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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
Q

what does PT measure?

A

extrinsic pathway

factors I, II, V, VII, X

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26
Q

What does PTT measure

A

intrinsic pathway

all factors except VII and XIII

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27
Q

Where is the defect in hemophilia A

A

factor VIII

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28
Q

where is the defect in hemophilia B

A

IX

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29
Q

coagulation labs for a person on hemodialysis

A

accumulation of uremic toxins impairs platelet aggregation and adhesion

prolonged bleeding time
normal PT
normal PTT
normal platelet count

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30
Q

prolonged bleeding and bleeding in joints is suggestive of what disease

A

hemophilia

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31
Q

What are the coag labs for hemophilia

A 
PTT prolonged (hemophilia is factor VIII or IX problem)
normal PT, thrombin time, and bleeding time.
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32
Q

what translocation is associated with follicular lymphoma?

what gene overexpression

A

t(14;18)

BCL-2

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33
Q

homocysteine needs B12 to synthesize what substance

A

methionine

34
Q

what is the mechanism of action of desmopressin to stop bleeding?

A

stim release of factor VIII and vWF from endothelial cells–> temporary increase in VIII

useful for hemophilia A (problem with VIII)

35
Q

anemia with elevated HbA2

A

beta thalassemia

36
Q

what is the defect in beta thalassemia?

A

defective globin mRNA transcription, processing, and translation

37
Q

Stop codons

A

UAA
UGA
UAG

38
Q

elevated WBC
peripheral smear with immature cells (bands, metamyelocytes, myelocytes)
decreased leukocyte alkaline phosphatase

A

CML

39
Q

translocation with CML

A

t(9; 22)

40
Q

translocation with Burkitt’s lymphoma

A

t(8; 14)

B looks like 8

41
Q

translocation with follicular lymphoma

A

t(14; 18)

Fourteen, follicular

42
Q

translocation with M3 AML

A

t(15; 17)

M3, 15/3

43
Q

translocation with Ewing sarcoma

A

t(11; 22)

44
Q

translocation with Mantle cell lymphoma

A

t(11; 14)

tl looks like 11

45
Q

overexpression with burkitt’s lymphoma

A

c-myc

46
Q

overexpression with follicular lymphoma

A

bcl-2

47
Q

translocation associated with B-ALL

A

t(12; 21)

48
Q

markers for CLL

A

CD5, CD20

49
Q

Rituximab

A

monoclonal Ab against CD20 (B cell marker)

good for treatment in non hodgkins B cell lymphoma

50
Q

thrombocytopenia
renal insufficiency
hemolytic anemia

A

HUS, think Ecoli O157:H7

undercooked hamburger

51
Q

bite cells

A

G6PD

52
Q

What is the difference in mechanism of action of unfractionated heparin and enoxaparin?

A

unfractionated heparin binds antithrombin and inactivates thrombin and factor Xa

enoxaparin inactivates Xa only

53
Q

what is the most likely cause of macrocytosis in sickle cell

A

folic acid deficiency

high turn over of RBC, need more folic acid

54
Q

antibiotic that causes aplastic anemia

A

choramphenicol

55
Q

/What is tumor lysis syndrome?

A

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
Q

How to prevent renal impairment in tumor lysis syndrome?

A

allopurinol or rasburicase

57
Q

family hx of multiple cancers before 45yo

A

Li-Fraumeni syndrome

58
Q

inheritance of Li fraumeni syndrome and associated mutation

A

autosome dominant

p53

59
Q

function of p53

A

arrest cell with mutant DNA in G1/S until it is repaired

cannot repair–> apoptotsis

60
Q

What is Kaposi Sarcoma associated with

A

HIV HHV8

61
Q

thrombosis with anemia and pancytopenia

CD55 and CD59 deficiency

A

paraoxysmal nocturnal hemoglobinuria

62
Q

what cranial nerves pass through the jugular foramen

A

CN IX, X, XI

63
Q

effects of radiation therapy in decreasing tumor size

A

double stranded DNA breaks

formation of Oxygen free radicals

64
Q

calculate attributable risk percent

A

(relative risk -1)/relative risk

65
Q

multidrug resistance gene

A

glycoprotein that functions as a ATP dependent efflux pump that pumps out chemotherapy agents out of tumor cells –> resistance

66
Q

difference between LN from malignancy and infection (benign)

A

malignancy: monoclonal lymphocytes
benign: polyclonal lymphocytes.

67
Q

microscopic exam of brain mass shows foci of necrosis and hemorrhage

A

glioblastoma multiforme

68
Q

What factors drive angiogenesis?

A

VEGF and FGF

69
Q

What are the top 3 cancers in women

A

breast, lung colon

70
Q

non tender cervical lymphnode that increases and decreases in size over time

A

follicular small cleaved cell lymphoma

71
Q

proto oncogenes

A 
ras
n-myc
ERB-B1
ERB-B2
TGF alpha
sis
abl
72
Q

anti oncogenes

A 
BRCA
NF1
APC/beta catenin
DCC
p53
Rb
WT1
73
Q

mechanism of action of etoposide

A

dysfunction of topoisomerase II–> DNA fractures

74
Q

What type of anemia is HUS?

A

microangiopathic hemolytic anemia

75
Q

most common bugs in sickle cell with septic shock

A

Strep pneumo

H. influenzae

76
Q

bugs in sickle cell osteomylelitis

A

Salmonella
Staph aureus
E. coli

77
Q

defect xeroderma pigmentosum

A

lack of endonuclease

78
Q

calculate relative risk reduction (RRR)

A

(control absolute risk - treatment absolute risk)/control absolute risk

79
Q

mechanism of damage of carbon tetra chloride

A

free radical injury

80
Q

induces cachexia

A

TNF alpha

81
Q

what is 6 mercatopurine inactivated by

A

xanthine oxidase

82
Q

What does Rb control?

A

G1-S transition

if hypophosphorylated, cannot progress to S

remember (16 decks)

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