Biochemistry Exam 3 Final Notecards Winter 2010

Front 1

Which coagulation factors have common names?

Back 1

I-IV (one through four)

Front 2

What is the Common Designation for Factor I?
(active and inactive)

Back 2

Fibrinogen (inactive)
Fibrin (active)

Front 3

What is the Common Designation for Factor II?
(active and inactive)

Back 3

Prothrombin to Thrombin

Front 4

What is the Common Designation for Factor III?
(active and inactive)

Back 4

Tissue Factor aka Thromboplastin
it is always in active form

Front 5

What is the Common Designation for Factor Iv?
(active and inactive)

Back 5

Calcium
it is always in active form

Front 6

What coagulation factors are always in active form?

Back 6

III & IV
Tissue Factor and Calcium

Front 7

How are tissue factors V-XIII designated as active or not?

Back 7

If they are active their roman numeral will be followed by the letter "a"

Example V will become Va

The exception is "VI" it is ommitted

Front 8

Which coagulation factors are stored in the α-granules of platelets?

Back 8

Factors V and VIII
5 & 8
the cofactors (except TF) that need activated
also the ones that are circulating

Front 9

Which of the factors are Serine proteases (zymogens)?

Back 9

II, VII, IX, X, XI, XII

Front 10

Which of the factors are Cofactor proteins?

Back 10

III, V, VIII
358

Front 11

What factor is Fibrin?

Back 11

I

Front 12

Which factors are Transglutaminase
(zymogens)?

Back 12

XIII

Front 13

Where are the The majority of the coagulation proteins are synthesized?

Back 13

the liver they float freely except for III which is a transmembrane protein on endothelial cells.

Front 14

Which cofactors need cleaved to function? Which do not?

Back 14

V, VIII do

III does not (its tissue factor and membrane bound)

Front 15

Which coagulation facors have unique vitamin-K dependent carboxylation of glutamate residues? (AKA GLA residues)

Back 15

(VII, IX, X, and II, and Proteins C and S)
7,9,10,2

Front 16

What are the GLA residues
(vitamin-K dependent) zymogens?

Back 16

VII, IX,X,II
7,9,10,2

Front 17

What are the Non-GLA residue
zymogens?

Back 17

XI - 11
XII -12
XIII-13

Front 18

What are the three circulating cofactors?

Back 18

V
VIII
Protein S

Front 19

What is the Cell membrane co factor?

Back 19

III (Tissue Factor; Thromboplastin)

Front 20

What is the structural coagulation factor?

Back 20

Fibrinogen, Fibrin

Front 21

What is the Coagulation Function of Factor VII?

Back 21

Serine protease (Initiation Complex)

Front 22

What is the Coagulation Function of Factor IX?

Back 22

Serine protease (Tenase Complex)

Front 23

What is the Coagulation Function of Factor X?

Back 23

Serine protease (Prothrombinase Complex)

Front 24

What is the Coagulation Function of Factor II?

Back 24

Thrombin/prothrombin
Serine protease. Feeds forward to activate XI, V, and VIII (11,5,8)

Front 25

What is the Coagulation Function of Factor XI?

Back 25

Serine protease (Intrinsic Pathway)

Front 26

What is the Coagulation Function of Factor XII? What is it's Common name?

Back 26

Serine protease (Intrinsic Pathway)
Hageman Factor

Front 27

What is the Coagulation Function of Factor XIII?

Back 27

Transglutaminase (does not have proteolytic activity)
Cofactor for factor 9 and is stabilized by vWf

Front 28

What is the Coagulation Function of Factor V?

Back 28

Cofactor for Factor Xa.

Front 29

What is the Coagulation Function of Factor VIII?

Back 29

Cofactor for Factor IXa. Stabilized by vWF.

Front 30

What is the Coagulation Function of Protein S?

Back 30

Cofactor for Activated Protein C

Front 31

What is the Coagulation Function of Cofactor III?
What it its common name?

Back 31

Cofactor for Factor VII.

Tissue Factor;
Thromboplastin

Front 32

What is the Coagulation Function of Cofactor I?
What it its common name?

Back 32

Forms meshwork around platelet plug

Fibrinogen, Fibrin

Front 33

What are the three ENDOGENOUS
INHIBITORS? (antocoagulants)

Back 33

Antithrombin III
TFPI
Activated Protein C

Front 34

What is the function of Antithrombin III?

Back 34

Inhibits thrombin, IXa and Xa (bound to heparan sulfate on endothelial cells)
2,9,10

Front 35

What is the function of TFPI?

Back 35

Inhibits VIIa and Xa in complex with TF on subendothelial cells

Front 36

What is the function of Activated Protein C?

Back 36

Degrades Va and VIIIa on platelet membranes

Front 37

What are the two NATURAL
FIBRINOLYTICS?

Back 37

a2-antiplasmin
PAI

Front 38

What is the function of PAI?

Back 38

Inhibits plasminogen activation

Front 39

What is the function of a2-antiplasmin?

Back 39

Neutralizes free plasmin in circulation

Front 40

What are the 4 THERAPEUTIC
ANTICOAGULANTS that we learned about?

Back 40

Heparin
Warfarin (Coumadin)
Streptokinase
t-PA

Front 41

How does Heparin work?

Back 41

Activates Antithrombin III; neutralizes
circulating coagulation factors

Front 42

How does Warfarin work?

Back 42

Inhibits modification of GLA residues on VII, IX, X, and II

Front 43

How does Streptokinase work?

Back 43

Bacterial protein that activates plasminogen to form plasmin

Front 44

How does theraputic t-PA work?

Back 44

Its Tissue plasminogen activator (tPA)
It does the same as the "natural" form
Activates fibrin-bound plasminogen to form plasmin (to degrade fibrin clot)

Front 45

Trans Fatty Acids have what metabolic effect?

Back 45

Increase LDL
Decrease HDL
Increase coronary heart risk

Front 46

Saturated Fatty Acids have what metabolic effect?

Back 46

Increase LDL
Little effect on HDL
Increase CHD, may increase risk of prostate and colon cancer

Front 47

MUFAs have what metabolic effect?

Back 47

Decrease LDL
Decrease HDL
Decrease incidence of CHD

Front 48

Omega 6 PUFAs have what metabolic effect?

Back 48

Decrease LDL
Decrease HDL
Provide arachadonic acid fro prostoglanding and leukotriene synthesis
Decrease rish for CHD

Front 49

Omega 3 PUFAs have what metabolic effect?

Back 49

Little effect on LDL or HDL
Decrease CHD
Decrease risk f sudden cardica death
suppress cardiac arrythemias
reduce TAGs Decrease tendency for thrombosis
lower blood pressure

Front 50

What constitutes macrocytic anemia

Back 50

MCV greater than 100fL

Front 51

Macrocytic anemias are typically,
Hypo, hyper or normochromic?

Back 51

Normochromic

Front 52

Megaloblastic anemia have what distinguishing characteristics?

Back 52

Caused by a deficiency in vitamin b12 or folate with a MCV usually between 110 & 130 as characteristic.

Front 53

What meagaloblastic anemia has impared DNA sysnthesis?

Back 53

Megaloblastic

Front 54

Is DNA sysntesis impared in nonmegaloblastic anemia?

Back 54

No

Front 55

Non-Megaloblastic anemia have what distinguishing characteristics?

Back 55

MCV of 100-110
no impared DNA synthesis
alcoholism, liver disease, and hyperthyroidism can cause

Front 56

What are the two categories of macrocytic anemia

Back 56

megaloblastic and non-meagaloblastic

Front 57

Morphology of megaloblastic anemias in blood smear?

Back 57

• Oval macrocytes
• Large hypersegmented neutrophils (at least 5 lobes in nuclei)
• Marked anisocytosis and poikilocytosis (high RDW)
• Presence of Howell-Jolly bodies (nuclear remnants)
• Low reticulocyte count (normal to low CR)
• Thrombocytopenia and leukopenia

Front 58

Morphology of megaloblastic anemias in bone smear?

Back 58

• Megaloblastic changes in all cell-lines, indicating nuclear/cytoplasmic asynchrony
(i.e.cytoplasm matures, nuclei do not) :
• all stages of red cell development (erythroid cells)
• Large megakaryocytes (platelet precursors) with hyperploid nuclei
• Giant granulocyte precursors
• Decreased number of precursor cells in all cell-lines:
• Decreased number of erythroid cells indicate insufficient and ineffective
erythropoiesis, which results in anemia
• Decreased number of granulocyte and platelet precursors result in leukopenia
and thrombocytopenia.

Front 59

Megaloblastic anemias are characterized as hypoproliferative or hyperproliverative anemias?

Back 59

hypoproliferative

Front 60

Insufficient erythropoiesis would have what lab result?

Back 60

(low CR)

Front 61

Ineffective erythropoiesis would have what lab result?

Back 61

(elevated IBIL)

Front 62

Vitamin B 12 (aka cobalamin) functions as a cofactor for two enzymes?

Back 62

homocysteine methyltransferase and methylmalonyl-CoA mutase.

Front 63

Impaired activity of homocysteine methyltransferase results in accumulation of what products?

Back 63

Accumulation of N5-methyl-tetrahydrofolate (N5-methyl-THF)
Known as the folate trap

Front 64

What is the significance of individuals with vitamin B 12 deficiency? Why is providing folate problematic?

Back 64

they exhibit a functional folate deficiency: As the bioavailable folate becomes trapped as N
5-methyl-THF, DNA synthesis is then compromised in a manner similar to that of an individual with folate deficiency. Giving folate will relieve megaloblastic anemia, but not fix neuropathy from insufficeint B12 needed for methylmalonyl CoA mutase reactions that make succinyl co-a.

Front 65

What do the levels of serum methylmalonic acid and serum
homocysteine tell you?

Back 65

Increased homocysteine indicates either a folate of B12 deficiency.
However only Methylmalonic acid levels will be elevated in vitamin b12 deficiency. It is the "determining" test.

Front 66

What is the role of the following protein in B12 absorption?
R-binder:

Back 66

mouth to stomach
In the stomach Pepsin hydrolzes b12 proteins and free b12 binds to r biner. low pH prevents binding of b12 to intrinsic factor

Front 67

What is the role of the following protein in B12 absorption? Intrinsic factor (IF):

Back 67

stomach to duodenum
in neutral pH of duodenum degrades R-Binder so b12 can bind to intrinsic factor

Front 68

What is the role of the following protein in B12 absorption? Intrinsic factor receptor:

Back 68

duodenum to circulatory system

Front 69

What is the role of the following protein in B12 absorption? Transcobalamin II:

Back 69

used in circulatory system
released by ileal cells into portal blood

Front 70

What do the type 1 antibodies of pernicious anemia do?

Back 70

BLOCK formation og intrinsic factoer b12 complex

Front 71

What do the type 2 antibodies of pernicious anemia do?

Back 71

BINDING antibodies that prevent IF-B12 from binding to ileal receptors

Front 72

What do Cardiac-Specific Troponins (cTn) tell you?

Back 72

cTn are specific for cardiac tissue
Positive troponin levels are considered virtually diagnostic of MI.
and are not normally
detectable in the circulation. Following an MI, cTn begin to leak into the serum, where levels rise
in 2-4 hours and peak at 48 hours. Elevated levels persist for 7-10 days.

Front 73

What do Creatine Kinase Isoenzyme MB (CK-MB) tell you?

Back 73

CK-MB is not normally found
in circulation, but it is elevated when any muscle (skeletal or cardiac) is injured.

Front 74

Prothrombin time (PT) tests what factors and pathways?

Back 74

Extrinsic System
7,10 & 5 (VII, X, V), prothrombin and fibrinogen;

it is also used to monitor oral anticoagulant therapy (Coumadin = warfari

Front 75

Activated partial thromboplastin time (PTT or aPTT) tests what factors and pathways?

Back 75

the intrinsic pathway (factors XII, XI, IX, VIII, prothrombin and fibrinogen);
it is also used to monitor heparin therapy.

Front 76

Which lab test monitors heparin therapy

Back 76

aPTT

Front 77

What lab test moitors warfarin therapy?

Back 77

PT

Front 78

what does the bleeding test look at?

Back 78

platelt function and vWF

Front 79

What are the overlapping factors/common pathway?

Back 79

5, 10, prothrombin and fibrinogen

Front 80

What is the inhibitor of the intiation complex?

Back 80

Tissue Factor Pathway Inhibitor

Front 81

What is the inhibitor of the Tenase complex?

Back 81

Antithrombin (ATIII) (binds 10)
and Activated Protein C (degrades 5)

Front 82

Waht is the inhibitor of the prothrombin complex?

Back 82

Antithrombin (ATIII)
and Activated Protein C

Front 83

What is the inhibitor of thrombin?

Back 83

ATIII and thrombomodulin

Front 84

What Laboratory reagents are
needed for reaction to occur in a PT test?

Back 84

 Tissue factor
 Phospholipid
 Ca 2+

Front 85

What Laboratory reagents are
needed for reaction to occur in a aPPT test?

Back 85

 Negatively charged surface
 Phospholipid
 Ca 2+

Front 86

What clotting factors are required to get a normal PT test?

Back 86

Extrinsic 7
Common 1,2,5,10

Front 87

What clotting factors are required to get a normal aPPT test?

Back 87

Intrinsic 8,9,11.12
Common 1,2,5,10

Front 88

Hemophilia A: Deficiency of factor

Back 88

8

Front 89

Hemophilila B: Deficiency of factor

Back 89

9

Front 90

What does factor 13 do?

Back 90

it is the transglutaminase enzyme which crosslinks fibrin.

Front 91

What is the Mechanism of Action of Aspirin?

Back 91

Inhibits platelet
aggregation (inhibition of
COX leading to decreased
synthesis of platelet
agonist Thromboxane A2)

Front 92

What is the Mechanism of Action of Unfractionated Heparin?

Back 92

It Activates antithrombin III which binds Thrombin, 9 & 10

Front 93

What is the Mechanism of Action of Warfarin ?

Back 93

Inhibits vitamin K epoxide
reductase; prevents -carboxyglutamate formation and 7.9.10 & 2 in that order

Front 94

What will cause a prolonged PT test

Back 94

prob with factor 7

Front 95

what will cause a prolonged bleeding time and aPPT test?

Back 95

Von Villebrand disease

Front 96

what will cause a prolonged aPPT?

Back 96

def of factors 9,11,8 or 12

Front 97

what can cause a prolonged PT and aPPT?

Back 97

liver diesase
def. vitamin k
heparin or warfarin
def in common fibrin, thrombin, 5 or 10

Front 98

What factors promote plasminogen to plasmin?

Back 98

urokinase
tPA
streptokinase

Front 99

what factors inhibit clot dissolution?

Back 99

alpha antiplasmin binds to free plasmin
PAI (plasmionogen activarot inhibitor) blocks the natural urokinase and t-PA promotors

Front 100

What does factor 7 turn on?

Back 100

10 & 9

Front 101

What does factor 10 turn on?

Back 101

2 (thrombin) which can turn on 5,8,11,and 13