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317 Cards in this Set
- Front
- Back
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What does null hypothesis mean
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no difference exists
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How do you define type I error?
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incorrectly rejects the null hypothesis
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what is type II error?
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incorrectly accepts the null hypothesis
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What is type III error?
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conclusions are not supported by data
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How is a prospective cohort study arranged?
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non-random assignment to treatment group
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What is a meta-analysis?
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review and combining of statistics from data of different studies
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What is an ANOVA t-test for?
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more than 2 samples of quantitative data
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What are non-parametric statistics for?
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Qualitative data analysis
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What are nominal qualitative variables?
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named variables, such as color
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What are ordinal qualitative variables?
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Arranged on a scale, such as pain from 1-10
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What is prevalence?
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Number of people having a disease in a population studied; prevelance is higher in long-lasting non-fatal diseases
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What is incidence?
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The number of newly diagnosed cases of a disease in a population over time, usually yearly.
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What is sensitivity?
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the ability to detect disease
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What is the equation for sensitivity? (+result and true +)
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positive test results / true positives
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What is specificity?
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Ability to state that no disease is present
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Equation for specificity
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negative test results / (true negatives + false positives)
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What cell is the source of fever in atalectasis?
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Alveolar macrophages
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What are the cellular characteristics of mitochondria?
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2 membranes with an inner matrix
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What cycle takes place in the inner matrix of mitochondria?
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TCA cycle
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How do the rough endoplasmic reticulum and outer membrane of nucleus relate?
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they are continuous
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Where are ribosomes made?
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Nucleolus, which has no membrane
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What proteins are made in the rough endoplasmic reticulum?
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proteins for export
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What proteins are made in the smooth endoplasmic reticulum?
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cytoplasmic proteins
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What are the contents and proportions of the plasma membrane?
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60%protein, 40% lipid.
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higher cholesterol in membrane equals ______ of proteins
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higher mobility
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Symptoms/ exam findings of malignant hyperthermia
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fever, tachycardia, rigidity, acidosis
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cause of malignant hyperthermia
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calcium release from sarcoplasmic reticulum
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First sign of malignant hyperthermia?
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increased end-tidal CO2
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What is the treatment for malignant hyperthermia?
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Stop operation and anesthetics, give dantrolene and supportive care
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T/F: Malignant hyperthermia usually occurs at a patient's first exposure to anesthesia.
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False, usually not first exposure
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What are the first and last muscles to recover from paralytics?
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First: Diaphragm. Last: neck and face.
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What type of tissues don't have lymphatics?
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Muscle, bone, tendon, brain
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How are the cells of lymphatics joined?
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Loosely in a cell to cell junction. No basement membrane.
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What is the rate limiting step in cholesterol formation?
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HMG co-A reductase, steroid precursor found in the liver
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What part of the target cell do steroid hormones go to?
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They are bound in the cytoplasm before going to the nucleus.
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What are the initial and final products of the Krebs cycle?
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one glucose makes 38 ATP
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What are the initial and final products of anaerobic glycolysis?
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one glucose makes 2 ATP and a lactate
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What drugs increase Cytochrome p450 activity?
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anticonvulsants, coumadin, theophylline
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What drugs decrease Cytochrome p450 activity?
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cimetidine, INH, MAOIs, disulfiram
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What makes renin?
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Macula Densa
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What does the macula densa sense?
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low Sodium and chloride levels
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Action of renin
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converts angiotensinogen to Angiotensin I
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What converts Angiotensin I to II? Where?
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Angiotensin converting enzyme, in the lung
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What is the action of angiotensin II?
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vasoconstrictor, increases aldosterone
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Electrolyte changes with aldosterone
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retaining sodium; losing potassium and hydrogen in the urine
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What changes occur with renal osteodystrophy?
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The kidney loses calcium and retains phosphorus, causing decreased Vit D hydroxylation
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What is renal osteodystrophy
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secondary hyperparathyroidism
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Hepatic branch comes off which part of the vagus?
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left (anterior)
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What branch does the right vagus give off?
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Celiac branch and criminal nerve of Degrassi
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Why is it the "criminal" nerve of Degrassi?
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Can lead to high post-vagotomy acid levels if undivided
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Which pathway is measured by ptt?
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intrinsic pathway
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What triggers the intrinsic pathway?
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exposed collagen
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Which pathway triggers factor X?
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both intrinsic and extrinsic
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How does factor X lead to clot formation?
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X activates thrombin to produce fibrin
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Which pathway is measured by PT?
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extrinsic pathway
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What triggers the extrinsic pathway?
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tissue factor
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____ crosslinks ____ to form "plug"
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Factor XIII; fibrin
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What is the best single test to evaluate synthetic function of the liver
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PT
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Banked blood is high or low in 2,3 DPG? increases or decreases O2 affinity?
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low; decreases O2 affinity (left shift)
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Which blood product contains fibrinogen and VWF-III?
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Cryoprecipitate
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In what bleeding disorders is cryoprecipitate used in?
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von willebrand's disease, hemophilia A, DIC if fibrinogen is low
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Which factors are inhibited by coumadin?
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Vit K: 2, 7, 9, 10, protein C and S
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What is the action of protein C? and S?
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C degrades active Factor V and VIII, S helps.
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Factors V and VIII are at ____ levels in stored blood
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low- these factors are labile
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What is the only factor not made by the liver?
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Factor VIII
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What are the coagulation test findings in Von Willebrands?
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long PTT, long bleeding time, positive ristocetin test
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What is the difference between Type I and III Von Willebrand disease and Type II?
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I and III: low levels of von willebrand's factor, whereas II has qualitatively poor vwf.
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What product is useful in von Willebrands Type I and III and why?
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DDAVP- causes von willebrand factor release
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DDAVP is useful in what bleeding dyscrasias?
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TYpe I and III VW disease, uremic platelet disfunction, pts on aspirin
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What bleeding dyscrasias are autosomal dominant?
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von Willebrand's, Rosenthal's XI deficiency
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What is the one inherited coagulopathy with a long bleeding time?
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Von Willebrand's
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What is Glanzmann's thrombasthenia?
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IIb/IIIa receptor deficiency in platelets, with decreasing platelet aggregation
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What is Bernard Soulier disease?
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Ib receptor deficiency in platelets, decreased adherence to exposed collagen
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PT/PTT results in Factor VII deficiency
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long PT, normal PTT
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What is hemophilia A?
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sex-linked recessive factor VIII deficiency
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To what % should Factor VIII be replaced pre-operatively in hemophilia A?
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100%
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PT/PTT results in hemophilia A
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long PTT, normal PT
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Treatment for a hemophiliac joint
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Do NOT aspirate. ice, range of morion therapy, give factor VIII
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What is hemophilia B?
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sex-linked factor IX deficiency (Christmas disease)
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To what % should Factor IX be replaced pre-operatively in hemophilia B?
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50%
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What is lupus anticoagulant?
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antiphospholipid antibodies, generally pre-coagulant and not associated with Lupus
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How can you diagnose lupus anticoagulant?
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long Russel Viper venom time, long PTT which does not correct by adding normal plasma
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Why is heparin needed in cardiopulmonary bypass?
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Factor XII is activated by bypass
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What is Factor V Leyden?
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activated protein C resistance (common cause of DVT)
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Plasmin degrades ____ and is inhibited by _____
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fibrinogen; alpha-2-plasmin inhibitor
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What is the mechanism of heparin?
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Binds and activates antithrombin III and inactivates Factors 9-12
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How does heparin change coag levels?
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elevates PTT
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How do you reverse heparin?
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protamine
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Treatment for thrombolytic overdose; how does it work?
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epsilon-aminocaproicacid (E-ACA) inhibits fibrinolysis
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Best test to moniter thrombolysis?
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thrombin time
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Lab values in DIC
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low platelets, prolonged PT/PTT, low fibrinogen, high fibrin split products
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What is HIT?
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"white clot syndrome": anti-platelet antibody causing platelet aggregation and thus thrombocytopenia
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When after heparin does HIT usually occur?
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about 5 days
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True or false: HIT doesn't occur with low molecular weight heparin
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False, it occurs but less frequently
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Action and origin of prostacyclin?
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decreases platelet aggregation, vasodilation, bronchial relaxation. from endothelium
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Action and origin of thromboxane
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increases platelet aggregation, causes vasoconstriction; from platelets
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Best pre-op test for patient on NSAIDs or aspirin?
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bleeding time
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Where is pepsinogen produced?
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Chief cells
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Action of pepsinogen?
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initiates proteolysis
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Cell of origin for intrinsic factor
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binds B12, absorbed in the terminal ileum
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Main stimuli for H+ production?
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Acetylcholine, Gastrin, Histamine
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How do Ach and gastrin work to produce acid?
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activate PIP system, releasing calcium to activate protein kinase C to increase HCl production
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What cells does histamine work on and via what?
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acts on parietal cells via cAMP to increase HCl
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What cells produce gastrin?
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Antral G cells
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What inhibits gastrin production?
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acidification of duodenum
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What stimulates gastrin production?
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Acetylcholine, amino acids in duodenum
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Action of omeprazole?
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blocks hydrogen/potassium ATPase in parietal cell
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Effects of somatostatin
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decreases gastrin, insulin, secretin, acetylcholine, pancreatic output, biliary output.
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What stimulates somatostatin?
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acid in duodenum
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Effects of proximal vagotomy on stomach emptying liquids?
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increased liquid emptying by abolishing receptive relaxation
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Effects of proximal vagotomy on stomach emptying solids?
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no change
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Effects of truncal vagotomy on stomach emptying solids?
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increased emptying when pyloroplasty done
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Most common post-vagotomy symptom
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Diarrhea- 35%
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How common is post-vagotomy dumping syndrome?
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10%
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Physiology of early dumping syndrome post-vagotomy
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hyperosmotic load causing fluid shift
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Physiology of late dumping syndrome post-vagotomy
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increased insulin, low glucose
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Usual treatment for dumping syndrom?
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except 1%, responds to dietary measures
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What activates trypsinogen into trypsin
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enterokinase
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Where is CCK secreted from
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intestinal mucosa
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Actions of CCK (3)
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gallbladder contraction, sphincter of Oddi relaxation, increased pancreatic enzyme secretion
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What is the primary stimulus of pancreatic bicarb secretion?
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Secretin
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High flow rate in the pancreas causes high or low bicarb, high or low chloride?
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high Bicarb, low chloride
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how does flow rate affect the bicarb and chloride concentrations in the pancreas?
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Slow flow allows the HCO3/Cl exhange to occur; slow flow is low bicarb, high chloride
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Action of enteroglucagon?
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increased small bowel mucosal hypertrophy, including adaptation after bowel resection
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What secretes Peptide YY?
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terminal ileum (in setting of proteins and carbs)
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What is the action of Peptide YY?
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"ileal brake"; acid secretion is inhibited
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Contents of bile
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80% bile salts, 15% lecithen, 5% cholesterol
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When do stones form in bile?
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if too much cholesterol or too little salts or lecithin
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How is bile concentrated?
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Active reabsorption of Na, Cl, followed by water in the gallbladder
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How large is the bile pool and how much is lost daily? how often is it recirculated?
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5 grams, 0.5 grams lost daily (10%). recirculates q4 hours
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What are the primary bile acids?
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Cholic acid, chenodeoxycholic acid.
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What are secondary bile acids? how do they form?
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deoxycholic acid, lithocholic acid- formed by intestinal bacteria
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What is the MMC?
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interdigestive motility
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How long are MMC cycles?
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90 minutes
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What organs are involved in MMC?
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stomach through terminal ileum consecutively
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Describe MMC phase I
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quiescence
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MMC Phase II
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gallbladder contraction
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MMC phase III
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peristalsis
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MMC phase IV
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subsiding electrical activity
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What is the stimulatory hormone for MMC?
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motilin
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how does erythromycin's prokinetic activity work?
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stimulates motilin receptor
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Which is more permeable to water, ileum or jejunum?
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Jejunum- paracellular absorption of sodium and water
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What stimulates B cells to become Ab-secreting plasma cells?
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IL 4
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What are opsonins?
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Ig's that can fix complement: IgG (2) or IgM (1)
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What operation decreases IgM levels?
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splenectomy
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What immunoglobulin is made first?
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IgM
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What immunoglobulin is in secretions?
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IgA
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What is the primary serum Ig?
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IgG
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Which Ig crosses the placenta?
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IgG
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What Ig is involved in parasitic reactions and allergic reactions?
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IgE
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What Ig is involved in Type I hypersensitivity?
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IgE
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Which region of the antibody is responsible for antigen recognition?
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variable region
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Which complement factors are anaphylatoxins?
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C3a, C5a
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Which parts of complement make the MAC?
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C5-9
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What activates the classic complement cascade?
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antibodies
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What activates the alternate path?
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bacteria
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Where do the classic and alternate paths meet?
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C3
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What does MHC class I activate?
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CD8 cells
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Where is MHC I found?
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all nucleated cells
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What does MHC class II activate?
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CD4 cells
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Where are MHC II found?
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B cells, dendrites, monocytes
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What is responsible for immunosurveillance against cancer?
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Natural Killer cells- they recognize cells without self-MHC
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What is the action of IL2 on natural killer cells?
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converts them to Lymphokine activated killers
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Is a Natural Killer Cell a T cell or B cell?
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neither, no antigen presentation needed, they recognize any cell without a Self-MHC
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Best test to evaluate cell-mediated immunity?
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intradermal skin test
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Source of histamine in the blood?
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basophils
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Source of histamine in the tissue?
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mast cells
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Endotoxin is from what type of bacteria?
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gram negatives
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What makes up endotoxin?
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lipopolysaccharide A
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Causes for SVo2>77%?
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cyanide or sepsis
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Effects of sepsis on glucose?
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Hyperglycemia comes 24hrs before overt sepsis
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how does sepsis effect oxygenation?
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decreases oxygen extraction, so increased SVO2, decreased delta A-V O2
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Possible locations of intrabdominal abscess (4)
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sub-diaphragmatic, sub-hepatic, interloop, pelvic
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Treatment for C Diff?
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oral vanco or flagyl
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Infections that present within first few post-op hours
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Beta-hemolytic strep and Clostridial
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Clear slime with chronic infection is characteristic of what bug?
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Staph Aureus (coag -)
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How do aminoglycosides work?
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bactericidal, irreversibly bind to ribosome
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How does resistance to aminoglycosides work?
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decreased active transport (toward ribosome)
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Clindamycin: bacteriostatic or bactericidal?
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bacteriostatic
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Erythromycin mechanism of action?
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reversible binding to ribosome (same as clinda and tetracycline)
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How does vanco work?
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Binds plasma membrane
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how does vanco resistance work?
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altered cell wall
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What causes MRSA resistance?
|
altered bacterial binding protein (not beta-lactamase)
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What drugs inhibit beta-lactamase?
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sulbactam, clavulanate (unasyn and augmentin)
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How does amphotericin work?
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binds sterols to alter fungal walls
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Side effects of amphotericin
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renal impairment (80%), fever, anemia
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Action of quinolones?
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inhibits DNA gyrase
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How does ketamine effect cardiac work? O2 use? blood pressure?
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increases cardiac work, as well as oxygen usage and blood pressure and secretions
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Effect of ketamine on respiratory drive
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Respiratory depression
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Side effect of ketamine
|
hallucinations
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Methoxyfluorane is toxic to what organ?
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kidneys
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Halothane is toxic to what organ?
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liver
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The only depolarizong agent
|
Succinylcholine
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Risk in burn patients with succinylcholine
|
hyperkalemia
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onset of action with succinylcholine
|
fast on/fast off
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Risks/side effects of succinylcholine
|
aspiration, glaucoma
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What antibiotic prolongs neuromuscular blockade?
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clindamycin
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Demerol should be avoided in which patients?
|
those on MAOIs
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What is octreotide?
|
long acting somatostatin analog
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Mechanism of metoclopramide
|
Dopamine antagonist, increasing LES tone and gastric motility
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Mechanism of omeprazole
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H+ ATPase blocker
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Mechanism of digoxin
|
glycoside which inhibits Na-K ATPase pump to increase calcium in the heart, slowing AV conduction, inotropic
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Benefit of digoxin as an intrope
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doesn't increase O2 consumption
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Side effects of digoxin
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gut ischemia from decreased splanchnic flow
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Electrolyte imbalance to avoid with digoxin
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hypokalemia
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Mechanism of amrinone
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phosphodiesterase inhibitor
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net effect of amrinone
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Inotropic, increasing CO, decreasing SVR
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Drugs creating medical adrenalectomy
|
metyrapone and aminoglutethimide
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Medical Orchiectomy drug
|
leuprolide
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Drug to give in GI bleed (besides PPI)
|
vasopressin: reduces splanchnic flow and portal flow about 40%
|
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Drug to give with vasopressin in gi bleed
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Beta blocker to avoid angina
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Drug that relaxes veins and arteries
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Sodium Nitroprusside
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Nitroglycerin relaxes arteries or veins?
|
veins
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Aspirin irreversibly binds _____; how long is the effect?
|
cyclooxygenase; 7 days, the life of a platelet
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________ blocks prostaglandin production
|
indomethacin
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how often is indomethacin effective in closing a PDA?
|
70%
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Other effect of indomethacin
|
decreases renal blood flow
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Cytoprotective drug for pt on NSAIDS to reduce PUD?
|
Misoprostil, replaces prostaglandin E2.
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lab values indicating prerenal azotemia
|
FeNa <1, Urine Na < 20, BUN/creatinine ratio >30
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three body fluids with the highest k concentration
|
1) Saliva, 20 mEq
2) Gastric, 10 3) Pancreatic/duodenal, 5 |
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Which amino acids are metabolized in muscle?
|
branched chain amino acids
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What are the essential amino acids?
|
Leucine, isoleucine, valine
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Where is vitamin D made, what activates it?
|
made in the skin, activate by hydroxylation in liver and kidney
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How do Vitamin D and calcium interact?
|
Vit D increases binding protein to increase intestinal absorption of calcium
|
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What reverses the effects of steroids on wound healing?
|
Vitamin A, systemic or topical
|
|
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Population with highest total body water
|
infants (80%)
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Total body water in men; women.
|
60%; 50%.
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What is the alteration in total body water for obese patients?
|
10% less than normal
|
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Distribution of water in the plastma, interstitium, cells
|
60% TBW: 40% cellular, 15% interstitium, 5% plasma
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Calories in carbs
|
3.4 kcal per gram
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Protein calories
|
4 kcal per gram
|
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Fat calories
|
9 kcal per gram
|
|
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Basal calorie expenditure and protein need
|
25 kcal/kg/day, 1g protein/kg/day needed
|
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Resp quotient definition
|
ratio of CO2 produced to O2 consumed
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Resp quotient in fat use
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0.7
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Resp quotient in carb use
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1.0
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How much nitrogen in protein?
|
1 g nitrogen in 6.25 g protein
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Preferred fuel of small bowel
|
glutamine
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#1 amino acid in bloodstream
|
glutamine
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glutamine levels ___ in stress due to ____
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decrease; glutamine goes to kidney to form ammonium to help acidosis
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What protein decreases translocation and aids mucosal health during bowel chemo/RT?
|
glutamine
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What two forms does fat take to be absorbed?
|
micelles absorbed by enterocytes and enter lymphatics. Medium and short chain TG's enter portal system
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|
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Chromium deficiency?
|
hyperglycemia (relative diabetes) neuropathy
|
|
|
Zinc deficiency
|
perioral rash, hair loss, poor healing, change in taste
|
|
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phosphate deficiency
|
resp weakness, encephalopathy due to phophate need for ATP
|
|
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Copper deficiency
|
anemia, neutropenia
|
|
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Linoleic acid
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dermatitis, hair loss, vision changes
|
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Most variable period of cell cycle
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G1 (growth factors act during it)
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Most sensitive cell cycle phase for RT
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M
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What makes RT most effective?
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high O2 levels
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|
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What decreases skin damage from RT
|
higher energy RT
|
|
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What is obliterative endarteritis?
|
impaired fibroblasts cause decreased healing after RT
|
|
|
How do you biopsy an extremity sarcoma?
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excisional if <4cm, longitudinal incisional biopsy if larger
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Why longitudinal biopsy in sarcoma?
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less lymphatic disruption, easier to excise scar
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Indications for RT in sarcoma
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high grade, close margins, tumor >5cm
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|
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Li Fraumeni syndrome
|
p53 mutation causing sarcomas, breast ca, brain tumor, leukemia
|
|
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How do sarcomas spread?
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hematogenously, not via lymphatics
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|
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Mutations in colon cancer (4)
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loss of APC gene, p53 mutation, DCC (deleted in colon cancer), k-ras activation
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|
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mutations associated with breast ca
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p53, Bcl-2, cmyc, cmyb, her 2 neu
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|
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Tumors associated with cmyc
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small cell lung Ca, neuroblastoma, Burkitts lymphoma
|
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Action of Bcl-2
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regulates apoptosis
|
|
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proto-oncogenes associated with apoptosis
|
BCl-2, p53, cmyc
|
|
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oncogene homologous to PDGF
|
SIS
|
|
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What does erb b oncogene code for?
|
epidermal derived growth factor receptor
|
|
|
tumor associated with decreased survival with erb b
|
breast ca
|
|
|
K ras protooncogene codes for _____
|
GTP protein
|
|
|
tumors associated with K ras
|
pancreatic (90%), colon (50%), lung ca
|
|
|
Proto-oncogene diagnostic for medullary thyroid carcinoma
|
Ret proto-oncogene
|
|
|
Appropriate therapy in a pt with family hx of MEN and + Ret proto-oncogene
|
total thyroidectomy
|
|
|
Action of tamoxifen
|
binds estrogen receptor, decreases breast ca in high risk pts
|
|
|
Risks with tamoxifen
|
DVT, endometrial ca
|
|
|
Chemo drugs causing pulmonary fibrosis
|
bleomycin and busulfan
|
|
|
Chemo drugs causing neurotoxicity
|
vincristine, cisplatin
|
|
|
What is Levamisole
|
antihelminthic drug, also an immunostimulant (chemo)
|
|
|
Cells which provide wound contraction
|
myofibroblasts
|
|
|
Cells responsible for healing by secondary intention
|
myofibroblasts (contracts from center)
|
|
|
Principle collagen in scar
|
Type I
|
|
|
Most abundant collagen type
|
Type I
|
|
|
type of collagen deficient in Ehlers Danlos
|
Type III
|
|
|
collagen type in healing wound
|
Type III
|
|
|
Collagen type in basement membrane
|
Type IV
|
|
|
Collagen type in cartilage
|
Type XI and II
|
|
|
What is the structure of collagen?
|
glycine x 3
|
|
|
What enzyme crosslinks collagen
|
prolyl hydroxylase
|
|
|
What cofactors are needed for collagen crosslinking?
|
alpha-ketoglutarate, Vit C, O2, iron
|
|
|
When does collagen production begin?
|
Day 3
|
|
|
When is maximal collagen production?
|
Day 21?
|
|
|
When does collagen crosslinking occur?
|
At week 3 (after day 21).
|
|
|
When does type III collagen become type I?
|
week 3
|
|
|
T/F: tensile strength in healed wound is equal to pre-wound
|
False, never equal
|
|
|
Opening a wound at least 5 days old will heal quicker, slower, or the same the 2nd time?
|
Quicker because cells and products are already there
|
|
|
Reduces harmful effects of steroids on wound healing
|
Vit A
|
|
|
Name in order the cells appearing in a wound
|
platelets, neutrophils, macrophages, fibroblasts
|
|
|
Cell essential to wound healing
|
macrophages
|
|
|
growth factor which stimulates fibroblasts
|
TGF-beta
|
|
|
result of too much or too long TGF-beta
|
fibrosis (cirrhosis and pulm fibrosis)
|
|
|
Action of TGF beta
|
stimulates fibroblasts, chemotactic for neutrophils, speeds healing
|
|
|
Action of PDGF
|
attracts fibroblasts and increases smooth muscle
|
|
|
Result of PDGF in a wound
|
speeds matrix deposition, collagen formation
|
|
|
Drug used in chemotherapy pts to increase neutrophil and macrophage activity
|
GmCSF
|
|
|
What cells make thromboxane?
|
platelets
|
|
|
Action of thromboxane
|
platelet aggregation, vasoconstriction
|
|
|
Action of PGI2, prostacyclin
|
platelet inhibition, vasodilation, bronchodilation
|
|
|
Which cytokines respond initially to injury?
|
TNF/IL1 (synergistic), Cxc, IL6
|
|
|
Main source of TNF
|
macrophages/monocyte
|
|
|
most potent stimulus for TNF production
|
endotoxin (lipopolysaccharide a) from gram negs
|
|
|
TNF has an anti- or pro- coagulant effect?
|
pro-coagulant
|
|
|
How does TNF cause cachexia in cancer?
|
lipolysis, glycolysis, anorexia
|
|
|
Result of TNF alpha neutrophil recriutment
|
more cytokines and free radicals, multi-organ system failure in exaggerated response
|
|
|
Which cells produce IL 1?
|
macrophages, monocytes
|
|
|
Responsible for fever
|
IL 1
|
|
|
action of IL 1
|
potentiates TNF, increases IL 6, increases endothelium adherence via selectins, ICAM, VCAM
|
|
|
symptoms of acute phase response
|
fever and catabolism
|
|
|
Substances increased in acute phase response
|
CRP, amyloid, fibrinogen, haptoglobin, ceruloplasmin, alpha-1 antitrypsin
|
|
|
Decreased in acute phase response
|
albumin, transferrin, fibronectin
|
|
|
Cxc chemokine action
|
chemotaxis, angiogenesis, wound healing (c for cysteine)
|
|
|
Active agent in Regranex
|
PDGF
|
