Physiology

Front 1

Synthesized in the liver as an end product of purine metabolism

Back 1

uric acid

Front 2

Synthesis of uric acid requires the enzyme _________ which is found in the liver.

Back 2

xanthine oxidase

Front 3

Common reasons for hyperuricemia include:
-excessive cell breakdown & catabolism of nucleic acids (as in ________)
-excessive production & destruction of cells (as in _______)
-diminished excretion of uric acid (as in _________)

Back 3

starvation, leukemia, renal failure

Front 4

creatine phosphate + ADP =

Back 4

creatine + ATP

Front 5

Creatine is synthesized in the _____ from the amino acids methionine, glycine & arginine

Back 5

liver

Front 6

At rest, __________ catalyzes the transfer of a phosphate group from ATP to creatine to form creatine phosphate

During contraction, CK catalyzes the transfer of the phosphate group from ____________ to ADP to create ATP

Back 6

creatine kinase (CK), creatine phosphate

Front 7

The kidneys excrete ________ very efficiently, as blood concentration and daily urinary excretion of creatinine in an individual also fluctuate very little. A disorder of _________ reduces the excretion of creatinine, which is the #1 reason why it’s level can increase in the blood.

________ and __________ are almost always ordered together on the same blood sample to assess renal function. Reference values for blood creatinine are 0.6-1.3 mg/dL for men and 0.5-1.0 mg/dL for women.

Back 7

creatinine, kidney function, BUN, creatinine

Front 8

Creatine phosphate doesn’t last forever – it is continually made and broken down. Creatinine is the by-product of ___________ degradation and is continually released into the blood.

The daily generation of creatinine remains fairly constant, with the exceptions of crushing injury or degenerative disease that causes massive damage to ______.

Back 8

creatine phosphate, muscle

Front 9

Bilirubin is a waste product generated from the breakdown of ____ by macrophages in the ____, ______ and ___________.

Back 9

heme, liver, spleen, bone marrow

Front 10

Free bilirubin has what two other names?

Back 10

uncongugated bilirubin and indirect bilirubin

Front 11

What is the other name for direct bilirubin?

Back 11

conjugated bilirubin

Front 12

Two main purines:

Back 12

adenosine and guanosine

Front 13

What is Allopurinol used for and how does it work?

Back 13

gout, it shuts down xanthine oxidase

Front 14

________ is transported in the blood attached to albumin. Why?

Back 14

free/uncongugate/indirect bilirubin, to be more water soluble so that it can be transported in the blood

Front 15

As free/uncongugated bilirubin passes through the liver, it is released from _____ & moved into hepatocytes which perform the following functions:
-Uptake of bilirubin from the circulation
-________ of bilirubin
-Excretion of bilirubin into the ____.

Back 15

albumin, conjugation, bile

Front 16

Conjugation involves attaching ___________ to bilirubin in a reaction catalyzed by the enzyme glucuronyl transferase. Conjugated bilirubin is _____ water-soluble than free or unconjugated bilirubin

Back 16

glucuronic acid, much more

Front 17

Right and left hepatic ducts collect bile, common bile duct passes through ______ and deposits bile into ______ of small intestine. Gall bladder stores bile. Bile contains cholesterol and conjugated bilirubin.

Back 17

pancreas, duodenum

Front 18

In the small intestine, half of the conjugated bilirubin is excreted in the feces and the other half is converted into the highly soluble _________ by the intestinal flora.
__________ is absorbed into the portal circulation or excreted in the feces as ___________. A small amount of the absorbed urobilinogen is excreted by the kidneys – most is returned to the liver and re-excreted in the ____.

Back 18

urobilinogen, urobilinogen, stercobilin, bile

Front 19

An increased urine _____________ is one of the earliest signs of acute hepatocyte damage.

Back 19

urobilinogen

Front 20

The ADA recommends that action be taken when A1C results are over ___, and considers diabetes to be under control when the A1C result is __ or less. In non-diabetics, the A1C is usually between ____%.

Back 20

8%, 7%, 4-6%

Front 21

______ plays an important role in nerve conduction, muscle function, acid-base balance and maintenance of osmotic pressure.

Along with calcium, _______ controls the rate and force of contraction of the heart, and hence affects cardiac output. In fact, potassium imbalances can be noted on the ECG.

Back 21

Potassium, potassium

Front 22

Chloride is an anion that exists predominantly in the ___________ spaces as a combination in sodium chloride (NaCl) or in the stomach as hydrochloric acid (HCl).

Chloride maintains cellular integrity through its influence on osmotic pressure and acid-base & water balance.

Back 22

extracellular

Front 23

________ has the reciprocal power of increasing or decreasing in concentration in response to concentrations of other anions or cations, so that electrical neutrality of the various fluids remains intact.

Back 23

Chloride

Front 24

When bilirubin levels are high (hyperbilirubinemia), a condition called _____ occurs, and further testing is needed to determine the cause. Too much _________ may mean that too much is being produced (usually due to increased destruction of red blood cells (hemolysis) or that the liver is incapable of adequately removing bilirubin in a timely manner [due to blockage of bile ducts, ______ diseases (such as cirrhosis, acute hepatitis), or inherited problems with bilirubin handling].

Back 24

jaundice, bilirubin, liver

Front 25

It is not uncommon to see high bilirubin levels in newborns, typically 1 to 3 days old. This is sometimes called _______________________-. Within the first 24 hours of life, up to 50% of full-term newborns, and an even greater percentage of pre-term babies, may have a high bilirubin level.

Back 25

physiological jaundice of the newborn

Front 26

A _________ is a phototherapy tool to treat newborn jaundice (hyperbilirubinemia) which in higher levels causes brain damage __________ leading to _______________,

Back 26

bili lights, Kernicterus, cerebral Palsy

Front 27

Hemoglobin is THE protein of RBCs……………..it is NOT a ________________. Hemoglobin not only binds and carries approx. _____% of the oxygen in the arterial blood, but is also binds and carries approx. 23% of the carbon dioxide in the venous blood.

Back 27

plasma protein, 98.5%

Front 28

Hemoglobin is routinely measured as part of the CBC, and can be used to measure the severity of ______ (too few red blood cells) or _______ (too many red blood cells) and to monitor the response to treatment

Back 28

anemia, polycythemia

Front 29

A ______ system consists of a weak acid and the base salt of that acid or of a weak base and its acid salt.

Acids are H+ ____ – in other words, they release H+

Bases are H+ _______ – in other words, they “soak up” H+

Back 29

buffers, donors, acceptors

Front 30

CBC

Back 30

Red cells
Total red blood cells - The number of red cells is given as an absolute number per litre.
Hemoglobin - The amount of hemoglobin in the blood, expressed in grams per litre. (Low hemoglobin is called anemia.)
Hematocrit or packed cell volume (PCV) - This is the fraction of whole blood volume that consists of red blood cells.
Mean corpuscular volume (MCV) - the average volume of the red cells, measured in femtolitres. Anemia is classified as microcytic or macrocytic based on whether this value is above or below the expected normal range. Other conditions that can affect MCV include thalassemia and reticulocytosis.
Mean corpuscular hemoglobin (MCH) - the average amount of hemoglobin per red blood cell, in picograms.
Mean corpuscular hemoglobin concentration (MCHC) - the average concentration of hemoglobin in the cells.
Red blood cell distribution width (RDW) - a measure of the variation of the RBC population

[edit] White cells
Total white blood cells - All the white cell types are given as a percentage and as an absolute number per litre.
A complete blood count with differential will also include:

Neutrophil granulocytes - May indicate bacterial infection. May also be raised in acute viral infections.
Lymphocytes - Higher with some viral infections such as glandular fever and. Also raised in lymphocytic leukaemia CLL.
Monocytes - May be raised in bacterial infection
Eosinophil granulocytes - Increased in parasitic infections.
Basophil granulocytes
A manual count will also give information about other cells that are not normally present in peripheral blood, but may be released in certain disease processes.


[edit] Platelets
Platelet numbers are given, as well as information about their size and the range of sizes in the blood.

Front 31

The 3 major buffer systems in the body are:

Back 31

-proteins
-carbonic acid /bicarbonate
-phosphate

Front 32

Protein: _____ groups on one end and _______ group on the other. Carboxyls make good acids and amine groups make good bases. pH determines if a buffer will act like a base or an acid.

Back 32

amine, carboxy

Front 33

________ are the largest buffer system in the body, as they contain many ionizable groups that can release or bind H+. The _______ buffers are largely located within cells (e.g. – hemoglobin). However, _____ and _______ make up a sizable portion within the vascular compartment.

Back 33

proteins, proteins, albumin, globulin

Front 34

The carbonic/bicarbonate _______ system is effective in maintaining what?

Back 34

buffer, blood pH

Front 35

The ________ buffer system is present is low concentrations in the ECF (approximately one-sixth that of the bicarbonate buffer system). Hence, it is not as important for buffering blood pH. However, it is a very effective buffer in the ______ and in the ICF where phosphate concentrations are high.

Back 35

phospate, urine

Front 36

______ is the most abundant cation in the body. Most of it is contained within the ECF at a concentration of 135-148 mEq/L. Some of its primary functions include:
-maintenance of _____ pressure of extracellular fluids
-maintenance of ____ and generation of action potentials in excitable tissues (e.g. – nervous & all muscular tissues)
-helping facilitate the absorption of glucose in the ____

Back 36

sodium, osmotic, RMP, small intestine

Front 37

Sodium levels are tightly regulated by the endocrine system via the hormones _____ and a______________________ (ANP).

Back 37

aldosterone, atrial natriuretic peptide (ANP)

Front 38

Besides enzymes, ________ can also release high amounts of potassium to the blood, producing hyperkalemia.

Back 38

damaged cells

Front 39

About 50% of blood calcium is ______; the rest is protein bound. However, only ______ calcium can be used by the body for such vital processes as:
-muscular contraction
-______ function
-enzyme activation
-exocytosis of _________ and certain hormones
-blood clotting

Back 39

ionized, ionized, cardiac, neurotransmitters

Front 40

The amount of ______ in the blood also affects calcium levels because 50% of the blood calcium is _______ bound. Thus, a decrease is serum albumin will result in a profound decrease in total serum calcium. The decrease, however, does not necessarily alter the concentration of the i_____ form. In the adult, _____ calcium levels are normally between 4.65-5.28 mg/dL, and total calcium levels are normally between 8.6-10.0 mg/dL.

Back 40

protein, protein, ionized, ionized

Front 41

Calcium levels are regulated by the endocrine system via the hormones _______________) and ________. Other influences on calcium levels include vitamin D, estrogens and androgens.

Back 41

parathyroid (PTH), calcitonin (CT)

Front 42

Behind potassium, ________ is the second most abundant intracellular cation. Of the total ________ content, 50% is stored in ______, 49% is contained in the ICF of cells, and the remaining 1% is dispersed in the ECF. The normal blood concentration of _________ is 1.3-2.1 mEq/L.

Back 42

magnesium, magnesium, bone, magnesium

Front 43

Magnesium is required for the use of ____ as a source of energy. Therefore, it is necessary for the action of numerous ______ systems, such as carbohydrate metabolism, protein synthesis, nucleic acid synthesis, and contraction of muscle tissue. Additionally, magnesium is required for functioning of _____________ in all cells. There is also some evidence to suggest that hypomagnesemia is associated with an impairment in PTH secretion.

Control of magnesium balance is poorly understood. Only 3-5% of filtered magnesium is excreted in the urine, suggesting that reabsorption of magnesium is efficient.

Back 43

ATP, enzyme, sodium - potassium pumps

Front 44

Because it is in equilibrium with tissue ferritin, _____ ferritin can be an excellent clinical indicator of iron stores. Besides plasma ferritin, other tests that analyze iron in the blood include:
-Serum iron
-Transferrin
-TIBC (total iron-binding capacity)

Back 44

plasma

Front 45

Ferritin is also stored in the ____ & _______ (in addition to the liver)
Ferritin is present in small quantities (18-270 ng/ml) in the plasma and is in equilibrium with virtually all ferritin-producing tissues.

Back 45

spleen, bone marrow

Front 46

Smaller quantities of iron can also be stored in an extremely insoluble form called ____________ . This is especially true when the total quantity of iron in the body is more than the ferritin storage can accommodate.

Back 46

hemosiderin

Front 47

__________ is characterized by increased accumulation of iron as hemosiderin in the liver, pancreas, heart, adrenals, pituitary and kidneys. Eventually, the patient may develop hepatic, pancreatic and/or cardiac insufficiency.

Back 47

Hemochromatosis

Front 48

In the small intestine, half of the conjugated bilirubin is excreted in the feces and the other half is converted into the highly soluble _________ by the intestinal flora.
__________ is absorbed into the portal circulation or excreted in the feces as ___________. A small amount of the absorbed urobilinogen is excreted by the kidneys – most is returned to the liver and re-excreted in the ____.

Back 48

urobilinogen, urobilinogen, stercobilin, bile

Front 49

An increased urine _____________ is one of the earliest signs of acute hepatocyte damage.

Back 49

urobilinogen

Front 50

The ADA recommends that action be taken when A1C results are over ___, and considers diabetes to be under control when the A1C result is __ or less. In non-diabetics, the A1C is usually between ____%.

Back 50

8%, 7%, 4-6%

Front 51

______ plays an important role in nerve conduction, muscle function, acid-base balance and maintenance of osmotic pressure.

Along with calcium, _______ controls the rate and force of contraction of the heart, and hence affects cardiac output. In fact, potassium imbalances can be noted on the ECG.

Back 51

Potassium, potassium

Front 52

Chloride is an anion that exists predominantly in the ___________ spaces as a combination in sodium chloride (NaCl) or in the stomach as hydrochloric acid (HCl).

Chloride maintains cellular integrity through its influence on osmotic pressure and acid-base & water balance.

Back 52

extracellular

Front 53

________ has the reciprocal power of increasing or decreasing in concentration in response to concentrations of other anions or cations, so that electrical neutrality of the various fluids remains intact.

Back 53

Chloride

Front 54

When bilirubin levels are high (hyperbilirubinemia), a condition called _____ occurs, and further testing is needed to determine the cause. Too much _________ may mean that too much is being produced (usually due to increased destruction of red blood cells (hemolysis) or that the liver is incapable of adequately removing bilirubin in a timely manner [due to blockage of bile ducts, ______ diseases (such as cirrhosis, acute hepatitis), or inherited problems with bilirubin handling].

Back 54

jaundice, liver, bilirubin

Front 55

It is not uncommon to see high bilirubin levels in newborns, typically 1 to 3 days old. This is sometimes called _______________________-. Within the first 24 hours of life, up to 50% of full-term newborns, and an even greater percentage of pre-term babies, may have a high bilirubin level.

Back 55

physiological jaundice of the newborn

Front 56

A _________ is a phototherapy tool to treat newborn jaundice (hyperbilirubinemia) which in higher levels causes brain damage __________ leading to _______________,

Back 56

bili lights, Kernicterus, cerebral Palsy

Front 57

Hemoglobin is THE protein of RBCs……………..it is NOT a ________________. Hemoglobin not only binds and carries approx. _____% of the oxygen in the arterial blood, but is also binds and carries approx. 23% of the carbon dioxide in the venous blood.

Back 57

plasma protein, 98.5%

Front 58

Hemoglobin is routinely measured as part of the CBC, and can be used to measure the severity of ______ (too few red blood cells) or _______ (too many red blood cells) and to monitor the response to treatment

Back 58

anemia, polycythemia

Front 59

A ______ system consists of a weak acid and the base salt of that acid or of a weak base and its acid salt.

Acids are H+ ____ – in other words, they release H+

Bases are H+ _______ – in other words, they “soak up” H+

Back 59

buffers, donors, acceptors

Front 60

CBC

Back 60

Red cells
Total red blood cells - The number of red cells is given as an absolute number per litre.
Hemoglobin - The amount of hemoglobin in the blood, expressed in grams per litre. (Low hemoglobin is called anemia.)
Hematocrit or packed cell volume (PCV) - This is the fraction of whole blood volume that consists of red blood cells.
Mean corpuscular volume (MCV) - the average volume of the red cells, measured in femtolitres. Anemia is classified as microcytic or macrocytic based on whether this value is above or below the expected normal range. Other conditions that can affect MCV include thalassemia and reticulocytosis.
Mean corpuscular hemoglobin (MCH) - the average amount of hemoglobin per red blood cell, in picograms.
Mean corpuscular hemoglobin concentration (MCHC) - the average concentration of hemoglobin in the cells.
Red blood cell distribution width (RDW) - a measure of the variation of the RBC population

[edit] White cells
Total white blood cells - All the white cell types are given as a percentage and as an absolute number per litre.
A complete blood count with differential will also include:

Neutrophil granulocytes - May indicate bacterial infection. May also be raised in acute viral infections.
Lymphocytes - Higher with some viral infections such as glandular fever and. Also raised in lymphocytic leukaemia CLL.
Monocytes - May be raised in bacterial infection
Eosinophil granulocytes - Increased in parasitic infections.
Basophil granulocytes
A manual count will also give information about other cells that are not normally present in peripheral blood, but may be released in certain disease processes.


[edit] Platelets
Platelet numbers are given, as well as information about their size and the range of sizes in the blood.

Front 61

The 3 major buffer systems in the body are:

Back 61

-proteins
-carbonic acid /bicarbonate
-phosphate

Front 62

Protein: _____ groups on one end and _______ group on the other. Carboxyls make good acids and amine groups make good bases. pH determines if a buffer will act like a base or an acid.

Back 62

amine, carboxy

Front 63

Iodine is essential for thyroid hormone synthesis by the thyroid gland. RDA is ____ mg/day.

Back 63

0.15

Front 64

Bicarbonate is an important base for maintaining acid-base balance in the body. It normally has an arterial blood concentration of 22-26 mEq/L.

It is normally measured as part of an ________.

Back 64

ABG; arterial blood gas