Fiser Absite. Ch 01-02. Cell Biology. Hematology Flashcards
(130 cards)
1
Q
What molecule increases membrane fluidity?
A
Cholesterol
2
Q
What is responsible creating the charge of cells? What is does it move and what is the net charge (positive or negative)?
A
Na/K ATPase, 3 Na+ out and 2 K+ in, negative
3
Q
What are the adhesion molecules that form cell-cell and cell-extracellular matrix adhesions?
A
desmosomes/hemidesmosomes
4
Q
What forms cell-cell occluding junctions to form an impermeable barrier (ie epithelium)?
A
tight junctions
5
Q
What type of junctions allow communication between cells and what are their subunits called?
A
gap junctions, connexin
6
Q
What is the intramembrane protein that transduces a signal from receptor to response enzyme?
A
G proteins
7
Q
What are the phases of the cell cycle?
A
G1, S, G2, M
8
Q
Which phase of the cell cycle is the most variable and determines the cycle length?
A
G1
9
Q
What is quiescent cell cycle phase called?
A
G0
10
Q
What are the 4 phases of mitosis?
A
Prophase, Metaphase, Anaphase, Telophase
11
Q
centromere attachment, spindle formation, nucleus disappears
A
Prophase
12
Q
In which phase of mitosis does chromosome alignment occur?
A
Metaphase
13
Q
In which phase of mitosis are the chromosomes pulled apart?
A
Anaphase
14
Q
In which phase of mitosis does a separate nucleus form around each set of chromosomes?
A
Telophase
15
Q
The outer membrane of the nucleus is continuous with what other structure?
A
rough endoplasmic reticulum
16
Q
Where are ribosomes made?
A
Nucleolus
17
Q
Steroid hormone - binds receptor in _____ then enters nucleus and acts as transcription factor.
A
nucleus
18
Q
Thyroid hormone - binds receptor in ____, then acts as transcription factor.
A
cytoplasm
19
Q
What are the purines?
A
adenine, guanine
20
Q
What are the pyrimidines?
A
cytosine, thymidine, (uracil in RNA)
21
Q
In glycolysis, 1 glucose molecule generates how many ATP and pyruvate molecules
A
2 each
22
Q
Where does the Krebs cycle occur?
A
mitochondrial matrix
23
Q
What is the overall ATPs produced from 1 molecule of glucose?
A
36
24
Q
What is converted to glucose in gluconeogenesis?
A
lactic acid and amino acids
25
An elegant mechanism for the hepatic conversion of muscle lactate into new glucose. Pyruvate plays a key role in this process.
Cori Cycle
26
What organelle synthesizes proteins that are exported (increased in pancreatic acinar cells)?
Rough endoplasmic reticulum
27
In what organelle does lipid/steroid synthesis as well as drug detox (increased in liver and adrenal cortex)?
Smooth endoplasmic reticulum
28
What organelle modifies proteins with carbohydrates; proteins are then transported to the cell membrane, are secreted or are targeted to lysosomes?
Golgi apparatus
29
Activated by calcium and diacylglycerol (DAG). Phosphorylates other enzymes and proteins.
Protein kinase C
30
Activated by cAMP. Phosphorylates other enzymes and proteins.
Protein kinase A
31
Thick filaments. Uses ATP to cause muscle contractions.
Myosin
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Thin filaments that interact with Myosin.
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.
Microtubules
34
A specialized microtubule involved in cell division (forms spindle fibers, which pull chromosomes apart).
Centriole
35
What are the three initial responses to vascular injury?
vascular vasoconstriction, platelet adhesion, thrombin generation
36
Which pathway starts with: exposed collagen + prekallikrein + HMW kininogen + factor XII?
Intrinsic Pathway
37
Which pathway starts with tissue factor (injured cells) + factor VII?
Extrinsic pathway
38
What does thrombin do?
converts fibrinogen to fibrin
39
What comprises the prothrombin complex and where does it form?
X, V, Ca, platelet factor 3 and prothrombin
40
Which factor is the convergence for the intrinsic and extrinsic pathways?
Factor X
41
What does tissue factor pathway inhibitor inhibit?
Factor X
42
Combines with platelets to form platelet plug leading to hemostasis.
Fibrin
43
Which factor helps crosslink fibers?
XIII
44
What is the key to coagulation? Converts fibrinogen to fibrin, activates V, VIII and platelets.
Thrombin
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What is the key to anticoagulation? Binds and inhibits thrombin. Inhibits IX, X, XI. And binds heparin.
Antithrombin III
46
Vitamin-K dependent. degrades factors V and VIII. degrades fibrin.
Protein C
47
Vitamin K dependent, protein C cofactor.
Protein S
48
Where is tissue plasminogen activator released from?
Endothelium
49
Degrades factors V and VIII, fibrinogen and fibrin
Plasmin
50
Natural inhibitor of plasmin, released from endothelium
Alpha 2 antiplasmin
51
Which coagulation factor has the shortest half-life?
VII
52
Which two coagulation factors are considered the labile factors, activity is lost in stored blood but activity not lost in FFP?
V and VIII
53
Which is the only coagulation factor not synthesized in the liver (synthesized in endothelium)?
Factor VIII
54
Which are the vitamin k dependent coagulation factors?
II, VII, IX, and X, proteins C and S
55
How long does it take for Vitamin K to take effect?
6 hours
56
When does FFP take effect and how long does it last?
immediate and 6 hrs
57
What is the normal half life of RBCs, platelets, and PMNs respectively?
120 days, 7 days, 1-2 days
58
From the endothelium, decreases platelet aggregation and promotes vasodilation.
Prostacyclin (PGI2)
59
Antagonistic to TXA2
Prostacyclin (PGI2)
60
From platelets, increases platelet aggregation, and promotes vasoconstriction.
Thromboxane (TXA2)
61
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
Thromboxane (TXA2)
62
Contains highest concentration of vWF VIII; used in von Willebrand's disease and hemophilia A (factor VIII deficiency), also contains fibrinogen
cyroprecipitate
63
Has high levels of all factors (including labile factors V and VIII), protein C, protein S and AT-III
FFP
64
What role does DDAVP and conjugated estrogens play in coagulation?
cause release of VIII and vWF from endothelium
65
Measures II, V, VII, and X; fibrinogen; best for liver synthetic function
PT
66
Measures most factors except VII and XIII (thus does not pick up factor VII deficiency); also measures fibrinogen
PTT
67
INR > ____ is a relative contraindication to performing surgical procedures. INR > ___ relative contraindication to central line placement, percutaneous needle bx and eye surgery
1.5, 1.3
68
Most common cause of surgical bleeding
Incomplete hemostasis
69
Most common congenital bleeding disorder
von Willebrand's disease
70
Links Gp1b receptor on platelets to collagen?
vWF
71
Which type of vW disease is most common? Which type causes the most severe bleeding?
Type I, Type III
72
What is the difference in treatment between vW disease types I and III and II?
Type I and III - recombinant VIII:vWF, DDAVP, cryoprecipitate, conjugated estrogens
73
Hemophilia A (VIII deficiency) levels need ___% preoperatively, keep ___% after surgery.
100%, 30%
74
Will newborns with hemophilia A bleed at circumcision?
No factor VIII crosses the placenta.
75
What is treatment for hemophiliac joint?
no aspiration
76
Pt with Hemophilia A and epistaxis, intracerebral hemorrhage or hematuria. What is the tx?
recombinant VIII:vWF or cryoprecipitate, possibly DDAVP
77
Christmas disease
hemophilia B
78
Hemophilia B (IX deficiency) levels needed preoperatively
100%
79
What is the PTT and PT in the hemophilias?
Prolonged PTT, normal PT
80
What is the tx for hemophilia B?
recombinant factor IX concentrate or FFP
81
What is the PT and PTT in Factor VII deficiency?
PT is prolonged, PTT is normal
82
What is the tx for factor VII deficiency?
recombinant factor VII concentrate, FFP
83
Name 2 medications that can cause acquired thrombocytopenia?
H2 blockers, heparin
84
GpIIa/IIIa receptor deficiency on platelets. What is it called and what is the tx?
Glanzmann's thrombocytopenia, platelets
85
Gp1b receptor deficiency on platelets (cannot bind to collagen). What is it called and what is the tx?
Bernard Soulier, platelets
86
What does uremia do to coagulation and what is the tx?
inhibits platelet function, tx hemodialysis (1st), DDAVP, platelets
87
What does ticlopidine do and what is the tx?
decreases ADP in platelets, prevents exposure of GpIIb/IIIa. Tx is platelets
88
Inhibits cAMP phosphodiesterase, increases cAMP, decreases ADP-induced platelet aggregation, Tx: platelets.
Dipyridamole
89
What does pentoxifylline do? and what is tx?
inhibits platelet aggregation, platelets
90
ADP receptor antagonist. Tx: platelets.
Clopidogrel
91
What is the concern with PCN/cephalosporins and coagulation?
bind platelets, can increase bleeding time
92
Thrombocytopenia due to antiplatelet antibodies. Can also cause platelet aggregation and thrombosis.
HITT (second T for thrombosis)
93
What is the tx for HITT
stop heparin. Argatroban, hirudin, ancrod or dextran to anticoagulate
94
Decreased platelets, prolonged PT, prolonged PTT, low fibrinogen, high fibrin split products, high D-dimer.
DIC
95
Inhibits cyclooxygenase in platelets, decreased TXA2
ASA
96
When to stop ASA before surgery?
7 days
97
When to stop Coumadin before surgery?
7 days, consider starting heparin
98
Keep platelets >____ before surgery and >____ after.
50K, 20K
99
Prostate surgery can release ___ which activates plasminogen leading to thrombolysis. What is the treatment?
urokinase. e-Aminocaproic acid (Amicar)
100
What is the best way to predict bleeding risk?
H and P
101
What is the symptom common with vWF deficiency and platelet disorders?
Epistaxis
102
What is the most common congenital hypercoagulability disorder?
Leiden factor
103
What is the defect in Leiden factor and what is the tx?
defect on factor V that causes resistance to activated protein C; tx: heparin, warfarin
104
What is the second most common hypercoagulability disorder and what is the treatment?
Hyperhomocysteinemia; Tx: folic acid and B12
105
What is the treatment for Prothrombin gene defect G20210 A or Protein C or S deficiency?
heparin/warfarin
106
What is the treatment for Antithrombin III deficiency?
(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
107
Defect in platelet function; usually have thrombosis, can have bleeding.
Polycythemia vera
108
What should the Hct and platelets be before surgery in a patient with polycythemia vera and was is the tx?
Hct < 48 and platelets < 400, ASA
109
What is diagnosed with: prolonged PTT (not corrected with FFP), positive Russell viper venom time, false-positive-RPR test for syphilis?
Lupus anticoagulant (antiphospholipid antibodies)
110
What is the treatment for Lupus anticoagulant?
heparin/warfarin
111
What is the most common factor causing acquired hypercoagulability?
tobacco
112
Pt >55 with venous thrombosis with no known cause. Best next step.
CT of chest, abdomen and pelvis to screen for CA.
113
What can occur when a pt is placed on Coumadin without being heparinized first? and why?
Warfarin induced skin necrosis. The short half life of protein c and s results in a relative hyperthrombotic state
114
Pts with what condition are the most susceptible to Warfarin induced skin necrosis.
Relative protein c deficiency
115
What are the key elements in venous thrombosis? what about arterial?
virchow's triad, endothelial injury
116
Tx for 1st DVT? 2nd? 3rd?
1st - warfarin for 6 months; 2nd - warfarin for 1 year; 3rd or significant PE - warfarin for lifetime
117
Most common source of DVT causing PE?
iliofemoral region
118
What does dextran do?
inhibits platelets and coagulation factors
119
Improve venous return but also induce fibrinolysis due to release of tPA from compression.
Sequential Compression Devices
120
How does heparin work?
Activates antithrombin III
121
What is the half-life of heparin and how is it cleared?
60-90 min; cleared by reticuloendothelial system
122
Treatment for hypercoagulability in pregnancy?
Warfarin crosses the placenta, heparin doesn't
123
What are 2 sx of long term heparin?
osteoporosis, alopecia
124
What percentage of pts treated with protamine develop protamine reaction and what are the sx?
4%-5%, hypotension, bradycardia and decreased heart function
125
Leeches, irreversible direct thrombin inhibitor also the most potent; at increased for bleeding complications want PTT 60-90
Hirudin (Hirulog)
126
Direct thrombin inhibitor, metabolized in the liver, half-life is 50 minutes, often used in pts with HITT.
Argatroban
127
Reversable direct thrombin inhibitor, metabolized by proteinase enzymes in the blood; half-life is 25-30 minutes
Bivalirudin (angiomax)
128
Malayan pit viper venom; stimulates tPA release
Ancrod
129
Inhibits fibrinolysis by inhibiting plasmin. Used in DIC, persistant bleeding following cardiopulmonary bypass, thrombolytic overdoses.
e-Aminocaproic acid (Amicar)
130
What do you follow after thrombolytics (streptokinase, urokinase, tPA)
fibrinogen <100 associated with increased risk and severity of bleeding
