Spotting nov

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Spotting nov

  1. 1.  Case studies Visuals Biochemistry for Medics Graphs Spot Questions www.namrata.co Glass wares Reagents Equipments Urine and blood reports Biochemistry For Medics 12/13/2012 1
  2. 2. A laboratory technician accidently consumedDinitrophenol. Soon after that his body wasobserved to be extreme hot. He was sweatingprofusely and was extremely thirsty.What could be the possible reason for thesesymptoms ? Biochemistry For Medics 12/13/2012 2
  3. 3.  Dinitrophenol is an uncoupler of oxidative phosphorylation. Oxidative phosphorylation is a coupled process, The uncouplers allow the oxidation to proceed but there is no ATP formation. The surplus energy that would have been used up for ATP formation is released in the form of heat. The symptoms in the given patient, high body temperature, sweating and thirst are due to heat released by the said uncoupling of oxidative phosphorylation. Biochemistry For Medics 12/13/2012 3
  4. 4. A patient of long standing Diabetes Mellituson treatment presents with recurrentfractures and generalized swelling.Physical Examination reveals- Pallor++ Puffiness around eyes+ B.P.- 160/100 mm Hg Biochemistry For Medics 12/13/2012 4
  5. 5. Laboratory Investigations-Blood BiochemistryGlucose 110 mg/dlUrea 100 mg/dlCreatinine 6 mg/dlUric acid 8.8 mg/dlCalcium 6 mg/dlHb 6 G /dl Biochemistry For Medics 12/13/2012 5
  6. 6. Urine ExaminationColor- NormalAppearance- ClearSpecific Gravity- 1.010Protein ++Reducing sugar NilWhat is your probable diagnosis ? Biochemistry For Medics 12/13/2012 6
  7. 7.  It is a case of Renal failure, as is evident from high blood urea and serum creatinine levels. Urinary specific gravity (1.010) and proteinuria are also additional findings in support of diagnosis. It might be a complication of long standing diabetes mellitus (Diabetic nephropathy ) which has progressed to renal failure. Anemia is due to reduced erythropoietin secretion from the kidney. Fractures and hypocalcemia are due to vitamin D deficiency. As the last step of activation of vitamin D takes place in kidney. Puffiness is due to water retention. Biochemistry For Medics 12/13/2012 7
  8. 8.  A fair chubby boy was brought to the hospital with the complaint that he has mental retardation. Blood Biochemistry revealed that phenyl alanine was abnormally high. Phenyl pyruvate was present in appreciable amount in urine. What is the probable diagnosis ? Which other metabolite can be found in urine ? Biochemistry For Medics 12/13/2012 8
  9. 9.  The child is suffering from Phenyl ketonuria It is a congenital disorder of phenyl alanine metabolism. Caused due to deficiency of phenyl alanine hydroxylase enzyme, that converts phenyl alanine to tyrosine In the deficiency of phenyl alanine hydroxylase, phenyl alanine accumulates in blood and is also alternatively transaminated to form phenyl pyruvate, that gets excreted excessively in urine Biochemistry For Medics 12/13/2012 9
  10. 10.  The other metabolites excreted in urine are phenyl acetyl glutamine and phenyl lactate Phenyl pyruvate produced from transamination reaction can be decarboxylated to phenyl acetate that is conjugated with glutamine to form phenyl acetyl glutamine, which is responsible for imparting characteristic mousy odor to the urine Phenyl lactate is produced from phenyl acetate by reduction. Biochemistry For Medics 12/13/2012 10
  11. 11.  Sodium Fluoride is used in combination with potassium oxalate (in the ratio of 1:3) while sample collection for Blood glucose estimation. Glycolysis is said to be inhibited as a result of inhibition of one of the enzymes of this pathway. The results are plotted to depict the mode of inhibition. Biochemistry For Medics 12/13/2012 11
  12. 12. State the type of inhibition and name theenzyme inhibited by the action of sodiumfluoride Biochemistry For Medics 12/13/2012 12
  13. 13.  There is no change in Km, but Vmax has decreased in the presence of inhibitor. It is a non competitive inhibition Enolase enzyme that catalyzes the conversion of 2-Phosphoglycerate to Phospho enol pyruvate is inhibited by sodium fluoride Glycolysis is required to be inhibited as otherwise, glucose of the sample would get oxidized and falsely low blood glucose values would be obtained and that happens if sodium fluoride is not used Biochemistry For Medics 12/13/2012 13
  14. 14. (A) (B) Out of the two instruments (A and B),Which one is use for the determination of pH of the solutions ? By what other methods, pH of solutions can be measured ? Biochemistry For Medics 12/13/2012 14
  15. 15.  The instrument (A) is pH meter that can be used for pH measurement. The other instrument (B) is Flame photometer that is use for the determination of the ions pH can also be determined by using indicators, pH papers, indicator papers and universal indicator solutions Biochemistry For Medics 12/13/2012 15
  16. 16.  Which out of the two glass wares (A and B) is used for the centrifugation of the biological fluids ? What is the use of the other glass ware ? (A) (B) Biochemistry For Medics 12/13/2012 16
  17. 17.  (A) is cuvette, that is used in the colorimetric procedures for determination of the absorbance value of the colored solutions. (B) is centrifuge tube, that is used for the centrifugation of biological fluids. Biochemistry For Medics 12/13/2012 17
  18. 18.  The urine test of a patient gave the following result- A purple ring at the junction of two liquids- Identify the substance present in the urine . Name the test carried out. Biochemistry For Medics 12/13/2012 18
  19. 19.  This is Rothera’s test carried out for the detection of urinary ketone bodies A positive reaction is given by acetone and acetoacetate. Beta- hydroxy butyrate does not give a positive reaction in this test. The patient is having ketonuria, that might be due to uncontrolled diabetes mellitus, starvation , high fat diet or heavy exercise. Biochemistry For Medics 12/13/2012 19
  20. 20.  A 45-year-old obese lady attended the outpatient department with- a history of severe right sided abdominal pain vomiting fever and yellow tinge of sclera. Ultrasound of the abdomen shows the presence of gall stones. Biochemistry For Medics 12/13/2012 20
  21. 21.  State the type of jaundice in this patient ? What would be the urinary findings in this patient ? Biochemistry For Medics 12/13/2012 21
  22. 22.  Gall stones cause obstruction in the common bile duct, hence it is obstructive jaundice Urine will show the presence of Bilirubin since it is conjugated hyperbilirubinemia Due to obstruction to the outflow of bile urobilinogen will not synthesized and hence it would be absent in urineNote-Only conjugated Bilirubin can appear in urine. Unconjugated Bilirubin is water insoluble and is also bound to albumin, hence can not be filtered to appear in urine. Biochemistry For Medics 12/13/2012 22
  23. 23.  The bone marrow smear of a strict vegetarian female patient presenting with weakness, fissured tongue and paralysis is displayed. Make a diagnosis and suggest the line of treatment. Biochemistry For Medics 12/13/2012 23
  24. 24.  Fissured tongue and megaloblastic anemia are signs of vitamin B12 deficiency The patient is a strict vegetarian that is another proof of vitamin B12 deficiency Neurological manifestations are also characteristic of B12 deficiency. The patient should be treated by a supplementation of a combination of folic acid and vitamin B12 Folic acid and B12 deficiencies always coexist due to trapping of folate in methylated form in B12 deficiency (Folate trap ) Biochemistry For Medics 12/13/2012 24
  25. 25.  A new born baby experienced abdominal distension, severe bowel cramps and diarrhea after being fed with milk. A hydrogen breath analysis of the exhaled breath discovered an eighty fold increase in the production of hydrogen 90 minutes after milk feeding. Biochemistry For Medics 12/13/2012 25
  26. 26.  The urine analysis revealed the presence of a reducing sugar which formed the characteristic osazone crystals as shown under the microscope. Identify and draw the crystals and mention the defect. Biochemistry For Medics 12/13/2012 26
  27. 27.  The given slide shows lactosazone crystals (Powder puff). The history and clinical features are also suggestive of Lactose intolerance Lactose intolerance is caused due to deficiency of lactase enzyme The undigested lactose is absorbed in the intestinal cells by pinocytosis that enters systemic circulation to appear in urine causing lactosuria. Biochemistry For Medics 12/13/2012 27
  28. 28.  An 8-year-old child has been brought to OPD with pain abdomen and vomiting. These episodes often occur upon consumption of table sugar and sugar candies. A provisional diagnosis of “Hereditary Fructose Intolerance "is framed for this child. There is inability to metabolized fructose in this disorder Biochemistry For Medics 12/13/2012 28
  29. 29.  Which of the two tests would be best suitable to confirm the presence of fructose in urine ? What is the significance of the other test? Barfoed Seliwanoff (A) (B) Biochemistry For Medics 12/13/2012 29
  30. 30.  Seliwanoff test is the most confirmatory test for fructose Barfoed test is given positive by all reducing monosaccharides, it is not a confirmatory test for fructose Keto hexose (Fructose) in the free or bound form gives this test positive. This test is also given positive by Sucrose. Biochemistry For Medics 12/13/2012 30
  31. 31.  Which of the two reagents is used for the detection of urinary chlorides ? What is the significance of the other reagent? Silver Nitrate Mercuric sulphate (A) (B) Biochemistry For Medics 12/13/2012 31
  32. 32.  Silver nitrate (A) is used for the detection of urinary chlorides Mercuric sulphate is used for the detection of Tyrosine by Millon’s test. Chlorides present in urine react with silver nitrate to form a white precipitate of silver chloride Biochemistry For Medics 12/13/2012 32
  33. 33. Urine Examination reportName- Mrs. ParvatiAge - 68 yearsSex - FemaleOccupation- HousewifePhysical Examination Color- Dark yellow Appearance- Slightly turbid Odor-Aromatic Volume – 75 ml pH- 7.0 Specific Gravity- 1.035 Biochemistry For Medics 12/13/2012 33
  34. 34. Chemical examination Reducing sugars- nil Proteins- nil Ketone bodies- nil Blood- nil Bilirubin- absent Urobilinogen- +++++Make a probable diagnosisBy which method Urinary Bilirubin can bedetected ? Biochemistry For Medics 12/13/2012 34
  35. 35.  Specific gravity is on the higher side probably due to the presence of urobilinogen Dark color of urine is also due to high urobilinogen content There is no Bilirubin. Since urine shows the presence of urobilinogen There is no other abnormal component It is a case of prehepatic jaundice (Acholuric Jaundice) In prehepatic jaundice bilirubin is Unconjugated, hence can not appear in urine. Urinary bilirubin can be detected by Fouchet’s test Biochemistry For Medics 12/13/2012 35
  36. 36.  A child stops making developmental progress at the age of 2 years and develops coarse facial features with thick mucus drainage. Skeletal deformities develop over the next year, and the child regresses to a vegetarian state by the age of 10 years. The child’s urine is positive for glycosaminoglycans, that include which of the followings ? Biochemistry For Medics 12/13/2012 36
  37. 37. A. Heparan SulfateB. CollagenC. GlycogenD. Gamma amino butyric acid Biochemistry For Medics 12/13/2012 37
  38. 38.  The right answer is (A). The child is most probably suffering from Hurler syndrome Heparan sulfate is the mucopolysaccharide (Glycosaminoglycan- out of all the options) that is excreted out in urine in such affected patients Collagen is a protein Glycogen is a storage form of glucose Gamma amino butyric acid is an inhibitory neurotransmitter The last three can not be excreted in urine. Biochemistry For Medics 12/13/2012 38
  39. 39.  A 14 –year-old boy was admitted to the hospital because of sudden pain on the left flank. Urine analysis reveals hexagonal crystals. 24 hours urine sample shows excessive excretion of Cystine. What is the probable diagnosis ? Biochemistry For Medics 12/13/2012 39
  40. 40.  It is a case of Cystinuria, an absorption defect Cystine, Ornithine , Arginine and Lysine are excessively lost in urine due to deficiency of transporter (COAL) Cystine is precipitated in acidic urine As urine becomes more concentrated in the kidneys, the excess cystine forms crystals in acidic pH. As these crystals become larger, they form stones that may lodge in the kidneys or in the bladder. Biochemistry For Medics 12/13/2012 40
  41. 41.  A chronic alcoholic has been brought to casualty in a semi-conscious statePhysical examination reveals mild icterus andmoderately enlarged liverBlood biochemistry reveals- High serum Bilirubin High blood ammonia level Low serum protein level A provisional diagnosis of Liver Cirrhosis is made Biochemistry For Medics 12/13/2012 41
  42. 42. 1) What is the normal range of blood ammonia level ?2) What is the cause of ammonia intoxication in brain ? Biochemistry For Medics 12/13/2012 42
  43. 43.  Normal blood ammonia level ranges between-10-80 μg/dl Excess of ammonia is detoxified by conversion of glutamate to glutamine- first line of defense Still excess if present- by conversion of Alpha keto glutarate to Glutamate As a result there is excess of glutamine, but less of glutamate and Alpha keto glutarate Biochemistry For Medics 12/13/2012 43
  44. 44.  Glutamine is exchanged with tryptophan, a precursor of serotonin, that causes over excitation Low glutamate- Low GABA (Inhibitory neurotransmitter )- State of hyper excitation Low Alpha keto glutarate- TCA cycle suppressed- Energy depletion Patients of ammonia intoxication present with slurring of speech, blurring of vision, convulsions, coma and death in untreated cases. Biochemistry For Medics 12/13/2012 44
  45. 45.  Mention the normal reference range ofserum total cholesterol Give the names of two cholesterol loweringdrugs to be prescribed to a patient withhypercholesterolemia State two most important causes ofhypercholesterolemia Biochemistry For Medics 12/13/2012 45
  46. 46.  Serum total cholesterol ranges between 150-220 mg/dl Statins are the most commonly used drugs to lower cholesterol levels The other lipid lowering drugs are- Ezetimibe, Niacin, Bile acid sequestrants, Fibrates etc Hypercholesterolemia is observed in Diabetes mellitus, Nephrotic syndrome, Hypothyroidism, Biliary cirrhosis, Obstructive jaundice and in familial cases (Familial hypercholesterolemia) Biochemistry For Medics 12/13/2012 46
  47. 47.  A young man withhypercholesterolemia wasrushed to the hospital withcrushing chest pain radiatingto the left arm and a probableheart attack.The attending physician afterconfirmation of the diagnosisadministered streptokinaseinjection. What is the role of this drugin heart attack ? Biochemistry For Medics 12/13/2012 47
  48. 48.  Streptokinase is given as a fibrinolytic agent in coronary thrombosis It acts by promoting conversion of plasminogen to plasmin ( that can degrade circulating fibrinogen) as well as plasminogen that is bound to a fibrin clot. It is given in the first 6 hours of myocardial infarction to dissolve the clot Being non specific in nature, can cause bleeding, it is largely replaced by t PA (tissue plasminogen activator) prepared by recombinant DNA technology. Biochemistry For Medics 12/13/2012 48
  49. 49. Interpret from graph 1) FBS ? 2) Peak value of blood glucose ?Biochemistry For Medics 12/13/2012 49
  50. 50. Urine Analysis ReportTime zero 1/2 1 1hour 2 2hour 3in 30 s 30hours mins minsUrinary + ++ ++++ ++++ ++++ ++++ ++++sugarKetone +++ +++ +++ +++ +++ +++ ++++bodiesMake a complete diagnosis from the blood andurinary findings Biochemistry For Medics 12/13/2012 50
  51. 51.  Fasting blood glucose is high (135 mg/dl) There is delayed peak and the peak value is also high (200 mg/dl) The blood glucose values after half an hour of glucose load have crossed renal threshold (160-180 mg/dl) Glucose and ketone bodies are there in almost all the urine samples It is a case of diabetic ketoacidosis. Biochemistry For Medics 12/13/2012 51
  52. 52.  A 70 year-old female patient was seen in anemergency service with a chief complaint ofcrushing substernal chest pain. Her past medical history revealed a diagnosisof hypertension for five years, for which shereceived Captopril 25 mg three times a day. Her family history was positive forhypertension and coronary artery disease. What is the basis of using Captopril in thispatient ? Biochemistry For Medics 12/13/2012 52
  53. 53.  Captopril is an ACEinhibitor (Angiotensinconverting enzyme inhibitor) Angiotensin II is a potentvasoconstrictor, by inhibitingACE, the formation ofAngiotensins fromAngiotensinogen is inhibited. Captopril acts bycompetitive inhibition. Biochemistry For Medics 12/13/2012 53

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