Friday Heme 3 Flashcards
Methotrexate inhibs __ which reduces FA to THF
used in purine/__ synthesis
5FU inhibs DNA synth by inhibiting __ synthetase
difference is mtx prevents formatin of __
5FU binds THF/TS to dec __ available for thymidine synth
L is THF derivative that bypasses DHFR and can be used to reduce toxicity of MTX
5FU is less toxic, unless given w L__ which strengthens binding to TS
DHFR
thymidine
thymidylate
THF
enzyme
leucovorin
leucovorin
C/G are pyramidine analog antimetabolites
F__ is deamination resistant purine nucleotide analg
inhibits DNA __, primase, ligse and RN __
used to tx ___
Cachexia results in \_\_ TNF aka C\_\_ causes necrosis of tumors but also _ can also be due to IL \_\_ and _ influences hypothalamus to \_\_ appetite also inc \_\_
cytarabine, gemcitabine
Fludarabine
poly, reductase
CLL
wasting cachexin cachexia 1B and IL6 suppress basal metabolic rate
ionizing radiation causes cell death via DNA __ breakage and __ formation via ionizatiion of water
most effective on __ cells as they are rapidly proliferating
thus, also effect __ surfaces
cell death curve is __ on initial exposure
w more exposure, curve gets __
Adenine __ indicates the template strand
DS, free radical
maligant
epithelial
flat
steep
methylation
E__ use glycolysis as pathway for energy
ATP generated when 13BPG converted to 3phosphoglycerate by P__ kinase
RBC can use bisphosphoglycerate __ to form 23BPG wout producing ATP
more likely to occur w H/anemia of __
aids in __ to tissues
T cells go from __ neg to __ positive
after producing __, final step is loss of __ or _ antigen
erythrocytes phosphoglycerate mutase hypoxia, chronic dz O2 delivery
double, double
TCR, CD4/CD8
inflammatory leuk pathway
M__ w inc vasc leakage, improving contact w PMNs
R__ as PMN roll on endothelium
bind S__ or PSGL1 to __ or __/__ selectin
A__ as slow rolling allows leuks to sample chemokines to produce integrins
Tight __- PMN attach via binding of CD18 B2 integrins M/L to ICAM1
Trans__- PMN squeezes into the cell via PECAM
LAD type 3 is like type __ w severe __ infections, delayed separation of __ and __ comps
margination
rolling
siayl lewis X, L-selectin, E/P
activation
adhesion
Mac 1 or LFA1
migration
1, bacterial, umbilical cord, bleeding
HS due to plasma membrane mutation in A/S/B
most specific marker is inc __
can be inherited __
coombs test is __
inc osmotic __ on acidified glycerol lysis test
abnromal __ 5 maleimde binding test
Tx w __ supplements, __ transfusions and S__
can have __ gallstones and __ crisis from parvob19
ankyrin, spectrin, band 3 MCHC AD neg fragility eosin
folate, blood, splenectomy
pigmented, aplastic
dermatomyositis biopsy shows mononuclear __ infiltrates w perifascicular atrophy and patch necrosis
can be seen in O/L/C/N ca
O2 binding affinity inc after first __ binds Hb
w more bound O2, less sites are __
leftward shift occurs when Hb has __ for O2
perimysial
ovarian, lung, colorectal, NHL
1st
open
higher
B cells are released by the __
mature B cell goes to LN and become exposed to __
can become __ or form __ that is site of B cell proliferation
activated B cells can become __ cells, while majority form __ secreting PC
Isotype switching occurs in __
__ chain regions are isotype specific, and change upon binding of CD40 to CD40L
__ region is antigen specific
VDJ recomb occurs in the _
Tolerance in periphery result of a__
Neg/Pos selection occur in __ thymus
bone marrow antigen, IgM, germinal center memory, antibody germinal center Heavy light
bone marrow
fetal
Telomeres lie at end of chromo and have __ repeat DNA seq rich in G/T
if not present, __ is activated to promote apoptosis
Telomerase is __ DNA poly
produces telomeric __ to replace lost ends and allow continual dividing
normal cells do not have __ (except germ/stem cells)
cancer cells __
__ is expressed at G1 to promote proliferation
tandem p53 RNA dep DNA seq telomerase do
Cyclin D1
in MM, neoplastic B cells mature into __ w excessive production of Ig
susceptible to __ inhibs like bortezomib
Proteasomes act as __ for protein, breaking products down
w inhibition, toxic proteins __ while inc expression of __ proteins
F__ is GCSF analog
VB3 is necessary for FA __/___ via NAD/NADP
VK def presents w I__, __ tract, cutaneous/umbilical and __ site bleeds
tx w __ VK
essential cofactor for G
allows for carboxylation and formation of __ binding site
allows for attraction to __ charged phospholipids on platelets/endo cells
plasma cells
Proteosome
recycling
accumulate, proapoptotic
filgastrim
oxidation/synthesis
intracranial, GI, surgical
IM
gamma-glutamyl carboxylase
Ca
neg
intracranial hemorrhage in infant presents w inc __ pressure
AMS, large __/__, downward __
suspect abusive head trauma w __ hemorrhage
CO can also bind cardiac __ impairing hearts use of O2
binds to __ oxidase to inhibit aerobic metab
NADH methehomglobin redctase generates __ from methemoblobin
if absent, results in congenital __
Aminocaproic acid is used to inhibit __ activators
FFP contains __ coag factors
Cryoprecipitate contains __ proteins
Factor __, Fibrinogen, __ and vitronectin
intracranial
head/fontanelle, eyes
myoglobin
cytochrome
hb
methemoglobinemia
plasminogne
all
8, vWF
DIC in pregnancy is mediated by __ found in trophoblast
released from placental __ to start the coag cascade
pt w vaginal bleeding, uterine tenderness, retroplacental hematoma, fetal demise has __ dx
result of severe __
number 1 cause of __ in preg
DIC also occurs in S, PPH, A
AFE assc w __ and cardio shock
DIC also occurs in acute _ of preg
microvesicular fatty infiltration impairs prodxn of __ factors
usually see N/V, ab pian and elevated ___
tissue factor/thromboplastin
injury
placental abbruption
HTN
DIC
sepsis, post partum hemorrhage, AF embolus
hypoTN
fatty liver
coag
lft
TLC can result in __ and arrhythmias
or uric acid precipitation in kidney w obstructive __ and acute renal failure
dec risk w aggressive __
R__ is urate oxidase, breaking down urate
A__ is XO inhib, prevents uric acid formation
Mesna used to prevent __ of cyclophosphamide
supplies __ group
hyperkalemia uropathy hydration rasburicase allopurinol
hemorrhagic cystitis
thiol
pO2 at which Hb is 50% saturated is __
if lower than normal, O2 curve has shifted to __
cannot release O2 to __, so compensatory erythrocytosis develops
pt is usually __
Osteolytic bone lesions are __ due to OC release
Osteblastic lesion appears __ due to OB
metastatic prostate cancer produces __ lesions
may have C/urinary sx
more common in __ men
confirm w __ and serum __
MM/NSCLC/Melanoma cause ___ lesions
p50
left
tissues
asx
lucent sclerotic sclerotic cachexia african american biopsy, PSA
lytic
mono usually has posterior __ or A__ LAN
atypical reactive __
drug resistance occurs w longstanding use of __ in HIV
due to high __ of genome
structural glycoproteins are encoded by HIV1 __ gene
viral evasion of immunity occurs w mutation in __ gene
mutation in __ gene responsible for resistance to ___ inhibs
change in HIV1 RT make enzyme reistant to __/__ RTI
HIV 1 can rapidly mutate epitopes recog by __, allowing for evasion of CMI
cervical, auricular
lymphocytosis
HAART mutation rate env env Pol protease N/NNT
CD8
think __ w hemolytic anemia after anti-malarial meds
look for __ bodies that are dark and appear w supravital stain
TTP due to def in __
uncleaved vWF __ trap platelets
presents w HA, T, R, N, F
tx w __ exchange, G, and R
G6PD
heinz
ADAMST13
multimers
hemolytic anemia, thrombo, renal failure, neuro, fever
plasma, GC, rituximab
Macrocytic anemia in alcolohic pt are likely due to __ def
necessary for forming __/__
panc insufficiency can also result in __ def, as enzymes are necessary to cleave __ binder from B12
HbA has neg charge, so it migrates fast toward __ on electrophoresis
both HbC and HbS have __ mutation, resulting in much slower migration
HbH is all beta, migrating __ on electrophoresis
folate
purine/pyrimidines
B12
R
pos end
missense
further
pt w SLE has __ hemolysis w warm __ antibodies against erythrocytes
S__ seen w positive coombs test and extravasc hemolysis
antibodies are directed against __ resulting in destruction (type 2 HS)
pain worse at night, inc age, persistent/prog pain not relieved is worrisome for __
Bony metastases include PB KTL
think infection w assc __ or hx of __/__
autoimmune
IgG
spherocytes
platelets
malignancy
prostate, breast, kidney, thyroid, lung
bleeding from venipuncture sites commonly indicates _
DIC due to gram neg sepsis has coag cascade activated by bacterial __
A__ are cells w irregularly spaced surface projections
such as a __ cell, seen in abetalipoproteinemia
In SCD, alteration to __ aa results in the formation of a hydrophobic pocket
interacts w complementary __ residue on other Hb molecule, leading to polymerization/sickling
In HbC, addition of __ aa prevents hydrophobic interaction
no __/__ occurs
DIC
endotoxins
acanthocytes
spur
nonpolar
nonpolar
charged
polymerization/sickling
BRCA1/2 involved in DNA \_\_ cellular \_\_ checkpoint in \_\_ regulating \_\_ mutation can result in \_\_ breaks inherited \_\_
RAS assc w panc __ and C
BRAF assc w H__ and M
both are P___
APC assc w C/G/E ca
seen in __
acts as __
repair differentiation cell cycle TF double strand AD
adenocarcinoma, cholangiocarcinoma
HCL, melanoma
protooncogenes
colon, gastric, endometrial
FAP
tumor suppressor
__ dz is most common in Ashkenazi Jews
__ inherited LSD
B__ def, glucocerebroside accumulates
__ laden macros described as appearing __
sx include bone __, H__ and p__
F__ anemia is inherited cause of aplastic anemia
Pancytopenia, hypo/hyper __ skin, short __ and hypoplastic __
Gaucher AR b glucocerebrosidase lipid wrinkled tissue paper
pain, HSM, pancytopenia
fanconi
pigmented, stature, thumbs
warfarin induced skin necrosis occurs in indiv w protein __/__ def
Factor 7 and Protein C are first to __ w warfarin
leads to transient __ state, promoting __ occlusion
tx includes stopping __ and administering __/__
pt w recurrent VTE resistant to heparin has __ def
C/S
deplete
hypercoagulable, microvascular
heparin, FFP/protein C conc
antithrombin
Plasma cells have __ distribution in the nucleus
perinuclear pale zone w well developed __ and centrioles
bone marrow >30% __ indicates MM
N/N anemia due to __
secretion of __/__ leads to bone resorption/lytic lesions, hyperCa
prodxn of monoclonal Ig leads to inc susceptibility to __
look for M protein in __ and Bence jones protein in __
may have Rouleax formation on __
AL __ forms due to accumulation of light chain
deposits in K/H/T/N
development of __ due to infiltration and inflammation
clock face
Golgi
plasma cells
bm infiltration
IL1/IL6
infections
serum, urine smear amyloid kidney, heart, tongue, CNS renal failure
__ is mc tumor in HIV
affects __/__ before spreading proximally
then on __
late stage, spreads to L/G
HHV8 infects vasc/lymphatic __ cells
differentiate into mixed __ w neoplastic potential
HTLV1` is a R__ virus
leads to adult __ lekemia
KS feet/legs mucus membranes lungs/gi endothelial phenotype
retroviridae
T cell
Hep B/C cause __ hyperplasia
inc hepatocyte divisions, inc risk for malignant __
since HBV is DNA virus, risk of HCC remains due to continued Trxn of proteins like __
disrupts cell cycle by inactivating __ suppressor
eventually, pt gets __
regenerative mutations HBx p53 HCC
M/H anemia w mental status changes and occupational exposure should indicate __ poison
inhibits __ syntesis via ALAD/ferrochelatase
iron studies are __
peripheral blood smear shows __ due to ribosomal aggregation and inability to __ RNA
__ are present in bone marrow
can also have __ at gum tooth line
wrsit/foot __ due to PN
venous/protoporphyrin levels are __
lead heme normal basophilic stippling degrade ring sideroblasts
lead lines
drop
inc
