Biochemistry Exam 3: Hemostasis and Clotting

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Questions and Answers

What is the primary function of desmosine in elastin?

  • Facilitating mineralization in bone
  • Providing unique chemical properties to elastin (correct)
  • Enhancing the flexibility of collagen
  • Acting as a growth factor binding site

Which protein provides a scaffold for elastin deposition?

  • Collagen
  • Fibrillin (correct)
  • Hydroxyapatite
  • Desmosine

What is the role of pyrophosphate in bone mineralization?

  • Promotes hydroxyapatite formation
  • Enhances osteocyte activity
  • Inhibits hydroxyapatite crystallization (correct)
  • Stimulates collagen synthesis

Which type of bone is described as dense and provides structural support?

<p>Cortical bone (C)</p> Signup and view all the answers

What is the primary function of osteoblasts in bone?

<p>Building new bone (C)</p> Signup and view all the answers

Which disease is associated with defects in fibrillin?

<p>Marfan syndrome (C)</p> Signup and view all the answers

How is collagen organized within bone?

<p>In brick-like shapes (D)</p> Signup and view all the answers

What role does hydroxyapatite play in the composition of bone?

<p>Offers hardness to bone (D)</p> Signup and view all the answers

What condition is indicated by petechia on the lower extremities and gumline along with a super deficient platelet count?

<p>Thrombocytopenia (C)</p> Signup and view all the answers

What is the main difference between direct and indirect bilirubin?

<p>Indirect bilirubin is bound to proteins, whereas direct bilirubin is not. (D)</p> Signup and view all the answers

What is the role of estrogen in bone health?

<p>It decreases the production of interleukin-6. (D)</p> Signup and view all the answers

How does calcium contribute to signal transduction?

<p>As a messenger conveying signals within the cell. (C)</p> Signup and view all the answers

Which specimen type is NOT commonly used in clinical testing?

<p>Bone marrow (D)</p> Signup and view all the answers

What factor can have the largest impact on laboratory results?

<p>Time of collection (B)</p> Signup and view all the answers

Which hormone is responsible for promoting calcium reabsorption in the kidneys?

<p>Parathyroid hormone (PTH) (C)</p> Signup and view all the answers

What is NOT included in a basic metabolic panel?

<p>Total Protein (A)</p> Signup and view all the answers

What triggers the release of parathyroid hormone (PTH)?

<p>Low blood calcium levels. (C)</p> Signup and view all the answers

Which of the following can occur if a patient eats before a fasting lab test?

<p>Lipemia (D)</p> Signup and view all the answers

What role does calcium play in muscle contraction?

<p>It activates cellular processes necessary for contraction. (B)</p> Signup and view all the answers

Which cells are responsible for bone resorption?

<p>Osteoclasts (A)</p> Signup and view all the answers

Which test is NOT part of liver function tests?

<p>Serum glucose (A)</p> Signup and view all the answers

What can imply a significant laboratory error due to sample collection issues?

<p>High levels of potassium and magnesium (D)</p> Signup and view all the answers

What effect does calcitonin have on calcium levels in the body?

<p>It inhibits calcium reabsorption in the kidneys. (B)</p> Signup and view all the answers

Which factor is NOT associated with promoting osteoclastic activity?

<p>Increased weight-bearing exercise (C)</p> Signup and view all the answers

What is a common characteristic of oral precancerous lesions?

<p>They are usually asymptomatic. (D)</p> Signup and view all the answers

Which of the following is considered a sign of advanced oral cancer?

<p>Pain radiating to the ear. (B)</p> Signup and view all the answers

What appearance is most concerning for oral cancer?

<p>Erythroplakia. (B)</p> Signup and view all the answers

What is considered the gold standard for diagnosing oral cancer?

<p>Biopsy. (A)</p> Signup and view all the answers

Which condition is a clear sign of hypophosphatasia?

<p>Loss of hydroxyapatite. (D)</p> Signup and view all the answers

Which alternative method is NOT scientifically backed for the diagnosis of oral lesions?

<p>Biopsy. (C)</p> Signup and view all the answers

In which area of the mouth is there a higher concern for abnormalities indicative of oral cancer?

<p>Sides of tongue. (B)</p> Signup and view all the answers

What lesser-known condition can resemble oral cancer and is caused by friction?

<p>Frictional hyperkeratosis. (C)</p> Signup and view all the answers

Which cells are primarily responsible for bone resorption?

<p>Osteoclasts (A)</p> Signup and view all the answers

What role do osteoblasts play in bone maintenance?

<p>They differentiate from stroma. (D)</p> Signup and view all the answers

How does estrogen influence bone density in postmenopausal women?

<p>It reduces osteoclast numbers. (D)</p> Signup and view all the answers

Which process occurs on the pressure side of moving teeth during orthodontic treatment?

<p>Increased osteoclast activity. (B)</p> Signup and view all the answers

What is the primary component of enamel that contributes to its hardness?

<p>Hydroxyapatite (A)</p> Signup and view all the answers

What happens to bone density with age, particularly in women?

<p>It decreases more significantly in women post-menopause. (A)</p> Signup and view all the answers

Which two factors are crucial for osteoclast differentiation?

<p>RANKL and m-CSF (B)</p> Signup and view all the answers

What is one consequence of increased osteoclast activity in conditions like osteoporosis?

<p>Bone erosion (A)</p> Signup and view all the answers

What is the primary component of plaque polysaccharides?

<p>Glucose polymers (B)</p> Signup and view all the answers

What happens to the anaerobic environment within dental plaque as it develops?

<p>It becomes increasingly anaerobic, favoring anaerobic bacteria. (B)</p> Signup and view all the answers

How does fluoride contribute to dental health?

<p>It increases the rate of remineralization of enamel. (A)</p> Signup and view all the answers

Which of the following is a major type of oral cancer?

<p>Squamous cell carcinoma (A)</p> Signup and view all the answers

What are common risk factors for developing oral cancer?

<p>Tobacco use, HPV, alcohol (D)</p> Signup and view all the answers

At what sites is oral cancer typically found?

<p>Tongue and floor of the mouth (D)</p> Signup and view all the answers

How does the access to oxygen change for bacteria in the interior of plaque?

<p>Bacteria have reduced access to oxygen. (C)</p> Signup and view all the answers

Which statement accurately describes fluoride levels in nature?

<p>Fluoride levels vary depending on the environment. (D)</p> Signup and view all the answers

Flashcards

Thrombocytopenia

A condition where the platelet count is below the normal range.

Direct Bilirubin

Water-soluble bilirubin processed by the liver, ready for excretion.

Indirect Bilirubin

Unconjugated, insoluble bilirubin, bound to albumin in the blood.

Pre-analytical variables

Factors affecting lab results from order to analysis, account for up to 75% of errors.

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Lipemia

Milky serum or plasma due to eating before a fasting lab test.

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Hemolysis

Rupture of red blood cells during collection, leading to elevated potassium, magnesium, and phosphate.

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Lipid Panel

Tests cholesterol (total, HDL, LDL) and triglycerides.

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Basic Metabolic Panel (BMP)

Group of chemistry tests measuring kidney function and electrolytes.

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Desmosine's role in elastin

Desmosine is a unique amino acid found only in elastin, formed from lysine reactions.

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Elastin's structure

Elastin has large hydrophobic domains and is highly elastic and flexible.

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Fibrillin's function

Fibrillin is an extracellular matrix protein that provides a scaffold for elastin deposition and limits growth factor availability.

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Bone composition

Bone is composed of collagen microfibrils and hydroxyapatite crystals.

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Collagen's role in bone

Collagen provides bone shape and strength by offering sites for hydroxyapatite crystal nucleation.

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Hydroxyapatite's role in bone

Hydroxyapatite crystals provide bone hardness and strength, filling spaces between collagen pieces.

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Osteoblasts

Cells that help build bone.

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Osteons

Structural units in compact bone that provide support for nerves and blood supply passage

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Osteoblast function

Osteoblasts create new bone and regulate osteoclast activity.

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Osteoclast role

Osteoclasts break down bone.

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RANKL and m-CSF

These proteins stimulate osteoclast formation and require calcium.

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Bone resorption and remodeling

The continuous process of bone breakdown and rebuilding, essential for tooth movement and maintaining bone structure.

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Enamel composition

Enamel is primarily hydroxyapatite (90%) and lacks collagen.

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Bone Density and Age

Bone density naturally decreases with age, more significantly for women during menopause.

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Menopause and Osteoporosis

Decreased estrogen levels during menopause lead to increased osteoclast activity and bone loss, increasing risk of osteoporosis.

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Bone loss in orthodontics

Tooth movement alters bone tension: pressure side increases osteoclast activity, tension side increases osteoblast activity.

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Estrogen's effect on bone

Estrogen helps reduce bone breakdown by decreasing the production of interleukin-6 (IL-6).

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Calcium's role in signal transduction

Calcium acts as a messenger, carrying signals from the cell surface to the cell's interior.

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Calcium's structural role

Calcium, in the form of calcium phosphate, is a major component of bone and teeth.

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Calcium homeostasis

The process of maintaining calcium levels in the blood within a specific range.

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Bone remodeling

The continuous process of breaking down and rebuilding bone tissue, using osteoclasts and osteoblasts.

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Parathyroid Hormone (PTH)

A hormone that increases blood calcium levels by promoting calcium reabsorption and inhibiting phosphate excretion.

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Vitamin D role in Calcium Homeostasis

Vitamin D is needed for calcium absorption in the intestine.

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Osteoporosis's effect on teeth

Osteoporosis weakens the jaw, potentially leading to gum recession and tooth loss.

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Dental Plaque

A sticky film of bacteria that forms on teeth, creating an anaerobic environment that promotes acid production.

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Anaerobic Microenvironment

An environment lacking oxygen, favoring the growth of anaerobic bacteria in dental plaque.

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Dextrans

The most abundant glucose polymers in dental plaque, contributing to its sticky nature.

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Fluoride's Role

Fluoride strengthens enamel, increasing remineralization rates and preventing tooth decay.

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Dental Calculus

Hardened plaque caused by calcium phosphate precipitation, often forming on teeth.

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Squamous Cell Carcinoma

The most common type of oral cancer, originating from the surface lining of the mouth and throat.

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Oral Cancer Risk Factors

Tobacco use, alcohol consumption, sun exposure, HPV infection, and iron deficiency are major risk factors for oral cancer.

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Oral Cancer Etiology

Mutations in genes controlling cell growth lead to uncontrolled cell division, creating tumors.

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Oral Precancer

A condition where cells in the mouth show changes that might lead to cancer. It's often asymptomatic but can appear as a white or red patch.

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Leukoplakia

A white patch in the mouth caused by abnormal cell growth, a potential precancerous condition.

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Erythroplakia

A red patch in the mouth, a more serious precancerous condition than Leukoplakia.

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Hypophosphatemia

Low levels of phosphate in the blood. Can be caused by insufficient intake, increased excretion, or impaired absorption.

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Hypophosphatasia

A rare genetic disorder where the body cannot produce enough alkaline phosphatase, affecting bone and teeth development.

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TNSALP

The enzyme tissue nonspecific alkaline phosphatase, essential for bone mineralization. A deficiency leads to Hypophosphatasia.

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Hydroxyapatite

The mineral component of bone, formed from calcium and phosphate, essential for bone strength.

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PPi (Pyrophosphate)

An inhibitor of bone mineralization, accumulation leads to weak bones in Hypophosphatasia.

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Study Notes

Biochemistry Exam 3 Study Notes

  • Hemostasis and Blood Clotting:

    • Clotting begins with platelet aggregation, triggered by contact with the sub endothelium, resulting in a prothrombotic response.
    • Platelets are activated by collagen, thromboxane A2 (TXA2), and ADP.
    • This process activates secondary messengers, IP3, leading to calcium release and platelet activation.
    • Inactive platelets have receptors for PGI2, which antagonizes activation and inhibits calcium release.
    • PGI2 and cyclic AMP decrease platelet aggregation, while TXA2 and ADP increase it.
    • Blood clotting occurs through vasoconstriction, platelet plug formation (adhesion, activation, aggregation), and coagulation cascade.
    • Blood clotting can be triggered by external or internal injury to the endothelial cell layer.
    • Clotting factors (like II, VII, IX, X) rely on vitamin K (in their synthesis).
    • Calcium plays a crucial role in the coagulation cascade.
    • Inhibitors like antithrombin III and others help regulate clotting.
  • Roles of Calcium and Vitamin K:

    • Clotting factors that bind calcium have modified amino acids.
    • Vitamin K is a cofactor for the enzyme that carboxylates glutamic acid residues in clotting factors.
    • These carboxylated residues are critical for binding calcium, an essential step in the clotting process.
    • Citrate and EDTA are calcium chelators, that can block clotting.
  • Heme Biosynthesis:

    • Heme is a prosthetic group found in hemoglobin and myoglobin.
    • It's composed of a porphyrin ring with an iron ion (Fe2+) at the center.
    • Critical steps of heme synthesis occur in mitochondria and cytoplasm.
    • The synthesis pathway includes the formation of d-amino levulinic acid (d-ALA).
    • The rate-limiting step in heme synthesis is the reaction catalyzed by d-ALA synthase.
    • Enzymes like d-amino levulinic acid dehydratase and ferrochelatase are very sensitive to lead poisoning.
    • Heme synthesis is regulated differently in liver and bone marrow. It can be regulated by feedback inhibition, by free heme, in the liver, through transcriptional and translational regulation of δ-aminolevulinate synthase. And in the bone marrow, heme synthesis is stimulated by erythropoietin and by iron.
  • Hemostasis Tests:

    • PT (prothrombin time) tests the extrinsic pathway (factors VII, X,V).
    • PTT (partial thromboplastin time) tests the intrinsic pathway (factors XII, XI, IX, VIII, X, V).
  • Blood Clotting Factors:

    • Factors 8 and 9 are Vitamin K dependent.
    • Factor Va is blocked by protein C in coagulation.

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