Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
240 Cards in this Set
- Front
- Back
T cells |
60 70% total lymphocyte count; ↓ AIDS, DiGeorge, adenine deaminase deficiency
|
|
B cells
|
10-20% total lymphocyte count; ↓ Bruton’s, adenine deaminase deficiency
|
|
Antigen presenting cells
|
B cells, macrophages, dendritic cells
|
|
Langerhan’s cells
|
antigen presenting cell in skin
|
|
Major histocompatibility complex
|
chromosome 6; HLA genes for self-identity
|
|
Class I proteins
|
recognized by CD8 T cells and NK cells
|
|
Class II proteins
|
recognized by CD4 TH cells
|
|
Type I reactions
|
IgE antibodies; mast cells; wheal and flare with bee sting
|
|
Type II reactions
|
antibody-mediated; Goodpasture’s syndrome, rheumatic fever
|
|
Type III reactions
|
immune complex-mediated; SLE glomerulonephritis
|
|
Type IV reactions
|
cellular immunity; granuloma, positive PPD
|
|
Delayed reaction hypersensitivity reactions
|
CD4 TH cells and macrophages
|
|
Cytotoxic reactions
|
CD8 T cells; killing viral infected cells and neoplastic cells
|
|
Graft viability
|
ABO compatibility most important; HLA match
|
|
Fetus
|
allograft that is not rejected
|
|
Hyperacute rejection
|
type II hypersensitivity; ABO incompatibility or anti-HLA antibodies
|
|
Acute rejection
|
predominately cell-mediated reaction; MC rejection
|
|
Graft vs. host reaction
|
jaundice, rash, bloody diarrhea
|
|
IgA immunodeficiency
|
MC hereditary immunodeficiency; giardiasis, allergies
|
|
Bruton’s agammaglobulinemia
|
XR; pre B cannot develop into B cells; S. pneumoniae infections
|
|
DiGeorge syndrome
|
failure 3rd/4th pharyngeal pouches to develop; T cell deficiency; absent thymus
|
|
S/S DiGeorge syndrome
|
absent thymic shadow; Candida, Pneumocystis infections; hypoparathyroidism
|
|
Adenine deaminase deficiency
|
AR; combined B and T cell deficiency; gene therapy
|
|
Wiskott Aldrich syndrome
|
XR; combined B and T cell deficiency; eczema, thrombocytopenia
|
|
AIDS
|
MC acquired immunodeficiency HIV
|
|
HIV transmission
|
MC sexually-transmitted; anal intercourse in homosexuals MCC
|
|
HIV transmission in health care workers
|
accidental needle stick from HIV positive patient
|
|
Follicular dendritic cell
|
reservoir for HIV in lymph nodes in latent phase
|
|
AIDS
|
HIV positive plus CD4, TH cell ≤200 cells/μL or AIDS-defining condition
|
|
Pneumocystis carinii pneumonia
|
MC AIDS-defining disorder
|
|
Screening test for HIV
|
ELISA test; detects anti-gp120
|
|
Confirmatory test for HIV
|
Western blot
|
|
HIV test with two peaks
|
p24 antigen; positive prior to seroconversion and when AIDS is diagnosed
|
|
MC cancer in AIDS
|
Kaposi sarcoma
|
|
MC infections CD4 TH <100 cells/μL
|
CMV, toxoplasmosis, M. avium-intracellulare
|
|
Hereditary angioedema
|
deficiency C1 esterase inhibitor; ↓ C2, C4, normal C3
|
|
Osmosis
|
H2O shift between ECF and ICF; controlled by serum Na+ and glucose
|
|
Serum Na+ ~ TBNa+/TBW
|
decreased TBNa+ dehydration; increased TBNa+ pitting edema
|
|
Isotonic loss
|
serum Na+ normal; adult diarrhea, loss whole blood; Rx with 0.9% saline
|
|
Isotonic gain
|
serum Na+ normal; Rx with salt and H2O restriction
|
|
Hyponatremia
|
ICF expanded; central pontine myelinolysis with rapid IV correction
|
|
Hyponatremia hypotonic gain pure water
|
inappropriate ADH syndrome
|
|
Hyponatremia hypotonic gain TBNa+ and TBW
|
pitting edema; cirrhosis, RHF
|
|
Hyponatremia hypertonic loss TBNa+
|
dehydration; loop diuretic, Addison’s, 11-hydroxylase deficiency
|
|
Hypertonic state
|
hypernatremia or hyperglycemia; ICF contraction
|
|
Hypernatremia hypertonic gain TBNa+
|
pitting edema; sodium bicarbonate
|
|
Hypernatremia hypotonic loss water
|
diabetes insipidus
|
|
Hypernatremia hypotonic loss TBNa+ and TBW
|
osmotic diuresis, sweat, baby diarrhea
|
|
Acidosis
|
potential for hyperkalemia (shift out of ICF)
|
|
Alkalosis
|
potential for hypokalemia (shift into ICF)
|
|
Hypokalemia
|
loop and thiazide diuretics MCC; alkalosis, albuterol/insulin; U wave
|
|
Hyperkalemia
|
renal failure MCC; acidosis, ß-blocker, digitalis toxicity; peaked T wave
|
|
Rx hyperkalemia
|
calcium gluconate → insulin with glucose → loop diuretic
|
|
Respiratory acidosis
|
PaCO2 >45 mm Hg; compensation metabolic alkalosis
|
|
Respiratory acidosis
|
chronic bronchitis, ARDS, barbiturate poisoning, paralysis diaphragms
|
|
Respiratory alkalosis
|
PaCO2 <33 mm Hg; compensation metabolic acidosis
|
|
Respiratory alkalosis
|
pulmonary embolus, anxiety, early bronchial asthma, restrictive lung disease
|
|
Metabolic alkalosis
|
HCO3- >28 mEq/L; compensation respiratory acidosis
|
|
Metabolic alkalosis
|
loop/thiazide diuretics, vomiting, primary aldosteronism
|
|
Metabolic acidosis
|
HCO3- <2 mEq/L; compensation respiratory alkalosis
|
|
↑ AG metabolic acidosis
|
add anions of acid to extracellular fluid
|
|
↑ AG metabolic acidosis
|
lactate, AcAc, ß-OHB, salicylate, oxalate (ethylene glycol), formate (methyl alcohol), phosphate/sulfate (renal failure)
|
|
Ethylene glycol, methyl alcohol
|
compete with alcohol for alcohol dehydrogenase
|
|
Ethylene glycol poisoning
|
antifreeze; converted to oxalic acid; renal failure
|
|
Methyl alcohol poisoning
|
window wiper fluid; converted to formic acid; blindness
|
|
Normal AG metabolic acidosis
|
lose HCO3-; e.g., diarrhea, proximal/distal renal tubular acidosis
|
|
AFP
|
increased in open neural tube defects; decreased in Down syndrome
|
|
PCR
|
uses DNA polymerase
|
|
Barr body
|
inactive X chromosome on nuclear membrane; 1 Barr body in females
|
|
Missense mutation
|
point mutation with different amino acid; sickle cell trait/disease, Marfan
|
|
Nonsense mutation
|
point mutation producing stop codon; ß-thalassemia major
|
|
Frameshift mutation
|
insertion or deletion nucleotides alters reading frame; Tay-Sachs
|
|
Trinucleotide repeat
|
disease worse in future generations (anticipation)
|
|
Trinucleotide repeat disorders
|
fragile X (XR), Huntington’s (AD), myotonic dystrophy (AD)
|
|
Nondisjunction
|
meiosis; unequal numbers of chromosomes
|
|
Robertsonian translocation
|
Down syndrome with 46 chromosomes
|
|
Microdeletion syndrome
|
genomic imprinting; chromosome 15
|
|
Paternal microdeletion
|
Prader-Willi; obese, mental retardation
|
|
Maternal microdeletion
|
Angelman’s syndrome; happy puppy syndrome, mental retardation
|
|
Advanced maternal age
|
increased risk for trisomies
|
|
Down syndrome
|
trisomy 21; leading cause mental retardation
|
|
S/S
|
slanted eyes; simian crease; endocardial cushion defect; Alzheimer’s
|
|
Turner’s syndrome
|
XO; no Barr bodies; short stature and primary amenorrhea; streak ovaries
|
|
Klinefelter’s syndrome
|
XXY; 1 Barr body; female secondary sex characteristics
|
|
AR
|
homozygous (aa) for disease; heterozygotes (Aa) asymptomatic
|
|
AR
|
most inborn errors metabolism, sickle cell, cystic fibrosis, hemochromatosis, Wilson’s
|
|
AD
|
homozygote (aa) or heterozygote (Aa) express disease
|
|
AD
|
spherocytosis, Marfan's syndrome, neurofibromatosis, von Willebrand, familial polyposis, polycystic kidney
|
|
AD
|
delayed manifestation; penetrance; variable expressivity
|
|
XR
|
male transmits to all daughters; female carrier transmits to 50% of sons
|
|
XR
|
G6PD deficiency, Bruton, Lesch-Nyhan, testicular feminization, fragile X, hemophilia A/B
|
|
Fragile X
|
mental retardation; macroorchidism at puberty; trinucleotide repeat
|
|
Lesch Nyhan
|
XR; deficiency HGPRT; hyperuricemia; mental retardation
|
|
Multifactorial inheritance
|
gout, type 2 diabetes, essential hypertension
|
|
Mitochondrial DNA disorder
|
maternal transmission to all children; no paternal transmission
|
|
Y chromosome
|
determines genetic sex
|
|
Testosterone
|
develops seminal vesicles, epididymis, vas deferens
|
|
Dihydrotestosterone
|
develops prostate and male external genitalia
|
|
Male pseudohermaphrodite
|
genetic male; phenotypically female
|
|
Female pseudohermaphrodite
|
genetic female; phenotypically male
|
|
Testicular feminization
|
XR; deficient androgen receptors; MCC male pseudohermaphrodite
|
|
21-Hydroxylase deficiency
|
↑ 17 KS, ↓ 17 OH, lose salt, hypotension; female pseudohermaphrodite
|
|
11-Hydroxylase deficiency
|
↑ 17 KS, ↑ 17 OH, retain salt, hypertension; female pseudohermaphrodite
|
|
17-Hydroxylase deficiency
|
↓ 17 KS, ↓ 17 OH, retain salt, hypertension; male pseudohermaphrodite
|
|
Calculate prevalence
|
carrier rate 1:30; couples at risk
|
|
Calculate carrier rate
|
1:3600; 3600 /4 = 900; √900) = 1:30
|
|
Malformation
|
intrinsic problem with morphogenesis
|
|
HOX gene
|
involved in embryogenesis
|
|
Alcohol
|
MCC of malformations; mental retardation; atrial septal defect
|
|
Isotretinoin acid
|
craniofacial and cardiac defects
|
|
Female with cystic acne needs Rx with retinoic acid
|
do pregnancy test before placing female on drug
|
|
DES
|
problem with mullerian development; clear cell carcinoma of vagina
|
|
Thalidomide
|
limb abnormalities
|
|
Vertical transmission
|
transplacental (MC), delivery, breast feeding
|
|
Congenital CMV
|
MC congenital infection; periventricular calcification; culture urine
|
|
Congenital toxoplasmosis
|
basal ganglia calcification; blindness; avoid cat litter in pregnancy
|
|
Congenital rubella
|
sensorineural hearing loss (MC); cataracts
|
|
Congenital syphilis
|
transplacental after 5-6 months; saddle nose, rhagades, blindness, deformed teeth
|
|
Congenital herpes
|
contracted during delivery; encephalitis
|
|
Deformation
|
extrinsic problem in fetal development; oligohydramnios causing Potter’s facies
|
|
Tobacco
|
leading cause premature death and cancer in United States
|
|
Nicotine
|
most addictive substance; attaches to nicotinic cholinergic receptors
|
|
Tobacco induced cancers
|
lung, oropharynx, larynx, pancreas, kidney, bladder
|
|
Alcohol
|
CNS depressant (cortex, limbic system); legally drunk 80-100 mg/dL
|
|
Alcohol
|
induces SER hyperplasia; increases alcohol metabolism
|
|
Alcohol MCC of
|
folate/thiamine deficiency; sideroblastic anemia; liver fatty change; pancreatitis
|
|
Alcohol
|
hypoglycemia; lactic/ketoacidosis; ↑ triglyceride; AST>ALT; ↑ GGT
|
|
Ketoacidosis in alcoholic
|
ß-hydroxybutyric acid
|
|
Heroin
|
poppy plant; non-cardiogenic pulmonary edema; focal segmental glomerulosclerosis
|
|
MPTP
|
meperidine derivative; produces parkinsonism
|
|
Cocaine
|
blocks uptake of dopamine/norepinephrine; mydriasis; AMI, CNS infarction
|
|
Marijuana
|
tetrahydrocannabinol (THC) binds basal ganglia receptors; delayed reaction time; red conjunctiva
|
|
Intravenous drug abuse
|
HBV hepatitis MC systemic disease
|
|
Acetaminophen toxicity
|
damage by FR acetaminophen; liver cell necrosis; renal papillary necrosis
|
|
Rx acetaminophen toxicity
|
N-acetylcysteine (increases synthesis of glutathione)
|
|
Salicylate toxicity
|
metabolic acidosis + respiratory alkalosis; hyperthermia; tinnitus, vertigo
|
|
Estrogen risks
|
thromboembolism; cholestasis; endometrial/breast cancer
|
|
Oral contraceptives
|
cholestasis, thrombosis, folate deficiency, hypertension, hepatic adenoma
|
|
Hemolytic anemia
|
penicillin, methyldopa, quinidine
|
|
Aplastic anemia
|
benzene, chloramphenicol
|
|
Qualitative platelet dysfunction
|
NSAIDs
|
|
Thrombocytopenia
|
heparin, quinidine
|
|
Macrocytic anemia
|
methotrexate, 5-fluorouracil, phenytoin, OC, alcohol
|
|
Congestive cardiomyopathy
|
doxorubicin, daunorubicin
|
|
Interstitial fibrosis
|
bleomycin, methotrexate
|
|
Hemorrhagic gastritis
|
iron toxicity, NSAIDs
|
|
Liver necrosis
|
acetaminophen, isoniazid, salicylates, halothane, isotretinoin acid
|
|
Cholestasis
|
anabolic steroids, OC
|
|
Fatty change in liver
|
amiodarone, tetracycline, alcohol
|
|
Photosensitive rash
|
tetracycline
|
|
SLE
|
procainamide, hydralazine
|
|
Isopropyl alcohol
|
↑ acetone; CNS dysfunction
|
|
Lead
|
microcytic anemia, nephrotoxic ATN (proximal tubule), gout, encephalopathy, neuropathy
|
|
Mercury
|
fish (tuna, salmon); nephrotoxic ATN; constricted visual fields
|
|
Organophosphates
|
blocks acetylcholine esterase; miosis; paralysis; Rx. atropine, pralidoxime
|
|
Polyvinyl chloride
|
plastic pipes; angiosarcoma of liver
|
|
Scorpion sting
|
paralysis, hypertension, pancreatitis
|
|
Crotaline bite
|
rattlesnakes, water moccasin, copperhead; DIC; serum sickness
|
|
Coral snake bite
|
neurotoxin; binds to presynaptic nerve terminals and acetylcholine receptors
|
|
Contact gunshot wound
|
soot + gunpowder (fouling)
|
|
Intermediate gunshot wound
|
powder tattooing
|
|
Distant gunshot wound
|
no powder tattooing; exit wound larger than entrance
|
|
Motor vehicle accidents
|
leading cause accidental death between 1-39 yrs of age
|
|
Burns
|
Pseudomonas aeruginosa sepsis MC COD
|
|
First degree burn
|
painful; complete healing
|
|
Second degree burn
|
painful; blister; complete healing
|
|
Third degree burn
|
painless; scarring
|
|
Frostbite
|
painless; ice crystallization in cells
|
|
Electrical injury
|
AC worse than DC; decreasing resistance (wet skin) increases current
|
|
House fires
|
carbon monoxide and cyanide poisoning
|
|
Heat exhaustion
|
fever and sweating
|
|
Heat stroke
|
fever and anhydrosis
|
|
Near drowning
|
survival following asphyxia due to submersion
|
|
Wet drowning
|
initial laryngospasm then relaxation and water into lungs
|
|
Dry drowning
|
intense laryngospasm without aspiration
|
|
Cold water drowning
|
shunts blood from periphery to central core
|
|
Drowning
|
hypoxemia key COD
|
|
Acute mountain sickness
|
headache MC; non-cardiogenic pulmonary edema (immediate descent)
|
|
High altitude
|
normal %O2; decreased barometric pressure; respiratory alkalosis; ↑ 2, 3 BPG
|
|
Ionizing radiation
|
DNA most susceptible protein
|
|
Ionizing radiation
|
lymphoid tissue most radiosensitive; bone least radiosensitive
|
|
Ionizing radiation cancers
|
leukemia (most common); thyroid cancer; osteogenic sarcoma
|
|
UVB-related cancers
|
basal cell carcinoma (most common); squamous cancer; melanoma
|
|
Carbohydrates
|
digestion begins in mouth
|
|
Fats
|
digestion begins in small intestine
|
|
Essential fatty acid deficiency
|
dermatitis, hair loss, poor wound healing
|
|
Proteins
|
digestion begins in stomach
|
|
Kwashiorkor
|
↓ protein intake; ↓ visceral protein; ↓ albumin (pitting edema); fatty liver
|
|
Marasmus
|
total calorie deprivation; ↓ somatic protein; broomstick extremities
|
|
Anorexia nervosa
|
starvation; secondary amenorrhea (↓ GnRH); osteoporosis; ventricular MC COD
|
|
Bulimia nervosa
|
binging with vomiting; hypokalemic metabolic alkalosis; ventricular MC COD
|
|
Body mass index (BMI)
|
weight in kg/height in m2
|
|
Obesity
|
hypertension (MC), cholecystitis, osteoarthritis, type 2 DM, endometrial/breast cancer
|
|
Leptin
|
obesity gene product released from adipose; maintains energy balance
|
|
All-trans retinoic acid
|
Rx acute promyelocytic leukemia; matures blasts to neutrophils
|
|
Vitamin A
|
maintain visual purple, prevent squamous metaplasia, growth
|
|
Vitamin A deficiency
|
night blindness; blindness; squamous metaplasia
|
|
Vitamin A toxicity
|
↑ intracerebral pressure; papilledema; hepatic necrosis
|
|
Vitamin D
|
maintain ionized Ca2+; mineralization of bone
|
|
Vitamin D metabolism
|
skin photoconversion or reabsorb in gut → 1st hydroxylation liver → 2nd hydroxylation proximal tubule (1-α-hydroxylase) Vitamin D deficiency
|
|
Causes
|
renal failure MCC; malabsorption; liver disease; ↓ sunlight
|
|
Lab
|
↓ Ca2+, ↓ phosphate (malabsorption), ↑ phosphate renal failure, ↑ PTH
|
|
Hypervitaminosis D
|
↑ Ca2+, renal stones
|
|
Vitamin E
|
prevents FR damage of cell membrane
|
|
Vitamin E deficiency
|
hemolytic anemia; posterior column/spinocerebellar tract degeneration
|
|
Vitamin E toxicity
|
↓ synthesis vitamin K-dependent procoagulation factors; anticoagulated
|
|
Vitamin K
|
γ-carboxylates vitamin K-dependent factors
|
|
Vitamin K deficiency
|
↓ epoxide reductase activity (↓ function vitamin K); hemorrhagic diathesis; ↑ PT
|
|
Warfarin
|
inhibits epoxide reductase
|
|
Causes vitamin K deficiency
|
antibiotics MC, newborn, malabsorption, warfarin
|
|
Thiamine functions
|
transketolase; dehydrogenase reactions (NADH for ATP synthesis)
|
|
Example of dehydrogenase reaction
|
pyruvate → acetyl CoA; pyruvate dehydrogenase
|
|
Thiamine deficiency
|
alcohol MCC; ↓ ATP synthesis
|
|
S/S
|
dry beriberi - Wernicke’s, Korsakoff’s, peripheral neuropathy; wet beriberi - cardiomyopathy
|
|
Niacin
|
oxidation-reduction reactions; NAD; NADP
|
|
Niacin deficiency
|
pellagra; dermatitis, diarrhea, dementia
|
|
Tryptophan
|
synthesis niacin, serotonin
|
|
Tryptophan deficiency
|
Hartnup’s disease (↓ reabsorption neutral amino acids); carcinoid syndrome
|
|
S/S niacin deficiency
|
diarrhea, dermatitis, dementia
|
|
Corn
|
deficient in niacin and tryptophan
|
|
Pyridoxine
|
heme synthesis, transamination, neurotransmitter synthesis
|
|
Cause
|
taking isoniazid
|
|
Pyridoxine (B6) deficiency
|
sideroblastic anemia; convulsions; peripheral neuropathy
|
|
Vitamin B12/folate
|
DNA maturation, odd chain fatty acid metabolism (propionyl CoA)
|
|
Vitamin B12/folate deficiency
|
macrocytic anemia
|
|
Biotin
|
carboxylase reactions (pyruvate → oxaloacetate)
|
|
Cause
|
eating raw eggs (avidin binds vitamin)
|
|
S/S
|
alopecia, dermatitis
|
|
Vitamin C
|
antioxidant, reduce ferric iron, hydroxylation proline/lysine, dopamine → norepinephrine
|
|
Vitamin C deficiency
|
scurvy; hemorrhagic diathesis; poor wound healing
|
|
Alkalotic state
|
lowers ionized Ca2+ producing tetany; total Ca2+ normal
|
|
Hypoalbuminemia
|
lowers total Ca2+; no tetany
|
|
Hypophosphatemia
|
decreased ATP; myoglobinuria
|
|
Hypomagnesemia
|
causes hypocalcemia by inhibiting PTH synthesis/release
|
|
Zinc deficiency
|
poor wound healing; dysgeusia (cannot taste); anosmia; perioral rash
|
|
Copper deficiency
|
iron deficiency; poor wound healing (cofactor lysyl oxidase); aortic dissection
|
|
Iodine deficiency
|
produces goiter and hypothyroidism
|
|
Chromium deficiency
|
glucose intolerance
|
|
Selenium
|
antioxidant that neutralizes peroxide
|
|
Fluoride deficiency
|
dental caries
|