Failure to Thrive Flashcards
on gel electrophoresis, M spike represent overproduction of […]
Monoclonal Ig
Starr: “monoclonal spike = monoclonal protein when talking about SPEP”
what would you expect to see on bone marrow biopsy in multiple myeloma?
clusters of plasma cells with clock face chromatin
intracytoplasmic Ig inclusions
Starr: “Recognize eccentric nucleus of a plasma cell.”
You will get a vignette of multiple myeloma with two clonal spikes: recognize that […] could occur within a clonal line, causing this phenomenon
switching
Would the rough Endoplasmic reticulum be active in Multiple Myeloma?
Yes - extensive synthesis of monoclonal proteins
what is the role of NF-kB?
transcription of pro-inflammatory mediatiors
TNF, IL-1, IL-6
what drugs inhibit NF-kB?
glucocorticoids
CRAB criteria for multiple myeloma
hyperCalcemia
Renal insufficiency
Anemia
Bone lytic lesions
Osteolytic lesions will have less bone appearing […] on x-ray or CT in multiple myeloma.
darker
MOA: Reversibly inhibits cyclooxygenase, mainly in the CNS
acetaminophen
MOA of hydrochlorothiazide
inhibit NaCl reabsorption in the early DCT
adverse effects of thiazide diuretics
hyperGLUC
hyperglycemia
hyperlipidemia
hyperuricemia –> uric acid stones
hypercalcemia
MOA of furosemide
loop diuretic
inhibit NKCC channels of thick ascending loop of Henle
MOA of fluoxetine
SSRI
inhibit serotonin reuptake at the 5-HT receptors
the more common use for this drug is peripheral neuropathy, although it is an effective anti-epileptic, and is used in alcohol withdrawal and abstinence therapy
Gabapentin
Gabapentin blocks […] channels
Ca2+
What would DKA look like on an arrow pushing table
pH:
PCO2:
HC03-:
pH: low
pCO2: low
HCO3-: low
(MUDPILES: anion gap acidosis)
(respiratory compensation occurs very quickly)
MOA: irreversibly blocks COX, downregulating TXA2 release
aspirin
MOA: Inhibition of P2Y12 receptor on platelets (ADP receptor) → ↓ expression of Gp IIb/IIIa receptors on platelets → inhibition of platelet aggregation
Clopidogrel
MOA of losartan
ARB
angiotensin receptor blocker
MOA of atorvastatin
HMG coA reductase inhibitor
unable to convert HMG-CoA to mevalonate (the rate-limiting step of cholesterol synthesis) → reduced intrahepatic cholesterol biosynthesis → upregulation of expression of LDL receptor gene via sterol regulatory element-binding protein (SREBP) → increased LDL recycling
MOA of omeprazole
Irreversible inhibition of H+/K+ATPase in parietal cells → increases stomach pH
Do not treat […] with verapamil or clonidine as first line therapy
hypertension
the buzzword when looking at a biopsy of hemochromatosis is […]
Prussian blue
dietary iron is absorbed in the […]
duodenum
[…] transports iron in the blood
transferrin
[…] is the primary iron storage protein of the body
ferritin
The enzyme […] decreases intestinal absorption of iron by inhibiting ferroportin
hepcidin
(upregulated in inflammatory states –> anemia of chronic disease)
[…] transports ferrous iron (Fe 2+) from the enterocytes to the bloodstream.
Ferroportin
describe the absoprtion of non-heme iron
- ascorbate ferrireductase reduces non-heme iron Fe3+ to Fe2+
- DMT cotransports Fe2+ with H+
- Fe2+ transfers to mobilferrin
- Fe2+ leaves cell via ferroportin and hephaestin oxidizes it to Fe3+
- iron binds to transferrin in plasma
why does hephaestin oxidize Fe2+ to Fe3+ ?
keeps it in interstitial space allowing it to bind to transferrin
describe the absoprtion of heme iron in the duodenum
- Heme Fe2+ enters cell (unknown mechanism)
- Fe2+ transfers to mobilferrin
- Fe2+ leaves cell via ferroportin and hephaestin oxidizes it to Fe3+
- iron binds to transferrin in plasma
[…] transports non-heme iron into the enterocyte
DMT-1
patients with hemochromatosis are at an increased risk for developing
cirrhosis
HCC
restrictive cardiomyopathy
Plasma […] is a marker of total body iron stores
ferritin
A liver biopsy showing macrophages with cytoplasmic granules that stain golden-yellow with hematoxylin describes […] deposits.
hemosiderin
(due to chronic iron overload)
In […], the HFE gene is mutated; this leads to defective binding of transferrin to its receptor, which signals decreased iron stores
hemochromatosis
(liver stops producing hepcidin)
seen on peripheral blood smear in MM
rouleux formation
MM can cause foamy urine due to […] proteinuria
light chain (Bence Jones proteins)
plasma cell dyscrasia characterized by abnormal proliferation of terminally differentiated B cells that produce monoclonal IgM antibodies
Waldenstrom macroglobulinemia
[…] acting insulins do not produce an observable peak in serum insulin concentration
long
(glargine)
high doses of […] especially in patients with underlying renal insufficiency, carry a risk of sensorineural hearing loss
loop diuretics
what HTN med can be used in the setting of osteoporosis to increase Ca reabsorption?
thiazide diuretic
enhances bicarbonate elimination in the proximal convoluted tubule
acetazolamide
(used to treat altitude sickness)
what HTN medication can cause gynecomastia?
spironolactone
ACE inhibitors inhibit […] arteriole constriction
efferent
(decrease GFR)
used for the treatment of stable angina pectoris in patients with aspirin allergy as well as adjunctive therapy in acute coronary syndromes
clopidogrel
(patient develops signs of acute asthmatic attack (wheezing, dyspnea) shortly after initiating therapy with aspirin)
most common adverse effect of aspirin
GI bleed
oral ulcers, sore throat, fever, and a low neutrophil count following initiation of a new medication
drug induced neutropenia
key mediator of platelet-induced coronary artery stenosis and thrombosis
TXA2
