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قضية الأسبوع رقم (2) و تحليل الــ CK (تم حلها)

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  • قضية الأسبوع رقم (2) و تحليل الــ CK (تم حلها)


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    A 50 years old male has the following serum test result:

    CK 170 U/L (normally 15-160 U/L)
    CK-MB > 6% (normally <6%)
    LD 280 U/L (normally 100-225 U/L)
    LD1 > LD2

    He went to the hospital after 4 hours when he feel some chest pain , pain, radiating into jaw, arm or shoulder, rapid pulls and changing in blood pressure.

    -----------------------------------------------------------------------------

    Q one- What is CK, when its order

    Q tow -What are the tissue sours of CK

    Q three- How many isoenzyme fractions

    Q four- What are the causes of High CK
    level "pathological and non pathological"

    Q five- What kind of tubes the sample to detect CK should be draw in

    Q six- What is the significance of a hemolysis, light on the sample

    Q seven- When CK decreased

    Q eight- Complete:
    In the sera of healthy people the major isoenzyme of CK is ………..

    Q nine- Put T or F:
    Time frame must be considered when interpreting CK level.

    Q ten- Can be used this enzyme as tumor marker

    Q eleven- What is the suspected diagnosis? And what is the other more specific test that confirms this diagnosis



    This case had been solved


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    التعديل الأخير تم بواسطة labspe; الساعة 10-02-2008, 09:45 PM.

  • #2
    ck is enzyme lead us if there is dameg in the muscels
    it is not specially for the heart muscels,it increased in many cuses,for example,hard exsersize, muscells dameg any where in the body,also in heart dameg
    about the other questions,should see the pationt first,so only the doctor there can diagnos this pationt, but in many casess, when the blood suger getting hight,it will show the same signes
    hope my informations will be helpful for you
    best regards

    تعليق


    • #3
      مرحبا

      يعطيكو الف عافية

      انا ارفقت الاجابه

      و ان شالله صح
      الملفات المرفقة
      ان عشت فعش حرا أومت كالاشجار وقوفا


      sigpic

      تعليق


      • #4
        Ans. one : CK called Creatine Kinase enzyme which catalyze the reaction of creatine with ATP molecule to form creatine phosphate and ADP and also catalyze the reverse reaction to release energy needed for the
        muscles before glycolysis is done


        Ans. two : CK enzyme present in Cardiac and skeletal muscles cells


        ans.Three: there are 3 isoezymes of CK each one consists of two sub unites
        CK-BB & CK-MB & CK-MM


        Ans. Four : CK is elevated pathologica when distruaction occur in muscle (or heart) cells thus its content of CK is trasefered out of cytoplasm to the blood , also CK level is increased non Pathological when hard exercises made by muscles


        Ans.five : Blood sample collected heparinised or without any anticoagulant


        Ans.six : hemolysis can increase the CK level in the sample but I donnot know the efect of light


        Ans.seven: in old people while their muscles are weak and sluggish


        Ans. eight : the amajor isoenzyme in the sera of healthy people is CK-MM


        Ans. nine : the statement is true because CK-MB is elevated after 4 hours after chest pain and return to normal in 24 hours after that


        Ans ten : CK connot be used as a tumor marker


        Ans.eleven : this case is diagnosis for acute myocardial infraction (AMI) disaese
        there are other more specific test that confirms this diagnosis as Triponine test


        هذا ما أعلم والله أعلى وأعلم
        :sm112:
        يا سائلى عما يجول بخاطرى
        قد دل حالى عنى فهل من ناظر
        إنى ظننت ان الخلاص منك بوسعيا
        وأنى على لهب الفراق لقادر

        :sm130:

        تعليق


        • #5
          indication of muscle disease
          Measurement of the activity of creatine kinase in the blood, analysis of a muscle biopsy, and recordings from an electromyograph frequently establish that the muscle weakness is due to primary degeneration of the muscles. Creatine kinase is an enzyme of muscle fibres that is released into the bloodstream when the fibres degenerate, as in the muscular dystrophies

          CK–MB levels, along with total CK, are tested in persons who have chest pain to diagnose whether they have had a heart attack. Since a high total CK could indicate damage to either the heart or other muscles, CK–MB helps to distinguish between these two sources. If your doctor thinks you have had a heart attack and gives you a “clot-dissolving” drug, CK–MB can help your doctor tell if the drug worked. When the clot dissolves, CK–MB tends to rise and fall faster. By measuring CK–MB in blood several times, your doctor can usually tell whether the drug has been effective

          انشالله استفدتم من المعلومات وانشالله اكون عند حسن ظنكم





          نعيب زماننا والعيب فينا وما لزماننا عيب سوانا
          ونهجو ذا الزمان بخير ذنب ولو نطق الزمان لنا هجانا
          :sm199:
          من فقد الله ماذا وجد..؟ومن وجد الله ماذا فقد...

          تعليق


          • #6
            CK: Creatinine Kinase is enzyme coming from Arg + Gly in kidney and converted to guanido aceteate (liver

            and converted to creatinine ( CK AND MUSCLE)converted to creatinine phosphate and last step give me creatinine .

            A2 : LIVER - KIDNEY - HEART - SKELETAL MUSCLE - ERYTHROCYTE

            A3: 3 Isoenzyme fraction CK-MM CK-MB CK BB

            A4: Pathological : myocarditis and cardiac failur •

            NON PATHOLOGICAL: angina and pericarditis

            A5: Plain Tube

            A6: Physical Activity

            A7: Alzheimer disease

            A8: CK-MM

            A9: True because CK-MB Increased 2-10 hours PEAK : 24 hours NORMAL :2-3 days

            A10 :Can not used

            A11 : Acute myocardial infraction

            SPECIFIC TEST : TROPININE (I) VERRY SPECIFIC FOR HEART TEST

            INCREASE 3-8 h

            PEAK 12-24H

            NORMAL : 5-10 DYES
            - من جن بالحب فهو عاقل ومن جن بغيره فهو مجنون

            -إذا أحبك مليون فأنا معهم.. وإذا أحبك واحد فهو أنا ..وإذا لم يحبك أحد فاعلم أنني مت.:sm184:.

            تعليق


            • #7

              Q one- What is CK, when its order
              an enzyme called Creatine Kinase
              creatine+ATP with CK it will give ADP + Creatine phosphate


              Q tow -What are the tissue sours of CK
              Major :Brain, Heart & Skeletal muscle

              Q three- How many isoenzyme fractions
              3isoenzymes
              CK-1 BB
              CK-2 BM
              CK-3 MM
              Macro CK => CK-BB + IgG
              Mi-CK => mitochondria


              Q four- What are the causes of High CK
              level "pathological and non pathological"
              Pathological: Acute Miocardial Infection, Musclar diseases
              Non pathological: in physiological increases=> in infant & pregnancy


              Q five- What kind of tubes the sample to detect CK should be draw in
              serum(plain) & heparinized plasma

              Q six- What is the significance of a hemolysis, light on the sample
              Hemolysis should be avoided because RBC contain CK
              Put in dark place because it's light sensitive


              Q seven- When CK decreased
              I think diseases in muscles

              Q eight- Complete:
              In the sera of healthy people the major isoenzyme of CK is ………..
              CK-MM

              Q nine- Put T or F:
              Time frame must be considered when interpreting CK level.
              True Ex. in AMI

              Q ten- Can be used this enzyme as tumor marker
              YES because when CK-BB elevate it cause central nervous system disirders such as tumor

              Q eleven- What is the suspected diagnosis? And what is the other more specific test that confirms this diagnosis
              AMI
              test that confirms this diagnosis: Triponine test



              جاوبت على الاسئله على حسب اللي فهمته :sm197:..
              وعلى الله ..:sm172:

              تعليق


              • #8
                Creatine kinase

                Creatine kinase
                From Wikipedia, the free encyclopedia
                Jump to: navigation, search

                Creatine KinaseCreatine kinase (CK), also known as phosphocreatine kinase or creatine phosphokinase (CPK) is an enzyme (EC 2.7.3.2) expressed by various tissue types. It catalyses the conversion of creatine to phosphocreatine, consuming adenosine triphosphate (ATP) and generating adenosine diphosphate (ADP).

                In tissues that consume ATP rapidly, especially skeletal muscle, but also brain and smooth muscle, phosphocreatine serves as an energy reservoir for the rapid regeneration of ATP. Thus Creatine Kinase is an important enzyme in such tissues.

                Clinically, creatine kinase is assayed in blood tests as a marker of myocardial infarction (heart attack), rhabdomyolysis (severe muscle breakdown) and in acute renal failure.





                Contents [hide]
                1 Types
                2 Laboratory testing
                3 See also
                4 Additional images
                5 References



                Types
                In most of the cell, the CK enzyme consists of two subunits, which can be either B (brain type) or M (muscle type). There are, therefore, three different isoenzymes: CK-MM, CK-BB and CK-MB. The genes for these subunits are located on different chromosomes: B on 14q32 and M on 19q13. In addition to those, there are two mitochondrial creatine kinases, the ubiquitous and sarcomeric form.

                creatine kinase, brain
                Identifiers
                Symbol CKB
                Alt. Symbols CKBB, CK-1
                Entrez 1152
                HUGO 1991
                OMIM 123280
                RefSeq NM_001823
                UniProt P12277
                Other data
                EC number 2.7.3.2
                Locus Chr. 14 q32.3
                creatine kinase, muscle
                Identifiers
                Symbol CKM
                Alt. Symbols CKMM, CK-3
                Entrez 1158
                HUGO 1994
                OMIM 123310
                RefSeq NM_001824
                UniProt P06732
                Other data
                EC number 2.7.3.2
                Locus Chr. 19 q13.2-13.3
                Isoenzyme patterns differ in tissues. CK-BB occurs mainly in tissues, and its levels do rarely have any significance in bloodstream. Skeletal muscle expresses CK-MM (98%) and low levels of CK-MB (1%). The myocardium (heart muscle), in contrast, expresses CK-MM at 70% and CK-MB at 25-30%. CK-BB is expressed in all tissues at low levels and has little clinical relevance.

                The mitochondrial creatine kinase (CKm), which produces ATP from ADP by converting creatine phosphate to creatine, is present between the two membranes of the mitochondrion. Apart from the mitochondrial form, there are three forms present in the cytosol—CKa (in times of acute need, produces ATP in the cytosol at the cost of creatine phosphate), CKc (maintains critical concentration of creatine and creatine phosphate in the cytosol by coupling their phosphorylation and dephosphorylation respectively with ATP and ADP) and CKg (which couples direct phosphorylation of creatine to the glycolytic pathway (see glycolysis).


                Laboratory testing
                CK is often determined routinely in emergency patients. In addition, it is determined specifically in patients with chest pain and acute renal failure is suspected. Normal values are usually between 25 and 200 U/L. This test is not specific for the type of CK that is elevated.

                Elevation of CK is an indication of damage to muscle. It is therefore indicative of injury, rhabdomyolysis, myocardial infarction, muscular dystrophy, myositis, myocarditis, malignant hyperthermia and neuroleptic malignant syndrome. It is also seen in McLeod syndrome and hypothyroidism. The use of statin medications, which are commonly used to decrease serum cholesterol levels, may be associated with elevation of the CPK level in about 1% of the patients taking these medications, and with actual muscle damage in a much smaller proportion.

                Lowered CK can be an indication of alcoholic liver disease and rheumatoid arthritis.

                Isoenzyme determination has been used extensively as an indication for myocardial damage in heart attacks. Troponin measurement has largely replaced this in many hospitals, although some centres still rely on CK-MB.
                http://up100.arabsh.com/files/syszi1ef3acfwusqkr93.jpg

                تعليق


                • #9
                  Q one- What is CK, when its order
                  Creatine kinase is an enzyme found in the heart, brain, and skeletal muscle. Enzymes are proteins that help cells perform their normal functions. In muscle, for example, CK helps cells make the energy needed to move

                  ck is order to determine if you have had a heart attack and if other muscles in your body have been damaged and if you have chest pain or muscle pain and weakness

                  Q tow -What are the tissue sours of CK
                  1-skeletal muscle
                  2-cardiac muscle
                  3-other organs such as brain


                  Q three- How many isoenzyme fractionsCK occurs in three major forms, called isoenzymes:
                  • CK-MB (found mostly in your heart muscle),
                  • CK-BB (found mostly in your brain), and
                  • CK-MM (found in your heart and other muscles).

                  Q four- What are the causes of High CK
                  level "pathological and non pathological
                  High CPK levels may be seen in patients who have:

                  • Heart attack
                  • Myocarditis (inflammation of the heart muscle)
                  • Central nervous system trauma or stroke
                  • Convulsions
                  • Delirium tremens
                  • Dermatomyositis or polymyositis
                  • Electric shock
                  • Muscular dystrophies
                  • Pulmonary infarction (lung tissue death)
                  Additional conditions may give positive test results:
                  • Hypothyroidism
                  • Pericarditis following a heart attack
                  • Rhabdomyolysis

                  People who have greater muscle mass have higher CK levels (for example a young fit male will have more muscle mass and hence a higher CK level than an elderly female), and Afro-Caribbeans may have higher CK levels than other ethnic groups. Raised CK levels can also be seen in those with hypothyroidism. Very heavy exercise (such as in weight lifting, contact sports, or long exercise sessions) can also increase CK.
                  Other forms of muscle damage, such as from a fall, a car accident, surgery, or after an injection, can also increase CK. Drinking too much alcohol slightly increases CK. Rarely, some drugs, particularly cholesterol-lowering drugs (statins), can damage muscle and increase CK

                  Q five- What kind of tubes the sample to detect CK should be draw in


                  Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic. An elastic band is placed around the upper arm to apply pressure and cause the vein to swell with blood.
                  A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the band is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.
                  In infants or young children, the area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. A bandage may be applied to the puncture site if there is any bleeding..

                  Q six- What is the significance of a hemolysis, light on the sample

                  it may cause rise ck
                  Q seven- When CK decreased

                  Early pregnancy can decrease CK levels


                  Q eight- Complete: In the sera of healthy people the major isoenzyme of CK is

                  CKMM


                  Q nine- Put T or F:
                  Time frame must be considered when interpreting CK level
                  true

                  Q ten- Can be used this enzyme as tumor marker

                  i think no


                  Q eleven- What is the suspected diagnosis? And what is the other more specific test that confirms this diagnosis
                  In the first 4 to 6 hours after a heart attack, CK in blood begins to rise. It reaches its highest level after about 18 to 24 hours, and returns to normal in about 2 to 3 days. The test for CK can also indicate if your other muscles are damaged.
                  A high CK, or one that increases usually indicates that there has been some damage to the heart or other muscle. It can also indicate that your muscles have experienced heavy use, for example if you have exercised excessively. If your doctor suspects a heart attack and your CK is high, they will usually also request troponin or CK-MB to see if your heart is damaged
                  http://www.9m.com/thumbnail/51279763/HPIM0301.jpg

                  تعليق


                  • #10
                    ans1 -ck- creatine kinase foundmainly in heart muscle-brain and skeletal muscle
                    ans2occure in tissues as smooth muscle
                    ans3 the iso enzyme are (ck-MM) (ck-MB) (ck-BB)
                    ans4 nonpathogenc -new born slightly raised and-parturition for afew days
                    pathological -myocardial infraction- -musculardystrophies- andbreak doun of skeletal mucsle and shock
                    ans5with anticoagulant tube or tube with heparin
                    ans6 inheamolysed sample increase thelight not effect
                    ans7 decrease hnold with weak muscle
                    ans8 ck-MM
                    ans9 true
                    ans10 can not be used
                    ans11 acute myocardial
                    *وقل ربي زدني علما*

                    تعليق


                    • #11
                      1. It is known as creatine phosphokinase (CPK), creatine kinase (CK) is a cardiac enzyme that helps convert creatine to creatinine, a reaction that is necessary for metabolism and energy production. Creatine kinase is made up of three important isoenzymes:

                      2. Exists in the brain ,skeletal muscle and it exists in the highest amount in the heart

                      -CK-BB (CK1 3..
                      CK-MB (CK2): (CK-MB2CK-MB1 -
                      CK-MM (CK3)-:

                      4-
                      -
                      pathological
                      Heart attack
                      Cardiac ischemia
                      Pericarditis
                      Alcoholic cardiomyopathy
                      Hypotension
                      Coronary artery disease
                      Platelet disorders
                      Muscular dystrophy
                      Hypothyroidism
                      Hypokalemia
                      High in viral infection

                      non pathological-

                      أي مجهود رياضي



                      5- we will draw in red tubes . the Plain tub




                      6- lD ,LDH1 and LDH2 exist primarily in the heart, red blood cells and kidneys,
                      so if the sample hemolysis it could effect of the result , heparinized plasma
                      and for the ck also .



                      7 –
                      Malnutrition
                      Congenital enzyme disorder





                      8- In the sera of healthy people the major isoenzyme of CK is……..the ck-mm

                      9-yes , it is tro because Begins to,Returns to normal in 3-4 daysand the rise 4-6 hours,Peaks 24 hours


                      بصراحه بنسبه لي ck ماعندي خالفيه اذ كان ممكن يستخدم في tumor marke بس بنسبه لي10-
                      ck-BB هذي معلومه صغير قريت عنها انه ممكن يستخدم as tumor marker prostate cancer



                      11. the Cardiac troponin is the cardiac isoforms are very specific for cardiac injury and are not present in serum from healthy people. Troponin I is the form frequently assessed. There is a new form (Troponin L), which may be detected earlier.
                      هذه بنسبه لاهم اختبار عشان نتاكد من ان المريض ماعنده ذبحه صدريه

                      معلومه صغيره ان لـ LDH يوجد خمسه انواع
                      Total LDH level. Normal levels are 45 to 90 micrograms per liter.
                      LDH1. Normal range is 14 to 26 percent of total LDH.
                      LDH2. Normal range is 29 to 39 percent of total LDH.
                      LDH3. Normal range is 20 to 26 percent of total LDH.
                      LDH4. Normal range is 8 to 16 percent of total LDH.
                      LDH5. Normal range is 6 to 16 percent of total LDH.
                      اللهم أغنيني بالعلم , وزيني بالحلم , وأكرمني بالتقوى , وجملني بالعافيه

                      تعليق


                      • #12
                        الإجابه علي case 2

                        يسعدنى الاشتراك معكم فى القضيه الثانيه
                        جوابى فى المرفقات
                        الملفات المرفقة
                        http://i30.tinypic.com/s42qn8.jpg

                        تعليق


                        • #13
                          السلام عليكم ورحمة الله وبركاته
                          ههههه لحسن الحظ توي مختبرة البايو الحمد لله وأخذنا نفس الموضوع بس أـمنى تكون إجاباتي صحيحة
                          1- CK is an enzyme called creatin kinase which participate in the folowing reaction
                          creatin+ATP=ADP+CREATIN PHOSPHATE
                          2- the source is:muscle cell and cardiac cell
                          3 -ther are 3 isoenzyme fraction CK-MM,CKMB,CKBB
                          -4-the non pathological increas is due to intense excercis
                          sorr,i do not know about pathological
                          5-may be heparenized tube
                          6-
                          7- may be whene there is defect in the heart

                          the statment is true
                          9

                          10=no we can not use it as a tumuer markers
                          11 this case is acute myocardial infarction
                          other test may be troponin test or myoglobin test
                          -

                          تعليق


                          • #14
                            C.K. is creatine kinase enzym .It ioccurs in greatest amount in skeletal muscle and heart [muscle . There is some in brain but little in other tissues . As there is little or none in the red blood cells .Haemolysis does not interfere seriously in the estimation as is the case with several other enzyms . An increase is found in Myocardial Infraction , in which it has been considered to be more sensitive index than Aspartate transaminase However its determination has been chiefly used in muscle diseases , in progressive muscle atrophy values between 1 and 100 unites per ml have been found .Smaller increase can be seen in dermatomyositis but normal results are obtained in conditions such as poliomyelitis in which the muscle abnormality is secondery to a netve lesion .Normal persons severely exercised may produce values cionsiderably above the usually accepted upper normal .There are three groups of iso(CK -MM , CK-MB , CK-BB) :more43::sm174]

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                            • #15
                              لسه بدري عليا قوي

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