Week 1 Random Flashcards

1
Q

Bloom’s Taxonomy

A
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2
Q

Components of Diagnosis

A

Explanation

Prognostication

Therapy

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3
Q

H & P

A

HISTORY

Chief Complain History of present illness Past medical history Surgical history Family history Social history Sexual history Review of systems Allergies Medications

PHYSICAL

Physical exam Labs Imaging and other ancillary tests Assessment/Differential Diagnosis

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4
Q

AP & CP and subcategories

A

AP

Surgical Pathology, Cytology, Hematopathology, Autopsy

CP

Clinical Chemistry, Microbiology, Blood Bank/Transfusion/ Molecular and Genetic Pathology, Hematopathology

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5
Q

Why order tests

A

Routine

Preoperative

Monitoring

Diagnostic

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6
Q

Lab categories

A

Chemistry

Urinalysis

Microbiology

Hematology

Serology (antigen interaction)

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7
Q

Reference Range vs. Optimal Range

A

Reference range – “normal” that encompasses 95% of population; specific to the equipment

Optimal (health) range – therapeutic target associated with optimal health set by us

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8
Q

Analytic Variability vs. Intraindividual variability

A

Analytic Variability – variability due to equipment

Intraindividual variability – natural biological fluctuations

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9
Q

General Chemistry (lab) / CMP

A

Aka Chem20, Profile1, Chem7 Comprehensive Metabolic Panel (CMP)

Liver, kideny, electrolytes, lipids, and glucose test

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10
Q

Liver function

A
  1. Synthesis and secretion of proteins Storage of energy (glycogen)

2 Metabolizes many drugs and toxins

  1. Transformation and Clearance (e.g. conjugation of bilirubin)
  2. Aids digestion (biliary system)
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11
Q

AST/ALT elevation

A

Hepatic injury or necrosis:

  1. viral hepatitis
  2. fatty liver
  3. toxins (including medications)
  4. strenuous exercise
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12
Q

What is the cause for uncojugated and conjugated bilirubin elevation?

A

Unconjugated: ELEVATED

  • hemolysis
  • kernicterus (destuction of baby’s blood)
  • Crigler-Najjar syndrome (deficiency of conjugating enzyme)
  • Gilbert’s disease (reduced activity of glucuronyltransferase)

Conjugated: ELEVATED

(due to obstruction)

  • hepatitis,
  • dubin-johnson syndrom (obstruction in secretion of conjugated form into bile)
  • biliary obsturction (bile cannot flow into intestine)
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13
Q

Hemoglobim breakdown

A

Hemoglobim

heam

biliverdin

bilirubin (uncoj)

bilirubin (conj)

urobilinogen

stercobiliongen

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14
Q

Albumin function

A
  1. Main agent of intravascular osmotic pressure
  2. Serves in the transport of bilirubin, hormones, and metals, vitamins, and drugs

* making 150-250mg/kg/day

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15
Q

Albumin increas and decrease

A

INCREASE:

  • Dehydration Decrease:

DECREASE (synthesis):

  • End-stage liver disease
  • intestinal malabsorption syndromes
  • protein malnutrition e.g.

DECREASE (loss):

  • nephrotic syndrome
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16
Q

Globulin function composition and test for the level

A

COMPOSITION

Serum proteins including carrier proteins

Enzymes

Complement

TEST

immunoglobulins serum electrophoresis

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17
Q

Kideny function

A

Filters 200L & removes 2L

Produces Erythropoeitin

Produces Renin

Produces Vit D

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18
Q

Kidney tests

A
  1. Blood Urea Nitrogen (BUN) – measures breakdown of proteins
  2. Creatinine – breakdown product of creatine in muscles
  3. Urinalysis (physical, chemical e.g. glucose, bilirubin, protein, leukocyte, pH, specific gravity, and microscopic examination)
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19
Q

Blood in urine symptom

A

Urinary Bladder Cancer

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20
Q

Heart tests

A
  1. Lipid Panel (possible blockage - artheroschlerosis)
  2. Beta Natriuretic Protein (released when heart stretches)
  3. Troponins (damage to muscle)
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21
Q

Brain tests

A

Lumbar puncture: protein, glucose, cell differential, culture, blood

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22
Q

Lungs tests

A

Arterial Blood Gas (ABG) pH, O2, CO2

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23
Q

Endocrine tests

A

Hemoglobin

A1c

TSH

FSH

LH

PTH

Testosterone

Estrogen *

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24
Q

Osler’s Rule

A

Correlate all abnormalities into a single plausible explanation

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25
Differential diagnosis
A systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible. Systematically obtain information then use process of elimination
26
Progressive disclosure
interaction design technique often used in human computer interaction to help maintain the focus of a user's attention by reducing clutter, confusion, and cognitive workload. This improves usability by presenting only the minimum data required for the task at hand.
27
RCT
Randomized Control Trial Prodivdes fair conclusion and blinding Removes bias
28
Coincidence vs. Concoted incidence
Coincidence -- unlikely event occurring by chance
29
Bayes' Theorem
Allows calculation of a probability if something is correct or incorrect based on the evidence
30
Research questions should be... Types of research questions...
Qualities: Specific, answerable, novel, and relevant Types: descriptive, evaluative, and explanatory
31
Evidence Based Medicine practice requirement: AAAAA
Asses the patient (clinicla problem) Ask the clinical question (PICO) Acquire the evidence (search for evidence) Appraise the evidence (usability and closeness to truth) Apply
32
Types of studies
Case series and case reports (based on chart notes) Case control studies (base on chart notes with control notes) Cohort studies (follow the group) Randomized Control Studies
33
Declaration of Helsinki
The placebo can be only used when no alternative drugs are availible. Patient consent.
34
Bradford-Hill Criteria for Causation
1. Strength of association 2. Consistency of different studies 3. Specificity of association with particular disease 4. Temoral relationship (exposure precedes disease) 5. Biological gradient (dose-response relationship) 6. Plausability (biological plausilibity) 7. Coherence (consistent with what is known) 8. Experiment reversibility 9. Existence of analogous evidence
35
Types of imaging
X-Ray Fluoroscopy (X-Ray real time) CT scan (forms sections) MRI (joints, neural tissue, dense breast tissue no good for blood or bone) Ultrasound (sonar, water) Mammography (good for dense breast tissue, not good for masses of blood, better for soft tissue)
36
Sievert values
1 Sv 5.5% chance of cancer 10,000 mSv radiation sickness 50 mSv lowest dose for cancer 15 mSv C.T. Scan of abdomen and pelvis 2 mSv head C.T. Scan 2 mSv natural radiation/year 0. 10 mSv cheast X-ray 0. 01 mSv dental X-ray
37
Standard position for Chest X-ray
PA
38
Number of X-Rays required to visualize 3D
2
39
X-Ray depends on
Atomic number, density, and thickness
40
Types of X-Ray anodes
Usually -- tungsten Mammography -- rhodium
41
Types of contrast media
High Osmolar HOCM Low Osmolar LOCM Iso Osmolar IOCM
42
Air-Liquid interfaces
Help to determine the position
43
Relationship between penetration, contrast, and voltage
Up penetration -\> lower contrast Up penetration -\> higher voltage Body penetration reduces dose Object Penetration reduces contrast
44
Window setting
Allow adjustment and focus on a specific tissue
45
Contrasts medium
Barium (Ba) CT -- safe unless there is a perforation Gadolinium (Ga) MRI -- changes the relaxation time; dangerous to kidney function if reduced; may cause nephrogenic systemic fibrosis (NSF)
46
Senescent
No division
47
Prescription abbreviations ac ; bid ; gtt ; od/s ; po ; pc ; prn ; q4h ; qd ; tid ; IV ; IM
ac - antre cibum - before meals bid - bis in die - twice a day gtt - gutta - drops od - oculus dexter - right eye os - oculus sinister po - per os - by mouth pc - post cibum - after meals prn - Pro re nata - as needed q3h - quaque 3 hora - every 3 hours qd - quaque die - every day tid - ter in die - 3 times a day IV (intravenously)
48
Prescription components
SUPERSCRIPTION 1) Name of practitioner including address 2) Patients name, address, age, weight, and date INSCIRPTION 3) Drug name, strength, quantity, ect. SUBSCRIPTION 4) Directions 5) Refil times 6) Label 7) Specify if brand and not generic is desired 8) Signature of practitioner
49
Categories of drugs
Over-the-Counter Legend Drugs (prescription) Controlled Substances (Principal or secondary site of action is the Central Nervous System generally)
50
Classification of controlled substances
Schedule I: no currently accepted medical use and may lead to serious dependence Schedule II: accepted medical use; may lead to severe dependence; may not be refilled; must be filled within 14 days (nv); do note fill before/dispense until; handwrited only; separate sheet Schedule III: Moderate to low physical dependence and possible high psychological dependence; 6 refill Schedule IV: Low dependence; 6 refill Schedule V: Limited dependence liability
51
Requirements for prescribing controlled substances
DEA number Registered with specific state Visible proof of registration Legitimate medical purpose Cannot self-prescribe Schedule II-IV
52
Bio-equivalents Therapeutic Equivalents
Bio-equivalents -- the same chemical property of a generic drug Therapeutic Equivalents -- the same effect of the drug
53
FDA Recall drugs classes
Class I -- Severe health consequence Class II -- cause temporary or medically reversible adverse health Class III -- is not likely to cause adverse health
54
FDA Category Use in Pregnancy
Category A -- fail to demonstrate a risk to the fetus Category B Category C -- Drugs should be given only if the potential benefit justifies the potential risk to the fetus Category D -- There is positive evidence of human fetal risk Category X -- the risk of the use of the drug in pregnant women clearly outweighs any possible benefit
55
Human mitochondrial genome
16.5 kb mtDNA encodes 13 proteins 22 tRNAs, and 2 rRNAs
56
4P's
Predictive Preventative Personalized Participatory
57
SSLPs
simple sequence length polymorphisms (SSLPs): tandem repeat sequences that display length variations. 1) minisatellites, also known as variable number tandem repeats (VNTRs) 2) microsatellites or simple tandem repeats (STRs)
58
Pol α Pol β Pol γ Pol δ Pol ε
Pol α - Primase activity; Initiates DNA synthesis; No Proof Pol β - DNA Repair; No Proof Pol γ - Replicates mitochondrial DNA; Proof Pol δ - Elongates Okazaki fragments; Proof Pol ε - Leading strand synthesis & DNA Repair; Proof
59
Herpes 1 vs 2
Herpes simplex 1 is a DNA virus that causes cold sores. Herpes simplex 2 causes most genital herpes infections.
60
Levels of Maternal Serum Alpha-Fetoprotein
HIGH: Dating error, Neural Tube defects, Twins, Abdominal Wall defect, Fetal demise, Low Birth Weight LOW: Fetal demise, Dating error, Lack of pregnancy, Molar Pregnancy, Trisomy
61
When and why are Heel stick blood draws done
Newborns before discharge and at 10-14 days, to test for Metabolic Disorders(phenylketonuria) Endocrine Disorders(Hypothroidism) Hematological Disorders (Sickle Cell) Cystic fibrosis
62
Breast Quadrants
UIQ, UOQ, LIQ, LOQ
63
Lipid Panel
Cholesterol Triglycerides HDL Cholest/HDL Ratio LDL
64
Quadruple aim
Triple Aim (Better patient experience, better patient outcome, lower cost) + physician experience
65
Mutations causes
Endogenous - attack by reactive oxygen species - replication errors Exogenous - UV and ionizing radiation including x-rays and gamma rays, plant toxins - Man-made mutagenic chemicals that act as DNA intercalating agents, cancer chemotherapy and radiotherapy - Viruses
66
Functions of blood
Gases-O2, CO2 Nutrients, electrolytes, waste Hormones, cell signals (cytokines) Immune response Inflammatory response Clotting Acid buffering
67
Complete Blood Count test results
1. RBC (quantity of blood) (count/uL) expressed in 10^6 2. Hgb (concentration of hemoglobin) -- Hemoglobin (spectronomny) in g/dL; O2 carrying capacity 3. Hct (concentration of blood) -- Hematocrit % of blood cells (HCT = RBC (cells/L) x MCV (L/cell)) 4. MCV (size of blood) -- Mean corpuscular volume (fL) measured by counter plotted on historgram 5. RDW -- Red cell distribution width (standard deviation) 5. Plt (count/uL) 6. WBC =white blood cells=leukocytes=white cells count/mL 7. WBC (count/uL)
68
RBC (erythorcyte) Hormone that simulates? How many cells are made per day? Lifespan of RBCs?
EPO 2-3 trillion 120 days
69
H/H
Hematocrit / Hemoglobin
70
Types of blood cells
Blood stem cells Myeloid stem cell RBC (early Reticulocyte) Platelest Myeloblast -\> all WBCs except Lymphocyte Neutrophilic stab=band cell (early Neutrophil) Lymphoid stem cell -\> Lymphoblast B, T Lymphocyte and NK Neutrophil = "polys" = "segs"
71
Effects on RBCs sizes
Lack B12 = large Lack Iron = small
72
Risk of occurence vs. reoccurence
occurence = Depends on population frequencies of the disorder and the rate of spontaneous mutations recurrence = the probability that a genetic disorder that has occurred in a family will recur in another member in the same or in future generations
73
Ka vs. Kd
Association constant = [P·L]/([P][L]) (affinity) Dissociation constant = ([P][L])/[P·L]
74
Michaelis Menten Equation
v = Vmax·[S]/(KM + [S]) where Vmax = [E]tot·k3 and KM = (k2 + k3)/k1
75
Lineweaver Burk Plot
The enzyme with the highest “specificity” or “preference” for catalyzing a reaction is the enzyme with the highest specificty v = Vmax·[S]/(Km + [S]) 1/v Km/(Vmax[S]) + 1/Vmax y 1/Vmax x = 1/Km slopeKm/Vmax
76
Enzyme types: Oxidoreductases Transferases Hydrolases Lyases Isomerases Ligases
Oxidoreductases -- e- transfer Transferases -- group transfer Hydrolases -- hydrolysis reaction Lyases -- addition of groups to double bonds or formation of double bonds by removal of groups Isomerases - transfer of groups within molecules Ligases - formation of C-C, C-S, C-O, and C-N bonds by condensation coupled with ATP
77
Enzyme Specificity
Vmax/KM
78
Irreversible Inhibitors Competitive Inhibition Non-Competitive Inhibition Uncompetitive Inhibition
Irreversible Inhibitors -- Vmax DOWN; Km unaffected (Removing the concentration of the enzyme) Competitive Inhibition -- Km UP; Vmax unaffected (Always can out compete the enzyme) Non-Competitive Inhibition -- Vmax DOWN; Km unaffected (alternative reactions) Uncompetitive Inhibition -- Vmax DOWN; Km DOWN (Even enzyme is saturated, rate will be slower; Km substrate binds more readily)
79
Anemia diagnosis
MCV and RDW
80
Repair systems and causes for activations
BaseER -- X-Ray, radicals, alkylating agents, spontaneous reaction NucleotideER - UV; polycyclic aromatic hydrocarbons RecR/NHEJ - IR, UV-light; X-rays; anti-tumor agents MismatchR - replication errors
81
Radiolucent
allow radiation to pass more freely
82
Positive contrast vs. Negative contrast examples
Barium (high density) vs. Air (low density)
83
Object penetration reduces what? Body penetration reduces what?
Object penetration reduces the contrast Body penetration reduces the dose
84
Brest mammography CC (craniocaudal) MLO (mediolateral oblique)
squeezed top-bottom squeezed left-right
85
Genome composition
1/2 Transposons (SINES, LINES, and retrovir like) 1/3 Genes (1.5% exons, introns) 1/4 Repeats, other?
86
Site specific recombination types: - DNA only - Retrovilar-like retrotransposons - Nonretroviral retrotransposons
DNA only - short inverted repeats - cut and paste Retroviral-like retrotransposons - Long terminal repeats - Reverse transcriptase and integrase Nonretroviral retrotransposons - Poly A at 3’ end of an RNA intermediate - Reverse transcriptase and endonuclease
87
PICO
P: Patient or population (age, sex, race) I: Intervention (exposure, diagnostic test, therapy) C: Comparison group (nothing, placebo, another intervention) O: Outcome of interest (clinical effect or intervention)
88
Four basic gene elements
Promoter, coding, intervening, structural (untranscribed and 3' and 5' UTR)
89
Radioucent material from most to least
Air, Fat, Water/tissues, Spongy, Bone, Compact Bone
90
Antibiotics acting on Topoisomerase
EUKYAROTES Irinotecan Act on: Human topoisomerase I Uses: Colon, ovarian, small cell lung cancers Etoposide Act on: Human topoisomerase II (prevents ligation) Testicular cancer Doxorubicin Act on: Human topoisomerase II (intercalating agent; stabilize topo II on DNA) A variety of cancers BACTERIA Ciprofloxacin Act on: Bacterial DNA gyrase (topoII) Use: Gm(-) infections, COPD
91
Jaundice
A medical condition with yellowing of the skin or whites of the eyes
92
Kernicterus
Hyperbilirubinemia during the neonatal period describes the history of nearly all individuals who suffer from kernicterus. It is thought that the blood–brain barrier is not fully functional in neonates and therefore bilirubin is able to cross the barrier.
93
Gilbert's disease
The cause of this hyperbilirubinemia is the reduced activity of the enzyme glucuronyltransferase, which conjugates bilirubin and a few other lipophilic molecules.
94
Kwashiorkor
Is a form of severe protein–energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. Sufficient calorie intake, but with insufficient protein consumption, distinguishes it from marasmus. Kwashiorkor cases occur in areas of famine or poor food supply.
95
Nephrotic syndrome
It is characterized by an increase in permeability of the capillary walls of the glomerulus leading to the presence of high levels of protein passing from the blood into the urine low levels of protein in the blood.
96
Atherosclerosis
Artery wall thickens as a result of invasion and accumulation of white blood cells and remnants of dead cells, including cholesterol and triglycerides, eventually calcium and other crystallized materials, within the outer-most and oldest plaque.
97
Nephrogenic systemic fibrosis (NSF)
Renal failure due to exposure to gadolinium
98
Heart hypertrophy
Increase in volume of the heart
99
Hemothorax
Is a type of pleural effusion in which blood accumulates in the pleural cavity.
100
Appendicitis
is an inflammation of the appendix; left untreated will burst and spill infections materials into the abdominal cavity
101
Fibroid
are non-cancerous growth that develop in or just outside a woman's uterus. Uterine fibroid develop from normal uterus muscle cells that start growing abnormally. As the cells grow, they form a benign tumor.
102
Pelvic inflammatory disease
is an infection of female reproductive organs; PID is one of the most serious complications of a sexually transmitted disease
103
Peritonitis
is an inflammation of the peritoneum the tissue that lines the inner wall of the abdomen; left untreated can result in sepsis; severe abdominal pain worsened by any movement
104
Ovarian torsion
refers to the rotation of the ovary to such a degree as to occlude the ovarian artery and/or vein
105
Endometriosis
Happens when tissue normally found inside the uterus grows in other parts of the body; it may attach to the ovaries, fallopian tubes, the exterior of the uterus, the bowel, or other internal parts.
106
Small bowel obstruction
occurs when small or large intestine is partly or completely blocked
107
Ectopic pregnancy
a pregnancy in which the fetus develops outside the uterus, typically in a Fallopian tube
108
Gastroenteritis
or stomach flu is an inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection and causing vomiting and diarrhea
109
Constipated
infrequent bowel movement and difficulty during defecation
110
Ovarian cyst
are fluid-filled sacs or pockets within or on the surface of an ovary; a large cysts can cause
111
Electrolytes
odium, Potassium, Chloride, Phosphorus, Calcium, Carbon dioxide, and Magnesium
112
AST ALT
aspartate transaminase–alanine transaminase ratio OR aspartate aminotransferase–alanine aminotransferase ratio
113
LFT
Liver profile
114
Medical Research Evidence Based Medicine Characteristics
1. Delcaration of Helsinki 2. Bradford-Hill criteria for causation 3. Data collection and outcomes 4. Sample size, power, and cuasation
115
Defining characteristics of studies
Primary outcomes must be well defined Secondary outcomes are common Sample size determined based on the primary outcome Composite outcomes can be useful
116
Sample SD Population SD
117
What properties can be changed in beam?
Volatge Anode
118
Under and Over Penetration
119
Breast Density and Composition Mammogram
120
Breast Mammogram
121
MRI characterstics
0.5-3 Tesla Small radio frequencies MRI constrast media are considered safer than CT media
122
Evidence: Case Series and Case Reports
Retrospective observational studies Determine commonalities in medical history or other associations among those affected
123
Evidence: Case Control Studies
Retrospective observational studies of a particular diagnosis or exposure Can establish correlations but cannot prove causation
124
Evidence: Cohort Studies
Used when a RCT would be unreasonable or unethical. Compare two groups of subjects over time, one having a particular condition or receiving a particular treatment, the other not
125
Evidence: Randomized Controlled Studies
Randomly assigns subjects into treatment group or a control group to compare efficacy of a treatment, diagnosis, drug
126
Over the counter Drugs characteristics
Deemed safe without professional guidance Quality standards during manufacturing Safety and effectiveness monitored by FDA
127
Legend / Prescirption drugs characteristics
Require physician to be dispenced Considered unsafe unless supervides by a licensed practitioner Must be labeled "Federal law prohibits dispensing without prescription"
128
Controlled Substances characteristics
Addictive potential for trafficing Primary or secondary stie on CNS Drug Enforcement Agency responsible for identifying and regulating drugs in this class Can be OTC, legend, or unabailable
129
Who is responisble for standards for drug purity in the US?
Non-profit organizations like USP or U.S. Pharmacopoeia
130
e.g. of DNA and RNA viurs
Herpes (DNA) and HIV-1 (RNA)
131
Purifying Selection
Negative Selection
132
Synteny
Stretches of conserved gene order on chromosomes e.g. globin genes clusters
133
Acyclovir
134
High fiedility proofreading mechanisms
135
Inherited Syndromes with DNA Repair defect
MSH2, 3, 6, MLH1, PMS2 (colon cancer) = mismatch repair Xeroderma pigmentosum (XP) (skin cancer) = nucleotide excision repair Ataxia–telangiectasia (AT) (leukemia) = ATM protein kinease BRCA2 (breast cancer) = homologous recombination Fanconi anemia (leukemia) = DNA interstand cross-link repair
136
Transposons
DNA only short inverted repeats cut and paste Retroviral-like retrotransposons Long terminal repeats Reverse transcriptase and integrase Nonretroviral retrotransposons Poly A at 3’ end of an RNA intermediate Reverse transcriptase and endonuclease
137
Role of RBCs, WBCs, and platelates
RBC: O2/CO2 transport, acid buffer WBCs: immune response, inflammation Platelets: clotting
138
Why there might be a little variability between RBCs?
Young RBCs (reticulocytes) are slightly larger.