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heme Flashcards

1
Q

mechanism of warfarin

A

inhibits vitamin K dependent carboxylation of glutamic acid residues for

factors II, VII, IX, X

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2
Q

What is the central regulator for iron storage and release

A

Hepcidin by interaction with ferroportin

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3
Q

Where is Hepcidin synthesized and secreted?

A

hepatic parenchymal cells

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4
Q

What is methemoglobin

A

when Fe 2+ in heme is oxidized to Fe2+

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5
Q

What causes methemoglobinemia?

A

drugs (nitrites, dapsone)

enzyme deficiencies and hemoglobinopathies

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6
Q

Pancytopenia with fatty looking bone marrow

A

aplastic anemia

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7
Q

What tissue does parvovirus B19 replicate in?

A

bone marrow

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8
Q

Why can’t mature RBCs synthesize heme?

A

no mitochondria

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9
Q

What to give to reverse warfarin?

A

fresh frozen plasma

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10
Q

what to give to reverse heparin

A

protamine

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11
Q

child with blast cells on peripheral blood smear
dysphagia, dyspnea

What neoplastic cell is responsible?

A

Acute lymphobastic leukemia, T lymphocyte type

dysphagia, dyspnea–> mediastinal mass compressing on trachea and esophagus (thymus is in medistinum and where T cells mature)

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12
Q

what chromosomal abnormalitiy with Auer rods

A

t (15;17)

AML, M3 variant

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13
Q

what amino acid substitution in Sickle cell anemia?

A

glutamic acid–> valine

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14
Q

What does enoxaparin bind?

A

binds antithrombin IIII

low molecular weight heparin, acts like heparin

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15
Q

anemia with spoon nails and dysphagia

A

Fe deficiency anemia

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16
Q

What protein does EBV bind to on B cells

A

CD21

binds EBV gp350

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17
Q

irreversibile inhibitor of COX1 and COX2

A

ASA

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18
Q

What is the structure of parvovirus B19

A

non enveloped

single stranded DNA

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19
Q

What enzymes are required to convert fructose 6 phospate to ribose?

A

transaldolase–> glyceraldehyde 3 P

transketolase–> ribose 5 phosepate

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20
Q

What causes the green color of a healing hematoma?

A

heme oxygenase converting heme to biliverdin (green)

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21
Q

what drugs enhance P450?

A

rifampicin
phenobarbital
phenytoin

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22
Q

What drugs inhibit P450

A

cimetidine
amiodarone
TMP-SMX
isonizad

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23
Q

What kind of drug is celecoxib

A

COX2 inhibitor

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24
Q

What is the advantage of COX2 inhibitors over traditional NSAIDs?

A

less risk of GI bleeds and ulcers

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25
what does PT measure?
extrinsic pathway | factors I, II, V, VII, X
26
What does PTT measure
intrinsic pathway | all factors except VII and XIII
27
Where is the defect in hemophilia A
factor VIII
28
where is the defect in hemophilia B
IX
29
coagulation labs for a person on hemodialysis
accumulation of uremic toxins impairs platelet aggregation and adhesion prolonged bleeding time normal PT normal PTT normal platelet count
30
prolonged bleeding and bleeding in joints is suggestive of what disease
hemophilia
31
What are the coag labs for hemophilia
``` PTT prolonged (hemophilia is factor VIII or IX problem) normal PT, thrombin time, and bleeding time. ```
32
what translocation is associated with follicular lymphoma? | what gene overexpression
t(14;18) | BCL-2
33
homocysteine needs B12 to synthesize what substance
methionine
34
what is the mechanism of action of desmopressin to stop bleeding?
stim release of factor VIII and vWF from endothelial cells--> temporary increase in VIII useful for hemophilia A (problem with VIII)
35
anemia with elevated HbA2
beta thalassemia
36
what is the defect in beta thalassemia?
defective globin mRNA transcription, processing, and translation
37
Stop codons
UAA UGA UAG
38
elevated WBC peripheral smear with immature cells (bands, metamyelocytes, myelocytes) decreased leukocyte alkaline phosphatase
CML
39
translocation with CML
t(9; 22)
40
translocation with Burkitt's lymphoma
t(8; 14) B looks like 8
41
translocation with follicular lymphoma
t(14; 18) | Fourteen, follicular
42
translocation with M3 AML
t(15; 17) | M3, 15/3
43
translocation with Ewing sarcoma
t(11; 22)
44
translocation with Mantle cell lymphoma
t(11; 14) | tl looks like 11
45
overexpression with burkitt's lymphoma
c-myc
46
overexpression with follicular lymphoma
bcl-2
47
translocation associated with B-ALL
t(12; 21)
48
markers for CLL
CD5, CD20
49
Rituximab
monoclonal Ab against CD20 (B cell marker) good for treatment in non hodgkins B cell lymphoma
50
thrombocytopenia renal insufficiency hemolytic anemia
HUS, think Ecoli O157:H7 undercooked hamburger
51
bite cells
G6PD
52
What is the difference in mechanism of action of unfractionated heparin and enoxaparin?
unfractionated heparin binds antithrombin and inactivates thrombin and factor Xa enoxaparin inactivates Xa only
53
what is the most likely cause of macrocytosis in sickle cell
folic acid deficiency high turn over of RBC, need more folic acid
54
antibiotic that causes aplastic anemia
choramphenicol
55
/What is tumor lysis syndrome?
killing too many tumor cells to fast releasing Na, K and nucleic acids into serum increased K causes arrythemia and peaked T waves increased nucleic acids--> increased uric acid--> precipitates in kidney causing renal failure
56
How to prevent renal impairment in tumor lysis syndrome?
allopurinol or rasburicase
57
family hx of multiple cancers before 45yo
Li-Fraumeni syndrome
58
inheritance of Li fraumeni syndrome and associated mutation
autosome dominant | p53
59
function of p53
arrest cell with mutant DNA in G1/S until it is repaired cannot repair--> apoptotsis
60
What is Kaposi Sarcoma associated with
HIV HHV8
61
thrombosis with anemia and pancytopenia | CD55 and CD59 deficiency
paraoxysmal nocturnal hemoglobinuria
62
what cranial nerves pass through the jugular foramen
CN IX, X, XI
63
effects of radiation therapy in decreasing tumor size
double stranded DNA breaks | formation of Oxygen free radicals
64
calculate attributable risk percent
(relative risk -1)/relative risk
65
multidrug resistance gene
glycoprotein that functions as a ATP dependent efflux pump that pumps out chemotherapy agents out of tumor cells --> resistance
66
difference between LN from malignancy and infection (benign)
malignancy: monoclonal lymphocytes benign: polyclonal lymphocytes.
67
microscopic exam of brain mass shows foci of necrosis and hemorrhage
glioblastoma multiforme
68
What factors drive angiogenesis?
VEGF and FGF
69
What are the top 3 cancers in women
breast, lung colon
70
non tender cervical lymphnode that increases and decreases in size over time
follicular small cleaved cell lymphoma
71
proto oncogenes
``` ras n-myc ERB-B1 ERB-B2 TGF alpha sis abl ```
72
anti oncogenes
``` BRCA NF1 APC/beta catenin DCC p53 Rb WT1 ```
73
mechanism of action of etoposide
dysfunction of topoisomerase II--> DNA fractures
74
What type of anemia is HUS?
microangiopathic hemolytic anemia
75
most common bugs in sickle cell with septic shock
Strep pneumo | H. influenzae
76
bugs in sickle cell osteomylelitis
Salmonella Staph aureus E. coli
77
defect xeroderma pigmentosum
lack of endonuclease
78
calculate relative risk reduction (RRR)
(control absolute risk - treatment absolute risk)/control absolute risk
79
mechanism of damage of carbon tetra chloride
free radical injury
80
induces cachexia
TNF alpha
81
what is 6 mercatopurine inactivated by
xanthine oxidase
82
What does Rb control?
G1-S transition | if hypophosphorylated, cannot progress to S

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