Test 3 Articles Flashcards
Hydromorphine (dilaudid):
10x more potent then morphine
Porphyria:
- Define:
- Other than anemia, what is the other issue with porphyria:
- Define:
A family name for diseases of faulty heme production. - Other than anemia, what is the other issue with porphyria:
There is a build up of toxic intermediates with porphyria. Depending on which of the eight enzymes is malfunctioning the toxic intermediate will cause different issues.
Acute Porphyria:
- Number of types:
- What makes them acute?
- Most Common type:
- Number of types: 4 types of acute - What makes them acute? Toxic intermediates cause damage to nerves in all areas of the body - Most Common type: Acute Intermittent Porphyria
How is porphyria treated?
You give hemen.
Hemen is the end product of the of the pathway porphyria disrupts. The end product causes the pathway to stop production, allowing for destruction of toxic intermediates.
Basophilic stippling:
- What is it?
- What is it indicative of?
- Causes?
- What is it?
patients RBCs contain bluish-purple staining granules (a form of nucleic acid protein) - What is it indicative of?
Toxic insult to the bone marrow - Causes:
LEAD POISONING! Also: certain drugs, severe bacterial infection, and alcoholism.
A patient had seizures associated with lead poisoning.
- Why is lead toxic?
- What is the treatment?
- Why is lead toxic? Body mistakes lead for Calcium (nerves are particularly damaged) - What is the treatment? Chelation therapy Diet rich in green veggies also helps
What is the most frequent cause of lead poisoning?
How does it effect IQ?
What has happened to the accepted threshold of lead poisoning.
Paint chips in old homes
Lowers it.
10 ug/dL -> 5 ug/dL
Prednisone:
- What other factor can prednisone effect?
Steroid that suppresses the immune system
How does birth control relate to thrombus formation?
Female hormones have been correlated with increased clotting factor and decreased inhibition of clotting
They give 4x the risk of clot formation
What is the name for a thrombus within the leg?
A deep vein thromboses (DVT)
Factors which increase the likelihood of a DVT?
Flying (anytime you sit for a long time)
Age
Contraceptives (at least oral)
Factor V Leiden (X linked recessive)
What makes DVTs dangerous?
They can break off pieces which cause a pulmonary embolism.
What is the treatment for a DVT?
Heparin (which activates antithrombin III, which in turn decreases fibronogen -> fibrin by inactivating factor X and the glycoproteins namesake, factor II (thrombin)
Purpura and thrombocytopenia are both symptoms of what?
Thrombocytopenia.
Possible DIT disseminated intravascular thrombosis
What is a possible treatment for thrombocytopenia?
Removal of spleen
Transfer of new thrombocytes
What is the believed cause of idiopathic thrombocytopenia purpura?
Autoimmune disease
What are possible treatments for a stroke (thrombosis):
Tissue Plasmin Activator (40% chance of survival)
Insertion of a catheter, followed by wire to drill into the clot, followed by a stent retriever device. Must be used with TPA (65% chance of survival)
Acute Aortic Dissection:
- Define:
- Common Causes:
- Define:
a tear occurs in the innermost layer of your aorta, blood is pumped into this tear separating it from rest of your body. This can cause rupture of the aorta, less effective flow of blood, and clotting. It is associated with pain. - Common Causes:
High blood pressure, atherosclerosis, inherited disease.
Treatment for an acute aortic dissection:
Open heart surgery:
- Synthetic grafts to the Aorta
- Replace aortic semilunar valve
What is the difference between a hemorrhagic and clot driven stroke?
One the oxygen is lost because of bleeding (blood exits before it can get to the proper location).
The other the oxygen is lost because of a clot.
How can tPA help to treat a hemorrhagic stroke?
If the ventricles fill up significantly with blood tPA can help to clear the blood.
Why does CO poisoning kill?
Normal half life of CO in blood:
It binds to hemoglobin with higher affinity then oxygen.
5 1/2 hours
Approved therapy for CO poisoning:
100% oxygen solution (Oxygen therapy)
- half life CO reduced to 74 minutes
100% oxygen solution at pressure (hyperbaric Oxygen therapy)
- half life CO reduced to ~20 minutes
New proposed therapy for CO poisoning:
A mutated neuroglobin which binds with CO with high affinity.
- half life CO reduced to 25 seconds
Symptoms of CO poisoning by percentage
- 10 - 20%:
- 30%
- Greater 30%:
- When death occurs:
- 10 - 20%: dizziness, weakness, impaired concentration and judgement - 30% labored breathing, chest pain and confusion - Greater 30%: loss of consciousness - When death occurs: depends on the person's health
Syncope define:
Syncope loss of consciousness due to low blood pressure
Vasovagal Syncope:
Your body has an excitatory stimuli, like the sight of blood. Your parasympathetic innervation (vagus nerve) counteracts it, a little bit too much. The drop in blood pressure as you calm down causes syncope.
Electrocardiogram:
- Explain what each wave means:
- Explain what each wave means:
P: atria depolarize
QRS: Ventricles depolarize
T: Ventricles repolarize
Right Bundle Branch Block:
- ECG:
- Define:
- ECG:
After the initial Q wave there is a second longer Q wave. - Define:
This is because the right bundle branch of the purkinje fibers is not transmitting. Charge instead spreads from the left ventricle to get to the right ventricle, but it is slower, causing a delay before the right contraction/depolarization.
Brugada Syndrome:
- What is it?
- Why is it caused?
- What is it?
An abnormal EKG of right bundle branch block.
Also has a puffed out S-T segment (puffed out because Na+ influx is slower) - Why is it caused?
A mutant protein in the Na channel for conduction of electrical impulse across cardiac cells. It causes the Na to enter slowly which leads to increased lag.
Sudden Unexpected Nocturnal Death Syndrome:
Is associated with Brugada Syndrome.
Night time vagal activity can cause generate uneven electrical conduction in the heart, which can cause you to pass out or die.
Treatment for Sudden Unexpected Nocturnal Death Syndrome:
Installing a implantable defibrillator.
What is meant by “A tumor is descriptive, not diagnostic”:
A tumor is just an unusual mass, the mass does not have to be cancerous.
What is the most helpful sign in deciding if a tumor is cancerous?
The Aretha Franklin sign. R-E-S-P-E-C-T. Even if the cells look tortured, ugly, and overly proliferative, if they show respect for other cells they are most likely benign.
What caused the collapse of the patient in the Arethra Franklin Sign article?
Endometriosis.
Define Endometriosis:
Endometrial cells migrate from the uterus for an unknown reason, and adhere to another tissue (usually the fallopian tubes or ovaries, where it can cause infertility). In our clinical application
Fibrillation:
is the rapid, irregular, and unsynchronized contraction of muscle fibers.
Rheumatic fever:
- Define:
- Mose commonly damaged valves:
- Side effects given which side of the heart is most likely damaged:
- Define:
Immune response against streptococcus also damages the heart and its valves. - Mose commonly damaged valves:
Mitral valve and aortic semilunar valve (Valves under the most pressure) - Side effects given which side of the heart is most likely damaged:
Overworked right side to increase pressure at the heart, increased chance of cardiac thrombosis
What is the name of the toxic intermediate which accumulates (at leas in the urine) due to acute intermittent porphyria.
porphobilinogen
