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129 Cards in this Set
- Front
- Back
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What molecule increases membrane fluidity? |
Cholesterol
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What is responsible creating the charge of cells? What is does it move and what is the net charge (positive or negative)?
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Na/K ATPase, 3 Na+ out and 2 K+ in, negative
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What are the adhesion molecules that form cell-cell and cell-extracellular matrix adhesions?
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desmosomes/hemidesmosomes
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What forms cell-cell occluding junctions to form an impermeable barrier (ie epithelium)?
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tight junctions
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What type of junctions allow communication between cells and what are their subunits called?
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gap junctions, connexin
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What is the intramembrane protein that transduces a signal from receptor to response enzyme?
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G proteins
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What are the phases of the cell cycle?
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G1, S, G2, M
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Which phase of the cell cycle is the most variable and determines the cycle length?
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G1
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What is quiescent cell cycle phase called?
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G0
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What are the 4 phases of mitosis?
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Prophase, Metaphase, Anaphase, Telophase
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In which phase of mitosis does the following occur?
centromere attachment, spindle formation, nucleus disappears |
Prophase
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In which phase of mitosis does chromosome alignment occur?
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Metaphase
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In which phase of mitosis are the chromosomes pulled apart?
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Anaphase
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In which phase of mitosis does a separate nucleus form around each set of chromosomes?
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Telophase
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The outer membrane of the nucleus is continuous with what other structure?
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rough endoplasmic reticulum
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Where are ribosomes made?
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Nucleolus
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Steroid hormone - binds receptor in _____ then enters nucleus and acts as transcription factor.
Thyroid hormone - binds receptor in ____, then acts as transcription factor. |
cytoplasm
nucleus |
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What are the purines?
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adenine, guanine
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What are the pyrimidines?
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cytosine, thymidine, (uracil in RNA)
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In glycolysis, 1 glucose molecule generates how many ATP and pyruvate molecules
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2 each
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Where does the Krebs cycle occur?
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mitochondrial matrix
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What is the overall ATPs produced from 1 molecule of glucose?
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36
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What is converted to glucose in gluconeogenesis?
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lactic acid and amino acids
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An elegant mechanism for the hepatic conversion of muscle lactate into new glucose. Pyruvate plays a key role in this process.
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Cori Cycle
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What organelle synthesizes proteins that are exported (increased in pancreatic acinar cells)?
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Rough endoplasmic reticulum
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In what organelle does lipid/steroid synthesis as well as drug detox (increased in liver and adrenal cortex)?
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Smooth endoplasmic reticulum
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What organelle modifies proteins with carbohydrates; proteins are then transported to the cell membrane, are secreted or are targeted to lysosomes?
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Golgi apparatus
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Activated by calcium and diacylglycerol (DAG). Phosphorylates other enzymes and proteins.
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Protein kinase C
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Activated by cAMP. Phosphorylates other enzymes and proteins.
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Protein kinase A
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Thick filaments. Uses ATP to cause muscle contractions.
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Myosin
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Thin filaments that interact with Myosin.
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Actin
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Form specialized cellular structures such as cilia, neuronal axons and mitotic spindles, also involved in the transport of organelles into the cell.
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Microtubules
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A specialized microtubule involved in cell division (forms spindle fibers, which pull chromosomes apart).
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Centriole
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What are the three initial responses to vascular injury?
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vascular vasoconstriction, platelet adhesion, thrombin generation
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Which pathway starts with: exposed collagen + prekallikrein + HMW kininogen + factor XII?
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Intrinsic Pathway
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Which pathway starts with tissue factor (injured cells) + factor VII?
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Extrinsic pathway
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What does thrombin do?
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converts fibrinogen to fibrin
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What comprises the prothrombin complex and where does it form?
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X, V, Ca, platelet factor 3 and prothrombin
on platelets |
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Which factor is the convergence for the intrinsic and extrinsic pathways?
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Factor X
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What does tissue factor pathway inhibitor inhibit?
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Factor X
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Combines with platelets to form platelet plug leading to hemostasis.
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Fibrin
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Which factor helps crosslink fibers?
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XIII
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What is the key to coagulation? Converts fibrinogen to fibrin, activates V, VIII and platelets.
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Thrombin
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What is the key to anticoagulation? Binds and inhibits thrombin. Inhibits IX, X, XI. And binds heparin.
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Antithrombin III
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Vitamin-K dependent. degrades factors V and VIII. degrades fibrin.
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Protein C
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Vitamin K dependent, protein C cofactor.
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Protein S
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Where is tissue plasminogen activator released from?
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Endothelium
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Degrades factors V and VIII, fibrinogen and fibrin
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Plasmin
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Natural inhibitor of plasmin, released from endothelium
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Alpha 2 antiplasmin
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Which coagulation factor has the shortest half-life?
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VII
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Which two coagulation factors are considered the labile factors, activity is lost in stored blood but activity not lost in FFP?
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V and VIII
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Which is the only coagulation factor not synthesized in the liver (synthesized in endothelium)?
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Factor VIII
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Which are the vitamin k dependent coagulation factors?
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II, VII, IX, and X, proteins C and S
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How long does it take for Vitamin K to take effect?
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6 hours
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When does FFP take effect and how long does it last?
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immediate and 6 hrs
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What is the normal half life of RBCs, platelets, and PMNs respectively?
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120 days, 7 days, 1-2 days
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From the endothelium, decreases platelet aggregation and promotes vasodilation.
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Prostacyclin (PGI2)
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Antagonistic to TXA2
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Prostacyclin (PGI2)
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From platelets, increases platelet aggregation, and promotes vasoconstriction.
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Thromboxane (TXA2)
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Triggers release of calcium in platelets, exposes GpIIb/IIIa receptor and causes platelet-to-platelet binding, platelet-to-collagen binding. Also activates the PIP system to further increase calcium
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Thromboxane (TXA2)
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Contains highest concentration of vWF VIII; used in von Willebrand's disease and hemophilia A (factor VIII deficiency), also contains fibrinogen
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cyroprecipitate
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Has high levels of all factors (including labile factors V and VIII), protein C, protein S and AT-III
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FFP
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What role does DDAVP and conjugated estrogens play in coagulation?
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cause release of VIII and vWF from endothelium
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Measures II, V, VII, and X; fibrinogen; best for liver synthetic function
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PT
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Measures most factors except VII and XIII (thus does not pick up factor VII deficiency); also measures fibrinogen
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PTT
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INR > ____ is a relative contraindication to performing surgical procedures. INR > ___ relative contraindication to central line placement, percutaneous needle bx and eye surgery
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1.5, 1.3
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Most common cause of surgical bleeding
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Incomplete hemostasis
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Most common congenital bleeding disorder
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von Willebrand's disease
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Links Gp1b receptor on platelets to collagen?
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vWF
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Which type of vW disease is most common? Which type causes the most severe bleeding?
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Type I, Type III
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What is the difference in treatment between vW disease types I and III and II?
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Type I and III - recombinant VIII:vWF, DDAVP, cryoprecipitate, conjugated estrogens
Type II - recombinant VIII:vWF, cryoprecipitate |
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Hemophilia A (VIII deficiency) levels need ___% preoperatively, keep ___% after surgery.
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100%, 30%
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Will newborns with hemophilia A bleed at circumcision?
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No factor VIII crosses the placenta.
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What is treatment for hemophiliac joint?
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no aspiration
ice, range of motion exercises, factor VIII concentrate or cryoprecipitate |
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Pt with Hemophilia A and epistaxis, intracerebral hemorrhage or hematuria. What is the tx?
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recombinant VIII:vWF or cryoprecipitate, possibly DDAVP
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Christmas disease
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hemophilia B
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Hemophilia B (IX deficiency) levels needed preoperatively
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100%
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What is the PTT and PT in the hemophilias?
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Prolonged PTT, normal PT
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What is the tx for hemophilia B?
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recombinant factor IX concentrate or FFP
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What is the PT and PTT in Factor VII deficiency?
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PT is prolonged, PTT is normal
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What is the tx for factor VII deficiency?
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recombinant factor VII concentrate, FFP
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Name 2 medications that can cause acquired thrombocytopenia?
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H2 blockers, heparin
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GpIIa/IIIa receptor deficiency on platelets. What is it called and what is the tx?
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Glanzmann's thrombocytopenia, platelets
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Gp1b receptor deficiency on platelets (cannot bind to collagen). What is it called and what is the tx?
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Bernard Soulier, platelets
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What does uremia do to coagulation and what is the tx?
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inhibits platelet function, tx hemodialysis (1st), DDAVP, platelets
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What does ticlopidine do and what is the tx?
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decreases ADP in platelets, prevents exposure of GpIIb/IIIa. Tx is platelets
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Inhibits cAMP phosphodiesterase, increases cAMP, decreases ADP-induced platelet aggregation, Tx: platelets.
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Dipyridamole
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What does pentoxifylline do? and what is tx?
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inhibits platelet aggregation, platelets
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ADP receptor antagonist. Tx: platelets.
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Clopidogrel
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What is the concern with PCN/cephalosporins and coagulation?
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bind platelets, can increase bleeding time
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Thrombocytopenia due to antiplatelet antibodies. Can also cause platelet aggregation and thrombosis.
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HITT (second T for thrombosis)
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What is the tx for HITT
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stop heparin. Argatroban, hirudin, ancrod or dextran to anticoagulate
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Decreased platelets, prolonged PT, prolonged PTT, low fibrinogen, high fibrin split products, high D-dimer.
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DIC
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Inhibits cyclooxygenase in platelets, decreased TXA2
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ASA
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When to stop ASA before surgery?
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7 days
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When to stop Coumadin before surgery?
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7 days, consider starting heparin
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Keep platelets >____ before surgery and >____ after.
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50K, 20K
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Prostate surgery can release ___ which activates plasminogen leading to thrombolysis. What is the treatment?
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urokinase. e-Aminocaproic acid (Amicar)
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What is the best way to predict bleeding risk?
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H and P
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What is the symptom common with vWF deficiency and platelet disorders?
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Epistaxis
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What is the most common congenital hypercoagulability disorder?
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Leiden factor
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What is the defect in Leiden factor and what is the tx?
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defect on factor V that causes resistance to activated protein C; tx: heparin, warfarin
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What is the second most common hypercoagulability disorder and what is the treatment?
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Hyperhomocysteinemia; Tx: folic acid and B12
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What is the treatment for Prothrombin gene defect G20210 A or Protein C or S deficiency?
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heparin/warfarin
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What is the treatment for Antithrombin III deficiency?
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(heparin does not work and this can develop after previous heparin exposure); tx: recombinant AT-III concentrate or FFP (highest concentration of AT-III) followed by heparin or hirudin or ancrod; warfarin
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Defect in platelet function; usually have thrombosis, can have bleeding.
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Polycythemia vera
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What should the Hct and platelets be before surgery in a patient with polycythemia vera and was is the tx?
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Hct < 48 and platelets < 400, ASA
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What is diagnosed with: prolonged PTT (not corrected with FFP), positive Russell viper venom time, false-positive-RPR test for syphilis?
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Lupus anticoagulant (antiphospholipid antibodies)
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What is the treatment for Lupus anticoagulant?
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heparin/warfarin
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What is the most common factor causing acquired hypercoagulability?
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tobacco
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Pt >55 with venous thrombosis with no known cause. Best next step.
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CT of chest, abdomen and pelvis to screen for CA.
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What can occur when a pt is placed on Coumadin without being heparinized first? and why?
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Warfarin induced skin necrosis. The short half life of protein c and s results in a relative hyperthrombotic state
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Pts with what condition are the most susceptible to Warfarin induced skin necrosis.
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Relative protein c deficiency
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What are the key elements in venous thrombosis? what about arterial?
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virchow's triad, endothelial injury
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Tx for 1st DVT? 2nd? 3rd?
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1st - warfarin for 6 months; 2nd - warfarin for 1 year; 3rd or significant PE - warfarin for lifetime
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Most common source of DVT causing PE?
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iliofemoral region
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What does dextran do?
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inhibits platelets and coagulation factors
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Improve venous return but also induce fibrinolysis due to release of tPA from compression.
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Sequential Compression Devices
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How does heparin work?
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Activates antithrombin III
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What is the half-life of heparin and how is it cleared?
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60-90 min; cleared by reticuloendothelial system
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Treatment for hypercoagulability in pregnancy?
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Warfarin crosses the placenta, heparin doesn't
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What are 2 sx of long term heparin?
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osteoporosis, alopecia
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What percentage of pts treated with protamine develop protamine reaction and what are the sx?
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4%-5%, hypotension, bradycardia and decreased heart function
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Leeches, irreversible direct thrombin inhibitor also the most potent; at increased for bleeding complications want PTT 60-90
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Hirudin (Hirulog)
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Direct thrombin inhibitor, metabolized in the liver, half-life is 50 minutes, often used in pts with HITT.
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Argatroban
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Reversable direct thrombin inhibitor, metabolized by proteinase enzymes in the blood; half-life is 25-30 minutes
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Bivalirudin (angiomax)
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Malayan pit viper venom; stimulates tPA release
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Ancrod
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Inhibits fibrinolysis by inhibiting plasmin. Used in DIC, persistant bleeding following cardiopulmonary bypass, thrombolytic overdoses.
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e-Aminocaproic acid (Amicar)
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What do you follow after thrombolytics (streptokinase, urokinase, tPA)
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fibrinogen <100 associated with increased risk and severity of bleeding
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