Case 3: Breaking Bad Flashcards
What is a bruise?
broken capillaries
What are our circadian rhythms regulated by?
body clock, clock genes, environment
Hoe can flight fatigue be treated?
melatonin pills, light therapy, going by destination times
What is serotonin converted to?
melatonin
What is melatonin production inhibited by? What does it do?
production inhibited by light
inhibits circadian alerting system
drowsiness and lowers body temp
What are the three components of blood?
plasma
buffy coat
RBC
What are three granulocytes? Where are they found and what type of nucleus do they have? What do they do?
neutrophils
eosinophils
basophils
cytoplasm
polymorphic
phagocytose bad things
Where do agranulocytes originate? What are four of their names and what do each do?
bone marrow
lymphocytes
T cells: mature in thymus, circulate and attack viruses
B cells: mature in marrow, produce antibodies to circulate
monocytes: can develop into dendritic cells and phagocytose
What 3 agranulocytes are considered natural killer cells?
lymphocytes, T cells, B cells
What are platelets derived from?
ruptured megakaryocytes
What are the four steps of coagulation of mature thrombus?
- injury
- platelets form primary haemostatic plug (soluble)
- recruitment of more platelets
- coagulation factors and thrombin = second haemostatis and fibrin clot (insoluble)
What does low platelet number indicate?
bone marrow/megakaryocyte disease
What does low RBC and haemoglobin indicate?
anaemia
bone marrow disease
What does low leukocytes indicate?
more likely to get infection
What does high Ca2+ indicate?
abnormal break down of bone
bone metabolism disorders
What 4 body systems maintain calcium homeostasis?
skeletal
GIT
endocrine
renal
What is high levels of calcium in the blood called and what are the symptoms?
hypercalcemia
decreased appetite, nausea, frequent urination, kidney stones
What are the 3 functions of the skeletal system?
mineral homeostasis
haematopoiesis
energy storage
What two substances are bones made out of?
collagen type 1
calcium crystalline hydroxypatite
Where is the periosteum located?
on the outside of the bone
Where is the endosteum located?
lines the medullary cavity
What are the four stages of bone remodeling?
resorption
reversal
formation
mineralization
How does aspirin inhibit bone growth?
interferes with collagen
How can bone health be tested? (2)
bone mineral density test
DXA test (T-score measured in standard deviations)
-4 to -1 unhealthy, -1 to +2 healthy
What are multiple lytic lesions?
oil droplet like formations where bone has weakened
How long after birth does haematopoiesis occur in the bone marrow?
by 10-12 weeks
What is the bone marrow distribution like at birth (red/yellow)?
all red
How can the cellular constitution of marrow be assessed?
biopsy of hipbone/posterior iliac crest
complete blood count test
What do plasma cells develop from? What do they produce?
B cells that originate in bone marrow
produce immunoglobins
How many chains are immunoglobins made up of and why is this important?
4 chains
dictate what antigen they attack
What is a paraprotein? What can it be detected by?
malignant plasma produce a single non-functional immunoglobin in large quantities (paraprotein)
Serum protein electrophoresis
What is the Bence-Jones protein? What cases are they present in?
abnormal plasma protein which also produce free immunoglobin light chains (filtered by kidneys)
present in 2/3 multiple myeloma cases
What are the features of multiple myeloma?
bone destruction and pain immunosuppression hypercalcemia bleeding/bruising renal failure (light chains trapped in tubules)
How can multiple myeloma be diagnosed?
SPEP
urine electrophoresis
bone marrow biopsy
x-ray
What are the five clinical phases of multiple myeloma?
post germinal centre B cell MGUS smouldering myeloma myeloma plasma cell leukemia
What is MGUS characterized by? (4)
benign
less than 10% plasmacytosis
paraprotein
no “CRAB”
What is smouldering myeloma characterized by? (3)
equal to or more than 10% plasmacytosis
increased paraprotein
no “CRAB”
What is myeloma stage characterized by? (5)
more than 10% plasmacytosis increased paraprotein "CRAB" staged I-III treatment begins
What are the “CRAB” symptoms?
calcium elevation
renal failure
anemia
bone pain
What is the prognosis of myeloma determined by?
clinical phase age "crab" symptoms response to initial treatment prognostic chromosomal changes
How is myeloma treated? (12)
hydration correction of hypercalcemia pain relief radiotherapy transfusion treatment of infection surgery vaccination chemotherapy targeted drugs high dose radiation therapy (+ injections of stem cells) novel agents (stop growth and kill)
