Case 3: Breaking Bad

Question 1

What is a bruise?

Answer 1

broken capillaries

Question 2

What are our circadian rhythms regulated by?

Answer 2

body clock, clock genes, environment

Question 3

Hoe can flight fatigue be treated?

Answer 3

melatonin pills, light therapy, going by destination times

Question 4

What is serotonin converted to?

Answer 4

melatonin

Question 5

What is melatonin production inhibited by? What does it do?

Answer 5

production inhibited by light
inhibits circadian alerting system
drowsiness and lowers body temp

Question 6

What are the three components of blood?

Answer 6

plasma
buffy coat
RBC

Question 7

What are three granulocytes? Where are they found and what type of nucleus do they have? What do they do?

Answer 7

neutrophils
eosinophils
basophils

cytoplasm

polymorphic

phagocytose bad things

Question 8

Where do agranulocytes originate? What are four of their names and what do each do?

Answer 8

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

Question 9

What 3 agranulocytes are considered natural killer cells?

Answer 9

lymphocytes, T cells, B cells

Question 10

What are platelets derived from?

Answer 10

ruptured megakaryocytes

Question 11

What are the four steps of coagulation of mature thrombus?

Answer 11

1. injury
2. platelets form primary haemostatic plug (soluble)
3. recruitment of more platelets
4. coagulation factors and thrombin = second haemostatis and fibrin clot (insoluble)

Question 12

What does low platelet number indicate?

Answer 12

bone marrow/megakaryocyte disease

Question 13

What does low RBC and haemoglobin indicate?

Answer 13

anaemia

bone marrow disease

Question 14

What does low leukocytes indicate?

Answer 14

more likely to get infection

Question 15

What does high Ca2+ indicate?

Answer 15

abnormal break down of bone

bone metabolism disorders

Question 16

What 4 body systems maintain calcium homeostasis?

Answer 16

skeletal
GIT
endocrine
renal

Question 17

What is high levels of calcium in the blood called and what are the symptoms?

Answer 17

hypercalcemia

decreased appetite, nausea, frequent urination, kidney stones

Question 18

What are the 3 functions of the skeletal system?

Answer 18

mineral homeostasis
haematopoiesis
energy storage

Question 19

What two substances are bones made out of?

Answer 19

collagen type 1

calcium crystalline hydroxypatite

Question 20

Where is the periosteum located?

Answer 20

on the outside of the bone

Question 21

Where is the endosteum located?

Answer 21

lines the medullary cavity

Question 22

What are the four stages of bone remodeling?

Answer 22

resorption
reversal
formation
mineralization

Question 23

How does aspirin inhibit bone growth?

Answer 23

interferes with collagen

Question 24

How can bone health be tested? (2)

Answer 24

bone mineral density test
DXA test (T-score measured in standard deviations)
-4 to -1 unhealthy, -1 to +2 healthy

Question 25

What are multiple lytic lesions?

Answer 25

oil droplet like formations where bone has weakened

Question 26

How long after birth does haematopoiesis occur in the bone marrow?

Answer 26

by 10-12 weeks

Question 27

What is the bone marrow distribution like at birth (red/yellow)?

Answer 27

all red

Question 28

How can the cellular constitution of marrow be assessed?

Answer 28

biopsy of hipbone/posterior iliac crest

complete blood count test

Question 29

What do plasma cells develop from? What do they produce?

Answer 29

B cells that originate in bone marrow

produce immunoglobins

Question 30

How many chains are immunoglobins made up of and why is this important?

Answer 30

4 chains

dictate what antigen they attack

Question 31

What is a paraprotein? What can it be detected by?

Answer 31

malignant plasma produce a single non-functional immunoglobin in large quantities (paraprotein)
Serum protein electrophoresis

Question 32

What is the Bence-Jones protein? What cases are they present in?

Answer 32

abnormal plasma protein which also produce free immunoglobin light chains (filtered by kidneys)
present in 2/3 multiple myeloma cases

Question 33

What are the features of multiple myeloma?

Answer 33

bone destruction and pain
immunosuppression
hypercalcemia
bleeding/bruising
renal failure (light chains trapped in tubules)

Question 34

How can multiple myeloma be diagnosed?

Answer 34

SPEP
urine electrophoresis
bone marrow biopsy
x-ray

Question 35

What are the five clinical phases of multiple myeloma?

Answer 35

post germinal centre B cell
MGUS
smouldering myeloma
myeloma
plasma cell leukemia

Question 36

What is MGUS characterized by? (4)

Answer 36

benign
less than 10% plasmacytosis
paraprotein
no “CRAB”

Question 37

What is smouldering myeloma characterized by? (3)

Answer 37

equal to or more than 10% plasmacytosis
increased paraprotein
no “CRAB”

Question 38

What is myeloma stage characterized by? (5)

Answer 38

more than 10% plasmacytosis
increased paraprotein
"CRAB"
staged I-III 
treatment begins

Question 39

What are the “CRAB” symptoms?

Answer 39

calcium elevation
renal failure
anemia
bone pain

Question 40

What is the prognosis of myeloma determined by?

Answer 40

clinical phase
age
"crab" symptoms
response to initial treatment
prognostic chromosomal changes

Question 41

How is myeloma treated? (12)

Answer 41

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)