives have on progesterone levels
Definition
women using oral contraceptives have suppressed progesterone levels
Term
what is PRL
Definition
a single chain polypeptide hormone secreted by the anterior pituitary gland under the control of prolactin-inhibiting and prolactin-releasing factors
Term
what secretes the inhibiting/releasing factors
Definition
hypothalamus
Term
where else is PRL synthesized
Definition
prolactin is also synthesized in the placenta and present in the amniotic fluid
Term
what does PRL do
Definition
intiates and maintains lactation in females
Term
what are elevated levels of PRL in the absence of pregnancy or post-pardum lactation indicative of
Definition
hyperprolactinemia
Term
what is the most common hypothalmic-pituitary dysfunction encountered in clinical endocrinology
Definition
hyperprolactinemia
Term
what does hyperprolactinemia result in
Definition

galactorrhea, amenorrhea, and infertility in females and impotence and hypogonadism in men

- it may also result in renal failure, hypothyroidism, and prolactin-secreting-pituitary adenomas

Term
which principle does the COBAS 6000 use to test PRL
Definition
sandwich principle
Term
what is Macroprolactin
Definition
a prolactin IgG complex
Term
what does estradiol do
Definition
responsible for the development of the secondary female sex characteristics
Term
what are the 3 primary hormones in the estrogen class
Definition

-estrone (E1)

-estradiol ( E2)

-estriol (E3)

Term
of the 3 hormones in the estrogen class which is the most potent
Definition
estradiol
Term
where are estrogens secreted from
Definition
corpus luteum and the placenta
Term
what is responsible for the majority of estrogen production during pregnancy
Definition
the placenta
Term
where is estrogen produced
Definition
estrogen is produces primarily in the ovaries but small quantities are also produced in the adrenal cortex and the testes
Term
how is the determination of estradiol used clinically
Definition
used for manifestations in the elucidation of fertility disorders in the hypothalamus-pituitary-gonad-axis, gynecomastasia, estrogen- producing ovarian and testicular cancers, and in hyperplasia of the adrenal cortex
Term
what effect does menopause and premature ovarion failure have on E2
Definition
it suppress E2
Term
how does estrogen replacement therapy effect E2
Definition
it may suppress or elevate E2
Term
how does monitoring of follicular development/hormone induction therapy with exogenous gonadotropins effect E2
Definition
e2 levels may be normal or elevated
Term
E2 levels in males
Definition

-gynecomastasia will result in elevated or normal e2 levels

-testicular, adrenal, or pituitary tumors will result in normal or elevated e2 levels

-testicular dysfunction will result in normal or elevated e2 levels

Term
E2 levels in children
Definition

-prococious puberty in girls will elevate e2

- delayed puberty in girls will suppress e2

Term
where is testosterone synthesized almost exclusively
Definition
leydig cells of the testes
Term
what regulates testosterone
Definition
testosterone is regulated by LH and subject to negative feedback via the pituitary or hypothalamus
Term
what does testosterone do
Definition

-promotes the development of the secondary sex characteristics in men

-serves to maintain the function of the prostate and seminal vesicles

Term
where is testosterone found in women
Definition
small amounts found in the ovaries
Term
what can increased production of testosterone in women cause
Definition
virilization, depending on the increase
Term
when is determination of testosterone levels in female helpful
Definition

-diagnosis of androgenic syndrome (AGS)

-polycystic ovaries

-when an ovarian tumor, adrenal tumor, adrenal hyperplasia or ovarian insufficiency is suspected

Term
when is testosterone levels determined in men
Definition

-when reduced testosterone is suspected.

-hypogonadism, estrogen therapy, chromosome abberations (such as Klinefelters syndrome) and liver cirrhois

Term
which principle does the COBAS 6000 use to test testosterone
Definition
competitive principle, using a monoclonal antibody specifically directed against testosterone
Term
what gives HCG its unique biochemical and immunological properties
Definition
the beta subunit
Term
where is hcg synthesized and what does it do
Definition
hcg is synthesized by the placenta and it is involved in maintaining the corpus luteum during pregnancy
Term
what happens to hcg levels in pregnancy
Definition
in pregnancy hcg levels increase exponentially for about 8-10 weeks after last menstrual period
Term
what are sources of elevated hcg other than pregnancy
Definition
eptopic pregnancy, threatened abortion, microabortion, recent termination of pregnancy, and more rarely hcg secreting tumors
Term
which principle does the COBAS 6000 use to test HCG 
Definition
sandwich principle
Term
what is cortisol
Definition

-the most prominent glucocorticosteriod

-it is essential for the maintenence of several body functions

Term
where is cortisol synthesized
Definition
it is synthesized from the common precursor cholesterol in the zona fasciculate of the cortex of the adrenal gland
Term
what are the most important physiological effects of cortisol
Definition

-the increase of blood glucose ( enhancement of glucogenesis and catabolic action)

- anti-inflammatory and immunosuppresive actions

Term
how are synthesis and secretion of cortisol controlled
Definition
a negative feedback mechanism within the hypothalamus-pituitary-adrenal cortex axis
Term
what is cortisol a negative feedback mechanism of
Definition
cortisol itself acts as a negative feedback mechanism on the pituiary gland and the hypothalamus
Term
serum cortisol normal shows diurnal variation. what does that mean
Definition
maximum concentrations are usually reached early in the morning
Term
cortisol status is helpful in diagnosising what
Definition
the function or malfunction of the adrenal gland, the pituitary, and the hypothalamus
Term
what is the specimen of choice for diagnosis of Cushing's syndrome and why
Definition
-the determination of cortisol in the 24hr urine is the specimen of choice for the detection of Cushing's syndrome since cortisol secretion in the urine is not subject to the diurnal rhythm of cortisol serum secretions
Term
What is Prostate Specific Antigen (PSA)
Definition
a single chain glycoprotein normally found in the cytoplasm of epithelial cells lining the acini and ducts of the prostate gland and in the seminal fluid
Term
when is psa detected in a males serum
Definition
psa is detected in the serum of males with normal, benign hypotrophic, and malignant prostate tissue
Term
what causes serum levels of PSA to be elevated
Definition
in diseases of the prostate including benign prostatic hypertrophy and prostatic carcinoma
Term
what are elevated psa levels indicative of
Definition
elevated psa levels are generally indicative of a pathological codition of the prostate
Term
is the % free psa lower or higher in patients who have prostate cancer
Definition
% free psa is significantly lower in patients having prostate cancer than those with benign disease or normal control
Term
what is Carcinoembryonic Antigen (CEA)
Definition
monomeric glycoprotein with a variable carbohydrate component
Term
where is cea found
Definition
cea is mainly found in the fetal gastrointestinal tract and in fetal serum
Term
where are high concentrations of cea frequently found
Definition
high concentrations of cea are frequently found in cases of colorectal adencarcinoma
Term
what causes slight to moderate elevations in cea
Definition
slight to moderate cea elevations occur in 20-50% of benign diseases of the liver, pancreas, intestine, and lungs
Term
does smoking effect cea levels
Definition
yes, smokers have elevated cea levels
Term
what is the main indication of cea determination
Definition
the main indication of cea determination is the follow-up and therapy management of colorectal carcinoma
Term
what is thyroxine
Definition
thyroxine is a hormone synthesized and secreted by the thyroid gland and it plays an important role in regulating metabolism
Term
how is thyroxine controlled
Definition

- secretion of thyroxine in the circulation is in response to TSH

-thyroxine is regulated by a negative feedback mechanism involving the thyroid gland, pituitary gland, and the hypothalamus

Term
what free thyroxine (FT4)
Definition
the physiologically active thyroxine component
Term
in what conditions does FT4 levels parallel changes in total T4 levels
Definition
hypothyroidism/ hyperthyroidism
Term
when is measuring ft4 useful
Definition
measuring ft4 is useful when altered levels of total t4 occur due to changes in t4 binding proteins, especially TBG
Term
what is measured when thyroid disorders are suspected
Definition
FT4 with TSH
Term
how is thyrosuppressive therapy monitored
Definition
determination of ft4 levels
Term
how is Thyroid Stimulating Hormone (TSH) controlled
Definition
tsh is synthesized and secreted in the anterior pituitary in response to negative feedback mechanisms involving concentrations of FT3 and Ft4
Term
what are the 2 main actions of TSH
Definition

- stimulate cell production and hypertrophy

-stimulate the thyroid gland to synthesize and secrete t3 and t4

Term
what directly stimulates tsh production
Definition
the hypothalamic tripeptide, thrytropin-releasing-hormone (TRH)
Term
why is quantitating tsh important
Definition

- quantitating tsh is important in evaluating thyroid function

-it is useful in differential diagnosis of primary(thyroid) secondary( pituitary) and tertiary (hypothalamus) hypothyroidism

Term
how are tsh levels affected in primary hypothyroidism
Definition
-tsh levels are significantly elevated
Term
how are tsh levels affected in secondary and tertiary hypothyroidism
Definition
tsh levels are low
Term
how does tsh respond to trh stimulation in secodary hypothyroidism
Definition
in secondary hypothyroidism tsh response to trh stimulation is absent
Term
how does tsh respond to trh stimulation in tertiary hypothyroidism
Definition
in tertiary hypothyroidism tsh response to trh stimulation is normal to exaggerated
Term
primary hypothyroidism
Definition
primary hypothyroidism is located om the thyroid, TSh levels are low and trh stimulations show elevated t3 and t4 levels with low to undetectable tsh levels
Term
secndary hypothyroidism
Definition
located in the pituitary, tsh levels are low, and tsh response to trh stimulation is absent
Term
tertiary hypothyroidism
Definition
located in the hypothalamus, tsh levels are low, and tsh response to trh is normal to exaggerated
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