Semester spotting

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Spot questions, case studies, laboratory reference values, glassware, equipment, reagents,graphs, visuals and nutrients.

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Semester spotting

  1. 1. 06/27/14 1 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  2. 2. SPOT QUESTION-1 A 28-year-old man complains of a rash on his sun exposed skin, diarrhea and loss of balance. His Urinanalysis results are significant for an increase in neutral amino acid level. The patient is diagnosed with Hartnup’s disease, a defective transport of neutral amino acids in the kidney. Which of the following amino acids would have been found in the urine sample? A. Lysine B. Tryptophan C. Arginine D. Histidine E. Glutamate 06/27/14 2 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  3. 3. ANSWER- SPOT-1 • The correct answer is-Tryptophan, which is the only neutral amino acid in the given options. Lysine, Arginine and Histidine are positively charged (basic amino acids), whereas Glutamic acid is a negatively charged amino acid (acidic amino acid ). • Hartnup disease is an absorption defect, transporter deficiency leads to reduced absorption of tryptophan, which is an essential amino acid , as well as a precursor of niacin and neurotransmitters. The patients of Hartnup disease manifest both the symptoms of tryptophan(neurological) as well as niacin deficiencies (pellagra). 06/27/14 3 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  4. 4. SPOT QUESTION-2 A 67-year-old man suffers from congestive heart failure. He is taking Digoxin, which helps the heart to beat more strongly and regularly. Digoxin is an ester that contains a sugar component and a non sugar (aglycone) component attached via oxygen. What is the chemical nature of Digoxin? A. Glycoprotein B. Glycoside C. Oligosaccharide D. Polysaccharide E. Disaccharide 06/27/14 4 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  5. 5. ANSWER- SPOT QUESTION -2 The correct option is Glycoside. Digoxin is a cardiac glycoside. Glycosides contain a sugar and a non sugar component (aglycone) linked together by O- Glycosidic linkage) 06/27/14 5 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  6. 6. SPOT QUESTION-3 A protein rich nutrient has been checked for the quality of its protein. Hopkin Cole color reaction has come out as negative while all other color reactions for different amino acids are positive? Which amino acid is lacking in the diet? What is your interpretation about the quality of the given protein? 06/27/14 6 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  7. 7. ANSWER- SPOT QUESTION-3 • Hopkin cole reaction is a confirmatory test for Tryptophan. • Negative Hopkin cole reaction signifies absence of tryptophan in the given protein. • Since other color reactions are positive, hence the given protein is deficient only in tryptophan (only one essential amino acid is lacking) • It is thus a class II or incomplete protein. 06/27/14 7 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  8. 8. SPOT QUESTION-4 A 54- year-old female who is 68 inches tall and weighs 198 Ib, has reported to the medical emergency complaining of “tight pressure like band of pain’’ across her chest, associated with shortness of breath, sweating, and a sense of light headedness. The symptoms appeared following a heated argument with the neighbor. She has a history of high blood pressure and elevated serum cholesterol. Blood biochemistry has revealed abnormal enzyme profile and high serum total cholesterol, suggestive of Acute Myocardial infarction (Acute M.I.). What is the range of serum total cholesterol in the normal health? Mention any two functions of cholesterol. 06/27/14 8 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  9. 9. ANSWER SPOT QUESTION-4 • The serum total cholesterol in normal health ranges between 150-220 mg/dl. • Cholesterol is a component of biological membranes, myelin sheath and is required for propagation of nerve impulse. • It is a precursor of vitamin D; bile salts and is also required for the formation of steroids, and sex hormones. 06/27/14 9 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  10. 10. SPOT QUESTION-5 A chronic Alcoholic with impaired liver functions has reported to the medical O.P.D. His serum sample has been sent to the laboratory for total proteins estimation. What do you expect out of the levels of serum total proteins; should they be normal, higher or lower than normal? What is the normal reference range for serum total proteins? Mention any two conditions in which the (Albumin: Globulin) A: G ratio is reversed.06/27/14 10 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  11. 11. ANSWER SPOT QUESTION-5 • Alcoholics are commonly malnourished, and in the presence of alcoholic liver disease(as in present situation) • The serum total protein level should be lower than normal. • The normal serum total plasma protein ranges between 6- 8 G/dl. • The A: G (Albumin to Globulin) ratio is reversed in conditions of hypoalbuminemia and hypergammaglobulinemia such as Protein energy malnutrition, liver and renal disorders, chronic diarrhea, chronic infections, leukemias, lymphomas and in HIV infection. 06/27/14 11 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  12. 12. SPOT QUESTION-6 A 23 year old female has been brought to the emergency. She was found semiconscious in her hostel room. Her friends have revealed that she was not taking anything from the last two days after her break up with her boyfriend. She was in good health previously. Physical examination reveals low blood pressure and feeble pulse. Chest and CVS examination are normal. No abnormality has been detected in the abdomen. Blood chemistry reveals low blood glucose levels. What is the significance of low blood glucose, which organ is most affected in this state? What is your opinion about normal reference range of blood glucose? 06/27/14 12 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  13. 13. ANSWER - SPOT QUESTION-6 • Glucose is a universal source of energy. • It is a preferred source of energy for brain and the sole source of energy for cells lacking mitochondria such as red blood cells. • These are the cells most affected. • Brain is the most affected organ. • In normal health blood glucose ranges between 60-90 mg/dl. 06/27/14 13 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  14. 14. GLASS WARE Identify the glass ware (A) and (B) Mention the use of each of them A B 06/27/14 14 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  15. 15. GLASS WARE A- is a funnel, It is used to transfer substances into containers that have narrow mouths. Some funnels act as filters, either because of their design of because filter paper or a sieve is placed on the funnel. B- is a watch glass, they can serve as lids for flasks and beakers. Watch glasses are used for holding small samples for observation under a low-power microscope. They are also used for evaporating liquid off of samples. 06/27/14 15 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  16. 16. GLASS WARE Identify the glass ware (A) and (B). Mention the use of each of them A B 06/27/14 16 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  17. 17. GLASS WARE A- is a glass pipette, Pipettes are droppers calibrated to deliver a specific volume. Some pipettes are marked like graduated cylinders. Other pipettes are filled to a line to reliably deliver one volume again and again. B- A stirring rod or stir rod is a piece of laboratory equipment used to mix chemicals and liquids for laboratory purposes. 06/27/14 17 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  18. 18. REAGENTS Which of the two displayed reagents (A and B) is used for the inversion test for sucrose? What is the use of other reagent? A B 06/27/14 18 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  19. 19. REAGENTS Reagent B – Concentrated HCl is used for the inversion test, a confirmatory test for sucrose. Reagent A – Concentrated sulphuric acid is used for the Molisch test. 06/27/14 19 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  20. 20. EQUIPMENT A 34-year-old female has been admitted in the emergency department with Atrial fibrillation. Blood sample has been drawn for estimation of serum electrolytes. Which of the two displayed equipment (A or B)should be used for this estimation? What is the use of second equipment? 06/27/14 20 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  21. 21. EQUIPMENT • Equipment -A is a colorimeter and equipment B is a photo electric flame photometer. • Equipment- B is used for measurement of electrolytes A B 06/27/14 21 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS A
  22. 22. EQUIPMENT A 56- year -old chronic smoker has developed worsening cough with purulent sputum and has been admitted to the hospital because of difficulty in breathing. He is drowsy and cyanosed His arterial blood gas analysis is as follows; p CO2 70 mm Hg HCO3 - 26 mmol/L P O2 50 mm Hg The symptoms and blood gas analysis are suggestive of Respiratory acidosis. Blood pH levels remains to be confirmed. Which of the two displayed equipment (A or B)should be used for this estimation? What is the use of the second displayed equipment in the clinical laboratory? 06/27/14 22 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  23. 23. EQUIPMENT Equipment B- Digital pH meter can be used for the determination of pH. Equipment A is a spectrophotometer, commonly used for the measurement of transmittance or reflectance of solutions. A B 06/27/14 23 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  24. 24. SPOT QUESTION The patients of diabetes mellitus are advised to supplement with dietary fiber. How does dietary fiber help these patients? What is the nutritive value of dietary fiber? 06/27/14 24 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  25. 25. ANSWER - SPOT QUESTION • Dietary fiber promotes utilization of glucose, inhibits absorption of dietary cholesterol and thus regulates blood glucose and serum cholesterol levels, which are high in diabetics. • It promotes peristalsis, provides roughage , thus relieves constipation, and also protects from piles and colon cancers. • It has no caloric value since it can not be digested. 06/27/14 25 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  26. 26. SPOT QUESTION A child develops chronic diarrhea and liver inflammation in the early infancy when the mother begins using formula that includes the corn syrup. Evaluation of the child demonstrates sensitivity to fructose in the diet. Most of the unutilized dietary fructose is either converted to glucose or is reduced to sugar alcohols in the body. Name the sugar alcohol/s obtained from reduction of fructose. Which dietary substance containing fructose should be avoided when feeding or treating this child? 06/27/14 26 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  27. 27. ANSWER- SPOT QUESTION • Fructose upon reduction produces sorbitol and mannitol since a new asymmetric carbon atom is generated upon reduction at C-2. Sorbitol and mannitol are C-2 epimers. • Fructose rich food items that can be avoided are Table sugar, honey, fruit, juices and corn syrup etc. 06/27/14 27 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  28. 28. CASE STUDY A 16-year-old man hospitalized in a state of coma after an automobile accident, was started on intravenous hyper alimentation. Although a complete vitamin mixture was present in the solution, fat was omitted in the diet because of solubility problem. After 3 months, the patient developed skin lesions, hair loss and a fatty liver. Plasma lipid analysis revealed normal cholesterol level but a very low level of Arachidonic acid. 24- Hour urine analysis indicated a low excretion of prostaglandin metabolites. What is the biochemical basis of clinical manifestations? What is the basis of low excretion of prostaglandin metabolites? 06/27/14 28 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  29. 29. DISCUSSION- CASE STUDY • The patient has exhibited signs of essential fatty acid deficiency since the fats are omitted in the diet. • Low prostaglandins are due to low Arachidonic acid. • Arachidonic acid is a precursor of Eicosanoids, since plasma arachidonic acid is low, there is les synthesis and hence there is less excretion of prostaglandins in the urine. 06/27/14 29 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  30. 30. SPOT IDENTIFICATION Identify the structure; mention the names of the biomolecules having this structure. 06/27/14 30 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  31. 31. ANSWER- SPOT IDENTIFICATION • It is beta pleated sheet structure, a secondary structure of proteins. • Beta keratin, silk fibroin, carbonic anhydrase and flavodoxin predominantly contain beta pleated sheet structure. 06/27/14 31 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  32. 32. SPOT IDENTIFICATION The individual reaction catalyzed by Enzyme E1 and E2 is shown below- 1) Comment on the class of enzyme and 2) Give examples of each of the class of enzymes (E1 and E2) E1 E2 06/27/14 32 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  33. 33. SPOT IDENTIFICATION • E1- is a Hydrolase- All proteolytic enzymes are hydrolases • E2 is a Transferase Example- Transaminase, Methyl transferase 06/27/14 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS 33
  34. 34. Identify and draw the crystals State the clinical situation if the above said substance is excessively excreted in urine ? 06/27/14 34 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  35. 35. OSAZONE CRYSTALS • These are lactosazone crystals (powder puff). • Lactosuria is the term used to denote excessive excretion of lactose in urine and that occurs in conditions of Lactose Intolerance. • The undigested lactose is absorbed by pinocytosis that goes to systemic circulation to get excreted through urine. 06/27/14 35 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  36. 36. CASE STUDY A 54- year-old woman who was bed bound in a nursing home began to develop swelling of her left leg. She was evaluated with venous Doppler ultra sound and was found to have a deep vein thrombosis. She was immediately started on heparin to prevent the clot from further enlarging What is the chemical nature of heparin ? What is the mechanism of action of heparin ? 06/27/14 36 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  37. 37. DEEP VEIN THROMBOSIS 06/27/14 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS 37
  38. 38. CASE STUDY- DISCUSSION • Heparin is a sulfated mucopolysaccharide • It is an anticoagulant widely used in clinical practice. • Binding of Heparin to antithrombin produces conformational changes which promote the binding of the latter to “thrombin” which is inhibited, thus fibrinogen is not converted to fibrin and the coagulation is inhibited. 06/27/14 38 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  39. 39. PLASMA PROTEIN ELECTROPHORESIS Identify peak E and mention two important functions of the biomolecule that occupies this region 06/27/14 39 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  40. 40. PLASMA PROTEIN ELECTROPHORESIS • The “E” peak is of gamma globulins • The gamma globulins are increased in various acute and chronic infections, liver diseases, multiple myeloma , HIV infection and various cancers. • “A” peak is of Albumin • ‘B” alpha-1 • “C” of Alpha-2 • “D” is of Beta globulins.06/27/14 40 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  41. 41. CASE STUDY A 48- year-old man presented with short history of severe low backache, loss of weight and diminished appetite. X-ray skull showed punched out lesions. Serum electrophoresis revealed an abnormal band between β globulins and γ globulin region. What is the probable diagnosis ? Which specific protein is detected in urine of such patients ? 06/27/14 41 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
  42. 42. CASE DISCUSSION • It is a case of multiple myeloma, a cancer of plasma cells. The symptoms and electrophoretic pattern are typical of multiple myeloma. • Bence jone’s proteins are excreted in a patient suffering from multiple myeloma.06/27/14 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS 42
  43. 43. FURTHER READING • Follow the link- Biochemistry for medics- Lecture notes by -Professor(Dr.) Namrata Chhabra http://www.namrata.co/ 06/27/14 43 NAMRATA CHHABRA- BIOCHEMISTRY FOR MEDICS
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