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Molecular Pathophysiology Exam 2
n/a
238
Medical
Graduate
03/27/2011

Additional Medical Flashcards

 


 

Cards

Term
Why have heart disease rates dropped in the US in the last 50 years
Definition
better drugs (antihypertensives) and less smoking
Term
What are the top 4 causes of cancer deaths in males and females?
Definition

Female: lung, breast, colon, pancreatic

Males: lung, prostate, colon, pancreatic

Term
How does cancer actually kill a person?
Definition

Anatomical: tumor obstructs a pivotal body part and you die of that (ex: cervical cancer obstructs ureters, die of renal failure)

 

Tumor mass: If the tumor gets big enough, it will take up too many of the body's nutrients 

 

Infection: bone marrow (anemia, WBC decereases) die of sepsis

Term
Smaller cancer masses are much more sensitive to ___-
Definition
chemo
Term
TNM grading for cancer
Definition

TNM

 

Tumor size: <2.5cm = T1, >5cm = T3

Nodes: 0= no nodal involvement

Metastases: 0 = not present, 1 = present

Term
Cancer staging
Definition

Stage 1 - T1, N0, M0

80-90% 5 year survival

 

Stage IV - survival rates very slim

 

Term
5 things that affect cancer prognosis
Definition

Staging

Overall health of Pt

Type of cancer

Presence/Type of receptor (some receptors can be blocked)

Availability of care

Term
How are cancers named?
Definition

Anatomical: Breast, liver, pancreas

 

Pathological:

Derived from squamous cells: carcinoma

Glandular tissue: adenocarcinoma

Mesodermal tissue (bone, muscle, connective tissue): sarcoma

Hematologic: leukemia, lymphoma, etc

Germ cell cancers: different names

Term
What's the difference between cancer cells and normal cells?
Definition

1. Neoplastic cell growth is poorly controlled

2. High nuclear to cytoplasmic ratio in neoplasia

3. cancer cells divide more often

4. cancer cells lose ability to fxn properly - mitosis occurs throughout cells, not just in basal layer

5. immortality - do not undergo apoptosis, telomeres are indestructable

Term
____ tumors are disorganized tissue in which mitosis occurs throughout the tissue and you can't tell where the tumor started or where it's going.
Definition
anaplastic
Term
What are HeLa cells
Definition
taken from a tumor - have been dividing continuously for 60 Years
Term
What does each do to your Cancer risk?

1st degree relative:

Lifetime risk for breast cancer?
Definition

1st degree relative doubles your risk

lifetime risk: 1/8

Term
What is a proto-oncogene?
Definition

it is a normal gene that helps cells grow... such as in chidlren or in adult bone marrow/skin cells

 

if it is mutated, it becomes an oncogene

Term
What is a tumor-suppresor gene?
Definition

Normal genes that repair DNA errors

Loss of tumor suppressor genes in a cell increases the risk of malignant transformation

Each cell has two copies of the TSG called BRCA-I and BRCA-II, having only one copy of this increases chance of cancer.

 

Term
Cancer in younger-than-normal poeple or cancer in multiple members of a family suggests what?
Definition
loss of tumor suppressor genes (BRCA I & II)
Term
What is the nuisance hypothesis?
Definition
must have oncogenes AND loss of tumor suppressor genes for cancer to happen
Term
____ - cells that are no longer "normal" but have not yet become cancerous.

These types of cells are the basis of what test?
Definition

dysplasia

pap smears

Term
Why does cancer risk increase with age?

What is the exception to this rule?
Definition

1. As we age, repair capacity decreases

2. accumulation of errors

 

Exception: germ cell tumors tend to show up in kids

Term
What is adjunctive therapy?
Definition

that in addition to primary cancer treatment (surgery & radiation)

 

Adjuncts: chemo, hormonal treatment (for receptor-pos tumors), monoclonal antibody drugs that targets HCR2)

Term
What is the significance of estrogen replacement therapy?
Definition

It is given to women to prevent/treat osteoporosis, however estrogen feeds breast cancer.

 

Solution? give estrogen that only stimulates bone receptors and blocks breast receptors

Term
2 examples of hormone modulation for cancer treatment
Definition

estrogen receptor blockers

aromatase inhibitors

Term
How are chemo drugs administered?
Definition

chemo drugs damage all the body's cells so they must be administered in a cyclic fashion so as to kill the tumor cells but not cause organ damage

 

1. pt gets hammered wtih drugs over a day or two

2. wait a few weeks for normal body cells to repair

3. do it again in a few weeks to knock tumor cells down a few notches

 

due to several times until tumor cells are gone

Term
A woman is scheduled for major colon surgery... how do we reduce her chances of post op infection?
Definition

1. prophylactic antibiotics for the most likely infections - staph, strep from skin, gram neg organisms from colon (e. coli, C diff)

 

2. Clean out colon as much as possible before surgery to reduce bacterial load

 

3. prep skin as much as possible before surgery to get bacteria off

Term
____: malignant tumor that tends to invade healthy tissue and spread to new sites

___: abnormal swelling within the body

___: abnormal growth that tends to spread

___: uncontrolled cell proliferation including benign and malignant tumors ("new growth")
Definition

cancer

tumor

malignant

neoplasia

Term
DNA insults that can result in cancer
Definition

copy errors

electromagnetic damage (UV, xrays, gamma rays)

cosmic rays

Chemicals (free radicals)

Term
___ is a protoonco gene with a gain of function mutation
Definition
oncogene
Term
____: genes that regulate the cell cycle by inhibiting growth via cell to cell contact

___: genes that repair DNA damage and maintain genmoe integrity
Definition

gatekeeper genes

caretaker genes

Term
P53
Definition

something about being a tumor suppressor gene

"guardian angel gene"

Term
Both alleles of tumor suppresor genes must be inactivated (loss of function mutation) to permit neoplasia

somatic mutations can cause loss of function

Individuals who inherit one non-functional allele are at risk for neoplasia

What hypothesis is this?
Definition
knudson hypothesis
Term
What is the single insult concept of neoplasia?
Definition

any cell can undergo malignant transformation

Toxins of some kind triggers the transformation (ionizing radiation, certain chemicals, perhaps viruses)

Transformation usually occurs relatively quickly (weeks to months)

Term
Multi-step theory of neoplasia
Definition

genetic background is important in determining susceptivility

several mutations must occur in one cell before transformation occurs (oncogene is activated and tumor suppressor gene is inactivate)

normal immune surveillance fails

usually requires long periods of time to occur

Term
Stem Cell Paradigm of neoplasia
Definition

cancer require multistep transformation of stem cells

most tumor cells can proliferatue only briefly (only malignant step cells are immortal and drive tumor growth)

if we can learn to control stem cells we may be able to control cancer

Term
Immunologic Catch 22
Definition

most cancer cells display self MHC molecules

T lymphs that are more effective against cancer cells would likely cause autoimmune disase and affect reporduction

Term
What 3 cancers (caused by viruses) have an increased risk in AIDS pt?
Definition

Kaposi's sarcoma (herpes virus 8)

cervical cancer (HPV)

lymphoma (epstein barr virus)

Term
cancer derived from undetermined cellular origin is called?
Definition
anaplastic
Term
Characteristics of neoplastic cells

___ = many or varying shapes
____ nuclear/cytoplasmic ratio
___ mitosis
___ of differentiation and function
___ of cell-cell cohesion
____ of apoptosis
Definition

pleomorphic

large

frequent

loss

loss

loss

Term
What are the 4 pillars of cancer treatment?
Definition

surgery

chemo

radiation

immunotherapy

Term
Are malignant cells or normal cells better able to repair intracellular damage?
Definition
normal - which is why chemo works. cancer cells die, normal cells are injured but can be repaired
Term
Why are big tumors less sensitive to drugs and radiaiton?
Definition
they have necrotic centers with poor vascular perfusion and thus low O2 and Low metabolism
Term
Where is BRCA 1 located?

Wher is BRCA 2 located?
Definition

chromosome 17

Chromosome 13

Term
Why is it that you lose hair and are more prone to illness when you're on chemo?
Definition

chemo targets rapidly dividing cells - like neoplasia, but also bone marrow & hair follicles (and embryonic/fetal cells and GI endothelium)

 

Bone marrow suppression results in:

Anemia (fatigue, less O2 transport)

neutropenia (infections)

thrombocytopenia (hemorrhage)

Term
Why is it important to prevent severe bone marrow depression?
Definition

it improves pt well being

improves pt functioning

***increases tolerance to additional chemo.. which leads to improved outcome ***

Term
What is HER-2
Definition

Human Epidermal growth factor Receptor

Represents a proto-oncogene that is + in about 1/3 of breast cancer

Mutation results in amplification of growth factor

HER-2 positivity lowers prognosis

 

Now trying anti-HER-2 treatment

Term
Eukaryotes v. prokaryotes
Definition

Eukaryotes - have nucleus - protozoa and fungi

 

Prokaryotes - gram neg (red) - gram pos (blue)

Have cell wall

anaerobic or aerobic

cocci or bacilli(rods)

 

Other prokaryotes: Mycoplasma - have no cell wall, Chlamydia - intracellular reproduction, rickettsia - typhus, rocky mtn spotted fever

 

Non-living pathogens - viruses, prions

Term
Gram classification and shape of each?

1. strep, staph, enterococcus

2. clostridium (anything that starts with C.), anthrax, cornybacteria (diphtheria),

3. neisseria

4. e. coli, coliform, proteus mirabilis, salmonella, kelbsiella, enterobacter aerogenes
Definition

gram + cocci

 

Gram + rods/bacilli

 

Gram - cocci

 

Gram - rods/bacilli

Term
Bacteriostatic vs. bacteriocidal
Definition

Bacteriostatic - slows microbial growth until host immune system can gain the upper hand - for routine infections

 

bacteriocidal - in compromised pts, employs agents designed to kill a significant # of microbes - for very serious infections

Term
4 basic points on bacteria that antibiotics target and ex of antibiotics that target each
Definition

1. Inhibit folate production - sulfa drugs, trimethoprim, bactrim

2. Inhibit cell wall symthesis (B-lactams - PENICILLIN, caphalosporins, vancomycin, bacitracin)

3. Inhibit protein synthesis - 50S or 30S inhibitors - TETRACYCLINES, aminoglycosides, marcolides (Erythromycin)

4. inhibit nucleic acid - fluoroquinolones

 

Term
2 most common fluoroquinolones
Definition
cipro, levaquin
Term
What is Psuedomembraneous colitis?
Definition

explosive bloody diarrhea which can be life threatening

C. DIFF

seen after antibiotics due to overgrowth of C.Diff

Therapy - hydration and vancomycin or metronidazole

Term
2 Anti-HIV drugs
Definition
Acyclovir (Zovirax) and Valacyclovir (Valtrex)
Term
Flu vaccines and flu antivirals
Definition

vaccines: amantadine (symmetrel) and Rimantadine (Flumadine) -- against Influenza A

 

Drugs: Neuraminidase inhbiitors - slow virus growth - zanamivir (relenza) & oseltamivir (tamiflu)

Term
What are anti-HIV drugs and how do they work?
Definition

Nucleoside reverse transcriptase (NRTIs) or protease inhibitors

 

Extend latent phase of HIV by keeping CD4 up and viral load down

Term
4 types of fugal infections
Definition

superificial (athlete's foot)

pulmonary infections (pneumonia)

CNS (meningitis, encephalitis)

systemic

Term
What kind of pathogen are these?

candida albicans
histoplasma capsulatum
coccidioides immitis
blastomyces dermatidis
cryptococcus neoformans
pneumocitis jyroveccii
Definition
fungi
Term
What is significant about pneumocitis jyrovecii?
Definition
AIDS-defining illness
Term
What type of microbe?


entemoeba histolytica

giardia lambia

toxoplasmosis gondii [cats transmit to prgnant women or immunocompromised (AIDS-defining)]

trichomonas vaginalis

plasmodium (malaria)
Definition
protozoa
Term
What kind of drug?

metronidazole

chloroquine
Definition
antiprotozoals
Term
what medication would you give?

protozoal infection
anaerobic
bacterial vaginosis
Definition
metronidazole
Term
"special" bacteria - give ex of each:

anaerobes
small bacteria without a cell wall
obligate intracellular bacteria
Definition

anaerobes - clostridia

no cell wall: mycoplasma

obligate intracellular: ricketsia, chlamydia

Term
How does a gram stain work?
Definition

Application of crystal violet

Application of iodine (blue - gram pos)

Alcohol wash

Application of safranin (red - gram neg)

Term
What type of bacteria are these (gram and shape)

Staph aureus
Strep pyogenes
strep pneumoniae
enterococcus faecalis
Definition
gram pos cocci
Term
What type of bacteria are these (gram and shape)

bacillus anthracis
corynebacterium diphtheriae
clostridium species
Definition
gram pos bacili
Term
What type of bacteria are these (gram and shape)

neisseria gonorrhoeae
neisseria meningitidis
Definition
gram neg cocci
Term
What type of bacteria are these (gram and shape)

escherichia coli (E. coli)
enterobacter aerogenes
proteus mirabilis
salmonella enterica (salmonella typhi)
klebsiella species
Definition
gram neg bacilli
Term
What disease does this cause?

strep pneumonia, mycoplasma and viruses
Definition
pneumonia
Term
What disease does this cause?

N. menigitidis, strep pneumoniae, viruses
Definition
meningitis
Term
What disease does this cause?

gram neg enteric bacteria (esp E. coli)
Definition
UTIs
Term
What disease does this cause?

staph aureaus, strep pyogenes
Definition
skin infections
Term
Acid-fast bacillis cause what disease?
Definition
TB, leprosy
Term
What disease?

caused by mycobacterium
initially either pulmonary or GI
in late stages can infect and affect every organ system
Definition
TB
Term
___ are the simplest known infectious agent

what disease do they cause
Definition

prion

Transmissible spongiform encephalopathies (TSE) - creutzgeldt-Jakob disease or Bovine spongiform encephalopathy

Term
The Viral Essence:


Genome protected by a ___ coat
Usually have ___ on the coat
Must harness intracellular machinery of the host cell to:
Replicate the ___
Produce the protein coat units
Assemble new ____
Achieve __ from host cell
Definition

protein

receptors

replicate the genome

assemble new viral particles

achieve release

Term
3 RNA-based and DNA-based viruses
Definition

RNA:

influenze, HIV, polio

 

DNA:

Herpes, hep B, adenovirus

Term
____: a substance made by a bacteria, fungus, or mycobacteria that kills or inhibits growth of other microorganisms.
Definition
antibiotics
Term
Match each person with what they did:

A. Pasteur
B. Lister
C. Pasteur and Joubert
D. Koch
E. Fleming
F. Domagk
G. Florey & Chain

1. Arsenic is "magic bullet" for syphilis
2. clinical trial with penicillin in UK
3. aerobic microorganisms inhibit anthrax
4. microorganisms cause fermentation
5. antisepsis
6. penicillium mold inhibits staph aureus
7. clinical trials with sulfaniliamides
Definition

A - 4

 B - 5

C - 3

D - 1

E - 6

F - 7

G - 2

Term
Cell wall inhibiting drugs are usually bacteriostatic or bacteriocidal?
Definition
cidal
Term
Folate and protein synthesis inhibiting drugs are usually bacteriostatic or bacteriocidal?
Definition
bacteriostatic
Term
Topical agents, IBS, UTIs can be treated by what antibiotic group?
Definition
sulfonamides
Term
General penicillin uses and weaknesses
Definition

gram pos organisms

gram neg cocci (neisseria)

Treponema pallidum (syphilis)

 

 

weaknesses: staph aureus, gram neg rods/bacilli

 

Term
Indications for extended spectrum penicillin use

Common side effects
Definition

otitis, UTI, dental prophylaxis

 

side effects: rash (esp ampicillin)

Term
What are these penicillins used for?

carbenicillin (Geocillin)
Mezocillin (mezlin)
Piperacillin (pipracil)
Ticarcillin (ticar)
Definition
anti-pseudomonal
Term
General penicillin side effects
Definition

Hypersensitivity (5% incidence) - rash, angioedema, anaphylaxis

 

Diarrhea

 

Nephritis

Term
1st, 2nd, 3rd, 4th generation cephalosporin
Definition

cefazolin (ancef, kefzol)

cefoxitin (mefoxin)

ceftriaxone (rocephin)

cefepime (maxipine)

Term
What do you use to treat c. diff?
Definition
vancomycin
Term
3 Protein synthesis inhibitors
Definition

tetracyclines

aminoglycosides

macrolides

Term
What antibiotic?

Broad spectrum bacteriostatic agents that are more effective against gram positive than gram negative.

Esp useful for chlamydia, mycoplasma pneumoniae, acne vulgaris, some protozoa
Definition
tetracycline
Term
Most common tetracycline
Definition

Doxycycline (Vibramycin)

 

All tetracyclines end in "cycline"

Term
Tetracycline:

Oral absorption is reduced by what?

Has ___ action, which is very useful in treating acne vulgaris
Definition

food dairy antacids

 

anti-inflammatory action

Term
Contraindications for tetracycline
Definition

pregnancy and children (8-14)

dental enamel dysplasia and discoloration

growth inhibation & bone deformity

photosensitivity

Term
Aminoglycosides are widely used in gram ___ infections.
Definition
gram neg
Term
____ drugs are poorly absorbed from the GI tract
Definition
parenterals
Term
Common ____:

Streptomycin
Amikacin (Amikin)
Gentamicin (Garamycin)
Tobramycin (Nebcin)
Neomycin
Definition
aminoglycosides
Term
What are some side effects of aminoglycosides
Definition

all are potentially ototoxic and nephrotoxic

toxicity increased by loop diuretics

Term
3 inhibitors of folate synthesis
Definition

sulfaonamides

trimethoprim

co-trimoxazole (septra, bactrim)

Term
Examples of cell wall synthesis inhibitors
Definition

B-Lactams - penicillins, cephalosporins

also, vancomycin

Term
2 extended spectrum penicillins
Definition

ampicillin

amoxicillin

 

Term
1 beta-lactamase inhibitor
Definition
augmentin (amoxicillin + clavulanic acid)
Term
3 inhibitors of protein synthesis
Definition

tetracyclines

aminoglycosides

macrolides

Term
What protein synthesis inhibitor is safe in pregnancy and peds?
Definition
macrolides
Term
What drug group inhibits nucleic acid
Definition

fluroquinolones

 

AKA DNA gyrase inhibitors

Term
1st line TB drugs
Definition

isoniazid

Rifampin

Ethambutol

Term
These drugs are anti-what disease?

ganciclovir
cidofovir
Definition
cytomegalovirus
Term
2 HIV drug categories
Definition

nucleoside reverse transcriptase inhibitors

protease inhibitors

Term
____ is used to treat both amebic colitis (dysentery) and trichomonas vaginalis
Definition
metronidazole
Term
1 anti-protozoal drug
Definition
chloroquine
Term
___ are immune-cell produced cytokines which are anti-viral and anti-neoplastic bc they activate key immune system components such as macrophages, NK cells, and antigen presention cells
Definition
interferons
Term
What does it mean that HIV is a retrovirus?
Definition
It converts from RNA to DNA and back  via a unique reverse transcriptase enzyme
Term
What is the "new strategy" for treating HIV
Definition

prevent HIV DNA from inserting in host DNA via "integrase inhibitors" - Raltegravir

 

Used in pts with multi-drug resistant HIV

 

Term
When should you initiate therapy for HIV?
Definition

CD4 counts less than 200-350 cells/cubic mL

HIV RNA levels > 100,000 copies/mL

Diagnosis of AIDS established

Term
What is the most common causative agent for malaria?
Definition
plasmodium falciparum
Term
2 general causes of anemia
Definition

1. RBC production problems

- nutritional deficiency

- loss of stimulation (erythropoietin)

- toxiciity

- neoplasia

Accelerated loss of RBC (often due to low iron in women)

- shortened life span (normal is 100-120 days)

- bleeding

Term
___ anemia is idiopathic

How is it treated?
Definition

aplastic

due to loss of hematopoietic stem cells (apoptosis)

 

Immunosuppresion, bone marrow transplant if that doesn't wrk

Term
How can cancer result in anemia?

What is a more liekly result?
Definition

it's  possible for enough bone marrow to be occupied by cancer to get anemia

 

more likely: myeloproliferative disorder

Term
5 myeloproliferative disorders
Definition

leukemias

lymphoma

multiple myeloma

polyctythemia

thrombocythemia

Term
4 basic kinds of leukemia
Definition

acute myeloid

chronic myeloid

acute lymphoid

chronic lymphoid

Term
2 types of lymphoma
Definition

Hodgkin's - most common

- young adults

 

 

Non-Hodgkins

Term
____ is a myeloproliferative disorder caused by malignant plasma cells


___ is a myeloproliferative disorder that causes RBCs to reporduce too quickly, resulting in Hgb around 18-20 and causing clotting problems

___ is a myeloproliferative disorder involving too many megakaryocytes, which results in too many platelets (~1M) and thus clotting problems
Definition

multiple myeloma

polycythemia

thrombocythemia

Term
How does HgB transport O2
Definition

in high partial pressure environments such as lthe lungs, Hgb lets go of O2

 

In low partial pressure environments such as the periphery, Hgb tends to hold on to O2

Term
Sickle Cell Anemia

____ mutation of HgbA to ____

Homozygous = ?
Heterozygous = ?

Result of a ___ mutation

Cells get stuck in capillaries and then destroyed in spleen.
Definition

autosomal recessive - HgbA - HgbS

 

Homozygous = sickle cell diesaese (1/400 blacks in US)

heterozygous = asymptomatic (8% of blacks)

 

Missense mutation

Term
Thalassemia:

Genetic defects in ___ biosynthesis

____ transmission

HOmozygous = significant disease called ___, that can only be treated with blood transfuiosn


Heterozygous = mild anemia or asymptomatic, called ____
Definition

globin

autosomal recessive

B-thalassemia major

B-thalassemia minor

Term
Dissolved blood components
Definition

nutrients (glucose, vitamins, minerals)

electrolytes

hormones

proteins (albumen, coagulation proteins, carrier proteins)

drugs

Term
suspended blood components
Definition

RBC

WBC

platelets

Term
Adult v. fetal hgb
Definition

adult: 2 alpha chains + 2 beta chains

 

Fetal: 2 alpha chains + 2 gamma chains

 

All have 1 oxygen-carrying heme group per chain

Term
Myeloid progenitor cells make what 4 cells
Definition

erythrocytes

megakaryocytes (platelets)

Granulocytes

monocytes

Term
lymphoid progenitor cells make what 4 cells
Definition

NK cells

dendritic cells

T lymphs

B lymphs

Term
3 granulocytes, 3 agranulocytes
Definition

granulocytes: basophils, neutrophils, eosinophils

 

agranulocytes: macrophages (monocyts), T & B lymphocytes

Term
___ are brand new "speckled" rbcs (have residual RNA). account for 1-2% of all RBCs. Give an idea as to bone marrow status
Definition
Reticulocytes
Term
Low reticulocyte count + significant anemia implies what?
Definition
bone marrow problems
Term
2 iron deficiency anemias
Definition
microcytic and hypochromic
Term
What is hemochromatosis?
Definition
chronic iron toxicity
Term
B-12 and folate deficiency cause ____ anemia
Definition

megaloblastic

 

Large RBCs, hypersegmented neutrophils, ineffective erythropoiesis (impaired DNA synthesis)

Term
___ is necessary in gastric parietal cells for B12 absorption
Definition
intrinsic factor
Term
Pernicious anemia:

auto-antibodies for ____

____ anemia
Progressive ____ deterioration

Anemia is a result of folate deficiency... why?
What would folate supplements do?

How is it diagnosed?
Definition

intrinsic factor (B12 absorber)

megaloblastic anemia

neurologic

 

B12 is cofactor in activation of folate

Folate supplements can correct the anemia but not repair neurologic damage

 

Diagnosed with Schilling test: give pt oral radiolabeled B12 & measure excretion.. then give oral intrinsic factor. if absorption increases = pernicious anemia

Term
What does this suggest:

rapid onset of fatigue, bleeding, infection
pancytopenia
high WBC count
Definition
acute leukemia
Term
What diagnosis?

Mean age of diagnosis = 55

Fatigue, night sweats, low grade fever

WBC > 150,000; Philadelphia chromosome

Prognosis much better recently: >80% survive 6 yrs or more
Definition
chronic myelogenous leukemia
Term
What diagnosis?
Two age peaks: 20’s and >50
Derived from B cells

Usually presents with painless lump (lymph node)
Fevers, weight loss also common

Good prognosis for stages I & II (radiation & chemo)

Moderate prognosis for stages III & IV
Definition
hodgkin's lymphoma
Term
A ___ cause of hemolysis has to do with a defect in RBC shape, size and function
Definition
intracorpuscular
Term
What is hemosiderosis and in what disease is it often found?
Definition
iron overload - B-Thalassemia major
Term
___ is the most common enzyme deficiency in the world. Heterozygotes have ___ protection.

Homozygotes are at risk for hemolysis, triggered by diseases, foods, and drugs.
Definition

G6PD

 

malaria

Term
___ hemolysis:

antibody mediated (immunohemolytic anemia, lupus, blood group incompatibility)

microangiopathic hemolysis

hypersplenism

infections/toxins/etc

trauma
Definition
extracorpuscular hemolysis
Term
Consequences of hemolysis

Elevated ___, resulting in jaundice

Gallstones

Depleted ___ and ___ stores
Definition

bilirubin

 

iron/folate

Term
___ is increased RBC production, and thus rsults in increased Hgb and Hct

Can be a chronic myeloproliferative disorder ___ Vera

Or due to env issues such as ____ or ___
Definition

Polycythemia

 

altitude inadaptation, sports doping

Term
____:

Mean age at diagnosis: 50-60 yrs

Elevated platelet counts (may be >2 million/ml)

Main risk is thrombosis

Good long term prognosis
Unless acute leukemia occurs (1-5% risk)
Definition
thrombocytosis
Term
2 hormones released by hypothalamus (besides various releasing and inhibiting factors)

6 hormones released by anterior pituitary
Definition

Hypothalamus: vasopressin, oxytocin

 

Anterior pituitary: ACTH, TSH, FSH, LH, Prolactin, Growth hormone

Term
Main purpose of thyroid
Definition

produce thyroid hormone from follicular cells

 

T3 - triodothyronine - main fxnal hormone

T4 - thyroxine - converted to T3 in tissues

 

Receptors throughout body - energy utilization, protein sythesis, sensitivity to other hormones

 

Term
___ is a spirochete-shaped bacterium
Definition
syphilis
Term
3 types of goiter:

___ - related to dietary availablity of iodine, usually results in hypothyroidism

___ - seen in hyperthyroidism

___
Definition

endemic

toxic nodular goiter

advanced cancer

Term
Not enough thyroxine causes which thyroid problem??

Hyper or Hypo?
Definition
hypo
Term
4 types of thyroid cancer
Definition

Papillary - most common and most beingn

Follicular - benign

Medullary - benign

Anaplastic - most lethal and rare

Term
3 treatments for thyroid cancer
Definition

surgical excision (thyroidectomy)

radioactive iodine

lifelong thyroid hormone replacement

Term
2 main types of hyperthyroidism (thyrotoxicosis)

What would lab tests show for:

TSH
T4
Autoimmune disorder test?

Symptoms?
Definition

grave's disease

toxic nodular goiter

 

TSH - low

T4 - high

autoimmune - sometimes pos

 

Symptoms: restlessness, anxiety, insomnia, tremor, weight loss, heat intolerance

Term
Severe ___ is AKA a "thyroid storm" or "thyroid crisis". It is a life-threatening condition.

___ is associated wtih high glucose intake or heavy exercise. It's seen in 15% of asian or native american men with new diagnosed hyperthyroidism
Definition

severe hyperthyroidism

 

hypokalemic periodic paralysis

Term
most common type of hyperthyroidism

results from auto-antibodies that bind to and activate TSH receptors, resulting in overproduction of T3/T4, genetic susceptibility

MUCH more common in men or women?

unique symptom? distinguishes it from toxic nodular goiter
Definition

grave's disease

 

much more common in women

 

exophthalmos

Term
Autonomic NS:

___ division is "rest and digest". Muscarinic and nicotinic receptors

___ division is "fight or flight"
Alpha and beta adrenergic receptors to raise BP and increase HR and dilate smooth muscle.
Definition

parasympathetic

sympathetic

Term
In hyperthyroid pts, which division of the autonomic NS is overactive?

Because of this, what are some ways to control hyperthyroid symtpoms
Definition

sympathetic

 

beta blockers - propranolol

stop t3/t4 production - thioamide drugs, prevent t3/4 release - potassium iodide

 

cure: thyroid excision or ablation

Term
The chosen "cure" for hyperthyroidism is ablation of the thyroid via radioactive iodine. How do we know it has worked?
Definition

monitor TSH levels, which are initially zero in hyperthyroid pt

 

As T4 falls, TSH rises

 

When TSH rises above normal - begin thyroid hormone replacement therapy wiht thyroxine

Term
2 general causes of hypothyroidism

Lab test for hypo
T4 levels
TSH levels

Symptoms
Definition

primary - due to failure of thyroid gland itself, has nothing to do with TSH. Accounts for 99% of cases

 

Secondary - due to failure of pituitary to release normal amounts of TSH. very rare.

 

T4 low

TSH very high

 

poor memory

inability to concentrate

weight gain

cold intolerance

 

 

Term
____: fairly common autoimmune disorder where the thyroid is infiltrated with T and B cells

___: hypothyroidism induced by amioderone (cardiac arrhythmia) or lithium carbonate (bipolar/manic depressive)
Definition

Hashimoto's thyroiditis

drug-induced hypothyroidism

Term
How to treat hypothyroidism
Definition
T4 daily
Term
____:

TSH level slightly or modestly elevated, T4 and T3 levles normal, causes increased/inappropriate prolactin secretion

What causes this?
Definition

compensated primary hypothyroidism

 

caused by failure of negative feedback loop from thyroid to pituitary

Term
What disease?

excess cortisol by adrenal gland

Causes:
1. iatrogenic (pharmacologic) - prednisone
2. Secondary adrenal hyperplasia - ACTH secreting tumor of pituitary or ACTH-secretign small cell cancer
3. Primary adrenal hyperplasia
Definition

Cushing's syndrome

 

 

Term
What actually causes Cushing's DISEASE?
Definition
ACTH secreting tumor of pituitary
Term
Adrenal gland:


___: part of sympathetic NS. secretes epinephrine and norepinephrine

___: secretes steroids (androgens, mineralcorticoids, CORTISOL)
Definition
medulla, cortex
Term
What does cortisol do to the body?
Definition

increase gastric acid and pepsin production

increase bone loss

muscle weakness

mental status change - makes you feel good

anti-nausea

resistance to stress

raise bp

lowers lymphocyte/monocyte levels

weight gain

impaired healing

bone loss

edema

peptic ulcers

euphoria

hallucinations

fatigue

muscle weakness

elevated glucose levels

cataracts

Term
Classic Cushings look
Definition

central obesity

moon facies

Term
Pt has HTN, striae, obesity, elevated cortisol levels, loss of diurnal pattern, elevated ACTH

What disease?
Definition
cushing's
Term
___ hormone:

increases osteoclastic activity in bone (eats away bone)

increases CALCIUM reabsorption in kidneys

stimulates ynthesis of active forms of vit D
Definition
parathyroid
Term
Low ___ levels cause:

tetany
carpopedal spasms
tingling of lips and hands
anxiety, personality changes
osteoporosis

High levels of ____ cause:
fatigue, anorexia, weight loss, nausea - acute
bone pain, urinary tones, psychosis, pancreatitis - chronic
Definition
calcium
Term
Hypoparathryodisms:

____: possible complication of thyroidectomy

___: due to inability of kidney to respond to PTH. may be due to genetic defect in PTH receptor

___: rare, presents in childhood, autoimmune thyroid and adrenal disease often present.
Definition

iatrogenic

pseudo-hyperparathyroidism

autoimmune hypoparathyroidism

Term
Lab tests for hypoparathyroidism:

Ca levels?
Phosphorous levels?
PTH levels?


Treatment for hypoparathyroidism?
Definition

low

high

low

 

treatment: replacement with vit d analogs to absorb Ca in gut

Term
Types of hyperparathyroidism

___: uncommon, usually appears after age 50. more common in females. due to PTH SECRETING PARATHYROID ADENOMA. occassionally due to hyperplasia or carcinoma


___: seen frequently with chronic renal disease. main problem is low vit d production. falling Ca levels stimulate parathyroids to secrete PTH.
Definition

primary

secondary

Term
Lab tests for primary hyperparathyroidism:

ca levles?
PTH?
phosphorous?



secondary:

PTH?
Ca?
Phosphorous?
BUN?
creatinine?
Definition

high

high

low

 

high

variable

variable

high

high

Term
most common cause of hyperparathyroidism?

most common cause of hypoparathyroidism?
Definition

hyper: chronic renal disease

hypo: iatrogenic

Term
DM:

characterized by chronic ____, caused by:
Relative or absolute deficiency in ___
OR a deficiency of ___ action ("___ resistance)
Definition

hyperglycemia

insulin

Term
Where is insulin produced?
Definition
pancreas - Beta cells in islets of langerhans
Term
Exocrin v. endocrine fxn of pancreas
Definition

exocrine - secrete digestive enzymes

endocrine - islets of langerhans secrete insulin, glucagon, others

Term
INsulin actions:

Inhibits catabolic actions; inhibits ___ breakdown

Promostes anabolic actions: promotes ___ production from glucose

Muscle: promotes __ synthesis, glucose transport, glycogen storage

Adipose tissue: increased ___ storage
Definition

glycogen

glycogen

protein

triglyceride

Term
Type I DM:

___ disorder

Rapid loss of __ cells, so insulin production very rapidly decreases

May be triggered by virus or toxin

Treatment: prevent loss of still viable __ cells
Definition

autoimmune

 

beta

Term
Type II DM:

___ predisposition

Obesity
Definition
genetic
Term
3 P's of DM

(DM symptoms)

Lethal complications
Definition

polydipsia

polyuria

polyphagia

 

Also: weight loss, fatigue

 

Complications: ketoacidosis, cardiovascular dx, renal dx, retinopathy/blindness, neuropathy

Term
What condition?

accumulation of acids
breakdown of fats/triglycerides
significant hyperglycemia
falling arterial pH
tachycardia, dehydration, SOB, lethargy

Death within hours
Definition
diabetic ketoacidosis
Term
Insulin and ___ have antagonistic effects o blood glucose levels
Definition
glucagon
Term
Group of drugs that sitmulate islet cells to secrete insulin in type II DM

Drugs that reduce insulin resistance in Type II DM

Drugs that provide exogenous insulin

Drugs that reduce glucagon secretion
Definition

sulfonylurias

 

metformin (glucophage) and Glitazones

 

NPH, glargine

 

GLP-1 substances

Term
Normal BMI
Definition
18.5-25
Term
How to calculate BMI
Definition

weight in kg divided by square of height in meters

 

weight in lbs x 700 divided by square of heigh in inches

Term
___ Adipose tissue:

cushion/protection
energy storage
endocrine fxn - leptin, aromatase

___ adipose:
thermogenesis
mostly seen in newborns

Morbidly obese have entirely which type?
Definition

white

brown

 

white

Term
___ is an enzyme that converts androgens into estrogens. it's found in fat cells.

obese menopausal woman may have more estrogen bc of this = ?

obese men = ?
Definition

aromatase

 

women: fewer hot flashes. greater risk for breast/uterine cancer

 

men: gynecomastia, prostate problems

Term
____: peptide that acts on CNS to regulate eating behavior, energy balance, and reproduction

high levels of this may cause ___ by activating NK cells and T lymphs
Definition

leptin

inflammation

Term
____: atherosclerotic plaques in arteries that interfere with blood flow in legs

___: consist of coronary artery disease, valvular disease, hypertensive haert disease, cardiomyopathy
Definition

Peripheral vascular disaese

heart disease

Term
"Hydraulic equation":

BP = CO x PVR

so raising either or both raises BP and lowering either or both lowers BP
Definition
Term
Peripheral resistance is mainly determined by what parameter?
Definition
arterial diameter
Term
To decrease BP, you need to decrease CO and/or PVR:

How would you reduce CO?

How owuld you reduce PVR?
Definition

Reduce HR

Reduce contractility

Reduce venous return

 

 

Reduce PVR via vasodilation

 

Both of these can be reduced by reducing sympathetic activity

Term
Basis of renin-angiotensin-aldosterone system:

Increase renin = increase angiotensin = increased aldosterone = ___ peripheral resistance = ___ BP
Definition
increased, increased
Term
Angiotensin II:

Binds to its receptors and causes:

vaso____
incrased/decreased sympathetic acitivity
release of ___
Definition

constriction

increased

aldosterone

Term
___ is most common ause of cardio disease
Definition
atherosclerosis
Term
____: macromolecules of lipids and proteins. designed to transport lipids.

___: fatty acid + glycerol

___: precursor for steroid hormone, endogenous from liver, exogenous from diet
Definition

lipoprotein

lipid

cholesterol

Term
LDL and HDL

which is good and which is bad?

Main goal of lipid therapy?
Definition

LDL bad

HDL good

 

Main goal: lower ldl, raise HDL

Term
Main lipid-lowering agent
Definition
Statins - HMG-CoA reductase inhibitors
Term
By definition, HTN is a bp of >_/_
Definition
140/90
Term
HTN:

___: most common. Body thinks "set point" for BP should be higher (150/100 instead of 120/80)

___: due to rare tumor of adrenal medulla or sympathetic ganglia taht secretes high levels of norepinephrine ( causes vasoconstriction). Cuases PERIODIC symptoms.
Definition

essential

pheochromocytoma

Term
If pt has occasional high BP along wtih severe headache, diaphoresis (sweat), palpitations, tremor, and axiety.. think what diseas
Definition
pheochromocytoma
Term
Main symptoms of essential HTN
Definition

none!

must be diagnosed via several BP tests

Term
HTN treatment:


Reduce ___ via beta blockers
Reduce ___ via alpha blockers or directly diating vasculature
Definition

CO

PVR

Term
Antihypertensive Drugs:

___: reduce blood volume. Include loop diuretics and thiazides

___: beta blockers, alpha antagonists, mixed andrenergic antagonists

___: calcium channel blockers

___: ACE inhibitors, Angiotensin II receptor antagonists
Definition

diuretics

 

sympatholytic drugs

 

vasodilators

 

renin-angiotensin-aldosterone inhibitors

Term
HTN treatment problems

Low or high ___ due to diuretics and ACE/aldosterone inhibitors, respectivley


Dry cough due to ____

Orthostatic hypotension

Malaise/fatigue due to ___
Definition

K+

ACe inhibitors

Beta blockers

Term
When is HTN an emergency?
Definition
BP > 210/150
Term
___ is reduced/absent blood flow... o2 supply is not sufficient for demand

Typically due to _____
Definition

ischemia

vessel stenosis or occlusion

Term
types of ischemia:

___: acute chest pain - substernal, epigastric, radiates down arm or into jaw. OR presents as no symptoms

___: anginal pain, axiety, sense of dread, dyspnea

___: low CO (as in CHF), dyspnea, orthopnea, edema, usually no pain
Definition

acute ischemia

subacute intermittent ischemia

chronic ischemia

Term
Acute coronary syndromes:


STEMI
NSTEMI
UA
Definition

STEMI = acute MI with ST segment elevation

NSTEMI = acute MIwithout ST elevation

 

Term
Acute MI:

Myocardial tissue death due to abrupt reduction in ___.
__ is almost always present

Initial event is usually ____
Definition

coronary blood flow

atherosclerosis

plaque rupture

Term
When is a person at most risk for AMI?
Definition

early morning - BP is at diurnal peak

increased viscosity due to overniight fast

cortisol at secretion peak

plus morning exercise = bad news

Term
AMI in women
Definition

likely to have atypical presentation

gastric symptoms

Term
AMI treatment

____: cardiac catheterizaiton
____: break up clot
Definition

PCI (percutaneous coronary intervention)

thrombolytic therapy

 

both reperfuse tissues wtih O2

Term
3 types of angina pectoris:

___: most common, recurring episodes of chest pain, often with predictable stressors. brought on by exertion, releived by rest.
Cause by what two things?

___: occurs at rest or with minimal activity

___: AKA Prinzmetals - extreme fatigue with minimal exertion
Definition

stable angina - unmet O2 demand to myocardium or coronary atherosclerosis

unstable angina

variant

Term
Diagnosis:

2-20 min of substernal pain (possibly with radiation) that feels like pressure (elephant on chest)

Inditiated by exercise, eating, emotions, cold weather
Definition

anginal episode

 

If it lasts longer than 20 min, it's likely an MI

Term
NItrates (immediate relief via vasodilation), beta blockers, ca channel blockers to treat ____
Definition
stable angina
Term
____: cardiac fxn insufficient to meet metabolic and blood flow requirements, even at resting levels

Usually caused by ___ or ___ disease

Symptoms: dysonea, orthopnea (graded by how many pillows pt needs to sleep), edema, cardiomegaly, reduced ejection fraction (below 50%), pulmonary edema
Definition

CHF

ischemic or HTN disease - more people survive MI's than before but then they end up with CHF

Term
Vicious cycle of CHF

Chronic ___ damages myocardium

___ occurs which results in progressive cardiac enlargement

Overstretching of myocardium reduces ventricular fxn with leads to more -___
Definition

ischemia

remodeling

ischemia

Term
CHF treatment:

Reduce cardiac workload by limiting ___, losing weight, and controlling ___

Reduce blood volume by restricting ___ intake and giving diuretics.

Give drugs such as ___ or ____
Definition

activity

HTN

 

Sodium

 

ACE inhibitor or ARB or Beta blockers (if no pulm edema)

Term
____ = "heart muscle disease" - CHF that is NOT due to ischemic heart disease

occurs in young, previously healthy individuals
Can be due to medication toxicity
most cases are idiopathic following precipitating event such as pregnancy, viral infection.
Spontaneous remission common
Definition
cardiomyopathy
Term
___:

1% of newborns have it
multifactorial inheritance - increased chance of having a child with it with increased # of family members with it

____ - lead to myocardial stress, damage, and ultimately CHF due to stenosis or regurgitation

___ - can allow signficiant amt of blood to bypass lungs and thus blood is underoxygenated = cyanosis, stunting of growth, SOB
Definition
congenital heart disease
Term
Congenital heart defects:

___ - congenital condition in which foramen ovale doesn't close properly. usually asymptomatic

___ - common congenital valvular disease. can lead to right sided heart failure


___ = blue baby syndrome. 4 abnormalities: overriding aorta, pulmonic stenosis, ventricular septal defect, right ventricular hypertrophy

___: high BP in arms, low BP in legs
Definition

atrial septal defect

 

pulmonary stenosis

 

tetrology of fallot

 

coarctation of aorta

Term
___ - blood clot in an intact vessel

___ - thrombus that dislodges and travels to distant site where it occludes an arterial vessel

___ - venous thrombs that embolizes to a pulmonary vein
Definition

Thrombosis

embolism

PE

Term
Virchow's triad - risk factors for PE
Definition

venous stasis

hypercoagulable state

vascular injury

 

Also - surgical procedures such as abdominal or pelvic but especially JOINT REPLACEMENTS

Term
Cardiac arrhthmias:

___: bradycardia and tachycardia

___: premature systole, atrial and ventriclar (PAC and PVC) ?

___: wolfe-parkinson-white, AV nodal reentry
Definition

rate abnormalities

ectopic depolarizaitons

deviant pathways (reentry)

Term
Anti-arrhythmic drugs

Class I: __ blockers

Class II: ___ blockers

Class III: ___ blockes

Clas IV: ___ blockers
Definition

Na channel

Beta

K+ channel

Ca 2+ channel

Term
Most common chronic arrhythmia

serious risk from this problem?
Definition

atrial fibrillation - creates irregularly irregular pulse

 

clots in atria can travel to brain and cause stroke in A fib pts

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