Block 4 Quiz Flashcards
Hemoglobin electrophoresis categories:
Fetus
6 month old
Adult
Fetus: wide HbF (80%) + HbA (20%)
6 months: transition to HbA
Adult: HbA (96%) + HbA2 (2.5) + HbF (<1)
Hemoglobin electrophoresis categories:
B-thalassemia minor
B-thalassemia major
Minor: narrow HbA + wide HbA2
Major: wide HbA2 + Wide HbF
Hemoglobin electrophoresis categories:
Sickle Cell Disease
Sickle Cell Trait
HbC Disease
HbC Trait
HbSC Disease
SS: HbS
AS: HbA + HbS
CC: wide HbC
AC: HbA + HbC
SC: HbS + HbC
Left shift in the Hemoglobin O2 dissociation curve:
“HigH Mile Flyer Prices & Low Bus Prices”
High:
Hb affinity (poor tissue oxygenation)
Methemoglobin
HbF
Ph
Low:
2,3 BPG
POC
Right shift in the hemoglobin-O2 dissociation curve:
“low Health Prices & high Bus/TrAin ExPenses”
Low:
- Hb affinity (lots of tissue oxygenation)
- pH
High:
- 2,3-BPG
- Temperature
- Altitude
- Exercise
- PCO2
Anemia:
Iron deficiency
“Having Persistent Fatigue May HurT Playful Kids with a Low Feeling”
Hypochromic
Parllor
Fatigue
Microcytic
High TIBC
PICA
Koilomychia (spooning nails)
Low Ferritin
Anemia:
ACD (Chronic inflammation)
“CaN Cause InflaMmatioN, low TItre, & High Ferritin”
- Cancer
- Normocytic
- Inflammation
- Microcytic
- Non-hemolytic
- Low TIBC & Iron
- High Ferritin
Anemia:
Sideroblastic anemia
“captaIn MarVeL’s high FlIghT & low Tough BlowS”
Isoniazid (TB Rx.)
Microcytic
Vit B6 deficiency (biotin)
Lead poisoning
High Ferritin, Iron, & Transferrin
Low TIBC
Basophilic Stippling
Alpha-Thalassemia:
“ARMy NEws”
& subtypes:
Silent
A-thalassemia trait
HbH disease
Hydrops fetalis
Alpha-Thalassemia:
- Reticulocytosis
- Microcytic anemia
- Normal Hemoglobin Electrophoresis
Subtypes:
Silent (-a/aa) Asymptomatic
Trait: (–/aa Asian or -a/-a African) Asymptomatic/mild anemia
HbH: (–/-a) intermittent-severe chronic anemia
Hydrops: (–/–) fatal
A-Thalassemia:
HbH Disease
“HbH Causes Jaundice, HigHeR Problems & lower HeMe adHesion”
HbH on the heme electrophoresis
Chronic hemolysis
Jaundice
High HbH (hypoxia), Reticulocytosis, & Hepatosplenomegaly
Poikilocytosis
Low Hb, MCV, Hct
Differentials for Alpha vs Beta thalassemias
Alpha minor/trait
Alpha HbH disease
Beta minor/major
Alpha minor/trait:
MCV (Normal/low)
HbA2 (Normal/low)
HbF (Normal)
HbH (Maybe present)
Alpha HbH disease:
MCV (Low)
HbA2 (Normal/low)
HbF (Normal/low)
HbH (Present)
Beta minor/major:
MCV (Low)
HbA2 (High)
HbF (High)
HbH (Absent)
Alpha-Thalassemia:
Hydrops Fetalis
“HuSHPuppiEs”
Hepatosplenomegaly
Heart failure
Edema
Prenatal death
Severe hypoxia
B-Thalassemia: ~6MONTHS
Minor
“Minor Melon RINds Have lower Healthy Minerals”
vs
Major
“My Terrible STD Penis gets BITCHeD & NoT CHuCked”
Minor: 1 allele deletion
Microcytic
Mild Anemia
Normal Reticulocytosis + Iron
Low Hb, Hct, MCV
Major: 2 allele deletion
Microcytic
Target cells
Severe Transfusion-Dependent anemia
Poikilocytosis
Transfused patients (Bronze pigmentation, Iron overload, Cardiomegaly, Hypogonadism, Diabetes)
Not Transfused (Crew-cut skull, Hepatosplenomegaly, Cardiac failure)
Sickle cell disease
“I CHANCeD An Proper Actual Home with BJs
Triggers: Infection dehydration, Hypoxia
Hemolytic anemia
Cholecystitis
Microvascular ischemia
Acute chest syndromes (bone pain)
Autosplenectomy
Poikilocytosis
Crew-Cut skull
Normocytic
Howell-Jowell bodies
Hemophilia A, B, C
A: VIII
B: IX
C: XI
Inactive II, VII, IX, X, C, S are turned into active carboxylated clotting factors & anticoagulants (C,S) via which enzyme:
Y-glutamyl carboxylase (Vit K dependent)
Extrinsic pathway (Tissue injury)
Factors:
Test:
Factors: VII goes to –> VIIa —>X
Prothrombin time test
Intrinsic pathway (Collagen, basement membrane, & activated platelets)
Factors:
Test:
Factors:
XII (XIIa) –> XI (XIa) –> IX (IXa) –> VIIIa
Activated Partial Thromboplastin Time (aPTT/PTT)
Common hemostasis pathway:
Factors:
X (Xa) –> II (Prothrombin) –> IIa (Thrombin)
–> I (Fibrinogen) —> Ia (Fibrin monomers) –> aggregation + Ca2+ & IIa (thrombin) activates XIIIa (XIIIa fibrinogen stabilizing factor)
–> Fibrin mesh for platelet plug
XIIa activates the kininogen system (aka Kinin cascade) & Plasminogen.
Kinin cascade:
HMWK –> (via Kallikrein) Bradykinin (more vasodilation, perm, pain)
Plasminogen:
Plasminogen –> (via tPA) Plasmin
Plasmin helps degrade fibrin mesh into D-dimers
Von Willebrand Disease (VIII)
“Poor PaTienTs BuTts get NePTunes PeaChy kiss,r wiPes with lower the PApeR towel”
- Def factor VIII (No platelet adhesion)
Prolonged:
PTT, BT
Normal:
PT, Platelet count
Low:
Platelet aggregation + Ristocetin
Vitamin K deficiency can be due to
“Dunk My WIenER In HaBanaro & PuT NoRi & PeanuTTs”
Diet (dark greens)
Malabsorption (pancreatic insufficiency)
Warfarin (inhibits Epoxide Reductase)
Bleeds (Hemarthosis, bleeding joints)
Prolonged PT/NR (Extrinsic coagulation pathway)
Prolonged PTT (Intrinsic coagulation pathway
Adrenal cortex
“GAMeR gAl FuCks GAy Cock & RiDes All Cock”
salty–> sweet –> sex
Glomerulosa
- Aldosterone
Mineralocorticoids
- reg via Angiotensin II
Fasciculata
- Cortisol
Glucocorticoids
- Reg via ACTH & CRH
Reticularis
- DHEA
Adrogen
- Reg via ACTH & CRH
common steps in Steroid hormone synthesis
Cholesterol (3)
Cholesterol hydroxylation
Pregnenolone
Cholesterol:
- Stored as CE’s
- De novo synthesis
- Uptake LDL via LDL receptors
Cholesterol hydroxylation:
Pregnenolone via desmolase (CYP11A + NADPH) RLS induced by ATCH & Angiotensin II
Pregnenolone:
Progesterone via 3-Beta-Hydroxysteroid Dehydrogenase (3BHSD)
Zona Glomerulosa Steroid hormone synthesis:
“Cold, PooPs Dunk, Crash, Chunk Alot”
Cholesterol ester (CEH)
Cholesterol (CYP11A1 & stAR)
Pregnenolone (3BHSD)
Progesterone (CYP21)
11-OH-Deoxycorticosterone (CYP11B2)
Corticosterone
18-OH-Corticosterone (Aldosterone synthase, Angiotensin II+)
Aldosterone (21ketosteroid)
Zona Fasiculata Steroid hormone synthesis:
“Cold PooPs 2 Hype Dudes Cool Cocks”
Cholesterol (Desmolase, ACTH +)
Pregnenolone (3BHSD)—>17 Hydroxypregnenolone
Progesterone (CYT17A) –> 17-Hydroxyprogesterone (CYP21)
11 deoxycortisol CYP11B2)
Cortisol (Steroid 11B hydroxylase) (CYT17A)
Cortisone
Zona Reticularis Steroid hormone synthesis:
“Cold PooPs Produce Pungent Aromas & Damage”
Cholesterol (Desmolase +ACTH)
Pregnenolone
(CYT17A) –> 17-OH Pregnenolone (17,21 lyase) –> DHEA (3B) –> Androstenedione
(3B) –> progesterone (CYT17A) –> 17-OH Progesterone (17,20 lyase) –> Androstenedione (17 ketosteroid)
Complete steroid hormone synthesis pathway
RAAS Pathway & Effects
Effects:
Hypertension (more aldosterone)
Hypernatremia
Hypokalemia
Metabolic alkalosis
Conn’s Syndrome (Primary Hyperaldosteronism)
VS
Secondary Hyperaldosteronism
Conns:
High Aldosterone
Low Renin & Angiotensin II
Secondary:
Renin-secreting tumor
High aldosterone, Renin, & Angiotensin II
Cortisol regulation pathway (pituitary)
& effects
Metabolism:
Bone reabsorption
Anti-inflammatory
Immunosuppresion
Less glucose uptake & insulin release
Cardiovascular system:
More synthesis of PNMT
Cortisol regulation conditions:
ACTH-Independent (primary adrenal disease)
Adrenocortical tumours (adenoma/carcinoma)
- high cortisol
- Low ACTH, adrenal androgens, DOC, & SMALLER ADRENAL GLANDS
Dexamethasone test diff pituitary adenoma vs ectopic ACTH-secreting tumor
Cortisol regulation conditions:
ACTH-Dependent (Cushing’s disease)
Pituitary adenomas
- High ACTH, Cortisol, Adrenal androgens
- Bigger adrenals
Moon face
Buffalo hump
Hyperglycemia
Purple striae
Rx. Suppress ACTH/Cortisol via a high dose of dexamethasone
Cortisol regulation conditions:
Ectopic (paraneoplastic) secretion
Small-cell lung carcinoma
- High ACTH, Cortisol, adrenal androgens
- Bigger adrenals
Dexamethasone doesn’t work.
Primary adrenal insufficiency
ADDISIONS DISEASE
high ACTH
low Aldosterone, Na, Cl, K. hypotension, cortisol, adrenal androgens
**BRONZE SKIN
Weight loss
Hypoglycemia
Postural hypotension
Adrenal crisis: low Na & high K!!!
21a-OH Def
21:
Low cortisol/aldosterone
High ACTH, Renin/ATII androgens, & urine 17-OH-progesterone
Females 46XX (virilized)
Males Precocious puberty
Salt wasting crisis (hypotension, hyponatremia, hyperkalemia, dehydration, & met acidosis)
11B-OH Def
11:
Low cortisol/aldosterone
High ACTH, Renin/ATII, Androgens, urine 11-DOC
Females 46XX
Males Precocious puberty
11DOC Mineralocorticoid effects:
Hypertension, hypernatremia, hypokalemia/ hydration, met alkalosis
17a-OH Def
High Aldosterone & 11DOC, ACTH
Low Renin, ATII, Cortisol, & Androgens
Female delayed puberty, no 2nd sex characteristics, primary amenorrhea
Male 46XY (Psuedohermaphroditism)
High mineralocorticoid effects:
Hypertension, Hypernatremia, Hydration, hypokalemia, met alkalosis
Treating
21a-OH Def
11B-OH Def
17a-OH Def
21:
Glucocorticoid therapy (reduce ACTH) + Mineralocorticoid replacement
11:
Glucocorticoid therapy
17:
Glucocorticoid & Sex hormone replacement
Ca2+ Homeostasis
regulates 3
regulated by 3
regulated at 3 sites
reg: Calcium, phosphorus, Bone
reg by: PTH, Calcitonin, VitD
Reg at: Kidney, Bone, Intestines
Calcium homeostasis & vitamin D pathway
Low Ca2+ –> ups PTH activate 1a-hydroxylase
Low Phosphorus activates 1a-hydroxylase
Vit D def Causes & 2 diseases
Causes:
Night-shifts
Kidney disease
Lipid malabsorption
High PTH
Low Ca, phosphorus, or calcitriol
Diseases
Rickets
Osteomalacia
Calcium homeostasis via PTH
& Clinical corr
Primary hyperparathyroidism
Clinical:
Primary hyperparathyroidism
- Hypercalcemia
- Parathyroid adenoma
- high PTH & Vit D
- Low phosphorus
Signs
Kidney stones
Osteoporosis
Gi issues
Muscle weakness
Mental changes
Polyuria
Calcium homeostasis via PTH
& Clinical Corr
Primary Hypoparathryoidsim
Pseudohypoparathyroidism
vit D deficiency/chronic renal failure
Primary Hypoparathryoidsim
-Hypocalcemia
-Low PTH, Vit D
-High Phosphorus
Genetic (DiGeorge) or Surgery PARA/THYROID
Pseudohypoparathyroidism
- Def PTH in bone/kidney
-Low Ca2+
- High PTH, phosphorus
vit D deficiency/chronic renal failure
- Low Ca2+ & Vit D
- High PTH
- high/low phosphorus
- renal failure signs
Link the disease to the letter
Primary hyperparathyroidism
Primary Hypoparathryoidsim
Pseudohypoparathyroidism
vit D deficiency/chronic renal failure
Kwashiokor DILUTED MILK FORMULA (NO BOOBIES)
“MEAL”
Neg nitrogen balance via protein def
Malnutrition
Edema (no albumin moon face)
Anemia (less globins)
Liver (fatty no apolipoproteins)
Dermatitis, gray hair (vit/mineral def)
Weightloss/fatigue
Marasmus (DILUTED MILK FORMULA) NO BOOBIES!
Neg nitrogen balance via protein/cal def
Tissue wasting
Oldman face, sparse hair
BMR calculation
BMR = 24 X Weight
Vit B1(Thiamine
TTP Cofactor (4)
Def causes
Beri-Beri
TTP:
PDH
aKG DH (TCA def means more Pyruvate, lactate, alanine (met acidosis)
BC a-Keto acid DH (Val, leu Ile)
Transketolate (HMP-path)
Causes:
Diet (polished rice/malnutrition)
BOOZE
Thiaminase (Raw seafood)
Beri-Beri
Wet BB= Edema, tachycardia, cardiomegaly, congestive heart failure
Dry BB= Neuromuscular, peripheral neuropathy
Wernicke-Korsakoff synd= Confusion, Ophthalmoplegia, ataxia
Reversible “CAN”: Confusion, Ataxia, Nystagmus
- Foci of hemorrhage & necrosis in mamillary bodies
Korsakoff psychosis “CAP”
Confabulation
Anterograde amnesia
Psychosis
Vit B2 Riboflavin
FAD/FMN cofactor
Def causes
Ariboflavinosis
FAD/FMN:
FMN-Dependent complexes (COMPLEX 1 OF ETC moves electrons to CoQ)
FAD0dependent enzymes
Succinate Dehydrogenase (Comple 2 ETC)
Fatty acyl CoA dehydrogenases
G3PDH
Glutathione reductase
Def causes:
Booze
Malnutrition
Beriberi, pellagra, Kwashiorkor
No UV light
Ariboflavinosis:
Angular stomatitis
CHEILOSIS
CORNEAL VASCULARIZATION (bloodshot eyes)
OXIDATIVE STRESS/NORMOCYTIC ANEMIA
Glossitis
Suborrhei dermatitis
Peripheral Neuropathy
Vit B3 Niacin
NAD/NADP Cofactor
DEF CAUSES
PELLAGRA
COfactor:
Glycolysis; Ox. decarboxylation; TCA cycle; Ox. Deamination; β-oxidation of fatty acids
Def causes
Corn diet (low tryptophan)
Hartnup disease
Carcinoid syndrome (high serotonin/ HIAA
Malnutrition
BOOZE
DEF PELLAGRA
DIARRHEA
DERMATITIS
DEMENTIA
Vit B6 Biotin
Cofactor
Causes
Def
Cofactor:
Acetyl CoA cARBOXYLASE (FA SYNTHESIS)
Pyruvate Carboxylase (GLUCONEOGENESIS)
Propionyl CoA Carboxylase (VOMIT PATHWAY)
CAUSES:
Eating 5-20 egg whites (WTF) AVIDIN BINDS BIOTIN & BLOCKS ABSORPTION
Parental nutrition
Def:
Seborrheic dermatitis
Anorexia
Alopecia
Mild lactic acidosis
Vit A retinol
Function (NOT COFACTOR)
DEF CAUSES
DEF
Function:
11-cis retinal (rhodopsin vision)
Retinoic acid (growth/cell diff)
Retinol (Repro)
Def causes:
Malnutrition
Fat malabsorption/fat free diet
Abetalipoproteinemia (impaired delivery to liver
Def
Night blindness
Xerophthalmia (dry eyes)
Corneal scarring
Imp diff of immune cells
Follicular hyperkeratosis (goose skin)
Dont use on preggos!!!!
Vit E Tocopherol
Function (not cofactor)
Def CAUSES
DEF
Function:
Antioxidant
Immune resp
Protects RBC’s from hemolysis
Structural comp of cells
Myelination in neurons
DEF CAUSES
Malnutrition
Fat malabsorption/;fatfree diet
Abetalipoproteinemia (imp delivery to liver)
Def:
Oxidative stress
Hemolytic anemia
Acanthocystosis RBCS (FRAGILE MEMBRANES)
Neuro deficits & muscle weakness
Peripheral neuropathy without megaloblastic anemia
Heme synthesis pathway
“GLASs PHotos of Ugly Corgis, Poodles, & Hounds”
Mito:
—> Glycine + Succinyl-CoA combine to make Aminolevulinic acid (via ALA synthase+ B6 (biotin))
Cyto:
—> Aminolevulinic acid leaves the mito & forms Porphobilinogen (via ALA Dehydrase)
—> Porphobilinogen forms Hydroxymethylbilane (via Porphobilinogen Deaminase/Hydroxymethylbilane synthase)
—> Hydroxymethylbilane forms Uroporphyrinogen III (via Uropophrynogen synthase)
—> Uroporphyrinogen forms Coporhyrinogen III (via Uroporphyrinogen Decarboxylase)
Mito:
—> Corporphyrinogen forms Protoporphyrin IX
—> Protoporphyrin forms Heme (via Ferrochetalase + Fe2+)
Inhibition of Heme synthesis
Lead (affects which 2 enzymes)
&
Heme & high glucose
Low iron
Lead: inhibits ALA Dehydrase & Ferrochetalase
Heme/hematin/hemenin & high glucose: ALA synthase I (Liver)
Low iron: ALA synthase II (Bone marrow)
Heme synthesis disorders:
Acute intermittent porphyria
“Ads No ACcePtABLe Pain”
Deficient Porphobilinogen Deaminase/Hydroxymethylbilane synthase:
Auto Dom + Late onset
Causes build-up of PBG (Porphobilinogen) & ALA (Cause neurological dysfunction)
Symptoms:
- Anxiety, confusion, Paranoia
- Acute Abdominal pain
- Port-wine urine (sometimes)
DON’T GIVE BARBITUATES or fast
5 P’s:
- Painful abdomen
- Port-wine urine
- Polyneuropathy
- Psych issues
- Precipitated by barbituates
Treat:
- Hematin/hemin
- high CHO diet
Heme synthesis disorders:
Porphyria cutanea tarda
“Ads Heat, PAin, & BuRns”
Deficient Uroporphyrinogen Decarboxylase
Auto DOM + Late onset
Causes build-up of cyclic tetrapyrroles (cause sunlight-induced lesions)
Symptoms:
- Photosensitivity
- Blistering/inflammation of the skin
- Red/Brown urine (build-up of uroporphyrinogen & abnormal liver enzymes)
- Hyperpigmentation
WORSE WITH ALCOHOL
Port-wine urine is due to build-up of which substrate & is associated with what conditions?
Build-up: Uroporphyrinogen
Ass.:
- Hepatitis
- HIV
- Alcoholism
- Oral contraceptives
- Acute int porphyria
- Porphyria cutanea tarda
Anemia types:
Microcytic (less than 80)
“MIcro AnTS”
Iron deficiency
ACD
Thalassemias
Sideroblastic anemia
Anemia types:
MCV (80-100)
Normocytic-Hemolytic & Intrinsic anemia
“Normal HIGHSchool Pressure”
G6PD, PK
Spherocytosis (hereditary
Paroxysmal nocturnal hemoglobinuria
Sickle cell
Hbc
Anemia types:
MCV (80-100)
Normocytic-Hemolytic & Extrinsic anemia
“A NormAl HEMIsphere”
MAHA
MIHA
Auto immune
Infection
Anemia types:
MVC (80-100)
Normocytic-Nonhemolytic anemia
“NAKed Ass”
ACD
Kidney disease
Aplastic anemia
Anemia types:
Macrocytic-Megaloblastic anemia
“Massive Mega-Bull Frogs”
Megaloblastic
B12 Def
Folate def
Anemia types:
Macrocytic-Megaloblastic: B12 def absorbed in the ileum
“VitAMin B12 in Breakfast Cereal, HeMP, Trout, HeARTy AniMal Meats, & PeAs”
Risks (Vegans, Atrophic gastritis, Bypass surgery, Tapeworms, ***Percarnious anemia, Crohn’s, AIDS)
2-3 yrs Onset
High methylmalonic acid
Megaloblastosis
Peripheral Neuropathy
Affected MM-CoA & Homocysteine methyltransferase
Anemia types:
Macrocytic-Megaloblastic: Folate def
“FolATe Affects How PregnanT woMen Deliver”
risks (Preggos, ***Alcoholics, & Drug users (phenytoin & spruce)
THF (active form via DHFR)
Affects Thymidylate synthase, Homocysteine methyltransferase, & purine synthesis
Megaloblastosis (ONLY)
Microlytic anemia: MCV < 80
Iron Deficiency
“IroN BinDs 2-3x Less THen TItanium Without PacKinG”
Iron def:
- Normal ALA
-Bleeding (colon cancer, GI ulcer, Menorrhagia
etc.)
Diet def (Protein def, ascorbic acid, vit C, or
copper)
Low Ferritin (Fe3+) & Iron (Fe2+) in serum
Tachycardia, Weakness/parllor, Glossitis, Pica, Koilonychia (spooning nails)
High TIBC (body wants more iron)
Microcytic anemia:
Sideroblastic anemia
- B6 deficiency
“IOns LAST & RADiatE Colour in Space”
&
Lead toxicity
“LABS PrOvIde bLADes For iNcisions”
B6 Def:
- Isoniazid (TB patients)
- Low ALA synthase (Low ALA levels mean no
Heme to bind iron)
Iron overload (high ferritin & iron)
Low TIBC (the body doesn’t need more iron)
Reduced AA decarboxylase activity (def GABA,
DA, NE/E = Epileptic convulsions)
Reduced CBS activity (Homocystinemia & risk
DVT/Stroke)
Lead poisoning:
- Lead exposure (paint chips)
- Abdominal pain (unexplained)
- Basophilic Stippling
- Peripheral neuropathy
- Iron Overload (high ferritin & iron)
- Low ALA Dehydrase (High ALA levels)
- Low ferrochelatase (sideroblastosis)
- Low TIBC (the body doesn’t want more iron)
- Neuro-toxic/psychic issues
Microcytic anemia:
Thalassemia
“thAlAssemiA Has Bad CHanges”
Alpha thalassemia:
- 1 deletion = asymptomatic
- 2 deletions = Mild anemia
- 3 deletions = Severe anemia
- 4 deletions = Hydropis fetalis (dead)
Beta thalassemia:
- 1 deletion = Minor B-T
- 2 deletions = Major B-T
(Hgb A2) reduces hematopoiesis in normal bone marrow in long bones, so it happens more in the skull (Chimpmunk Facies)
Microcytic/Normocytic anemia:
ACD (Anemia of Chronic Diseases)
“CD’s in the KAR”
The body can’t tell the difference between chronic inflammation and infection, so it hides its iron from siderophoric bacteria.
It releases Hepcidin (lowers iron reabsorption & increases storage)
Low iron & ferritin
High TIBC
Kidney disease
Autoimmune disease
Rheumatological disease
Normocytic anemia (80-100):
Paroxysmal Nocturnal Hemoglobinuria
“PNH Can DRoP PIGA”
Pancytopenia, Negative Coombes test, & Hibernation (during sleep)
Complement system isn’t inhibited by CD55/59
Defective PIGA gene
Decreased CD55/59
Premature RBC lyses
Normocytic Intrinsic anemia:
“NO FRee SHots of Gin or FireBall Pay your Dollars”
No NADPH
Glutathione isn’t reduced
Oxidative stress on RBCs
Free radicals aren’t destroyed
Sulfa, Dapsone, primaquine, & favabeans
Heinz bodies + Bite cells
Normocytic Intrinsic anemia:
Hereditary Spherocytosis
“DABS are Cool as SHIt”
Dsyfunctional RBC membrane protein (Ankyrin, Bands & Spectrin)
Coombs negative test
Splenomegaly
Howell-Jolly bodies
Indirect Jaundice
Anti Cancer Drugs:
“MethotRexAte CLoSes & ALMost DRIPS”
Rheumatoid arthritis
Abortion/ectopic preggos
Choriocarcinoma
Lymphoma
Sarcoma
Acute Lymphocytic Myelogenous Leukemia
Inhibited Dihydrofolate Reductase
S Phase
Anti Cancer Drugs:
5’ Fluorouracil
“SiP IPA BITCheS”
S Phase
Inhibits Pyrimidine Analog
Basal cell carcinoma
Inhibits Thymidylate synthase (reduce dTMP & DNA synthesis)
Colon cancer
Solid tumors
Anti-Cancer drugs:
Hydroxyurea
“SPIRR MCS”
S Phase
Inhibits Ribonucleotide Reductase
Melanoma
CML
Sickle Cell
Carcinoid Tumors:
“cArcinoiDS Produce Gross HIAtAl”
Amine Precursors Uptake Decarboxylase Cells
Diarrhea
High Serotonin & Sweating
Pellagra Niacin def (B3) (Diarrhea, Dementia, Dermatitis)
Gi Tumors
5-HIAA (5-Hydroyindoleacetic acid)
Li-Fraumeni syndrome:
Rare AUTO DOM
Breast, colon, brain, adrenocortical tumours
Somatic mutations inactivate the TP53 gene = cancers.
Proto-oncogenes:
BRAF
BCR-ABL
JAK2
BRAF: 7q34, makes Ser, Thr kinase, Melanoma, Non-Hodgkin lymphoma, Papillary thyroid carcinoma, Hairy cell leukemia
BCR-ABL: zt(9;22) Philadelphia chromosome, makes non-receptor tyrosine kinase, CML
JAK2: 9p24.1, non tyrosine kinase receptor, Chronic myeloproliferative disorders
Proto-oncogenes:
HER2/neu
ALK
RET
HER2/neu(c-erbB2): 17q12, Receptor Tyrosine Kinase, Breast/gastric cancer
ALK: 2p23.2-p23.1, Receptor tyrosine kinase, Lung adenocarcinoma
RET: 10q11.21, receptor tyrosine kinase, Papillary thyroid cancer, pheochromocytoma, MEN2A & MEN2B
Proto-oncogenes:
c-KIT
L-myc-1 (MYCL1)
N-myc (MYCN)
c-myc
c-KIT: 4q12, Cytokine receptor, GI stromal tumors, Mastocytosis
L-myc-1 (MYCL1): 1p34.2, Transcription factors, Lung cancer
N-myc (MYCN): 2p24.3, Transcription factors, Neuroblastoma
c-myc: 8q24.21, Transcription factors, Burkitt Lymphoma
Proto-Oncogenes:
KRAS
BCL-2
CDK4
CCND1
ERBB1
KRAS: 12p12.1, GTPase, Colorectal, lung, pancreatic cancer
BCL-2: 18q21.33, Antiapoptotic molecule, Follicular lymphoma, Diff large B cell lymphoma
CDK4: 12q14.1, Cyclin-dependent kinase, Liposarcoma, Melanoma, Glioblastoma multiforme
CCND1: 11q13.32, cyclin D, Mantle cell lymphoma
ERBB1: 7p11.2, Epidermal growth factor receptor, NSCLC (lung cancer)
Tumor Suppressor gene:
TP53
Rb
CDKN2A
APC gene
TP53: 17p13.1, p53 cell apoptosis, arrests cell cycle G1 phase (most cancers & Li-Fraumeni synd)
Rb: 13q14.2, Retinoblatoma protein (cell cycle arrest G1, inhibits E2F), Retinoblastoma, Osteosarcoma
CDKN2A: 9p21.3, p16 (arrests cell cycle in G1 phase), Melanoma, pancreatic, lung cancer
APC gene: 5q22.2, inhibits B-catenin synthesis (B-catenin/Wnt pathway), Familial adenomatous polyposis, colon cancer
Tumor Suppressor gene:Tumor Suppressor gene:
PTEN
BRCA1
BRCA2
MMR gene family
DCC
PTEN: 10q23, Neg regs the Pl3k/AKT pathway, Breast cancer, prostate, endometrial, Cowden syndrome
BRCA1: 17q21.31, DNA repair protein, Breast, Ovarian, Pancreatic
BRCA2: 13Q13.1, DNA repair protein, Breast, Ovarian, Pancreatic
MMR gene family: DNA repair protein, Lynch Syndrome
DCC: 18q21.2, Transmembrane receptor in apoptosis, Colorectal cancer
Tumor Suppressor gene:
SMAD4
MEN 1
NF1
NF2
SMAD4: 18q21.2, DNA binding protein (signal transduction TGF-B), Pancreatic cancer
MEN 1: 11q13.1, Menin, MEN1
NF1: 17q11.2, Neurofibromin (Ras GTPase activating protein), Neurofibromatosis type 1
NF2: 22q12.2, Merlin (Schwannomin), Neurofibromatosis type 2
Tumor Suppressor gene:
TSC1
TSC2
VHL
WT1
WT2
TSC1: 9q34.13, Hamartin protein, Tuberous sclerosis
TSC2: 16p13.3, Tuberin protein, Tuberous sclerosis
VHL: 93p25.3, (Degredation of hypoxia-inducile-factor 1a), Von Hippel Lindau disease)
WT1: 11P13, tRANSCRIPTION FACTOR (Urogen development), Nephroblastoma (Wilms tumor)
WT2: 11p15.5, transcription factor (urogen development), Nephroblastoma
Radiation:
Nonionizing radiation
VS
Ionizing radiation
Nonionizing radiation:
UV-B = Skin cancers
Ionizing radiation:
X-rays, Gamma rays = Leukemias, Papillary thyroid cancer, Osteosarcoma, Liver angiosarcoma
Oncogenic infections:
EBV (Epstein Barr Virus)
HBV
HHV
HHV8
HPV16
EBV:
Burkitt lymphoma
Hodgkin lymphoma
Nasopharyngeal carcinoma
Oral hairy leukoplakia
Primary CNS lymphoma in immunocompromised patients
Gastric carcinoma
HBV:
Hepatocellular carcinoma
HHV-8:
Kaposi sarcoma
HPV-16 & 18
E6 inhibits TP53
E7 inhibits RB1
Squamous cell carcinoma (urogenital)
Oncogenic infections:
HTLV-1
HCV
HTLV-1:
Adult T-cell Leukemia
HCV:
Hepatocellular carcinoma
Oncogenic infections:
Schistosoma haematobium
Clonorchis Sinensis (Chinese liver fluke)
H.Pylori
Streptococcus bovis
Schistosoma haematobium:
Squamous cell carcinoma bladder
Clonorchis Sinensis (Chinese liver fluke):
Cholangiocarcinoma, MALT Lymphoma
H.Pylori:
Colorectal cancer
Streptococcus bovis
Tumor growth grading
G1
G2
G3
G4
Gx
G1: Well-differentiated (low grade)
G2: Moderately differentiated (intermediate)
G3: Poorly differentiated (high grade)
G4: Undifferentiated/anaplastic (high grade)
Gx: Differentiation can’t be assessed
Tumor stages
T
N
M
T: size/direct extent of primary tumor
N: Involves lymph nodes
M: metastasis
Dronabinol
Mirtazapine
Megestrol acetate
D: For Chemotherapy induced nausea & vomiting
M: For insomnia & depression-related anorexia in cancer treatment
M: Progesterone analogs & corticosteroids are appetite stimulants
