Biochemistry Exam #3 New

Front 1

Hypernatremia is most commonly due to a) reduced or b) increased water intake.

Back 1

Reduced

Front 2

Hypernatremia is more commonly due to low water intake in a) children or b) elderly.

Back 2

Elderly

Front 3

Hypernatremia from polyuria may be the result of increase water loss due to diabetes _______ or diabetes ________.

Back 3

Mellitis, Insipidus

Front 4

What type of diabetes leads to osmotic diuresis?

Back 4

Diabetes Mellitus

Front 5

What plasma molecule should be evaluated?

Back 5

Glucose

Front 6

What type of diabetes leads to reduced ADH?

Back 6

Diabetes Insipidus

Front 7

In children, what are the two most common causes of hypernatremia?

Back 7

diarrhea and sweating

Front 8

Which two steroidal hormones, in excess, may cause hypernatremia?

Back 8

aldosterone and cortisol

Front 9

Which hormone is elevated in Conn’s Syndrome, an adenoma?

Back 9

Aldosterone

Front 10

Which hormone is elevated in Cushing’s Syndrome?

Back 10

Cortisol (more formally as hydrocortisone)

Front 11

Is Hypernatremia or Hyponatremia more common in the hospital?

Back 11

hyponatremia

Front 12

Is hyponatremia due to a) more water or b) less water?

Back 12

more water

Front 13

In cardiac failure, cirrhosis and nephrosis, is there a a) increase or b) decrease in effective circulating plasma volume?

Back 13

decrease

Front 14

The six common factors that contribute to formation of edema are:

Back 14

• increased hydrostatic pressure
• reduced oncotic pressure within blood vessels
• increased tissue oncotic pressure
• increased blood vessel wall permeability e.g. inflammation
• obstruction of fluid clearance via the lymphatic system
• changes in the water retaining properties of the tissues themselves

Front 15

A deficiency in which two hormones promotes hyponatremia?

Back 15

TSH/T4 hypothyroidism, morning cortisol/adrenal insufficiency

Front 16

What are three “pre-analytical factors” which may result in erroneous hyperkalemia values?

Back 16

haemolysis, EDTA contamination, delayed sample separation

Front 17

Hyperkalemia due to renal failure may be due to:

Back 17

a) Reduction in urine flow
b) Renal tubular damage
c) Potassium release into extracellular fluid by disease
d) Acidosis inhibiting potassium secretion
f) Addison’s Disease
g) hyperaldosteronism

Front 18

Name two blood pressure drugs which may result in hyperkalemia.

Back 18

ACE inhibitors and Beta blockers

Front 19

Name one anticoagulant drug which may result in hyperkalemia.

Back 19

Heparin

Front 20

Which hormone that controls serum glucose uptake is important for managing hyperkalemia?

Back 20

insulin

Front 21

Which hormone excess (that controls serum glucose) may induce hypokalemia?

Back 21

cortisol

Front 22

Which two drugs commonly used in asthma patients may result in hypokalemia? One is a short-acting β2-adrenergic receptor agonist. One is a methylxanthine similar to caffeine.

Back 22

Salbutamol, Theophylline

Front 23

In which organ does the urea cycle occur?

Back 23

Liver (primarily)

Front 24

In which two cellular compartments does the urea cycle occur?

Back 24

mitochondria and cytoplasm

Front 25

What amino acid is the direct precursor for urea?

Back 25

Arginine

Front 26

If the urea cycle is not working correctly, which neurotoxic molecule builds up?

Back 26

Ammonia, but only after a period of higher serum glutamine.

Front 27

What are the symptoms for acute hyperammonemia?

Back 27

tachypnea, lethargy, vomiting, convulsions, encephalopathy

Front 28

What are the symptoms of chronic hyperammonemia?

Back 28

vomiting (may be cyclical), faddy eating (high protein food avoidance), behavioral changes, neurological deficits (eg spastic diplegia as in arginase deficiency)

Front 29

Which amino acid is a non-specific feature which builds up in the serum for all urea cycle defects?

Back 29

glutamine

Front 30

A decrease in plasma urea may be due to which three conditions:

Back 30

low protein intake, liver disease, hemodilution in pregnancy

Front 31

Creatinine levels in plasma will increase a) immediately or b) after a 50% reduction in the kidney glomerular filtration rate.

Back 31

After a 50% reduction in the kidney glomerular filtration rate.

Front 32

Creatinine levels are a) higher or b) lower in women and the elderly.

Back 32

lower

Front 33

Most proteins in the blood (except particular globulins) are synthesized in the a) intestine or b) liver.

Back 33

liver

Front 34

Infection/inflammation is a cause of a) low protein or b) high protein in the blood.

Back 34

high protein

Front 35

Myeloma is a) “polyclonal gammopathy” or b) a “monoclonal gammopathy."

Back 35

monoclonal gammopathy

Front 36

Burns result in a) high or b) low plasma protein.

Back 36

low plasma protein

Front 37

Chronic liver disease results in a) high or b) low plasma protein.

Back 37

low plasma protein

Front 38

Insulin, anabolic steroids, cortisol and thyroxin cause an a) increase or b) decrease in serum protein.

Back 38

increase

Front 39

Which protein has a major role in the oncotic pressure and plasma transport of short fats and many negatively charged and hydrophobic molecules?

Back 39

serum albumin

Front 40

The breakdown of heme creates:

Back 40

bilirubin

Front 41

In general, what are the three ways by which bilirubin’s metabolic pathway becomes a problem?

Back 41

If this metabolic pathway is interrupted through 1. haemolysis, 2. liver disease or 3. obstructive biliary disease then bilirubin can accumulate in the plasma and be deposited in tissues (sclera of eyes, mucous membranes and skin) to produce the yellow/green color of jaundice.

Front 42

Alanine aminotransferase is a specific marker for _______________damage.

Back 42

hepatocellular

Front 43

How can one differentiate ethanol based liver damage?

Back 43

AST > ALT by 2:1

Front 44

What is AST?

Back 44

Aspartate aminotransferase

Front 45

What common medicine to control cholesterol may induce liver damage?

Back 45

Statins/various herbal

Front 46

What comprises steatosis?

Back 46

Steatosis (also called fatty change, fatty degeneration or adipose degeneration) is the process describing the abnormal retention of lipids within a cell-leads to NASH and alcoholic steatohepatitis, which has inflammation.

Front 47

Hemochromatosis is also called _______________.

Back 47

Iron overload disease

Front 48

How common is hemochromatosis in Celtic, British and Scandinavians?

Back 48

10% carriers; 1% sufferers

Front 49

What is the expected result of high meat intake, high alcohol intake and high vitamin C intake for those with hemochromatosis?

Back 49

increased liver damage, cirrhosis, steatohepatitis

Front 50

What is Wilson’s disease?

Back 50

Copper overload disease

Front 51

What pathology is associated with alpha 1 antitrypsin deficiency?

Back 51

Liver cirrhosis

Front 52

What non-hepatic common condition results in increased ALT?

Back 52

rhabdomyolysis

Front 53

What are the two most clinically relevant isoenzymes of alkaline phosphatase?

Back 53

Liver and bone- intestinal may play minor diagnostic roles

Front 54

In bone, which three bone diseases result in an increase in alkaline phosphatase derived from osteoblasts?

Back 54

malignancy, osteomalacia, Pagets disease

Front 55

What enzyme is important for the transport of amino acids into cells and in glutathione metabolism?

Back 55

Gamma-glutamyltransferase (GGT)

Front 56

Name a common antiepileptic drug that may increase GGT?

Back 56

Phenytoin, aka dilantin

Front 57

What is the difference between fatty liver disease (FLD), steatohepatitis, NAFLD and NASH.

Back 57

http://en.wikipedia.org/wiki/Non-alcoholic_steatohepatitis

Front 58

What is metabolic syndrome?

Back 58

Includes five factors including obesity, high triglycerides, high blood pressure, low HDL and high blood sugar. Individuals with metabolic syndrome are at higher risk for diabetes and heart disease.

Front 59

What is NHANES?

Back 59

National Health and Nutrition Examination Survey

Front 60

What type of tissue produces leptin and what does it signal?

Back 60

Adipose tissue (fat cells) and it signals the feeling of satiety.

Front 61

Consuming a 44 oz soft drink daily is estimated to cause an increase of:

Back 61

60 lbs/yr

Front 62

Soft drinks contain caffeine that acts as a diuretic, and 55 mg of sodium/12 oz can. What is the effect of these two compounds?

Back 62

Increased thirst

Front 63

Considering glucose, fructose and sucrose, which are monosaccharides? Which are disaccharides?

Back 63

Glucose, fructose; Sucrose, Sucrase cleaves sucrose into glucose and fructose.

Front 64

Considering glucose, fructose and sucrose, which sugar is “non-reducing” (ie has the “anomeric” carbon fixed)? Which sugars are “reducing”?

Back 64

Glucose, Fructose; Kidneys can recycle sugars up to 100 deciliter; after that, you see glucosuria (sugar in urine).

Front 65

The presence of “reducing” sugars in urine is a test for:

Back 65

diabetes mellitus.

Front 66

Is there any difference between juice and pop in terms of sugar?

Back 66

No, both contain fructose.

Front 67

Considering the historical trend, low fat food typically contains more:

Back 67

sugar

Front 68

Considering the variability in two LDL types, which blood markers provide the best indication for a reduced risk for CVD (cardiovascular disease)?

Back 68

Triglycerides and HDL

Front 69

What is “AGE” (advanced glycation end-products)?

Back 69

Chain of chemical reactions after an initial glycation reaction. AGEs affect nearly every type of cell and molecule in the body, and are thought to be one factor in aging and some age related chronic diseases. They are also believed to play a causative role in the vascular complications of diabetes mellitus.

Front 70

Approximately how much fiber was consumed with a Paleolithic diet?

Back 70

100-300 grams/day

Front 71

Approximately what is the intake of fiber in our present diet?

Back 71

15 grams/day

Front 72

Rank these fats from best to worst:

Back 72

mono-unsaturated fats, omega-3 fats, omega-6 fats, saturated fat, partially hydrogenated (ie trans) fat

Front 73

What four organs play a dominant role in fuel metabolism?

Back 73

Liver
Adipose
Brain
Muscle

Front 74

What is the importance of sulfonylureas in the treatment of diabetes?

Back 74

They increase insulin secretion by closing ATP-sensitive potassium channels.

Front 75

What biological effects are INCREASED as a result of INSULIN binding?

Back 75

Glucose uptake
Glycogen synthesis
Protein synthesis
Fat synthesis

Front 76

What biological effects are DECREASED as a result of INSULIN binding?

Back 76

Gluconeogenesis
Glycogenolysis
Lipolysis

Front 77

When insulin INCREASES, glucagon a) decreases or b) increases?

Back 77

Decreases

Front 78

What effect does epinepherine have on insulin and glucagon?

Back 78

Epinepherine is a sympathetic nervous system neurotransmitter and is stimulated during the fight or flight response.

In periods of stress, glucagon levels are elevated in anticipation of increased glucose use. In contrast, insulin levels are decreased.

Front 79

What biological effects are INCREASED as a result of GLUCAGON binding?

Back 79

Glycogenolysis
Gluconeogenesis
Lipolysis
Ketogenesis
Uptake of amino acids

Front 80

What biological effects are DECREASED as a result of GLUCAGON binding?

Back 80

Glycogenesis

Front 81

Neuroglycopenia is the result of:

Back 81

Hypoglycemia

Front 82

What are the symptoms of neuroglycopenia?

Back 82

headache, confusion, slurred speech, seizures, coma, death

Front 83

At what blood glucose level, do neuroglycopenia symptoms begin?

Back 83

50 mg/dl

Front 84

At what blood glucose level does insulin production decrease?

Back 84

85 mg/dl

Front 85

Insulin is released by ___________ cells in the pancreas.

Back 85

Beta

Front 86

Glucagon is released by ___________ cells in the pancreas.

Back 86

Alpha

Front 87

How are chylomicrons important in the feed/fast cycle?

Back 87

Chylomicrons (lipoproteins in the bloodstream) transport dietary fats and cholesterol from intestines to tissues.

Front 88

What is the half-life of insulin?

Back 88

Six minutes, then it is degraded by liver and kidney insulinase.

Front 89

Approximately how long after eating a meal does gluconeogenesis begin?

Back 89

4-6 hours, it plays a major role in maintaining blood glucose during overnight fasting.

Front 90

By what process does the body begin to produce fuel after 2-3 days of fasting?

Back 90

Ketogenesis

Front 91

What is the primary ketone produced during ketogenesis?

Back 91

3-hydroxybutyrate

Front 92

What does adipose tissue degrade in order to provide fuel for the body in prolonged fasting?

Back 92

Stored triacylglycerols (TAGs)

Front 93

What does the liver degrade during short periods of fasting?

Back 93

Glycogen, via gluconeogenesis

Front 94

What provides the NADH and ATP required for gluconeogeneis?

Back 94

Fatty acid oxidation - this increases during fasting.

Front 95

What products are formed from TAG mobilization and are required for ketogenesis?

Back 95

Fatty acids and precursors for ketone bodies

Front 96

Along with insulin, what polypeptide is a part of glycemic control?

Back 96

Amylin

Front 97

What transporters, does insulin promote the recruitment of?

Back 97

Insulin-sensitive glucose transporters (GLUT-4)

Front 98

What tissues do NOT require insulin (insulin insensitive) for glucose uptake?

Back 98

Erythrocytes, leukocytes, lens of eye, cornea, liver, brain, renal tubules, choroid plexus and intestinal epithelia

Front 99

What tissues DO require insulin for glucose uptake?

Back 99

skeletal muscle, cardiac muscle, adipose tissue

Front 100

Where are GLUT-4 transporters recruited from?

Back 100

Intracellular stores in skeletal muscle and adipose tissue

Front 101

What enzyme phosphorlates glucose into glucose 6-phosphate?

Back 101

Hexokinase

Front 102

In insulin formation, what is formed after the signal sequence is cleaved?

Back 102

Proinsulin