June 5th Flashcards
Pyruvate dehydrogenase cycle and cofactors
Glycolysis to TCA Cycle Requires "TLC For Nancy" Thiamine pyrophosphate B1 Lipoid acid CoA B5 FAD B2 NAD B3
4 fates of pyruvate
Oxalacetate
Alanine
Lactate
Acetyl CoA
3 Enzymes to know in TCA cycle and which is the RLS?
Citrate synthase
Isocitrate dehydrogenase (RLS)
Alpha ketoglutarate dehydrogenase (same enzymes and cofactors as pyruvate dehydrogenase)
Inhibitors of ETC
Inhibits Complex 1 = MPP, Amytal, Rotenone
Inhibits Complex 3 = Antimycin A
Inhibits Complex 4 = N3-, CO, H2S, CN (cyanide)
Inhibits ATP synthase = Oligomycin A (macrolide)
ETC Uncouplers
High dose aspirin
2,6 - dinitrophenol
Thermogenin
Causes of Acute Pancreatitis
"BAD HITS" Biliary causes Alcohol Drugs (HIV Rx) HyperCa and Hypertriglycermia Idiopathic Trauma (ECRP) Scorpion sting
Deficient enzyme in Galactokinase Deficiency and Sx
Galactokinase
Infantile cataracts
Galactose in blood and urine
Deficient enzyme in Fructose intolerance and Sx
Aldolase B
“Bad Dz”
Inhibition of glycogenolysis and gluconeogenesis due to builup in fructose - 1- phosphate
Fasting hypoglycemia, jaundice, vomiting with consumption of fructose
Deficient enzyme in Lactose deficiency
Lactase
Bloating/osmotic diarrhea due to colonic bacteria digestion of lactose
Deficient enzyme in Classic Galactosemia and Sx
Galactose - 1 - phosphate uridyltransferase Failure to thrive Infantile cataracts Intellectual disability Jaundice Hepatomegaly E.coli sepsis
Deficient enzyme in Essential Fructosuria
Fructokinase
Asx with fructose in blood and urine
Causes of G6PD Deficiency Hemolysis
"Spleen Purges Nasty Inclusion From Damaged Cells" Sulfonamides Primaquine Nitrofurantoin Isoniazid Fava beans Dapsone Chloroquine
RBC findings in G6PD Deficiency
Heinz bodies = denatured Hb precipitates in cells
Bite cells
What does G6PD do?
Regnerates NAPH for the production of GSH (reduced glutathione) which is an important antioxidant in RBCs
How does GSH protect against oxygen radicals? (ENZYME)
GSH reduces H202 to H20 through glutathione peroxidase
What disease is NADPH oxidase deficient in? and what bacterial are they susceptible to?
Chronic Granulomatous disease
At risk for infection with catalase + bacteria (Staph and Strep)
Sx of Serotonin Syndrome
Muscle rigidity
Hyperthermia
Cardiovascular collapse due to Autonomic instability
Kwashiokor defect and Sx
Protein malnutrition "FLAMES" Fatty liver (no ApoB100 = lipid buildup) Anemia Malnutrition Edema Skin lesions
Defect in familial hypercholesterolemia
LDL Receptors
Apolipoprotein that activates LCAT
ApoA-1
Apolipoprotein that mediates chylomicron secretion
ApoB-48
Apolipoprotein that mediates VLDL secretion
ApoB-100
Apolipoprotein that cofactor for lipoprotein lipase
ApoC-II
Apolipoprotein that mediates uptake of remanent particles
ApoE
Rate limiting enzyme of fatty acid synthesis
Acetyl CoA carboxylase
Rate limiting enzyme of B-oxidation of fatty acids
Carnithine acyltransferase 1
Rate limiting enzyme of ketone body synthesis
HMG CoA synthetase
Rate limiting enzyme of cholesterol synthesis
HMG CoA reductase (inhibited by Statins)
Phenylalanine derivatives
Tyrosine >> thyroxine = TH Dopa >> melanin Dopamine >> HVA NE >> VMA Epi >> Metanephrines
Tryptophan derivatives
Uses Vit B6
Niacin»_space; NAD/NADH
Serotonin»_space; Melanin
Histidine derivatives
Uses Vit B6
Histamine
Glycine derivatives
Uses Vit B6
Porphyrin»_space; Heme
Glutamate derivatives
Uses Vit B6»_space; GABA
Glutathione (antioxidant)
Arginine derivatives
Urea
Creatinine
Nitric oxide***
Anti-HTN safe in pregnancy
"Htn Moms Love Nifidepine" Hydralazine Methyldopa Labetalol Nifidipine
What do these cells secrete? G cells I cells S cells D cells Parietal cells
Gastrin CCK Secretin Somatostatin IF and gastric acid
Zinc deficiency Sx
Delayed wound healing Decreased adult hair Dysgusia (loss of taste) Anosmia Acrodermatitis enteropathica (well demarcated scaly patches in anus, eye, mouth) Anorexia & diarrhea Growth retardation Depressed mental status Impaired night vision Infertility
Organs affected by excess mercury
Kidneys and brain
Hypocalcemia signs
Tetany and neuromuscular irritability
Chovestek
Trousseau –> carpal pedal spasm
Basophilic stippling and ring sideroblasts
Iron toxicity
Describe bacillus anthracis skin lesion
Black eschar with necrosis surrounded by edematous ring (due to lethal factor and edema factor)
Common causes of ARDS
Shock Infxn Toxic gas inhalation Heroin OD Aspiration Acute pancreatitis High O2 concentrations
How can sarcoidosis cause Vit D tox?
Increased activation of Vit D by epithelial macrophages
Study looking at populations
Ecological survey
Can only draw hypothesis
Crytococcus neoformans meningitis tx
Amphoteracin B
Tx of chronic bronchial asthma to reduce luminal inflammation
Corticosteroids (Flutacisone)
