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158 Cards in this Set

  • Front
  • Back
What is a trace element?
Found as 1 microgram per gram of tissue.
Function as enzyme cofactors.
How much IRON is in the body?
3-5 g of iron in the body
~2-2.5 g in hemoglobin
~ 130 mg in myoglobin
~8 mg in tissues (bound to enzymes)
~3-5 mg found in plasma –bound to transferrin, albumin and free hemoglobin
Also stored as ferritin and hemosiderin in BM, liver and spleen
On average, how much iron is lost per day in adults?
1 mg
What enzyme reduces iron from the ferric to the ferrous state?
Ferric reductase. Ferrous iron allows hemoglobin to bind reversibly to oxygen and CO2.
What oxidizes iron from the ferrous to the ferric state and why?
Ceruloplasmin so iron can be transferred by transferrin.
How much iron is lost per day with each menstrual cycle? Each pregnancy?
Menstrual Cycle: 20 - 40 mg
Pregnancy: 600 - 900 mg
What is hemochromatosis?
excess absorption of iron from normal diet. Increase in serum iron and ferritin, Decrease in transferrin.
What does hemochromatosis lead to?
Iron accumulation in tissues, altered liver function, and causes hyperpigmentation. Treat with therapeutic phlebotomy.
How can iron status be determined?
Measuring hemoglobin or serum iron (diurnal variation, cannot be hemolyzed).
What is the formula for TIBC in mg/dL?
serum transferrin(mg/dL) X 1.25
What is the formula for % saturation?
(total iron/TIBC) X 100
How does copper travel through the body?
Through the blood bound to albumin or histidine for transport to liver, brain, heart, and kidneys.
T/F
Half of dietary copper is excreted through feces.
True.
What happens to the copper that is not excreted?
Most is incorporated as ceruloplasmin, an acute phase reactant.
What usually causes an iron deficiency and what does this cause?
premature infants, malnutrition, chronic diarrhea.

results in decreased hemoglobin and collagen production.
T/F
Zinc is 2nd to iron in importance as a trace element?
True
T/F
Zinc is higher in concentration in plasma or serum than in erythrocytes.
False.
What levels of lead are toxic to adults and children?
Adults: 30 mg/dL
Children: 10 mg/dL
How is lead exposed to the body? What is the final storage of lead that is not excreted?
Exposure is respiratory or gastrointestinal.
Final Storage: ~ 5% soft tissues
~ 95% bones
What is selenium a component of?
Glutathion peroxidase and T-5 deiodinase
How is selenium incorporated into our diet?
Organ meats, seafood, cereals, dairy products, fruits, and vegetables.
Where is low selenium often found? How do you treat it?
Parts of China resulting in Keshan disease or Kashian-Bek disease. Selenium replacement completely corrects problem.
The majority of iron in whole blood is found where?
Bound to hemoglobin.
Blood specimens for iron and TIBC are drawn early in the morning because, why?
Iron exhibits diurnal variation.
What is likely to occur first in IDA?
Decreased serum ferritin.
What protein binds ferric iron and is increased in IDA?
Transferrin.
What is the method of choice for detecting ALL trace metals?
Atomic absorption spectroscopy
What are considered macronutrients?
proteins, lipids and carbs.
provides information about duration of malnutrition.
What are micronutrients?
vitamins and minerals.
assessment of kidney, liver, heart and bone.
What are the nitrogenous biomarkers of nutritional status?
creatinine, albumin, retinol-binding protein, transferrin, iron, and transthyretin.
How long is albumin's half life?
18 - 20 days
What does hypoalbuminemia indicate?
protein deficiency and hydration status.
T/F
Retinol-binding protein correlates with protein energy status.
True
What is transferrin's half-life?
8 days; sensitive marker of recent protein energy.
T/F
Transthyretin is the least sensitive of all the biomarkers.
False. Transthyretin carries thyroid hormones and has a half life of 1-2 days, making it VERY SENSITIVE!
T/F
A negative nitrogen balance is recommended for therapy of certain disorders.
FALSE! A positive nitrogen balance is recommended.
What are the FAT SOLUBLE vitamins?
A, D, E, K
absorbed and stored for long periods.
What is Vitamin A also known as?
retinal, retinol, retinoic acid
What are dietary sources of Vitamin A?
liver, organ meats, fish oil, yellow to orange fruits and green leafy vegetables.
What does a deficiency in Vitamin A lead to?
night blindness and abnormal growth.
What is another name for Vitamin D?
Cholecalciferol
How does the body obtain Vitamin D?
exposure to sunlight, irradiated foods, and commercially prepared milk.
What is the RDA for Vitamin D?
5 mg/day
deficiency leads to rickets in children or osteomalacia in adults.
What vitamin is also known as alpha-tocopherol?
Vitamin E
T/F
Vitamin E is only attained through dietary intake.
True.
egg yolks, vegetables, and legumes.
What are benefits of Vitamin E?
Functions as an antioxidant and is critical for neurological structure and function. Protects erythrocyte membrane from oxidant stress.
Deficiency can lead to hemolytic anemia.
What is another name for Vitamin K?
Phylloquinone
supplied partly by diet and partly synthesized by intestinal bacteria.
T/F
Vitamin K is essential in formation of coagulation factors.
True.
prothrombin, Factors VII, IX and X, protein C and S
What are dietary sources of Vitamin K?
cabbage, cauliflower, spinach, pork, liver, soy beans, and vegetable oils.
Deficiency leads to hemorrhage.
What is ascorbic acid?
Vitamin C
What are some benefits of Vitamin C?
reducing agent, functions in synthesis of collagen, and aids in biosynthesis of some neurotransmitters. considered important in reducing the risk of Certain Cancers and Common Cold.
What are the major dietary sources of Vitamin C?
Citrus fruits and vegetables.
What does a long term deficiency of Vitamin C cause?
Scurvy.
What is the function of the B complex?
Most serve as enzyme cofactors functioning to transport atoms between molecules in enzyme coupled reactions.
What vitamins make up the B complex?
thiamine - B1, riboflavin - B2, niacin, pantothenic acid, biotin, pyridoxine B6, folates, and cyanocobalamin B12.
What can a Vitamin B12 deficiency lead to?
Pernicious anemia
What does a Vitamin B12 and folate deficiency lead to?
megaloblastic anemia
What is the reference range of serum folate?
RBC folate?
Serum folate: 2.6 - 12.2 mg/L
RBC folate: 103 - 411 mg/L
What enzyme breaks down starch?
Amylase.
What cells is pepsin released from?
Chief cells.
What acid is secreted from parietal cells and stimulates gastrin?
HCl
What stimulates the release of bile form the gall bladder?
Cholecystokinin.
Where does absorption take place in the body?
Small intestine.
Glucagon, insulin, and somatostatin are produced where in the body?
Pancreas in the islets of langerhans.
T/F
Sodium bicarbonate is in the pancreas and functions to neutralize gastric fluid.
True.
What are the proteolytic enzymes?
Trypsin, chymotrypsin, elastase, carboxypeptidase, nuclease, and secretin.
What are the pancreatic hormones and where are they located?
Amylase, lipase, peptidases, disaccharidases. Located in the islets of langerhans.
What are the symptoms of malabsorption?
Weight loss, bruising, flatulance, bloating, diarrhea, steatorrhea
What disease is characterized by an inherited autoimmune intolerance to gluten?
Celiac disease.
Ag-Ab complex deposits in intestinal mucosa, causes a specific lesion. Leads to poor absorption and irritation of stomach.
T/F
Tropical sprue is an inherited disease that causes abnormalities of the small bowel.
False.
It is Acquired.
What condition is also known as toxic megacolon?
Ulcerative Colitis.
Chronic inflammation disorder.
Mucosa of rectum and left colon are most affected.
What is Crohn's disease?
Chronic inflammation of intestine of unknown etiology that can lead to intestinal obstruction. Ileum and colon are most affected.
What is the function of chief cells?
production of pepsinogen
What syndrome causes a gastrin producing tumor in the pituitary and parathyroid glands?
Zollinger Ellison syndrome
T/F
50% of the gastrinomas are malignant and 25% of the malignant have multiple tumors.
True.
What is the most common carbohydrate malabsorption disorder?
Lactose Intolerance.
____% of people affected by lactose intolerance show diminished lactase activity after first few years of life.
70%
What test is used to detect gastrinomas?
gastrin stimulation test
What do normal fecal lipids consist of?
60% fatty acids
30% sterols
10% tri-acyl glycerols
What does increased fecal fat indicate?
Biliary obstruction or malabsorption
What 2 stains are used to stain fat globules?
Sudan III and Sudan IV
What are the reference ranges for qualitative (random) and quantitative (72 hr collection) fecal fat analysis?
Qualitative: 40- 50 droplets/hpf
Quantitative: >/= 6g/day
What does the D-Xylose test assess and how much passes through the intestinal mucosa?
Assesses mucosal absorption of small intestine.
Approximately 60% taken in an oral dose will pass through intestinal mucosa.
What does low absorption of D-Xylose indicate?
Disorders of the small intestine.
Crohn's, malabsorption, celiac, etc.
What type of procedure is the D-Xylose reaction?
Spectrophotometric
Describe the reaction of D-Xylose.
xylose is measured by heating the protein free specimen to convert xylose to fufural. Which then combines with a chromagen for measurement.
What is the reference range for a 5g oral dose of D-Xylose?
Normal >/= 1.4 g
Borderline 1.2 - 1.4 g
Abnormal < 1.2 g
What is pancreatitis?
Viral, autoimmune, tumor, or toxin related to destruction of acinar cells of pancreas. Reflux of bile and duodenal contents into pancreas lead to release of pancreatic enzymes into the blood stream.
T/F
Chronic pancreatitis is reversible and has a low mortality rate.
False.
Chronic pancreatitis is irreversible with a high mortality rate.
A rapid increase in serum amylase, urine amylase, and serum lipase indicates what disorder?
Acute Pancreatitis.
What is the most common single-gene inherited disease in people of Northern European heritage?
Cystic Fibrosis.
What causes cystic fibrosis to occur?
Cystic fibrosis mutant gene – CFTR (cystic fibrosis transmembrane-conductance regulator) occurs on chromosome 7.
70% of cases are F508
What does the cystic fibrosis mutation cause?
All exocrine secretions to have less water.
-salty sweat
-malabsorption
What is the reference range for the sweat chloride screening test?
Normal <35 mmol/L
CF > 60 mmol/L
How is sweat stimulated in the sweat chloride test?
Iontophoresis of pilocarpine
T/F
Amylase requires Cl and Ca for full activity.
True.
Which analytic method measures the rate of hydrolysis of starch by amylase using turbidometry or nephelometry?
Amyloclastic.
What does the saccarogenic method measure?
Rate of production of monosaccharides or disaccharides produced in the reaction when amylase reacts with the substrate.
What is the reaction formula for the saccharogenic method?
4-NP-(glucose)7 + a-amylase --> 4-NP-(glucose)4,3,2 + (glucose)5,4,3

4-NP-(glucose)4,3,2 + a-glucosidase --> 4-NP-(glucose)4 + X-glucose + 4-NP
What is the formula for the methods for lipase?
triglycerides + lipase --> fatty acids + glycerol
glycerol + ATP(Mg+2) + glycerol kinase --> glycerol- 1-phosphate + ADP
glycerol-1-phosphate + O2 + glycerol oxidase --> DHAP + H2O2
H2O2 + 4-AAP + dye-precursor --> H2O + quinonimine dye (colored)
What is a tumor/neoplasm?
Abnormal/uncontrolled proliferation of cells.
Benign vs. Malignant
Benign: remains confined to primary site.

Malignant: capable of invading surrounding tissue and metastasizing through circulatory and lymphatic systems.
What is the term for loss of cell differentiation and change in cell/tissue structure?
Anaplasia
What is a carcinoma?
malignant growth from skin/organ.
What is an adenoma?
benign growth arising from glandular epithelium.
What are the desirable traits of a tumor marker?
- Specific for type of cancer
- Always present with that cancer
- Amount correlates with tumor load
- Short half-life
- Levels should have prognostic value
What should a good screening test have?
- high diagnostic sensitivity
- low rate of false negatives
What should a confirmatory test have?
- high diagnostic specificity
- low rate of false positives
What are types of tumor markers?
- enzymes and isoenzymes
- hormones, neurotransmitters and their metabolites
- receptors
- proteins
- genetic markers
What cancers is Carcinoembryonic Antigen (CEA) elevated in?
-colon - ovarian
- lung - uterine
- gastric - prostate
- breast
- pancreatic
What are some problems with CEA and what is it most useful for?
Problems: elevated in nonmalignant conditions

Useful: establishing prognosis and monitoring therapy and reoccurance of disease.
What is the only tissue-specific marker?
Prostate Specific Antigen (PSA)
-serine protease produced by epithelial of prostate.
- not specific for prostate cancer
- also elevated in Benign Prostatic Hyperplasia
What hormone is also known as the "pregnancy hormone"?
Human Chorionic Gonadotropin (HCG)
What can HCG be used for besides detecting pregnancy?
Monitoring trophoblastic pathologies and germ cell tumors of the testes and ovaries.
What tumor marker is synthesized in the yolk sac, fetal liver, GI tract and kidney?
Alpha-fetoprotein (AFP)
What is AFP used for?
A marker for neural tube defects and a screening tool for down syndrome. Moderate elevations in liver disease.
What is Cancer Antigen 15-3?
Glycoprotein on mammary epithelium.
Increased in breast cancer
- also increased in pancreatic, lung, ovarian, colorectal, and liver cancer
What is CA 15-3 primarily used for?
Monitoring patients after surgery.
Used in combination with CA 27-29 for monitoring reocurrance.
Clinical assays for most tumor markers are important for:
Monitoring the course of a known cancer.
The most specific tumor marker for prostatic cancer is:
PSA
CA 125 is elevated in the serum of patients with:
ovarian cancer
What is the oncofetal antigen marker for liver cancer?
AFP
T/F
CA 125 is useful for diagnosis but limited in monitoring disease state.
False.
Limited use in diagnosis but useful in conjunction with CEA.
Useful in monitoring disease in ovarian cancer patients.
What is CA 19-9?
- blood group antigen
- specific for pancreatic cancer but also present in other gastrointestinal cancers.
- used to monitor therapy and predict reoccurance.
Name the cancer/affected body part associated with each enzyme/isoenzyme.

Prostatic acid phosphatase
prostate cancer
CK-BB
prostate and stomach cancer
ALP
bone and liver
Amylase/Lipase
pancreatic
What is the difference between endocrine and paracrine hormones?
Endocrine travel away from the site they were produced.

Paracrine are released into interstitial space, target close to production.
What are the physiological functions of hormones?
- Maintenance of internal environment
- Reproduction
- Growth and Development
- Energy storage, production and utilization
What are characteristics of protein hormones?
- from amino acids
- water soluble
- short half-life (5 - 60 minutes)
What are characteristics of steroid hormones?
- synthesized from cholesterol
- lipid soluble; require transport proteins
- long half-life (60 - 100 minutes)
What are amines?
Hormones with characteristics of protein and steroid hormones.
Ex: catecholamines and thyroxine
What happens when a hormone binds to a cell receptor?
- This leads to the production of a second generation messenger which mediates the hormone's effect on intracellular enzymes and/or gene's expression.
- provides target organ specificity
What is a G Protein receptor?
monomeric proteins with an extracellular domain and cytoplasmic domain.
- use guanine nucleotide-binding proteins as the interface with target proteins
What are protein kinase receptors?
Contain intrinsic hormone-activated tyrosine kinase activity.
- direct catalysts of phosphorylation rxn
Ex: insulin receptor
Describe how steroid hormones work.
Steroid hormones bind to an inactive receptor

Shape change occurs, becomes activated

Complex binds to DNA at hormone response elements
"biologically active"
How do thyroid hormones work?
Thyroid hormones bind to specific chromatin receptors

Chemical change

activation/repression of gene transcription
T/F
Exposure of high concentrations of hormone may decrease number and affinity of surface receptors.
True.
This is referred to as "down regulation" or "desensitization".
T/F
Hormones have no affect on each other.
False.
Some hormones can influence others but most hormones only influence their own receptors.
Ex: estrogen can increase the binding of oxytocin
What is "specificity spill-over"?
Hormones may have varying affinity levels; strong for their receptors, weak for others.
T/F
Secretions of hormones are continuously released at a constant rate throughout the day.
False.
The secretions are rhythmic and occur in bursts.
- vary over minutes, hours, days, or weeks
How does the hypothalamus play into the the secretion of hormones?
produces several neurosecretory factors that stimulate or inhibit the release of corresponding hormones from the anterior pituitary.
- the hormones from the anterior pituitary then act on other target endocrine glands
Does the following describe negative or positive feedback?

Stimulating hormone induces production of a specific hormone. Elevated levels of this hormone turns off the release of the stimulating hormone.
Negative feedback
What is the positive feedback mechanism?
Stimulating hormone induce production of a specific hormone. Elevated levels of this hormone induces MORE stimulating hormone to be released.
Describe the Adenohypophysis (anterior lobe of pituitary gland).
- Composed of nests of different cell types that secrete different hormones or tropins.
- provides secondary level of control
- hormone secretion is controlled by hypothalamus
- referred to as master gland, due to the many hormones it secretes.
Ex: PRL, GH, FSH, LH, TSH, ACTH
Describe the Neurohypohysis (posterior lobe of pituitary gland).
- closely associated with hypothalamus, connected via a stalk
- does not synthesize any hormones
- primarily stores and releases hormones produced by hypothalamus
- serves as storage area for oxytocin and ADH
What cells in the anterior pituitary produce the protein hormone, prolactin?
Lactotrophs
What chain of events follows a decrease in Prolactin Inhibitory Factor (dopamine)?
Increase in Prolactin RF from hypothalamus --> Increase in Prolactin form anterior pituitary --> Increase in milk production by mammary glands
T/F
Prolactin is also present normally in men, children, and non-lactating women.
True.
<20 ng/mL
What is a prolactinoma?
Prolactin producing tumor which causes HYPERPROLACTINEMIA.
Hyperprolactinemia leads to galactorhea and gynecomastia.
What hormone is secreted by the somatotroph cells in the anterior pituitary and stimulates growth and metabolism for whole body?
Growth Hormone (GH) aka somatotropin
- controlled by hypothalamic GHRH
Acromegaly is characterized by what traits?
excess GH in adults causing enlarged bones
What disorder is caused by excess GH pre-puberty?
Gigantism
What disorder causes small, proportional stature in children but has no effect on adults?
Dwarfism: pre-puberty deficiency of GH
What hormone plays a critical role in lactation, labor, and parturition?
Oxytocin
- contraction action in parturition
- ejaculation of milk
What areas of the body does oxytocin play major roles in?
Smooth muscle
- uterus
- mammary gland
Elevated levels of GH are useful in diagnosis of _____?
Acromegaly