Test 3 Articles

Question 1

Hydromorphine (dilaudid):

Answer 1

10x more potent then morphine

Question 2

Porphyria:

• Define:
• Other than anemia, what is the other issue with porphyria:

Answer 2

• Define:
  A family name for diseases of faulty heme production.
• Other than anemia, what is the other issue with porphyria:
  There is a build up of toxic intermediates with porphyria. Depending on which of the eight enzymes is malfunctioning the toxic intermediate will cause different issues.

Question 3

Acute Porphyria:

• Number of types:
• What makes them acute?
• Most Common type:

Answer 3

- Number of types:
4 types of acute
- What makes them acute?
Toxic intermediates cause damage to nerves in all areas of the body
- Most Common type:
Acute Intermittent Porphyria

Question 4

How is porphyria treated?

Answer 4

You give hemen.
Hemen is the end product of the of the pathway porphyria disrupts. The end product causes the pathway to stop production, allowing for destruction of toxic intermediates.

Question 5

Basophilic stippling:

• What is it?
• What is it indicative of?
• Causes?

Answer 5

• What is it?
  patients RBCs contain bluish-purple staining granules (a form of nucleic acid protein)
• What is it indicative of?
  Toxic insult to the bone marrow
• Causes:
  LEAD POISONING! Also: certain drugs, severe bacterial infection, and alcoholism.

Question 6

A patient had seizures associated with lead poisoning.

• Why is lead toxic?
• What is the treatment?

Answer 6

- Why is lead toxic?
Body mistakes lead for Calcium (nerves are particularly damaged)
- What is the treatment?
Chelation therapy
Diet rich in green veggies also helps

Question 7

What is the most frequent cause of lead poisoning?
How does it effect IQ?
What has happened to the accepted threshold of lead poisoning.

Answer 7

Paint chips in old homes
Lowers it.
10 ug/dL -> 5 ug/dL

Question 8

Prednisone:

- What other factor can prednisone effect?

Answer 8

Steroid that suppresses the immune system

Question 9

How does birth control relate to thrombus formation?

Answer 9

Female hormones have been correlated with increased clotting factor and decreased inhibition of clotting
They give 4x the risk of clot formation

Question 10

What is the name for a thrombus within the leg?

Answer 10

A deep vein thromboses (DVT)

Question 11

Factors which increase the likelihood of a DVT?

Answer 11

Flying (anytime you sit for a long time)
Age
Contraceptives (at least oral)
Factor V Leiden (X linked recessive)

Question 12

What makes DVTs dangerous?

Answer 12

They can break off pieces which cause a pulmonary embolism.

Question 13

What is the treatment for a DVT?

Answer 13

Heparin (which activates antithrombin III, which in turn decreases fibronogen -> fibrin by inactivating factor X and the glycoproteins namesake, factor II (thrombin)

Question 14

Purpura and thrombocytopenia are both symptoms of what?

Answer 14

Thrombocytopenia.

Possible DIT disseminated intravascular thrombosis

Question 15

What is a possible treatment for thrombocytopenia?

Answer 15

Removal of spleen

Transfer of new thrombocytes

Question 16

What is the believed cause of idiopathic thrombocytopenia purpura?

Answer 16

Autoimmune disease

Question 17

What are possible treatments for a stroke (thrombosis):

Answer 17

Tissue Plasmin Activator (40% chance of survival)
Insertion of a catheter, followed by wire to drill into the clot, followed by a stent retriever device. Must be used with TPA (65% chance of survival)

Question 18

Acute Aortic Dissection:

• Define:
• Common Causes:

Answer 18

• Define:
  a tear occurs in the innermost layer of your aorta, blood is pumped into this tear separating it from rest of your body. This can cause rupture of the aorta, less effective flow of blood, and clotting. It is associated with pain.
• Common Causes:
  High blood pressure, atherosclerosis, inherited disease.

Question 19

Treatment for an acute aortic dissection:

Answer 19

Open heart surgery:

• Synthetic grafts to the Aorta
• Replace aortic semilunar valve

Question 20

What is the difference between a hemorrhagic and clot driven stroke?

Answer 20

One the oxygen is lost because of bleeding (blood exits before it can get to the proper location).
The other the oxygen is lost because of a clot.

Question 21

How can tPA help to treat a hemorrhagic stroke?

Answer 21

If the ventricles fill up significantly with blood tPA can help to clear the blood.

Question 22

Why does CO poisoning kill?

Normal half life of CO in blood:

Answer 22

It binds to hemoglobin with higher affinity then oxygen.

5 1/2 hours

Question 23

Approved therapy for CO poisoning:

Answer 23

100% oxygen solution (Oxygen therapy)
- half life CO reduced to 74 minutes
100% oxygen solution at pressure (hyperbaric Oxygen therapy)
- half life CO reduced to ~20 minutes

Question 24

New proposed therapy for CO poisoning:

Answer 24

A mutated neuroglobin which binds with CO with high affinity.
- half life CO reduced to 25 seconds

Question 25

Symptoms of CO poisoning by percentage - 10 - 20%: - 30% - Greater 30%: - When death occurs:

Answer 25

``` - 10 - 20%: dizziness, weakness, impaired concentration and judgement - 30% labored breathing, chest pain and confusion - Greater 30%: loss of consciousness - When death occurs: depends on the person's health ```

Question 26

Syncope define:

Answer 26

Syncope loss of consciousness due to low blood pressure

Question 27

Vasovagal Syncope:

Answer 27

Your body has an excitatory stimuli, like the sight of blood. Your parasympathetic innervation (vagus nerve) counteracts it, a little bit too much. The drop in blood pressure as you calm down causes syncope.

Question 28

Electrocardiogram: | - Explain what each wave means:

Answer 28

- Explain what each wave means: P: atria depolarize QRS: Ventricles depolarize T: Ventricles repolarize

Question 29

Right Bundle Branch Block: - ECG: - Define:

Answer 29

- ECG: After the initial Q wave there is a second longer Q wave. - Define: This is because the right bundle branch of the purkinje fibers is not transmitting. Charge instead spreads from the left ventricle to get to the right ventricle, but it is slower, causing a delay before the right contraction/depolarization.

Question 30

Brugada Syndrome: - What is it? - Why is it caused?

Answer 30

- What is it? An abnormal EKG of right bundle branch block. Also has a puffed out S-T segment (puffed out because Na+ influx is slower) - Why is it caused? A mutant protein in the Na channel for conduction of electrical impulse across cardiac cells. It causes the Na to enter slowly which leads to increased lag.

Question 31

Sudden Unexpected Nocturnal Death Syndrome:

Answer 31

Is associated with Brugada Syndrome. Night time vagal activity can cause generate uneven electrical conduction in the heart, which can cause you to pass out or die.

Question 32

Treatment for Sudden Unexpected Nocturnal Death Syndrome:

Answer 32

Installing a implantable defibrillator.

Question 33

What is meant by "A tumor is descriptive, not diagnostic":

Answer 33

A tumor is just an unusual mass, the mass does not have to be cancerous.

Question 34

What is the most helpful sign in deciding if a tumor is cancerous?

Answer 34

The Aretha Franklin sign. R-E-S-P-E-C-T. Even if the cells look tortured, ugly, and overly proliferative, if they show respect for other cells they are most likely benign.

Question 35

What caused the collapse of the patient in the Arethra Franklin Sign article?

Answer 35

Endometriosis.

Question 36

Define Endometriosis:

Answer 36

Endometrial cells migrate from the uterus for an unknown reason, and adhere to another tissue (usually the fallopian tubes or ovaries, where it can cause infertility). In our clinical application

Question 37

Fibrillation:

Answer 37

is the rapid, irregular, and unsynchronized contraction of muscle fibers.

Question 38

Rheumatic fever: - Define: - Mose commonly damaged valves: - Side effects given which side of the heart is most likely damaged:

Answer 38

- Define: Immune response against streptococcus also damages the heart and its valves. - Mose commonly damaged valves: Mitral valve and aortic semilunar valve (Valves under the most pressure) - Side effects given which side of the heart is most likely damaged: Overworked right side to increase pressure at the heart, increased chance of cardiac thrombosis

Question 39

What is the name of the toxic intermediate which accumulates (at leas in the urine) due to acute intermittent porphyria.

Answer 39

porphobilinogen