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73 Cards in this Set
- Front
- Back
Carbohydrates are...
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-complex sugars
-metablized into basic sugars |
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Blood glucose may change d/t...
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-inc or dec metabolism of carbs into sugar
-inc or dec rate of consumption of glucose by cells -hormones help to regulate glucose movement into and out of the cell |
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What decreased blood sugar?
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Insulin
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What increased blood sugar?
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-glucagon
-cortisol -epi -growth hormone |
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Insulin
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-produced in pancreas in islets of langerhans (beta cells)
-controls cells ability to take glucose from the blood stream (increases cells uptake of glucose) |
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What factor is most important in regulating insulin secretion?
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circulating concentration of blood glucose
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Diabetes Mellitus
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-disruption of insulin relgulation
-deficient beta cell insulin production or release (pancreatic factor) -insulin receptor dysfcn (extra-pancreatic factor) |
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Testing/Monitoring Diabetes
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-measuring insulin is ideal but difficult and costly
-C-peptide predicts insulin levels |
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What is c-peptide?
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-insulin precursor
-protein connecting alpha chain of pro-insulin -released into bloodstream when insulin is produced -CORRELATES WITH INSULIN LEVELS (generally) |
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Can use c-peptide instead of insulin for..
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-diabetics with anti-insulin antibodies
-pt who secretly admin insulin to themselves -diabetic taking insulin -pts with insulinoma (excess insulin) |
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What is more accurate than whole blood glucose for monitoring glucose?
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serum glucose
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Tube of choice for glucose monitoring
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serum separator tube (completely separates cells and serum)
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If whole blood glucose is your only option for monitoring glucose, what tube should you use?
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-Grey top tube (NaFl) because it blocks glucose metabolsim
-normally whole blood glucose drops 10 mg/dl for each hour it sits |
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What do most labs used for monitoring glucose?
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automated glucose oxidase methodology
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CLIA approved procedures for monitoring glucose include...
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-glucose oxidase
-orthotoludidine |
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What may interfere with glucose reading?
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-increased HCT can increase glucose
-ascorbic acid or lipemia |
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Fasting Glucose:
Adult Neonate Gestational Diabetes Non gestational Diabetes |
Adult: 70-115 mg/dl
Neonate: 30-40 mg/dl Gestational Diabetes: >105 mg/dl Non-gestational Diabetes: >140 mg/dl |
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Glucose Tolerance Tests:
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-3 hr procedure used to rule out DM in border line cases
-prep includes 150 gm carb diet for 3 days, followed by 12 hour fast |
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Glucose Tolerance Test: Expecected reactions
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Fasting: 70-100 mg/dl
Peak (30 min -1 hour): 120-170 mg/dl 1 Hour: 120-170 mg/dl 2 Hours: 70-120 3 hours: 70-120 **ALL VALUES MUST BE IN RANGE TO BE CONSIDERED NORMAL *If you extend it for 5 hours, it can detect hypoglcemia (values will drop below 70 and stay down for a long time) |
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how do test results differ with diabetics?
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-after the peak, there is a slow decrease
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Under normal circumstances, glucose attached to ....
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Beta chain of hemoglobin A
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glucose + hemoglobin A produces...
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hemoglobin A1C
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What is the link between glycosylation of hemoglobin and blood glucose levels?
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Glucosylation will increase with sustained levels of blood glucose
(increase in blood glucose levels leads to increases glycosylation) |
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Hb A1C values indicate glucose levels over what amount of time?
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over the past 3 months
Because of RBCs lifespan (110-120 days) |
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High glycosylated hemoglobin levels indicates...
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poor control in a diabetic
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What is the Normal non-diabetic glycosylated Hb level?
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<6%
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How is glycosylated Hb test used?
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-to monitor diabetic therapy
-differentiate short term hyperglycemia from a diabetic condition -eliminate ficticous report by pt |
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Causes of hyperglycemia:
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-diabetes
-states of stress (MI, CVA, trauma, general anesthesia) -acute panreatitis -drugs (corticosteroids, some dieretics, beta blockers) -IV fluids with dextrose |
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Causes of hypoglycemia:
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-excess inslun
-sulfonylurea (drugs that cause pancreas to produce insulin) -insulinoma (excess insulin) -hypothyroidism -starvation |
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Plasma lipoproteins carries most of the ..... and ...... in the blood
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carries most of the cholesterol and esterified lipids in the blood
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4 major lipoprotein classes:
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-chylomicrons
-very low density lipoproteins (VLDL) -low density lipoproteins (LDL) -high density lipoproteins (HDL) |
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Major fucntion of the lipoproteins is...
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transport of trigylceride and cholesterol from sites of origin (intestine and liver) to sites of energy storage and utilization
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Normal Triglycerides
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<150 mg/dl
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Normal Total Cholesteral
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<200 mg/dl
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Normal HDL
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>40 mg/dl
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Normal LDL
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<100 mg/dl
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Normal Chol:HDL ratio
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<5
10 = double the risk 20 = triple the risk |
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Which lipid values change with fasting state? Which do not?
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Triglycerides change with a fasting state
Total cholesterol does not |
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Cholesterol is the main lipid associated with....?
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arteriosclerotic vascular disease
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Is cholesteral a good indicator of CAD?
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by, itself, cholesterol is NOT an accurate predictor of CAD (it fluctuates daily)
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What is a better measure of CAD?
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Total cholesteral:HDL ratio
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What is cholesterol used for?
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required for production of sex hormones, steroids, etc.
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What percentages of cholesteral are bound to LDL and HDL?
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75% to LDL
25% to HDL |
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Causes of increased cholesterol?
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-lifestyle
-familial hyperlipidemia -pregnancy -uncontrolled diabetes |
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Causes of decreased cholesterol?
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-severe liver disease
-malnutrition -MI (levels falls 24-48 hours, reach low point at 7-10 days at ~30-40% lower than normal) |
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Where are tricglycerides produced,transported, etc.?
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-Produced in the liver and tranported by LDL
-Incorporated into the chylomicrons (protein shell) -gives blood a milky appearance if too high |
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Triglycerides are hydrolyzed by .... into ....
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hydrolyzed by pancreatic lipase into FFA and monoglycerides
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Triglycerides can be measured as an assessment of...
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Coronary risk
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Normal Triglycerides
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Male: 40-160
Female: 35-135 |
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Causes of increased triglycerides:
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-glycogen storage disease
-familial hyperlipidemia -chornic renal disease |
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Causes of decreased triglcyerides:
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-malabsoprtion
-hyperthyroidism |
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Where and how is LDL produced?
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Produced in the liver by combingin Tg and cholestereol with apoproteins
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LDL consists of...
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35% protein
50% cholesterol 10% Tg |
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What does LDL do?
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-carries Tg to peripheral tissue to be used by cells
-contributes to deposition of cholesterol in the artery walls |
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LDL values:
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<100 desirable (<70 if hx of MI)
100-160 borderline >160 high risk |
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HDL consists of..
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50% protein
20% cholesterol trace Tg |
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What does HDL do?
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-transports cholesterol from tissue back to liver
-offers some protection from atherosclerosis |
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HDL values:
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Male 35-65 mg/dl (<35 is CAD risk)
Female 35-80 mg/dl (<40 is CAD risk) |
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What are apolipoproteins?
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-polyproteins that make up the protein component of lipoproteins
-involved in the binding of lipoproteins to receptors on the cell surface (facilitates lipid uptake by cells) |
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What is the major polypeptide component of HDL? of LDL?
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HDL: Apolipoprotein A
LDL: Apolipoprotein B |
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Indication for apolipoproteins labs?
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evaluate the risk of atherogenic heart disease or peripheral vascular disease
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Factors affecting lipid panel results:
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-pt not on usual diet for past 2 weeks
-medications (OCPs, estrogens, BP meds) -thyroid, hepatic, or kidney dz -prolonged use of touniquet during blood draw (inc level) -pregnancy (inc level) |
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Two main types of proteins:
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-Albumin
-Globulin (lipoprotein, glycoprotein, immunoglobulins) |
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What can be used to separate albumin and globulin?
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-protein electrophoresis can be used to separate albumin and globulin and establishes levels of various components that are specific for certain disease states
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Electrophoresis is used to ..
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-detect gammopathies
-assess severe liver dz -assess nutritional status |
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Albumin
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-most common protein (2/3 of total)
-smaller and light than globulins -produced in liver |
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What does Albumin do?
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-maintains serum osmotic pressure
-transports various substances (carrier protein) such as calcium, magnesium, bilirubin, coumadin, etc. -source of endogenous amino acids |
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Albumin assays
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-assayed by chemical method that react with nitrogen atoms or with a dye that binds to albumin and produces a color change
-ultra-centrifugation has been used to study some groups of globulins |
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Total serum protein =
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albumin + globulins
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Normal Total Serum Protein
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Adults: 6-8 g/dl
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Causes of hyperproteinemia:
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-dehydration
-gammopathies -liver dz -collage disorders (SLE,RA) |
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Causes of hypoproteinemia:
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-increased protein loss (nephrotic syndrome, burns, etc)
-increased catabolism (inflammation, malignancy) -decreased synthesis (liver dz, decreased AA intake) |
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Immunoglobins
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-proteins that act as antibodies in the immune system
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