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Part 1 Pathophysiology > Haemodynamic And Cell/ Immunity > Flashcards

Haemodynamic And Cell/ Immunity Flashcards

1
Q

Prothrombin time

A

Extrinsic pathway
VII X V
II(thrombin) and fibrinogen

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2
Q

PTT

A

Intrinsic pathways
XII XI IX VIII X V II(thrombin) and fibrinogen

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3
Q

Platelet alpha granules

A

P selectin
vWF, fibrinogen, V, XI, XII
Platelet factor 4, fibronectin, PDGF,
VEGF

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4
Q

Platelet dense granules

A

Serotonin
ADP ATP
calcium
Adrenaline

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5
Q

Haptoglobin

A

Carries hb releases from damaged red cells in circulation

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6
Q

Glial cell production

A

Ectodermal tissue embryo, not bone marrow

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7
Q

Agammaglobulinaemia

A

X linked primary immunodeficiency
B cells don’t mature
Recurrent resp infections

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8
Q

GPIIB/IIIA

A

integrin on plt
vwf and fibrinogen receptor
plt activation
main job fibrinogen -> coag
Blocker - tirofiban

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9
Q

Thrombomodulin

A

from endothelium - anticoag
activated protein C which inhibits tPA inhibitors -> inc plasmin

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10
Q

Virchows triad

A

hypercoagulable
stasis
injury

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11
Q

petichiae vs purpura

A

petichiae - 1-2mm, inc intravasc pressure, dec plt
purpura 3mm - fragile vessels, vasclitis, amyloid

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12
Q

causes non thrombocytopenic purpura

A

meningococcal, HSP, telangelactasia, CMV

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13
Q

cause of vasoconstriction at injury

A

endothelin

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14
Q

hyperaemia vs congestion

A

hyperaemia due to inc blood flow ACTIVE
inflammation, arteriolar dilation
Etythema,haemosiderrin laden macrophages
congestion stasis e.g. pulm oedema CCF
Cyanosis

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15
Q

Thrombi morphology

A

lines of zahn if blood flow
if post mortem red bottom white top

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16
Q

thrombi location art vs venous

A

art coronary > cerebral > femoral
venous 90% leg

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17
Q

PE

A

95% from dvt upper leg
60-80% silent
>60% occlusion bad
risk pulm haemorrhage rather than infarct due to dual blood

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18
Q

Morphology infarcts

A

red infarct venous/ dual circulation
white infarct solid organ
ischaemic coagulative necrosis takes 4-12 h to appear

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19
Q

Metabolic abnormalities in sepsis

A

insulin resistance and inc BSL
dec insulin secretion, dec GLUT4
lactic acidosis
late stage dec BSL due to adrenal insufficiency

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20
Q

cells in innate and adaptive immunity

A

macrophages and dendritic (APCs)

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21
Q

IgM

A

pentamer, 1st response by B cells, produced by foetus, doesn’t cross placenta
complement activation

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22
Q

IgG

A

2nd response, crosses placenta, opsonises
80% of Igs

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23
Q

BCell CD 40 and 21

A

40 - for activation by T helper
21 - binds EBV

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24
Q

T cells

A

60-70% of lymphocytes
helper 60% - activate B, + phagocytes, secrete cytokines
CD8 cytotoxic kill (30%)
regulatory T supress immune response

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25
Q

NK cells

A

CD16 - Fc receptor for IgG
CD56
Inhibitory receptor for MHCI - don’t kill self
early defence without prior exposure

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26
Q

Location lymphocytes secondary lymph organs

A

Lymph nodes - B cortical in follicles, T paracortical
spleen - B follicles, T periarteriolar

27
Q

MHCI

A

on all nucleated cells + platelets
HLA ABC
viral + tumour antigens (endogenous) –> ER then expressed
CD8

28
Q

MHC II

A

on phagocytes
HLA D
endocytosed, proteolysis
exogenous antigens e.g. microbes
CD4

29
Q

HLA

A

A - inherited errors metabolism - haemochromatosis
B - inflammatory B27 ank spond
D - autoimmune, sjorgens, arthritis

30
Q

Costimulators

A

+ APC -> naive t cell stiulation
B7 proteins (CD80+86)
recognised by CD28 on t cell

31
Q

CD4 activation B cells and macrophages

A

secretes IL2 - more t cells activated
expressed CD40 ligand which binds CD40 on B cells and macrophages

32
Q

Th1

A

Activated macrophages and IgG
defence against intracellular
secrete IFNy

33
Q

Th2

A

Activate IgE, mast and eosinophils
Allergy and humoral immunity
Secrete IL4,5,13

34
Q

Th17

A

Activate neutrophils and monocytes
against extra cellular bacteria
mucosal immunity
Secrete IL17 and 22

35
Q

Mast cell activators

A

IgE, C3a+C5a, IL8, codeine, morphine, adenosine
IgE coated mast calls are ‘sensitise’

36
Q

IL5

A

activates eosinophils

37
Q

T1 hypersensitivity summary

A

sensitisation - B cell produces IgE which coats mast cell
re exposure - degranulation
IL4 activates Th2 (secretes more IL4)
IL5 activates eosinophils
IL13

38
Q

TII hypersensitivity summary

A

antibody mediated
reaction to antigen on cell surface
complement activation
+ IgG and M - recognised on NK cells - perforins and granzymes

39
Q

TIII hypersensitivity summary

A

antibody/ antigen complex
soluble complex in blood
deposited in tissue
inflammation and tissue injury
complement (lots of it)
cause fibrinoid necrosis

40
Q

TIV hypersensitivity summary

A

cell mediated
CD4 and 8
IL12–>Th1 (IFNy–>macrophage)
IL1+6–>Th17 (neutrophil)
CD4 presents peptide
secretes IL2 in autocrine manner
CD8 - perforins and granzymes

41
Q

T II examples

A

transfusion, haemolytic anaemia, thrombocytopenia purpura
goodpastures, rheumatic fever, ANCA
MG, insulin resistance diabetes

42
Q

T III examples

A

SLE
serum sickness, arthurs reaction
post strep glomerulonephritis
polyarteritis nodosa
reactive arthritis
farmers lung
Henoch schonlein

43
Q

T IV examples

A

contact dermatitis
mantoux test
TB
MS
T1DM

44
Q

Central tolerance

A

in BM and thymus
T cell negative selection and deletion
B cell apoptosis or receptor editing

45
Q

Peripheral tolerance

A

Anergy - made so won’t be activated by costimulator
suppression by regulatory T
deletion by apoptosis

46
Q

Hyperacute rejection

A

avoided by cross matching blood
pre formed antibodies
Ischaemic + thrombotic
IgG+ complement, fibrin + plt

47
Q

Acute rejection

A

antidonor ABs produced post transplant
T cells - tubulitis + vasculitis
B cell - complement

48
Q

Chronic rejection

A

Progressive renal failure, no ABs in graft
Arterioscleosis, parenchymal fibrosis

49
Q

RNA genome contains

A

gag, pol, env genes

50
Q

HIV viral glycoproteins

A

GP120 - binds CD4 allowing CCR5 to bind
GP41 - fusion virus to cell

51
Q

Seroconversion HIV

A

3-7 weeks
Assoc viral like illness

52
Q

HIV defining cancers

A

Kaposi - HHV8 most common, can have normal CD4
Non hodgkins CNS lymphoma - assoc EBV, low CD4
Cervical invasive

53
Q

HIV defining viruses

A

HSV, VZV, CMV, PML

54
Q

HIV defining bacterial infections

A

atypical mycobacteria
nocardiosis
disseminated salmonella

55
Q

HIV defining Fungal + protozoal

A

pneumocytis, cryptococcus, histoplasmosis
cryptosporidiosis, toxoplasmosis (CNS/ pneum)

56
Q

Spherocytosis tx

A

tx with splenectomy or folate or blood transfusions

57
Q

Megaloblastic anaemia

A

oval shaped macrocytosis with large hypersegmented neutrophils and abnormal megakaryocytes
Hyperchromic
anisocytosis and poikilocytosis
reticulocyte count is low

58
Q

cause reticulocytosis

A

haemolytic anaemia (which also causes inc bilirubin and ldh)

59
Q

Trousseau syndrome

A

migratory thrombophlebitis due to hypercoagulable state

60
Q

Types vWD

A

1 - autosomal dominant, deficiency (mild)
2 - autosomal dominant dysfunction (mild)
3 - autosomal recessive, complete deficiency

61
Q

Traumatic haemolysis (exercise/ heart valve)

A

red cell fragments (schistocytes), burr cells, helmet cells, and triangle cells

62
Q

Methaemoglobin

A

Hb containing Fe3 ferric

63
Q

Steps haemostasis

A
  1. vasoconstriction
  2. PRIMARY - plt actovation
  3. SECONDARY - clotting cascade
  4. Clot stabilisation
64
Q

Platelet activation stages

A
  1. vWF binds GB1b and binds collagen
  2. Plt changes shape
  3. Granules secreted e.g. ADP to recruit more plt, TXA2 aggregates
  4. GPIIbIIIa binds fibrinogen

Part 1 Pathophysiology (15 decks)

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